Effect of local metronidazole application of periodontal healing following guided tissue regeneration. Clinical findings
The purpose of this investigation was to evaluate the effect of a locally applied metronidazole gel on periodontal healing in combination with guided tissue regeneration (GTR).Twelve patients between 20 and 60 years of age were included in the study. Patients underwent an initial examination and were selected if they presented with two deep periodontal pockets (> 6 mm) in association with radiographically distinct and similar two- or three-wall intrabony defects with a depth of at least 4 mm measured on radiographs as the distance from the alveolar bone crest to the bottom of the defect. Initial therapy was performed in all areas of the dentition with the exception of the two experimental defects. Oral hygiene was evaluated two months following phase I therapy, and only those subjects with plaque scores of less than 2 on 90% of the tooth surfaces were included in the surgical phase of the study. The defects were randomly assigned to test or control, and the mucogingival flap surgery was performed. Test sites were treated by filling the defect with metronidazole gel and then placement of a membrane to cover the defect. Control defects were treated with membrane alone. Membranes were removed six weeks postsurgically. Clinical measurements were performed three and six months after removal of the membrane. No membranes were exposed to the oral cavity within the first six days after treatment.
Fourteen days after insertion, seven control membranes and nine test membranes had become exposed. All remaining membranes became exposed to the oral cavity between 14 and 30 days after insertion. Probing depth reduction was not significantly different for test versus control at either the three- or the six-month examinations. Probing attachment level was only significantly different between test and control for the lingual sites at the six-month examination. The attachment gain was found to be significantly better for test (92%) versus control (50%) at both the three- and six-month examinations. The median gain in bone height after six months was significantly higher in the test defects. The authors conclude that the local application of metronidazole gel has a beneficial effect on healing of periodontal vertical defects treated by GTR. [M.J.D.]
Sander, L., E.V.G. Frandsen, D. Arnbjerg K. Warrer, and T. Karring, J Periodont, 65:914, 1994