{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T20:02:28Z","timestamp":1784404948677,"version":"3.55.0"},"reference-count":35,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aap.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Periodontology"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Immunomodulatory agents such as omega\u20103 (\u03c9\u20103) and low\u2010dose aspirin (ASA) have been proposed as effective adjuncts in the treatment of periodontitis. However, they still lack long\u2010term studies and head\u2010to\u2010head evaluation with metronidazole (MTZ) and amoxicillin (AMX), the adjunct protocol with the strongest scientific evidence of clinical benefit. This study aimed to evaluate the clinical effects of (\u03c9)\u20103 and ASA, alone or combined with MTZ\u00a0+\u00a0AMX, to treat periodontitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adults with stage III\/IV periodontitis were randomly allocated to receive: (i) subgingival instrumentation (SI) and placebo; (ii) SI with adjunctive MTZ (400\u00a0mg)\u00a0+\u00a0AMX (500\u00a0mg) three times\/day for 14 days (ATB); (iii) SI with adjunctive \u03c9\u20103 (3\u00a0g)\u00a0+\u00a0ASA (100\u00a0mg\/day) for 6 months (IM); and (iv) SI with adjunctive ATB and IM (ATB\u00a0+\u00a0IM). The patients were followed for 1 year post\u2010therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      109 patients were included. At 1 year, 58.6%, 57.7%, and 57.1% of patients receiving ATB, IM, and ATB+IM, respectively, achieved the treatment endpoint [\u22644 sites with a probing depth (PD) of \u22655\u00a0mm], compared with 23.1% in the SI group (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.023). Each adjunctive therapy resulted in a greater reduction in the number of sites with PD\u22655\u00a0mm compared with SI (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Adjunctive ATB, IM, or ATB+IM each provided clinically meaningful benefits beyond mechanical therapy. The results suggested no added benefit from combining ATB and IM. These findings support MTZ\u00a0+\u00a0AMX or \u03c9\u20103\u00a0+\u00a0ASA, without routine combination, as effective adjuncts in periodontal treatment and provide a basis for precision\u2010based trials and data\u2010driven models to identify patients most likely to benefit from each approach. ensaiosclinicos.gov.br RBR\u20107nh566t<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Plain language summary<\/jats:title>\n                    <jats:p>This study explored whether adding antibiotics or anti\u2010inflammatory supplements (omega\u20103 and low\u2010dose aspirin), either alone or in combination, could enhance the results of subgingival instrumentation (non\u2010surgical periodontal therapy) in patients with severe periodontitis. All participants received the standard periodontal treatment and were randomly assigned to also take a placebo, antibiotics, omega\u20103 with aspirin, or a combination of both therapies. After 1 year, patients who received any of the additional therapies showed greater improvements, with fewer sites of deep periodontal pockets, compared with those who received subgingival instrumentation alone. However, combining antibiotics with omega\u20103 and aspirin did not lead to better outcomes than using either one of them individually. These findings suggest that in patients with more severe forms of periodontitis, adding either antibiotics or omega\u20103 with low\u2010dose aspirin to standard care can provide meaningful clinical benefits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jper.70081","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T05:24:45Z","timestamp":1778649885000},"page":"1454-1466","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Immunomodulators, associated or not with systemic antibiotics, to treat periodontitis: A 1\u2010year multicenter, placebo\u2010controlled, double\u2010blind, randomized clinical trial"],"prefix":"10.1002","volume":"97","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2041-9426","authenticated-orcid":false,"given":"Nidia C.","family":"Castro dos Santos","sequence":"first","affiliation":[{"name":"Faculdade Israelita de Ci\u00eancias da Sa\u00fade Albert Einstein Hospital Israelita Albert Einstein S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael N. de Brito","family":"Silva","sequence":"additional","affiliation":[{"name":"Dental Research Division Guarulhos University Guarulhos S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernanda S.","family":"Colombo","sequence":"additional","affiliation":[{"name":"Dental Research Division Guarulhos University Guarulhos S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid","family":"Oliveira\u2010Cardoso","sequence":"additional","affiliation":[{"name":"Dental Research Division Guarulhos University Guarulhos S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2696-3051","authenticated-orcid":false,"given":"Lina J.","family":"S\u00faarez","sequence":"additional","affiliation":[{"name":"Dental Research Division Guarulhos University Guarulhos S\u00e3o Paulo Brazil"},{"name":"Departamento de Ciencias B\u00e1sicas y Medicina Oral Universidad Nacional de Colombia Bogot\u00e1 Colombia"},{"name":"Centro de Investigaciones Odontol\u00f3gicas, Pontificia Universidad Javeriana Bogot\u00e1 Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9930-4690","authenticated-orcid":false,"given":"Rodrigo","family":"Martins","sequence":"additional","affiliation":[{"name":"Dental Research Division Guarulhos University Guarulhos S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciene C.","family":"de Figueiredo","sequence":"additional","affiliation":[{"name":"Dental Research Division Guarulhos University Guarulhos S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0231-3409","authenticated-orcid":false,"given":"Heitor Marques","family":"Hon\u00f3rio","sequence":"additional","affiliation":[{"name":"Bauru School of Dentistry University of S\u00e3o Paulo Bauru S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ademir Melo Leite","family":"Filho","sequence":"additional","affiliation":[{"name":"School of Dentistry of Ribeir\u00e3o Preto University of S\u00e3o Paulo Ribeir\u00e3o Preto S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8072-3983","authenticated-orcid":false,"given":"Flavia A. 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