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LONG-TERM CLINICAL RESPONSE TO TREATMENT AND MAINTENANCE OF
LOCALIZED AGGRESSIVE PERIODONTITIS A COHORT STUDY
KA Miller et alJ Clin Periodontol 44 (2) 158-1682016 Dec 27
PRESENTED BYBIBINA GEORGE
INTRODUCTION
Localized Aggressive Periodontitis (LAP)
bull Early onset
bull Affecting families of systemically healthy individuals mostly African-descendants
bull Presenting rapid verticalarc shaped bone loss around incisors and first molars with
minimal calculus
(Armitage 1999 Albandar and Tinoco 2002 Susin et al 2014)
bull Phagocyte abnormalities and a hyper-responsive phenotype ( Secondary feature)
(Armitage 1999 Shaddox et al 2010 Shapira et al 1994)
bull Premature tooth loss
TREATMENT REGIMEN
Mechanical Debridement
with adjunctive Abx
Control of invading and highly
pathogenic microorg on tissue
Aa
Mechanical debridement Saxen et al1986
Christersson et al 1985 helliphelliphellipHerbert et al 2015 Aberg et al 2015)
Darby amp Curtis2001hellip Shaddox et al 2012
Tetracycline qid 7days
Doxycycline 100 mgday
Amox-metronidazole combination TD 7days
AIM
bull To evaluate long-term clinical response to periodontal therapy along with systemic
antibiotics
bull To evaluate the impact of compliance with drug regimen as well as with clinical
appointments
bull To retrospectively evaluate the past history of bone loss in primary dentition in LAP
cases diagnosed on permanent dentition
MATERIALS AND METHODS
bull SOURCE OF DATA
Patients diagnosed with LAP from the year Dec2006 ndash Dec 2014 from
Leon County Health Department Tallahassee Florida Duval County Health
Department Jacksonville Florida and University of Florida Gainesville Florida
bull Ethical clearance
Reviewed and approved by Institutional Review Board at University of
Florida
141 Systemically healthy African Americans
5-25 yrs
SELECTION CRITERIA
INCLUSION CRITERIA
bull At least two sites (incisor andor
first molar in permanent or
primary dentition) involved
(Armitage 1999 Albandar 2014)
bull Healthy siblings (HS) of LAP
patients were included in the
retrospective radiographic
analysis
EXCLUSION CRITERIA
bull Ho systemic disease with a potential to influence periodontal diseases
bull On antibiotics within the previous 3 months
bull Smoking
bull Pregnancy and lactation
bull Diseased patients presenting allergy to penicillin
bull If they missed two consecutive time points or were no longer able to contact for appointments
EXPERIMENTAL DESIGN
Clinical Parameters
bull Visible plaque
bull Bleeding on Probing (BOP)
bull Probing pocket depth (PPD)
bull Clinical attachment loss
measurements
Clinical Examination
bull Measured 6 sites per tooth
bull Mesio-buccal
bull Buccal
bull Disto-buccal
bull Mesio-lingual
bull Lingual
bull Disto-lingual
TIME PERIOD
bull Baselinebull 36121824 monthsbull 2 annual visits
Armamentarium
UNC-15 probe
Florida Probe
PERIODONTAL
TREATMENT
SUPRASUBGINGIVAL FULL MOUTH DEBRIDEMENT WITH
ULTRASONIC SCALER
FOLLOW- UP
Amoxicillin 500mg
1-1-1x 7 days
Metronidazole 250 mg 21
1-1-1 x 7 days
LA
(Buchmann et al 2002 Kaner et al 2007 Moreira and Feres-Filho 2007)
BASELINE
SRP manually in deep pockets
21
bull Side effects noted
bull Inspection of medication
bottles
If pockets gt 4mm MDSRP
OHIElectric tooth brush
bull Elimination of Aabull Better clinical
response (Mombelli et al 2013)
bull Ptnts have hyper-inflammatory response to bact LPS
PATIENT COMPLIANCE
ANTIBIOTICS CLINICAL APPOINTMENTS
CLINICAL TREATMENT
RESPONSE
COMPLIANT Taken gt frac12 pills Completed all time points
Analysis of clinical parameters at all time points
NONCOMPLIANT Didnrsquot take at all or lt frac12 pills or not taken pill for gt 2 or more consecutive days
Missed 1 or more appointment
Missed analysis at any time points
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
Dental records of all patients diagnosed with
LAP in permanent dentitions at baseline
were examined for presence of bone loss in
bitewing radiographs from their primary
dentition
STATISTICAL ANALYSIS
bull Means of PD and CAL were calculated
bull Tests
Kruskal-Wallis test
Dunnrsquos multiple comparisons
Mann-Whitney test
Spearman correlations analysis
Multivariate analyses
bull Software SPSS amp GraphPad Prism 50
RESULTS
Baseline demographic amp clinical parameters of LAPincluded in the analysis
CLINICAL TREATMENT RESPONSE
GRAPHICAL REPRESENTATION OF PD AND CAL GAIN
About 50 to slightly above 60 sites
present with reduction in PD and
CAL at all time points
PATIENT COMPLIANCENo significant difference for clinical parameters
14 yr F clin
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
BASELINE
1 YR
A- 8yr old F WITH BOTH PRIMARY 1ST AND 2nd molar and healthy permanent dentition (B)
C - E 13 yr old HS of LAP
C - At 5 yrs Some bone loss
D - 1yr later Bone loss progressed to2nd primary molar
E ndash No bone loss in permanent dentition
F ndash G 15 yr F with LAP in permanent dentition
F- Primary at 5 yrs with severe bone loss around molars
G ndash Perm showing bone loss in mand 1st and 2nd molars
DISCUSSION
bull First long-term evaluation of clinical treatment response of a large LAP cohort
as well as associated factors that may contribute to such response
bull Vast majority of LAP patients were successfully treated with nonsurgical
mechanical debridement and a one course of systemic antibiotic therapy and
that compliance with both antibiotics and appointments was important
bull Radiographic alveolar bone loss in the primary dentition of most LAP patients
suggest that this disease may indeed start in primary dentition and thus early
diagnosis in addition to this treatment approach are important tools to control
LAP disease
bull Shorter duration of the antibiotic regimen (7-day course rather than a 14 day-
course) to avoid possible side effects and antibiotic activity on possible new
biofilm re-formation after the first week which would have reduced its
effectiveness
(Harper and Robinson 1987 Quirynen et al 2005)
bull No patients presented an increase in the number of affected sites after
treatment at any time point (no progression)
bull Vast majority of patients actually showed gt50 reduction in the percentage of
sites with disease (~60 at 3 months then up to 100 at last follow up)
which shows the gradual improvement of the disease with time
bull Rabelo CC et al Systemic antibiotics in the treatment of aggressive
periodontitis A systematic review and a Bayesian Network meta-
analysis J Clin Periodontol 2015 Jul42(7)647-57 assessed the effect of
systemic antibiotic therapy on the treatment of aggressive periodontitis and concluded
that SRP plus systemic antibiotics led to an additional clinical effect compared with
SRP alone in the treatment of AgP Mtz and MtzAmx provided to the most beneficial
outcomes
bull Mombelli A et al Are There Specific Benefits of Amoxicillin Plus Metronidazole
in Aggregatibacter actinomycetemcomitans-Associated Periodontitis Double-
Masked Randomized Clinical Trial of Efficacy and Safety Journal of
Periodontology June 2013 Vol 84 No 6 Pages 715-724 evaluated 41 participants
who were positive for A actinomycetemcomitans and 41 participants who were negative
for A actinomycetemcomitans with full-mouth periodontal debridement performed within
48 hours after which they received either systemic antibiotics (375 mg amoxicillin and 500
mg metronidazole three times daily) or placebo for 7 days and found no specific benefit
from amoxicillin plus metronidazole on patients who were positive for A
actinomycetemcomitans Sites on molars benefited significantly more from the antibiotics
than non-molar sites
bull Cogen et al Destructive Periodontal Disease in Healthy Children Journal of Periodontology September 1992 Vol 63 No 9 Pages 761-765 conducted a retrospective cross-sectional study in which diagnosis of JP was based on age (le 15 years) negative medical history and radiographic evidence of arc-shaped alveolar bone loss
The study population was one-third white and two-thirds black and the malefemale ratio was 11 reflecting the general patient population
The prevalence among whites was 03 with a femalemale ratio 41
Among blacks the prevalence was 15 with a female male ratio 11
Among the black JP subjects with radiographs of the mixed dentition 857 presented evidence of bone loss and of those with radiographs of the deciduous
dentition 714 had discernible alveolar bone loss
CONCLUSION
bull Full mouth suprasubgingival debridement along with a one-time 7-day course of
amoxicillin and metronidazole and proper maintenance was effective in reducing
clinical parameters of affected sites in this population with LAP at 3 months post
treatment and were maintained for 4 years
bull The lsquogrossrsquo non-compliance with antibiotics and visits slightly and negatively affected
these results
bull Majority of patients diagnosed with LAP in the permanent dentition who were
analyzed retrospectively also presented radiographic bone loss in their primary
dentition which may suggest an early initiation for this disease
LIMITATIONS
bull The present study was not properly designed to evaluate the specific effects of
plaque control on LAP response to treatment
bull Lacks comparison with other treatment approaches and the evaluation of
antibiotic resistance which should be performed
o Does not evaluate effectiveness of this treatment regimen against SRP alone
o Previous studies on antibiotic resistance show that a one-course systemic antibiotic use adjunct to
mechanical debridement have resulted in transient bacterial resistance which decreased shortly
after cessation of antibiotic intake
(Feres et al 2002 Feres et al 1999 Fiehn and Westergaard 1990 Haffajee 2006)
INTRODUCTION
Localized Aggressive Periodontitis (LAP)
bull Early onset
bull Affecting families of systemically healthy individuals mostly African-descendants
bull Presenting rapid verticalarc shaped bone loss around incisors and first molars with
minimal calculus
(Armitage 1999 Albandar and Tinoco 2002 Susin et al 2014)
bull Phagocyte abnormalities and a hyper-responsive phenotype ( Secondary feature)
(Armitage 1999 Shaddox et al 2010 Shapira et al 1994)
bull Premature tooth loss
TREATMENT REGIMEN
Mechanical Debridement
with adjunctive Abx
Control of invading and highly
pathogenic microorg on tissue
Aa
Mechanical debridement Saxen et al1986
Christersson et al 1985 helliphelliphellipHerbert et al 2015 Aberg et al 2015)
Darby amp Curtis2001hellip Shaddox et al 2012
Tetracycline qid 7days
Doxycycline 100 mgday
Amox-metronidazole combination TD 7days
AIM
bull To evaluate long-term clinical response to periodontal therapy along with systemic
antibiotics
bull To evaluate the impact of compliance with drug regimen as well as with clinical
appointments
bull To retrospectively evaluate the past history of bone loss in primary dentition in LAP
cases diagnosed on permanent dentition
MATERIALS AND METHODS
bull SOURCE OF DATA
Patients diagnosed with LAP from the year Dec2006 ndash Dec 2014 from
Leon County Health Department Tallahassee Florida Duval County Health
Department Jacksonville Florida and University of Florida Gainesville Florida
bull Ethical clearance
Reviewed and approved by Institutional Review Board at University of
Florida
141 Systemically healthy African Americans
5-25 yrs
SELECTION CRITERIA
INCLUSION CRITERIA
bull At least two sites (incisor andor
first molar in permanent or
primary dentition) involved
(Armitage 1999 Albandar 2014)
bull Healthy siblings (HS) of LAP
patients were included in the
retrospective radiographic
analysis
EXCLUSION CRITERIA
bull Ho systemic disease with a potential to influence periodontal diseases
bull On antibiotics within the previous 3 months
bull Smoking
bull Pregnancy and lactation
bull Diseased patients presenting allergy to penicillin
bull If they missed two consecutive time points or were no longer able to contact for appointments
EXPERIMENTAL DESIGN
Clinical Parameters
bull Visible plaque
bull Bleeding on Probing (BOP)
bull Probing pocket depth (PPD)
bull Clinical attachment loss
measurements
Clinical Examination
bull Measured 6 sites per tooth
bull Mesio-buccal
bull Buccal
bull Disto-buccal
bull Mesio-lingual
bull Lingual
bull Disto-lingual
TIME PERIOD
bull Baselinebull 36121824 monthsbull 2 annual visits
Armamentarium
UNC-15 probe
Florida Probe
PERIODONTAL
TREATMENT
SUPRASUBGINGIVAL FULL MOUTH DEBRIDEMENT WITH
ULTRASONIC SCALER
FOLLOW- UP
Amoxicillin 500mg
1-1-1x 7 days
Metronidazole 250 mg 21
1-1-1 x 7 days
LA
(Buchmann et al 2002 Kaner et al 2007 Moreira and Feres-Filho 2007)
BASELINE
SRP manually in deep pockets
21
bull Side effects noted
bull Inspection of medication
bottles
If pockets gt 4mm MDSRP
OHIElectric tooth brush
bull Elimination of Aabull Better clinical
response (Mombelli et al 2013)
bull Ptnts have hyper-inflammatory response to bact LPS
PATIENT COMPLIANCE
ANTIBIOTICS CLINICAL APPOINTMENTS
CLINICAL TREATMENT
RESPONSE
COMPLIANT Taken gt frac12 pills Completed all time points
Analysis of clinical parameters at all time points
NONCOMPLIANT Didnrsquot take at all or lt frac12 pills or not taken pill for gt 2 or more consecutive days
Missed 1 or more appointment
Missed analysis at any time points
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
Dental records of all patients diagnosed with
LAP in permanent dentitions at baseline
were examined for presence of bone loss in
bitewing radiographs from their primary
dentition
STATISTICAL ANALYSIS
bull Means of PD and CAL were calculated
bull Tests
Kruskal-Wallis test
Dunnrsquos multiple comparisons
Mann-Whitney test
Spearman correlations analysis
Multivariate analyses
bull Software SPSS amp GraphPad Prism 50
RESULTS
Baseline demographic amp clinical parameters of LAPincluded in the analysis
CLINICAL TREATMENT RESPONSE
GRAPHICAL REPRESENTATION OF PD AND CAL GAIN
About 50 to slightly above 60 sites
present with reduction in PD and
CAL at all time points
PATIENT COMPLIANCENo significant difference for clinical parameters
14 yr F clin
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
BASELINE
1 YR
A- 8yr old F WITH BOTH PRIMARY 1ST AND 2nd molar and healthy permanent dentition (B)
C - E 13 yr old HS of LAP
C - At 5 yrs Some bone loss
D - 1yr later Bone loss progressed to2nd primary molar
E ndash No bone loss in permanent dentition
F ndash G 15 yr F with LAP in permanent dentition
F- Primary at 5 yrs with severe bone loss around molars
G ndash Perm showing bone loss in mand 1st and 2nd molars
DISCUSSION
bull First long-term evaluation of clinical treatment response of a large LAP cohort
as well as associated factors that may contribute to such response
bull Vast majority of LAP patients were successfully treated with nonsurgical
mechanical debridement and a one course of systemic antibiotic therapy and
that compliance with both antibiotics and appointments was important
bull Radiographic alveolar bone loss in the primary dentition of most LAP patients
suggest that this disease may indeed start in primary dentition and thus early
diagnosis in addition to this treatment approach are important tools to control
LAP disease
bull Shorter duration of the antibiotic regimen (7-day course rather than a 14 day-
course) to avoid possible side effects and antibiotic activity on possible new
biofilm re-formation after the first week which would have reduced its
effectiveness
(Harper and Robinson 1987 Quirynen et al 2005)
bull No patients presented an increase in the number of affected sites after
treatment at any time point (no progression)
bull Vast majority of patients actually showed gt50 reduction in the percentage of
sites with disease (~60 at 3 months then up to 100 at last follow up)
which shows the gradual improvement of the disease with time
bull Rabelo CC et al Systemic antibiotics in the treatment of aggressive
periodontitis A systematic review and a Bayesian Network meta-
analysis J Clin Periodontol 2015 Jul42(7)647-57 assessed the effect of
systemic antibiotic therapy on the treatment of aggressive periodontitis and concluded
that SRP plus systemic antibiotics led to an additional clinical effect compared with
SRP alone in the treatment of AgP Mtz and MtzAmx provided to the most beneficial
outcomes
bull Mombelli A et al Are There Specific Benefits of Amoxicillin Plus Metronidazole
in Aggregatibacter actinomycetemcomitans-Associated Periodontitis Double-
Masked Randomized Clinical Trial of Efficacy and Safety Journal of
Periodontology June 2013 Vol 84 No 6 Pages 715-724 evaluated 41 participants
who were positive for A actinomycetemcomitans and 41 participants who were negative
for A actinomycetemcomitans with full-mouth periodontal debridement performed within
48 hours after which they received either systemic antibiotics (375 mg amoxicillin and 500
mg metronidazole three times daily) or placebo for 7 days and found no specific benefit
from amoxicillin plus metronidazole on patients who were positive for A
actinomycetemcomitans Sites on molars benefited significantly more from the antibiotics
than non-molar sites
bull Cogen et al Destructive Periodontal Disease in Healthy Children Journal of Periodontology September 1992 Vol 63 No 9 Pages 761-765 conducted a retrospective cross-sectional study in which diagnosis of JP was based on age (le 15 years) negative medical history and radiographic evidence of arc-shaped alveolar bone loss
The study population was one-third white and two-thirds black and the malefemale ratio was 11 reflecting the general patient population
The prevalence among whites was 03 with a femalemale ratio 41
Among blacks the prevalence was 15 with a female male ratio 11
Among the black JP subjects with radiographs of the mixed dentition 857 presented evidence of bone loss and of those with radiographs of the deciduous
dentition 714 had discernible alveolar bone loss
CONCLUSION
bull Full mouth suprasubgingival debridement along with a one-time 7-day course of
amoxicillin and metronidazole and proper maintenance was effective in reducing
clinical parameters of affected sites in this population with LAP at 3 months post
treatment and were maintained for 4 years
bull The lsquogrossrsquo non-compliance with antibiotics and visits slightly and negatively affected
these results
bull Majority of patients diagnosed with LAP in the permanent dentition who were
analyzed retrospectively also presented radiographic bone loss in their primary
dentition which may suggest an early initiation for this disease
LIMITATIONS
bull The present study was not properly designed to evaluate the specific effects of
plaque control on LAP response to treatment
bull Lacks comparison with other treatment approaches and the evaluation of
antibiotic resistance which should be performed
o Does not evaluate effectiveness of this treatment regimen against SRP alone
o Previous studies on antibiotic resistance show that a one-course systemic antibiotic use adjunct to
mechanical debridement have resulted in transient bacterial resistance which decreased shortly
after cessation of antibiotic intake
(Feres et al 2002 Feres et al 1999 Fiehn and Westergaard 1990 Haffajee 2006)
TREATMENT REGIMEN
Mechanical Debridement
with adjunctive Abx
Control of invading and highly
pathogenic microorg on tissue
Aa
Mechanical debridement Saxen et al1986
Christersson et al 1985 helliphelliphellipHerbert et al 2015 Aberg et al 2015)
Darby amp Curtis2001hellip Shaddox et al 2012
Tetracycline qid 7days
Doxycycline 100 mgday
Amox-metronidazole combination TD 7days
AIM
bull To evaluate long-term clinical response to periodontal therapy along with systemic
antibiotics
bull To evaluate the impact of compliance with drug regimen as well as with clinical
appointments
bull To retrospectively evaluate the past history of bone loss in primary dentition in LAP
cases diagnosed on permanent dentition
MATERIALS AND METHODS
bull SOURCE OF DATA
Patients diagnosed with LAP from the year Dec2006 ndash Dec 2014 from
Leon County Health Department Tallahassee Florida Duval County Health
Department Jacksonville Florida and University of Florida Gainesville Florida
bull Ethical clearance
Reviewed and approved by Institutional Review Board at University of
Florida
141 Systemically healthy African Americans
5-25 yrs
SELECTION CRITERIA
INCLUSION CRITERIA
bull At least two sites (incisor andor
first molar in permanent or
primary dentition) involved
(Armitage 1999 Albandar 2014)
bull Healthy siblings (HS) of LAP
patients were included in the
retrospective radiographic
analysis
EXCLUSION CRITERIA
bull Ho systemic disease with a potential to influence periodontal diseases
bull On antibiotics within the previous 3 months
bull Smoking
bull Pregnancy and lactation
bull Diseased patients presenting allergy to penicillin
bull If they missed two consecutive time points or were no longer able to contact for appointments
EXPERIMENTAL DESIGN
Clinical Parameters
bull Visible plaque
bull Bleeding on Probing (BOP)
bull Probing pocket depth (PPD)
bull Clinical attachment loss
measurements
Clinical Examination
bull Measured 6 sites per tooth
bull Mesio-buccal
bull Buccal
bull Disto-buccal
bull Mesio-lingual
bull Lingual
bull Disto-lingual
TIME PERIOD
bull Baselinebull 36121824 monthsbull 2 annual visits
Armamentarium
UNC-15 probe
Florida Probe
PERIODONTAL
TREATMENT
SUPRASUBGINGIVAL FULL MOUTH DEBRIDEMENT WITH
ULTRASONIC SCALER
FOLLOW- UP
Amoxicillin 500mg
1-1-1x 7 days
Metronidazole 250 mg 21
1-1-1 x 7 days
LA
(Buchmann et al 2002 Kaner et al 2007 Moreira and Feres-Filho 2007)
BASELINE
SRP manually in deep pockets
21
bull Side effects noted
bull Inspection of medication
bottles
If pockets gt 4mm MDSRP
OHIElectric tooth brush
bull Elimination of Aabull Better clinical
response (Mombelli et al 2013)
bull Ptnts have hyper-inflammatory response to bact LPS
PATIENT COMPLIANCE
ANTIBIOTICS CLINICAL APPOINTMENTS
CLINICAL TREATMENT
RESPONSE
COMPLIANT Taken gt frac12 pills Completed all time points
Analysis of clinical parameters at all time points
NONCOMPLIANT Didnrsquot take at all or lt frac12 pills or not taken pill for gt 2 or more consecutive days
Missed 1 or more appointment
Missed analysis at any time points
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
Dental records of all patients diagnosed with
LAP in permanent dentitions at baseline
were examined for presence of bone loss in
bitewing radiographs from their primary
dentition
STATISTICAL ANALYSIS
bull Means of PD and CAL were calculated
bull Tests
Kruskal-Wallis test
Dunnrsquos multiple comparisons
Mann-Whitney test
Spearman correlations analysis
Multivariate analyses
bull Software SPSS amp GraphPad Prism 50
RESULTS
Baseline demographic amp clinical parameters of LAPincluded in the analysis
CLINICAL TREATMENT RESPONSE
GRAPHICAL REPRESENTATION OF PD AND CAL GAIN
About 50 to slightly above 60 sites
present with reduction in PD and
CAL at all time points
PATIENT COMPLIANCENo significant difference for clinical parameters
14 yr F clin
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
BASELINE
1 YR
A- 8yr old F WITH BOTH PRIMARY 1ST AND 2nd molar and healthy permanent dentition (B)
C - E 13 yr old HS of LAP
C - At 5 yrs Some bone loss
D - 1yr later Bone loss progressed to2nd primary molar
E ndash No bone loss in permanent dentition
F ndash G 15 yr F with LAP in permanent dentition
F- Primary at 5 yrs with severe bone loss around molars
G ndash Perm showing bone loss in mand 1st and 2nd molars
DISCUSSION
bull First long-term evaluation of clinical treatment response of a large LAP cohort
as well as associated factors that may contribute to such response
bull Vast majority of LAP patients were successfully treated with nonsurgical
mechanical debridement and a one course of systemic antibiotic therapy and
that compliance with both antibiotics and appointments was important
bull Radiographic alveolar bone loss in the primary dentition of most LAP patients
suggest that this disease may indeed start in primary dentition and thus early
diagnosis in addition to this treatment approach are important tools to control
LAP disease
bull Shorter duration of the antibiotic regimen (7-day course rather than a 14 day-
course) to avoid possible side effects and antibiotic activity on possible new
biofilm re-formation after the first week which would have reduced its
effectiveness
(Harper and Robinson 1987 Quirynen et al 2005)
bull No patients presented an increase in the number of affected sites after
treatment at any time point (no progression)
bull Vast majority of patients actually showed gt50 reduction in the percentage of
sites with disease (~60 at 3 months then up to 100 at last follow up)
which shows the gradual improvement of the disease with time
bull Rabelo CC et al Systemic antibiotics in the treatment of aggressive
periodontitis A systematic review and a Bayesian Network meta-
analysis J Clin Periodontol 2015 Jul42(7)647-57 assessed the effect of
systemic antibiotic therapy on the treatment of aggressive periodontitis and concluded
that SRP plus systemic antibiotics led to an additional clinical effect compared with
SRP alone in the treatment of AgP Mtz and MtzAmx provided to the most beneficial
outcomes
bull Mombelli A et al Are There Specific Benefits of Amoxicillin Plus Metronidazole
in Aggregatibacter actinomycetemcomitans-Associated Periodontitis Double-
Masked Randomized Clinical Trial of Efficacy and Safety Journal of
Periodontology June 2013 Vol 84 No 6 Pages 715-724 evaluated 41 participants
who were positive for A actinomycetemcomitans and 41 participants who were negative
for A actinomycetemcomitans with full-mouth periodontal debridement performed within
48 hours after which they received either systemic antibiotics (375 mg amoxicillin and 500
mg metronidazole three times daily) or placebo for 7 days and found no specific benefit
from amoxicillin plus metronidazole on patients who were positive for A
actinomycetemcomitans Sites on molars benefited significantly more from the antibiotics
than non-molar sites
bull Cogen et al Destructive Periodontal Disease in Healthy Children Journal of Periodontology September 1992 Vol 63 No 9 Pages 761-765 conducted a retrospective cross-sectional study in which diagnosis of JP was based on age (le 15 years) negative medical history and radiographic evidence of arc-shaped alveolar bone loss
The study population was one-third white and two-thirds black and the malefemale ratio was 11 reflecting the general patient population
The prevalence among whites was 03 with a femalemale ratio 41
Among blacks the prevalence was 15 with a female male ratio 11
Among the black JP subjects with radiographs of the mixed dentition 857 presented evidence of bone loss and of those with radiographs of the deciduous
dentition 714 had discernible alveolar bone loss
CONCLUSION
bull Full mouth suprasubgingival debridement along with a one-time 7-day course of
amoxicillin and metronidazole and proper maintenance was effective in reducing
clinical parameters of affected sites in this population with LAP at 3 months post
treatment and were maintained for 4 years
bull The lsquogrossrsquo non-compliance with antibiotics and visits slightly and negatively affected
these results
bull Majority of patients diagnosed with LAP in the permanent dentition who were
analyzed retrospectively also presented radiographic bone loss in their primary
dentition which may suggest an early initiation for this disease
LIMITATIONS
bull The present study was not properly designed to evaluate the specific effects of
plaque control on LAP response to treatment
bull Lacks comparison with other treatment approaches and the evaluation of
antibiotic resistance which should be performed
o Does not evaluate effectiveness of this treatment regimen against SRP alone
o Previous studies on antibiotic resistance show that a one-course systemic antibiotic use adjunct to
mechanical debridement have resulted in transient bacterial resistance which decreased shortly
after cessation of antibiotic intake
(Feres et al 2002 Feres et al 1999 Fiehn and Westergaard 1990 Haffajee 2006)
AIM
bull To evaluate long-term clinical response to periodontal therapy along with systemic
antibiotics
bull To evaluate the impact of compliance with drug regimen as well as with clinical
appointments
bull To retrospectively evaluate the past history of bone loss in primary dentition in LAP
cases diagnosed on permanent dentition
MATERIALS AND METHODS
bull SOURCE OF DATA
Patients diagnosed with LAP from the year Dec2006 ndash Dec 2014 from
Leon County Health Department Tallahassee Florida Duval County Health
Department Jacksonville Florida and University of Florida Gainesville Florida
bull Ethical clearance
Reviewed and approved by Institutional Review Board at University of
Florida
141 Systemically healthy African Americans
5-25 yrs
SELECTION CRITERIA
INCLUSION CRITERIA
bull At least two sites (incisor andor
first molar in permanent or
primary dentition) involved
(Armitage 1999 Albandar 2014)
bull Healthy siblings (HS) of LAP
patients were included in the
retrospective radiographic
analysis
EXCLUSION CRITERIA
bull Ho systemic disease with a potential to influence periodontal diseases
bull On antibiotics within the previous 3 months
bull Smoking
bull Pregnancy and lactation
bull Diseased patients presenting allergy to penicillin
bull If they missed two consecutive time points or were no longer able to contact for appointments
EXPERIMENTAL DESIGN
Clinical Parameters
bull Visible plaque
bull Bleeding on Probing (BOP)
bull Probing pocket depth (PPD)
bull Clinical attachment loss
measurements
Clinical Examination
bull Measured 6 sites per tooth
bull Mesio-buccal
bull Buccal
bull Disto-buccal
bull Mesio-lingual
bull Lingual
bull Disto-lingual
TIME PERIOD
bull Baselinebull 36121824 monthsbull 2 annual visits
Armamentarium
UNC-15 probe
Florida Probe
PERIODONTAL
TREATMENT
SUPRASUBGINGIVAL FULL MOUTH DEBRIDEMENT WITH
ULTRASONIC SCALER
FOLLOW- UP
Amoxicillin 500mg
1-1-1x 7 days
Metronidazole 250 mg 21
1-1-1 x 7 days
LA
(Buchmann et al 2002 Kaner et al 2007 Moreira and Feres-Filho 2007)
BASELINE
SRP manually in deep pockets
21
bull Side effects noted
bull Inspection of medication
bottles
If pockets gt 4mm MDSRP
OHIElectric tooth brush
bull Elimination of Aabull Better clinical
response (Mombelli et al 2013)
bull Ptnts have hyper-inflammatory response to bact LPS
PATIENT COMPLIANCE
ANTIBIOTICS CLINICAL APPOINTMENTS
CLINICAL TREATMENT
RESPONSE
COMPLIANT Taken gt frac12 pills Completed all time points
Analysis of clinical parameters at all time points
NONCOMPLIANT Didnrsquot take at all or lt frac12 pills or not taken pill for gt 2 or more consecutive days
Missed 1 or more appointment
Missed analysis at any time points
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
Dental records of all patients diagnosed with
LAP in permanent dentitions at baseline
were examined for presence of bone loss in
bitewing radiographs from their primary
dentition
STATISTICAL ANALYSIS
bull Means of PD and CAL were calculated
bull Tests
Kruskal-Wallis test
Dunnrsquos multiple comparisons
Mann-Whitney test
Spearman correlations analysis
Multivariate analyses
bull Software SPSS amp GraphPad Prism 50
RESULTS
Baseline demographic amp clinical parameters of LAPincluded in the analysis
CLINICAL TREATMENT RESPONSE
GRAPHICAL REPRESENTATION OF PD AND CAL GAIN
About 50 to slightly above 60 sites
present with reduction in PD and
CAL at all time points
PATIENT COMPLIANCENo significant difference for clinical parameters
14 yr F clin
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
BASELINE
1 YR
A- 8yr old F WITH BOTH PRIMARY 1ST AND 2nd molar and healthy permanent dentition (B)
C - E 13 yr old HS of LAP
C - At 5 yrs Some bone loss
D - 1yr later Bone loss progressed to2nd primary molar
E ndash No bone loss in permanent dentition
F ndash G 15 yr F with LAP in permanent dentition
F- Primary at 5 yrs with severe bone loss around molars
G ndash Perm showing bone loss in mand 1st and 2nd molars
DISCUSSION
bull First long-term evaluation of clinical treatment response of a large LAP cohort
as well as associated factors that may contribute to such response
bull Vast majority of LAP patients were successfully treated with nonsurgical
mechanical debridement and a one course of systemic antibiotic therapy and
that compliance with both antibiotics and appointments was important
bull Radiographic alveolar bone loss in the primary dentition of most LAP patients
suggest that this disease may indeed start in primary dentition and thus early
diagnosis in addition to this treatment approach are important tools to control
LAP disease
bull Shorter duration of the antibiotic regimen (7-day course rather than a 14 day-
course) to avoid possible side effects and antibiotic activity on possible new
biofilm re-formation after the first week which would have reduced its
effectiveness
(Harper and Robinson 1987 Quirynen et al 2005)
bull No patients presented an increase in the number of affected sites after
treatment at any time point (no progression)
bull Vast majority of patients actually showed gt50 reduction in the percentage of
sites with disease (~60 at 3 months then up to 100 at last follow up)
which shows the gradual improvement of the disease with time
bull Rabelo CC et al Systemic antibiotics in the treatment of aggressive
periodontitis A systematic review and a Bayesian Network meta-
analysis J Clin Periodontol 2015 Jul42(7)647-57 assessed the effect of
systemic antibiotic therapy on the treatment of aggressive periodontitis and concluded
that SRP plus systemic antibiotics led to an additional clinical effect compared with
SRP alone in the treatment of AgP Mtz and MtzAmx provided to the most beneficial
outcomes
bull Mombelli A et al Are There Specific Benefits of Amoxicillin Plus Metronidazole
in Aggregatibacter actinomycetemcomitans-Associated Periodontitis Double-
Masked Randomized Clinical Trial of Efficacy and Safety Journal of
Periodontology June 2013 Vol 84 No 6 Pages 715-724 evaluated 41 participants
who were positive for A actinomycetemcomitans and 41 participants who were negative
for A actinomycetemcomitans with full-mouth periodontal debridement performed within
48 hours after which they received either systemic antibiotics (375 mg amoxicillin and 500
mg metronidazole three times daily) or placebo for 7 days and found no specific benefit
from amoxicillin plus metronidazole on patients who were positive for A
actinomycetemcomitans Sites on molars benefited significantly more from the antibiotics
than non-molar sites
bull Cogen et al Destructive Periodontal Disease in Healthy Children Journal of Periodontology September 1992 Vol 63 No 9 Pages 761-765 conducted a retrospective cross-sectional study in which diagnosis of JP was based on age (le 15 years) negative medical history and radiographic evidence of arc-shaped alveolar bone loss
The study population was one-third white and two-thirds black and the malefemale ratio was 11 reflecting the general patient population
The prevalence among whites was 03 with a femalemale ratio 41
Among blacks the prevalence was 15 with a female male ratio 11
Among the black JP subjects with radiographs of the mixed dentition 857 presented evidence of bone loss and of those with radiographs of the deciduous
dentition 714 had discernible alveolar bone loss
CONCLUSION
bull Full mouth suprasubgingival debridement along with a one-time 7-day course of
amoxicillin and metronidazole and proper maintenance was effective in reducing
clinical parameters of affected sites in this population with LAP at 3 months post
treatment and were maintained for 4 years
bull The lsquogrossrsquo non-compliance with antibiotics and visits slightly and negatively affected
these results
bull Majority of patients diagnosed with LAP in the permanent dentition who were
analyzed retrospectively also presented radiographic bone loss in their primary
dentition which may suggest an early initiation for this disease
LIMITATIONS
bull The present study was not properly designed to evaluate the specific effects of
plaque control on LAP response to treatment
bull Lacks comparison with other treatment approaches and the evaluation of
antibiotic resistance which should be performed
o Does not evaluate effectiveness of this treatment regimen against SRP alone
o Previous studies on antibiotic resistance show that a one-course systemic antibiotic use adjunct to
mechanical debridement have resulted in transient bacterial resistance which decreased shortly
after cessation of antibiotic intake
(Feres et al 2002 Feres et al 1999 Fiehn and Westergaard 1990 Haffajee 2006)
MATERIALS AND METHODS
bull SOURCE OF DATA
Patients diagnosed with LAP from the year Dec2006 ndash Dec 2014 from
Leon County Health Department Tallahassee Florida Duval County Health
Department Jacksonville Florida and University of Florida Gainesville Florida
bull Ethical clearance
Reviewed and approved by Institutional Review Board at University of
Florida
141 Systemically healthy African Americans
5-25 yrs
SELECTION CRITERIA
INCLUSION CRITERIA
bull At least two sites (incisor andor
first molar in permanent or
primary dentition) involved
(Armitage 1999 Albandar 2014)
bull Healthy siblings (HS) of LAP
patients were included in the
retrospective radiographic
analysis
EXCLUSION CRITERIA
bull Ho systemic disease with a potential to influence periodontal diseases
bull On antibiotics within the previous 3 months
bull Smoking
bull Pregnancy and lactation
bull Diseased patients presenting allergy to penicillin
bull If they missed two consecutive time points or were no longer able to contact for appointments
EXPERIMENTAL DESIGN
Clinical Parameters
bull Visible plaque
bull Bleeding on Probing (BOP)
bull Probing pocket depth (PPD)
bull Clinical attachment loss
measurements
Clinical Examination
bull Measured 6 sites per tooth
bull Mesio-buccal
bull Buccal
bull Disto-buccal
bull Mesio-lingual
bull Lingual
bull Disto-lingual
TIME PERIOD
bull Baselinebull 36121824 monthsbull 2 annual visits
Armamentarium
UNC-15 probe
Florida Probe
PERIODONTAL
TREATMENT
SUPRASUBGINGIVAL FULL MOUTH DEBRIDEMENT WITH
ULTRASONIC SCALER
FOLLOW- UP
Amoxicillin 500mg
1-1-1x 7 days
Metronidazole 250 mg 21
1-1-1 x 7 days
LA
(Buchmann et al 2002 Kaner et al 2007 Moreira and Feres-Filho 2007)
BASELINE
SRP manually in deep pockets
21
bull Side effects noted
bull Inspection of medication
bottles
If pockets gt 4mm MDSRP
OHIElectric tooth brush
bull Elimination of Aabull Better clinical
response (Mombelli et al 2013)
bull Ptnts have hyper-inflammatory response to bact LPS
PATIENT COMPLIANCE
ANTIBIOTICS CLINICAL APPOINTMENTS
CLINICAL TREATMENT
RESPONSE
COMPLIANT Taken gt frac12 pills Completed all time points
Analysis of clinical parameters at all time points
NONCOMPLIANT Didnrsquot take at all or lt frac12 pills or not taken pill for gt 2 or more consecutive days
Missed 1 or more appointment
Missed analysis at any time points
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
Dental records of all patients diagnosed with
LAP in permanent dentitions at baseline
were examined for presence of bone loss in
bitewing radiographs from their primary
dentition
STATISTICAL ANALYSIS
bull Means of PD and CAL were calculated
bull Tests
Kruskal-Wallis test
Dunnrsquos multiple comparisons
Mann-Whitney test
Spearman correlations analysis
Multivariate analyses
bull Software SPSS amp GraphPad Prism 50
RESULTS
Baseline demographic amp clinical parameters of LAPincluded in the analysis
CLINICAL TREATMENT RESPONSE
GRAPHICAL REPRESENTATION OF PD AND CAL GAIN
About 50 to slightly above 60 sites
present with reduction in PD and
CAL at all time points
PATIENT COMPLIANCENo significant difference for clinical parameters
14 yr F clin
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
BASELINE
1 YR
A- 8yr old F WITH BOTH PRIMARY 1ST AND 2nd molar and healthy permanent dentition (B)
C - E 13 yr old HS of LAP
C - At 5 yrs Some bone loss
D - 1yr later Bone loss progressed to2nd primary molar
E ndash No bone loss in permanent dentition
F ndash G 15 yr F with LAP in permanent dentition
F- Primary at 5 yrs with severe bone loss around molars
G ndash Perm showing bone loss in mand 1st and 2nd molars
DISCUSSION
bull First long-term evaluation of clinical treatment response of a large LAP cohort
as well as associated factors that may contribute to such response
bull Vast majority of LAP patients were successfully treated with nonsurgical
mechanical debridement and a one course of systemic antibiotic therapy and
that compliance with both antibiotics and appointments was important
bull Radiographic alveolar bone loss in the primary dentition of most LAP patients
suggest that this disease may indeed start in primary dentition and thus early
diagnosis in addition to this treatment approach are important tools to control
LAP disease
bull Shorter duration of the antibiotic regimen (7-day course rather than a 14 day-
course) to avoid possible side effects and antibiotic activity on possible new
biofilm re-formation after the first week which would have reduced its
effectiveness
(Harper and Robinson 1987 Quirynen et al 2005)
bull No patients presented an increase in the number of affected sites after
treatment at any time point (no progression)
bull Vast majority of patients actually showed gt50 reduction in the percentage of
sites with disease (~60 at 3 months then up to 100 at last follow up)
which shows the gradual improvement of the disease with time
bull Rabelo CC et al Systemic antibiotics in the treatment of aggressive
periodontitis A systematic review and a Bayesian Network meta-
analysis J Clin Periodontol 2015 Jul42(7)647-57 assessed the effect of
systemic antibiotic therapy on the treatment of aggressive periodontitis and concluded
that SRP plus systemic antibiotics led to an additional clinical effect compared with
SRP alone in the treatment of AgP Mtz and MtzAmx provided to the most beneficial
outcomes
bull Mombelli A et al Are There Specific Benefits of Amoxicillin Plus Metronidazole
in Aggregatibacter actinomycetemcomitans-Associated Periodontitis Double-
Masked Randomized Clinical Trial of Efficacy and Safety Journal of
Periodontology June 2013 Vol 84 No 6 Pages 715-724 evaluated 41 participants
who were positive for A actinomycetemcomitans and 41 participants who were negative
for A actinomycetemcomitans with full-mouth periodontal debridement performed within
48 hours after which they received either systemic antibiotics (375 mg amoxicillin and 500
mg metronidazole three times daily) or placebo for 7 days and found no specific benefit
from amoxicillin plus metronidazole on patients who were positive for A
actinomycetemcomitans Sites on molars benefited significantly more from the antibiotics
than non-molar sites
bull Cogen et al Destructive Periodontal Disease in Healthy Children Journal of Periodontology September 1992 Vol 63 No 9 Pages 761-765 conducted a retrospective cross-sectional study in which diagnosis of JP was based on age (le 15 years) negative medical history and radiographic evidence of arc-shaped alveolar bone loss
The study population was one-third white and two-thirds black and the malefemale ratio was 11 reflecting the general patient population
The prevalence among whites was 03 with a femalemale ratio 41
Among blacks the prevalence was 15 with a female male ratio 11
Among the black JP subjects with radiographs of the mixed dentition 857 presented evidence of bone loss and of those with radiographs of the deciduous
dentition 714 had discernible alveolar bone loss
CONCLUSION
bull Full mouth suprasubgingival debridement along with a one-time 7-day course of
amoxicillin and metronidazole and proper maintenance was effective in reducing
clinical parameters of affected sites in this population with LAP at 3 months post
treatment and were maintained for 4 years
bull The lsquogrossrsquo non-compliance with antibiotics and visits slightly and negatively affected
these results
bull Majority of patients diagnosed with LAP in the permanent dentition who were
analyzed retrospectively also presented radiographic bone loss in their primary
dentition which may suggest an early initiation for this disease
LIMITATIONS
bull The present study was not properly designed to evaluate the specific effects of
plaque control on LAP response to treatment
bull Lacks comparison with other treatment approaches and the evaluation of
antibiotic resistance which should be performed
o Does not evaluate effectiveness of this treatment regimen against SRP alone
o Previous studies on antibiotic resistance show that a one-course systemic antibiotic use adjunct to
mechanical debridement have resulted in transient bacterial resistance which decreased shortly
after cessation of antibiotic intake
(Feres et al 2002 Feres et al 1999 Fiehn and Westergaard 1990 Haffajee 2006)
SELECTION CRITERIA
INCLUSION CRITERIA
bull At least two sites (incisor andor
first molar in permanent or
primary dentition) involved
(Armitage 1999 Albandar 2014)
bull Healthy siblings (HS) of LAP
patients were included in the
retrospective radiographic
analysis
EXCLUSION CRITERIA
bull Ho systemic disease with a potential to influence periodontal diseases
bull On antibiotics within the previous 3 months
bull Smoking
bull Pregnancy and lactation
bull Diseased patients presenting allergy to penicillin
bull If they missed two consecutive time points or were no longer able to contact for appointments
EXPERIMENTAL DESIGN
Clinical Parameters
bull Visible plaque
bull Bleeding on Probing (BOP)
bull Probing pocket depth (PPD)
bull Clinical attachment loss
measurements
Clinical Examination
bull Measured 6 sites per tooth
bull Mesio-buccal
bull Buccal
bull Disto-buccal
bull Mesio-lingual
bull Lingual
bull Disto-lingual
TIME PERIOD
bull Baselinebull 36121824 monthsbull 2 annual visits
Armamentarium
UNC-15 probe
Florida Probe
PERIODONTAL
TREATMENT
SUPRASUBGINGIVAL FULL MOUTH DEBRIDEMENT WITH
ULTRASONIC SCALER
FOLLOW- UP
Amoxicillin 500mg
1-1-1x 7 days
Metronidazole 250 mg 21
1-1-1 x 7 days
LA
(Buchmann et al 2002 Kaner et al 2007 Moreira and Feres-Filho 2007)
BASELINE
SRP manually in deep pockets
21
bull Side effects noted
bull Inspection of medication
bottles
If pockets gt 4mm MDSRP
OHIElectric tooth brush
bull Elimination of Aabull Better clinical
response (Mombelli et al 2013)
bull Ptnts have hyper-inflammatory response to bact LPS
PATIENT COMPLIANCE
ANTIBIOTICS CLINICAL APPOINTMENTS
CLINICAL TREATMENT
RESPONSE
COMPLIANT Taken gt frac12 pills Completed all time points
Analysis of clinical parameters at all time points
NONCOMPLIANT Didnrsquot take at all or lt frac12 pills or not taken pill for gt 2 or more consecutive days
Missed 1 or more appointment
Missed analysis at any time points
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
Dental records of all patients diagnosed with
LAP in permanent dentitions at baseline
were examined for presence of bone loss in
bitewing radiographs from their primary
dentition
STATISTICAL ANALYSIS
bull Means of PD and CAL were calculated
bull Tests
Kruskal-Wallis test
Dunnrsquos multiple comparisons
Mann-Whitney test
Spearman correlations analysis
Multivariate analyses
bull Software SPSS amp GraphPad Prism 50
RESULTS
Baseline demographic amp clinical parameters of LAPincluded in the analysis
CLINICAL TREATMENT RESPONSE
GRAPHICAL REPRESENTATION OF PD AND CAL GAIN
About 50 to slightly above 60 sites
present with reduction in PD and
CAL at all time points
PATIENT COMPLIANCENo significant difference for clinical parameters
14 yr F clin
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
BASELINE
1 YR
A- 8yr old F WITH BOTH PRIMARY 1ST AND 2nd molar and healthy permanent dentition (B)
C - E 13 yr old HS of LAP
C - At 5 yrs Some bone loss
D - 1yr later Bone loss progressed to2nd primary molar
E ndash No bone loss in permanent dentition
F ndash G 15 yr F with LAP in permanent dentition
F- Primary at 5 yrs with severe bone loss around molars
G ndash Perm showing bone loss in mand 1st and 2nd molars
DISCUSSION
bull First long-term evaluation of clinical treatment response of a large LAP cohort
as well as associated factors that may contribute to such response
bull Vast majority of LAP patients were successfully treated with nonsurgical
mechanical debridement and a one course of systemic antibiotic therapy and
that compliance with both antibiotics and appointments was important
bull Radiographic alveolar bone loss in the primary dentition of most LAP patients
suggest that this disease may indeed start in primary dentition and thus early
diagnosis in addition to this treatment approach are important tools to control
LAP disease
bull Shorter duration of the antibiotic regimen (7-day course rather than a 14 day-
course) to avoid possible side effects and antibiotic activity on possible new
biofilm re-formation after the first week which would have reduced its
effectiveness
(Harper and Robinson 1987 Quirynen et al 2005)
bull No patients presented an increase in the number of affected sites after
treatment at any time point (no progression)
bull Vast majority of patients actually showed gt50 reduction in the percentage of
sites with disease (~60 at 3 months then up to 100 at last follow up)
which shows the gradual improvement of the disease with time
bull Rabelo CC et al Systemic antibiotics in the treatment of aggressive
periodontitis A systematic review and a Bayesian Network meta-
analysis J Clin Periodontol 2015 Jul42(7)647-57 assessed the effect of
systemic antibiotic therapy on the treatment of aggressive periodontitis and concluded
that SRP plus systemic antibiotics led to an additional clinical effect compared with
SRP alone in the treatment of AgP Mtz and MtzAmx provided to the most beneficial
outcomes
bull Mombelli A et al Are There Specific Benefits of Amoxicillin Plus Metronidazole
in Aggregatibacter actinomycetemcomitans-Associated Periodontitis Double-
Masked Randomized Clinical Trial of Efficacy and Safety Journal of
Periodontology June 2013 Vol 84 No 6 Pages 715-724 evaluated 41 participants
who were positive for A actinomycetemcomitans and 41 participants who were negative
for A actinomycetemcomitans with full-mouth periodontal debridement performed within
48 hours after which they received either systemic antibiotics (375 mg amoxicillin and 500
mg metronidazole three times daily) or placebo for 7 days and found no specific benefit
from amoxicillin plus metronidazole on patients who were positive for A
actinomycetemcomitans Sites on molars benefited significantly more from the antibiotics
than non-molar sites
bull Cogen et al Destructive Periodontal Disease in Healthy Children Journal of Periodontology September 1992 Vol 63 No 9 Pages 761-765 conducted a retrospective cross-sectional study in which diagnosis of JP was based on age (le 15 years) negative medical history and radiographic evidence of arc-shaped alveolar bone loss
The study population was one-third white and two-thirds black and the malefemale ratio was 11 reflecting the general patient population
The prevalence among whites was 03 with a femalemale ratio 41
Among blacks the prevalence was 15 with a female male ratio 11
Among the black JP subjects with radiographs of the mixed dentition 857 presented evidence of bone loss and of those with radiographs of the deciduous
dentition 714 had discernible alveolar bone loss
CONCLUSION
bull Full mouth suprasubgingival debridement along with a one-time 7-day course of
amoxicillin and metronidazole and proper maintenance was effective in reducing
clinical parameters of affected sites in this population with LAP at 3 months post
treatment and were maintained for 4 years
bull The lsquogrossrsquo non-compliance with antibiotics and visits slightly and negatively affected
these results
bull Majority of patients diagnosed with LAP in the permanent dentition who were
analyzed retrospectively also presented radiographic bone loss in their primary
dentition which may suggest an early initiation for this disease
LIMITATIONS
bull The present study was not properly designed to evaluate the specific effects of
plaque control on LAP response to treatment
bull Lacks comparison with other treatment approaches and the evaluation of
antibiotic resistance which should be performed
o Does not evaluate effectiveness of this treatment regimen against SRP alone
o Previous studies on antibiotic resistance show that a one-course systemic antibiotic use adjunct to
mechanical debridement have resulted in transient bacterial resistance which decreased shortly
after cessation of antibiotic intake
(Feres et al 2002 Feres et al 1999 Fiehn and Westergaard 1990 Haffajee 2006)
EXPERIMENTAL DESIGN
Clinical Parameters
bull Visible plaque
bull Bleeding on Probing (BOP)
bull Probing pocket depth (PPD)
bull Clinical attachment loss
measurements
Clinical Examination
bull Measured 6 sites per tooth
bull Mesio-buccal
bull Buccal
bull Disto-buccal
bull Mesio-lingual
bull Lingual
bull Disto-lingual
TIME PERIOD
bull Baselinebull 36121824 monthsbull 2 annual visits
Armamentarium
UNC-15 probe
Florida Probe
PERIODONTAL
TREATMENT
SUPRASUBGINGIVAL FULL MOUTH DEBRIDEMENT WITH
ULTRASONIC SCALER
FOLLOW- UP
Amoxicillin 500mg
1-1-1x 7 days
Metronidazole 250 mg 21
1-1-1 x 7 days
LA
(Buchmann et al 2002 Kaner et al 2007 Moreira and Feres-Filho 2007)
BASELINE
SRP manually in deep pockets
21
bull Side effects noted
bull Inspection of medication
bottles
If pockets gt 4mm MDSRP
OHIElectric tooth brush
bull Elimination of Aabull Better clinical
response (Mombelli et al 2013)
bull Ptnts have hyper-inflammatory response to bact LPS
PATIENT COMPLIANCE
ANTIBIOTICS CLINICAL APPOINTMENTS
CLINICAL TREATMENT
RESPONSE
COMPLIANT Taken gt frac12 pills Completed all time points
Analysis of clinical parameters at all time points
NONCOMPLIANT Didnrsquot take at all or lt frac12 pills or not taken pill for gt 2 or more consecutive days
Missed 1 or more appointment
Missed analysis at any time points
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
Dental records of all patients diagnosed with
LAP in permanent dentitions at baseline
were examined for presence of bone loss in
bitewing radiographs from their primary
dentition
STATISTICAL ANALYSIS
bull Means of PD and CAL were calculated
bull Tests
Kruskal-Wallis test
Dunnrsquos multiple comparisons
Mann-Whitney test
Spearman correlations analysis
Multivariate analyses
bull Software SPSS amp GraphPad Prism 50
RESULTS
Baseline demographic amp clinical parameters of LAPincluded in the analysis
CLINICAL TREATMENT RESPONSE
GRAPHICAL REPRESENTATION OF PD AND CAL GAIN
About 50 to slightly above 60 sites
present with reduction in PD and
CAL at all time points
PATIENT COMPLIANCENo significant difference for clinical parameters
14 yr F clin
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
BASELINE
1 YR
A- 8yr old F WITH BOTH PRIMARY 1ST AND 2nd molar and healthy permanent dentition (B)
C - E 13 yr old HS of LAP
C - At 5 yrs Some bone loss
D - 1yr later Bone loss progressed to2nd primary molar
E ndash No bone loss in permanent dentition
F ndash G 15 yr F with LAP in permanent dentition
F- Primary at 5 yrs with severe bone loss around molars
G ndash Perm showing bone loss in mand 1st and 2nd molars
DISCUSSION
bull First long-term evaluation of clinical treatment response of a large LAP cohort
as well as associated factors that may contribute to such response
bull Vast majority of LAP patients were successfully treated with nonsurgical
mechanical debridement and a one course of systemic antibiotic therapy and
that compliance with both antibiotics and appointments was important
bull Radiographic alveolar bone loss in the primary dentition of most LAP patients
suggest that this disease may indeed start in primary dentition and thus early
diagnosis in addition to this treatment approach are important tools to control
LAP disease
bull Shorter duration of the antibiotic regimen (7-day course rather than a 14 day-
course) to avoid possible side effects and antibiotic activity on possible new
biofilm re-formation after the first week which would have reduced its
effectiveness
(Harper and Robinson 1987 Quirynen et al 2005)
bull No patients presented an increase in the number of affected sites after
treatment at any time point (no progression)
bull Vast majority of patients actually showed gt50 reduction in the percentage of
sites with disease (~60 at 3 months then up to 100 at last follow up)
which shows the gradual improvement of the disease with time
bull Rabelo CC et al Systemic antibiotics in the treatment of aggressive
periodontitis A systematic review and a Bayesian Network meta-
analysis J Clin Periodontol 2015 Jul42(7)647-57 assessed the effect of
systemic antibiotic therapy on the treatment of aggressive periodontitis and concluded
that SRP plus systemic antibiotics led to an additional clinical effect compared with
SRP alone in the treatment of AgP Mtz and MtzAmx provided to the most beneficial
outcomes
bull Mombelli A et al Are There Specific Benefits of Amoxicillin Plus Metronidazole
in Aggregatibacter actinomycetemcomitans-Associated Periodontitis Double-
Masked Randomized Clinical Trial of Efficacy and Safety Journal of
Periodontology June 2013 Vol 84 No 6 Pages 715-724 evaluated 41 participants
who were positive for A actinomycetemcomitans and 41 participants who were negative
for A actinomycetemcomitans with full-mouth periodontal debridement performed within
48 hours after which they received either systemic antibiotics (375 mg amoxicillin and 500
mg metronidazole three times daily) or placebo for 7 days and found no specific benefit
from amoxicillin plus metronidazole on patients who were positive for A
actinomycetemcomitans Sites on molars benefited significantly more from the antibiotics
than non-molar sites
bull Cogen et al Destructive Periodontal Disease in Healthy Children Journal of Periodontology September 1992 Vol 63 No 9 Pages 761-765 conducted a retrospective cross-sectional study in which diagnosis of JP was based on age (le 15 years) negative medical history and radiographic evidence of arc-shaped alveolar bone loss
The study population was one-third white and two-thirds black and the malefemale ratio was 11 reflecting the general patient population
The prevalence among whites was 03 with a femalemale ratio 41
Among blacks the prevalence was 15 with a female male ratio 11
Among the black JP subjects with radiographs of the mixed dentition 857 presented evidence of bone loss and of those with radiographs of the deciduous
dentition 714 had discernible alveolar bone loss
CONCLUSION
bull Full mouth suprasubgingival debridement along with a one-time 7-day course of
amoxicillin and metronidazole and proper maintenance was effective in reducing
clinical parameters of affected sites in this population with LAP at 3 months post
treatment and were maintained for 4 years
bull The lsquogrossrsquo non-compliance with antibiotics and visits slightly and negatively affected
these results
bull Majority of patients diagnosed with LAP in the permanent dentition who were
analyzed retrospectively also presented radiographic bone loss in their primary
dentition which may suggest an early initiation for this disease
LIMITATIONS
bull The present study was not properly designed to evaluate the specific effects of
plaque control on LAP response to treatment
bull Lacks comparison with other treatment approaches and the evaluation of
antibiotic resistance which should be performed
o Does not evaluate effectiveness of this treatment regimen against SRP alone
o Previous studies on antibiotic resistance show that a one-course systemic antibiotic use adjunct to
mechanical debridement have resulted in transient bacterial resistance which decreased shortly
after cessation of antibiotic intake
(Feres et al 2002 Feres et al 1999 Fiehn and Westergaard 1990 Haffajee 2006)
PERIODONTAL
TREATMENT
SUPRASUBGINGIVAL FULL MOUTH DEBRIDEMENT WITH
ULTRASONIC SCALER
FOLLOW- UP
Amoxicillin 500mg
1-1-1x 7 days
Metronidazole 250 mg 21
1-1-1 x 7 days
LA
(Buchmann et al 2002 Kaner et al 2007 Moreira and Feres-Filho 2007)
BASELINE
SRP manually in deep pockets
21
bull Side effects noted
bull Inspection of medication
bottles
If pockets gt 4mm MDSRP
OHIElectric tooth brush
bull Elimination of Aabull Better clinical
response (Mombelli et al 2013)
bull Ptnts have hyper-inflammatory response to bact LPS
PATIENT COMPLIANCE
ANTIBIOTICS CLINICAL APPOINTMENTS
CLINICAL TREATMENT
RESPONSE
COMPLIANT Taken gt frac12 pills Completed all time points
Analysis of clinical parameters at all time points
NONCOMPLIANT Didnrsquot take at all or lt frac12 pills or not taken pill for gt 2 or more consecutive days
Missed 1 or more appointment
Missed analysis at any time points
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
Dental records of all patients diagnosed with
LAP in permanent dentitions at baseline
were examined for presence of bone loss in
bitewing radiographs from their primary
dentition
STATISTICAL ANALYSIS
bull Means of PD and CAL were calculated
bull Tests
Kruskal-Wallis test
Dunnrsquos multiple comparisons
Mann-Whitney test
Spearman correlations analysis
Multivariate analyses
bull Software SPSS amp GraphPad Prism 50
RESULTS
Baseline demographic amp clinical parameters of LAPincluded in the analysis
CLINICAL TREATMENT RESPONSE
GRAPHICAL REPRESENTATION OF PD AND CAL GAIN
About 50 to slightly above 60 sites
present with reduction in PD and
CAL at all time points
PATIENT COMPLIANCENo significant difference for clinical parameters
14 yr F clin
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
BASELINE
1 YR
A- 8yr old F WITH BOTH PRIMARY 1ST AND 2nd molar and healthy permanent dentition (B)
C - E 13 yr old HS of LAP
C - At 5 yrs Some bone loss
D - 1yr later Bone loss progressed to2nd primary molar
E ndash No bone loss in permanent dentition
F ndash G 15 yr F with LAP in permanent dentition
F- Primary at 5 yrs with severe bone loss around molars
G ndash Perm showing bone loss in mand 1st and 2nd molars
DISCUSSION
bull First long-term evaluation of clinical treatment response of a large LAP cohort
as well as associated factors that may contribute to such response
bull Vast majority of LAP patients were successfully treated with nonsurgical
mechanical debridement and a one course of systemic antibiotic therapy and
that compliance with both antibiotics and appointments was important
bull Radiographic alveolar bone loss in the primary dentition of most LAP patients
suggest that this disease may indeed start in primary dentition and thus early
diagnosis in addition to this treatment approach are important tools to control
LAP disease
bull Shorter duration of the antibiotic regimen (7-day course rather than a 14 day-
course) to avoid possible side effects and antibiotic activity on possible new
biofilm re-formation after the first week which would have reduced its
effectiveness
(Harper and Robinson 1987 Quirynen et al 2005)
bull No patients presented an increase in the number of affected sites after
treatment at any time point (no progression)
bull Vast majority of patients actually showed gt50 reduction in the percentage of
sites with disease (~60 at 3 months then up to 100 at last follow up)
which shows the gradual improvement of the disease with time
bull Rabelo CC et al Systemic antibiotics in the treatment of aggressive
periodontitis A systematic review and a Bayesian Network meta-
analysis J Clin Periodontol 2015 Jul42(7)647-57 assessed the effect of
systemic antibiotic therapy on the treatment of aggressive periodontitis and concluded
that SRP plus systemic antibiotics led to an additional clinical effect compared with
SRP alone in the treatment of AgP Mtz and MtzAmx provided to the most beneficial
outcomes
bull Mombelli A et al Are There Specific Benefits of Amoxicillin Plus Metronidazole
in Aggregatibacter actinomycetemcomitans-Associated Periodontitis Double-
Masked Randomized Clinical Trial of Efficacy and Safety Journal of
Periodontology June 2013 Vol 84 No 6 Pages 715-724 evaluated 41 participants
who were positive for A actinomycetemcomitans and 41 participants who were negative
for A actinomycetemcomitans with full-mouth periodontal debridement performed within
48 hours after which they received either systemic antibiotics (375 mg amoxicillin and 500
mg metronidazole three times daily) or placebo for 7 days and found no specific benefit
from amoxicillin plus metronidazole on patients who were positive for A
actinomycetemcomitans Sites on molars benefited significantly more from the antibiotics
than non-molar sites
bull Cogen et al Destructive Periodontal Disease in Healthy Children Journal of Periodontology September 1992 Vol 63 No 9 Pages 761-765 conducted a retrospective cross-sectional study in which diagnosis of JP was based on age (le 15 years) negative medical history and radiographic evidence of arc-shaped alveolar bone loss
The study population was one-third white and two-thirds black and the malefemale ratio was 11 reflecting the general patient population
The prevalence among whites was 03 with a femalemale ratio 41
Among blacks the prevalence was 15 with a female male ratio 11
Among the black JP subjects with radiographs of the mixed dentition 857 presented evidence of bone loss and of those with radiographs of the deciduous
dentition 714 had discernible alveolar bone loss
CONCLUSION
bull Full mouth suprasubgingival debridement along with a one-time 7-day course of
amoxicillin and metronidazole and proper maintenance was effective in reducing
clinical parameters of affected sites in this population with LAP at 3 months post
treatment and were maintained for 4 years
bull The lsquogrossrsquo non-compliance with antibiotics and visits slightly and negatively affected
these results
bull Majority of patients diagnosed with LAP in the permanent dentition who were
analyzed retrospectively also presented radiographic bone loss in their primary
dentition which may suggest an early initiation for this disease
LIMITATIONS
bull The present study was not properly designed to evaluate the specific effects of
plaque control on LAP response to treatment
bull Lacks comparison with other treatment approaches and the evaluation of
antibiotic resistance which should be performed
o Does not evaluate effectiveness of this treatment regimen against SRP alone
o Previous studies on antibiotic resistance show that a one-course systemic antibiotic use adjunct to
mechanical debridement have resulted in transient bacterial resistance which decreased shortly
after cessation of antibiotic intake
(Feres et al 2002 Feres et al 1999 Fiehn and Westergaard 1990 Haffajee 2006)
PATIENT COMPLIANCE
ANTIBIOTICS CLINICAL APPOINTMENTS
CLINICAL TREATMENT
RESPONSE
COMPLIANT Taken gt frac12 pills Completed all time points
Analysis of clinical parameters at all time points
NONCOMPLIANT Didnrsquot take at all or lt frac12 pills or not taken pill for gt 2 or more consecutive days
Missed 1 or more appointment
Missed analysis at any time points
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
Dental records of all patients diagnosed with
LAP in permanent dentitions at baseline
were examined for presence of bone loss in
bitewing radiographs from their primary
dentition
STATISTICAL ANALYSIS
bull Means of PD and CAL were calculated
bull Tests
Kruskal-Wallis test
Dunnrsquos multiple comparisons
Mann-Whitney test
Spearman correlations analysis
Multivariate analyses
bull Software SPSS amp GraphPad Prism 50
RESULTS
Baseline demographic amp clinical parameters of LAPincluded in the analysis
CLINICAL TREATMENT RESPONSE
GRAPHICAL REPRESENTATION OF PD AND CAL GAIN
About 50 to slightly above 60 sites
present with reduction in PD and
CAL at all time points
PATIENT COMPLIANCENo significant difference for clinical parameters
14 yr F clin
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
BASELINE
1 YR
A- 8yr old F WITH BOTH PRIMARY 1ST AND 2nd molar and healthy permanent dentition (B)
C - E 13 yr old HS of LAP
C - At 5 yrs Some bone loss
D - 1yr later Bone loss progressed to2nd primary molar
E ndash No bone loss in permanent dentition
F ndash G 15 yr F with LAP in permanent dentition
F- Primary at 5 yrs with severe bone loss around molars
G ndash Perm showing bone loss in mand 1st and 2nd molars
DISCUSSION
bull First long-term evaluation of clinical treatment response of a large LAP cohort
as well as associated factors that may contribute to such response
bull Vast majority of LAP patients were successfully treated with nonsurgical
mechanical debridement and a one course of systemic antibiotic therapy and
that compliance with both antibiotics and appointments was important
bull Radiographic alveolar bone loss in the primary dentition of most LAP patients
suggest that this disease may indeed start in primary dentition and thus early
diagnosis in addition to this treatment approach are important tools to control
LAP disease
bull Shorter duration of the antibiotic regimen (7-day course rather than a 14 day-
course) to avoid possible side effects and antibiotic activity on possible new
biofilm re-formation after the first week which would have reduced its
effectiveness
(Harper and Robinson 1987 Quirynen et al 2005)
bull No patients presented an increase in the number of affected sites after
treatment at any time point (no progression)
bull Vast majority of patients actually showed gt50 reduction in the percentage of
sites with disease (~60 at 3 months then up to 100 at last follow up)
which shows the gradual improvement of the disease with time
bull Rabelo CC et al Systemic antibiotics in the treatment of aggressive
periodontitis A systematic review and a Bayesian Network meta-
analysis J Clin Periodontol 2015 Jul42(7)647-57 assessed the effect of
systemic antibiotic therapy on the treatment of aggressive periodontitis and concluded
that SRP plus systemic antibiotics led to an additional clinical effect compared with
SRP alone in the treatment of AgP Mtz and MtzAmx provided to the most beneficial
outcomes
bull Mombelli A et al Are There Specific Benefits of Amoxicillin Plus Metronidazole
in Aggregatibacter actinomycetemcomitans-Associated Periodontitis Double-
Masked Randomized Clinical Trial of Efficacy and Safety Journal of
Periodontology June 2013 Vol 84 No 6 Pages 715-724 evaluated 41 participants
who were positive for A actinomycetemcomitans and 41 participants who were negative
for A actinomycetemcomitans with full-mouth periodontal debridement performed within
48 hours after which they received either systemic antibiotics (375 mg amoxicillin and 500
mg metronidazole three times daily) or placebo for 7 days and found no specific benefit
from amoxicillin plus metronidazole on patients who were positive for A
actinomycetemcomitans Sites on molars benefited significantly more from the antibiotics
than non-molar sites
bull Cogen et al Destructive Periodontal Disease in Healthy Children Journal of Periodontology September 1992 Vol 63 No 9 Pages 761-765 conducted a retrospective cross-sectional study in which diagnosis of JP was based on age (le 15 years) negative medical history and radiographic evidence of arc-shaped alveolar bone loss
The study population was one-third white and two-thirds black and the malefemale ratio was 11 reflecting the general patient population
The prevalence among whites was 03 with a femalemale ratio 41
Among blacks the prevalence was 15 with a female male ratio 11
Among the black JP subjects with radiographs of the mixed dentition 857 presented evidence of bone loss and of those with radiographs of the deciduous
dentition 714 had discernible alveolar bone loss
CONCLUSION
bull Full mouth suprasubgingival debridement along with a one-time 7-day course of
amoxicillin and metronidazole and proper maintenance was effective in reducing
clinical parameters of affected sites in this population with LAP at 3 months post
treatment and were maintained for 4 years
bull The lsquogrossrsquo non-compliance with antibiotics and visits slightly and negatively affected
these results
bull Majority of patients diagnosed with LAP in the permanent dentition who were
analyzed retrospectively also presented radiographic bone loss in their primary
dentition which may suggest an early initiation for this disease
LIMITATIONS
bull The present study was not properly designed to evaluate the specific effects of
plaque control on LAP response to treatment
bull Lacks comparison with other treatment approaches and the evaluation of
antibiotic resistance which should be performed
o Does not evaluate effectiveness of this treatment regimen against SRP alone
o Previous studies on antibiotic resistance show that a one-course systemic antibiotic use adjunct to
mechanical debridement have resulted in transient bacterial resistance which decreased shortly
after cessation of antibiotic intake
(Feres et al 2002 Feres et al 1999 Fiehn and Westergaard 1990 Haffajee 2006)
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
Dental records of all patients diagnosed with
LAP in permanent dentitions at baseline
were examined for presence of bone loss in
bitewing radiographs from their primary
dentition
STATISTICAL ANALYSIS
bull Means of PD and CAL were calculated
bull Tests
Kruskal-Wallis test
Dunnrsquos multiple comparisons
Mann-Whitney test
Spearman correlations analysis
Multivariate analyses
bull Software SPSS amp GraphPad Prism 50
RESULTS
Baseline demographic amp clinical parameters of LAPincluded in the analysis
CLINICAL TREATMENT RESPONSE
GRAPHICAL REPRESENTATION OF PD AND CAL GAIN
About 50 to slightly above 60 sites
present with reduction in PD and
CAL at all time points
PATIENT COMPLIANCENo significant difference for clinical parameters
14 yr F clin
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
BASELINE
1 YR
A- 8yr old F WITH BOTH PRIMARY 1ST AND 2nd molar and healthy permanent dentition (B)
C - E 13 yr old HS of LAP
C - At 5 yrs Some bone loss
D - 1yr later Bone loss progressed to2nd primary molar
E ndash No bone loss in permanent dentition
F ndash G 15 yr F with LAP in permanent dentition
F- Primary at 5 yrs with severe bone loss around molars
G ndash Perm showing bone loss in mand 1st and 2nd molars
DISCUSSION
bull First long-term evaluation of clinical treatment response of a large LAP cohort
as well as associated factors that may contribute to such response
bull Vast majority of LAP patients were successfully treated with nonsurgical
mechanical debridement and a one course of systemic antibiotic therapy and
that compliance with both antibiotics and appointments was important
bull Radiographic alveolar bone loss in the primary dentition of most LAP patients
suggest that this disease may indeed start in primary dentition and thus early
diagnosis in addition to this treatment approach are important tools to control
LAP disease
bull Shorter duration of the antibiotic regimen (7-day course rather than a 14 day-
course) to avoid possible side effects and antibiotic activity on possible new
biofilm re-formation after the first week which would have reduced its
effectiveness
(Harper and Robinson 1987 Quirynen et al 2005)
bull No patients presented an increase in the number of affected sites after
treatment at any time point (no progression)
bull Vast majority of patients actually showed gt50 reduction in the percentage of
sites with disease (~60 at 3 months then up to 100 at last follow up)
which shows the gradual improvement of the disease with time
bull Rabelo CC et al Systemic antibiotics in the treatment of aggressive
periodontitis A systematic review and a Bayesian Network meta-
analysis J Clin Periodontol 2015 Jul42(7)647-57 assessed the effect of
systemic antibiotic therapy on the treatment of aggressive periodontitis and concluded
that SRP plus systemic antibiotics led to an additional clinical effect compared with
SRP alone in the treatment of AgP Mtz and MtzAmx provided to the most beneficial
outcomes
bull Mombelli A et al Are There Specific Benefits of Amoxicillin Plus Metronidazole
in Aggregatibacter actinomycetemcomitans-Associated Periodontitis Double-
Masked Randomized Clinical Trial of Efficacy and Safety Journal of
Periodontology June 2013 Vol 84 No 6 Pages 715-724 evaluated 41 participants
who were positive for A actinomycetemcomitans and 41 participants who were negative
for A actinomycetemcomitans with full-mouth periodontal debridement performed within
48 hours after which they received either systemic antibiotics (375 mg amoxicillin and 500
mg metronidazole three times daily) or placebo for 7 days and found no specific benefit
from amoxicillin plus metronidazole on patients who were positive for A
actinomycetemcomitans Sites on molars benefited significantly more from the antibiotics
than non-molar sites
bull Cogen et al Destructive Periodontal Disease in Healthy Children Journal of Periodontology September 1992 Vol 63 No 9 Pages 761-765 conducted a retrospective cross-sectional study in which diagnosis of JP was based on age (le 15 years) negative medical history and radiographic evidence of arc-shaped alveolar bone loss
The study population was one-third white and two-thirds black and the malefemale ratio was 11 reflecting the general patient population
The prevalence among whites was 03 with a femalemale ratio 41
Among blacks the prevalence was 15 with a female male ratio 11
Among the black JP subjects with radiographs of the mixed dentition 857 presented evidence of bone loss and of those with radiographs of the deciduous
dentition 714 had discernible alveolar bone loss
CONCLUSION
bull Full mouth suprasubgingival debridement along with a one-time 7-day course of
amoxicillin and metronidazole and proper maintenance was effective in reducing
clinical parameters of affected sites in this population with LAP at 3 months post
treatment and were maintained for 4 years
bull The lsquogrossrsquo non-compliance with antibiotics and visits slightly and negatively affected
these results
bull Majority of patients diagnosed with LAP in the permanent dentition who were
analyzed retrospectively also presented radiographic bone loss in their primary
dentition which may suggest an early initiation for this disease
LIMITATIONS
bull The present study was not properly designed to evaluate the specific effects of
plaque control on LAP response to treatment
bull Lacks comparison with other treatment approaches and the evaluation of
antibiotic resistance which should be performed
o Does not evaluate effectiveness of this treatment regimen against SRP alone
o Previous studies on antibiotic resistance show that a one-course systemic antibiotic use adjunct to
mechanical debridement have resulted in transient bacterial resistance which decreased shortly
after cessation of antibiotic intake
(Feres et al 2002 Feres et al 1999 Fiehn and Westergaard 1990 Haffajee 2006)
RESULTS
Baseline demographic amp clinical parameters of LAPincluded in the analysis
CLINICAL TREATMENT RESPONSE
GRAPHICAL REPRESENTATION OF PD AND CAL GAIN
About 50 to slightly above 60 sites
present with reduction in PD and
CAL at all time points
PATIENT COMPLIANCENo significant difference for clinical parameters
14 yr F clin
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
BASELINE
1 YR
A- 8yr old F WITH BOTH PRIMARY 1ST AND 2nd molar and healthy permanent dentition (B)
C - E 13 yr old HS of LAP
C - At 5 yrs Some bone loss
D - 1yr later Bone loss progressed to2nd primary molar
E ndash No bone loss in permanent dentition
F ndash G 15 yr F with LAP in permanent dentition
F- Primary at 5 yrs with severe bone loss around molars
G ndash Perm showing bone loss in mand 1st and 2nd molars
DISCUSSION
bull First long-term evaluation of clinical treatment response of a large LAP cohort
as well as associated factors that may contribute to such response
bull Vast majority of LAP patients were successfully treated with nonsurgical
mechanical debridement and a one course of systemic antibiotic therapy and
that compliance with both antibiotics and appointments was important
bull Radiographic alveolar bone loss in the primary dentition of most LAP patients
suggest that this disease may indeed start in primary dentition and thus early
diagnosis in addition to this treatment approach are important tools to control
LAP disease
bull Shorter duration of the antibiotic regimen (7-day course rather than a 14 day-
course) to avoid possible side effects and antibiotic activity on possible new
biofilm re-formation after the first week which would have reduced its
effectiveness
(Harper and Robinson 1987 Quirynen et al 2005)
bull No patients presented an increase in the number of affected sites after
treatment at any time point (no progression)
bull Vast majority of patients actually showed gt50 reduction in the percentage of
sites with disease (~60 at 3 months then up to 100 at last follow up)
which shows the gradual improvement of the disease with time
bull Rabelo CC et al Systemic antibiotics in the treatment of aggressive
periodontitis A systematic review and a Bayesian Network meta-
analysis J Clin Periodontol 2015 Jul42(7)647-57 assessed the effect of
systemic antibiotic therapy on the treatment of aggressive periodontitis and concluded
that SRP plus systemic antibiotics led to an additional clinical effect compared with
SRP alone in the treatment of AgP Mtz and MtzAmx provided to the most beneficial
outcomes
bull Mombelli A et al Are There Specific Benefits of Amoxicillin Plus Metronidazole
in Aggregatibacter actinomycetemcomitans-Associated Periodontitis Double-
Masked Randomized Clinical Trial of Efficacy and Safety Journal of
Periodontology June 2013 Vol 84 No 6 Pages 715-724 evaluated 41 participants
who were positive for A actinomycetemcomitans and 41 participants who were negative
for A actinomycetemcomitans with full-mouth periodontal debridement performed within
48 hours after which they received either systemic antibiotics (375 mg amoxicillin and 500
mg metronidazole three times daily) or placebo for 7 days and found no specific benefit
from amoxicillin plus metronidazole on patients who were positive for A
actinomycetemcomitans Sites on molars benefited significantly more from the antibiotics
than non-molar sites
bull Cogen et al Destructive Periodontal Disease in Healthy Children Journal of Periodontology September 1992 Vol 63 No 9 Pages 761-765 conducted a retrospective cross-sectional study in which diagnosis of JP was based on age (le 15 years) negative medical history and radiographic evidence of arc-shaped alveolar bone loss
The study population was one-third white and two-thirds black and the malefemale ratio was 11 reflecting the general patient population
The prevalence among whites was 03 with a femalemale ratio 41
Among blacks the prevalence was 15 with a female male ratio 11
Among the black JP subjects with radiographs of the mixed dentition 857 presented evidence of bone loss and of those with radiographs of the deciduous
dentition 714 had discernible alveolar bone loss
CONCLUSION
bull Full mouth suprasubgingival debridement along with a one-time 7-day course of
amoxicillin and metronidazole and proper maintenance was effective in reducing
clinical parameters of affected sites in this population with LAP at 3 months post
treatment and were maintained for 4 years
bull The lsquogrossrsquo non-compliance with antibiotics and visits slightly and negatively affected
these results
bull Majority of patients diagnosed with LAP in the permanent dentition who were
analyzed retrospectively also presented radiographic bone loss in their primary
dentition which may suggest an early initiation for this disease
LIMITATIONS
bull The present study was not properly designed to evaluate the specific effects of
plaque control on LAP response to treatment
bull Lacks comparison with other treatment approaches and the evaluation of
antibiotic resistance which should be performed
o Does not evaluate effectiveness of this treatment regimen against SRP alone
o Previous studies on antibiotic resistance show that a one-course systemic antibiotic use adjunct to
mechanical debridement have resulted in transient bacterial resistance which decreased shortly
after cessation of antibiotic intake
(Feres et al 2002 Feres et al 1999 Fiehn and Westergaard 1990 Haffajee 2006)
CLINICAL TREATMENT RESPONSE
GRAPHICAL REPRESENTATION OF PD AND CAL GAIN
About 50 to slightly above 60 sites
present with reduction in PD and
CAL at all time points
PATIENT COMPLIANCENo significant difference for clinical parameters
14 yr F clin
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
BASELINE
1 YR
A- 8yr old F WITH BOTH PRIMARY 1ST AND 2nd molar and healthy permanent dentition (B)
C - E 13 yr old HS of LAP
C - At 5 yrs Some bone loss
D - 1yr later Bone loss progressed to2nd primary molar
E ndash No bone loss in permanent dentition
F ndash G 15 yr F with LAP in permanent dentition
F- Primary at 5 yrs with severe bone loss around molars
G ndash Perm showing bone loss in mand 1st and 2nd molars
DISCUSSION
bull First long-term evaluation of clinical treatment response of a large LAP cohort
as well as associated factors that may contribute to such response
bull Vast majority of LAP patients were successfully treated with nonsurgical
mechanical debridement and a one course of systemic antibiotic therapy and
that compliance with both antibiotics and appointments was important
bull Radiographic alveolar bone loss in the primary dentition of most LAP patients
suggest that this disease may indeed start in primary dentition and thus early
diagnosis in addition to this treatment approach are important tools to control
LAP disease
bull Shorter duration of the antibiotic regimen (7-day course rather than a 14 day-
course) to avoid possible side effects and antibiotic activity on possible new
biofilm re-formation after the first week which would have reduced its
effectiveness
(Harper and Robinson 1987 Quirynen et al 2005)
bull No patients presented an increase in the number of affected sites after
treatment at any time point (no progression)
bull Vast majority of patients actually showed gt50 reduction in the percentage of
sites with disease (~60 at 3 months then up to 100 at last follow up)
which shows the gradual improvement of the disease with time
bull Rabelo CC et al Systemic antibiotics in the treatment of aggressive
periodontitis A systematic review and a Bayesian Network meta-
analysis J Clin Periodontol 2015 Jul42(7)647-57 assessed the effect of
systemic antibiotic therapy on the treatment of aggressive periodontitis and concluded
that SRP plus systemic antibiotics led to an additional clinical effect compared with
SRP alone in the treatment of AgP Mtz and MtzAmx provided to the most beneficial
outcomes
bull Mombelli A et al Are There Specific Benefits of Amoxicillin Plus Metronidazole
in Aggregatibacter actinomycetemcomitans-Associated Periodontitis Double-
Masked Randomized Clinical Trial of Efficacy and Safety Journal of
Periodontology June 2013 Vol 84 No 6 Pages 715-724 evaluated 41 participants
who were positive for A actinomycetemcomitans and 41 participants who were negative
for A actinomycetemcomitans with full-mouth periodontal debridement performed within
48 hours after which they received either systemic antibiotics (375 mg amoxicillin and 500
mg metronidazole three times daily) or placebo for 7 days and found no specific benefit
from amoxicillin plus metronidazole on patients who were positive for A
actinomycetemcomitans Sites on molars benefited significantly more from the antibiotics
than non-molar sites
bull Cogen et al Destructive Periodontal Disease in Healthy Children Journal of Periodontology September 1992 Vol 63 No 9 Pages 761-765 conducted a retrospective cross-sectional study in which diagnosis of JP was based on age (le 15 years) negative medical history and radiographic evidence of arc-shaped alveolar bone loss
The study population was one-third white and two-thirds black and the malefemale ratio was 11 reflecting the general patient population
The prevalence among whites was 03 with a femalemale ratio 41
Among blacks the prevalence was 15 with a female male ratio 11
Among the black JP subjects with radiographs of the mixed dentition 857 presented evidence of bone loss and of those with radiographs of the deciduous
dentition 714 had discernible alveolar bone loss
CONCLUSION
bull Full mouth suprasubgingival debridement along with a one-time 7-day course of
amoxicillin and metronidazole and proper maintenance was effective in reducing
clinical parameters of affected sites in this population with LAP at 3 months post
treatment and were maintained for 4 years
bull The lsquogrossrsquo non-compliance with antibiotics and visits slightly and negatively affected
these results
bull Majority of patients diagnosed with LAP in the permanent dentition who were
analyzed retrospectively also presented radiographic bone loss in their primary
dentition which may suggest an early initiation for this disease
LIMITATIONS
bull The present study was not properly designed to evaluate the specific effects of
plaque control on LAP response to treatment
bull Lacks comparison with other treatment approaches and the evaluation of
antibiotic resistance which should be performed
o Does not evaluate effectiveness of this treatment regimen against SRP alone
o Previous studies on antibiotic resistance show that a one-course systemic antibiotic use adjunct to
mechanical debridement have resulted in transient bacterial resistance which decreased shortly
after cessation of antibiotic intake
(Feres et al 2002 Feres et al 1999 Fiehn and Westergaard 1990 Haffajee 2006)
GRAPHICAL REPRESENTATION OF PD AND CAL GAIN
About 50 to slightly above 60 sites
present with reduction in PD and
CAL at all time points
PATIENT COMPLIANCENo significant difference for clinical parameters
14 yr F clin
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
BASELINE
1 YR
A- 8yr old F WITH BOTH PRIMARY 1ST AND 2nd molar and healthy permanent dentition (B)
C - E 13 yr old HS of LAP
C - At 5 yrs Some bone loss
D - 1yr later Bone loss progressed to2nd primary molar
E ndash No bone loss in permanent dentition
F ndash G 15 yr F with LAP in permanent dentition
F- Primary at 5 yrs with severe bone loss around molars
G ndash Perm showing bone loss in mand 1st and 2nd molars
DISCUSSION
bull First long-term evaluation of clinical treatment response of a large LAP cohort
as well as associated factors that may contribute to such response
bull Vast majority of LAP patients were successfully treated with nonsurgical
mechanical debridement and a one course of systemic antibiotic therapy and
that compliance with both antibiotics and appointments was important
bull Radiographic alveolar bone loss in the primary dentition of most LAP patients
suggest that this disease may indeed start in primary dentition and thus early
diagnosis in addition to this treatment approach are important tools to control
LAP disease
bull Shorter duration of the antibiotic regimen (7-day course rather than a 14 day-
course) to avoid possible side effects and antibiotic activity on possible new
biofilm re-formation after the first week which would have reduced its
effectiveness
(Harper and Robinson 1987 Quirynen et al 2005)
bull No patients presented an increase in the number of affected sites after
treatment at any time point (no progression)
bull Vast majority of patients actually showed gt50 reduction in the percentage of
sites with disease (~60 at 3 months then up to 100 at last follow up)
which shows the gradual improvement of the disease with time
bull Rabelo CC et al Systemic antibiotics in the treatment of aggressive
periodontitis A systematic review and a Bayesian Network meta-
analysis J Clin Periodontol 2015 Jul42(7)647-57 assessed the effect of
systemic antibiotic therapy on the treatment of aggressive periodontitis and concluded
that SRP plus systemic antibiotics led to an additional clinical effect compared with
SRP alone in the treatment of AgP Mtz and MtzAmx provided to the most beneficial
outcomes
bull Mombelli A et al Are There Specific Benefits of Amoxicillin Plus Metronidazole
in Aggregatibacter actinomycetemcomitans-Associated Periodontitis Double-
Masked Randomized Clinical Trial of Efficacy and Safety Journal of
Periodontology June 2013 Vol 84 No 6 Pages 715-724 evaluated 41 participants
who were positive for A actinomycetemcomitans and 41 participants who were negative
for A actinomycetemcomitans with full-mouth periodontal debridement performed within
48 hours after which they received either systemic antibiotics (375 mg amoxicillin and 500
mg metronidazole three times daily) or placebo for 7 days and found no specific benefit
from amoxicillin plus metronidazole on patients who were positive for A
actinomycetemcomitans Sites on molars benefited significantly more from the antibiotics
than non-molar sites
bull Cogen et al Destructive Periodontal Disease in Healthy Children Journal of Periodontology September 1992 Vol 63 No 9 Pages 761-765 conducted a retrospective cross-sectional study in which diagnosis of JP was based on age (le 15 years) negative medical history and radiographic evidence of arc-shaped alveolar bone loss
The study population was one-third white and two-thirds black and the malefemale ratio was 11 reflecting the general patient population
The prevalence among whites was 03 with a femalemale ratio 41
Among blacks the prevalence was 15 with a female male ratio 11
Among the black JP subjects with radiographs of the mixed dentition 857 presented evidence of bone loss and of those with radiographs of the deciduous
dentition 714 had discernible alveolar bone loss
CONCLUSION
bull Full mouth suprasubgingival debridement along with a one-time 7-day course of
amoxicillin and metronidazole and proper maintenance was effective in reducing
clinical parameters of affected sites in this population with LAP at 3 months post
treatment and were maintained for 4 years
bull The lsquogrossrsquo non-compliance with antibiotics and visits slightly and negatively affected
these results
bull Majority of patients diagnosed with LAP in the permanent dentition who were
analyzed retrospectively also presented radiographic bone loss in their primary
dentition which may suggest an early initiation for this disease
LIMITATIONS
bull The present study was not properly designed to evaluate the specific effects of
plaque control on LAP response to treatment
bull Lacks comparison with other treatment approaches and the evaluation of
antibiotic resistance which should be performed
o Does not evaluate effectiveness of this treatment regimen against SRP alone
o Previous studies on antibiotic resistance show that a one-course systemic antibiotic use adjunct to
mechanical debridement have resulted in transient bacterial resistance which decreased shortly
after cessation of antibiotic intake
(Feres et al 2002 Feres et al 1999 Fiehn and Westergaard 1990 Haffajee 2006)
PATIENT COMPLIANCENo significant difference for clinical parameters
14 yr F clin
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
BASELINE
1 YR
A- 8yr old F WITH BOTH PRIMARY 1ST AND 2nd molar and healthy permanent dentition (B)
C - E 13 yr old HS of LAP
C - At 5 yrs Some bone loss
D - 1yr later Bone loss progressed to2nd primary molar
E ndash No bone loss in permanent dentition
F ndash G 15 yr F with LAP in permanent dentition
F- Primary at 5 yrs with severe bone loss around molars
G ndash Perm showing bone loss in mand 1st and 2nd molars
DISCUSSION
bull First long-term evaluation of clinical treatment response of a large LAP cohort
as well as associated factors that may contribute to such response
bull Vast majority of LAP patients were successfully treated with nonsurgical
mechanical debridement and a one course of systemic antibiotic therapy and
that compliance with both antibiotics and appointments was important
bull Radiographic alveolar bone loss in the primary dentition of most LAP patients
suggest that this disease may indeed start in primary dentition and thus early
diagnosis in addition to this treatment approach are important tools to control
LAP disease
bull Shorter duration of the antibiotic regimen (7-day course rather than a 14 day-
course) to avoid possible side effects and antibiotic activity on possible new
biofilm re-formation after the first week which would have reduced its
effectiveness
(Harper and Robinson 1987 Quirynen et al 2005)
bull No patients presented an increase in the number of affected sites after
treatment at any time point (no progression)
bull Vast majority of patients actually showed gt50 reduction in the percentage of
sites with disease (~60 at 3 months then up to 100 at last follow up)
which shows the gradual improvement of the disease with time
bull Rabelo CC et al Systemic antibiotics in the treatment of aggressive
periodontitis A systematic review and a Bayesian Network meta-
analysis J Clin Periodontol 2015 Jul42(7)647-57 assessed the effect of
systemic antibiotic therapy on the treatment of aggressive periodontitis and concluded
that SRP plus systemic antibiotics led to an additional clinical effect compared with
SRP alone in the treatment of AgP Mtz and MtzAmx provided to the most beneficial
outcomes
bull Mombelli A et al Are There Specific Benefits of Amoxicillin Plus Metronidazole
in Aggregatibacter actinomycetemcomitans-Associated Periodontitis Double-
Masked Randomized Clinical Trial of Efficacy and Safety Journal of
Periodontology June 2013 Vol 84 No 6 Pages 715-724 evaluated 41 participants
who were positive for A actinomycetemcomitans and 41 participants who were negative
for A actinomycetemcomitans with full-mouth periodontal debridement performed within
48 hours after which they received either systemic antibiotics (375 mg amoxicillin and 500
mg metronidazole three times daily) or placebo for 7 days and found no specific benefit
from amoxicillin plus metronidazole on patients who were positive for A
actinomycetemcomitans Sites on molars benefited significantly more from the antibiotics
than non-molar sites
bull Cogen et al Destructive Periodontal Disease in Healthy Children Journal of Periodontology September 1992 Vol 63 No 9 Pages 761-765 conducted a retrospective cross-sectional study in which diagnosis of JP was based on age (le 15 years) negative medical history and radiographic evidence of arc-shaped alveolar bone loss
The study population was one-third white and two-thirds black and the malefemale ratio was 11 reflecting the general patient population
The prevalence among whites was 03 with a femalemale ratio 41
Among blacks the prevalence was 15 with a female male ratio 11
Among the black JP subjects with radiographs of the mixed dentition 857 presented evidence of bone loss and of those with radiographs of the deciduous
dentition 714 had discernible alveolar bone loss
CONCLUSION
bull Full mouth suprasubgingival debridement along with a one-time 7-day course of
amoxicillin and metronidazole and proper maintenance was effective in reducing
clinical parameters of affected sites in this population with LAP at 3 months post
treatment and were maintained for 4 years
bull The lsquogrossrsquo non-compliance with antibiotics and visits slightly and negatively affected
these results
bull Majority of patients diagnosed with LAP in the permanent dentition who were
analyzed retrospectively also presented radiographic bone loss in their primary
dentition which may suggest an early initiation for this disease
LIMITATIONS
bull The present study was not properly designed to evaluate the specific effects of
plaque control on LAP response to treatment
bull Lacks comparison with other treatment approaches and the evaluation of
antibiotic resistance which should be performed
o Does not evaluate effectiveness of this treatment regimen against SRP alone
o Previous studies on antibiotic resistance show that a one-course systemic antibiotic use adjunct to
mechanical debridement have resulted in transient bacterial resistance which decreased shortly
after cessation of antibiotic intake
(Feres et al 2002 Feres et al 1999 Fiehn and Westergaard 1990 Haffajee 2006)
RETROSPECTIVE RADIOGRAPHIC ANALYSIS
BASELINE
1 YR
A- 8yr old F WITH BOTH PRIMARY 1ST AND 2nd molar and healthy permanent dentition (B)
C - E 13 yr old HS of LAP
C - At 5 yrs Some bone loss
D - 1yr later Bone loss progressed to2nd primary molar
E ndash No bone loss in permanent dentition
F ndash G 15 yr F with LAP in permanent dentition
F- Primary at 5 yrs with severe bone loss around molars
G ndash Perm showing bone loss in mand 1st and 2nd molars
DISCUSSION
bull First long-term evaluation of clinical treatment response of a large LAP cohort
as well as associated factors that may contribute to such response
bull Vast majority of LAP patients were successfully treated with nonsurgical
mechanical debridement and a one course of systemic antibiotic therapy and
that compliance with both antibiotics and appointments was important
bull Radiographic alveolar bone loss in the primary dentition of most LAP patients
suggest that this disease may indeed start in primary dentition and thus early
diagnosis in addition to this treatment approach are important tools to control
LAP disease
bull Shorter duration of the antibiotic regimen (7-day course rather than a 14 day-
course) to avoid possible side effects and antibiotic activity on possible new
biofilm re-formation after the first week which would have reduced its
effectiveness
(Harper and Robinson 1987 Quirynen et al 2005)
bull No patients presented an increase in the number of affected sites after
treatment at any time point (no progression)
bull Vast majority of patients actually showed gt50 reduction in the percentage of
sites with disease (~60 at 3 months then up to 100 at last follow up)
which shows the gradual improvement of the disease with time
bull Rabelo CC et al Systemic antibiotics in the treatment of aggressive
periodontitis A systematic review and a Bayesian Network meta-
analysis J Clin Periodontol 2015 Jul42(7)647-57 assessed the effect of
systemic antibiotic therapy on the treatment of aggressive periodontitis and concluded
that SRP plus systemic antibiotics led to an additional clinical effect compared with
SRP alone in the treatment of AgP Mtz and MtzAmx provided to the most beneficial
outcomes
bull Mombelli A et al Are There Specific Benefits of Amoxicillin Plus Metronidazole
in Aggregatibacter actinomycetemcomitans-Associated Periodontitis Double-
Masked Randomized Clinical Trial of Efficacy and Safety Journal of
Periodontology June 2013 Vol 84 No 6 Pages 715-724 evaluated 41 participants
who were positive for A actinomycetemcomitans and 41 participants who were negative
for A actinomycetemcomitans with full-mouth periodontal debridement performed within
48 hours after which they received either systemic antibiotics (375 mg amoxicillin and 500
mg metronidazole three times daily) or placebo for 7 days and found no specific benefit
from amoxicillin plus metronidazole on patients who were positive for A
actinomycetemcomitans Sites on molars benefited significantly more from the antibiotics
than non-molar sites
bull Cogen et al Destructive Periodontal Disease in Healthy Children Journal of Periodontology September 1992 Vol 63 No 9 Pages 761-765 conducted a retrospective cross-sectional study in which diagnosis of JP was based on age (le 15 years) negative medical history and radiographic evidence of arc-shaped alveolar bone loss
The study population was one-third white and two-thirds black and the malefemale ratio was 11 reflecting the general patient population
The prevalence among whites was 03 with a femalemale ratio 41
Among blacks the prevalence was 15 with a female male ratio 11
Among the black JP subjects with radiographs of the mixed dentition 857 presented evidence of bone loss and of those with radiographs of the deciduous
dentition 714 had discernible alveolar bone loss
CONCLUSION
bull Full mouth suprasubgingival debridement along with a one-time 7-day course of
amoxicillin and metronidazole and proper maintenance was effective in reducing
clinical parameters of affected sites in this population with LAP at 3 months post
treatment and were maintained for 4 years
bull The lsquogrossrsquo non-compliance with antibiotics and visits slightly and negatively affected
these results
bull Majority of patients diagnosed with LAP in the permanent dentition who were
analyzed retrospectively also presented radiographic bone loss in their primary
dentition which may suggest an early initiation for this disease
LIMITATIONS
bull The present study was not properly designed to evaluate the specific effects of
plaque control on LAP response to treatment
bull Lacks comparison with other treatment approaches and the evaluation of
antibiotic resistance which should be performed
o Does not evaluate effectiveness of this treatment regimen against SRP alone
o Previous studies on antibiotic resistance show that a one-course systemic antibiotic use adjunct to
mechanical debridement have resulted in transient bacterial resistance which decreased shortly
after cessation of antibiotic intake
(Feres et al 2002 Feres et al 1999 Fiehn and Westergaard 1990 Haffajee 2006)
A- 8yr old F WITH BOTH PRIMARY 1ST AND 2nd molar and healthy permanent dentition (B)
C - E 13 yr old HS of LAP
C - At 5 yrs Some bone loss
D - 1yr later Bone loss progressed to2nd primary molar
E ndash No bone loss in permanent dentition
F ndash G 15 yr F with LAP in permanent dentition
F- Primary at 5 yrs with severe bone loss around molars
G ndash Perm showing bone loss in mand 1st and 2nd molars
DISCUSSION
bull First long-term evaluation of clinical treatment response of a large LAP cohort
as well as associated factors that may contribute to such response
bull Vast majority of LAP patients were successfully treated with nonsurgical
mechanical debridement and a one course of systemic antibiotic therapy and
that compliance with both antibiotics and appointments was important
bull Radiographic alveolar bone loss in the primary dentition of most LAP patients
suggest that this disease may indeed start in primary dentition and thus early
diagnosis in addition to this treatment approach are important tools to control
LAP disease
bull Shorter duration of the antibiotic regimen (7-day course rather than a 14 day-
course) to avoid possible side effects and antibiotic activity on possible new
biofilm re-formation after the first week which would have reduced its
effectiveness
(Harper and Robinson 1987 Quirynen et al 2005)
bull No patients presented an increase in the number of affected sites after
treatment at any time point (no progression)
bull Vast majority of patients actually showed gt50 reduction in the percentage of
sites with disease (~60 at 3 months then up to 100 at last follow up)
which shows the gradual improvement of the disease with time
bull Rabelo CC et al Systemic antibiotics in the treatment of aggressive
periodontitis A systematic review and a Bayesian Network meta-
analysis J Clin Periodontol 2015 Jul42(7)647-57 assessed the effect of
systemic antibiotic therapy on the treatment of aggressive periodontitis and concluded
that SRP plus systemic antibiotics led to an additional clinical effect compared with
SRP alone in the treatment of AgP Mtz and MtzAmx provided to the most beneficial
outcomes
bull Mombelli A et al Are There Specific Benefits of Amoxicillin Plus Metronidazole
in Aggregatibacter actinomycetemcomitans-Associated Periodontitis Double-
Masked Randomized Clinical Trial of Efficacy and Safety Journal of
Periodontology June 2013 Vol 84 No 6 Pages 715-724 evaluated 41 participants
who were positive for A actinomycetemcomitans and 41 participants who were negative
for A actinomycetemcomitans with full-mouth periodontal debridement performed within
48 hours after which they received either systemic antibiotics (375 mg amoxicillin and 500
mg metronidazole three times daily) or placebo for 7 days and found no specific benefit
from amoxicillin plus metronidazole on patients who were positive for A
actinomycetemcomitans Sites on molars benefited significantly more from the antibiotics
than non-molar sites
bull Cogen et al Destructive Periodontal Disease in Healthy Children Journal of Periodontology September 1992 Vol 63 No 9 Pages 761-765 conducted a retrospective cross-sectional study in which diagnosis of JP was based on age (le 15 years) negative medical history and radiographic evidence of arc-shaped alveolar bone loss
The study population was one-third white and two-thirds black and the malefemale ratio was 11 reflecting the general patient population
The prevalence among whites was 03 with a femalemale ratio 41
Among blacks the prevalence was 15 with a female male ratio 11
Among the black JP subjects with radiographs of the mixed dentition 857 presented evidence of bone loss and of those with radiographs of the deciduous
dentition 714 had discernible alveolar bone loss
CONCLUSION
bull Full mouth suprasubgingival debridement along with a one-time 7-day course of
amoxicillin and metronidazole and proper maintenance was effective in reducing
clinical parameters of affected sites in this population with LAP at 3 months post
treatment and were maintained for 4 years
bull The lsquogrossrsquo non-compliance with antibiotics and visits slightly and negatively affected
these results
bull Majority of patients diagnosed with LAP in the permanent dentition who were
analyzed retrospectively also presented radiographic bone loss in their primary
dentition which may suggest an early initiation for this disease
LIMITATIONS
bull The present study was not properly designed to evaluate the specific effects of
plaque control on LAP response to treatment
bull Lacks comparison with other treatment approaches and the evaluation of
antibiotic resistance which should be performed
o Does not evaluate effectiveness of this treatment regimen against SRP alone
o Previous studies on antibiotic resistance show that a one-course systemic antibiotic use adjunct to
mechanical debridement have resulted in transient bacterial resistance which decreased shortly
after cessation of antibiotic intake
(Feres et al 2002 Feres et al 1999 Fiehn and Westergaard 1990 Haffajee 2006)
DISCUSSION
bull First long-term evaluation of clinical treatment response of a large LAP cohort
as well as associated factors that may contribute to such response
bull Vast majority of LAP patients were successfully treated with nonsurgical
mechanical debridement and a one course of systemic antibiotic therapy and
that compliance with both antibiotics and appointments was important
bull Radiographic alveolar bone loss in the primary dentition of most LAP patients
suggest that this disease may indeed start in primary dentition and thus early
diagnosis in addition to this treatment approach are important tools to control
LAP disease
bull Shorter duration of the antibiotic regimen (7-day course rather than a 14 day-
course) to avoid possible side effects and antibiotic activity on possible new
biofilm re-formation after the first week which would have reduced its
effectiveness
(Harper and Robinson 1987 Quirynen et al 2005)
bull No patients presented an increase in the number of affected sites after
treatment at any time point (no progression)
bull Vast majority of patients actually showed gt50 reduction in the percentage of
sites with disease (~60 at 3 months then up to 100 at last follow up)
which shows the gradual improvement of the disease with time
bull Rabelo CC et al Systemic antibiotics in the treatment of aggressive
periodontitis A systematic review and a Bayesian Network meta-
analysis J Clin Periodontol 2015 Jul42(7)647-57 assessed the effect of
systemic antibiotic therapy on the treatment of aggressive periodontitis and concluded
that SRP plus systemic antibiotics led to an additional clinical effect compared with
SRP alone in the treatment of AgP Mtz and MtzAmx provided to the most beneficial
outcomes
bull Mombelli A et al Are There Specific Benefits of Amoxicillin Plus Metronidazole
in Aggregatibacter actinomycetemcomitans-Associated Periodontitis Double-
Masked Randomized Clinical Trial of Efficacy and Safety Journal of
Periodontology June 2013 Vol 84 No 6 Pages 715-724 evaluated 41 participants
who were positive for A actinomycetemcomitans and 41 participants who were negative
for A actinomycetemcomitans with full-mouth periodontal debridement performed within
48 hours after which they received either systemic antibiotics (375 mg amoxicillin and 500
mg metronidazole three times daily) or placebo for 7 days and found no specific benefit
from amoxicillin plus metronidazole on patients who were positive for A
actinomycetemcomitans Sites on molars benefited significantly more from the antibiotics
than non-molar sites
bull Cogen et al Destructive Periodontal Disease in Healthy Children Journal of Periodontology September 1992 Vol 63 No 9 Pages 761-765 conducted a retrospective cross-sectional study in which diagnosis of JP was based on age (le 15 years) negative medical history and radiographic evidence of arc-shaped alveolar bone loss
The study population was one-third white and two-thirds black and the malefemale ratio was 11 reflecting the general patient population
The prevalence among whites was 03 with a femalemale ratio 41
Among blacks the prevalence was 15 with a female male ratio 11
Among the black JP subjects with radiographs of the mixed dentition 857 presented evidence of bone loss and of those with radiographs of the deciduous
dentition 714 had discernible alveolar bone loss
CONCLUSION
bull Full mouth suprasubgingival debridement along with a one-time 7-day course of
amoxicillin and metronidazole and proper maintenance was effective in reducing
clinical parameters of affected sites in this population with LAP at 3 months post
treatment and were maintained for 4 years
bull The lsquogrossrsquo non-compliance with antibiotics and visits slightly and negatively affected
these results
bull Majority of patients diagnosed with LAP in the permanent dentition who were
analyzed retrospectively also presented radiographic bone loss in their primary
dentition which may suggest an early initiation for this disease
LIMITATIONS
bull The present study was not properly designed to evaluate the specific effects of
plaque control on LAP response to treatment
bull Lacks comparison with other treatment approaches and the evaluation of
antibiotic resistance which should be performed
o Does not evaluate effectiveness of this treatment regimen against SRP alone
o Previous studies on antibiotic resistance show that a one-course systemic antibiotic use adjunct to
mechanical debridement have resulted in transient bacterial resistance which decreased shortly
after cessation of antibiotic intake
(Feres et al 2002 Feres et al 1999 Fiehn and Westergaard 1990 Haffajee 2006)
bull Radiographic alveolar bone loss in the primary dentition of most LAP patients
suggest that this disease may indeed start in primary dentition and thus early
diagnosis in addition to this treatment approach are important tools to control
LAP disease
bull Shorter duration of the antibiotic regimen (7-day course rather than a 14 day-
course) to avoid possible side effects and antibiotic activity on possible new
biofilm re-formation after the first week which would have reduced its
effectiveness
(Harper and Robinson 1987 Quirynen et al 2005)
bull No patients presented an increase in the number of affected sites after
treatment at any time point (no progression)
bull Vast majority of patients actually showed gt50 reduction in the percentage of
sites with disease (~60 at 3 months then up to 100 at last follow up)
which shows the gradual improvement of the disease with time
bull Rabelo CC et al Systemic antibiotics in the treatment of aggressive
periodontitis A systematic review and a Bayesian Network meta-
analysis J Clin Periodontol 2015 Jul42(7)647-57 assessed the effect of
systemic antibiotic therapy on the treatment of aggressive periodontitis and concluded
that SRP plus systemic antibiotics led to an additional clinical effect compared with
SRP alone in the treatment of AgP Mtz and MtzAmx provided to the most beneficial
outcomes
bull Mombelli A et al Are There Specific Benefits of Amoxicillin Plus Metronidazole
in Aggregatibacter actinomycetemcomitans-Associated Periodontitis Double-
Masked Randomized Clinical Trial of Efficacy and Safety Journal of
Periodontology June 2013 Vol 84 No 6 Pages 715-724 evaluated 41 participants
who were positive for A actinomycetemcomitans and 41 participants who were negative
for A actinomycetemcomitans with full-mouth periodontal debridement performed within
48 hours after which they received either systemic antibiotics (375 mg amoxicillin and 500
mg metronidazole three times daily) or placebo for 7 days and found no specific benefit
from amoxicillin plus metronidazole on patients who were positive for A
actinomycetemcomitans Sites on molars benefited significantly more from the antibiotics
than non-molar sites
bull Cogen et al Destructive Periodontal Disease in Healthy Children Journal of Periodontology September 1992 Vol 63 No 9 Pages 761-765 conducted a retrospective cross-sectional study in which diagnosis of JP was based on age (le 15 years) negative medical history and radiographic evidence of arc-shaped alveolar bone loss
The study population was one-third white and two-thirds black and the malefemale ratio was 11 reflecting the general patient population
The prevalence among whites was 03 with a femalemale ratio 41
Among blacks the prevalence was 15 with a female male ratio 11
Among the black JP subjects with radiographs of the mixed dentition 857 presented evidence of bone loss and of those with radiographs of the deciduous
dentition 714 had discernible alveolar bone loss
CONCLUSION
bull Full mouth suprasubgingival debridement along with a one-time 7-day course of
amoxicillin and metronidazole and proper maintenance was effective in reducing
clinical parameters of affected sites in this population with LAP at 3 months post
treatment and were maintained for 4 years
bull The lsquogrossrsquo non-compliance with antibiotics and visits slightly and negatively affected
these results
bull Majority of patients diagnosed with LAP in the permanent dentition who were
analyzed retrospectively also presented radiographic bone loss in their primary
dentition which may suggest an early initiation for this disease
LIMITATIONS
bull The present study was not properly designed to evaluate the specific effects of
plaque control on LAP response to treatment
bull Lacks comparison with other treatment approaches and the evaluation of
antibiotic resistance which should be performed
o Does not evaluate effectiveness of this treatment regimen against SRP alone
o Previous studies on antibiotic resistance show that a one-course systemic antibiotic use adjunct to
mechanical debridement have resulted in transient bacterial resistance which decreased shortly
after cessation of antibiotic intake
(Feres et al 2002 Feres et al 1999 Fiehn and Westergaard 1990 Haffajee 2006)
bull No patients presented an increase in the number of affected sites after
treatment at any time point (no progression)
bull Vast majority of patients actually showed gt50 reduction in the percentage of
sites with disease (~60 at 3 months then up to 100 at last follow up)
which shows the gradual improvement of the disease with time
bull Rabelo CC et al Systemic antibiotics in the treatment of aggressive
periodontitis A systematic review and a Bayesian Network meta-
analysis J Clin Periodontol 2015 Jul42(7)647-57 assessed the effect of
systemic antibiotic therapy on the treatment of aggressive periodontitis and concluded
that SRP plus systemic antibiotics led to an additional clinical effect compared with
SRP alone in the treatment of AgP Mtz and MtzAmx provided to the most beneficial
outcomes
bull Mombelli A et al Are There Specific Benefits of Amoxicillin Plus Metronidazole
in Aggregatibacter actinomycetemcomitans-Associated Periodontitis Double-
Masked Randomized Clinical Trial of Efficacy and Safety Journal of
Periodontology June 2013 Vol 84 No 6 Pages 715-724 evaluated 41 participants
who were positive for A actinomycetemcomitans and 41 participants who were negative
for A actinomycetemcomitans with full-mouth periodontal debridement performed within
48 hours after which they received either systemic antibiotics (375 mg amoxicillin and 500
mg metronidazole three times daily) or placebo for 7 days and found no specific benefit
from amoxicillin plus metronidazole on patients who were positive for A
actinomycetemcomitans Sites on molars benefited significantly more from the antibiotics
than non-molar sites
bull Cogen et al Destructive Periodontal Disease in Healthy Children Journal of Periodontology September 1992 Vol 63 No 9 Pages 761-765 conducted a retrospective cross-sectional study in which diagnosis of JP was based on age (le 15 years) negative medical history and radiographic evidence of arc-shaped alveolar bone loss
The study population was one-third white and two-thirds black and the malefemale ratio was 11 reflecting the general patient population
The prevalence among whites was 03 with a femalemale ratio 41
Among blacks the prevalence was 15 with a female male ratio 11
Among the black JP subjects with radiographs of the mixed dentition 857 presented evidence of bone loss and of those with radiographs of the deciduous
dentition 714 had discernible alveolar bone loss
CONCLUSION
bull Full mouth suprasubgingival debridement along with a one-time 7-day course of
amoxicillin and metronidazole and proper maintenance was effective in reducing
clinical parameters of affected sites in this population with LAP at 3 months post
treatment and were maintained for 4 years
bull The lsquogrossrsquo non-compliance with antibiotics and visits slightly and negatively affected
these results
bull Majority of patients diagnosed with LAP in the permanent dentition who were
analyzed retrospectively also presented radiographic bone loss in their primary
dentition which may suggest an early initiation for this disease
LIMITATIONS
bull The present study was not properly designed to evaluate the specific effects of
plaque control on LAP response to treatment
bull Lacks comparison with other treatment approaches and the evaluation of
antibiotic resistance which should be performed
o Does not evaluate effectiveness of this treatment regimen against SRP alone
o Previous studies on antibiotic resistance show that a one-course systemic antibiotic use adjunct to
mechanical debridement have resulted in transient bacterial resistance which decreased shortly
after cessation of antibiotic intake
(Feres et al 2002 Feres et al 1999 Fiehn and Westergaard 1990 Haffajee 2006)
bull Rabelo CC et al Systemic antibiotics in the treatment of aggressive
periodontitis A systematic review and a Bayesian Network meta-
analysis J Clin Periodontol 2015 Jul42(7)647-57 assessed the effect of
systemic antibiotic therapy on the treatment of aggressive periodontitis and concluded
that SRP plus systemic antibiotics led to an additional clinical effect compared with
SRP alone in the treatment of AgP Mtz and MtzAmx provided to the most beneficial
outcomes
bull Mombelli A et al Are There Specific Benefits of Amoxicillin Plus Metronidazole
in Aggregatibacter actinomycetemcomitans-Associated Periodontitis Double-
Masked Randomized Clinical Trial of Efficacy and Safety Journal of
Periodontology June 2013 Vol 84 No 6 Pages 715-724 evaluated 41 participants
who were positive for A actinomycetemcomitans and 41 participants who were negative
for A actinomycetemcomitans with full-mouth periodontal debridement performed within
48 hours after which they received either systemic antibiotics (375 mg amoxicillin and 500
mg metronidazole three times daily) or placebo for 7 days and found no specific benefit
from amoxicillin plus metronidazole on patients who were positive for A
actinomycetemcomitans Sites on molars benefited significantly more from the antibiotics
than non-molar sites
bull Cogen et al Destructive Periodontal Disease in Healthy Children Journal of Periodontology September 1992 Vol 63 No 9 Pages 761-765 conducted a retrospective cross-sectional study in which diagnosis of JP was based on age (le 15 years) negative medical history and radiographic evidence of arc-shaped alveolar bone loss
The study population was one-third white and two-thirds black and the malefemale ratio was 11 reflecting the general patient population
The prevalence among whites was 03 with a femalemale ratio 41
Among blacks the prevalence was 15 with a female male ratio 11
Among the black JP subjects with radiographs of the mixed dentition 857 presented evidence of bone loss and of those with radiographs of the deciduous
dentition 714 had discernible alveolar bone loss
CONCLUSION
bull Full mouth suprasubgingival debridement along with a one-time 7-day course of
amoxicillin and metronidazole and proper maintenance was effective in reducing
clinical parameters of affected sites in this population with LAP at 3 months post
treatment and were maintained for 4 years
bull The lsquogrossrsquo non-compliance with antibiotics and visits slightly and negatively affected
these results
bull Majority of patients diagnosed with LAP in the permanent dentition who were
analyzed retrospectively also presented radiographic bone loss in their primary
dentition which may suggest an early initiation for this disease
LIMITATIONS
bull The present study was not properly designed to evaluate the specific effects of
plaque control on LAP response to treatment
bull Lacks comparison with other treatment approaches and the evaluation of
antibiotic resistance which should be performed
o Does not evaluate effectiveness of this treatment regimen against SRP alone
o Previous studies on antibiotic resistance show that a one-course systemic antibiotic use adjunct to
mechanical debridement have resulted in transient bacterial resistance which decreased shortly
after cessation of antibiotic intake
(Feres et al 2002 Feres et al 1999 Fiehn and Westergaard 1990 Haffajee 2006)
bull Mombelli A et al Are There Specific Benefits of Amoxicillin Plus Metronidazole
in Aggregatibacter actinomycetemcomitans-Associated Periodontitis Double-
Masked Randomized Clinical Trial of Efficacy and Safety Journal of
Periodontology June 2013 Vol 84 No 6 Pages 715-724 evaluated 41 participants
who were positive for A actinomycetemcomitans and 41 participants who were negative
for A actinomycetemcomitans with full-mouth periodontal debridement performed within
48 hours after which they received either systemic antibiotics (375 mg amoxicillin and 500
mg metronidazole three times daily) or placebo for 7 days and found no specific benefit
from amoxicillin plus metronidazole on patients who were positive for A
actinomycetemcomitans Sites on molars benefited significantly more from the antibiotics
than non-molar sites
bull Cogen et al Destructive Periodontal Disease in Healthy Children Journal of Periodontology September 1992 Vol 63 No 9 Pages 761-765 conducted a retrospective cross-sectional study in which diagnosis of JP was based on age (le 15 years) negative medical history and radiographic evidence of arc-shaped alveolar bone loss
The study population was one-third white and two-thirds black and the malefemale ratio was 11 reflecting the general patient population
The prevalence among whites was 03 with a femalemale ratio 41
Among blacks the prevalence was 15 with a female male ratio 11
Among the black JP subjects with radiographs of the mixed dentition 857 presented evidence of bone loss and of those with radiographs of the deciduous
dentition 714 had discernible alveolar bone loss
CONCLUSION
bull Full mouth suprasubgingival debridement along with a one-time 7-day course of
amoxicillin and metronidazole and proper maintenance was effective in reducing
clinical parameters of affected sites in this population with LAP at 3 months post
treatment and were maintained for 4 years
bull The lsquogrossrsquo non-compliance with antibiotics and visits slightly and negatively affected
these results
bull Majority of patients diagnosed with LAP in the permanent dentition who were
analyzed retrospectively also presented radiographic bone loss in their primary
dentition which may suggest an early initiation for this disease
LIMITATIONS
bull The present study was not properly designed to evaluate the specific effects of
plaque control on LAP response to treatment
bull Lacks comparison with other treatment approaches and the evaluation of
antibiotic resistance which should be performed
o Does not evaluate effectiveness of this treatment regimen against SRP alone
o Previous studies on antibiotic resistance show that a one-course systemic antibiotic use adjunct to
mechanical debridement have resulted in transient bacterial resistance which decreased shortly
after cessation of antibiotic intake
(Feres et al 2002 Feres et al 1999 Fiehn and Westergaard 1990 Haffajee 2006)
bull Cogen et al Destructive Periodontal Disease in Healthy Children Journal of Periodontology September 1992 Vol 63 No 9 Pages 761-765 conducted a retrospective cross-sectional study in which diagnosis of JP was based on age (le 15 years) negative medical history and radiographic evidence of arc-shaped alveolar bone loss
The study population was one-third white and two-thirds black and the malefemale ratio was 11 reflecting the general patient population
The prevalence among whites was 03 with a femalemale ratio 41
Among blacks the prevalence was 15 with a female male ratio 11
Among the black JP subjects with radiographs of the mixed dentition 857 presented evidence of bone loss and of those with radiographs of the deciduous
dentition 714 had discernible alveolar bone loss
CONCLUSION
bull Full mouth suprasubgingival debridement along with a one-time 7-day course of
amoxicillin and metronidazole and proper maintenance was effective in reducing
clinical parameters of affected sites in this population with LAP at 3 months post
treatment and were maintained for 4 years
bull The lsquogrossrsquo non-compliance with antibiotics and visits slightly and negatively affected
these results
bull Majority of patients diagnosed with LAP in the permanent dentition who were
analyzed retrospectively also presented radiographic bone loss in their primary
dentition which may suggest an early initiation for this disease
LIMITATIONS
bull The present study was not properly designed to evaluate the specific effects of
plaque control on LAP response to treatment
bull Lacks comparison with other treatment approaches and the evaluation of
antibiotic resistance which should be performed
o Does not evaluate effectiveness of this treatment regimen against SRP alone
o Previous studies on antibiotic resistance show that a one-course systemic antibiotic use adjunct to
mechanical debridement have resulted in transient bacterial resistance which decreased shortly
after cessation of antibiotic intake
(Feres et al 2002 Feres et al 1999 Fiehn and Westergaard 1990 Haffajee 2006)
CONCLUSION
bull Full mouth suprasubgingival debridement along with a one-time 7-day course of
amoxicillin and metronidazole and proper maintenance was effective in reducing
clinical parameters of affected sites in this population with LAP at 3 months post
treatment and were maintained for 4 years
bull The lsquogrossrsquo non-compliance with antibiotics and visits slightly and negatively affected
these results
bull Majority of patients diagnosed with LAP in the permanent dentition who were
analyzed retrospectively also presented radiographic bone loss in their primary
dentition which may suggest an early initiation for this disease
LIMITATIONS
bull The present study was not properly designed to evaluate the specific effects of
plaque control on LAP response to treatment
bull Lacks comparison with other treatment approaches and the evaluation of
antibiotic resistance which should be performed
o Does not evaluate effectiveness of this treatment regimen against SRP alone
o Previous studies on antibiotic resistance show that a one-course systemic antibiotic use adjunct to
mechanical debridement have resulted in transient bacterial resistance which decreased shortly
after cessation of antibiotic intake
(Feres et al 2002 Feres et al 1999 Fiehn and Westergaard 1990 Haffajee 2006)
LIMITATIONS
bull The present study was not properly designed to evaluate the specific effects of
plaque control on LAP response to treatment
bull Lacks comparison with other treatment approaches and the evaluation of
antibiotic resistance which should be performed
o Does not evaluate effectiveness of this treatment regimen against SRP alone
o Previous studies on antibiotic resistance show that a one-course systemic antibiotic use adjunct to
mechanical debridement have resulted in transient bacterial resistance which decreased shortly
after cessation of antibiotic intake
(Feres et al 2002 Feres et al 1999 Fiehn and Westergaard 1990 Haffajee 2006)
