Effect of systemic antibiotics on the outcomes of regenerative periodontal surgery in intrabony defects: a randomized, controlled, clinical study

Abstract

Objectives: To assess the potential influence of systemic antibiotic administration on the healing of periodontal intrabony defects treated with deproteinized bovine bone mineral (DBBM) and collagen membrane.

Materials and methods: Forty-one intrabony defects were treated by means of DBBM and collagen membrane (GTR). Postoperatively, the patients received either systemic antibiotics (i.e., 1 g of amoxicillin, twice daily for 7 days) (test) or no antibiotics (control). Clinical attachment level (CAL), probing depth (PD), and gingival recession (GR) were measured at baseline and at 1 year following regenerative surgery. The depth of the intrabony component (INTRA DD) and its width (INTRA DW) were measured during surgery and after 1 year at reentry. The depth (RxD) and width (RxW) of the intrabony defects were evaluated radiographically at baseline and at 1 year.

Results: No adverse events were observed in any of the two groups throughout the entire study period. In the test group, mean CAL changed from 8.7 ± 1.4 mm at baseline to 5.0 ± 1.7 mm at 1 year (p < 0.0001), while PD decreased from 7.8 ± 1.5 mm at baseline to 4.0 ± 0.9 mm at 1 year (p < 0.0001). In the control group, mean CAL changed from 8.6 ± 1.9 mm to 5.9 ± 1.6 mm (p < 0.001) and mean PD improved from 7.4 ± 1.3 mm to 4.1 ± 1.3 mm (p < 0.001). Mean CAL gain measured 3.6 ± 1.6 mm in the test and 2.7 ± 1.6 mm in the control group, respectively. Defect fill (i.e., INTRA DD gain) at re-entry measured 3.7 ± 1.8 mm in the test and 2.7 ± 2.1 mm in the control group. A CAL gain of ≥ 3 mm was measured in 76% of the defects in the test group and in 40% of the defects in the control group, respectively. In both groups, all evaluated clinical and radiographic parameters improved statistically significantly compared with baseline, but no statistically significant differences were found between the two groups.

Conclusions: Within their limits, the present study has failed to show any substantial added clinical benefits following the postoperative administration of amoxicillin in conjunction with regenerative periodontal surgery using DBBM and GTR.

Clinical relevance: The post-surgically administration of systemic antibiotics does not seem to be necessary following regenerative periodontal surgery.

Keywords: Deproteinized bovine bone mineral; Guided tissue regeneration; Periodontal intrabony defects; Periodontal regeneration; Systemic antibiotics.

Fig. 1

Consort flowchart of the study

Fig. 2

Representative bone defect treated with DBBM/GTR + AB (test group). (a) Baseline clinical view, lower right first molar (46) presenting with a pre-operative probing depth (PD) of 10 mm. (b) Surgical view after flap elevation and granulation tissue removal, intrasurgical probing of the defect (INTRA DD = 8 mm). (c) Surgical view after filling the defect with Cerabone® (botiss, biomaterials GmbH, Zossen, Germany) and covering with trimmed collagen membrane (Collprotect®, botiss, biomaterials GmbH, Zossen, Germany). (d) One year post-op clinical view, lower right first molar presenting with a post-operative probing depth (PD) of 4 mm. (e) One year post-op minimally invasive reentry; view of the buccal bone plate that has been restored. (f) Reentry; probing of the residual defect INTRA DD = 2 mm (after granulation tissue removal). (g) Baseline radiographic aspect of the intrabony defect distally to the lower right first molar. (h) Radiographic result 1 year after treatment

Fig. 3

Representative bone defect treated with DBBM/GTR (control group). (a) Baseline clinical view, lower left molar (36) presenting with a pre-operative probing depth (PD) of 9 mm. (b) Surgical view after flap elevation and granulation tissue removal, presenting with a intraoperative probing of the defect INTRA DD = 5 mm. (c) Surgical view of the lingual aspect of the bony defect. (d) Intrasurgical view of the defect filled with Cerabone® (botiss, biomaterials GmbH, Zossen, Germany) and covered with trimmed collagen membrane (Collprotect®, botiss, biomaterials GmbH, Zossen, Germany). (e) Clinical view 1 year after treatment; a post-operative probing depth (PD) of 4 mm. (f, g) One year post-op minimally invasive reentry; complete filling of the defect with bonelike tissue. (h) Reentry; probing of the residual defect INTRA DD = 3 mm (after granulation tissue removal). (i) Baseline radiographic aspect of intrabony defect mesially to the lower left first molar. (j) Radiographic result 1 year after treatment