Comparative Evaluation of Cost-Effectiveness, Clinical and Microbiological Parameters of Systemic Antibiotics Versus Local Drug Delivery in Aggressive Periodontitis

Abstract

Background: Periodontitis is a biofilm-associated inflammatory disease of the periodontium in which microbial component contributes to its initiation that mainly includes chronic periodontitis and aggressive periodontitis (AgP).Aim: The present study aimed to ascertain a cost-effective treatment approach in AgP with minimal side effects by comparing systemic antibiotics (SA) and local drug delivery (LDD) as an adjunct to scaling and root planning (SRP). Furthermore, the objectives were to analyze its effect on clinical and microbial parameters.Materials and Methods: The participants were randomly divided into two groups A and B with eleven participants each. Group A was administered with Chlosite Gel [LDD] whereas group B with amoxicillin (AMX) 500 mg + metronidazole (MTZ) 400 mg [SA] thrice daily for 14 days. Clinical parameters such as plaque index (PI), gingival index (GI), clinical attachment level (CAL), and pocket probing depth (PPD)] were recorded at baseline and three months postoperatively. Microbiological parameters i.e Aggregatibacter actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg) counts were also measured at baseline and after three months.Results: Statistically significant difference was observed in all clinical parameters i.e. PI, GI, CAL, and PPD after three months follow-up in groups A and B. Reduced bacterial load i.e. Aa and Pg was significant at three months in both the groups. However, on comparing the total expenditure of both the groups, group A ranged from 920-1480 ₹ while in group B it ranged from 330-360 ₹. Hence, lower expenditure in group B (3.7 fold) compared to group A was evident.Conclusions: Cost-effective approach recommended in the present study is mainly to promote awareness among periodontal patients in the public and private sectors, who refuse to get dental treatment due to fear of high expenditure. This can be attained by incorporating SA as an alternative to LDD in AgP patients.

Comparative Study of Systemic vs. Local Antibiotics with Subgingival Instrumentation in Stage III–IV Periodontitis: A Retrospective Analysis

“…The available evidence in the field is limited; there are a small number of studies comparing systemically versus locally administrated antibiotics in periodontitis patients [24,37,47,48]. No such comparison using the mentioned antimicrobials has been published to date.…”

Use of Systemic Doxycycline as An Adjunct to Initial Periodontal Therapy in Mild to Moderate Generalized Periodontitis: A Randomized Clinical Trial

“…Systemic antibiotics have been used as an adjunct to the traditional periodontal treatment of scaling and root planing procedure with the sole aim of providing higher concentration of the antibiotics to the diseased site [16,17]. Studies by Chiu show that sub antibacterial doses of doxycycline increases its concentration in the gingival crevicular fluid [18].…”

Immunomodulatory Effect of Novel Electrospun Nanofibers Loaded with Doxycycline as an Adjuvant Treatment in Periodontitis

“…The limitations of the manual instrumentation reside in the inefficient debridement of deep periodontal pockets, due to the irregular radicular surfaces and the narrow furcation areas, which are inaccessible to periodontal instruments [ 16 , 17 ]. Given the infectious nature of periodontitis and the limitations of the non-surgical periodontal treatment, the use of local antibacterial and anti-inflammatory substances has been proposed [ 18 ]. However, due to the current lack of satisfactory long-term therapeutic outcomes, as well as the difficult application and deficient maintenance, the use of local antibiotics and antiseptics is limited [ 17 , 19 ].…”