The Effects of Antibiotics in Conjunction with Scaling and Root Planing in the Management of Acute Periodontal Abscess
Periodontal abscess is an acute condition requiring an emergency care. Thorough scaling/ root planing (SRP) in severely inflamed tissue usually results in marked gingival recession, thus unaesthetic outcome. Objective: To compare the clinical outcomes of pre-SRP antibiotic admi- nistration to SRP alone to in the management of periodontal abscess. Methods: Twenty patients (mean aged 46.2 years) with periodontal abscesses were randomly assigned to one of 4 groups, i.e., (1) SRP alone, (2) systemic doxycycline, (3) local delivery 2% minocycline gel (Periocline), or (4) local delivery 25% metronidazole gel (Elyzol®). At baseline, drainage of the abscess was performed for all patients. Then, group 1 received SRP, while other groups received antibiotics, according to their regimens starting from day 0. At week 2 where inflammation subsided, SRP was performed for groups 2, 3 and 4. Clinical parameters including gingival margin level (GM-CEJ), probing depth (PD), clinical attachment level (CAL), plaque index, and tooth mobility were measured at baseline, 1, 2 and 3 months. Results: At baseline, average PDs ranged 7.5-8.9 mm with average CALs of 7.0-9.4 mm. There were no statistically significant differences in baseline PDs and CALs among groups. At month 3, all groups demon- strated significant PD reductions and CAL gains with significantly more REC (p<0.05). All antibiotic groups tended to respond clinically better than SRP group. PD reductions at 3 months were 3.8, 4.6, 4.6 and 5.2 mm, with CAL gains of 2.5, 3.1, 3.0 and 3.7 mm in groups 1, 2, 3 and 4, respectively. Groups 1, 2, 3 and 4 demonstrated changes in REC of 1.3, 1.5, 1.5 and 1.5 mm, respectively. However, there were no statistically significant differences in changes in REC, PD reductions and CAL gains among groups. Conclusion: The use of antibiotics prior to SRP did not result in additional improvements in clinical outcomes when compared to SRP alone in management of periodontal abscess.
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