Title: Influence of Initial Bleeding Scores on Periodontal Treatment Responses

Objective: Recent studies suggest that subjects with periodontitis and high bleeding on probing (BOP>50%) have exaggerated inflammatory phenotypes at the biofilm-gingival interface(BGI).Our goal was to determine the effect of scaling and root planing(S&RP) on clinical and bacterial responses among BGI inflammatory groups.

Methods: This is a secondary analysis of a single-blinded, delayed-treatment-controlled, randomized clinical trial. A total of 106 patients were randomized to S&RP therapy or delayed treatment. Clinical parameters, serum and bacterial samples were collected at baseline 2 & 6 weeks and 3 & 6 months. All participants had Type III or IV periodontitis and were stratified post hoc into BGI-P2 [BOP>10%<50%,n=17(controls),n=19(S&RP)] and BGI-P3 [BOP>50%,n=36 controls),n=34(S&RP) p=.68]. Plaque and serum samples were assayed by checkerboard arrays for bacterial counts (8 organisms) and IgG titers (17 organisms). Data were analyzed by Chi-Square and ANCOVA adjusting for baseline values and delayed treatment control with significance defined as p<0.05.

Results: Baseline characteristics were balanced between the groups. Compared to untreated controls, both treatment groups showed a trend for clinical improvement s (GI ,PD ,BOP,AL) however only the BGI-P3 group showed a statistically significant sustained improvement in clinical signs over 6 months(p<0.05). Both BGI/S&RP groups demonstrated a peak in the 2-week IgG titers that decreased subsequently. At 6 months the BGI-2/S&RP group showed a significant 3.9-fold reduction in total bacterial counts compared to non-significant 1.9 fold reduction in total counts among BGI-3/S&RP. This suggests that the IgG response among BGI-3 subjects was not associated with a reduction in biofilm microbes, but was associated with clinical improvement.

Conclusions: These data suggest that the effects of scaling and root planing comparing the two BGI categories results in different biofilm and clinical outcomes. Work supported by RR00046 and P60-DE-13079.