Western Society of Periodontics

Clinical Studies

Volume Number 4, 1995

A comparative clinical study: the use of human type I collagen with and without the addition of metronidazole in the GTR method of treatment of periodontal disease

The aim of this study was to primarily determine whether a type I collagen membrane loaded with metronidazole enhanced periodontal regeneration beyond that of plain human collagen when used as a barrier material in GTR. The rationale for this experiment comes from Selvig (1990), where he describes that the main problem arising from an attempt to use a biodegradable membrane as a physical barrier is that of contamination by oral microorganisms. To reduce the chances of contamination by the oral environment, to maintain the flap position, and for patient hygiene, it is recommended that the collagen be placed subgingivally and antimicrobial agents incorporated in order to solve this problem of infection. In 1993 Al-Arrayed showed that collagen membranes do release antimicrobials at significant levels without altering the membrane biodegradability itself.

This study utilized 16 patients with moderate to severe periodontitis with 78 bilaterally matched periodontal defects. Surgical flaps with sulcular incisions were created to allow scaling and root planing and exposure of the bony defects. At the experimental sites, which were selected at random, the flap was closed over metronidazole-impregnated collagen as a GTR membrane, the contralateral sites receiving a plain collagen barrier as control. The plaque index, gingival index, bleeding index, probing pocket depth, and probing attachment level were recorded at baseline, 6,12, and 26 weeks.

The results showed that all sites improved clinically and that there was less postoperative discomfort when metronidazole was incorporated in the collagen. Nevertheless, the latter did not appear to enhance periodontal regeneration beyond that of collagen alone. [D.H.]