Clinical and Immunological Changes Following Different Antibiotics in Aggressive Periodontitis

Objective: To examine changes in clinical parameters and cytokines levels in gingival crevicular fluid (GCF) of patients with aggressive periodontitis (AgP) who received mechanical periodontal therapy in conjunction with systemic antibiotic. Methods: AgP patients have been enrolled. They received conventional periodontal mechanical therapy, and randomly assigned either doxycyline (100mg daily) or amoxicillin (500mg tid) plus metronidazole (250mg tid). At baseline and 3 months later, patients were examined clinically and PI, GI, PPD, CAL were recorded; GCF samples were taken from Ramfjord index teeth. IL-1b, TNF-a, PGE2 amounts were analyzed using a commercially available ELISA kit and Sunrise reader. Results: Twenty patients were enrolled, eight completed both treatment and measurements and are included in this report. Mean baseline clinical parameters were similar for both groups. At 3 months, both groups exhibited statistically significant changes: PI {1.16 (p=0.0028) and 0.86 (p=0.026)}, GI {1.17 (p=0.0057) and 1.06 (p=0.0079)}, PPD {0.927 mm (p=0.0038) and 0.99 mm (p=0.0001)}, CAL{1.9mm (p=0.0418) and 1.875mm (p=0.0195)}for the Doxy and Pen-Met groups ,respectively ; however there was no statistical difference between groups. Mean PGE2 had decreased significantly from 236.4pg at baseline to 84.4pg at 3 months (p=0.016). To the contrary, TNF-a showed minimal insignificant changes. IL-1b levels showed greater reduction from 105.86±19.21ng to 47.89±33.68ng; however these changes did not reach statistical significance (p=0.1985). Comparing both groups for changes in cytokine levels, non was proven superior to the other (DPGE2 =83.35; 86.47; DIL-1b= 19.26;38.95; TNF-a=0.6; -1.72; for Doxy and Pen-Met groups respectively, p>0.05). Pearson`s correlation co-efficient test showed that baseline GI was found to be associated with PGE2 levels (r=0.655, p=0.077). Conclusion: Mechanical and chemical therapy has proven effective, using both antibiotic protocols. Cytokines and PGE2 levels have shown to be significantly correlated with the degree of inflammation, which may provide another diagnostic tool for monitoring the effectiveness of periodontal therapy