Treatment of periodontal disease based on microbiological diagnosis. Relation between microbiological and clinical parameters during 5 years
The purpose of this study was to assess the clinical effect of treatment aimed at suppressing Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis below detection level, and Prevotella intermedia below 5% of the cultivable periodontal pocket flora. Sixteen patients age 28 to 54 meeting the following criteria were included in the study: (1) the patient should not be medically compromised, (2) periodontal and/or antibiotic treatment should not have been performed within the past six months; and (3) there should be at least three sites with a probing depth > 6 mm. A total of 11 periodontal pockets were included in the study. Twelve patients and a total of 77 sites completed the five-year study. Oral hygiene instructions were given, and scaling and root planing was performed by a dental hygienist. After six months the effect was evaluated. Sites harboring the marker bacteria A. actinomycetemcomitans or P. gingivalis (in detectable amounts), or P. intermedia (more than 5%) in one of the duplicate samplings at six-month examination were subjected to treatment phase II. Treatment phase II included redebridement or periodontal surgery in a split-mouth design. At 18 months a reevaluation was performed. Sites fulfilling the microbiological criteria for treatment were subject to treatment phase m. Treatment phase III included a second surgical procedure combined with systemic administration of tetracycline. All study sites then were reevaluated by microbial sampling and clinical measurements after 27, 33, 39, 51, and 63 months.
The results demonstrated clinical improvement of probing depth and gain of clinical attachment level of 3.4 mm and 1.2 mm, respectively. In order to eliminate A. actinomycetemcomitans from a majority of the sites, a combination of surgery and generalized tetracycline treatment was performed. The presence of A. actinomycetemcomitans, P. gingivalis, and P. intermedia, alone or in combination, correlated with attachment-level change on the individual level. [M.R.]
Renvert, S., G. Dahlen, and M. Wikstrom, J Periodont, 67:562, 1996