minocycline and Periodontitis

Tetracyclines are broad-spectrum antibiotics that act as such at the ribosomal level where they interfere with protein synthesis. They were first widely prescribed by dermatologists in the early 1950s when it was discovered that they were effective as a treatment for acne. More recently, biologic actions affecting inflammation, proteolysis, angiogenesis, apoptosis, metal chelation, ionophoresis, and bone metabolism have been researched. The therapeutic effects of tetracycline and its analogues in various diseases have also been investigated. These include rosacea, bullous dermatoses, neutrophilic diseases, pyoderma gangrenosum, sarcoidosis, aortic aneurysms, cancer metastasis, periodontitis, and autoimmune disorders such as rheumatoid arthritis and scleroderma. We review the nonantibiotic properties of tetracycline and its analogues and their potential for clinical application.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Anti-Inflammatory Agents; Aortic Aneurysm, Abdominal; Apoptosis; Arthritis, Rheumatoid; Doxycycline; Humans; Matrix Metalloproteinases; Minocycline; Neoplasms; Neovascularization, Physiologic; Periodontitis; Rosacea; Sarcoma, Kaposi; Skin Diseases; Skin Diseases, Vesiculobullous; Tetracyclines

Chronic periodontitis affects many adults in the United States, some severely enough to threaten tooth loss. Of particular clinical importance is whether scaling and root planing (SRP) accompanied by a local adjunctive therapeutic agent improves outcomes over time compared to SRP alone. The adjunctive therapeutic agents investigated include: tetracycline, minocycline, metronidazole, a group of other antibiotics, chlorhexidine, and a group of antimicrobials. Primary outcomes considered are reductions in probing depth (PD) and gains in clinical attachment level (CAL).. RTI-UNC Evidence-Based Practice Center staff searched MEDLINE (1966 through December 2002) and EMBASE (through February 2002) to identify clinical trials published in English that 1) involved adults with chronic periodontitis but no serious comorbidities; 2) tested one or more chemical antimicrobial agents as an adjunct to SRP alone or with a placebo; 3) had a concurrent control group that received the same SRP as the treatment group; 4) reported outcomes for specified, fixed time periods; and 5) if multiple antimicrobials were tested, reported outcomes for each agent separately. We performed qualitative analyses and meta-analyses of PD and CAL effect sizes when the necessary data were available from at least three studies at 6-month follow-up.. Among the locally administered adjunctive antimicrobials, the most positive results occurred for tetracycline, minocycline, metronidazole, and chlorhexidine. Adjunctive local therapy generally reduced PD levels. Differences between treatment and SRP-only groups in the baseline-to-follow-up period typically favored treatment groups but usually only modestly (e.g., from about 0.1 mm to nearly 0.5 mm) even when the differences were statistically significant. Effects for CAL gains were smaller and statistical significance less common. The marginal improvements in PD and CAL were a fraction of the improvement from SRP alone.. Whether such improvements, even if statistically significant, are clinically meaningful remains a question. A substantial agenda of future research to address this and other issues (e.g., costs, patient-oriented outcomes) is suggested.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents, Local; Chemotherapy, Adjuvant; Chlorhexidine; Chronic Disease; Clinical Trials as Topic; Dental Scaling; Humans; Metronidazole; Minocycline; Periodontitis; Tetracycline

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Chronic Disease; Contraindications; Drug Delivery Systems; Humans; Microspheres; Minocycline; Periodontitis

It is well recognized that periodontal diseases are bacterial in nature. An essential component of therapy is to eliminate or control these pathogens. This has been traditionally accomplished through mechanical means (scaling and root planing [SRP]), which is time-consuming, difficult, and sometimes ineffective. Over the past 20 years, locally delivered, anti-infective pharmacological agents, most recently employing sustained-release vehicles, have been introduced to achieve this goal.. This systematic review evaluates literature-based evidence in an effort to determine the efficacy of currently available anti-infective agents, with and without concurrent SRP, in controlling chronic periodontitis.. In patients with chronic periodontitis, what is the effect of local controlled-release anti-infective drug therapy with or without SRP compared to SRP alone on changes in clinical, patient-centered, and adverse outcomes?. MEDLINE, the Cochrane Central Trials Register, and Web of Science were searched. Hand searches were performed of the Journal of Clinical Periodontology, Journal of Periodontology, and Journal of Periodontal Research. Searches were performed for articles published through April 2002. In addition, investigators contacted editors of the above-mentioned journals and companies sponsoring research on these agents for related unpublished data and studies in progress.. Studies included randomized controlled clinical trials (RCT), and case-controlled and cohort studies at least 3 months long. Therapeutic interventions had to include 1) SRP alone; 2) local anti-infective drug therapy and SRP; or 3) local anti-infective drug therapy alone. Included studies had to report patient-based mean values and measures of variation for probing depth (PD) and/or clinical attachment levels (CAL) for both test and control groups.. Studies were excluded if they: 1) included data from a previously published article; 2) included daily rinsing with chlorhexidine (CHX); or 3) had unclear descriptions of randomization procedures, examiner masking, or concomitant therapies.. For the meta-analysis, PD and CAL were expressed as summary mean effects with 95% confidence intervals (CI) for the effect, and analyzed using a standardized difference between SRP alone and experimental agent groups. The results were assessed with both fixed-effects and random-effects models. Studies were ranked according to the York system.. 1. Thirty-two studies were included (28 RCT, 2 cohort, and 2 case-control), incorporating a total patient population of 3,705 subjects. 2. Essentially all studies reported substantial reductions in gingival inflammation and bleeding indices, which were similar in both control and experimental groups. 3. A meta-analysis completed on 19 studies that included SRP and local sustained-release agents compared with SRP alone indicated significant adjunctive PD reduction or CAL gain for minocycline (MINO) gel, microencapsulated MINO, CHX chip and doxycycline (DOXY) gel during SRP compared to SRP alone. 4. Use of antimicrobial irrigants or anti-infective sustained-release systems as an adjunct to SRP does not result in significant patient-centered adverse events.. 1. In some populations, anti-infective agents in a sustained-release vehicle alone can reduce PD and bleeding on probing (BOP) equivalent to that achieved by SRP alone. 2. No evidence was found for an adjunctive effect on reduction of PD and BOP of therapist-delivered CHX irrigation during SRP compared to SRP alone. 3. Additional RCTs are needed which evaluate the effectiveness of these therapies in all forms of periodontitis. 4. The study protocol for future RCTs should include appropriate statistical analyses and complete data sets to facilitate future evidence-based reviews. 5. Alternative surrogate parameters to PD and CAL need to be identified and validated such as microbial, inflammatory, or tissue-destructive markers that could be used in conjunction with clinical parameters to help determine the patient's response to emerging technologies that target the infectious and/or inflammatory aspects of periodontitis. 6. Future Phase IV clinical trials should be designed that evaluate local anti-infective therapies in conjunction with SRP in a manner consistent with current standards of care and evaluate cost-effectiveness. 7. The use of local anti-infective agents in at-risk patient populations and for the treatment of at-risk disease sites needs to be validated in randomized controlled clinical trials. 8. Several local anti-infective agents combined with SRP appear to provide additional benefits in PD reduction and CAL gain compared to SRP alone. The decision to use local anti-infective adjunctive therapy remains a matter of individual clinical judgment, the phase of treatment, and the patient's status and preferences.

Topics: Alkaloids; Anti-Bacterial Agents; Anti-Infective Agents, Local; Benzophenanthridines; Chlorhexidine; Delayed-Action Preparations; Dental Scaling; Doxycycline; Humans; Isoquinolines; Metronidazole; Minocycline; Periodontitis; Tetracycline

Five local delivery systems with five different antimicrobial agents have been discussed. All are capable of delivering high concentrations of their antimicrobial to the site of the periodontal infection. Although only one system, tetracycline fiber, is available in United States, two other systems, chlorhexidine chip and doxycycline polymer, may be available in the near future. Two other systems, metronidazole gel and minocycline ointment, are available in other countries. Data from pertinent studies were presented as were techniques for using the various systems. Indications for the use of the products were also discussed. In selecting the appropriate delivery system, the clinician has to weigh the efficacy of the products, ease of use, availability, and cost. Although local delivery systems do not replace existing periodontal therapies, they do have a place in the treatment of periodontitis and offer the dentist additional methods to aid in the control of periodontal diseases.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Anti-Infective Agents, Local; Chlorhexidine; Doxycycline; Drug Costs; Drug Delivery Systems; Europe; Gels; Humans; Metronidazole; Minocycline; Ointments; Periodontitis; Pharmaceutical Vehicles; Polyvinyls; United States

This review article evaluates the role of local drug delivery systems in the management of periodontal diseases. The efficacy of several local delivery devices (i.e., tetracycline fibers, metronidazole and minocycline gels, chlorhexidine chips, and doxycycline polymer) which are either commercially available in the United States or abroad, or are currently under consideration for Food and Drug Administration (FDA) approval are discussed. The drug delivery systems are assessed with regard to their functional characteristics, effectiveness as a monotherapy, as compared to scaling and root planing, and ability to enhance conventional therapy. Furthermore, controversies associated with local delivery are addressed (e.g., induction of bacterial resistant strains, the efficacy of systemic versus local drug delivery, and whether local drug delivery should function as an alternative or as an adjunct to conventional treatment).

Topics: Administration, Topical; Anti-Bacterial Agents; Anti-Infective Agents, Local; Antitrichomonal Agents; Chlorhexidine; Doxycycline; Drug Delivery Systems; Drug Resistance, Microbial; Drug Utilization; Humans; Metronidazole; Minocycline; Periodontitis; Root Planing

Periodontitis is a bacterial infection. It appears in a generalised form but more often appears in local areas in a patient's mouth or is reduced to localised areas by mechanical treatment. Periodontitis lends itself well to treatment by means of a controlled local delivery system using an antimicrobial agent. Several products have been introduced or are in the process of clearing regulatory agencies. It is the goal of all local delivery systems to deliver high concentrations of an antimicrobial directly to the site of the periodontal infection. Concentrations of medication can be achieved considerably higher than could be obtained with systemic administration, while the systemic uptake of the medication is minimal. Five local delivery systems (tetracycline fibre, doxycycline polymer, chlorhexidine chip, minocycline ointment and metronidazole gel) are now available. Techniques for their use and the supporting scientific evidence are presented and indications for the use of the various systems are also discussed. These local delivery systems offer the clinician additional therapeutic procedures to aid in the treatment of the chronic inflammatory periodontal diseases.

Topics: Administration, Topical; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Infective Agents, Local; Chlorhexidine; Chronic Disease; Doxycycline; Drug Delivery Systems; Drug Implants; Gels; Humans; Metronidazole; Minocycline; Ointments; Periodontitis; Polymers; Tetracycline

Tetracyclines are frequently used in the treatment of periodontitis; however, emergence of resistant bacterial strains has decreased the utility of these drugs. At present, there are a lot of data in the literature from which one can draw conclusions regarding the use of local drug delivery. This paper reviews the utility and different systems of local delivery of minocycline, a semisynthetic tetracycline, in the treatment of periodontitis.

Topics: Administration, Topical; Anti-Bacterial Agents; Chronic Disease; Contraindications; Humans; Microspheres; Minocycline; Ointments; Periodontitis

Periodontitis is a result of an infection with specific pathogenic microorganisms. Thus, the local delivery of antimicrobials has been investigated as a possible method for controlling this infection and treating periodontal disease. A number of antimicrobial agents have been studied both as adjunctive therapies with scaling and root planing and as stand-alone chemotherapies. These agents have been administered in irrigation solutions and as single-dose formulations, but with little long-term efficacy in the treatment of periodontitis. Recent investigations have focused on the delivery of antimicrobials in sustained-release formulations designed to maintain effective concentrations of drug within the periodontal pocket. This article provides an overview of the development of the use of locally delivered antimicrobials in periodontal therapy and the current state-of-the-art of the technique.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Delayed-Action Preparations; Doxycycline; Drug Delivery Systems; Humans; Metronidazole; Minocycline; Periodontitis; 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

Topics: Adult; Animals; Anti-Bacterial Agents; Chronic Disease; Drug Evaluation; Drug Evaluation, Preclinical; Humans; Minocycline; Periodontitis; Tetracyclines

Despite widespread use, the impact of minocycline hydrochloride microspheres on the shifts of oral bacterial species resistant to minocycline remains unknown. This study aimed at examining the percentage and taxonomy of minocycline-resistant isolates in saliva and subgingival plaque samples before and after minocycline microspheres application in periodontitis patients during maintenance.. Patients received supra- and sub-gingival debridement with (test) or without (control) minocycline microspheres application to sites with probing depth >4 mm and were clinically monitored at baseline, 1, 3, and 6 months. Samples were collected at baseline, 1 and 6 months and analyzed via cultivation with or without 4 μg/mL minocycline. Percentage of resistant strains was determined by colony counting and taxonomy by checkerboard DNA-DNA hybridization. Significant clinical changes were sought with the Mann-Whitney test and differences in percentage of resistant isolates with the Friedman and Mann-Whitney tests.. Groups showed similar clinical improvements. Mean percentage of resistant isolates rose at 1 month and decreased at 6 months in saliva and plaque samples in test group (P <0.05) but remained unchanged in control group. Percentage of resistant isolates of Gemella morbillorum and Eubacterium saburreum increased significantly at 6 months in both groups. Antibiotic resistance by Aggregatibacter actinomycetemcomitans, Tannerella forsythia, and Porphyromonas gingivalis was either absent or infrequent.. Minocycline microspheres result in transient selection of minocycline resistant species in saliva and subgingival plaque samples.

Topics: Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Clostridiales; Drug Resistance, Bacterial; Gemella; Humans; Microspheres; Minocycline; Periodontitis; Porphyromonas gingivalis

This paper aimed to study the effect of metronidazole sustained-release film combined with minocycline hydrochloride on treating periodontitis. 138 patients with chronic periodontitis were collected and randomly divided into control group and observation group (each of 69 cases). Patients in control group were treated by using minocycline hydrochloride, while those in observation group were treated using metronidazole sustained-release film with minocycline hydrochloride, and each group with 4 weeks of treatment. Then we observed the periodontal mend matters, therapeutic effect, adverse reaction and relapse situation of patients in two groups. Results showed that compared with the prior treatment, the gingival index, dental plaque index, odontoseisis index and pocket depth of patients in two groups was significantly reduced. Moreover, the reduction range in observation group was significantly larger and the curative effect was superior to that in control group. Therefore, metronidazole sustained-release film combined minocycline hydrochloride can evidently improve patients' periodontal status, enhance drug therapeutic effect. It has less adverse reaction and low relapse rate, thus is worthy of clinical promotion.

Topics: Adolescent; Adult; Aged; Delayed-Action Preparations; Drug Therapy, Combination; Female; Humans; Male; Metronidazole; Middle Aged; Minocycline; Periodontitis

The present study evaluated the effects of systemic minocycline on clinical and biochemical parameters of chronic periodontitis, which is a common inflammatory disorder of the periodontium initiated by the presence of bacteria in the gingival sulcus. Besides nonsurgical periodontal therapy, 20 individuals received minocycline systemically while another 20 subjects received placebo capsules for 2 weeks. Plaque index (PI), sulcus bleeding index (SBI), probing depth (PD), and relative attachment level (RAL) were measured and gingival crevicular fluid (GCF) samples were obtained at baseline and first, third, and sixth months. Matrix metalloproteinase-8 (MMP-8) and prostaglandin E₂ (PGE₂) levels were analyzed by enzyme immunoassay method. Significant improvements in all parameters in both groups were recorded. In the minocycline group, changes in PI and SBI were significantly greater only at first month, whereas reductions in PD, RAL, MMP-8, and PGE₂ levels were greater at all times. MMP-8 and PGE₂ exhibited positive correlations with SBI, PD, and each other. Minocycline demonstrated clinical benefit for periodontal therapy and provided further improvements on inflammatory mediators promising a host-modulating capacity.

Topics: Adult; Anti-Bacterial Agents; Dental Plaque Index; Dinoprostone; Female; Gingival Crevicular Fluid; Humans; Male; Matrix Metalloproteinase 8; Minocycline; Periodontal Attachment Loss; Periodontal Index; Periodontitis; Pilot Projects

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 aims of this study were to evaluate the effect of mechanical periodontal treatment with local application of minocycline (APT) on serum adiponectin as a marker of insulin resistance improvement in type 2 diabetes mellitus (T2DM) patients and to investigate if effect of APT on serum adiponectin level was sustained by periodontal maintenance (PM).. Twenty-seven T2DM patients were randomly assigned into test or control groups. Test received scaling with ultrasonic devices at baseline and APT biweekly for 2 months while control received scaling at baseline and mechanical tooth cleaning (MPT) at the same interval. At 6 months, all patients received mechanical tooth cleaning as PM. Periodontal examination and blood measurements were performed at baseline, 4 and 9 months.. Adiponectin concentrations in test had significantly increased by 31.4% after APT (p=0.024) and by 30.4% after PM (p=0.002) compared with baseline. The percentage of >or=4 mm probing depths (PD) had shown 8.3% and 9.3% reduction after APT and PM (p=0.046, 0.02) in test while 5.0% reduction after MPT in control group (p=0.031).. Our results suggested that APT and PM not only improve periodontal disease but also increase serum adiponectin in T2DM patients.

Topics: Adiponectin; Administration, Topical; Adult; Anti-Bacterial Agents; Dental Scaling; Diabetes Mellitus, Type 2; Female; Humans; Male; Minocycline; Periodontitis; Ultrasonic Therapy

The aim of the study was to evaluate the effects of minocycline microspheres on periodontal probing depth reduction when used in combination with surgery in adults with moderate to severe, chronic periodontitis.. Sixty patients with a minimum of one non-molar periodontal site > or =6 mm in two oral quadrants received either local minocycline microspheres at baseline, immediately following each of two surgical therapies (Weeks 2 and 3), and at Week 5 or surgery alone.. The mean probing depth reduction at Week 25 at sites > or =5 mm at baseline was 2.51 mm in the test group and 2.18 mm in the control group. Smokers in the test group had a significantly greater probing depth reduction (2.30 mm) than smokers in the control group (2.05 mm). The number of sites with probing depth reductions of > or =2 and > or =3 mm were significantly higher in the test group than in the control group.. Applications of local minocycline as an adjunct to surgery in adults with moderate to severe, chronic periodontitis were associated with statistically significant greater reductions in probing depth than surgery alone.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Chemotherapy, Adjuvant; Chronic Disease; Female; Humans; Male; Microspheres; Middle Aged; Minocycline; Oral Surgical Procedures; Periodontal Index; Periodontitis; Single-Blind Method; Smoking; Statistics, Nonparametric; Surgical Flaps; Treatment Outcome

Peri-implantitis is an inflammatory process caused by microorganisms affecting the tissues around an osseointegrated implant in function, resulting in a loss of supporting bone. Limited data exist regarding the treatment of peri-implantitis. The aim of this study was to assess the clinical and microbiologic outcome of repeated local administration of minocycline microspheres, 1 mg, in cases of peri-implantitis.. Thirty-two subjects with at least one implant with a probing depth > or =4 mm combined with bleeding and/or exudate on probing and the presence of putative pathogenic bacteria were included in the study. At baseline, subjects were randomly assigned to receive local minocycline microspheres (17 subjects and 57 implants) or chlorhexidine gel (15 subjects and 38 implants) following debridement. Treatments were performed on three occasions: baseline and days 30 and 90. Follow-up examinations were conducted at 10 days and at 1, 3, 6, 9, and 12 months.. The use of minocycline resulted in significant improvements in probing depths compared to chlorhexidine at days 30, 90, and 180 (P = 0.5, P = 0.01, and P = 0.04, respectively). For the deepest sites of the minocycline-treated implants, the mean probing depth reduction was 0.6 mm at 12 months. Regarding bleeding on probing, significant differences between groups, based on all four sites at the implants, were found at days 30, 90, 180, 270, and 360. Both treatments resulted in a marked reduction in the indicator bacteria.. The use of a repeated local antibiotic as an adjunct to the mechanical treatment of peri-implantitis lesions demonstrated improvements in probing depths that were significantly different from controls and were sustained for 6 months. The adjunctive use of minocycline microspheres is beneficial in the treatment of peri-implant lesions, but the treatment may have to be repeated.

Topics: Adult; Aged; Anti-Infective Agents, Local; Bacteria; Chi-Square Distribution; Chlorhexidine; Colony Count, Microbial; Combined Modality Therapy; Delayed-Action Preparations; Dental Implantation, Endosseous; Dental Implants; Dental Scaling; Female; Follow-Up Studies; Gels; Humans; Male; Microspheres; Middle Aged; Minocycline; Periodontal Index; Periodontitis; Prosthesis-Related Infections; Retreatment; Single-Blind Method; Statistics, Nonparametric

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

Smoking increases the risk for periodontal disease and reduces the healing response. We examined the antimicrobial and clinical effects of scaling and root planing (SRP) with and without minocycline HCl 1 mg microspheres (MM) relative to smoking status in subjects with periodontitis.. A total of 127 subjects (46 never smokers, 44 former smokers, and 37 current smokers) with moderate to advanced periodontitis were randomized to receive MM + SRP (N = 62) or SRP alone (N = 65). Subgingival plaque samples collected at baseline and day 30 were examined for the presence of 40 periodontal bacteria by DNA probe analysis.. MM + SRP reduced red-complex bacteria (RCB) numbers and proportions to a greater extent than SRP alone, irrespective of smoking status. RCB numbers were not reduced by SRP in current smokers. The difference in the reduction in numbers of RCB by SRP relative to MM + SRP in current smokers was statistically significant (P <0.05). Numbers and proportions of orange complex bacteria (OCB) were reduced in all groups treated with MM + SRP. Proportions of OCB increased in current smokers treated with SRP alone. In current smokers, MM + SRP significantly reduced probing depth (PD), increased clinical attachment level (CAL), and reduced bleeding on probing (BOP) to a greater extent than SRP alone (P <0.05).. SRP alone was ineffective at reducing numbers or proportions of RCB or OCB in current smokers, whereas MM + SRP significantly reduced both. MM + SRP also improved PD, BOP, and CAL to a greater extent than SRP alone independent of smoking status.

Topics: Analysis of Variance; Anti-Bacterial Agents; Bacteroides; Colony Count, Microbial; Dental Plaque; Dental Scaling; Female; Humans; Male; Microspheres; Middle Aged; Minocycline; Periodontal Index; Periodontitis; Porphyromonas gingivalis; Single-Blind Method; Smoking; 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

This randomized clinical trial presents a 12-month follow-up of the clinical and microbiological results after application of minocycline microspheres as an adjunct to mechanical treatment of incipient peri-implant infections compared with an adjunctive treatment using 1% chlorhexidine gel application.. Thirty-two subjects with probing depth > or =4 mm, combined with bleeding and/or exudate on probing and presence of putative pathogenic bacteria were given oral hygiene instructions and mechanical treatment of infected areas adjacent to implants. The subjects were then randomly assigned adjunctive subgingival antimicrobial treatment using either chlorhexidine gel or minocycline microspheres. Sixteen patients in the minocycline group and 14 in the chlorhexidine group completed the study. Follow-up examinations were carried out after 10 days, 1, 2, 3, 6, 9 and 12 months.. The adjunctive use of minocycline microspheres resulted in improvements of probing depths and bleeding scores, whereas the adjunctive use of chlorhexidine only resulted in limited reduction of bleeding scores. For the deepest sites of the treated implants in the minocycline group, the mean probing depth was reduced from 5.0 to 4.4 mm at 12 months. This study could not show any significant difference in the levels of bacterial species or groups at any time point between the two antimicrobial agents tested. The present findings encourage further studies on adjunctive use of minocycline microspheres in the treatment of peri-implant lesions.. The use of a local antibiotic as an adjunct to mechanical treatment of incipient peri-implantitis lesions demonstrated improvements in probing depths that were sustained over 12 months.

Topics: Adult; Aged; Anti-Infective Agents, Local; Bacteria, Anaerobic; Chlorhexidine; Colony Count, Microbial; Dental Implantation, Endosseous; Dental Implants; Dental Plaque; Dental Plaque Index; DNA, Bacterial; Gels; Humans; Microspheres; Middle Aged; Minocycline; Periodontal Index; Periodontitis; Prosthesis-Related Infections; Single-Blind Method

The use of adjunctive minocycline with mechanical debridement in treating periodontitis has been widely studied using different methods. However, the results from these studies are equivocal.. The purpose of this study was to clarify the efficacy of the adjunctive use of subgingival minocycline application plus scaling/root planing as compared with the results of one episode of scaling/root planing in the treatment of chronic periodontitis.. Fifteen patients were enrolled in this split-mouth clinical trial. Probing depth, clinical attachment loss, gingival index, and bleeding on probing were evaluated at the baseline before scaling/root planing and 6, 10, 14, and 18 weeks later according to a single-blind protocol. The amount of interleukin-1beta (interleukin-1beta pg/site) at each lesion was also simultaneously measured in gingival crevicular fluid in a parallel comparison design. After full-mouth baseline measurements and scaling/root planing, 78 lesions with a residual mean probing depth of 5 mm at anterior teeth were selected and equally distributed in either right or left sites based on a split-mouth symmetrical design and randomly assigned to one of two treatment groups (with or without minocycline administration, n = 39 for each group).. Probing depth significantly decreased from the baseline (week 0) to week 6 after scaling/root planing (p < 0.05) in both groups, but there was no statistically significant difference between the two groups (p > 0.05). However, at weeks 10, 14, and 18, the experimental group showed significantly greater improvement in pocket reduction than the control group (p < 0.05). Similarly, both groups also showed significant decreases in gingival index scores from weeks 0-6 (p < 0.05), but gingival index reductions at weeks 10, 14, and 18 were statistically significant in favor of the experimental group (p < 0.05). The experimental group had more attachment gain than the control group at weeks 14 and 18 (p < 0.05). Values of interleukin-1beta (pg/site) at the experimental sites were significantly reduced at weeks 10, 14, and 18, as compared to values at control sites (p < 0.01). Finally, the incidence of bleeding on probing showed no differences between the two groups for any time interval (p > 0.05).. In this 18-week clinical trial, the results suggested that scaling/root planing with adjunctive subgingival administration of minocycline ointment has a significantly better and prolonged effect compared to scaling/root planing alone on the reduction of probing depth, clinical attachment loss, gingival index, and interleukin-1beta content, but not on bleeding on probing.

Topics: Adult; Anti-Bacterial Agents; Chronic Disease; Dental Scaling; Female; Humans; Interleukin-1; Male; Middle Aged; Minocycline; Periodontitis; Root Planing; Single-Blind Method; Statistics, Nonparametric

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

Injectable polysaccharide microcapsules holding minocycline were fabricated from alginate and chitosan for the treatment of periodontitis. The microcapsules were examined for the release and degradation of minocycline, as well as antimicrobial activity. The microcapsules were biodegradable and released minocycline between 10 and 1000 microg ml(-1), which was higher than the usual therapeutic concentration (1-5 microg ml(-1)), for up to 7 days. These microcapsules showed a statistically significant suppression of pathogenic bacteria, such as Prevotella intermedia causing periodontitis. The microcapsules are thus potentially useful for drug delivery for the treatment of periodontitis.

Topics: Absorbable Implants; Capsules; Diffusion; Drug Implants; Humans; Injections; Minocycline; Periodontitis; Polysaccharides; Treatment Outcome

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

A recent Phase 3 trial demonstrated that adjunctive treatment with minocycline microspheres resulted in significant reductions in patient mean probing depths as compared to scaling and root planing (SRP) alone. The objective of the present study was to evaluate clinical relevance of these changes within the trial using proposed site-based criteria.. A total of 499 patients with moderate to advanced chronic periodontitis were enrolled in a multi-center trial and randomized to either: 1) SRP alone or 2) SRP plus minocycline microspheres. Subjects received complete probing examinations including the measurement of probing depths at baseline, and 1 and 3 months. Probing depth reductions were tabulated by treatment, examination time, and baseline depths, and inter-group differences were evaluated with logistic regression models for correlated data.. Significantly more sites treated with adjunctive minocycline microspheres exhibited probing depths < 5 mm at 1 (P = 0.0009) and 3 (P = 0.01) months as compared to sites treated with SRP alone, both in the overall population and in smokers. In addition, significantly more sites decreased by 1, 2, or 3 mm in the adjunctive minocycline group than in the SRP alone group at 1 and 3 months, both overall as well as in smokers (P < 0.05).. This secondary analysis indicates that treatment with SRP plus minocycline microspheres is consistently more effective than SRP alone in providing clinically relevant site-based responses in patients with chronic periodontitis.

Topics: Anti-Bacterial Agents; Chronic Disease; Dental Scaling; Female; Humans; Logistic Models; Male; Microspheres; Middle Aged; Minocycline; Periodontitis; Smoking; Treatment Outcome

To compare the efficacy of 2 available periodontal systems for local delivery of antibiotics.. 26 teeth with moderate to severe periodontitis (PD > or = 4 mm) from 11 patients were selected. The teeth were randomly divided into test group and control group. Periocline (2% minocycline hydrochoride ointment) was applied to the teeth in the test group, while Yakang (local metronidazole) was applied in the control group. The data including clinical indices and microbiological parameters was collected before and on the 7th, 14th day after the therapy.. Before treatment, the mean of each clinical indices and microbiological parameters between the two groups was not different (P > 0.05). But both groups demonstrated significant differences with control after treatment (P < 0.05), while there were no significant differences between the two test groups (P > 0.05).. Both Periocline and Yakang were effective and secure local delivery drug for treating periodontitis.

Topics: Anti-Bacterial Agents; Humans; Metronidazole; Minocycline; Ointments; Periodontitis

This report presents the clinical results three months after application of minocycline microspheres as an adjunct to mechanical treatment of incipient peri-implant infections compared to adjunctive treatment employing 1% chlorhexidine gel application. Sixteen patients in the minocycline group and 14 in the chlorhexidine group completed the study. Each patient had one or more implants with probing depth > or = 4 mm combined with bleeding and/or exudate on probing and presence of putative pathogenic bacteria. At baseline, patients were randomly assigned to minocycline or chlorhexidine treatment. Follow-up examinations were carried out after 10, 30, 60 and 90 days. The combined mechanical/antimicrobial treatment for the chlorhexidine group did not result in any reduction in probing depth and only limited reduction of bleeding scores. The adjunctive use of minocycline microspheres, on the other hand, resulted in improvements in both probing depths and bleeding scores. For the deepest sites of the treated implants, mean probing depth was reduced from 5.0 mm to 4.1 mm. The reductions in bleeding scores, although greater than for the chlorhexidine group, were modest. Thus, the question as to what extent the combined mechanical/minocycline treatment could be considered adequate for the treated lesions remains to be answered. The present short-term findings, however, encourage further studies with longer observation intervals on adjunctive use of minocycline microspheres in the treatment of periimplant lesions.

Topics: Adult; Aged; Anti-Bacterial Agents; Chemotherapy, Adjuvant; Chlorhexidine; Debridement; Dental Implants; Female; Humans; Male; Microspheres; Middle Aged; Minocycline; Periodontitis

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

Locally delivered antibiotics are used to treat periodontitis and these agents are found to be effective in improving the treatment result. Microencapsulated minocycline hydrochloride (Arestin) has been tested and reported to provide significantly greater probing depth reduction in conjunction with scaling and root-planing than scaling and root-planing alone. Thus, it was suggested that the use of locally delivered antimicrobial agents should be incorporated as part of an optimal non-surgical therapeutic regimen. This paper evaluates the efficacy of the minocycline microspheres in patients with moderate to severe periodontitis in a model, which is a randomised, evaluator-blinded study with an open-label; four arm parallel design. The patients were selected based upon 'active' disease, as determined by at least two teeth having one site each with pocket depth (PD) > or = 6 mm and with prostaglandin E2 (PGE2) levels > 66.2 ng/ml in gingival crevicular fluid. The trial was of 6 months duration and used a formulation of minocycline microspheres containing 1 mg minocycline. Responses of groups receiving SRP followed by one dose per pocket of the minocycline microspheres (SRP + MPTS) were compared to SRP alone, MPTS alone or no treatment. There were substantially greater reductions in PD and gains in clinical attachment level (CAL) at each post-treatment time point in the SRP + MPTS group compared to the other treatment groups. PD reduction and gain in CAL at month 3 in the SRP + MPTS group vs. SRP alone was statistically significant. These data further support the adjunctive use of minocycline in a slow release vehicle for the treatment of periodontitis with SRP.

Topics: Analysis of Variance; Anti-Bacterial Agents; Chemotherapy, Adjuvant; Dental Scaling; Humans; Matched-Pair Analysis; Microspheres; Minocycline; Periodontal Index; Periodontitis; Single-Blind Method; Treatment Outcome

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

To determine clinical, enzymatic, and microbiologic effects of controlled-release localized administration of minocycline on dogs with periodontitis.. Five adult Beagles with periodontitis.. After tooth scaling and root planing, 2 treatment, 1 placebo, and 1 control site were selected for each dog. Treatment sites (n = 10) received a periodontal formulation of minocycline hydrochloride, placebo sites (5) received ointment without minocycline, and control sites (5) did not receive ointment. Treatments were administered 4 times at weekly intervals. Peptidase activity and clinical and microbiologic effects were evaluated and compared among sites for 17 weeks.. Bleeding of the gums on probing (BOP) and pocket depth (PD) improved at the treatment site and were maintained for 13 weeks after treatment. However, BOP and PD in placebo and control sites increased from weeks 9 to 17 Peptidase activity in the periodontal pocket decreased noticeably from week 1 to 17, compared with baseline values for the treatment site. However, peptidase activity for placebo and control sites increased and were above baseline values on week 9 and week 13, respectively. Total bacterial counts decreased by 90% for treatment sites and remained at that value for 13 weeks. However, for placebo and control sites, bacterial counts increased and reached the baseline value on week 17.. Increased peptidase activity is correlated with the progression of periodontitis in dogs. Treatment with minocycline, using a localized delivery system, was effective in dogs for at least 13 weeks after cessation of drug administration.

Topics: Animals; Anti-Bacterial Agents; Colony Count, Microbial; Delayed-Action Preparations; Dental Scaling; Dog Diseases; Dogs; Minocycline; Mouth Mucosa; Peptide Hydrolases; Periodontitis

To evaluate the effect of scaling and root planing combined with local application of 2% minocycline hydrochoride ointment(Periocline) on the level of collagenase activity releasing from PMNs in GCF.. This was a randomized, single-blinded, split mouth design study. The target sites of 31 patients with moderate to severe periodontitis (PD > 5 mm) was randomized by left-side and right-side into one of the two groups (the test group and the control group). Subsequently each patient was scheduled for two appointments for the full-month supra-gingival scaling and oral hygiene instruction. At baseline all patients received subgingival scaling and root planing and were followed by 4-time applications of Periocline with one-week interval for totally four weeks in the test group. All patients were taken GCF for measuring collagenase by the method of Nakashima et al (1996) and were examined based on four parameters, including plaque index, pocket depth, attachment loss and bleeding on probing.. Four weeks after root planing with 4-time applications of Periocline, all clinical parameters and active collagenase in GCF decreased significantly in the test groups[(593 +/- 112) mU/sample vs (311 +/- 98) mU/sample, P < 0.001]. On the other hand, simple root-planing therapy had limited effect on the active collagenase[(611 +/- 123) mU/sample vs (523 +/- 127) mU/sample], although all clinical parameters were also reduce significantly. Interestingly, seven weeks later, gingival inflammation and the active collagenase were reduced more significantly than those after four-week root planing in both groups[Test: (311 +/- 98) mU/sample vs (207 +/- 57) mU/sample;. (523 +/- 127) mU/sample vs (345 +/- 117) mU/sample, P < 0.001]. At eleven week, gingival inflammation and the level of collagenase activity were rebounded in the control group[(467 +/- 108) mU/sample]. However, in the test group they were kept in lower level[(213 +/- 121) mU/sample]. The level of collagenase activity showed significantly positive correlation with GCF volumes and AL in two groups.. These results indicate that local application of 2% minocycline hydrochoride ointment may effectively inhibit the level of active collagenase from PMNs and may inhibit connective tissue breakdown by inhibiting neutrophil collagenase.

Topics: Adult; Anti-Bacterial Agents; Collagenases; Female; Humans; Male; Middle Aged; Minocycline; Periodontitis; 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

Topical locally delivered minocycline is an adjunctive to non-surgical periodontal treatment, but there are few reported trials. Previous trials have reported differences between changes in probing depth in treatment and control groups, but no differences in probing attachment level. In the present study, 30 subjects were paired according to gender, age, ethnic group, smoking habits, and probing depths. Both groups received intensive oral hygiene education and root planing with local anaesthesia. Active or placebo gel was placed subgingivally at planed sites in each subject according to a double-blind protocol, immediately after instrumentation, and 2 and 4 weeks later. A periodontal examination was made with a constant force probe before instrumentation, and 6 and 12 weeks later, 2 subjects failed to complete the study, and their pairs were therefore not included in the analysis. Results were tested with analysis of covariance. Differences between groups in mean probing depth did not reach statistical significance at any visit (baseline: test (T) = 5.93 mm, control (C) = 5.74 mm; 6 weeks: T = 3.53 mm, C = 3.63 mm; 12 weeks: T = 3.29 mm, C = 3.44 mm), but mean probing attachment levels were different (p < 0.05) at both reassessments (baseline: T = 6.86 mm, C = 6.83 mm; 6 weeks: T = 4.93 mm, C = 5.30 mm; 12 weeks T = 4.91 mm, C = 5.27 mm). There was also a difference in the number of sites with bleeding on deep probing at 12 weeks (p < 0.05). This trial showed that adjunctive minocycline gel provided a more advantageous outcome for nonsurgical periodontal treatment in terms of probing attachment level and bleeding on deep probing. This trial was a good example of experimental, as opposed to community, design, and used limited resources to show a clear result.

Topics: Administration, Topical; Adult; Anti-Bacterial Agents; Double-Blind Method; Female; Gels; Humans; Male; Middle Aged; Minocycline; Outcome and Process Assessment, Health Care; Periodontal Attachment Loss; Periodontal Index; Periodontitis; Randomized Controlled Trials as Topic; Research Design; Root Planing; Statistics, Nonparametric

The objectives of the present study were to establish in a long-term investigation the safety as well as the clinical and microbiological efficacy of scaling and rootplaning combined with local application of 2% minocycline hydrochloride-gel versus placebo-gel in patients with moderate to severe chronic adult periodontitis. This was an 18 months, randomized, double-blind, parallel, comparative study, in which 20 healthy patients with moderate to severe chronic periodontitis participated. At baseline, all patients received professional oral hygiene-instruction and supra- and subgingival scaling and root planing. The minocycline-gel was applied subgingivally baseline, 2 weeks, 1, 3, 6, 9 and 12 months. Microbiological evaluation was carried out using DMDx to identify the following bacteria: Porphyromonas gingivalis, Prevotella intermedia, Actinobacillus actinomycetemcomitans, Campylobacter rectus, Fusobacterium nucleatum and Treponema denticola. In addition standard microbiological techniques were used for the detection of P. gingivalis, P. intermedia, P. micros, A. actinomycetemcomitans, C. rectus, F. nucleatum, C. albicans and Enterobacteriaceae. Results showed a statistically significant improvement for all clinical parameters irrespective of the treatment modality. No differences were observed between test and control with regard to probing depth and attachment level. The DMDx data showed a significant reduction in both the numbers and the prevalence over the 15 months period, but no significant difference between groups. Culture data showed that at baseline two-third were positive for P. gingivalis and P. intermedia. Analysis over the 18 month period showed no significant difference between the two treatment modalities. C. albicans and Enterobacteriaceae were detected only in small proportions at each time interval in a limited number of patients. No adverse reactions were observed during the trial period. The present patient group responded favourably to scaling and rootplaning, but did not benefit from an effect of local of minocycline. Subgingival debridement in combination with oral hygiene instruction by itself has been shown to be effective. It remains to be studied whether local application of minocycline can be effective as an adjunct to mechanical therapy in sites that respond poorly to conventional treatment.

Topics: Administration, Topical; Adult; Analysis of Variance; Anti-Bacterial Agents; Bacteria; Colony Count, Microbial; Dental Plaque Index; Dental Scaling; DNA, Bacterial; Double-Blind Method; Female; Humans; Male; Middle Aged; Minocycline; Periodontal Index; Periodontitis; Statistics, Nonparametric

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

Topics: Adult; Dental Plaque; Female; Gingival Crevicular Fluid; Gingivitis; Humans; Male; Minocycline; Periodontitis; Saliva; Time Factors; Tissue Distribution

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

Periodontitis is a chronic inflammatory disease that leads to the loss of alveolar bone, among several studies focusing on reconstructing periodontal bone caused by periodontitis, guided bone regeneration (GBR) is a promising approach. In this study a serial clinically applied antibiotics loaded poly(L-lactide-co-glycolide)/poly(L-lactide-co-ε-caprolactone) (PLGA/PLCA) fibrous mesh to prevent and reconstruct defective bone in periodontitis were prepared by electrospinning. Incorporation of antibiotics promoted the hydrophilicity but decreased the crystallinity of PLGA/PLCA membranes. Antibiotics could be sustained released from membranes. Metronidazole, minocycline, and doxycycline incorporated membranes could suppress Porphyromonas gingivalis (P. gingivalis) within 21 days in vitro. Metronidazole and minocycline incorporated membranes decreased 41% and 55.5% colony counts in rat gingival crevicular fluid in vivo. Minocycline-loaded membrane could support the proliferation of MC3T3-E1 cells and maintained 79% viability of human ligament fibroblasts cultured on it. And MC3T3-E1 cells could undergo osteoblastic differentiation when cultured with pure PLGA/PLCA membrane and minocycline incorporated membrane. Then in vivo repairable effects of those antibiotics loaded membranes were evaluated in alveolar bone defected P. gingivalis infected model. The application of minocycline loaded membranes, effectively prevented the bone resorption of periodontitis caused by P. gingivalis. After been treated with minocycline incorporated membrane, volume of defected bone of maintained at about 50% level of control rats. 8 weeks post-operation, newly regenerated bone was observed in the operative alveolar bone of the pure PLGA/PLCA membrane, metronidazole and minocycline incorporated PLGA/PLCA membrane treated groups. Minocycline/PLGA/PLCA electrospinning membrane is a promising GBR material that can be applied to guide regeneration of periodontitis-induced alveolar bone damage.

Topics: Animals; Anti-Bacterial Agents; Humans; Metronidazole; Minocycline; Periodontitis; Rats

The main development process of periodontitis involves periodontal pathogenic bacteria as the initiating factor causing the onset of destructive inflammation, which in turn stimulates the destruction of periodontal tissue. It is difficult to achieve the eradication of periodontitis due to the complex interaction among antibacterial, anti-inflammatory, and bone restoration. Herein, we propose an antibacterial-anti-inflammatory-bone restoration procedural treatment strategy with minocycline (MIN) for the efficient treatment of periodontitis. In brief, MIN was prepared into PLGA microspheres with tunable release behavior using different species of PLGA, respectively. The optimally selected PLGA microspheres (LA:GA with 50:50, 10 kDa, and carboxyl group) had a drug loading of 16.91%, an in vitro release of approximately 30 days, which also had a particle size of approximately 11.8 µm with a smooth appearance and a rounded morphology. The DSC and XRD results showed that the MIN was completely encapsulated in the microspheres as an amorphous state. Cytotoxicity tests demonstrated the safety and biocompatibility of the microspheres (cell viabilities at a concentration of 1-200 μg/mL were greater than 97%), and in vitro bacterial inhibition tests showed that the selected microspheres could achieve effective bacterial inhibition at the initial stage after administration. The favorable anti-inflammatory (low TNF-α and IL-10 levels) and bone restoration effects (BV/TV: 71.8869%; BMD: 0.9782 g/cm

Topics: Animals; Anti-Bacterial Agents; Anti-Inflammatory Agents; Microspheres; Minocycline; Periodontitis; Polylactic Acid-Polyglycolic Acid Copolymer; Rats; Rats, Sprague-Dawley

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

Topics: Animals; Anti-Bacterial Agents; Delayed-Action Preparations; Drug Carriers; Gels; Hydrophobic and Hydrophilic Interactions; Minocycline; Nanoparticles; Particle Size; Periodontitis; Rats

The critical challenge for periodontitis therapy is thoroughly eliminating the dental plaque biofilm, particularly penetrating the deep periodontal tissue. Regular therapeutic strategies are insufficient to penetrate the plaque without disturbing the commensal microflora of the oral cavity. Here, we constructed a Fe. In order to penetrate and remove the biofilm effectively, Fe. The multifunctional nanoparticles exhibited intense anti-biofilm activity and good biocompatibility. The magnetic forces could pull FMP NPs against the biofilm mass and kill bacteria deep in the biofilms both in vivo and in vitro. The integrity of the bacterial biofilm is disrupted under the motivation of the magnetic field, allowing for improved drug penetration and antibacterial performance. The periodontal inflammation recovered well after FPM NPs treatment in rat models. Furthermore, FPM NPs could be monitored in real-time and have magnetic targeting potentials.. FPM NPs exhibit good chemical stability and biocompatibility. The novel nanoparticle presents a new approach for treating periodontitis and provides experimental support for using magnetic-targeted nanoparticles in clinic applications.

Topics: Animals; Anti-Bacterial Agents; Biofilms; Minocycline; Nanoparticles; Periodontitis; Rats

The present study aims to assess a proposed treatment approach or therapy for periodontitis by using the in-silico technique. The proposed treatment strategy offers a singular vehicular system consisting of minocycline (antibiotic), celecoxib (selective COX-II inhibitor), doxycycline hyclate (matrix metalloproteinase inhibitor), and hydroxyapatite (osteogenic agent).. Molecular docking studies of drugs were performed using Maestro version 9.4 software Schrödinger, and 3-Dimensional Crystallographic X-ray protein structures of targeted proteins were downloaded from RCSB protein data bank in .pdb file format. These agents were docked, and their affinities towards the receptors/protein/enzyme were calculated. Furthermore, their affinities were compared with the standard drug.. The study suggests that minocycline and metronidazole possess equal affinity towards the RGPB and Inlj protein of P.gingivalis. Celecoxib, a well-known inhibitor of the COX-II enzyme, showed very high affinity. Selective inhibitor of MMP-8 possessed higher affinity than doxycycline, whereas CMT-3 showed equal affinity as doxycycline for MMP-13. Similarly, hydroxyapatite and simvastatin also showed a comparatively similar affinity for osteopontin receptor.. Based upon molecular docking results, it can be concluded that the proposed treatment strategy would be a suitable approach for periodontitis and all the selected therapeutic agents have potential similar to the standard drugs, thereby constituting a reliable system for periodontitis.

Topics: Anti-Bacterial Agents; Celecoxib; Doxycycline; Humans; Hydroxyapatites; Matrix Metalloproteinase 13; Matrix Metalloproteinase 8; Matrix Metalloproteinase Inhibitors; Metronidazole; Minocycline; Molecular Docking Simulation; Osteopontin; Periodontitis; Simvastatin

This prospective pilot study aimed to evaluate the effect of minocycline-HCl ointment (MO), locally delivered as an adjunct to scaling and root planing (SRP), on subgingival microflora. A total of 59 periodontitis patients received SRP as an initial periodontal therapy. In the selected periodontal pockets with probing depths (PD) of 6−9 mm, the sites that exhibited a positive reaction following a bacterial test using an immunochromatographic device were subsequently treated with MO (SRP + MO group, n = 25). No additional treatment was performed at sites showing a negative reaction (SRP group, n = 34). In addition to subgingival plaque sampling, measurement of clinical parameters including PD, clinical attachment level (CAL), bleeding on probing (BOP), plaque index and gingival index (GI) were performed at baseline and 4 weeks after the initial periodontal therapy. The subgingival microflora were assessed by terminal restriction fragment-length polymorphism analysis. Relative to baseline values, the mean scores for PD-, CAL-, BOP-, and GI-sampled sites were significantly decreased post treatment in both groups (p < 0.01). The intra-comparisons showed a significant decrease in the counts of the genera Eubacterium, Parvimonas, Filifactor, Veillonella, Fusobacterium, Porphyromonas, Prevotella, and unknown species in the SRP + MO group (p < 0.05). Inter-comparisons indicated a significant decrease in the genera Veillonella in the SRP + MO group (p = 0.01). Combination therapy of SRP and local MO induced a change in the subgingival microbial community: particularly, the number of Veillonella spp. was markedly reduced.

Topics: Humans; Minocycline; Periodontitis; Pilot Projects; Prospective Studies; Root Planing

Antibiotics provide promising strategies for treating periodontitis, while their delivery and controllable release with desired oral retention remain challenging. Here, inspired by the unique suction-cup structures of abalones, a novel adhesive and photo-responsive microparticle (MP) delivery system is developed to treat periodontitis through microfluidic electrospray technology. Such MPs are generated by quickly ionic cross-linking of sodium alginate together with photo-curing of poly(ethylene glycol) diacrylate of the distorted microfluidic droplets during their high-speed dropping into calcium chloride solution. Attributing to their unique concave structures, the abalone-inspired MPs exhibit desired underwater adhesion ability and stability under running water. In addition, due to the loading of antibiotics minocycline hydrochloride and near-infrared (NIR)-responsive black phosphorus during their fabrication, the resultant MPs can not only eradicate bacteria directly, but also realize a controllable and effective drug release upon NIR irradiation. Based on these features, it is demonstrated from in vivo periodontitis that the abalone-inspired MPs are firmly adhesive and can controlled-release drugs on the tooth, and thus have outstanding antibacterial efficacy against Porphyromonas gingivalis. These results indicate the particular values of the abalone-inspired MPs for oral-related disease treatment.

Topics: Adhesives; Alginates; Anti-Bacterial Agents; Calcium Chloride; Delayed-Action Preparations; Humans; Minocycline; Periodontitis; Phosphorus; Polyethylene Glycols; Water

Minocycline hydrochloride (MINO) has been one of the most frequently used antibiotics in the treatment of periodontitis due to its antibacterial activity and osteogenesis effects; however, high levels of MINO administered during the treatment halt the formation of new bone. Therefore, the purpose of the present study was to prepare a MINO-microsphere/sucrose acetate isobutyrate (SAIB) hybrid depot to reduce the burst release of MINO and ensure antibacterial and osteogenesis effects of MINO in the treatment of periodontitis. Uniform microspheres, approximately 5 µm size, with a slightly rough surface and different MINO loading (10, 12, and 14%) were prepared, and the microspheres were added into SAIB, after which the burst release significantly decreased from 66.18 to 2.92%, from 71.82 to 3.82%, and from 73.35 to 4.45%, respectively, and the release from all the MINO-microspheres/SAIB hybrid depots lasted for 77 days. In addition, cytotoxicity test showed that the MINO-microsphere with 12% drug loading promoted the proliferation of osteoblasts the most and was subsequently used in vivo experiments. Moreover, in the model of ligatured-induced periodontitis in SD rats, the MINO-microsphere/SAIB hybrid depot not only significantly increased the alveolar bone height and bone volume but also reduced the inflammation of the periodontal tissue. Additionally, it also inhibited the expression of the receptor activator of nuclear factor-kappa B ligand (RANKL) and promoted the expression of osteoprotegerin (OPG).. These results indicated that the MINO-microsphere/SAIB hybrid depot might be promising in the treatment of periodontitis.

Topics: Animals; Anti-Bacterial Agents; Chemistry, Pharmaceutical; Delayed-Action Preparations; Drug Implants; Drug Liberation; Microspheres; Minocycline; Osteoblasts; Osteogenesis; Osteoprotegerin; Periodontitis; Polylactic Acid-Polyglycolic Acid Copolymer; Rats; Rats, Sprague-Dawley; Receptor Activator of Nuclear Factor-kappa B; Sucrose

We describe the development of flexible minocycline-lipid-complex extrudates with optimized mechanical and drug release properties. These extrudates contain a minocycline - magnesium stearate chelate complex with a higher stability in aqueous media, which has now been incorporated in a PEG-PLGA (polyethylene glycol - poly(lactic-co-glycolic acid)) matrix. PEG 1500 has been utilized in different concentrations to serve as plasticizer. The novel formulations have been characterized by texture analysis, X-Ray powder diffraction (XRPD) and differential scanning calorimetry (DSC). Extrudates with a reduced diameter of 300 µm (previously 600 µm) were introduced, and a more sensitive quantification method with a tandem-mass spectrometry detector was developed. From all tested formulations, the extrudates consisting of Expansorb DLG 50 - 6P (PEG-PLGA, molar weight 30-60 kDa) paired with 10% PEG 1500 emerged as best formulation. These extrudates feature a drug content of 11.5% and a controlled release over at least 42 days. The release profile is without a lag time and shows initially a slightly higher release rate, which is desired. Compared to previous developments, the extrudates now offer a high flexibility combined with a large mechanical resilience, which will ease the handling and administration.

Topics: Anti-Bacterial Agents; Chemistry, Pharmaceutical; Delayed-Action Preparations; Drug Carriers; Drug Liberation; Lipids; Minocycline; Periodontitis; Plasticizers; Polyesters; Polyethylene Glycols; Stearic Acids

The current experiment was carried out to observe and analyze the effects of three orthodontic appliances combined with minocycline on periodontitis and inflammatory factors of gingival crevicular fluid. the patients included in this study were 180 patients with dental crowding treated in our hospital. They were divided into three groups, namely the invisible orthodontic appliance group (n=60), self-ligation orthodontic appliance group (n=60), traditional ligation bracket group (n=60), all of which were applied with minocycline therapy. The therapeutic effects of the three groups were observed. after three months of treatment, the periodontal index of each group showed an upward trend (p<0.05). At six months to one year, the periodontal index of the self-ligation orthodontic appliance group and conventional ligation bracket group was higher than that of the invisible orthodontic appliance group, p<0.05. After treatment, the expression of IL-1β and TNF-α increased for the three groups, p<0.05; the self-ligation orthodontic appliance group and the traditional ligation bracket group were the same as the invisible orthodontic appliance group in at 24 months, p>0.05. in the early stage of orthodontic treatment, the invisible orthodontic appliance can keep the oral cavity in a clean and hygienic state. However, after 18 months of orthodontic treatment, all three orthodontic treatments did not have a significant impact on oral hygiene.

Topics: Adult; Female; Gingival Crevicular Fluid; Humans; Interleukin-1beta; Male; Minocycline; Orthodontic Appliances; Periodontal Index; Periodontitis; Tumor Necrosis Factor-alpha; Young Adult

Periodontitis is a chronic, destructive inflammatory disease that injures tooth- supporting tissues, eventually leading to tooth loss. Complete eradication of periodontal pathogenic microorganisms is fundamental to allow periodontal healing and commonly precedes periodontal tissue regeneration. To address this challenge, we report a strategy for developing an enzyme-mediated periodontal membrane for targeted antibiotic delivery into infectious periodontal pockets; the unique components of the membrane will also benefit periodontal alveolar bone repair. In this approach, a chitosan membrane containing polyphosphoester and minocycline hydrochloride (PPEM) was prepared. Physical, morphological, and ultrastructural analyses were carried out in order to assess cellular compatibility, drug release and antibacterial activity in vitro. Additionally, the functionality of the PPEM membrane was evaluated in vivo with a periodontal defect model in rats. The results confirm that the PPEM membrane exhibits good physical properties with excellent antibacterial activity and successfully promotes periodontal tissue repair, making it promising for periodontal treatment.

Topics: Animals; Anti-Bacterial Agents; Bone Regeneration; Cell Survival; Cells, Cultured; Chitosan; Drug Liberation; Enzymes; Fibroblasts; Gingiva; Humans; Male; Membranes, Artificial; Minocycline; Osteoblasts; Periodontitis; Rats, Sprague-Dawley

Global prevalence of the severe periodontitis is at the alarming stage and its association with the systemic complications is highly evident which cannot be neglected. An insight into the pathophysiology of the periodontitis reveals that the promising amelioration could only be envisaged with the 4-D/multi-pronged approach of combining antibiotic along with the host modulating agents. The complications of the disease itself suggest that the use of antibiotic alone is not able to cater the symptoms completely. There is a need of other host modulatory agents too, such as Cyclo-oxygenase -II (COX II) enzyme inhibitors, Matrix metalloproteinase's (MMPs) inhibitors and osteo-integrating agents. Also, there is an unmet need of singular treatment modality through which all these agents can be sequentially and directly delivered into the periodontal cavity. The current hypothesis takes it a step forward wherein an antibiotic is combined with other three host modulatory agents in a singular drug delivery system. The encapsulation of multiple therapeutic agents with controlled release would therefore allow for reduced drug dose thus minimizing side effects; contributing to enhanced patient compliance and treatment efficacy. Hence this approach can be presented as a 4-D/multi-pronged approach for circumvention of periodontitis.

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Celecoxib; Combined Modality Therapy; Cyclooxygenase Inhibitors; Doxycycline; Drug Administration Schedule; Drug Synergism; Drug Therapy, Combination; Durapatite; Gingiva; Humans; Matrix Metalloproteinase Inhibitors; Minocycline; Models, Biological; Osseointegration; Periodontics; Periodontitis; Regeneration; Substance-Related Disorders

The objective of this study was to develop an improved drug delivery system for the local antimicrobial treatment of periodontitis, that offers enhanced drug stability, easy application and controlled release over several weeks. Chelate complexes consisting of a tetracycline antibiotic and a fatty acid salt were developed. Minocycline and doxycycline were paired with magnesium- and calcium stearate in different molar ratios. These chelate complexes stabilize the active pharmaceutical ingredient and enable the incorporation into a PLGA (poly(lactic-co-glycolic acid)) polymer matrix via hot melt extrusion. The chelate complexes were characterized via UV/Vis- and IR-spectroscopy. A high antibiotic activity of the complex was observed in a disc diffusion test. The drug complex was mixed with different PLGA-polymers and cryomilled in advance of the extrusion. The hot melt extrusion yielded homogeneous extrudates with a diameter from 600 to 900 µm. They contain 11.5% of minocycline, are adjustable in length and are easy to handle. In vitro release studies revealed a controlled release of the drug over 42 days. In conclusion, the developed extrudates are promising systems to improve the treatment of periodontitis.

Topics: Anti-Bacterial Agents; Delayed-Action Preparations; Doxycycline; Drug Carriers; Drug Compounding; Drug Liberation; Drug Stability; Kinetics; Minocycline; Particle Size; Periodontitis; Polylactic Acid-Polyglycolic Acid Copolymer; Staphylococcus aureus; Stearic Acids

Topics: Animals; Anti-Bacterial Agents; Cell Survival; Cells, Cultured; Dose-Response Relationship, Drug; Drug Carriers; Drug Evaluation, Preclinical; Gingiva; Hydrogels; Male; Minocycline; Nanoparticles; Periodontitis; Rats; Rats, Sprague-Dawley; Serum Albumin; Zinc Oxide

Periodontitis is a localized inflammatory disorder. If not treated timely, the disease can result in loosening and subsequent loss of teeth. In situ hydrogel prepared with phase separation technique has emerged as an attractive alternative for periodontal pocket injection.. Minocycline (MCL)-loaded in situ hydrogel was prepared composed of poly(lactide-coglycolide) (PLGA) and N-methylpyrrolidone (NMP) to improve the topical treatment effect of periodontitis.. A series of reasonable and applicable formulations were optimized by investigating their syringeability, viscosity and in vitro drug release. The rheological profiles, antimicrobial activities and pharmacodynamics were further studied to evaluate its effect on periodontitis treatment.. The prepared MCL/PLGA hydrogel exhibited the characteristic of Newton fluid with acceptable syringeability. Drug release could last for more than 48 hours with an acceptable "burst release". It also had obvious antimicrobial activities and pharmacodynamics efficiency similar to the commercial product, Parocline®.. MCL/PLGA in situ hydrogel may be a promising clinical formulation for periodontitis treatment.

Topics: Animals; Anti-Bacterial Agents; Dinoprostone; Drug Carriers; Drug Liberation; Gingiva; Hydrogels; Lactic Acid; Male; Minocycline; Periodontitis; Polyglycolic Acid; Polylactic Acid-Polyglycolic Acid Copolymer; Porphyromonas gingivalis; Rats, Sprague-Dawley; Tumor Necrosis Factor-alpha

Topics: Adult; Debridement; Dentition; Humans; Minocycline; Periodontal Debridement; Periodontitis; Photochemotherapy

In this study, an optimized in situ reversed hexagonal mesophase loaded with minocycline hydrochloride (MH) was developed for the chronic periodontitis treatment. The in situ hexagonal liquid crystals (ISH2) comprised phytantriol (PT), propylene glycol (PG), water and vitamin E acetate (VitEA). The physicochemical properties, in vitro drug release and the therapeutic effects on chronic periodontitis of the formed samples were tested. The injectable liquid crystal-forming systems were characterized by crossed-polarized light microscopy, small angle X-ray scattering, and rheological measurements. The optimal ISH2 (PT/PG/water/VitEA, 56:27:10:7, w/w/w/w) loaded with 20 mg·g-1 MH was proved to be injectable with suitable pH, and was able to sustain the drug release for 10 days. The pharmacodynamic studies of the optimal formula were performed on male SPF rats, the Periocline® ointment was used as a control. The investigated ISH2 loaded with MH was demonstrated to be effective for periodontal treatment with significantly improved gingival index, pocket depth and alveolar bone loss. The developed ISH2 may be a promising application for local delivery system of MH in treating periodontal diseases.

Topics: Alveolar Bone Loss; Animals; Anti-Bacterial Agents; Chemistry, Pharmaceutical; Disease Models, Animal; Drug Delivery Systems; Drug Liberation; Fatty Alcohols; Hydrogen-Ion Concentration; Liquid Crystals; Male; Microscopy, Polarization; Minocycline; Periodontal Index; Periodontitis; Propylene Glycol; Rats; Rheology; Vitamin E; Water

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

The purpose of this in vitro study was to determine the antimicrobial activity of two different taurolidine gel formulations in comparison with minocycline microspheres.. Three percent taurolidine gel (TLG3) and 2 % taurolidine gel (TLG2) were compared to minocycline microspheres (MINO) against single bacterial species and a 12-species-mixture. The antimicrobial activity was proven by determination of minimal inhibitory concentrations (MICs), killing assays, after exposure of the antimicrobials as well as within a biofilm.. The MICs against the single species were between 0.5 and 2 mg/ml of taurolidine. MICs of the used mixed microbiota were 1.5 mg/ml (TLG3) and 4 mg/ml (TLG2). Fusobacterium nucleatum and Porphyromonas gingivalis were completely killed by 10 % TLG3 and TLG2 (equivalent to 3 and 2 mg/ml taurolidine) after 6 h. The mixture of 12 species was not completely killed by any of the test substances. Taurolidine gels showed a post-antimicrobial activity, however being less than that of MINO. On biofilms, taurolidine gels reduced concentration dependently the colony forming unit (CFU) counts (multi-species biofilms by 3.63 log10 after 100 % (30 mg/ml) of TLG3), reductions were 2.12 log10 after MINO (1000 μg/ml minocycline).. Taurolidine gel formulations exert antimicrobial activity against bacteria associated with periodontal disease. Nevertheless, a complete elimination of biofilms seems to be impossible and underlines the importance of mechanical removal of biofilms prior to application of the antimicrobial.. Taurolidine gels may represent a potential alternative for adjunctive topical antimicrobial treatment in periodontitis and infectious peri-implant diseases.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Bacteria; Biofilms; Colony Count, Microbial; Fusobacterium nucleatum; Gels; In Vitro Techniques; Microbial Sensitivity Tests; Microspheres; Minocycline; Periodontitis; Porphyromonas gingivalis; Taurine; Thiadiazines

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

Rapid local drug clearance of antimicrobials is a major drawback for the treatment of chronic periodontitis. In the study reported here, minocycline-loaded poly(ethylene glycol)-poly(lactic acid) nanoparticles were prepared and administered locally for long drug retention and enhanced treatment of periodontitis in dogs.. Biodegradable poly(ethylene glycol)-poly(lactic acid) was synthesized to prepare nanoparticles using an emulsion/solvent evaporation technique. The particle size and zeta potential of the minocycline-loaded nanoparticles (MIN-NPs) were determined by dynamic light scattering and the morphology of the nanoparticles was observed by transmission electron microscopy. The in vitro release of minocycline from MIN-NPs and in vivo pharmacokinetics of minocycline in gingival crevice fluid, after local administration of MIN-NPs in the periodontal pockets of beagle dogs with periodontitis, were investigated. The anti-periodontitis effects of MIN-NPs on periodontitis-bearing dogs were finally evaluated.. Transmission electron microscopy examination and dynamic light scattering results revealed that the MIN-NPs had a round shape, with a mean diameter around 100 nm. The in vitro release of minocycline from MIN-NPs showed a remarkably sustained releasing characteristic. After local administration of the MIN-NPs, minocycline concentration in gingival crevice fluid decreased slowly and retained an effective drug concentration for a longer time (12 days) than Periocline(®). Anti-periodontitis effects demonstrated that MIN-NPs could significantly decrease symptoms of periodontitis compared with Periocline and minocycline solution. These findings suggest that MIN-NPs might have great potential in the treatment of periodontitis.

Topics: Animals; Anti-Bacterial Agents; Disease Models, Animal; Dogs; Drug Carriers; Gingival Crevicular Fluid; Lactates; Minocycline; Particle Size; Periodontal Index; Periodontitis; Polyethylene Glycols; Random Allocation

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

To evaluate the therapeutic effects of 2% minocycline hydrochloride liposome controlled-release gel on the periodontitis in an established rat periodontitis model.. Biocompatibility was tested by oral perfusion sample solution for long-term observation. Minocycline hydrochloride liposome controlled-release gel was utilized to treat the established rat periodontitis model. The rats were selected randomly and divided into three groups: group A (PERIO-treated group), group B (minocycline hydrochloride liposome controlled-release gel treated group), and group C (negative control group). The gingival index (GI) and probing depth (PD) were detected, and the number of mononuclear and broken bone cells were examined after 7, 14, 28, and 56 d.. The minocycline hydrochloride liposome controlled-release gel exhibited excellent biocompatibility based on weight measure and tissue section evaluation. The rats with periodontitis demonstrated that GI, PD, and the number of mononuclear and broken bone cells of group B decreased in 14, 28, and 56 d. Pathological observation showed that new bones and fibers were formed in group B.. Minocycline hydrochloride liposome controlled-release gel improves rat periodontitis, thereby providing valuable evidence for clinical application.

Topics: Animals; Anti-Bacterial Agents; Delayed-Action Preparations; Dental Scaling; Liposomes; Minocycline; Periodontal Index; Periodontitis; Rats

Although polymicrobial infections, such as peri-implantitis or periodontitis, were postulated in the literature to be caused by synergistic effects of bacteria, these effects remain unclear looking at antibiotic susceptibility. The aim of this study is to compare the antibiotic susceptibilities of pure cultures and definite cocultures.. Laboratory strains of Aggregatibacter actinomycetemcomitans (Aa) (previously Actinobacillus actinomycetemcomitans), Capnocytophaga ochracea (Co), and Parvimonas micra (Pm) (previously Peptostreptococcus micros) were cultivated under anaerobic conditions, and their susceptibilities to 10 antibiotics (benzylpenicillin G, ampicillin, amoxicillin, ampicillin/sulbactam, amoxicillin/clavulanic acid, minocycline, metronidazole, linezolid, azithromycin, and moxifloxacin) were tested using the Epsilometertest. Cocultures, each consisting of two or three bacteria, were treated analogously.. All four cocultures showed lower susceptibilities to azithromycin and minocycline than to pure cultures. The coculture Aa-Co showed a lower susceptibility to moxifloxacin as did the coculture Aa-Pm to benzylpenicillin G; the coculture Co-Pm showed a lower susceptibility to amoxicillin, amoxicillin/clavulanic acid, metronidazole, and benzylpenicillin G. However, the coculture Co-Pm showed a higher susceptibility to ampicillin, linezolid and moxifloxacin as did Aa-Pm and Aa-Co-Pm to linezolid.. In addition to established in vitro assays, it was demonstrated that antimicrobial cocultures caused antibiotic susceptibilities that differed from those of pure cultures. Bacterial cocultures frequently showed lowered susceptibilities to antibiotics.

Topics: Acetamides; Actinobacillus Infections; Aggregatibacter actinomycetemcomitans; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents; Aza Compounds; Azithromycin; Capnocytophaga; Coculture Techniques; Coinfection; Drug Resistance, Bacterial; Fluoroquinolones; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Linezolid; Metronidazole; Microbial Interactions; Minocycline; Moxifloxacin; Oxazolidinones; Penicillin G; Peptostreptococcus; Peri-Implantitis; Periodontitis; Quinolines; Sulbactam

Topical tetracyclines, such as minocycline ointment, are frequently used for the treatment of periodontal infection. We investigated the influence of minocycline ointment use on oral bacteria, using supragingival plaque samples from adults who had not taken any antibiotics for 6 months. Initially we investigated the effect of topical minocycline administration on the emergence of tetracycline-resistant oral bacteria in four healthy adults. The isolation frequency of tetracycline-resistant oral bacteria to total viable bacteria increased substantially on day 6 after treatment, although it returned to baseline on day 25. Subsequently we investigated the isolation frequency of tetracycline-resistant oral streptococci (TOS) as a representative oral bacterium, using samples from 41 subjects with periodontal diseases. The percentage of TOS (of the total oral streptococci) increased significantly (from 11.9±15.6% to 34.2±24.0%) after minocycline treatment. Various TOS species were identified; S. mitis, S. salivarius, S. sanguinis, and S. oralis were frequently isolated. PCR and Southern blotting allowed us to identify tetM on the Tn916-like elements as the gene responsible for tetracycline-resistance. These findings suggest that the potential risk of the spread of similar genetic elements through bacteria in the oral cavity should be considered.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteria; Bacterial Load; DNA Transposable Elements; DNA, Bacterial; Female; Genes, Bacterial; Humans; Male; Microbial Viability; Middle Aged; Minocycline; Ointments; Periodontitis; Tetracycline Resistance

Topics: Anti-Bacterial Agents; Bacteremia; Cardiovascular Diseases; Conscious Sedation; Crowns; Dental Implants; Dental Scaling; Gingivitis; Humans; Inflammation Mediators; Minocycline; Periodontitis; Probiotics; Risk Assessment; Thrombosis; Tooth Loss; United States

To assess changes over time and determine the minimally important difference (MID) in the Oral Impact on Daily Performances (OIDP) index for patients with severe generalized periodontitis receiving periodontal treatment.. This study was nested in a larger randomized controlled trial and consisted of 45 consecutive subjects of the larger trial (17 receiving intensive and 28 receiving conservative periodontal care). The OIDP index assessed impacts on quality of life (QoL) at baseline and 1 month after treatment. Repeated-measures ANOVA was used for comparison over time and between treatment groups. To estimate the MID, two subjective global transition scales, related to periodontal and oral health, respectively, were used as anchors, whereas the effect size (ES), standardized response mean and standard error of measurement were also calculated.. The mean OIDP score after treatment was significantly lower than at baseline, indicating improvement in QoL, but there were no differences between treatment groups. Based on an agreement between different methods, the MID of the OIDP index was around five scale points and corresponded to a moderate ES.. The MID for the OIDP index among patients treated for severe generalized periodontitis provides meaning to change scores and facilitates interpretation of findings.

Topics: Activities of Daily Living; Adult; Anti-Bacterial Agents; Chi-Square Distribution; Dental Scaling; Female; Humans; Male; Middle Aged; Minocycline; Outcome Assessment, Health Care; Periodontal Debridement; Periodontitis; Quality of Life; Randomized Controlled Trials as Topic; Sickness Impact Profile; Statistics, Nonparametric; Surveys and Questionnaires

Dentists generally recognize the importance of periodontal treatment in patients with leukemia, with the most attention paid to preventing the development of odontogenic infection. For physicians, the worst type of infection is one caused by multidrug-resistant bacteria. Here, we report a patient with an abnormal increase in multidrug-resistant opportunistic bacteria in the gingiva during hematopoietic cell transplantation (HCT).. A 53-year-old woman receiving HCT for leukemia had an insufficient blood cell count for invasive periodontal treatment before HCT. Even brushing caused difficulties with hemostasis. Therefore, frequent pocket irrigation and local minocycline administration were performed.. The multidrug-resistant opportunistic bacterium Stenotrophomonas maltophilia was detected first in phlegm 2 days before HCT, and it was detected in a gingival smear and a blood sample 7 and 11 days after HCT, respectively. The patient developed sepsis on day 11 and died 14 days after HCT. Frequent irrigation and local antibiotic application were ineffective against S. maltophilia on the gingiva. Inflammatory gingiva without scaling and root planing showed bleeding tendency, and this interfered with the eradication of this bacterium.. The gingiva in patients undergoing leukemia treatment acts as sites of proliferation and reservoirs for multidrug-resistant opportunistic bacteria. Severe systemic infection by multidrug-resistant bacteria in such patients with leukemia also may involve the gingiva. To prevent abnormal increases in such bacteria on the gingiva, scaling and/or root planing before chemotherapy, which reduces bleeding on brushing during the neutropenic period caused by chemotherapy, may contribute to infection control in such patients, although it was impossible in this case.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Drug Resistance, Multiple, Bacterial; Fatal Outcome; Female; Gingival Diseases; Gingivitis; Gram-Negative Bacterial Infections; Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Middle Aged; Minocycline; Opportunistic Infections; Periodontitis; Povidone-Iodine; Sepsis; Stenotrophomonas maltophilia; Transplantation Conditioning; Whole-Body Irradiation

Topics: Adult; Anti-Bacterial Agents; Humans; Microspheres; Minocycline; Periodontitis

The purpose of this study was to utilize an in vitro biofilm model of subgingival plaque to investigate resistances in subgingival biofilm communities to antibiotics commonly used as adjuncts to periodontal therapy.. Biofilms were grown on saliva-coated hydroxyapatite supports in trypticase-soy broth for 4 h-10 days and then exposed for 48 h to either increasing twofold concentrations of tetracycline, amoxicillin, clindamycin, and erythromycin or therapeutically achievable concentrations of tetracycline, doxycycline, minocycline, amoxicillin, metronidazole, amoxicillin/clavulanate, and amoxicillin/metronidazole.. Concentrations necessary to inhibit bacterial strains in steady-state biofilms were up to 250 times greater than the concentrations needed to inhibit the same strains grown planktonically. In the presence of therapeutically available antibiotic concentrations, significantly higher proportions of the biofilms remained viable as the biofilms reached steady-state growth. The combinations of amoxicillin/clavulanate and amoxicillin/metronidazole were the most effective in suppressing growth. These combinations were particularly effective against biofilms up to and including 7 days of age and inhibited 90% or more of the bacteria present relative to untreated controls. As the biofilms approached steady state, these combinations were less effective with 50-60% of the bacteria retaining viability.. Most, but not all, species of subgingival bacteria are considerably more resistant in biofilms than in planktonic cultures. Resistance appeared to be age-related because biofilms demonstrated progressive antibiotic resistance as they matured with maximum resistance coinciding with the steady-state phase of biofilm growth.

Topics: Adult; Aged; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents; Biofilms; Clindamycin; Dental Pellicle; Dental Plaque; Dose-Response Relationship, Drug; Doxycycline; Drug Resistance, Bacterial; Durapatite; Erythromycin; Gingiva; Gram-Negative Bacteria; Humans; Metronidazole; Middle Aged; Minocycline; Periodontitis; Tetracycline; Time Factors

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 purpose of this study was to compare the effectiveness of minocycline on treating experimentally induced periodontitis in rats when administered either as a systemic subantimicrobial dose or as a topical ointment.. Thirty-two adult male Sprague-Dawley rats in four experimental groups-(1) model group; (2) systemic subantimicrobial dose of minocycline (5mg/kg/day) treatment group; (3) topical subgingival dose of minocycline (2mg/animal/week) treatment group; (4) control group. Experimentally induced periodontitis-silk ligatures were placed around the crevices of the second molar teeth and the animals fed a 10% sucrose drink. Assessment was carried out at days 28 and 56 using a number of different visual, histological and ultrastructure approaches. (1) Visual assessment-tooth mobility, gingival index and alveolar bone loss. (2) Histological examination-monocyte infiltration and resorption lacunae with osteoclasts. (3) Transmission electron microscopy (TEM)-morphological transformation of fibroblasts and osteoclasts. The collected data were analysed for statistical significance using the analysis of variance statistical test.. Minocycline significantly reduced tooth mobility, gingival index and alveolar bone loss when administered either systemically or as a topical ointment compared to the model group (P<0.01). However, the alveolar bone loss was significantly less (P<0.01 in the systemic treatment group compared to the local treatment group. Monocyte infiltration and resorption lacunae with osteoclasts were significantly less in the both treatment groups compared to the model group (P<0.01). The osteoclasts failed to form a ruffled border in the systemic treatment group.. Topical treatment significantly reduces gingivitis while systemic treatment is beneficial in terms of inhibiting alveolar bone loss.

Topics: Administration, Oral; Administration, Topical; Alveolar Bone Loss; Animals; Anti-Bacterial Agents; Bone Resorption; Disease Models, Animal; Male; Microscopy, Electron, Transmission; Minocycline; Monocytes; Osteoclasts; Periodontal Index; Periodontitis; Periodontium; Random Allocation; Rats; Rats, Sprague-Dawley; Tooth Mobility

To evaluate the clinical outcome and the effects of treating peri-implantitis with periocline.. Thirty-two sites in 32 implants with peri-implantitis were treated with periocline. The parameters including plaque index, probing depth (PD) of pocket, sulcular bleeding index (SBI) were measured at baseline, 1, 3, 6 and 12 weeks after treatment and followed up for 6 months.. Statistically significant decrease (P < 0.05) in SBI, and PD occurred at all time intervals compared to baseline. The treatment could last for at lest four weeks in peri-implantitis cases without fistula.. Periocline could be safely and effectively used in treating peri-implantitis in cases without peri-implant fistula. Peri-implantitis with fistula should be treated in combination with surgical methods, and periocline can also be used to control inflammation before surgery.

Topics: Adult; Anti-Bacterial Agents; Dental Implantation, Endosseous; Dental Implants; Female; Humans; Male; Middle Aged; Minocycline; Periodontitis

To assess the microbiological outcome of local administration of minocycline hydrochloride microspheres 1 mg (Arestin) in cases with peri-implantitis and with a follow-up period of 12 months.. After debridement, and local administration of chlorhexidine gel, peri-implantitis cases were treated with local administration of minocycline microspheres (Arestin). The DNA-DNA checkerboard hybridization method was used to detect bacterial presence during the first 360 days of therapy.. At Day 10, lower bacterial loads for 6/40 individual bacteria including Actinomyces gerensceriae (P<0.1), Actinomyces israelii (P<0.01), Actinomyces naeslundi type 1 (P<0.01) and type 2 (P<0.03), Actinomyces odontolyticus (P<0.01), Porphyromonas gingivalis (P<0.01) and Treponema socranskii (P<0.01) were found. At Day 360 only the levels of Actinobacillus actinomycetemcomitans were lower than at baseline (mean difference: 1x10(5); SE difference: 0.34x10(5), 95% CI: 0.2x10(5) to 1.2x10(5); P<0.03). Six implants were lost between Days 90 and 270. The microbiota was successfully controlled in 48%, and with definitive failures (implant loss and major increase in bacterial levels) in 32% of subjects.. At study endpoint, the impact of Arestin on A. actinomycetemcomitans was greater than the impact on other pathogens. Up to Day 180 reductions in levels of Tannerella forsythia, P. gingivalis, and Treponema denticola were also found. Failures in treatment could not be associated with the presence of specific pathogens or by the total bacterial load at baseline. Statistical power analysis suggested that a case control study would require approximately 200 subjects.

Topics: Adult; Aged; Anti-Bacterial Agents; Dental Implants; Dental Restoration Failure; DNA Probes; DNA, Bacterial; Drug Delivery Systems; Epidemiologic Methods; Female; Humans; Male; Middle Aged; Minocycline; Periodontitis; Treatment Outcome

Aplastic anemia (AA) is a rare hematologic disease characterized by hypo-cellular bone marrow. The clinical features include fatigue, increased bruising, and gingival bleeding caused by anemia, leukopenia, and thrombocytopenia. A patient with AA is at high risk for infection because of leukopenia. The risk of systemic infection is especially high in AA patients with severe local infections, including periodontitis. Accordingly, periodontal treatment should include antibiotic prophylaxis to reduce the risk of systemic infection. However, treatment of periodontitis in the AA patient is significantly complicated by the bleeding disorder. We present a case report of the successful periodontal treatment of an AA patient with spontaneous gingival bleeding.. The patient was closely monitored for platelet and neutrophil counts before every treatment. The patient's platelet count was always under 10,000/microl. Therefore, it was necessary to increase platelet counts to over 25,000/microl by transfusion, after which subgingival scaling with anesthesia was performed. When the neutrophil count was less than 2,000/microl, local minocycline chemotherapy was applied to the pockets. Periodontal infection was monitored by detection of bacterial DNA and measurement of serum immunoglobulin (Ig) G titer against periodontal bacteria.. Following the physical and chemical treatment, the gingival appearance improved dramatically and the spontaneous gingival bleeding disappeared. Moreover, the IgG titer against periodontal bacteria decreased to normal range and specific periodontal pathogens were no longer detectable in the tested pockets.. We believe that the treatment strategy in the present report provides new sight into treatment planning for severely medically compromised patients.

Topics: Adult; Anemia, Aplastic; Anti-Bacterial Agents; Antibodies, Bacterial; Bacteroidaceae Infections; Dental Care for Chronically Ill; Dental Scaling; Gingival Hemorrhage; Humans; Male; Minocycline; Periodontitis; Platelet Transfusion; Prevotella intermedia

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Chronic Disease; Delayed-Action Preparations; Doxycycline; Drug Delivery Systems; Humans; Microspheres; Minocycline; Periodontitis

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Chlorhexidine; Chronic Disease; Combined Modality Therapy; Dental Scaling; Evidence-Based Medicine; Humans; Metronidazole; Minocycline; Periodontal Index; Periodontitis; Research Design; Root Planing; Tetracycline; Treatment Outcome

Topics: Anti-Bacterial Agents; Endoscopes; Gels; Health Education, Dental; Humans; Light; Minocycline; Periodontitis

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

Matrix Metaloproteinases (MMPs) play a crucial role in the pathogenesis of the periodontal disease. This group of enzymes can degrade most of the proteins that compose the extracellular matrix. Recently a new concept of treatment, the "host modulating therapy" (HMT) was developed. The rationale behind this concept is to inhibit the production of the inflammatory mediators and/or to block the production of the host MMPs and thus inhibiting disease production. In the recent years it was found that Tetracyclines (TC) decrease the levels of TNF-alpha, IL-1, Nitric Oxide, and prostaglandins, and via intra and extra cellular mechanisms inhibit the production and activation of the MMPs. A capsule of 20 mg Doxycycline, called later Low Dose Doxycycline (LDD), was the first HMT in the periodontal disease. In a 9 month study it was found that LDD bid after supragingival scaling statistically increased pocket reduction and attachment gain compared to supragingival scaling alone. However, this improvement was found only in pockets of 7 mm or more, and was not compared yet to periodontal supportive therapy every three month. There is a need for more basic and clinical research in the field of HMT in the treatment of periodontal disease, to expand our knowledge and clinical experience that will enable us to decide when and how to use medications to modulate host response.

Topics: Anti-Bacterial Agents; Dental Scaling; Disease Progression; Humans; Inflammation Mediators; Matrix Metalloproteinase Inhibitors; Matrix Metalloproteinases; Minocycline; Nitric Oxide; Periodontitis; Prostaglandins; Tissue Inhibitor of Metalloproteinases; Tumor Necrosis Factor-alpha

Elevated levels of C-reactive protein (CRP) and decreased plasma adiponectin are associated with increased risk of atherosclerosis. Furthermore, recent observations suggested that adiponectin and tumor necrosis factor-alpha (TNF-alpha) suppressed each other's production. Since periodontal disease has been suggested to act as a risk factor for atherosclerosis, we examined the effects of antimicrobial periodontal treatment on CRP, adiponectin, and TNF-alpha levels.. Fifteen chronic periodontitis patients with various systemic conditions at high risk for atherosclerosis were enrolled in the study. Patients were non-surgically treated with topical application of antibiotics and mechanical debridement of calculus once a week for 1 month. Before and after therapy, CRP, adiponectin, and TNF-alpha levels were measured.. Both CRP and TNF-alpha levels were significantly decreased after treatment (P<0.01 and P<0.03, respectively), while adiponectin levels did not change significantly.. Periodontal treatment is effective in reducing CRP and TNF-alpha, while adiponectin does not appear to be influenced by periodontal treatment. Elevated levels of CRP and TNF-alpha may be associated with increased risk for future development of atherosclerosis in periodontitis patients.

Topics: Adiponectin; Adult; Aged; Anti-Bacterial Agents; C-Reactive Protein; Coronary Disease; Female; Humans; Intercellular Signaling Peptides and Proteins; Male; Middle Aged; Minocycline; Periodontitis; Proteins; Risk Factors; Statistics, Nonparametric; Tumor Necrosis Factor-alpha

Antimicrobial agents are sometimes used as adjuncts for the treatment of aggressive and refractory forms of periodontitis. In this study, we used a culture plate assay to investigate the effect of suboptimal doses of antimicrobial agents on proteinase activity of Porphyromonas gingivalis.. A culture plate assay using gelatin as the substrate, which allows a semiquantitative determination of proteinase activity, was developed. Suboptimal inhibitory concentrations of tetracycline, minocycline, doxycycline, metronidazole, penicillin G, or chlorhexidine were added to the medium, and proteolysis zones were determined following the growth of three strains of P. gingivalis. The effect of antimicrobials on outer membrane vesicle-associated gingipains also was determined.. The gelatin plate assay was a convenient, simple procedure for investigating the effect of suboptimal inhibitory concentrations of antimicrobial agents on proteinases produced by P. gingivalis. The largest reduction (> 75%) in the proteolysis zones produced by three strains of P. gingivalis was obtained with minocycline. Tetracycline and doxycycline also reduced the proteolysis zones. A suboptimal inhibitory concentration of chlorhexidine increased the proteolysis zones by up to 70%. Metronidazole and penicillin G produced no noticeable effect. The suboptimal inhibitory concentrations of minocycline, tetracycline, and doxycyline did not reduce the activity of outer membrane vesicle-associated Arg- and Lys-gingipains.. Results from this study suggest that sublethal concentrations of some antimicrobial agents in subgingival sites have the potential to affect the physiology of P. gingivalis, notably by increasing or decreasing the proteolytic activity of the bacteria.

Topics: Adhesins, Bacterial; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Infective Agents, Local; Bacterial Outer Membrane Proteins; Chlorhexidine; Cysteine Endopeptidases; Cysteine Proteinase Inhibitors; Doxycycline; Endopeptidases; Gelatin; Gingipain Cysteine Endopeptidases; Hemagglutinins; Humans; Metronidazole; Minocycline; Penicillin G; Periodontitis; Porphyromonas gingivalis; Protease Inhibitors; Tetracycline

This investigation attempts to clarify the proanabolic effects of minocycline and indomethacin by studying their effects on androgen metabolism and mediation by estradiol. A cell culture model was used with androgen substrates because of the proanabolic effects of androgen metabolites.. Monolayer cultures of human gingival fibroblasts (HGF) derived from 6 patients were incubated in duplicate with 14C- testosterone or 14C-4-androstenedione as substrates and optimal concentrations of estradiol (E1,3 microgram/ml) and minocycline (M25 microgram/ml) or indomethacin (I, 1 microgram/ml) alone and in combination (E1,3+11 or E1,3+M25 microgram/ml); similar experiments were carried out with human oral periosteal fibroblasts (HPF), M, I, E, and the combinations. At the end of a 24-hour incubation period in Eagle's MEM, the medium was solvent extracted with ethyl acetate and the metabolites were separated by TLC in a benzene:acetone solvent system (4:1 v/v). The separated metabolites were quantified using a radioisotope scanner.. Both androgens were metabolized to 5alpha-dihydrotestosterone (DHT) and 4-androstenedione (4-A) or testosterone (T) at baseline and in response to the agents tested, by HGF and HPF. With HGF, there were significant increases in the yields of DHT and 4-A or T in response to M, E, and M+E, resulting in 50% to 2.4-fold increases in these metabolites over control incubations (n = 6; P<0.01). The responses to I and combinations of I+E were similar. HPF also demonstrated significant increases of 29% to 4-fold in the yields of androgen metabolites in response to M, E, and M+E (n = 6; P<0.01). I and E similarly increased the yields of androgen metabolites, alone and in combination.. Adjunctive periodontal treatment with minocycline or indomethacin can contribute to hormone-modulated anabolic responses in males and females in gingival and periosteal fibroblasts derived from a chronically inflamed source.

Topics: Analysis of Variance; Androgens; Androstenedione; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Cells, Cultured; Chromatography, Gas; Dihydrotestosterone; Drug Combinations; Estradiol; Female; Fibroblasts; Gingiva; Humans; Indomethacin; Male; Mass Spectrometry; Metabolism; Minocycline; Periodontitis; Periosteum; Testosterone

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

Systemically-administered tetracyclines have been used widely for treatment of periodontal diseases with little understanding of their delivery characteristics to periodontal tissues. This study was designed to measure concentrations of 3 tetracyclines in gingival crevice fluid (GCF), plasma and saliva of following systemic administration.. The concentration of tetracycline (TC), minocycline (MN) and doxycycline (DX) was measured in gingival crevice fluid (GCF), plasma and saliva of 20 subjects following single sequential standard oral systemic doses. Gingival crevice fluid concentration was measured at 4 sites (2 shallow and 2 deep) before administration, and at 1 h and 2 h following administration. Plasma and saliva concentrations were measured from in samples at the same time points. No antibacterial activity was detected before administration. The highest concentrations were measured 2 h after administration.. The average concentrations at 2 h were highest in plasma (TC = 1.02, MN=2.18, DX=2.35 microg/ml). Intermediate concentrations were measured in GCF (TC=0.61, MN= 1.49, DX= 1.65 microg/ml). Saliva concentrations (TC=0.09 MN=0.31, DX=0.47 microg/ml) were the lowest of the 3 fluids monitored. Data are presented indicating that the average GCF concentration of systemically administered tetracyclines is less than the that of plasma concentration. The concentration of tetracyclines in GCF was strongly associated with plasma concentration, indicating a primary role of drug absorption in the delivery of these systemically administered antibiotics to the site of action in periodontal therapy. The average GCF concentration in individuals varied widely (between 0 and 8 microg/ml) with approximately 50% of samples not achieving levels of 1 microg/ml.. These observations suggest that poor absorption of orally-administered tetracyclines in many individuals may account for much of the variability in clinical response to antibiotics observed in practice.

Topics: Administration, Oral; Adult; Aged; Analysis of Variance; Anti-Bacterial Agents; Biological Availability; Doxycycline; Female; Gingival Crevicular Fluid; Humans; Least-Squares Analysis; Male; Middle Aged; Minocycline; Periodontal Index; Periodontitis; Saliva; Tetracycline; Tetracyclines; Time Factors

The aim of this study was to obtain information for an effective antimicrobial therapy against orofacial odontogenic infections; such information was obtained from recent bacteriologic features and antimicrobial susceptibility data.. The bacteriology and antimicrobial susceptibility of major pathogens in 163 patients with orofacial odontogenic infections to 7 antibiotics was examined.. Mixed infection of strict anaerobes with facultative anaerobes (especially viridans streptococci) was observed most often in dentoalveolar infections, periodontitis, and pericoronitis. Penicillin (penicillin G) was effective against almost all pathogens, although it did not work well against beta-lactamase-positive Prevotella. Cefmetazole was effective against all test pathogens. Erythromycin was ineffective against viridans streptococci and most Fusobacterium. Clindamycin exerted a strong antimicrobial activity on anaerobes. Minocycline was effective against almost all the test pathogens. The antimicrobial activity of levofloxacin against viridans streptococci was not strong.. An antibiotic that carries out antimicrobial activity against both viridans streptococci and oral anaerobes should be suitable for treatment of dentoalveolar infection, periodontitis, and pericoronitis. Penicillin remains effective as an antimicrobial against most major pathogens in orofacial odontogenic infections. Cefmetazole, clindamycin, and minocycline may be effective against most pathogens, including penicillin-unsusceptible bacteria.

Topics: Anti-Bacterial Agents; Bacteria, Anaerobic; Bacterial Infections; beta-Lactamases; Cefmetazole; Chi-Square Distribution; Clindamycin; Drug Resistance, Microbial; Erythromycin; Humans; Microbial Sensitivity Tests; Minocycline; Mouth Diseases; Penicillins; Periapical Abscess; Pericoronitis; Periodontal Abscess; Periodontitis; Prevotella; Streptococcus

Semisynthetic tetracyclines used in the adjunctive treatment of inflammatory periodontal disease enhance collagen expression in induced periodontal lesions of rats. Polypeptide growth factors regulate key cellular events in tissue repair. The physiologically active androgen 5 alpha-dihydrotestosterone (DHT) stimulates bone and connective tissue turnover. It was relevant to study the effects of transforming growth factor beta (TGF-beta)/platelet-derived growth factor (PDGF) and minocycline alone and in combination on the formation of biologically effective androgens which can influence repair.. Confluent monolayer cultures of human gingival fibroblasts of the fifth through the ninth passage were incubated in Eagle's minimum essential medium, with 14C-testosterone/14C-4-androstenedione in the presence or absence of optimal concentrations of TGF-beta/PDGF/minocycline (M), alone and in combination. At the end of a 24-hour incubation period, the medium was analyzed for steroid metabolites and quantified using a radioisotope scanner.. The androgen substrates 14C-testosterone (14C-T) and 14C-4-androstenedione (14C-4-A) were metabolized to DHT and 4-androstenedione/testosterone respectively. There were significant increases in the formation of DHT from 14C-T in response to M, TGF-beta, and PDGF, alone and in combination (13 to 48%), compared with controls (n = 4; P<0.01). The yields of 4-androstenedione were also greater in response to these agents (31%; 3-fold). When 14C-4-A was used as substrate, there were 21 to 80% increases in the formation of DHT in response to these agents alone and in combination (n = 4; P<0.01).. The biologically effective androgen metabolites formed in response to minocycline, TGF-beta, and PDGF can contribute to reparatory events in the inflamed periodontium. Judicious, adjunctive usage of the chemically-modified tetracyclines in the treatment of periodontal diseases can obviate the risk of microbial resistance, with potential applications of their anti-inflammatory and proanabolic effects in regenerative technology.

Topics: Adult; Androstenedione; Anti-Bacterial Agents; Carbon Radioisotopes; Cells, Cultured; Dihydrotestosterone; Female; Fibroblasts; Gingiva; Humans; Male; Minocycline; Periodontitis; Platelet-Derived Growth Factor; Statistics, Nonparametric; Testosterone; Transforming Growth Factor beta

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

To evaluate the clinical and microbiological efficacy of minocycline in a subgingival local delivery system as an adjunct to tooth scaling and root planing in dogs with periodontal disease.. Nine 4- to 7-year-old Beagles with periodontitis.. After scaling of teeth and root planing, 2 treatment and 1 or 2 control sites were selected for each dog: treated sites (n = 18) received minocycline hydrochloride periodontal formulation and control sites (n = 12) received ointment base (no minocycline). Gingival crevicular fluid was collected at a baseline (prior to treatment) and at week 4. Clinical and microbiological effects were evaluated and compared among sites.. In minocycline-treated sites, clinical indices were significantly decreased at week 4, compared with those at baseline. Minocycline-treated sites were associated with a significant decrease in gingival crevicular fluid, probing depth, and bleeding on probing values, compared with those for control sites at week 4. Compared with that for control sites, total bacteria count in periodontal pockets of minocycline-treated sites had an obvious tendency to decrease by week 4. Proportions of Porphyromonas and Fusobacterium spp were significantly decreased at week 4, compared with proportions at control sites and with pretreatment (baseline) values.. When used as an adjunct to tooth scaling and root planing, minocycline periodontal formulation stimulated favorable clinical and antimicrobial responses.

Topics: Animals; Anti-Bacterial Agents; Delayed-Action Preparations; Dog Diseases; Dogs; Fusobacterium; Gingiva; Minocycline; Ointments; Periodontitis; Porphyromonas; Streptococcus; Time Factors

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

Subgingival plaque samples were collected from 68 patients with a history of moderate to severe adult periodontitis and enumerated on Trypticase-soy blood agar plates, with and without tetracycline at 4 micrograms/ml. Each different colony morphotype was enumerated, and a representative colony was subcultured for identification and examined for the tetracycline resistance gene tet(Q) by polymerase chain reaction (PCR) amplification and DNA hybridization, using a fragment of tetA(Q)2 from Bacteroides fragilis 1126. PCR primers (5'-GGCTTCTACGACATCTATTA-3' and 5'-CATCAACATTTATCTCTCTG-3') were chosen to amplify a 755 bp region of tet(Q). The subgingival plaque samples were also tested by PCR. Approximately 12% of the total cultivable flora was resistant to tetracycline, and the percentage of the tetracycline-resistant cultivable flora with the tet(Q) gene varied greatly from one patient to another with a range from 0.0 to 67%. Half of the 68 subgingival plaque samples were positive or weakly positive for tet(Q) by PCR. Approximately 15% of the 210 isolates subcultured with resistance to tetracycline, (> or = 4 micrograms/ml) contained tet(Q), and 60% contained tet(M). All of the tet(Q)-resistant isolates were gram-negative anaerobic bacilli and included all of the Prevotella and Bacteroides isolates.

Topics: Adult; Anti-Bacterial Agents; Bacteria, Anaerobic; Bacterial Proteins; Bacteroides; Base Sequence; Dental Plaque; DNA Primers; DNA Probes; DNA, Bacterial; Doxycycline; Genes, Bacterial; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Microbial Sensitivity Tests; Minocycline; Molecular Sequence Data; Periodontitis; Polymerase Chain Reaction; Prevotella; Sensitivity and Specificity; Tetracycline; Tetracycline Resistance

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

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

This study was performed to assess the effect of scaling and root planing clinically and microbiologically during one year. Nine patients with moderate to severe periodontitis were studied. After the process of plaque control, the selected single rooted teeth with 5mm probing depth were debrided mechanically under non-local anesthesia four times biweekly. Observing the results of the treated teeth until three months, the experimental teeth were divided into two groups. The standard of division was whether they showed good response to the mechanical debridement or not. Observation was continued until one year after the debridement according to the following criteria: 1. The sites which showed good responses at three months were continued to be observed biweekly. 2. The sites which showed no improvement at three months were applied the gel of minocycline (Periocline) four times biweekly. 3. The untreated sites used as control until three months received mechanical debridement four times biweekly. The following results were obtained: The sites that showed good responses to the mechanical debridement at three months were maintained in good condition continuously during one year. The topical application of Periocline was effective in reducing the inflammation and probing depth clinically and microbiologically until three months.

Topics: Administration, Topical; Adult; Debridement; Dental Scaling; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Male; Middle Aged; Minocycline; Periodontitis; Root Planing

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

Twenty subgingival plaque samples from patients with chronic periodontitis were screened for the presence of three periodontal 'pathogens'--Porphyromonas gingivalis, Fusobacterium nucleatum and Eikenella corrodens. Nineteen of the samples were found to contain at least one of the three organisms and six samples contained all three. The subgingival plaque samples were cultured in the presence of various concentrations of minocycline, and those organisms which appeared to be least susceptible to the antibiotic were isolated and identified. A total of 40 isolates were obtained and these consisted of 18 different species, only one of which, Fusobacterium nucleatum, is generally recognized as being associated with chronic periodontitis. The minimum inhibitory concentrations of minocycline for many of the organisms isolated were greater than the concentration of attainable in gingival crevicular fluid following routine parenteral administration of the antibiotic.

Topics: Adult; Dental Plaque; Eikenella; Female; Fusobacterium; Gingiva; Gram-Negative Bacteria; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Minocycline; Periodontitis

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

The purpose of this report is to illustrate the use of microbiology in the diagnosis and treatment in four cases of severe adult periodontitis. All four patients were subgingivally infected with Actinobacillus actinomycetemcomitans which was the basis for an adjunct minocycline therapy. Scaling and root planing plus minocycline were not able to establish a clinically stable periodontal condition. A. actinomycetemcomitans was not eliminated from the pockets in any of the patients. Good clinical and microbiological results were obtained after continuous conventional treatment with an adjunct therapy of metronidazole plus amoxycillin. With a 7 day course of this antibiotic therapy, the pockets of all four patients became free of A. actinomycetemcomitans and were still negative on repeated sampling on recall visits. Microbiological monitoring of severe periodontitis in adults seems to be a valuable adjunct to clinical examination. Furthermore, effective antibiotic therapy in A. actinomycetemcomitans-associated periodontitis appears of paramount importance in obtaining a stable periodontal situation.

Topics: Actinobacillus; Adult; Amoxicillin; Colony Count, Microbial; Combined Modality Therapy; Dental Scaling; Drug Therapy, Combination; Humans; Metronidazole; Middle Aged; Minocycline; Periodontitis

A large number of bacterial species are found in the periodontal pocket. It has been shown that the composition of the subgingival microbiota can differ significantly between individual pockets in one patient, as well as between different subjects. These different types of microfloras can be characterized by indicator bacteria. These indicator bacteria are strongly associated with active periodontal breakdown. Therefore, these microorganisms can be useful in the periodontal treatment of individual patients. It also supports the use of antibiotics in specific forms of periodontal disease. The application of microbiological data in diagnosis and treatment planning in four severe periodontitis patients is illustrated.

Topics: Actinobacillus; Bacteroides; Humans; Microbial Sensitivity Tests; Minocycline; Patient Care Planning; Periodontal Diseases; Periodontitis

In the present study we examined alterations in the proportions of cultivable flora of A. actinomycetemcomitans (A.a.) in subgingival plaque of 25 patients with different forms of periodontitis, 7 days after systemic administration of 200 mg/d Minocycline-HCl. Remarkable shifts in the flora were apparent. Sites with low or extremely low initial levels of A.a. (less than 10%) showed an increase in mean proportions from 2.7% to 15.7% (p less than 0.01). A.a. was eliminated in only 18% of sites after 1 week of minocycline therapy. Subgingival scaling resulted in 80% of sites without detectable A.a. However, if present, the organism accounted for 51% of the cultivable microflora, on average. Our data emphasize the importance of a sufficiently extended period of antibiotic therapy and efficient mechanical debridement of all tooth surfaces to eliminate the organism.

Topics: Actinobacillus; Analysis of Variance; Dental Plaque; Humans; Minocycline; Periodontitis

The effects of minocycline on subgingival plaque samples from patients with chronic periodontitis were investigated in vitro. Minocycline concentrations as low as 1.0 microgram/ml inhibited 95.7% of the cultivable bacteria in the samples but 256 micrograms/ml was necessary to inhibit all of the cultivable bacteria in the samples. Although up to 99.9% of bacteria in the plaque samples were killed by a 6 h exposure to 8.0 micrograms/ml of minocycline, large numbers of viable bacteria remained. These results imply that adequate reductions in the numbers of viable subgingival plaque bacteria are unlikely to occur after exposure to minocycline at concentrations attainable in gingival crevicular fluid after systemic administration.

Topics: Adult; Aged; Bacteria; Chronic Disease; Colony Count, Microbial; Dental Plaque; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Minocycline; Periodontitis; Time Factors

The in vitro susceptibility of 55 strains of subgingival plaque bacteria to minocycline was determined. A concentration of 1 microgram/ml minocycline was found to inhibit 85% of the strains tested and the MIC ranged from 0.03 to 32 micrograms/ml. For 71% of the strains tested the MBC was at least 4 times greater than the corresponding MIC, suggesting a bacteriostatic activity for minocycline. A concentration of 20 mg/ml of magnesium ions was capable of neutralizing 8 micrograms/ml of minocycline and was used to eliminate "carry-over" effects inherent in the experimental procedure. After 6 to 7 weeks exposure to sub-lethal concentrations of minocycline there was no appreciable increase in the MICs of most organisms with the exception of Actinobacillus actinomycetemcomitans NCTC 10981 and Campylobacter concisus NCTC 11485. Short term (6 hour exposure of bacteria to minocycline (8 micrograms/ml) markedly reduced the viability of a number of periodontopathogens but had little effect on the viability of Veillonella parvula NCTC 11456 and Fusobacterium nucleatum NCTC 11326. These in vitro investigations have demonstrated that minocycline is capable of inhibiting most of the periodontitis-associated bacteria tested and can kill some of these bacteria after a comparatively short exposure time. However, some of the organisms tested exhibited a low susceptibility to minocycline and others became less susceptible following exposure to low concentrations of the antibiotic for several weeks.

Topics: Bacteria; Bacteroides; Dental Plaque; Humans; Magnesium Sulfate; Minocycline; Periodontitis; Tetracycline Resistance; Tetracyclines; Time Factors

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: Anti-Infective Agents, Local; Humans; Microbial Sensitivity Tests; Minocycline; Ointments; Periodontitis; Tetracyclines

Topics: Adolescent; Adult; Dental Care for Disabled; Dental Plaque; Diabetes Complications; Female; Gingivectomy; Humans; Male; Minocycline; Neutrophils; Oral Hygiene; Periodontitis

Topics: Adult; Combined Modality Therapy; Humans; Middle Aged; Minocycline; Nitroimidazoles; Periodontitis; Tetracyclines; Tinidazole

The purpose of this study was to determine the passage into and concentration of Minocycline HCl (Minocin) in gingival crevicular fluid (GCF) and the relationship between its concentration of saliva. GCF, serum and changes in periodontal health. Over an 8 day period, 10 adults with periodontal disease received orally 200 mg/day of Minocin and 10 other received 150 mg/day. The parameter evaluated included the DMF, gingival index, plaque index, crevice depth, oral soft tissue evaluation. SMA-12, CBC, prothrombin time, and concentrations of Minocin in serum, saliva and GCF. The DMF score, crevice depth, SMA-12, CBC and prothrombin time were determined on days 1 and 8. All other parameters were evaluated on days 1, 2, 3, 5 and 8. The results of this study showed that Minocin administration resulted in no significant changes in blood chemistry, blood counts and prothrombin time, was effective against oral microorganisms as shown by reductions in plaque scores, produces an improvement in gingival health, is present in serum at therapeutically effective levels when given in doses of either 200 mg or 150 mg per day and is concentrated in gingival crevicular fluid at levels 5 times as high as serum.

Topics: Adult; Female; Gingival Crevicular Fluid; Gingival Pocket; Gingivitis; Humans; Male; Middle Aged; Minocycline; Periodontal Diseases; Periodontal Index; Periodontitis; Saliva; Tetracyclines