Periodontitis hastalarında ilave amoksisilin/metronidazol tedavisinin subgingival Tannerella forsythia, Prevotella intermedia ve Fusobacterium nucleatum rekolonizasyon seviyelerine etkisi

Amaç: Periodontitis tedavisinde cerrahi olmayan periodontal tedavi ile eş zamanlı antibiyotik uygulamaları kabul görmüş bir yaklaşımdır. Bununla beraber, bakteri rekolonizasyonu tedavi kazanımlarının idamesini güçleştiren bir durumdur. Bu çalışmanın amacı, periodontitis tedavisinde amoksisilin ve metronidazol kombinasyonunun tedavi sonrası 6 aylık dönemde klinik ve mikrobiyolojik etkilerinin değerlendirilmesidir. Gereç ve Yöntemler: Yirmi iki periodontitis hastası test (n=12) ve kontrol (n=10) gruplarına ayrıldı. Test grubu diştaşı temizliği ve kök yüzeyi düzleştirmesi işlemlerine ilaveten eş zamanlı amoksisilin ve metronidazol tedavisi alır iken, kontol grubuna yalnızca diştaşı temizliği ve kök yüzeyi düzleştirmesi uygulandı. Klinik değerlendirmeler başlangıçta ve 1, 3 ve 6. takip aylarında gerçekleştirildi. Fusobacterium nucleatum, Tannerella forsythia ve Prevotella intermedia seviyeleri gerçek zamanlı polimeraz zincir reaksiyonu yöntemi ile belirlendi. Bulgular: Her iki grupta da bütün takip aylarında başlangıca göre anlamlı düzelmeler gözlendi. Bununla beraber, test grubunda 3. ve 6. aylarda kontrol grubunda göre daha fazla düzeyde klinik iyileşmeler tespit edildi. Her iki grupta da incelenen bakterilerin miktarlarında belirli düşüşler görülse de yalnızca T. forsythia seviyeleri tüm takip aylarında test grubunda kontrol grubuna göre anlamlı seviyelerde düşüş gösterdi. Sonuç: Bu çalışmanın sonuçları, diştaşı temizliği ve kök yüzeyi düzleştirmesine ilaveten uygulanan amoksisilin/metronidazole tedavisinin ilave klinik faydalar ortaya koyduğunu göstermektedir. Ayrıca, destekleyici antibiyotik tedavisi T. forsythia rekolonizasyonunu baskılamıştır

Effect of adjunctive amoxicillin/metronidazole treatment on the recolonization levels of subgingival Tannerella forsythia, Prevotella intermedia and Fusobacterium nucleatum in periodontitis patients

Background: The use of antibiotics adjunctive to non-surgicalperiodontal treatment is an accepted approach in the treatment ofperiodontitis. However, bacterial recolonization is a major drawbackwhich complicates the maintenance of therapeutic acquisitions. Theaim of this study was to evaluate the clinical and microbiologicaleffects of adjunctive amoxicillin and metronidazole combination inthe treatment of periodontitis during 6 months follow-up. Materials and Methods: Twenty-two periodontitis patients wereassigned as test (n=12) and control (n=10) groups. While testgroup received amoxicillin and metronidazole combination as anadjunct to scaling and root planing, control group treated withscaling and root planing alone. Clinical examinations andsubgingival dental plaque sampling were conducted at baselineand 1, 3 and 6. months during the follow-up. Fusobacteriumnucleatum, Tannerella forsythia and Prevotella intermedia levelswere determined using real time polymerase chain reactionmethod.Results: Both groups exhibited significant improvements in eachfollow-up period when compared to baseline. However, clinicalimprovements in test group were more prominent than controlgroup as 3rd and 6th months. While some decrease was notable inthe counts of all investigated bacteria in both groups, only T.forsythia levels significantly reduced at all follow-up months in testgroup comparing with controls.Conclusion: The results of this study indicated thatamoxicillin/metronidazole treatment adjunctive to scaling and rootplaning provided additional clinical benefits and suppressed the T.forsythia recolonization.

PDF

___

1. Meng H, Xu L, Li Q, Han J, Zhao Y. Determinants of host susceptibility in aggressive periodontitis. Periodontol 2000 2007; 43: 133-59.
2. Marsh PD. Dental plaque: biological significance of a biofilm and community life-style. J Clin Periodontol 2005; 32: 7-15.
3. Socransky SS, Haffajee AD, Cugini MA, Smith C, Kent RL. Microbial complexes in subgingival plaque. J Clin Periodontol 1998; 25: 134-44.
4. Bradshaw DJ, Marsh PD, Watson GK, Allison C. Role of Fusobacterium nucleatum and coaggregation in anaerobe survival in planktonic and biofilm oral microbial communities during aeration. Infect Immun 1998; 66: 4729-32.
5. Sharma A. Virulence mechanisms of Tannerella forsythia. Periodontol 2000 2010; 54: 106-16.
6. 6. Sharma A, Inagaki S, Sigurdson W, Kuramitsu HK. Synergy between Tannerella forsythia and Fusobacterium nucleatum in biofilm formation. Oral Microbiol Immun 2005; 20: 39-42.
7. Huang RJ, Li MY, Gregory RL. Bacterial interactions in dental biofilm. Virulence 2011; 2: 435-44.
8. Mombelli A. Maintenance therapy for teeth and implants. Periodontol 2000 2019; 79: 190-9.
9. Suvan JE. Effectiveness of mechanical nonsurgical pocket therapy. Periodontol 2000 2005; 37: 48-71.
10.Mombelli A. Microbial colonization of the periodontal pocket and its significance for periodontal therapy. Periodontol 2000 2018; 76: 85-96.
11.Slots J, Ting M. Systemic antibiotics in the treatment of periodontal disease. Periodontol 2000 2002; 28: 106-76.
12.Adriaens PA, Edwards CA, De Boever JA, Loesche WJ. Ultrastructural observations on bacterial invasion in cementum and radicular dentin of periodontally diseased human teeth. J Periodontol 1988; 59: 493- 503.
13.Feres M, Figueiredo LC, Soares GMS, Faveri M. Systemic antibiotics in the treatment of periodontitis. Periodontol 2000 2015; 67: 131 -86.
14.Schlagenhauf U, Burgemeister S. Adjunctive use of amoxicillin/metronidazole in aggressive periodontitis refractory to mechanical/surgical therapy. Clinical results after 1 year. J Dent Res 2002; 81: B249.
15.Rabelo CC, Feres M, Goncalves C, et al. Systemic antibiotics in the treatment of aggressive periodontitis. A systematic review and a Bayesian Network meta-analysis. J Clin Periodontol 2015; 42: 647-57.
16.McGowan K, McGowan T, Ivanovski S. Optimal dose and duration of amoxicillin-plus-metronidazole as an adjunct to non-surgical periodontal therapy: A systematic review and meta-analysis of randomized, placebo-controlled trials. J Clin Periodontol 2018; 45: 56-67.
17. Caton JG, Armitage G, Berglundh T, et al. A new classification scheme for periodontal and peri-implant diseases and conditions Introduction and key changes from the 1999 classification. J Clin Periodontol 2018; 45: 1 - 8.
18. Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol 1999; 4: 1 -6.
19. Keestra JAJ, Grosjean I, Coucke W, Quirynen M, Teughels W. Non-surgical periodontal therapy with systemic antibiotics in patients with untreated aggressive periodontitis: a systematic review and metaanalysis. J Periodontal Res 2015; 50: 689- 706.
20. Keestra JAJ, Grosjean I, Coucke W, Quirynen M, Teughels W. Non-surgical periodontal therapy with systemic antibiotics in patients with untreated chronic periodontitis: a systematic review and metaanalysis. J Periodontal Res 2015; 50: 294- 314.
21. Guerrero A, Griffiths GS, Nibali L, et al. Adjunctive benefits of systemic amoxicillin and metronidazole in non-surgical treatment of generalized aggressive periodontitis: a randomized placebo-controlled clinical trial. J Clin Periodontol 2005; 32: 1096-1107.
22. Xajigeorgiou C, Sakellari D, Slini T, Baka A, Konstantinidis A. Clinical and microbiological effects of different antimicrobials on generalized aggressive periodontitis. J Clin Periodontol 2006; 33: 254-64.
23. Mombelli A, Brochut P, Plagnat D, Casagni F, Giannopoulou C. Enamel matrix proteins and systemic antibiotics as adjuncts to nonsurgical periodontal treatment: clinical effects. J Clin Periodontol 2005; 32: 225-30.
24. Ehmke B, Moter A, Beikler T, Milian E, Flemmig TF. Adjunctive antimicrobial therapy of periodontitis: Long-term effects on disease progression and oral colonization. J Periodontol 2005; 76: 749-59.
25. Gomi K, Yashima A, Nagano T, Kanazashi M, Maeda N, Arai T. Effects of full-mouth scaling and root planing in conjunction with systemically administered azithromycin. J Periodontol 2007; 78: 422-9.
26. Goodson JM, Haffajee AD, Socransky SS, et al. Control of periodontal infections: A randomized controlled trial I. The primary outcome attachment gain and pocket depth reduction at treated sites. J Clin Periodontol 2012; 39: 526-36.
27. Lopez NJ, Socransky SS, Da Silva I, Japlit MR, Haffajee AD. Effects of metronidazole plus amoxicillin as the only therapy on the microbiological and clinical parameters of untreated chronic periodontitis. J Clin Periodontol 2006; 33: 648-60.
28. Varela VM, Heller D, Silva-Senem MX, Torres MCMB, Colombo APV, Feres EJ. Systemic Antimicrobials Adjunctive to a Repeated Mechanical and Antiseptic Therapy for Aggressive Periodontitis: A 6-Month Randomized Controlled Trial. J Periodontol 2011; 82: 1121 -30.
29. Ribeiro ED, Bittencourt S, Zanin ICJ, et al. Full-Mouth Ultrasonic Debridement Associated With Amoxicillin and Metronidazole in the Treatment of Severe Chronic Periodontitis. J Periodontol 2009; 80: 1254-64.
30. Paster BJ, Dewhirst FE. Molecular microbial diagnosis. Periodontol 2000 2009; 51: 38-44.
31. Boutaga K, Van Winkelhoff AJ, Vandenbroucke-Grauls CMJE, Savelkoul PHM. The additional value of realtime PCR in the quantitative detection of periodontal pathogens. J Clin Periodontol 2006; 33: 427-33.
32. Casarin RCV, Ribeiro ED, Sallum EA, Nociti FH, Goncalves RB, Casati MZ. The Combination of Amoxicillin and Metronidazole Improves Clinical and Microbiologic Results of One-Stage, Full-Mouth, Ultrasonic Debridement in Aggressive Periodontitis Treatment. J Periodontol 2012; 83: 988-98.
33. Cionca N, Giannopoulou C, Ugolotti G, Mombelli A. Microbiologic Testing and Outcomes of Full-Mouth Scaling and Root Planing With or Without Amoxicillin/Metronidazole in Chronic Periodontitis. J Periodontol 2010; 81: 15-23.
34. Yek EC, Cintan S, Topcuoglu N, Kulekci G, Issever H, Kantarci A. Efficacy of Amoxicillin and Metronidazole Combination far the Management of Generalized Aggressive Periodontitis. J Periodontol 2010; 81: 964- 74.
35. Matto J, Asikainen S, Vaisanen ML, et al. Betalactamase production in Prevotella intermedia, Prevotella nigrescens, and Prevotella pallens genotypes and in vitro susceptibilities to selected antimicrobial agents. Antimicrob Agents Chemother 1999; 43: 2383-8.
36. Duncan MJ. Genomics of oral bacteria. Crit Rev Oral Biol M 2003; 14: 175-87.