Clinical responses to subgingival application of a metronidazole 25% gel compared to the effect of subgingival scaling in adult periodontitis

Abstract

Abstract. A newly developed metronidazole 25% dental gel was compared with subgingival scaling in the treatment of adult periodontitis. 206 patients in 9 centres participated in the study. Probing pocket depth (PPD) and bleeding on probing (BOP) were recorded before treatment and 2, 6, 12, 18, and 24 weeks after the treatment. All patients had at least I tooth in each quadrant with a PPD of 5 mm or more. The treatments consisted of 2 applications of dental gel (days 0 and 7) in 2 randomly selected quadrants (split mouth design) and 2 sessions of subgingival scaling (1 quadrant on day 0, and 1 quadrant on day 7). Instruction in oral hygiene was given 2 weeks after completed treatment. The average PPD and the average frequency of BOP were calculated over all sites with initial PPD of 5 mm or more. PPD and BOP were thus, at each examination, calculated from the same sites. The mean PPD was 5.9 mm before gel application and 5.8 mm before scaling (p= 0.31). BOP was 88% in both treatment groups. 24 weeks after the treatment. PPD and BOP were significantly reduced in both groups and for both parameters (p < 0.01). PPD was reduced by 1.3 mm after gel application and 1.5 mm after scaling; BOP was reduced by 32% and 39%, respectively. The difference between the treatments was statistically significant, but considered as clinically unimportant.

The Antimicrobial Treatment of Periodontal Disease: Changing the Treatment Paradigm

“…In other multi-center studies, a 25% metronidazole gel (Ainamo et al, 1992), a 25% tetracycline fiber , and a 10% doxycycline gel (Polson et al, 1997b), in the absence of scaling and root planing, were compared with scaling and root planing. The fact that the metronidazole gel and the tetracycline fiber seemed to show equivalency to scaling and root planing, and that the doxycycline gel was statistically superior to scaling and root planing, can best be explained by the favorable microbe-to-agent ratios that can be obtained with these agents (Table 4).…”

“…These studies are planned in consultation with the FDA, and power calculations are done so that adequate sample sizes are achieved. A new problem in data interpretation can emerge, since now the difference between/among the treatment groups can be statistically significant but may be of minimal clinical relevance, i.e., differences of 0.2 to 0.3 mm gain in attachment between/among treatment groups (Ainamo et al, 1992;Soskolne et al, 1997).…”

Subgingival Delivery of Therapeutic Agents in the Treatment of Periodontal Diseases

“…The recommended therapy is two separate applications in each pocket, one week apart (Klinge et al, 1992). The results of clinical studies comparing this therapeutic approach alone with scaling and root planing indicate that the metronidazole gel results in a reduction in probing pocket depth and bleeding on probing which is not significantly different from the results obtained with scaling and root planing (Ainamo et al, 1992;Pedrazzoli et al, 1992;Stelzel and Flores-de-Jacoby, 1996).…”

Photolysis of Hydrogen Peroxide, an Effective Disinfection System via Hydroxyl Radical Formation

“…The former includes removal of caries lesions using a low-speed round burr (16), reaming and filing of infected root canals (26), and scaling and root planning of infected root surfaces (5). The latter includes systemic antibiotic therapy (32), local antibiotic therapy (1), and mouth rinsing with a chemical solution. In general, mechanical removal of pathogenic bacteria is preferable to chemical disinfection because mechanical removal is more reliable in terms of plaque removal.…”