Aggressive periodontitis is a rapidly progressing form of periodontal disease, characterized by alveolar bone loss and significant attachment loss despite relatively small amounts of plaque and calculus. The rapid tissue destruction in aggressive periodontitis demands a more intensive therapeutic approach compared to chronic periodontitis. The primary treatment remains based on mechanical debridement principles, namely Scaling and Root Planing (SRP). However, due to the involvement of specific bacteria such as Aggregatibacter actinomycetemcomitans and a hyperactive immune response, adjunctive therapy such as local antibiotics is often indicated.
Principles of Combination Therapy
1. Mechanical Debridement (Scaling and Root Planing)
A non-surgical procedure to remove subgingival biofilm, endotoxins, and calculus that harbor pathogenic bacteria. SRP aims to:
- Reduce pocket depth
- Improve tissue attachment
- Inhibit progression of bone destruction
2. Local Antibiotics
Local antibiotics can be applied directly into the periodontal pocket in the form of gels, chips, or microspheres. Their advantages include:
- High drug concentration at the target site
- Low risk of systemic side effects
- Longer duration of action within the pocket
Benefits of Combining SRP with Local Antibiotics
- Greater bacterial reduction,especially anaerobic bacteria associated with aggressive periodontitis
- Faster clinical recoverysuch as reduction in bleeding on probing (BOP) and probing depth
- Overcoming the limitations of mechanical access in deep pockets or furcation areas
- Preventing bacterial recolonization after mechanical cleaning
In cases of aggressive periodontitis, as discussed in an article in the MKGI Journal, Faculty of Dentistry, UGM by Dr. Dahlia Herawati, SU, Sp.Perio(K), particularly in generalized forms, the combination of SRP and local antibiotics is strongly recommended as a first-line approach before considering systemic or surgical therapy.
***
Combination therapy using mechanical debridement and local antibiotics has been proven effective in controlling aggressive periodontitis. This approach allows for more thorough eradication of pathogenic microorganisms and supports the healing of damaged periodontal tissues. Proper case selection and long-term follow-up are crucial to ensure the success of this therapy.
References
MKGI, Dr. drg. Dahlia Herawati, SU, Sp.Perio(K), Combination Therapy of Root Debridement and Antibiotics in Aggressive Periodontitis, https://journal.ugm.ac.id/mkgi/article/view/15426
Author: Rizky B. Hendrawan | Editor: drg. Aulia Ayub, Sp.Ort
Photo: Freepik
