1. 謝世賢 ▲ ( Hsieh SH), 林承俊 ( Lin CJ) 戴德森醫療財團法人嘉義基督教醫院牙周病科 (Periodontal Department of Ditmanson Medical Chia-Yi Christian Hospital) Systemic administration of doxycycline in the treatment of aggressive periodontitis – a case report 系統性抗生素用於治療侵犯性牙周炎之病例報告 Introduction Introduction Aggressive periodontitis which is known about its poor prognosis than chronic periodontitis becase of responding unpredictably to conventional therapy, including oral hygiene instructions (OHI), non-surgical therapy, surgery, and Supportive Periodontal therapy (SPT). There is compelling evidence that adjunctive antibiotic treatment frequently results in more favorable clinical response than conventional therapy alone. The object of our report was to evaluate the clinical effect of systemic tetracycline derivative- doxycycline for patient with aggesressive periodntitits during non-surgical treatment. Case report The patient is a 48 year-old male with his complain about pus discharge from sulcus of multiple teeth. According to the criteria offered by the American Academy of Periodontology in 1999,the patient was diagnosed as general aggressive periodontitis. Because his teeth number is more than 20, and shows clinical attachment loss and a probing pocket depth (PPD) of ≥ 6 mm more than 2 sites in least 12 teeth during the screening examination. At least 3 teeth other than the first molars and incisors were involved, and observation with absence of large accumulations of plaque and calculus (fig.1 & fig.2). He underwent a hygiene phase that involved supragingival scaling and polishing, and was instructed in proper oral hygiene. Full mouth subgingival scaling and root planing was performed following with chlorhexidine mouthwash irrigation once a week for a month. We performed mechanical debridement combine doxycycline 100mg once daily for one month during non-surgical phase. Clinical parameters for all teeth present were measured at baseline and 2 months after treatment. Probing depth, clinical attachment level, gingival index, gingival bleeding index and plaque index were measured to identify the periodontal status. The outcome of re-evaluaiton demonstrated obvious improvement in these clinical parameters and stable periodontal tissue situation at following 3 months recall visit (fig.3). Fig.1 The patients were clinically and radiographically evaluated for GAP according to the criteria accepted by the American Academy of Periodontology in 1999. Fig.2 Initial full mouth photogaphic. Fig.3 Full mouth photogaphic after mechanical treatment in combination with systemic antibiotics Discussion Discussion The presence of periodontal pathogens, specifically A. actinomycetemcomitans, has been suspected as the etiology that aggressive periodontitis does not respond to conventional therapy alone 1. The use of systemic antibiotics was considered to be necessary to eliminate pathogenic bacteria from the periodontal pocket. An ideal antibiotic therapy for prevention and treatment of periodontal disease should be specific for periodontal pathogens, inexpensive, nontoxic, and not in general use for treatment of other diseases 2. Currently, an ideal such antibiotics does not exist 3. Many studies support the use of mechanical treatment in combination with systemic antibiotics for general aggressive periodontitis (GAP) although no specific treatment protocol and types of antibiotics were recommended 4 5. The importance of doxycycline arises from the fact that it has higher availability in gingival sulcus about 7–20 times more than than other drug 6. In current studies, combination of mechanical debridement and antibiotics improved the PD and CAL with GAP, and then reduced the opportunity for periodontal surgery. In this case a significant decrease in deep pocket depth and improvement of periodontal condition were observed. Systemic use of doxycycline as an adjunct to conventional therapy may be used for the patients with aggressive periodontitis, and the effect of treatment is predictable. Doxycycline may be an appropriate treatment option for patients with general aggressive periodontitis. However, more long-term studies are also necessary. Reference: 1. Christersson LA, Wikesjo UM, Albini B, Zambon JJ, Genco RJ. Tissue localization of Actinobacillus actinomycetemcomitans in human periodontitis. II. Correlation between immunofluorescence and culture techniques. J Periodontol. 1987;58:540 2.Gibson W. Antibiotics and periodontal disease: A selective review of the literature. J Am Dent Assoc.1982;104:213. 3.Jorgensen MG, Slots J. Practical antimicrobial periodontal therapy. Compend Contin Educ Dent.2000;21:111 4.Haffajee AD, Socransky SS, Gunsolley JC. Systemic anti-infective periodontal therapy. A systematic review. Ann Periodontol. 2003 Dec;8(1):115-81 5.Herrera D, Alonso B, Leon R, Roldán S, Sanz M. Antimicrobial therapy in periodontitis: the use of systemic antimicrobials against the subgingival biofilm. J Clin Periodontol. 2008 Sep;35(8 Suppl):45-66 6.Slots J, Rams TE. Antibiotics and periodontal therapy: Advantages and disadvantages. J Clin Periodontol. 1990;17:479 7.Parameter on aggressive periodontitis. American Academy of Periodontology. J Periodontol. 2000 May;71(5 Suppl):867-9 Conclusion Conclusion