4. Discussion
periodontitis, USI, LDD, tooth
PERIODONTITIS
To our knowledge, the present study is the only clinical trial comparing the clinical and microbiological effects of GelcideThe S3-level clinical guideline for the treatment of periodontitis [There are currently only two studies available assessing the clinical and microbiological effectiveness of locally applied piperacillin plus tazobactam in patients with periodontitis. They reported adjunctive benefits of modest magnitude and limited duration. Our results also showed improvements in clinical parameters after SI + locally delivered antibiotics; however, they were similar to SI alone.This study proposed doxycycline and piperacillin plus tazobactam as effective antibacterial agents in subjects diagnosed with stage III-IV periodontitis with deep pockets, while in other similar studies, more shallow periodontal sites have been studied [In the current study, the PPD decrease in all three study groups was similar to PPD reductions in earlier studies following combined SI and local antibiotics [Regarding BOP, the baseline proportion of sites was GelcideCAL showed significant differences in all groups at 3 and 6 months (In our study, patients’ levels of hygiene improved. The intragroup analysis showed a statistically significant reduction in FMPS at the 3-month time point (The adjunctive use of piperacillin plus tazobactam in conjunction with SI in Step 3 therapy showed a tendency to produce better clinical and microbiological results, although not reaching a statistical difference. At 3 months after the application, the percentage of patients that achieved the endpoint of therapy (PPD ≤ 4 mm and BOP absence) was greater but not statistically significant in group A, and almost remained stable over time. Based on the evidence of the importance of this endpoint for the stability of the periodontal condition [Regarding pocket closure in the present study, a reduction of 65.48% was recorded after 3 months in group A, 60.23% in group B, and 58.33% in the placebo group, respectively. At the end of the follow-up, the pocket closure attained 46.43% in group A, 43.18% in group B, and 36.90% in the placebo group, respectively. The reduction was almost comparable with the reduction after nonsurgical periodontal therapy reported by Tomasi et al. (expressed as 50% of the tooth sites with an initial PD ≥ 5 mm after 3 months), in a study using locally delivered doxycycline, as well [In our trial, the reduction in biofilm was achieved by using repeated USI at sites with PPD ≥4 mm at the 3- and 6-month follow-up for both the test and control groups, while the gel application was performed only once, counting on the duration of the adjunctive advantage of GelcideDue to the broad range of pertinent factors that vary from research to research, such as the included teeth, treatment duration, and study population, it is rather challenging to evaluate the clinical results obtained by various controlled clinical trials involving topical administration adjuvant to SI. In general, the outcomes for SI alone, when compared to SI combined with LDD at 3 and 6 months after therapy, were less favorable in all studies on adjunctive topical delivery of antibiotics evaluated [There are currently few clinical studies examining the effectiveness of treating stage III-IV periodontitis patients with a single dose of piperacillin plus tazobactam to reduce bacterial counts in periodontal pockets [The inclusion of the antibiotics in an insoluble biodegradable pellicle generated by mixing with a volatile polymer could be one of the possible benefits of the piperacillin plus tazobactam formulation. The manufacturers claim that this novel presentation is able to keep the antibiotic active for 7–12 days after the application in the periodontal pocket; however, these claims are not backed by published research so far. Further studies should clarify this aspect, as well.The major strength of this study is the fact that this is the first study comparing piperacillin plus tazobactam gel with doxycycline and a placebo gel as an adjunct to subgingival instrumentation. The limitations of this study include the unknown duration of the effect of the adjunctive topical administration of antibiotics and the relatively short follow-up period. Despite the effect’s decrease over time, the improvements noted during the follow-up period may be sufficient to demonstrate some benefit of the treatment, as LDDs are anticipated to have the strongest antimicrobial effects during the first few days following treatment, when still detectable in subgingival sites [