Effects of a single episode of subgingival irrigation with tetracycline HCl or chlorhexidine: A clinical and microbiological study
Abstract and Figures
The present study was designed to evaluate clinical and antimicrobial effects of a single episode of subgingival tetracycline or chlorhexidine (CHX) irrigation in the absence of scaling and root planing.
Thirty patients diagnosed with chronic periodontitis were recruited for this study, each providing four non-adjacent untreated periodontal pockets with a probing depth equal to or exceeding 6 mm. The four deep periodontal pockets in each patient were assigned to be irrigated with 150 ml each of CHX digluconate 0.2% (group A), tetracycline HCl at concentrations of 10 and 50 mg/ml (groups B and C, respectively), or sterile saline (group D) in a single episode. Recordings of plaque index (PI), gingival index (GI), probing pocket depth (PD), clinical attachment level (CAL), and subgingival bacterial counts from paper point samples were made pre-irrigation (day 0), and at days 7, 28, 56, and 84, post-irrigation.
The mean PI and GI scores for all the four groups were reduced post-irrigation, the reduction being significantly higher in group C compared to the other groups. The reduction in the PD and CAL was more significant in group C from day 0 to day 7, whereas the other groups showed minimal changes during this period. The change in the bacterial count was altered towards one of the periodontal health, it being more significant and consistent in the group C.
The results of this study suggest that subgingival irrigation with high concentrations of tetracycline may play a beneficial role in the management of chronic periodontitis patients.
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... The ideal sample size to ensure an adequate power for the study was calculated based on the results from a study by Stabholz et al., [5] Krishna et al., [6] and Hosaka et al. [7] Based on the calculation, it was decided that minimum 17 subjects per group were necessary for 80% power at 95% confidence interval (α = 0.05). ...
... Our study is not in agreement with Stabholz et al. [5] and Krishna et al. [6] who evaluated the results of a single episode of irrigation with tetracycline 10 mg/ml and 50 mg/ml in the absence of SRP in the experimental sites. According to their study, the amount of antimicrobial activity retained is proportional to the concentration of tetracycline HCl used for irrigation, so 10 mg/ml tetracycline was not sufficient to bring significant clinical results. ...
Background:
This study was performed to evaluate and compare the clinical and antimicrobial efficacy of subgingival irrigation with tetracycline and povidone-iodine as an adjunct to nonsurgical periodontal therapy.
Materials and methods:
Twenty subjects with chronic moderate periodontitis were recruited in this split-mouth study with probing pocket depth of >3 and ≤5 mm and clinical attachment loss of 3-4 mm in relation to 16, 36, and 46. In each subject, three selected periodontal pockets were assigned to receive one out of three irrigants (1) sterile water (control) in 16; (2) tetracycline at 10 mg/ml in 36; (3) 2% povidone-iodine in 46, and these sites were designated as Group A, Group B, and Group C, respectively. Plaque score, gingival score, pocket probing depth, and clinical attachment level were evaluated before treatment and at 1 and 3 months posttreatment. Multiplex polymerase chain reaction was used to detect Porphyromonas gingivalis and Tannerella forsythensis which have been implicated as the major risk factors for periodontal disease. Subgingival plaque collected before treatment and at 1 and 3 months posttreatment. Data were analysed using ANOVA and repeated measure ANOVA. Results were considered significant if P < 0.05.
Results:
Clinical and microbiological parameters were reduced posttreatment, the reduction being significantly higher in Group B compared to Group C.
Conclusion:
It can be concluded that chemical and mechanical therapies were of slight benefit in the treatment of chronic moderate periodontitis, and there was an adjunctive effect of significance when scaling and root planing was combined with a single subgingival irrigation with tetracycline or povidone-iodine in lower concentration.
... The ideal sample size to ensure an adequate power for the study was calculated based on the results from a study by Stabholz et al., [5] Krishna et al., [6] and Hosaka et al. [7] Based on the calculation, it was decided that minimum 17 subjects per group were necessary for 80% power at 95% confidence interval (α = 0.05). ...
... Our study is not in agreement with Stabholz et al. [5] and Krishna et al. [6] who evaluated the results of a single episode of irrigation with tetracycline 10 mg/ml and 50 mg/ml in the absence of SRP in the experimental sites. According to their study, the amount of antimicrobial activity retained is proportional to the concentration of tetracycline HCl used for irrigation, so 10 mg/ml tetracycline was not sufficient to bring significant clinical results. ...
... Professional periodontal treatment may not always accomplish satisfactory debridement [9]. To overcome the drawbacks of conventional therapy, several antimicrobial agents have been used systemically or locally [10]. The null hypothesis was that antiplaque efficacy is same between essential oils, chlorhexidine gluconate and sterile saline groups. ...
Background: According to Egyptian pictograms and medical records, non-surgical periodontal treatment (NSPT) has been practised for a very long time. Several clinical studies have depicted relevant clinical results when subgingival irrigation was carried out as an adjuvant therapy to SRP. This study aims to compare essential oils as subgingival irrigant agents with chlorhexidine gluconate (CHX) and sterile saline over a period of 21 days. Setting and Design: This is a comparative study of three groups (chlorhexidine group, essential oil group, sterile saline group). Each group had ten patients having chronic periodontitis who were randomly assigned and treated with subgingival irrigants. For, the essential oil group, the irrigant was indigenously prepared at chairside. Material and Methods: Following the initial examination and selection of patients, clinical parameters were noted and collection of plaque samples was done. These samples were then sent for microbiological assay at baseline. SRP was done along with subgingival irrigation at baseline, 7 th and 14 th day. Clinical parameters were monitored again and plaque samples were sent for microbiological test on the 21 st day. Results: There was no significant difference noted between the groups in any of the clinical parameters. However, regarding microbiological parameter, better results were demonstrated in CHX group and essential oil group compared to sterile saline group that was statistically significant. CHX and essential oil group demonstrated no statistical difference. Conclusion: The result of this study suggests that essential oils can be used as a subgingival irrigant in the treatment of chronic periodontitis.
... Local antimicrobial solutions and gels provide an alternative for eliminating pathogenic microorganisms in areas where dental scaling and root planing cannot reach [5]. Among the chemical agents, chlorhexidine (CHX) has been frequently used because of its proven antimicrobial effect, availability, low cost, safety, efficacy, and low toxicity [6,7]. CHX reduces biofilm formation, alters adsorption and bacterial adhesion to the tooth surface, and disrupts the bacterial wall by cell lysis [8,9]. ...
Objective
Mouthwash is effective in maintaining oral hygiene in patients; however, there is concern that it may adversely affect human oral mucosa. We evaluated a pH-neutral electrolyzed super-oxidized solution (ESS, tradename OxOral®) combined with dental scaling in periodontitis patients. This longitudinal study was conducted with 34 patients divided into three groups. The control group treated with scaling plus saline, the second with scaling plus ESS mouthwash, and another with scaling plus ESS mouthwash and gel. The plaque index (PI), gingival index (GI), and probing depth (PD) were determined before and after periodontal treatment.
Results
The final PI and GI decreased compared with the initial measurements in the three treatment groups (p < 0.05). Scaling plus ESS mouthwash and gel significantly reduced the final PI, GI, and DP compared to the control group (p < 0.05).
Conclusion
Our study shows the antiseptic properties of ESS with mouthwash and gel. Further studies are needed to verify the results.
... This study is in accord with Stabholz et al. 9 and Krishna et al. 10 who assessed the use of a single period of tetracycline (10 mg/ mL) irrigation with no SRP at the investigational sites. As per their study, the extent of antimicrobial activity achieved is comparative to the tetracycline HCl concentration used for irrigation. ...
... 2 In addition, various systemic and local chemical antimicrobial agents have been introduced for the treatment of peri-implantitis, which suppress periodontopathogens more effectively compared to mechanical techniques, and improve the results of conventional mechanical therapeutic techniques. [3][4][5][6][7] Some disadvantages of antimicrobial agents' use, (such as antibiotics) include an increase in the counts of bacteria resistant to these agents, the need for the use of different antibiotics due to the diversity of periodontopathogens, an increase in the number of immunosuppressed patients and the incidence of unfavorable reactions. Considering the complications above, it is necessary to expand research ...
Introduction: Side effects related to antibiotic therapy for peri-implantitis are rare in laser therapy (LT); therefore, the aim of this study was to evaluate the effectiveness of LT and photodynamic therapy (PDT) on patients with primary peri-implantitis. Methods: In this randomized clinical trial, 40 implants presenting primary peri-implantitis in 20 patients with a mean age of 52.6 years old were included using the simple sampling technique. Periodontal treatment comprising scaling and root planing (SRP) was accomplished for the whole mouth while mechanical debridement with titanium curettes and air polishing with sodium bicarbonate powder was accomplished around the implants. The implants were randomly divided into two groups and treated with LT (control) and PDT (test). The clinical indices were measured at baseline, 6 weeks and 3 months after treatment. Real-time polymerase chain reaction (PCR) was used for analysis of microbial samples at baseline and 3-month follow-up. Data were analyzed with SPSS 20, using repeated-measures analysis of variance (ANOVA) and Friedman's and Mann-Whitney tests (a = 0.05). Results: Both groups showed statistically significant improvements in terms of bleeding on probing (P < 0.001), probing pocket depth (PPD) (P = 0.006) and modified plaque index (P < 0.001), with no significant differences between the 2 groups (P > 0.05). The number of Aggregatibacter actinomycetemcomitans (P = 0.022), Tannerella forsythia (P = 0.038) and Porphyromonas gingivalis (P = 0.05) in the test group and Porphyromonas gingivalis (P = 0.015) in the control group significantly decreased. Conclusion: The results suggested that LT and PDT have significant short-term benefits in the treatment of primary peri-implantitis.
... Krishna et al. [19] found similar improvements in CAL value after irrigation of periodontal pockets with both chlorhexidine and saline, which is in accordance with the results of MacAlpine et al. [17] and the results of our study. ...
Objective:
The aim of this study was to evaluate clinical efficacy of different chlorhexidine gluconate (CHX) preparations applied subgingivally as an adjunct to scaling and root planing (SRP).
Material and methods:
A total of 120 periodontal pockets was included in this randomized, controlled, split mouth designed study. According to protocols used in treatment, periodontal pockets were assigned to experimental and control groups as follows: CHX solution as an addition to SRP versus control SRP group; CHX gel as an addition to SRP versus control SRP; CHX chip as an addition to SRP versus control SRP group. Following clinical parameters were recorded at baseline, one and three months after the baseline: plaque index (PI), probing pocket depth (PPD), bleeding index (BI) and clinical attachment level (CAL).
Results:
The most significant improvements were found concerning PI in CHX solution with SRP and CHX gel with SRP groups over controls at one month recall, as well as concerning BI and PPD in CHX chip with SRP group over SRP alone at three-month recall.
Conclusion:
Results of this study favour combination therapy using CHX chip as an adjunct to SRP due to greater improvements in BI and PPD compared to those obtained by SRP alone in the treatment of chronic periodontitis.
... Moreover, Stabolhz et al. [6] in a randomized, split mouth clinical The favorable results obtained in the abovementioned studies may be due to the high concentration of tetracycline HCl used (100mg/ml) and repeated administration (every other day for a two-week period) and the localized concentration of the drug at the site of disease activity. [27] The amount of drug delivered often creates sulcular medication concentrations exceeding the equivalent of 1mg/ml. This level is considered bactericidal for the majority of bacteria that exhibit resistance to systemically delivered concentrations. ...
Background:
The development and progression of periodontal diseases is a result of the dynamic interaction of microorganisms within their habitat, and changes in this habitat generate a dysbiotic state. Fusobacterium nucleatum and Prevotella intermedia are bridging microorganisms between the pioneer communities and other microorganisms responsible for periodontitis such as Porphyromonas gingivalis. Tetracycline hydrochloride (TTC-HCl) is commonly used as a coadjutant in periodontal treatment in the form of an antiseptic. However, there are no clear dilution or concentration protocols.
Objective:
This study aimed to evaluate the in vitro antimicrobial activity of TTC-HCl diluted in sterile water, saline solution, and 2% lidocaine with epinephrine 1:80,000 at concentration of 125, 250, and 500 mg, at three time points- 30, 60, and 120 s - on P. intermedia, F. nucleatum, and P. gingivalis using the Kelsey-Maurer technique.
Materials and methods:
The antimicrobial activity of TTC-HCl was evaluated at the proposed concentrations and times, dissolved in the different vehicles at pH 1.9 and 7.0, on F. nucleatum, P. intermedia, and P. gingivalis. The Kelsey-Maurer test was used to verify the presence or absence of colony-forming units. Each test was performed in triplicates with its respective viability controls.
Results:
Inhibition of F. nucleatum, P. intermedia, and P. gingivalis was achieved with TTC-HCl at all concentrations, dissolved in distilled water, saline solution, and 2% lidocaine with epinephrine 1:80,000 for all times.
Conclusions:
The results show that TTC-HCl is a good antimicrobial alternative against F. nucleatum, P. intermedia, and P. gingivalis regardless of the vehicle in which it was dissolved, concentration, pH, or time used in this investigation.
Objectives
To evaluate the influence of boric acid (BA) on various aspects of the human periodontal ligament stem cells (hPDLSCs), including proliferation, migration, and adhesion.
Methods
BA was prepared at increasing concentrations of 0.5%, 0.75%, 1%, 1.5%, 3%, and 6%, and an [3-(4,5-dimethylthiazol-2-YL)-2,5-diphenyl] (MTT) assay was used to determine the non-toxic concentrations of BA on hPDLSCs. The appropriate concentrations of BA were applied in subsequent experiments to evaluate its effect on three particular aspects of hPDLSCs: proliferation, migration, and adhesion. The proliferation of hPDLSCs was determined with a hemocytometer. The migration of hPDLSCs was evaluated using a scratch assay, followed by analysis of the recorded digital images using the Image-Analysis J 1.51j8 software. The adhesion of hPDLSCs to sterilized root surfaces that retained or lacked a cementum was assessed using the MTT assay.
Results
Non-toxic concentrations of BA against hPDLSCs were 0.5% and 0.75%, allowing a relative growth rate of greater than 75%. Treated hPDLSCs proliferated and migrated uneventfully, with no significant differences to the control group. hPDLSCs adhered to both types of the prepared root surfaces; however, those lacking a cementum allowed more effective adhesion than those retaining it. Qualitatively, the adhesion ability of hPDLSCs was better in the 0.5% rather than the 0.75% BA-treated or control groups.
Conclusions
BA at concentrations of 0.5% and 0.75% did not impede the proliferation, migration, or adhesion ability of hPDLSCs to root surfaces, indicating that this sterilizing agent could be advanced to clinical trials.
Abstract Substantivity of tetracycline HCI and chlorhexidine digluconate to human root dentin was assessed in vitro. 51 extracted single-rooted teeth, their crowns removed, were assigned to 1 of 4 treatments in groups of 12. A control groups included 3 roots. Each group was divided into 3 subgroups to allow evaluation of drug exposure for 1, 3 or 5 min. The roots were immersed in tetracycline HCI (10 or 50 mg/ml) or chlorhexidine digluconate (0.12 or 0.2%) solutions following root planing. Control roots were immersed in sterile saline (0.9%). Following drug immersion, the roots were transferred to tubes containing 2 ml tris buffered saline. The tubes were incubated at room temperature for 22 days. Desorption media were replaced at 24-h intervals. Removed media were examined for antimicrobial activity using a microtiter assay in which bacterial growth was evaluated by optical density readings. Roots immersed in tetracycline HCl 50 mg/ml released antimicrobial activity to successive desorption media for 14 days. Tetracycline HCl 10 mg/ml activity lasted 4 days. Roots subjected to chlorhexidine digluconate released antimicrobial activity for 24 h only. Within each treatment, there were no differences between the 3 exposure intervals of 1, 3 or 5 min. Our findings suggest usage of the periodontally exposed instrumented root as a depot for sustained release of tetracycline HCI, but not chlorhexidine digluconate, to the subgingival environment. The substantiveness of tetracycline HCI seems related to drug concentration rather than the exposure interval. Clinical trials are needed to confirm the clinical significance of these in vitro observations.
T his investigation was conducted on seven individuals referred for treatment of moderate adult periodontitis. Twenty‐eight sites with an average probing depth of 5.6 ± 0.9 mm were evaluated. One tooth per jaw quadrant was randomly assigned to receive one of the following treatments: (I) no treatment, i.e., control; (II) saline irrigation; (III) tetracycline irrigation and (IV) scaling and root planing (SC/RP).
A plaque control program was instituted one week prior to the experimental period and reinforced throughout the eight‐week study. Irrigation was performed every 48 hours during the first two weeks of the experiment for Groups II and III, and the single treatment of SC/RP was carried out immediately following the baseline examination for Group IV. Clinical and microbiologic changes were monitored every two weeks using plaque and gingival indices, gingival fluid flow, probing depths, bleeding on probing and dark‐field microscopic examination of the subgingival microbial flora.
The tetracycline and SC/RP treatment modalities resulted in statistically significant clinical and microbiological improvements when compared with the control. Tetracycline irrigation alone and SC/RP alone had a similar effect in changing the subgingival microflora from one associated with disease to one associated with health. Thus, these treatment modalities are effective methods of producing statistically significant alterations in the subgingival microflora. The property of substantivity may contribute to the sustained duration of the effect of locally delivered tetracycline.
64 sites with probing pocket depth 6 mm from 11 patients were treated with plaque control instruction and one episode of root planing. Subsequently, selected sites in each patient were irrigated with either chlorhexidine, tetracycline, saline or served as non‐irrigated control sites. Irrigation immediately followed instrumentation, and was repealed every 2 weeks for 24 weeks. Healing was monitored at 8, 16, and 24 weeks clinically and at 7, 15, and 23 weeks with subgingival washings for determination of % as well as total number of spirochetes.
The following changes were apparent from comparing pooled site means al 24 weeks with pre‐treatment data: (1) bleeding sites decreased from 62 of 64 sites initially to 22 of 64 at 24 weeks; (2) spirochetes decreased from 34% to 2%; (3) probing pocket depths decreased from 7.6 to 4.7 mm; (4) probing attachment levels showed a gain of 1.2 mm. The improvement of the chlorhexidine and tetracycline irrigated sites was similar to that of the saltne irrigated and non‐irrigated control sites.
Thus, biweekly chlorhexidine, tetracycline or saline irrigation of deep pockets did not appear to augment the effects of non‐surgical periodontal therapy.
The purpose of this investigation was to examine periodontal disease recurrence from 3 to 12 months following various treatments with scaling and root planing and controlled-release tetracycline fibers. One-hundred-twenty-two (122) adult volunteers with at least one bleeding pocket > or = 5 mm in each of four quadrants were enrolled in this study. One or two such sites in each quadrant were selected as test sites. Quadrants were randomly assigned to receive one of four treatments: scaling and root planing (S); scaling and root planing plus tetracycline fiber for 10 days (SF); fiber therapy alone for 10 days (F); or fiber therapy alone for 20 days (FF). After treatment, no supportive care was provided during the 12-month study period. Probing depth (PD), attachment loss (AL), plaque, and bleeding on probing were measured at baseline, and at 1, 3, 6, 9, and 12 months after treatment. PD and AL measures were taken at three locations within each site and averaged for each site. Disease recurrence was defined as > or = 1 mm mean attachment loss at a site during the 3- to 12-month period. One-hundred-sixteen (116) subjects completed the study. Sites treated with SF experienced significantly (P < 0.05) less disease recurrence (4%) than S, F, or FF (9%, 10%, and 12%, respectively). Results of this study suggest that, compared to S, F, or FF, scaling and root planing in conjunction with tetracycline fiber therapy for 10 days can significantly reduce disease recurrence 3 to 12 months following treatment in the absence of supportive care.
To evaluate the long-term effect of subgingival irrigations with amine fluoride mixed with stannous fluoride on the repopulation of bacteria in deep periodontal pockets (> 5 mm) following the active phase of non-surgical mechanical treatment.
A split-mouth design was utilized in eight periodontal patients and the effect of the treatment was evaluated by microbiological culturing and clinical parameters.
Slight reduction in total anaerobe counts were detected in both treated and control sides, up to the first 5 weeks, followed by an increase in the counts reaching a plateau after 30 weeks. In contrast, black-pigmented bacteroides species (BPB) were significantly suppressed in the treated sides as compared to the control sides over the whole study period. The difference between the clinical parameters and between the tested and control sides, although in some points were found to be statistically significant, seem to have no clinical significance. The use of amine fluoride-stannous fluoride gel for irrigations of deep periodontal pockets as an adjunctive to conventional treatment, can prevent the repopulation of the pockets by BPB, which are considered to be a major group of periodontal pathogens.
Substantivity of tetracycline HCl and chlorhexidine digluconate was assessed in extracted teeth. Fifty periodontally compromised teeth scheduled for extraction with probing depths ranging between 6 and 12 mm were root planed and then irrigated in situ with 1 of 4 solutions: tetracycline HCl at concentrations of 10 or 50 mg/ml, 0.12% chlorhexidine digluconate, or 0.9% sterile saline. Each tooth was exposed to 150 ml of the respective irrigation solution. Following extractions, the teeth were transferred to tris buffered saline and incubated at room temperature for 22 days. Incubation solutions were replaced at 24-hour intervals. Removed solutions were examined for desorbed antimicrobial activity using a microtiter assay in which bacterial growth was evaluated by optical density readings. Tetracycline HCl 50 mg/ml exhibited significantly greater antimicrobial activity than chlorhexidine digluconate for 12 days and greater than saline for 16 days. Tetracycline HCl 10 mg/ml exhibited significantly greater antimicrobial activity than chlorhexidine digluconate and saline for 4 days. Chlorhexidine digluconate did not exhibit any significant antimicrobial activity at any time point. Our findings demonstrate long-lasting substantivity of tetracycline HCl, but not chlorhexidine digluconate, by teeth exposed to a single episode of pocket irrigation of their periodontally-exposed roots. The amount of antimicrobial activity retained is proportional to the concentration of tetracycline HCl used for irrigation.
Previous in vitro studies have suggested that tetracycline-HCl (TTC-HCl) is adsorbed and actively released from root dentin. The aim of the current study was to evaluate the binding to and release of TTC-HCl from human root dentin surfaces in vivo, and to evaluate the clinical utility of TTC-HCl irrigation as an adjunct to scaling and root planing. Experiment I utilized two contralateral mandibular single-rooted teeth which were examined in four adults with severe generalized periodontitis. One tooth in each patient was carefully scaled and root planed, under local anesthesia, and the other used as an unscaled control. Each subgingival root surface was irrigated for 5 min with an aqueous TTC-HCl solution at a concentration of 100 mg/ml. Gingival crevicular fluid samples were collected on paper strips for the next three weeks. The TTC-HCl concentrations in each sample were determined by the inhibition zone of B. cereus cultured on agar plates. The TTC-HCl concentrations in gingival crevicular fluid collected 15 min after irrigation were 3100 +/- 670 micrograms/ml from the scaled lesions and 4700 +/- 1300 micrograms/ml from the unscaled root surfaces. The antibiotic concentrations decreased logarithmically over the next 7 days; 1500 +/- 270 micrograms/ml and 1100 +/- 330 micrograms/ml at 2 h, 880 +/- 350 micrograms/ml and 1300 +/- 360 micrograms/ml at 6 h and 19 +/- 5 micrograms/ml and 31 +/- 26 micrograms/ml at 1 week for scaled and unscaled root surfaces, respectively. Results for week two and three indicated an average of over 8 micrograms/ml.(ABSTRACT TRUNCATED AT 250 WORDS)
The safety and efficacy of a degradable, subgingivally placed drug delivery system containing 2.5 mg chlorhexidine (CHX) were evaluated in a randomized, blinded, multi-center study of 118 patients with moderate periodontitis. A split-mouth design was used to compare the treatment outcomes of scaling and root planing (SRP) alone with the combined use of SRP and the CHX in pockets with probing depths of 5 to 8 mm. The two maxillary quadrants were used for the two treatment arms of the study. Scaling and root planing was performed at baseline only, while the CHX was inserted both at baseline and at 3 months. Clinical and safety measurements including probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) as well as gingivitis, plaque, and staining indices were recorded at baseline, and at 1, 3, and 6 months. The average PD reduction in the CHX-treated sites was significantly greater than in the sites receiving SRP alone at both 3 and 6 months with a mean difference of 0.42 mm (P < or = 0.01) at 6 months. The reduction in CAL at the treated sites was greater than at the SRP sites, although the difference was statistically significant at the 6-month visit only. An analysis of patients with initial probing depths of 7 to 8 mm (n = 56) revealed a significantly greater reduction in PD and CAL in those pockets treated with CHX compared to SRP at both 3 and 6 months. The mean differences between test and control sites at 6 months were 0.71 mm and 0.56 mm PD and CAL respectively.
A controlled clinical trial was carried out to compare the clinical effect of combined antimicrobial-mechanical treatment modalities on moderate-to-deep periodontal pockets in patients with adult periodontitis. Twelve patients having at least three nonadjacent sites of periodontitis were included in the split-mouth study. Gingival Index, Plaque Record, bleeding on probing, probing depth, attachment level, and recession depth were recorded immediately before treatment. In the control site, supragingival and subgingival scaling was performed with an ultrasonic scaler. One experimental site received supplemental irrigation with 15 mL of a 100-mg/mL tetracycline solution, while the other received a tetracycline-loaded fiber after mechanical instrumentation. Fibers were left in place for 10 days. Reevaluation 30 and 60 days after treatment showed that all three treatment modalities were effective in improving clinical parameters. No adjunctive effect on the healing response was obtained by augmenting mechanical debridement with tetracycline.