Influence of Scaling and Root Planing with Minocycline Microspheres on Clinical Outcomes of Patients with Periodontitis

Background: Scaling and root planning (SRP) has been established as a “gold-standard” non-surgical initial treatment for periodontitis. Along with SRP, some systemic adjuncts like systemic antibiotics were used in the past to gain maximum benefits of SRP by reducing the need for further periodontal surgeries. Due to some drawbacks of systemic antibiotic use, like “transient antibiotic resistance”, “non-adherence” and “insufficient concentrations in the periodontal pockets to be clinically effective”, there was a shift towards the use of local antibiotic adjuncts to SRP like minocycline, tetracycline, chlorhexidine etc. Minocycline is a semi-synthetic tetracycline derivative which is available in a powder form, clinically marketed as “Arestin*”. With its property of substantivity (remains active in the periodontal pocket upto 7-10 days and releases minocycline till 14 days) and dual mode of action(bactericidal and minimize tissue destruction), it seems to be clinically effective as an adjunct to SRP, however, the evidence is heterogenous. Aim: To identify the change in proportion of sites with residual periodontal pocket depth (PD) >/=5mm in a patient with periodontitis when treated with initial non-surgical therapy of SRP alone or in combination with locally administered minocycline microspheres(MM, Arestin*). Also to detect any difference within groups(SRP alone v/s SRP + MM) and amongst groups from baseline to final follow up visit for different PD categories of shallow (PD 1-4mm), moderately deep(5-6mm) and deep (>/=7mm) and bleeding on probing(BOP) and furcation involvement(FI).(This study is a part of the larger study aiming to detect the compositional and functional difference in the microbiome of the subgingival plaque samples obtained from different PD categories for patients with periodontitis before and after treatment with either SRP alone or SRP + MM and compare it with healthy patients.) Materials and Methods: This was a randomized clinical trial. 28 Stage II, III or IV periodontitis patients were enrolled in the study. There were 4 visits in the study. 1st visit consisted of enrolment, periodontal exam and radiographic exam. 2nd visit was scheduled after 2 weeks of 1st visit and entailed removal of supragingival plaque from shallow, moderately deep and deep PD sites, collection of subgingival plaque from these sites. 3rd visit included the treatment with either SRP alone or in combination with MM. 4th visit was scheduled after 2 months of 3rd visit and plaque samples were collected the same way from the same sites as visit 2, followed by periodontal exam. Results: From a total of 28