Adjunctive use of a subgingival controlled-release chlorhexidine chip reduces probing depth and improves attachment level compared with scaling and root planing alone

Xanthan-based chlorhexidine gel effects in non-surgical periodontal therapy? A meta-analysis

OBJECTIVE

To carry out a systematic review and meta-analysis of randomized controlled clinical trials (RCTs) and controlled clinical trials (CCTs) comparing scaling and root planing (SRP) or placebo with subgingival application of xanthan-based CHX (chlorhexidine) gel as adjunct to SRP.

MATERIALS AND METHODS

The literature search was carried out in PubMed/MEDLINE, EMBASE, and SCOPUS; primary outcomes were probing pocket depth (PPD) reduction and gain in clinical attachment level (CAL).

RESULTS

Overall, 15 studies were included. Three studies were judged to be at moderate risk of bias while the remaining 12 were rated at high risk of bias. A significant improvement in PPD reduction (standardized mean difference, SMD, 0.87, 95% CI, 0.41-1.34) and CAL gain (SMD = 0.84, 95% CI, 0.36-1.33) emerged for the SRP + CXH gel compared to the SRP alone group, in the presence of significant high heterogeneity among the studies.

CONCLUSIONS

Our systematic review and meta-analysis showed that xanthan-based chlorhexidine gel as adjunct to non-surgical periodontal therapy gives benefit in terms of PPD reduction and CAL gain as compared to non-surgical periodontal therapy only. Since there was high heterogeneity among studies and the quality of the evidence is low, further studies characterized by a better methodology, adequate sample size and longer follow-up are warranted in the next future.

REGISTRATION

The protocol of this scoping review was registered in the International Prospective Register of Systematic Reviews (https://www.crd.york.ac.uk/PROSPERO) with ID: CRD42023391589.

Effects of Coriander on the Repair Process of Experimentally-induced Periodontitis in Rats

The aim of this study was to evaluate the effects of Coriandrum sativum L. (CSL) seed extract on gingival levels of antioxidant enzymes, pro-inflammatory cytokines and on alveolar bone and attachment levels after experimental periodontitis induction in rats and compare it with low-dose doxycycline (LDD). Forty adult male Wistar Albino rats were divided randomly into 5 groups as follows: 1 = periodontally healthy (control); 2 = periodontitis; 3 = periodontitis + CSL (32 mg/kg); 4 = periodontitis + CSL (200 mg/kg); and 5 = periodontitis + LDD (6 mg/kg). Gingival superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT) levels were evaluated by enzyme-linked immunosorbent assay. The presence of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-1βeta (IL-1β) immunoreactivity was detected immunohistochemically. Alveolar bone area in the furcation space (ABA), alveolar bone loss (ABL), and attachment loss (AL) were evaluated histomorphometrically. The SOD level was lower in group 5 than in groups 2, 3, and 4. The IL-1β level was highest in group 4. The TNF-α level was statistically higher in groups 2 and 4 than in groups 1, 3, and 5. The IL-6 level was highest in group 4. Its level was higher in groups 2 and 3 than in group 5. ABA was less in groups 2, 3, and 4 compared to groups 1 and 5. ABL was less in group 5 than in groups 2, 3, and 4. AL was greater in group 4 than in group 5. The use of 200 mg/kg CSL showed a pro-inflammatory effect and IL-1β and TNF-α levels decreased after 32 mg/kg CSL application in the treatment of periodontitis.

Supra and subgingival application of antiseptics or antibiotics during periodontal therapy

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.

Controlled release devices as adjuvants in nonsurgical periodontal therapy: A systematic review

Controlled release devices (CRD) have been widely studied regarding their application in periodontal therapy. Therefore, the present study aims to evaluate the use and effectiveness of controlled-release devices in nonsurgical periodontal therapy through a systematic review. The research was carried out in six different databases, namely: Online Medical Literature Search and Analysis System (Medline-PubMed), Web of Science, Science Direct, Scopus, Scielo, and Google Scholar. The descriptors "Delayed-Action Preparation," "Therapeutics," and "Periodontitis," were used with their EntryTerms and connected through the Boolean operators AND and OR. A total of 2847 studies were found, and after applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist flowchart, 34 were selected using the eligibility criteria. After that, the qualitative results were tabulated and the risk of bias in each of them was evaluated. It can be observed that the use of CRD presents itself as a successful alternative for adjuvant treatment to periodontal therapy, a fact due to its availability and local concentration in the crevicular fluid. However, further clinical research is still needed to develop devices that are effective, with an easy and quick application, as well as available at a good cost-benefit ratio.

A Placebo-Controlled Trial to Evaluate Two Locally Delivered Antibiotic Gels (Piperacillin Plus Tazobactam vs. Doxycycline) in Stage III-IV Periodontitis Patients

Background and objectives: this study aims to evaluate the clinical and microbiological effects of a single subgingival administration of a locally delivered antibiotic gel containing piperacillin plus tazobactam and compare it with a slow-release doxycycline (14%) gel and a placebo gel, following subgingival instrumentation (SI) in patients with severe periodontitis. Materials and methods: sixty-four patients diagnosed with stage III-IV periodontitis were enrolled, were randomly assigned into three groups, and were treated additionally with a single subgingival administration of piperacillin plus tazobactam gel (group A); doxycycline gel (group B); and placebo gel (group C). The primary outcome variable was the change in mean probing pocket depth (PPD) 6 months after the intervention. Secondary outcome variables were changes in mean full-mouth bleeding score (FMBS); full-mouth plaque score (FMPS); overall bleeding index (BOP); pocket closure; and clinical attachment level (CAL), along with changes in the numbers of five keystone bacteria: Aggregatibacter actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), Prevotella intermedia (P.i.), Tannerella forsythia (T.f.), and Treponema denticola (T.d.). Intergroup and intragroup differences were evaluated at 3 and 6 months. Results: at baseline, the three groups were comparable. An improvement in clinical parameters such as PPD, CAL, and BOP between groups was observed at 3 and 6 months, but without statistical significance (p > 0.05). At 6 months, the intragroup analysis showed a significant reduction in clinical parameters. Even though the piperacillin plus tazobactam group showed slightly higher PPD reduction, this was not statistically significant when compared to both control groups. Conclusions: The groups had similar results, and subgingival instrumentation can be executed without adjunctive antimicrobials, reducing the costs for the patient and the working time/load of the professional.

Evaluation of efficacy of subgingival administration of 1% chlorhexidine gel as an adjunct to scaling and root planing in the treatment of chronic periodontitis - A clinical and microbiological study

AIM

The aim of the present study was to evaluate the clinical and microbiological effects of subgingival administration of 1% chlorhexidine gel (Chlorhexamed® 1% gel) in patients with chronic periodontitis.

SETTINGS AND DESIGN

The study was done in a parallel-arm design with a total of 30 patients with 60 sites suffering from chronic periodontitis. The patients were divided into control and experimental groups.

MATERIALS AND METHODS

The clinical parameters recorded were plaque index, gingival index, modified sulcular bleeding index, probing pocket depth and relative attachment level at baseline, 1 month and 3 month. Microbiological colony-forming units were assessed for Porphyromonas gingivalis, Fusobacterium nucleatum and Tannerella forsythia at baseline, 1 week, 1 month and 3 months. The control group received scaling and root planing (SRP) after baseline evaluation; however, the experimental group received the application of Chlorhexamed® gel within 48 hours after SRP. Then, the values obtained were subjected to statistical analysis.

RESULTS

Both groups showed significant improvement from the baseline to 3 months in all clinical and microbiological parameters. The experimental group showed better improvement in all parameters.

CONCLUSION

The use of Chlorhexamed® gel has proven to be an efficacious adjunct with SRP in the treatment of chronic periodontitis.

Unusual Findings in Trials Evaluating Adjuncts to Scaling and Root Planing: Meta-analysis (Part 1)

BACKGROUND

A number of studies in patients with periodontitis have compared scaling and root planning (SRP) combined with an adjunctive treatment to SRP alone. Within that literature, an array of studies with overlapping investigators has consistently yielded substantially greater effects of adjunctive treatments than had been previously noted. This report investigates discrepancies between that cluster of research and the most recent American Dental Association (ADA) systematic review.

METHODS

This review was preregistered at https://osf.io/4meyd/. A search using the Scopus platform identified 32 articles published from 2010 to 2017 by investigators affiliated with the Government Dental College and Research Institute (GDCRI) in Bangalore, India. The primary outcome used in this meta-analysis was the change in clinical attachment level (CAL) after 6 mo. Effect sizes were estimated using Comprehensive Meta-Analysis software after categorizing agents into groups based on pharmacologic similarity.

RESULTS

The search identified 32 studies encompassing 5 sets of adjunctive agents. Across the GDCRI studies, the CAL averaged 1.67 mm (95% confidence interval [CI]: 1.43-1.91 mm), substantially exceeding values reported in the ADA review (mean: 0.39 mm, 95% CI: 0.27-0.51 mm). For categories of studies in which comparable subgroup estimates were available, the evaluations yielded overlapping estimates of SRP alone, but CAL estimates were discrepant for both locally delivered antimicrobials (GDCRI studies: mean: 1.45 mm, 95% CI: 0.63-2.27 mm; ADA review: mean: 0.38 mm, 95% CI: 0.16 -0.60 mm) and systemic antibiotics (GDCRI studies: mean: 1.35 mm, 95% CI: 0.97-1.73 mm; ADA review: mean: 0.39 mm, 95% CI: 0.21-0.57 mm).

CONCLUSION

In the literature on adjunctive agents supplementing SRP, findings from investigators linked to GDCRI stand out as having significantly more favorable estimated effects. Meanwhile, some agents studied by GDCRI-linked investigators have not been investigated by other researchers. In the absence of a clear explanation for discrepant results, it is recommended that unusually favorable reported effects of adjunctive agents be viewed with caution.

KNOWLEDGE TRANSFER STATEMENT

The present meta-analysis observed an unusually large effect size of adjunctive agents to scaling and root planning in studies conducted by the same research group. These results were not consistent with trials on adjunctive agents and previous reports. As this research group has exclusively tested most of the agents, their results must be viewed with caution until other independent groups replicate the studies and reproduce the effect size.

Evaluating efficacy of a novel dentifrice in reducing probing depths in Stage I and II periodontitis maintenance patients: A randomized, double-blind, positive controlled clinical trial

BACKGROUND

Compliance to periodontal maintenance therapy (PMT) is essential for long-term periodontal health. Between PMT visits, patients must maintain good oral hygiene. A dentifrice with demonstrable clinical benefits for use between PMT visits would be highly desirable. The aim of this clinical study was to investigate the effect of a novel dental gel on probing depths (PD) and inflammation when used as a home care dentifrice in Stage I and II periodontitis patients.

METHODS

This double-blind clinical study randomized 65 subjects with Stage I and II periodontitis to the novel dental gel containing 2.6% EDTA, and a commercially available anti-gingivitis dentifrice with 0.454% stannous fluoride. Primary endpoint was PD at 6 months for those sites with baseline PD ≥ 4 mm and secondary endpoints included whole mouth mean scores of modified gingival index (MGI), modified sulcus bleeding index (mSBI) and plaque index (PI). No SRP was performed at baseline.

RESULTS

Subjects using the novel dentifrice showed significant PD reductions of 1.18 mm (from 4.27 mm at baseline to 3.09 mm at 6 months) compared to 0.93 mm (from 4.23 mm at baseline to 3.30 mm at 6 months) shown for those using the positive control dentifrice. Difference between treatments at 6 months was 0.21 mm with P-value = 0.0126. Significant improvements in MGI (P = 0.0000), mSBI (P = 0.0000), and PI (P = 0.0102) were also observed in 6 months.

CONCLUSION

The novel dentifrice showed significant reductions in PD and gingival inflammation over 6 months solely as a home care dentifrice without baseline SRP in Stage I and II periodontitis maintenance patients.

Adjunctive effect of locally delivered antimicrobials in periodontitis therapy: A systematic review and meta-analysis

AIM

To answer the following PICOS question: in adult patients with periodontitis, which is the efficacy of adjunctive locally delivered antimicrobials, in comparison with subgingival debridement alone or plus a placebo, in terms of probing pocket depth (PPD) reduction, in randomized clinical trials with at least 6 months of follow-up.

MATERIAL AND METHODS

A systematic search was conducted: 59 papers, reporting 50 different studies, were included. Data on clinical outcome variables changes were pooled and analysed using weighted mean differences (WMDs) and 95% confidence intervals (CI), and prediction intervals (PI), in case of significant heterogeneity.

RESULTS

Statistically significant differences were observed, in 6- to 9-month studies, for PPD (WMD = 0.365, 95% CI [0.262; 0.468], PI [-0.29; 1.01]) and clinical attachment level (CAL) (WMD = 0.263, 95% CI [0.123; 0.403], PI [-0.43; 0.96]). For long-term studies, significant differences were observed for PPD (WMD = 0.190, 95% CI [0.059; 0.321]), but not for CAL. For adverse events, no differences were observed. Results were affected by study design (split-mouth versus parallel studies) and assessment (full- or partial-mouth), as well as by the formulation tested.

CONCLUSIONS

The use adjunctive locally delivered antimicrobials in periodontitis therapy results in statistically significant benefits in clinical outcomes, without relevant side effects.

Repeated delivery of chlorhexidine chips for the treatment of peri-implantitis: A multicenter, randomized, comparative clinical trial

BACKGROUND

Peri-implantitis is a challenging condition to manage and is frequently treated using non-surgical debridement. The local delivery of antimicrobial agents has demonstrated benefit in mild to moderate cases of peri-implantitis. This study compared the safety and efficacy of chlorhexidine gluconate 2.5 mg chip (CHX chips) as an adjunctive treatment to subgingival debridement in patients afflicted with peri-implantitis.

METHODS

A multicenter, randomized, single-blind, two-arm, parallel Phase-3 study was conducted. Peri-implantitis patients with implant pocket depths (IPD) of 5-8 mm underwent subgingival implant surface debridement followed by repeated bi-weekly supragingival plaque removal and chlorhexidine chips application (ChxC group) for 12 weeks, or similar therapy but without application of ChxC (control group). All patients were followed for 24 weeks. Plaque and gingival indices were measured at every visit whereas IPD, recession, and bleeding on probing were assessed at 8, 12, 16, 24 week.

RESULTS

A total of 290 patients were included: 146 in the ChxC group and 144 in the control. At 24 weeks, a significant reduction in IPD (P = 0.01) was measured in the ChxC group (1.76 ± 1.13 mm) compared with the control group (1.54 ± 1.13 mm). IPD reduction of ≥2 mm was found in 59% and 47.2% of the implants in the ChxC and control groups, respectively (P = 0.03). Changes in gingival recession (0.29 ± 0.68 mm versus 0.15 ± 0.55 mm, P = 0.015) and relative attachment gain (1.47 ± 1.32 mm and 1.39 ± 1.27 mm, P = 0.0017) were significantly larger in the ChxC group. Patients in the ChxC group that were < 65 years exhibited significantly better responses (P < 0.02); likewise, non-smokers had similarly better response (P < 0.02). Both protocols were well tolerated, and no severe treatment-related adverse events were recorded throughout the study.

CONCLUSIONS

Patients with peri-implantitis that were treated with an intensive treatment protocol of bi-weekly supragingival plaque removal and local application of chlorhexidine chips had greater mean IPD reduction and greater percentile of sites with IPD reduction of ≥2 mm as compared with bi-weekly supra-gingival plaque removal.

Sustained-release delivery of antimicrobial drugs for the treatment of periodontal diseases: Fantasy or already reality?

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.

Application of totarol as natural antibacterial coating on dental implants for prevention of peri-implantitis

Peri-implantitis is the most important issue threatening the long-term survival rate of dental implants. Various efforts have been made to reduce implant surface plaque formation, which is one of the essential causes of peri-implantitis. In our study, we applied the natural antibacterial agent totarol as a coating on experimental silicon wafer and titanium implant surfaces. To analyze the interaction between the totarol coating and the oral primary colonizer S. gordonii and isolates of mixed oral bacteria, samples were incubated in a model system simulating the oral environment and analyzed by Live/Dead staining, crystal violet staining and scanning electron microscopy (SEM). After 4 d, 8 d, 12 d, 16 d, and 24 d salivary incubation, the stability and antibacterial efficiency of totarol coating was evaluated through SEM. The results indicated that totarol coatings on both silicon wafer and Ti surfaces caused efficient contact killing and an inhibition effect towards S. gordonii and mixed oral bacterial film growth after 4 h, 8 h, 24 h, and 48 h incubation. After longtime salivary incubation of 12 d, the bactericidal effect started to weaken, but the anti-adhesion and inhibition effect to biofilm development still exist after 24 d of salivary incubation. The application of a totarol coating on implant or abutment surfaces is a promising potential prophylactic approach against peri-implantitis.

Commercial Local Pharmacotherapeutics and Adjunctive Agents for Nonsurgical Treatment of Periodontitis: A Contemporary Review of Clinical Efficacies and Challenges

Periodontal infections tend to be site-specific, mostly confined to the periodontal pocket. With the surge of antibiotic-resistant bacteria, the trend is shifting towards other therapeutic modalities, especially locally delivered approaches that include other pharmacotherapeutic drugs and medical devices. This narrative review aimed to provide insights into the clinical efficacy of local drug delivery and adjunctive agents used in nonsurgical management of periodontitis. Electronic (PubMed/MEDLINE, CENTRAL, and EMBASE) and bibliographic searches of past systematic reviews were carried out to identify previous publications on the topic. Only relevant literature and randomized controlled trials published in English were selected. In addition, a literature review was developed based on the selected articles. Experimental drugs or agents were excluded. This review highlights the clinically proven and commercially available therapeutic agents related to the management of periodontal disease with comparisons of their clinical efficacies and challenges. A vast array of commercial local pharmacotherapeutic agents had been clinically tested, but the methodologies and clinical results varied within and between each agent used, causing difficulty in drawing conclusions and providing support to the superiority of one agent over another. Considering the benefit-cost ratio with the modest clinical results, the long-term usefulness of these agents remains debatable.

Local Drug Delivery Based Treatment Approaches for Effective Management of Periodontitis

Background:

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

Recent Approaches:

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

The anti-inflammatory effect of locally delivered nano-doxycycline gel in therapy of chronic periodontitis

BACKGROUND AND OBJECTIVE

To date, various drugs as host modulating agents had been suggested as adjunctive treatment modality in the therapy of chronic periodontal disease. In this study, the anti-inflammatory effect of subgingivally delivered nanostructured doxycycline gel (nDOX) was evaluated and compared to conventional doxycycline gel (DOX) used as adjunct to scaling and root planning (SRP) in the treatment of moderate chronic periodontitis to reduce probing pocket depth.

MATERIAL AND METHODS

Nanostructured doxycycline gel (nDOX) was prepared using spray-drying technique with chitosan (CH) as a matrix polymer, followed by dispersion in polyvinyl alcohol (PVA). The deepest periodontal pocket in 45 patients suffering from moderate chronic periodontitis was selected. The patients were divided into three groups following scaling and root planning (SRP); group I: SRP + nDOX, group II: SRP + DOX and group III: SRP + placeboCH. Plaque Index (PI), Gingival Index (GI), pocket depth (PD) and clinical attachment level(CAL), as well as ginigival crevicular fluid levels of (GCF) IL-6 and TNF-α were assessed at baseline, 1 and 3 months following local drug application.

RESULTS

Group I showed significant reduction in probing depth and attachment gain compared with group II and III at one and three months period. The inflammatory mediators levels were significantly reduced in all treatment groups at one-month period. Except for group I, the reduced values were observed at three-month period.

CONCLUSION

The results suggest that treatment with nDOX gel as an adjunct to SRP had anti-inflammatory effect by improving both clinical parameters and inflammatory markers up to three months period.

Evaluation of Turmeric Chip Compared with Chlorhexidine Chip as a Local Drug Delivery Agent in the Treatment of Chronic Periodontitis: A Split Mouth Randomized Controlled Clinical Trial

AIMS AND OBJECTIVE

The aim of this study was to evaluate and compare the effect of chlorhexidine (CHX) chip and turmeric chip as a local drug delivery (LDD) agent in the treatment of patients with chronic periodontitis.

MATERIALS AND METHODS

A total of 120 sites with pocket depths 5-8 mm were chosen as a split mouth design at 3 sites in the same patient. Selected sites were randomly divided into three groups to receive CHX chip in addition to scaling and root planing (SRP) in group A, turmeric chip in addition to SRP in group B, and SRP only in group C. Clinical parameters, that is, plaque index (PI), gingival index (GI), probing pocket depth (PPD), and relative attachment level (RAL) were recorded at baseline, 1 month, and 3 months interval.

RESULT

On applying statistical analysis, results revealed that there was a significant reduction in all the clinical parameters, that is, PI, GI, PPD, and gain in RAL from baseline to 1 month and 3 months in all the three groups. These results were found to be significantly high in the CHX group and turmeric group than in the SRP group. Also, the results in both the test groups were maintained till the end of the study periods, but SRP group showed a significant deterioration after 1 month as was seen by increase in PPD and decrease in RAL scores after 3 months in the SRP group.

CONCLUSION

Both the treatment modalities with the application of LDD as an adjunct to SRP proved to be equally beneficial in the treatment of chronic periodontitis.

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

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

Physical key properties of antibiotic-free, PLGA/HPMC-based in-situ forming implants for local periodontitis treatment

In-situ forming implants (ISFI) offer an interesting potential for the treatment of periodontitis, allowing for time-controlled drug release directly at the site of action (which is difficult to reach). For this purpose, ISFI loaded with antibiotics have been reported in the literature. But the use of antibiotic drugs at low doses over prolonged periods of time can lead to the development of bacterial resistances. This risk should be avoided. The aim of this study was to develop a novel type of in-situ forming implants, loaded with the antiseptic drug chlorhexidine. Special emphasis was placed on the physical properties of the systems, assuring a reliable residence time in the periodontal pockets of patients suffering from periodontitis. In particular, the risk of premature, accidental loss of the formulations due to mechanical stress (e.g. during tooth brushing and chewing) was to be reduced. Two commercially available drug products for local periodontitis treatment were studied for reasons of comparison: Chlo-site and Parocline. The syringeability and swelling behavior of the formulations were investigated, and the hardness, springiness, resilience and "stickiness" of the systems determined using extracted human teeth. Interestingly, the novel in-situ forming implants, based on PLGA/HPMC and being free of antibiotics, exhibit highly promising physical key properties: They are intensively sticking to teeth' surfaces and provide adequate mechanical strength to assure reliable and prolonged residence times in periodontal pockets. In contrast, the commercial drug products showed limited adhesion and either rapidly shrank (Chlo-site), or substantially swelled and were mechanically very weak (Parocline).

Silicon Nitride Bioceramics Induce Chemically Driven Lysis in Porphyromonas gingivalis

Organisms of Gram-negative phylum bacteroidetes, Porphyromonas gingivalis, underwent lysis on polished surfaces of silicon nitride (Si3N4) bioceramics. The antibacterial activity of Si3N4 was mainly the result of chemically driven principles. The lytic activity, although not osmotic in nature, was related to the peculiar pH-dependent surface chemistry of Si3N4. A buffering effect via the formation of ammonium ions (NH4(+)) (and their modifications) was experimentally observed by pH microscopy. Lysis was confirmed by conventional fluorescence spectroscopy, and the bacteria's metabolism was traced with the aid of in situ Raman microprobe spectroscopy. This latter technique revealed the formation of peroxynitrite within the bacterium itself. Degradation of the bacteria's nucleic acid, drastic reduction in phenilalanine, and reduction of lipid concentration were observed due to short-term exposure (6 days) to Si3N4. Altering the surface chemistry of Si3N4 by either chemical etching or thermal oxidation influenced peroxynitrite formation and affected bacteria metabolism in different ways. Exploiting the peculiar surface chemistry of Si3N4 bioceramics could be helpful in counteracting Porphyromonas gingivalis in an alkaline pH environment.

Inhibitors of bacterial protease enzymes for periodontal therapy

Locally applied therapeutic agents have become established in the treatment of periodontal disease. Inhibition of human metalloproteases by metal-chelating antibiotics contributes to the utility of local therapy. Adding inhibitors of bacterial proteases might extend and improve local therapy. The periodontal pathogen Porphyromonas gingivalis (Pg) produces two extracellular cysteine proteases (gingipains Rgp and Kgp) that are virulence factors and contribute to destruction of oral tissues. Our aims were to compare efficacy of protease inhibitors against gingipains and evaluate bactericidal activity of the inhibitors. Protease activity was measured in fluorescent assays with specific Rgp and Kgp substrates. Bacterial viability was measured with BacLight™ (Invitrogen, Inc., Carlsbad, CA) reagents. Pairs of inhibitors of Rgp and Kgp, respectively, were leupeptin and cathepsin B inhibitor II, KYT-1 and KYT-36, and PPACK and Z-FK-ck. The cysteine-protease inhibitor E64 was also tested. Rgp activity was higher than Kgp activity, and activity was higher in Pg 33277 and 49417 cell suspensions than in media. Concentrations required for 50% inhibition of Rgp in cell suspensions were 2 × 10-9, 2 × 10-9, 2 × 10-8, and 5 × 10-5 M for KYT-1, PPACK, leupeptin, and E64, respectively. Concentrations required for 50% Kgp inhibition were 5 × 10-10, 1 × 10-9, and 5 × 10-8 M for Z-FK-ck, KYT-36, and cathepsin B inhibitor II. E64 did not inhibit Kgp. Inhibition of Rgp could be accounted for by competition for binding between the arginine residue of the substrate and the guanidinobutane portion of E64. PPACK was the least selective, with a 10-fold difference in concentrations that inhibited Rgp and Kgp. KYT-1 and Z-FK-ck inhibited both Rgp and Kgp, but inhibitory concentrations differed by 10,000-fold. At up to 1 × 10-4 M, only Z-FK-ck was bactericidal. KYT-1 and KYT-36 were remarkably effective even when used in cell suspensions in which bacterial proteins could bind inhibitors or compete for binding to gingipains. These inhibitors might prove useful as an addition to locally applied therapeutic agents.

Adjunctive Effects of A Piscean Collagen-Based Controlled-Release Chlorhexidine Chip in the Treatment of Chronic Periodontitis: A Clinical and Microbiological Study

INTRODUCTION

PerioChip a bovine origin gelatine based CHX chip has shown beneficial effects in the management of Chronic Periodontitis. A new fish collagen based CHX chip similar to PerioChip is currently available; however this product has not been thoroughly researched.

AIM

The aim of the present study was to evaluate the effectiveness of a new Piscean collagen-based controlled-release chlorhexidine chip (CHX chip) as an adjunctive therapy to scaling and root planing (SRP).

SETTINGS AND DESIGN

The study was conducted as a randomised, split-mouth, controlled clinical trial at Krishnadevaraya College of Dental Sciences, Bangalore, India.

MATERIALS AND METHODS

In a split-mouth study involving 20 sites in 10 patients with chronic periodontitis, control sites received scaling and root planing and test sites received scaling and root planing (SRP) and the intrapocket CHX chip placement as an adjunct. Subgingival plaque samples were collected from both control and test sites at baseline, 11 days and 11 weeks and the anaerobic colony count were assessed. Clinical parameters that were recorded at baseline and 11 weeks were gingival index, Plaque index, Probing pocket depth (PPD), and Clinical attachment level (CAL). Plaque index was recorded additionally at 11 days.

RESULTS

In the test group there was a statistically significant reduction in the total anaerobic colony count, gingival index and plaque scores from baseline as compared to control sites at all time intervals. An additional 0.8mm reduction in mean probing pocket depth was noted in the test group. Gain in Clinical attachment level was comparable in both groups.

CONCLUSION

The adjunctive use of the new collagen-based CHX chip yielded significant antimicrobial benefit accompanied by a reduction in probing depth and a clinical attachment level gain as compared to SRP alone. This suggests that it may be a useful treatment option of nonsurgical periodontal treatment of chronic periodontitis.

Comparison of Periochip (chlorhexidine gluconate 2.5 mg) and Arestin (Minocycline hydrochloride 1 mg) in the management of chronic periodontitis

BACKGROUND

The aim of the study was to compare the efficacy of chlorhexidine gluconate 2.5 mg (Periochip) and Minocycline hydrochloride 1 mg (Arestin) as local drug delivery agents in the management of chronic periodontitis.

MATERIALS AND METHODS

Twenty patients in the age group of 30-50 years suffering from chronic periodontitis (12 males and 8 females), with almost identical probing depth bilaterally (5-8 mm), and exhibiting bleeding on probing were selected and divided into two groups: Group I consisted of periodontal pockets on the left side and received Periochip and group II consisted of periodontal pockets on the right side and received Arestin. Patients were recalled after 6 weeks and 3 months intervals from the baseline visit to record plaque index, gingival index, and probing depth.

RESULTS

There was reduction in all the parameters in both the groups at 6 weeks and 3 months as compared to baseline.

CONCLUSION

From the results of the present study, it was concluded that both the drugs were equally effective in reduction of plaque scores as well as gingival scores. It was further observed that Arestin resulted in better results at 6 weeks while Periochip showed better results at 3 months with respect to probing depth reduction.

Effect of chlorhexidine chip in the treatment of chronic periodontitis

AIMS

The evaluation of clinical and specific microbiological changes associated with chlorhexidine chip in the chronic periodontitis patients.

MATERIALS AND METHODS

A total of 30 chronic periodontitis patients (aged 20-65 years) having pocket depth of ≥5 mm in molar teeth were selected and randomly divided into following treatment groups: Group 1 - Scaling and root planning (SRP), Group 2 - SRP along with chlorhexidine chip and Group 3 - Only chlorhexidine chip. The clinical and microbial parameters were recorded at baseline and 1 and 3 months post-treatment as above. Benzoyl-DL-arginine-naphthylamide (BANA) chair side test was used for estimation of specific microbiota.

RESULTS

Gingival index, probing pocket depth and clinical attachment level scores in selected teeth within the groups at different time intervals was significantly (P < 0.001) different. Although, the comparison between groups for specific microbiota in selected sites at different intervals was not statistically significant at baseline and 1 month, it reached statistical significance at 3(rd) month post-treatment. Although significant reductions in percentage of BANA positive sites were observed in all three groups, the Group 2 had significantly greater percentage of BANA negative sites.

CONCLUSION

Local drug delivery using chlorhexidine chip enhances the benefit of SRP in the treatment of chronic periodontitis.

Chlorhexidine chip in the treatment of chronic periodontitis - a clinical study

AIM

The aim of this study was to clinically evaluate the use of biodegradable chlorhexidine chip when used as an adjunct to scaling and root planing (SRP) in the treatment of moderate to severe periodontitis patients. The study also intended to compare the combined therapy (SRP and Chlorhexidine chip) with chlorhexidine chip alone in individuals with periodontitis.

MATERIALS AND METHODS

Fifteen patients with three sites having a probing depth of 5-8mm were considered for the study. Sites were numbered 1, 2, 3 randomly. The clinical parameters assessed were the Plaque Index (PI), gingival index (GI), Bleeding on probing (BOP), Clinical attachment level (CAL) and Probing pocket depth (PPD). Following baseline evaluation, on two sites scaling and root planing (SRP) was performed, no treatment was carried out in the third site. Chlorhexidine chips were placed on one site with SRP and another without SRP. A periodontal pack was placed on the site to prevent dislodgement of the CHX chip. Clinical parameters were recorded at baseline, one month and three months. Duration of the study was for three months.

STATISTICAL ANALYSIS

T-test and Analysis of variance (ANOVA) has been carried out in the present study.

RESULTS

All three groups presented with an improvement in the clinical parameters compared to baseline. There was no statistically significant difference between the SRP and SRP + CHIP group in all parameters. There was a significant difference when these two groups were compared to the chip alone group. The mean reductions in PPD were 2.8mm (SRP group), 2.6 (SRP+CHIP group), 0.8 (chip alone group) The mean gain in CAL were 2.8mm (SRP group), 2.5 (SRP+CHIP group), 0.7 (chip alone group). Reduction in bleeding on probing were significant for the SRP and SRP +CHIP group but not for the chip alone group.

CONCLUSION

The CHX chip did not provide any clinical benefit beyond that achieved with conventional scaling and rootplaning after a three month period.

Comparative evaluation of subgingivally delivered xanthan-based chlorhexidine gel and herbal extract gel in the treatment of chronic periodontitis

Background:

Local drug delivery agents can effectively deliver the antimicrobial drugs in bactericidal concentration, and have shown improved clinical outcomes when used as an adjunct to mechanical therapy. The aim of this study was to evaluate the efficacy of a xanthan-based chlorhexidine gel versus herbal extracts’ gel as an adjunct to periodontal therapy in the treatment of chronic periodontitis.

Materials and Methods:

A total of 150 sites, age group of 30-50 years, periodontal pockets measuring 5-8 mm and diagnosed with chronic periodontitis were selected for the study. The selected sites were randomized in five groups: Scaling and root planing (SRP) alone (Group A), SRP + Chlosite gel (Group B), SRP + Herbal gel (Group C), Chlosite gel alone (Group D) and Herbal gel alone (Group E). Clinical parameters such as Plaque Index, Gingival Index, probing pocket depth and clinical attachment level were recorded at baseline and 1- and 3-month intervals.

Results:

After 3 months, there were statistically significant reductions in all the clinical parameters for Groups B and C compared with Group A. There was no significant reduction in all clinical parameters between Group D and E where no mechanical therapy was performed.

Conclusion:

The results indicate that the local application of herbal gel can be comparably used as chlorhexidine gel in the treatment of chronic periodontitis as an adjunct to mechanical periodontal therapy.

In situ forming implants for periodontitis treatment with improved adhesive properties

Novel in situ forming implants are presented showing a promising potential to overcome one of the major practical hurdles associated with local periodontitis treatment: limited adhesion to the surrounding tissue, resulting in accidental expulsion of at least parts of the implants from the patients' pockets. This leads to high uncertainties in the systems' residence times at the site of action and in the resulting drug exposure. In the present study, the addition of different types and amounts of plasticizers (acetyltributyl citrate and dibutyl sebacate) as well as of adhesive polymers (e.g., cellulose derivatives such as hydroxypropyl methylcellulose) is shown to allow for a significant increase in the stickiness of poly(lactic-co-glycolic acid)-based implants. The systems are formed in situ from N-methyl pyrrolidone-based liquid formulations. Importantly, at the same time, good plastic deformability of the implants can be provided and desired drug release patterns can be fine-tuned using several formulation tools. The antimicrobial activity of this new type of in situ forming implants, loaded with doxycycline hyclate, was demonstrated using the agar well diffusion method and multiple Streptococcus strains isolated from the oral microflora of patients suffering from periodontitis.

Therapeutic effects of local drug delivery systems - PerioChip® in the treatment of periodontal disease

The primary goal of periodontal treatment is to stop periodontal disease progression and reduce future risks in disease recurrence. In order to overcome the limitations of the conventional treatment, controlled drug delivery systems for application in periodontal pockets have been developed. Their use offers several advantages: the therapeutic agent is targeted directly to the disease site and concentrations are 10-100 folds higher than the concentrations achieved by systemic administration, with low incidence of side effects. The PerioChip® is as local controlled-release biodegradable delivery system containing chlorhexidine digluconate. Several multicenter clinical trials have shown that the application of the PerioChip® in periodontal pockets as adjunct to the conventional periodontal treatment significantly improved the clinical parameters. In this article, the results from controlled clinical studies aimed to evaluate the clinical and microbiological efficacy of the PerioChip®, are discussed.

A chlorhexidine-loaded biodegradable cellulosic device for periodontal pockets treatment

Absorbent points widely used in endodontic therapy were transformed into bioresorbable chlorhexidine delivery systems for the treatment of the periodontal pocket by preventing its recolonization by the subgingival microflora. These paper points (PPs) were first oxidized to promote their resorption, then grafted with β-cyclodextrin (CD) or maltodextrin (MD) in order to achieve sustained delivery of chlorhexidine. We investigated the oxidation step parameters through the time of reaction and the nitric and phosphoric acid ratios in the oxidizing mixture, and then the dextrin grafting step parameters through the time and temperature of reaction. A first selection of the appropriate functionalization parameters was undertaken in relation to the degradation profile kinetics of the oxidized (PPO) and oxidized-grafted samples (PPO-CD and PPO-MD). Samples were then loaded with chlorhexidine digluconate (digCHX), a widely used antiseptic agent in periodontal therapy. The release kinetics of digCHX from PPO-CD and PPO-MD samples were compared to PP, PPO and to PerioChip(®) (a commercial digCHX containing gelatine chip) in phosphate buffered saline (pH 7.4) by ultraviolet spectrophotometry. The cytocompatibility of the oxidized-grafted PP was demonstrated by cell proliferation assays. Finally, the disc diffusion test from digCHX loaded PPO-MD samples immersed in human plasma was developed on pre-inoculated agar plates with four common periodontal pathogenic strains: Fusobacterium nucleatum, Prevotella melaninogenica, Aggregatibacter actinomycetem comitans and Porphyromonas gingivalis. To conclude, the optimized oxidized-dextrin-grafted PPs responded to our initial specifications in terms of resorption and digCHX release rates and therefore could be adopted as a reliable complementary periodontal therapy.

Evaluation of the literature: evidence assessment tools for clinicians

The progressive improvement in the quality of scientific articles has led to an increase in difficulty in reading and interpreting them so that now clinical knowledge and experience must be complemented by methodological, statistical and computer skills. The aim of this article is to offer practitioners the tools, the simplest keys, that will allow them to understand and critically judge the results of scientific studies. The "peer-review" process of a clinical article submitted to a journal is described and the Science Citation Index and the Impact Factor are presented to the reader as essential instruments to evaluate a specific article's impact and the impact of a given journal on the scientific world, respectively. An article should be evaluated on the basis of some key issues which include, at least, an assessment of methodological aspects, a critical analysis of the statistical component and a proper understanding of the clinical impact of the study outcomes. The standard approach for evaluating the quality of individual studies is based on a hierarchical grading system of research design which represents an essential tool to identify the strength of the evidence of an article. Many different biases may affect the reliability of study results. Randomized Control Trials (RCTs) and Systematic Reviews (SRs) are able to minimize the number of biases and thus are at the highest level of the scale of evidence representing the final steps of a treatment's "career." Finally, moving from research to clinical practice, attention on the clinical impact of study's outcomes is of paramount importance as the literature contains studies (including RCTs) that present statistically significant results but which, from the clinical standpoint, are only relatively or not at all significant. Clinical Practice Guidelines represent a useful tool for practitioners assisting the decision-making process when choosing the most appropriate treatment for their patients.

Comparison of the efficacy of chlorhexidine varnish and chip in the treatment of chronic periodontitis

BACKGROUND

The purpose of this study was to clinically evaluate the benefits of sub gingival chlorhexidine (CHX) varnish and biodegradable CHX chip application used as an adjunct to scaling and root planning (SRP) as combined therapy and also to compare the effect of combined therapy with SRP alone.

MATERIALS AND METHODS

Fifteen patients with at least three sites with a probing pocket depth (PPD) of 5-8 mm were considered. Following baseline evaluation, all three sites were subjected for SRP. After completing SRP, each site was randomly subjected for CHX varnish, CHX chip application and the 3(rd) site was left without any medication as a control. Clinical parameters such as sulcus bleeding index, plaque index, bleeding on probing (BOP), PPD, and clinical attachment level (CAL) were recorded at baseline, 1 month and 3 months post-operatively.

RESULTS

All three groups presented with an improvement in clinical parameters compared to baseline. The mean reduction in PPD was 2.4 mm in SRP sites, 2.5 mm in SRP + CHX varnish sites and 2.8 mm in SRP + CHX chip sites. The mean gain in CAL was 2.4 mm in SRP sites, 2.3 mm in SRP + CHX varnish sites and 2.8 mm SRP + CHX chip sites.

INTERPRETATION AND CONCLUSION

The present study indicated that application of CHX varnish and placement of CHX chip as an adjunct to SRP produced a clinically significant reduction in the PPD, BOP and a gain in CAL at 30(th) day and 90(th) day from baseline when compared to SRP alone. The results though were not statistically significant.

Effect of controlled-release Periochip™ on clinical and microbiological parameters in patients of chronic periodontitis

BACKGROUND

The aim of the present study was to evaluate and compare the clinical and microbiological effectiveness of Periochip™ as an adjunct to scaling and root planing (SRP) with SRP alone in patients with chronic periodontitis.

MATERIALS AND METHODS

This randomized, split mouth, 3-month clinical and microbiological trial included 30 sites in 15 patients aged 30-50 years diagnosed with chronic periodontitis. In each patient, two bilateral pockets probing 5-7 mm were randomly assigned to test and control groups. The test group received SRP plus Periochip™, whereas the control group received SRP alone. Clinical indices and anaerobic culture analysis was done at baseline, 1 month, and 3 months interval. Total bacterial count and analysis of four major periodontopathogenic bacteria Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Aggregatibacter actinomycetemcomitans (Aa), and Fusobacterium nucleatum (Fn) was done.

RESULTS

Significant improvement was obtained in all clinical variables in the test group as compared to the control group over the study period. Total colony counts were significantly reduced in the test group as compared to control over the period of time. At baseline Aa was recovered from 4 test group sites and 5 control group sites, Pg from 15 test group and 14 control group sites, Pi from 5 test group and 2 control group sites, Fn from 7 test and 7 control group sites. At 3 months, Aa was recovered from 1 test group and 4 control group sites, Pg from 4 test group and 8 control group sites, Pi from 1 test group and 1 control group site, Fn from 3 test and 4 control group sites.

CONCLUSION

Periochip™ placement as an adjunct to SRP, showed promising results, when compared to SRP alone. Healthy microflora can be maintained for a longer period of time and delay in the repopulation by periodontopathic microorganisms was observed.

Effectiveness of a controlled release chlorhexidine chip (PerioCol™-CG) as an adjunctive to scaling and root planing when compared to scaling and root planing alone in the treatment of chronic periodontitis: A comparative study

Aims and objectives:

The aim of this study is to evaluate the effectiveness of a controlled-release chlorhexidine chip as an adjunctive therapy to scaling and root planing when compared with scaling and root planing alone in the treatment of chronic periodontitis.

Materials and Methods:

20 patients with a total number of 40 posterior sites were selected. These sites were divided into two groups in a split mouth design,: Group A (control site) had 20 sites treated with scaling and root planing alone and Group B (test site) had 20 sites treated with scaling and root planing and PerioCol™-CG. The clinical parameters (Plaque index, bleeding on probing, probing pocket depth, clinical attachment level) were recorded at baseline, 90^th and 180^th day for both the groups.

Results:

When both groups were compared the change in Plaque index was significantly higher in Group B when compared to Group A on the 90^th day and 180^th day. However, there was no statistically significant difference in the mean percentage of gingival bleeding sites between the two groups on the 90^th day, though Group B showed a statistically higher reduction in the mean percentage of gingival bleeding sites at the end of 180^th day. There was no statistically significant difference in probing pocket depth between the two groups on both 90^th and 180^th day. Gain in clinical attachment level was significantly higher in Group B when compared to Group A on the 90^th and 180^th day.

Conclusion:

From the results observed in this study, it can be concluded that the adjunctive use of PerioCol™-CG was safe and provided significant improvement in both Plaque index and gingival bleeding index. It was also more favorable than scaling and root planing alone for gain in clinical attachment level.

Effect of insertion of xanthan-based chlorhexidine gel in the maintenance phase following the treatment of chronic periodontitis

OBJECTIVES

The aim of this study was to evaluate the efficacy of subgingivally administered xanthan-based chlorhexidine gel when used in the maintenance phase following scaling and root planing (SRP) in the treatment of chronic periodontitis.

MATERIALS AND METHODS

A randomized, controlled, single-center study was conducted involving 92 sites in 46 systemically healthy patients suffering from moderate to advanced chronic periodontitis with isolated pockets. The selected sites were randomized to two treatment arms: Group A (SRP alone) and Group B (SRP + insertion of chlorhexidine gel after 1 month). The gingival index, plaque index, probing pocket depth (PPD) and clinical attachment level (CAL) were recorded at baseline and subsequently after 1 month and 3 months.

RESULTS

Both the groups showed significant reductions in PPD and CAL at both follow-up visits when compared with the baseline values (P<0.001).

CONCLUSIONS

The results suggest that the application of xanthan based chlorhexidine gel following SRP in the maintenance phase might be beneficial in treatment of the chronic periodontitis in comparison to SRP alone. Greater improvements may be achieved when antimicrobial agents are used following SRP.

A systematic review on the effects of local antimicrobials as adjuncts to subgingival debridement, compared with subgingival debridement alone, in the treatment of chronic periodontitis

AIMS

To update the existing scientific evidence on the efficacy of local antimicrobials as adjuncts to subgingival debridement in the treatment of chronic periodontitis.

MATERIAL AND METHODS

Fifty-six papers were selected, reporting data from 52 different investigations. All the studies reported changes in probing pocket depth (PPD) and clinical attachment level (CAL) and most in plaque index (PlI) and/or bleeding on probing (BOP). Meta-analyses were performed with the data retrieved from the studies fulfilling the inclusion criteria.

RESULTS

The overall effect of the subgingival application of antimicrobials was statistically significant (p = 0.000) for both changes in PPD and CAL with a weighted mean difference (WMD) of -0.407 and -0.310 mm respectively. No significant differences occurred for changes in BOP and PlI. Subgingival application of tetracycline fibres, sustained released doxycycline and minocycline demonstrated a significant benefit in PPD reduction (WMD between 0.5 and 0.7 mm). The rest of the tested outcomes demonstrated a high heterogeneity. The local application of chlorhexidine and metronidazole showed a minimal effect when compared with placebo (WMD between 0.1 and 0.4 mm).

CONCLUSIONS

The scientific evidence supports the adjunctive use of local antimicrobials to debridement in deep or recurrent periodontal sites, mostly when using vehicles with proven sustained release of the antimicrobial.

Successful treatment of osseous lesion associated with palatoradicular groove using local drug delivery and guided tissue regeneration: A report of two cases

Developmental grooves are not rare and often appear on maxillary lateral and central incisors and are an important predisposing factor to localized periodontal disease. Various techniques have been adopted to eliminate the groove and regenerate lost periodontium. This report of two cases describes the technique of using the local drug delivery system with chlorehexidine and the guided tissue regeneration (GTR) to control the disease progression and regeneration.

Diagnosis and non-surgical periodontal management in congenital afibrinogenemia: report of a rare case

Medical records have an important role in the diagnosis and planning treatment modalities of periodontal diseases. Surgical periodontal procedures can pose severe complications if the underlying systemic condition is not recorded. To substantiate this, we present a rare case of afibrinogenemia that was reported to the Department of Periodontics, Narayana Dental College, Nellore, India. The present case report gives details of fibrinogen disorder and the dental management of such cases.

The study of release of chlorhexidine from preparations with modified thermosensitive poly-N-isopropylacrylamide microspheres

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.

To assess the effectiveness of a chlorhexidine chip in the treatment of chronic periodontitis: A clinical and radiographic study

CONTEXT

Controlled local delivery of disinfecting agents has been demonstrated to be efficient in improving the outcome of periodontal therapy.

AIMS

The aim of the present study was to evaluate the efficacy of a controlled-release biodegradable chlorhexidine chip (Periocol CG) when used as an adjunct to scaling and root planing in the treatment of periodontitis.

SETTINGS AND DESIGN

The study was carried out as randomized controlled two-group parallel clinical trial.

MATERIALS AND METHODS

Forty patients in the age group of 30-65 years suffering from mild to moderate chronic periodontitis, having pocket depth ranging between 5 and 8 mm, were selected for the study. At the screening visit, complete history taking, periodontal examination and full-mouth supragingival scaling was carried out for each patient. At the baseline visit (on the 7(th) day), all clinical parameters and radiographic parameters were recorded at selected sites and patients were randomly assigned to either the control group (group A) or the treatment group (group B). All patients in both the groups received complete subgingival scaling and root planing. Then, in group B, chlorhexidine chip (Periocol CG) was inserted at the selected site. Patients were recalled at 1 month, 2 months and 3 months from the baseline for recording clinical observations, and radiographic parameters were recorded at the end of the study.

STATISTICAL ANALYSIS

Mean, standard deviation, Chi-square test, "t" test for equality of means and paired samples correlations were used.

RESULTS

There was a statistically significant clinical attachment gain, reduction in bleeding index scores, probing pocket depth reduction and bone gain in both the groups, but group B showed better results than group A, and these differences were statistically significant.

CONCLUSIONS

The results of this study show that chlorhexidine chip (PerioCol-CG) is an effective adjunctive therapy to scaling and root planing in the treatment of chronic periodontitis.