Effect of combined antibiotic therapy on gingival crevicular fluid enzymes

Objective: Creatine kinase (CK), lactate dehydrogenase (LDH), and aspartate aminotransferase (AST) are three functionally related intracytoplasmic enzymes that are involved in the pathogenesis of periodontal diseases. The aim of the present study was to evaluate the potential effect of combined treatment on clinical periodontal status and the gingival crevicular fluid (GCF) levels of these enzymes in aggressive periodontitis (AP). Methods: A total of 31 AP patients were included and were divided into 2 groups based on the provided treatment. While in one group (n=16) (29±5.22) only non-surgical treatment was provided, in the other group (n=15) (27±5.3) a course of antibiotic therapy (250 mg metronidazole+375 mg amoxicillinx3 for 7 days) before non-surgical therapy was provided. Besides clinical parameters (Gingival Index (GI), Gingival Bleeding Time Index (GBTI), Plaque Index (PI), and probing depths (PD), GCF samples were obtained and enzyme levels were spectrophotometrically analyzed at baseline, 10 days after antibiotic treatment and 2 weeks after completion of non-surgical treatment. Fifteen periodontally healthy individuals served as the control group. While Mann-Whitney U test was used for among-group comparisons, for within-group comparisons Wilcoxon paired signed rank test was used. Results: At baseline all clinical values and GCF enzyme levels were higher in all AP patients than the controls (p<0.05). Non-surgical treatment alone, reduced clinical parameters (p<0.05), but did not significantly change enzyme levels (p>0.05). However, when non-surgical treatment was combined with antibiotic treatment a decrease in both the clinical scores and enzyme levels (even lower than the healthy group) at both stages were observed (p<0.05). Conclusion: These findings may indicate the benefit of the provision of combination of systemic metronidazole plus amoxicillin treatment prior to scaling and root planning for the improvement of clinical periodontal status and enzymatic profile of GCF and also for reducing the need for surgical periodontal therapy.