Clinical effectiveness of subgingival application of 25%metronidazole gel as a monotherapy & as adjunctive treatment of chronic periodontitis


Metronidazole has been used successfully as an adjunctive antimicrobial drug inthe treatment of periodontal diseases. The aim of this study was to determine if twosubgingival applications of 25% metronidazole (MET) gel of one week interval aloneor adjunct to root planing (RP) have a significant effect on the following periodontalparameters: plaque index (PLI), bleeding on probing (BOP), Probing pocket depth(PPD), relative attachment level (RAL).A metronidazole 25 % dental gel has been developed for application locally intothe periodontal pocket, the gel disintegrates in the periodontal pocket and releasesmetronidazole. A total of 20 patients with an age range of (30-40) yr, each patientwith at least 4 sites with PPD ≥ 4mm and clinical attachment loss (1-2) mmparticipated in this study. The study protocol included a pretreatment phase of plaquecontrol instructions followed by scaling and polishing until the oral hygiene statusreached to mean PLI (0.4).An alginate impression was taken and an occlusal stent wasconstructed for each patient to measure the relative attachment level. A total of 270sites were randomly assigned to receive either 25% MET gel alone (group 1) or rootplaning plus 25% MET gel (group 2). Clinical periodontal parameters which include:PLI, BOP, PPD and RAL were recorded at day zero, after 2 weeks, 4 weeks, 6 weeksand 8 weeks.Statistical analysis of data of the two groups revealed significant improvements inall periodontal parameters (PPD, RAL, BOP) at all subsequent visits when comparedwith the base line, the same result was demonstrated when the two groups werecompared with each other at week 8 except (group 1) which did not show a significantgain in RAL at week 2 only. Mean plaque scores were improved in the two groups atall visits and non significant differences were demonstrated when the two groupswere compared with the baseline and at week 8.In conclusion, double applications of 25% MET gel subgingivally have a positiveeffect on reducing the clinical signs of periodontal disease.