Clinical, microbiological and oxidative stress evaluation of periodontitis patients treated with two regimens of systemic antibiotics, adjunctive to non-surgical therapy. A placebo-controlled randomized clinical trial

Abstract

Aim of research was to evaluate and compare the clinical and microbiological effects of two different regimens of amoxicillin (AMX) and metronidazole (MTZ) combined with non-surgical periodontal therapy in patients with chronic periodontitis (CP), and identify antibiotic-resistant bacteria and changes in oxidative stress (OS). Forty-six patients with generalized CP were randomly assigned to group A [scaling and root planing within 24 h (SRP) + placebo for 7 days), group B [SRP + AMX + MTZ, both 500 mg three times daily (TID), 3 days), and group C [SRP + AMX + MTZ, both 500 mg TID, 7 days). Periodontal pocket depth (PPD-primary outcome), clinical attachment level (CAL), full-mouth bleeding scores (FMBS), plaque scores (FMPS), blood and subgingival plaque were assessed at baseline and after three months. OS was evaluated via derivatives of reactive oxygen metabolites (d-ROMs) and assessments of biological antioxidant potential (BAP). Bacterial profiling was performed by PCR. Antibiotic resistance was evaluated in cultures. PPD, CAL, number of sites with PPD ≥6 mm, their PPD, CAL and FMBS decreased (P<0.05) in all groups, as well as FMPS in groups A and B, and d-ROMs in group C. There were significant differences among groups regarding decreases in the frequency of detection for Aa and Tf. For Aa, there were differences between groups A and C (P=0.048) and between groups B and C (P=0.048), but not between groups A and B;whereas for Tf, groups A and B were different from group C (P<0.001), but not from each other (P=0.920). No resistance to AMX was identified prior to treatment; two strains were resistant after treatment. Before treatment, 13 strains were resistant to MTZ, and 2 were resistant after. One strain in the same patient was sensitive prior to treatment, and later became resistant to both antibiotics. SRP with a 7-day course of antibiotic therapy was more effective for improving clinical parameters, in decrease of detection of several periopathogens, and in improvement of OS when compared to a 3-day regimen. Resistance was found in fewer strains after treatment than before.

Non-Surgical Periodontal Therapy with Adjunctive Amoxicillin/Metronidazole or Metronidazole When No Aggregatibacter actinomycetemcomitans Is Detected—A Randomized Clinical Trial

“…In the AMX/MET group, the reduction was a median of 2.5 mm after three months, which remained stable after six months. The reduction of PD and the attachment gain are in coincidence to improvements reported in the literature; higher than those reported by Boia et al [ 38 ] and Morales et al [ 39 ] but lower than in the study of Duarte et al [ 40 ] or Mombelli et al [ 41 ]. Our study reports improvements of sites with initial ≥6 mm as described by Duarte et al [ 40 ] to evaluate the status of closed pocket and incomplete periodontal therapy related to the necessity of additional surgical periodontal therapy [ 37 , 42 ].…”

Klotho inhibits H2O2‐induced oxidative stress and apoptosis in periodontal ligament stem cells by regulating UCP2 expression

“…Given that oxidative stress is characterized by a high level of reactive oxygen species (ROS) [5], the deleterious products induced by ROS activities need evaluation for assessing oxidative stress-related diseases [6]. Moreover, the exacerbation of oxidative stress may play a role in the underlying mechanism for the aggravation of periodontitis [7]. Furthermore, evaluation of antioxidant enzymes including superoxide dismutase (SOD) is required to clarify the complex process of oxidative stress [8].…”

“…Heightened oxidative stress might play a role in the underlying mechanisms that aggravate periodontitis 6 . Oxidative stress can trigger a series of inflammatory cytokines that accelerate periodontitis 7 .…”

Klotho inhibits H 2 O 2 -induced oxidative stress and apoptosis in periodontal ligament stem cells by regulating UCP2 expression

“…Given that oxidative stress is characterized by a high level of reactive oxygen species (ROS) [5], the deleterious products induced by ROS activities need evaluation for assessing oxidative stress-related diseases [6]. Moreover, the exacerbation of oxidative stress may play a role in the underlying mechanism for the aggravation of periodontitis [7]. Furthermore, evaluation of antioxidant enzymes including superoxide dismutase (SOD) is required to clarify the complex process of oxidative stress [8].…”