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Full mouth periodontal debridement with or without adjunctive metronidazole gel in smoking patients with chronic periodontitis: A pilot study
Author(s) -
Bergamaschi C. C.,
Santamaria M. P.,
Berto L. A.,
CogoMüller K.,
Motta R. H. L.,
Salum E. A.,
Nociti F. H.,
Goodson J. M.,
Groppo F. C.
Publication year - 2016
Publication title -
journal of periodontal research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 83
eISSN - 1600-0765
pISSN - 0022-3484
DOI - 10.1111/jre.12278
Subject(s) - medicine , debridement (dental) , metronidazole , chronic periodontitis , dentistry , gingival and periodontal pocket , periodontitis , placebo , clinical attachment loss , adjunctive treatment , antibiotics , pathology , alternative medicine , microbiology and biotechnology , biology
Background and Objective The evidence of effectiveness of metronidazole ( M tz) as an adjunct therapy to periodontal procedure in the treatment of patients with chronic periodontitis is not conclusive. The aim of this study was to compare the effect of M tz (delivered locally as a gel or systemically as a tablet) as an adjunctive therapy with full mouth periodontal debridement (1 h of ultrasonic calculus/plaque removal) in smokers with chronic periodontitis. Material and Methods This pilot study involved 30 smokers with at least six teeth with a clinical attachment loss of ≥ 5 mm and probing pocket depth ( PPD ) of ≥ 5 mm. They were randomly assigned into one of three groups ( n = 10): (i) 3 g daily of placebo gel applied topically (using a dental tray with the gel overnight) + periodontal debridement; (ii) 3 g daily of a 15% M tz benzoate gel applied topically (using a dental tray with the gel overnight) + periodontal debridement; and (iii) a daily single dose of 750 mg M tz (Flagyl ® ) + periodontal debridement. Clinical parameters (visible plaque index, gingival bleeding index [ GBI] , relative attachment level and PPD ) and quantitative analysis (by real‐time polymerase chain reaction) of A ggregatibacter actinomycetemcomitans , P orphyromonas gingivalis and T annerella forsythia were assessed at baseline and at 1, 3 and 6 mo after periodontal debridement. Results There was no statistically significant difference in the average GBI and visible plaque index values at baseline between the groups ( p ≥ 0.05). There was no significant difference between groups in all parameters evaluated ( p ≥ 0.05). Significant reductions in GBI at 3 and 6 mo were observed in all groups ( p < 0.05). Significant reductions in both PPD and relative attachment level at 1, 3 and 6 mo were observed in all groups ( p < 0.05). Significant reductions in bacterial levels at 7 and 30 d were observed in all groups ( p < 0.05). Conclusion Adjunctive use of M tz (gel or tablet) to periodontal debridement had similar clinical and microbiological improvement compared to treatment with placebo + periodontal debridement in smokers with chronic periodontitis up to 6 mo post‐treatment. Further studies are necessary to confirm the clinical relevance of these findings.