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Mishra P, Bhargava A, Nigam-Gupta N. A pilot study to evaluate the effectiveness of adjunctive use of two antimicrobial topical gels in chronic gingivitis. J Clin Exp Dent 2021; 13:e342-e349. [PMID: 33841732 PMCID: PMC8020310 DOI: 10.4317/jced.57635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/10/2020] [Indexed: 11/08/2022] Open
Abstract
Background Gingivitis is one of the most prevalent oral disease in humans. The most important etiological factor of gingivitis is dental plaque. Plaque control procedures comprises of several mechanical and chemical methods. Many studies have advocated that chemical plaque control methods can be used successfully as an adjunct to mechanical plaque control procedures. Thus, the aim of this pilot study is to evaluate the effectiveness of two topical antimicrobial gels as an adjunct to mechanical plaque control over a period of 2 weeks in treatment of chronic gingivitis patients.
Material and Methods This is a single blind, two arm parallel design pilot clinical study including 60 systemically healthy patients with 1) chronic generalized gingivitis (MGI>1), 2) probing depth ≤ 3mm and 3) zero clinical attachment loss. The study participants were randomly assigned into two groups i.e., Group I- Chlorhexidine Gluconate (CHX) gel, Group II- combination gel of Chlorhexidine gluconate and Metronidazole (CHX-MTZ) gel. Clinical parameters viz. Gingival Index (GI) and Modified Sulcus bleeding index (MSBI) were recorded firstly at baseline after Scaling and Root Planing(SRP), and secondly at the end of the study period of two weeks. Intra and inter-group comparisons of clinical parameters were done using appropriate statistical tests.
Results There was high significant reduction in GI and MSBI scores at the end of 2 weeks period in both the groups. Further, combination gel of Group II (CHX+MTZ) was found to be statistically more effective as compared to Group I (CHX) used alone.
Conclusions Our study suggests that Chemotherapeutic agents like CHX and combination CHX-MTZ Gel are clinically effective as adjunct to Scaling and Root Planning(SRP) in treatment of Chronic Gingivitis. Further, post statistical comparative analysis has proved CHX-MTZ combination gel regime to be more clinically effective than CHX gel used alone in treatment of Chronic Gingivitis as adjunct to SRP. Key words:Scaling and Root Planning (SRP), Chronic Gingivitis, Chlorhexidine Gluconate (CHX) gel, Combination (CHX+MTZ) Gel, Metronidazole (MTZ).
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Affiliation(s)
- Priyanka Mishra
- Junior Resident, Department of Dentistry, Gandhi Medical College and Hamidia Hospital, Bhopal, M.P, India
| | - Anuj Bhargava
- Associate Professor, Department of Dentistry, Gandhi Medical College and Hamidia, Hospital Bhopal, M.P, India
| | - Neha Nigam-Gupta
- Senior Resident, Department of Dentistry, Gandhi Medical College and Hamidia Hospital, Bhopal, M.P, India
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Herrera D, Matesanz P, Martín C, Oud V, Feres M, Teughels W. Adjunctive effect of locally delivered antimicrobials in periodontitis therapy: A systematic review and meta-analysis. J Clin Periodontol 2021; 47 Suppl 22:239-256. [PMID: 31912531 DOI: 10.1111/jcpe.13230] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- David Herrera
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Paula Matesanz
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Conchita Martín
- BIOCRAN (Craniofacial Biology) Research Group, University Complutense, Madrid, Spain
| | - Valerie Oud
- Department of Oral Health Sciences, KU Leuven & Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
| | - Magda Feres
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, Brazil
| | - Wim Teughels
- Department of Oral Health Sciences, KU Leuven & Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
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Professionally Delivered Local Antimicrobials in the Treatment of Patients with Periodontitis-A Narrative Review. Dent J (Basel) 2020; 9:dj9010002. [PMID: 33375176 PMCID: PMC7822216 DOI: 10.3390/dj9010002] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 12/19/2022] Open
Abstract
This review sheds light on the recent published scientific evidence relating to the use of professionally delivered local antimicrobial agents (LA’s). The review also analyses drug delivery systems available to date and provides an update on the latest scientific evidence about the benefits, limitations, and clinical results obtained by use of local drugs in the treatment of periodontal disease. The search strategy revealed randomized controlled trials (RCTs) that compared the efficacy of adjunctive LA’s to mechanical therapy alone. Based on the available evidence gathered from this review, we can infer that the use of local antimicrobial agents in conjunction to scaling and root debridement (SRD) delivers significant benefits in periodontal therapy and it is a useful aid, avoiding many of the side effects that systemic antibiotic therapy may involve. Local drug delivery (LDD) is an efficient and effective means of delivering drugs based on the evidence presented in the review. The authors of this review would suggest the use of local antimicrobials in cases of localized periodontitis or individual areas that do not respond to the usual mechanical therapy alone. This review summarizes the current use of local drug delivery in periodontal management ensuring that the general practitioners are able to choose an appropriate local antimicrobial.
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Tan OL, Safii SH, Razali M. Clinical Efficacy of Single Application Local Drug Delivery and Adjunctive Agents in Nonsurgical Periodontal Therapy: A Systematic Review and Network Meta-Analysis. Pharmaceutics 2020; 12:E1086. [PMID: 33198248 PMCID: PMC7698182 DOI: 10.3390/pharmaceutics12111086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/29/2022] Open
Abstract
This review aimed to rank the clinical efficacy of commercially available single-application local drug delivery and adjunctive agents (LDAs) compared with subgingival mechanical debridement (SMD) in nonsurgical periodontal therapy (NSPT). Randomized controlled clinical trials that compared LDAs against SMD alone or with placebo in adults (aged at least 18 years) diagnosed with periodontitis with a minimum of 6 months follow-up were included. A frequentist approach to random-effects network meta-analysis was implemented. The efficacies of the LDAs measured by probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain were reported as mean difference (MD) with 95% confidence intervals (CIs). The treatments were ranked according to their P-score. Four network meta-analyses suggested that sulfonic/sulfuric acid gel (PPD MD -1.13 mm, 95% CI -1.74 to -0.53, P-score 0.91; CAL MD -1.09 mm, 95% CI -1.58 to -0.61, P-score 0.95) and doxycycline hyclate gel (PPD MD -0.90 mm, 95% CI -1.50 to -0.30, P-score 0.93; CAL MD -0.84 mm, 95% CI -1.40 to -0.28, P-score 0.92) were the most effective in reducing PPD and gaining CAL in split-mouth and parallel studies, respectively (moderate certainty of evidence). LDAs have differing efficacies, but they present with possible clinical significance over SMD alone in NSPT.
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Affiliation(s)
- Oi Leng Tan
- Centre for Restorative Dentistry, Unit of Periodontology, Faculty of Dentistry, National University of Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Syarida Hasnur Safii
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur 50603, Malaysia;
| | - Masfueh Razali
- Centre for Restorative Dentistry, Unit of Periodontology, Faculty of Dentistry, National University of Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
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Wang CY, Yang YH, Li H, Lin PY, Su YT, Kuo MYP, Tu YK. Adjunctive local treatments for patients with residual pockets during supportive periodontal care: A systematic review and network meta-analysis. J Clin Periodontol 2020; 47:1496-1510. [PMID: 33010026 DOI: 10.1111/jcpe.13379] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/31/2020] [Accepted: 09/22/2020] [Indexed: 11/29/2022]
Abstract
AIM This systematic review and network meta-analysis aimed to evaluate the efficacy of adjunctive locally delivered antimicrobials, compared to subgingival instrumentation alone or plus a placebo, on changes in probing pocket depth (PPD) and clinical attachment level (CAL), in patients with residual pockets during supportive periodontal care. MATERIALS AND METHODS Literature search was performed with electronic databases and by hand until 31 May 2020. Primary outcome was the changes in PPD. The treatment effects between groups were estimated with weighted mean differences (WMD) with 95% confidence intervals (CI) and prediction intervals (PI) by using random-effects network meta-analysis. RESULTS Twenty-two studies were included. Significantly greater PPD reduction was achieved in chlorhexidine chip group (WMD: 0.65 mm, 95% CI: 0.21-1.10) and tetracycline fibre group (WMD: 0.64 mm, 95% CI: 0.20-1.08) over 6-month follow-up. Other adjunctive antimicrobial agents achieved non-significant improvements compared to scaling and root planing alone. All differences between adjunctive therapies were statistically non-significant. Similar findings were observed for CAL gain. CONCLUSION Adjunctive local antimicrobial agents achieved small additional PPD reduction and CAL gain in residual pockets for a follow-up of up to 6 months. Tetracycline fibre and chlorhexidine chip achieved better results than other antimicrobials.
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Affiliation(s)
- Chen-Ying Wang
- School of Dentistry, National Taiwan University, Taipei, Taiwan.,Division of Periodontics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Hao Yang
- School of Dentistry, National Taiwan University, Taipei, Taiwan.,Division of Periodontics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Hua Li
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ping-Yi Lin
- Department of Dentistry, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Yu-Ting Su
- Department of Dentistry, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Mark Yen-Ping Kuo
- School of Dentistry, National Taiwan University, Taipei, Taiwan.,Division of Periodontics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Kang Tu
- School of Dentistry, National Taiwan University, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Badar SB, Zafar K, Ghafoor R, Khan FR. Comparative evaluation of Chlorhexidine, Metronidazole and combination gels on gingivitis: A randomized clinical trial. Int J Surg Protoc 2019; 14:30-33. [PMID: 31851746 PMCID: PMC6913552 DOI: 10.1016/j.isjp.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 11/27/2022] Open
Abstract
Introduction Dental plaque has been established as an etiological factor in the development of gingivitis and periodontitis. Several antimicrobials including Chlorhexidine and Metronidazole have been used as an adjuvant to mechanical plaque removal. Objective To compare 0.8% Metronidazole gel, 0.2% Chlorhexidine gel and alternate application of the two gels in reducing gingival inflammation when used for 14 days as an adjuvant with home based oral hygiene instructions. Methods The bleeding sites, probing depth and the gingival index score will be calculated. (Group A standard 0.2% Chlorhexidine gel applied on the marginal gingiva; Group B subjects will be instructed to apply 0.8% Metronidazole gel; Group C subjects 0.2% Chlorhexidine gel on the marginal gingiva after morning tooth brushing and 0.8% Metronidazole gel after evening tooth brushing). After 2 weeks second clinical examination will be carried out for bleeding sites, probing depth and the gingival index score. Scaling & polishing of teeth in all three groups and oral hygiene instructions will be reinforced. Subjects will be recalled at 6 weeks for evaluation of gingival and oral hygiene indices. Descriptive statistics for variables such as age, baseline clinical parameters including probing depth, bleeding sites, gingival index, and oral hygiene index will be computed. Generalized estimation equation (GEE) will be run to account for the correlated data for the comparison of study arms. Friedman test will be used to assess the bleeding sites among three study groups at the baseline and endpoint. Similarly, gingival index and oral hygiene index in the three groups at baseline, after 2 weeks and 4 weeks will be compared. The level of significance will be kept at 0.05.
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Affiliation(s)
| | - Kamil Zafar
- Aga Khan University Hospital, Karachi, Pakistan
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Bergamaschi CC, Santamaria MP, Berto LA, Cogo-Müller K, Motta RHL, Salum EA, Nociti Júnior FH, Goodson JM, Groppo FC. Full mouth periodontal debridement with or without adjunctive metronidazole gel in smoking patients with chronic periodontitis: A pilot study. J Periodontal Res 2015; 51:50-9. [PMID: 25900347 DOI: 10.1111/jre.12278] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE The evidence of effectiveness of metronidazole (Mtz) as an adjunct therapy to periodontal procedure in the treatment of patients with chronic periodontitis is not conclusive. The aim of this study was to compare the effect of Mtz (delivered locally as a gel or systemically as a tablet) as an adjunctive therapy with full mouth periodontal debridement (1 h of ultrasonic calculus/plaque removal) in smokers with chronic periodontitis. MATERIAL AND METHODS This pilot study involved 30 smokers with at least six teeth with a clinical attachment loss of ≥ 5 mm and probing pocket depth (PPD) of ≥ 5 mm. They were randomly assigned into one of three groups (n = 10): (i) 3 g daily of placebo gel applied topically (using a dental tray with the gel overnight) + periodontal debridement; (ii) 3 g daily of a 15% Mtz benzoate gel applied topically (using a dental tray with the gel overnight) + periodontal debridement; and (iii) a daily single dose of 750 mg Mtz (Flagyl(®)) + periodontal debridement. Clinical parameters (visible plaque index, gingival bleeding index [GBI], relative attachment level and PPD) and quantitative analysis (by real-time polymerase chain reaction) of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia were assessed at baseline and at 1, 3 and 6 mo after periodontal debridement. RESULTS There was no statistically significant difference in the average GBI and visible plaque index values at baseline between the groups (p ≥ 0.05). There was no significant difference between groups in all parameters evaluated (p ≥ 0.05). Significant reductions in GBI at 3 and 6 mo were observed in all groups (p < 0.05). Significant reductions in both PPD and relative attachment level at 1, 3 and 6 mo were observed in all groups (p < 0.05). Significant reductions in bacterial levels at 7 and 30 d were observed in all groups (p < 0.05). CONCLUSION Adjunctive use of Mtz (gel or tablet) to periodontal debridement had similar clinical and microbiological improvement compared to treatment with placebo + periodontal debridement in smokers with chronic periodontitis up to 6 mo post-treatment. Further studies are necessary to confirm the clinical relevance of these findings.
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Affiliation(s)
- C C Bergamaschi
- Department of Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
| | - M P Santamaria
- Division of Periodontics, College of Dentistry, State University of São Paulo, São José dos Campos, Brazil
| | - L A Berto
- Department of Pharmacology, Anesthesiology and Therapeutics, Dental School of Piracicaba, State University of Campinas, Piracicaba, Brazil
| | - K Cogo-Müller
- Department of Dentistry, University of Santo Amaro, São Paulo, Brazil
| | - R H L Motta
- Department of Pharmacology, Anesthesiology and Therapeutics, São Leopoldo Mandic Dental School, Campinas, Brazil
| | - E A Salum
- Department of Prosthodontics and Periodontology, Dental School of Piracicaba, State University of Campinas, Piracicaba, Brazil
| | - F H Nociti Júnior
- Department of Prosthodontics and Periodontology, Dental School of Piracicaba, State University of Campinas, Piracicaba, Brazil
| | - J M Goodson
- Department of Clinical Research, The Forsyth Institute, Boston, MA, USA
| | - F C Groppo
- Department of Pharmacology, Anesthesiology and Therapeutics, Dental School of Piracicaba, State University of Campinas, Piracicaba, Brazil
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Eastham JE, Seymour RA. Local drug delivery in the management of periodontal diseases part 2: specific agents. ACTA ACUST UNITED AC 2014. [DOI: 10.12968/denu.2014.41.9.796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Jane E Eastham
- Research Assistant, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4BW, UK
| | - Robin A Seymour
- Emeritus Professor of Restorative Dentistry, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4BW, UK
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Sallam AS, Hamudi FF, Khalil EA. Effect of ethylcellulose and propylene glycol on the controlled-release performance of glyceryl monooleate-mertronidazole periodontal gel. Pharm Dev Technol 2013; 20:159-68. [PMID: 24262092 DOI: 10.3109/10837450.2013.852573] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Controlled-release metronidazole, mucoadhesive gel proposed as a drug-delivery system for periodontal application was developed and characterized. The system was based on a mixture of glycerylmonooleate (GMO) and ethylcellulose (EC). The mechanism of release depends: firstly, on the ability of GMO to form a viscous liquid crystalline mesophases and secondly on the solubilized EC to form a hydrophobic network when the mixture comes into contact with water resulting in sustaining the release of the drug. Ethylcellulose dissolved in GMO had a profound influence on the rate of drug release, reduced the initial drug release and prolonged the sustained release of metronidazole. Propylene glycol (PG) was added to increase the solubility of the drug and water was added with PG to control the viscosity. A controlled release formulation containing w/w, 20% metronidazole, 10% PG, 5% water and 65% GMO that contains 7% EC was found to be mucoadhesive, easily injectable at room temperature, and to follow Fickian diffusion release mechanism. When the drug loading was increased the drug release was accelerated, and the mechanism followed anomalous controlled-release mechanism. Stability studies indicated that the formulation should be stored at 4 °C in a dark place.
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Paderni C, Compilato D, Giannola LI, Campisi G. Oral local drug delivery and new perspectives in oral drug formulation. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:e25-34. [PMID: 22771408 DOI: 10.1016/j.oooo.2012.02.016] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 02/17/2012] [Accepted: 02/24/2012] [Indexed: 11/24/2022]
Abstract
Modern pharmaceutical science has provided us with a wide range of substances to be administered with a wide large variety of dosage forms. Local drug delivery systems have been used for a long time; in particular, for the local therapy of diseases affecting the oral cavity. Although these diseases are often extremely responsive to local therapy, the mouth often presents various difficulties in the application of topical compounds (owing to saliva and the mouth's different functions), resulting in a short retention time of dosage forms with a consequent low therapeutic efficacy. To resolve these limitations, research today concentrates on the development of bioadhesive formulations. This review focuses on the permeability features of oral mucosa, the rationale of oral local drug delivery, and new potential bioadhesive local delivery systems. Furthermore, the most promising mucoadhesive systems proposed to locally treat oral diseases are discussed.
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Affiliation(s)
- Carlo Paderni
- Department of Surgical and Oncological Disciplines, Section of Oral Medicine V. Margiotta, University of Palermo, Palermo, Italy
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The effect of smoking on the bioavailability of metronidazole in plasma and saliva. J Am Dent Assoc 2012; 143:149-56. [DOI: 10.14219/jada.archive.2012.0125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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