Microbiological analysis and the outcomes of periodontal treatment with or without adjunctive systemic antibiotics-a...

The purpose of this retrospective study was to assess the impact of microbiological diagnostics on the outcomes of periodontal treatment with or without adjunctive use of systemic antibiotics.

Patient files were screened for microbiological analysis before (T1) and after non-surgical periodontal therapy (T2). Medical history, diagnosis, clinical data, and results of the microbiological analysis were extracted from the patient's file. After descriptive statistics, logistic regression analysis was performed to model the presence of 90 and 50% reductions of numbers of sites with probing depths (PD) of ≥ 5 mm at T2 (90%-PD5 and 50%-PD5), respectively, against the presence of bacterial species, clinical diagnosis, and adjunctive use of systemic antibiotics.

Eighteen patients diagnosed with aggressive periodontitis (AP, 17 with adjunctive antibiotics) and 84 with chronic periodontitis (CP, 31 with adjunctive antibiotics) were included in the analysis. Logistic modeling of bacteria at T1 to 90%-PD5 failed to show any statistical significance. Using 50%-PD5, presence of all Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola and in particular of T. denticola at T1 was associated with good response to therapy. Modeling of bacterial presence to 90-%PD5 and to 50-%PD5 at T2 found an association with absence of T. forsythia (90-%PD5 and 50-%PD5) and of T. denticola and Campylobacter rectus (50%-PD5). Modeling bacteria at T1, antibiotic group and oral hygiene at T2 on 50%-PD5 revealed odds ratio (OR) of the adjunctive antibiotic group between 2.70 and 52.4, of the oral hygiene between 3.27 and 4.11, and of the bacteria at T1 up to 28.6 (Porphyromonas gingivalis, T. forsythia, or T. denticola).

Microbiological analysis of the most important species associated with periodontal diseases appears to support a clinically based decision for the adjunctive use of systemic antibiotics.

The present findings appear to support the use microbiological testing to strengthen the clinical decision making process for either using or not using systemic antibiotics in conjunction with non-surgical periodontal therapy.