Cml. Bollen et M. Quirynen, MICROBIOLOGICAL RESPONSE TO MECHANICAL TREATMENT IN COMBINATION WITH ADJUNCTIVE THERAPY - A REVIEW OF THE LITERATURE, Journal of periodontology, 67(11), 1996, pp. 1143-1158
THE RECOGNITION OF THE MICROBIAL ORIGIN and the specificity of periodo
ntal infections has resulted in the development of several adjunctive
therapies (antibiotics and/or antiseptics) to scaling and root planing
in the treatment of chronic adult periodontitis. This article aims to
review the ''additional'' effect of a subgingival irrigation with chl
orhexidine, or a local or systemic application of tetracycline or metr
onidazole, performed in combination with a single course of scaling an
d root planing in patients with chronic adult periodontitis. All treat
ment modalities are compared with scaling and root planing, based on t
heir impact on: the probing depth (PD); total number of colony forming
units per mi (CFU/ml); the proportions and/or the detection-frequency
of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, an
d Prevotella intermedia; and/or on the percentages of cocci, spirochet
es, motile, and other microorganisms on dark field microscopy examinat
ion. All treatment modalities, including scaling and root planing with
out additional chemical therapy, resulted in significant reductions in
the probing depth and the proportions of periodontopathogens, at leas
t during the first 8 weeks post-therapy. However in comparison to a si
ngle course of scaling and root planing, the supplementary effect of a
djunctive therapies seems to be limited. In general, only the irrigati
on with chlorhexidine 2%, the local application of minocycline, and th
e systemic use of metronidazole (in case of large proportions of spiro
chetes) or doxycycline (in case of large proportions of A. actinomycet
emcomitans) seem to result in a prolonged supplementary effect when co
mpared to scaling and root planing. Therefore, the use of antibiotics
on a routine basis, especially in a systemic way, in the treatment of
chronic adult periodontitis, can no longer be advocated, considering t
he increasing danger for the development of microbial resistance.