Periodontal Regeneration with a Doxycycline Containing Barrier and Autogeneous Bone

Objectives: Results of periodontal regenerative procedures have been shown to vary with the presence of putative periodontal pathogens or smoking habits. This randomized controlled trial assessed the efficacy of a barrier containing 4% doxycycline in combination with autogenous bone graft in the treatment of intra-osseous defects.

Methods: 51 patients with at least one intra-osseous defect (≥4mm) were included into this two center study. Patients received full mouth mechanical debridement and, if necessary, resective surgery in posterior sites other than the investigational sites. Sites with remaining pocket probing depth ≥ 5 mm received local 8.8% doxycyline hyclate in a poly (DL-lactide) carrier. Patients were balanced with respect to smoking habits and randomly assigned to test (a 4% doxycycline containing poly (DL-lactide) barrier and autogenous bone graft) or control therapy (access flap). Supportive periodontal therapy was performed in three to six months intervalls. Primary outcome variable was the change in alveolar bone level after 12 months. Secondary variables were soft tissue measurements and intraoral infection patterns

Results: 23 test and 25 control patients completed the 12-month trial. Differences in alveolar bone gain between test and control group failed to reach statistical significance (2.58±0.81mm and 1.91±1.61mm, respectively, P≥0.05). In smokers, however, test patients showed significantly more alveolar bone gain compared to controls (2.43±1.01mm and 0.8±0.86mm, respectively, P<0.05). Attachment level gain was 1.81±1.78mm in test and 1.52±1.57mm in control group patients, whereas pocket probing depth reduction was 2.67±1.12mm and 2.11±1.42mm, respectively (P<0.05). Periodontal pathogens prevalence declined following therapy and by the end of the study, returned to or even above baseline levels.

Conclusion: Following comprehensive antimicrobial therapy, both the assessed regenerative surgical approach and flap debridement alone can result in significant bone gain in intra-osseous periodontal defects. Active smokers may benefit most from the assessed regenerative therapy. Supported by Atrix GmbH, Bad Homburg, Germany.