amoxicillin-potassium-clavulanate-combination and Aggressive-Periodontitis

Although the use of systemic antibiotics has been studied in patients with generalized aggressive periodontitis (formerly rapidly progressive periodontitis), the use of adjunctive tetracycline fibers in these patients has not been reported. The purpose of the present study was to compare the clinical response of local versus systemic antibiotic treatment as adjuncts to scaling and root planing in patients with GAgP.. After initial therapy and full-mouth scaling and root planing (SRP), 30 patients were randomly assigned to 1 of 2 antibiotic treatment groups. Probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded with an automated probe prior to SRP at baseline (BL) and 15, 30, 41, and 54 weeks later. Three months after SRP, the patients were treated with amoxicillin/clavulanic acid (500 mg tid; SRP + AUG group) or with local tetracycline fiber in pockets with PD > or =5 mm (SRP + TCF group).. In both treatment groups, PD decreased significantly from BL to week 54 (6.2+/-1.5 mm to 4.7+/-1.4 mm for SRP + TCF and 6.5+/-1.4 mm to 4.2+/-0.6 mm for SRP + AUG). However, there was no statistically significant difference between the 2 groups in pocket reduction. Similarly, in both treatment groups, there were small but significant gains in CAL from BL to week 54 (12.0+/-1.8 mm to 11.3+/-1.8 mm for SRP + TCF and 12.3+/-1.5 mm to 11.2+/-1.2 mm for SRP + AUG). The difference in CAL gain between the 2 groups was not statistically significant. At the final examination, both groups showed significant PD reduction and CAL gain (P <0.001) compared to BL. The frequency and percentage of bleeding sites decreased significantly in both groups. At week 54, this decrease was significantly greater in the SRP + AUG group (31.67% for SRP + TCF versus 3.85% for SRP + AUG).. These results indicate that the local delivery of tetracycline by a fiber or the systemic administration of amoxicillin/clavulanic acid given 3 months after scaling and root planing produced similar clinical outcomes over the 9-month observation period.

Topics: Administration, Oral; Administration, Topical; Adult; Aggressive Periodontitis; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Dental Scaling; Drug Therapy, Combination; Humans; Periodontal Index; Periodontitis; Statistics, Nonparametric; Tetracycline

Generalized aggressive periodontitis (GAgP) encompasses a distinct type of periodontal disease exhibiting much more rapid periodontal tissue destruction than chronic periodontitis. The best method for management of GAgP may include the use of both regenerative periodontal techniques and the administration of systemic antibiotics.. The treatment of a case of GAgP over a period of 6.7 years is presented in this case report. Initial periodontal therapy (week 1- 32) consisted of supragingival plaque control and three appointments of scaling and root planing. Based on the periodontal pathogens isolated (5 species), the patient also received metronidazole plus amoxicillin for one week, followed 10 weeks later by metronidazole plus amoxicillin/clavulanate for one week. The patient was put on regular supportive periodontal therapy (SPT) thereafter. Orthodontic treatment was performed after completion of the initial therapy for 96 weeks. Measurements of clinical attachment level, bleeding on probing and plaque index were obtained at every examination.. Antimicrobial and mechanical treatment resulted in eradication of all periopathogens and significantly improved all clinical parameters. During orthodontic treatment and active maintenance, there was no relapse of GAgP. The patient participated in SPT for 194 weeks and thereafter decided to discontinue SPT. Twenty-four months later a relapse of GAgP was diagnosed and all teeth had to be extracted.. These results indicate that a combined mechanical and antimicrobial treatment approach can lead to consistent resolution of GAgP. Further studies including a larger number of cases are warranted to validate these findings.

Topics: Adult; Aggregatibacter actinomycetemcomitans; Aggressive Periodontitis; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents; Bacteroides; Dental Plaque; Dental Plaque Index; Dental Scaling; Female; Follow-Up Studies; Humans; Malocclusion, Angle Class II; Metronidazole; Orthodontics, Corrective; Periodontal Attachment Loss; Periodontal Index; Porphyromonas gingivalis; Recurrence; Root Planing; Treatment Outcome

Prepubertal periodontitis affects both primary and permanent dentition. The purpose of this study was to examine the composition of subgingival microflora of the permanent dentition in an 11-year-old Caucasian female, who had premature exfoliation of her deciduous teeth on her 5th year of age, and the response of this condition to the antibiotic therapy and supportive periodontal care. Gingival tissues were highly inflamed and alveolar bone loss was detected radiographically. The girl had experienced frequent upper respiratory tract infections, tonsilitis and recurrent otitis media. Her mother had history of early onset periodontitis associated with chronic idiopathic neutropenia. Blood chemistry tests and immunological examinations were also performed. Subgingival plaque samples were collected from the proximal sites of permanent molars, incisors, canines and maxillary premolars. 27 different microbial species were isolated from the subgingival microflora. Among the predominant species were Porphyromonas gingivalis (17.6%-7.3%), Prevotella intermedia (12.4%-4.7%), Capnocytophaga sputigena (14.4%-10.4%), Capnocytophaga ochracea (13.2%-6.9%) and Actinobacillus actinomycetemcomitans (9.3%-5.5%). Periodontal treatment consisted of scaling, root planing in conjunction with antibiotic administration of Augmentin 312.5 mg and Flagyl 200 mg, each t.i.d. for 10 days. 3 weeks after the antibiotic therapy, bacterial samples were collected from the same sites. All the periodontal pathogens were recovered in lower levels and A.actinomycetemcomitans was almost eliminated in the 3-week period. The evaluation of clinical indices at 3, 6 and 12 months showed that periodontal treatment in conjunction with antibiotics was effective and rapidly followed by marked clinical improvement. The microbiological monitoring at 3, 6 and 12 months after antibiotic treatment and each time prior to supportive periodontal care, revealed that the periodontal pathogens fluctuated in low levels even 12 months after treatment and could be maintained at low level by supportive periodontal care at 3-month intervals.

Topics: Aggregatibacter actinomycetemcomitans; Aggressive Periodontitis; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteria; Capnocytophaga; Child; Chronic Disease; Dental Plaque; Dental Scaling; Drug Therapy, Combination; Female; Follow-Up Studies; Gingiva; Humans; Metronidazole; Neutropenia; Porphyromonas gingivalis; Prevotella intermedia; Root Planing

The treatment of localized juvenile periodontitis has been previously described in the literature, utilizing primarily a long-term (2 to 6 week) antibiotic regimen, notably tetracycline. This case report of juvenile periodontitis with extensive bone loss describes a short-term treatment (8 days), using a combination of two antibiotics and mechanical debridement. Clinical treatment included instruction of proper oral hygiene techniques. Initial scaling and root planing were performed to remove supragingival and subgingival accretions, followed by 2-month maintenance recalls. Pre- and postoperative radiographs, taken one year after the treatment, are used to document the evidence of natural bone regeneration. The learning objective of this article is to present an effective method of treatment-a debridement/antibiotic combination, followed by bone regeneration.

Topics: Aggregatibacter actinomycetemcomitans; Aggressive Periodontitis; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Child; Clavulanic Acids; Dental Scaling; Drug Therapy, Combination; Humans; Male; Metronidazole