Locally delivered doxycycline improves the healing following non-surgical periodontal therapy in smokers

Insights into Intra Periodontal Pocket Pathogenesis, Treatment, In Vitro-In Vivo Models, Products and Patents, Challenges and Opportunity

Periodontal disease is a multifactorial pathogenic condition involving microbial infection, inflammation, and various systemic complications. Here, a systematic and comprehensive review discussing key-points such as the pros and cons of conventional methods, new advancements, challenges, patents and products, and future prospects is presented. A systematic review process was adopted here by using the following keywords: periodontal diseases, pathogenesis, models, patents, challenges, recent developments, and 3-D printing scaffolds. Search engines used were "google scholar", "web of science", "scopus", and "pubmed", along with textbooks published over the last few decades. A thorough study of the published data rendered an accurate and deep understanding of periodontal diseases, the gap of research so far, and future opportunities. Formulation scientists and doctors need to be interconnected for a better understanding of the disease to prescribe a quality product. Moreover, prime challenges (such as a lack of a vital testing model, scarcity of clinical and preclinical data, products allowing for high drug access to deeper tissue regions for prolonged residence, lack of an international monitoring body, lack of 4D or time controlled scaffolds, and lack of successful AI based tools) exist that must be addressed for designing new quality products. Generally, several products have been commercialized to treat periodontal diseases with certain limitations. Various strategic approaches have been attempted to target certain delivery regions, maximize residence time, improve efficacy, and reduce toxicity. Conclusively, the current review summarizes valuable information for researchers and healthcare professional to treat a wide range of periodontal diseases.

Influence of locally delivered doxycycline on the clinical and molecular inflammatory status of intrabony defects prior to periodontal regeneration: A double-blind randomized controlled trial

OBJECTIVES

To test the effect of locally delivered doxycycline (DOX) administered 2 weeks prior to minimally invasive periodontal regeneration in terms of presurgical inflammatory status and cytokine expression profile in the gingival crevicular fluid (GCF). Secondary aim was to assess the early wound healing index (EHI) at 2 weeks after surgery.

BACKGROUND

It is hypothesized that healing after periodontal regeneration is dependent on preoperative soft tissue condition, and that local antibiotics may improve the site-specific inflammatory status at short time.

METHODS

Sites associated with periodontal intrabony defects requiring regenerative surgery and showing bleeding on probing (BoP) were included. At T0, experimental sites were randomly treated with subgingival instrumentation with or without topic DOX application. After 2 weeks (T1), defects were approached by means of minimally invasive surgical technique. GCF was sampled at both T0 and T1 for inflammatory biomarker analysis. Two weeks after surgery, the EHI was evaluated (T2).

RESULTS

Forty-four patients were included. At T1, the number of BoP+ sites was statistically significantly less in the test group (27.3% vs. 72.7%; p < .01). The total amount of interleukin (IL)-1β (p < .001), matrix-metalloproteinases (MMP)-8 (p < .001), and MMP-9 (p = .010) in the GCF significantly decreased in the test group at T1, with relevant differences compared to controls. At T2, the EHI had an average value of 1.45 ± 0.86 in the test group while in the control, it was 2.31 ± 1.43 (p = .027). A statistically significantly positive correlation was observed between the amount of IL-1β and MMP-9 and EHI scores.

CONCLUSIONS

Within the limitations of this study, sites treated with DOX showed improved clinical and molecular inflammatory parameters before surgery, as well as soft tissue healing 2 weeks after surgery.

The influence of smoking on oral neutrophils and matrix metalloproteinase-8 in periodontitis patients before and after nonsurgical treatment

Objective

To evaluate and compare the oral neutrophil numbers (ONN) in saliva, the level of matrix metalloproteinase-8 (MMP-8) in gingival crevicular fluid (GCF) and the periodontal parameters in smokers versus non-smokers with periodontitis, before and after nonsurgical periodontal treatment (NSPT).

Materials and method

40 chronic periodontitis patients including 20 smokers and 20 non-smokers were enrolled in this quasi-experimental study. All patients were received the NSPT included instructing oral hygiene, scaling and root planing. At baseline (T0) and after NSPT 1 month (T1) and 3 months (T3), all patients were assessed for salivary ONN, GCF MMP-8, and clinical parameters like plaque index (PlI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD) and clinical attachment loss (CAL). The differences between the two groups were analyzed using the independent sample t-test and the Mann-Whitney U test; and the differences between T0, T1 and T3 of each group were analyzed with paired-samples t-test and Wilcoxon signed-rank test. The level of significance was set at 0.05.

Results

The ONN was significantly less in smokers than in non-smokers although there was no significant difference in other parameters between the two groups at baseline (p > 0.05). All clinical periodontal parameters reduced significantly after 1 month and 3 months of NSPT in both groups (p < 0.01). PPD of non-smokers was significantly lower than those of smokers at T1 and T3. ONN and MMP-8 level showed a significant decrease in non-smoking subjects, while there was no significant difference in smoking ones after NSPT (T1 and T3). At 1 month after treatment, ONN tended to reduce in non-smokers whereas to increase in smokers significantly.

Conclusion

Smoking reduced ONN, impaired treatment effect in reducing PPD, and changed the MMP-8 level in gingival crevicular fluid to NSPT.

Trial registration

Identifier NCT04974502 in CLinicalTrials.gov.

Influence of Smoking on Periodontal and Implant Therapy: A Narrative Review

BACKGROUND

smoking is considered the most modifiable risk factor for periodontal disease.

OBJECTIVE

the aim of this narrative review is to emphasize the effect of smoking on periodontal and implant therapy.

METHODS

The authors reviewed the literature reporting the clinical outcomes of smoking on periodontal surgical and nonsurgical treatment. The impact of smoking on implant therapy and sinus lifting procedures were also reviewed.

RESULTS

Periodontal and implant therapy outcomes are adversely affected by smoking. Smokers respond less favorably to periodontal therapy and periodontal flap procedures as compared to nonsmokers. Clinical outcomes for smokers are 50-75% worse than for nonsmokers. Studies reveal that smokers experience a significantly lower reduction in pocket depth compared to nonsmokers as well as less bone growth after treating infra-bony defects with guided tissue regeneration. The relative risk of implant failure is significantly higher in patients who smoke 20 cigarettes or more per day compared to nonsmokers. Additionally, smoking has also been shown to increase postoperative wound dehiscence and infection rates following sinus floor elevation. Longitudinal studies on smoke cessation have shown a reduction in bone loss and probing depths for periodontitis patients after cessation compared to those who smoke.

CONCLUSION

Smoking cessation can reduce probing depths and improve clinical attachment after nonsurgical periodontal therapy. There is insufficient evidence regarding the effect of smoking on peri-implantitis, as well as the loss of implants in the long-term.

The role of cigarette smoking in periodontal disease and treatment outcomes of dental implant therapy

Tobacco smoking has been implicated in periodontal pathology through various mechanisms, including perturbations of the inflammatory and host responses to putative periodontal pathogens, alterations in the subgingival microbial communities, and a compromised healing potential of the tissues leading to imbalance of tissue homeostasis. This review provides the evidence for the relationship between cigarette smoking and periodontal disease in an attempt to explain possible mechanisms of how tobacco smoking may exert its negative effects on the periodontal tissues via systemic and localized pathways. Early and more recent studies explore cigarette smoking-induced changes in periodontal clinical indices; in subgingival microbial flora by employing traditional detection methods for selected microorganisms, in addition to modern techniques such as deep sequencing and bioinformatics analyses that are able to fully characterize the microbial communities; and in inflammatory and immune responses critically appraising study limitations and differences in study protocol designs. Periodontal treatment outcomes and implant therapy outcomes are reviewed in an attempt to shed light on possible mechanisms for the inferior treatment outcome noted in smokers. The potential harmful effects of passive smoking are also reviewed, providing evidence for the advantages of smoking cessation. Quitting cigarette smoking should be recommended by the dentist, and effort should be made to inform smokers about the negative effects of smoking on the periodontal status and implant therapy outcomes.

Local Drug Delivery Based Treatment Approaches for Effective Management of Periodontitis

Background:

Periodontal disease is an immuno-inflammatory condition of tissues that surround and hold the teeth. It is the disease which succeeds in all races, groups and both genders. Almost 10 to15% of the global population gets suffered from severe periodontitis as per WHO reports. Periodontal disease may likely cause other systemic diseases such as cardiovascular disease and pre-term low birth weight infants. Mechanical removal of plaques and calculus deposits from supra and subgingival environment is the backbone of periodontal treatment till date whereas complete elimination of these deleterious agents is quite unrealistic as the pocket depth increases.

Recent Approaches:

Recently controlled local drug delivery application is more encouraging in comparison to systemic approach as it mainly targets to enhance the therapeutic efficacy by maintaining site-specificity, avoiding first pass metabolism, reduction in gastrointestinal (GI) side effects and decreasing the dose. Several drugs such as antiseptics and antibiotics alongwith various carriers are being formulated as local drug delivery systems for effective management of the disease. Various local delivery systems reported are fibers, films, strips, compacts, injectables, microparticles, vesicular carriers, gels and nanoparticles. These local carriers provide effective prolonged treatment at the site of infection at reduced doses. This review enlightens detailed pathophysiology and various phases of periodontitis, challenges in treatment of disease and various antimicrobial agents (along with their marketed formulations) used. The main emphasis of the review is to cover all carrier systems developed so far for local delivery application in the effective management of periodontitis, as a patient compliant drug therapy.

Antimicrobial activity of NO-releasing compounds against periodontal pathogens

This study describes the successful synthesis of nitric oxide (NO)-releasing compounds with biodegradable and injectable properties and demonstrates that the kinetics of NO release vary according to the type of NO donor. The antimicrobial activity of NO-releasing compounds against three common periodontal pathogens, i.e., Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Actinomyces israelii, was investigated using a susceptibility assay. Human gingival fibroblasts were treated with NO-releasing compounds at the minimum concentrations required for bacterial growth and cytotoxicity was evaluated using the MTT cell proliferation assay. Our results suggest that NO-releasing compounds can be used topically to treat both gram-negative and gram-positive periodontal pathogens. Comparison of the antimicrobial activity and cytotoxicity assay results between the NO-releasing compounds revealed that an NO donor comprising a macromolecule without surface charge, a lower instantaneous NO concentration, and an adequate supply of NO were associated with a strong bactericidal effect and low cytotoxicity. NO-releasing compounds with these properties may be suitable for treatment of periodontitis.

Antibiotics/antimicrobials: systemic and local administration in the therapy of mild to moderately advanced periodontitis

This review gives an update of the current scientific evidence on the efficacy of the adjunctive use of systemic and local antibiotics/antimicrobials in the treatment of periodontitis. In particular, it addresses whether their use can improve the results of nonsurgical mechanical therapy in mild-to-moderate forms of the disease. Large numbers of randomized clinical trials and systematic reviews with meta-analyses have clearly established that adjunctive systemic antibiotics, combined with mechanical debridement, offer clinical improvements additional to those obtained with scaling and root planing alone. These effects are more pronounced in aggressive periodontitis and in initially deep pockets, whereas more limited additional improvements, of 0.3 mm for additional pocket reduction and 0.2 mm for additional clinical attachment gain, have been documented for moderately deep sites (4-6 mm) in patients with chronic periodontitis. The marginal clinical benefit in patients with moderate disease has to be balanced against possible side effects. Notably, it has to be realized that an increasing number of warnings have been articulated against the unrestricted use of antibiotics in treating periodontal diseases because of the emerging global public health issue of bacterial resistance. The effects of the adjunctive local administration of antimicrobials have also been very well documented in several systematic reviews. Overall, in persistent or recurrent localized deep sites, the application of antimicrobials by sustained-delivery devices may offer a benefit of an additional 0.4 mm in pocket depth reduction and 0.3 mm in clinical attachment level gain. In conclusion, the slight additional benefits of adjunctive antimicrobials, which were shown for moderate forms of periodontitis, have to be balanced against their side effects and therefore their prescription should be limited as much as possible.

Risk factors for periodontal disease

Risk factors play an important role in an individual's response to periodontal infection. Identification of these risk factors helps to target patients for prevention and treatment, with modification of risk factors critical to the control of periodontal disease. Shifts in our understanding of periodontal disease prevalence, and advances in scientific methodology and statistical analysis in the last few decades, have allowed identification of several major systemic risk factors for periodontal disease. The first change in our thinking was the understanding that periodontal disease is not universal, but that severe forms are found only in a portion of the adult population who show abnormal susceptibility. Analysis of risk factors and the ability to statistically adjust and stratify populations to eliminate the effects of confounding factors have allowed identification of independent risk factors. These independent but modifiable, risk factors for periodontal disease include lifestyle factors, such as smoking and alcohol consumption. They also include diseases and unhealthy conditions such as diabetes mellitus, obesity, metabolic syndrome, osteoporosis, and low dietary calcium and vitamin D. These risk factors are modifiable and their management is a major component of the contemporary care of many periodontal patients. Genetic factors also play a role in periodontal disease and allow one to target individuals for prevention and early detection. The role of genetic factors in aggressive periodontitis is clear. However, although genetic factors (i.e., specific genes) are strongly suspected to have an association with chronic adult periodontitis, there is as yet no clear evidence for this in the general population. It is important to pursue efforts to identify genetic factors associated with chronic periodontitis because such factors have potential in identifying patients who have a high susceptibility for development of this disease. Many of the systemic risk factors for periodontal disease, such as smoking, diabetes and obesity, and osteoporosis in postmenopausal women, are relatively common and can be expected to affect most patients with periodontal disease seen in clinics and dental practices. Hence, risk factor identification and management has become a key component of care for periodontal patients.

The use of controlled release locally delivered 10% doxycycline hyclate gel as an adjunct to scaling and root planing in the treatment of chronic periodontitis: clinical and microbiological results

BACKGROUND

Local delivery of antimicrobial agents provides higher concentration of the drug in the periodontal site for longer periods than systemically delivered methods. In the present study an attempt is made to know the efficacy of controlled local drug delivery of doxycycline as an adjunctive treatment in the management of chronic periodontitis.

MATERIALS AND METHODS

A total of 12 patients, diagnosed as Chronic Periodontitis in the age of 25 to 55 years, were selected of both the sexes in this study. They were divided into Experimental group consisted of 30 sites who received complete scaling and root planing (SRP) followed by placement of Atridox gel and control group consisted of 30 sites who received only SRP. Clinical parameters were recorded at, baseline, days 30, 90 and 180. Parameters were plaque index, gingival index, gingival bleeding index and microbial analysis, probing pocket depth and Clinical attachment level (CAL). The microbiological analysis was done at baseline visit and at 90th day. Probing pocket depth and CAL were recorded only on day 0 and 180th day.

RESULTS

In 180 days study, both the groups exhibited a significant improvement in periodontal status. Significant gain in attachment level was observed in both the group. Between both the groups the clinical parameters in the experimental groups exhibited better results as compared to the control group. Both the groups exhibited significant reduction in the number of spirochetes.

CONCLUSION

Combination therapy of SRP and 10% DH gel demonstrated better results at all levels suggesting that this therapy can play a significant role as an adjunct to SRP in the management of chronic periodontitis.

Efficacy of locally-delivered doxycycline microspheres in chronic localized periodontitis and on Porphyromonas gingivalis

AIM

This study aimed to assess the efficacy and effect of locally-delivered doxycycline microspheres with scaling and root planing in periodontal pocket therapy and on Porphyromonas gingivalis, respectively.

METHODS

Twenty sites with a probing pocket depth of 4-6 mm were divided into two groups: a control group consisting of scaling and root planing, with one application of doxycycline microspheres only at baseline, and a test group consisting of scaling and root planing, with an application of doxycycline microspheres at baseline and 1 and 3 months. Clinical readings included the plaque index, gingival index, probing pocket depth, and relative attachment level. Rapid polymerase chain reaction method was used for the detection of P. gingivalis.

RESULTS

A statistically-significant reduction in probing pocket depth and attachment gain was found in both groups; the test group showed a significant reduction in probing pocket depth and attachment gain compared with the control at 3 and 6 months. P. gingivalis cell count in the test group was significantly reduced at all the time periods, except from 1 to 3 months.

CONCLUSION

Local drug delivery of doxycycline microspheres significantly improved the treatment outcomes in periodontal pocket therapy and reduced P. gingivalis in the periodontal pocket.

The effect of locally delivered doxycycline as an adjunctive therapy to scaling and root planing in smokers

BACKGROUND

Locally delivered doxycycline is found to be effective in managing periodontitis as an adjunct to scaling and root planing.

AIM

To evaluate the effect of locally delivered doxycycline (10%) with scaling and root planing in the periodontal treatment of smokers and to compare it with scaling and root planing alone.

METHODS

Twelve smokers with chronic periodontitis and a pocket depth (⩾5 mm) on posterior teeth that bleed on probing were selected. Patients were randomly assigned to scaling and root planing (SRP) or scaling and root planing followed by local application of doxycycline (SRP-D). Plaque, bleeding on probing, gingival recession, clinical attachment level (CAL), and probing depth (PD) were recorded at the baseline, 6 and 12 weeks.

RESULTS

Both groups showed a significant reduction in Plaque, Bleeding on Probing and pocket depth at 6th and 12th week from the baseline. A statistically significant gain of attachment was observed in both groups after treatment. Even though the doxycycline group showed slightly higher attachment gain it was not statistically significant compared to the control group.

CONCLUSION

The observations of the study reveal that the additional benefit of topical application of doxycycline as an adjunct to scaling and root planing in smokers is not convincing. However, further clinical studies may be necessary to substantiate the present observations.

Microbiologic changes following administration of locally delivered doxycycline in smokers: a 15-month follow-up

BACKGROUND

Additional clinical benefits have been reported with the use of locally delivered antimicrobials in the treatment of smokers; however, long-term changes in the subgingival microbiota following the use of these drugs in smokers have not been documented. The aim of this study was to evaluate long-term microbiologic changes following locally delivered doxycycline in the treatment of smokers.

METHODS

Sixteen smokers with chronic periodontitis presenting a minimum of four pockets (probing depth>or=5 mm) were selected. Patients were assigned randomly to receive scaling and root planing (SRP) or SRP and local doxycycline (SRP-D). Patients were treated at baseline and 12 months. Subgingival plaque samples were collected at baseline; 3, 6, and 12 months; and 45 and 90 days following retreatment. Polymerase chain reaction and DNA-DNA hybridization analyses were performed to detect the presence of selected periodontal pathogens.

RESULTS

The reduction in the number of sites positive for Porphyromonas gingivalis and Tannerella forsythia (previously T. forsythensis) was statistically significant for SRP-D at 3 months (68% and 41.3%, respectively) and for SRP at 6 months (75% and 52%, respectively) following treatment. The SRP group showed a greater frequency of P. gingivalis than the SRP-D group at 3 months (58% and 25%, respectively). There also was a greater reduction in the frequency of P. gingivalis at 3 months following retreatment with SRP-D compared to SRP (47% and 8%, respectively).

CONCLUSION

In smokers, adjunctive local doxycycline resulted in a greater reduction in the frequency of P. gingivalis following initial and supportive therapy compared to conventional treatment.

Doxycycline sustained release from brushite cements for the treatment of periodontal diseases

Doxycycline (DOXY) is a wide spectrum antibiotic used in the treatment of dental, periodontal, and bone infections. Brushite cements are calcium phosphate biomaterials especially interesting for bone regeneration processes. In this work, we describe the preparation of a brushite cement containing DOXY and the drug release from the cement. DOXY solutions were mixed with the cement powder and after a 50% burst release in the first 12 h, a slow and controlled release was achieved over 3.5 days. The release of DOXY hyclate was controlled by both, diffusion and Ca(2+) interaction. Formation of DOXY-Ca(2+) chelates was detected in the cement structure using solid state fluorescence. The brushite cement loaded with DOXY hyclate had antibacterial activity against periodontal pathogens: Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Bacteroides frosthytus. This new biomaterial may be helpful for the treatment of periodontal diseases.

Factors influencing the outcome of non-surgical periodontal treatment: a multilevel approach

AIM

To investigate, by means of multilevel analysis, factors that may affect the short-term clinical outcome of non-surgical periodontal treatment.

MATERIALS AND METHODS

Forty-one patients randomly assigned to two protocols of non-surgical therapy were included. The impact of different covariates on the probability of "pocket closure" [i.e. probing pocket depth (PPD)<or=4 mm] was explored using a logistic multilevel model. The impact on the final PPD was explored using a continuous multilevel model.

RESULTS

The logistic model revealed a significant impact of smoking (p<0.001), presence of plaque at the site (p<0.001) and location of the pocket at a multi-rooted tooth (p<0.001). The model explained 44% of the total variability. Of the unexplained variance, 19% was attributed to inter-patient variability. The continuous model revealed the same factors to be significant and an additional significant impact of interactions between the covariates. The R(2) was 0.50 and the random slopes model revealed an increase in the variability of the final pocket depth with an increase in the initial PPD.

CONCLUSION

Smoking habits, plaque at site level and tooth type were significant factors in determining the short-term clinical outcome of non-surgical periodontal treatment.

Mechanical Therapy With Adjunctive Minocycline Microspheres Reduces Red-Complex Bacteria in Smokers

BACKGROUND

Smoking increases the risk for periodontal disease and reduces the healing response. We examined the antimicrobial and clinical effects of scaling and root planing (SRP) with and without minocycline HCl 1 mg microspheres (MM) relative to smoking status in subjects with periodontitis.

METHODS

A total of 127 subjects (46 never smokers, 44 former smokers, and 37 current smokers) with moderate to advanced periodontitis were randomized to receive MM + SRP (N = 62) or SRP alone (N = 65). Subgingival plaque samples collected at baseline and day 30 were examined for the presence of 40 periodontal bacteria by DNA probe analysis.

RESULTS

MM + SRP reduced red-complex bacteria (RCB) numbers and proportions to a greater extent than SRP alone, irrespective of smoking status. RCB numbers were not reduced by SRP in current smokers. The difference in the reduction in numbers of RCB by SRP relative to MM + SRP in current smokers was statistically significant (P <0.05). Numbers and proportions of orange complex bacteria (OCB) were reduced in all groups treated with MM + SRP. Proportions of OCB increased in current smokers treated with SRP alone. In current smokers, MM + SRP significantly reduced probing depth (PD), increased clinical attachment level (CAL), and reduced bleeding on probing (BOP) to a greater extent than SRP alone (P <0.05).

CONCLUSIONS

SRP alone was ineffective at reducing numbers or proportions of RCB or OCB in current smokers, whereas MM + SRP significantly reduced both. MM + SRP also improved PD, BOP, and CAL to a greater extent than SRP alone independent of smoking status.

Gingival crevicular fluid prostaglandin E(2) and thiobarbituric acid reactive substance levels in smokers and non-smokers with chronic periodontitis following phase I periodontal therapy and adjunctive use of flurbiprofen

BACKGROUND

It has been established that smoking is an important risk factor for the initiation and progression of chronic periodontitis (CP). This study investigates the effects of phase I periodontal therapy and adjunctive flurbiprofen administration on prostaglandin E(2) (PGE(2)) and thiobarbituric acid reactive substance (TBARS) levels in gingival crevicular fluid (GCF) samples from smoker and non-smoker patients with CP.

METHODS

Twenty-one non-smoker and 21 smoker patients with CP were divided into four groups according to treatment modalities. Group 1 (non-smokers with CP) and group 3 (smokers with CP) patients received daily 100-mg flurbiprofen tablets in a 2 x 1 regimen for 10 days together with scaling and root planing (SRP). Patients in group 2 (non-smokers with CP) and group 4 (smokers with CP) received placebo tablets in a 2 x 1 regimen for 10 days together with SRP. Plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment level (CAL) measurements were recorded and GCF samples were collected at baseline and on day 10 of drug intake from each sampling area by a single examiner who was unaware of the treatment modality. Assays for GCF PGE(2) and TBARS were carried out by an enzyme-linked immunosorbent assay and fluorometric method, respectively.

RESULTS

All groups showed statistically significant reductions in PI and GI scores following the phase I periodontal treatment on day 10 (P <0.05), but no statistical differences were observed in PD and CAL scores after the therapy. In groups 1 and 2, the reduction of GCF PGE(2) and TBARS levels were not significant after the therapy compared to baseline levels. In group 3, GCF PGE(2) and TBARS levels exhibited a statistically significant decrease (P <0.05) after the therapy. Group 4 showed significant reductions (P <0.05) in GCF PGE(2) levels after the therapy. No statistically significant reductions were observed in group 4 with regard to GCF TBARS levels. When groups 1 and 3 were compared according to GCF TBARS levels after the therapy, a more statistically significant reduction was observed in group 3 (P = 0.001).

CONCLUSION

These results suggest that additional flurbiprofen administration may have more inhibitory effects on GCF levels of PGE(2) and TBARS in the groups of smokers compared to non-smokers with CP.

Local Drug Delivery in the Treatment of Periodontal Diseases: Assessing the Clinical Significance of the Results

BACKGROUND

Local drug delivery can be used in the management of periodontal patients. However, statistically significant responses to therapy recorded in clinical trials may not be clinically significant.

METHODS

Controlled clinical trials were selected that assessed the capability of local drug delivery to improve periodontal health.

RESULTS

Several local drug delivery systems employed as monotherapies improved periodontal health and provided results that were not statistically significantly different than attained with scaling and root planing (SRP) alone. In contrast, many local drug delivery devices when used as adjuncts to SRP provided a statistically significant enhancement of parameters commonly used to monitor periodontal status. However, mean improvements with respect to probing depth reduction or gain of clinical attachment were often limited to tenths of millimeters. Several devices also achieved specific criteria that can be used to identify clinically significant findings (e.g., number of sites with probing depth reduction >or=2 mm). However, there are conflicting data with respect to the ability of local drug delivery to enhance results of SRP at deep probing sites, and there is limited information relative to its capability to inhibit disease progression or enhance osseous repair in infrabony defects.

CONCLUSION

The decision to use local drug delivery during active treatment or maintenance should be based upon clinical findings, responses to therapy recorded in the literature, desired clinical outcomes, and the patient's dental and medical history.

Locally Delivered Doxycycline as an Adjunctive Therapy to Scaling and Root Planing in the Treatment of Smokers: A 2-Year Follow-Up

BACKGROUND

The aim of this clinical study was to evaluate the association of locally delivered doxycycline 10% with scaling and root planing in the periodontal treatment of smokers during a 2-year period.

METHODS

Forty-eight chronic periodontitis patients, presenting a minimum of four pockets (>or=5 mm) that bled on probing on anterior teeth were included. Patients were randomly assigned to receive one of the following treatments: scaling and root planing (SRP) and scaling and root planing followed by local application of doxycycline (SRP-D). Assigned treatments were performed at baseline and at 12 months. Clinical parameters, including probing depth (PD) and relative attachment level (RAL), were recorded at baseline; 45 days; 3, 6, and 12 months (retreatment); 45 days following retreatment; and at 15, 18, and 24 months.

RESULTS

In initially deep pockets (>or=7 mm), SRP-D showed greater PD reduction than SRP at 6 and 18 months (mean difference between groups of 1.18 and 1.73 mm, respectively; P <0.05) and greater RAL gain in all periods after 3 months (mean difference between groups of 1.16, 1.99, and 1.78 mm, at 6, 18, and 24 months, respectively; P <0.05). Also, the proportion of sites showing >or=2 mm PD reduction was greater for SRP-D at 6 months (81.2% x 50.8%; P <0.001) and at 24 months (65.5% x 46.5%; P = 0.01). As for RAL gain, this proportion was 34.4% and 18.1% for SRP-D and SRP at 24 months, respectively (P = 0.008).

CONCLUSION

The use of locally delivered doxycycline may constitute an important adjunct for the active and supportive treatments of severe periodontal disease in smokers.

The effect of smoking on periodontal treatment response: a review of clinical evidence

BACKGROUND

Smoking has been identified as a significant risk factor for periodontal diseases and is regarded as being responsible for incomplete or delayed healing in patients following treatment.

AIM AND METHOD

The aim of this conventional review was to review, collate and tabulate the relative effectiveness of treatments of chronic periodontitis in smokers, non-smokers and ex-smokers.

OBSERVATIONS

The majority of clinical trials show significantly greater reductions in probing depths and bleeding on probing, and significantly greater gain of clinical attachment following non-surgical and surgical treatments in non-smokers compared with smokers. This benefit is also seen at class I and II furcation sites and in patients prescribed systemic or local antimicrobial treatments.

CONCLUSIONS

Data from epidemiological, cross-sectional and case-control studies strongly suggest that quitting smoking is beneficial to patients following periodontal treatments. The periodontal status of ex-smokers following treatment suggests that quitting the habit is beneficial although there are only limited data from long-term longitudinal clinical trials to demonstrate unequivocally the periodontal benefit of quitting smoking.

Nonsurgical approaches for the treatment of periodontal diseases

This article reviews nonsurgical approaches for the management of periodontal diseases. A brief review of the pathogenesis of periodontitis allows the reader to identify the potential points of intervention. Assessment of risk factors for periodontitis and the potential for risk reduction are introduced as the first part of a three-pronged approach to therapy. Antimicrobial approaches, including the use of mechanical therapy, antiseptics, and antibiotics,are described next. Host modulatory therapy is addressed as the fi-nal component of the nonsurgical approach to periodontal therapy. Clinical applications of these nonsurgical options are presented as part of the treatment strategy.