Clinical and microbiological effects of adjunctive local delivery of minocycline (Periocline ® ) in patients receiving supportive periodontal therapy: a pilot study

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Abstract

Purpose

This study aimed to evaluate the clinical and microbiological efficacy of adjunctive local delivery of minocycline (Periocline ^®) in patients receiving supportive periodontal therapy (SPT) after initial treatment.

Methods

The participants were 16 men and 8 women (age, 20–65 years) who had at least 15 natural teeth, underwent SPT for more than 1 year due to chronic periodontitis, had 4 or more periodontal pocket sites deeper than 5 mm, and showed >25% gingival bleeding on probing (BoP). They were randomly assigned to the test and control groups. In the test group, mechanical debridement and local antibiotic delivery were performed for all periodontal sulci/pockets; in the control group, mechanical debridement and saline irrigation were performed. In patients who underwent SPT for more than 1 year, clinical and microbiological examinations were performed at baseline and 1 and 3 months after SPT. The clinical examination included an assessment of the periodontal pocket depth, clinical attachment level, plaque index, and BoP. Microbial tests were performed using real-time polymerase chain reaction; the relative ratios of Porphyromonas gingivalis and Fusobacterium nucleatum were determined.

Results

Both groups showed significant improvements in clinical parameters at 1 and 3 months from baseline; there were no significant changes between months 1 and 3. Intergroup differences were insignificant. The microbiological analysis revealed no significant differences in P. gingivalis and F. nucleatum ratios across time points. While intergroup differences were insignificant, there was a tendency for the P. gingivalis and F. nucleatum ratios to decrease in the test group.

Conclusions

Mechanical debridement in patients receiving maintenance therapy resulted in clinically significant improvement; the effectiveness of additional local delivery of antibiotics was not significant. The ratios of P. gingivalis and F. nucleatum showed a tendency to decrease in the test group, although it was not significant.

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Most cited references 24

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Bacterial invasion and persistence: critical events in the pathogenesis of periodontitis?

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Periodontitis is chronic inflammation of the periodontium caused by the host's inflammatory response to plaque biofilm, which destroys tooth-supporting soft and hard tissues. Periodontitis is a complex disease that involves interactions among three main features - microbial challenge, the host immune response, and environmental and genetic risk factors - in its pathogenesis. Although periodontitis has been regarded as the result of hyperimmune or hyperinflammatory responses to plaque bacteria, recent studies indicate that periodontal pathogens are rather poor activators and/or suppressors of the host immune response. This raises the question of how periodontal pathogens cause inflammation. To resolve this issue, in the present review we propose that bacterial invasion into gingival tissue is a key event in the initiation of periodontitis and that the persistence of these bacteria within host tissue results in chronic inflammation. In support of this hypothesis, we present the ways in which microbial, environmental and genetic risk factors contribute to bacterial invasion. It is hoped that the current model will instigate active discussion and new research to complete the puzzle of this complex disease process.

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Accurate quantitation of the number of cells of individual bacterial species in dental plaque samples is needed for understanding the bacterial etiology of periodontitis. Real-time PCR offers a sensitive, efficient, and reliable approach to quantitation. Using the TaqMan system we were able to determine both the amount of Porphyromonas gingivalis and the total number of bacterial cells present in plaque samples. Using species-specific primers and a fluorescent probe, detection of DNA from serial dilutions of P. gingivalis cells was linear over a large range of DNA concentrations (correlation coefficient = 0.96). No difference was observed between P. gingivalis DNA alone and the same DNA mixed with DNA isolated from dental plaque, indicating that P. gingivalis levels can be determined accurately from clinical samples. The total number of cells of all bacterial species was determined using universal primers and a fluorescent probe. Standard curves using four different bacterial species gave similar results (correlation coefficient = 0.86). Levels of both P. gingivalis and total bacteria were determined from a series of human plaque samples. High levels of P. gingivalis were observed in several of the samples from subjects with periodontitis and none of those from healthy subjects. Real-time quantitative PCR provided a sensitive and reliable method for quantitating P. gingivalis. In addition, it allowed the determination of the total number of bacterial cells present in a complex sample so that the percentage of P. gingivalis cells could be determined.

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Complete removal of calculus is a primary part of achieving a "biologically acceptable" tooth surface in the treatment of periodontitis. Rabbani et al. reported that a single episode of scaling did not completely remove subgingival calculus and that the deeper the periodontal pocket, the less complete the calculus removal. The purpose of the present study was to evaluate the effectiveness of scaling relative to calculus removal following reflection of a periodontal flap. Each of 21 patients who required multiple extractions had 2 teeth scaled, 2 teeth scaled following the reflection of a periodontal flap, and 2 teeth serve as controls. Local anesthesia was used. Following extraction, the % of subgingival tooth surfaces free of calculus was determined using the method described by Rabbani with a stereomicroscope. Results showed that while scaling only (SO) and scaling with a flap (SF) increased the % of root surface without calculus, scaling following the reflection of a flap aided calculus removal in pockets 4mm and deeper. Comparison of SO versus SF at various pocket depths for % of tooth surfaces completely free of calculus showed 1 to 3 mm pockets to be 86% versus 86%, 4 to 6 mm pockets to be 43% versus 76% and greater than 6 mm pockets to be 32% versus 50%. The extent of residual calculus was directly related to pocket depth, was greater following scaling only, and was greatest at the CEJ or in association with grooves, fossae or furcations. No differences were noted between anterior and posterior teeth or between different tooth surfaces.

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Author and article information

Journal

Journal ID (nlm-ta): J Periodontal Implant Sci

Journal ID (iso-abbrev): J Periodontal Implant Sci

Journal ID (publisher-id): JPIS

Title: Journal of Periodontal & Implant Science

Publisher: Korean Academy of Periodontology

ISSN (Print): 2093-2278

ISSN (Electronic): 2093-2286

Publication date Collection: February 2021

Publication date (Electronic): 09 December 2020

Volume: 51

Issue: 1

Pages: 53-62

Affiliations

[1 ]Department of Periodontology and Research Institute of Oral Sciences, Gangneung-Wonju National University College of Dentistry, Gangneung, Korea.

[2 ]Department of Microbiology and Immunology and Research Institute of Oral Sciences, Gangneung-Wonju National University College of Dentistry, Gangneung, Korea.

Author notes

Correspondence: Jae-Kwan Lee. Department of Periodontology and Research Institute of Oral Sciences, Gangneung-Wonju National University College of Dentistry, 7 Jukheon-gil, Gangneung 25457, Korea. periojk@ 123456gwnu.ac.kr , Tel: +82-33-640-3199, Fax: +82-33-640-3113

Author information

EunHa Choi https://orcid.org/0000-0003-1097-1866

Heung-Sik Um https://orcid.org/0000-0002-7986-1019

Beom-Seok Chang https://orcid.org/0000-0002-5280-3249

Si Young Lee https://orcid.org/0000-0001-8826-1413

Jae-Kwan Lee https://orcid.org/0000-0003-1710-1580

Article

DOI: 10.5051/jpis.2002720136

PMC ID: 7920842

PubMed ID: 33634615

SO-VID: 47b94729-9e86-41df-888c-85bf10897503

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0/).

History

Date received : 04 May 2020

Date revision received : 03 August 2020

Date accepted : 09 November 2020

Funding

Funded by: Gangneung-Wonju National University, CrossRef https://doi.org/10.13039/501100006716;

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