Amoxicilina e metronidazol sistêmicos como coadjuvantes à raspagem e alisamento radicular no tratamento da periodontite crônica: estudo clínico e microbiológico

AUTOR(ES)
DATA DE PUBLICAÇÃO

2008

RESUMO

The aim of this study was to evaluate and to compare the clinical and microbiological changes provided by scaling and root planing (SRP) associated or not with metronidazole or metronidazole and amoxicillin systemic in the treatment of subjects with chronic periodontitis 90 days post-therapy. Thirty-six subjects were randomly assigned to 3 groups, control (C, n=12) that received SRP, Test 1 (T1, n=12) that received SRP and systemic metronidazole (400 mg, 3xday for 14 days), and Test 2 (T2, n=12) that received SRP, systemic metronidazole (400mg) and amoxicillin (500 mg) 3xday for 14 days. The clinical parameters evaluated at 6 sites per tooth at baseline and at 90 days posttherapy were: probing depth (PD), clinical attachment level (CAL), visible plaque, gingival bleeding, bleeding on probing and suppuration. Nine subgingival biofilm samples were collected per subject, 3 samples in each of the following initial PD categories: shallow (PD ≤ 3mm), moderate (PD 4-6 mm), and deep (PD ≥ 7mm). The samples were evaluated for the levels and proportions of 40 bacterial subgingival species using checkerboard DNA-DNA hybridization. The three therapies provided improvements in all clinical parameters at 90 days. The T2 group showed higher CAL reduction mean, for full mouth, comparing C and T1 groups that were similar (p>0.05). Related to the different categories of the initial probing depth the best clinical benefits in PD and CAL were observed in deep pockets for the groups that combined antibiotic therapy and SRP. The mean total counts were reduced (p<0.05) by the three therapies. At 90 days the T2 group (1.0x107) presented the lowest total level of microorganisms (p<0.05) in comparison to the T1 (1.5x107) and C (1.6x107) groups. The proportions of the red complex changed from 30.8%, 31.6% and 22.2% at baseline to 15.7%, 8.0% and 8.3% at days post-therapy in C, T1 e T2 groups, respectively. The orange complex was affected only by the therapy that combined metronidazole and amoxicillin (42.5% to 22.8%). On the other hand, the beneficial species increased mainly in group T2 that showed significant changes in the blue complex from 9.4% at baseline to 36.5% at 90 days post-therapy, purple (2.9% to 7.4%) and green (5.8% to 7.3%), followed by T1 group, specially the blue complex (10.8% to 27.2%). In conclusion, the association of antibiotics provided clinical and microbiological improvement that were superior to SRP. Marked benefits were evidenced in the subjects that used metronidazole and amoxicillin and SRP.

ASSUNTO(S)

periodontite crônica microbiologia bucal chronic periodontitis periodontal treatment oral microbiology antibiotics tratamento periodontal antibióticos odontologia

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