TREATMENT OF SUBJECTS WITH REFRACTORY PERIODONTAL-DISEASE

The aim of the present study was to evaluate the effect of non-surgica l periodontal therapy with the adjunct of a selected antibiotic in sub jects diagnosed with refractory periodontal disease. 21 subjects were selected for the study; all had a history of periodontal surgery, tetr acycline therapy, and regular maintenance by a periodontist. When dise ase activity was detected, a bacterial sample was taken and a whole pl aque susceptibility test was performed. Before the outcome of the susc eptibility test the subjects were assigned to either antibiotic or pla cebo therapy. All subjects received scaling and rootplaning prior to a ntibiotic or placebo therapy. Based on the susceptibility test, subjec ts in the antibiotic group were treated either with Augmentin(R) or cl indamycin. The results demonstrated that in subjects with refractory p eriodontal disease there was no significant difference (N.S.) in the p roportion of sites losing attachment before and after treatment (11.3% and 12.4%, respectively) over a 2-year post therapy observation perio d. However, the proportion of sites showing gain of attachment increas ed from 0.9% before therapy to 5.1% (p=0.029) following selective anti biotic therapy when combined with scaling and rootplaning. The remaind er of sites shelved no change between pre- and post-therapy monitoring periods. The progression of attachment loss in the active sites could not be completely stopped over the entire 2-year period. After 12-15 months following therapy, there was a tendency towards new loss of att achment and an increase of pocket depth. However, all 4 subjects treat ed with placebo drug demonstrated continuous deterioration and had to be retreated. Although the proportion of sites losing attachment decre ased from 5.1% to 2.3% (N.S.), the proportion of sites gaining attachm ent also decreased from 2.0% to 1.0% (N.S.). The results suggest that scaling and rootplaning together with selected antibiotic therapy repe ated every 12-15 months may be beneficial for these subjects although it may not completely stop progressive attachment loss.