Antibiotics in the treatment of young patients with molar‐incisor pattern periodontitis (C‐MIP)

Abstract Grade C molar‐incisor pattern periodontitis (C‐MIP) is characterized by an aggressive and rapid loss of tooth‐supporting structures, affecting 1st molars incisors. This response seems to be due to an exaggerated host inflammatory response triggered by a dysbiotic and specific microbial environment. With higher prevalence in young individuals of lower socioeconomic status and African descendants, or from mixed‐race populations, this disease also shows a strong familial aggregation that points to a genetic contribution, not yet fully elucidated. Despite the high focus on 1st molar and incisor permanent dentition with usual onset around puberty, this aggressive attachment bone loss has also been reported in the primary dentition, with some retrospective studies suggesting a possible disease initiation in the prepubertal stages. A. actinomycetemcomitans has been strongly implicated in C‐MIP severity and progression, although newer technologies have pointed out some other associated species implicated in this disease. Although several clinical therapies have been proposed to treat C‐MIP over time, nonsurgical mechanical treatment with systemic antibiotics (ABX) has shown a positive impact on clinical, immunological, and microbiological outcomes in the short and long term, both in primary and permanent affected dentitions. Despite the limited comparative clinical trials approaching C‐MIP, the combination of adjunctive amoxicillin (AMX) and metronidazole (MTZ) with nonsurgical debridement is the most recommended ABX regimen to date. Several bacterial species associated with C‐MIP are also reduced following this regimen, along with an increased number of health‐associated species and modulation of the inflammatory response, both locally and systemically, associated with clinical parameters of success. Despite the systemic ABX benefits, the authors emphasize the importance of early diagnosis and patients' compliance with frequent maintenance care to sustain successful outcomes. Surgical intervention may also be recommended based on remaining residual pockets, along with residual intrabony defects and furcation involvement. In this review, the authors also highlight a comparison of treatment approaches with generalized forms of the disease in young individuals (C‐G) and discuss potential future strategies to understand better, prevent, and successfully treat this aggressive disease.