Clinical Relevance of Adjunctive Minocycline Microspheres in Patients With Chronic Periodontitis: Secondary Analysis of a Phase 3 Trial

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.

Bacterial resistance to minocycline after adjunctive minocycline microspheres during periodontal maintenance: A randomized clinical trial

BACKGROUND

Despite widespread use, the impact of minocycline hydrochloride microspheres on the shifts of oral bacterial species resistant to minocycline remains unknown. This study aimed at examining the percentage and taxonomy of minocycline-resistant isolates in saliva and subgingival plaque samples before and after minocycline microspheres application in periodontitis patients during maintenance.

METHODS

Patients received supra- and sub-gingival debridement with (test) or without (control) minocycline microspheres application to sites with probing depth >4 mm and were clinically monitored at baseline, 1, 3, and 6 months. Samples were collected at baseline, 1 and 6 months and analyzed via cultivation with or without 4 μg/mL minocycline. Percentage of resistant strains was determined by colony counting and taxonomy by checkerboard DNA-DNA hybridization. Significant clinical changes were sought with the Mann-Whitney test and differences in percentage of resistant isolates with the Friedman and Mann-Whitney tests.

RESULTS

Groups showed similar clinical improvements. Mean percentage of resistant isolates rose at 1 month and decreased at 6 months in saliva and plaque samples in test group (P <0.05) but remained unchanged in control group. Percentage of resistant isolates of Gemella morbillorum and Eubacterium saburreum increased significantly at 6 months in both groups. Antibiotic resistance by Aggregatibacter actinomycetemcomitans, Tannerella forsythia, and Porphyromonas gingivalis was either absent or infrequent.

CONCLUSION

Minocycline microspheres result in transient selection of minocycline resistant species in saliva and subgingival plaque samples.

Evaluation of the efficacy of lycopene gel compared with minocycline hydrochloride microspheres as an adjunct to nonsurgical periodontal treatment: A randomised clinical trial

Background/purpose

The prescription of antibiotics as an adjunct to mechanical periodontal therapy in patients with severe periodontitis is recommended; however, the side effects of antibiotics are a major concern. The aim of this study was to evaluate the efficacy of lycopene (Lyc) antioxidant gel versus minocycline hydrochloride microspheres (ARISTIN) as an adjunct to the nonsurgical treatment of periodontitis.

Materials and methods

Three identical periodontal pockets/patient received root surface debridement followed by the random application of either ARISTIN, Lyc, or placebo gel (control, Ctrl). Clinical parameters, plaque index, bleeding on probing, probing pocket depth, and clinical attachment loss, were recorded at the baseline and after 30 days. Additionally, the levels of interleukin-8 (IL-8), matrix metallopeptidase 9, and tissue inhibitor of metalloproteinases 1 (TIMP1) in gingival crevicular fluid samples were assessed at the same time points.

Results

Twenty-three patients with periodontitis completed the study. Both ARISTIN and Lyc treatments showed significantly greater gains in attachment (1.94 ± 1.33 and 1.72 ± 0.88, respectively) than the Ctrl treatment (1.04 ± 0.96). Compared with those in the Ctrl, only ARISTIN showed a significant reduction in IL-8 level, whereas TIMP1 levels were significantly upregulated in the Lyc gel and ARISTIN sites. The effect size estimation indicated that Lyc gel exhibited considerably greater efficacy than the Ctrl gel.

Conclusion

Lyc gel and ARISTIN offer almost equal improvement in both clinical and biochemical parameters of periodontitis.

Nanotechnology in dentistry: Unleashing the hidden gems

Nanotechnology in dentistry refers to new generation research carried out to develop newer technologies, restorative materials and drugs of Nano dimensions. The word “Nano” refers to Nanoscale particles. Although the science of nanotechnology in dentistry is recent and less developed, but still has vast potential to show advancement and improvement in the field of dentistry. As nanotechnology is making firm grip in other fields such as drug delivery system and reducing toxicity by the emergence of more biocompatible materials. Clinicians, researchers, and manufacturers are taking keen interest and participation in the advancement of this field. This paper is an attempt in unleashing the hidden gems of nanotechnology-focusing latest developments in field restorative and surgical dentistry to enhance the quality and biocompatibility of newer generation dental materials and technology. This paper will also focus on potential hurdles encountered in the development of newer materials by utilizing the science of nanotechnology and their potential safety issues concern.

Minocycline Ointment as a Local Drug Delivery in the Treatment of Generalized Chronic Periodontitis - A Clinical Study

INTRODUCTION

The primary goal in periodontal therapy includes removal of the etiological factors by mechanical periodontal treatment, which sometimes fail to eliminate the anaerobic infection at the base of the pocket and requires adjuvant chemical therapy.

AIM

The aim of the study was to evaluate the effectiveness of 2% minocycline ointment when used as an adjunct to periodontal flap surgery and post-operative maintenance period for the treatment of generalized chronic periodontitis.

MATERIALS AND METHODS

The study included 30 subjects comprising of 60 posterior sextants in a split mouth design in which 30 sextants were treated as experimental and 30 sextants as control with a probing pocket depth≥6mm. In Group A (experimental group) 30 sextants were treated with open flap debridement followed by the application of minocycline ointment as a local drug delivery. In Group B (control group) 30 sextants were treated with open flap debridement alone. Minocycline hydrochloride ointment was applied on the 0 day and 3(rd) month. The clinical parameters such as plaque index, probing pocket depth, clinical attachment level and gingival bleeding index were recorded at 0 day, 3(rd) month and 6(th) month in both the groups. Paired and unpaired t-test were used to compare the means of the two groups.

RESULTS

When Group A and Group B were compared, Group A showed significantly greater reduction in gingival bleeding index, probing pocket depth and gain in clinical attachment level than Group B, from 0 day to 3 months and from 0 day to 6 months. Group A showed significant reduction in plaque index than Group B when they were compared at 6 months.

CONCLUSION

The results demonstrate that there was significant reduction in the clinical parameters with improvement in the periodontal status on application of minocycline ointment as an adjunct to periodontal flap surgery in generalized chronic periodontitis.

In vitro activity of taurolidine gel on bacteria associated with periodontitis

OBJECTIVES

The purpose of this in vitro study was to determine the antimicrobial activity of two different taurolidine gel formulations in comparison with minocycline microspheres.

METHODS

Three percent taurolidine gel (TLG3) and 2 % taurolidine gel (TLG2) were compared to minocycline microspheres (MINO) against single bacterial species and a 12-species-mixture. The antimicrobial activity was proven by determination of minimal inhibitory concentrations (MICs), killing assays, after exposure of the antimicrobials as well as within a biofilm.

RESULTS

The MICs against the single species were between 0.5 and 2 mg/ml of taurolidine. MICs of the used mixed microbiota were 1.5 mg/ml (TLG3) and 4 mg/ml (TLG2). Fusobacterium nucleatum and Porphyromonas gingivalis were completely killed by 10 % TLG3 and TLG2 (equivalent to 3 and 2 mg/ml taurolidine) after 6 h. The mixture of 12 species was not completely killed by any of the test substances. Taurolidine gels showed a post-antimicrobial activity, however being less than that of MINO. On biofilms, taurolidine gels reduced concentration dependently the colony forming unit (CFU) counts (multi-species biofilms by 3.63 log10 after 100 % (30 mg/ml) of TLG3), reductions were 2.12 log10 after MINO (1000 μg/ml minocycline).

CONCLUSIONS

Taurolidine gel formulations exert antimicrobial activity against bacteria associated with periodontal disease. Nevertheless, a complete elimination of biofilms seems to be impossible and underlines the importance of mechanical removal of biofilms prior to application of the antimicrobial.

CLINICAL RELEVANCE

Taurolidine gels may represent a potential alternative for adjunctive topical antimicrobial treatment in periodontitis and infectious peri-implant diseases.

Comparative evaluation of locally delivered minocycline and metronidazole in the treatment of periodontitis

Objective:

The aim of this study was to evaluate and compare the efficacy of subgingivally delivered Minocycline microspheres and 25% Metronidazole gel when used as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis.

Materials and Methods:

A randomized, controlled, single center study was conducted involving 60 sites in 20 patients suffering from moderate to advanced chronic periodontitis. Each patient contributed three sites which were randomized to three treatment groups: SRP + insertion of Minocycline microspheres at day 1 (Group A), SRP + insertion of Metronidazole gel at day 1 and at day 7 (Group B), and SRP alone (Group C). Gingival index (GI), plaque index (PI), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded at day 1, 1 month, and 3 months post therapy.

Results:

All treatments showed significant reductions in PPD and CAL at 1 and 3 months when compared to baseline values (P < 0.001). At 3 months, sites treated with minocycline showed an additional reduction in PPD of 0.85 ± 0.03 mm, significantly greater than SRP alone. Differences in mean PPD reduction between Group B and Group C and between Group A and Group B were not significant. At 3 months, difference in CAL gain between Group A and C was 0.50 ± 0.45, which was statistically significant and between Group B and C was 0.35 ± 0.11, which was not found to be statistically significant (P = 0.20). Differences in relative CAL between Group A and Group B were also not found to be statistically significant (P = 0.53).

Conclusion:

The results concluded that treatment with Minocycline microspheres and Metronidazole gel improve PPD and CAL in patients with periodontitis compared to SRP alone.

Effects of cranberry components on human aggressive periodontitis gingival fibroblasts

BACKGROUND AND OBJECTIVE

Aggressive periodontitis (AgP) causes rapid periodontal breakdown involving AgP gingival fibroblast production of cytokines [i.e. interleukin (IL)-6, a bone metabolism regulator], and matrix metalloproteinase (MMP)-3. Lipopolysaccharide upregulates fibroblast IL-6 and MMP-3, via transcription factors (i.e. NF-κB). Cranberry (Vaccinium macrocarpon) inhibits lipopolysaccharide-stimulated macrophage and normal gingival fibroblast activities, but little is known of its effects on AgP fibroblasts. Objectives of this study are to use AgP fibroblasts, to determine cytotoxicity of cranberry components or periodontopathogen (Fusobacterium nucleatum, Porphyromonas gingivalis) lipopolysaccharide ± cranberry components, and effects of cranberry components on lipopolysaccharide-stimulated NF-κB activation and IL-6 and MMP-3 production.

MATERIAL AND METHODS

AgP fibroblasts were incubated ≤ 6 d with high molecular weight non-dialyzable material (NDM) (derived from cranberry juice (1-500 μg/mL) or lipopolysaccharide (1 μg/mL) ± NDM. Membrane damage and viability were assessed by enzyme activity released into cell supernatants and activity of a mitochondrial enzyme, respectively. Secreted IL-6 and MMP-3 were measured by ELISA. NF-κB p65 was measured via binding to an oligonucleotide containing the NF-κB consensus site. Data were analyzed using analysis of variance and Scheffe's F procedure for post hoc comparisons.

RESULTS

Short-term exposure to NDM, or lipopolysaccharide ± NDM caused no membrane damage. NDM (≤ 100 μg/mL) or lipopolysaccharide ± NDM had no effect on viability ≤ 7 d exposure. NDM (50 μg/mL) inhibited lipopolysaccharide-stimulated p65 (P ≤ 0.003) and constitutive or lipopolysaccharide-stimulated MMP-3 (P ≤ 0.02). NDM increased AgP fibroblast constitutive or lipopolysaccharide-stimulated IL-6 (P ≤ 0.0001), but inhibited normal human gingival fibroblast IL-6 (P ≤ 0.01).

CONCLUSION

Lack of toxicity of low NDM concentrations, and its inhibition of NF-κB and MMP-3, suggest that cranberry components may regulate AgP fibroblast inflammatory responses. Distinct effects of NDM on AgP and gingival fibroblast production of IL-6 (which can have both positive and negative effects on bone metabolism) may reflect phenotypic differences in IL-6 regulation in the two cell types.

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

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

Adjunctive treatment of chronic periodontitis with daily dietary supplementation with omega-3 Fatty acids and low-dose aspirin

BACKGROUND

Host modulatory therapy has been proposed as a treatment for periodontal diseases. Omega-3 (ω-3) polyunsaturated fatty acids (PUFAs), including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), were shown to have therapeutic anti-inflammatory and protective actions in inflammatory diseases including periodontitis. The goal of this study was to test an innovative strategy for periodontal treatment in a clinical experiment.

METHODS

Eighty healthy subjects (40 in each group) with advanced chronic periodontitis were enrolled in Mansoura, Egypt, in a parallel-design, double-masked clinical study. The control group was treated with scaling and root planing (SRP) and a placebo, whereas the ω-3 group was treated with SRP followed by dietary supplementation of fish oil (900 mg EPA + DHA) and 81 mg aspirin daily. Saliva samples were obtained from all patients at baseline and 3 and 6 months for evaluation of receptor activator of nuclear factor-kappa B ligand (RANKL) and matrix metalloproteinase-8 (MMP-8). Plaque and gingival indices, bleeding on probing, probing depths, and attachment levels were recorded at the same time points.

RESULTS

Statistical analyses demonstrated a significant reduction in probing depths and a significant attachment gain after 3 and 6 months in the ω-3 group compared to baseline and the control group (P <0.05). Salivary RANKL and MMP-8 levels showed significant reductions in the ω-3 group in response to treatment at 3 and 6 months and compared to the control group at 6 months (P <0.01). Supplementation with ω-3 + aspirin resulted in a significant shift in the frequency of pockets with probing depths <4 mm (P <0.05).

CONCLUSION

The results of this preliminary clinical study suggest that dietary supplementation with ω-3 PUFAs and 81 mg aspirin may provide a sustainable, low-cost intervention to augment periodontal therapy.

A critical review of the implication of nanotechnology in modern dental practice

Curiosity has its own reason for existing. For thousands of years, mankind has been harnessing its curiosity into inquiry and the process of scientific methodology. If we consider technology as an engine, then science is its fuel. Science of miniaturization (nanotechnology) is manipulating matter at nanometer level and the application of the same to medicine is called nanomedicine. Nanotechnology holds promise for advanced diagnostics, targeted drug delivery, and biosensors. When we gain access to hold the nanorobots, we will be able to treat very rapidly a number of diseases that are a continuous threat for mankind today. The present article aims to provide an early glimpse on the impact and future implication of nanotechnology in dentistry, especially in oral surgery and orthodontics.

A role for non-antimicrobial actions of tetracyclines in combating oxidative stress in periodontal and metabolic diseases: a literature review

This review addresses the role of adjunctive tetracycline therapy in the management of periodontal diseases and its efficacy in reducing inflammatory burden, oxidative stress and its sequelae in patients with coexisting features of metabolic syndrome. Removal of the dimethylamine group at C4 of the tetracycline molecule reduces its antibiotic properties, enhancing its non-antimicrobial actions; this strategy has aided the development of several chemically modified tetracyclines such as minocycline and doxycycline, by altering different regions of the molecule for focused action on biological targets. Tetracyclines are effective in reducing inflammation by inhibiting matrix metalloproteinases, preventing excessive angiogenesis, inhibiting apoptosis and stimulating bone formation. There are important applications for tetracyclines in the management of diabetic, dyslipidaemic periodontal patients who smoke. The diverse mechanisms of action of tetracyclines in overcoming oxidative stress and enhancing matrix synthesis are discussed in this review.

Minocycline HCl Microspheres Reduce Red-Complex Bacteria in Periodontal Disease Therapy

BACKGROUND

The objective of this trial was to measure the antimicrobial effects of a minocycline HCl microsphere (MM) local drug-delivery system when used as an adjunct to scaling and root planing (SRP). DNA probe analysis for 40 bacteria was used to evaluate the oral bacteria of 127 subjects with moderate to advanced chronic periodontitis.

METHODS

Subjects were randomly assigned to either SRP alone (N = 65) or MM + SRP (N = 62). The primary endpoints of this study were changes in numbers and proportions of the red-complex bacteria (RCB) and the sum of Porphyromonas gingivalis, Tannerella forsythia (formally T. forsythensis), and Treponema denticola relative to 40 oral bacteria at each test site from baseline to day 30. Numbers of RCB from the five test sites were averaged to provide a value for each subject.

RESULTS

MM + SRP reduced the proportion of RCB by 6.49% and the numbers by 9.4 x 10(5). The reduction in RCB proportions and numbers by SRP alone (5.03% and 5.1 x 10(5), respectively) was significantly less. In addition, MM + SRP reduced probing depth by 1.38 mm (compared to 1.01 mm by SRP alone), bleeding on probing was reduced by 25.2% (compared to 13.8% by SRP alone), and a clinical attachment level gain of 1.16 mm (compared to 0.80 mm by SRP alone) was achieved.

CONCLUSION

These observations support the hypothesis that RCBs are responsible for periodontal disease and that local antimicrobial therapy using MM + SRP effectively reduces numbers of RCBs and their proportions to a greater extent than SRP alone.

Adjunctive local antibiotic therapy in the treatment of peri-implantitis II: clinical and radiographic outcomes

AIM

To monitor over 12 months clinical and radiographic changes occurring after adjunctive local delivery of minocycline microspheres for the treatment of peri-implantitis.

MATERIAL AND METHODS

In 25 partially edentulous subjects, 31 implants diagnosed with peri-implantitis were treated. Three weeks after oral hygiene instruction, mechanical debridement and local antiseptic cleansing using 0.2% chlorhexidine gel, baseline (Day 0) parameters were recorded. Minocycline microspheres (Arestin) were locally delivered to each implant site with bone loss and a probing pocket depth (PPD) >or=5 mm. Rescue therapy with Arestin was allowed at Days 180 and 270 at any site exhibiting an increase in PPD>or=2 mm from the previous visit. The following clinical parameters were recorded at four sites/implant at Day 0, 10, 30, 60, 90, 180, 270 and 360: PPD, clinical attachment level (CAL), bleeding on probing (BOP) and plaque index (PlI).

RESULTS

Six implants in six subjects were either rescued or exited because of persisting active peri-implantitis. Successful implants showed a statistically significant reduction in both PPD and percentage of sites with BOP between baseline and Day 360 (P<0.05). At mesial implant sites, the mean PPD reduction amounted to 1.6 mm (95% CI: 0.9-2.2 mm, P<0.001) and was accompanied by a statistically significant reduction of the BOP value (P<0.001). Binary regression analysis showed that the clinical parameters and smoking history could not discriminate between successfully treated and rescued or exited implants at any observation time point.

CONCLUSION

Non-surgical mechanical treatment of peri-implantitis lesions with adjunctive local delivery of microencapsulated minocycline led to positive effects on clinical parameters up to 12 months.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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