Efectos del raspaje y alisado radicular a boca completa con azitromicina sobre los niveles de proteina C reactiva ultra sensible, parametros clínicos y microbiológicos periodontales. Ensayo clinico aleatorizado

• Soto-Franco, Jorge-Enrique ^[1] ; Aldana, Heberth-Fernando ^[1] ; Navia, Juan-Manuel ^[2] ; Peláez, Melissa ^[1] ; Quisoboni, Jorge ^[1] ; O'Meara, María-Alexandra ^[1] ; Contreras, Adolfo ^[1]
  1. [1] Universidad del Valle (Colombia)

     Universidad del Valle (Colombia)

     Colombia

     
  2. [2] Odontólogo, Especialista en Periodoncia
• Localización: Revista Estomatología, ISSN-e 2248-7220, Vol. 24, Nº. 2, 2016
• Idioma: español
• Títulos paralelos:
  • High sensitive- C reactive protein, periodontal parameters and periodontal microbiota after scaling-root planning plus Azithromycin as treatment of Chronic Periodontitis: A Randomized Clinical Trial
• Enlaces
  • Texto completo (pdf)
• Dialnet Métricas: 1 Cita
• Resumen
  • español

    RESUMENObjetivo: El propósito de este ensayo clínico controlado aleatorizado simpleciego fue determinar el efecto del raspaje y alisado radicular en una sesión adjunto a azitromicina oral, sobre los niveles de proteína C reactiva ultra sensible y otros biomarcadores sanguíneos, parámetros clínicos y microbiológicos periodontales en pacientes con periodontitis crónica tres meses después del tratamiento.

    Materiales y Métodos: 49 sujetos con periodontitis crónica participaron en el estudio y fueron asignados aleatoriamente en dos grupos de 27 pacientes, el grupo intervención recibió raspaje y alisado radicular adjunto a azitromicina (RAR+Azi) 500 mg/día por cinco días, y el grupo control recibió raspaje y alisado radicular más placebo (RAR+Pb), ambos tratamiento en sesión única. Los grupos de periodontitisrecibieron un examen periodontal a boca completa, análisis de sangre y cultivos microbiológicos al inicio del estudio y tres meses después del tratamiento. Se incluyó un grupo referencia de 25 pacientes periodontalmente sanos tomando muestras sólo al inicio. La variable principal de desenlace fue la variación de la proteína C reactiva ultra sensible. Las variables de resultado secundarias fueron la variación de trigliceridos, colesterol de alta densidad (HDL), colesterol de baja densidad (LDL), glucosa en ayunas, profundidad al sondaje (PS) y composición microbiana.

    Resultados: La terapia RAR+Azi no redujo significativamente los niveles plasmáticosde hsPCR, sin embargo, se observó una tendencia positiva (4,33 a 2,99 mg/L). Este grupo obtuvo también una mayor reducción en PS, índice arterial y frecuencia de detección de Porphyromonas gingivalis y Prevotela intermedia en comparación con el grupo RAR+Pb (p-0.05). Los otros parámetros sanguíneos no cambiaron significativamente. En contraste, el grupo control aumentó los niveles de hsPCR después dela terapia y en algunos casos se detectó un aumento de PS.

    Conclusiones: La terapia de RAR+Azi ofrece a corto plazo beneficios clínicos y microbiológicos comparado a RAR solo. No se encontraron diferencias significativas en los niveles de hsPCR. Es necesariorealizar estudios con mayor tiempo de seguimiento para confirmar o rechazar la hipótesis que el tratamiento periodontal solo o con antibióticos generan efectos enlos niveles de hsPCR y otros marcadores de riesgo cardiovascular.

    Palabras clave: Periodontitis crónica,proteína C reactiva, azitromicina, ensayoclínico aleatorizado.

  • español

    clinical trial (RCT) determined the effect ofscaling and root planning plus azithromycin(SRP+Azi) in serum C reactive proteinlevels and other blood biomarkers, clinicalperiodontal parameters and subgingivalmicrobial composition three months afterperiodontal therapy.Materials and Methods: Forty-ninechronic periodontitis patients participatedin the study and were randomly assigned to a test group of 27 patients received onesession of scaling and root planning plusoral azithromycin 500 mg daily for fivedays (SRP+Azi) while, 27 patients in thecontrol group received the same singlesession of scaling and root planning plusplacebo (SRP+Pb). A group of 25 subjectspresenting periodontal health-gingivitiswere included as a comparison group andin them was determined clinical periodontalparameters, blood parameters and microbiotaat baseline. Periodontitis groups receiveda full mouth periodontal examination,blood test and microbiological cultures atbaseline, and three months after therapy.Primary outcome variable was the variationin serum high sensitive C- reactive protein(hs-CRP). Secondary outcome variableswere variation of triglycerides, Highdensity Cholesterol (HDL), low densityCholesterol (LDL), fasting glucose, pocketdepth and microbial composition.Results: Therapy with SRP+Azi do notsignificantly reduce the plasmatic levels ofhs-CRP however, a positive trend was notice(4,33 to 2,99 mg/l). This group obtainedalso greater reduction of pocket depth (PD),artery index and P. gingivalis and P intermediadetection frequency when comparedto the SRP-placebo group (p<0.05). Otherblood biochemistry parameters did notchanged significantly in the test group. Incontrast, the control group increased the hs-CRP levels after therapy and in some casesa increase of pocket depth was detected.Conclusions: Combined SRP+Azi therapyin chronic periodontitis did not reduced hs-CRP serum level significantly after threemonths. However, this group reduced significantlytheir probing pocket depth, reducedP. gingivalis and P intermedia frequencyand increased clinical attachment gain.

  • English

    Objective: This single blind randomized clinical trial (RCT) determined the effect of scaling and root planning plus azithromycin (SRP+Azi) in serum C reactive protein levels and other blood biomarkers, clinical periodontal parameters and subgingival microbial composition three months after periodontal therapy.

    Materials and Methods: Forty-nine chronic periodontitis patients participatedin the study and were randomly assignedsession of scaling and root planning plus oral azithromycin 500 mg daily for five days (SRP+Azi) while, 27 patients in the control group received the same single session of scaling and root planning plus placebo (SRP+Pb). A group of 25 subjects presenting periodontal health-gingivitis were included as a comparison group and in them was determined clinical periodontal parameters, blood parameters and microbiota at baseline. Periodontitis groups received a full mouth periodontal examination, blood test and microbiological cultures at baseline, and three months after therapy.

    Primary outcome variable was the variation in serum high sensitive C- reactive protein (hs-CRP). Secondary outcome variables were variation of triglycerides, High density Cholesterol (HDL), low density Cholesterol (LDL), fasting glucose, pocket depth and microbial composition.

    Results: Therapy with SRP+Azi do not significantly reduce the plasmatic levels of hs-CRP however, a positive trend was notice (4,33 to 2,99 mg/l). This group obtained also greater reduction of pocket depth (PD), artery index and P. gingivalis and P intermedia detection frequency when compared to the SRP placebo group (p<0.05). Other blood biochemistry parameters did not changed significantly in the test group. In contrast, the control group increased the hs- CRP levels after therapy and in some cases a increase of pocket depth was detected.

    Conclusions: Combined SRP+Azi therapy in chronic periodontitis did not reduced hs- CRP serum level significantly after three months. However, this group reduced significantly their probing pocket depth, reduced P. gingivalis and P intermedia frequency and increased clinical attachment gain.

    Key words: Chronic periodontitis, Creactive protein, azithromycin, randomized clinical trial.