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Ashique S, Hussain A, Khan T, Pal S, Rihan M, Farid A, Webster TJ, Hassan MZ, Asiri YI. Insights into Intra Periodontal Pocket Pathogenesis, Treatment, In Vitro-In Vivo Models, Products and Patents, Challenges and Opportunity. AAPS PharmSciTech 2024; 25:121. [PMID: 38816555 DOI: 10.1208/s12249-024-02842-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/15/2024] [Indexed: 06/01/2024] Open
Abstract
Periodontal disease is a multifactorial pathogenic condition involving microbial infection, inflammation, and various systemic complications. Here, a systematic and comprehensive review discussing key-points such as the pros and cons of conventional methods, new advancements, challenges, patents and products, and future prospects is presented. A systematic review process was adopted here by using the following keywords: periodontal diseases, pathogenesis, models, patents, challenges, recent developments, and 3-D printing scaffolds. Search engines used were "google scholar", "web of science", "scopus", and "pubmed", along with textbooks published over the last few decades. A thorough study of the published data rendered an accurate and deep understanding of periodontal diseases, the gap of research so far, and future opportunities. Formulation scientists and doctors need to be interconnected for a better understanding of the disease to prescribe a quality product. Moreover, prime challenges (such as a lack of a vital testing model, scarcity of clinical and preclinical data, products allowing for high drug access to deeper tissue regions for prolonged residence, lack of an international monitoring body, lack of 4D or time controlled scaffolds, and lack of successful AI based tools) exist that must be addressed for designing new quality products. Generally, several products have been commercialized to treat periodontal diseases with certain limitations. Various strategic approaches have been attempted to target certain delivery regions, maximize residence time, improve efficacy, and reduce toxicity. Conclusively, the current review summarizes valuable information for researchers and healthcare professional to treat a wide range of periodontal diseases.
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Affiliation(s)
- Sumel Ashique
- Department of Pharmaceutics, School of Pharmacy, Bharat Institute of Technology (BIT), Meerut, 250103, UP, India
| | - Afzal Hussain
- Department of Pharmaceutics, College of Pharmacy, King Saud University, 11451, Riyadh, Saudi Arabia.
| | - Tasneem Khan
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Sejuti Pal
- School of Pharmacy, College of Health and Medicine, University of Tasmania, Churchill Ave, Sandybay, Hobart, TAS- 7005, Australia
| | - Mohd Rihan
- Department of Pharmacology, National Institute of Pharmaceutical Education and Research (NIPER), S.A.S. Nagar, Punjab, 160062, India
| | - Arshad Farid
- Gomal Center of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan, 29050, Pakistan
| | - Thomas J Webster
- Division of Pre-college and Undergraduate Studies, Brown University, Providence, Rhode Island, 02912, USA.
| | - Mohd Zaheen Hassan
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Khalid University, Asir, Saudi Arabia
| | - Yahya I Asiri
- Department of Pharmacology, College of Pharmacy, King Khalid University, Asiri, Saudi Arabia
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Kuo TY, Hsieh MC, Cheng CD, Huang RY, Van Dyke TE, Sung CE, Wang CY, Hsieh YS, Cheng WC. Chlorhexidine gel topical application ameliorates inflammatory bone loss in experimental periodontitis. J Formos Med Assoc 2023; 122:899-910. [PMID: 36801153 DOI: 10.1016/j.jfma.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 12/19/2022] [Accepted: 02/03/2023] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the impact of chlorhexidine (CHX) gel on inflammation-induced periodontal tissue destruction, osteoclastogenesis, subgingival microbiota, and on the modulation of the RANKL/OPG as well as inflammatory mediators during bone remodeling in vivo. MATERIALS AND METHODS Ligation- and LPS injection-induced experimental periodontitis were created to investigate the effect of topical application of CHX gel in vivo. Alveolar bone loss, osteoclast number and gingival inflammation was evaluated by micro-CT, histological, immunohistochemistry and biochemical analysis. The composition of the subgingival microbiota was characterized by 16S rRNA gene sequencing. RESULTS Data shows significant decreases in the alveolar bone destruction in rats from ligation-plus-CHX gel group compared to ligation group. In addition, significant decreases in the number of osteoclasts on bone surface and the protein level of receptor activator of nuclear factor κB ligand (RANKL) in gingival tissue were observed in rats from ligation-plus-CHX gel group. Moreover, data shows significantly decreased inflammatory cell infiltration and decreased expression of cyclooxygenase (COX-2) and inducible NO synthase (iNOS) in gingival tissue from ligation-plus-CHX gel group versus ligation group. Assessment of the subgingival microbiota revealed changes in rats with CHX gel application treatment. CONCLUSION HX gel presents protective effect on gingival tissue inflammation, osteoclastogenesis, RANKL/OPG expression, inflammatory mediators, and alveolar bone loss in vivo, which may have a translational impact on the adjunctive use in the management of inflammation-induced alveolar bone loss.
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Affiliation(s)
- Ting-Yen Kuo
- Dental Department, Taichung Armed Forces General Hospital, Taichung, Taiwan; Department of Periodontology, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Ming-Chieh Hsieh
- Dentistry Division, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan
| | - Chia-Dan Cheng
- Department of Periodontology, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Ren-Yeong Huang
- Department of Periodontology, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Thomas E Van Dyke
- Center for Clinical and Translational Research, Forsyth Institute, Cambridge, MA, United States; Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, United States
| | - Cheng-En Sung
- Department of Periodontology, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Chen-Ying Wang
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan; Department of Periodontology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Shing Hsieh
- Department of Operative Dentistry and Endodontics, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Wan-Chien Cheng
- Department of Periodontology, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan.
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Wanasathop A, Murawsky M, Kevin Li S. Modification of Small Dissolution Chamber System for Long-acting Periodontal Drug Product Evaluation. Int J Pharm 2022; 618:121646. [PMID: 35259441 PMCID: PMC9136688 DOI: 10.1016/j.ijpharm.2022.121646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
Conventional dissolution testing methods may not be suitable for long-acting periodontal drug products due to the small volume, slow fluid flow rate, and environment in the periodontal pocket. The objective of this study was to evaluate a 3D-printed small volume flow-through dissolution chamber system (modified from a previous study) for biorelevant and dose-discriminating testing. Three periodontal drug products with different dosage forms were tested: Atridox, Arestin, and PerioChip. Modifications were made to suit the specific characteristics of these dosage forms. No significant differences were observed between the % drug release profiles in vitro and in vivo except for Atridox. The differences observed with Atridox could be related to the exposing surface area of the drug product. Similar differences were observed from this effect in COMSOL model simulations. Overall, the drugs show reasonable in vitro-in vivo correlations (R2 ≥ 0.91) with linear regression slopes close to unity. For dose discrimination between 75% and full dosing, significant differences were observed in the drug release data at specific time points of the products (p ≤ 0.05). The present results suggest that a small volume dissolution chamber with slow flow rate could potentially provide biologically relevant and dose-discriminating evaluations for periodontal drug products.
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Valsan S, Biniraj KR, Emmatty R, Paul TP, Jose P, Divyasree KA. The effect of chlorhexidine gluconate chips on clinical status of peri-implant mucosa and plaque formation on healing abutments following single-stage implant surgeries. J Indian Soc Periodontol 2022; 26:585-590. [PMID: 36582945 PMCID: PMC9793918 DOI: 10.4103/jisp.jisp_382_21] [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: 06/10/2021] [Revised: 10/10/2021] [Accepted: 10/31/2021] [Indexed: 12/12/2022] Open
Abstract
Background An experimental study was designed to evaluate the effect of chlorhexidine gluconate chips on clinical status of peri-implant mucosa and plaque formation on healing abutments following single-stage implant surgeries. Materials and Methods Twenty-eight single-stage implant sites were grouped into 14 test and control sites. The study commences from the time of suture removal following surgery, designated as day 0. Chlorhexidine chip insertion into peri-implant sulcus in test sites was done on day 0, 10, and 20. Peri-implant crevicular fluid was collected on day 0, 10, 20, and 30 for biochemical estimation of aspartate aminotransferase (AST). The modified sulcus bleeding index (mBI) score was obtained in both test and control sites on day 10, 20, and 30. On day 30, all the healing abutments were unscrewed and sent for stereomicroscopic analysis to assess the plaque formation on its surface. Results Statistically significant difference was not observed in AST levels and mBI in both test and control groups in various time intervals. In the stereomicroscopic assessment of healing abutment, mild grade of plaque accumulation was seen in three samples in test group, one sample in control group, and severe grade was seen in six samples in test group and nine samples in the control group. Conclusion Inflammatory condition of peri-implant mucosa and plaque retentive properties on healing abutment surface were found to have reduced with the usage of chlorhexidine gluconate chips. However, the study failed to establish a statistically significant correlation of these observations.
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Affiliation(s)
- Swetha Valsan
- Department of Clinical Periodontology and Oral Implantology, Royal Dental College, Palakkad, Kerala, India,Address for correspondence: Dr. Swetha Valsan, Sreya, Near Nellikode Vishnu temple, Chevarambalam P.O. Calicut -673017, Kerala, India. E-mail:
| | - K. R. Biniraj
- Department of Clinical Periodontology and Oral Implantology, Royal Dental College, Palakkad, Kerala, India
| | - Rishi Emmatty
- Department of Clinical Periodontology and Oral Implantology, Royal Dental College, Palakkad, Kerala, India
| | - Tony P. Paul
- Department of Clinical Periodontology and Oral Implantology, Royal Dental College, Palakkad, Kerala, India
| | - Priya Jose
- Department of Clinical Periodontology and Oral Implantology, Royal Dental College, Palakkad, Kerala, India
| | - K. A. Divyasree
- Department of Clinical Periodontology and Oral Implantology, Royal Dental College, Palakkad, Kerala, India
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Kida D, Zakrzewska A, Zborowski J, Szulc M, Karolewicz B. Polymer-Based Carriers in Dental Local Healing-Review and Future Challenges. MATERIALS 2021; 14:ma14143948. [PMID: 34300865 PMCID: PMC8308048 DOI: 10.3390/ma14143948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/01/2021] [Accepted: 07/08/2021] [Indexed: 02/01/2023]
Abstract
Polymers in drug formulation technology and the engineering of biomaterials for the treatment of oral diseases constitute a group of excipients that often possess additional properties in addition to their primary function, i.e., biological activity, sensitivity to stimuli, mucoadhesive properties, improved penetration of the active pharmaceutical ingredient (API) across biological barriers, and effects on wound healing or gingival and bone tissue regeneration. Through the use of multifunctional polymers, it has become possible to design carriers and materials tailored to the specific conditions and site of application, to deliver the active substance directly to the affected tissue, including intra-periodontal pocket delivery, and to release the active substance in a timed manner, allowing for the improvement of the form of application and further development of therapeutic strategies. The scope of this review is polymeric drug carriers and materials developed from selected multifunctional groups of natural, semi-synthetic, and synthetic polymers for topical therapeutic applications. Moreover, the characteristics of the topical application and the needs for the properties of carriers for topical administration of an active substance in the treatment of oral diseases are presented to more understand the difficulties associated with the design of optimal active substance carriers and materials for the treatment of lesions located in the oral cavity.
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Affiliation(s)
- Dorota Kida
- Department of Drug Form Technology, Wroclaw Medical University, Borowska 211 A, 50-556 Wroclaw, Poland;
- Correspondence: ; Tel.: +48-71-784-0315
| | - Aneta Zakrzewska
- Department of Periodontology, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland; (A.Z.); (J.Z.); (M.S.)
| | - Jacek Zborowski
- Department of Periodontology, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland; (A.Z.); (J.Z.); (M.S.)
| | - Małgorzata Szulc
- Department of Periodontology, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland; (A.Z.); (J.Z.); (M.S.)
| | - Bożena Karolewicz
- Department of Drug Form Technology, Wroclaw Medical University, Borowska 211 A, 50-556 Wroclaw, Poland;
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Use of chlorhexidine chip after scaling and root planning on periodontal disease: A systematic review and meta-analysis. Saudi Dent J 2021; 33:1-10. [PMID: 33473236 PMCID: PMC7801239 DOI: 10.1016/j.sdentj.2020.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/22/2020] [Accepted: 11/01/2020] [Indexed: 11/26/2022] Open
Abstract
Objective This systematic review aims to assess the efficacy chlorhexidine chip as an adjunctive therapy of scaling and root planning on periodontal disease treatment. Material and methods This study follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) and was registered in the PROSPERO database (CRD42019148221). The search was performed in PubMed/MEDLINE, Scopus, and Cochrane databases until April 2020. The PICO question was: “Is the chlorhexidine chip (CHX) effective as an adjunctive therapy of scaling and root planning on periodontal disease treatment?”. Inclusion criteria involved: randomized controlled clinical trials, with a minimum of 15 patients included on the sample and each patient has two sites of probing depth of ≥5 mm; The minimum follow up was at least 1 months of follow-up and the outcomes present in the studies probing depth (PD), plaque index (PI) and clinical attachment level (CAL) after scaling and root planning (SRP). Results After searching the databases, 13 articles were selected for qualitative and 8 for quantitative analysis. Were included 427 patients, with a mean age of 45.6 years. The results shown that the association of chlorhexidine chips to scaling and root planning reduce periodontal pocket depths (P < 0.00001; MD −0.77 [CI −1.0 to −0.55]; I2 = 23%, P = 0.24), gain on the clinical attachment level (P < 0.0001; MD −0.57 [CI −0.86 to −0.27]; I2 = 33%, P = 0.18P < 0.0001) and reduction on plaque index (P = 0.04; MD −0.23 [CI −0.45 to −0.01]; I2 = 91%, P < 0.00001). Conclusions Thus, we can conclude that chlorhexidine chip when used associated to scaling and root planning promoted a significant improvement the reduction of periodontal diseases.
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Brookes ZLS, Bescos R, Belfield LA, Ali K, Roberts A. Current uses of chlorhexidine for management of oral disease: a narrative review. J Dent 2020; 103:103497. [PMID: 33075450 PMCID: PMC7567658 DOI: 10.1016/j.jdent.2020.103497] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/04/2020] [Accepted: 10/10/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Chlorhexidine (CHX) is a commonly used antiseptic mouthwash, used by dental practitioners and the public, due to its antimicrobial effects. The aim of this article was to provide a narrative review of current antimicrobial uses of CHX relevant to dentistry in the context of oral diseases, highlighting need for further studies to support its safe and appropriate use. STUDY SELECTION, DATA AND SOURCES Randomised controlled trials, systematic reviews and national (UK and US) guidelines were consulted where available, with search terms for each subject category entered into MEDLINE, PubMed, Google Scholar and the Cochrane database. RESULTS Some evidence existed to support adjunctive short-term use of CHX to manage dental plaque, and reduce clinical symptoms of gingivitis, dry socket, as well as reduce aerosolisation of bacteria. However, use must be weighed alongside the less desirable effects of CHX, including extrinsic staining of teeth, antimicrobial resistance to antiseptic agents and the rare, but fatal, allergic reactions to CHX. Conversely, evidence for the effectiveness of chlorhexidine to manage or prevent periodontitis, dental caries, necrotising periodontal diseases, peri-implantitis, and infections associated with extraction and aerosolised viruses remains less certain. CONCLUSIONS The use of CHX in dentistry and oral healthcare continues to be widespread and thus it is important that dental practitioners understand that, based on its differential mechanisms of action on different microbes, appropriate clinical and dental use of CHX should be oral disease specific. However, further scientific and clinical research is required before full recommendations can be made.
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Affiliation(s)
- Zoë L S Brookes
- Peninsula Dental School, University of Plymouth, Plymouth, PL4 8AA, UK.
| | - Raul Bescos
- School of Health Professions, University of Plymouth, Plymouth, PL4 8AA, UK
| | - Louise A Belfield
- Peninsula Dental School, University of Plymouth, Plymouth, PL4 8AA, UK
| | - Kamran Ali
- Peninsula Dental School, University of Plymouth, Plymouth, PL4 8AA, UK
| | - Anthony Roberts
- Cork University Dental School and Hospital/University College Cork, Wilton, Cork, T12 E8YV, Ireland
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Ma L, Diao X. Effect of chlorhexidine chip as an adjunct in non-surgical management of periodontal pockets: a meta-analysis. BMC Oral Health 2020; 20:262. [PMID: 32957945 PMCID: PMC7507294 DOI: 10.1186/s12903-020-01247-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 09/07/2020] [Indexed: 01/19/2023] Open
Abstract
Background The aim of this meta-analysis was to evaluate the difference in treatment outcomes between sub-gingival placement of chlorhexidine chip (CHX chip) in adjunct to scaling and root planing (SRP) and SRP alone for the management of periodontal pockets in patients suffering from chronic periodontitis. Methods We searched the MEDLINE (PubMed), SCOPUS and CENTRAL databases and identified 15 randomized clinical trials published within the last decade (2007–2019): 9 with split-mouth design and 6 with parallel study design. We extracted data and performed both qualitative and quantitative syntheses. The primary outcomes assessed were gain in clinical attachment level (CAL), reduction in probing pocket depth (PPD), improvement in gingival inflammation, and results of microbiological assays. Results We used meta-analysis plots to assess all the clinical outcomes. The mean differences in PPD reductions at 1 month (MD 0.63), 3 months (MD 0.69), and 6 months (MD 0.75); and the CAL gains at 1 month (MD 0.54), 3 months (MD 0.64), and 6 months (MD 0.68) showed more favorable responses in sites treated with the CHX chip as an adjuvant to SRP, than in sites treated with SRP alone. Conclusion SRP with adjunctive CHX chips showed better clinical outcomes than SRP alone for the management of periodontal pockets in patients with chronic periodontitis.
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Affiliation(s)
- Lili Ma
- Department of stomatology, Zaozhuang Maternal and Child Health Hospital, Zaozhuang, 277100, Shandong, China
| | - Xiuchun Diao
- Department of stomatology, Zaozhuang Hospital of Traditional Chinese Medicine, 2666 Taihangshan Road, Xuecheng District, Zaozhuang, Shandong, 277000, P.R. China.
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Aggarwal G, Verma S, Gupta M, Nagpal M. Local Drug Delivery Based Treatment Approaches for Effective Management of Periodontitis. CURRENT DRUG THERAPY 2019. [DOI: 10.2174/1574885514666190103112855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Periodontal disease is an immuno-inflammatory condition of
tissues that surround and hold the teeth. It is the disease which succeeds in all races,
groups and both genders. Almost 10 to15% of the global population gets suffered from
severe periodontitis as per WHO reports. Periodontal disease may likely cause other systemic
diseases such as cardiovascular disease and pre-term low birth weight infants. Mechanical
removal of plaques and calculus deposits from supra and subgingival environment
is the backbone of periodontal treatment till date whereas complete elimination of
these deleterious agents is quite unrealistic as the pocket depth increases.
Recent Approaches:
Recently controlled local drug delivery application is more encouraging
in comparison to systemic approach as it mainly targets to enhance the therapeutic
efficacy by maintaining site-specificity, avoiding first pass metabolism, reduction in gastrointestinal
(GI) side effects and decreasing the dose. Several drugs such as antiseptics
and antibiotics alongwith various carriers are being formulated as local drug delivery systems
for effective management of the disease. Various local delivery systems reported are
fibers, films, strips, compacts, injectables, microparticles, vesicular carriers, gels and
nanoparticles. These local carriers provide effective prolonged treatment at the site of
infection at reduced doses. This review enlightens detailed pathophysiology and various
phases of periodontitis, challenges in treatment of disease and various antimicrobial
agents (along with their marketed formulations) used. The main emphasis of the review is
to cover all carrier systems developed so far for local delivery application in the effective
management of periodontitis, as a patient compliant drug therapy.
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Affiliation(s)
- Geeta Aggarwal
- Delhi Pharmaceutical Sciences and Research University, Pushp Vihar, Sector-3 MB Road, New Delhi-110017, India
| | - Sonia Verma
- Delhi Pharmaceutical Sciences and Research University, Pushp Vihar, Sector-3 MB Road, New Delhi-110017, India
| | - Madhu Gupta
- Delhi Pharmaceutical Sciences and Research University, Pushp Vihar, Sector-3 MB Road, New Delhi-110017, India
| | - Manju Nagpal
- Chitkara College of Pharmacy, Chitkara University, Chandigarh-Patiala National Highway, Rajpura, Patiala-140401, India
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Hugar SS, Patil S, Metgud R, Nanjwade B, Hugar SM. Influence of application of chlorhexidine gel and curcumin gel as an adjunct to scaling and root planing: A interventional study. J Nat Sci Biol Med 2016; 7:149-54. [PMID: 27433065 PMCID: PMC4934104 DOI: 10.4103/0976-9668.184701] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Currently, the most common therapy for periodontal diseases consists of professional scaling and root planing (SRP). However, it was found to be of limited efficacy especially in areas which are inaccessible to periodontal instrumentation. Therefore, treatment strategies using antimicrobials in conjunction with conventional therapy have evolved. Thus, the study was undertaken with an. Aim: To evaluate the efficacy of application of chlorhexidine gel and curcumin gel as an adjunct to SRP. Materials and Methods: The study was conducted on thirty chronic periodontitis patients who were divided into two groups as control and experimental groups using a split-mouth design. After SRP chlorhexidine gel was applied in control and curcumin gel in experimental groups. The plaque index, gingival index, sulcus bleeding index, probing pocket depth were recorded at baseline and subsequently after 1 month and 45 days. Results: The results revealed that both chlorhexidine gel and curcumin gel have an effect on mild to moderate periodontal pockets in chronic periodontitis patients, but greater reduction was observed in the experimental group than the control group. Conclusion: It can be concluded that both control and experimental gel can be used as an adjunct to SRP, but the curcumin gel was more effective than the chlorhexidine gel in the treatment of mild to moderate periodontal pockets with a significant reduction in the indice scores when compared to the baseline values.
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Affiliation(s)
- Shweta S Hugar
- Department of Periodontics, KLE VK Institute of Dental Sciences, KLE University, Belgaum, Karnataka, India
| | - Suvarna Patil
- Department of Periodontics, Maratha Mandal's NGH Institute of Dental Sciences, Belgaum, Karnataka, India
| | - Renuka Metgud
- Department of Periodontics, KLE VK Institute of Dental Sciences, Belgaum, Karnataka, India
| | - Basavraj Nanjwade
- Department of Pharmaceutics, KLES College of Pharmacy, Belgaum, Karnataka, India
| | - Shivayogi M Hugar
- Department of Pedodontics and Preventive Dentistry, KLE VK Institute of Dental Sciences, Belgaum, Karnataka, India
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Jose KA, Ambooken M, Mathew JJ, Issac AV, Kunju AP, Parameshwaran RA. Management of Chronic Periodontitis Using Chlorhexidine Chip and Diode Laser-A Clinical Study. J Clin Diagn Res 2016; 10:ZC76-80. [PMID: 27190958 DOI: 10.7860/jcdr/2016/13241.7669] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 07/25/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The use of adjuncts like chlorhexidine local delivery and diode laser decontamination have been found to improve the clinical outcomes of scaling and root planing in non-surgical periodontal therapy in patients with chronic periodontitis. AIM To evaluate the effects of diode laser and chlorhexidine chip as adjuncts to scaling and root planing in the management of chronic periodontitis. The objective is to evaluate the outcome of chlorhexidine chip and diode laser as adjuncts to scaling and root planing on clinical parameters like Plaque Index, Gingival Index, probing pocket depth and clinical attachment level. STUDY AND DESIGN Department of Periodontics. Randomized clinical trial with split mouth design. MATERIALS AND METHODS Fifteen chronic periodontitis patients having a probing pocket depth of 5mm-7mm on at least one interproximal site in each quadrant of the mouth were included in the study. After initial treatment, four sites in each patient were randomly subjected to scaling and root planing (control), chlorhexidine chip application (CHX chip group), diode laser (810 nm) decontamination (Diode laser group) or combination of both (Diode laser and chip group). Plaque Index (PI), Gingival Index (GI), probing pocket depth (PPD) and clinical attachment level (CAL) were assessed at baseline, one month and three months. STATISTICAL ANALYSIS Results were statistically analysed using paired T test, one-way ANOVA, Tukey's HSD test and repeated measure ANOVA. RESULTS Post-treatment, the test and control sites showed a statistically significant reduction in PI, GI, PPD, and CAL. After three months, a mean PPD reduction of 1.47±0.52 mm in control group, 1.40±0.83 mm in diode laser group, 2.67±0.62 mm in CHX group, and 2.80± 0.77 mm in combination group was seen. The mean gain in CAL were 1.47±0.52 mm in the control group, 1.40±0.83 mm in diode laser group, 2.67± 0.49 mm in CHX group and 2.67± 0.82 mm in combination group respectively. The differences in PPD reduction and CAL gain between control group and CHX chip and combination groups were statistically significant (p<0.05) at three months, whereas, the diode laser group did not show any significant difference from the control group. CONCLUSION Chlorhexidine local delivery alone or in combination with diode laser decontamination is effective in reducing probing pocket depth and improving clinical attachment levels when used as adjuncts to scaling and root planing in non-surgical periodontal therapy of patients with chronic periodontitis.
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Affiliation(s)
- Kachapilly Arun Jose
- Post Graduate Student, Department of Periodontics, Mar Baselios Dental College , Kothamangalam, Kerala, India
| | - Majo Ambooken
- Professor and Head, Department of Periodontics, Mar Baselios Dental College , Kothamangalam, Kerala, India
| | - Jayan Jacob Mathew
- Professor, Department of Periodontics, Mar Baselios Dental College , Kothamangalam, Kerala, India
| | - Annie Valayil Issac
- Post Graduate Student, Department of Periodontics, Mar Baselios Dental College , Kothamangalam, Kerala, India
| | - Ajithkumar Parachalil Kunju
- Post Graduate Student, Department of Periodontics, Mar Baselios Dental College , Kothamangalam, Kerala, India
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John P, Lazarus F, George JP, Selvam A, Prabhuji MLV. Adjunctive Effects of A Piscean Collagen-Based Controlled-Release Chlorhexidine Chip in the Treatment of Chronic Periodontitis: A Clinical and Microbiological Study. J Clin Diagn Res 2015; 9:ZC70-4. [PMID: 26155567 DOI: 10.7860/jcdr/2015/11534.5965] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 03/25/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION PerioChip a bovine origin gelatine based CHX chip has shown beneficial effects in the management of Chronic Periodontitis. A new fish collagen based CHX chip similar to PerioChip is currently available; however this product has not been thoroughly researched. AIM The aim of the present study was to evaluate the effectiveness of a new Piscean collagen-based controlled-release chlorhexidine chip (CHX chip) as an adjunctive therapy to scaling and root planing (SRP). SETTINGS AND DESIGN The study was conducted as a randomised, split-mouth, controlled clinical trial at Krishnadevaraya College of Dental Sciences, Bangalore, India. MATERIALS AND METHODS In a split-mouth study involving 20 sites in 10 patients with chronic periodontitis, control sites received scaling and root planing and test sites received scaling and root planing (SRP) and the intrapocket CHX chip placement as an adjunct. Subgingival plaque samples were collected from both control and test sites at baseline, 11 days and 11 weeks and the anaerobic colony count were assessed. Clinical parameters that were recorded at baseline and 11 weeks were gingival index, Plaque index, Probing pocket depth (PPD), and Clinical attachment level (CAL). Plaque index was recorded additionally at 11 days. RESULTS In the test group there was a statistically significant reduction in the total anaerobic colony count, gingival index and plaque scores from baseline as compared to control sites at all time intervals. An additional 0.8mm reduction in mean probing pocket depth was noted in the test group. Gain in Clinical attachment level was comparable in both groups. CONCLUSION The adjunctive use of the new collagen-based CHX chip yielded significant antimicrobial benefit accompanied by a reduction in probing depth and a clinical attachment level gain as compared to SRP alone. This suggests that it may be a useful treatment option of nonsurgical periodontal treatment of chronic periodontitis.
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Affiliation(s)
- Priya John
- Senior Lecturer, Mar Baselious Dental College , Kothamangalam, Kerala, India
| | - Flemingson Lazarus
- Former Professor and HOD, Department of Periodontology, Best Dental College , Madurai, India
| | - Joann Pauline George
- Professor, Department of Periodontics, Krishnadevaraya College of Dental Sciences , Bangalore, India
| | - Arul Selvam
- Professor and HOD, Department of Microbiology, Krishnadevaraya College of Dental Sciences , Bangalore, India
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