Decision-making on systemic antibiotics in the management of periodontitis: A retrospective comparison of two concepts

IF 5.8 1区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Journal of Clinical Periodontology Pub Date : 2024-06-03 DOI:10.1111/jcpe.14003

Patrizia C. Winkler, Leander Benz, Katrin Nickles, Hari C. Petsos, Peter Eickholz, Bettina Dannewitz

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Abstract

Aim

To retrospectively compare two approaches for the adjunctive use of systemic antibiotics in non-surgical periodontal therapy: one based on the detection of Aggregatibacter actinomycetemcomitans (Aa) and the other on age and severity of periodontitis (Age & PPD). We also assessed the additional benefit of antibiotics in reducing the need for further surgical therapy in each group.

Materials and Methods

Patients of the Department of Periodontology, Goethe University Frankfurt, Germany, were screened for microbiological testing between 2008 and 2018. Patients were categorized by their microbiological result (Aa+/−) and demographic/clinical data (Age & PPD+/−). Agreement on antibiotic indication was tested. The clinical evaluation focussed on teeth with probing pocket depths (PPDs) ≥ 6 mm.

Results

Analysis of 425 patients revealed 30% categorized as Age & PPD+ and 34% as Aa+. Sixty-three percent had consistent antibiotic recommendations (phi coefficient 0.14, p = .004). Patients in the Age & PPD+ group receiving antibiotics showed the most substantial reduction in the number of teeth with PPD ≥ 6 mm after non-surgical periodontal therapy.

Conclusions

Both strategies resulted in a significant clinical improvement compared with those without antibiotic treatment and restricted antibiotic use similarly, but targeted different patient groups. Younger individuals with severe periodontitis benefited most from antibiotics, reducing the need for additional surgeries. The study was registered in an international trial register (German Clinical Trial Register number DRKS00028768, registration date 27 April 2022, https://drks.de/search/en/trial/DRKS00028768).

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牙周炎治疗中全身使用抗生素的决策：两种概念的回顾性比较。

目的：回顾性比较在非手术牙周治疗中辅助使用全身抗生素的两种方法：一种是基于放线菌（Aa）的检测，另一种是基于牙周炎的年龄和严重程度（年龄和 PPD）。我们还评估了抗生素在减少每组患者进一步手术治疗需求方面的额外益处：2008 年至 2018 年期间，德国法兰克福歌德大学牙周病学系的患者接受了微生物检测筛查。根据微生物检测结果（Aa+/-）和人口学/临床数据（年龄和 PPD+/-）对患者进行分类。对抗生素适应症的一致性进行了测试。临床评估的重点是探查袋深度（PPD）≥ 6 毫米的牙齿：对 425 名患者的分析显示，30% 的患者被归类为年龄和 PPD+，34% 的患者被归类为 Aa+。63%的患者得到了一致的抗生素建议（phi系数0.14，p = .004）。接受抗生素治疗的年龄和 PPD+ 组患者在接受非手术牙周治疗后，PPD ≥ 6 mm 的牙齿数量明显减少：结论：与未使用抗生素治疗的患者相比，两种策略都能显著改善临床症状，并且限制抗生素的使用，但针对的患者群体不同。年轻的重度牙周炎患者从抗生素中获益最多，从而减少了额外手术的需求。该研究已在国际试验注册中心注册（德国临床试验注册号 DRKS00028768，注册日期 2022 年 4 月 27 日，https://drks.de/search/en/trial/DRKS00028768）。

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来源期刊

Journal of Clinical Periodontology 医学-牙科与口腔外科

CiteScore

13.30

自引率

10.40%

发文量

175

审稿时长

3-8 weeks

期刊介绍： Journal of Clinical Periodontology was founded by the British, Dutch, French, German, Scandinavian, and Swiss Societies of Periodontology. The aim of the Journal of Clinical Periodontology is to provide the platform for exchange of scientific and clinical progress in the field of Periodontology and allied disciplines, and to do so at the highest possible level. The Journal also aims to facilitate the application of new scientific knowledge to the daily practice of the concerned disciplines and addresses both practicing clinicians and academics. The Journal is the official publication of the European Federation of Periodontology but wishes to retain its international scope. The Journal publishes original contributions of high scientific merit in the fields of periodontology and implant dentistry. Its scope encompasses the physiology and pathology of the periodontium, the tissue integration of dental implants, the biology and the modulation of periodontal and alveolar bone healing and regeneration, diagnosis, epidemiology, prevention and therapy of periodontal disease, the clinical aspects of tooth replacement with dental implants, and the comprehensive rehabilitation of the periodontal patient. Review articles by experts on new developments in basic and applied periodontal science and associated dental disciplines, advances in periodontal or implant techniques and procedures, and case reports which illustrate important new information are also welcome.