minocycline and Periodontal-Pocket

This study aimed to evaluate the efficacy of 2% minocycline hydrochloride combined with flap surgery in the treatment of chronic periodontitis. The superiority of this therapy to simple flap surgery was also explored.. We searched the databases of CNKI, VIP, Wanfang, Chinese Biomedical Literature, PubMed, ScienceDirect, and Embase from inception to July 2017. Two reviewers independently screened literature, extracted data, and evaluated the bias risk of included studies. Then, Meta-analysis was performed using RevMan 5.3 software.. A total of seven randomized controlled trials involving 217 patients were included. Meta-analysis showed that, in two groups, the changes in probing depth (PD) [MD=-0.55, 95%CI (-0.84, -0.26), P=0.000 2] and plaque index [MD=-0.08, 95%CI (-0.15, -0.01), P=0.03] at 3 and 6 months of PD [MD=-0.62, 95%CI (-1.04, -0.21), P=0.003] had statistically significant difference (P<0.05). The clinical attachment loss (CAL) [MD=-0.21, 95%CI (-0.47, 0.04), P=0.10] had no statistically significant difference after 3 months (P>0.05), but the improvement in CAL was significantly improved by minocycline hydrochloride combined with flap therapy.. Periodontal flap combined with minocycline adjuvant therapy for chronic periodontitis is effective in short-term observations.. 目的 系统评价牙周翻瓣术中使用2%盐酸米诺环素处理根面的疗效，为其治疗慢性牙周炎提供循证医学证据。方法 检索中国期刊全文数据库、维普、万方、中国生物医学文献数据库、PubMed、ScienceDirect和Embase等数据库，检索时限为从建库到2017年7月。由2名评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后，采用RevMan 5.3对数据进行Meta分析。结果 最终纳入7个随机对照实验，共217例受试者。Meta分析结果显示，与单纯翻瓣术（FO）组比较，盐酸米诺环素联合翻瓣术（FM）组患者随访3个月时的探诊深度减少[MD=-0.55，95%CI（-0.84，-0.26），P=0.000 2]，菌斑指数降低[MD=-0.08，95%CI（-0.15，-0.01），P=0.03]，随访6个月时探诊深度减少[MD=-0.62，95%CI（-1.04，-0.21），P=0.003]方面更加明显，组间比较差异有统计学意义（P<0.05）。FM组患者随访3个月时在临床附着丧失获得[MD=-0.21，95%CI（-0.47，0.04），P=0.10]方面改变的差异无统计学意义（P>0.05）。结论 在翻瓣下机械清创治疗慢性牙周炎中，使用2%盐酸米诺环素处理根面减少探诊深度和炎症控制方面有明显的效果。.

Topics: Anti-Bacterial Agents; Chronic Periodontitis; Dental Plaque Index; Humans; Minocycline; Periodontal Pocket; Surgical Flaps

This paper reports a meta-analysis of studies that have investigated the effect of scaling and root planing on periodontal probing depth and attachment loss.. The criteria used for inclusion of studies were as follows: root planing and scaling alone was one of the primary treatment arms; patients or quadrants of each patient were randomly assigned to study groups; 80% of patients enrolled were included in first year follow-up examinations; periodontal probing depth and attachment loss were reported in mm; the sample size of each study and substudy was reported. Sample size was used to weight the relative contribution of each study since standard errors were not reported by many studies and sample size is highly correlated with standard error and therefore statistically able to explain a substantial portion of the standard error on studies that use similar measures.. The meta-analysis results show that periodontal probing depth and gain of attachment level do not improve significantly following root planing and scaling for patients with shallow initial periodontal probing depths. However, there was about a 1-mm reduction for medium initial periodontal probing depths and a 2-mm reduction for deep initial periodontal probing depths. Similarly, there was about a 0.50-mm gain in attachment for medium initial periodontal probing depth measurements and slightly more than a l-mm gain in attachment for deep initial periodontal probing depth measurements. Surgical therapy for patients with deep initial probing depths showed better results than scaling and root planing in reducing probing depths. When patients were followed up over 3 years or more, these differences were reduced to less than 0.4 mm. Antibiotic therapy showed similar results to scaling and root planing. However, a consistent improvement in periodontal probing depth and gain of attachment is demonstrated when local antibiotic therapy is combined with root planing and scaling.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Combined Modality Therapy; Dental Scaling; Follow-Up Studies; Humans; Metronidazole; Minocycline; Periodontal Attachment Loss; Periodontal Pocket; Randomized Controlled Trials as Topic; Root Planing; Sample Size; Statistics as Topic; Surgical Flaps; Tetracycline; Treatment Outcome

Since it is a disease mainly caused by plaque--an aggregate of various bacteria--periodontal disease can be considered a local infection. Thus, it has seemed reasonable to utilize antibiotics to suppress the intrapocket bacteria, specifically or nonspecifically. When antibiotics are administered orally, however, massive doses over a prolonged period of time are needed to attain a therapeutic effect. This increases the risk of adverse reactions as well as developing resistant strains of bacteria. To overcome these problems, local drug delivery systems (LDDS) were devised to combat the local infection. However, the intrapocket antibiotic delivery systems have yet to be fully evaluated for clinical effectiveness; to prove the therapeutic effectiveness of locally administered antibiotics, the drug must reach the base of the periodontal pocket and the effective concentration of the antibiotic against the pathogenic bacteria must be maintained for a long time. This concise review presents with figures, tables, and a comprehensive list of references the many studies which have used the various tetracyclines as LDDS to treat periodontal disease.

Topics: Administration, Topical; Anti-Bacterial Agents; Bacterial Infections; Biodegradation, Environmental; Delayed-Action Preparations; Drug Delivery Systems; Humans; Minocycline; Periodontal Pocket; Tetracycline; Therapeutic Irrigation

Periodontal therapy has the primary aim of halting periodontal disease progression. Clinical trials over the years have indicated that meticulous scaling and root planing in conjunction with a patient's proper plaque control can arrest periodontitis, but this therapy is not always completely effective and thus adjunctive therapies need to be considered. Local delivery of antibacterial agents into periodontal pockets has been extensively developed and investigated since the late 1970s and many systems have been designed to maintain high levels of antimicrobial agents in the crevicular fluid with minimal systemic uptake. More recently subgingival antimicrobial delivery systems have become available to the practising periodontist for clinical use. These systems, employ different antimicrobial agents but also different delivery systems which influence the concentration of available drug over time. The dental profession is confused by the wide variety of available slow release subgingival antimicrobial devices on the market and clearly comparative independent assessment of these therapies is needed. This review will summarise the findings of a comparative study on three commonly available periodontal local delivery antimicrobial systems on sites with previously unsuccessful mechanical therapy. The slow release devices studied adjunctively with root planing were: Actisite, Dentomycin and Elyzol, compared to root planing alone. Substantivity of an antimicrobial system is the ability of the system to maintain an effective concentration of drug over time which may be the most significant difference between the three delivery systems rather than the type of antimicrobial drug used. Although all three locally applied antimicrobial systems seem to offer some benefit over scaling and root planing alone, a treatment regime of scaling and root planing plus tetracycline fibre placement gave the greatest reduction in probing pocket depth over the six months after treatment.

Topics: Administration, Topical; Anti-Bacterial Agents; Anti-Infective Agents; Biocompatible Materials; Cellulose; Delayed-Action Preparations; Dental Scaling; Disease Progression; Drug Delivery Systems; Gingival Crevicular Fluid; Glycerides; Humans; Metronidazole; Minocycline; Periodontal Diseases; Periodontal Pocket; Root Planing; Sesame Oil; Tetracycline

Since last reviewing the field, controlled release products have made the jump from research to clinical practice. The potential to extend the efficacy of periodontal therapy with such products is exciting, but also needs careful evaluation. This review will look at recent developments and also will examine the eventual place for these products in periodontics.

Topics: Anti-Bacterial Agents; Delayed-Action Preparations; Drug Delivery Systems; Gels; Humans; Metronidazole; Minocycline; Patient Care Planning; Patient Selection; Periodontal Pocket; Periodontitis; Polyvinyls; Root Planing; Tetracycline

This study tests the effects of scaling and root planing (SRP) versus SRP plus minocycline hydrochloride microspheres (SRP+MM) on 11 periodontal pathogens and clinical outcomes in Stage II-IV Grade B periodontitis participants.. Seventy participants were randomized to receive SRP (n = 35) or SRP+MM (n = 35). Saliva and clinical outcomes were collected for both groups at baseline before SRP, 1-month reevaluation, and at 3- and 6-month periodontal recall. MM were delivered to pockets ≥5 mm immediately after SRP and immediately after the 3-month periodontal maintenance in the SRP+MM group. A proprietary saliva test. Significant reduction in Tannerella forsythia, Treponema denticola, Fusobacterium nucleatum, Prevotella intermedia, Parvimonas micra, and Eikenella corrodens were identified at the 1-month reevaluation after SRP+MM. Six months after SRP with a re-application of MM 3 months after SRP, Fusobacterium nucleatum, Prevotella intermedia, Campylobacter rectus, and Eikenella corrodens were significantly reduced. SRP+MM participants had significant clinical outcome reductions in pockets ≥5 mm at the reevaluation, 3- and 6-month periodontal maintenance, and clinical attachment loss gains at the 6-month periodontal maintenance.. MM delivered immediately after SRP and reapplication at 3 months appeared to contribute to improved clinical outcomes and sustained decreased numbers of Fusobacterium nucleatum, Prevotella intermedia, Campylobacter rectus, and Eikenella corrodens at 6 months.

Topics: Anti-Bacterial Agents; Dental Scaling; Eikenella corrodens; Follow-Up Studies; Fusobacterium nucleatum; Humans; Microspheres; Minocycline; Periodontal Attachment Loss; Periodontal Pocket; Prevotella intermedia; Root Planing

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Dental Scaling; Female; Follow-Up Studies; Gingival Crevicular Fluid; Gingival Hemorrhage; Humans; Male; Microspheres; Middle Aged; Minocycline; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Root Planing

To investigate the additional influence of either antimicrobial photodynamic therapy (aPDT; Helbo® Photodynamic Systems) or local application of minocycline microspheres (MC; Arestin, OraPharma) on clinical and microbiological healing results in deep periodontal pockets (PPD ≥6 mm) following non-surgical periodontal therapy (SRP).. Forty-five patients with chronic periodontitis were evaluated: test group aPDT + SRP (n = 15), positive control group MC + SRP (n = 15), and negative control group SRP-alone (n = 15). Clinical and microbiological healing parameters were recorded in every patient for four experimental teeth at baseline, 6 weeks, and 3, 6, and 12 months. Wilcoxon signed-rank test and Mann-Whitney U test were used for statistical analysis (α = 0.05).. Significant improvements in clinical and microbiological parameters were found for all groups after 6 weeks and 3, 6, and 12 months. Differences between groups were not statistically significant. Changes after 12 months [median (25/75%)] are as follows: reduction in PPD [mm]: aPDT + SRP 2 (1/3), MC + SRP 3 (1/4), SRP-alone 2 (1/3); percentage of residual BOP positive teeth [%]: aPDT + SRP 75 (25/100), MC + SRP 33.3 (0/50), SRP-alone 66.7 (25/75).. Within the limitations of this study, neither the applied aPDT system nor MC showed a significant additional influence on clinical and microbiological healing outcomes in deep periodontal pockets compared to SRP alone.. In deep periodontal defects, the efficacy of non-surgical periodontal treatment seems not to be improved by adjunctive use of antimicrobial photodynamic therapy or minocycline microspheres.

Topics: Anti-Infective Agents; Chronic Periodontitis; Female; Humans; Male; Microspheres; Middle Aged; Minocycline; Periodontal Pocket; Photochemotherapy; Treatment Outcome

The aim of this study was to evaluate clinical and microbiological effects of subgingival minocycline microgranules when used as an adjunct to scaling and root planing in subjects with Chronic periodontitis. Twenty-six non-smoker volunteers participated in the study. Four opposite sites, clinically standardized, with bleeding on probing (BOP) and pocket depth (PD) ≥ 6 mm were selected. Baseline BOP, PD and Clinical attachment level (CAL) were measured and microbiological samples were collected from the study sites and analyzed using PCR. Porphyromonas gingivalis (Pg) Tannerella forsythia (Tf), Treponema denticola (Td) and Aggregatibacter actinomycetemcomitans (Aa) were detected. One side of the mouth was randomly allocated to the experimental treatment: scaling and root planing plus minocycline microgranules (Test group=T) and the other side of the mouth to scaling and root planing alone (Control group=C). At days 30 and 90, clinical and microbiological examination was repeated. After 30 days BOP was reduced to 81% in C and to 12% in T and at day 90 to 58% in C and to 8% in T (p<0.05). PD was significantly reduced in both groups (C: 4.8mm, T: 4.2mm) favoring T at days 30 and 90 (p<0.05). CAL reduction at day 30 showed no difference between groups. At day 90, CAL reduction was higher in T (p<0.05). At days 30 and 90 Pg, Tf, Td and Aa was reduced in both groups. Pg reduction was significantly greater in group T. At day 90 frequency of sites with Td decreased in T and increased in C (p<0.05). No adverse effect was observed. This study showed that minocycline microgranules adjunct to scaling and root planing resulted in grater reduction of BOP and PD, higher CAL gain, increased probability of Pg suppression and retarded recolonization of Td than root instrumentation alone.

Topics: Chronic Periodontitis; Dental Scaling; Follow-Up Studies; Humans; Minocycline; Periodontal Pocket; Porphyromonas gingivalis; Root Planing

The aim of this study was to evaluate changes in clinical parameters and levels of inflammatory biomarkers in plasma in periodontal patients with poorly controlled type 2 diabetes mellitus (T2DM) after non-surgical periodontal therapy. Twenty-eight poorly controlled T2DM patients were randomly assigned to treatment with scaling and root planning (SRP) and SRP + subgingival minocycline administration. Clinical parameters, including the probing depth (PD), bleeding on probing (BOP), plaque score (PS), clinical attachment level (CAL), and plasma interleukin (IL)-6, soluble receptor of advanced glycation end products (sRAGE), chronic reactive protein (CRP), and hemoglobin A1c (HbA1c) were measured before and after a 6-month treatment period. Significant changes in PD, BOP, PS, and CAL were found in both groups. The latent growth curve model showed an overall reduction in the log HbA1c level in the SRP group (-0.082, p = 0.033). Small changes in the log sRAGE level and log CRP level in plasma were found in both groups. IL-6 in the plasma increased in the SRP group, but slightly decreased in the SRP+minocycline group (0.469 pg/ml, p = 0.172). Non-surgical periodontal therapy with or without subgingival minocycline application may achieve significant periodontal improvement and moderate improvement in HbA1c, but had no significant effect on plasma levels of IL-6, CRP, or sRAGE in patients with poorly controlled T2DM. For patients with both periodontal diseases and diabetes, non-surgical periodontal treatments may be helpful in their diabetic control.

Topics: Administration, Topical; Adult; Aged; Anti-Bacterial Agents; C-Reactive Protein; Dental Plaque Index; Dental Scaling; Diabetes Mellitus, Type 2; Female; Follow-Up Studies; Gingival Hemorrhage; Glycated Hemoglobin; Glycation End Products, Advanced; Humans; Interleukin-6; Male; Middle Aged; Minocycline; Periodontal Attachment Loss; Periodontal Diseases; Periodontal Pocket; Receptor for Advanced Glycation End Products; Receptors, Immunologic; Root Planing

The purpose of this study was to determine the effectiveness of adjunctive application of locally delivered minocycline ointment associated with flap surgery for the treatment of patients with chronic severe periodontitis.. Twenty patients with chronic severe periodontitis were treated in a split-mouth study to either adjunctive application of locally delivered minocycline ointment in association with flap surgery (FM) or flap surgery only (FO); additional minocycline application was performed at 3 months post operation. Clinical evaluation of the plaque index, probing depth (PD), bleeding on probing (BOP), gingival recession, and clinical attachment level (CAL) was conducted at baseline and at 3 and 6 months after treatment.. Clinical evaluations revealed that although both sites exhibited clinical improvement, there was a statistically significant reduction in PD (3.34 ± 0.03 mm) and BOP (78.01 ± 11.42%), and a significant gain of CAL (1.88 ± 0.21 mm) at the FM site compared with the FO site (reduction of PD and BOP: 2.62 ± 0.06 mm, 50.33 ± 15.01%, and gain of CAL: 1.55 ± 0.13 mm) at 6 months post operation (p < 0.05).. Adjunctive application of locally delivered minocycline may be beneficial to the surgical treatment protocol of chronic severe periodontitis.

Topics: Administration, Topical; Adult; Aged; Anti-Bacterial Agents; Chronic Periodontitis; Combined Modality Therapy; Dental Plaque Index; Female; Follow-Up Studies; Gingival Hemorrhage; Gingival Recession; Humans; Male; Middle Aged; Minocycline; Ointments; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Surgical Flaps; Treatment Outcome

To compare the therapeutic effects of minocycline, metronidazole and iodine glycerin on periodontitis.. A total of 123 patients were randomly divided into 3 groups to receive the 3 topical remedies administered into the periodontal pockets. The total response rate of the 3 treatments was calculated, and the changes in GI, PL I, PD and BO P were observed.. All the clinical indices of the 3 groups showed obvious improvements after the treatments compared with the baseline levels. The clinical indices of minocycline group and metronidazole group showed significant greater improvements than those of iodine glycerin group. The total response rate in minocycline group and metronidazole group was higher than that of iodine glycerin group.. Minocycline and metronidazole as topical remedies can be effective auxiliary treatments of periodontitis.

Topics: Administration, Topical; Adult; Aged; Anti-Bacterial Agents; Female; Humans; Iodine; Male; Metronidazole; Middle Aged; Minocycline; Periodontal Pocket; Periodontitis; Young Adult

The objective of this study was to investigate the association between the antimicrobial and clinical efficacy of minocycline hydrochloride microspheres when used adjunctively with scaling and root planing.. 127 subjects with moderate-to-advanced chronic periodontitis were randomly assigned to receive either minocycline microspheres plus scaling and root planing (n = 62) or scaling and root planing alone (n = 65). Deoxyribose nucleic acid analysis and clinical data were obtained at baseline and 30 days after treatment. End points included changes in the mean sum of red complex bacteria, pocket depth, number of deep pockets, bleeding on probing, and clinical attachment level from baseline to day 30. Regression analysis determined the association between microbiological and clinical efficacy.. Minocycline microspheres plus scaling and root planing reduced pocket depth, the number of deep pockets and bleeding on probing, and increased clinical attachment level significantly more than scaling and root planing alone (p < 0.05). Comparing minocycline microspheres plus scaling and root planing with scaling and root planing alone, the number needed to treat for a 2 mm pocket depth reduction difference was 6.5. Pocket depth reduction correlated significantly with a decrease in the numbers and proportions of red complex bacteria. Minocycline microspheres significantly improved all clinical parameters compared to scaling and root planing alone.. The addition of minocycline microspheres to scaling and root planing led to a greater reduction in the proportions and numbers of red complex bacteria. The reduction in pocket depth was significantly correlated with the reduction of the proportions and numbers of red complex bacteria. Additionally, there were statistically greater improvements in all clinical parameters examined.

Topics: Administration, Topical; Analysis of Variance; Anti-Bacterial Agents; Anti-Infective Agents, Local; Chronic Periodontitis; Combined Modality Therapy; Dental Plaque; Dental Scaling; DNA, Bacterial; Drug Delivery Systems; Female; Gram-Negative Anaerobic Bacteria; Humans; Longitudinal Studies; Male; Microspheres; Middle Aged; Minocycline; Periodontal Index; Periodontal Pocket; Severity of Illness Index; Single-Blind Method; Treatment Outcome

The purpose of this study was to evaluate the presence of A. actinomycetemcomitans, P. gingivalis, P. intermedia, E. corrodens and F. nucleatum in 30 subjects with chronic periodontitis treated by scaling and root planing (SRP) plus minocycline (test group) during 12 months with regular trimester maintenance care. Additionally, we evaluated whether the beneficial effects of the therapy on the microbial flora persisted for 24 months. The test group (n = 15) and the control group [SRP plus placebo (n = 15)] were randomly assigned. After SRP, subjects received minocycline or placebo at the baseline, and at 3, 6, and 9 months at all sites with a periodontal pocket depth (PD) of >or= 6 mm. Moreover, two homologous teeth, initially PD >or= 6 mm, were clinically and microbially monitored by PCR at the baseline, and at 3, 6, 9, 12 and 24 months. Differences in mean PD values between groups were analyzed by Student's t-test (P < 0.05). The results for bacterial frequencies showed no significant differences between groups (Fisher's Exact test, P < 0.05) or between time-points (Friedman test, P < 0.05). We failed to detect any differences between groups related to the presence of target pathogens for 12 months. The effects of both therapies on the microbial flora did not persist for 24 months. The group without supportive periodontal therapy showed an improvement in the pattern of pathogens with either of the therapies.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacteria, Anaerobic; Chronic Periodontitis; Colony Count, Microbial; Dental Scaling; DNA, Bacterial; Double-Blind Method; Humans; Middle Aged; Minocycline; Periodontal Pocket; Polymerase Chain Reaction

To investigate changes in bacterial counts in subgingival plaque from patients with acute periodontal abscess by IAI-PadoTest.. Ninety-one patients were randomly allocated to either test or control groups. In all the patients, pockets with acute periodontal abscess were irrigated with sterilized physiological saline, and in the test group, 2% minocycline hydrochloride ointment was applied once into the pocket in addition. Subgingival plaque samples were collected by paper point before treatment and 7 days after treatment. The total bacterial count was determined and Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia, were detected using IAI-PadoTest, a DNA/RNA probe method.. The total bacterial count decreased in both groups, with a significant decrease in the test group. The counts and number of sites positive for P. gingivalis, T. forsythia and T. denticola significantly decreased in the test group after treatment, compared with those in the control group. Pocket depth decreased in the both groups, with a statistically significant decrease in the test group.. Topical treatment with minocycline in pockets with acute periodontal abscess was effective in reducing the bacterial counts as shown by the microbiological investigation using PadoTest 4.5.

Topics: Acute Disease; Administration, Topical; Aged; Anti-Bacterial Agents; Bacterial Typing Techniques; Bacteroides; Colony Count, Microbial; Dental Plaque; DNA Probes; Female; Humans; Male; Middle Aged; Minocycline; Periodontal Abscess; Periodontal Pocket; RNA Probes; Subgingival Curettage; Treatment Outcome

The objective of this trial was to measure the antimicrobial effects of a minocycline HCl microsphere (MM) local drug-delivery system when used as an adjunct to scaling and root planing (SRP). DNA probe analysis for 40 bacteria was used to evaluate the oral bacteria of 127 subjects with moderate to advanced chronic periodontitis.. Subjects were randomly assigned to either SRP alone (N = 65) or MM + SRP (N = 62). The primary endpoints of this study were changes in numbers and proportions of the red-complex bacteria (RCB) and the sum of Porphyromonas gingivalis, Tannerella forsythia (formally T. forsythensis), and Treponema denticola relative to 40 oral bacteria at each test site from baseline to day 30. Numbers of RCB from the five test sites were averaged to provide a value for each subject.. MM + SRP reduced the proportion of RCB by 6.49% and the numbers by 9.4 x 10(5). The reduction in RCB proportions and numbers by SRP alone (5.03% and 5.1 x 10(5), respectively) was significantly less. In addition, MM + SRP reduced probing depth by 1.38 mm (compared to 1.01 mm by SRP alone), bleeding on probing was reduced by 25.2% (compared to 13.8% by SRP alone), and a clinical attachment level gain of 1.16 mm (compared to 0.80 mm by SRP alone) was achieved.. These observations support the hypothesis that RCBs are responsible for periodontal disease and that local antimicrobial therapy using MM + SRP effectively reduces numbers of RCBs and their proportions to a greater extent than SRP alone.

Topics: Administration, Topical; Anti-Bacterial Agents; Bacteria; Bacteroides; Colony Count, Microbial; Dental Plaque; Dental Scaling; Drug Delivery Systems; Female; Gingival Hemorrhage; Humans; Male; Microspheres; Middle Aged; Minocycline; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Root Planing; Single-Blind Method; Treatment Outcome; Treponema denticola

To compare the short-term performance of subgingival local delivery of 2% minocycline gel and conventional subgingival debridement in supportive periodontal therapy (SPT) patients.. Forty adult patients having completed active treatment for moderate to advanced chronic periodontitis were included in a randomized, controlled, single masked maintenance care pilot study. Sites with residual pocket probing depths > or =5 mm and bleeding on probing were treated with either minocycline gel (minocycline-group) or scaling and root planing only (debridement-group) at baseline, 3, 6, and 9 months. Clinical and microbiological examinations were performed at baseline, 3, 6, 9, and 12 months.. Full-mouth plaque and bleeding scores remained <10% and <20%, respectively, for both groups throughout the study. In both groups there was a persistent reduction in number of teeth and sites with probing pocket depths > or =5 mm (p<0.05) with no significant differences between the groups. The prevalence of Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Actinobacillus actinomycetemcomitans, Prevotella intermedia, and Prevotella nigrescens, remained at levels < or =10(5) in the majority of patients and sites in both groups.. This pilot study failed to show a difference between local delivery of 2% minocycline gel as mono-therapy and traditional subgingival debridement in patients on SPT.

Topics: Adult; Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Bacteroides; Colony Count, Microbial; Dental Scaling; Female; Follow-Up Studies; Gels; Gingival Hemorrhage; Humans; Male; Middle Aged; Minocycline; Periodontal Pocket; Periodontitis; Pilot Projects; Porphyromonas gingivalis; Prevotella intermedia; Prevotella nigrescens; Root Planing; Single-Blind Method; Treponema denticola

The clinical benefits of minocycline in combination with thorough scaling and root planing (SRP) have been examined in multicenter studies. The aim of this longitudinal investigation was to evaluate the clinical response to scaling and root planing combined with the use of locally delivered minocycline microspheres for 720 days in individuals with advanced chronic periodontitis.. A total of 26 individuals aged 26 to 69 years (mean: 46.8+/-12.1 years) were included in this double-blind randomized clinical trial. After randomization, 13 individuals were selected for the test group (TG) and treated with SRP plus subgingival minocycline at baseline and 90, 180, and 270 days, and 13 individuals were selected for the control group (CG) and received SRP plus vehicle at the same timepoints. Two homologous sites with probing depth (PD)>or=6 mm were chosen in each subject. To evaluate the clinical response after treatment, PD, plaque index (PI), and gingival index (GI) were assessed at baseline and 90, 180, 270, 360, and 720 days.. No statistical differences were found between test and control groups in relation to PD at the different timepoints. The mean values of PD demonstrated a higher reduction in the test group at 270 and 360 days. No statistical differences were observed at 90, 180, and 720 days between TG and CG (P<0.05; Wilcoxon test). There were no statistically significant differences between TG and CG concerning PI and GI (P<0.05; analysis of variance and t test) at all evaluated timepoints.. Our findings demonstrated that both therapies reduced mean PD from 90 to 360 days; however, SRP combined with the use of subgingival minocycline showed a higher reduction at 270 and 360 days following therapy.

Topics: Adult; Aged; Anti-Bacterial Agents; Chronic Disease; Combined Modality Therapy; Dental Plaque Index; Dental Scaling; Double-Blind Method; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Microspheres; Middle Aged; Minocycline; Periodontal Index; Periodontal Pocket; Periodontitis; Placebos; Root Planing

Severe periodontitis has been associated with increased systemic inflammation. In a three-arm preliminary randomized trial, we investigated the impact of standard (SPT) and intensive periodontal therapy (IPT) on serum inflammatory markers and cholesterol levels. Medical and periodontal parameters, C-reactive protein (CRP), interleukin-6 (IL-6), total cholesterol, and LDL cholesterol were evaluated in 65 systemically healthy subjects suffering from severe generalized periodontitis. Two months after treatment, both SPT and IPT resulted in significant reductions in serum CRP compared with the untreated control (0.5 +/- 0.2 mg/L for SPT, P = 0.030 and 0.8 +/- 0.2 mg/L for IPT, P = 0.001). Similar results were observed for IL-6. Changes in inflammation were independent of age, gender, body mass index, and ethnicity, but a significant interaction between cigarette smoking and treatment regimen was found. The IPT group also showed a decrease in total and LDL cholesterol after 2 months. Analysis of these data indicates that periodontitis causes moderate systemic inflammation in systemically healthy subjects.

Topics: Adult; Age Factors; Anti-Bacterial Agents; C-Reactive Protein; Cholesterol; Cholesterol, LDL; Dental Plaque Index; Female; Follow-Up Studies; Humans; Interleukin-6; Male; Middle Aged; Minocycline; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Sex Factors; Smoking; Subgingival Curettage

The purpose of the present study was to assess the effects of Nd:YAG laser irradiation into periodontal pockets with or without the combination of local antibiotic application on clinical parameters and microbiological prevalence. Sixteen patients, each of whom had 4 or more sites with probing depth e x 4mm were included in this study. They were monitored clinically and microbiologically at baseline, 1 and 3 months after the treatment. Subgingival plaque samples were taken from periodontally involved sites with a probing depth of e x 4mm. A total of 135 sites were randomly assigned to the following treatments; Nd:YAG laser alone (Group L: 10 pps, 200 mJ for 90 sec, n = 37), local minocycline administration following laser treatment (Group LP, n = 33), povidone-iodine irrigation following laser treatment (Group LI, n = 33), and control group (Group C: sham procedure, n = 32). The prevalence of 18 subgingival taxa were determined using the checkerboard technique. The mean value of the pocket probing depth (PPD) significantly decreased in Group L, Group LP and Group LI, and the mean clinical attachment loss (CAL) decreased in all three treatment groups. Multivariate logistic regression analysis showed that Group LP showed the most improvement in PPD or CAL at 3 months. The proportions of Porphyromonas gingivalis, Tannerella forsythia (formerly Bacteroides forsythus) and Prevotella intermedia were significantly lower in Group LP than in Group L after 3 months. These results showed that Nd:YAG laser irradiation plus local minocycline provides a much greater reduction in PPD, CAL and the amount of periodontopathogenic bacteria than laser irradiation alone in periodontitis patients.

Topics: Anti-Infective Agents, Local; Bacteria, Anaerobic; Bacterial Typing Techniques; Colony Count, Microbial; Dental Plaque; DNA, Bacterial; Humans; Laser Therapy; Logistic Models; Middle Aged; Minocycline; Neodymium; Nucleic Acid Hybridization; Periodontal Index; Periodontal Pocket; Povidone-Iodine; Statistics, Nonparametric

This study compared clinical results of 40 periodontal osseous defects treated by two types of absorbable barrier materials.. Thirty patients (23 males and seven females) suffering from moderate to advanced periodontitis (with comparable osseous defects) were randomly assigned to receive either Atrisorb barrier (n = 22; group A) or Resolut XT barrier (n = 18; group B) therapy. Periodontal phase I treatment and oral hygiene instruction were performed before periodontal surgery. Papillary preservation, partial thickness flap, citric acid root conditioning, and decortication procedures were applied during the operation. Bone defects were filled with demineralized freeze-dried bone allograft and minocycline mixture (4:1 ratio). Postoperative care included 0.10% chlorhexidine rinse daily and antibiotic medication for 2 weeks. Clinical assessments including probing depth (PD), clinical attachment level (CAL), gingival recession (GR), plaque index (PII), gingival index (GI), and radiographic examinations were taken at the baseline, preoperatively and at 3 and 6 months after regenerative surgery.. Six months following therapy, both Atrisorb and Resolut XT groups had achieved comparable clinical improvement in pocket reduction (3.9 versus 4.4 mm), attachment tissue gain (clinical attachment gain; 3.5 versus 3.6 mm), and reduction in the GI and in the PII. Within-group comparisons showed significant attachment gain and pocket reduction between baseline data and those at both 3 and 6 months postoperatively (p < 0.01). There were no statistically significant differences in any measured data between groups A and B.. The results of this study indicate that a comparable and favorable regeneration of periodontal defects can be achieved with both Atrisorb and Resolut XT barriers. Further long-term study and histologic observations of tissue healing are needed to evaluate whether Atrisorb is promising for clinical use.

Topics: Absorbable Implants; Adult; Alveolar Bone Loss; Anti-Bacterial Agents; Biocompatible Materials; Bone Transplantation; Dental Plaque Index; Female; Follow-Up Studies; Gingival Recession; Guided Tissue Regeneration, Periodontal; Humans; Lactic Acid; Male; Membranes, Artificial; Middle Aged; Minocycline; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Polyesters; Polyglactin 910; Polymers

Recent studies have demonstrated the effectiveness of locally delivered antibiotics adjunctive with scaling and root planing (SRP) in patients with chronic periodontitis. Specifically, several studies have demonstrated the efficacy of minocycline microspheres (Arestin). The objective of the current study was to evaluate the use of Arestin in a study using private practices all over the United States and adopting a predefined protocol. Eight hundred ninety-five dentists and 2805 patients participated in the largest reported trial in chronic periodontal disease in private practice. The protocol outlined that patients were to have SRP at baseline with one application of Arestin in all pockets > or = 5 mm, a recall visit three months later that included a second application of Arestin, and a final assessment after 6 months. One thousand ninety five patients were treated in accordance with the protocol, and 1710 patients returned for a second assessment but only received one therapeutic intervention. Mean pocket depth reduction from baseline in the 1710 patients was 1.82 mm (p < 0.0001) and for the 1095 patients at 6 months it was 1.94 mm (p < 0.0001). Similar results were obtained in smokers, diabetes patients and patients with a history of cardiovascular disease. After 1 treatment 62% of sites had decreased to less than 5 mm and after two treatments the corresponding number was 67%. There were no serious adverse events in the study. This study demonstrated that a large study could be conducted in a private practice setting, that Arestin and SRP were effective in reducing pocket depth, and that adherence to the protocol yielded additional benefits.

Topics: Anti-Infective Agents, Local; Female; Humans; Male; Middle Aged; Minocycline; Periodontal Diseases; Periodontal Pocket; Statistics, Nonparametric

This article presents the results of a single-arm, open-label, multicenter clinical trial of the topical use of sustained-release minocycline hydrochloride (HCl) microspheres as an adjunct to scaling and root planing. The objective of this study was to evaluate the long-term safety and efficacy of the subgingival application of resorbable minocycline microspheres as an adjunct to scaling and root planing in the treatment of chronic periodontitis. The primary outcome measures were the reduction in probing pocket depth at 9- and 12-month evaluations, and the percent of bleeding upon probing. A total of 173 patients with moderate-to-severe chronic periodontitis were enrolled in this multicenter clinical trial. All patients received full-mouth scaling and root planing plus minocycline microspheres in all periodontal pockets that probed > or = 5 mm. All sites treated at baseline and any new sites > or = 5 mm again received minocycline microspheres at 3- and 6-month follow-up appointments with no further scaling and root planing. Significant improvements in all clinical parameters measured were found at all time points (1, 3, 6, 9 and 12 months). The product was found to be well-tolerated by patients, safe, and easy to deliver. Scaling and root planing with the topical application of minocycline microspheres appeared to give better results than would have been expected with scaling and root planing alone.

Topics: Absorbable Implants; Adult; Anti-Bacterial Agents; Chronic Disease; Combined Modality Therapy; Delayed-Action Preparations; Dental Scaling; Female; Follow-Up Studies; Gingival Hemorrhage; Humans; Male; Microspheres; Minocycline; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Root Planing; Safety; Statistics, Nonparametric; Treatment Outcome

The aim of the present analysis of a larger phase 3 clinical trial was to evaluate the efficacy of 1 mg minocycline hydrochloride microencapsulated in 3 mg of resorbable polymer, subgingivally administered as an adjunct to scaling and root planing (SRP) in smokers with chronic periodontitis.. Two hundred and seventy-one patients who smoked were randomized to one of three treatment groups: (1) SRP alone, (2) SRP plus vehicle (polymer without minocycline) or (3) SRP plus minocycline microspheres. Full mouth SRP was performed for all groups at baseline, and vehicle or minocycline microspheres were administered to the appropriate patients at all periodontal pockets > or =5 mm at baseline, 3 and 6 months. Efficacy was evaluated over 9 months.. Significantly greater pocket depth reductions with SRP plus adjunctive minocycline microsphere treatment were observed at 1, 6 and 9 months (p<0.05) versus control treatments. At 9 months, smokers treated with SRP plus minocycline microspheres exhibited a pocket depth reduction of 1.19 mm from baseline, as compared to 0.90 mm for smokers treated with SRP alone. The efficacy of adjunctive minocycline microspheres was consistent among all tested smoking subcohorts, including those based on gender, age and smoking exposures.. These data indicate that treatment with SRP plus locally delivered minocycline microspheres is more effective than SRP alone in reducing pocket depths in smokers with periodontitis.

Topics: Administration, Topical; Adult; Anti-Bacterial Agents; Cohort Studies; Combined Modality Therapy; Dental Scaling; Female; Follow-Up Studies; Humans; Male; Microspheres; Middle Aged; Minocycline; Periodontal Pocket; Periodontitis; Pharmaceutical Vehicles; Root Planing; Single-Blind Method; Smoking; Wound Healing

Gingival crevicular fluid (GCF) biomarkers associated with bone resorption may be useful to determine periodontal disease status and response to therapy. The pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen (ICTP), a bone-specific degradation product, and interleukin 1-beta (IL-1), a potent bone-resorptive cytokine, have both been associated with periodontal disease activity. Minocycline is a tetracycline derivative possessing antimicrobial effects on periodontal pathogens and inhibitory properties on matrix metalloproteinases (MMPs) associated with tissue destruction. The aim of this study was to evaluate the effect of periodontal treatment in the form of scaling and root planing (SRP) and locally administered minocycline microspheres on the GCF levels of ICTP and IL-1.. Forty-eight chronic periodontitis patients were randomly assigned to 2 groups (SRP plus subgingival application of vehicle control [SRP + V], or SRP plus subgingival application of minocycline microspheres [SRP + M]) and monitored at 8 sites per subject at baseline and 1, 3, and 6 months. Four shallow (PD < or = 3 mm) and 4 deep (PD > or = 5 mm) sites were evaluated for both marker levels and for probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP). Eight periodontally healthy control subjects with no probing depths >3 mm and no loss of attachment were also monitored at the same time intervals. GCF levels of ICTP and IL-1 were determined using radioimmunoassay and enzyme-linked immunosorbent assay techniques, respectively.. Significant differences (P<0.001) in GCF levels of ICTP and IL-1 were found between deep and shallow sites at all time points in both treatment groups. In addition, healthy subjects demonstrated significantly reduced levels of both markers compared to both shallow and deep sites in periodontitis patients (P <0.001). Only the SRP + M treated patients exhibited significant reductions (P <0.05) in both ICTP and IL-1 levels 1 month after treatment. Furthermore, the SRP + M group demonstrated significantly lower IL-1 levels (P <0.02) at 1 month compared to the SRP + V group.. Results of this study indicate that GCF levels of ICTP and IL-1 correlate with clinical measures of periodontal disease and may aid in assessing disease status and response to periodontal therapy. Furthermore, local administration of minocycline microspheres led to a potent short-term reduction in GCF IL-1 levels. Additional studies are needed to address whether repeated administration of scaling and root planing along with minocycline microspheres will achieve long-term reductions in GCF ICTP and IL-1 levels.

Topics: Administration, Topical; Adult; Aged; Analysis of Variance; Anti-Bacterial Agents; Biomarkers; Bone Resorption; Chronic Disease; Collagen; Collagen Type I; Dental Scaling; Female; Follow-Up Studies; Gingival Crevicular Fluid; Gingival Hemorrhage; Humans; Interleukin-1; Male; Matched-Pair Analysis; Microspheres; Middle Aged; Minocycline; Peptides; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Root Planing; Single-Blind Method; Statistics as Topic

A clinical trial was performed to determine if a single dose of subgingival minocycline has (i) a clinical spillover effect at adjacent and remote sites and (ii) an adjunctive effect to scaling and root-planing.. Each of the 15 adult subjects included in the study had to present with at least two pairs of adjacent 6-9 mm pockets each pair located on adjacent teeth in an interproximal space, on opposite sides of the mouth. Each study site was required to have at least 3 mm loss of attachment. Following a baseline examination including assessments of plaque, pocket depth (PD), clinical attachment levels (CAL) and bleeding on probing (BOP), instruction in oral hygiene was given. Each subject was treated with a single episode of scaling and root-planing (SRP), of approximately 90 minutes duration using ultrasonic and hand instrumentation under local anaesthetic, if indicated. This was followed by a single application of 1 mg of minocycline in the form of Minocycline Periodontal Therapeutic System (MPTS) into one of the four sites selected at random by another clinician, who also randomly selected one of the two sites on the opposite side of the mouth to be designated the Remote site. Clinical re-examinations were performed at 3- and 6-months.. At six months the CAL gains at the MPTS sites were statistically significantly different when compared with the Adjacent sites (P=0.04). The proportion of sites demonstrating a CAL gain (> or = 2 mm) was higher in the MPTS group (73%) compared with the Adjacent (40%) and Remote sites (53%). Periodontal therapy, (MPTS+SRP) and (SRP alone) resulted in a statistically significant reduction in mean pocket depths (P<0.01). However no statistically significant differences in pocket depths were found between treatment groups over the six months of the study. The proportion of sites demonstrating a clinically significant reduction in PD (> or = 2 mm) was higher in the MPTS sites (80%) compared with the Adjacent sites (53%) and Remote sites (53%). BOP was significantly reduced at all sites over the duration of the study except at the Adjacent sites at three months (P<0.05).. No apparent clinical spillover effect of minocycline was demonstrated over the six months of the study. There was a trend for greater improvement in all clinical parameters at the MPTS sites compared with the Adjacent and Remote sites except for plaque scores. This trend needs to be examined in a study with a sufficient number of subjects to allow statistical significance.

Topics: Adult; Aged; Anti-Bacterial Agents; Chemotherapy, Adjuvant; Chi-Square Distribution; Dental Scaling; Female; Humans; Male; Middle Aged; Minocycline; Periodontal Index; Periodontal Pocket; Pilot Projects; Single-Blind Method; Statistics, Nonparametric; Treatment Outcome

Smoking is considered a risk factor for periodontitis and an impediment to treatment. The current studies evaluated the efficacy of the local administration of 1 mg minocycline hydrochloride encapsulated in a bioresorbable polymer in periodontal pockets of > or = 5 mm in all three studies. Two hundred and seventy one patients who smoked were enrolled in the two single blind controlled studies (data pooled) with efficacy compared to scaling and root planing (SRP) and 71 smokers were enrolled in an open label study. In the three studies SRP was performed at baseline and the unit dose minocycline administered at baseline, three and six months. Efficacy and safety were measured at one, three, six, and nine months. Adjunctive treatment resulted in statistically significant pocket depth reduction in both studies in these smokers. In the controlled studies the difference in probing depth reduction between the adjunctive therapy group and the SRP alone group was statistically significant at one, three, six, and nine months. No serious adverse events were recorded in any of the studies.

Topics: Adult; Analysis of Variance; Anti-Bacterial Agents; Chemotherapy, Adjuvant; Dental Scaling; Female; Humans; Male; Microspheres; Minocycline; Periodontal Index; Periodontal Pocket; Single-Blind Method; Smoking; Statistics, Nonparametric

Locally delivered antimicrobials represent an expanding class of therapeutics that may complement conventional mechanical treatments for chronic periodontitis. Currently available locally delivered antimicrobials include a tetracycline fiber, chlorhexidine chip, doxycycline gel, and newly approved minocycline microspheres. This last therapeutic is formulated to contain 3 mg polyglycolide-co-dl lactide (PGLA) copolymer and 1 mg of minocycline per unit (pocket) dose. As the polymer microspheres resorb, minocycline is released locally within the periodontal pocket at effective concentrations for at least 14 days. Recently, three phase 3 human clinical trials were conducted to assess the efficacy and safety of minocycline microspheres in patients with moderate-to-advanced chronic periodontitis. Data from an open-label trial involving 173 subjects indicated that minocycline microspheres plus scaling and root planing (SRP) at baseline produced significant improvements in pocket depth (PD) (> or = 1.5 mm) at 1 and 3 months. Retreatment with minocycline microspheres at 3 and 6 months maintained these improvements for 12 months. Two concurrent, blinded studies cumulatively recruited 748 periodontitis subjects who were randomized to SRP plus minocycline microspheres, SRP plus vehicle (placebo), or SRP alone at baseline. Minocycline microspheres or the vehicle were readministered per the randomization at 3 and 6 months. Patients receiving minocycline microspheres plus SRP exhibited significantly greater PD reduction at 1, 3, 6, and 9 months compared to patients receiving SRP plus vehicle or SRP alone. Overall, mean PD reduction with adjunctive minocycline-microsphere treatment increased when patients with more advanced periodontitis (mean PD > or = 6 mm or 7 mm) were considered. Similarly, significant improvements in clinical attachment level and percent bleeding on probing were observed among advanced periodontitis patients treated with SRP plus minocycline microspheres relative to controls. Patients treated with minocycline microspheres plus SRP were 50% more likely to shift to an overall mean PD < 5 mm or to a more maintainable case definition. No increased incidence of adverse events or tetracycline resistance were observed with minocycline-microsphere treatment. The data from these clinical trials indicate that minocycline microspheres plus SRP are safe in patients and more effective than SRP alone in reducting the signs of chronic periodontitis.

Topics: Analysis of Variance; Anti-Bacterial Agents; Chronic Disease; Delayed-Action Preparations; Dental Scaling; Drug Carriers; Female; Follow-Up Studies; Gingival Hemorrhage; Humans; Lactic Acid; Male; Microspheres; Middle Aged; Minocycline; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Placebos; Polyglycolic Acid; Polylactic Acid-Polyglycolic Acid Copolymer; Polymers; Root Planing; Safety; Single-Blind Method; Treatment Outcome

Alternative regimens using subgingival antimicrobials compared to conventional periodontal maintenance (PM) may lead to more efficient protocols. The purpose of this study was to evaluate treatment time and clinical and radiographic outcomes in 2 periodontitis cohorts, one receiving conventional PM and the other receiving scaling and root planing (SRP) and multiple doses of subgingival minocycline.. Moderate to advanced chronic periodontitis patients were concurrently treated with either: 1) scaling and root planing and 4 subgingival doses of minocycline microspheres in all > or = 5 mm pockets over a 6-month period (RP/M; n = 24 patients); or 2) conventional 3-month periodontal maintenance (PM; n = 24 patients). Clinical and radiographic measurements, including probing depth (PD), clinical attachment level (CAL), and interproximal bone height (BH), were analyzed in 2 premolar/molar interproximal > or = 5 mm pockets at baseline and 1 year using paired t tests, analysis of variance, chi-square analysis, and correlation coefficients.. Baseline clinical and radiographic data were similar between RP/M and PM patients. Probing depths showed greater mean improvement in RP/M (0.9 +/- 0.1 versus 0.4 +/- 0.1 mm, P = 0.02), with 25% of subjects in RP/M gaining > or = 2 mm compared to 4.2% in PM (differences were statistically significant). The mean loss in bone height and percent subjects losing bone height were less in RP/M (0.05 +/- 0.05 mm; 12.5%) than PM (0.09 +/- 0.08 mm; 16.7%), but bone height differences were not statistically significant. A subset of RP/M molar furcation sites responded with similar PD reduction and no BH loss over 1 year. While cross-sectional RP/M data between CAL and BH, or PD and CAL were highly correlated, changes over 1 year were not correlated among any of these parameters.. Scaling and root planing and subgingival minocycline in experimental sites took little time (<5 minutes/appointment), but resulted in more probing depth reduction and less frequent bone height loss than conventional periodontal maintenance.

Topics: Administration, Topical; Alveolar Bone Loss; Analysis of Variance; Anti-Bacterial Agents; Bicuspid; Case-Control Studies; Chi-Square Distribution; Chronic Disease; Cohort Studies; Dental Scaling; Female; Follow-Up Studies; Gingiva; Humans; Male; Matched-Pair Analysis; Middle Aged; Minocycline; Molar; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Radiography; Root Planing; Statistics as Topic; Treatment Outcome

Infection after a periodontal surgical site has been prepared for guided tissue regeneration (GTR) is one of the common complications that can compromise healing. The purpose of this study was to assess the effect of repeated local antimicrobial therapy following GTR for improving clinical attachment gains, and to histologically evaluate the various cell populations and bacterial contamination of the retrieved expanded polytetrafluoroethylene membrane (ePTFE).. Forty periodontal intrabony defects in 40 patients were treated by a flap procedure that included the use of ePTFE membranes to allow GTR. Patients were randomly assigned to 2 treatment groups: 20 patients were treated with the ePTFE alone (control group), and the other 20 were treated with the ePTFE combined with the administration of a weekly repeated local application of minocycline ointment for 8 weeks after membrane placement (test group). The membranes were retrieved 6 weeks after the initial surgery and sectioned serially in a coronal-apical plane. The sections were then divided into 9 fields and examined by light microscopy for the presence of inflammatory cells and oral bacteria. Clinical measurements were taken at the time of baseline examination and at a 6-month follow-up examination after removal of the ePTFE.. At the 6-month follow-up examination, control and test groups showed significant improvement; i.e., reduction in the probing depth and increased clinical attachment gain compared with the values at the baseline examination. However, the mean clinical attachment gain of the test group (3.0+/-0.3 mm) was significantly (P = 0.03) greater than that of the control group (2.0+/-0.5 mm). Histologically, the total number of the cells of both groups was similar. In both groups, mononuclear cells were dominant and fibroblasts, neutrophils, and plasma cells were rarely encountered. There was a tendency for the number of macrophages to be somewhat higher in the control group. The total number of bacteria in the test group was significantly less than that in the control group. The number of bacteria in both control and test groups decreased toward the apical portion.. In the present study, clinical attachment gain of intrabony defects following GTR was favorable with repeated local administration of minocycline ointment. However, a complete microbial eradication was not achieved.

Topics: Administration, Topical; Adult; Alveolar Bone Loss; Analysis of Variance; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacteria; Female; Follow-Up Studies; Guided Tissue Regeneration, Periodontal; Humans; Leukocytes, Mononuclear; Macrophages; Male; Membranes, Artificial; Middle Aged; Minocycline; Ointments; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Periodontium; Polytetrafluoroethylene; Statistics as Topic; Statistics, Nonparametric; Surgical Flaps; Surgical Wound Infection; Wound Healing

This study was designed to evaluate the clinical significance of antibiotic therapy combined with guided tissue regeneration (GTR) therapy with a collagen membrane. The subjects were 20 adults diagnosed with periodontitis (20 intrabony periodontal defects). Ten patients were treated with GTR alone (control group) and the other 10 patients were treated with a combination of GTR and antibiotics (antibiotic group). In the antibiotic group, minocycline ointment was applied locally before GTR therapy, and doxycycline and amoxyline were systemically administered after GTR therapy. Clinical manifestations, the presence or absence of exposed membrane, and microbiological findings were assessed 1 month before, immediately after, and 2 weeks, 6 weeks, and 3 months after GTR therapy. The results showed no significant differences in reduction of probing depth, probing attachment gain (PAG), or the ratio of PAG to intraoperative depth of the intrabony defect (vertical relative attachment gain) between the antibiotic group and the control group before and 3 months after GTR therapy. A DNA probe test and specific enzymatic activity test revealed no significant differences in the improvement and the rate of bacterial negativity before, and 6 weeks and 3 months after, GTR therapy. These findings indicate that antibiotic therapy is not clinically beneficial when combined with GTR therapy with a collagen membrane.

Topics: Absorbable Implants; Adult; Aged; Aggregatibacter actinomycetemcomitans; Alveolar Bone Loss; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteroides; Collagen; DNA Probes; Doxycycline; Drug Therapy, Combination; Female; Follow-Up Studies; Guided Tissue Regeneration, Periodontal; Humans; Male; Membranes, Artificial; Middle Aged; Minocycline; Ointments; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Prevotella intermedia; Statistics as Topic; Treponema

Periodontitis is an inflammatory condition of tooth-supporting tissues that is usually treated by mechanical removal of plaque and microorganisms that adhere to teeth. This treatment, known as scaling and root planing, is not optimally effective. Adjunctive therapy with locally delivered antimicrobials has resulted in improved clinical outcomes such as probing depth reduction. This article reports on the efficacy and safety of locally administered microencapsulated minocycline.. Seven hundred forty-eight (748) patients with moderate to advanced periodontitis were enrolled in a multi-center trial and randomized to 1 of 3 treatment arms: 1) scaling and root planing (SRP) alone; 2) SRP plus vehicle; or 3) SRP plus minocycline microspheres. The primary outcome measure was probing depth reduction at 9 months. Clinical assessments were performed at baseline and 1, 3, 6, and 9 months.. Minocycline microspheres plus scaling and root planing provided substantially more probing depth reduction than either SRP alone or SRP plus vehicle. The difference reached statistical significance after the first month and was maintained throughout the trial. The improved outcome was observed to be independent of patients' smoking status, age, gender, or baseline disease level. There was no difference in the incidence of adverse effects among treatment groups.. Scaling and root planing plus minocycline microspheres is more effective than scaling and root planing alone in reducing probing depths in periodontitis patients.

Topics: Administration, Topical; Adult; Age Factors; Aged; Analysis of Variance; Anti-Bacterial Agents; Capsules; Combined Modality Therapy; Confidence Intervals; Dental Scaling; Female; Follow-Up Studies; Gingival Hemorrhage; Humans; Male; Microspheres; Middle Aged; Minocycline; Odds Ratio; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Pharmaceutical Vehicles; Safety; Sex Factors; Smoking; Treatment Outcome

Currently, several local antimicrobial delivery systems are available to periodontists. The aim of this 6-month follow-up parallel study was to evaluate the efficacy of three commercially available local delivery systems as adjuncts to scaling and root planing in the treatment of sites with persistent periodontal lesions.. Seventy-nine patients with 4 pockets > or = 5 mm and bleeding on probing and/or suppuration were randomized into 4 treatment groups which included: scaling and root planing alone (S) (20 patients), or in conjunction with the application of 25% tetracycline fibers (S+Tet) (19 patients), or 2% minocycline gel (S+Min) (21 patients), or 25% metronidazole gel (S+Met) (19 patients). Clinical measurements were taken at baseline, 6 weeks, 3 months, and 6 months after antimicrobial application. Treatments were applied using the distributors' recommended protocols.. All 4 therapies resulted in significant improvements from baseline in probing depth, attachment level, bleeding on probing, and the Modified Gingival Index (MGI) scores. The improvements in clinical parameters were greater in all 3 adjunctive treatment groups than scaling and root planing alone. The mean probing depth reductions at 6 months were: scaling + tetracycline = 1.38 mm; scaling + metronidazole = 0.93 mm; scaling + minocycline = 1.10 mm; and scaling alone = 0.71 mm. The probing depth reduction at all time points was significantly greater in the scaling plus tetracycline fiber group than the scaling and root planing alone group (P<0.01). There was also a significant improvement for scaling plus tetracycline fiber application over scaling and metronidazole at both 6 weeks and 3 months, although this did not remain significant at the 6-month visit. While the frequency of sites with suppuration was markedly reduced following all antimicrobial treatments, the most effective reductions were seen in the scaling plus tetracycline fiber group, followed by the minocycline group.. Although all 3 locally applied antimicrobial systems seem to offer some benefit over scaling and root planing alone, a treatment regimen of scaling and root planing plus tetracycline fiber placement gave the greatest reduction in probing depth over the 6 months after treatment.

Topics: Adult; Analysis of Variance; Anti-Bacterial Agents; Anti-Infective Agents, Local; Chronic Disease; Dental Scaling; Drug Delivery Systems; Female; Follow-Up Studies; Gels; Humans; Linear Models; Male; Metronidazole; Middle Aged; Minocycline; Periodontal Index; Periodontal Pocket; Statistics, Nonparametric; Tetracycline; Treatment Outcome

A double-blind, randomized, parallel, comparative study was designed to evaluate the long-term safety and efficacy of subgingivally administered minocycline ointment versus a vehicle control.. One hundred four patients (104) with moderate to severe adult periodontitis (34 to 64 years of age; mean 46 years) were enrolled in the study. Following scaling and root planing, patients were randomized to receive either 2% minocycline ointment or a matched vehicle control. Study medication was administered directly into the periodontal pocket with a specially designed, graduated, disposable applicator at baseline; week 2; and at months 1, 3, 6, 9, and 12. Scaling and root planing was repeated at months 6 and 12. Standard clinical variables (including probing depth and attachment level) were evaluated at baseline and at months 1, 3, 6, 9, 12, and 15. Microbiological sampling using DNA probes was done at baseline; at week 2; and at months 1, 3, 6, 9, 12, and 15.. Both treatment groups showed significant and clinically relevant reductions in the numbers of each of the 7 microorganisms measured during the entire 15-month study period. When differences were detected, sites treated with minocycline ointment always produced statistically significantly greater reductions than sites which received the vehicle control. For initial pockets > or =5 mm, a mean reduction in probing depth of 1.9 mm was seen in the test sites, versus 1.2 mm in the control sites. Sites with a baseline probing depth > or =7 mm and bleeding index >2 showed an average of 2.5 mm reduction with minocycline versus 1.5 mm with the vehicle. Gains in attachment (0.9 mm and 1.1 mm) were observed in minocycline-treated sites, with baseline probing depth > or =5 mm and > or =7 mm, respectively, compared with 0.5 mm and 0.7 mm gain at control sites. Subgingival administration of minocycline ointment was well tolerated.. Overall, the results demonstrate that repeated subgingival administration of minocycline ointment in the treatment of adult periodontitis is safe and leads to significant adjunctive improvement after subgingival instrumentation in both clinical and microbiologic variables over a 15-month period.

Topics: Adult; Aggregatibacter actinomycetemcomitans; Analysis of Variance; Anti-Bacterial Agents; Campylobacter; Canada; Chronic Disease; Colony Count, Microbial; Dental Plaque Index; Dental Scaling; Double-Blind Method; Eikenella corrodens; Europe; Female; Fusobacterium nucleatum; Humans; Longitudinal Studies; Male; Middle Aged; Minocycline; Ointments; Periodontal Index; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Prevotella intermedia; Statistics, Nonparametric; Treatment Outcome; Treponema

To evaluate a 2% w/w minocycline gel (Dentomycin) in the treatment of older adults with chronic periodontitis.. Vehicle-controlled, split-mouth. Dental Institute, St Bartholomew's and the Royal London School of Medicine and Dentistry.. 22 adults (mean age 60 years).. At baseline, patients received scaling and root planing. Test and placebo were applied at contralateral disease sites surrounding 22 test and 22 control teeth at baseline, and at weeks 2 and 4.. Probing pocket depth, bleeding on probing and supragingival plaque measurements, and microbiological sampling, at one pocket site per tooth were undertaken at baseline, and at weeks 2, 4, 6 and 16.. Microbial counts of Porphyromonas gingivalis, Prevotella intermedia and Eikenella corrodens did not change significantly over 16 weeks. No significant reductions in bleeding on probing and supragingival plaque score occurred with either gel. A larger reduction in mean pocket depth, from baseline to week 16, was found at test (6.50 to 4.95 mm; 24% reduction; P < 0.01) than at control sites (6.41 to 5.53 mm; 14% reduction; P < 0.05).. Minocycline gel administration is a useful adjunct to scaling and root planing in the treatment of older adults with periodontitis.

Topics: Aged; Anti-Bacterial Agents; Dental Plaque; Epidemiologic Methods; Female; Humans; Male; Middle Aged; Minocycline; Periodontal Pocket; Periodontitis

The aim of this investigation was to evaluate the effect of smoking on the outcome of periodontal therapy. The study consisted of 54 patients who participated in a 4-group parallel-arm clinical trial on the efficacy of three locally delivered antimicrobial systems as adjuncts to scaling and root planing in the treatment of sites with persistent pocketing after a course of scaling and root planing. These groups included scaling and root planing either alone (S) (n = 3), or in conjunction with the application of 25% tetracycline fibers (S&T) (n = 13), 2% minocycline gel (S&Mi) (n = 14), or 25% metronidazole gel (S&Me) (n = 14). In each patient four pockets > 5 mm with bleeding on probing (BOP) and/or suppuration were studied. The number of subjects who smoked was: 8 (61.5%) in the S&T group, 8 (57.1%) in the S&Mi group, 6 (42.9%) in the S&Me group, and 6 (46.2%) in the S group. The probing depth, attachment level and other clinical parameters were assessed at baseline and 6 weeks after treatments. The clinical results of this comparative study have been previously reported. Regardless of the type of treatment, the change in the probing depth (delta PD) and attachment gain (delta AL) were greater in non-smoker subjects than smoker subjects. delta PD was 1.14 mm versus 0.76 mm (P = 0.019), and delta AL was 0.52 mm versus 0.50 mm at (P = 0.845) for non-smokers and smokers respectively. The analysis of variance using the general linear model (GLM) was used for delta PD and delta AL and took into account the variations in the treatments, number of smoker subjects per group, and baseline probing depth. There was a significant interaction between the "smoking" and the "baseline PD." Further analysis using linear regression indicated that, while there was a significant relationship between the baseline PD and the delta PD or delta AL among the non-smokers, weak and insignificant relationship existed among the smoker subjects. Thus, smoking may have an important role in determining the prognosis of periodontal treatment, particularly in persistent and deep pockets.

Topics: Adult; Analysis of Variance; Anti-Bacterial Agents; Dental Plaque Index; Dental Scaling; Female; Humans; Linear Models; Male; Metronidazole; Middle Aged; Minocycline; Outcome Assessment, Health Care; Periodontal Index; Periodontal Pocket; Prognosis; Root Planing; Smoking; Tetracycline

The aim of this study was to evaluate the efficacy of 3 commercially available periodontal systems for local delivery of antibiotics as adjuncts to scaling and root planing in treatment of sites with persistent periodontal lesions following a course of scaling and root planing. Fifty-four patients with 4 pockets > or = 5 mm and bleeding on probing and/or suppuration were randomized in 4 treatment groups including: scaling and root planing plus application of 25% tetracycline fiber (S + Tet) (13 patients), scaling and root planing plus application of 2% minocycline gel (S + Min) (14 patients), scaling and root planing plus application of 25% metronidazole gel (S + Met) (14 patients), and scaling and root planing alone (S) (13 patients). Clinical measurements were taken at baseline and 6 weeks after the end of treatment periods. All treatments were applied using the distributors' recommended protocols and resulted in significant improvement in probing depth, attachment level, bleeding on probing and the modified gingival index (MGI) scores. The improvements in clinical parameters were greater in all three adjunctive treatment groups than scaling and root planing alone. The mean probing depth reductions were: S + Tet = 1.35 mm, S + Met = 0.95 mm, S + Min = 0.87 mm and S = 0.60 mm. The probing depth reduction was significantly greater in the scaling plus tetracycline fiber group than the scaling and root planing alone group (P = 0.002). The difference between groups in improvement of attachment level or bleeding on probing was not significant Scaling plus tetracycline fiber treatment resulted in the greatest reduction in the MGI scores which was significantly greater than all other groups. While the frequency of sites with suppuration was markedly reduced following all treatments, it reached zero in the scaling plus tetracycline fiber group. No serious adverse effects were observed or reported for any treatment. While all three locally applied antimicrobial systems seem to offer some benefit over scaling and root planing alone, a treatment regimen of scaling and root planing plus tetracycline fiber replacement gave the greatest advantage in the treatment of persistent periodontal lesions at least during the 6-week period following treatment.

Topics: Administration, Topical; Analysis of Variance; Anti-Bacterial Agents; Chemotherapy, Adjuvant; Chi-Square Distribution; Dental Scaling; Humans; Linear Models; Metronidazole; Minocycline; Periodontal Pocket; Single-Blind Method; Statistics, Nonparametric; Tetracycline; Treatment Outcome

Recent investigations imply that a key mechanism in the pathogenesis of periodontal disease may be the ability of oral microorganisms to induce production and/or activation of matrix metalloproteinases (MMPs) in the host tissues. It has been suggested that the pharmacologic inhibition of MMP activity could play an important role in achieving a desirable outcome in periodontal therapy. The efficacy of locally delivered antibiotics on the level of gingival crevicular fluid (GCF) stromelysin (SL) and tissue inhibitor of metalloproteinases (TIMP) on sites with a history of a poor response to mechanical treatment was studied. Fifty-two patients with 4 periodontal pockets > or = 5 mm and bleeding on probing were randomized into four groups of 13 patients. One group received scaling and root planing alone and the other three groups received scaling and root planing plus a locally delivered antimicrobial system. These included 25% tetracycline fiber, 2% minocycline gel, and 25% metronidazole gel. The GCF samples taken at baseline and 6 weeks after treatments were analyzed using an enzyme linked immunosorbent assay (ELISA). GCF SL levels significantly decreased after adjunctive tetracycline fiber (paired t-test, P = 0.020) and minocycline gel (paired t-test, P = 0.023) treatments whereas it remained almost unchanged in the other two groups. While the GCF TIMP level did not change significantly in the scaling and root planing alone group, it significantly increased for all three adjunctive antimicrobial treatments (for tetracycline fiber P < 0.001, minocycline gel P = 0.005, metronidazole gel P < 0.001). The use of adjunctive locally delivered antimicrobial systems, particularly the tetracycline family, may offer an advantage in changing the metalloproteinase profile of the GCF to one more compatible with periodontal health.

Topics: Administration, Topical; Adult; Aged; Analysis of Variance; Anti-Bacterial Agents; Chemotherapy, Adjuvant; Dental Scaling; Female; Gingival Crevicular Fluid; Glycoproteins; Humans; Male; Matrix Metalloproteinase 3; Metalloendopeptidases; Metronidazole; Middle Aged; Minocycline; Periodontal Pocket; Protease Inhibitors; Tetracycline; Tissue Inhibitor of Metalloproteinases

The aim of the present study was to compare total numbers of cultivable bacteria and prevalence of resistance to minocycline among periodontal bacteria following subgingival or systemic application of minocycline in patients suffering from periodontal disease. 10 adult patients were administered 2% minocycline ointment subgingivally into their periodontal pockets at baseline, week 2 and months 1, 3, 6 and 9. Patients had scaling/root planing at baseline and month 6. In addition, 10 patients undergoing scaling/root planing followed by a 10-day course of systemic minocycline therapy, were studied and compared with the subgingival application group. Bacterial samples were taken from the 4 deepest pockets before each subgingival application of the drug. The systemic administration group was sampled at baseline and at week 2, as well as months 1 and 3 after completing the antibiotic treatment. For each patient at each sampling, bacterial samples were pooled, diluted, seeded on parallel blood agar plates and incubated aerobically and anerobically. After incubation, 30 colonies were picked at random and transferred to blood agar plates supplemented with 10 micrograms/ml minocycline, to estimate prevalence of minocycline-resistant bacteria. The results of this study indicate that subgingival application of minocycline ointment resulted in an initial reduction in total numbers of cultivable bacteria, which then remained depressed during the full year of the study. No such observation was made in the systemic administration. Both in the subgingival and the systemic administration group, the % of cultivable aerobic and anaerobic minocycline-resistant bacterial strains increased transiently following administration of the drug, but returned to baseline levels within 3 months post-treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Oral; Administration, Topical; Adult; Analysis of Variance; Bacteria; Colony Count, Microbial; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Minocycline; Periodontal Pocket; Periodontitis; Streptococcus; Tetracycline Resistance

The clinical efficacy of minocycline in a subgingival local delivery system was evaluated alone (M) or as an adjunct to scaling and root planing (M + SRP), in comparison to scaling and root planing (SRP) or to no subgingival treatment (NoTx) in adult periodontitis. Fifty-one adult patients with > or = 7 mm periodontal pockets demonstrating the presence by culture of Porphyromonas gingivalis (Pg), Prevotella intermedia (P(i)), or Actinobacillus actinomycetemcomitans (Aa) were randomized into one of the above 4 treatment groups. All sites > or = 5 mm in the most diseased quadrant in each patient received the therapy. Other quadrants were not treated. All patients received standardized oral hygiene instructions at the beginning of the study. At 0, 1, 3 and 6 months following therapy the 7 mm experimental sites were evaluated for selected periodontal pathogens by DNA probe analysis. At these same time points, the plaque index, gingival index, and bleeding on probing were evaluated as well as probing depth and relative clinical attachment level which were assessed by means of an automated probe. Probing depth reduction with M + SRP was significantly greater than all other groups at one month and significantly greater than NoTx and SRP at 3 months. There were no differences in probing depth reduction among groups at 6 months. At 6 months the gain in clinical attachment level was significantly greater for SRP than for either the NoTx or M groups. The prevalence of Pg decreased significantly in the M and M + SRP groups at one month.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Topical; Adult; Aged; Aggregatibacter actinomycetemcomitans; Campylobacter; Colony Count, Microbial; Delayed-Action Preparations; Dental Plaque Index; Dental Scaling; DNA Probes; Eikenella corrodens; Fusobacterium nucleatum; Humans; Microbial Sensitivity Tests; Middle Aged; Minocycline; Periodontal Index; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Prevotella intermedia; Root Planing

The safety and efficacy of subgingivally-applied 2% minocycline ointment was evaluated in a randomized, double-blind study of 103 adults with moderate to severe periodontitis. Two groups were compared; one received the test minocycline ointment and the other a vehicle control. Both groups had scaling and root planing at baseline, after which the test or control ointments were applied with an applicator into the periodontal pockets at baseline, and at 2, 4, and 6 weeks. Assessment of clinical response was made by measuring probing depth and probing attachment level and gingival bleeding. These measurements were made at baseline prior to scaling and root planing, and at weeks 4 and 12. Microbiological assessment of the subgingival flora was carried out with DNA probes at baseline, and at weeks 2, 4, 6, and 12 to identify and quantify Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinomycetemcomitans. Subgingival minocycline ointment resulted in statistically significantly greater reduction of P. gingivalis at weeks 2, 4, 6, and 12; P. intermedia at weeks 2, 4, 6, and 12; and A. actinomycetemcomitans at weeks 6 and 12. Probing depth reductions were seen for both groups at weeks 4 and 12; however, this reduction was statistically significantly greater in subjects treated with minocycline ointment. Reduction in gingival index and probing attachment gain were seen in both groups, however, the differences between the groups were not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Topical; Adult; Aged; Aggregatibacter actinomycetemcomitans; Bacteroides; Belgium; Chronic Disease; Colony Count, Microbial; Dental Plaque Index; DNA Probes; Double-Blind Method; Female; Humans; Male; Middle Aged; Minocycline; Ointments; Periodontal Index; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Treatment Outcome

The purpose of this study was to conduct a direct comparison of two dose regimens of minocycline to determine 1) whether they achieved crevicular fluid concentrations in a therapeutic range; and 2) the frequency of side effects. In a double-blind design, 30 patients divided into 2 groups were given either 100 mg minocycline or 200 mg minocycline per day for an 8-day period. The concentration of minocycline in the gingival clevicular fluid (GCF) at 8 days was 4.77 micrograms/ml for the 100 mg a day group and 5.97 micrograms/ml for the 200 mg a day group and at 15 days was 4.30 micrograms/ml for the 100 mg a day group and 4.17 micrograms/ml for the 200 mg a day group. There was no significant difference in the antibiotic concentration in the gingival crevicular fluid between the 2 groups. Reported adverse experiences to the minocycline were greater in the 200 mg a day group. Short-term changes in periodontal health as measured by plaque index, gingival index, pocket depth, and bleeding upon probing showed improvements in all parameters over the 15 day period. There were no significant differences in these parameters between the 100 mg a day and 200 mg a day group. At 8 days reduced levels of Porphyromonas gingivalis and Prevotella intermedia were achieved but they were not eliminated from infected subgingival sites in either group. Achieving bacteriostatic concentrations of GCF, fewer side effects, and the potential for better compliance suggests that a single daily dose of 100 mg minocycline should now be investigated for its efficacy in managing periodontal infections manifesting as periodontitis.

Topics: Adult; Aged; Aggregatibacter actinomycetemcomitans; Bacteroides; Colony Count, Microbial; Dental Plaque Index; Dose-Response Relationship, Drug; Double-Blind Method; Female; Gingival Crevicular Fluid; Gingival Hemorrhage; Gingivitis; Humans; Male; Middle Aged; Minocycline; Periodontal Index; Periodontal Pocket; Periodontitis; Placebos; Porphyromonas gingivalis

The purpose of this study was to determine the microbiological efficacy of an adjunctive minocycline periodontal formulation delivered subgingivally. Subjects were systemically healthy but exhibited severe periodontitis; i.e., probing depths greater than 6 mm. The two study groups included individuals who received minocycline or a placebo periodontal formulation after root planing. Subgingival plaque samples were obtained at baseline; prior to treatment; and at 1, 3, and 6 months. Plaque was evaluated by darkfield microscopy and further analyzed for total dark-pigmented Bacteroides species, P. intermedia, P. gingivalis and Streptococcus, Actinomyces, Eikenella, Actinobacillus, Capnocytophaga, and Fusobacterium species using cultivable flora techniques. In addition, plaque was evaluated for yeast on a selective agar medium. When compared to the placebo, the minocycline group had significantly lower proportions of spirochetes at 1 and 3 months and lower proportions of motile rods at 3 months. Furthermore, when compared to the placebo group, the minocycline patients had lower mean proportions of dark-pigmented Bacteroides spp. and P. intermedia at 1 and 3 months as well as lower proportions of E. corrodens at 1 month. The minocycline group had significant decreases in proportions of spirochetes at 1 and 3 months, motile rods at 1 and 3 months, and increases in cocci at 1, 3, and 6 months when compared to baseline. In the placebo group, root planing was also effective at decreasing spirochetes at 1, 3, and 6 months, but with significant differences seen only at 3 and 6 months. However, the degree of reduction in spirochete proportions was greater in the minocycline group when compared with the placebo group.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Actinomyces; Adult; Aged; Bacteria; Bacteroides; Colony Count, Microbial; Delayed-Action Preparations; Dental Plaque; Dental Scaling; Drug Implants; Female; Gingiva; Humans; Male; Middle Aged; Minocycline; Periodontal Pocket; Placebos; Root Planing; Spirochaetales

Periodontitis is the most important oral disease causing human tooth loss. Although supragingival and subgingival scaling is the main strategy of periodontitis clinical treatments, drug treatment has an indispensable auxiliary role to some degree. Periodontitis medical treatment is divided into systemically administered treatments and local periodontally administered treatments. Compared with systemic administration, local administration can increase local drug concentrations, reduce dosages, and prolong action times while also improving patient compliance and avoiding possible adverse effects due to systemic administration responses. However, some studies show that minocycline ointment, a clinical local drug commonly used in periodontal pockets, has an unstable release rate; 80% of the drug is usually released within 2-3 days after pocket placement. This release is not conducive to controlling periodontal infection and may hinder the periodontal tissue repair and regeneration. Therefore, choosing a suitable carrier for minocycline hydrochloride is necessary to control its local release in periodontal tissue. Phase transition lysozyme (PTL) has been widely used in many studies and the development of macromolecular carrier material, and we selected PTL as the carrier for minocycline hydrochloride drugs because of its good biocompatibility, good drug-carrying capacity, and stable release. Due to its release characteristics and simple preparation, PTL is a promising carrier material.

Topics: Anti-Bacterial Agents; Chronic Periodontitis; Dermatologic Agents; Humans; Minocycline; Muramidase; Periodontal Pocket

Effective therapeutic system to periodontitis was designed using cross-linked cyclodextrin metal-organic framework (COF) as carrier for iodine and further suspended in hydroxyethyl cellulose gel as I

Topics: Animals; Anti-Infective Agents; Cyclodextrins; Delayed-Action Preparations; Drug Liberation; Hydrogels; Iodine; Male; Metal-Organic Frameworks; Minocycline; Molecular Docking Simulation; Particle Size; Periodontal Pocket; Periodontium; Rats, Sprague-Dawley

To retrospectively evaluate the clinical outcomes of subgingival debridement (e.g. scaling and root planing, SRP) and application of either a chlorhexidine chip (PerioChip, PC) or Arestin (AR) minocycline microspheres in patients with chronic periodontitis during supportive periodontal treatment (SPT).. Patients diagnosed with moderate to severe chronic periodontitis who were treated with SRP and a slow-release device during SPT were evaluated (total n = 53; n = 37 received PC, n = 16 received AR). Clinical measurements at baseline, 3, 6 and 12 months included changes in probing pocket depth (PD), bleeding on probing (BOP) and clinical attachment level (CAL).. Both treatments led to a reduction in PD and gain of CAL. AR showed higher improvements in pockets of ≥7 mm compared with PC. In contrast, PC was more effective in 5-6 mm PD. At one year following treatment, both treatments reduced the need-for-surgery index (95% to 100%) of the sites at baseline to 30% for AR and 42% for PC, with no differences between PC and AR.. In patients enrolled in SPT, the use of both PC and AR in conjunction with subgingival mechanical debridement represents an effective treatment modality for improving the clinical outcomes and reducing the need for surgery.

Topics: Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Chronic Periodontitis; Dental Scaling; Female; Humans; Male; Microspheres; Middle Aged; Minocycline; Periodontal Attachment Loss; Periodontal Debridement; Periodontal Index; Periodontal Pocket; Retrospective Studies; Root Planing

In this study, a thermoresponsive gel for minocycline (MCL) with chitosan/β-glycerophosphate (C/β-GP) was formulated and its characterization, in vitro release, stability, toxicity and pharmacodynamics were investigated. The formulation containing MCL was prepared by pouring the chitosan solution directly onto the sterilized drug powder and stirring before mixing with the β-glycerophosphate (β-GP) solution. The final preparations contained 0.5% (w/v) chitosan, 1.8% (w/v) β-GP and 2% (w/v) MCL. The drug content of prepared gels was in the range of 92-99%, and the pH value of the optimized formulation was found to be 5.6-6.2. The gelation temperature of the prepared C/β-GP thermogelling solutions was 37 °C. Color, consistency, pH, viscosity and drug content of the in situ gels were found to be consistent, and no signs of separation and deterioration were observed over a period of 90 d. In vivo studies showed that rats' liver and kidney tissue sections were normal, with no structural damage. The constituents of the in situ gels formulation had a well-sustained release efficacy on the animal model of periodontitis.

Topics: Administration, Oral; Animals; Anti-Bacterial Agents; Bacteroidaceae Infections; Chitosan; Delayed-Action Preparations; Disease Models, Animal; Drug Carriers; Drug Compounding; Drug Stability; Female; Gels; Glycerophosphates; Hydrogen-Ion Concentration; Kinetics; Male; Minocycline; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Rats, Sprague-Dawley; Solubility; Technology, Pharmaceutical; Temperature; Viscosity

Here we report a case of generalized aggressive periodontitis treated with periodontal therapy including adjunct antimicrobial therapy and periodontal surgery. The patient was a 22-year-old woman who presented with the chief complaint of gingival recession. Baseline examination revealed generalized plaque deposition and gingival inflammation. Thirty-nine percent of the sites had a probing depth (PD) of 4-6 mm and 2% a PD of ≥7 mm; 63% exhibited bleeding on probing (BOP). Radiographic examination revealed vertical bone loss in the molars and horizontal bone loss in other teeth. Microbiological examination of subgingival plaque revealed the presence of Aggregatibacter actinomycetemcomitans and Tannerella forsythia. Oral health-related quality of life was assessed as a measure of patient-reported outcome. Based on a clinical diagnosis of generalized aggressive periodontitis, initial periodontal therapy and adjunct antimicrobial therapy were implemented. After reducing inflammation and subgingival bacteria, open flap debridement was performed for teeth with a PD of ≥4 mm. Reevaluation showed no sites with a PD of ≥5 mm, a minimal level of BOP, and a marked reduction in the level of the targeted periodontal pathogens. The patient's oral health-related quality of life was slightly worsened during supportive periodontal therapy (SPT). Implementation of adjunct antimicrobial therapy targeting periodontal pathogens and subsequent periodontal surgery resulted in improvement in periodontal and microbiological parameters. This improvement has been adequately maintained over a 2-year period. However, additional care is necessary to further improve the patient's oral health-related quality of life during SPT.

Topics: Adult; Aggregatibacter actinomycetemcomitans; Aggressive Periodontitis; Aluminum Compounds; Alveolar Bone Loss; Anti-Bacterial Agents; Chemotherapy, Adjuvant; Cuspid; Dental Enamel Proteins; Dental Plaque; Dental Plaque Index; Dentin Sensitivity; Female; Fluorides; Furcation Defects; Gingival Recession; Gingivitis; Gram-Negative Bacterial Infections; Humans; Malocclusion; Minocycline; Molar; Oral Hygiene; Pasteurellaceae Infections; Patient Care Planning; Periodontal Debridement; Periodontal Index; Periodontal Pocket; Quality of Life; Silicon Compounds; Tannerella forsythia; Tokyo; Treatment Refusal

In-situ forming implant formulations based on poly(lactic-co-glycolic acid) (PLGA), acetyltributyl citrate (ATBC), minocycline HCl, N-methyl pyrrolidone (NMP) and optionally hydroxypropyl methylcellulose (HPMC) were prepared and thoroughly characterized in vitro. This includes electron paramagnetic resonance (EPR), nuclear magnetic resonance ((1)H NMR), mass change and drug release measurements under different conditions, optical microscopy, size exclusion chromatography (SEC) as well as antibacterial activity tests using gingival crevicular fluid samples from periodontal pockets of periodontitis patients. Based on these results, deeper insight into the physico-chemical phenomena involved in implant formation and the control of drug release could be gained. For instance, the effects of adding HPMC to the formulations, resulting in improved implant adherence and reduced swelling, could be explained. Importantly, the in-situ formed implants effectively hindered the growth of bacteria present in the patients' periodontal pockets. Interestingly, the systems were more effectively hindering the growth of pathogenic bacterial strains (e.g., Fusobacterium nucleatum) than that of strains with a lower pathogenic potential (e.g., Streptococcus salivarius). In vivo, such a preferential action against the pathogenic bacteria can be expected to give a chance to the healthy flora to re-colonize the periodontal pockets.

Topics: Adhesiveness; Anti-Bacterial Agents; Drug Compounding; Drug Implants; Drug Liberation; Fusobacterium; Humans; Hypromellose Derivatives; Lactic Acid; Microbial Sensitivity Tests; Minocycline; Periodontal Pocket; Periodontitis; Phase Transition; Polyglycolic Acid; Polylactic Acid-Polyglycolic Acid Copolymer; Porosity; Solvents; Streptococcus; Surface Properties

The purpose of this study is to investigate the antimicrobial effects of minocycline hydrochloride microspheres versus infrared light at 810 nm from a diode laser on multispecies oral biofilms in vitro. These biofilms were grown from dental plaque inoculum (oral microcosms) and were obtained from six systemically healthy individuals with generalized chronic periodontitis.. Multispecies biofilms were derived using supra- and subgingival plaque samples from mesio-buccal aspects of premolars and molars exhibiting probing depths in the 4- to 5-mm range and 1- to 2-mm attachment loss. Biofilms were developed anaerobically on blood agar surfaces in 96-well plates using a growth medium of prereduced, anaerobically sterilized brain-heart infusion with 2% horse serum. Minocycline HCl 1 mg microspheres were applied on biofilms on days 2 and 5 of their development. Biofilms were also exposed on days 2 and 5 of their growth to 810-nm light for 30 seconds using a power of 0.8 W in a continuous-wave mode. The susceptibility of microorganisms to minocycline or infrared light was evaluated by a colony-forming assay and DNA probe analysis at different time points.. At all time points of survival assessment, minocycline was more effective (>2 log10 colony-forming unit reduction) than light treatment (P <0.002). Microbial analysis did not reveal susceptibility of certain dental plaque pathogens to light, and it was not possible after treatment with minocycline due to lack of bacterial growth.. The cumulative action of minocycline microspheres on multispecies oral biofilms in vitro led to enhanced killing of microorganisms, whereas a single exposure of light at 810 nm exhibited minimal and non-selective antimicrobial effects.

Topics: Anti-Bacterial Agents; Bacterial Load; Bacteriological Techniques; Biofilms; Chronic Periodontitis; Dental Plaque; Female; Humans; Lactic Acid; Lasers, Semiconductor; Low-Level Light Therapy; Male; Microspheres; Middle Aged; Minocycline; Periodontal Attachment Loss; Periodontal Pocket; Polyglycolic Acid; Polylactic Acid-Polyglycolic Acid Copolymer

In situ gelling formulations allow easy application to the target area. Gelation is induced by physiological stimuli at the site of application where the formula attains semisolid properties and exerts sustained drug release. In situ gelling formulations containing either 3% meloxicam (Mx) or 2% minocycline HCl (MH) were prepared for local application into the periodontal pockets. Gel formulations were based on the thermosensitive Pluronic(®) (Pl) and the pH-sensitive Carbopol(®) (C) polymers. C gels were prepared in combination with HPMC (H) to decrease its acidity. The total percent drug released from Pl formulae was 21.72% after 1 week for Mx and 85% after 3 days for MH. Their release kinetics data indicated anomalous non-Fickian behavior that could be controlled by both diffusion and chain relaxation. Addition of MH to C/H gels (1:2.5) resulted in liquefaction, followed by drug precipitation. Regarding C/H gel containing Mx, it showed a prolonged release rate up to 7 days with an initial burst effect; the kinetics data revealed Fickian-diffusion mechanism. The in vitro antibacterial activity studies for MH gel in Pl revealed that the drug released exceeded the minimum inhibitory concentration (MIC) of MH against Staphylococcus aureus ATCC 6538; placebo gel showed no effect on the microorganism. Clinical evaluation of Pl gels containing either Mx or MH showed significant improvement in chronic periodontitis patients, manifested by decrease in pocket depth and gingival index and increase in bone density.

Topics: Adult; Anti-Bacterial Agents; Chemistry, Pharmaceutical; Delayed-Action Preparations; Diffusion; Drug Liberation; Female; Gels; Humans; Kinetics; Meloxicam; Minocycline; Periodontal Pocket; Polymers; Staphylococcus aureus; Thiazines; Thiazoles; Young Adult

To compare the clinical effect of Ginkgo biloba extract gel (Ginkgo biloba extract,EGB) and minocycline hydrochloride (Periocline) on periodontitis and their inhibition on putative periodontal pathogens.. Thirty patients with moderate-to-severe periodontitis were selected. The patients were divided into an experimental group and a positive control group (minocycline hydrochloride). Supragingival and subgingival scaling were performed on all patients. Subgingival plaque samples were collected before treatment, 1 week, 2 months and 4 months after treatment. The four major periodontal pathogens Porphyromonas gingivalis (Pg), Bacteroides forsythus (Bf), Prevotella intermedia (Pi), Treponema denticola (Td) were detected by polymerase chain reaction. Clinical indexes plaque index (PLI), bleeding index (BI) and probing depth (PD), attachment loss (AL) were examined before treatment, 3 months and 6 months after treatment. The results were statistically analyzed.. The detection rates of the 4 periodontal pathogens were Td (83.3%), Tf (95.0%), Pi (80.0%), Pg (81.7% ) in experimental group and Td (83.3%), Tf (95.0%), Pi (80.0%), Pg (81.7%) in control group before treatment. The detection rates in experimental group were not significantly different with those in control group after treatment, except for the detection rate of Pg 1 week after treatment (P < 0.01, the detection of Pg was 56.7% in experimental group and 53.3% in control group 1 week after treatment). The PLI and BI were not significantly different between experimental group and control group after treatment (P > 0.05). The difference was statistically significant at 6 months after treatment [(3.5 ± 0.5) mm for experimental group and (3.2 ± 0.4) mm for control group, P = 0.00]. The mean of AL decreased with time. The difference was statistically significant at 6 months after treatment [ (4.5 ± 0.4) mm for experimental group and (4.3 ± 0.4) mm for control group at 6 months, P = 0.01].. The inhibition effects of EGB and minocycline hydrochloride were comparable for major periodontal pathogens within short term.

Topics: Aggregatibacter actinomycetemcomitans; Anti-Infective Agents; Dental Plaque; Dental Plaque Index; Dental Scaling; Ginkgo biloba; Humans; Minocycline; Periodontal Index; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Prevotella intermedia; Treponema denticola

Periodontitis is a common oral infection and inflammatory condition. Following treatment, residual or persistent periodontal inflammation is associated with disease progression and tooth loss. Cumulative evidence from clinical trials and meta-analyses support a complementary medical-mechanical model that combines locally delivered antimicrobials with scaling and root planing for the treatment of chronic periodontitis. Accordingly, greater pocket depth reductions and/or attachment level gains occur in patients treated with adjunctive locally administered antimicrobials (eg, tetracycline, chlorhexidine, doxycycline, and minocycline). These responses are clinically relevant because they are accompanied by a higher probability of patient maintenance or pocket resolution. Recent trials also indicate that locally administered antimicrobials may enhance the effects of periodontal surgical therapy and may reduce the signs of peri-implantitis. The consistency of these findings supports the use of locally administered antimicrobials for managing dental patients with chronic periodontitis.

Topics: Anti-Infective Agents, Local; Bacteria, Anaerobic; Biofilms; Chlorhexidine; Chronic Periodontitis; Dental Plaque; Dental Scaling; Disease Progression; Doxycycline; Gram-Negative Bacteria; Humans; Microspheres; Minocycline; Periodontal Pocket

To evaluate the efficacy of minocycline as an adjunct to scaling and root planning (SRP) in treating chronic periodontitis.. 64 male smokers with moderate to advanced periodontitis were randomly divided into two groups: SRP alone (SRP) and SRP plus minocycline (SRP+M). All clinical parameters including plaque index (Pll), gingival index (GI), bleeding on probing (BOP), probing depth (PD) and attachment gain were recorded at baseline, 3 and 6 months after treatment.. According to PlI, GI and BOP, there was no significant difference between the two groups at 3 and 6 months after periodontal therapy (1 > 0.05). However, PD reduction and attachment gain were significantly greater for SRP+M than that for SRP (P < 0.05). For SRP+M and SRP groups, PD reduction were 1.98 mm and 1.32 mm, and attachment gain were 1.87 mm and 1.14 mm respectively. Deep pockets in SRP+M group showed more obvious PD reduction (3.48 mm versus 2.21 mm, P < 0.01) and attachment gain (2.62 mm versus 1.23 zmm, P < 0.01) than that in SRP group.. Treatment with SRP plus locally delivered minocycline is more effective than SRP alone in male smokers with chronic periodontitis. Mechanical debridement plus locally delivered antibiotics are recommended especially for smokers with deep pocket periodontitis.

Topics: Adult; Anti-Bacterial Agents; Chronic Periodontitis; Dental Plaque Index; Dental Scaling; Follow-Up Studies; Humans; Male; Middle Aged; Minocycline; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Periodontitis; Root Planing

The microflora that develops on minocycline strips, used as an adjunct in non-surgical periodontal therapy was studied.. Minocycline (1.4 mg in polycaprolactone vehicle) and control strips were applied into all residual pockets (PD > or = 5mm, > or =2 pockets/subject) of patients with chronic periodontitis 1 month after a course of non-surgical periodontal therapy. Strips were inserted and retained for 3 days, changed to new strips for 3 more days and then removed. Strips were recovered from 14 (eight test, six control) of the 34 participants at day 0 (strip inserted, left for 30 s, removed), days 3 and 6, for (i) anaerobic culture, (ii) coliforms culture, using MacConkey agar, (iii) yeast culture, using Sabouraud's dextrose agar.. The mean anaerobic cfu/strip (x10(5); control/test) were 2/6, 24/2, 11/2 at days 0, 3 and 6, respectively (P > 0.05). The corresponding mean proportion of Gram-negative rods and fusiforms were 27%/21%, 27%/15% and 55%/8%. The proportions of Gram-negative rods on test strips by day 6 were significantly reduced (P < 0.05). A significantly increased prevalence of Streptococcus mitis biovar 1 was found on spent test strips (control versus test; 0% versus 38%, Fisher exact test, P = 0.01). Coliform prevalence at days 0, 3 and 6 on control/test strips were 0/13%, 50%/38% and 50%/13%. Yeasts were occasionally isolated.. The findings indicated that the minocycline strips but not the control strip supported a microbial colonisation compatible with periodontal health by day 6.

Topics: Administration, Oral; Anti-Bacterial Agents; Bacteria, Aerobic; Bacteria, Anaerobic; Chronic Disease; Colony Count, Microbial; Enterobacteriaceae; Female; Gram-Negative Facultatively Anaerobic Rods; Humans; Male; Middle Aged; Minocycline; Periodontal Pocket; Periodontium; Pharmaceutical Vehicles; Streptococcus mitis; Yeasts

This article addresses the benefits of using minocycline microspheres as an adjunct to conventional periodontal therapy. The author reviewed data from a large controlled clinical trial. The investigation indicated that scaling and root planing, plus minocycline microspheres, attained statistically significant improvements, with regard to several clinical parameters, when compared with scaling and root planing alone. Because it is the clinical meaningfulness of data that determines whether a therapy should be implemented, these data are interpreted with respect to their clinical relevance.

Topics: Anti-Bacterial Agents; Chronic Disease; Combined Modality Therapy; Data Interpretation, Statistical; Dental Scaling; Gingival Hemorrhage; Humans; Microspheres; Minocycline; Odds Ratio; Periodontal Pocket; Periodontitis; Root Planing; Treatment Outcome

The management of periodontal diseases has included both non-surgical and surgical treatment options. Non-surgical treatment traditionally has referred to the role of mechanical instrumentation of the root surface with either scalers or curettes. However, the introduction of locally delivered anti-microbial medications, which can be placed directly into a periodontal pocket, has provided the practitioner with another treatment option. This article looks at the different locally delivered anti-microbial medications being used in the non-surgical management of periodontal diseases.

Topics: Absorbable Implants; Administration, Topical; Anti-Bacterial Agents; Anti-Infective Agents; Cellulose; Chlorhexidine; Contraindications; Delayed-Action Preparations; Dental Scaling; Doxycycline; Drug Delivery Systems; Drug Implants; Humans; Minocycline; Periodontal Diseases; Periodontal Pocket; Root Planing; Subgingival Curettage; Tetracycline

Tumor necrosis factor-alpha (TNF-alpha) may play an important role in insulin resistance. In this study, we hypothesized that TNF-alpha produced due to periodontal inflammation synergistically affects insulin resistance as well as TNF-alpha produced from adipose tissues in insulin-resistant type 2 diabetes patients. Therefore, to understand the effects of antimicrobial periodontal therapy on serum TNF-alpha concentration and subsequent metabolic control of diabetes, we examined the periodontal and diabetic status on 13 type-2 diabetes patients.. These patients were treated with local minocycline administration in every periodontal pocket around all existing teeth once a week for a month. Before and after treatment, the number of total bacteria in the periodontal pockets and circulating TNF-alpha concentration were measured and the HbA1c value was assessed.. Antimicrobial therapy significantly reduced the number of microorganisms in periodontal pockets (P <0.01). After treatment, the circulating TNF-alpha level was significantly reduced (P <0.015). The HbA1c value was also reduced significantly (P <0.007). In addition, the 6 patients who were not receiving insulin therapy demonstrated decreased fasting insulin levels (P <0.03), and HOMA-R (P <0.03) indices. The average reductions in circulating TNF-alpha concentration and HbA1c value were 0.49 pg/ml and 0.8%, respectively.. The results indicate that anti-infectious treatment is effective in improving metabolic control in diabetics, possibly through reduced serum TNF-alpha and improved insulin resistance.

Topics: Adult; Aged; Anti-Bacterial Agents; Blood Glucose; Body Mass Index; Dental Plaque; Diabetes Mellitus, Type 2; Fasting; Female; Follow-Up Studies; Glycated Hemoglobin; Humans; Insulin; Insulin Resistance; Male; Middle Aged; Minocycline; Periodontal Diseases; Periodontal Index; Periodontal Pocket; Periodontitis; Statistics as Topic; Statistics, Nonparametric; Tumor Necrosis Factor-alpha

The current data suggest that local delivery of antimicrobials into the periodontal pocket can improve periodontal health. However, they do not provide a superior result to scaling and root planing. In conjunction with scaling and root planing, the adjunctive use of local drug delivery devices may enhance the results in sites which do not respond to conventional therapy.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Doxycycline; Drug Hypersensitivity; Drug Resistance, Microbial; Humans; Minocycline; Periodontal Pocket; Periodontitis; Tetracycline

The purpose of this study was to investigate the distribution of several periodontopathic bacteria in adult periodontitis, their in vitro susceptibility to minocycline-HCl, and whether the efficacy of the drug changes with a decrease in bacterial susceptibility. Twenty-one patients (43 to 75 years old) with 62 periodontal lesions from pockets > or =4 mm participated in the study. After subgingival sampling, an ointment containing 2% minocycline-HCl was applied locally to the selected pockets once a week for 4 weeks. The lesions were clinically examined after 1 and 4 weeks of administration. The distribution of the subgingival microorganisms included Capnocytophaga sputigena (37.1%), Prevotella intermedia (22.6%), Porphyromonas gingivalis (22.6%), Fusobacterium nucleatum (20.1%), Actinobacillus actinomycetemcomitans (9.7%), and Eikenella corrodens (4.8%). The distribution was complex, with 76.8% of the sites containing 1 to 3 bacterial spieces. The minimum inhibitory concentration (MIC) of minocycline-HCl for each organism showed that most were inhibited by a minocycline-HCl concentration equal to or less than the MIC for reference strains. However, some clinical strains of Prevotella intermedia seemed to exihibit low susceptibility to minocycline-HCl. There were no significant differences among sites with strains exhibiting low or normal susceptibility to minocycline-HCl. The concentration of the drug applied to deep periodontal pockets inhibited the growth of most of the microorganisms investigated in this study.

Topics: Administration, Topical; Adult; Aged; Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Capnocytophaga; Colony Count, Microbial; Eikenella corrodens; Female; Fusobacterium nucleatum; Gingiva; Gram-Negative Bacteria; Humans; Male; Middle Aged; Minocycline; Ointments; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Prevotella intermedia; Tetracycline Resistance

By local delivery of antibiotics to periodontal pockets, very high initial concentrations are often quickly succeeded by subinhibitory concentrations, which may facilitate development of bacterial resistance. The purpose of the present study was to investigate possible development of resistance in suspected periodontal pathogens after exposure to subinhibitory concentrations of metronidazole and minocycline. The minimal inhibitory concentration (MIC) of 18 reference strains and 12 clinical isolates was determined by a broth dilution method. Subsequently, all strains with MIC < 8 micrograms/ml were exposed to serial passage on plates containing subinhibitory and gradually increasing concentrations of antibiotics, until growth was inhibited. Initially, most strains were inhibited at < or = 0.250 microgram/ml of minocycline and < or = 0.5 microgram/ml of metronidazole, though A. actinomycetemcomitans was resistant to metronidazole. After growth at subinhibitory concentrations, 8 strains survived 1-2 x and 11 stains survived 8-32 x their initial MIC of metronidazole, growing at up to 8 micrograms/ml. All A. actinomycetemcomitans survived 8-64 x their initial MIC of minocycline, growing at > or = 2 micrograms/ml, while all other strains were inhibited at < or = 0.250 microgram/ml, corresponding to a 1-8 x increase in their initial MIC. Thus, development of resistance was observed for periodontal bacteria growing at up to 64 x their initial MIC, but the final level of resistance was moderate.

Topics: Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Bacteria, Anaerobic; Campylobacter; Dose-Response Relationship, Drug; Drug Resistance, Microbial; Fusobacterium nucleatum; Humans; Metronidazole; Microbial Sensitivity Tests; Minocycline; Periodontal Pocket; Porphyromonas gingivalis; Prevotella intermedia; Serial Passage; Tetracycline Resistance; Treponema

Clinical and microbiological effects of subgingival delivery of 10% minocycline-loaded (MC), bioabsorbable microcapsules were examined in 15 adult periodontitis patients. Patients received oral hygiene instruction 2 weeks prior to the study. At baseline (day 0) all teeth received supragingival scaling (SC); 2 quadrants received no further treatment and 1 quadrant received subgingival scaling and root planning (SRP). In the fourth quadrant, the tooth with the deepest probing sites (at least 1 site > or = 5 mm) was treated with minocycline microcapsules. The sites were evaluated at baseline and weeks 1, 2, 4, and 6. Clinical indices included bleeding on probing (BOP), probing depths (PD), and attachment loss (AL). Microbiological evaluations included percent morphotypes by phase-contrast microscopy; cultivable anaerobic, aerobic, and black-pigmented Bacteroides (BPB); and percent Porphyromonas gingivalis, Prevotella intermedia, Eikenella corrodens, and Actinomyces viscosus by indirect immunofluorescence. In the SC + MC group, BOP, PD, and AL were significantly reduced from baseline for weeks 1 to 6. BOP in the SC + MC group was significantly reduced compared to the SRP group from weeks 2 to 6. In the SC + MC group the percent of spirochetes and motile rods decreased and the percent of cocci increased after 1 week. The increased cocci and decreased motile rods were statistically greater at weeks 4 and 6 in the SC + MC group compared to the SRP group. This study demonstrates that local subgingival delivery of 10% minocycline-loaded microcapsules as an adjunct to scaling results in reduction in the percent sites bleeding on probing greater than scaling and root planning alone and induces a microbial response more favorable for periodontal health than scaling and root planing.

Topics: Absorption; Actinomyces viscosus; Adult; Anti-Bacterial Agents; Bacteroides; Capsules; Combined Modality Therapy; Delayed-Action Preparations; Dental Scaling; Drug Implants; Eikenella corrodens; Female; Fluorescent Antibody Technique, Indirect; Follow-Up Studies; Gingival Hemorrhage; Humans; Male; Minocycline; Oral Hygiene; Patient Education as Topic; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Prevotella intermedia; Root Planing; Spirochaetales

The purpose of this investigation was to evaluate the effect of non-surgical periodontal treatment and adjunctive systemic minocycline therapy on the level of neutral protease activity in whole saliva of adults with periodontitis. A test group of 21 adult patients with moderate to severe periodontitis was compared to a control group of 5 adults with healthy periodontium. Four test groups were examined: 1) scaling and root planing (SRP), probing depth = 4 to 5 mm; 2) SRP, PD > or = 6 mm; 3) SRP and adjunctive systemic minocycline therapy, PD = 4 to 5 mm; 4) SRP and adjunctive systemic minocycline therapy, PD > or = 6 mm. Clinical parameters and levels of neutral protease in whole saliva were assessed at baseline and on the sixth week after the non-surgical periodontal treatment. Neutral protease activity was measured by spectrofluorimetric method. Statistical tests of Mann-Whitney and Spearman Rank correlation coefficient were used in the evaluation of the mean values of measurements. The mean values of protease activity were significantly higher in the test groups than in the control group at baseline. Six weeks after non-surgical therapy, patients with 4 to 5 mm probing depth had approximate values of protease activity comparable to the control group. Hence it can be argued that these patients did not need minocycline HCL as an adjunctive therapy. However, non-surgical therapy had limited effects on both clinical parameters and enzyme activities for subjects with > or = 6 mm probing depth; on the other hand, gingival inflammation and enzyme activities were reduced significantly by the usage of minocycline as adjunctive therapy in these patients. According to our results, neutral protease activity in saliva is related to probing depth and gingival bleeding index, and not related to age and epithelial cell number. For these reasons, systemic minocycline therapy might be useful as an adjunct to non-surgical therapy in the presence of deep pockets, especially for reinfected cases. Further investigations are needed to confirm this suggestion.

Topics: Adult; Age Factors; Anti-Bacterial Agents; Cell Count; Chemotherapy, Adjuvant; Dental Scaling; Endopeptidases; Epithelium; Female; Follow-Up Studies; Gingival Hemorrhage; Gingivitis; Humans; Male; Middle Aged; Minocycline; Periodontal Pocket; Periodontitis; Root Planing; Saliva; Salivary Proteins and Peptides; Spectrometry, Fluorescence

Periodontitis, similar to other infectious diseases, is known to progress as chronic inflammation with recurrent acute phases. The purpose of this study was to clarify the microbiological composition of the acute phase and to compare the bacterial flora with that of comparable chronic periodontal pockets. We also evaluated the effect of application of minocycline gel locally on the change in the microflora in the acute pockets. Microbial flora from the subgingival pockets of 28 patients in the acute phase of periodontitis and of 12 patients in a comparable chronic phase as the control were investigated by various bacterial culture methods including TS blood agar and TSBV plates. Minocycline gel was applied to the acute periodontal pockets. Changes in the microbiological proportion and clinical parameters at one week after baseline examination were followed by dark-field analysis, culture method, and indirect immunofluorescence technique. Characteristic features of bacterial proportions in the acute site were observed as an increase in Bacteroides forsythus. The number of Porphyromonas gingivalis and black pigmented anaerobic rods also increased. Application of minocycline gel in the acute pocket without any debridement produced improvement in clinical symptoms at one week. Black-pigmented anaerobic rods, P. gingivalis, and B. forsythus decreased significantly at one week after the application. Results indicate that periodontopathic bacteria including B. forsythus and P. gingivalis were predominant in the acute phase of periodontitis and a locally delivered antibiotic may be effective as an alternative modality of treating the acute inflammation.

Topics: Acute Disease; Administration, Topical; Anti-Bacterial Agents; Bacteroides; Chronic Disease; Colony Count, Microbial; Delayed-Action Preparations; Female; Fluorescent Antibody Technique, Indirect; Gels; Humans; Male; Middle Aged; Minocycline; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Statistics, Nonparametric

Tetracycline in combination with scaling and root planing is frequently used to treat refractory periodontal disease. This study examined tetracycline resistance in bacteria recovered from periodontal pockets of patients with refractory periodontitis. Bacterial isolates resistant to 10 micrograms/ml of tetracycline were isolated from plaque samples of 17 patients, of whom 6 had received tetracycline within 8 weeks prior to sampling. Minimal inhibitory concentrations (MICs) of tetracycline and minocycline were determined by agar dilution. In the 6 patients who had received tetracycline, a mean of 22.9% (+/- 38.2) of the total cultivable subgingival flora were resistant to tetracycline, compared with a mean of 7.2% (+/- 8.5) in the untreated group. Although various organisms were isolated, in most patients, the tetracycline-resistant organisms were dominated by Streptococcus spp. Overgrowth of Candida was found in one patient, and of Enterobacteriaceae in another patient, while small numbers of yeast or Staphylococcus spp. were isolated from the plaque samples of 9 others. 3 out of 4 patients who did not respond to tetracycline treatment had a variety of tetracycline-resistant anaerobic Gram-negative rods present. No correlation was found between increased proportions of tetracycline resistance in the whole bacterial sample and the presence of resistant periodontal pathogens.

Topics: Adult; Chronic Disease; Colony Count, Microbial; Dental Plaque; Enterobacteriaceae; Gram-Negative Anaerobic Bacteria; Humans; Microbial Sensitivity Tests; Middle Aged; Minocycline; Periodontal Pocket; Periodontitis; Streptococcus; Tetracycline; Tetracycline Resistance

The present study was carried out to examine the distribution of six periodontopathic bacteria in deep periodontal pockets and to reconfirm the effect of Periocline on these periodontopathic bacteria. Samples from sixty-two periodontal pockets were collected at pocket depths of over 4 mm in twenty-one periodontitis patients aged 43 to 75 years. After sampling, Periocline was applied topically to the selected pockets once a week for four weeks and reexamined. The detected rates of the periodontopathic bacteria were Capnocytophaga sputigena (37.1%), Prevotella intermedia (22.6%), Porphyromonas gingivalis (22.6%), Fusobacterium nucleatum (20.1%), Actinobacillus actinomycetemcomitans (9.7%) and Eikenella corrodens (4.8%). The distribution of the bacteria was compound because two or three bacterial species were found to coexist. In view of the MIC of minocycline-HCI for these bacteria, increase of most of the measured bacteria was suppressed by the concentration of drugs, including Periocline. However, clinical strains of P. i. were considered to have low susceptibility to minocycline-HCl. In view of the effect of topical application of drugs, no significant differences were found. From these results, it was suggested that Periocline contained effective concentration of minocycline-HCl.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Female; Humans; Male; Middle Aged; Minocycline; Periodontal Pocket; Periodontitis; Tetracycline Resistance

A case of post-juvenile periodontitis in a 28-year-old female patient is described along with new periodontal treatment modalities. Administration of minocycline-HCl with local drug delivery system was introduced as a part of initial periodontal therapy following microbiological and immunological examinations. The lesions were subsequently treated by guided tissue regeneration, which resulted in considerable gain of attachment with minimal recession of marginal gingiva. This observation suggests that the local delivery of antibiotics and regenerative therapy may prove to be effective alternative modalities in treatment of post-juvenile periodontitis.

Topics: Administration, Topical; Adult; Aggregatibacter actinomycetemcomitans; Aggressive Periodontitis; Combined Modality Therapy; Female; Follow-Up Studies; Guided Tissue Regeneration, Periodontal; Humans; Minocycline; Periodontal Attachment Loss; Periodontal Pocket; Porphyromonas gingivalis; Prevotella intermedia

Noting the acid-conditioning effect of minocycline on the root surface, we investigated the ability of minocycline to remove endotoxin on untreated, diseased cementum in vitro. Root surface specimens affected by periodontal disease were immersed in minocycline solution (10 mg/ml, 50 micrograms/ml, and 5 micrograms/ml) for 10 minutes, 1 day, 3 days, and 7 days, and endotoxin eluted was determined by the limulus amoebocyte lysate (LAL) assay. Specimens serving as controls were treated by immersion in pyrogen-free water, agitation, polishing, or exposure to citric acid (pH 1.0) for 3 minutes. When the period of immersion was the same, the root treatment with minocycline (10 mg/ml) yielded a significantly higher rate of neutralization of endotoxin than that with a 5 micrograms/ml or 50 micrograms/ml solution. However, the detoxifying effect of this method was less adequate than that of polishing or treatment with citric acid solution. There was variability in the effects of polishing among the teeth tested. To obtain the expected effect of the root treatment with minocycline solution; i.e., removal of the endotoxin, the combining of minocycline with a mechanical root preparation, such as polishing or root planing, seems to be effective.

Topics: Analysis of Variance; Dental Cementum; Endotoxins; Female; Humans; Male; Middle Aged; Minocycline; Periodontal Pocket; Periodontitis; Tooth Root

To study the effects of a step-wise treatment regimen on Actinobacillus actinomycetemcomitans-(Aa) associated periodontitis, 4 clusters among 33 patients harboring the organism were followed during successive periods of systemic minocycline plus mechanical debridement and minocycline plus modified Widman flap treatment. Localized periodontitis was found in 2 clusters, one with 7 localized juvenile periodontitis patients and a 24-year old male with localized destruction and extremely low plaque levels (LJP), and the other consisting of 10 patients with plaque and gingivitis and a wider age range (16 to 54 years, LP). Generalized severe and moderate periodontitis was found in 2 clusters which were further discriminated by severe gingivitis and high levels of supragingival plaque (9 patients, GSP), and mild inflammation and low plaque levels (6 patients, GMP). Mean percentages of Aa, as determined by selective cultivation of microbiota from at least 2 periodontal pockets of 6 mm or more were 63, 16, 33, and 7.8% in the clusters (P < 0.01). Six months after active treatment, Aa was present in 6/9 patients and 50% of sites in GSP, and 3/6 patients and 46% of sites in GMP patients. In contrast, the organism was virtually eliminated by scaling and flap procedures in the localized periodontitis clusters, and did not reappear after 6 months (P < 0.05). Combined antibiotic, mechanical, and surgical therapy resulted in a persistence of 20% of sites with residual probing depth of > or = 4 mm in GMP patients after active therapy. At this point, 3 of the GMP patients and 1 GSP patient left the study. Multiple regression analysis showed a significant influence of log-transformed numbers in Aa in cheek and saliva samples at the end of the study, and cluster on the percent residual number of sites with periodontal probing depth of > or = 7 mm (P < 0.001). The present results suggest that the applied therapy would be appropriate in localized forms of Aa periodontitis, but inappropriate in more severe and generalized forms to predictably eliminate Aa. Controlled long-term studies with larger groups of patients will be needed to establish the difference in treatment response suggested by these studies.

Topics: Adolescent; Adult; Aggregatibacter actinomycetemcomitans; Aggressive Periodontitis; Chemotherapy, Adjuvant; Colony Count, Microbial; Dental Plaque Index; Dental Scaling; Female; Humans; Male; Middle Aged; Minocycline; Mouth Mucosa; Periodontal Index; Periodontal Pocket; Periodontitis; Root Planing; Saliva; Surgical Flaps; Tongue; Treatment Outcome

Considerable problems have been reported in the eradication of Actinobacillus actinomycetemcomitans from periodontal sites. The present communication describes the 2-year results of a comprehensive combined mechanical/surgical and adjunctive minocycline (200 mg/day for 3 and another 2 weeks) treatment regimen in 28 patients with A. actinomycetemcomitans-associated periodontitis. Elimination of A. actinomycetemcomitans at periodontal sites was a prerequisite for gain of clinical attachment of > or = 2 mm or decrease of probing depth to < or = 4 mm after subgingival scaling plus minocycline (p < 0.01). Whereas 2 years after active treatment A. actinomycetemcomitans could not be detected at monitored sites in 23 patients, the organism was found on buccal mucosa and in saliva in 17 and 12 cases, respectively. One or 2 years after periodontal surgery, there was a significant association between log10-numbers of A. actinomycetemcomitans in buccal samples and numbers of residual pockets of > or = 7 mm as well as gingival sites with overt gingivitis (R2 = 0.687, p < 0.001). Present results indicate failure of an even prolonged administration of adjunctive minocycline to eliminate oral A. actinomycetemcomitans in most cases of A. actinomycetemcomitans-associated periodontitis.

Topics: Adolescent; Adult; Aggregatibacter actinomycetemcomitans; Chemotherapy, Adjuvant; Combined Modality Therapy; Dental Plaque; Dental Scaling; Female; Follow-Up Studies; Granulation Tissue; Humans; Male; Middle Aged; Minocycline; Mouth Mucosa; Periodontal Pocket; Periodontitis; Root Planing; Saliva; Surgical Flaps

Topics: Adolescent; Aggregatibacter actinomycetemcomitans; Aggressive Periodontitis; Guided Tissue Regeneration, Periodontal; Humans; Male; Membranes, Artificial; Minocycline; Orthodontics, Corrective; Patient Care Planning; Periodontal Pocket; Polytetrafluoroethylene

This study was designed to investigate whether antibiotic resistant micro-organisms are able to contaminate and survive on syringe tips used for subgingival deposition of antibiotics, and to test simple and effective means of disinfecting the syringe tip between applications. In the first part of the study, syringe tips used for application of Minocycline subgingival formula in 20 adult periodontitis patients were cultured for bacteria resistant to this drug before and after disinfecting them with ethanol. The results showed that 80% of the unwashed syringes were culture positive for minocycline resistant bacteria, whereas only 1 ethanol washed syringe tip was contaminated. In part II of the study, after dispensing minocycline periodontal formula in 20 patients, 10 of the syringe tips were washed with ethanol while 10 were left untreated. All syringes were stored in a refrigerator for 8 days, whereafter the tips were sampled for resistant bacteria. 20% of the unwashed tips were contaminated after 8 days incubation at 4 degrees C. None of the ethanol washed syringe tips were culture positive. We conclude that syringe tips may be contaminated with antibiotic resistant bacteria after dispensing the antibiotic in periodontal pockets. The transmission of these bacteria to other periodontal sites may be avoided by disinfecting the syringe tip with ethanol between applications. We have also shown that antibiotic resistant bacteria may survive on the syringe tip following 8 days storage in a refrigerator, suggesting that syringes used for subgingival deposition of an antibiotic should not be stored for reuse.

Topics: Aged; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cold Temperature; Colony Count, Microbial; Disinfection; Disposable Equipment; Equipment Contamination; Ethanol; Female; Humans; Infection Control; Male; Middle Aged; Minocycline; Periodontal Pocket; Syringes; Tetracycline Resistance

Topics: Adult; Aggregatibacter actinomycetemcomitans; Dental Plaque; Dental Plaque Index; Female; Humans; Minocycline; Periodontal Diseases; Periodontal Index; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Tetracycline

Topics: Minocycline; Periodontal Pocket

This study was designed to evaluate the clinical and microbiological effects of local administration of 2% minocycline-HCl ointment (Periocline) combined with scaling and root planing in recurrent periodontal pockets. Thirty-three sites were selected for this examination. The sites had probing depths greater than 5 mm and loss of attachment greater than 2 mm within the previous 3 months. They were assigned as test (22 sites) or control sites (11 sites). After meticulous scaling (SC) and root planing (RP), Periocline was delivered into the periodontal pockets of test sites: control sites were irrigated with biological saline following SC/RP. Administration of Periocline or irrigation with saline was performed once a week for 4 consecutive weeks. The effects on clinical conditions including probing pocket depth, clinical attachment level, and bleeding on probing were evaluated at baseline, 2, 4, 8, and 12 weeks. Microbiological examinations consisting of darkfield microscopic study and culture were performed at baseline, 4, and 12 weeks. Clinical conditions improved in both groups following treatment; significantly better improvements were obtained in the test group. Microbiological study revealed that Periocline effectively eliminated periodontopathic gram-negative bacteria. These results indicated that a combination of SC/RP with local administration of 2% minocycline for recurrent periodontal pockets brought about more satisfactory results than conventional SC/RP.

Topics: Administration, Topical; Anti-Infective Agents, Local; Humans; Minocycline; Ointments; Periodontal Pocket

Sixty-one cultures of Gram-negative anaerobic rods were isolated from deep periodontal pockets of patients with rapidly progressive periodontitis. Isolates were speciated as Bacteroides gingivalis (18 isolates), Bacteroides intermedius (8), Bacteroides oris (1), Bacteroides gracilis (17) and Fusobacterium nucleatum (17). Their susceptibilities, to seven antimicrobial agents, were determined in vitro using a plate dilution technique. Amoxycillin and amoxycillin with clavulanic acid were active against all isolates (MIC less than 1 mg/l) and proved the most effective agents tested. F. nucleatum and B. gracilis showed resistance to erythromycin; F. nucleatum had MIC values ranging from 0.03 mg/l up to 128 mg/l when tested with this, least effective agent. Metronidazole was effective against all isolates except for a few strains of B. gracilis (MIC less than 4 mg/l). Tetracycline hydrochloride and minocycline were active against all isolates except for a few strains of B. gracilis (MIC less than 2 mg/l with both minocycline and tetracycline hydrochloride). Penicillin proved less effective than amoxycillin with regard to inhibition of B. gracilis.

Topics: Amoxicillin; Anaerobiosis; Anti-Bacterial Agents; Bacteriological Techniques; Bacteroides; Clavulanic Acid; Clavulanic Acids; Drug Resistance, Microbial; Erythromycin; Fusobacterium; Humans; Metronidazole; Minocycline; Penicillin Resistance; Penicillin V; Periodontal Pocket; Periodontitis; Tetracycline Resistance

Local drug delivery by using biocompatible polymers has been developed in the treatment of periodontitis for many years. The purpose of this study was to examine the release kinetics of minocycline from monolithic film prepared from polycaprolactone and polyethylene glycol and to examine the antimicrobial activity in vitro. Polycaprolactone (Mwt 60,000), polyethylene glycol and minocyline was dissolved by chloroform, which was vigorously stirred for 24 hours and it was dried in vacuum chamber. The thickness of cast films containing 20%, 30% and 40% minocycline was 200 +/- 10 microns. Release rate of minocycline from the film was measured by means of a UV spectrophotometer. In vitro releasing test, each film showed a large burst effect within first two and three hours and a steady state release kinetic at the rate of 4-8 micrograms/cm/hour for 7 days. In antimicrobial test, each sample (one fourth inch in diameter) sunk in the broth that had been innoculated with periodontopathic bacteria showed growth inhibitory activity after 48 hr anaerobic incubation. In cytotoxicity test, there was no significant cytotoxic effect in casting film to human gingival fibroblast. This study showed that, by embedding minocycline in polycaprolactone, it is feasible to obtain substained release of the drug within the periodontal pocket for seven days and should be useful tool for elimination of pathogenic microflora from periodontal pocket or reducing inflammation in periodontal disease.

Topics: Adolescent; Adult; Bacteremia; Drug Delivery Systems; Female; Humans; Male; Minocycline; Periodontal Pocket; Polyesters; Polyethylene Glycols

The purpose of this study was to evaluate a new system of drug delivery to periodontal pocket by means of intracanal dressing and additional iontophoresis in vitro. Forty extracted human teeth with a single root were used. After the root canal was prepared endodontically, the periphery root apex was painted with the Silux system (3 M Co.) to close the apical foramen. Each tooth was planted into an agar block. Three drugs (zinc iodide-iodine, penicillin G. potassium, minocycline HCl) were used (Table 1), and 50 microliters of each drug was injected into an individual root canal. Then a cathodic current (3 mA x 40 min) was applied using an automatic current volte regulater (PAV-200, Jooko Co.) with a platinum wire electrode inserted in the root canal (Fig. 1). The degree of drugs diffusion in the agar around teeth was estimated by individual color reactions zinc iodide-iodin test for starch, penicillin G. potassium test for phosphomolybdic acid, minocycline HCl test for ferric chloride). And also, the effects of root planing and etching by Quick Jet (Yosida Co.) on the root surface were evaluated in the same way. The results were as follow: 1. The degree of diffusion by intracanal electrical medication was greater in the cervical third area than the middle and apical third. 2. Several small areas stained by the iodo-starch color reaction were observed around the cervical root surface where greater diffusion was observed. 3. Many dentinal tubules were observed on a limited root surface where root planing and Quick Jet, were employed caused greater diffusion. 4. The results suggest the new delivery system for management of the microorganisms by intracanal medication and additional iontophoresis.

Topics: Humans; Iodides; Iontophoresis; Minocycline; Penicillin G; Periodontal Pocket; Periodontitis; Root Canal Therapy; Tetracyclines; Tooth Root; Zinc; Zinc Compounds

Topics: Adult; Animals; Collagen; Diabetes Mellitus, Experimental; Doxycycline; Gingival Crevicular Fluid; Gingivitis; Humans; Male; Microbial Collagenase; Minocycline; Periodontal Pocket; Rabbits; Rats; Tetracycline; Tetracyclines

In a series of experiments, Golub et al. demonstrated that tetracyclines, but not other antibiotics, can inhibit mammalian collagenases and proposed that this property could be useful in treating diseases, such as periodontal disease (but also included certain medical conditions, e.g., corneal ulcers) characterized by excessive collagen degradation (J Periodont Res 1983, 1984 and 1985; Experientia 1984; Cornea 1984). One effect was the dramatic reduction of tissue collagenase activity within the gingival crevicular fluid (GCF) of periodontal pockets after administering a standard regimen of a tetracycline (e.g., 200 mg minocycline or 1000 mg tetracycline/day). The preliminary studies described below determined the effect of (1) low-dose (LD; 40-80 mg/day) orally administered minocycline on GCF collagenase activity and on the subgingival microflora (Exp. I), and (2) tetracycline-loaded monolithic fibers (TF) on collagenase activity in vitro (Exp. II). In Exp. I, GCF collagenase activity was reduced by 45 to 80% 2 weeks after initiating LD minocycline therapy, an effect that lasted for at least several weeks after stopping drug treatment. No consistent change in the relative proportions of G(+), G(-) and motile subgingival microorganisms was detected as a result of LD treatment suggesting that the reduction in GCF collagenase activity was a direct inhibition of the enzyme by the drug. In Exp. II, 3- and 6-mm lengths of TF in vitro established tetracycline concentrations in 250 microliters of 132 micrograms/ml, from 3-mm lengths, and 265 micrograms/ml, from 6-mm lengths, after an 18-hour incubation.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Delayed-Action Preparations; Female; Gingival Crevicular Fluid; Humans; In Vitro Techniques; Male; Microbial Collagenase; Middle Aged; Minocycline; Periodontal Diseases; Periodontal Pocket; Tetracycline; Tetracyclines