Radiographic osseous regeneration after initial therapy with systemic doxycycline

Military Medicine, Oct 2000 by Fowler, Edward B

In contrast to these reports, Wennstrom et al. followed 16 patients who had been diagnosed with either LJP or post-WP for 5 years. They reported that meticulous scaling and root planing was as effective as modified Widman flap surgery, even though adjunctive antibiotics were not used. The authors felt that supervised maintenance was critical for preventing disease recurrence. They also stated that the healing response in this group of patients was similar to that seen in patients classified with adult-onset periodontitis.15

Several studies that have investigated the use of doxycycline in early-onset periodontitis have reported conflicting results. Asikainen et al. used 100 mg of doxycycline daily for 14 days as an adjunct to nonsurgical therapy in 16 WP patients.16 They reported that doxycycline did not appear to confer clinical or microbiological efficacy beyond that of root planing. Mandell et al. studied three modalities of treatment on four patients with LJP.17 They determined that only surgery with 14 days of adjunctive doxycycline therapy (200 mg on the first day, then 100 mg each day thereafter) was effective in treating LAP patients. Mandell and Socransky also reported on eight LJP patients treated with surgery and systemic doxycycline (200 mg on the first day, then 100 mg daily for 14 days).18 They followed these patients for 1 year and determined that even without initial therapy or osseous surgery, a flap for access and systemic antibiotics were effective in the treatment of WP. Elimination or suppression of Aa was associated with gains in clinical attachment levels and improved clinical appearance. High levels of Aa led to further loss of probing attachment. Recurrence was found in 25% of the patients and in 9% of the sites.

The following case presentation illustrates the use of systemic doxycycline as an adjunct to periodontal therapy during the treatment of a severe periodontal condition classified as rapidly progressive periodontitis.

Case Presentation

In November 1996, a 22-year-old African-American female soldier was referred to the periodontal department for evaluation of radiographic bone loss suggestive of WP. Her medical history was reviewed and found to be noncontributory. Extraoral and intraoral examinations revealed no pathology. Her dental examination was significant for numerous missing and impacted teeth as well as dental caries. A comparison of radiographs taken between 1993 and 1996 demonstrate a rapid progression of alveolar bone loss (Figs. 1 and 2).

The periodontal examination was significant for very poor hygiene. Gross plaque and calculus were noted, with generalized edema and erythema of the marginal gingiva. Suppuration was present at teeth 20 and 29. Probing depths were noted in all sextants, with the greatest depth of 10 mm recorded at the distal of tooth 20. At this appointment, the cause and treatment of periodontal diseases were discussed, as was proper home care.

The patient was classified with generalized severe periodontitis (American Dental Association type IV, probably rapidly progressive periodontitis. It was elected to provide initial therapy with adjunctive systemic antibiotics. Doxycycline (100 mg) was prescribed, with a regimen of one capsule twice a day for the first day, then one capsule daily until gone (a total of 21 days). The patient was instructed to start the antibiotic therapy 4 days before initial therapy. Scaling and root planing under local anesthesia were completed as two separate appointments 1 week apart. During the initial therapy phase, the improvement in this patient's hygiene was significant.