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Figuero E, Serrano J, Arweiler NB, Auschill TM, Gürkan A, Emingil G. Supra and subgingival application of antiseptics or antibiotics during periodontal therapy. Periodontol 2000 2023. [PMID: 37766668 DOI: 10.1111/prd.12511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/17/2023] [Accepted: 06/22/2023] [Indexed: 09/29/2023]
Abstract
Periodontal diseases (gingivitis and periodontitis) are characterized by inflammatory processes which arise as a result of disruption of the balance in the oral ecosystem. According to the current S3 level clinical practice guidelines, therapy of patients with periodontitis involves a stepwise approach that includes the control of the patient's risk factors and the debridement of supra and subgingival biofilm. This debridement can be performed with or without the use of some adjuvant therapies, including physical or chemical agents, host modulating agents, subgingivally locally delivered antimicrobials, or systemic antimicrobials. Therefore, the main aim of this article is to review in a narrative manner the existing literature regarding the adjuvant application of local agents, either subgingivally delivered antibiotics and antiseptics or supragingivally applied rinses and dentifrices, during the different steps in periodontal therapy performed in Europe.
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Affiliation(s)
- Elena Figuero
- Department of Dental Clinical Specialties, Etiology and Therapy of Periodontal and Peri-implant Research Group, Faculty of Dentistry, University Complutense of Madrid, Madrid, Spain
- Etiology and Therapy of Periodontal and Peri-implant Research Group, University Complutense of Madrid, Madrid, Spain
| | - Jorge Serrano
- Etiology and Therapy of Periodontal and Peri-implant Research Group, University Complutense of Madrid, Madrid, Spain
| | - Nicole Birgit Arweiler
- Department of Periodontology and Peri-implant Diseases, Philipps University of Marburg, Marburg, Germany
| | - Thorsten Mathias Auschill
- Department of Periodontology and Peri-implant Diseases, Philipps University of Marburg, Marburg, Germany
| | - Ali Gürkan
- Department of Peridontology, Ege University School of Dentistry, Bornova, Turkey
| | - Gülnur Emingil
- Department of Peridontology, Ege University School of Dentistry, Bornova, Turkey
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Zussman M, Zilberman M. Injectable metronidazole-eluting gelatin-alginate hydrogels for local treatment of periodontitis. J Biomater Appl 2022; 37:166-179. [PMID: 35341363 DOI: 10.1177/08853282221079458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Infection of the periodontal pocket presents two major challenges for drug delivery: administration into the periodontal pocket and a high fluid clearance rate in the pocket. The current study aimed to develop and study a novel hydrogel system for delivery of the antibiotic drug metronidazole directly into the periodontal pocket via injection followed by in situ gelation. The natural polymers gelatin and alginate served as basic materials, and their crosslinking using a carbodiimide resulted in a dual hydrogel network. The study focused on the effects of the hydrogel's formulation parameters on the drug release profile and the hydrogel's physical and mechanical properties. A cell viability test was conducted on human fibroblasts. The metronidazole-loaded hydrogels demonstrated a decreasing release rate with time, where most of the drug eluted within 24 h. These hydrogels exhibited fibroblast viability of at least 75% after 24 and 48 h, indicating that they are highly biocompatible. Although the alginate concentration used in this study was relatively low, it had a strong effect on the physical as well as the mechanical properties of the hydrogel. An increase in the alginate concentration increased the crosslinking rate and enabled enhanced entanglement of the 3D structure, resulting in a decrease in the gelation time (less than 10 s) and swelling degree, which are both desired for the studied periodontal application. Increasing the gelatin concentration without changing the crosslinker concentration resulted in significant changes in the physical properties and slight changes in the mechanical properties. Metronidazole incorporation slightly decreased the hydrophilicity of the hydrogel and therefore also its viscosity, and affected the sealing ability and the tensile and compression moduli. The developed hydrogels exhibited controllable mechanical and physical properties, can target a wide range of conditions, and are therefore of high significance in the field of periodontal treatment.
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Affiliation(s)
- Merav Zussman
- Department of Materials Science and Engineering, 99050Iby and Aladar Fleischman Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Meital Zilberman
- Department of Biomedical Engineering, 99050Iby and Aladar Fleischman Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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Zussman M, Giladi S, Zilberman M. In vitro
characterization of injectable
chlorhexidine‐eluting
gelatin hydrogels for local treatment of periodontal infections. POLYM ADVAN TECHNOL 2022. [DOI: 10.1002/pat.5640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Merav Zussman
- Department of Materials Science and Engineering Tel‐Aviv University Tel‐Aviv Israel
- Department of Biomedical Engineering Tel‐Aviv University Tel‐Aviv Israel
| | - Shir Giladi
- Department of Materials Science and Engineering Tel‐Aviv University Tel‐Aviv Israel
| | - Meital Zilberman
- Department of Materials Science and Engineering Tel‐Aviv University Tel‐Aviv Israel
- Department of Biomedical Engineering Tel‐Aviv University Tel‐Aviv Israel
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Steinberg D, Friedman M. Sustained-release delivery of antimicrobial drugs for the treatment of periodontal diseases: Fantasy or already reality? Periodontol 2000 2020; 84:176-187. [PMID: 32844422 DOI: 10.1111/prd.12341] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Periodontal diseases are prevalent in humans. Conventional means of combating these diseases involve basic oral hygiene, mostly toothbrushing, use of mouthwashes, and flossing. Supplementary means of treatment, either clinical or pharmaceutical, are often necessary. The use of sustained-release delivery systems, applied locally to the periodontal pocket, seems to be one feasible approach: local sustained-release delivery of antibacterial agents to treat periodontal diseases is conceivable. The use of local (intrapocket) sustained-release delivery systems has numerous clinical, pharmacologic, and toxicologic advantages over conventional treatments for periodontal diseases. Sustained-release technology has been proven to be effective over the last few decades. Films, gels, and fibers are the three main classical intrapocket pharmaceutical delivery systems. Research today is more focused on improving drug delivery, and less on introducing new drugs. New approaches, eg, those making use of nanotechnology, are emerging for local drug-delivery systems. The local sustained-release delivery system concept is innovative and a few products are already commercially available.
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Affiliation(s)
- Doron Steinberg
- Biofilm Research Laboratory, Faculty of Dental Medicine, Institute of Dental Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Friedman
- School of Pharmacy, The Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
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A New Controlled-Release Material Containing Metronidazole and Doxycycline for the Treatment of Periodontal and Peri-Implant Diseases: Formulation and In Vitro Testing. Int J Dent 2019; 2019:9374607. [PMID: 30956660 PMCID: PMC6425423 DOI: 10.1155/2019/9374607] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/22/2019] [Accepted: 01/28/2019] [Indexed: 11/17/2022] Open
Abstract
Background Several locally administered antimicrobials have been studied in the literature as adjunctive or primary treatments for periodontitis and peri-implantitis with conflicting results. Objective The aim of this study was twofold: (1) the formulation of a controlled-release material containing metronidazole and doxycycline; (2) an in vitro evaluation of its antibacterial properties against planktonic and biofilm species involved in periodontal and peri-implant diseases. Methods Doxycycline (10 mg/ml) and metronidazole (20 mg/ml) were incorporated into a hydroxyethylcellulose-polyvinylpyrrolidone-calcium polycarbophil gel. Three milliliters of gel were dialyzed against Dulbecco's phosphate-buffered saline for 13 days. Antibiotics release at 3, 7, 10, and 13 days was determined spectroscopically. The inhibitory activity of the experimental gel was tested against A. actinomycetemcomitans, S. sanguinis, P. micra, and E. corrodens with an agar diffusion test, an inactivation biofilm test, and a confocal laser scanning microscope study (CLSMS) for S. sanguinis up to 20 days. Results After 13 days, the released doxycycline was 9.7% (at 3 days = 1.2 mg; 7 days = 0.67 mg; 10 days = 0.76 mg; 13 days = 0.29 mg), while metronidazole was 67% (30 mg, 6.8 mg, 2.5 mg, and 0.9 mg at the same intervals). The agar diffusion test highlights that the formulated gel was active against tested microorganisms up to 312 h. Quantitative analysis of biofilm formation for all strains and CLSMS for S. sanguinis showed a high growth reduction up to 13 days. Conclusions The in vitro efficacy of the newly formulated gel was confirmed both on planktonic species and on bacterial biofilm over a period of 13 days. The controlled-release gel containing metronidazole and doxycycline had an optimal final viscosity and mucoadhesive properties. It can be argued that its employment could be useful for the treatment of periodontal and peri-implant diseases, where conventional therapy seems not successful.
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Agarwal S, Chaubey KK, Chaubey A, Agarwal V, Madan E, Agarwal MC. Clinical efficacy of subgingivally delivered simvastatin gel in chronic periodontitis patients. J Indian Soc Periodontol 2017; 20:409-416. [PMID: 28298823 PMCID: PMC5341316 DOI: 10.4103/0972-124x.194270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: Simvastatin (SMV), a new locally delivered drug of class statins, is a specific competitive inhibitor of 3-hydroxy-2-methyl-glutaryl coenzyme A reductase. Statins, besides having lipid-lowering abilities, also have pleiotropic effects like host modulation and bone regeneration. The present study was designed to investigate the effectiveness of SMV, 1.2 mg, in an indigenously prepared biodegradable controlled-release gel as an adjunct to scaling and root planing (SRP). Materials and Methods: A total of 60 sites, with pocket depth ≥5 mm, two from each of 30 patients after SRP, were categorized into two treatment groups, for subgingival placement of placebo (Gp 1) or SMV (Gp 2). Clinical parameters were recorded at baseline and at 1, 3 and 6 months comprising plaque index, gingival index, probing pocket depth (PPD) and clinical attachment level (CAL). The osseous changes were evaluated radiographically by measuring vertical gain, INFRA 1 and angle of the defect, INFRA 2 from baseline to 6 months. Results: All subjects tolerated the drug, without any post-application complication. The treatment improved the periodontal condition in both the groups but significant reductions in PPD (p= 0.04), and INFRA 1 (p= 0.000), along with gain in CAL (p= 0.02) and INFRA 2 (p= 0.000) were observed in Gp 2. In one site, an unexpected 5 mm decrease in INFRA 1 was found. Conclusion: Local drug delivery of SMV enhanced the beneficial effect of SRP, in pocket reduction, gain in CAL and bone fill.
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Affiliation(s)
- Swati Agarwal
- Department of Periodontics, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Krishna Kumar Chaubey
- Department of Periodontics, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Abhinav Chaubey
- Department of Conservative Dentistry and Endodontics, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Vikas Agarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ellora Madan
- Department of Periodontics, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Manvi Chandra Agarwal
- Department of Periodontics, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
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Dang AB, Chaubey KK, Thakur RK, Mohan R, Chowdhary Z, Tripathi R. Comparative evaluation of efficacy of three treatment modalities - tetracycline fibers, scaling and root planing, and combination therapy: A clinical study. J Indian Soc Periodontol 2016; 20:608-613. [PMID: 29238141 PMCID: PMC5713084 DOI: 10.4103/jisp.jisp_52_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Tetracycline is one of the primary antibiotics prescribed for antimicrobial therapy in periodontics. It has a broad spectrum of activity being effective against most bacteria as well as spirochetes. Due to limitations of systemic drug therapy, recent formulations of the drug for local administration in the subgingival area have been introduced, including collagen fibers impregnated with tetracycline. Aims and Objective To compare the effectiveness of tetracycline fibers alone or in combination with scaling and root planing (SRP) on clinical parameters in chronic periodontitis patients. Materials and Methods A total of twenty patients comprising of both sexes in the age group of 35-60 years with chronic periodontitis were selected. Split-mouth design was used, and three teeth from each patient with periodontal pocket measuring > 5 mm were selected which were treated with different treatment modality. They were randomly divided into site A (SRP), site B (tetracycline fibers only), and site C (combination therapy). Clinical parameters of plaque index (PI), gingival index (GI), pocket probing depth, and clinical attachment level (CAL) were recorded at 0, 30, and 45 days. The data obtained was compiled and put to statistical analysis. Results All the three groups showed improvement in PI, GI, probing pocket depth, and CAL. Results of the study showed greater improvements in clinical parameters in Group C compared to Group A and Group B. Conclusion The results indicate that the adjunctive use of tetracycline fibers with SRP is a clinically effective and simple nonsurgical treatment method to improve periodontal health.
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Affiliation(s)
- Aashima Bajaj Dang
- Department of Periodontology, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Krishan Kumar Chaubey
- Department of Periodontolgy, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Rajesh Kumar Thakur
- Department of Periodontolgy, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Ranjana Mohan
- Department of Periodontology, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Zoya Chowdhary
- Department of Periodontology, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Richa Tripathi
- Department of Periodontolgy, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
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Yuvaraja M, Reddy NR, Kumar PM, Ravi KS, Alqahtani N. Thermoreversible gel for intrapocket delivery of green tea catechin as a local drug delivery system: An original research. J Adv Pharm Technol Res 2016; 7:139-143. [PMID: 27833893 PMCID: PMC5052940 DOI: 10.4103/2231-4040.191422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The periodontal therapies along with systemic antibiotic therapy aim at eliminating the subgingival microbiota to arrest the progression of periodontal diseases. The complete elimination is often difficult, and thus the probability of repopulation after periodontal therapy is also high. The objectives of the study are to develop in situ thermoreversible gelling system of green tea catechins suitable for periodontal pocket administration, which would act as an adjunct to mechanical periodontal therapy. Gel is prepared on a weight basis using a cold process. In vitro drug release pattern is observed through spectrophotometer analysis at 277 nm. The gel is subjected to serial dilution analysis to determine the minimum inhibitory concentration (MIC) and disc diffusion analysis to determine the in vitro antibacterial effectiveness. Release pattern studies showed a complete release of drug from gel occurred by 36 h. A volume of 1.25 mg/ml was determined as MIC required against the periodontal pathogens. Disc diffusion analysis showed a 14 mm zone of inhibition is present around the 75 µl well for all the four species and 12 mm zone of inhibition around the 50 µl well. The advantage of F-127 is its thermoreversible nature that used for in situ gel formulation. Pluronic gel proved to be a promising carrier for prolong and effective release of green tea catechin.
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Affiliation(s)
- M Yuvaraja
- Department of Periodontics, Rajas Dental College and Hospital, Tirunelveli, Tamil Nadu, India
| | - N Raghavendra Reddy
- Department of Preventive Dental Science, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - P Mohan Kumar
- Department of Periodontics, St. Joseph Dental College, Eluru, Andhra Pradesh, India
| | - K S Ravi
- Department of Preventive Dental Science, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Nabeeh Alqahtani
- Department of Preventive Dental Science, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
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Vijayalashmi R, Ravindranath SM, Jayakumar ND, Padmalatha, Vargheese SH, Kumaraswamy KL. Kinetics of drug release from a biodegradable local drug delivery system and its effect on Porphyromonas gingivalis isolates: An in vitro study. J Indian Soc Periodontol 2013; 17:429-34. [PMID: 24174719 PMCID: PMC3800402 DOI: 10.4103/0972-124x.118311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 07/20/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Conventional anti-microbial therapy largely consisted of systemic administration of various drugs effective against periodontal pathogens, but fraught with several problems. Based on the concept of local drug delivery a bioresorbable device made of pure fibrillar collagen has been developed. The aim of this study was to study the release of Tetracycline from this collagen fiber (Type I collagen) impregnated with Tetracycline and its antibacterial activity against Porphyromonas gingivalis. MATERIALS AND METHODS Porphyromonas gingivalis was isolated from plaque samples of chronic periodontitis patients by using a CO2 incubator. DNA isolation was done followed by polymerase chain reaction (PCR) amplification to confirm the presence of bacteria. The release pattern of Tetracycline was assessed for a period of 10 days in water (group I) and Serum inoculated with Porphyromonas gingivalis (group II). RESULTS A significant presence of Tetracycline on all days in Group I and group II and the zone of inhibition was also present in both groups with a steady decline from day 1 to day 10. CONCLUSION Since the results were well within the therapeutic concentration of drug required to inhibit the growth of gram -ve bacteria (Porphyromonas gingivalis), this bioresorbable Tetracycline fiber has the potential for clinical application.
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Affiliation(s)
| | | | | | - Padmalatha
- Department of Periodontics, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India
| | - Sheeja H. Vargheese
- Department of Periodontics, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India
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Musial W, Voncina B, Pluta J, Kokol V. The study of release of chlorhexidine from preparations with modified thermosensitive poly-N-isopropylacrylamide microspheres. ScientificWorldJournal 2012; 2012:243707. [PMID: 22629123 PMCID: PMC3353284 DOI: 10.1100/2012/243707] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 11/20/2011] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to investigate and compare the release rates of chlorhexidine (CX) base entrapped in the polymeric beads of modified poly-N-isopropylacrylamides (pNIPAMs) at temperatures below and over the volume phase transition temperature (VPTT) of synthesized polymers: pNIPAM-A with terminal anionic groups resulting from potassium persulfate initiator, pNIPAM-B with cationic amidine terminal groups, and pNIPAM-C comprising anionic terminals, but with increased hydrophobicity maintained by the N-tert-butyl functional groups. The preparations, assessed in vitro below the VPTT, release an initial burst of CX at different time periods between 120 and 240 min, followed by a period of 24 h, when the rate of release remains approximately constant, approaching the zero-order kinetics; the release rates for the polymers beads are as follows: pNIPAM-C>pNIPAM-B>pNIPAM-A. The pattern of release rates at temperature over the VPTT is as follows: pNIPAM-C>pNIPAM-A>pNIPAM-B. In the presence of pNIPAM-C, the duration between the start of the release and the attained minimal inhibitory concentration (MIC) for most of the microbes, in conditions over the VPTT, increased from 60 to 90 min. The release prolongation could be ascribed to some interactions between the practically insoluble CX particle and the hydrophobic functional groups of the polymer.
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Affiliation(s)
- Witold Musial
- Department of Pharmaceutical Technology, Wroclaw Medical University, ul Szewska 38, 50-139 Wrocław, Poland.
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Bhat G, Kudva P, Dodwad V. Aloe vera: Nature's soothing healer to periodontal disease. J Indian Soc Periodontol 2011; 15:205-9. [PMID: 22028505 PMCID: PMC3200013 DOI: 10.4103/0972-124x.85661] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Accepted: 05/25/2010] [Indexed: 11/29/2022] Open
Abstract
Background: Recent interest and advances in the field of alternative medicine has promoted the use of various herbal and natural products for multiple uses in the field of medicine. Aloe vera is one such product exhibiting multiple benefits and has gained considerable importance in clinical research. This clinical study focuses on Aloe vera and highlights its property when used as a medicament in the periodontal pocket. Materials and Methods: A total number of 15 subjects were evaluated for clinical parameters like plaque index, gingival index, probing pocket depth at baseline, followed by scaling and root planing (SRP). Test site comprised of SRP followed by intra-pocket placement of Aloe vera gel, which was compared with the control site in which only SRP was done, and clinical parameters were compared between the two sites at one month and three months from baseline. Results: Results exhibited encouraging findings in clinical parameters of the role of Aloe vera gel as a drug for local delivery. Conclusion: We conclude that subgingival administration of Aloe vera gel results in improvement of periodontal condition. Aloe vera gel can be used as a local drug delivery system in periodontal pockets.
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Affiliation(s)
- Geetha Bhat
- Department of Periodontics, Jaipur Dental College, Jaipur, Rajasthan, India
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12
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Zamani M, Morshed M, Varshosaz J, Jannesari M. Controlled release of metronidazole benzoate from poly ε-caprolactone electrospun nanofibers for periodontal diseases. Eur J Pharm Biopharm 2010; 75:179-85. [DOI: 10.1016/j.ejpb.2010.02.002] [Citation(s) in RCA: 210] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 12/04/2009] [Accepted: 02/02/2010] [Indexed: 11/26/2022]
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Singh S, Roy S, Chumber SK. Evaluation of two local drug delivery systems as adjuncts to mechanotherapy as compared to mechanotherapy alone in management of chronic periodontitis: A clinical, microbiological, and molecular study. J Indian Soc Periodontol 2009; 13:126-32. [PMID: 20379409 PMCID: PMC2848782 DOI: 10.4103/0972-124x.60224] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 07/10/2009] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Modern concepts of treating inflammatory periodontal disease aim at changes in the subgingival ecosystems within the periodontal pockets to alter the complex microbial community into a microbiota compatible with good periodontal health. Systemic antimicrobial therapy, although effective, involves a relatively high dose with repeated intakes over a prolonged period of time to achieve the required inhibitory concentrations in the sulcular fluid. The adjunctive use of local drug delivery may provide a beneficial response, especially in specific areas where conventional forms of therapy might fail. The aim of this study was to compare the efficacy of two local drug delivery systems, one containing metronidazole and the other containing tetracycline hydrochloride as adjuncts to mechanotherapy in the treatment of chronic periodontitis. MATERIALS AND METHODS There were three groups that were labeled as group A (Scaling + Tetracycline), group B (Scaling + Metronidazole), and group C (Scaling alone). A microbiological analysis was carried out to determine the efficacy of these systems in changing the pathogenic flora in deep pockets. In addition, a multiplex polymerase chain reaction was carried out to confirm the presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis (Pg), and Tannerella forsythensis in the flora associated with chronic periodontitis. RESULTS There was clinical improvement in groups A and B, which correlated with an improvement in the microbiological parameters; these results were sustained for 90 days following therapy. In Group C, the flora showed a shift towards baseline at the end of 90 days. CONCLUSIONS According to this study, both the local antibiotic therapies resulted in greater improvement in microbiological parameters when used as an adjunct to mechanotherapy as compared to mechanotherapy alone.
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Affiliation(s)
| | - Subrata Roy
- Officer Commanding, Military Dental Centre, Barrackpore, WB, India
| | - S. K. Chumber
- Classified Specialist (Microbiology), Base Hospital, Tezpur, Assam, India
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14
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Shifrovitch Y, Binderman I, Bahar H, Berdicevsky I, Zilberman M. Metronidazole-loaded bioabsorbable films as local antibacterial treatment of infected periodontal pockets. J Periodontol 2009; 80:330-7. [PMID: 19186975 DOI: 10.1902/jop.2009.080216] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Periodontal disease is infectious in nature and leads to an inflammatory response. It arises from the accumulation of subgingival bacterial plaque and leads to the loss of attachment, increased probing depth, and bone loss. It is one of the world's most prevalent chronic diseases. In this study we developed and studied metronidazole-loaded 50/50 poly(DL-lactide-co-glycolide) (PDLGA), 75/25 PDLGA, and poly(DL-lactic acid) (PDLLA) films. These films are designed to be inserted into the periodontal pocket and treat infections with controlled-release metronidazole for >or=1 month. METHODS The structured films were prepared using the solution-casting technique. Concentrated solutions and high solvent-evaporation rates were used to get most of the drug located in the bulk, i.e., in whole film's volume. The effects of copolymer composition and drug content on the release profile, cell growth, and bacterial inhibition were investigated. RESULTS The PDLLA and 75/25 PDLGA films generally exhibited a low- or medium-burst release followed by a moderate release at an approximately constant rate, whereas the 50/50 PDLGA films exhibited a biphasic release profile. The drug released from films loaded with 10% weight/weight metronidazole resulted in a significant decrease in bacterial viability within several days. When exposed to human gingival fibroblasts in cell culture conditions, these films maintained their normal fibroblastic features. CONCLUSIONS This study enabled the understanding of metronidazole-release kinetics from bioabsorbable polymeric films. The developed systems demonstrated good biocompatibility and the ability to inhibit Bacteroides fragilis growth; therefore, they may be useful in the treatment of periodontal diseases.
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Affiliation(s)
- Yael Shifrovitch
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
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15
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Karunakar B, Sabu K, Udupa N, Varma BRR. Design and Evaluation of Tinidazole Dental Implants. Drug Dev Ind Pharm 2008. [DOI: 10.3109/03639049409050194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Bruschi ML, Jones DS, Panzeri H, Gremião MPD, de Freitas O, Lara EHG. Semisolid systems containing propolis for the treatment of periodontal disease: in vitro release kinetics, syringeability, rheological, textural, and mucoadhesive properties. J Pharm Sci 2007; 96:2074-89. [PMID: 17301966 DOI: 10.1002/jps.20843] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Formulations containing poloxamer 407 (P407), carbopol 934P (C934P), and propolis extract (PE) were designed for the treatment of periodontal disease. Gelation temperature, in vitro drug release, rheology, hardness, compressibility, adhesiveness, mucoadhesion, and syringeability of formulations were determined. Propolis release from formulations was controlled by the phenomenon of relaxation of polymer chains. Formulations exhibited pseudoplastic flow and low degrees of thixotropy or rheopexy. In most samples, increasing the concentration of C934P content significantly increased storage modulus (G'), loss modulus (G''), and dynamic viscosity (eta'), at 5 degrees C, G'' exceeded G'. At 25 and 37 degrees C, eta' of each formulation depended on the oscillatory frequency. Formulations showed thermoresponsive behavior, existing as a liquid at room temperature and gel at 34-37 degrees C. Increasing the C934P content or temperature significantly increased formulation hardness, compressibility, and adhesiveness. The greatest mucoadhesion was noted in the formulation containing 15% P407 (w/w) and 0.25% C934P (w/w). The work of syringeability values of all formulations were similar and very desirable with regard to ease of administration. The data obtained in these formulations indicate a potentially useful role in the treatment of periodontitis and suggest they are worthy of clinical evaluation.
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Affiliation(s)
- Marcos L Bruschi
- Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Av. Zeferino Vaz, s/n, CEP 14040-903, Ribeirão Preto, SP, Brazil.
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17
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Abstract
Chlorhexidine salts are available in various formulations for dental applications. This study tested the hypothesis that the release of chlorhexidine from a urethane dimethacrylate and triethylene glycol dimethacrylate resin system can be effectively controlled by the chlorhexidine diacetate content and pH. The filler concentrations were 9.1, 23.1, or 33.3 wt%, and the filled resins were exposed to pH 4 and pH 6 acetate buffers. The results showed that Fickian diffusion was the dominant release mechanism. The rates of release were significantly higher in pH 4 buffer, which was attributed to the increase of chlorhexidine diacetate solubility at lower pH. The higher level of filler loading reduced the degree of polymerization, leading to a greater loss of organic components and higher chlorhexidine release rates.
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18
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Parker S, Meththananda I, Braden M, Pearson GJ. Characterisation of some experimental silicones. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2006; 17:1255-8. [PMID: 17143756 DOI: 10.1007/s10856-006-0599-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2005] [Accepted: 01/04/2006] [Indexed: 05/12/2023]
Abstract
Release of antimicrobials/antibacterials like chlorhexidine diacetate (CHD) has proved successful in inhibiting Candidal colonisation of silicone-based biomaterials. However, their addition will increase water uptake and may compromise the mechanical integrity. Two experimental silicones (S1 and S2) differing only in the surface treatment of the filler, were investigated. Ultimate tensile strength (UTS), % elongation at break (Eb), Shore A hardness and, when doped with 1% CHD, water uptake and CHD release were measured. Elastic modulus (E) was calculated from the hardness measurements. There was no significant difference in UTS and Eb between the two materials. However S1 had a higher hardness (30.6 +/- 0.97) and thus E (0.76 MPa) than S2 (hardness = 23.8 +/- 0.48, E = 0.45 MPa). Water uptake for S2 (0.6%) was higher than for S2 (0.1) and addition of CHD dramatically increased the uptake of both (S1 = 3.1%, S2 = 4.0%). Release of CHD was higher for S2 (30%) than S1 (27%). Equating osmotic pressure within the droplets with elastic restraining force gave an extension ratio of 1.95 for S1 and 5.39 for S2. Thus, addition of a hydrophilic agent can compromise the mechanical integrity of low modulus silicones.
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Affiliation(s)
- S Parker
- Biomaterials in Relation to Dentistry, IRC in Biomedical Materials, Barts & the London, Queen Mary's School of Medicine & Dentistry, Francis Bancoft Building, Mile End Road, London, E1 4NS, UK.
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19
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Cetin EO, Buduneli N, Atlihan E, Kirilmaz L. In vitro studies on controlled-release cellulose acetate films for local delivery of chlorhexidine, indomethacin, and meloxicam. J Clin Periodontol 2004; 31:1117-21. [PMID: 15560815 DOI: 10.1111/j.1600-051x.2004.00620.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Delivery of medications into periodontal pockets to suppress or eradicate the pathogenic microbiota or modulate the inflammatory response, thereby limiting periodontal tissue destruction, has attracted significant interest with the purpose of effective periodontal treatment. However, no study has previously attempted to develop a controlled-release formulation of anti-inflammatory agents to be used in the field of periodontology. The aim of the present study was to examine the in vitro release profile of chlorhexidine gluconate, indomethacin, and meloxicam from cellulose acetate films. METHODS Cellulose acetate films containing chlorhexidine gluconate, indomethacin, and meloxicam were prepared and cut in a form to fit to the periodontal pocket anatomy. The release of active agents was studied in 10 ml artificial saliva at 37 degrees C. Apparatus Vibrax was used at 150 r.p.m. Determinations were carried out spectrophotometrically and the release profiles were plotted as a function of time. RESULTS The formulations showed two different release patterns for a total observation period of approximately 120 h. When the formulations of the three active agents were compared, the release patterns of meloxicam and chlorhexidine gluconate were found to be similar, while the indomethacin-containing formulation exhibited the fastest release rate. CONCLUSIONS As a conclusion, cellulose acetate may be a suitable inert material for obtaining a prolonged local release of various anti-inflammatory agents like meloxicam. Further in vitro and in vivo studies are required before starting clinical applications of these controlled-release formulations of anti-inflammatory agents.
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Affiliation(s)
- Emel Oykü Cetin
- Department of Biopharmaceutics and Pharmacokinetics, School of Pharmacy, Ege University, Izmir, Turkey
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20
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Jones DS, Woolfson AD, Brown AF, Coulter WA, McClelland C, Irwin CR. Design, characterisation and preliminary clinical evaluation of a novel mucoadhesive topical formulation containing tetracycline for the treatment of periodontal disease. J Control Release 2000; 67:357-68. [PMID: 10825567 DOI: 10.1016/s0168-3659(00)00231-5] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study describes the formulation, characterisation and preliminary clinical evaluation of mucoadhesive, semi-solid formulations containing hydroxyethylcellulose (HEC, 1-5%, w/w), polyvinylpyrrolidine (PVP, 2 or 3%, w/w), polycarbophil (PC, 1 or 3%, w/w) and tetracycline (5%, w/w, as the hydrochloride). Each formulation was characterised in terms of drug release, hardness, compressibility, adhesiveness (using a texture analyser in texture profile analysis mode), syringeability (using a texture analyser in compression mode) and adhesion to a mucin disc (measured as a detachment force using the texture analyser in tensile mode). The release exponent for the formulations ranged from 0.78+/-0.02 to 1. 27+/-0.07, indicating that drug release was non-diffusion controlled. Increasing the concentrations of each polymeric component significantly increased the time required for 10 and 30% release of the original mass of tetracycline, due to both increased viscosity and, additionally, the unique swelling properties of the formulations. Increasing concentrations of each polymeric component also increased the hardness, compressibility, adhesiveness, syringeability and mucoadhesion of the formulations. The effects on product hardness, compressibility and syringeability may be due to increased product viscosity and, hence, increased resistance to compression. Similarly, the effects of these polymers on adhesiveness/mucoadhesion highlight their mucoadhesive nature and, importantly, the effects of polymer state (particularly PC) on these properties. Thus, in formulations where the neutralisation of PC was maximally suppressed, adhesiveness and mucoadhesion were also maximal. Interestingly, statistical interactions were primarily observed between the effects of HEC and PC on drug release, mechanical and mucoadhesive properties. These were explained by the effects of HEC on the physical state of PC, namely swollen or unswollen. In the preliminary clinical evaluation, a formulation was selected that offered an appropriate balance of the above physical properties and contained 3% HEC, 3% PVP and 1% PC, in addition to tetracycline 5% (as the hydrochloride). The clinical efficacy of this (test) formulation was compared to an identical tetracycline-devoid (control) formulation in nine periodontal pockets (>/=5 mm depth). One week following administration of the test formulation, there was a significant improvement in periodontal health as identified by reduced numbers of sub-gingival microbial pathogens. Therefore, it can be concluded that, when used in combination with mechanical plaque removal, the tetracycline-containing semi-solid systems described in this study would augment such therapy by enhancing the removal of pathogens, thus improving periodontal health.
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Affiliation(s)
- D S Jones
- School of Pharmacy, The Queen's University of Belfast, Medical Biology Centre, 97, Lisburn Road, BT9 7BL, Northern Ireland, Belfast, UK.
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21
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Vyas SP, Sihorkar V, Mishra V. Controlled and targeted drug delivery strategies towards intraperiodontal pocket diseases. J Clin Pharm Ther 2000; 25:21-42. [PMID: 10771461 DOI: 10.1046/j.1365-2710.2000.00261.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Advances in the understanding of the aetiology, epidemiology, pathogenesis and microbiology of periodontal pocket flora have revolutionized the strategies for the management of intraperiodontal pocket diseases. Intra-pocket, sustained release, drug delivery devices have been shown to be clinically effective in the treatment of periodontal infections. Several degradable and non-degradable devices are under investigation for the delivery of antimicrobial agents into the periodontal pocket including non-biodegradable fibres, films (biodegradable and non-biodegradable), bio-absorbable dental materials, biodegradable gels/ointments, injectables and microcapsules. With the realization that pocket bacteria accumulate as biofilms, studies are now being directed towards eliminating/killing biofilm concentrations rather than their planktonic (fluid phase) counterparts. Intraperiodontal pocket drug delivery has emerged as a novel paradigm for the future research. Similarly, bioadhesive delivery systems are explored that could significantly improve oral therapeutics for periodontal disease and mucosal lesions. A strategy is to target a wide range of molecular mediators of tissue destruction and hence arrest periodontal disease progression. Research into regenerating periodontal structures lost as a result of disease has also shown substantial progress in the last 25 years.
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Affiliation(s)
- S P Vyas
- Drug Delivery Research Laboratory, Department of Pharmaceutical Sciences, Dr H. S. Gour University, Sagar, M.P., India.
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22
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Steinberg D, Friedman M. Development of sustained-release devices for modulation of dental plaque biofilm and treatment of oral infectious diseases. Drug Dev Res 2000. [DOI: 10.1002/1098-2299(200007/08)50:3/4<555::aid-ddr39>3.0.co;2-p] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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23
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Kinane DF, Radvar M. A six-month comparison of three periodontal local antimicrobial therapies in persistent periodontal pockets. J Periodontol 1999; 70:1-7. [PMID: 10052765 DOI: 10.1902/jop.1999.70.1.1] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Currently, several local antimicrobial delivery systems are available to periodontists. The aim of this 6-month follow-up parallel study was to evaluate the efficacy of three commercially available local delivery systems as adjuncts to scaling and root planing in the treatment of sites with persistent periodontal lesions. METHODS Seventy-nine patients with 4 pockets > or = 5 mm and bleeding on probing and/or suppuration were randomized into 4 treatment groups which included: scaling and root planing alone (S) (20 patients), or in conjunction with the application of 25% tetracycline fibers (S+Tet) (19 patients), or 2% minocycline gel (S+Min) (21 patients), or 25% metronidazole gel (S+Met) (19 patients). Clinical measurements were taken at baseline, 6 weeks, 3 months, and 6 months after antimicrobial application. Treatments were applied using the distributors' recommended protocols. RESULTS All 4 therapies resulted in significant improvements from baseline in probing depth, attachment level, bleeding on probing, and the Modified Gingival Index (MGI) scores. The improvements in clinical parameters were greater in all 3 adjunctive treatment groups than scaling and root planing alone. The mean probing depth reductions at 6 months were: scaling + tetracycline = 1.38 mm; scaling + metronidazole = 0.93 mm; scaling + minocycline = 1.10 mm; and scaling alone = 0.71 mm. The probing depth reduction at all time points was significantly greater in the scaling plus tetracycline fiber group than the scaling and root planing alone group (P<0.01). There was also a significant improvement for scaling plus tetracycline fiber application over scaling and metronidazole at both 6 weeks and 3 months, although this did not remain significant at the 6-month visit. While the frequency of sites with suppuration was markedly reduced following all antimicrobial treatments, the most effective reductions were seen in the scaling plus tetracycline fiber group, followed by the minocycline group. CONCLUSIONS Although all 3 locally applied antimicrobial systems seem to offer some benefit over scaling and root planing alone, a treatment regimen of scaling and root planing plus tetracycline fiber placement gave the greatest reduction in probing depth over the 6 months after treatment.
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Affiliation(s)
- D F Kinane
- Adult Dental Care Department, Glasgow Dental Hospital and School, Scotland, UK
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24
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Magnusson I. The use of locally delivered metronidazole in the treatment of periodontitis. Clinical results. J Clin Periodontol 1998; 25:959-63; discussion 978-9. [PMID: 9839853 DOI: 10.1111/j.1600-051x.1998.tb02398.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Local delivery of antimicrobials has been investigated as a possible method for controlling and treating periodontal disease. A number of antimicrobial agents have been studied both as adjunctive therapies with scaling and root planing and as stand-alone chemotherapies. More recent investigations have focussed on the delivery of antimicrobials in sustained-release formulations designed to maintain effective concentrations of drug within the periodontal pocket. This article provides an overview of the development of the use of locally-delivered metronidazole in periodontal therapy and the current state-of-the-art of the technique. It is concluded that treatment with local delivery of metronidazole seems to be as effective as scaling and root planing in untreated as well as in recall subjects. However, there are reasons to suggest that local delivery of metronidazole should not be used as a substitute for conventional treatment of periodontal disease, since side-effects of long-term use and repeated use are not known. The antibiotic regimen should preferably be used as an adjunct to surgical and non-surgical therapy.
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Affiliation(s)
- I Magnusson
- Periodontal Disease Research Center, Department of Oral Biology, University of Florida, Gainesville, USA
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25
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Rudhart A, Purucker P, Kage A, Hopfenmüller W, Bernimoulin JP. Local metronidazole application in maintenance patients. Clinical and microbiological evaluation. J Periodontol 1998; 69:1148-54. [PMID: 9802715 DOI: 10.1902/jop.1998.69.10.1148] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this investigation was to evaluate the clinical and microbiological effect of local antibiotic therapy in comparison with subgingival scaling and root planing in a randomized semi-masked study. Forty-six recall patients who completed systematic periodontal therapy 6 to 24 months prior to the study were enrolled. The inclusion requirements were at least one site with probing depth > or = 5 mm in each quadrant, no scaling, and no antibiotic therapy during the last 6 months. After randomization each patient received 2 different treatments: in 2 quadrants metronidazole 25% dental gel was applied subgingivally to the pockets at day 0 and day 7; scaling and root planing was carried out in the 2 other quadrants, one at day 0 and in the remaining quadrant at day 7. Subgingival microbiological samples were taken from each patient before treatment and on days 21, 91, and 175 after the treatment. The analyses were carried out by indirect immunofluorescence assay. At all treated sites probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded on days 0, 21, 91, and 175. Both treatments resulted in PD reduction and CAL gain. PD reduction was statistically significant (P < 0.01) for both treatment modalities after 6 months. The CAL gain was not significant for either treatment. There was no statistical significance between scaling and antibiotic therapy. Treponema denticola, Porphyromonas gingivalis, and Prevotella intermedia were significantly reduced after therapy; however, there were no statistically significant differences between treatments. If Actinobacillus actinomycetemcomitans was present before therapy, it was also present after treatment in both groups. The conclusion is that, in recall patients, local application of metronidazole and scaling and root planing showed similar clinical and microbiological effects without statistically significant differences.
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Affiliation(s)
- A Rudhart
- Department of Periodontology, University Hospital Charité, Humboldt University Berlin, Germany
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26
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Somayaji BV, Jariwala U, Jayachandran P, Vidyalakshmi K, Dudhani RV. Evaluation of antimicrobial efficacy and release pattern of tetracycline and metronidazole using a local delivery system. J Periodontol 1998; 69:409-13. [PMID: 9609369 DOI: 10.1902/jop.1998.69.4.409] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The present study compared the effectiveness of two antimicrobials, tetracycline and metronidazole, in reducing subgingival microorganisms in periodontal pockets using an ethyl cellulose strip as the delivery medium. The study involved 30 patients, with a minimum of 3 periodontal pockets with probing depths > 6 mm throughout the oral cavity. Patients were given supragingival scaling and then divided into 5 groups, depending on the length of time the medication was in place. Sites were marked for tetracycline, metronidazole, and placebo. Sites were wiped and isolated, and baseline microbiology samples were taken for Gram staining and culture methods. After treatment, subgingival microbiological samples were taken again. The ethyl cellulose strips were removed and analyzed for any remaining drug. Results showed that tetracycline and metronidazole can both be applied locally to periodontal sites using ethyl cellulose strips and markedly suppress the subgingival bacteria over a period of several days. The tetracycline showed a faster release; however, the metronidazole required a lesser concentration to achieve complete reduction of the subgingival flora.
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Affiliation(s)
- B V Somayaji
- Department of Periodontics, A. B. Shetty Memorial Institute of Dental Sciences, Mangalore, India
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27
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Yeom HR, Park YJ, Lee SJ, Rhyu IC, Chung CP, Nisengard RJ. Clinical and microbiological effects of minocycline-loaded microcapsules in adult periodontitis. J Periodontol 1997; 68:1102-9. [PMID: 9407404 DOI: 10.1902/jop.1997.68.11.1102] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Clinical and microbiological effects of subgingival delivery of 10% minocycline-loaded (MC), bioabsorbable microcapsules were examined in 15 adult periodontitis patients. Patients received oral hygiene instruction 2 weeks prior to the study. At baseline (day 0) all teeth received supragingival scaling (SC); 2 quadrants received no further treatment and 1 quadrant received subgingival scaling and root planning (SRP). In the fourth quadrant, the tooth with the deepest probing sites (at least 1 site > or = 5 mm) was treated with minocycline microcapsules. The sites were evaluated at baseline and weeks 1, 2, 4, and 6. Clinical indices included bleeding on probing (BOP), probing depths (PD), and attachment loss (AL). Microbiological evaluations included percent morphotypes by phase-contrast microscopy; cultivable anaerobic, aerobic, and black-pigmented Bacteroides (BPB); and percent Porphyromonas gingivalis, Prevotella intermedia, Eikenella corrodens, and Actinomyces viscosus by indirect immunofluorescence. In the SC + MC group, BOP, PD, and AL were significantly reduced from baseline for weeks 1 to 6. BOP in the SC + MC group was significantly reduced compared to the SRP group from weeks 2 to 6. In the SC + MC group the percent of spirochetes and motile rods decreased and the percent of cocci increased after 1 week. The increased cocci and decreased motile rods were statistically greater at weeks 4 and 6 in the SC + MC group compared to the SRP group. This study demonstrates that local subgingival delivery of 10% minocycline-loaded microcapsules as an adjunct to scaling results in reduction in the percent sites bleeding on probing greater than scaling and root planning alone and induces a microbial response more favorable for periodontal health than scaling and root planing.
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Affiliation(s)
- H R Yeom
- Department of Periodontology, College of Dentistry, Seoul National University, Korea
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28
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Soskolne WA. Subgingival delivery of therapeutic agents in the treatment of periodontal diseases. CRITICAL REVIEWS IN ORAL BIOLOGY AND MEDICINE : AN OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION OF ORAL BIOLOGISTS 1997; 8:164-74. [PMID: 9167091 DOI: 10.1177/10454411970080020501] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This article reviews the current status of controlled local delivery of antibacterial agents in the treatment of periodontitis. The principle of local intrapocket delivery of antibacterial agents and their delivery are discussed. The dosage forms include fibers, film/slabs, and injectable systems, some of which are degradable, while others are not and need to be removed at the termination of the treatment. The antibacterial agents used cover a range of antibiotics as well as antiseptics, and the composition of the delivery systems, their reported use, and the clinical results are summarized. The use of these systems in clinical practice is relatively recent, and therefore their application and integration into the dental office are not yet clearly defined. Clinical applications that have been tested are critically reviewed, and clinical situations in which controlled delivery of antibacterial agents may prove to be clinically useful are suggested for scientific evaluation.
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Affiliation(s)
- W A Soskolne
- Department of Periodontics, Hebrew University-Hadassah Faculty of Dental Medicine, Jerusalem, Israel
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29
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Affiliation(s)
- C H Drisko
- Department of Periodontics, Endodontics, and Dental Hygiene, University of Louisville, Kentucky, USA
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30
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Radvar M, Pourtaghi N, Kinane DF. Comparison of 3 periodontal local antibiotic therapies in persistent periodontal pockets. J Periodontol 1996; 67:860-5. [PMID: 8884642 DOI: 10.1902/jop.1996.67.9.860] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The aim of this study was to evaluate the efficacy of 3 commercially available periodontal systems for local delivery of antibiotics as adjuncts to scaling and root planing in treatment of sites with persistent periodontal lesions following a course of scaling and root planing. Fifty-four patients with 4 pockets > or = 5 mm and bleeding on probing and/or suppuration were randomized in 4 treatment groups including: scaling and root planing plus application of 25% tetracycline fiber (S + Tet) (13 patients), scaling and root planing plus application of 2% minocycline gel (S + Min) (14 patients), scaling and root planing plus application of 25% metronidazole gel (S + Met) (14 patients), and scaling and root planing alone (S) (13 patients). Clinical measurements were taken at baseline and 6 weeks after the end of treatment periods. All treatments were applied using the distributors' recommended protocols and resulted in significant improvement in probing depth, attachment level, bleeding on probing and the modified gingival index (MGI) scores. The improvements in clinical parameters were greater in all three adjunctive treatment groups than scaling and root planing alone. The mean probing depth reductions were: S + Tet = 1.35 mm, S + Met = 0.95 mm, S + Min = 0.87 mm and S = 0.60 mm. The probing depth reduction was significantly greater in the scaling plus tetracycline fiber group than the scaling and root planing alone group (P = 0.002). The difference between groups in improvement of attachment level or bleeding on probing was not significant Scaling plus tetracycline fiber treatment resulted in the greatest reduction in the MGI scores which was significantly greater than all other groups. While the frequency of sites with suppuration was markedly reduced following all treatments, it reached zero in the scaling plus tetracycline fiber group. No serious adverse effects were observed or reported for any treatment. While all three locally applied antimicrobial systems seem to offer some benefit over scaling and root planing alone, a treatment regimen of scaling and root planing plus tetracycline fiber replacement gave the greatest advantage in the treatment of persistent periodontal lesions at least during the 6-week period following treatment.
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Affiliation(s)
- M Radvar
- Periodontal Unit, Adult Dental Care Department, Glasgow Dental Hospital and School, Scotland
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31
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Addy M, Renton-Harper P. Local and systemic chemotherapy in the management of periodontal disease: an opinion and review of the concept. J Oral Rehabil 1996; 23:219-31. [PMID: 8730268 DOI: 10.1111/j.1365-2842.1996.tb00845.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Periodontal disease appears to arise from the interaction of pathogenic bacteria with a susceptible host. The main aims of disease management have been to establish a high standard of oral hygiene and to professionally and thoroughly debride the root surface Chemical agents could be considered for both aspects of management. Chemoprevention using supragingivally delivered agents such as chlorhexidine may be questioned for value in the pre-treatment hygiene phase but have well-established efficacy immediately preoperatively and during the post-operative weeks. Long-term maintenance use of chlorhexidine is problematic due to local side effects. Antiplaque toothpastes show modest benefits to gingivitis but are not proven to prevent recurrence of periodontitis. Chemotherapy may be directed at subgingival plaque, using antimicrobials, or at the host response using anti-inflammatory agents. Antimicrobials can be locally or systemically delivered. In most cases antimicrobial chemotherapy should be considered adjunctive to mechanical debridement. The advantages of local and systemic chemotherapy must be balanced against the disadvantages and potential side effects of agents. Antimicrobial chemotherapy offers little or no benefit to the treatment of most chronic adult periodontitis patients and should be reserved for the more rapid or refractory types of disease, and after the debridement phase. Despite the large number of studies there are insufficient comparative data to support any one local delivery system or systemic regimen as superior to another. Systemic versus local antimicrobials have not been compared to date. Host response modifying drugs such as non-steriodal anti-inflammatory drugs (NSAIDS) offer the potential to reduce breakdown and promote healing, including bone regeneration. However until more data are available, NSAIDs should not be used in the management of chronic periodontal diseases, there being no specific agent(s) or regimen established for use. Chemotherapy has an important place in the management of chronic periodontal diseases but routine use must be considered as an over prescription of these valuable agents.
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Affiliation(s)
- M Addy
- Division of Restorative Dentistry, Dental School, Bristol, U.K
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32
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Umeda M, Tominaga Y, He T, Yano K, Watanabe H, Ishikawa I. Microbial flora in the acute phase of periodontitis and the effect of local administration of minocycline. J Periodontol 1996; 67:422-7. [PMID: 8708969 DOI: 10.1902/jop.1996.67.4.422] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Periodontitis, similar to other infectious diseases, is known to progress as chronic inflammation with recurrent acute phases. The purpose of this study was to clarify the microbiological composition of the acute phase and to compare the bacterial flora with that of comparable chronic periodontal pockets. We also evaluated the effect of application of minocycline gel locally on the change in the microflora in the acute pockets. Microbial flora from the subgingival pockets of 28 patients in the acute phase of periodontitis and of 12 patients in a comparable chronic phase as the control were investigated by various bacterial culture methods including TS blood agar and TSBV plates. Minocycline gel was applied to the acute periodontal pockets. Changes in the microbiological proportion and clinical parameters at one week after baseline examination were followed by dark-field analysis, culture method, and indirect immunofluorescence technique. Characteristic features of bacterial proportions in the acute site were observed as an increase in Bacteroides forsythus. The number of Porphyromonas gingivalis and black pigmented anaerobic rods also increased. Application of minocycline gel in the acute pocket without any debridement produced improvement in clinical symptoms at one week. Black-pigmented anaerobic rods, P. gingivalis, and B. forsythus decreased significantly at one week after the application. Results indicate that periodontopathic bacteria including B. forsythus and P. gingivalis were predominant in the acute phase of periodontitis and a locally delivered antibiotic may be effective as an alternative modality of treating the acute inflammation.
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Affiliation(s)
- M Umeda
- Department of Periodontology, Faculty of Dentistry, Tokyo Medical and Dental University, Japan
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Maze GI, Reinhardt RA, Agarwal RK, Dyer JK, Robinson DH, DuBois LM, Tussing GJ, Maze CR. Response to intracrevicular controlled delivery of 25% tetracycline from poly(lactide/glycolide) film strips in SPT patients. J Clin Periodontol 1995; 22:860-7. [PMID: 8550863 DOI: 10.1111/j.1600-051x.1995.tb01785.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Controlled local delivery of antibiotics has been shown to reduce periodontopathic micro-organisms with minimal side-effects. Clinical studies in our laboratory have shown that 25% tetracycline HCl delivered from poly(D,L-lactide/glycolide) film strips (25 TTC-PLGA) released therapeutic concentrations of tetracycline for 10 days. The present pilot study compared the intracrevicular delivery of 25% tetracycline HCl incorporated in these biodegradable film strips to scaling and root planing (SRP) in 10 adult periodontitis patients, who in spite of therapy and regular supportive periodontal treatment (SPT), continued to possess 5 bleeding periodontal pockets at least 5 mm deep. Sites were randomly selected to receive the following treatments: (1) 25 TTC-PLGA, (2) control strips without TTC (PLGA), (3) SRP, and (4) untreated control. Film-strip retention was augmented with a suture/cement technique, followed by strip removal after 2 weeks. Clinical parameters and subgingival bacterial morphotypes (darkfield analysis) were evaluated over time (0, 2.4, 8, 12, 26 weeks). Results indicated that, compared to baseline, 25 TTC-PLGA film strips caused significant (p < or = 0.01): (1) probing depth reduction for 26 weeks, (2) a clinical attachment level gain for 12 weeks, (3) lower %s of spirochetes for 4 weeks and motile rods for 8 weeks (p < or = 0.05), and (4) an accompanying increase in cocci for 4 weeks. In the scaled and root planed sites, probing depth was the only finding that demonstrated a significant change from baseline (p < or = 0.01). Controls and PLGA showed isolated reductions in probing depth and % of motile organisms. From these findings, applications of intracrevicular 25 TTC-PLGA, when compared to scaling and root planing, appears to have an enhanced antibacterial effect and a similar clinical effect in SPT patients. The results of this study indicate further investigation of 25 TTC-PLGA film strips should be undertaken using more subjects and sophisticated microbiological and clinical measurements.
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Affiliation(s)
- G I Maze
- Department of Surgical Specialities/Periodontics, University of Nebraska Medical Center, College of Dentistry, Lincoln 68583-0740, USA
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Abstract
Antimicrobial agents are of value in the management of certain types of periodontal disease, notably early onset, juvenile and refractory periodontitis. The diagnosis of these conditions is often made on clinical grounds but microbial sampling of the pocket flora is of value in determining the type of antimicrobial therapy. Routine systemic use of these drugs in the management of chronic adult periodontitis is contraindicated, and is no substitute for root surface debridement and thorough supragingival plaque control. Tetracyclines and metronidazole are the agents most frequently used in the management of periodontal disease. Both drugs can be given systemically or applied topically into the periodontal pocket. The latter route is preferred since the dose is reduced considerably, but the local tissue concentration is increased. The efficacy of local drug delivery is dependent upon the release kinetics of the drug from the delivery vehicle. Although local application can be time consuming, it reduces the risk of adverse reactions and drug interactions. The tetracyclines have the additional advantage of inhibiting collagenases. This property may facilitate repair and new attachment formation. Systemic metronidazole appears to be useful as an adjunct to conventional periodontal therapy. The combination of metronidazole 250 mg and amoxycillin 375 mg has been shown to be effective in the treatment of refractory periodontitis, including cases which are resistant to tetracycline. Clindamycin has also been used in the management of refractory periodontitis, but the unwanted effects of this drug must limit its systemic use for this purpose.
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Affiliation(s)
- R A Seymour
- Department of Restorative Dentistry, Dental School, University of Newcastle upon Tyne, UK
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35
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Abstract
Periodontal diseases essentially comprise a group of oral infections whose primary aetiological factor is dental plaque. Removal of the cause (and its effects) is the primary aim of both non-surgical and surgical treatment regimens, although the infective nature of the diseases has led to the widespread use of antimicrobials as an adjunct to mechanical debridement. The tetracyclines are primarily bacteriostatic agents that are effective against many Gram-negative species including putative periodontopathogens such as Actinobacillus actinomycetemcomitans (A.a.). The proven efficacy of this group of drugs in the management of periodontal diseases may be related not only to their antibacterial actions, but to a number of additional properties that have been recently identified. These include collagenase inhibition, anti-inflammatory actions, inhibition of bone resorption and their ability to promote the attachment of fibroblasts to root surfaces. Consequently, tetracyclines have also been used as an adjunct to bone grafting in periodontal defects, and as agents for 'conditioning' root surfaces to enhance the regeneration of periodontal tissues. When tetracyclines are taken orally, consideration must be given both to the potential unwanted effects and to interactions with other drugs that are taken concurrently. Such problems are minimised however, when the drugs are incorporated into controlled, slow-release formulations which are currently being researched and marketed for intra-oral use.
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Affiliation(s)
- R A Seymour
- Department of Restorative Dentistry, Dental School, Newcastle upon Tyne, UK
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Gibson MT, Mangat D, Gagliano G, Wilson M, Fletcher J, Bulman J, Newman HN. Evaluation of the efficacy of a redox agent in the treatment of chronic periodontitis. J Clin Periodontol 1994; 21:690-700. [PMID: 7852614 DOI: 10.1111/j.1600-051x.1994.tb00788.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A redox dye, methylene blue, was compared with subgingival root surface debridement and sterile water in the treatment of adult periodontitis. Plaque and gingival indices, bleeding on probing, and microbiological samples were obtained at baseline, and at 1, 4, 8 and 12 weeks following treatment. All subjects had matched pockets in each of the 4 quadrants, of 5 mm or more. One treatment consisted of 0.1% methylene blue gel irrigated professionally at 0, 1 and 4 weeks, and by subjects at days in between up to 4 weeks, at chosen sites within a randomly selected quadrant (split-mouth design). A 2nd treatment was sterile water irrigation as above. A 3rd quadrant received subgingival debridement, and sites in the 4th received methylene blue incorporated into a slow-release device of a biodegradable collagen alginate vicryl composite. All sites showed improvements in clinical and microbiological parameters. However, no statistically significant differences between treatment types were found for clinical measurements. Although plaque index tended to increase after week 1, gingival index was reduced, as was the papilla bleeding index. Probing depth reductions were approximately 1.2 mm for all treatments. Microbiological variables showed an increase in cocci and a decrease in motile organisms for all groups, the latter reaching statistical significance for subgingival debridement. The reductions in spirochaetes were significant for subgingival debridement and methylene blue by slow-release. Culture demonstrated an increase in the aerobe:anaerobe ratio for all groups, which was statistically significant initially (weeks 1 and 4) for subgingival debridement. Methylene blue was also effective statistically in improving this ratio, both by irrigation and slow-release (week 4). Methylene blue also significantly reduced the numbers of black-pigmented anaerobes during the trial period, both by irrigation and slow-release, which sterile water and subgingival debridement failed to do. No serious adverse experiences were seen, however, significantly greater morbidity was associated with subgingival debridement. These results clearly demonstrate that in altering the microflora to one that is more compatible with periodontal health, methylene blue treatment is comparable, or even better, than the currently standard treatment of subgingival debridement, and is better tolerated.
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Affiliation(s)
- M T Gibson
- Department of Periodontology, Eastman Dental Hospital, London, UK
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Jones AA, Kornman KS, Newbold DA, Manwell MA. Clinical and microbiological effects of controlled-release locally delivered minocycline in periodontitis. J Periodontol 1994; 65:1058-66. [PMID: 7853130 DOI: 10.1902/jop.1994.65.11.1058] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The clinical efficacy of minocycline in a subgingival local delivery system was evaluated alone (M) or as an adjunct to scaling and root planing (M + SRP), in comparison to scaling and root planing (SRP) or to no subgingival treatment (NoTx) in adult periodontitis. Fifty-one adult patients with > or = 7 mm periodontal pockets demonstrating the presence by culture of Porphyromonas gingivalis (Pg), Prevotella intermedia (P(i)), or Actinobacillus actinomycetemcomitans (Aa) were randomized into one of the above 4 treatment groups. All sites > or = 5 mm in the most diseased quadrant in each patient received the therapy. Other quadrants were not treated. All patients received standardized oral hygiene instructions at the beginning of the study. At 0, 1, 3 and 6 months following therapy the 7 mm experimental sites were evaluated for selected periodontal pathogens by DNA probe analysis. At these same time points, the plaque index, gingival index, and bleeding on probing were evaluated as well as probing depth and relative clinical attachment level which were assessed by means of an automated probe. Probing depth reduction with M + SRP was significantly greater than all other groups at one month and significantly greater than NoTx and SRP at 3 months. There were no differences in probing depth reduction among groups at 6 months. At 6 months the gain in clinical attachment level was significantly greater for SRP than for either the NoTx or M groups. The prevalence of Pg decreased significantly in the M and M + SRP groups at one month.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A A Jones
- Department of Periodontics, University of Texas Health Science Center at San Antonio
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Jeong SN, Han SB, Lee SW, Magnusson I. Effects of tetracycline-containing gel and a mixture of tetracycline and citric acid-containing gel on non-surgical periodontal therapy. J Periodontol 1994; 65:840-7. [PMID: 7990020 DOI: 10.1902/jop.1994.65.9.840] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The purpose of this study was to assess the clinical and microbiological effects of a newly developed root conditioning gel system containing tetracycline or a mixture of tetracycline and citric acid on non-surgical periodontal therapy. Sixty-four (64) single-rooted teeth with a probing depth of 4 to 6 mm were randomly subjected to one of the following four treatments; 1) root planing alone (RP group); 2) tetracycline-containing gel alone (TCG group); 3) root planing plus tetracycline-containing gel (RP + TCG group); or 4) root planing plus a mixture of tetracycline and citric acid-containing gel (RP + TC-CAG group). Probing depth, attachment level, and tooth mobility were measured and the presence of dental plaque and gingival inflammation was recorded at baseline and after 2, 4, 8, and 12 weeks. Subgingival plaque samples from each site were collected at the same visits and examined with phase contrast microscopy for proportions of motile rods and spirochetes. Plaque index, gingival sulcus bleeding index (SBI), probing depth, and attachment level decreased significantly in all groups compared to the baseline values (P < 0.05). A significant decrease in probing pocket depth was noted after 12 weeks in RP + TC-CAG group compared to the other groups (P < 0.05). Significantly more gain in attachment was detected in the RP + TC-CAG group compared to the TCG group (P < 0.05). Tooth mobility scores also decreased later in the study. A significant decrease in the proportion of motile rods was found primarily in the RP + TC-CAG group.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S N Jeong
- Department of Periodontology, College of Dentistry, Seoul National University, Korea
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39
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Unsal E, Akkaya M, Walsh TF. Influence of a single application of subgingival chlorhexidine gel or tetracycline paste on the clinical parameters of adult periodontitis patients. J Clin Periodontol 1994; 21:351-5. [PMID: 8034781 DOI: 10.1111/j.1600-051x.1994.tb00725.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The clinical effects of subgingivally placed 1% chlorhexidine gel (w/w) and 40% tetracycline (w/w) paste in periodontal pockets of 22 adult periodontitis patients were studied. The 2 agents were applied following scaling and root planing in pockets exceeding 4 mm. The patients were randomly divided into 3 groups: (a) scaling and root planing (SCRP) only, the control group; (b) corsodyl gel+SCRP; (c) Tetracycline paste+SCRP. Gel or paste were gently applied using a syringe with a blunt needle until the selected pocket was overfilled. Evaluations were made of clinical parameters including the plaque index (PI), gingival index (GI), bleeding index (GI-S), probing pocket depths, probing attachment levels and position of the gingival margin. The results suggested that all the treatment modalities were effective in producing statistically significant improvements in clinical parameters. It was concluded that the conventional treatment modalities were essential in the treatment of periodontal diseases, but in view of the structure of the periodontal pocket and adjacent complex root surface, subgingival drug application in certain cases, might also provide adjunctive improvement.
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Affiliation(s)
- E Unsal
- Department of Periodontology, Ankara University, Faculty of Dentistry, Turkey
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40
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Medlicott NJ, Ferry DG, Tucker IG, Rathbone MJ, Holborow DW, Jones DS. High Performance Liquid Chromatographic (HPLC) Assay for the Determination of Chlorhexidine in Saliva Film. ACTA ACUST UNITED AC 1994. [DOI: 10.1080/10826079408013183] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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41
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42
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Medlicott NJ, Rathbone MJ, Tucker IG, Holborow DW. Delivery systems for the administration of drugs to the periodontal pocket. Adv Drug Deliv Rev 1994. [DOI: 10.1016/0169-409x(94)90033-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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43
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Kornman KS. Controlled-release local delivery antimicrobials in periodontics: prospects for the future. J Periodontol 1993; 64:782-91. [PMID: 8410618 DOI: 10.1902/jop.1993.64.8s.782] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
New knowledge about the microbial etiology of periodontal diseases emerged in the 1970s and 1980s and led to widespread interest in the use of antimicrobial agents to treat periodontitis. The controlled-release delivery of antimicrobials directly into the periodontal pocket has received great interest and appears to hold some promise in periodontal therapy. Some techniques for applying antimicrobials subgingivally, such as subgingival irrigation, involve local delivery but not controlled-release. Controlled-release local delivery systems, in which the antimicrobial is available at therapeutic levels for several days, have been evaluated in several forms and using different antimicrobials. Although most studies with such systems have focused on drug delivery kinetics and "proof of principle" evaluations, some controlled clinical trials have recently been reported. The most widely tested system, monolithic tetracycline-containing fibers, has shown significant clinical benefit when used alone as compared to no subgingival therapy. Similarly, controlled trials involving chlorhexidine strips used subgingivally every 3 months in place of routine supportive periodontal therapy have shown significant clinical benefit for up to 2 years. Although these data are now emerging, many questions concerning the optimal use and role of this therapy in clinical practice remain. This review attempts to summarize and interpret current data and to outline key remaining questions that must be addressed as this technology is transferred into clinical practice.
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Affiliation(s)
- K S Kornman
- Department of Periodontics, University of Texas Health Science Center, San Antonio
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44
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Klinge B, Kuvatanasuhati J, Attström R, Kalfas S, Edwardsson S. The effect of topical metronidazole therapy on experimentally-induced periodontitis in the beagle dog. J Clin Periodontol 1992; 19:702-7. [PMID: 1447390 DOI: 10.1111/j.1600-051x.1992.tb02532.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The present study was performed to assess the effect of topical metronidazole therapy on ligature-induced periodontitis in beagle dogs. 6 beagle dogs with experimentally-induced periodontitis on the mandibular 2nd, 3rd and 4th premolars were treated with metronidazole 10% dental paste 2 x daily for 4 weeks in an open placebo-controlled study using a split-mouth design. Recordings of probing pocket depth, bleeding on probing and gingival index were performed before commencement of treatment and repeated weekly during the 4-weeks treatment period. Concurrently, samples for microbiological analysis were collected from 2 of the dogs. The results demonstrated that probing pocket depth, bleeding on probing and gingival index had improved significantly in the metronidazole-treated side compared with the placebo-treated side. Black pigmented Bacteroides spp. and Spirochetes, present in all samples before treatment, were eliminated from the metronidazole-treated side after the 1st week of treatment and throughout the treatment period, whereas they were present in all samples from the placebo-treated side. The result of the present study demonstrates that topical application of metronidazole in a dental paste, improves the clinical features of the experimentally-induced periodontitis and eliminates some of the micro-organisms associated with the disease.
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Affiliation(s)
- B Klinge
- Department of Periodontology and Oral Microbiology, Lund University, Malmö, Sweden
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45
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Klinge B, Attström R, Karring T, Kisch J, Lewin B, Stoltze K. 3 regimens of topical metronidazole compared with subgingival scaling on periodontal pathology in adults. J Clin Periodontol 1992; 19:708-14. [PMID: 1447391 DOI: 10.1111/j.1600-051x.1992.tb02533.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This report presents the findings from an open randomized multicentre clinical trial designed to compare the clinical efficacy of scaling with application of 3 different preparations/dose frequencies of topical metronidazole in the treatment of adult periodontitis. The 4 treatments were: (A) metronidazole 25% dental gel administered 1 x a week for 2 weeks; (B) metronidazole 15% dental gel applied 1 x a week for 2 weeks; (C) metronidazole 15% dental gel applied 2 x a week for 2 weeks; (D) subgingival scaling, performed 1 x only. A split mouth design was used. Patients were included in the study if they had at least 1 tooth in each quadrant with a pocket depth > or = 5 mm in at least 1 of 4 sites. A total of 61 patients from 4 centres were entered into the study. The efficacy parameters were probing pocket depth and bleeding on probing. Follow-up visits for recording of clinical efficacy were made at 2, 4, 6 and 12 weeks after the end of metronidazole treatment. All 3 antibiotic treatments (A, B, C) reduced the symptoms of periodontal pathology and yielded results comparable to those seen after subgingival scaling (D). When using a topical drug therapy, it seems important to use a preparation that requires as few applications as possible. The best candidate for drug therapy would therefore be treatment (A) metronidazole 25% applied 1 x a week for 2 weeks.
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Affiliation(s)
- B Klinge
- Lund University, Centre for Oral Health Sciences, Malmö, Sweden
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46
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Ainamo J, Lie T, Ellingsen BH, Hansen BF, Johansson LA, Karring T, Kisch J, Paunio K, Stoltze K. Clinical responses to subgingival application of a metronidazole 25% gel compared to the effect of subgingival scaling in adult periodontitis. J Clin Periodontol 1992; 19:723-9. [PMID: 1447392 DOI: 10.1111/j.1600-051x.1992.tb02535.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A newly developed metronidazole 25% dental gel was compared with subgingival scaling in the treatment of adult periodontitis. 206 patients in 9 centres participated in the study. Probing pocket depth (PPD) and bleeding on probing (BOP) were recorded before treatment and 2, 6, 12, 18, and 24 weeks after the treatment. All patients had at least 1 tooth in each quadrant with a PPD of 5 mm or more. The treatments consisted of 2 applications of dental gel (days 0 and 7) in 2 randomly selected quadrants (split mouth design) and 2 sessions of subgingival scaling (1 quadrant on day 0, and 1 quadrant on day 7). Instruction in oral hygiene was given 2 weeks after completed treatment. The average PPD and the average frequency of BOP were calculated over all sites with initial PPD of 5 mm or more. PPD and BOP were thus, at each examination, calculated from the same sites. The mean PPD was 5.9 mm before gel application and 5.8 mm before scaling (p = 0.31). BOP was 88% in both treatment groups. 24 weeks after the treatment, PPD and BOP were significantly reduced in both groups and for both parameters (p < 0.01). PPD was reduced by 1.3 mm after gel application and 1.5 mm after scaling; BOP was reduced by 32% and 39%, respectively. The difference between the treatments was statistically significantly, but considered as clinically unimportant.
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47
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Itic J, Serfaty R. Clinical effectiveness of subgingival irrigation with a pulsated jet irrigator versus syringe. J Periodontol 1992; 63:174-81. [PMID: 1593412 DOI: 10.1902/jop.1992.63.3.174] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Previous studies have shown clinical and microbiological improvement with subgingival irrigation particularly after scaling and root planing. In this study we monitored the effects of saline irrigation on non-treated periodontal pockets. Ten subjects with severe periodontal disease and symmetrical lesions on multirooted teeth were selected. They had not received periodontal treatment or antibiotics for the previous 6 months. Patients were given simplified oral hygiene instructions. Neither scaling nor root planing was provided during the study. Two teeth were randomly selected per quadrant for subgingival irrigation with saline solution. One side was treated with a syringe and the other side with a pulsated jet irrigator with a modified tip, professionally administered. Clinical parameters (pocket depth, plaque index, gingival index, crevicular fluid, bleeding index, attachment level, and subgingival microflora) were evaluated on days 0, 15, 30, 60, and 90. Both subgingival irrigation products induced changes (reductions) in these indices during the study. Significant differences (P less than 0.001) with the oral irrigator were found for the following parameters: microscopy, pocket depth, crevicular fluid, and plaque index. In this study, professionally administered saline irrigation with a pulsated jet irrigator was more effective than syringe treatment with the same solution. Neither treatment resulted in a detectable gain in probing attachment level. Since gain in attachment level is achievable by other techniques, neither of these subgingival irrigation procedures alone can be considered adequate for periodontal therapy.
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Affiliation(s)
- J Itic
- Department of Periodontology, School of Dental Surgery, Paris University, France
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48
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Eckles TA, Refnhardt RA, Dyer JK, Tussing GJ, Szydlowski WM, DuBous LM. Intracrevicular application of tetracycline in white petrolatum for the treatment of periodontal disease. J Clin Pharm Ther 1992. [DOI: 10.1111/j.1365-2710.1992.tb01215.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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49
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Wade WG, Moran J, Morgan JR, Newcombe R, Addy M. The effects of antimicrobial acrylic strips on the subgingival microflora in chronic periodontitis. J Clin Periodontol 1992; 19:127-34. [PMID: 1602037 DOI: 10.1111/j.1600-051x.1992.tb00451.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study investigated the effects of root planing and/or the placement of acrylic strips containing chlorhexidine, metronidazole or tetracycline on the composition and antimicrobial susceptibility of the subgingival flora in chronic periodontitis. 101 periodontal pockets from 73 patients were entered into 6 treatment groups which were, chlorhexidine, metronidazole or tetracycline strips, root planing, root planing followed by metronidazole strips and a control, no treatment group. Total anaerobic counts and anaerobe/aerobe ratios were estimated from samples taken before treatment and 1, 2, 4, 8 and 12 weeks after treatment. In addition, a more detailed analysis of the effects of the treatments on the subgingival flora was carried out on 12 pockets in 12 patients. Tetracycline strips, metronidazole strips and root planing and metronidazole strips were more effective than chlorhexidine strips in causing reductions in total anaerobic count and anaerobe/aerobe ratio. However, the changes in microbial parameters rebounded to approach baseline levels 4 weeks after treatment. Chlorhexidine caused no detectable changes in the composition of the subgingival microflora, while metronidazole had a variable effect. Tetracycline appeared to effect major shifts in the composition of the microflora of treated pockets but caused a marked selection of tetracycline-resistant organisms.
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Affiliation(s)
- W G Wade
- Department of Periodontology, University of Wales College of Medicine, Heath Park, Cardiff, UK
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50
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Yamagami H, Takamori A, Sakamoto T, Okada H. Intrapocket chemotherapy in adult periodontitis using a new controlled-release insert containing ofloxacin (PT-01). J Periodontol 1992; 63:2-6. [PMID: 1552457 DOI: 10.1902/jop.1992.63.1.2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PT-01 is a newly developed water-soluble controlled-release insert containing ofloxacin (OFLX) as an antibacterial agent. The effect of PT-01 was evaluated by split-mouth application after oral hygiene instruction. No mechanical debridement was carried out during the experiment. PT-01 was applied once a week for 4 weeks in the periodontal pockets of 46 patients with adult periodontitis. The control insert without any antibacterial agent was applied in a selected pocket in a different quadrant for each patient. Clinical findings plaque index, PI; gingival index, GI; bleeding on probing, BOP; pus discharge, pus; and probing depth, PD at both PT-01 and control sites were measured at every visit for 4 weeks. Clinical findings were improved at both PT-01 and control sites, but the improvements were much more significant at PT-01 sites, in particular BOP and PD, than at control sites. PI was also significantly reduced at PT-01 sites. These results suggest that weekly application of PT-01 in the periodontal pocket has a significant effect on the resolution of periodontal inflammation and has an inhibitory effect on supragingival plaque deposition.
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Affiliation(s)
- H Yamagami
- Division of Dentistry, Sakai Municipal Hospital, Osaka, Japan
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