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Table 2 Study description

From: An estimate of pocket closure and avoided needs of surgery after scaling and root planing with systemic antibiotics: a systematic review

Autor, year of publication

Population

Diagnosis

Treatment prior to intervention

Intervention test/control

Intervention

Control

Parameter assessment

Invest. period

Maintenance

Exclusion

Smokers

Mean age, gender

Aimetti[36]

n = 39 systemically healthy; ≥20 teeth excluding teeth indicated for extraction and ≥2 sites around at least 12 teeth with CAL and PD ≥6 mm

gen. aggr. periodontitis

Supragingival Sc and polishing, ohi including Bass technique and id cleaning, tongue 1x/d

1w after screening: OSFMD, SRP in 2 sessions within 24 h (Us), no time limit, dorsum brushing with 1% CHX gel, mouth rinse 2x/d 0.2% CHX, pharynx sprayed (4x tonsil) with 0.2% CHX spray, all pockets irrigated 3x within 10 min with 1% CHX Gel, repeated 8d later; for 2 m: 0.2% CHX 2x/d, tonsil spray 2x

n = 19 OSFMD + A 500 mg + M 500 mg 3x/d for 7d

n = 20 OSFMD + Placebo

Presesence of plaque BOP PD Rec CAL (PD + Rec) at 6 sites around all present teeth BL, 3 m, 6 m

6 m

Every 2d to reminder to take medication; no control of empty bottles; check CHX staining, ohi reinforced, full-mouth supraging debridement and professional cleaning on a 2w intervall in first 6w and every 2 m up to 6 m evaluation

Medical disorders or consumption of drugs affecting periodontal status, AB therapy within last 6 m, long-term administration of antiinflammatory drugs, periodontal treatment in previous 6 m, pregnancy, lactation

Excluded

Age T: 36.3 ± 3.2 C: 35.7 ± 2.8 Gender T: 58% f C: 50% f

Cionca[29]

n = 47 (4 drop-outs) systemically healthy, ≥12 teeth, no orthodontic appliances, no fixed prostetics, no implants, ≥4 teeth with PD >4 mm, CAL ≥2 mm + rx bone loss.

adult chronic periodontitis

supraging Sc, ohi after 10d: check oral hyg and re-instruction

FM debridement in 2 visits within 48 h: subgingival ScRp: Us, then Gracey, 0.1% CHX, at home 0.2% CHX for 10d 2x/d at the end of final treatment: medication Parallel design

n = 23 M 500 mg + A 375 mg 3x/d 7d

n = 24 Placebo

GI, PD, BOP, REC (on 6 sites of teeth with PD >4 mm at BL); Plaque (6 sites, all teeth); microbiological sample at BL, 3 m, 6 m

6 m

10d post-treatment: compliance control, bring back the medication remained; recall 1w, 3 m, 6 m after medication: ohi reinforced, supragingival calculus removed

Systemic diseases, pregnancy, lactation, systemic AB within last 2mt, use of NSAID, periodontal treatment within last year

Recorded

25-70y

Feres 2012[41]

n = 118 (at 6 m 5 drop-outs, at 12 m 17 drop-outs); good gen health; ≥30y; ≥6 teeth with at least 1 site each with PD and CAL ≥5 mm, at least 30% of sites with PD and CAL ≥4 mmm and BOP

gen chronic periodontitis

ohi, same dentifrice (Colgate total)

SRP in 4–6 session for 1 h each, manual instruments; entire oral cavity within 14d

Immediately after first session of SRP n = 39 M 400 mg 3x/d 14d CHX +/- n = 39 SRP + M 400 mg + A 500 mg 3x/d 14d CHX +/- CHX: rinse 15 ml 0.12% CHX or placebo for 1 min 2x/d 2 min

n = 40 SRP + Placebo CHX +/-

visible plaque gingival bleeding BOP Suppuration PD (at 6 sites) CAL (at 6 sites) Hu-Friedy BL, 3 m, 6 m, 12

12 m

At 3 m, 6 m, 12 m; at the end of each week of medications asked to return bottles/flasks; questionnaire about self-perceived side effects; calling subjects every 2d to monitor AB-compliance

Previous subgingival periodontal therapy, pregnancy, nursing, systemic diseases affecting periodontal status, long-term administration of anti-inflammatory drugs, need for AB-premedication for routine dental therapy, AB therapy within last 6 m, allergy to M, A or CHX

Excluded

C: 45.8 ± 8.54y 12 m/28f M: 43.4 ± 8.26y 15 m/24f MA: 46.3 ± 8.59y 17 m/22f

Heller[45]

n = 31 (4 drop-outs) ≥16 teeth; ≥4 sites on different teeth with PD ≥6 mm, CAL ≥5 mm, moderate to severe bone loss and BOP

gen aggr periodontitis

ohi in 2 weekly sessions, aim <20% PlI

Phase I: FM debridment with Us 2x1h, irrigation of all pockets with a gel 0.2% CHX within 24 h, rinse and gargle 2x/d with 0.12% CHX, brush tongue 2x/d with gel for 45d. After last session assigned to group test or control. Phase II: quadrant scaling manual 1 h within 4-6w; irrigation of pockets: 0.2% CHX Parallel design

n = 18 A 500 mg + M 250 mg 3x/d 10d

n = 17 Placebo

Clin exams at BL, 3 m, 6 m 6 sites per tooth PD and CAL BOP + or – Plaque GI Suppuration BL, 3 m, 6 m

6 m

3 m follow up visit: ohi reinforcement, FM supragingival cleaning; sites with PD > 4 mm and BOP were reinstrumented unter LA

Allergy to penicillin, M or CHX, systemic diseases affecting periodontal status, longterm-used antiinflammatory medication, periodontal treatment or AB in last 6 m, pregnancy, lactation

No data

18-39y

Matarazzo[40]

n = 43 (2 drop-outs) ≥15 teeth, ≥6 sites with PD 5-7 mm and CAL 5-10 mm

chronic periodontitis

Clinical and mikrobiological monitoring, FM supragingival scaling, ohi, same toothpaste (Colgate total)

SRP in 4-6x appointments 1 h each within max of 21d, AB therapy initiated at first SRP visit

n = 14 SRP A 400 mg M 400 mg 3x/d 14d n = 14 SRP + M 400 mg + A 500 mg 3x/d 14d

n = 15 SRP + Placebos

Visible plaque gingival bleeding BOP Suppuration PD CAL at 6 sites, Hu-Friedy BL, 3 m

3 m

Had to bring tubes containing medication at every SRP visit (pills were counted); calling every 4d to monitor compliance

Aggr periodontitis, pregnancy, lactation, periodontal or AB therapy in previous 6 m, systemic conditions affecting progression of periodontal disease, longterm administration of antiinflammatory drugs, need for AB coverage for routine dental therapy, allergy to M and/or penicillin

Only smokers at least 10 cig/d for last 5y

All >30y age SRP: 40.5 ± 8.2 y SRP + M: 40.8 ± 5.1 y SRP + M + A: 42.8 ± 7.1 y gender SRP: 7/8 m/f SRP + M: 7/8 (6/8) m/f SRP + M + A: 7/8 (6/8) m/f

Mestnik[37]

n = 30 systemically healthy, ≥ 20 teeth, ≥6 permanent teeth including incisiors and/or first molars with PD and CAL ≥5 mm and ≥6 teeth other that first molar and incisors with at least one site each with PD and CAL ≥5 mm, familiar aggregation

gen aggr periodontitis

FM supraging Sc and ohi, same Dentrifice (Colgate total)

FM SRP in max 6 sessions 1 h within 14d, manual instruments; rinsing with 15 ml 0.12% CHX 1 min 2x/d 60d. AB and CHX rinses starts immediately after 1. session of mechanical instrumentation.

n = 15 SRP M 400 mg + A 500 mg 3x/d for 14d

n = 15 SRP und Placebo

Visible plaque Gingival bleeding BOP Suppuration PD CAL at 6 sites BL, 3 m

3 m

1x/w bring packs back, check compliance; calling every 2d to monitor compliance

Previous subgingival periodontal therapy, smoking, pregnancy, systemic desease affecting progression of periodontal disease, long-term administration of anti-inflammatory medication, need for AB coverage for routine dental therapy, AB therapy in previous 6 m, allergy to CHX, A, M

Excluded

≤30y Age T: 26.8 ± 3.9 y C: 27.6 ± 3.5 y Gender T: 6/9 m/f C: 4/11 m/f

Mombelli [[24]

n = 82 systemically healthy, ≥12 scorable teeth (no 3th molars, no teeth with orthodontic appliances, bridges, crowns or impl), diagnosif of periodontitis with ≥4teeth with PD >4 mm, CAL ≥2 mm + rx evidence of bone loss

chronic periodontitis (untreated moderate to advanced)

supragingival cleaning, ohi, recalled to assure good oral hygiene

SRP within 48 h usually in 2 sessions with Us, Gracey curettes, then irrigated the pockets with 0.1% CHX; at home rinse 2x/d for 10d with 0.2% CHX

n = 22 Aac - n = 22 Aac + SRP + 500 mg M + 375 A 3x/d for 7d

n = 19 Aac - n = 19 Aac + SRP + Placebo

GI PD REC BOP Suppuration PS (6sites of all teeth) on 6 sites of each tooth with PD >4 mm at BL BL, 3 m

3 m

1w after treatment: return any medication left

systemic illnesses, pregnancy, lactation, AB taken within previous 2 m, use of NSAIDs, confirmed or suspected intolerance to 5-nitroimidazole-derivates or A, subgingival SRP or surgical periodontal therapy in the last year

Recorded

25-70y T: 21 females 17 smokers C: 20 females 12 smokers

Preus[99]

n = 180 (4 drop-outs) no prior systematic periodontal treatment, after pre-study hygiene phase ≥5sites with PD ≥5 mm remained,

moderate to severe oeridontitis

3 m hygiene phase: ohi, supraging. Sc, necessary extraction, endodontic treatment, filling and temporary prosthetics done by general dentist

Gr 1 + 2: FM SRP (FMD) completed within a single workday in 2x 65 min, 2 h apart, SRP completed in 2x 65 min each, 21d apart All: rinsed for 1 min with 10 ml 0.2% CHX; Us, hand and rotating instruments, first 1. + 4.Q, second 2. + 3 Q; air-flow or pumice paste; contact points flossed, sulci + pockets filled with a 1% CHX gel Home care instructions in brushing teeth and tongue and rinse with 0.2% CHX: every morning for 9d parallel design

n = 44 FMD + M 400 mg 3x/d 10d n = 45 SRP + M 400 mg 3x/d 10d

n = 45 FMD + Placebo n = 46 SRP + Placebo

PD CAL Plaque yes no BOP 4 sites of all teeth BL, 3 m, 12 m

12 m

After 7d a quality control of the scaling and 7w later (8w posttreatment) reinforcement of ohi Supportive treatment sessions at 3, 6, 12 m after active therapy

Syst diseases known to be associated with perio, contunuous medication known to affect perio, allergy to M

Recorded

35-75y Gr1: 53.7 ± 7.6y 43.5% women 47.8% current smokers 93.5% current/former smokers Gr2: 55.1 ± 7.9y 62.2% women 53.3% current smokers 75.6% current/former smokers Gr3: 56.8 ± 8.3y 43.5% women 63.0% current smokers 84.8% current/former smokers Gr4: 54.9 ± 8.5y 51.1% women 57.5% current smokers 95.7% current/former smokers

Sigusch 2001[57]

n = 25 (M) systemically healthy, average of 16 sites with PD >8 mm and intrabony lesion at ≥ 1–5 teeth over two-thirds of the root length

gen rapidly progressive periodontitis

 

1.step: SRP in 4–5 sessions including ohi 2.step: 3w later FM Rp in 1 or 2 2 h -sessions with no more than 2d between sessions, wound dressing

First dose immediately after the 2.step n = 12 Doxy n = 15 M 2x500mg, 8 days n = 11 Clindamycin

n = 10

BL, 3w after SRP (first step), 6 m, 24 m after enhanced Rp (second step) PI Sulcus BI PD CAL Suppuration at six sites per tooth

6 m, 24 m

Recall sessions every 4-6w for 6 m and every 12w thereafter

AB therapy within last 6 m, history of recurrent disease other than periodontitis; flap surgery in the past 6y

Excluded, unless they had stopped smoking 2 m prior to therapy

Mean age: 32.4y Gender m/f 20/28

Winkel[48]

n = 21 > 25y, ≥3 natural teeth in each quadrant; ≥1 site with PPD >5 mm with BOP and rx evidence of bone loss in each quadrant

gen adult periodontitis

 

FM initial perio dontal treatment: SRP and ohi, 3–6 sessions of 1 h, at each session ohi reinforced. 6w after last SRP session: FM check up and SRP if PD > 3 mm and BOP. Ohi and reinforcment

n = 10 A 500 mg + Clavulanic acid 125 mg 3x/d for 10d

n = 11 SRP

PPD CAL constant force probe, Brodontic PI GI BOP

BL, 3 m, 6 m, 9 m, 12 m

Recording time of intake medication on a diary; returned the unused pills, call 2w after the end of the medication

hypersensitivity toward ß-lactam agents, professional SRP or surgical periodontal therapy in the past and AB therapy 6 m prior to treatment, pregnancy, lactation, planing pregnancy, systemic disease, acute necrotising periodontitis; use of non-steroidal anti-inflammatory drugs

Smoker: T: 5 C: 5

Gender m/f T: 2/8 C: 4/7 age T: 49y (36–66) C: 39y (28–47)

Winkel[49]

n = 49 ≥ 3 natural teeth in each quadrant; ≥1 site in at least 3 of the 4 quadrants with PPD >6 mm and CAL ≥3 mm, BoP and radiographic evidence of alveolar bone loss

no data

 

FM SRP in 3–6 sessions of 1 h, at each session ohi reinforced 6w after 1st session: recall for FM check-up and SRP at sites with PD >3 mm and BOP, including ohi reinforcement. on this day: medication

n = 23 A 375 mg + M 250 mg 3x/d, 7d

n = 26

PI PPD BI (bleeding index) CAL

BL, 6 m

Ohi reinforcement at every SRP session and after 6w return med after 7d

SRP or surgical periodontal therapy; periodontal AB therapy 6 m prior to the initiation of the study; pregnancy, lactating or planing pregnancy; systemic ; acute necrotising periodontitis; use of NSAIDs, use of mouthrinses

Recorded. smoker = also if had stopped within the last year T: 14/23 C: 18/26

mean age 42y (28–63) mean age T: 45y (32–63) mean age P: 40y (28–55) gender m/f T: 11/12 C: 10/16

Xajigeorgiou[50]

n = 43 (4 drop-outs) n = 33 (A + M) ≥20 teeth,

gen aggr periodontitis (with amiliar aggregation)

BL sampling of subging plaque and FM clinical recordings

Ohi and FM SRP, 4 visits; f PI ≤20 continued after the 6w; debridement

n = 10 SRP M 500 mg + A 500 mg 3x/d, 7d n = 12 SRP+ M 500 mg 3x/d, 7d

n = 11 SRP

BL 6w after SRP 6 m PD (Hu-Friedy) AL BOP at six sites

6 m

reinforcement of ohi biweekly from BL to 6w

AB intake in the last 3 m, AB allergies, periodontal treatment during previous 12 m, pregnancy, lactation

Recorded MA 3/10 M 5/12 C 4/11

Age 22-49y M + A 38.9 ± 8.7 M 40.9 ± 4.6 C 37 ± 5.6 Gender m/f M + A 5/5 M 4/6 C 6/5

  1. A → Amoxicillin.
  2. AB → antibiotics.
  3. aggr → aggressive.
  4. AL → Attachment level.
  5. BOP → Bleeding on probing.
  6. CAL → clinical attachment level.
  7. CHX → chlorhexidine.
  8. d → day/days.
  9. FM → full mouth.
  10. FMPS → Full Mouth Plaque Score.
  11. FMBS → Full Mouth Bleeding Score.
  12. GBI → gingival bleeding index.
  13. gen → generalized.
  14. GI → Gingival index.
  15. id → interdental.
  16. io → intraoral.
  17. loc → localized.
  18. m → month(s).
  19. M → Metronidazole.
  20. m/f → ratio males/females.
  21. NSAID → non steroid anti-inflammatory drugs.
  22. ohi → oral hygiene instruction.
  23. OSFMD → One Stage Full Mouth Disinfection.
  24. PD → probing depth.
  25. PI → plaque index.
  26. pol → polishing.
  27. PS → Plaque score.
  28. REC → Recession of the gingival margin.
  29. rx → radiographic.
  30. Sc → scaling.
  31. SRP → Scaling and Root planing.
  32. Us → Ultrasonic device.
  33. VPI → visible plaque index.
  34. w → week(s).