Effect of modified Widman flap surgery and systemic tetracycline on the subgingival microbiota of periodontal lesions

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Abstract
33 subjects with evidence of active destructive periodontal disease were treated by modified Widman flap surgery and systemic tetracycline (1 g/day for 21 days). Subgingival plaque samples were taken from 41 sites in 12 of these subjects before and 6 months after therapy for predominant cultivable microbiota studies. Mean pocket depth and attachment levels in the 41 sampled sites were 7.1 ± 2.9 mm and 7.7 ± 3.2 mm prior to therapy and 4.8 ± 2.3 mm and 6.2 ± 3.4 mm after therapy. B. melaninogenicus and V. parvula were more frequently detected in samples taken after therapy, while S. intermedius, S. morbillorum, S. uberis and W. recta were less frequently detected after therapy. A. actinomycetemcomitans was detected in 7 sites pretherapy and 1 site post therapy. The frequency of detection of B. gingivalis and B. intermedius was virtually unchanged. The mean levels of the Aetinomyces sp., A. actinomycetemcomitans, B. gingivalis, B. intermedius, S. morbillorum. S. uberis and W. recta were decreased after therapy, while the mean levels of B. melaninogenicus, S. mitis, S. sanguis II and V. parvula were increased after therapy. V. parvula showed the greatest increase to 8.2% of the microbiota. In the second phase of the study, subgingival plaque samples from 94 sites in the 33 treated subjects were analyzed by predominant cultivable techniques. As a result of therapy, 24 sites exhibited attachment loss >2 mm, 23 sites exhibited “gain” >2 mm and the remaining 47 sites were considered to be unchanging. The microbiological findings from the treated sites were compared with the predominant cultivable microbiotas of 100 “active” sites (i.e., sites which lost >2.5 mm of attachment prior to therapy). There was an increase in the frequency of detection of S. mitis, S. sanguis I and II and V. parvula in sites which showed no change or “gain” in attachment after therapy. A. actinomycetemcomitans, B. forsythus, B. gingivalis, B. intermedius B. melaninogenicus, P. micros and IV. recta were detected less frequently in these sites. A. actinomycetemcomitans, B. forsythus, B. gingivalis, B. intermedius, B. melaninogenicus, P. micros, S. intermedius and W. recta were recovered in highest mean levels in active sites and or sites which lost attachment after therapy. The opposite pattern was observed for the Actinomyces sp., S. mitis, S. sanguis I and II and V. parvula.