THE USE OF METRONIDAZOLE AND AMOXICILLIN IN THE TREATMENT OF ADVANCEDPERIODONTAL-DISEASE - A PROSPECTIVE, CONTROLLED CLINICAL-TRIAL

The present clinical trial was performed to study the effect of system ic administration of metronidazole and amoxicillin as an adjunct to me chanical therapy in patients with advanced periodontal disease. 16 ind ividuals, 10 female and 6 male, aged 35-58 years, with advanced period ontal disease were recruited. A baseline examination included assessme nt of clinical, radiographical, microbiological and histopathological characteristics of periodontal disease. The 16 patients were randomly distributed into 2 different samples of 8 subjects each. One sample of subjects received during the first 2 weeks of active periodontal ther apy, antibiotics administered via the systemic route (metronidazole an d amoxicillin). During the corresponding period, the 2nd sample of sub jects received a placebo drug (placebo sample). In each of the 16 pati ents, 2 quadrants (1 in the maxilla and 1 in the mandible) were expose d to non-surgical subgingival scaling and root planing. The contralate ral quadrants were left without subgingival instrumentation. Thus, 4 d ifferent treatment groups were formed; group 1: antibiotic therapy but no scaling, group 2: antibiotic therapy plus scaling, group 3: placeb o therapy but no scaling, group 4: placebo therapy plus scaling. Re-ex aminations regarding the clinical parameters were performed, samples o f the subgingival microbiota harvested and 1 soft tissue biopsy from 1 scaled and 1 non-scaled quadrant obtained 2 months and 12 months afte r the completion of active therapy. The teeth included in groups 1 and 3 were following the 12-month examination exposed to non-surgical per iodontal therapy, and subsequently exited from the study. Groups 2 and 4 were also re-examined 24 months after baseline. The findings demons trated that in patients with advanced periodontal disease, systemic ad ministration of metronidazole plus amoxicillin resulted in (i) an impr ovement of the periodontal conditions, (ii) elimination/suppression of putative periodontal pathogens such as A. actinomycetemcomitans, P. g ingivalis, P. intermedia and (iii) reduction of the size of the inflam matory lesion. The antibiotic regimen alone, however, was less effecti ve than mechanical therapy with respect to reduction of BoP - positive sites, probing pocket depth reduction, probing attachment gain. The c ombined mechanical and systemic antibiotic therapy (group 2) was more effective than mechanical therapy alone in terms of improvement of cli nical and microbiological features of periodontal disease.