Topical metronidazole application compared with subgingival scaling

Abstract

The aim of this study was to compare the topical application of a metronidazole 25% dental gel with subgingival scaling. 30 patients from the recall program participated in this open randomised study with split-mouth design. Pocket probing depths (PPD) and bleeding on probing (BOP) were measured before and 2, 12 and 24 weeks after the end of the treatment period. In addition, subgingival plaque samples were taken from all mesial sites and analysed with dark-field microscopy. All patients had at least 1 tooth in each quadrant with a PPD of 5 mm or more that should bleeding on probing, when entering the study. The treatment consisted of 2 applications of the dental gel in 2 randomly selected quadrants (on days 0 and 7) as well as simultaneous subgingival scaling of the remaining quadrants. Oral hygiene instruction was given on day 21. The average PPD and the average frequency of BOP were calculated for all sites with an initial PPD of 5 mm or more and continued at each examination, using the same sites. The statistical analyses showed that both treatments were effective in reducing PPD and BOP over the 6-month period. At the end of the follow-up period, the mean reduction in PPD was 1.3 mm after gel treatment and 1.5 mm after subgingival scaling. BOP was reduced by 35% and 42%, respectively. No significant differences between the 2 treatments were detected. Dark-field microscopy showed a shift toward a more healthy microflora for both treatment modalities; this persisted throughout the 6-month period. Application of a 25% metronidazole dental gel on recall patients seems to be as effective on the investigated clinical and microbiological parameters as subgingival scaling.

Subgingival Delivery of Therapeutic Agents in the Treatment of Periodontal Diseases

“…This therapeutic approach has been used in studies with the injectable gel formulation with metronidazole (Elyzol) as the effective agent (Ainamo et al, 1992;Klinge et al, 1992;Pedrazzoli et al, 1992;Stelzel and Flores-de-lacoby, 1996). This approach has several problems associated with it, since it challenges the routine, proven, and highly effective treatment of SRP To this purpose, it has to be shown either to be significantly better than SRP in affecting periodontitis or to be "at least as good as" SRP.…”

Comparative evaluation of locally delivered minocycline and metronidazole in the treatment of periodontitis

“…[22] Since metronidazole does not have substantivity beyond 24 h, the application of Elyzol was repeated at 7 days, to maintain effective levels for periopathogens, and to produce additional benefit of the drug for remaining microbes. [23]…”

Effectiveness of metronidazole gel on cyclosporine-induced gingival overgrowth in heart transplant patients

“…So far there are no data in the literature on use of locally applied metronidazole in CsA-induced GO, while its efficacy in periodontitis remains a controversial issue [2,3,4,9,13,14,15,16,22,23].…”

“…Non-surgical periodontal treatment in association with a strong/rigid plaque control has been proposed to reduce the rate of GO, but with controversial results [17,20], while locally delivered metronidazole in association with non-surgical periodontal therapy has been more recently recommended in patients affected by adult chronic periodontitis, [9,10,22,23].…”