Topical versus Systemic Antibiotics: Scaling and Root Planing Still Leads in Periodontal Therapy, Study Finds

While systemic metronidazole can penetrate deep into periodontal pockets, its use is often associated with side effects, including gastrointestinal disturbances and drug interactions. This led researchers to explore topical metronidazole in gel form as an alternative, given its targeted application and reduced systemic exposure. The findings suggest that the topical gel can be a safe and effective addition to SRP without the side effects associated with systemic delivery.

Chronic periodontitis is a progressive inflammatory disease that can lead to tooth loss if left untreated. The standard treatment for this condition is scaling and root planing considered the gold standard for managing periodontal diseases. However, using antibiotics as adjunctive therapies has gained attention for their potential to improve treatment outcomes.

Against the above background, Maryam Mehravani, Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran, and colleagues sought to evaluate and compare the impacts of local versus systemic metronidazole in managing chronic periodontitis.

For this purpose, the researchers conducted a randomized clinical study involving 30 patients, each contributing three teeth for evaluation. Participants were divided into three groups: one received SRP alone, the second received adjunctive treatment with metronidazole tablets, and the third received adjunctive treatment with metronidazole gel.

Key parameters—bleeding on probing (BOP), pocket probing depth (PPD), and clinical attachment level (CAL)—were assessed at baseline and three months post-treatment.

The key findings were as follows:

• There were significant improvements in BOP, CAL, and PPD levels across all treatments after three months compared to baseline.
• There were no significant differences in BOP, CAL, and PPD levels between the three treatment groups post-treatment.

The findings showed that metronidazole gel, metronidazole tablets, and SRP treatment effectively improved clinical parameters such as CAL, PPD, and BOP. However, adding local or systemic metronidazole in patients with periodontitis beyond Stage II and Grade B showed no significant advantage over SRP alone.

"SRP remains the gold standard for periodontal disease treatment, and further research is necessary to validate these findings," the researchers wrote.

"Systemic antibiotics can reach the depths of periodontal pockets but with notable side effects. As an alternative, a simpler form, such as a topical gel, may offer a more effective adjunctive therapy for treating chronic periodontitis," they concluded.

Reference:

Mehravani, M., Houshyar, E., Jamalnia, S., & Gharaaghaji, R. (2024). Effects of Local and Systemic Metronidazole as Adjunctive Treatment in Chronic Periodontitis Patients. Clinical and Experimental Dental Research, 10(6), e70050. https://doi.org/10.1002/cre2.70050