Adjunctive benefits of subantimicrobial dose doxycycline in the management of severe, generalized, chronic periodontitis

Background: Severe, generalized periodontitis is a form of chronic periodontitis that appears to be associated with an exaggerated host response. Little information is available on the benefits of using adjunctive host modulation in the management of this form of periodontal disease. Methods: Thirty subjects less than or equal to 45 years of age with severe, generalized periodontitis received subgingival debridement and oral hygiene instructions each week for 4 weeks, plus 6 months of adjunctive subantimicrobial doxycycline (SDD) or placebo. Periodontal status was monitored at baseline, and at 1, 3, 5.25, and,8.25 months following completion of the hygiene sessions. Maintenance therapy was performed at 3, 5.25, and 8.25 months for both groups. Results: Ten subjects in each group completed all phases of the study. Subgingival debridement plus adjunctive SDD reduced deep pockets (greater than or equal to7 mm at baseline) by an average of 3.02 mm after 9 months versus 1.42 mm for the placebo group. A significant clinical response was seen in both groups as soon as 1 month, but the response was always clinically and statistically greater in the SDD group. In the SDD group, nearly 40% of 237 pockets greater than or equal to7 mm were reduced by greater than or equal to4 mm, and 55% were reduced by greater than or equal to3 mm. In addition, only 2 pockets deepened by greater than or equal to4 mm in the SDD group versus 10 in the placebo group. Conclusions: The supplementation of hygienist-delivered full mouth subgingival and supragingival debridement with a hostmodulating agent, SDD, provides clinically and statistically significant benefits in the reduction of deep pockets in patients with severe, generalized periodontitis. In addition, adjunctive SDD is more effective than a placebo in preventing further increases in probing depth.