Combining host modulation and topical antimicrobial therapy in the management of moderate to severe periodontitis: A randomized multicenter trial

Background: Previous studies showed that host modulation therapy (HMT) or topical antimicrobial therapy (TAT) provided significant adjunctive benefits to scaling and root planing (SRP) in the treatment of chronic periodontitis (CP). The purpose of this study was to evaluate a combination therapy involving SRP, HMT, and TAT in the treatment of moderate to severe CP. Methods: A 6-month, randomized, multicenter, placebo-controlled, examiner-masked study was undertaken to evaluate the clinical usefulness of a combination treatment of systemically delivered doxycycline hyclate (HMT; 20 mg, twice a day) plus locally delivered doxycycline hyclate gel (TAT; 10%, in pockets ≥5 mm) in combination with SRP versus SRP plus placebo. Clinical outcomes included mean changes in probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and gingival index (GI) at baseline and at 3 and 6 months. Results: In 171 subjects, combination therapy provided significantly greater clinical benefits than control therapy for all clinical measures at 3 and 6 months. In moderate CP (PD of 4 to 6 mm), combination therapy provided significant benefits over control for PD (3 and 6 months: P<0.01), CAL (3 months: P<0.01; 6 months: P <0.03), BOP (3 months: P<0.02; 6 months: P<0.05), and Gl (3 months: P<0.01; 6 months: P<0.03). In severe CP (PD ≥7 mm), combination therapy provided significant benefits over control for PD (3 and 6 months: P<0.01), CAL (3 months: P<0.01; 6 months: P<0.02), BOP (3 months: P<0.01; 6 months: P>0.05), and GI (3 months: P<0.01; 6 months: P<0.01). Conclusion: Combination therapy, including SRP, HMT, and TAT, provided significantly greater clinical benefits than SRP alone in the treatment of moderate to severe CP.