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Gegout PY, Stutz C, Huck O. Gels as adjuvant to non-surgical periodontal therapy: A systematic review and meta-analysis. Heliyon 2023; 9:e17789. [PMID: 37455970 PMCID: PMC10345361 DOI: 10.1016/j.heliyon.2023.e17789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 06/14/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
Objective This systematic review and meta-analysis evaluated the effect of the use of available drugs loaded gels used as adjunct to non-surgical periodontal therapy. Methods Systematic research on PubMed/MEDLINE, Cochrane Central register of Controlled Trials, and Embase databases up to December 2021 was performed. Randomized clinical trials (RCT) which compared the outcomes of scaling and root planing (SRP) + local adjuvant administration (gel) versus SRP + placebo or SRP alone in Humans were included. The primary outcome measures were PPD and CAL changes at 3 months. Results After articles screening, 77 articles were included and assessed for quality. Then, a meta-analysis was conducted in studies with at least 3 months of follow-up. Clinical improvements were found to be significant for tetracyclines (-0.51 [-0.71;-0.31] p < 0.001), macrolides (-0.71 [-1.04;-0.38] p < 0.001), statins (-0.84 [-0.98;-0.70] p < 0.001), metformin (-1.47 [-1.66;-1.29] p < 0.001) and hyaluronan (-1.61 [-2.28;-0.94] p < 0.001) loaded gels, but non-significant for chlorhexidine (-0.48 [-1.10; 0.14] p = 0.13), metronidazole (-0.50 [-1.20; 0.20] p = 0.16) and bisphosphonates (-0.42 [-1.39; 0.54] p = 0.539) gels. Conclusion Adjunctive use of drugs loaded gels to non-surgical periodondal treatment could improve PPD reduction at 3 months. However, huge disparities remain when comparing the outcomes of the differents drugs used. Future comparative studies should be considered to determine precisely short and long term benefits of such treatments.
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Affiliation(s)
- Pierre-Yves Gegout
- Université de Strasbourg, Faculté de Chirurgie Dentaire, Periodontology, Strasbourg, France
- Hôpitaux Universitaires de Strasbourg, Pôle de Médecine et Chirurgie Bucco-dentaires, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Céline Stutz
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Olivier Huck
- Université de Strasbourg, Faculté de Chirurgie Dentaire, Periodontology, Strasbourg, France
- Hôpitaux Universitaires de Strasbourg, Pôle de Médecine et Chirurgie Bucco-dentaires, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
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Huang R, He YX, Jia XT, Liu JN, Fan XC, Zeng N, Huang XF. Investigation of periodontal status and bacterial composition aroundmini-implants. Am J Orthod Dentofacial Orthop 2023:S0889-5406(23)00070-7. [PMID: 36858877 DOI: 10.1016/j.ajodo.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 03/02/2023]
Abstract
INTRODUCTION Mini-implants are now widely used in orthodontic treatment. Soft-tissue inflammation around the mini-implant is an important factor affecting its stability. This study aimed to investigate the periodontal status and the bacterial composition around mini-implants. METHODS A total of 79 mini-implants in 40 patients (aged 18-45 years) were evaluated in this study. The mini-implant probing depth (mPD), mini-implant gingival sulcus bleeding index (mBI), mini-implant plaque index (mPLI), and the composition of the supragingival and subgingival plaque around the mini-implants were recorded. After Congo red staining, the bacteria were classified and counted under a light microscope. RESULTS The mPLI and mBI around mini-implants in the infrazygomatic crest were higher than those in the buccal shelf and interradicular area. The mPD was higher on the coronal site of the mini-implant than on the mesial, distal, and apical sites in the infrazygomatic crest. The mPLI around the mini-implant was positively correlated with the mBI, and the mBI was positively correlated with the mPD. The supragingival and subgingival bacterial composition around the mini-implants was similar to that of natural teeth. Compared with supragingival bacterial composition, the subgingival bacteria of mini-implants had a significantly lower proportion of cocci and a higher proportion of bacilli and spirochetes. CONCLUSIONS The bacteria composition of the plaque and the location are important factors in the inflammation around mini-implants. Similar to natural teeth, mini-implants require health maintenance to prevent inflammation of the surrounding soft tissue and maintain stability.
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Affiliation(s)
- Rui Huang
- Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yin-Xue He
- Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xue-Ting Jia
- Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ji-Nan Liu
- Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiao-Chuan Fan
- Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Na Zeng
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, and School of Public Health, Peking University, Beijing, China
| | - Xiao-Feng Huang
- Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Thakur A, Jain S, Pant A, Sharma A, Kumar R, Singla N, Suttee A, Kumar S, Barnwal RP, Katare OP, Singh G. Cyclodextrin Derivative Enhances the Ophthalmic Delivery of Poorly Soluble Azithromycin. ACS OMEGA 2022; 7:23050-23060. [PMID: 35847282 PMCID: PMC9280958 DOI: 10.1021/acsomega.1c07218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Azithromycin (AZM), a macrolide antibiotic used for the treatment of chlamydial conjunctivitis, is less effective for the treatment of this disease due to its poor bioavailability (38%). Various alternatives have been developed for improving the physicochemical properties (i.e., solubility) of the AZM without much success. To overcome the problems associated with AZM, an inclusion complex employing a modified cyclodextrin, i.e., sulfobutylether-β-cyclodextrin (SBE-β-CD), was prepared and characterized by phase solubility studies and PXRD techniques. The results portrayed the formation of an inclusion complex of AZM with SBE-β-CD in 1:2 molar stoichiometric ratios. This inclusion complex was later incorporated into a polymer matrix to prepare an in situ gel. Various combinations of Carbopol 934P and hydroxypropyl methylcellulose (HPMC K4M) polymers were used and evaluated by rheological and in vitro drug release studies. The optimized formulation (F4) containing Carbopol 934P (0.2% w/v) and HPMC K4M (0.2% w/v) was evaluated for clarity, pH, gelling capacity, drug content, rheological properties, in vitro drug release pattern, ocular irritation test, and antimicrobial efficacy. Finally, owing to the improved antimicrobial efficacy and increased residence time, the AZM:SBE-β-CD in situ gel was found to be a promising formulation for the efficient treatment of bacterial ocular disease.
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Affiliation(s)
- Anil Thakur
- Lachoo
Memorial College of Science and Technology, Jodhpur 342001, India
- University
Institute of Pharmaceutical Sciences, Panjab
University, Chandigarh 160014, India
| | - Sourabh Jain
- Lachoo
Memorial College of Science and Technology, Jodhpur 342001, India
| | - Anjali Pant
- University
Institute of Pharmaceutical Sciences, Panjab
University, Chandigarh 160014, India
| | - Akanksha Sharma
- University
Institute of Pharmaceutical Sciences, Panjab
University, Chandigarh 160014, India
- Department
of Biophysics, Panjab University, Chandigarh 160014, India
| | - Rajiv Kumar
- University
Institute of Pharmaceutical Sciences, Panjab
University, Chandigarh 160014, India
| | - Neha Singla
- Department
of Biophysics, Panjab University, Chandigarh 160014, India
| | - Ashish Suttee
- Lovely
Professional University, Phagwara, Panjab 144411, India
| | - Santosh Kumar
- Department
of Biotechnology, Panjab University, Chandigarh 160014, India
- National
Centre for Cell Science, NCCS Complex, S.
P. Pune University Campus, Ganeshkhind, Pune, Maharashtra 411007, India
| | - Ravi P. Barnwal
- Department
of Biophysics, Panjab University, Chandigarh 160014, India
| | - Om Prakash Katare
- University
Institute of Pharmaceutical Sciences, Panjab
University, Chandigarh 160014, India
| | - Gurpal Singh
- University
Institute of Pharmaceutical Sciences, Panjab
University, Chandigarh 160014, India
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Combined Release of Antiseptic and Antibiotic Drugs from Visible Light Polymerized Biodegradable Nanocomposite Hydrogels for Periodontitis Treatment. Pharmaceutics 2022; 14:pharmaceutics14050957. [PMID: 35631542 PMCID: PMC9146496 DOI: 10.3390/pharmaceutics14050957] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 02/04/2023] Open
Abstract
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.
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5
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Novel In-Situ NanoEmulGel (NEG) of Azithromycin with Eugenol for the Treatment of Periodontitis: Formulation Development and Characterization. J CLUST SCI 2021. [DOI: 10.1007/s10876-021-02172-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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6
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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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Shaheen MA, Elmeadawy SH, Bazeed FB, Anees MM, Saleh NM. Innovative coenzyme Q 10-loaded nanoformulation as an adjunct approach for the management of moderate periodontitis: preparation, evaluation, and clinical study. Drug Deliv Transl Res 2020; 10:548-564. [PMID: 31953677 DOI: 10.1007/s13346-019-00698-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Periodontal diseases are worldwide chronic inflammatory conditions that are associated with heavy production of reactive oxygen species followed by damage of the tooth-supporting tissues. Although the mechanical approach of scaling and root planing (SRP) for removing of plaque is considered as the key element for controlling periodontitis, the anatomical complexity of the teeth hinders accessibility to deeper points. The aim of this study was to design a micellar nanocarrier of coenzyme Q10 (Q10) to support the management of moderate periodontitis. Q10 was formulated in nanomicelles (NMQ10) and evaluated regarding encapsulation efficiency, loading efficiency, percent yield, hydrodynamic size (Dh), polydispersity index (PDI), and zeta potential (ζ potential). NMQ10 was incorporated to in situ gelling systems and the in vitro release of Q10 was studied. A clinical study including evaluation of periodontal parameters and biochemical assay of total antioxidant capacity (T-AOC) and lipid peroxide was achieved. Results revealed that Q10 was efficiently entrapped in spherical-shaped stable NMQ10 with Dh, PDI, and ζ potential of 154.0 nm, 0.108, and - 31.67 mV, respectively. The clinical study revealed that SRP only exhibited improvement of the periodontal parameters. Also, assay of T-AOC and lipid peroxide revealed that their values diminished by 21.5 and 23.8%, respectively. On the other hand, SRP combined with local application of NMQ10 resulted in a significant management of the periodontal parameters, and likewise, the assayed biomarkers proved enhanced antioxidant activity over SRP alone. In conclusion, NMQ10 can be suggested as a promising nanosystem as an approach to support the management of chronic periodontitis. Such results could be used to conduct larger clinical studies. Graphical abstrac.
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Affiliation(s)
| | - Samah H Elmeadawy
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Fagr B Bazeed
- Department of Medical Biochemistry, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed M Anees
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Noha M Saleh
- Department of Pharmaceutics, Faculty of Pharmacy, Mansoura University, Gomhoreyah St., Mansoura, 35516, Egypt.
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Kadadasu R, Atchuta A, Palaparthy R, Reddy SH, Sisinty V, Beeravolu M. 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. J Oral Maxillofac Pathol 2020; 24:26-32. [PMID: 32508444 PMCID: PMC7269311 DOI: 10.4103/jomfp.jomfp_253_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 09/12/2019] [Accepted: 09/24/2019] [Indexed: 11/09/2022] Open
Abstract
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.
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Affiliation(s)
- Ramyasri Kadadasu
- Department of Periodontics, Kamineni Institute of Dental Sciences, Nalgonda, Telangana, India
| | - Abhinav Atchuta
- Department of Periodontics, Kamineni Institute of Dental Sciences, Nalgonda, Telangana, India
| | - Rajababu Palaparthy
- Department of Periodontics, Kamineni Institute of Dental Sciences, Nalgonda, Telangana, India
| | - S Harinath Reddy
- Department of Periodontics, Kamineni Institute of Dental Sciences, Nalgonda, Telangana, India
| | - Vidyasagar Sisinty
- Department of Periodontics, Kamineni Institute of Dental Sciences, Nalgonda, Telangana, India
| | - Mounika Beeravolu
- Department of Periodontics, Kamineni Institute of Dental Sciences, Nalgonda, Telangana, India
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Ramanauskaite E, Machiulskiene V. Antiseptics as adjuncts to scaling and root planing in the treatment of periodontitis: a systematic literature review. BMC Oral Health 2020; 20:143. [PMID: 32418540 PMCID: PMC7232842 DOI: 10.1186/s12903-020-01127-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 04/29/2020] [Indexed: 12/11/2022] Open
Abstract
Background Periodontitis is microbially-associated, host-mediated inflammatory condition that results in loss of periodontal attachment. The goals of periodontal therapy include arresting the disease progression, establishing healthy, stable, maintainable periodontal conditions. A fundamental strategy of treating periodontitis is scaling and root planning (SRP), however its efficacy may be restricted in areas inaccessible for mechanical instrumentation. As periodontitis is infectious in nature, it might be helpful to use additional antimicrobial adjuncts, in order to eliminate or inactivate pathogenic microflora. The aim of this study is to evaluate the current evidence regarding the potential clinical benefits of using additional antiseptics for SRP in nonsurgical periodontal therapy. Methods An electronic literature search was conducted in the MEDLINE (Ovid) and Cohrane Central Register of Controlled Trials (CENTRAL) databases for articles published between January 1, 2000 and September 22, 2019. Randomized controlled clinical trials in English that compare the effectiveness of one or more antiseptic agents as adjuncts to SRP with a follow-up of ≥6 months were included. A meta-analysis using the random-effects model was performed on the selected qualifying articles. Results The search resulted in 12 articles that met the inclusion criteria. Based on the vehicle employed to deliver the antiseptic agent, studies were divided into adjunctive sustained-release antiseptics (gels, chips and varnish) and adjunctive irrigation with antiseptics. The meta-analysis demonstrated significant improvements in probing depth (PD) reduction (p = 0.001), clinical attachment level (CAL) gain (p = 0.001), and bleeding on probing (BOP) values (p = 0.001) following the adjunctive subgingival application of sustained-release antiseptics. Additional subgingival irrigation with antiseptics failed to show significant improvements in PD (p = 0.321), CAL (p = 0.7568), or BOP values (p = 0.3549) over SRP alone. Conclusions Adjunctive subgingivally delivered antiseptics with a sustained-release delivery have significant clinical benefits compared to SRP alone.
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Affiliation(s)
- Egle Ramanauskaite
- Clinic of Dental and Oral Diseases, Faculty of Dentistry, Lithuanian University of Health Sciences, Eiveniu 2, 5009, Kaunas, Lithuania.
| | - Vita Machiulskiene
- Clinic of Dental and Oral Diseases, Faculty of Dentistry, Lithuanian University of Health Sciences, Eiveniu 2, 5009, Kaunas, Lithuania
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Teshome A, Girma B, Aniley Z. The efficacy of azithromycin on cyclosporine-induced gingival enlargement: Systematic review and meta-analysis. J Oral Biol Craniofac Res 2020; 10:214-219. [PMID: 32489824 PMCID: PMC7254476 DOI: 10.1016/j.jobcr.2019.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 12/28/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Cyclosporine is one of the powerful immunosuppressant drugs commonly used to avoid transplant rejection and autoimmune condition management. However, this drug has many side effects, such as nephrotoxicity, hepatotoxicity, hypertension, and gingival overgrowth. Gingival enlargement is one of the most commonly reported adverse drug outcome in patients with long term usage of the drug with the exclusion of other confounding factors. Hence, this systematic review and Meta-analysis was planned to investigate the effect of azithromycin on cyclosporine A-induced gingival enlargement. METHODS We used 4 electronic databases: MEDLINE (up to January 2018), EMBASE (up to January 2018), CINAHL (up to January 2018), Cochrane Library (up to January 2018) to search all the available literature between February 1, 2018, and January 1, 2019. All papers, published up to January 2018, on the efficacy of azithromycin on cyclosporine-induced gingival enlargement were included on this systematic review and meta-analysis. RevMan 5.3 software was used to make the quantitative analysis and the pooled effect presented in terms of the mean difference. Meanwhile, the presence of heterogeneity is presented in terms of I2. RESULTS Five Randomized controlled trials with a total of 167 participants were eligible for this study. The effect of azithromycin on cyclosporine-induced gingival growth, probing depth and plaque index was reported in 3 studies and the selected 5 studies reported its effect on bleeding on probing. The pooled effect revealed there was a significant reduction of gingival enlargement (MD, 1.58, 95%CI: 0.77-2.39) and bleeding on probing in the intervention group (MD, 1.32, 95%CI: 0.39-2.24). Statistically non-significant effects were observed on the effect of azithromycin on plaque index and probing depth in patients with cyclosporine-induced gingival enlargement. CONCLUSION Azithromycin has a clinically significant effect on the reduction of cyclosporine-induced gingival enlargement and bleeding on probing.
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Affiliation(s)
- Amare Teshome
- Department of Dentistry, School of Medicine, College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Biruk Girma
- Oral and Maxillofacial Surgery, Department of Dentistry, School of Medicine, College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Zelallem Aniley
- Oral and Maxillofacial Surgery, Department of Dentistry, School of Medicine, College of Medicine and Health Science, University of Gondar, Ethiopia
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A New Controlled-Release Material Containing Metronidazole and Doxycycline for the Treatment of Periodontal and Peri-Implant Diseases: Formulation and In Vitro Testing. Int J Dent 2019; 2019:9374607. [PMID: 30956660 PMCID: PMC6425423 DOI: 10.1155/2019/9374607] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/22/2019] [Accepted: 01/28/2019] [Indexed: 11/17/2022] Open
Abstract
Background Several locally administered antimicrobials have been studied in the literature as adjunctive or primary treatments for periodontitis and peri-implantitis with conflicting results. Objective The aim of this study was twofold: (1) the formulation of a controlled-release material containing metronidazole and doxycycline; (2) an in vitro evaluation of its antibacterial properties against planktonic and biofilm species involved in periodontal and peri-implant diseases. Methods Doxycycline (10 mg/ml) and metronidazole (20 mg/ml) were incorporated into a hydroxyethylcellulose-polyvinylpyrrolidone-calcium polycarbophil gel. Three milliliters of gel were dialyzed against Dulbecco's phosphate-buffered saline for 13 days. Antibiotics release at 3, 7, 10, and 13 days was determined spectroscopically. The inhibitory activity of the experimental gel was tested against A. actinomycetemcomitans, S. sanguinis, P. micra, and E. corrodens with an agar diffusion test, an inactivation biofilm test, and a confocal laser scanning microscope study (CLSMS) for S. sanguinis up to 20 days. Results After 13 days, the released doxycycline was 9.7% (at 3 days = 1.2 mg; 7 days = 0.67 mg; 10 days = 0.76 mg; 13 days = 0.29 mg), while metronidazole was 67% (30 mg, 6.8 mg, 2.5 mg, and 0.9 mg at the same intervals). The agar diffusion test highlights that the formulated gel was active against tested microorganisms up to 312 h. Quantitative analysis of biofilm formation for all strains and CLSMS for S. sanguinis showed a high growth reduction up to 13 days. Conclusions The in vitro efficacy of the newly formulated gel was confirmed both on planktonic species and on bacterial biofilm over a period of 13 days. The controlled-release gel containing metronidazole and doxycycline had an optimal final viscosity and mucoadhesive properties. It can be argued that its employment could be useful for the treatment of periodontal and peri-implant diseases, where conventional therapy seems not successful.
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Gershenfeld L, Kalos A, Whittle T, Yeung S. Randomized clinical trial of the effects of azithromycin use in the treatment of peri-implantitis. Aust Dent J 2018; 63:374-381. [PMID: 29679488 DOI: 10.1111/adj.12614] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND The aim of this clinical trial was to establish a proof of concept that the adjunctive use of systemic azithromycin (AZM) in conjunction with mechanical debridement has an increased benefit in reducing soft tissue inflammation in the treatment of peri-implantitis. METHODS In a randomized, double-blind, clinical trial, the treatment group (nine patients) received AZM as well as mechanical debridement in a single course of treatment, whereas the control group (eight patients) received a placebo and mechanical debridement. The primary outcome variables studied were bleeding on probing, suppuration, pocket probing depth and gingival recession. The secondary variables studied were gingival index, plaque index, microbiological and interleukin-1β status. The observation period was 6 months. RESULTS Over the 6 months' observation period, the treatment patients showed a consistently greater reduction of gingival inflammation and an improvement in soft tissue healing than the control patients. CONCLUSIONS The adjunctive use of a single course of systemic azithromycin can assist in the control of peri-implant mucositis in the treatment of peri-implantitis.
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Affiliation(s)
- L Gershenfeld
- Faculty of Dentistry, University of Sydney, Sydney, New South Wales, Australia
| | - A Kalos
- Faculty of Dentistry, University of Sydney, Sydney, New South Wales, Australia
| | - T Whittle
- Jaw Function Research Unit, Westmead Centre for Oral Health, University of Sydney, Sydney, New South Wales, Australia
| | - S Yeung
- Department of Oral Restorative Sciences (Periodontics), Westmead Centre for Oral Health, University of Sydney, Sydney, New South Wales, Australia
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Latif SA, Vandana KL, Thimmashetty J, Dalvi PJ. Azithromycin buccal patch in treatment of chronic periodontitis. Indian J Pharmacol 2017; 48:208-13. [PMID: 27127325 PMCID: PMC4825441 DOI: 10.4103/0253-7613.178829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim: This study aims to explore the clinical, microbiological, and biochemical impact of azithromycin (AZM) buccal patch in chronic generalized patients as a monotherapy as well as an adjunct to nonsurgical therapy. Materials and Methods: A parallel design was used forty periodontitis patients were randomly allocated into five groups, namely Group 1 scaling root planing (SRP) alone, Group 2 (SRP + AZM patch group), Group 3 (SRP + AZM tablet group), Group 4 (AZM patch monotherapy), and Group 5 (AZM tablet as monotherapy). Plaque index, gingival bleeding index, modified gingival index, probing pocket depth (PPD), and clinical attachment level (CAL) were assessed at baseline and 21 and 90 days. Subgingival pooled plaque sample was collected to assess periodontopathogens like Porphyromonas gingivalis and Prevotella intermedia (Pi) by anaerobic culture method. Tumor necrosis factor alpha (TNF-α) was also evaluated at baseline and 21 days. Periodontal maintenance was performed in Group 1 until 90th day, and clinical parameter was assessed at the end of 90th day. Results: SRP + AZM tablets showed greater reduction in clinical parameters (P < 0.05) AZM as monotherapy did not offer clinical benefits over SRP. Baseline data were compared at the end, i.e., 90th day a significant reduction in plaque scores, gingival bleeding, and PPD was observed however no significant gain in the clinical attachment was observed. Conclusion: The monotherapy resulted in no improvement of periodontal parameters, microbial parameters, and TNF-α level. It is safe to use AZM + SRP as a mode of nonsurgical treatment in periodontitis patients.
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Affiliation(s)
- Sajith Abdul Latif
- Department of Periodontics, Bapuji Dental College and Hospital, Davangere, Karnataka, India
| | - K L Vandana
- Department of Periodontics, College of Dental Sciences, Bapuji Pharmacy College, Davangere, Karnataka, India
| | - J Thimmashetty
- Department of Pharmaceutics, Bapuji Pharmacy College, Bapuji Pharmacy College, Davangere, Karnataka, India
| | - Priyanka Jairaj Dalvi
- Department of Periodontics, College of Dental Sciences, Bapuji Pharmacy College, Davangere, Karnataka, India
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Ratre MS, Mehta DS. Effect of azithromycin on gingival overgrowth induced by cyclosporine A + nifedipine combination therapy: A morphometric analysis in rats. J Indian Soc Periodontol 2016; 20:396-401. [PMID: 28298821 PMCID: PMC5341314 DOI: 10.4103/0972-124x.194271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: Drug-induced gingival overgrowth (DIGO) is a well-known adverse effect of cyclosporine A (CsA) and nifedipine (Nf) therapy. The aim of the present morphometric study was to evaluate the effect of azithromycin (Azi) on the combined GO in rats induced by CsA + Nf combination. Materials and Methods: Thirty Sprague-Dawley male rats were randomly divided equally into three groups. Group 1 (control) received olive oil only; Group 2 received a combination of CsA and Nf in olive oil throughout the study period; Group 3 received CsA + Nf combination therapy, and Azi was added for 1 week in the 5th week. All the drugs were delivered by oral route. Impressions of the mandibular central incisal regions were taken, and study models were prepared at baseline and biweekly up to the 8 weeks. Statistical analysis was done by one-way analysis of variance and intergroup comparisons were made using Tukey's post hoc analysis. Results: Significant GO was evident in Group 2 and Group 3 rats when compared to Group 1. However, in Group 3 (Azi), GO was observed up to the 4th week, but a significant decrease in GO was noticed during 6–8th week after the administration of Azi in 5th week. Conclusion: Azi is an effective drug in the remission of DIGO induced by combined therapy of CsA + Nf and thereby can be considered as a useful therapeutic regimen in minimizing the DIGO in transplant patients.
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Affiliation(s)
- Madhu Singh Ratre
- Department of Periodontology, Government College of Dentistry, Indore, Madhya Pradesh, India
| | - Dhoom Singh Mehta
- Department of Periodontology, Bapuji Dental College and Hospital, Davangere, Karnataka, India
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15
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Zhang Z, Zheng Y, Bian X. Clinical effect of azithromycin as an adjunct to non-surgical treatment of chronic periodontitis: a meta-analysis of randomized controlled clinical trials. J Periodontal Res 2015; 51:275-83. [PMID: 26362529 DOI: 10.1111/jre.12319] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2015] [Indexed: 12/11/2022]
Abstract
The results of recent published studies focusing on the effect of azithromycin as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis are inconsistent. We conducted a meta-analysis of randomized controlled clinical trials to examine the effect of azithromycin combined with SRP on periodontal clinical parameters as compared to SRP alone. An electronic search was carried out on Pubmed, Embase and the Cochrane Central Register of Controlled Trials from their earliest records through December 28, 2014 to identify studies that met pre-stated inclusion criteria. Reference lists of retrieved articles were also reviewed. Data were extracted independently by two authors. Either a fixed- or random-effects model was used to calculate the overall effect sizes of azithromycin on probing depth, attachment level (AL) and bleeding on probing (BOP). Heterogeneity was evaluated using the Q test and I(2) statistic. Publication bias was evaluated by Begg's test and Egger's test. A total of 14 trials were included in the meta-analysis. Compared with SRP alone, locally delivered azithromycin plus SRP statistically significantly reduced probing depth by 0.99 mm (95% CI 0.42-1.57) and increased AL by 1.12 mm (95% CI 0.31-1.92). In addition, systemically administered azithromycin plus SRP statistically significantly reduced probing depth by 0.21 mm (95% CI 0.12-0.29), BOP by 4.50% (95% CI 1.45-7.56) and increased AL by 0.23 mm (95% CI 0.07-0.39). Sensitivity analysis yielded similar results. No evidence of publication bias was observed. The additional benefit of systemic azithromycin was shown at the initially deep probing depth sites, but not at shallow or moderate sites. The overall effect sizes of systemic azithromycin showed a tendency to decrease with time, and meta-regression analysis suggested a negative relation between the length of follow-up and net change in probing depth (r = -0.05, p = 0.02). This meta-analysis provides further evidence that azithromycin used as an adjunct to SRP significantly improves the efficacy of non-surgical periodontal therapy on reducing probing depth, BOP and improving AL, particularly at the initially deep probing depth sites.
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Affiliation(s)
- Z Zhang
- Department of Periodontology, Tianjin Stomatological Hospital, Nankai University, Tianjin, China
| | - Y Zheng
- Department of General Dentistry, Stomatological Hospital, Tianjin Medical University, Tianjin, China
| | - X Bian
- Department of Periodontology, Stomatological Hospital, Tianjin Medical University, Tianjin, China
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Eick S, Gloor N, Püls C, Zumbrunn J, Sculean A. In vitro activity of taurolidine gel on bacteria associated with periodontitis. Clin Oral Investig 2015; 20:597-606. [PMID: 26254142 DOI: 10.1007/s00784-015-1549-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 07/22/2015] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Sigrun Eick
- Department of Periodontology; Laboratory of Oral Microbiology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
| | - Nicoletta Gloor
- Department of Periodontology; Laboratory of Oral Microbiology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Cecilia Püls
- Department of Periodontology; Laboratory of Oral Microbiology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Jürg Zumbrunn
- Department of Preclinical and Clinical R&D, Geistlich Pharma AG, Wolhusen, Switzerland
| | - Anton Sculean
- Department of Periodontology; Laboratory of Oral Microbiology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
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Priyanka N, Kalra N, Saquib S, Kudyar N, Malgaonkar N, Jain H, Pradeep AR. Clinical and microbiological efficacy of 3% satranidazole gel as a local drug delivery system in the treatment of chronic periodontitis: A randomized, controlled clinical trial. Contemp Clin Dent 2015; 6:364-70. [PMID: 26321836 PMCID: PMC4549988 DOI: 10.4103/0976-237x.161891] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM The present clinical trial was designed to investigate the effectiveness of subgingivally delivered satranidazole (SZ) gel as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. MATERIALS AND METHODS Seventy subjects with probing depth (PD) ≥5 mm were selected. Thirty-five subjects each were randomly assigned to SRP + placebo (Group 1) and SRP + SZ (Group 2). The clinical outcomes evaluated were plaque index, gingival index, clinical attachment level (CAL), and PD at baseline; 1 month, 3 months, and 6 months interval. Furthermore, microbial analysis using polymerase chain reaction was done to estimate the number of sites harboring periodontopathogens. RESULTS Sixty four subjects were evaluated up to 6 months. At 6 months, the Group 2 resulted in greater mean reduction (4.10 mm) in PD as compared to Group 1 (1.49 mm), and also a greater mean CAL gain (4.20 mm) in Group 2 as compared to Group 1 (1.13 mm). These subjects also showed a significant reduction in the number of sites harboring periodontopathogens. CONCLUSION The use of 3% SZ gel, when used as an adjunct to nonsurgical periodontal therapy in subjects with periodontitis, achieved better results than initial periodontal treatment alone.
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Affiliation(s)
- N Priyanka
- Department of Periodontics, Government Dental College and Research Institute, Bengaluru, India
| | - Nitish Kalra
- Department of Periodontics, Government Dental College and Research Institute, Bengaluru, India
| | - Shahab Saquib
- Department of Periodontics, Yogita Dental College and Hospital, Khed, Ratnagiri, Maharashtra, India
| | - Nitin Kudyar
- Department of Periodontics, Himachal Dental College, Sundernagar, Himachal Pradesh, India
| | - Nikhil Malgaonkar
- Department of Oral Pathology, Al-Farabi College of Dentistry and Nursing, Riyadh, Saudi Arabia
| | - Hunny Jain
- Department of Oral Surgery, Yogita Dental College and Hospital, Khed, Ratnagiri, Maharashtra, India
| | - A. R. Pradeep
- Department of Periodontics, Government Dental College and Research Institute, Bengaluru, India
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18
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Barca E, Cifcibasi E, Cintan S. Adjunctive use of antibiotics in periodontal therapy. J Istanb Univ Fac Dent 2015; 49:55-62. [PMID: 28955547 PMCID: PMC5573506 DOI: 10.17096/jiufd.90144] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 03/13/2015] [Indexed: 11/24/2022] Open
Abstract
Periodontal diseases are infectious diseases with a
mixed microbial aetiology and marked inflammatory
response leading to destruction of underlying tissue.
Periodontal therapy aims to eliminate pathogens
associated with the disease and attain periodontal
health. Periodontitis is generally treated by nonsurgical
mechanical debridement and regular
periodontal maintenance care. Periodontal surgery
may be indicated for some patients to improve access
to the root surface; however, mechanical debridement
alone may not be helpful in all cases. In such cases,
adjunctive systemic antibiotic therapy remains the
treatment of choice. It can reach microorganisms
at the base of the deep periodontal pockets and
furcation areas via serum, and also affects organisms
residing within gingival epithelium and connective
tissue. This review aims to provide an update on
clinical issues regarding when and how to prescribe
systemic antibiotics in periodontal therapy. The
points discussed are the mode of antibiotic action,
susceptible periodontal pathogens, antibiotic dosage,
antibiotic use in treatment of periodontal disease, and
mechanism of bacterial resistance to each antibiotic.
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Affiliation(s)
- Ece Barca
- Department of Periodontology, Faculty of Dentistry, Istanbul University, Turkey
| | - Emine Cifcibasi
- Department of Periodontology, Faculty of Dentistry, Istanbul University, Turkey
| | - Serdar Cintan
- Department of Periodontology, Faculty of Dentistry, Istanbul University, Turkey
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19
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Bhansali RS. Non-surgical periodontal therapy: An update on current evidence. World J Stomatol 2014; 3:38-51. [DOI: 10.5321/wjs.v3.i4.38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 11/06/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
Periodontal disease is an inflammatory condition that involves a complex interaction between pathogenic bacteria, environmental and acquired factors and host related factors. Till recently periodontal treatment was directed primarily towards reduction of bacterial load by subgingival debridement of root surfaces and modification of environmental risk factors. The current paradigm of periodontal disease stresses greater role of host-mediated inflammatory response in tissue destruction characteristic of periodontal disease. Various therapeutic modalities have been developed adjuvant to mechanical periodontal therapy. The use of laser and photodynamic therapy show great promise but their effectiveness has still not been conclusively proven. Chemotherapeutic agents, either systemic and local antimicrobials or host modulating drugs, played pivotal role in better and more predictable management of periodontal disease. The present review focuses on the best available evidence, for the current management of the chronic periodontal patients, gathered from systematic reviews and meta-analysis of mechanical non surgical periodontal therapy (NSPT) (subgingival debridement, laser therapy and photodynamic therapy) and the adjunctive chemotherapeutic approaches such as systematic and local antibiotics and antiseptics, subgingival pocket irrigation and host modulation therapies. The review also attempts to briefly introduce future developments in some of these modalities. At the end, the review summarizes the analysis of the current evidence that suggests that thorough subgingival debridement remains the mainstay of NSPT and that adjunct use of chemotherapeutic agents may offer better management of clinical parameters in periodontitis patients.
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20
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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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21
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Gannon SC, Cantley MD, Haynes DR, Hirsch R, Bartold PM. Azithromycin suppresses human osteoclast formation and activity in vitro. J Cell Physiol 2013; 228:1098-107. [PMID: 23065774 DOI: 10.1002/jcp.24259] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 10/03/2012] [Indexed: 12/29/2022]
Abstract
Azithromycin is an antibiotic with anti-inflammatory properties used as an adjunct to treat periodontitis, a common inflammatory mediated condition featuring pathologic alveolar bone resorption. This study aimed to determine the effect of azithromycin on human osteoclast formation and resorptive activity in vitro. Osteoclasts were generated from peripheral blood mononuclear cells stimulated with macrophage colony stimulating factor (M-CSF) and receptor activator of nuclear factor kappa B (RANK) ligand. The effects of azithromycin at concentrations ranging from 0.5 to 40 µg/ml were tested. Osteoclast formation and activity, acidification, actin ring formation and expression of mRNA, and protein encoding for key osteoclast genes were assessed. The results demonstrated that azithromycin reduced osteoclast resorptive activity at all concentrations tested with osteoclast formation being significantly reduced at the higher concentrations (20 and 40 µg/ml). mRNA and protein expression of key osteoclast transcription factor Nuclear Factor of Activated T cells (NFATc1) was significantly reduced by azithromycin at later stages of osteoclast development (day 17). Azithromycin also reduced tumor necrosis factor receptor associated factor-6 (TRAF6) mRNA expression at day 14, and cathepsin K mRNA expression at days 14 and 17. Integrin β3 and MMP-9 mRNA expression was reduced by azithromycin at day 17 in osteoclasts cultured on dentine. The osteoclast proton pump did not appear to be affected by azithromycin, however formation of the actin ring cytoskeleton was inhibited. This study demonstrates that azithromycin inhibits human osteoclast function in vitro, which may account for at least some of the beneficial clinical effects observed with azithromycin treatment in periodontitis.
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Affiliation(s)
- Siobhan C Gannon
- Colgate Australian Clinical Dental Research Centre, School of Dentistry, University of Adelaide, South Australia, Australia
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22
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Muniz FWMG, de Oliveira CC, de Sousa Carvalho R, Moreira MMSM, de Moraes MEA, Martins RS. Azithromycin: a new concept in adjuvant treatment of periodontitis. Eur J Pharmacol 2013; 705:135-9. [PMID: 23499686 DOI: 10.1016/j.ejphar.2013.02.044] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 01/31/2013] [Accepted: 02/13/2013] [Indexed: 10/27/2022]
Abstract
In most patients periodontitis is successfully treated by scaling and root planing, but some studies have shown that certain sites continue to show periodontal tissue destruction despite conventional periodontal therapy. To solve this problem, antibiotics may be administered as an adjuvant treatment. This includes azithromycin (AZM), which is effective against Gram-negative aerobic and anaerobic bacteria and has a long half-life in periodontal tissues. The purpose of the present study was to determine the efficacy of azithromycin as an adjuvant treatment for periodontitis through a review of the literature in Medline, Lilacs and Scielo, combining the keywords "azithromycin", "periodontal treatment" and "periodontitis" in both Portuguese and English languages. To be included, articles had to be clinical trials, randomized, controlled, double-blind or blind, and published between 2001 and 2011. 70 articles were found, of which 12 were selected based on title and abstract. Most studies used AZM as an adjuvant treatment for chronic periodontitis, usually in a single daily dose of 500 mg over three days, and indicated that AZM significantly reduced probing depth and increased periodontal attachment when compared to controls. Furthermore, a reduction in red and orange complex and an increase in bacteria associated with healthy periodontal conditions were observed in subjects treated with AZM. It may be concluded that the use of AZM as an adjuvant treatment for periodontitis improves clinical and microbiological parameters when compared to conventional treatment alone.
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Affiliation(s)
- Francisco Wilker Mustafa Gomes Muniz
- School of Dentistry, Faculty of Pharmacy, Denstistry and Nursing, Federal University of Ceará, 570, Vereador Pedro Paulo Street, Fortaleza, Ceará 60430-355, Brazil.
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23
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Antibacterial and immunomodulatory properties of azithromycin treatment implications for periodontitis. Inflammopharmacology 2013; 21:321-38. [DOI: 10.1007/s10787-012-0165-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 11/30/2012] [Indexed: 12/19/2022]
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Pradeep AR, Bajaj P, Agarwal E, Rao NS, Naik SB, Kalra N, Priyanka N, Priyanaka N. Local drug delivery of 0.5% azithromycin in the treatment of chronic periodontitis among smokers. Aust Dent J 2013; 58:34-40. [PMID: 23441790 DOI: 10.1111/adj.12019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Along with conventional periodontal surgical therapy, local delivery of antibiotics may provide more effective treatment in smokers by targeting tissue-invasive bacteria. The aim of this randomized, placebo-controlled, double-masked clinical trial was to evaluate the adjunctive effects of subgingivally delivered 0.5% azithromycin (AZM) as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis in smokers. METHODS Fifty-four patients were randomized and categorized into two treatment groups: Group 1 - 26 subjects who received (SRP) plus placebo gel and Group 2 - 28 subjects who received (SRP) plus 0.5% azithromycin. Clinical parameters were recorded at baseline, 3, 6 and 9 months. They included Plaque Index (PI), modified Sulcus Bleeding Index (mSBI), probing depth (PD) and clinical attachment level (CAL). RESULTS Azithromycin resulted in significant improvements. A single application of AZM resulted in attachment gain at 9 months of 2.44 ± 0.64 mm as compared to 0.18 ± 0.68 mm for the placebo. Similarly, pocket depth and PI were significantly reduced but no change in the mSBI was noted. CONCLUSIONS When compared to the placebo, the adjunctive use of 0.5% AZM resulted in significant improvement in clinical outcome in the treatment of chronic periodontitis among smokers.
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Affiliation(s)
- A R Pradeep
- Department of Periodontics, Government Dental College and Research Institute, Bangalore, India.
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25
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Lauenstein M, Kaufmann M, Persson GR. Clinical and microbiological results following nonsurgical periodontal therapy with or without local administration of piperacillin/tazobactam. Clin Oral Investig 2013; 17:1645-60. [DOI: 10.1007/s00784-012-0856-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 09/27/2012] [Indexed: 10/27/2022]
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26
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Matesanz-Pérez P, García-Gargallo M, Figuero E, Bascones-Martínez A, Sanz M, Herrera D. A systematic review on the effects of local antimicrobials as adjuncts to subgingival debridement, compared with subgingival debridement alone, in the treatment of chronic periodontitis. J Clin Periodontol 2013; 40:227-41. [PMID: 23320860 DOI: 10.1111/jcpe.12026] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2012] [Indexed: 12/30/2022]
Abstract
AIMS To update the existing scientific evidence on the efficacy of local antimicrobials as adjuncts to subgingival debridement in the treatment of chronic periodontitis. MATERIAL AND METHODS Fifty-six papers were selected, reporting data from 52 different investigations. All the studies reported changes in probing pocket depth (PPD) and clinical attachment level (CAL) and most in plaque index (PlI) and/or bleeding on probing (BOP). Meta-analyses were performed with the data retrieved from the studies fulfilling the inclusion criteria. RESULTS The overall effect of the subgingival application of antimicrobials was statistically significant (p = 0.000) for both changes in PPD and CAL with a weighted mean difference (WMD) of -0.407 and -0.310 mm respectively. No significant differences occurred for changes in BOP and PlI. Subgingival application of tetracycline fibres, sustained released doxycycline and minocycline demonstrated a significant benefit in PPD reduction (WMD between 0.5 and 0.7 mm). The rest of the tested outcomes demonstrated a high heterogeneity. The local application of chlorhexidine and metronidazole showed a minimal effect when compared with placebo (WMD between 0.1 and 0.4 mm). CONCLUSIONS The scientific evidence supports the adjunctive use of local antimicrobials to debridement in deep or recurrent periodontal sites, mostly when using vehicles with proven sustained release of the antimicrobial.
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Affiliation(s)
- Paula Matesanz-Pérez
- Graduate Periodontology, Faculty of Odontology, University Complutense, Plaza Ramon y Cajal s/n, Madrid, Spain
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27
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Kathariya R, Pradeep AR, Raghavendra NM, Gaikwad R. Evaluation of subgingivally delivered 0.5% clarithromycin as an adjunct to nonsurgical mechanotherapy in the management of chronic periodontitis: a short-term double blinded randomized control trial. ACTA ACUST UNITED AC 2012; 5:23-31. [PMID: 23097216 DOI: 10.1111/jicd.12009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 08/25/2012] [Indexed: 12/15/2022]
Abstract
OBJECTIVE As the risk involved with systemic antimicrobials (high doses, microbial resistance, adverse reactions, etc.) restricts their use and local delivery of antimicrobials into periodontal pockets improves periodontal health, this study was designed to investigate the effects of subgingivally delivered clarithromycin (CLM; 0.5%) as an adjunct to nonsurgical mechanotherapy in chronic periodontitis subjects. METHODS Ninety-eight patients were categorized into two treatment groups: scaling and root planing (SRP) plus 0.5% CLM (test; group 1) and SRP plus placebo (control; group 2). Clinical parameters included gingival index (GI), sulcus bleeding index (SBI), plaque index (PI), probing depth (PD), and periodontal attachment level (PAL), recorded at 4, 8 and 12 weeks. The concentration of 0.5% CLM in gingival fluid was estimated by reverse-phase high pressure liquid chromatography. anova, the chi-square test and the Scatterthwaite test were used for statistical analysis. RESULTS Patients treated with SRP + CLM showed enhanced reductions in GI, SBI, and PD, and gains in PAL (P < 0.001) over time, as compared with the placebo group. However, no statistically significant differences were noted for PI. The mean concentration of CLM was detected in gingival crevicular fluid for up to 7 weeks, fulfilling the conditions for a controlled-release device. CONCLUSION Adjunctive use of 0.5% CLM as a controlled drug delivery system enhanced the clinical outcome up to 3 months.
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Affiliation(s)
- Rahul Kathariya
- Department of Periodontology, Government Dental College and Research Institute, Bangalore, India
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28
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Bajaj P, Pradeep AR, Agarwal E, Kumari M, Naik SB. Locally delivered 0.5% clarithromycin, as an adjunct to nonsurgical treatment in chronic periodontitis with well-controlled type 2 diabetes: a randomized controlled clinical trial. ACTA ACUST UNITED AC 2012; 3:276-83. [PMID: 22976782 DOI: 10.1111/j.2041-1626.2012.00168.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 06/30/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Several epidemiologic studies have identified a greater incidence of periodontitis in patients with type 2 diabetes. Recent developments suggest that local delivery of antimicrobials into periodontal pockets improve periodontal health. The present study was designed to investigate the adjunctive effects of subgingivally delivered clarithromycin (CLM) (0.5% concentration) as an adjunct to scaling and root planing for treating chronic periodontitis in patients with well-controlled type 2 diabetes. METHODS Sixty-three patients were categorized into two treatment groups: Group 1, scaling and root planing (SRP) plus 0.5% CLM; Group 2, SRP plus placebo gel. Clinical parameters were recorded at baseline, 1, 2, and 3 months; which included gingival index (GI), sulcus bleeding index (SBI), plaque index (PI), probing depth (PD), and periodontal attachment level (PAL). RESULTS Both therapies resulted in significant improvements. Using a subject-based analysis, patients in Group 1 treated with SRP + CLM showed enhanced reductions in PI, GI, SBI, and PD, and gains in PAL (P < 0.001) over a period of 6 months as compared to Group 2. CONCLUSION Although both treatment strategies seemed to benefit the patients, the adjunctive use of 0.5% CLM as a controlled drug delivery system enhanced the clinical outcome.
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Affiliation(s)
- Pavan Bajaj
- Department of Periodontics, Government Dental College and Research Institute, Bangalore, India
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Agarwal E, Pradeep A, Bajaj P, Naik SB. Efficacy of Local Drug Delivery of 0.5% Clarithromycin Gel as an Adjunct to Non-Surgical Periodontal Therapy in the Treatment of Current Smokers With Chronic Periodontitis: A Randomized Controlled Clinical Trial. J Periodontol 2012; 83:1155-63. [DOI: 10.1902/jop.2012.110600] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Herrera D, Matesanz P, Bascones-Martínez A, Sanz M. Local and Systemic Antimicrobial Therapy in Periodontics. J Evid Based Dent Pract 2012; 12:50-60. [DOI: 10.1016/s1532-3382(12)70013-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Tariq M, Iqbal Z, Ali J, Baboota S, Talegaonkar S, Ahmad Z, Sahni JK. Treatment modalities and evaluation models for periodontitis. Int J Pharm Investig 2012; 2:106-22. [PMID: 23373002 PMCID: PMC3555006 DOI: 10.4103/2230-973x.104394] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Periodontitis is the most common localized dental inflammatory disease related with several pathological conditions like inflammation of gums (gingivitis), degeneration of periodontal ligament, dental cementum and alveolar bone loss. In this perspective, the various preventive and treatment modalities, including oral hygiene, gingival irrigations, mechanical instrumentation, full mouth disinfection, host modulation and antimicrobial therapy, which are used either as adjunctive treatments or as stand-alone therapies in the non-surgical management of periodontal infections, have been discussed. Intra-pocket, sustained release systems have emerged as a novel paradigm for the future research. In this article, special consideration is given to different locally delivered anti-microbial and anti inflammatory medications which are either commercially available or are currently under consideration for Food and Drug Administration (FDA) approval. The various in vitro dissolution models and microbiological strain investigated to impersonate the infected and inflamed periodontal cavity and to predict the in vivo performance of treatment modalities have also been thrashed out. Animal models that have been employed to explore the pathology at the different stages of periodontitis and to evaluate its treatment modalities are enlightened in this proposed review.
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Affiliation(s)
- Mohammad Tariq
- Department of Pharmaceutics, Faculty of Pharmacy, Jamia Hamdard, Hamdard Nagar, New Delhi-110062, India
| | - Zeenat Iqbal
- Department of Pharmaceutics, Faculty of Pharmacy, Jamia Hamdard, Hamdard Nagar, New Delhi-110062, India
| | - Javed Ali
- Department of Pharmaceutics, Faculty of Pharmacy, Jamia Hamdard, Hamdard Nagar, New Delhi-110062, India
| | - Sanjula Baboota
- Department of Pharmaceutics, Faculty of Pharmacy, Jamia Hamdard, Hamdard Nagar, New Delhi-110062, India
| | - Sushama Talegaonkar
- Department of Pharmaceutics, Faculty of Pharmacy, Jamia Hamdard, Hamdard Nagar, New Delhi-110062, India
| | - Zulfiqar Ahmad
- Department of Pharmaceutics, Faculty of Pharmacy, Jamia Hamdard, Hamdard Nagar, New Delhi-110062, India
| | - Jasjeet K Sahni
- Department of Pharmaceutics, Faculty of Pharmacy, Jamia Hamdard, Hamdard Nagar, New Delhi-110062, India
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Liu R, Li N, Liu N, Zhou X, Dong ZM, Wen XJ, Liu LC. Effects of systemic ornidazole, systemic and local compound ornidazole and pefloxacin mesylate on experimental periodontitis in rats. Med Sci Monit 2012; 18:BR95-102. [PMID: 22367122 PMCID: PMC3560749 DOI: 10.12659/msm.882514] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The purpose of the current study is to evaluate the effects of systemic ornidazole (SO) and systemic and local compound ornidazole and pefloxacin mesylate (SCOPM/LCOMP) on the inflammatory response associated with rat experimental chronic periodontitis (ECP) in sites with subgingival debridement. Material/Methods Periodontitis was induced in male Sprague-Dawley rats by placing a thin steel ligature around the upper first molars and inoculating them with Porphyromonas gingivalis 381. After the successful induction of the rat ECP, the periodontitis rats were randomly divided into 3 different combined treatment groups: (A) SO with scaling and root planing (SRP); (B) SCOMP with SRP; and (C) LCOMP with SRP. After 2 weeks the effects of the treatments were evaluated based on gingivitis, plaque index, probing pocket depth, aspartate aminotransferase, alveolar bone loss, and hematoxylin-eosin staining of the region around the first molars. Results After treatment, comparison with ECP was performed. The mean percentage reductions of SBI in SO, SCOPM, and LCOPM were 27.73%, 33.61%, and 58.82%, respectively. Those of PI were 33.20%, 42.80%, and 60.00%; those of PPD were 48.66%, 55.70%, and 72.48%; those of GCF-AST were 41.64%, 49.03%, and 66.42%; and those of ABL were 41.19%, 43.63%, and 54.47%, respectively. The inflammatory score of H&E showed median scores of 2.5, 1.75, 1.63, and 0.95 for ECP, SO, SCOMP, and LCOMP, respectively. All 3 treatment groups exhibited significantly reduced inflammation indicators (P<0.05). Of the 3, group C was the most effective (P<0.05). Conclusions Although all the combined treatment groups responded to therapy with significant resolution of the infection, adjunctive LCOMP therapy is more effective for periodontitis.
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Affiliation(s)
- Rui Liu
- Department of Stomatology, Research Institute of Surgery and Daping Hospital, 3rd Military Medical University, Chongqing, China
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Agarwal E, Bajaj P, Naik SB, Pradeep AR. Locally Delivered 0.5% Azithromycin as an Adjunct to Non-Surgical Treatment in Patients With Chronic Periodontitis With Type 2 Diabetes: A Randomized Controlled Clinical Trial. J Periodontol 2012; 88:1281-1287. [PMID: 22655911 DOI: 10.1902/jop.2012.120172] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Several epidemiologic studies have identified a greater incidence of periodontitis in patients with type 2 diabetes. Recent developments suggest that local delivery of antimicrobials into periodontal pockets improve periodontal health. The present study is designed to investigate the adjunctive effects of subgingivally delivered azithromycin (AZM; 0.5% concentration) as an adjunct to scaling and root planing (SRP) for treating chronic periodontitis in patients with type 2 diabetes. METHODS A total of 63 patients were categorized into two treatment groups: 1) group 1: SRP + placebo gel and 2) group 2: SRP + 0.5% AZM. Clinical parameters were recorded at baseline and 3, 6, and 9 months; they included modified sulcus bleeding index (mSBI), plaque index (PI), probing depth (PD), and clinical attachment level (CAL). RESULTS Both therapies resulted in significant improvements. Using a patient-based analysis, patients in group 2 treated with SRP + 0.5% AZM showed enhanced reductions in PI, GI, mSBI, and PD and gains in CAL (P <0.05) over 9 months compared with group 1. CONCLUSION Although both treatment strategies seem to benefit the patients, the adjunctive use of 0.5% AZM as a controlled drug delivery system enhances the clinical outcome.
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Affiliation(s)
- Esha Agarwal
- Department of Periodontics, Government Dental College and Research Institute, Bangalore, Karnataka, India
| | - Pavan Bajaj
- Department of Periodontics, Government Dental College and Research Institute, Bangalore, Karnataka, India
| | - Savitha B Naik
- Department of Conservative Dentistry and Endodontics, Government Dental College and Research Institute
| | - A R Pradeep
- Department of Periodontics, Government Dental College and Research Institute, Bangalore, Karnataka, India
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Hallström H, Persson GR, Lindgren S, Olofsson M, Renvert S. Systemic antibiotics and debridement of peri-implant mucositis. A randomized clinical trial. J Clin Periodontol 2012; 39:574-81. [DOI: 10.1111/j.1600-051x.2012.01884.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Hadar Hallström
- Department of Periodontology; Maxillofacial Unit; Hospital of Halland; Halmstad; Sweden
| | | | - Susann Lindgren
- Department of Periodontology; Maxillofacial Unit; Hospital of Halland; Halmstad; Sweden
| | - Maria Olofsson
- Department of Periodontology; Maxillofacial Unit; Hospital of Halland; Halmstad; Sweden
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Hirsch R, Deng H, Laohachai MN. Azithromycin in periodontal treatment: more than an antibiotic. J Periodontal Res 2011; 47:137-48. [PMID: 22050485 DOI: 10.1111/j.1600-0765.2011.01418.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Azithromycin is a macrolide antibiotic used extensively in medicine for the treatment of a wide range of infections such as upper respiratory tract infections, middle ear infections, sexually transmitted infections and trachoma. It is also effective against the most common periodontopathogens. The versatility of the macrolides extends beyond their antibiotic properties as a result of their well-documented immune-modulating/anti-inflammatory effects. Macrolides, including azithromycin, are therefore used to treat diseases not associated with bacteria, such as severe asthma, chronic obstructive pulmonary diseases and, more recently, cystic fibrosis. Azithromycin is concentrated in neutrophils, macrophages and particularly fibroblasts; all of these cells are central players in the pathogenesis of most periodontal diseases. This paper reviews the diverse properties of azithromycin and the clinical periodontal studies of its effects in both the treatment of periodontitis and in resolving drug-related gingival overgrowth. Evidence exists to support the use of a single course of azithromycin in the treatment of advanced periodontal diseases. Azithromycin could have a triple role in the treatment and resolution of periodontal diseases: suppressing periodontopathogens, anti-inflammatory activity and healing through persistence at low levels in macrophages and fibroblasts in periodontal tissues, even after a single course of three tablets. If future periodontal research confirms these properties, it could become a valuable host-modulator in periodontal treatment.
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Affiliation(s)
- R Hirsch
- School of Dentistry, The University of Adelaide, Adelaide, SA, Australia.
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Machtei EE, Hirsh I, Falah M, Shoshani E, Avramoff A, Penhasi A. Multiple applications of flurbiprofen and chlorhexidine chips in patients with chronic periodontitis: a randomized, double blind, parallel, 2-arms clinical trial. J Clin Periodontol 2011; 38:1037-43. [PMID: 22092475 PMCID: PMC3586660 DOI: 10.1111/j.1600-051x.2011.01779.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2011] [Indexed: 11/29/2022]
Abstract
AIM The aim of the present randomized, double blind, parallel, 2-arm clinical study was to examine the safety and efficacy of frequent applications of chlorhexidine chip (CHX) and flurbiprofen chip (FBP) in patients with chronic periodontitis. METHODS Sixty patients were randomized into CHX and FBP groups. Following OHI and scaling and root planing (SRP), baseline pocket depth (PD) measurements, gingival recession and bleeding on probing (BOP) were performed and repeated at week 4 and 8. The assigned chip was placed at weeks 0, 1, 2, 3, 5, 7. RESULTS Mean PD reduction in the CHX group was 2.08 mm (7.17 to 5.09, p < 0.0001). Mean PD reduction in the FBP group was 2.27 mm (6.72 to 4.45, p < 0.0001). Ninety-seven percentage and 95% of these sites exhibited PD reduction ≥1 mm, while 38% and 34% of the sites exhibited PD ≥3 mm (FBP and CHX, respectively). Clinical attachment level gain (1.66 and 1.95 mm, respectively) was statistically significant (p < 0.0001). Baseline BOP dropped from 98% and 100% to 24% and 30% for the CHX and FBP groups, respectively (p < 0.0001). CONCLUSION Frequent applications of CHX and FBP chips resulted in a significant improvement in the periodontal condition in these sites. Furthermore studies will be required to compare this new treatment regimen to SRP or SRP with single chip application.
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Affiliation(s)
- Eli E Machtei
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus and the Faculty of Medicine - Technion (I.I.T.), Haifa, Israel.
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Eick S, Radakovic S, Pfister W, Nietzsche S, Sculean A. Efficacy of taurolidine against periodontopathic species—an in vitro study. Clin Oral Investig 2011; 16:735-44. [DOI: 10.1007/s00784-011-0567-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 05/11/2011] [Indexed: 12/25/2022]
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HIRSCH R. Azithromycin: Author’s Reply. Aust Dent J 2010. [DOI: 10.1111/j.1834-7819.2010.01277_3.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Oteo A, Herrera D, Figuero E, O'Connor A, González I, Sanz M. Azithromycin as an adjunct to scaling and root planing in the treatment of Porphyromonas gingivalis-associated periodontitis: a pilot study. J Clin Periodontol 2010; 37:1005-15. [DOI: 10.1111/j.1600-051x.2010.01607.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Non-surgical chemotherapeutic treatment strategies for the management of periodontal diseases. Dent Clin North Am 2010; 54:13-33. [PMID: 20103470 DOI: 10.1016/j.cden.2009.08.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Periodontal diseases are initiated by subgingival periodontal pathogens in susceptible periodontal sites. The host immune response toward periodontal pathogens helps to sustain periodontal disease and eventual alveolar bone loss. Numerous adjunctive therapeutic strategies have evolved to manage periodontal diseases. Systemic and local antibiotics, antiseptics, and past and future host immune modulatory agents are reviewed and discussed to facilitate the dental practitioner's appreciation of this ever-growing field in clinical periodontics.
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Effects of azithromycin in combination with vancomycin, daptomycin, fosfomycin, tigecycline, and ceftriaxone on Staphylococcus epidermidis biofilms. Antimicrob Agents Chemother 2009; 53:3205-10. [PMID: 19451280 DOI: 10.1128/aac.01628-08] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Staphylococcal biofilms on surgical implants are the underlying cause of a lack of response to antimicrobial treatment. We investigated the effects of vancomycin (VAN), daptomycin (DAP), fosfomycin (FOS), tigecycline (TGC), and ceftriaxone (CRX), alone and in combination with azithromycin (AZI), on established biofilms of Staphylococcus epidermidis. Biofilms were studied using the static microtiter plate model with established S. epidermidis biofilms, with an initial inoculum of 10(6)/ml in 96-well polystyrene flat-bottom microtiter plates. Biofilms were inoculated with VAN, DAP, FOS, TGC, or CRX at two concentrations, alone or in combination with AZI (2, 512, or 1,024 mg/liter). To assess the reduction in biomass, the optical density ratio (ODr), calculated as (optical density [OD] of the treated biofilm)/(OD of the untreated biofilm, taken as 1), was used. For antibacterial efficacy, the viable bacterial count was used. Reductions in the biofilm ODr were observed for VAN (15 and 40 mg/liter) and FOS (200 mg/liter) only (ODr [mean +/- standard deviation] for VAN at 15 and 40 mg/liter, 0.77 +/- 0.32 and 0.8 +/- 0.35, respectively; ODr for FOS at 200 mg/liter, 0.78 +/- 0.26; P < 0.05), but not for DAP (2 and 5 mg/liter), TGC (0.2 and 2 mg/liter), or CRX (600 and 2,400 mg/liter). The addition of AZI had no further effect on the ODr, but a significant reduction of bacterial growth was achieved with high doses of AZI plus TGC or AZI plus CRX (a 3-log count reduction for AZI at 1,024 mg/liter plus CRX at 600 mg/liter and for AZI at 512 or 1,024 mg/liter plus CRX at 2,400 mg/liter; a 2-log count reduction for AZI at 512 or 1,024 mg/liter plus TGC at 2 mg/liter [P < 0.05]). No significant reduction in bacterial growth was observed for FOS (50 and 200 mg/liter), DAP (2 and 5 mg/liter), or TGC (0.2 mg/liter) in combination with AZI. None of the antibiotics at either concentration reduced the bacterial count of the biofilms when used alone. Thus, the use of a combination of AZI plus TGC, FOS, or CRX at high concentrations has little effect on biofilm density but significantly reduces bacterial growth.
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