A comparative evaluation of the clinical effects of systemic and local doxycycline in the treatment of chronic periodontitis

Abstract

In this study, the clinical efficacies of systemic doxycycline (SD) and local doxycycline (LD) in the treatment of chronic periodontitis were compared. Forty-five patients were studied in 3 main groups with 5 treatments: SD alone, SD+scaling-root planing (SD+SRP), LD alone, LD+SRP and SRP alone. Antibiotic-treated patients were given doxycycline treatment alone in 1 quadrant of their upper jaws, and doxycycline+SRP was given in the contralateral quadrant. The areas included at least 4 teeth with ≥ 5 mm pockets. Probing depth (PD), clinical attachment level, gingival index, sulcular bleeding index and plaque index values were recorded at baseline and the 7 th week. The results were statistically analyzed. All of the clinical parameters were significantly reduced by all treatments (P ≤ 0.05). The SD and LD treatments alone provided significant clinical healings. The significant differences among the groups were only in PD at the 7th week. The LD treatment provided significantly higher PD reduction than the SD treatment (P ≤ 0.05). No significant difference was found between the SD+SRP and the LD+SRP treatments. There was no significant difference between SD+SRP and SRP alone treatment (P > 0.05). The SD group showed lower PD reduction than SRP group (P ≤ 0.05), while no significant difference was found between LD and SRP treatments. The LD alone treatment seemed more effective than SD alone treatment on PD reduction, but no significant difference was found between them when combined with the SRP. LD may be more preferable than SD as an adjunct to mechanical treatment since LD seems more effective than SD on PD reduction and does not have the side effects of SD. (J. Oral Sci. 46, [25][26][27][28][29][30][31][32][33][34][35] 2004) Key Words: tetracycline; systemic doxycycline; local doxycycline; periodontal treatment; local drug delivery; chronic periodontitis. IntroductionCurrently, periodontal disease is accepted as an infection of the periodontium since the primary etiologic factor is bacteria, which triggers the host immune response and the consequent tissue destruction. Because of its infectious nature, in a biological view, the main target for periodontal treatment must be the suppression of the effective bacteria (1,2). In light of this conceptual development, it recently has been considered that mechanical treatment alone is insufficient in the periodontal treatment strategy. Antimicrobial therapy, especially antibiotic treatment, is of special importance as an adjunct to mechanical periodontal treatment (1,3,4).To date, the most widely used antibiotics in the treatment of periodontal disease have been tetracyclines since they show the highest concentrations in gingival crevicular fluid (GCF) and are highly effective on Actinobacillus Actinomycetemcomitans (Aa) (5,6). Recently, some nonJournal of Oral Science, Vol. 46, No. 1, 25-35, 2004 7,8). In one of the studies, patients with moderate chronic periodontitis were administered doxycycline for 2 weeks prior to a full-thickness flap procedur...

Non Antimicrobial Effects of Antibacterial Agents

“…Bu özelliklerinden dolayı enflamasyonla birlikle olan akne vulgaris ve rozaseada düşük dozlarda iyileştirici etkileri gösterilmiştir. Üstelik, 1998 yılında ilk kez düşük doz doksisiklin (20 mg), erişkin periodontit tedavisi için Amerikan İlaç ve Gıda Dairesi (FDA) tarafından onaylanmıştır [16][17][18] . Ayrıca diğer anti-enflamatuvar etkiden sorumlu mekanizma ise, matriks metalloproteinaz (MMP) enzimlerini inhibe etmeleridir ve buna bağlı olarak pek çok enflamatuvar hastalık, yara iyileşmesi, embriyogenez, tümör invazyonu ve anjiyogenez gibi olayları etkilemeleridir.…”

In vivo evaluation of a metronidazole-containing gel for the adjuvant treatment of chronic periodontitis: preliminary results

“…The association of an antibiotic with a slow-releasing drug delivery system may facilitate the maintenance of effective therapeutic concentrations at the application site for longer periods. In addition, the risks of adverse drug reactions and the development of bacterial resistance are reduced [12,13].…”

Impact of scaling and root planing on clinical periodontal status and glycemic levels in prediabetic patients

“…Therefore, SRP with adjunct antibiotic therapy is usually performed, which helps in the extermination of pathogenic microbes from infected periodontal pockets [24,25]. In the study by Akalın et al [24], clinical effi cacies of locally delivered and systemically delivered doxycycline were compared as adjuncts to conventional SRP in the treatment of periodontal disease. The results demonstrated that locally delivered or systemically delivered doxycycline when used as adjuncts to SRP are equally eff ective in the treatment of periodontal disease [24].…”

“…In the study by Akalın et al [24], clinical effi cacies of locally delivered and systemically delivered doxycycline were compared as adjuncts to conventional SRP in the treatment of periodontal disease. The results demonstrated that locally delivered or systemically delivered doxycycline when used as adjuncts to SRP are equally eff ective in the treatment of periodontal disease [24]. It was therefore hypothesized that SRP when performed with adjunct antibiotic therapy is more eff ective in reducing periodontal infl ammation and hyperglycemia as compared to when SRP is used as a sole therapeutic strategy.…”