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

Effect of atorvastatin gel in non-surgical treatment of peri-implant mucositis: A randomized controlled clinical trial

Background

Peri-implant diseases, such as peri-implant mucositis and peri-implantitis, are inflammatory conditions caused by biofilms that can lead to the loss of surrounding soft tissues and bone. The most effective treatment involves non-surgical mechanical debridement to remove plaque, but other treatment modalities have shown limited success. This study investigated the anti-inflammatory and immunomodulatory effects of atorvastatin (ATV) gel as an additional treatment for peri-implant mucositis.

Methods

In this double-masked, randomized clinical trial, 49 patients with peri-implant mucositis were randomly divided into two treatment groups: mechanical debridement (MD)+placebo or MD+ATV gel. At baseline, 1 month, and 3 months after the intervention, periodontal parameters, including probing depth (PD), bleeding on probing (BOP), clinical attachment level (CAL), and pain on probing (POP), were measured. Data were analyzed using independent t-test and paired t-test.

Results

Statistically significant improvements in CAL and POP were observed from baseline to each time point throughout the study period (P≤0.001). PD and BOP were statistically significant 1 month and 3 months after the intervention, respectively (P<0.05).

Conclusion

The clinical parameters associated with peri-implant mucosal inflammation further improved when ATV gel was used with MD.

Comparative evaluation of the clinical and radiographic efficacy of 0.05% zoledronate gel as local drug delivery system in treating intrabony defects in stage III grade B periodontitis patients with and without type-2 diabetes mellitus-A randomized split-mouth clinical trial

BACKGROUND

This 6-month randomized split-mouth and placebo-controlled clinical trial aimed to evaluate the clinical and radiographic efficacy of adjunctive use of 0.05% zoledronate (ZLN) gel as local drug delivery to scaling and root planing (SRP) in stage III, grade B periodontitis patients with and without controlled type-2 diabetes mellitus (DM).

METHODS

A total of 120 infrabony sites were divided into two groups: Group-1 (non-diabetic periodontitis) and Group-2 (periodontitis + DM). A total of 60 sites in each group were randomized to receive treatment with SRP + placebo gel (control) or SRP + 0.05% ZLN gel (test). Plaque index (PI), modified sulcus bleeding index (mSBI), pocket probing depth (PPD), and relative attachment levels (RAL) were assessed at baseline, 3 and 6 months, and digital intraoral periapical and cone-beam computed tomography imaging were used to measure the linear and percentage reduction of intrabony defect depth (DD, DDR%) after 6 months.

RESULTS

Group-1 showed significant reduction in PI (0.56 ± 0.15 and 0.52 ± 0.19 from 0.67 ± 0.17), mSBI (0.7 ± 0.60 and 0.47 ± 0.57 from 0.9 ± 0.48), PPD (4.6 ± 0.85 and 3.43 ± 0.63 from 6.5 ± 1.04) and gain in RAL (7.03 ± 0.85 and 5.93 ± 0.69 from 8.9 ± 1.09) in the ZLN-treated sites than the placebo sites and also from Group-2 sites after 3 and 6 months, respectively. A significant reduction in DD of 28.79% in Group-1 and 22.20% in Group-2 at ZLN sites was seen compared to placebo sites of both groups.

CONCLUSION

ZLN gel applied subgingivally in infrabony pockets resulted in significant clinical improvements evident by probing depth reduction and gain in attachment levels along with radiographic evidence of more bone fill seen in non-diabetic patients compared to diabetic periodontitis patients.

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

OBJECTIVES

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Impact of local drug delivery and natural agents as new target strategies against periodontitis: new challenges for personalized therapeutic approach

Periodontitis is a persistent inflammation of the soft tissue around the teeth that affects 60% of the population in the globe. The self-maintenance of the inflammatory process can cause periodontal damage from the alveolar bone resorption to tooth loss in order to contrast the effects of periodontitis, the main therapy used is scaling and root planing (SRP). At the same time, studying the physiopathology of periodontitis has shown the possibility of using a local drug delivery system as an adjunctive therapy. Using local drug delivery devices in conjunction with SRP therapy for periodontitis is a potential tool since it increases drug efficacy and minimizes negative effects by managing drug release. This review emphasized how the use of local drug delivery agents and natural agents could be promising adjuvants for the treatment of periodontitis patients affected or not by cardiovascular disease, diabetes, and other system problems. Moreover, the review evidences the current issues and new ideas that can inspire potential later study for both basic research and clinical practice for a tailored approach.

An injectable MB/BG@LG sustained release lipid gel with antibacterial and osteogenic properties for efficient treatment of chronic periodontitis in rats

Periodontitis is a chronic inflammatory disease characterized by the colonization of pathogenic microorganisms and the loss of periodontal supporting tissue. However, the existing local drug delivery system for periodontitis has some problems including subpar antibacterial impact, easy loss, and unsatisfactory periodontal regeneration. In this study, a multi-functional and sustained release drug delivery system (MB/BG@LG) was developed by encapsulating methylene blue (MB) and bioactive glass (BG) into the lipid gel (LG) precursor by Macrosol technology. The properties of MB/BG@LG were characterized using a scanning electron microscope, a dynamic shear rotation rheometer, and a release curve. The results showed that MB/BG@LG could not only sustained release for 16 days, but also quickly fill the irregular bone defect caused by periodontitis through in situ hydration. Under 660 ​nm light irradiation, methylene blue-produced reactive oxygen species (ROS) can reduce local inflammatory response by inhibiting bacterial growth. In addition, in vitro and vivo experiments have shown that MB/BG@LG can effectively promote periodontal tissue regeneration by reducing inflammatory response, promoting cell proliferation and osteogenic differentiation. In summary, MB/BG@LG exhibited excellent adhesion properties, self-assembly properties, and superior drug release control capabilities, which improved the clinical feasibility of its application in complex oral environments.

A multiple controlled-release hydrophilicity minocycline hydrochloride delivery system for the efficient treatment of periodontitis

The complexity of periodontitis, including the complex formation mechanisms and the complex periodontium physiological environment, as well as the complex association with multiple complications, often results in poor therapy effects. Herein, we aimed to design a nanosystem with a controlled release of minocycline hydrochloride (MH) and good retention to effectively treat periodontitis by inhibiting inflammation and repairing the alveolar bone. Firstly, insoluble ion-pairing (IIP) complexes were constructed to improve the encapsulation efficiency of hydrophilic MH in PLGA nanoparticles. Then, a nanogenerator was constructed and combined with a double emulsion method to encapsulate the complexes into PLGA nanoparticles (MH-NPs). The average particle size of MH-NPs was about 100 nm as observed by AFM and TEM, and the drug loading and encapsulation efficiency were 9.59% and 95.58%, respectively. Finally, a multifunctional system (MH-NPs-in-gels) was prepared by dispersing MH-NPs into thermosensitive gels, which could continue to release drug for 21 days in vitro. And the release mechanism showed that this controlled release behavior for MH was influenced by the insoluble ion-pairing complex, PLGA nanoparticles, and gels. In addition, the periodontitis rat model was established to investigate the pharmacodynamic effects. After 4 weeks of treatment, changes in the alveolar bone were assessed by Micro-CT (BV/TV: 70.88%; BMD: 0.97 g/cm³; TB.Th: 0.14 mm; Tb.N: 6.39 mm^-1; Tb.Sp: 0.07 mm). The mechanism of MH-NPs-in-gels in vivo was clarified by the analysis of pharmacodynamic results, which showed that insoluble ion-pairing complexes with the aid of PLGA nanoparticles and gels achieved significant anti-inflammatory effects and bone repair capabilities. In conclusion, the multiple controlled-release hydrophilicity MH delivery system would have good prospects for the effective treatment of periodontitis.

Effects of Locally Delivered Minocycline Microspheres in Postmenopausal Female Patients with Periodontitis: A Clinical and Microbiological Study

The postmenopausal period, due to low hormonal concentrations, can exert a negative influence on both periodontitis and osteoporosis evolution. The present study aimed to identify potential clinical and microbiological benefic effects of locally delivered minocycline microspheres (Arestin®) in post-menopausal female patients with moderate and severe periodontitis. Probing depth, clinical attachment levels and bleeding on probing index, along with BANA tests for Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola, were performed before and at 3 months after a combined treatment of scaling, root planing (SRP), and Arestin® placed in deep periodontal pockets. The association between SRP and Arestin® exerted significant improvements in terms of clinical periodontal parameters, as well as significant reductions in the red complex bacteria detection.

Pharmacological Therapies for the Management of Inflammatory Bone Resorption in Periodontal Disease: A Review of Preclinical Studies

Periodontitis, a highly prevalent multicausal chronic inflammatory and destructive disease, develops as a result of complex host-parasite interactions. Dysbiotic bacterial biofilm in contact with the gingival tissues initiates a cascade of inflammatory events, mediated and modulated by the host's immune response, which is characterized by increased expression of several inflammatory mediators such as cytokines and chemokines in the connective tissue. If periodontal disease (PD) is left untreated, it results in the destruction of the supporting tissues around the teeth, including periodontal ligament, cementum, and alveolar bone, which lead to a wide range of disabilities and poor quality of life, thus imposing significant burdens. This process depends on the differentiation and activity of osteoclasts, the cells responsible for reabsorbing the bone tissue. Therefore, the inhibition of differentiation or activity of these cells is a promising strategy for controlling bone resorption. Several pharmacological drugs that target osteoclasts and inflammatory cells with immunomodulatory and anti-inflammatory effects, such as bisphosphonates, anti-RANK-L antibody, strontium ranelate, cathepsin inhibitors, curcumin, flavonoids, specialized proresolving mediators, and probiotics, were already described to manage inflammatory bone resorption during experimental PD progression in preclinical studies. Meantime, a growing number of studies have described the beneficial effects of herbal products in inhibiting bone resorption in experimental PD. Therefore, this review summarizes the role of several pharmacological drugs used for PD prevention and treatment and highlights the targeted action of all those drugs with antiresorptive properties. In addition, our review provides a timely and critical appraisal for the scientific rationale use of the antiresorptive and immunomodulatory medications in preclinical studies, which will help to understand the basis for its clinical application.

Combined Release of Antiseptic and Antibiotic Drugs from Visible Light Polymerized Biodegradable Nanocomposite Hydrogels for Periodontitis Treatment

The in situ application of the combination of different types of drugs revolutionized the area of periodontal therapy. The purpose of this study was to develop nanocomposite hydrogel (NCHG) as a pH-sensitive drug delivery system. To achieve local applicability of the NCHG in dental practice, routinely used blue-light photopolymerization was chosen for preparation. The setting time was 60 s, which resulted in stable hydrogel structures. Universal Britton–Robinson buffer solutions were used to investigate the effect of pH in the range 4–12 on the release of drugs that can be used in the periodontal pocket. Metronidazole was released from the NCHGs within 12 h, but chlorhexidine showed a much longer elution time with strong pH dependence, which lasted more than 7 days as it was corroborated by the bactericidal effect. The biocompatibility of the NCHGs was proven by Alamar-blue test and the effectiveness of drug release in the acidic medium was also demonstrated. This fast photo-polymerizable NCHG can help to establish a locally applicable combined drug delivery system which can be loaded with the required amount of medicines and can reduce the side effects of the systemic use of drugs that have to be used in high doses to reach an ideal concentration locally.

Self-assembled nanoparticles containing photosensitizer and polycationic brush for synergistic photothermal and photodynamic therapy against periodontitis

Background

Periodontitis is a chronic inflammatory disease in oral cavity owing to bacterial infection. Photothermal therapy (PTT) and photodynamic therapy (PDT) have many advantages for antibacterial treatment. As an excellent photosensitizer, indocyanine green (ICG) shows prominent photothermal and photodynamic performances. However, it is difficult to pass through the negatively charged bacterial cell membrane, thus limiting its antibacterial application for periodontitis treatment.

Results

In this work, self-assembled nanoparticles containing ICG and polycationic brush were prepared for synergistic PTT and PDT against periodontitis. First, a star-shaped polycationic brush poly(2-(dimethylamino)ethyl methacrylate) (sPDMA) was synthesized via atom transfer radical polymerization (ATRP) of DMA monomer from bromo-substituted β-cyclodextrin initiator (CD-Br). Next, ICG was assembled with sPDMA to prepare ICG-loaded sPDMA (sPDMA@ICG) nanoparticles (NPs) and the physicochemical properties of these NPs were characterized systematically. In vitro antibacterial effects of sPDMA@ICG NPs were investigated in porphyromonas gingivalis (Pg), one of the recognized periodontitis pathogens. A ligature-induced periodontitis model was established in Sprague–Dawley rats for in vivo evaluation of anti-periodontitis effects of sPDMA@ICG NPs. Benefiting from the unique brush-shaped architecture of sPDMA polycation, sPDMA@ICG NPs significantly promoted the adsorption and penetration of ICG into the bacterial cells and showed excellent PTT and PDT performances. Both in vitro and in vivo, sPDMA@ICG NPs exerted antibacterial and anti-periodontitis actions via synergistic PTT and PDT.

Conclusions

A self-assembled nanosystem containing ICG and polycationic brush has shown promising clinical application for synergistic PTT and PDT against periodontitis.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s12951-021-01114-w.

Local drug delivery systems as therapeutic strategies against periodontitis: A systematic review

Periodontitis is a chronic inflammation of the soft tissue surrounding and supporting the teeth, which causes periodontal structural damage, alveolar bone resorption, and even tooth loss. Its prevalence is very high, with nearly 60% of the global population affected. Hence, periodontitis is an important public health concern, and the development of effective healing treatments for oral diseases is a major target of the health sciences. Currently, the application of local drug delivery systems (LDDS) as an adjunctive therapy to scaling and root planning (SRP) in periodontitis is a promising strategy, giving higher efficacy and fewer side effects by controlling drug release. The cornerstone of successful periodontitis therapy is to select an appropriate bioactive agent and route of administration. In this context, this review highlights applications of LDDS with different properties in the treatment of periodontitis with or without systemic diseases, in order to reveal existing challenges and future research directions.

Tailored Doxycycline Hyclate Loaded In Situ Gel for the Treatment of Periodontitis: Optimization, In Vitro Characterization, and Antimicrobial Studies

Currently, periodontitis is treated by oral dosage forms (antibiotics) which shows systemic side effects and failed to reach the therapeutic concentration (above minimum inhibitory concentration, MIC) in the periodontal pocket. The present study aimed to overcome the above issues, by designing tailored doxycycline hyclate laden in situ gel by Poloxamer 407, chitosan, and polyethylene glycol 600. The in situ gel-forming system has attracted attention owing to its ability of sustained drug release above MIC, easy administration (syringeability), and high drug retention (localization) in the periodontal cavity. The Box-Behnken design (BBD) was used to tailor and optimize the concentration of Poloxamer 407 (X₁ = 14.3%), chitosan (X₂ = 0.58%), and polyethylene glycol 600 (X₃ = 1.14%) to achieve sufficient syringeability (149 N), t_90% (1105 min), and viscosity at non-physiological condition (512 cps) and physiological condition (5415 cps). The optimized in situ gel was clear and isotonic (RBCs test). The gelation temperature of the optimized in situ was 34 ± 1°C with sufficient mucoadhesive strength (26 ± 2 dyn/cm²), gel strength (29 ± 2 sec), and texture profile for periodontal application. The in vitro drug release studies showed sustain release from optimized in situ gel (24h) in comparison to marketed gel (7h). The antimicrobial activity (cup plate technique) of the in situ gel was equivalent to the marketed doxycycline gel, which suggests that the doxycycline hyclate retained its antimicrobial efficacy when formulated as in situ gelling system. In conclusion, BBD was effectively utilized to optimize in situ gel with minimum level of polymers to achieve the required characteristics of the in situ gel for sustaining drug delivery to treat periodontitis.

GSK3 inhibitor-loaded osteotropic Pluronic hydrogel effectively mitigates periodontal tissue damage associated with experimental periodontitis

Periodontitis is a chronic inflammatory disease caused by complex interactions between the host immune system and pathogens that affect the integrity of periodontium. To prevent disease progression and thus preserve alveolar bone structure, simultaneous anti-inflammatory and osteogenic intervention are essential. Hence, a glycogen synthase kinase 3 beta inhibitor (BIO) was selected as a potent inflammation modulator and osteogenic agent to achieve this treatment objective. BIO's lack of osteotropicity, poor water solubility, and potential long-term systemic side effects, however, have hampered its clinical applications. To address these limitations, pyrophosphorylated Pluronic F127 (F127-PPi) was synthesized and mixed with regular F127 to prepare an injectable and thermoresponsive hydrogel formulation (PF127) of BIO, which could adhere to hard tissue and gradually release BIO to exert its therapeutic effects locally. Comparing to F127 hydrogel, PF127 hydrogels exhibited stronger binding to hydroxyapatite (HA). Additionally, BIO's solubility in PF127 solution was dramatically improved over F127 solution and the improvement was proportional to the polymer concentration. When evaluated on a rat model of periodontitis, PF127-BIO hydrogel treatment was found to be very effective in preserving alveolar bone and ligament, and preventing periodontal inflammation, as shown by the micro-CT and histological data, respectively. Altogether, these findings suggested that the thermoresponsive PF127 hydrogel is an effective local drug delivery system for better clinical management of periodontitis and associated pathologies.

Immune modulatory and antioxidant effects of locally administrated vitamin C in experimental periodontitis in rats

Background: Vitamin C is an important water-soluble vitamin with antioxidant and immune-modulatory actions. The aim of this study was to investigate the effects of locally applied vitamin C on alveolar bone resorption in rats with experimental periodontitis.Methods: Twenty-one male Sprague-Dawley rats divided into three groups with seven animals in each group: (1) control, (2) experimental periodontitis and 3) experimental periodontitis-local vitamin C treatment group. After ligature was removed, 50 μL vitamin C was locally administered into the subperiosteum of the buccal gingiva of periodontitis vitamin C (PvitC) group rats for three times in intervals of 2 days. At the end of the study, the animals were scarified, and serum and gingival samples were collected for analysis of serum IL-1β, oxidative stress index (OSI), CTX and malondialdehyde (MDA) levels and gingival MMP-8 immunostaining. Alveolar bone loss and attachment loss were determined based on measurements on histological sections obtained from rat mandibles.Results: Serum MDA and OSI levels which are related to the oxidative stress were significantly lower in the PvitC group as compared with those in the P group (p < .05). Serum CTX levels which are related to the bone resorption were significantly lower in the PvitC group as compared with those in the P group (p < .05). The numeric density of MMP-8-positive cells was significantly lower in the PvitC group compared to P group (p < .05). Alveolar bone loss and attachment loss were significantly lower in the PvitC group compared to P group (p < .05)Conclusions: The local vitamin C administration provided protection against inflammation-induced alveolar bone resorption by decreasing oxidative stress and inflammation-induced tissue breakdown vitamin C may be a therapeutic agent that can be used in periodontitis treatment.

Clinicomicrobiological evaluation of the efficacy of local delivery of moxifloxacin and ibuprofen gel as an adjunct to scaling and root planing in chronic periodontitis patients

Aims:

To evaluate the clinical and microbiological effects of local drug delivery of moxifloxacin and ibuprofen gel as an adjunct to conventional periodontal therapy in chronic periodontitis patients.

Subjects and Methods:

Twenty patients with moderate-to-severe chronic generalized periodontitis with probing pocket depth (PPD) of ≥5 mm and <8 mm were randomly assigned to one of the following two treatment modalities: scaling and root planing (SRP) group and moxifloxacin and ibuprofen combination gel as an adjunct to SRP group. Clinical parameters include plaque index (PI), gingival index (GI), probing depths and clinical attachment level (CAL) that were recorded at baseline and 1 and 3 months after the treatment, and microbiologic assessment was done using dark-field microscopy.

Results:

A statistically significant difference in mean PI and GI scores and reduction in PPD and gain in CAL were observed at different study intervals with greater difference in the test group. On microbiological examination, the percentage of cocci increased, while a statistically significant decrease in the mean percentage of bacilli and spirochetes was observed in both groups at given intervals. In-vitro dissolution showed controlled release of both the drugs.

Conclusions:

Among the two treatment modalities, treatment with moxifloxacin and ibuprofen local delivery as an adjunct to SRP gave superior results in clinical and microbiological parameters compared to SRP group.

Periodontal tray application of chlorine dioxide gel as an adjunct to scaling and root planing in the treatment of chronic periodontitis

OBJECTIVE

Clinical improvement after periodontal tray application of chlorine dioxide gel as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis was studied for a period of 30 days.

MATERIALS AND METHODS

The tray fabrication was performed in a dental laboratory using the Soft - Tray Sheets (Ultradent™), whereas scaling and root planing were done using ultrasonic scaler and hand instruments. A total of 36 subjects with chronic periodontitis were divided into 3 treatment groups: group I was treated with SRP procedure combined with the prescription-tray application of chlorine dioxide gel; group II was treated with SRP procedure with the application of chlorine dioxide alone; and group III was treated with SRP procedure alone. Clinical parameters examined were probing pocket depth (PPD) and papillary bleeding index (PBI); measurements were taken at baseline (day0) and 30 days after SRP (day 30). Comparison between treatment groups was tested statistically by Kruskal Wallis test and Analysis of Variance (ANOVA).

RESULTS

There were significant differences in the decrease of the average pocket depth and bleeding index in all the 3 treatment groups (P = 0.001). Decreases in the pocket depth of groups I, II, and III were 50.9%, 47.9%, and 27.8%, respectively. Decreases in the papillary bleeding index of groups I, II, and III were 88.2%, 68.9%, and 51.1%, respectively.

CONCLUSION

The application of chlorine dioxide gel using the custom tray after SRP in the treatment of chronic periodontitis showed better clinical improvement in pocket depth reduction and bleeding index compared to SRP alone.

Repeated application of photodynamic and antibiotic therapy as an adjunct to root surface debridement in patients with grade C and stage III or IV aggressive periodontitis

PURPOSE

To evaluate the efficacy of antimicrobial photodynamic therapy (aPDT) and antimicrobial therapy on clinical and immunological outcomes of periodontal treatment in patients with periodontitis grade C and stage III or IV.

MATERIAL AND METHOD

The patients recruited in the current research fulfil the clinical case definition of periodontitis 'grade C' in terms of onset of the infection and stage III or IV that defines degree and severity of the disease. One-stage full-mouth ultrasonic debridement (UD) was performed and randomly divided in two groups: Group-I - four applications of aPDT, and Group-II - combination of metronidazole (MTZ) and amoxicillin (AMX) 3 tablets each for 7 days. Whole-mouth periodontal parameters were recorded at baseline, 3-, 6-months after completion of treatment. Gingival crevicular fluid samples were obtained for assessment of inflammatory interleukin (IL)-10 and IL-17 at the same time points.

RESULTS

Seventeen healthy patients completed the study protocol and revealed similar clinical findings at baseline. Bleeding scores significantly reduced in group-I at 3 months post treatment (p < 0.05). It could be seen that group-I showed statistically significant reduction of deep periodontal pockets and gain in CAL in patients with GAP at 3 months (p < 0.05). This difference was maintained at 6 months of follow-up (p < 0.001). Group-II was capable of increasing the levels of IL-10 and reducing IL-17 in GCF at both time periods compared to Group-I (p < 0.05). Group-I did not have significant effect on either cytokine levels in GCF (p > 0.05).

CONCLUSION

Antimicrobial photodynamic therapy improved severe deep periodontal pockets. However, the combination of antimicrobial therapy helped in reducing proinflammation in grade C and stage III or IV periodontitis.

Development and in vitro evaluation of chitosan based system for local delivery of atorvastatin for treatment of periodontitis

In recent years, statin group drugs have been widely investigated in treatment of periodontal diseases due to their anti-inflammatory effect. The efficacy of statins can be enhanced by local administration into the periodontal pocket by appropriate delivery systems. The aim of our study was to develop a bioadhesive delivery system for local delivery of atorvastatin in treatment of periodontal disease. For this purpose, gel formulations were prepared using different types of chitosan (base and water soluble) and viscosity, bioadhesivity and syringeability of the gels as well as in vitro drug release properties were investigated vitro. Furthermore, anti-inflammatory effect of the formulations was studied in vitro using tumor necrosis factor (TNF)-alfa induced human gingival fibroblast (hGF) cells. Release of proinflammatory (IL-1β, IL-6, IL-8) and anti-inflammatory (TGF-β1, TGF-β2, TGF-β3, IL-10) cytokines were measured after incubating the hGF cells with the formulations. The viscosity of the formulations was found to be suitable for a local application into periodontal pocket. In presence of drug, bioadhesive property of the formulations was found to increase, and bioadhesion force was within the range, which would retain the delivery system at the application site, subsequently maintain drug levels at desired amount for longer period of time. The release of atorvastatin from the gels was found to be slower than that of the solution. The cytokine levels were found to decrease following application of the formulations, and anti-inflammatory effect was observed to enhance in presence of chitosan. No significant differences were found between base and water-soluble chitosan.

Local Application of Pyrophosphorylated Simvastatin Prevents Experimental Periodontitis

PURPOSE

Simvastatin (SIM), a HMG-CoA reductase inhibitor widely prescribed for hypercholesterolemia, has been reported to ameliorate inflammation and promote osteogenesis. Its clinical applications on these potential secondary indications, however, have been hampered by its lack of osteotropicity and poor water solubility. To address this challenge, we propose to design and evaluate the therapeutic efficacy of a novel simvastatin prodrug with better water solubility and bone affinity.

METHOD

The prodrug (SIM-PPi) was synthesized by directly conjugating a SIM trimer to a pyrophosphate (PPi). It was characterized and evaluated in vitro for its water solubility, osteotropicity, toxicity, anti-inflammatory and osteoinductive properties. It was then tested for anti-inflammatory and osteoinductive properties in vivo by three weekly injections into gingiva of a ligature-induced experimental periodontitis rat model.

RESULTS

In vitro studies showed that SIM-PPi has greatly improved water-solubility of SIM and shows strong binding to hydroxyapatite (HA). In macrophage culture, SIM-PPi inhibited LPS-induced pro-inflammatory cytokines (IL-1β, IL-6). In osteoblast culture, it was found to significantly increase alkaline phosphatase (ALP) activity with accelerated mineral deposition, confirming the osteogenic potential of SIM-PPi. When tested in vivo on an experimental periodontal bone-loss model, SIM-PPi exhibited a superior prophylactic effect compared to dose equivalent SIM in reducing inflammatory cells and in preserving alveolar bone structure, as shown in the histological and micro-CT data.

CONCLUSION

SIM-PPi may have the potential to be further developed for better clinical management of bone loss associated with periodontitis.

Periodontal thermoresponsive, mucoadhesive dual antimicrobial loaded in-situ gel for the treatment of periodontal disease: Preparation, in-vitro characterization and antimicrobial study

BACKGROUND

This study aimed to formulate and characterize in-situ gel containing levofloxacin and metronidazole to release drugs in controlled manner for treatment of periodontitis.

MATERIAL AND METHODS

Medicated in-situ gel with levofloxacin (10% w/v), metronidazole (25% w/v) and vehicle in-situ gel without drugs having poloxamer 407 (20% w/v) and chitosan (0.5%, 1%, 1.5%, 2.0% 2.5% w/v) were prepared and characterized for physicochemical, mechanical properties, stability and in-vitro drug release. Fourier transform infrared spectroscopy and differential scanning calorimetery studies were done. Optimized formulation was evaluated by scanning electron microscope (SEM) and in-vitro antimicrobial activity against 5 bacterial strains.

RESULTS

The results revealed that drugs and polymers were compatible to formulate. All formulations were light yellow, clear and syringeable except formulation having 2.5% w/v chitosan. pH was in the range of 6.20 to 6.74. 1.0% w/v and 1.5% w/v chitosan formulations showed gelation temperature 37 ± 0.32 °C and 34 ± 0.21 °C. Further, mucoadhesive strength indicated mucoadhesivity of gel. In-vitro release study of 1.5% w/v chitosan formulation showed initial burst where about 55-60% MZ and 60-70% LVF got released within 6-7 hrs followed by sustained release upto 48 hrs. SEM images of 1.5% w/v chitosan optimized medicated in-situ and vehicle in-situ gel appeared similar indicating homogeneous mixing of polymers with drugs. In-vitro antimicrobial study showed that medicated in-situ gel was more effective than vehicle.

CONCLUSIONS

In conclusion, optimized 1.5% w/v chitosan in-situ gel was thermoresponsive, mucoadhesive, syringeable, and released drugs in slow and controlled manner with effectiveness against broad range of microbes.

Supportive periodontal therapy (SPT) for maintaining the dentition in adults treated for periodontitis

BACKGROUND

Periodontitis is a bacterially-induced, chronic inflammatory disease that destroys the connective tissues and bone that support teeth. Active periodontal treatment aims to reduce the inflammatory response, primarily through eradication of bacterial deposits. Following completion of treatment and arrest of inflammation, supportive periodontal therapy (SPT) is employed to reduce the probability of re-infection and progression of the disease; to maintain teeth without pain, excessive mobility or persistent infection in the long term, and to prevent related oral diseases.According to the American Academy of Periodontology, SPT should include all components of a typical dental recall examination, and importantly should also include periodontal re-evaluation and risk assessment, supragingival and subgingival removal of bacterial plaque and calculus, and re-treatment of any sites showing recurrent or persistent disease. While the first four points might be expected to form part of the routine examination appointment for periodontally healthy patients, the inclusion of thorough periodontal evaluation, risk assessment and subsequent treatment - normally including mechanical debridement of any plaque or calculus deposits - differentiates SPT from routine care.Success of SPT has been reported in a number of long-term, retrospective studies. This review aimed to assess the evidence available from randomised controlled trials (RCTs).

OBJECTIVES

To determine the effects of supportive periodontal therapy (SPT) in the maintenance of the dentition of adults treated for periodontitis.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 8 May 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 5), MEDLINE Ovid (1946 to 8 May 2017), and Embase Ovid (1980 to 8 May 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

Randomised controlled trials (RCTs) evaluating SPT versus monitoring only or alternative approaches to mechanical debridement; SPT alone versus SPT with adjunctive interventions; different approaches to or providers of SPT; and different time intervals for SPT delivery.We excluded split-mouth studies where we considered there could be a risk of contamination.Participants must have completed active periodontal therapy at least six months prior to randomisation and be enrolled in an SPT programme. Trials must have had a minimum follow-up period of 12 months.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened search results to identify studies for inclusion, assessed the risk of bias in included studies and extracted study data. When possible, we calculated mean differences (MDs) and 95% confidence intervals (CIs) for continuous variables. Two review authors assessed the quality of evidence for each comparison and outcome using GRADE criteria.

MAIN RESULTS

We included four trials involving 307 participants aged 31 to 85 years, who had been previously treated for moderate to severe chronic periodontitis. Three studies compared adjuncts to mechanical debridement in SPT versus debridement only. The adjuncts were local antibiotics in two studies (one at high risk of bias and one at low risk) and photodynamic therapy in one study (at unclear risk of bias). One study at high risk of bias compared provision of SPT by a specialist versus general practitioner. We did not identify any RCTs evaluating the effects of SPT versus monitoring only, or of providing SPT at different time intervals, or that compared the effects of mechanical debridement using different approaches or technologies.No included trials measured our primary outcome 'tooth loss'; however, studies evaluated signs of inflammation and potential periodontal disease progression, including bleeding on probing (BoP), clinical attachment level (CAL) and probing pocket depth (PPD).There was no evidence of a difference between SPT delivered by a specialist versus a general practitioner for BoP or PPD at 12 months (very low-quality evidence). This study did not measure CAL or adverse events.Due to heterogeneous outcome reporting, it was not possible to combine data from the two studies comparing mechanical debridement with or without the use of adjunctive local antibiotics. Both studies found no evidence of a difference between groups at 12 months (low to very low-quality evidence). There were no adverse events in either study.The use of adjunctive photodynamic therapy did not demonstrate evidence of benefit compared to mechanical debridement only (very low-quality evidence). Adverse events were not measured.The quality of the evidence is low to very low for these comparisons. Future research is likely to change the findings, therefore the results should be interpreted with caution.

AUTHORS' CONCLUSIONS

Overall, there is insufficient evidence to determine the superiority of different protocols or adjunctive strategies to improve tooth maintenance during SPT. No trials evaluated SPT versus monitoring only. The evidence available for the comparisons evaluated is of low to very low quality, and hampered by dissimilarities in outcome reporting. More trials using uniform definitions and outcomes are required to address the objectives of this review.

Efficacy of statin delivery as an adjunct to scaling and root planing in the treatment of chronic periodontitis: A meta-analysis

The action of statins in stimulating bone formation and having other pleiotropic effects, such as anti-inflammatory and immunomodulatory effects, has justified their use as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis (CP). The aim of the present study was to evaluate the efficacy of statin delivery as an adjunct to SRP in the treatment of CP. Electronic searches were conducted using the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register, up until July 2017. The primary outcome was probing depth (PD), while the secondary outcomes were changes in clinical attachment level (CAL) and bone defect (BD) fill. Eleven studies were included, and all showed significant PD reduction, CAL gain, and BD fill with adjunctive statin delivery compared to SRP alone. The meta-analysis showed significant improvement in periodontal parameters for atorvastatin (PD: weighted mean difference [WMD] = -1.84, -2.56 to -1.12, P < .001; CAL: WMD = -2.31, -3.58 to -1.03, P < .001; BD fill: WMD = 2.66, -3.92 to -1.39, P < .001), simvastatin (PD: WMD = -1.91, -2.27 to -1.55, P < .001; CAL: WMD = -1.91, -2.27 to -1.55, P = .001; BD: WMD = -1.52, -2.20 to -0.85, P < .001), and rosuvastatin (PD: WMD = -0.94, -1.32 to -0.55, P < .001; CAL: WMD = -1.00, -1.41 to -0.60, P < .001; BD fill: WMD = -1.30, -1.80 to -0.79, P < .001). Adjunctive statin delivery appears to be effective in reducing PD, CAL gain, and BD fill in CP, and therefore, these drugs could be a promising therapeutic option for periodontal regeneration in future.

Systemic antibiotics in the treatment of periodontitis

Despite the fact that several clinical studies have shown additional benefits when certain systemic antibiotics are used as adjuncts to periodontal treatment, clear guidelines for the use of these agents in the clinical practice are not yet available. Basic questions concerning the use of systemic antibiotics to treat periodontitis remain unanswered, such as: which drug(s) should be used; which patients would most benefit from treatment; which are the most effective protocols (i.e. doses and durations); and in which phase of the mechanical therapy should the drug(s) be administered? Although not all of those questions have been directly addressed by controlled randomized clinical trials, recent concepts related to the ecology of periodontal diseases, as well as the major advances in laboratory and clinical research methods that have occurred in the past decade, have significantly broadened our knowledge in this field. This article endeavored to provide a 'state of the art' overview on the use of systemic antibiotics in the treatment of periodontitis, based on the most recent literature on the topic as well as on a compilation of data from studies conducted at the Center of Clinical Trials at Guarulhos University (São Paulo, Brazil) from 2002 to 2012.

New Irradiation Method with Indocyanine Green-Loaded Nanospheres for Inactivating Periodontal Pathogens

Antimicrobial photodynamic therapy (aPDT) has been proposed as an adjunctive strategy for periodontitis treatments. However, use of aPDT for periodontal treatment is complicated by the difficulty in accessing morphologically complex lesions such as furcation involvement, which the irradiation beam (which is targeted parallel to the tooth axis into the periodontal pocket) cannot access directly. The aim of this study was to validate a modified aPDT method that photosensitizes indocyanine green-loaded nanospheres through the gingivae from outside the pocket using a diode laser. To establish this trans-gingival irradiation method, we built an in vitro aPDT model using a substitution for gingivae. Irradiation conditions and the cooling method were optimized before the bactericidal effects on Porphyromonas gingivalis were investigated. The permeable energy through the gingival model at irradiation conditions of 2 W output power in a 50% duty cycle was comparable with the transmitted energy of conventional irradiation. Intermittent irradiation with air cooling limited the temperature increase in the gingival model to 2.75 °C. The aPDT group showed significant bactericidal effects, with reductions in colony-forming units of 99.99% after 5 min of irradiation. This effect of aPDT against a periodontal pathogen demonstrates the validity of trans-gingival irradiation for periodontal treatment.

Efficacy of bisphosphonate as an adjunct to nonsurgical periodontal therapy in the management of periodontal disease: a systematic review

AIMS

The aim of this systematic review was to assess the efficacy of bisphosphonate therapy as an adjunct to scaling and root planing (SRP) in the management of periodontitis.

METHODS

Databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Cochrane Oral Health Group Trials Register databases) were searched up to and including July 2016. The primary outcome was probing depth (PD), and the secondary outcomes were changes in clinical attachment level (CAL) and bone defect (BD) fill. The mean differences (MD) of outcomes and 95% confidence intervals (CI) for each variable were calculated using random effect model.

RESULTS

Eight clinical studies were included. Seven studies used alendronate as an adjunct to SRP; of these, four studies used topical application and three used oral alendronate. Considering the effects of adjunctive bisphosphonates as compared to SRP alone, a high degree of heterogeneity for PD (Q value = 39.6, P < 0.0001, I²  = 87.38%), CAL (Q value = 13.65, P = 0.008, I²  = 70.71%), and BD fill (Q value = 53.26, P < 0.0001, I²  = 92.49%) was noticed among both the groups. Meta-analysis showed a statistically significant PD reduction (MD = -1.18, 95% CI = -1.91 to -0.44, P = 0.002), CAL gain (MD = -0.69, 95% CI = -1.20 to -0.18, P = 0.008) and BD fill (MD = -2.36, 95% CI = -3.64 to -1.08, P < 0.001) for SRP + bisphosphonate treatment vs. SRP alone.

CONCLUSIONS

Adjunctive bisphosphonate therapy appears to be effective in managing periodontitis, however, due to the potential risk of osteonecrosis of the jaws and short-term follow-up of the studies, their clinical application is debatable.

pH-Responsive Hydrogel With an Anti-Glycation Agent for Modulating Experimental Periodontitis

BACKGROUND

Stimulus-responsive devices have emerged as a novel approach for local drug delivery. This study investigates the feasibility of a novel chitosan-based, pH-responsive hydrogel loaded with N-phenacylthiazolium bromide (PTB), which cleaves the crosslinks of advanced glycation end products on the extracellular matrix.

METHODS

A chitosan-based hydrogel loaded with PTB was fabricated, and the in vitro release profile was evaluated within pH 5.5 to 7.4. BALB/cJ mice and Sprague-Dawley rats were used to evaluate the effects during the induction and recovery phases of periodontitis, respectively, and animals in each phase were divided into four groups: 1) no periodontitis induction; 2) ligature-induced experimental periodontitis (group PR); 3) experimental periodontitis plus hydrogel without PTB (group PH); and 4) experimental periodontitis plus hydrogel with PTB (group PP). The therapeutic effects were evaluated by microcomputed tomographic imaging of periodontal bone level (PBL) loss and histomorphometry for inflammatory cell infiltration and collagen density.

RESULTS

PTB was released faster at pH 5.5 to 6.5 and consistently slower at pH 7.4. In the induction phase, PBL and inflammatory cell infiltration were significantly reduced in group PP relative to group PR, and the loss of collagen matrix was significantly reduced relative to that observed in group PH. In the recovery phase, PBL and inflammatory cell infiltration were significantly reduced, and significantly greater collagen deposition was noted in group PP relative to groups PR and PH at 4 and 14 days after silk removal.

CONCLUSION

Chitosan-based, pH-responsive hydrogels loaded with PTB can retard the initiation of and facilitate the recovery from experimental periodontitis.

In vitro behavior of poly-lactic-co-glycolic acid microspheres containing minocycline, metronidazole, and ciprofloxacin

AIM

In the present study, we aimed to fabricate poly-lactic-co-glycolic acid (PLGA) microspheres containing a mixture of three antibiotics-minocycline, metronidazole, and ciprofloxacin (MMC)-to assess their efficacy and properties.

METHODS

MMC were loaded onto PLGA biopolymer microspheres at a 1:1:1 ratio using the double emulsion technique. The morphology of microspheres was observed by a (SEM). The controlled release of antibiotics was evaluated over an 18-day period. The antibacterial efficacy of released antibiotics against Aggregatibacter actinomycetemcomitans was evaluated by measuring the diameter of the growth-inhibition zone. The cytotoxicity of MMC-containing microspheres was also evaluated and compared using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. One-way anova was used for the data analysis.

RESULTS

SEM micrographs confirmed the spherical shape and smooth surface of microspheres. The adequate release of antibiotics was observed from the microspheres within the desired time period of 16-18 days. The MMC-containing microspheres showed antibacterial activity for 11 days. Moreover, MMC-containing microspheres showed superior cell biocompatibility compared to the free mixture of the three antibiotics (P < 0.05).

CONCLUSION

Microspheres containing triple antibiotics showed good release, antibacterial activity for 11 days, and similar cell biocompatibility compared to the empty microspheres.

Efficacy of a local-drug delivery gel containing extracts of Quercus brantii and Coriandrum sativum as an adjunct to scaling and root planing in moderate chronic periodontitis patients

Objective:

Recent advances in the field of alternative medicine introduced various herbal products for the treatment of periodontitis. The purpose of this study was to evaluate the effects of combined extracts from Quercus brantii and Coriandrum sativum on periodontal indices in adult periodontitis patients.

Methods:

In this randomized, double-blinded clinical trial, performed in Isfahan Dental School in 2012, a new herbal medicament containing combined extracts from Q. brantii and C. sativum was formulated in the gel form for subgingival application. Following scaling and root planing (SRP), both herbal and placebo gels were delivered at the experimental and control sites, respectively. Periodontal pocket depth, clinical attachment level, papilla bleeding index, and plaque index were measured at baseline, 1 month and 3 months later. Both intra-and inter-groups changes were registered. The obtained data were analyzed by SPSS software, using repeated measure analysis of variance, paired t-test, Mann-Whitney, Friedman, and Wilcoxon tests. Differences with P < 0.05 were considered to be significant.

Findings:

Both groups indicated statistically significant improvements in the periodontal indices (P < 0.05), but there were no significant differences between two study groups with this regard.

Conclusion:

The herbal gel does not have considerable advantages over SRP alone as an adjunct in periodontal treatment.

Simvastatin local drug delivery in smokers with chronic periodontitis: a randomized controlled clinical trial

BACKGROUND

Simvastatin (SMV) is a specific competitive inhibitor of 3-hydroxy-2-methyl-glutaryl coenzyme A reductase. Statins have recently been shown to promote bone formation. This study was designed to investigate the effectiveness of SMV 1.2% in an indigenously prepared biodegradable controlled release gel as an adjunct to scaling and root planing (SRP) in the treatment of smokers with chronic periodontitis.

METHODS

Forty patients were categorized into two treatment groups: SRP plus SMV 1.2% and SRP plus placebo. Clinical parameters were recorded at baseline and at 3, 6 and 9 months; they included modified sulcus bleeding index (mSBI), probing depth (PD) and clinical attachment level (CAL). At baseline, after 6 months and 9 months, radiologic assessment of intrabony defect (IBD) fill was done using computer-aided software.

RESULTS

Mean probing depth reduction and mean clinical attachment level gain was greater in the SMV group than the placebo group at all visits. Furthermore, significantly greater mean percentage of bone fill was found in the SMV group (32.37 ± 10.23%) compared to the placebo (4.18 ± 5.39%).

CONCLUSIONS

There was a greater decrease in mSBI and PD and more CAL gain with significant IBD fill at sites treated with SRP plus locally delivered SMV in smokers with chronic periodontitis.

Treatment modalities and evaluation models for periodontitis

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.

Sub-Micrometric Liposomes as Drug Delivery Systems in the Treatment and Periodontitis

Periodontitis is a complex disease and bacterial infection is one of the most common factors involved in this disease. Current strategies for the local delivery of antibiotics do not allow a complete clearance of bacteria filling dentinal tubules and this limits their therapeutic efficacy. Therefore, there is a strong need for the development of new delivery strategies aimed at improving the efficacy of antibiotic therapy for periodontitis with special reference to their ability to penetrate into the tubules. The aim of the present study is to develop liposome-based delivery systems of sub-micron dimension, able to diffuse into the dentinal tubules. A further aim of the research is to develop a protocol for enhanced diffusion based on the use of magnetic liposomes and magnetic fields. Liposomes were produced by hydration of a pre-liposomal formulation. The vesicles were stabilised with PEG and their re-sizing was achieved by extrusion. Magnetite nanoparticles were synthesized inside the vesicles, i.e., the chemical reaction involving FeCl2, FeCl3 and NH3 occurred within the core of the newly formed liposomes. Dynamic Light Scattering analysis was performed for size characterization. A mathematical model was implemented to predict the diffusion of the liposomes in dentinal tubules. Ex-vivo validation was performed on extracted human teeth. We produced PEG-ylated liposomes (average size 204.3 nm) and PEG-ylated magnetic liposomes (average size 286 nm) and an iron content of 4.2μg/ml. Through mathematical modelling, we deduced that sub-micrometer vesicles are able to penetrate into dentinal tubules. This penetration is considerably more effective when the vesicles are magnetized and subjected to an external magnetic field which accelerates their movement within the tubules. The liposome-based delivery systems developed by the present study are able to penetrate deeply into the tubules, sometimes reaching their terminal ends.

Effects of a single topical doxycycline administration adjunctive to mechanical debridement in patients with persistent/recurrent periodontitis but acceptable oral hygiene during supportive periodontal therapy

OBJECTIVES

To evaluate the efficacy of a slow release doxycycline gel (SRD) adjunctively administered to non-surgical therapy in subjects with recurrent or persistent periodontitis but acceptable oral hygiene during supportive periodontal care.

MATERIAL & METHODS

In this single blind, parallel group, multicentre study, 202 of 203 recruited periodontal maintenance subjects with recurrent or persistent periodontitis were randomly assigned to subgingival ultrasonic/sonic instrumentation (USI) with (test) or without (control) subsequent administration of SRD in all residual periodontal pockets ≥4 mm. Intergroup differences in probing depth, BOP reductions, treatment time, probing attachment levels were evaluated at 3, 6 and 12 months. The primary outcome was the inter-group difference in absolute change of probing pocket depth (PPD) 3, 6 and 12 months after intervention.

RESULTS

At baseline, the two groups were comparable. At 3 months, the test group showed a significantly higher decrease in mean probing depth than the control group at 3 months (mean difference = 0.11 mm, 95% CI 0.03-0.19 mm, p = 0.003). Administration of SRD resulted in significantly greater odds of transition of bleeding pockets ≥5 mm to a category of non bleeding sites with PPD ≤4 mm at 3 and 6 months (O.R. = 1.4, 95% CI 1.2-1.8 at 3 months). At 6 months, SRD benefit was observed only in the deeper pockets. 7.5% of subjects (no significant difference between test and control) showed disease progression (attachment loss ≥2 mm) and were exited from the study. No difference in the incidence of adverse events was observed between groups.

CONCLUSION

The trial results show that topically administered SRD may provide short-term benefit in controlling inflammation and deep pockets in treated periodontal patients participating in a secondary prevention programme and able to maintain a satisfactory level of oral hygiene.

Evaluation of local drug-delivery system containing 2% whole turmeric gel used as an adjunct to scaling and root planing in chronic periodontitis: A clinical and microbiological study

Aim:

To compare the effect of experimental local-drug delivery system containing 2% whole turmeric (gel form) as an adjunct to scaling and root planing (SRP) with the effect achieved using SRP alone by assessing their respective effects on plaque, gingival inflammation, bleeding on probing pocket depth, relative attachment levels and trypsin-like enzyme activity of “red complex” microorganisms, namely, Bacteroides forsythus, Porphvromonas gingivalis and Treponema denticola.

Material and Methods:

Thirty subjects with chronic localized or generalized periodontitis with pocket depth of 5 to 7 mm were selected in a split-mouth study design. Control sites received SRP alone, while experimental sites received SRP plus experimental material (2% whole turmeric gel). Plaque index (PI), gingival index (GI), sulcus bleeding index (SBI), probing pocket depth (PPD), relative attachment loss (RAL), microbiological study of collected plaque sample for trypsin-like activity of “red complex” by BAPNA assay were the parameters recorded on day 0, 30 days and 45 days.

Results:

Both groups demonstrated statistically significant reduction in PI, GI, SBI, PPD; and gain in RAL. Significant reduction in the trypsin-like enzyme activity of “red complex” (BAPNA values) was observed for both the groups when compared to the baseline activity. Greater reduction was seen in all the parameters in the experimental group in comparison to the control group.

Conclusion:

The experimental local drug-delivery system containing 2% whole turmeric gel can be effectively used as an adjunct to scaling and root planing and is more effective than scaling and root planing alone in the treatment of periodontal pockets.

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.

Short-term effects of photodynamic therapy on periodontal status and glycemic control of patients with diabetes

BACKGROUND

Periodontitis is a major cause of tooth loss among adults. Several studies have shown a possible systemic impact of periodontal infection, including poor glycemic control in patients with diabetes. Recently, photodynamic therapy (PDT) was used to successfully treat periodontal infection. PDT provides a broad spectrum antimicrobial efficacy with no local or systemic side effects. The objective of this study was to examine the effect of the adjunctive use of PDT on periodontal status and glycemic control of patients with diabetes and periodontitis.

METHODS

Forty-five patients with type 2 diabetes and moderate to severe chronic periodontitis were selected and randomly assigned to one of the following three treatment modalities (15 subjects each): scaling and root planing (SRP) only, SRP plus systemic doxycycline, and SRP plus PDT. The plaque and bleeding scores, probing depth, clinical attachment level, and glycosylated hemoglobin (HbA1c) level were recorded at baseline and 3 months after periodontal treatment. Descriptive statistics, the paired t test, and analysis of variance (ANOVA) were used for data analysis.

RESULTS

Statistically significant differences in the mean probing depth, clinical attachment level, plaque deposit, and bleeding on probing were found between baseline and 12 weeks post-treatment for all groups. No significant differences in periodontal parameters and glucose levels were detected among the three groups. Reduction in the mean HbA1c level after treatment was observed in all groups but was only significant for the SRP plus doxycycline group.

CONCLUSION

The results of the present study indicate that PDT does not benefit conventional non-surgical periodontal therapy in patients with diabetes.

Periodontal management of a patient with severe aplastic anemia: a case report

This article describes the periodontal management of a patient with severe aplastic anemia. A 51-year-old female patient was hospitalized with aplastic anemia and was referred for the management of her cyclosporine-induced gingival enlargement and bleeding from her gums. She also complained of pain in the palatal area and the mandibular anterior region. The patient was managed successfully with supra- and subgingival instrumentation, local drug delivery (LDD), electrosurgery, repeated oral hygiene instruction, and constant supervision. The treatment resulted in dramatic improvement in the patient's oral health and quality of life. This report highlights the importance of nonsurgical therapy followed by electrosurgery for the management of residual gingival enlargement.