Full-mouth Periodontal Debridement and Metronidazole Gel in Patients With Chronic Periodontitis

Full-mouth Periodontal Debridement With or Without Adjunctive Metronidazole Gel in Smoking Patients With Chronic Periodontitis

Hypothesis: metronidazole gel applied topically after periodontal debridement in smokers volunteers could improve clinical parameters when compared to metronidazole tablets + periodontal debridement. Method: 30 smokers with chronic periodontitis were randomly assigned into 3 groups: periodontal debridement combined with 3 g placebo gel; periodontal debridement combined with daily topical application of 3 g metronidazole benzoate gel (15%); and periodontal debridement combined with a daily single dose of 750 mg metronidazole. Clinical parameters evaluated were visible plaque, gingival bleeding, probing pocket depth and relative attachment level.

Background. The benefit of adjunctive metronidazole on periodontal procedure in smokers with chronic periodontitis (CP) is uncertain. The authors compared the effect of metronidazole (Mtz) on full-mouth periodontal debridement (PD= 1 hour of ultrasonic calculus/plaque removal) in smokers with CP.

Methods. This pilot study involved 30 Individuals (having at least six teeth with a clinical attachment loss of ≥ 5 mm and probing pocket depth (PPD) of ≥5 mm) that were randomly assigned into three groups (n=10): 1) PD plus 3 g of placebo gel daily topical application 2) PD plus daily topical application of 3 g of 15% Mtz benzoate gel; and 3) PD plus a daily single dose of 750 mg Mtz (Flagyl®). Clinical parameters visible plaque index (VPI), gingival bleeding index (GBI), relative attachment level (RAL) and PPD; and the quantitative analysis (real-time PCR) of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia were assessed baseline, 1, 3 and 6 months after PD.

Inclusion Criteria:

• diagnosis of chronic periodontitis
• presence of at least 6 periodontal pockets with a clinical attachment loss of ≥5 mm
• bleeding on probing (BOP)
• radiographic bone loss
• probing pocket depth higher or equal to 5 mm in at least six teeth
• at least 20 teeth in mouth (third molars excluded)
• an established smoking habit (at least 10 cigarettes per day for the past 4 years)

Exclusion Criteria:

• periapical alterations in qualifying teeth
• medical disorders requiring prophylactic antibiotic therapy or interfering with the treatment
• periodontal treatment in the past 6 months
• use of drugs known to affect periodontal status (antibiotic, anti-inflammatory, anticonvulsant, immunosuppressant and calcium channel blocker) within the past 6 months
• orthodontic therapy
• pregnancy and lactation
• allergy to metronidazole
• any systemic diseases (e.g.: diabetes and immunological disorders)