Evaluation of antioxidant capacity and clinical assessment of patients with chronic periodontitis treated with non-surgical periodontal therapy and adjunctive systemic antibiotherapy

Abstract

This study aims to evaluate the oxidative stress changes in patients with chronic periodontitis (CP) undergoing non-surgical periodontal therapy alone, compared with non-surgical periodontal therapy with adjunctive systemic antibiotic therapy. Sixteen patients with CP, randomly assigned into two equal groups, were treated either with scaling and root planing (SRP) + Amoxicillin + Metronidazole, each 500 mg, three times daily, for seven days (test group), or with SRP + placebo for seven days (control group). Venous blood and unstimulated saliva samples were collected. Non-surgical periodontal therapy was performed simultaneously with antibiotics administration. Oxidative stress balance was evaluated by measuring derivatives of reactive oxygen metabolites (d-ROMs) and the biological antioxidant potential (BAP) in plasma. After the microscopic evaluation of the pathological aspect of the epithelial cells (ECs), their number, viability and the presence of C-reactive protein (CRP) were reevaluated from saliva at seven days, while reduced glutathione (GSH) level, d-ROMs and BAP at three months. Wilcoxon and Kruskal-Wallis rank-tests were used for statistics. At three months, statistical significant reductions of mean periodontal pocket depth (PPD) and clinical attachment level (CAL) gains (both p=0.01) were found in test group. Full-mouth plaque score (FMPS) decreased statistically significant in control group (p=0.02), d-ROMs decreased statistically significant in test group (mean difference 116.24±107.6 U CARR, p=0.01). Mean GSH, BAP level, number of ECs, their viability and CRP were statistically non-significant. In test group patients, oxidative stress status changed from a very high level to a medium one, suggesting that adjunctive use of antibiotics could have contributed to the reduction of reactive oxygen metabolites, along with significant clinical improvements.