Retrospective Analysis of Positive Radiographic Bone Changes as a Result of Micro Ultrasonic Debridement with Adjunctive Systemic Antibiotics
John Y. Kwan, DDS, unpublished evaluation, 1999
Non-Surgical treatment utilizing micro ultrasonic instrumentation and adjunctive systemic antibiotics has been shown to result in significant improvements in clinical probing depths and reduction in bleeding and probing. Patients treated in this fashion have also shown radiographic improvement. In private clinical practice, it is not always that radiographs are consistent in angulation, processing, type of film (original or duplication), and/or area covered. Since many baseline radiographs come from a ref erring source, subsequent radiographs for comparison may or may not be close to the "same shot".
However, in the course of practice there are instances when two films are close in comparison and allow us to appreciate changes in the periodontal hard tissues that can be interpreted as being positive. 68 sites in 28 patients were selected for analysis because of their appreciable Osseous change upon visual examination, and because angulation was very close to the same before treatment and one year following treatment. All patients presented with a diagnosis of chronic adult periodontal disease, and were treated non-surgically in one session, under local anesthesia and given a course of systemic antibiotics. Antibiotic regimens were either metronidazole and amoxicillin, each 250 mg tid for 5 days. Instrumentation was accomplished with micro ultrasonic instrumentation only, no hand instrumentation was done. Patients were reevaluated at 6 weeks, and then placed on SPT at 3-4 month intervals with clinical and radiographic reevaluation done one year from initial treatment.
Radiographs were sent to Ernest Hausmann, DDS, PhD, Department of Oral Biology, State University of New York Buffalo. Each radiograph was scanned and digitized for comparative analysis, consistent with previous published protocol for analysis of unstandardized x-rays.
Analysis indicated that mean gain in height was 1.70mm, SD 1.52mm, p=.0001
With this analysis of unstandardized radiographs, gains over 1.00mm can be interpreted as being "true gains" with confidence. 18 sites showed bone gain of over 2.5mm, up to as much as 6.7mm. The analysis of these 68 sites indicate that bone can regenerate with non-surgical treatment, and the changes shown with this sample are highly statistically significant.