in periodontitis patients harboring Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forsythia: exploratory analyses from a clinical trial
Objective: Considering the etiopathogenesis of periodontitis, it is relevant to evaluate the efficacy of the adjunctive use of systemic antimicrobials based on microbial occurrence. This report explores whether patients harboring Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis(Pg), or Tannerella forsythia (Tf) at baseline could receive greater clinical benefits from adjunctive moxifloxacin (MXF) and amoxicillin plus metronidazole (AM+MT) in comparison to patients without the presence of these microorganisms before therapy for generalized periodontitis. A control group was established that received subgingival debridement (SD) alone.
Method and materials: Thirty-six patients younger than 30 years of age were randomly allocated to one of three treatment groups: SD plus placebo, systemic MXF with SD, or AM+MT combined with SD. Subgingival samples were studied. The effects of the therapies on probing depth and clinical attachment level, including interactions with Aa, Pg, or Tf at baseline, were explored using regression models.
Results: At 6 months, all treatment groups showed improved clinical outcomes in patients harboring Aa, Pg, or Tf at baseline compared to the patients who did not harbor these microorganisms at baseline. Indeed, in the presence of Aa, Pg, or Tf at baseline, the patients receiving antimicrobial protocols showed the most significant gains compared to the control group. Furthermore, the percentage of sites ≥ 6 mm was reduced in the test groups, compared to the control group; these periodontopathogens were not present in sites with probing depth ≥ 6 mm in the MXF group. The interactions of Aa, Pg, and Tf with the test groups significantly improved clinical parameters at 6 months (P < .001). Interestingly, the R2 value in the models that explored clinical attachment gain produced a high degree of correlation (> 0.75), indicating that a high percentage (> 75%) of the total variation in clinical attachment level gain can be explained by the independent variables.
Conclusions: Although all patients benefited from the treatments, patients harboring Aa, Pg, or Tf at baseline showed improved clinical benefits at 6 months, suggesting that Aa, Pg, or Tf at baseline may change the effects of systemic MXF and AM+MT in generalized periodontitis. After 6 months, Aa, Pg, and Tf were not present in sites with probing depth ≥ 6 mm in the MXF group. (Quintessence Int 2021;52:20–29; doi: 10.3290/j.qi.a44927)