A multilevel analysis of a randomized clinical trial comparing adjunctive moxifloxacin versus amoxicillin/metronidazole for the treatment of aggressive periodontitis

Abstract

Background: It was documented that the clinical outcomes of mechanical periodontal treatment
can fluctuate not merely concerning patients but equally among various tooth sites in the
subject. This trial evaluates the clinical parameters related with the patient, tooth, and site that
generate more changes in clinical attachment level (CAL) gain and probing depth (PD) reduction,
using moxifloxacin (MOX) versus amoxicillin plus metronidazole (AMOX + ME) as adjuncts to
scaling and root planing (SRP), in comparison to SRP only, post‑therapy in generalized aggressive
periodontitis (GAgP).
Materials and Methods: The analysis of this clinical trial included 6012 tooth sites at 1002 teeth
in 36 patients; they were randomly assigned to three protocols: Systemically intake of MOX or
AMOX + ME plus SRP, or SRP + placebo for 7 days. The clinical effect of the patient, tooth, and
site characteristics, in terms of CAL gain and PD reduction, was explored using a multilevel linear
model. P < 0.05 was statistically significant.
Results: Following 6 months of treatment, the differences between the groups were statistically
significant, favoring the MOX and AMOX + ME protocols (P < 0.0001). Moreover, the multilevel model
showed that adjunctive MOX, AMOX + ME, non‑molar, and interproximal sites were the features
that contribute significantly to CAL improvement, and PD decreases in GAgP (P ≤ 0.001 for all).
Conclusion: The most relevant characteristics for the changes in CAL increase and PD diminution,
after adjunctive antimicrobials, were ascribable to the features related to the tooth. MOX and
AMOX + ME, non‑multi‑radicular‑tooth, and interdental sites indicated superior clinical gains at
the tooth and site levels in GAgP.
Key Words: Amoxicillin, clinical trial, metronidazole, moxifloxacin, multilevel analysis