|Year : 2019 | Volume
| Issue : 1 | Page : 8-12
Effect of systemic doxycycline on scaling and root planing in chronic periodontitis
Dhwani Vyas, Neeraj Chandrahas Deshpande, Deepak Dave
Department of Periodontology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
|Date of Web Publication||20-Jun-2019|
Dr. Neeraj Chandrahas Deshpande
K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara - 391 760, Gujarat
Source of Support: None, Conflict of Interest: None
Background: Periodontitis is a multifactorial chronic inflammatory disease. It occurs due to inflammation and tooth-supporting tissues destruction by subgingival microbiota. Anti-infective therapy has been accepted as the cornerstone of periodontal treatment. Aim: The aim of the study was to evaluate the efficacy of doxycycline as adjunct to scaling and root planing in treatment of chronic periodontitis. Materials and Methods: A total of 52 participants having moderate to severe chronic periodontitis were included and divided into 2 groups: Group A (Test group-SRP+Doxycycline) and Group B (Control group-SRP alone). Plaque Index (PI), Gingival Index (GI), Probing Depth (PD) and Clinical Attachment Level (CAL) were assessed at baseline and 3 months interval. Result: Significant differences were seen from baseline to 3 months in both test and control groups in terms of reduction in PI, GI, PD and gain in CAL (P<0.001). Inter-group analysis showed significant differences between the two groups after 3 months, with GI, PD and CAL with P-value <0.001. Conclusion: At the end of 3 months, Doxycycline showed better results after mechanical therapy in the treatment of patients with chronic periodontitis because it has an anticollagenase effect that can inhibit tissue destruction and aid bone regeneration.
Keywords: Chronic periodontitis, doxycycline, scaling and root planing
|How to cite this article:|
Vyas D, Deshpande NC, Dave D. Effect of systemic doxycycline on scaling and root planing in chronic periodontitis. J Integr Health Sci 2019;7:8-12
|How to cite this URL:|
Vyas D, Deshpande NC, Dave D. Effect of systemic doxycycline on scaling and root planing in chronic periodontitis. J Integr Health Sci [serial online] 2019 [cited 2019 Nov 18];7:8-12. Available from: http://www.jihs.in/text.asp?2019/7/1/8/260830
| Introduction|| |
Periodontitis is a multifactorial chronic inflammatory disease. It occurs due to the destruction of tooth-supporting tissues., The subgingival microorganisms are responsible for the inflammation of tooth-supporting tissues in patients with chronic periodontitis. Scaling and root planing (SRP) is the nonspecific and standard treatment for removal of supragingival and subgingival plaque and calculus in one or two appointments. This procedure helps to reduce microbial load. However, few patients may experience inflammation and periodontal attachment loss after the nonsurgical periodontal therapy. Mainly, there are two reasons for this inflammation and destruction of tissues:first due to improper nonsurgical periodontal therapy to suppress periodontal pathogens and second not maintaining proper oral hygiene by a patient with chronic periodontitis.,,
Some of the studies, have stated that Use of systemic administration of antimicrobial agents as an adjuncts to nonsurgical periodontal therapy. In the subgingival areas, these antimicrobial agents exert their action through the gingival crevicular fluid and help to reach the areas which are improperly cleaned by mechanical instrumentation. Nowadays, various local and systemic antibiotics have been used for the management of chronic and aggressive periodontitis such as lincosamides, macrolides, penicillins, and tetracyclines.
Tetracycline is a broad-spectrum antibiotic. It is bacteriostatic and effective against rapidly multiplying bacteria and exerts its action by inhibiting protein synthesis. It also has an anticollagenase effect that can inhibit tissue destruction and may aid bone regeneration. Doxycycline is a semisynthetic member of tetracyclines. It has more compliance because of its absorption from the gastrointestinal tract. After searching the literature and databases such as PubMed, Medline, and EBSCO till October 2017, with no restriction on language, very few studies, have evaluated the antimicrobial effect of systemic doxycycline on the periodontal tissues of chronic periodontitis patients. The aim of this study was to investigate the effect of SRP in conjunction with the administration of an antimicrobial dose of systemic doxycycline on the clinical parameters in chronic periodontitis patients.
| Methodology|| |
This was a protocol study. Drug tested was doxycycline 100 mg (trade name: Laa-LB tablets manufactured by Bombay Tablet Manufacturing Corporation) [Figure 1].
The final sample size was 52 and sample per group was 26. Based on the study done by Akalin et al., the sample size was calculated as follows: mean probing depth (PD) reduction by 0.3 with standard deviation (SD) of 0.37 at 5% risk and 80% power.
where Z = value of normal table, SD = standard deviation, and d = mean difference.
First all participants were informed about the procedure to be undertaken after that they signed the consent report before procedure. Recruitment of the participants and sites were as per the inclusion and exclusion criteria. Inclusion criteria comprised systemically healthy participants with untreated moderate to advanced periodontitis, age between 25 and 70 years, presence of > 12 scorable teeth (not including third molars and teeth with orthodontic appliances, bridges, crowns, or implants), presence of at least four teeth with a PD >4 mm, clinical attachment level (CAL) >2 mm, and radiographic evidence of bone loss. Exclusion criteria comprised systemic illnesses (i.e., diabetes mellitus, cancer, human immunodeficiency syndrome, bone metabolic diseases, or disorders that compromise wound healing, radiation, or immunosuppressive therapy), pregnancy or lactation, systemic antibiotics taken within the previous 2 months, use of nonsteroidal anti-inflammatory drugs, confirmed or suspected intolerance to tetracycline, subgingival SRP, or surgical periodontal therapy in the last year and participants with a history of smoking.
The nonsurgical periodontal therapy was done with the ultrasonic and hand instrumentation. Oral hygiene instructions were given to the participants after nonsurgical periodontal therapy and also prescribed chlorhexidine mouthwash rinse twice daily after brushing for 2 weeks [Figure 2] and [Figure 3]. After Phase 1 therapy [Figure 4]a,[Figure 4]b, [Figure 4]c,[Figure 4]d, one chit was allotted to each participant after they randomly picked up the chit. All participants in the Group A were given systemic doxycycline 100 mg twice on the 1st day, then once a day for 14 days [Figure 1], and in the Group B were not given any placebo drug, after completion of SRP. Doxycycline was allotted to Group A by a co-investigator, and data were collected by a primary investigator who was blinded for the allocation. All clinical parameters such as plaque index (PI), gingival index (GI), PD, and clinical attachment level (CAL) were assessed at baseline and 3-month interval. The data obtained were subjected to statistical analysis.
|Figure 4: Nonsurgical treatment in test group (a) Preoperative view of the right side. (b) Preoperative view of the left side. (c) Postoperative view of the right side after 3 months. (d) Postoperative view of the left side after 3 months|
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| Results|| |
Results were analyzed at baseline and posttreatment after 3 months, within each group and between the two groups with paired t-test and independent t-test.
The mean age in the test group was 49.12 years and in the control group was 48.88 years. There were 50.0% of males and 50.0% of females in the test group and 46.2% of males and 53.8% of females in the control group. There was no statistical difference between the two groups with respect to age (P = 0.87).
In the test group (SRP + doxycycline), from baseline to 3-month period, statistically significant differences were seen in terms of PI from 2.10 + 0.195 to 0.35 + 0.147. The GI significantly improved from 1.65 + 0.150 to 0.12 + 0.051. There was a decrease in PD from 5.70 ± 0.211 to 3.78 ± 0.167 and a gain in clinical attachment level from 6.45 ± 0.138 to 4.53 ± 0.215 at the end of 3 months, which was statistically significant [Table 1].
|Table 1: Comparison of the plaque index, gingival index, probing depth, and clinical attachment level values in terms of mean (standard deviation) pre and post using paired t-test (test group)|
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In the control group (SRP alone), from baseline to 3-month period, statistically significant differences were seen in terms of PI 2.10 ± 0.209–0.34 ± 0.157. The GI significantly improved from 1.70 ± 0.137 to 0.35 ± 0.106. There was a decrease in PD from 5.66 ± 0.254 to 5.19 ± 0.309 and a gain in clinical attachment level from 6.46 ± 0.162 to 5.93 ± 0.158 at the end of 3 months, which was statistically significant [Table 2].
|Table 2: Comparison of the plaque index, gingival index, probing depth, and clinical attachment level values in terms of mean (standard deviation) pre and post using paired t-test (control group)|
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The differences between clinical parameters of the test and control groups were compared at baseline, and at the end of 3 months (intergroup analysis), GI, PD, and clinical attachment level showed statistically significant differences with P < 0.001. No significant difference was seen in terms of PI (P = 0.86) [Table 3].
|Table 3: Comparison of the mean difference (pre-post) of plaque index, gingival index, probing depth, and clinical|
attachment level values in terms of mean (standard deviation) pre and post among test and control groups using
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| Discussion|| |
This study was carried out with the aim of evaluating the efficacy of doxycycline as an adjunct to SRP in the treatment of chronic periodontitis. Local drug delivery is indicated when there is a presence of isolated pockets in moderate periodontitis but when generalized pockets are present the use of systemic doxycycline is indicated because treating multiple sites with local drug delivery becomes very difficult.
Chronic periodontitis can be considered as a complex disease that is mainly caused by intraoral biofilms that harbor periodontal pathogenic microorganisms. Nonsurgical and surgical mechanical therapies are ineffective at reducing the presence of periodontal pathogenic bacteria in nondental intraoral habitats., Consequently, recolonization of the subgingival area by pathogens is common after treatment.
Antibiotics are effective means of treating bacterial infections and therefore constitute a reasonable consideration in the treatment of periodontal infections. In the present study, clinical parameters such as PI, GI, PD, and clinical attachment level were evaluated at baseline and 3 months posttreatment.
Although both the groups showed statistically significant improvements from baseline to the end of 3 months, the test group (SRP + doxycycline) showed superior results as compared to the control group (SRP alone) at 3-month interval. There was a statistically significant difference found in GI, PD, and clinical attachment level at the end of 3 months (P< 0.001). The PI did not show any statistically significant difference between the two groups at the end of 3 months (P = 0.86).
Akincibay et al. and Baltacioglu et al. evaluated the effect of systemic doxycycline in patients with aggressive periodontitis after completion of SRP and found that use of systemic doxycycline is superior to SRP alone. Similar, in the present study, the results favor the systemic doxycycline group.
Eickholz and Hagh conducted a study and found that the use of doxycycline as an adjunct provided more significant improvement in periodontal parameters. In the present study also shows significant improvement in periodontal parameters.
As the subgingival microbiota in adult periodontitis is constituted variety of periodontal pathogens which differ in their antimicrobial susceptibility, several investigators have used a systemic antibiotic to provide more effective therapy.
In the present study, there are certain limitations such as determining the microbiological analysis which helps to determine bacterial role in periodontitis. Second, the study was a single-blinded, which can be made a double-blinded study to reduce the risk of bias. Furthermore, the participants were followed up at 3 months, which could have been done for at least 6 months. Future well-designed randomized controlled trials with larger sample size, longer follow-up, and microbial analysis are required to confirm these results.
| Conclusion|| |
Doxycycline showed better results after mechanical therapy in the treatment of patients with chronic periodontitis because it has an anticollagenase effect that can inhibit tissue destruction and aid bone regeneration.
Financial support and sponsorship
This is a self-funded study.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Yücel OO, Berker E, Gariboǧlu S, Otlu H. Interleukin-11, interleukin-1beta, interleukin-12 and the pathogenesis of inflammatory periodontal diseases. J Clin Periodontol 2008;35:365-70.
Oteo A, Herrera D, Figuero E, O'Connor A, González I, Sanz M. Azithromycin as an adjunct to scaling and root planing in the treatment of Porphyromonas gingivalis
-associated periodontitis: A pilot study. J Clin Periodontol 2010;37:1005-15.
Zandbergen D, Slot DE, Niederman R, Fridus A, Weijden V. The concomitant administration of systemic amoxicillin and metronidazole compared to scaling and root planning alone in treating periodontitis: A systematic review. BMC Oral Health 2016;27:1-11.
Winkel EG, Van Winkelhoff AJ, Timmerman MF, Van der Velden U, Van der Weijden GA. Amoxicillin plus metronidazole in the treatment of adult periodontitis patients. A double-blind placebo-controlled study. J Clin Periodontol 2001;28:296-305.
Hung HC, Douglass CW. Meta-analysis of the effect of scaling and root planing, surgical treatment and antibiotic therapies on periodontal probing depth and attachment loss. J Clin Periodontol 2002;29:975-86.
Colombo AP, Boches SK, Cotton SL, Goodson JM, Kent R, Haffajee AD, et al.
Comparisons of subgingival microbial profiles of refractory periodontitis, severe periodontitis, and periodontal health using the human oral microbe identification microarray. J Periodontol 2009;80:1421-32.
Teles RP, Haffajee AD, Socransky SS. Microbiological goals of periodontal therapy. Periodontol 2000 2006;42:180-218.
Haffajee AD, Teles RP, Socransky SS. The effect of periodontal therapy on the composition of the subgingival microbiota. Periodontol 2000 2006;42:219-58.
Sgolastra F, Gatto R, Petrucci A, Monaco A. Effectiveness of systemic amoxicillin/metronidazole as adjunctive therapy to scaling and root planing in the treatment of chronic periodontitis: A systematic review and meta-analysis. J Periodontol 2012;83:1257-69.
Yek EC, Cintan S, Topcuoglu N, Kulekci G, Issever H, Kantarci A. Efficacy of amoxicillin and metronidazole combination for the management of generalized aggressive periodontitis. J Periodontol 2010;81:964-74.
Tripathi KD. Essentials of Pharmacology for Dentistry. New Delhi: Jaypee Brothers; 2011. p. 378.
Akalin FA, Baltacioǧlu E, Sengün D, Hekimoǧlu S, Taşkin M, Etikan I, et al.
Acomparative evaluation of the clinical effects of systemic and local doxycycline in the treatment of chronic periodontitis. J Oral Sci 2004;46:25-35.
Al-Nowaiser AM, Al-Zoman H, Baskaradoss JK, Robert AA, Al-Zoman KH, Al-Sohail AM, et al.
Evaluation of adjunctive systemic doxycycline with non-surgical periodontal therapy within type 2 diabetic patients. Saudi Med J 2014;35:1203-9.
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.
Socransky SS, Haffajee AD. Dental biofilms: Difficult therapeutic targets. Periodontol 2000 2002;28:12-55.
Danser MM, Timmerman MF, van Winkelhoff AJ, van der Velden U. The effect of periodontal treatment on periodontal bacteria on the oral mucous membranes. J Periodontol 1996;67:478-85.
Renvert S, Wikström M, Dahlén G, Slots J, Egelberg J. Effect of root debridement on the elimination of Actinobacillus actinomycetemcomitans
and Bacteroides gingivalis
from periodontal pockets. J Clin Periodontol 1990;17:345-50.
Akincibay H, Orsal SO, Sengün D, Tözüm TF. Systemic administration of doxycycline versus metronidazole plus amoxicillin in the treatment of localized aggressive periodontitis: A clinical and microbiologic study. Quintessence Int 2008;39:e33-9.
Baltacioglu E, Aslan M, Saraç Ö, Saybak A, Yuva P. Analysis of clinical results of systemic antimicrobials combined with nonsurgical periodontal treatment for generalized aggressive periodontitis: A pilot study. J Can Dent Assoc 2011;77:b97.
Eickholz P. Systemic doxycycline and nonsurgical periodontal treatment in diabetic patients. Evid Based Dent 2007;8:14.
Hagh GL. Clinical effect of scaling and root planning with or without doxycycline in type 2 diabetic patients with chronic periodontitis. Jundishapur Med J 2010;9:149-56.
Zia A, Gupta N, Bey A, Khan AU, Khan S, Andarbi MN, et al
. the effect of systemic doxycycline and mechanical therapy on GCF bita glucoronidase levels in chronic periodontitis patients. J Dent Indones 2017;24:38-44.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3]