A BiO-Optimizing Site Targeted (BOOST) Approach to Periodontal Regeneration Through Local Doxycycline Prior to Surgery: A Randomized Clinical Trial

Aim: To test a BiO-Optimizing Site Targeted (BOOST) approach to periodontal regeneration by the adjunctive use of locally delivered doxycycline (DOX) 2 weeks prior to minimally invasive surgery in terms of clinical and radiographic outcomes at 1 year. Methods: For this randomized clinical trial, stage III/IV periodontitis patients presenting sites with intrabony defects and bleeding on probing (BoP+) after steps 1–2 of periodontal treatment were included. Sites were treated via subgingival instrumentation with or without a BOOST approach by local DOX. After 2 weeks, defects were accessed by minimally invasive surgical technique with xenograft and amelogenins. Primary (clinical attachment level [CAL] gain) and secondary (probing pocket depth [PPD] reduction, composite outcomes, radiographic bone defect fill) outcomes were assessed at 12 months. Results: Sixty patients completed the study (30 on each group). BOOST led to lower preoperative BoP (p < 0.001) and better wound healing after surgery (p = 0.027). Both groups showed clinical and radiographic improvements at 1 year, with significant differences in mean CAL gain (4.1 ± 1.9 vs. 3.2 ± 2.0 mm; p = 0.019) and PPD reduction (4.4 ± 1.8 vs. 3.6 ± 1.9 mm; p = 0.040) favoring the test group. BOOST group also achieved higher composite outcome measure (PPD ≤ 4 mm and CAL gain ≥ 3; 83.3% vs. 46.7%; p = 0.006), pocket closure (PPD ≤ 3 mm or 4 mm BoP−; 83.3% vs. 60.0%; p = 0.045), and defect fill (3.5 ± 1.2 vs. 2.7 ± 1.3 mm; p < 0.001) compared to the control group. Conclusion: A BOOST approach by local doxycycline 2 weeks before surgery enhanced the local inflammatory control prior to periodontal regeneration and post-operative early wound healing, yielding to improved clinical and radiographic outcomes at 1 year. Trial Registration: ClinicalTrials.gov identifier: NCT05878353.