Effect of non‐surgical periodontal therapy combined with adjunctive antibiotics in subjects with “refractory” periodontal disease

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Abstract
The aim of the present study was to evaluate the clinical effect of non‐surgical periodontal therapy with the adjunct of a selected antibiotic in subjects with refractory periodontitis. 10 subjects were selected for the study; all had a history of periodontal surgery, tetracycline therapy, and regular maintenance by a periodontist. Clinical registrations including gingival index, plaque index, presence of bleeding and suppuration, pocket depth, and duplicate measurements of attachment level were performed at baseline and at monthly intervals. When disease activity was detected based on the tolerance method, a bacterial sample was taken from the active site and its susceptibilities to a number of antibiotics were determined. For the selected 10 subjects, Augmentin® was the antibiotic of choice. Each subject received 750 mg/day for 2 weeks, during which time a full‐month scaling and root Planing was performed under local anesthesia. Clinical re‐evaluation was performed after 3, 6, 9 and 12 months. At the time disease activity was detected, the average loss of attachment at all active sites was 2.2 mm, and the increase in pocket depth 1.5 mm. At 3 months post‐therapy, these sites had regained 2 mm of attachment which remained stable through the 12‐month examination. Pocket depths decreased 2.5 mm over the first 6 months and then stabilized‐ The frequency of all sites that gained 1 mm or more of attachment increased by approximately 10% over the first 9 months following therapy. The frequency of all sites that decreased 1 mm or more in pocket depth increased approximately 15% over the same period. The frequency of bleeding and suppuration was low initially and did not change significantly. Plaque scores were low throughout the study. Post‐therapy, the frequency of sites with a GI score of 2–3 decreased from 13.3 to 1.9%. The results suggest that non‐surgical periodontal therapy with adjunctive use of a selected antibiotic may reduce the incidence of attachment Joss for at least 12 months in individuals who previously had been refractory to treatment.