The sustaining effect of three polymers on the release of chlorhexidine from a controlled release drug device for root canal disinfection

Development and Characterization of pH-Dependent Cellulose Acetate Phthalate Nanofibers by Electrospinning Technique

The aim of this work was to obtain pH-dependent nanofibers with an electrospinning technique as a novel controlled release system for the treatment of periodontal disease (PD). Cellulose acetate phthalate (CAP) was selected as a pH-sensitive and antimicrobial polymer. The NF was optimized according to polymeric dispersion variables, polymer, and drug concentration, and characterized considering morphology, diameter, entrapment efficiency (EE), process efficiency (PE), thermal properties, and release profiles. Two solvent mixtures were tested, and CHX-CAP-NF prepared with acetone/ethanol at 12% w/v of the polymer showed a diameter size of 934 nm, a uniform morphology with 42% of EE, and 55% of PE. Meanwhile, CHX-CAP-NF prepared with acetone/methanol at 11% w/v of polymer had a diameter of 257 nm, discontinuous nanofiber morphology with 32% of EE, and 40% of PE. EE and PE were dependent on the polymer concentration and the drug used in the formulation. Studies of differential scanning calorimetry (DSC) showed that the drug was dispersed in the NF matrix. The release profiles of CHX from CHX-CAP-NF followed Fickian diffusion dependent on time (t^0.43−0.45), suggesting a diffusion–erosion process and a matrix behavior. The NF developed could be employed as a novel drug delivery system in PD.

Polysaccharide-Based Micro- and Nanosized Drug Delivery Systems for Potential Application in the Pediatric Dentistry

The intensive development of micro- and nanotechnologies in recent years has offered a wide horizon of new possibilities for drug delivery in dentistry. The use of polymeric drug carriers turned out to be a very successful technique for formulating micro- and nanoparticles with controlled or targeted drug release in the oral cavity. Such innovative strategies have the potential to provide an improved therapeutic approach to prevention and treatment of various oral diseases not only for adults, but also in the pediatric dental practice. Due to their biocompatibility, biotolerance and biodegradability, naturally occurring polysaccharides like chitosan, alginate, pectin, dextran, starch, etc., are among the most preferred materials for preparation of micro- and nano-devices for drug delivery, offering simple particle-forming characteristics and easily tunable properties of the formulated structures. Their low immunogenicity and low toxicity provide an advantage over most synthetic polymers for the development of pediatric formulations. This review is focused on micro- and nanoscale polysaccharide biomaterials as dental drug carriers, with an emphasis on their potential application in pediatric dentistry.

Should local drug delivery systems be used in dentistry?

In dentistry, the use of biomaterial-based drug delivery systems (DDS) aiming the release of the active compounds directly to the site of action is slowly getting more awareness among the scientific and medical community. Emerging technologies including nanotechnological platforms are offering novel approaches, but the majority are still in the proof-of-concept stage. This study critically reviews the potential use of DDS in anesthesiology, oral diseases, cariology, restorative dentistry, periodontics, endodontics, implantology, fixed and removable prosthodontics, and orthodontics with a special focus on infections. It also stresses the gaps and challenges faced. Despite numerous clinical and pharmacological advantages, some disadvantages of DDS pose an obstacle to their widespread use. The biomaterial's biofunctionality may be affected when the drug is incorporated and may cause an additional risk of toxicity. Also, the release of sub-therapeutic levels of drugs such as antibiotics may lead to microbial resistance. Multiple available techniques for the manufacture of DDS may affect drug release profiles and their bioavailability. If the benefits outweigh the costs, DDS may be potentially used to prevent or treat oral pathologies as an alternative to conventional strategies. A case-by-case approach must be followed.

An Innovative Drug Delivery System Loaded with a Modified Combination of Triple Antibiotics for Use in Endodontic Applications

The objective of the current study was to introduce "Polylactic co-Glycolic Acid- (PLGA-) Coated Ceramic Microparticles" as an innovative drug delivery system, loaded with a new combination of triple antibiotics (penicillin G, metronidazole, and ciprofloxacin (PMC)) for use in endodontic treatments. Ceramic microparticles were made from β-tricalcium phosphate and hydroxyapatite and examined by "Scanning Electronic Microscope (SEM)." Then, fixed amounts of the selected antibiotics were added to a prepared PLGA solution and stirred thoroughly. Next, the prepared ceramic microparticles were dispersed completely in the drugs solution. The deposited "PMC-loaded PLGA-coated ceramic microspheres (PPCMs)" were dried and incubated in phosphate buffer saline (PBS) for 21 days. The drug release from PPCMs was quantified by a UV spectrophotometer. The antimicrobial activity of PPCMs was investigated using the "Agar Plate Diffusion Test (ADT)," "Minimum Inhibitory Concentration (MIC)," and "Minimum Bactericidal Concentration (MBC)" against Enterococcus faecalis (E. faecalis) and Aggregatibacter actinomycetemcomitans (A.a). The cell viability test (MTT) was conducted for cytotoxicity against human gingival fibroblasts. SEM micrographs of PPCMs showed spherical-like ceramic microparticles with smooth surfaces. Crystal-like antibiotic particles (chunks) were also found on PPCMs. Initial burst of antibiotics (31 µg/mL, 160 µg/mL, and 18 µg/mL for ciprofloxacin, metronidazole, and penicillin G, respectively, in the first 4 days) followed by gradual and sustained release was observed within a period of 21 days. PPCMs demonstrated pH close to normal physiological environment and antibacterial activity against E. faecalis and A.a in the first 2 days. MTT showed cell viability of more than 70% for PPCMs after 24 h and 72 h of exposure. In conclusion, PPCMs demonstrated satisfactory release of antibiotics, antibacterial activity against the selected microorganisms, and biocompatibility. Thus, PPCMs may be used to deliver modified triple antibiotics to the root canal system for use in endodontic applications.

Development of Biocomposite Polymeric Systems Loaded with Antibacterial Nanoparticles for the Coating of Polypropylene Biomaterials

The development of a biocomposite polymeric system for the antibacterial coating of polypropylene mesh materials for hernia repair is reported. Coatings were constituted by a film of chitosan containing randomly dispersed poly(d,l-lactide-co-glycolide) (PLGA) nanoparticles loaded with chlorhexidine or rifampicin. The chlorhexidine-loaded system exhibited a burst release during the first day reaching the release of the loaded drug in three or four days, whereas rifampicin was gradually released for at least 11 days. Both antibacterial coated meshes were highly active against Staphylococcus aureus and Staphylococcus epidermidis (10⁶ CFU/mL), displaying zones of inhibition that lasted for 7 days (chlorhexidine) or 14 days (rifampicin). Apparently, both systems inhibited bacterial growth in the surrounding environment, as well as avoided bacterial adhesion to the mesh surface. These polymeric coatings loaded with biodegradable nanoparticles containing antimicrobials effectively precluded bacterial colonization of the biomaterial. Both biocomposites showed adequate performance and thus could have potential application in the design of antimicrobial coatings for the prophylactic coating of polypropylene materials for hernia repair.

Design and Evaluation of pH-Dependent Nanosystems Based on Cellulose Acetate Phthalate, Nanoparticles Loaded with Chlorhexidine for Periodontal Treatment

This work aimed to develop and evaluate pH-dependent systems based on nanospheres (NSphs) and nanocapsules (NCs) loaded with chlorhexidine (CHX) base as a novel formulation for the treatment of periodontal disease. Cellulose acetate phthalate (CAP) was employed as a pH-dependent polymeric material. The NSphs and NCs were prepared using the emulsion-diffusion technique and then characterized according to encapsulation efficiency (EE), size, zeta-potential, morphology, thermal properties, release profiles and a preliminary clinical panel test. The formulations showed 77% and 61% EE and 57% and 84% process efficiency (PE), respectively. Both systems were spherical with an average size of 250–300 nm. Differential scanning calorimetry (DSC) studies showed that the drug has the potential to be dispersed molecularly in the NSph matrix or dissolved in the oily center of the NCs. The CHX release test revealed that the release of NSphs-CHX follows Fickian diffusion involving diffusion-erosion processes. The NCs showed a slower release than the NSphs, following non-Fickian diffusion, which is indicative of anomalous transport. These nanosystems may, therefore, be employed as novel formulations for treating periodontal disease, due to (1) their coverage of a large surface area, (2) the controlled release of active substances at different pH, and (3) potential gingival tissue infiltration.

Effect of Polymeric Microparticles Loaded With Catechin on the Physicochemical Properties of an Adhesive System

The objective of this study was to synthesize and characterize epigallocatechin-3-gallate (EGCG)-loaded/poly(D-L lactide-co-glycolide) acid (PLGA) microparticles, evaluate their effects on degree of conversion and release assay of adhesives, and subsequently to examine the resin-dentin bond strength of two EGCG formulations (free EGCG or loaded into PLGA microparticles) applied as a pretreatment or incorporated into an adhesive system. The formulations were prepared according to a PLGA:EGCG ratio of 16:1 using the spray-drying technique. The size and polydispersity index were determined by light scattering in aqueous dispersion. The degree of conversion (%DC) and release assay were assessed by Fourier transform infrared spectroscopy and ultraviolet-visible spectrophotometer, respectively. Subsequently, 45 third molars were divided into five groups (n=9) according to the different EGCG application modes and prepared for bond strength testing in a universal testing machine. Results demonstrated no statistically significant difference among the DC means after the PLGA microparticles were loaded with EGCG. For the release assay, the 1.0% PLGA/EGCG group presented better results after being elected for use in the bond strength test. The resin-dentin bond strengths of the experimental groups after 12 months of water storage were significantly higher than in the control group. EGCG could improve the durability of the resin-dentin bond over time and promote a new era for adhesive dentistry with the concept of controlled release.

Improving the efficacy of chlorhexidine-releasing elastomerics using a layer-by-layer coating technique

The aims of this study were to identify the optimal concentration of coated orthodontic elastomerics using a layer-by-layer technique that can release chlorhexidine (CHX) as an antimicrobial material, and to measure the physical properties and antimicrobial effects of the coated elastomerics. Ethyl cellulose (EC) was used as the polymer, and five study groups with various combinations of solvents (i.e., ethanol and dichloromethane [DCM]) were included. The coated elastomerics were evaluated with a spectrophotometer to confirm the release of CHX, and their surfaces were observed by SEM. The CHX+EC+DCM group sustained antimicrobial release for the longest period (168 h, p<0.001) and exhibited the largest antimicrobial effect in an inhibition zone test using S. mutans for 7 days (p<0.05). This group had most effective physical properties and antimicrobial effects of coated elastomerics produced using a layerby-layer technique, and so its composition should be considered for use in clinical applications in orthodontics.

Polymeric nanoarchitectures on Ti-based implants for antibacterial applications

Because of the excellent mechanical properties and good biocompatibility, titanium-based metals are widely used in hard tissue repair, especially load-bearing orthopedic applications. However, bacterial infection and complication during and after surgery often causes failure of the metallic implants. To endow titanium-based implants with antibacterial properties, surface modification is one of the effective strategies. Possessing the unique organic structure composed of molecular and functional groups resembling those of natural organisms, functionalized polymeric nanoarchitectures enhance not only the antibacterial performance but also other biological functions that are difficult to accomplish on many conventional bioinert metallic implants. In this review, recent advance in functionalized polymeric nanoarchitectures and the associated antimicrobial mechanisms are reviewed.

HaCaT Keratinocytes Response on Antimicrobial Atelocollagen Substrates: Extent of Cytotoxicity, Cell Viability and Proliferation

The effective and widely tested biocides: Benzalkonium chloride, bronopol, chitosan, chlorhexidine and irgasan were added in different concentrations to atelocollagen matrices. In order to assess how these antibacterial agents influence keratinocytes cell growth, cell viability and proliferation were determined by using MTT assay. Acquired data indicated a low toxicity by employing any of these chemical substances. Furthermore, cell viability and proliferation were comparatively similar to the samples where there were no biocides. It means that regardless of the agent, collagen-cell-attachment properties are not drastically affected by the incorporation of those biocides into the substrate. Therefore, these findings suggest that these atelocollagen substrates enhanced by the addition of one or more of these agents may render effectiveness against bacterial stains and biofilm formation, being the samples referred to herein as “antimicrobial substrates” a promising view in the design of novel antimicrobial biomaterials potentially suitable for tissue engineering applications.

Composition and characterization of in situ usable light cured dental drug delivery hydrogel system

Biodegradable polymers are compatible, permeable and nontoxic, thus they can provide a useful tool for drug delivery or tissue engineering. These polymers can form hydrogels, which are suitable vehicles for different types of materials e.g. drugs, bioactive molecules or cells. In the case of dentistry, photopolymerization is an obvious method to obtain in situ useable devices which can provide a more efficient way of tailoring drug release. A hydrogel system was developed based on poly-gamma-glutamic acid that was modified with methacryloyl groups to achieve this purpose. The resulting new reactive structure was proved by NMR spectroscopy. The swelling ratio of this type of hydrogel has been found remarkable, over 300 % after 24 h, and it can release 5 ng/mm(2) metronidazole. The prepared hydrogels were nontoxic as viability, cytotoxicity tests and cell morphology investigations proved it. These results render this model system an excellent candidate for use as an in situ curing local drug delivery device. The new photoactive system can be utilized in the treatment of periodontal diseases or raising the effectiveness of drugs used only in the minimal effective dose.

Dentin adhesion and MMPs: a comprehensive review

This review examines the fundamental processes responsible for the aging mechanisms involved in the degradation of resin-bonded interfaces, as well as some potential approaches to prevent and counteract this degradation. Current research in several research centers aims at increasing the resin-dentin bond durability. The hydrophilic and acidic characteristics of current dentin adhesives have made hybrid layers highly prone to water sorption. This, in turn, causes polymer degradation and results in decreased resin-dentin bond strength over time. These unstable polymers inside the hybrid layer may result in denuded collagen fibers, which become vulnerable to mechanical and hydrolytical fatigue, as well as degradation by host-derived proteases with collagenolytic activity. These enzymes, such as matrix metalloproteinases and cysteine cathepsins, have a crucial role in the degradation of type I collagen, the organic component of the hybrid layer. This review will also describe several methods that have been recently advocated to silent the activity of these endogenous proteases.

Effect of chlorhexidine application on the bond strength of resin core to axial dentin in endodontic cavity

OBJECTIVES

This study evaluated the influence of chlorhexidine (CHX) on the microtensile bonds strength (µTBS) of resin core with two adhesive systems to dentin in endodontic cavities.

MATERIALS AND METHODS

Flat dentinal surfaces in 40 molar endodontic cavities were treated with self-etch adhesive system, Contax (DMG) and total-etch adhesive system, Adper Single Bond 2 (3M ESPE) after the following surface treatments: (1) Priming only (Contax), (2) CHX for 15 sec + rinsing + priming (Contax), (3) Etching with priming (Adper Single Bond 2), (4) Etching + CHX for 15 sec + rinsing + priming (Adper Single Bond 2). Resin composite build-ups were made with LuxaCore (DMG) using a bulk method and polymerized for 40 sec. For each condition, half of specimens were submitted to µTBS after 24 hr storage and half of them were submitted to thermocycling of 10,000 cycles between 5℃ and 55℃ before testing. The data were analyzed using ANOVA and independent t-test at a significance level of 95%.

RESULTS

CHX pre-treatment did not affect the bond strength of specimens tested at the immediate testing period, regardless of dentin surface treatments. However, after 10,000 thermocycling, all groups showed reduced bond strength. The amount of reduction was greater in groups without CHX treatments than groups with CHX treatment. These characteristics were the same in both self-etch adhesive system and total-etch adhesive system.

CONCLUSIONS

2% CHX application for 15 sec proved to alleviate the decrease of bond strength of dentin bonding systems. No significant difference was shown in µTBS between total-etching system and self-etching system.

Joint-action of antifouling substances in copper-free paints

Due to the environmentally harmful impact of tributyltin self-polishing paints, there is a critical need of more ecological alternatives. The aim of the present work is to study the joint-action of three molecules chosen in order to combine the two modes of prevention: chemical and physical repelling of biofouling. This "hybrid" system is principally dedicated to disturb durable settlement of microfouling. Each component was chosen according to its specific properties: chlorhexidine is a bisdiguanide antiseptic with antibacterial activity, zinc peroxide is an inorganic precursor of high instable entities which react with seawater to create hydrogen peroxide, Tween 85 is a non ionic surfactant disturbing interactions between colonizing organisms and surface. Obtained results highlighted the interest on mixing such molecules to get additive action on antifouling efficiency.

Chlorhexidine delivery system from titanium/polybenzyl acrylate coating: evaluation of cytotoxicity and early bacterial adhesion

OBJECTIVES

The formation of biofilms on titanium dental implants is one of the main causes of failure of these devices. Streptococci are considered early colonizers that alter local environment favouring growing conditions for other colonizers. Chlorhexidine (CHX) is so far the most effective antimicrobial treatment against a wide variety of Gram-positive and Gram-negative organisms as well as fungi. This study was designed to develop a CHX delivery system appropriate for healing caps and abutments, with suitable drug release rate, effective as antimicrobial agent, and free of cytotoxic effects.

METHODS

Polybenzyl acrylate (PBA) coatings with and without CHX (Ti/PBA and Ti/PBA-CHX, respectively) and different drug loads (0.35, 0.70, and 1.40%, w/w) were assayed. The cytotoxic effect of CHX released from the different substrates on UMR106 cells was tested by alkaline phosphatase specific activity (ALP), and microscopic evaluation of the cells. Non-cytotoxic drug load (0.35%, w/w) was selected to evaluate the antimicrobial effectiveness of the system using a microbial consortium of Streptococcus species.

RESULTS

The kinetic profile of CHX delivered by Ti/PBA-CHX showed an initial fast release rate followed by a monotonic increase of delivered mass over 48 h. The number of attached bacteria decreased in the following order: Ti>Ti/PBA>Ti/PBA-0.35.

CONCLUSIONS

PBA-0.35 coating is effective to inhibit the adhesion of early colonizers on Ti without any cytotoxic effect on UMR-106 cells.

Reactive calcium-phosphate-containing poly(ester-co-ether) methacrylate bone adhesives: setting, degradation and drug release considerations

This study has investigated novel bone adhesives consisting of fluid photo-polymerizable poly(lactide-co-propylene glycol-co-lactide)dimethacrylate (PGLA-DMA) mixed with systematically varying fillers of β-tricalcium phosphate (β-TCP) and monocalcium phosphate monohydrate (MCPM), for the delivery of an antibacterial drug chlorhexidine (CHX). All formulations were found to polymerize fully within 200 s after exposure to blue light. In addition, water sorption by the polymerized materials catalyzed varying filler conversion to dicalcium phosphate (DCP) (i.e. brushite and monetite). With greater DCP levels, faster degradation was observed. Moreover, increase in total filler content enhanced CHX release, associated with higher antibacterial activity. These findings thus suggest that such rapid-setting and degradable adhesives with controllable drug delivery property could have potential clinical value as bone adhesives with antibacterial activity.

The Application of Microencapsulation Techniques in the Treatment of Endodontic and Periodontal Diseases

In the treatment of intracanal and periodontal infections, the local application of antibiotics and other therapeutic agents in the root canal or in periodontal pockets may be a promising approach to achieve sustained drug release, high antimicrobial activity and low systemic side effects. Microparticles made from biodegradable polymers have been reported to be an effective means of delivering antibacterial drugs in endodontic and periodontal therapy. The aim of this review article is to assess recent therapeutic strategies in which biocompatible microparticles are used for effective management of periodontal and endodontic diseases. In vitro and in vivo studies that have investigated the biocompatibility or efficacy of certain microparticle formulations and devices are presented. Future directions in the application of microencapsulation techniques in endodontic and periodontal therapies are discussed.

Chlorhexidine release and antibacterial properties of chlorhexidine-incorporated polymethyl methacrylate-based resin cement

This study evaluated chlorhexidine release from experimental, chlorhexidine-incorporated polymethyl methacrylate (PMMA)-based resin cements prepared from Super-Bond C&B (Sun Medical) and examined the antimicrobial activity against Streptococcus mutans and Enterococcus faecalis. Chlorhexidine diacetate was added into PMMA polymer to obtain chlorhexidine concentration of 0.0, 1.0, 2.0, 3.0, and 4.0 wt %. Chlorhexidine-incorporated, cured resin disks were immersed in distilled water at 37 degrees C for 5 weeks, and the chlorhexidine release was analyzed by high-performance liquid chromatography. The antibacterial effect of freshly mixed resin cements was examined using the agar diffusion test. For the direct contact test, the wells (n = 6) of microtiter plates were coated with cements. The coated wells were aged up to 3 weeks prior to the placement of bacterial suspensions directly on cured cements. The 3.0 and 4.0% chlorhexidine-incorporated cement exhibited chlorhexidine release for 5 weeks; however, more than 98% of chlorhexidine was retained in resin matrix. No release was detected from the 1.0 and 2.0% incorporated cement at 1 week and 2 weeks, respectively. The agar diffusion test failed to detect antibacterial effects against Enterococcus faecalis, whereas the direct contact test revealed the antibacterial effect of 3.0 and 4.0% incorporated cements against each microbe for 2 weeks. The 3.0 and 4.0% chlorhexidine-incorporated resin cement possessed prolonged chlorhexidine release and antibacterial properties for 2 weeks.

In vitro drug release study of methacrylate polymer blend system: effect of polymer blend composition, drug loading and solubilizing surfactants on drug release

The application of polymers as the drug delivery systems for treating oral infections is a relatively new area of research. The present study was to test the release of the antibacterial drug chlorhexidine diacetate (CHDA), the antifungal drug Nystatin (NYS) and the antiviral drug acyclovir (ACY) from polymer blends of poly(ethyl methacrylate) and poly(n-hexyl methacrylate) of different compositions. The effects of polymer blend composition, drug loading and solubilizing surfactants on the release of the drugs have been studied. Measurements of the in vitro rate of drug release showed a sustained release of drug over extended periods of time. Drug release rates decreased with increasing PEMA content in polymer blends. CHDA release rates increased steadily with increasing drug load. The drug release rates increased with the addition of surfactants. This study demonstrates that the three therapeutic agents show a sustained rate of drug release from polymer blends of PEMA and PHMA over extended periods of time. By varying polymer blend compositions as well as the drug concentration (loading), it is possible to control the drug release rates to a desired value. The drug release rate is enhanced by addition of surfactants that solubilize drugs in the polymer blends.

Concentration dependent aggregation properties of chlorhexidine salts

PURPOSE

Chlorhexidine (CHX), a chemical antiseptic, is known to bind to dentin and has been shown to be effective in treating bacterial infections caused by microbes. The solubility and aggregation properties of CHX salts were determined to guide the development of a sustained release formulation for long-term disinfection.

METHODS

The amount of CHX in solution was determined as a function of counterion concentration (chloride, acetate (Ac) or gluconate (G)) by UV spectrophotometry at 255nm. The weight average molecular weight was determined from the angular dependence of the scattered light. Proton NMR spectroscopy was used to investigate the dependence of the peak intensity and chemical shift on solution concentration and diffusion measurements were performed by Fourier-transform pulsed-field gradient spin-echo (PFG-SE) (1)H NMR.

RESULTS

The observed CHX concentration was highly dependent on the type and concentration of salt present in solution with the greatest CHX concentration achieved with gluconate, moderate to low with diacetate, and very low with dichloride solutions. Addition of sodium gluconate enhanced the amount of CHX-Ac(2) in solution; however, only low concentrations of chlorhexidine can be achieved in the presence of chloride ions. For solutions of CHX-G(2), the aggregate number appeared to range from a dimer at 40mM to perhaps a pentamer at 150mM. In contrast, no aggregation of CHX-Cl(2) or CHX-Ac(2) was detected, which was corroborated by diffusion NMR results. The change in chemical shift of protons is consistent with association of the phenyl group of one CHX with the hexamethylene chain of a second CHX. Based on the analysis of NMR peak intensities of CHX, gluconate, and acetate in saturated solutions, it appears that solubilization of the diacetate species occurs within digluconate aggregates, since the solubility product of chlorhexidine diacetate is such that the concentration of CHX will exceed the critical micelle concentration (CMC). However, no solubilization of CHX-Cl(2) occurs because the solubility product falls below the CMC.

CONCLUSIONS

The low concentration of CHX that can be achieved in physiological concentrations of chloride in the oral cavity may be problematic for dental and slow release formulations. Achieving a high concentration of CHX appears to require that the monomer be present at a concentration greater than that required to produce self-association.

EVA copolymer matrix for intra-oral delivery of antimicrobial and antiviral agents

Biocompatible ethylene vinyl acetate copolymer (EVA) was utilized to study the release of an antiviral drug (acyclovir (ACY)) and an antimicrobial drug (doxycycline hyclate (DOH)). Release of both drugs from EVA was measured individually and in combination. The effect of drug combination of DOH and ACY is presented. Additionally, the release rate of DOH after coating of the matrix with a different copolymer, in drug-loading with increasing loads of DOH, and with increases in temperature are also presented. The drugs incorporated in EVA films were prepared from the dry sheet obtained by solvent evaporation of polymer casting solutions with drugs. Drug release from the films was examined for about 12 days in distilled water at 37 degrees C. Changes in optical density were followed spectrophotometrically. The combination of ACY and DOH resulted in an increased release of ACY by about three times (P < 0.001) while DOH showed a decrease in rate of about two times compared to the individual release rates (P = 0.008). Increases in drug levels of DOH resulted in increases in drug release rates (P = 0.001). The release rate of DOH increased with temperature (P = .001; 27, 32, 37 and 42 degrees C were studied) and the energy of activation (DeltaE ( not equal) = 56.69 kJ/mol) was calculated using the Arrhenius equation for the diffusion of DOH molecules. Thus, the release rates of drugs were influenced by many factors: drug combination, coating the device, drug-loading, and temperature variation. Therefore it is proposed that controlling these variables should make it possible to obtain therapeutic levels of drugs released from drug loaded polymer, which may be beneficial in treating oral infections.