Minocycline or glycine air polishing with endoscope-assisted SRP improves periodontal parameters and reduces inflammation in periodontitis.

Periodontitis, a chronic inflammatory disease affecting the supporting structures of teeth, is a major cause of tooth loss. Current standard-of-care, scaling and root planing (SRP), often leaves residual pockets, leading to disease recurrence. The persistent bacterial biofilm and associated inflammatory response, involving cytokines like interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), necessitate more effective adjunctive therapies. This study investigates whether advanced mechanical debridement via endoscope-assisted SRP, combined with either an antimicrobial like minocycline hydrochloride or a biofilm disruption method like subgingival air polishing with glycine powder, can enhance outcomes in these challenging residual pockets.

This single-center, randomized controlled trial (RCT) enrolled 80 patients with periodontitis (Stage II-IV, Grade A-C). Patients were randomized into four groups: SRP alone, endoscope-assisted SRP (E-SRP), E-SRP plus minocycline hydrochloride (E-SRP+M), or E-SRP plus subgingival air polishing (E-SRP+AP) using glycine powder. The primary outcome was mean reduction in probing depth (PD) at 6 months in residual pockets (PD ≥ 4 mm at baseline). Periodontal parameters (PD, BI, CAL) were assessed at 6 weeks, 3 months, and 6 months. Inflammatory factors (IL-6, TNF-α, CRP) and Porphyromonas gingivalis (P. gingivalis) abundance were quantified at multiple time points up to 6 months post-intervention.

Following endoscope-assisted SRP (E-SRP), levels of P. gingivalis, IL-6, TNF-α, and CRP in deep periodontal pockets initially showed a slight increase. However, these inflammatory markers and bacterial loads subsequently remained significantly lower than those observed in the SRP-alone group. Periodontal indices, including probing depth (PD), bleeding index (BI), and clinical attachment loss (CAL), demonstrated greater improvement in the E-SRP group compared to the SRP-alone group at the 6-week follow-up. The study also compared the combination therapy groups: E-SRP plus minocycline hydrochloride (E-SRP+M) and E-SRP plus subgingival air polishing (E-SRP+AP). While these combination therapies were evaluated for their effects on periodontal parameters and inflammatory levels, the abstract concludes before detailing the specific quantitative outcomes or comparative efficacy between these groups or against E-SRP alone.