MICROBIOLOGICAL RESPONSE TO MECHANICAL TREATMENT IN COMBINATION WITH ADJUNCTIVE THERAPY - A REVIEW OF THE LITERATURE

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.