Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline

Sanz, Mariano; Herrera, David; Kebschull, Moritz; Chapple, Iain; Jepsen, Søren; Beglundh, Tord; Sculean, Anton; Tonetti, Maurizio S.; Consultants, Methodological

doi:10.1111/jcpe.13290

Cited by 894 publications

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References 144 publications

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“…The adjunctive use of antibiotics is not without any concern respecting public and patient´s health. Following this, it is not recommended to treat all periodontitis patients routinely with adjunctive antibiotics (Treatment of stage I-III Periodontitis) [ 12 ]. However, higher initial probing depths benefit from systemic antibiotics adjunctively given to the subgingival instrumentation [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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

2020

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Background: The aim was to compare two different systemic antibiotics regimens adjunctive to non-surgical periodontal therapy when Aggregatibacter actinomycetemcomitans was not detected in the subgingival biofilm. Methods: A total of 58 patients with periodontitis and with no A. actinomycetemcomitans in the subgingival biofilm were treated with full-mouth subgingival instrumentation and either metronidazole (MET; n = 29) or amoxicillin/metronidazole (AMX/MET; n = 29). Probing depth (PD), clinical attachment level (CAL) and bleeding on probing (BOP) were recorded at baseline, as well as after three and six months. Subgingival biofilm and gingival crevicular fluid were collected and analyzed for major periodontopathogens and biomarkers. Results: PD, CAL and BOP improved at 3 and 6 months (each p < 0.001 vs. baseline) with no difference between the groups. Sites with initial PD ≥ 6 mm also improved in both groups after 3 and 6 months (p < 0.001) with a higher reduction of PD in the AMX/MET group (p < 0.05). T. forsythia was lower in the AMX/MET group after 3 months (p < 0.05). MMP-8 and IL-1β were without significant changes and differences between the groups. Conclusion: When A. actinomycetemcomitans was not detected in the subgingival biofilm, the adjunctive systemic use of amoxicillin/metronidazole results in better clinical and microbiological outcomes of non-surgical periodontal therapy when the application of systemic antibiotics is scheduled.

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Section: Introductionmentioning

confidence: 99%

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

2020

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“…As regards the existing NSPT protocols, the present study was based on the FM-SRP [31] and the AZM prescription (500 mg/24 h, for 3 days), was carried out after the last session. Current evidence indicates that the outcomes of NSPT are not dependent on the type of protocol employed [1]. Nevertheless, prior research shows better clinical and microbiological results with FM-SRP [31,32].…”

Section: Discussionmentioning

confidence: 98%

“…A better clinical result when the meticulous mechanical removal of bio lm and dental calculus is accompanied by antibiotic therapy has been reported [16]. Nevertheless, due to the overuse of antibiotics, and the development of bacterial resistance, its routine administration as an adjunct to NSPT is not recommended [1]. Its indication should be considered for speci c categories, e.g., generalized periodontitis stage III/IV, in patients 55 years or younger, and those with full-mouth NSPT [17].…”

Section: Discussionmentioning

confidence: 99%

Effect of Periodontal Debridement Plus Systemic Azithromycin v/s Periodontal Debridement as Unique Therapy in Subjects with Periodontitis: A Randomized Controlled Clinical Trial.

Navarrete

Oñate

Loyola

et al. 2020

Preprint

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Background: Recently, it has been suggested that azithromycin (AZM) may be a useful adjunct to non-surgical periodontal therapy (NSPT). However, current scientific evidence is still not conclusive as to its efficacy as an adjunct of NSPT. This study aimed to evaluate the effect of the systemic administration of AZM as an adjunct to NSPT on the clinical and microbiological variables of patients with periodontitis.Methods: Eighteen volunteers with Periodontitis received NSPT combined with placebo or AZM (500 mg/day) for 3 days (n=9/group). They were monitored clinically for probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI) and bleeding on probing (BoP) at baseline and during the first, third and sixth month and monitored microbiologically at baseline and at 3 and 6 months after therapy. The microbiological variables were detected by conventional polymerase chain reaction tests. The normality was checked using the Shapiro-Wilk test. The level of statistical significance was measured by the unpaired t-test, Mann-Whitney U, Fisher’s exact and Chi-Square tests.Results: Fourteen patients completed the study (n=7/group). The group receiving NSPT + AZM presented with a significantly lower mean PPD at 3 (p = 0.05) and 6 months (p = 0.04) with a greater probing depth reduction (p = 0.02). Moreover, at the third month post NSPT, there was a significant increase in the number of sites with a PPD 1–3 mm (p < 0.001) and a decrease in the number of sites with a PPD 4–6 mm (p < 0.001). In addition, a significant decrease in the mean number of sites with a PPD ≥ 7 mm (p = 0.04) was detected at 6 months post treatment. There was also a significant decrease in BoP at 1 (p = 0.01), 3 (p < 0.001) and 6 (p = 0.01) months post intervention. Conclusions: AZM as an adjuvant to NSPT provides additional beneficial effects for PPD and BoP compared to NSPT alone. This could be related to its anti-inflammatory properties more than to its antibiotic characteristics.Trial registration: ClinicalTrials.gov: NCT03629288. https://clinicaltrials.gov/ct2/show/NCT03629288Retrospectively registered on August 14, 2018.

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“…During the rst seven days after SI all patients used a chlorhexidine digluconate mouthrinse (Chlorhexamed forte 0.2%, GlaxoSmithKline Healthcare, Bühl, Germany) for one minute twice daily. Using chlorhexidine digluconate after SI is recommended by the EFP S3 level guideline [20]. After SI careful normal oral hygiene using toothbrush and interdental brushes was performed.…”

Section: Clinical Procedures and Sampling Methodsmentioning

confidence: 99%

Adjunctive air-polishing with erythritol in nonsurgical periodontal therapy – a randomized clinical trial

Jentsch

Flechsig

Kette

et al. 2020

Preprint

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Background: This study was aimed to investigate if the adjunctive use of erythritol air-polishing powder applied with the nozzle-system during subgingival instrumentation (SI) has an effect on the outcome of non-surgical periodontal treatment in patients with moderate to severe periodontitis. Methods:Forty-two individuals with periodontitis received nonsurgical periodontal therapy by SI without (controls, n=21) and with adjunctive air-polishing using nozzle + erythritol powder (test, n=21). They were analyzed for the clinical variables BOP (primary outcome at six month), probing depth (PD), attachment level (AL), four selected microorganisms and two biomarkers at baseline, before SI as well as three and six months after SI. Statistical analysis included nonparametric tests for intra- and intergroup comparisons. Results: In both groups, the clinical variables probing depth (PD), attachment level and BOP significantly improved three and six months after SI. The number of sites with PD ≥ 5mm was significantly lower in the test group than in the control group after six months. At six months vs. baseline, there were significant reductions of Tannerella forsythia and Treponema denticola counts as well as lower levels of MMP-8 in the test group. Conclusions:Subgingival instrumentation with adjunctive erythritol air-polishing powder does not reduce BOP. But it may add beneficial effects like reducing the probing depth measured as number of residual periodontal pocket with PD ≥ 5mm when compared with subgingival instrumentation only. Clinical relevanceThe adjunctive use of erythritol air-polishing powder applied with the nozzle-system during SI may improve the clinical outcome of SI and may reduce the need for periodontal surgery.

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Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline

Abstract: On behalf of the EFP Workshop Participants and Methodological Consultants EFP Workshop Participants and Methodological Consultants are presented in Appendix 1.

Cited by 894 publications

References 144 publications

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

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

Effect of Periodontal Debridement Plus Systemic Azithromycin v/s Periodontal Debridement as Unique Therapy in Subjects with Periodontitis: A Randomized Controlled Clinical Trial.

Adjunctive air-polishing with erythritol in nonsurgical periodontal therapy – a randomized clinical trial

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Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline

Abstract: On behalf of the EFP Workshop Participants and Methodological Consultants EFP Workshop Participants and Methodological Consultants are presented in Appendix 1.

Cited by 894 publications

References 144 publications

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

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

Effect of Periodontal Debridement Plus Systemic Azithromycin v/s&nbsp;Periodontal Debridement as Unique Therapy in Subjects with Periodontitis: A Randomized Controlled Clinical Trial.

Adjunctive air-polishing with erythritol in nonsurgical periodontal therapy – a randomized clinical trial

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Effect of Periodontal Debridement Plus Systemic Azithromycin v/s Periodontal Debridement as Unique Therapy in Subjects with Periodontitis: A Randomized Controlled Clinical Trial.