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Zacher A, Marretta SM. Diagnosis and Management of Furcation Lesions in Dogs - A Review. J Vet Dent 2022; 39:151-172. [PMID: 35234060 DOI: 10.1177/08987564221076908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The furcation is the anatomic area where the roots divide on a multirooted tooth. Periodontal disease causing alveolar bone loss can lead to furcation lesions of various stages. Once furcation involvement has occurred, the area can be more difficult to clean or treat due to the complex anatomy and morphology of furcations. Teeth with short root trunks, longer tooth roots, and roots with wide furcation entrance areas/degrees of separation and wide root divergence are considered better candidates for long term maintenance. Dog teeth possess many of these advantageous anatomic features compared to human teeth. Treatment options for teeth with furcation lesions include: closed debridement, open debridement, furcation plasty, tunneling, partial tooth or root resection, root separation (hemisection or trisection), regenerative therapies, or exodontia. There are many factors to consider in determining treatment options. The favorable and unfavorable characteristics for maintenance of teeth with furcation lesions are summarized. Home care and ongoing professional care are important aspects of periodontal disease control for any patient. Studies of systemic and local antibiotic therapies in human patients have not demonstrated reduction of furcation stages, and probiotic effects at furcation sites have not been specifically examined. Human review studies show that most molar teeth once deemed "hopeless" due to stage 3 furcation lesions can be maintained for at least 5 to 15 years with supportive periodontal therapy. Similar long term studies in dogs are needed to improve the evidence-based management of canine patients with furcation lesions.
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Affiliation(s)
| | - Sandra Manfra Marretta
- 14589Professor Emerita University of Illinois College of Veterinary Medicine, Champaign-Urbana, IL, USA
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Lee DB, Snyder CJ, Mans C, Clyde VL, Scheels J. Management of Severe Periodontal Disease and Gingival Enlargement in a Dwarf Mongoose ( Helogale parvula). J Vet Dent 2020; 37:141-148. [PMID: 33241762 DOI: 10.1177/0898756420971872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Development of gingival enlargement and periodontitis is described in a young dwarf mongoose. Repeated treatments resulted in gingival resection and histologic evaluation however gingival enlargement was ultimately responsive to extraction of associated teeth. In cases such as these, surgical extraction of teeth associated with severe recurrent gingival enlargement should be considered to avoid the stress and risk of repeated immobilizations.
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Affiliation(s)
- Da Bin Lee
- 70725School of Veterinary Medicine, University of Wisconsin-Madison, WI, USA.,Dentistry and Oral Surgery Service, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Christopher J Snyder
- Veterinary Dentistry and Oral Surgery, Department of Surgical Sciences, 70725School of Veterinary Medicine, University of Wisconsin-Madison, WI, USA
| | - Christoph Mans
- Zoological Medicine, Department of Surgical Sciences, 70725School of Veterinary Medicine, University of Wisconsin-Madison, WI, USA
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Wang B, Booij-Vrieling HE, Bronkhorst EM, Shao J, Kouwer PHJ, Jansen JA, Walboomers XF, Yang F. Antimicrobial and anti-inflammatory thermo-reversible hydrogel for periodontal delivery. Acta Biomater 2020; 116:259-267. [PMID: 32937208 DOI: 10.1016/j.actbio.2020.09.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 01/06/2023]
Abstract
In periodontal treatment, topical adjunctive therapy with antimicrobials or anti-inflammatory agents is frequently applied. However, currently available drug carrier biomaterials often exhibit poor perfusion into small crevices, such as the deep and irregular periodontal pockets, due to relatively high viscosity. Moreover, high polymer concentrations of the polymer can potentially be cytotoxic upon confined local administration. This study aimed to formulate an antimicrobial and anti-inflammatory treatment option, by incorporating doxycycline (DOX) and/or lipoxin A4 (LXA4) into 0.5 wt% thermo-reversible polyisocyanopeptide (PIC). PIC can form hydrogels upon low polymer concentration, and we hypothesized that the thermo-reversible nature of the material would allow for application into the periodontal pocket. The formulations were characterized in vitro and finally tested in dogs with naturally occurring periodontitis, which were not euthanized afterward. Results showed that PIC/DOX/LXA4 hydrogel could be easily prepared and injected into periodontal pockets. The PIC hydrogel facilitated the release of DOX or LXA4 for around 4 days in vitro. When applied in dogs, the hydrogel exerted no local or systemic adverse effects. Gels loaded with LXA4 and/or DOX reduced the subgingival bacterial load and pro-inflammatory interleukin-8 level. In addition, PIC-DOX and PIC-DOX+LXA4 improved gingival clinical attachment by 0.6 mm compared with conventional periodontal treatment alone (i.e. mechanical debridement). In conclusion, the thermo-reversible PIC hydrogel is a safe and effective vehicle for periodontal drug delivery.
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Affiliation(s)
- Bing Wang
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Dentistry - Biomaterials, Philips van Leydenlaan 25, 6525 EX Nijmegen, the Netherlands; School of Stomatology, Shandong University, Jinan, Shandong, China
| | - Henriëtte E Booij-Vrieling
- Department of Clinical Sciences of Companion Animals, General Surgery, Faculty of Veterinary Medicine, Utrecht University, the Netherlands
| | - Ewald M Bronkhorst
- Radboud University Medical Center, Department of Dentistry, Philips van Leydenlaan 25, 6525 EX Nijmegen, the Netherlands
| | - Jinlong Shao
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Dentistry - Biomaterials, Philips van Leydenlaan 25, 6525 EX Nijmegen, the Netherlands; School of Stomatology, Shandong University, Jinan, Shandong, China
| | - Paul H J Kouwer
- Institute for Molecules and Materials, Radboud University, Nijmegen, the Netherlands
| | - John A Jansen
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Dentistry - Biomaterials, Philips van Leydenlaan 25, 6525 EX Nijmegen, the Netherlands
| | - X Frank Walboomers
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Dentistry - Biomaterials, Philips van Leydenlaan 25, 6525 EX Nijmegen, the Netherlands
| | - Fang Yang
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Dentistry - Biomaterials, Philips van Leydenlaan 25, 6525 EX Nijmegen, the Netherlands.
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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: 18] [Impact Index Per Article: 4.5] [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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Martel DP, Fox PR, Lamb KE, Carmichael DT. Comparison of closed root planing with versus without concurrent doxycycline hyclate or clindamycin hydrochloride gel application for the treatment of periodontal disease in dogs. J Am Vet Med Assoc 2019; 254:373-379. [PMID: 30668243 DOI: 10.2460/javma.254.3.373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare improvements in values for periodontal disease indices in dogs following treatment with closed root planing (CRP) alone, CRP with concurrent 8.5% doxycycline hyclate gel application, and CRP with concurrent 2% clindamycin hydrochloride reverse-polymer hydrogel application. DESIGN Randomized, blinded, controlled clinical trial. ANIMALS 34 client-owned dogs with periodontal pockets measuring 3.5 to 5.5 mm deep. PROCEDURES Dogs were randomly assigned to receive 1 of 3 treatments: CRP alone (n = 10) or CRP plus 8.5% doxycycline hyclate (12) or 2% clindamycin hydrochloride (12) gel applied within the periodontal pockets. Indices of periodontal disease severity were recorded before and 12 weeks after treatment, and outcomes were compared among treatment groups. RESULTS Except for gingivitis index, no significant differences were identified among the 3 treatment groups in the amount of improvement observed in values for periodontal disease indices following treatment. A minor but clinically unimportant improvement in mean gingivitis index values was identified for dogs treated with CRP plus doxycycline gel, which differed significantly from improvements in the other 2 groups. Teeth that were initially more severely affected (pocket depths, 5.0 to 5.5 mm) had the greatest amount of improvement, whereas teeth with only mildly high initial pocket depths (3.5 to 4.0 mm) had less improvement. CONCLUSIONS AND CLINICAL RELEVANCE Overall, addition of doxycycline or clindamycin gel application to CRP for the treatment of periodontal disease in dogs yielded no clinically relevant benefit over CRP during the 12-week follow-up period.
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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: 0.7] [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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Arciniegas Ruiz SM, Gutiérrez Olvera L, Bernad Bernad MJ, Caballero Chacón SDC, Vargas Estrada D. Comparative pharmacokinetics of a new oral long-acting formulation of doxycycline hyclate: A canine clinical trial. Eur J Pharm Sci 2015; 80:9-15. [PMID: 26393684 DOI: 10.1016/j.ejps.2015.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 07/21/2015] [Accepted: 09/18/2015] [Indexed: 01/20/2023]
Abstract
Doxycicline is used in dogs as treatment of several bacterial infections, mycoplasma, chlamydia and rickettsial diseases. However, it requires long treatments and several doses to be effective. The aim of this study was to determine the pharmacokinetics of four formulations of doxycycline hyclate, administered orally, with different proportions of excipients, acrylic acid-polymethacrylate-based matrices, to obtain longer therapeutic levels than conventional formulation. Forty-eight dogs were randomly assigned in five groups to receive a single oral dose (20mg/kg) of doxycycline hyclate without excipients (control) or a long-acting formulation containing doxycycline, acrylic acid polymer, and polymethacrylate in one of the following four proportions: DOX1(1:0.25:0.0035), DOX2(1:0.5:0.0075), DOX3 (1:1:0.015), or DOX4(1:2:0.0225). Temporal profiles of serum concentrations were obtained at several intervals after each treatment. Therapeutic concentrations were observed for 60h for DOX1 and DOX4, 48h for DOX2 and DOX3 and only 24h for DOX-C. None of the pharmacokinetic parameter differed significantly between DOX1 and DOX2 or between DOX3 and DOX4; however, the findings for the control treatment were significantly different compared to all four long-acting formulations. Results indicated that DOX1 had the most adequate pharmacokinetic-pharmacodynamic relationships for a time-dependent drug and had longer release times than did doxycycline alone. However, all four formulations can be effective depend on the minimum effective serum doxycycline concentration of the microorganism being treated. These results suggest that the use of any of these formulations can reduce the frequency of administration, the patient's stress, occurrence of adverse effects and the cost of treatment.
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Affiliation(s)
- Sara Melisa Arciniegas Ruiz
- Departamento de Fisiología y Farmacología, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, México
| | - Lilia Gutiérrez Olvera
- Departamento de Fisiología y Farmacología, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, México
| | - María Josefa Bernad Bernad
- Departamento de Tecnología Farmacéutica, Facultad de Química, Universidad Nacional Autónoma de México, México
| | - Sara Del Carmen Caballero Chacón
- Departamento de Fisiología y Farmacología, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, México
| | - Dinorah Vargas Estrada
- Departamento de Fisiología y Farmacología, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, México.
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Ruiz SMA, Olvera LG, Chacón SDCC, Estrada DV. Pharmacokinetics of an oral extended-release formulation of doxycycline hyclate containing acrylic acid and polymethacrylate in dogs. Am J Vet Res 2015; 76:367-72. [PMID: 25815578 DOI: 10.2460/ajvr.76.4.367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the pharmacokinetics of doxycycline hyclate administered orally in the form of experimental formulations with different proportions of acrylic acid-polymethacrylate-based matrices. ANIMALS 30 healthy adult dogs. PROCEDURES In a crossover study, dogs were randomly assigned (in groups of 10) to receive a single oral dose (20 mg/kg) of doxycycline hyclate without excipients (control) or extended-release formulations (ERFs) containing doxycycline, acrylic acid polymer, and polymethacrylate in the following proportions: 1:0.5:0.0075 (ERF1) or 1:1:0.015 (ERF2). Serum concentrations of doxycycline were determined for pharmacokinetic analysis before and at several intervals after each treatment. RESULTS Following oral administration to the study dogs, each ERF resulted in therapeutic serum doxycycline concentrations for 48 hours, whereas the control treatment resulted in therapeutic serum doxycycline concentrations for only 24 hours. All pharmacokinetic parameters for ERF1 and ERF2 were significantly different; however, findings for ERF1 did not differ significantly from those for the control treatment. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that both ERFs containing doxycycline, acrylic acid polymer, and polymethacrylate had an adequate pharmacokinetic-pharmacodynamic relationship for a time-dependent drug and a longer release time than doxycycline alone following oral administration in dogs. Given the minimum effective serum doxycycline concentration of 0.26 μg/mL, a dose interval of 48 hours can be achieved for each tested ERF. This minimum inhibitory concentration has the potential to be effective against several susceptible bacteria involved in important infections in dogs. Treatment of dogs with either ERF may have several benefits over treatment with doxycycline alone.
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Affiliation(s)
- Sara Melisa Arciniegas Ruiz
- Departamento de Fisiología y Farmacología, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Delegación Coyoacán, Ciudad de México C.P. 04510, México
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Ahamed S, Jalaluddin M, Khalid I, Moon N, Shaf TK, Ali FM. The use of controlled release locally delivered 10% doxycycline hyclate gel as an adjunct to scaling and root planing in the treatment of chronic periodontitis: clinical and microbiological results. J Contemp Dent Pract 2013; 14:1080-1086. [PMID: 24858755 DOI: 10.5005/jp-journals-10024-1455] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Local delivery of antimicrobial agents provides higher concentration of the drug in the periodontal site for longer periods than systemically delivered methods. In the present study an attempt is made to know the efficacy of controlled local drug delivery of doxycycline as an adjunctive treatment in the management of chronic periodontitis. MATERIALS AND METHODS A total of 12 patients, diagnosed as Chronic Periodontitis in the age of 25 to 55 years, were selected of both the sexes in this study. They were divided into Experimental group consisted of 30 sites who received complete scaling and root planing (SRP) followed by placement of Atridox gel and control group consisted of 30 sites who received only SRP. Clinical parameters were recorded at, baseline, days 30, 90 and 180. Parameters were plaque index, gingival index, gingival bleeding index and microbial analysis, probing pocket depth and Clinical attachment level (CAL). The microbiological analysis was done at baseline visit and at 90th day. Probing pocket depth and CAL were recorded only on day 0 and 180th day. RESULTS In 180 days study, both the groups exhibited a significant improvement in periodontal status. Significant gain in attachment level was observed in both the group. Between both the groups the clinical parameters in the experimental groups exhibited better results as compared to the control group. Both the groups exhibited significant reduction in the number of spirochetes. CONCLUSION Combination therapy of SRP and 10% DH gel demonstrated better results at all levels suggesting that this therapy can play a significant role as an adjunct to SRP in the management of chronic periodontitis.
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Affiliation(s)
- Shabeer Ahamed
- Associate Professor, Department of Periodontics, Malabar Dental College, Edapal, Kerala, India, Phone: 9746074655, e-mail:
| | - Md Jalaluddin
- Reader, Department of Periodontics and Oral Implantology, Kalinga Institute of Dental Sciences, Bhubaneswar-24, Odisha, India
| | - Imran Khalid
- Reader, Department of Oral and Maxillofacial Surgery, MGM Dental College, Navi Mumbai, Maharashtra, India
| | - Ninad Moon
- Professor and Head, Department of Periodontics, RKDF Dental College and Research Centre, Bhopal, Madhya Pradesh, India
| | - T K Shaf
- Reader, Department of Periodontics, Kannur Dental College, Kannur, Kerala, India
| | - Fareedi Mukram Ali
- Reader, Department of Oral and Maxillofacial Surgery, SMBT Dental College, Sangamner Taluka, Maharashtra, India
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Gamal AY, Kumper RM, Al Gendy AERR. Doxycycline-Loaded β-Tricalcium Phosphate Release Following EDTA Root Surface Etching Improved the Clinical Outcomes in Chronic Periodontitis: An In Vivo Study. J Periodontol 2013; 84:924-33. [DOI: 10.1902/jop.2012.120343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Agarwal P, Rupenthal ID. Injectable implants for the sustained release of protein and peptide drugs. Drug Discov Today 2013; 18:337-49. [PMID: 23410799 DOI: 10.1016/j.drudis.2013.01.013] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 11/02/2012] [Accepted: 01/14/2013] [Indexed: 12/20/2022]
Abstract
Protein and peptide macromolecules have emerged as promising therapeutic agents in recent years. However, their delivery to the target site can be challenging owing to their susceptibility to denaturation and degradation, short half-life and, therefore, poor bioavailability. In situ-forming implants present an attractive parenteral delivery platform for proteins and peptides because of their ease of application, sustained-release properties, tissue biocompatibility and simple manufacture. In this review, we discuss the various mechanisms by which polymer systems assemble in situ to form implant devices for sustained release of therapeutic macromolecules, and highlight recent advances in polymer systems that gel in response to a combination of these mechanisms. Finally, we examine release mechanisms, marketed products and limitations of injectable implants.
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Affiliation(s)
- Priyanka Agarwal
- Drug Delivery Research Unit, School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
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Kim SE, Kim S, Jeong M, Lee Y, Ahn JT, Park YW, Ahn JS, Lee E, Ryu DY, Seo K. Experimental determination of a subantimicrobial dosage of doxycycline hyclate for treatment of periodontitis in Beagles. Am J Vet Res 2013; 74:130-5. [DOI: 10.2460/ajvr.74.1.130] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chadha VS, Bhat KM. The evaluation of doxycycline controlled release gel versus doxycycline controlled release implant in the management of periodontitis. J Indian Soc Periodontol 2012; 16:200-6. [PMID: 23055585 PMCID: PMC3459499 DOI: 10.4103/0972-124x.99262] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Accepted: 12/29/2011] [Indexed: 11/25/2022] Open
Abstract
Background: Investigators have sought different methods to deliver antimicrobials to periodontal pockets. This study was designed to assess the efficacy of locally made doxycycline gel versus locally made doxycycline implant as biodegradable controlled local delivery systems, by evaluating the pharmacological drug release and improvement in gingival status, gain in attachment, and reduction in pocket depth. Materials and Methods: Thirty patients with localized periodontal pockets ≥5 mm were randomly divided into three groups. The first group received the doxycycline gel, the second the doxycycline implant, and the third received only scaling and root planing (the control group). The patients in the first two groups were selected for the drug release. Clinical parameters such as gingival index, plaque index, probing depth, and attachment levels were recorded at baseline and the 90th day. Gingival crevicular fluid (GCF) and saliva samples were collected 1 hour following gel and implant placement and then on the 10th, 30th, and 60th days. Results: There was a statistically significant difference in the release of doxycycline from the gel when compared with the implant in the GCF and saliva on the 10th and 30th days. All the three groups showed improvement in clinical parameters. The improvements in both gel and implant groups were greater when compared with the control group with no statistically significant difference between the implant and gel systems. Conclusion: The use of local delivery of doxycycline through gel and Implant media further enhances the positive changes obtained following scaling and root planing. The release of doxycycline from the implant and the gel was comparable.
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Gamal AY, Kumper RM. A Novel Approach to the Use of Doxycycline-Loaded Biodegradable Membrane and EDTA Root Surface Etching in Chronic Periodontitis: A Randomized Clinical Trial. J Periodontol 2012; 83:1086-94. [DOI: 10.1902/jop.2011.110476] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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Qin Y, Yuan M, Li L, Li W, Xue J. Formulation and evaluation of in situ forming PLA implant containing tinidazole for the treatment of periodontitis. J Biomed Mater Res B Appl Biomater 2012; 100:2197-202. [PMID: 22887609 DOI: 10.1002/jbm.b.32788] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 07/02/2012] [Accepted: 07/07/2012] [Indexed: 11/05/2022]
Abstract
Periodontitis is caused by periodontopathic bacteria and antibacterial agents are placed in a periodontal pocket with the intention of enhancing the local effect. To maximize the therapeutic effects while reducing the adverse effects, tinidazole was delivered by in situ forming system. One approach for reducing burst release rate was to testify in situ forming effect. The effect of 0%-10% (w/w) polyethylene glycol 400 and 3% (w/w) glycerol on the tinidazole release from a poly(DL-lactide) (PLA) injectable implant was evaluated. The results showed that the in vitro initial burst release rate was decreased in the presence of poly(ethyleneglycol) PEG 400 and glycerol. A formulation containing 30% (w/w) PLA (M(w) 7300) dissolved in 62% (w/w) N-methyl-2-pyrrolidone, 5% (w/w) PEG 400, and 3%(w/w) glycerol with 5% (w/w) tinidazole was shown to be optimum. Twelve adult beagle dogs were used in the periodontitis model. The treatment group I, II, and positive control group was administrated with gel containing 5%(w/w) tinidazole, 2.5%(w/w) tinidazole, and periocline, respectively. Dog studies revealed that periocline and the developed formulation could significantly decrease symptoms of periodontitis, and they were better than gel containing 2.5% (w/w) tinidazole. The developed formulation could sustain the release of tinidazole for local delivery over 7 days. These findings suggested that the developed formulation was a viable alternative to conventional drug to cure periodontitis.
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Affiliation(s)
- Yuyue Qin
- Faculty of Chemical Engineering, Kunming University of Science and Technology, Kunming 650550, People's Republic of China.
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Tariq M, Iqbal Z, Ali J, Baboota S, Talegaonkar S, Ahmad Z, Sahni JK. Treatment modalities and evaluation models for periodontitis. Int J Pharm Investig 2012; 2:106-22. [PMID: 23373002 PMCID: PMC3555006 DOI: 10.4103/2230-973x.104394] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Periodontitis is the most common localized dental inflammatory disease related with several pathological conditions like inflammation of gums (gingivitis), degeneration of periodontal ligament, dental cementum and alveolar bone loss. In this perspective, the various preventive and treatment modalities, including oral hygiene, gingival irrigations, mechanical instrumentation, full mouth disinfection, host modulation and antimicrobial therapy, which are used either as adjunctive treatments or as stand-alone therapies in the non-surgical management of periodontal infections, have been discussed. Intra-pocket, sustained release systems have emerged as a novel paradigm for the future research. In this article, special consideration is given to different locally delivered anti-microbial and anti inflammatory medications which are either commercially available or are currently under consideration for Food and Drug Administration (FDA) approval. The various in vitro dissolution models and microbiological strain investigated to impersonate the infected and inflamed periodontal cavity and to predict the in vivo performance of treatment modalities have also been thrashed out. Animal models that have been employed to explore the pathology at the different stages of periodontitis and to evaluate its treatment modalities are enlightened in this proposed review.
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Affiliation(s)
- Mohammad Tariq
- Department of Pharmaceutics, Faculty of Pharmacy, Jamia Hamdard, Hamdard Nagar, New Delhi-110062, India
| | - Zeenat Iqbal
- Department of Pharmaceutics, Faculty of Pharmacy, Jamia Hamdard, Hamdard Nagar, New Delhi-110062, India
| | - Javed Ali
- Department of Pharmaceutics, Faculty of Pharmacy, Jamia Hamdard, Hamdard Nagar, New Delhi-110062, India
| | - Sanjula Baboota
- Department of Pharmaceutics, Faculty of Pharmacy, Jamia Hamdard, Hamdard Nagar, New Delhi-110062, India
| | - Sushama Talegaonkar
- Department of Pharmaceutics, Faculty of Pharmacy, Jamia Hamdard, Hamdard Nagar, New Delhi-110062, India
| | - Zulfiqar Ahmad
- Department of Pharmaceutics, Faculty of Pharmacy, Jamia Hamdard, Hamdard Nagar, New Delhi-110062, India
| | - Jasjeet K Sahni
- Department of Pharmaceutics, Faculty of Pharmacy, Jamia Hamdard, Hamdard Nagar, New Delhi-110062, India
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17
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Johnston TP, Mondal P, Pal D, MacGee S, Stromberg AJ, Alur H. Canine Periodontal Disease Control Using a Clindamycin Hydrochloride Gel. J Vet Dent 2011; 28:224-9. [DOI: 10.1177/089875641102800402] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Stabilizing or reducing periodontal pocket depth can have a positive influence on the retention of teeth in dogs. A topical 2 % clindamycin hydrochloride gel (CHgel) was evaluated for the treatment of periodontal disease in dogs. The CHgel formulation provides for the sustained erosion of the matrix, but also flows into the periodontal pocket as a viscous liquid, and then rapidly forms a gel that has mucoadhesive properties and also may function as a physical barrier to the introduction of bacteria. A professional teeth cleaning procedure including scaling and root planing was done in dogs with one group receiving CHgel following treatment. Periodontal health was determined before and after the procedure including measurement of periodontal pocket depth, gingival index, gingival bleeding sites, and number of suppurating sites. There was a statistically significant decrease in periodontal pocket depth (19 %), gingival index (16 %), and the number of bleeding sites (64 %) at 90-days in dogs receiving CHgel. Additionally, the number of suppurating sites was lower (93 %) at 90-days for the group receiving CHgel. The addition of CHgel effectively controlled the bacterial burden (e.g., Fusobacterium nucleatum) at both day 14 and 90. Gingival cells in culture were shown to rapidly incorporate clindamycin and attain saturation in approximately 20-minutes. In summary, a professional teeth cleaning procedure including root planning and the addition of CHgel improves the gingival index and reduces periodontal pocket depth.
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Affiliation(s)
- Thomas P. Johnston
- From the Division of Pharmaceutical Science, School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO; Companion Animal Dentistry of Kansas City (MacGee), Lenexa, KS; Department of Statistics (Stromberg), University of Kentucky, Lexington, KY; and, Trilogic Pharma LLC (Alur), Montgomery, AL
| | - Pravakar Mondal
- From the Division of Pharmaceutical Science, School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO; Companion Animal Dentistry of Kansas City (MacGee), Lenexa, KS; Department of Statistics (Stromberg), University of Kentucky, Lexington, KY; and, Trilogic Pharma LLC (Alur), Montgomery, AL
| | - Dhananjay Pal
- From the Division of Pharmaceutical Science, School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO; Companion Animal Dentistry of Kansas City (MacGee), Lenexa, KS; Department of Statistics (Stromberg), University of Kentucky, Lexington, KY; and, Trilogic Pharma LLC (Alur), Montgomery, AL
| | - Scott MacGee
- From the Division of Pharmaceutical Science, School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO; Companion Animal Dentistry of Kansas City (MacGee), Lenexa, KS; Department of Statistics (Stromberg), University of Kentucky, Lexington, KY; and, Trilogic Pharma LLC (Alur), Montgomery, AL
| | - Arnold J. Stromberg
- From the Division of Pharmaceutical Science, School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO; Companion Animal Dentistry of Kansas City (MacGee), Lenexa, KS; Department of Statistics (Stromberg), University of Kentucky, Lexington, KY; and, Trilogic Pharma LLC (Alur), Montgomery, AL
| | - Hemant Alur
- From the Division of Pharmaceutical Science, School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO; Companion Animal Dentistry of Kansas City (MacGee), Lenexa, KS; Department of Statistics (Stromberg), University of Kentucky, Lexington, KY; and, Trilogic Pharma LLC (Alur), Montgomery, AL
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18
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Abstract
Delivery of biologically active agents to animals is often perceived to be the poor relation of human drug delivery. Yet this field has a long and successful history of species-specific device and formulation development, ranging from simple approaches and devices used in production animals to more sophisticated formulations and approaches for a wide range of species. While several technologies using biodegradable polymers have been successfully marketed in a range of veterinary and human products, the transfer of delivery technologies has not been similarly applied across species. This may be due to a combination of specific technical requirements for use of devices in different species, inter-species pharmacokinetic, pharmacodynamic and physiological differences, and distinct market drivers for drug classes used in companion and food-producing animals. This chapter reviews selected commercialised and research-based parenteral and non-parenteral veterinary drug delivery technologies in selected domestic species. Emphasis is also placed on the impact of endogenous drug transporters on drug distribution characteristics in different species. In vitro models used to investigate carrier-dependent transport are reviewed. Species-specific expression of transporters in several tissues can account for inter-animal or inter-species pharmacokinetic variability, lack of predictability of drug efficacy, and potential drug-drug interactions.
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Affiliation(s)
- David J Brayden
- School of Agriculture, Food Science and Veterinary Medicine, University College Dublin (UCD) and UCD Conway Institute, Belfield, Dublin 4, Ireland.
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19
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Hoffman SL, Kressin DJ, Verstraete FJM. Myths and misconceptions in veterinary dentistry. J Am Vet Med Assoc 2008; 231:1818-24. [PMID: 18081520 DOI: 10.2460/javma.231.12.1818] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Sharon L Hoffman
- North Florida Veterinary Dentistry, 2961 Egret Walk Terrace S, Jacksonville, FL 32226, USA
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20
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Akalin FA, Baltacioğlu E, Sengün D, Hekimoğlu S, Taşkin M, Etikan I, Fişenk I. A comparative evaluation of the clinical effects of systemic and local doxycycline in the treatment of chronic periodontitis. J Oral Sci 2004; 46:25-35. [PMID: 15141721 DOI: 10.2334/josnusd.46.25] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
In this study, the clinical efficacies of systemic doxycycline (SD) and local doxycycline (LD) in the treatment of chronic periodontitis were compared. Forty-five patients were studied in 3 main groups with 5 treatments: SD alone, SD+scaling-root planing (SD+SRP), LD alone, LD+SRP and SRP alone. Antibiotic-treated patients were given doxycycline treatment alone in 1 quadrant of their upper jaws, and doxycycline+SRP was given in the contralateral quadrant. The areas included at least 4 teeth with > or = 5 mm pockets. Probing depth (PD), clinical attachment level, gingival index, sulcular bleeding index and plaque index values were recorded at baseline and the 7th week. The results were statistically analyzed. All of the clinical parameters were significantly reduced by all treatments (P < or = 0.05). The SD and LD treatments alone provided significant clinical healings. The significant differences among the groups were only in PD at the 7th week. The LD treatment provided significantly higher PD reduction than the SD treatment (P < or = 0.05). No significant difference was found between the SD+SRP and the LD+SRP treatments. There was no significant difference between SD+SRP and SRP alone treatment (P > 0.05). The SD group showed lower PD reduction than SRP group (P < or = 0.05), while no significant difference was found between LD and SRP treatments. The LD alone treatment seemed more effective than SD alone treatment on PD reduction, but no significant difference was found between them when combined with the SRP. LD may be more preferable than SD as an adjunct to mechanical treatment since LD seems more effective than SD on PD reduction and does not have the side effects of SD.
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Affiliation(s)
- Ferda Alev Akalin
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey.
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21
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Machion L, Andia DC, Benatti BB, Carvalho MD, Nogueira-Filho GR, Casati MZ, Nociti FH, Sallum EA. Locally Delivered Doxycycline as an Adjunctive Therapy to Scaling and Root Planing in the Treatment of Smokers: A Clinical Study. J Periodontol 2004; 75:464-9. [PMID: 15088885 DOI: 10.1902/jop.2004.75.3.464] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this clinical study was to evaluate the association of locally delivered doxycycline (10%) with scaling and root planing in the periodontal treatment of smokers. METHODS Forty-three patients with chronic periodontitis and a minimum of four pockets (> or = 5 mm) on anterior teeth that bled on probing were selected. Patients were randomly assigned to scaling and root planing (SRP) or scaling and root planing followed by local application of doxycycline (SRP-D). Plaque, bleeding on probing, gingival recession, relative attachment level (RAL), and probing depth (PD) were recorded at baseline, 45 days, and 3 and 6 months. Differences between baseline and each period were considered for analysis. RESULTS At 6 months, no difference was found between groups regarding plaque, bleeding reduction, gingival recession or PD (P > 0.05). However, RAL gain was greater for SRP-D (1.63 +/- 0.93 mm) than for SRP (1.04 +/- 0.71 mm) (P = 0.025). In addition, deep pockets (> or = 7 mm) showed a significant reduction (3.78 +/- 1.41 versus 2.60 +/- 1.28 mm, P = 0.039) and RAL gain (2.54 +/- 1.27 mm versus 1.29 +/- 0.95 mm, P = 0.01) when doxycycline was applied. The proportion of sites showing RAL gain of 1 to 2 mm was 36.8% versus 21.7% for SRP-D and SRP, respectively (P = 0.01). CONCLUSION The use of locally delivered doxycycline may constitute an important adjunct for the treatment of severe periodontal disease in smokers.
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Affiliation(s)
- Luciana Machion
- Department of Periodontics and Prosthodontics, Division of Periodontics, School of Dentistry at Piracicaba, University of Campinas, Piracicaba, São Paulo, Brazil
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22
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Einmahl S, Capancioni S, Schwach-Abdellaoui K, Moeller M, Behar-Cohen F, Gurny R. Therapeutic applications of viscous and injectable poly(ortho esters). Adv Drug Deliv Rev 2001; 53:45-73. [PMID: 11733117 DOI: 10.1016/s0169-409x(01)00220-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Poly(ortho esters) (POE) are hydrophobic and bioerodible polymers that have been investigated for pharmaceutical use since the early 1970s. Among the four described generations of POE, the third (POE III) and fourth (POE IV) are promising viscous and injectable materials which have been investigated in numerous biomedical applications. POE III has been extensively studied for ophthalmic drug delivery, it presents an excellent biocompatibility and is currently being investigated as a vehicle for sustained drug delivery to treat diseases of the posterior segment of the eye. POE IV is distinguishable by a highly reproducible and controlled synthesis, a higher hydrophobicity, and an excellent biocompatibility. It is currently under development for a variety of applications, such as ocular delivery, periodontal disease treatment and applications in veterinary medicine. This review will also focus on new perspectives for this promising family of polymers, such as guided tissue regeneration, treatment of osteoarthritis, as well as peptide and protein delivery.
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Affiliation(s)
- S Einmahl
- Department of Pharmaceutics and Biopharmaceutics, School of Pharmacy, University of Geneva, 30 quai Ernest-Ansermet, CH-1211 Geneva 4, Switzerland
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23
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Abstract
Dentistry is a relatively new field in veterinary medicine, despite the fact that dental disease is common in dogs and cats. Obstacles to the development of dental treatments in animals include the diversity of the dentition among the species, the difficulty in administration of oral treatments, the different presentations of oral disease, and the cost of regulatory approval for each species. Mechanical removal of plaque and calculus has been the mainstay of periodontal disease treatment in animals and humans. New adjunctive therapies, as well as new applications for older drugs, are being introduced for periodontal therapy.
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Affiliation(s)
- W P Cleland
- Heska Corporation, 1613 Prospect Parkway, Fort Collins, CO 80525, USA.
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24
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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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25
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Abstract
Severe infections are uncommon following orthopedic surgery, yet they can be frustrating for the veterinarian and owner to treat and can result in devastating consequences for the patient. This article reviews the common causes for postoperative infection, reviews established treatment, and introduces newer methods for treatment and control. A thorough understanding of the pathogenesis, application of appropriate diagnostic procedures, the institution of aggressive treatment regimens, with adherence to established principles, will often result in satisfactory outcomes even with severe orthopedic infections. For those more refractory to treatment, the use of newer treatment methods, specifically locally implantable materials for sustained release of antimicrobials can improve success in the treatment of these more difficult cases.
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Affiliation(s)
- W S Dernell
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, USA
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26
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Garrett S, Johnson L, Drisko CH, Adams DF, Bandt C, Beiswanger B, Bogle G, Donly K, Hallmon WW, Hancock EB, Hanes P, Hawley CE, Kiger R, Killoy W, Mellonig JT, Polson A, Raab FJ, Ryder M, Stoller NH, Wang HL, Wolinsky LE, Evans GH, Harrold CQ, Arnold RM, Southard GL. Two multi-center studies evaluating locally delivered doxycycline hyclate, placebo control, oral hygiene, and scaling and root planing in the treatment of periodontitis. J Periodontol 1999; 70:490-503. [PMID: 10368053 DOI: 10.1902/jop.1999.70.5.490] [Citation(s) in RCA: 119] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The clinical efficacy and safety of doxycycline hyclate (8.5% w/w) delivered subgingivally in a biodegradable polymer (DH) was compared to placebo control (VC), oral hygiene (OH), and scaling and root planing (SRP) in 2 multi-center studies. METHODS Each study entered 411 patients who demonstrated moderate to severe periodontitis. Patients had 2 or more quadrants each with a minimum of 4 qualifying pockets > or =5 mm that bled on probing. At least 2 of the pockets were > or =7 mm. Treatment with DH, VC, OH, or SRP was provided at baseline and again at month 4. Clinical parameters were recorded monthly. RESULTS DH and SRP resulted in nearly identical clinical changes over time in both studies. Mean 9 month clinical attachment level gain (ALG) was 0.8 mm for the DH group and 0.7 mm for the SRP group in Study 1, and 0.8 mm (DH) and 0.9 mm (SRP) in Study 2. Mean probing depth (PD) reduction was 1.1 mm for the DH group and 0.9 mm for the SRP group in Study 1 and 1.3 mm for both groups in Study 2. Frequency distributions showed an ALG > or =2 mm in 29% of DH sites versus 27% of SRP sites in Study 1 and 31% of DH sites versus 34% of SRP sites in Study 2. PD reductions > or =2 mm were seen in 32% of DH sites versus 31% of SRP sites in Study 1 and 41% of DH sites versus 43% of SRP sites in Study 2. Comparisons between DH, VC, and OH treatment groups showed DH treatment to be statistically superior to VC and OH. Safety data demonstrated a benign safety profile with use of the DH product. CONCLUSIONS Results of this trial demonstrate that treatment of periodontitis with subgingivally delivered doxycycline in a biodegradable polymer is equally effective as scaling and root planing and superior in effect to placebo control and oral hygiene in reducing the clinical signs of adult periodontitis over a 9-month period. This represents positive changes resulting from the use of subgingivally applied doxycycline as scaling and root planing was not limited regarding time of the procedure or use of local anesthesia.
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Affiliation(s)
- S Garrett
- Atrix Laboratories, Inc., Fort Collins, CO 80525, USA
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27
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Jendresen MD, Allen EP, Bayne SC, Donovan TE, Hansson TL, Klooster J, Kois JC. Annual review of selected dental literature: report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 1997; 78:54-92. [PMID: 9237147 DOI: 10.1016/s0022-3913(97)70088-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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28
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Polson AM, Garrett S, Stoller NH, Bandt CL, Hanes PJ, Killoy WJ, Harrold CQ, Southard GL, Duke SP. Multi-center comparative evaluation of subgingivally delivered sanguinarine and doxycycline in the treatment of periodontitis. I. Study design, procedures, and management. J Periodontol 1997; 68:110-8. [PMID: 9058327 DOI: 10.1902/jop.1997.68.2.110] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The design and conduct of a 9-month multi-center clinical trial to evaluate the safety and efficacy of subgingivally delivered 5% sanguinarium chloride (SC) and 10% doxycycline hyclate (DH) from a biodegradable drug delivery system in the treatment of adult periodontitis is described. The 3-group randomized study of 180 adults with moderate to severe periodontitis was a modified double-blind parallel design. One group received DH, one group received SC, and the other group received the vehicle control (VC). Patients selected had two quadrants with a minimum of four periodontal pockets > or = 5 mm in depth with two sites > or = 7 mm. All qualifying sites exhibited bleeding on gentle probing. Qualifying sites were treated at baseline and again at 4 months. Clinical response was assessed by measuring attachment level, probing depth, and bleeding on probing at monthly examinations at qualifying sites and the entire dentition. The plaque index was measured monthly to verify oral hygiene status. The parallel design afforded the opportunity to distinguish between treatment effectiveness of SC, DH, and VC independent of possible crossover effects. Also the effectiveness of oral hygiene in untreated sites of the mouth could be evaluated. Finally, treatment effects in moderate (5 to 6 mm) and deep (> or = 7 mm) pockets in both treated and untreated sites could be compared. The design was capable of simulating a periodontal practice maintenance program and assessing the response according to maintenance and treatment history. Study management procedures that emphasized center examiner and therapist training and adherence to protocol and procedures to reduce variability are described.
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Affiliation(s)
- A M Polson
- University of Pennsylvania, School of Dental Medicine, Philadelphia, USA
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29
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Polson AM, Garrett S, Stoller NH, Bandt CL, Hanes PJ, Killoy WJ, Southard GL, Duke SP, Bogle GC, Drisko CH, Friesen LR. Multi-center comparative evaluation of subgingivally delivered sanguinarine and doxycycline in the treatment of periodontitis. II. Clinical results. J Periodontol 1997; 68:119-26. [PMID: 9058328 DOI: 10.1902/jop.1997.68.2.119] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The clinical safety and effectiveness of a subgingivally delivered biodegradable drug delivery system containing either 10% doxycycline hyclate (DH), 5% sanguinarium chloride (SC) or no agent (VC) was evaluated in a 9-month multi-center trial. The study was a randomized parallel design with 180 patients who demonstrated moderate to severe periodontitis. All patients had at least two quadrants with a minimum of four qualifying pockets > or = 5 mm that bled on probing. Two of the qualifying pockets were required to be > or = 7 mm. At baseline and at 4 months all qualified sites were treated with the test article administered via syringe. Probing depth reduction (PDR), attachment level gain (ALG), bleeding on probing reduction (BOP), and plaque index were determined monthly. Analysis of efficacy data from the 173 efficacy-evaluable patients indicated that all treatments gave significant positive clinical changes from baseline at all subsequent timepoints. DH was superior to SC and VC in PDR at all timepoints (P < or = 0.01 to 0.001) with a maximum reduction of 2.0 mm at 5 months. For ALG, DH was superior to VC at months 2, 3, 4, 5, 6, 8, and 9 (P < or = 0.04 to 0.002) and superior to SC at months 5, 6, 7, 8, and 9 (P < or = 0.01 to 0.001) with a maximum ALG of 1.2 mm at 6 months. For BOP reduction, DH was superior to VC at all time points (P < or = 0.05) and to SC at months 3, 5, 6, 8, and 9 (P < or = 0.03). For DH, the maximum ALG in deep (> or = 7 mm) pockets was 1.7 mm and PDR 2.9 mm compared to 0.8 mm and 1.6 mm, respectively for moderate (5 to 6 mm) pockets. Test articles were applied without anesthesia and no serious adverse events occurred in the trial. The results of this study indicate that 10% doxycycline hyclate delivered in a biodegradable delivery system is an effective means of reducing the clinical signs of adult periodontitis and exhibits a benign safety profile.
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Affiliation(s)
- A M Polson
- University of Pennsylvania, School of Dental Medicine, Philadelphia, USA
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