%0 Journal Article
%T Antimicrobial or Subantimicrobial Antibiotic Therapy as an Adjunct to the Nonsurgical Periodontal Treatment: A Meta-Analysis
%A Ana Patricia Moreno Villagrana
%A Jos¨¦ Francisco G¨®mez Clavel
%J ISRN Dentistry
%D 2012
%R 10.5402/2012/581207
%X The use of antibiotics in nonsurgical periodontal treatment is indicated in cases in which scaling and root planing present important limitations. However, their use is controversial due to the secondary effects associated with them and the disagreements regarding their prescription. The aim of this study is to determine the effectiveness of systemic antibiotics in the management of aggressive and chronic periodontitis. The study was based on a search of randomized, controlled clinical trials. Common data were concentrated and evaluated by means of an analysis of variance (ANOVA), and a meta-analysis of the results was performed. The meta-analysis ( , 95% confidence interval, post hoc Bonferroni) determined that the supplementation of nonsurgical periodontal therapy with a systemic antibiotic treatment¡ªamoxicillin with clavulanic acid and metronidazole or subantimicrobial dose doxycycline¡ªprovides statistically significant results in patients with aggressive or chronic periodontitis under periodontal treatment, whilst increasing the clinical attachment level of the gingiva and reducing periodontal probing depth. 1. Introduction It is now recognized that the majority of connective tissue and bone destruction in periodontal tissues occurs indirectly as a result of an excessive immunoinflammatory response in the host to the presence of bacterial plaque in susceptible individuals. Although bacterial pathogens initiate the periodontal inflammation, the host response to these pathogens is equally if not more important in mediating connective tissue breakdown, including bone loss [1, 2]. The host-derived enzymes known as matrix-degrading metalloproteinases (MMPs) as well as changes in osteoclast activity driven by cytokines and prostanoids catalyze the breakdown of proteins, including collagen, gelatin, proteoglycan core protein, fibronectin, laminin, and elastin, located either on the cell plasma membrane or within the extracellular matrix [3¨C6]. Pathologically excessive levels of activity of the various MMPs degrade all of the major components of the extracellular matrix in the gingiva, the periodontal ligament, and the alveolar bone, including the collagen fibers (mostly type I and III), proteoglycans, ground substance, and basement membranes [7¨C9]. The standard treatment for periodontitis remains highly nonspecific, consisting of the mechanical debridement of the affected root surface in order to reduce the total bacterial load and change the environmental conditions of these microbial niches [19]. However, not all patients nor all sites respond uniformly
%U http://www.hindawi.com/journals/isrn.dentistry/2012/581207/