RESUMEN

AIM: To evaluate the effects of the adjunctive use of metronidazole (MTZ) or MTZ + amoxicillin (AMX) in the treatment of generalized chronic periodontitis (ChP). A secondary aim was to examine a possible added effect of chlorhexidine to these therapies. METHODS: One hundred and eighteen subjects received scaling and root planing (SRP) only or with MTZ [400 mg/thrice a day (TID)] or MTZ+AMX (500 mg/TID) for 14 days. Half of the subjects in each group rinsed with 0.12% chlorhexidine twice a day (BID) for 2 months. Subjects were clinically monitored at baseline, 3, 6 and 12-months post-therapy. RESULTS: The two antibiotic groups showed lower mean number of sites with probing depth (PD) ≥5 mm and fewer subjects exhibiting ≥9 of these sites at 1-year post-treatment. Logistic regression analysis showed that antibiotics were the only significant predictors of subjects presenting ≤4 sites with PD ≥5 mm at 1 year (MTZ+AMX: OR, 13.33; 95%CI, 3.75-47.39/p = 0.0000; MTZ: OR, 7.26; 95%CI, 2.26-23.30/p = 0.0004). The frequency of adverse events did not differ between the two antibiotic treatments (p > 0.05). The chlorhexidine subgroups showed a trend (p > 0.05) to present fewer residual sites ≥5 mm compared with the placebo subgroups at 1 year. CONCLUSION: Treatment of generalized ChP is significantly improved by the adjunctive use of MTZ+AMX and MTZ.

Asunto(s)

Amoxicilina/uso terapéutico , Antibacterianos/uso terapéutico , Periodontitis Crónica/tratamiento farmacológico , Metronidazol/uso terapéutico , Adulto , Amoxicilina/efectos adversos , Análisis de Varianza , Antibacterianos/efectos adversos , Quimioterapia Adyuvante , Clorhexidina/uso terapéutico , Raspado Dental , Método Doble Ciego , Combinación de Medicamentos , Femenino , Humanos , Modelos Logísticos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Antisépticos Bucales/uso terapéutico , Índice Periodontal , Bolsa Periodontal/tratamiento farmacológico , Bolsa Periodontal/patología , Estadísticas no Paramétricas , Resultado del Tratamiento

RESUMEN

BACKGROUND: This study compares the changes to the subgingival microbiota of individuals with "refractory" periodontitis (RP) or treatable periodontitis (good responders [GR]) before and after periodontal therapy by using the Human Oral Microbe Identification Microarray (HOMIM) analysis. METHODS: Individuals with chronic periodontitis were classified as RP (n = 17) based on mean attachment loss (AL) and/or >3 sites with AL ≥2.5 mm after scaling and root planing, surgery, and systemically administered amoxicillin and metronidazole or as GR (n = 30) based on mean attachment gain and no sites with AL ≥2.5 mm after treatment. Subgingival plaque samples were taken at baseline and 15 months after treatment and analyzed for the presence of 300 species by HOMIM analysis. Significant differences in taxa before and post-therapy were sought using the Wilcoxon test. RESULTS: The majority of species evaluated decreased in prevalence in both groups after treatment; however, only a small subset of organisms was significantly affected. Species that increased or persisted in high frequency in RP but were significantly reduced in GR included Bacteroidetes sp., Porphyromonas endodontalis, Porphyromonas gingivalis, Prevotella spp., Tannerella forsythia, Dialister spp., Selenomonas spp., Catonella morbi, Eubacterium spp., Filifactor alocis, Parvimonas micra, Peptostreptococcus sp. OT113, Fusobacterium sp. OT203, Pseudoramibacter alactolyticus, Streptococcus intermedius or Streptococcus constellatus, and Shuttlesworthia satelles. In contrast, Capnocytophaga sputigena, Cardiobacterium hominis, Gemella haemolysans, Haemophilus parainfluenzae, Kingella oralis, Lautropia mirabilis, Neisseria elongata, Rothia dentocariosa, Streptococcus australis, and Veillonella spp. were more associated with therapeutic success. CONCLUSION: Persistence of putative and novel periodontal pathogens, as well as low prevalence of beneficial species was associated with chronic refractory periodontitis.

Asunto(s)

Bacterias/clasificación , Periodontitis Crónica/microbiología , Periodontitis Crónica/terapia , Placa Dental/microbiología , Tipificación Molecular/métodos , Análisis de Secuencia por Matrices de Oligonucleótidos/métodos , Amoxicilina/uso terapéutico , Antiinfecciosos/uso terapéutico , Distribución de Chi-Cuadrado , Periodontitis Crónica/patología , ADN Bacteriano/genética , Raspado Dental , Combinación de Medicamentos , Femenino , Humanos , Masculino , Metronidazol/uso terapéutico , Persona de Mediana Edad , Procedimientos Quirúrgicos Orales , ARN Ribosómico 16S/genética , Estadísticas no Paramétricas

RESUMEN

AIM: To examine changes in levels of gingival crevicular fluid (GCF) cytokines, after periodontal therapy of generalized aggressive periodontitis (GAgP). MATERIALS AND METHODS: Twenty-five periodontally healthy and 24 GAgP subjects had periodontal clinical parameters measured and gingival crevicular fluid (GCF) samples collected from up to 14 sites/subject. GCF samples were analysed using multiplex bead immunoassay for: GM-CSF, IFN-γ, IL-10, IL-1ß, IL-2, IL-6 and TNF-α. Aggressive periodontitis subjects were randomly assigned to either scaling and root planing (SRP) alone or SRP plus systemic amoxicillin (500 mg) and metronidazole (400 mg) 3 times a day for 14 days. Clinical parameters and GCF cytokines were re-measured 6 months after treatment. Differences over time were analysed using the Wilcoxon test and between groups using the Mann-Whitney test. RESULTS: Significant reductions in GCF GM-CSF, IL-1ß and the ratio IL-1ß/IL-10 and increases in GCF IL-6 were detected after therapy. The mean change in GCF cytokines did not differ significantly between groups. CONCLUSIONS: Periodontal therapy improved GCF cytokine profiles by lowering IL-1ß and increasing IL-10 levels. The reduction in GCF GM-CSF after therapy implicates this cytokine in the pathogenesis of GAgP. There was no difference between therapies in changes of GCF cytokines.

Asunto(s)

Periodontitis Agresiva/metabolismo , Periodontitis Agresiva/terapia , Antibacterianos/uso terapéutico , Citocinas/metabolismo , Raspado Dental , Líquido del Surco Gingival/química , Adulto , Periodontitis Agresiva/patología , Amoxicilina/uso terapéutico , Análisis de Varianza , Citocinas/análisis , Método Doble Ciego , Femenino , Factor Estimulante de Colonias de Granulocitos y Macrófagos/análisis , Factor Estimulante de Colonias de Granulocitos y Macrófagos/metabolismo , Humanos , Interferón gamma/análisis , Interferón gamma/metabolismo , Interleucina-10/análisis , Interleucina-10/metabolismo , Interleucina-1beta/análisis , Interleucina-2/análisis , Interleucina-2/metabolismo , Interleucina-6/análisis , Interleucina-6/metabolismo , Masculino , Metronidazol/uso terapéutico , Estadísticas no Paramétricas , Factor de Necrosis Tumoral alfa/análisis , Factor de Necrosis Tumoral alfa/metabolismo , Adulto Joven

RESUMEN

BACKGROUND: This study determines the gingival crevicular fluid (GCF) levels of interleukin (IL)-1 beta, IL-2, IL-4, IL-8, interferon (IFN)-gamma and elastase activity in inflamed shallow and deep periodontal sites from patients with generalized chronic (GCP) and generalized aggressive periodontitis (GAgP), and to compare them to shallow sites from subjects with gingivitis. A secondary aim analyzes the microbiologic profile of these subjects. METHODS: Cross-sectional clinical data were obtained from 20 GCP, 17 GAgP, and 10 gingivitis subjects. GCF samples were collected with paper strips and the levels of IL-1 beta, IL-2, IL-4, IL-8, and IFN-gamma were measured using a multiplexed bead immunoassay. Elastase activity was assessed by an enzymatic assay. Subgingival plaque samples were analyzed using checkerboard DNA-DNA hybridization. Significance of differences among groups for immunologic and microbiologic data was examined using Kruskal-Wallis adjusting for multiple comparisons. RESULTS: Mean clinical parameters and GCF volumes were higher in patients with GCP and GAgP compared to the gingivitis group. Higher levels of IL-1 beta and higher elastase activity were found in deep sites compared to shallow sites in both periodontitis groups (P <0.05). The microbiologic data showed significantly higher levels of the red complex species in patients with GCP and GAgP compared to gingivitis (P <0.05). There were no statistically significant differences in levels of GCF biomarkers and in levels of subgingival bacterial species between subjects with GCP and GAgP. CONCLUSION: There were no statistically significant differences in the measured immunologic and microbiologic parameters between subjects with GCP and GAgP.

Asunto(s)

Periodontitis Agresiva/inmunología , Periodontitis Agresiva/microbiología , Periodontitis Crónica/inmunología , Periodontitis Crónica/microbiología , Mediadores de Inflamación/metabolismo , Adulto , Análisis de Varianza , Biomarcadores/metabolismo , Estudios Transversales , Placa Dental/microbiología , Femenino , Líquido del Surco Gingival/química , Gingivitis/inmunología , Gingivitis/microbiología , Humanos , Interferón gamma/metabolismo , Interleucinas/metabolismo , Elastasa de Leucocito/metabolismo , Masculino , Hibridación de Ácido Nucleico , Fumar , Estadísticas no Paramétricas

RESUMEN

BACKGROUND: This study compared the subgingival microbiota of subjects with refractory periodontitis (RP) to those in subjects with treatable periodontitis (GRs = good responders) or periodontal health (PH) using the Human Oral Microbe Identification Microarray (HOMIM). METHODS: At baseline, subgingival plaque samples were taken from 47 subjects with periodontitis and 20 individuals with PH and analyzed for the presence of 300 species by HOMIM. The subjects with periodontitis were classified as having RP (n = 17) based on mean attachment loss (AL) and/or more than three sites with AL >or=2.5 mm after scaling and root planing, surgery, and systemically administered amoxicillin and metronidazole or as GRs (n = 30) based on mean attachment gain and no sites with AL >or=2.5 mm after treatment. Significant differences in taxa among the groups were sought using the Kruskal-Wallis and chi(2) tests. RESULTS: More species were detected in patients with disease (GR or RP) than in those without disease (PH). Subjects with RP were distinguished from GRs or those with PH by a significantly higher frequency of putative periodontal pathogens, such as Parvimonas micra (previously Peptostreptococcus micros or Micromonas micros), Campylobacter gracilis, Eubacterium nodatum, Selenomonas noxia, Tannerella forsythia (previously T. forsythensis), Porphyromonas gingivalis, Prevotella spp., Treponema spp., and Eikenella corrodens, as well as unusual species (Pseudoramibacter alactolyticus, TM7 spp. oral taxon [OT] 346/356, Bacteroidetes sp. OT 272/274, Solobacterium moorei, Desulfobulbus sp. OT 041, Brevundimonas diminuta, Sphaerocytophaga sp. OT 337, Shuttleworthia satelles, Filifactor alocis, Dialister invisus/pneumosintes, Granulicatella adiacens, Mogibacterium timidum, Veillonella atypica, Mycoplasma salivarium, Synergistes sp. cluster II, and Acidaminococcaceae [G-1] sp. OT 132/150/155/148/135) (P <0.05). Species that were more prevalent in subjects with PH than in patients with periodontitis included Actinomyces sp. OT 170, Actinomyces spp. cluster I, Capnocytophaga sputigena, Cardiobacterium hominis, Haemophilus parainfluenzae, Lautropia mirabilis, Propionibacterium propionicum, Rothia dentocariosa/mucilaginosa, and Streptococcus sanguinis (P <0.05). CONCLUSION: As determined by HOMIM, patients with RP presented a distinct microbial profile compared to patients in the GR and PH groups.

Asunto(s)

Bacterias/clasificación , Periodontitis Crónica/microbiología , Periodontitis/microbiología , Periodoncio/microbiología , Adulto , Amoxicilina/uso terapéutico , Antibacterianos/uso terapéutico , Bacteroides/clasificación , Bacteroidetes/clasificación , Campylobacter/clasificación , Periodontitis Crónica/terapia , Placa Dental/microbiología , Raspado Dental , Eikenella corrodens/clasificación , Eubacterium/clasificación , Femenino , Bacterias Gramnegativas/clasificación , Bacterias Grampositivas/clasificación , Humanos , Masculino , Metronidazol/uso terapéutico , Análisis por Micromatrices , Persona de Mediana Edad , Peptostreptococcus/clasificación , Periodontitis/terapia , Porphyromonas gingivalis/clasificación , Prevotella/clasificación , Proteobacteria/clasificación , Aplanamiento de la Raíz , Selenomonas/clasificación , Treponema/clasificación

RESUMEN

AIM: To determine the effect of metronidazole plus amoxicillin (M+A) as the sole therapy, on the subgingival microbiota of chronic periodontitis. MATERIAL AND METHODS: Twenty-two patients with untreated chronic periodontitis were randomly assigned to a group that received M+A for 7 days, or to a group receiving scaling and root planing (SRP) and two placebos. Clinical measurements including sites with plaque, bleeding on probing (BOP), probing depth (PD) and attachment level (AL) were made at baseline, 3, 6, 9 and 12 months. Subgingival plaque samples were taken from all teeth at baseline 3, 6, 9 and 12 months for the counts of 40 subgingival species using checkerboard DNA-DNA hybridization. RESULTS: Mean PD was reduced from 2.80+/-0.45 at baseline to 1.95+/-0.05 at 12 months (P<0.001) and from 2.39+/-0.41 to 1.95+/-0.10 (P<0.001) in the M+A- and SRP-treated patients, respectively. Corresponding values for relative mean AL were 10.07+/-1.30-9.77+/-0.34 (P<0.001) and 9.94+/-0.28-9.77+/-0.26 (P<0.001). Percentage of sites exhibiting BOP were 40.6+/-18.3-14.0+/-1.4 (P<0.001), and 38.5+/-5.1-19.0+/-2.8 (P<0.001) in the M+A and SRP groups, respectively. Mean total DNA probe counts and counts of the majority of the 40 test species were significantly reduced over time in both groups, with no significant differences detected at any time point between groups. At 12 months many of the species were still present at significantly lowered levels compared with their baseline counts in both groups. CONCLUSIONS: Changes in clinical and microbiological parameters were similar after receiving systemically administered M+A as the sole therapy or after receiving SRP only.

Asunto(s)

Amoxicilina/uso terapéutico , Antibacterianos/uso terapéutico , Antiinfecciosos/uso terapéutico , Metronidazol/uso terapéutico , Periodontitis/tratamiento farmacológico , Adulto , Anciano , Amoxicilina/administración & dosificación , Antibacterianos/administración & dosificación , Antiinfecciosos/administración & dosificación , Bacterias/clasificación , Bacterias/efectos de los fármacos , Estudios de Casos y Controles , Enfermedad Crónica , Placa Dental/microbiología , Placa Dental/terapia , Raspado Dental , Combinación de Medicamentos , Femenino , Estudios de Seguimiento , Hemorragia Gingival/terapia , Humanos , Masculino , Metronidazol/administración & dosificación , Persona de Mediana Edad , Cooperación del Paciente , Pérdida de la Inserción Periodontal/terapia , Bolsa Periodontal/terapia , Periodontitis/microbiología , Periodontitis/terapia , Placebos , Aplanamiento de la Raíz , Fumar

RESUMEN

A busca pelos agentes etiológicos das doenças periodontais iniciou na Época de Ouro da bacteriologia médica, quando os agentes de diversas infecções foram identificados. Após o entusiasmo inicial em estabelecer a natureza infecciosa da doença periodontal, este conceito foi ignorado por quatro décadas. Até o início dos anos 70, terapias baseadas na hipótese da placa não-específica focavam a redução da quantidade de placa. Posteriormente, a hipótese da placa específica determinou o papel de alguns microorganismos como A.actinomycetemcomitams, P.gingivalis, T.forsythensis, T.denticola , P.intermedia e F.nucleatum nas diferentes formas de doença periodontal. Recentemente, foi sugerido que estes patógenos periodontais não atuam isoladamente e interações entre espécies, como o equilíbrio entre bactérias patogênicas e benéficas afetam a progressão da doença e a resposta tecidual à terapia periodontal. Atualmente está bem estabelecido que um dos objetivos da terapia é o controle destes patógenos. Dentre as terapias mais freqüentemente utilizadas no tratamento da periodontite estão raspagem e alisamento radicular (RAR), controle da placa supragengival e cirurgias periodontais. Muitos estudos confirmaram a redução de espécies do "complexo vermelho" pela RAR, e mostraram que o retalho reposicionado apicalmente pode levar a um efeito benéfico adicional na microbiota subgengival pela diminuição nos níveis de espécies dos "complexos vermelho" e "laranja". Além disso, o controle de placa mantido pelos indivíduos é considerado determinante para a prevenção da recorrência de doença periodontal destrutiva.

Asunto(s)

Raspado Dental , Periodontitis/terapia , Aggregatibacter actinomycetemcomitans , Enfermedades Periodontales/microbiología , Enfermedades Periodontales/terapia , Fusobacterium nucleatum , Bacterias Gramnegativas , Procedimientos Quirúrgicos Orales , Porphyromonas gingivalis , Prevotella intermedia , Periodontitis/microbiología , Cepillado Dental

RESUMEN

BACKGROUND: An association between race/ethnicity and the composition of the subgingival microbiota has been found in chronic periodontitis. A study was undertaken to determine the characteristics of the subgingival microbiota of chronic periodontitis in Chileans residing in Santiago. METHODS: Twenty-six subjects (mean age 45 +/- 7 years) with chronic periodontitis, mean probing depth (PD) 2.63 +/- 0.5 mm, mean attachment level (AL) 3.70 +/- 0.77 mm, and without a history of periodontal therapy were selected. Measurements of PD, AL, bleeding on probing, and plaque accumulation were recorded at six sites per tooth. Subgingival plaque samples were taken from the mesial aspect of every tooth and evaluated for the presence, levels, and proportions of 40 bacterial taxa using whole genomic DNA probes and checkerboard DNA-DNA hybridization. The microbial data of the Chileans were compared with data from 115 chronic periodontitis patients from Boston, Massachusetts. Since several clinical and demographic parameters differed between the two populations, significance of differences for each species was determined using analysis of covariance, adjusting for age, plaque level, mean PD, gender, and smoking status. RESULTS: Each of the individual test species was present in at least 25 of the 26 subjects, and 12 subjects (46.1%) harbored all 40 test species. With the exception of Prevotella intermedia, all test species colonized more than 75% of sites, and 25 species colonized > or = 90% of sites including the co-colonizing species of advanced periodontal lesions, termed the red complex, composed of the three species Porphyromonas gingivalis, Tannerella forsythensis (formerly Bacteroides forsythus), and Treponema denticola as well as Fusobacterium nucleatum subspecies, Campylobacter rectus, Peptostreptococcus micros, and Treponerma socranskii. Sixteen of the 40 species differed significantly between Chilean and U.S. subjects. Red, yellow, and other complexes were significantly higher in the Chileans, while the Actinomyces were higher in the U.S. subjects. CONCLUSIONS: The composition of the subgingival plaque differs among different subject populations. Thus, care should be taken when extrapolating the findings of one study to different ethnic groups.

Asunto(s)

Periodontitis/microbiología , Adulto , Factores de Edad , Anciano , Bacteroides/clasificación , Boston , Campylobacter/clasificación , Chile , Placa Dental/microbiología , Femenino , Fusobacterium nucleatum/clasificación , Encía/microbiología , Hemorragia Gingival/microbiología , Humanos , Masculino , Persona de Mediana Edad , Peptostreptococcus/clasificación , Pérdida de la Inserción Periodontal/microbiología , Bolsa Periodontal/microbiología , Periodontitis/etnología , Porphyromonas gingivalis/clasificación , Factores Sexuales , Fumar , Treponema/clasificación

RESUMEN

The search for the etiologic agents of periodontal diseases started in the Golden Era of medical bacteriology, when the etiologic agents of many bacterial infections were isolated and characterized. After the initial enthusiasm in establishing the infectious nature and the true agents of periodontal diseases, this concept was virtually ignored for the next four decades. Until the early 1970s treatment regimens based on the non-specific plaque hypothesis were directed towards a non-specific reduction in plaque amount. Later, the specific plaque hypothesis established the role of some microorganisms such as A. actinomycetemcomitans, P. gingivalis, T. forsythensis, T. denticola, P. intermedia and F. nucleatum in different forms of periodontal diseases. It was recently suggested that these suspected periodontal pathogens seem to not act alone and interactions between species, especially the balance between pathogenic and beneficial species affect both progression of disease and response of tissues to periodontal therapy. Nowadays it is well established that one of the goals of therapy is to control such periodontal pathogens. Among the most commonly used therapies to treat periodontal infections are scaling and root planing (SRP), supragingival plaque control and periodontal surgeries. Many studies confirmed the reduction of "red complex" species by SRP, and apically repositioned flap can lead to an additional beneficial effect in the subgingival microbiota by decreasing levels of "red" and "orange complexes" species. Furthermore, the level of plaque control maintained by the patients has been considered a crucial step in preventing recurrence of destructive periodontitis.