From the Guidelines
Treatment of aggressive periodontitis (AgP) should prioritize mechanical therapy, including thorough scaling and root planing, and emphasize meticulous daily oral hygiene, rather than relying on systemic antibiotics as a first-line treatment. The most recent and highest quality study 1 suggests that antibiotics should not be used as a primary treatment for chronic periodontitis or peri-implantitis, and their use in acute dental infections should be limited to specific cases with systemic involvement or severe infections. Key aspects of treatment include:
- Thorough scaling and root planing to remove bacterial plaque and calculus
- Regular maintenance appointments every 3 months to monitor and prevent disease recurrence
- Meticulous daily oral hygiene, including brushing twice daily with fluoride toothpaste and daily flossing
- Possible use of antimicrobial mouth rinses containing chlorhexidine 0.12% twice daily for two weeks following deep cleaning
- Addressing modifiable risk factors such as smoking cessation and diabetes control In severe cases, surgical interventions like flap surgery or regenerative procedures using bone grafts may be necessary. It's essential to note that the use of systemic antibiotics, such as amoxicillin and metronidazole, should be reserved for cases with systemic complications or severe infections, as recommended by recent guidelines 1. The treatment approach should be comprehensive, focusing on mechanical therapy, oral hygiene, and risk factor management, rather than relying solely on antibiotics.
From the Research
Treatment Guidelines for Aggressive Periodontitis (AgP)
- The goal of treatment is to create a clinical condition that is conducive to retaining as many teeth as possible for as long as possible 2.
- The initial phase of active treatment consists of mechanical debridement, either alone or supplemented with antimicrobial drugs 2.
- Systemic antibiotics as an adjuvant to scaling and root planing are more effective in controlling disease compared with scaling and root planing alone or with supplemental application of local antibiotics or antiseptics 2.
- Regimens of amoxicillin combined with metronidazole or regimens of clindamycin are the most effective and are preferable to regimens containing doxycycline 2.
- Azithromycin has been shown to be a valid alternative to the regimen of amoxicillin plus metronidazole 2.
- Surgical treatment, including access surgery and regenerative techniques, has shown good results in patients with aggressive periodontitis, provided that proper oral hygiene is maintained, a strict maintenance program is followed, and modifiable risk factors are controlled 2.
- Minimally invasive flap surgery and enamel matrix derivative have been used in the treatment of localized aggressive periodontitis, with good efficacy and stability of the treatment outcome 3.
- Systemic use of combined amoxicillin and metronidazole as an adjunctive treatment to full-mouth scaling and root planing has been proposed for the treatment of generalized aggressive periodontitis, with significant gain in clinical attachment level and reduction in probing depth 4.
Treatment Outcomes
- Full-mouth scaling and root planing within 24 hours, with or without adjunctive use of an antiseptic, has been compared to conventional quadrant subgingival instrumentation, with no clear evidence of a benefit for full-mouth scaling or full-mouth disinfection over conventional treatment 5.
- One stage full-mouth disinfection has been shown to result in a significant additional probing depth reduction and gain in attachment up to 8 months, compared to standard therapy 6.
- The use of systemic amoxicillin/metronidazole as an adjunctive therapy to full-mouth scaling and root planing has been shown to be effective and safe in the treatment of aggressive periodontitis 4.