A 2-step non-surgical procedure and systemic antibiotics in the treatment of rapidly progressive periodontitis

Background: In the last few years knowledge about periodontal infections ha s increased enormously, nevertheless practitioners are still seeking guidel ines for suitable treatment concepts. Methods: The aim of this study was to examine the effect of doxycycline, me tronidazole, and clindamycin used adjunctively in a 2-step non-surgical pro cedure in patients with rapidly progressive periodontitis (RPP). The first step included scaling, root planing, and polishing (SRP) in each quadrant u sing 4 to 5 visits. The second step included full-mouth enhanced root plani ng (RP) and wound dressing in 1 or 2 visits after SRP and the beginning of antibiotic therapy. Forty-eight patients (mean age 32.4 years) with general ized RPP, with an average of 16 sites with probing depths (PD) deeper than 8 mm, and high counts of Porphyromonas gingivalis were randomly assigned to 4 different groups: group 1 (doxycycline) n = 12, group 2 (metronidazole) n = 15, group 3 (clindamycin) n = 11, and group 4 (control group; no antibi otic treatment) n = 10. Clinical evaluations, including plaque index (PI), sulcus bleeding index (SBI), probing depth (PD), clinical attachment level (CAL), and bacteriological and crevicular cell sampling, were done at basel ine (BL), 3 weeks after SRP, and 6 and 24 months after RP. Results: After the first step (SRP), we observed an improvement of PI and S BI in all 4 groups, but did not see any statistically significant PD reduct ion 3 weeks after SRP compared to baseline. However, 6 and 24 months after the second step (RP) we observed a significantly greater reduction of PD in groups 2 and 3 and a significantly greater CAL gain in comparison to group s 1 and 4. After 24 months, the attachment level gain in group 1 and group 4 was less than 1.5 mm, and less than 1.0 mm in PD site categories 6 to 9 m m and >9 mm. PI showed no significant difference between the groups through out the period after SRP until 24 months, compared to 3 weeks after SRP SBI decreased most in the metronidazole and clindamycin groups. P. gingivalis and Actinobacillus actinomycetemcomitans were almost completely eradicated in these 2 groups 24 months after RP In addition, the phagocytotic capacity of crevicular polymorphonuclear neutrophils was increased in groups 2 and 3 after the second step. Conclusions: The present results show that metronidazole and clindamycin ar e effective antibiotics when used adjunctively in a 2-step non-surgical pro cedure of scaling and root planing in RPP patients.