Comparative Evaluation of the Role of Azithromycin, Probiotics, Omega-3 Fatty Acids, and Placebo in Stage I and Stage II Periodontitis: A Clinical Study

intrapocket medicaments such as probiotics, omega-3 fatty acids, and azithromycin have been explored in periodontal therapy.4 A new classification system for periodontal disease was introduced in 2017, dividing the disease into stages based on severity, complexity, distribution, and extent.5 One of the key challenges in therapy is that antibiotic-resistant bacteria are embedded within the biofilm, which makes them difficult to IntroductIonPeriodontal disease is an immune-inflammatory condition influenced by multiple factors that ultimately lead to the destruction of the toothsupporting tissues.Early periodontal therapy is essential for preserving oral function, improving quality of life, and achieving favorable esthetic outcomes.For many years, a wide range of nonsurgical and surgical therapeutic options have been employed to manage periodontitis.Although the disease is multifactorial, the presence of gram-negative bacteria within the periodontal pocket has been recognized as a key indicator of disease progression.Consequently, treatment modalities are primarily directed toward modifying both the microbial flora and the host immune response to achieve better outcomes.1 Periodontal therapy typically follows four distinct phases: (1) systemic, (2) initial/preliminary, (3) corrective/surgical, and (4) maintenance.Following the initial phase, a critical stage arises when the effectiveness of mechanical debridement is evaluated in terms of residual bleeding on probing (BOP) and probing depth (PD) ≥ 5 mm.At this point, the need for surgical intervention must be considered.2 In addition to mechanical debridement, a variety of locally and systemically administered antimicrobials and other adjunctive agents with immunomodulatory, antibacterial, and anti-inflammatory properties are now widely used.3 Recently,