Gianfranco Carnevale

Full-mouth disinfection and systemic antimicrobial therapy in generalized aggressive periodontitis: a randomized, placebo-controlled trial.

AIM The present investigation aimed to analyse clinical and microbiological effects of systemic administration of metronidazole and amoxicillin combined with the One-Stage-Full-Mouth-Disinfection protocol (OSFMD) in generalized aggressive periodontitis patients (G-AgP). MATERIALS AND METHODS Thirty-nine systemically healthy patients with G-AgP were consecutively included. The test group (n = 19) received amoxicillin-metronidazole combination (500 mg of each, three times a day for 7 days) and the OSFMD, the control group (n = 20) received the OSFMD and a placebo. In addition to clinical parameters subgingival plaque samples from moderate (4-5 mm) and deep (≥ 6 mm) pocket sites were analysed for the presence of Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola using polymerase chain reaction. RESULTS Both therapies led to a statistically significant decrease in clinical and microbiological parameters compared to baseline (p < 0.001). The most beneficial changes were observed in the test group which showed significantly greater improvements in probing depth and clinical attachment level and a lower prevalence of Aggregatibacter actinomycetemcomitans, Treponema denticola, and Tannerella forsythia compared to the control one (p < 0.05). CONCLUSIONS Systemic administration of metronidazole and amoxicillin as an adjunct to OSFMD therapy significantly improved clinical and microbiological outcomes in patients with G-AgP over a 6-month period.

One-Stage Full-Mouth Disinfection as a Therapeutic Approach for Generalized Aggressive Periodontitis

BACKGROUND Data concerning treatment outcomes in patients with generalized aggressive periodontitis (GAgP) are limited. The aim of this study is to investigate 6-month clinical and microbiologic outcomes of the one-stage full-mouth disinfection (OSFMD) in the management of patients with GAgP. METHODS Twenty-seven patients with advanced GAgP were included in this prospective follow-up intervention study. Clinical and microbiologic parameters were collected at baseline and 3 and 6 months after the OSFMD. Patient-, tooth-, and site-level analyses were carried out. Subgingival samples from moderate (4 to 5 mm) and deep (≥6 mm) pocket sites were analyzed using a polymerase chain reaction for Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans), Prevotella intermedia, Porphyromonas gingivalis, Tannerella forsythia (previously T. forsythensis), and Treponema denticola. RESULTS The OSFMD resulted in significant improvements in all parameters. After 6 months, the whole-mouth probing depth (PD) decreased from 4.2 ± 1.1 mm to 2.8 ± 0.6 mm, and the clinical attachment level was reduced from 4.5 ± 1.2 mm to 3.4 ± 1.1 mm (P <0.001). When data were analyzed based on the frequency distribution of PD, the number of sites with PD ≥5 mm decreased by 61% from baseline values, and mean PD reductions of 1.5 and 2.5 mm were noted in moderate and deep pockets, respectively. At 6 months, percentages of moderate and deep sites free of pathogens were 40% and 27%, respectively. CONCLUSION The OSFMD may be a viable approach to deal with severe GAgP.

Fibre retention osseous resective surgery: how deep is the infrabony component of the osseous-resected defects?

BACKGROUND The Aims of this retrospective study were: (i) to describe the applicability of Fibre Retention Osseous Resective Surgery (FibReORS) to infrabony defects with different radiographic depths and (ii) to identify significant anatomical elements associated with the decision of tooth extraction or application of FibReORS in the context of a treatment approach aimed at pocket elimination. MATERIAL AND METHODS Baseline radiographs with detectable infrabony defects were collected from 68 periodontal patients. Selected teeth with radiographic evidence of infrabony defects had probing depths (PD) >4 mm at revaluation following non-surgical periodontal therapy. Teeth were then surgically treated with FibReORS or extracted on the basis of the decision making of an experienced periodontist and in the context of the overall treatment plan. The total root length and the defect depth were quantified for each selected tooth using radiographic reference points. RESULTS A total of 324 teeth with infrabony defects were identified. Fifty-three (16%) teeth with a mean radiographic infrabony defect of 8.5+/-1.7 mm (range 6-12 mm) were extracted; 271 (84%) teeth with a mean infrabony defect of 3.0+/-1.4 mm (1-8 mm) were surgically treated, achieving PD < or =3 mm in all sites at 6-month follow-up. Surgically treated teeth showed baseline radiographic infrabony defects < or =4 mm in 86% of the cases. Logistic multilevel modelling indicated that the probability of extraction was influenced by root length (p=0.0230) and by the radiographic defect depth (p=0.0112). CONCLUSION FibReORS is applicable in the treatment of shallow to moderate bony defects and deeper defects associated with longer roots.

Authors' Response: Re: Finkelman RD. Letter to the Editor: Re: “Clinical Guidelines of the Italian Society of Periodontology for the Reconstructive Surgical Treatment of Angular Bony Defects in Periodontal Patients”

We appreciate the interest and the comments by Dr. Richard D. Finkelman1 about our article titled ‘‘Clinical guidelines of the Italian Society of Periodontology for the reconstructive surgical treatment of angular bony defects in periodontal patients.’’2 He suggested that the randomized clinical trial by Reddy et al.3 on standard regenerative surgery in infrabony defects using a combined treatment (placement of a freeze-dried demineralized bone allograft, coverage with a bioabsorbable guided tissue regeneration membrane, and adjunctive use of systemic antibiotics) should be included in the guidelines. Even if this study is interesting, the guidelines considered only single treatments of angular bony defects as reported in the Materials and Methods, ‘‘Results concerning combinations of . . . treatments (e.g., bone graft beneath a membrane) were not taken into consideration because . . . it would be difficult to determine the contributions of the single techniques to the overall results.’’2 Therefore, the quoted article3 (as well as other papers) was excluded from the clinical guidelines.