tetracycline and Periodontitis

The objective of the study was to evaluate the prevalence and proportions of antibiotic-resistant species in periodontitis patients.. A systematic scoping review of randomized clinical trials (RCTs) was conducted using the PRISMA extension for scoping reviews involving different databases. MeSH terms and keywords were provided to examine only RCTs with antibiotic-resistant results that included at least 3 months of follow-up of systematically healthy patients diagnosed with periodontitis and treated with systemic or local antibiotics adjunctive to subgingival debridement. RCTs that managed participants surgically, duplicate publications, and investigations implemented on animals were discarded.. Six RCTs were chosen. These studies included 465 patients. Most investigations observed that while Aggregatibacter actinomycetemcomitans, Tannerella forsythia, and Porphyromonas gingivalis had low resistance to amoxicillin, microorganisms in many sites showed resistance to tetracycline, metronidazole, and azithromycin pretreatment. A. actinomycetemcomitans showed high resistance to tetracycline pre- and post-therapy. The proportion of antibiotic-resistant samples augmented rapidly after the prescription of antibiotics in all test groups. The percentage of antibiotic-resistant microorganisms decreased over time; at the end of the follow-up period, resistance levels were close to baseline levels.. Adjunctive local and systemic antibiotic treatment temporarily increased the antibiotic resistance of subgingival microorganisms; nonetheless, many bacteria remained susceptible to antibiotics during their administration.

Topics: Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Drug Resistance, Microbial; Humans; Periodontitis; Porphyromonas gingivalis; Randomized Controlled Trials as Topic; Tetracycline

Plaque bacteria are the primary initiators of periodontal disease in susceptible persons and therapy is largely based on mechanical bacterial biofilm disruption. Patients' response to periodontal treatment is unpredictable and periodontal stability is not always achieved. Locally delivered antimicrobials (LDAs) may be used as adjuncts to mechanical therapy in treatment of recalcitrant deep (> or = 5mm), active, non-responding sites, providing the patient's oral hygiene is adequate. Their use as a monotherapy cannot be justified. The literature reveals that LDAs are safe and that they achieve statistically significant, yet clinically modest, gains in clinical attachment and reductions in pocket depths.. It has been suggested that LDAs may improve the clinical outcome in the treatment of recurrent and refractory cases of periodontitis when used as an adjunct to scaling and root surface instrumentation. This paper examines and discusses the evidence.

Topics: Animals; Anti-Bacterial Agents; Anti-Infective Agents; Combined Modality Therapy; Drug Implants; Humans; Metronidazole; Periodontitis; Tetracycline

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

Both systemic and topical antibiotics are increasingly used in the management of periodontal infections. Whilst these drugs are used mostly on an empirical basis, some contend that rational use of antibiotics should be the norm due to their wide abuse and consequential global emergence of antibiotic resistance organisms. Here we review the rationale and principles of antimicrobial therapy, treatment goals, drug delivery routes and various antibiotics that are used in the management of periodontal diseases. The pros and cons of systemic and local antibiotic therapy are described together with practical guidelines for their delivery. The available data indicate, in general, that mechanical periodontal treatment alone is adequate to ameliorate or resolve the clinical condition in most cases, but adjunctive antimicrobial agents, delivered either locally or systemically, can enhance the effect of therapy in specific situations. This is particularly true for aggressive (early onset) periodontitis, in patients with generalised systemic disease that may affect host resistance and in case of poor response to conventional mechanical therapy. Locally delivered antibiotics together with mechanical debridement are indicated for non-responding sites of focal infection or in localised recurrent disease. After resolution of the periodontal infection, the patient should be placed on an individually tailored maintenance care programme. Optimal plaque control by the patient is of paramount importance for a favourable clinical and microbiological response to any form of periodontal therapy.

Topics: Actinobacillus Infections; Administration, Oral; Administration, Topical; Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Anti-Infective Agents, Local; Bacteroidaceae Infections; Chlorhexidine; Humans; Metronidazole; Periodontitis; Porphyromonas gingivalis; Tetracycline

Meta-analysis was used to assess the clinical efficacy of local delivery of tetracycline alone or as an adjunct to conventional mechanical therapy in patients with chronic periodontitis.. Studies were identified in MEDLINE and others sources. Meta-analyses were performed on the basis of probing depth (PD) at baseline, type of antimicrobial used, and experimental and control regimens (i.e., tetracycline plus scaling and root planing [SRP] versus SRP, tetracycline versus SRP, and tetracycline versus placebo, or no treatment). The effect of local tetracycline was evaluated for follow-up times of 4, 8, 12, 16, 24, and 36 weeks. Sensitivity analysis was performed according to antimicrobial delivery mode (irrigation, fibers, strips). A random effects model was used.. The literature search identified 29 studies that met our inclusion criteria and were entered Into the meta-analysis. A significant mean reduction in PD for the combined tetracycline and SRP was observed regardless of initial probing depth and independently to the duration of follow-up. Tetracycline alone did not perform better than SRP, whereas they performed significantly better than placebo. Differences in improvement of attachment level (AL) were substantially similar to those encountered for PD.. Our results documented that local. delivery of tetracycline improves the clinical outcomes of traditional treatment and should be considered particularly as an adjunct to SRP. Considerations regarding the adverse effects of widespread use of tetracycline should be taken into account when choosing a therapeutic strategy of chronic periodontitis.

Topics: Administration, Topical; Anti-Bacterial Agents; Chronic Disease; Combined Modality Therapy; Dental Scaling; Follow-Up Studies; Humans; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Placebos; Root Planing; Tetracycline; Treatment Outcome

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

Periodontal diseases are infections and thus systemically administered antibiotics are often employed as adjuncts for their control. There are conflicting reports as to whether these agents provide a therapeutic benefit.. The purpose of this systematic review is to determine whether systemically administered antibiotics improve a primary clinical outcome measure, periodontal attachment level change.. In patients with periodontitis, what is the effect of systemically administered antibiotics as compared to controls on clinical measures of attachment level?. The Pub/Med database was searched from 1966 to May 2002. Searches were limited to human studies published in English. Hand searches were performed on the Journal of Clinical Periodontology, Journal of Periodontology, and Journal of Periodontal Research. References in relevant papers and review articles were also examined.. Trials were selected if they met the following criteria: randomized controlled clinical trials, quasi-experimental studies, and cohort studies of > 1 month duration with a comparison group; subjects with aggressive, chronic, or recurrent periodontitis and periodontal abscess; use of a single or a combination of systemically administered antibiotics(s) versus non-antibiotic therapy; and a primary outcome of mean attachment level change (AL).. Studies involving the use of low-dose doxycycline, combinations of locally plus systemic antibiotics, or where the control group included a systemically administered antibiotic were excluded.. A mean difference in AL between groups was available for all papers used in the meta-analysis. A standard deviation (SD) for the difference was used if provided or calculated from the SD or standard error of the mean (SEM) when provided for single measurements. Data were subset by antibiotic employed, type of adjunctive therapy, and disease type. Results were assessed with both fixed-effects and random-effects models.. 1. Twenty-nine studies, 26 RCTs and 3 quasi-experimental (36 comparisons), met the entry criteria. Total study population, both control and test groups, was estimated at over 1,200. 2. Twenty-two studies (27 comparisons) were used in the meta-analysis, evaluating if the antibiotics provided a consistent benefit in mean AL change for different patient populations, for different therapies, and for different antibiotics. 3. For the majority of the comparisons, systemically administered antibiotics exhibited a more positive attachment level change than the control group in the study. The combined results were statistically significant (P < 0.001). 4. The systemic antibiotics were uniformly beneficial in providing an improvement in AL when used as adjuncts to scaling and root planing (SRP) and were consistently beneficial, although of borderline significance, when used as adjuncts to SRP plus surgery or as a stand alone therapy. 5. When examining the effects of individual or combinations of antibiotics, it was found that there were statistically significant improvements in AL for tetracycline, metronidazole, and an effect of borderline statistical significance for the combination of amoxicillin plus metronidazole. 6. Improvements in mean AL were consistent for both chronic and aggressive periodontitis subjects, although the aggressive periodontitis patients benefited more from the antibiotics.. 1. The use of systemically administered adjunctive antibiotics with and without SRP and/or surgery appeared to provide a greater clinical improvement in AL than therapies not employing these agents. 2. The data supported similar effect sizes for the majority of the antibiotics; therefore, the selection for an individual patient has to be made based on other factors. 3. Due to a lack of sufficient sample size for many of the antibiotics tested, it is difficult to provide guidance as to the more effective ones.

Topics: Administration, Oral; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Clindamycin; Consensus; Dental Scaling; Doxycycline; Humans; Metronidazole; Penicillins; Periodontal Attachment Loss; Periodontal Index; Periodontitis; Spiramycin; Tetracycline

Periodontal regeneration has been a relentless goal of the periodontist. Perhaps the oldest and most frequently attempted type of regeneration has involved chemical modification of the root surface. Varying results from histological and clinical studies have created controversy about the clinical effectiveness of root surface decalcification.. This systematic review assesses the efficacy of root surface biomodification through the use of citric acid, tetracycline, or ethylenediaminetetraacetic acid (EDTA) in patients with chronic periodontitis.. Does the use of chemical root declacification result in effective periodontal regeneration and improved clinical outcomes in patients with chronic periodontitis?. The Cochrane Database of Systematic Reviews; Database of Abstracts of Reviews of Effectiveness; Cochrane Central Register of Controlled Trials; American College of Physicians Journal Club, evidence-based MEDLINE journals; and National Center for Biotechnology Information PubMed Journals, as well as Dogpile, Google, and Copernic search engines were screened. Hand searches were performed on the Journal of Clinical Periodontology, Journal of Periodontology, Journal of Periodontal Research, and Periodontology 2000. Searches were performed for relevant clinical trials published through September 25, 2002.. Histological and clinical studies evaluating the effects of citric acid, tetracycline, or EDTA on root surfaces of patients with chronic periodontitis were considered for inclusion.. Studies evaluating extracellular matrix proteins (e.g., fibronectin), enamel matrix proteins (e.g., amelogenins), or other proteins or growth factors applied to the root surface were not included.. Primary outcome measures included changes in connective tissue attachment, cementogenesis, clinical attachment levels, probing depths, and gingival recession. Secondary outcome measures included changes in bone level, gingival inflammation, and plaque levels. Results for continuous outcome measures for primary variables (clinical attachment levels, probing depths, and recession) were expressed as mean differences or standardized mean differences. Clinical attachment levels and reduction in probing depth were evaluated using meta-analysis. All papers were rated according to methodological strength of evidence.. 1. Thirty-four studies incorporating a total patient population of 575 were analyzed: 26 for citric acid, 5 for tetracycline, and 3 for EDTA treatment. 2. Four of 8 human histological studies reported regeneration with the use of citric acid. Only 1 of 18 clinical studies reported attachment gain. 3. Of the 5 studies examined using tetracycline, 1 histological study and 1 clinical study reported attachment gain. 4. No regeneration was reported in the 3 studies evaluating the use of EDTA. 5. Meta-analysis performed on 28 clinical trials did not show any significant effects of acid root treatment on attachment level gains or probing depth.. 1. Evidence to date suggests that the use of citric acid, tetracycline, or EDTA to modify the root surface provides no benefit of clinical significance to regeneration in patients with chronic periodontitis. 2. The best method for ascertaining the clinical efficacy of acid-treated root regeneration would be to conduct a randomized clinical trial with sufficient statistical power that is supported by quantitative histological evaluation. 3. The majority of the studies that evaluated the regenerative potential of root surface modifiers were observational in nature; therefore, the value of conclusions reached in this manuscript must be carefully considered.

Topics: Citric Acid; Consensus; Decalcification Technique; Edetic Acid; Humans; Periodontitis; Regeneration; Surface Properties; Tetracycline; Tooth Root

The purpose of this review is to provide the clinician with some practical rationale for the selection and use of antibiotics in the treatment of destructive periodontal diseases. We have attempted to integrate approximately 20 years of periodontal literature describing antibiotic therapy with personal experience and 21st century ideas. This article addresses antibiotic use during treatment of aggressive periodontitis with emphasis on juvenile disease and adult refractory diseases. The literature review revealed few large, controlled studies that compared efficacy of adjunctive antibiotic use to mechanical therapy alone. Even fewer studies evaluated the efficacy of one antibiotic relative to another. However, based on the evidence available, certain conclusions were drawn. Adjunctive use of an antibiotic along with mechanical debridement is recommended for the treatment of Actinobacillus actinomycetemcomitans-associated periodontitis as an acceptable therapeutic regimen. Due to the emergence of tetracycline-resistant A. actinomycetemcomitans, the combination of metronidazole and amoxicillin may be preferable. In aggressive refractory periodontitis, compelling evidence exists that the use of an appropriate adjunctive antibiotic frequently gives a more favorable clinical response than mechanical therapy alone. Unfortunately, the selection of antibiotic is not as clear and is probably case-dependent. Positive responses have been reported with amoxicillin/clavulanic acid, clindamycin, metronidazole, and the combination therapy metronidazole plus amoxicillin. The introduction of local delivery antibiotics specifically for the treatment of periodontitis offers a novel concept for the treatment of localized disease. The latter, in particular, may prove useful in the treatment of recurrent disease activity or where only a few individual sites are involved.

Topics: Adult; Aggregatibacter actinomycetemcomitans; Aggressive Periodontitis; Amoxicillin; Anti-Bacterial Agents; Chemotherapy, Adjuvant; Child; Clavulanic Acid; Dental Scaling; Drug Delivery Systems; Drug Therapy, Combination; Gram-Negative Anaerobic Bacteria; Humans; Metronidazole; Periodontitis; Tetracycline

Topics: Animals; Cell Adhesion; Citric Acid; Dogs; Edetic Acid; Haplorhini; Humans; Periodontitis; Tetracycline; Tooth Root

This article addresses controversial issues associated with four different subjects: the usefulness of povidone iodine in the treatment of adult periodontitis, genetic susceptibility testing for severe periodontitis, local drug delivery in the treatment of periodontal diseases, and differentiating between statistical and clinical significance. Conclusions are drawn based on published evidence. Each subject is also assessed with regard to their practical application in the management of patients.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents, Local; Clinical Trials as Topic; Drug Delivery Systems; Genetic Predisposition to Disease; Genetic Testing; Humans; Interleukin-1; Odds Ratio; Periodontitis; Povidone-Iodine; Tetracycline

This article discusses the principles, products, and techniques currently available for local delivery of antimicrobials in the treatment of adult periodontitis. Four principles provide the scientific basis for the treatment of periodontitis: it is caused by bacteria; it cannot be cured, but it can be controlled; clinicians cannot remove all the plaque and calculus; and periodontitis reinfects. This article stresses how the local delivery of antimicrobials can help the clinician achieve the goals of arresting the disease and maintaining the disease in the arrested or controlled state. Rationales for reevaluating the treated patient and treatment options are presented. Local-delivery systems are reviewed, stressing those available in the United States. Pharmacokinetics, multicenter randomized trials, and techniques are presented.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents, Local; Cellulose; Chlorhexidine; Clinical Trials as Topic; Doxycycline; Drug Delivery Systems; Humans; Periodontitis; Secondary Prevention; Tetracycline; United States

This article discusses the use of tetracyclines in the clinical management of periodontal infections. A review of the drugs pharmacology, pharmacokinetics, and potential adverse effects shows that they are relatively safe if used in appropriate dosages and under controlled conditions. Current data suggest that the routine use of tetracyclines in conjunction with the treatment of periodontitis is unnecessary. However, their distinctive characteristics can be utilized in different delivery systems as an adjunctive aid to conventional treatment of juvenile and refractory forms of periodontitis.

Topics: Adult; Aggressive Periodontitis; Anti-Bacterial Agents; Drug Delivery Systems; Humans; Periodontal Diseases; Periodontitis; Tetracycline; Tetracycline Resistance

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

This manuscript reviews the development over the last 20 years of the evidence supporting the clinical application of a controlled delivery device for the treatment of human periodontitis. The device is a monolithic ethylene vinyl-acetate fibre loaded with 25% w/w tetracycline HCI (tetracycline fibre). It releases tetracycline at a steady state rate of 2 microg/cm x h and results in the maintenance of essentially constant, highly-effective concentrations of tetracycline at the site of action. A series of controlled, randomised, single-blind, phase-III clinical trials including a total of 463 patients has indicated that: (1) tetracycline fibres result in significantly better outcomes than the scaling and root planing positive control; (2) combination of tetracycline fibres with subgingival mechanical debridement results in significant improvement over debridement alone. Evidence from these studies has led to approval of this treatment modality by the US Food and Drug Administration and by the European Union Regulatory Bodies. A clinical usage study involving 2711 subjects treated by 68 clinicians in Europe and North America indicated that the magnitude of the observed clinical outcomes is clinically relevant and that adverse events were rarely observed. A variety of clinical investigations aimed at the optimal incorporation of tetracycline fibres in a treatment strategy provide guidance in case selection. Cost of therapy and concerns of unnecessary usage of antibiotics should be considered. It is nonetheless concluded that combination of tetracycline fibres with mechanical debridement represents a documented treatment alternative, the application of which may offer clinical benefits to many patients.

Topics: Administration, Topical; Anti-Bacterial Agents; Clinical Trials as Topic; Drug Delivery Systems; Humans; Periodontitis; Tetracycline; Treatment Outcome

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

The high incidence of allergic reactions to some common dental antibiotics, primarily topical penicillins, has led to general concerns about all topical antibiotics. The development of resistant bacterial strains and efforts to reserve key antibiotics for life-threatening infections have also limited topical use of antibiotics. Delivery technologies providing for site-specific drug delivery have renewed interest in the use of topical antimicrobials to treat adult periodontitis. Topical tetracycline has an extremely low sensitizing potential and is not one of the antibiotics reserved by the medical community for use in life-threatening situations. Despite tetracycline's widespread dermatologic use and increasing use in adjunctive treatment of adult periodontitis, the incidence of allergic response to topical tetracycline is very low. Also, it is unlikely to cause resistance when used locally for short durations--particularly at the high per-site concentrations achieved with tetracycline periodontal fiber. Studies with tetracycline fiber showed no significant change in the tetracycline susceptibility of gram-negative periodontal microorganisms.

Topics: Administration, Topical; Adult; Anti-Bacterial Agents; Drug Hypersensitivity; Gram-Negative Bacteria; Humans; Periodontitis; Tetracycline; Tetracycline Resistance

The main goal in the treatment of periodontitis is to control the subgingival infection. Systemic periodontal antibiotic therapy aims to reinforce mechanical debridement procedures and to support the host defense system in overcoming the infection that remains after conventional mechanical treatment. In particular, patients with early onset periodontitis and patients with refractory periodontitis may benefit from systemic antimicrobial therapy. Outside clinical parameters, the use of microbiologic information can assist in selecting the most optimal antibiotic regimen based on the presence and levels of selected periodontal pathogens.

Topics: Administration, Oral; Amoxicillin; Anti-Bacterial Agents; Drug Therapy, Combination; Humans; Metronidazole; Patient Care Planning; Periodontitis; Tetracycline

Refractory periodontitis appears to be a patient phenomenon with a clinical pattern that may be the result of different influences including genetic factors and exogenous factors that alter the host response to the bacterial challenge. Different patients may have different mechanisms involved in their disease and therefore may show different response patterns following therapy. Although localized non-responsive sites in otherwise responsive patients should not be considered refractory periodontitis, such sites do present substantial therapeutic problems. Initial evidence suggests that local delivery tetracycline provides significant advantages in the management of such sites. Although refractory periodontitis cases appear to be primarily the result of host alterations, the most predictable approach to therapy at present involves systemic antibiotics in conjunction with local therapy. The goal of antibiotic therapy should be to eliminate from detection the target bacteria that were present prior to therapy. Good plaque control, regular professional maintenance therapy, regular microbial monitoring, and control of risk factors are important aspects of the long term maintenance of these cases.

Topics: Anti-Bacterial Agents; Bacteria; Dental Plaque; Disease Susceptibility; Drug Delivery Systems; Humans; Periodontitis; Risk Factors; Tetracycline

The microbial flora in the natural dentition sulcus/pocket and the implant crevice/pocket is very similar in both health and disease. In health, coccal forms predominate, and in disease, large numbers of Gram-negative pathogens are associated with both tooth and implant. It has also been demonstrated that the bacteria in the partially edentulous implant case may be more pathogenic (especially Gram-negative rods and spirochetes) than in the fully edentulous case, indicating a possible seeding mechanism from tooth pocket to implant crevice. Detoxification procedures involving the use of tetracycline and citric acid prior to regenerative procedures with the use of barrier membranes and grafting materials are necessary, and the same problems attendant to premature exposure of the barrier membrane(s) in the natural dentition situation apply to the implant case. It is apparent that periodontitis = peri-implantitis in etiology and therapy.

Topics: Anti-Bacterial Agents; Bacteria; Chelating Agents; Citric Acid; Dental Implants; Gingiva; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Guided Tissue Regeneration, Periodontal; Humans; Jaw, Edentulous, Partially; Membranes, Artificial; Mouth, Edentulous; Periodontal Pocket; Periodontitis; Spirochaetales; Tetracycline; Tooth; Virulence

The recognition of the microbial origin and the specificity of periodontal infections has resulted in the development of several adjunctive therapies (antibiotics and/or antiseptics) to scaling and root planing in the treatment of chronic adult periodontitis. This article aims to review the "additional" effect of a subgingival irrigation with chlorhexidine, or a local or systemic application of tetracycline or metronidazole, performed in combination with a single course of scaling and root planing in patients with chronic adult periodontitis. All treatment modalities are compared with scaling and root planing, based on their impact on: the probing depth (PD); total number of colony forming units per ml (CFU/ml); the proportions and/or the detection-frequency of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia; and/or on the percentages of cocci, spirochetes, motile, and other micro-organisms on dark field microscopy examination. All treatment modalities, including scaling and root planing without additional chemical therapy, resulted in significant reductions in the probing depth and the proportions of periodontopathogens, at least during the first 8 weeks post-therapy. However in comparison to a single course of scaling and root planing, the supplementary effect of adjunctive therapies seems to be limited. In general, only the irrigation with chlorhexidine 2%, the local application of minocycline, and the systemic use of metronidazole (in case of large proportions of spirochetes) or doxycycline (in case of large proportions of A. actinomycetemcomitans) seem to result in a prolonged supplementary effect when compared to scaling and root planing. Therefore, the use of antibiotics on a routine basis, especially in a systemic way, in the treatment of chronic adult periodontitis, can no longer be advocated, considering the increasing danger for the development of microbial resistance.

Topics: Administration, Oral; Administration, Topical; Adult; Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Anti-Infective Agents, Local; Antitrichomonal Agents; Chemotherapy, Adjuvant; Chlorhexidine; Chronic Disease; Colony Count, Microbial; Dental Scaling; Gels; Humans; Metronidazole; Periodontitis; Porphyromonas gingivalis; Prevotella intermedia; Root Planing; Spirochaetales; Tetracycline; Therapeutic Irrigation

Topics: Anti-Bacterial Agents; Drug Carriers; Humans; Patient Selection; Periodontal Pocket; Periodontitis; Polyvinyls; Recurrence; Retreatment; Tetracycline

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

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

This article addresses the use of tetracycline-impregnated fibers in the treatment of periodontal diseases. Clinical and microbiologic data are reviewed to provide pragmatic guidelines for fiber use. In addition, controversial issues associated with the labeling of Actisite, the potential of developing antibiotic-resistant strains, and the benefits of systemic vs local drug delivery are discussed. Ultimately, the article concludes that tetracycline-impregnated fibers can be used as an adjunct to scaling and root planing in certain patients at sites that do not respond to conventional therapy.

Topics: Aggregatibacter actinomycetemcomitans; Drug Delivery Systems; Evaluation Studies as Topic; Humans; Periodontal Diseases; Periodontal Pocket; Periodontitis; Tetracycline; Tetracycline Resistance; Tetracyclines; Time Factors

Topics: Administration, Topical; Adolescent; Adult; Anti-Infective Agents, Local; Child; Gels; Humans; Metronidazole; Mouthwashes; Periodontitis; Tetracycline

Tetracyclines have recently been shown to inhibit the activity of some but not all mammalian matrix metalloproteinases believed to mediate periodontal destruction. However, the specificity of this effect, which could have significant therapeutic implications for different periodontal diseases, has not been examined in detail. Doxycycline and 4-de-dimethylaminotetracycline (CMT-1) have been tested in vitro for their ability to inhibit human neutrophil and fibroblast interstitial collagenases and collagenase in human gingival crevicular fluid (GCF). The GCF samples were obtained from systemically healthy and insulin-dependent diabetic adult periodontitis patients and from localized juvenile periodontitis (LJP) patients. The concentrations of these 2 tetracyclines required to inhibit 50% of the collagenase activity (IC50) were found to be 15 to 30 microM for human neutrophil collagenase and for collagenase in GCF of systemically healthy and diabetic adult periodontitis patients. These concentrations approximate the tetracycline levels observed in vivo during treatment with these drugs. In contrast, human fibroblast collagenase and GCF collagenase from LJP patients were both relatively resistant to tetracycline inhibition; the IC50 for doxycycline and CMT-1 for these 2 sources of collagenase were 280 and 500 microM, respectively. Based on these and other findings, we propose the following: 1) that systemic levels of tetracycline may inhibit connective tissue breakdown by inhibiting neutrophil collagenase; 2) that tetracyclines do not inhibit fibroblast-type collagenase, which may help explain their lack of effect on normal connective tissue remodeling; 3) that tetracycline inhibition of collagenases may serve to identify the cellular origin of the enzyme; and 4) that tetracyclines can also prevent the oxidative activation of latent human procollagenases.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Collagenases; Doxycycline; Fibroblasts; Gingival Crevicular Fluid; Humans; Inflammation; Matrix Metalloproteinase Inhibitors; Neutrophils; Periodontal Diseases; Periodontitis; Tetracycline; Tetracyclines

Topics: Anti-Bacterial Agents; Benzoates; Clinical Trials as Topic; Dental Research; Meta-Analysis as Topic; Mouthwashes; Outcome Assessment, Health Care; Periodontal Diseases; Periodontitis; Research Design; Sodium Dodecyl Sulfate; Tetracycline

Topics: Animals; Cell Adhesion; Citric Acid; Humans; Periodontitis; Periodontium; Surface Properties; Tetracycline; Tooth Demineralization; Tooth Root; Wound Healing

Topics: Administration, Topical; Delayed-Action Preparations; Drug Delivery Systems; Epithelium; Humans; Periodontal Pocket; Periodontitis; Tetracycline; Tooth Root

The use of systemic tetracycline in the treatment of periodontal disease has been controversial. To investigate this controversy, we performed a quality assessment and attempted to perform a meta-analysis of 13 published studies. We evaluated the quality of the study protocol and data analysis and presentation for each study. We were unable to combine data from the majority of studies due to heterogeneity of the outcomes evaluated and limitations in data reported in the individual studies. Therefore, only 2 studies were included in the quantitative meta-analysis. On a scale of 0-1, the mean score for this group of studies was 0.27 (+/- 0.19) for study protocol and 0.31 (+/- 0.11) for data analysis and presentation. Mean reduction in probing depth for the group treated with tetracycline plus scaling was 2.45 mm; for the group which received only scaling, 2.02 mm; for the group that received only tetracycline, 1.98 mm; and for the control group, 0.65 mm. We conclude that analysis of data from the published literature does not demonstrate that the use of systemic tetracycline is more beneficial than conventional treatment in the management of adult periodontal disease. More information is needed in order to perform an extensive meta-analysis of this subject.

Topics: Adult; Chronic Disease; Clinical Protocols; Data Interpretation, Statistical; Dental Scaling; Humans; Meta-Analysis as Topic; Periodontal Pocket; Periodontitis; Research Design; Tetracycline; Treatment Outcome

Periodontal diseases are common oral diseases that afflict all humans to some degree. The major aetiological agent is dental plaque--the complex microflora which forms on teeth in the absence of effective oral hygiene. The interaction of the microbial flora and the periodontal tissues produces an inflammatory response and tissue breakdown. Recent information has categorized periodontal diseases on the basis of increased knowledge about the particular microorganisms associated with the different clinical conditions. In addition, the important role of host defences, in particular the phagocytic cellular elements, has allowed for a better understanding of the pathological processes. This knowledge is contributing towards the development of rational and effective therapy for all forms of periodontal diseases. Because of the widespread occurrence of periodontal diseases and their potential relationships to systemic conditions, it is important that medical practitioners should be able to recognize, and be conversant with methods of treatment of, these diseases.

Topics: Acute Disease; Adult; Child; Chronic Disease; Dental Plaque; Gingivitis; Gingivitis, Necrotizing Ulcerative; Humans; Metronidazole; Oral Hygiene; Periodontal Diseases; Periodontal Pocket; Periodontitis; Periodontium; Stomatitis, Herpetic; Tetracycline

Topics: Aggressive Periodontitis; Anti-Bacterial Agents; Chlorhexidine; Gingivitis; Gingivitis, Necrotizing Ulcerative; Humans; Periodontal Diseases; Periodontitis; Periodontium; Tetracycline

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Humans; Periodontitis; Tetracycline

Topics: Adolescent; Adult; Bone Resorption; Child; Humans; Malocclusion; Medical History Taking; Models, Dental; Molar; Orthodontic Appliances; Orthodontics, Corrective; Patient Care Planning; Periodontal Prosthesis; Periodontitis; Periodontium; Prognosis; Radiography, Dental; Tetracycline; Tooth Movement Techniques

To evaluate the influence of tetracycline gel, brushed on tooth surfaces, on periodontal clinical parameters following root debridement.. 20 subjects diagnosed with chronic periodontitis and presenting a minimum of two proximal sites on anterior teeth (maxillary or mandibular) with probing depth +/- 5 mm, were selected. Following oral hygiene instructions and ultrasonic supragingival instrumentation, subjects were assigned to one of the following groups: RDS--root debridement with Gracey curettes and root brushing with saline solution; and RDT--root debridement with Gracey curettes and root brushing with 40% tetracycline gel. Full-thickness flaps were reflected and instrumentation was performed using a clinical microscope to optimize calculus detection. Probing depth (PD), relative gingival margin level (RGML) and relative attachment level (RAL) measures were registered at five visits: baseline and days 30, 60, 90 and 120 postoperative.. Both approaches were able to markedly reduce the PD values from baseline in all periods (P < 0.0001). No differences were found for RAL values in any of the groups. No differences were found between groups. In conclusion, the application of tetracycline gel does not seem to provide any additional improvement on clinical periodontal parameters after root debridement.

Topics: Administration, Topical; Adult; Anti-Bacterial Agents; Combined Modality Therapy; Dental Scaling; Female; Follow-Up Studies; Gels; Gingival Recession; Humans; Male; Middle Aged; Oral Hygiene; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Root Planing; Subgingival Curettage; Surgical Flaps; Tetracycline; Tooth Root; Ultrasonic Therapy

To evaluate the effect of mechanical periodontal treatment combined with tetracycline on periodontal attachment, distances of cementum-enamel junction (CEJ) to the bone defect bottom and to the alveolar crest, and avidity of serum IgG against Porphyromonas gingivalis (Pg) lipopolysaccharide (LPS) in patients with aggressive periodontitis.. Twenty-six patients with aggressive periodontitis were divided equally into two groups to receive mechanical periodontal treatment combined with tetracycline or exclusive mechanical periodontal treatment, with another 20 periodontally healthy subjects serving as the control group. In the two patient groups, routine clinical examination of the subjects was performed to record periodontal attachment level and distances of CEJ to the bottom of the bone defects and to the alveolar crest before and 3 and 6 months after the treatment. The avidity of serum IgG against Pg LPS was measured by ELISA with thiocyanate elution before and after periodontal treatment.. Compared with patients with exclusive mechanical periodontal treatment, patients with combined treatments showed significant improvement in periodontal attachment level and the distance of CEJ to the bone defect bottom after the treatment (P<0.01 and P<0.05, respectively) with also significantly reduced avidity of serum IgG against Pg LPS (P<0.01).. Mechanical periodontal treatment combined with tetracycline produces favorable effects in patients with aggressive periodontitis.

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Combined Modality Therapy; Female; Humans; Immunoglobulin G; Lipopolysaccharides; Male; Periodontitis; Porphyromonas gingivalis; Tetracycline

The purpose of this split-mouth study was to evaluate the clinical response of enamel matrix proteins (EMPs, Emdogain Gel in intra-osseous defects with or without a combined application of a tetracycline-coated expanded polytetrafluoroethylene barrier membrane (e-PTFE, Gore-Tex).. Twelve pairs of intra-osseous periodontal defects in 11 patients received the application of EMPs on the exposed root surface (EMP). One of the two defects received randomly, as an adjunct to EMP treatment, a tetracycline-coated e-PTFE membrane (MEMP). At baseline, 6- and 12-month probing pocket depth (PPD), clinical attachment level (CAL) and probing bone level (PBL) were measured.. After 12 months, the EMP defects showed a significant mean PPD reduction of 2.86+/-0.75 mm, a mean gain in CAL of 1.28+/-2.04 mm, a mean PBL gain of 1.63+/-1.21 mm and a mean increase of recession (REC) of 1.56+/-2.30 mm. The MEMP defects showed a significant mean PPD reduction of 3.02+/-1.55 mm, a mean gain in CAL of 1.65+/-1.29 mm, a mean PBL gain of 1.58+/-1.92 mm and a mean increase of REC of 1.38+/-1.63 mm. Except for significantly more post-operative discomfort at the MEMP sites, no significant differences were found between EMP and MEMP defects.. Within the limits of this study, it is concluded that in the treatment of intra-osseous defects with EMP, the adjunctive use of a tetracycline-coated e-PTFE membrane failed to show more gain of CAL and PBL.

Topics: Adolescent; Adult; Alveolar Bone Loss; Analysis of Variance; Anti-Infective Agents, Local; Bone Regeneration; Dental Enamel Proteins; Female; Guided Tissue Regeneration, Periodontal; Humans; Male; Membranes, Artificial; Middle Aged; Oral Surgical Procedures; Periodontitis; Polytetrafluoroethylene; Single-Blind Method; Statistics, Nonparametric; Tetracycline; Treatment Outcome

The aim of our study was to evaluate the clinical, radiological and microbiological response to the local delivery of tetracycline (TE) of sites with persistent periodontal lesions.. The study was conducted in a split-mouth design. Nineteen patients with at least four bilateral pockets 4-5 mm and bleeding on probing (BOP) were treated with scaling and root planing (SRP) plus TE fibres (test sites) or with SRP alone (control sites). Clinical and radiological measurements were taken at baseline, 6 months and 12 months post-operatively. Subgingival plaque samples were collected at baseline, at fibres removal, 6 and 12 months following treatment and analysed by polymerase chain reaction.. Both treatments yielded a statistically significant (p<0.05) reduction of probing depth (2.05 and 1.21 mm), gain of clinical attachment level (1.71 and 0.53 mm) and reduction of BOP scores (23.68% and 57.89%) for TE and SRP groups, respectively, when comparing 12-month data with baseline. The differences between two groups were significant. The prevalence of Treponema denticola and Bacteroides forsythus decreased after therapy in both groups but only in the test sites Actinobacillus actinomycetemcomitans and Prevotella intermedia were not yield detected. The pathogens could be eliminated from five periodontal pockets by SRP alone, while 21 TE sites were not recolonized at 12 months.. SRP plus TE fibres gave the greatest advantage in the treatment of periodontal persistent lesions at least 12 months following treatment.

Topics: Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Bacteroides; Cellulose; Dental Plaque; Dental Scaling; Drug Delivery Systems; Female; Follow-Up Studies; Gingival Hemorrhage; Humans; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Prevotella intermedia; Root Planing; Tetracycline; Treponema

Tetracyclines have been extensively used as adjunctives to conventional periodontal therapy. Emergence of resistant strains, however, has been reported. This study evaluated longitudinally the tetracycline resistance patterns of the subgingival microbiota of periodontitis subjects treated with systemic or local tetracycline therapy+scaling and root planing (SRP).. Thirty chronic periodontitis patients were randomly assigned to three groups: SRP+500 mg of systemic tetracycline twice/day for 14 days; SRP alone and SRP+tetracycline fibers (Actsite) at four selected sites for 10 days. Subgingival plaque samples were obtained from four sites with probing pocket depths (PPD)> or =6 mm in each patient at baseline, 1 week, 3, 6 and 12 months post-therapy. Samples were dispersed and diluted in pre-reduced anaerobically sterilized Ringer's solution, plated on Trypticase Soy Agar (TSA)+5% blood with or without 4 microg/ml of tetracycline and incubated anaerobically for 10 days. The percentage of resistant microorganisms were determined and the isolates identified by DNA probes and the checkerboard method. Significance of differences among and within groups over time was sought using the Kruskal-Wallis and Friedman tests, respectively.. The percentage of resistant microorganisms increased significantly at 1 week in the tetracycline groups, but dropped to baseline levels over time. The SRP+Actsite group presented the lowest proportions of resistant species at 6 and 12 months. No significant changes were observed in the SRP group. The predominant tetracycline-resistant species included Streptococcus spp., Veillonela parvula, Peptostreptococcus micros, Prevotella intermedia, Gemella morbillorum and Actinobacillus actinomycetemcomitans (Aa). A high percentage of sites with resistant Aa, Porphyromonas gingivalis and Tanerella forsythensis was observed in all groups at baseline. However, T. forsythensis was not detected in any group and P. gingivalis was not present in the SRP+Actsite group at 1 year post-therapy. Aa was still frequently detected in all groups after therapy. However, the greatest reduction was observed in the SRP+Actsite group.. Local or systemically administered tetracycline results in transitory selection of subgingival species intrinsically resistant to this drug. Although the percentage of sites harboring periodontal pathogens resistant to tetracycline were quite elevated in this population, both therapies were effective in reducing their prevalence over time.

Topics: Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Bacteroides; Cellulose; Dental Plaque; Dental Scaling; Drug Delivery Systems; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Middle Aged; Peptostreptococcus; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Prevotella intermedia; Root Planing; Streptococcus; Tetracycline; Tetracycline Resistance; Veillonella

Conventional mechanical periodontal treatment of Papillon-Lefevre syndrome (PLS) has often been reported to fail. This study describes the outcome of a non-surgical periodontal therapy including antimicrobial treatment of nine patients diagnosed with PLS. The patients originate from a total of 15 children and adolescents with PLS for which clinical characteristics are presented.. Clinical examination including conventional periodontal measurements. Initial treatment including oral hygiene instruction, scaling and root planing and systemic amoxicillin-metronidazole therapy for 6 weeks. After that the patients were enrolled in a 3-month recall maintenance program. In addition to this mechanical supportive maintenance treatment, tetracycline was prescribed and used continuously for 1.5 years.. On five patients who were showing acceptable standard of oral hygiene and also compliance with the antibiotic medication, development of periodontitis on erupting teeth was prevented and disease activity on the previously periodontally involved teeth controlled during a 3-year period. Poor results of treatment were observed for three patients, all siblings. These patients failed to comply with the medication and also failed to improve their oral hygiene.

Topics: Adolescent; Amoxicillin; Anti-Bacterial Agents; Child; Dental Care for Chronically Ill; Dental Scaling; Humans; Male; Metronidazole; Papillon-Lefevre Disease; Patient Compliance; Periodontitis; Tetracycline; Treatment Outcome

The purpose of the present study was to evaluate the effects of tetracycline fibres (TCF) as an adjunct to scaling in the treatment of generalised aggressive periodontitis and to compare the effects with mechanical treatment only. Ten patients, 24-39 years old referred for treatment to the Department of Preventive Dentistry, Periodontology and Implant Biology, Aristotle University of Thessaloniki took part in the study. A split-mouth experimental design was used. Measurements referring to bleeding on probing (BOP), pocket depth (PD) and clinical attachment level (CAL) were performed at 12 sites randomly selected. Clinical recordings were made at baseline, 2 and 6 months, after treatment. Subgingival plaque samples were taken for microbiological analysis using the 'checkerboard' DNA-DNA hybridisation technique at baseline, immediately after treatment and at 2 and 6 months. Full-mouth scaling and root planing were performed, with the exception of 2 pre-selected sites, which served as controls. Tetracycline fibres were applied in 5 pockets located in the same half mouth. Analysis of clinical findings showed that mechanical instrumentation in combination with TCF application led to a greater improvement in clinical parameters than scaling and root planing only. Microbial analysis showed a statistically significant greater reduction in the percentages of detection for B. forsythus, P. nigrescens and A. naeslundii genospecies II in pockets where tetracycline fibres were applied. In conclusion, the clinical and microbiological data of the present study suggest that the adjunctive use of TCF improves the clinical response of scaling and root planing in aggressive periodontitis patients.

Topics: Actinomyces; Adult; Analysis of Variance; Anti-Bacterial Agents; Bacteroides; Cellulose; Chi-Square Distribution; Colony Count, Microbial; Dental Scaling; Drug Delivery Systems; Follow-Up Studies; Humans; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Periodontitis; Prevotella; Root Planing; Tetracycline

Several antibacterial agents have been studied as a means to produce bactericidal or bacteriostatic activity as an adjunct to mechanical treatment of periodontal disease. The primary purpose of this study was to evaluate the efficacy of tetracycline strips administered singly or in multiples in conjunction with root planing, versus root planing alone, or to an untreated control. Secondary purposes were to compare gingival crevicular fluid (GCF) volume and GCF concentrations of tetracycline in pockets treated with strips; to evaluate strip insertion time; and to compare ease of placement for single or multiple strips.. Using a 4-quadrant design, 4 test teeth in 24 patients were treated with either root planing and single strip application; root planing and multiple strip application; root planing alone; or an untreated control.. Single and multiple strip placement resulted in a significant reduction in probing depth (P = 0.033) compared to root planing and untreated groups. The multiple strip group significantly decreased bleeding on probing (P = 0.05) compared to all other treatment groups. There was no treatment effect on GCF; however, there was a significant reduction in the GCF volume over time (P = 0.001). The time required for placement was, on average, 1.9 minutes for single strips and 3.25 minutes for multiple strips.. Our data suggest that multiple strips are superior to a single strip in reducing bleeding on probing, and that local delivery of tetracycline is superior to root planing alone in reducing probing depth.

Topics: Adult; Aged; Analysis of Variance; Anti-Bacterial Agents; Delayed-Action Preparations; Dental Plaque Index; Dental Scaling; Drug Carriers; Drug Delivery Systems; Female; Follow-Up Studies; Gingival Crevicular Fluid; Gingival Hemorrhage; Humans; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Periodontitis; Polymers; Root Planing; Single-Blind Method; Statistics as Topic; Tetracycline; Time Factors; Treatment Outcome

Class II furcations present difficult treatment problems and historically several treatment approaches to obtain furcation fill have been used.. The response of mandibular Class II facial furcations to treatment with either bioactive glass (PG) bone replacement graft material or expanded polytetrafluoroethylene (ePTFE) barrier membrane was evaluated in 27 pairs of mandibular molars in 27 patients with moderate to advanced periodontitis. Following initial preparation, full thickness flaps were raised in the area being treated, the bone and furcation defects debrided of granulomatous tissue, and the involved root surfaces mechanically prepared and chemically conditioned. By random allocation, PG or ePTFE was placed into or fitted over the furcations, packed or secured in place, and the host flap replaced or coronally positioned with sutures. Postsurgical deplaquing was performed every 10 days leading up to ePTFE removal at about 6 weeks. Continuing periodontal maintenance therapy was provided until surgical reentry at 6 months for documentation and any further necessary treatment.. Direct clinical measurements demonstrated essentially similar clinical results with both treatments for bone and soft tissue changes. There were no statistically or clinically significant differences (e.g., mean horizontal furcation fill 1.4 mm PG, 1.3 mm ePTFE; mean percent horizontal furcation fill 31.6% PG, 31.1% ePTFE, both P>0.85). Seventeen of the PG treated and 18 of the ePTFE furcations became Class I clinically and 1 furcation completely closed clinically with each treatment. Intrapatient comparisons showed similar horizontal furcation responses with both treatments.. The findings of this study suggest essentially equal clinical results with PG bone replacement graft material and e-PTFE barriers in mandibular molar Class II furcations. PG use was associated with simpler application and required no additional material removal procedures.

Topics: Adult; Aged; Analysis of Variance; Anti-Bacterial Agents; Bone Substitutes; Ceramics; Debridement; Dental Plaque; Female; Follow-Up Studies; Furcation Defects; Gingival Recession; Humans; Male; Mandible; Membranes, Artificial; Middle Aged; Molar; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Polytetrafluoroethylene; Statistics, Nonparametric; Surgical Flaps; Tetracycline; Tooth Root; Treatment Outcome

Although the use of systemic antibiotics has been studied in patients with generalized aggressive periodontitis (formerly rapidly progressive periodontitis), the use of adjunctive tetracycline fibers in these patients has not been reported. The purpose of the present study was to compare the clinical response of local versus systemic antibiotic treatment as adjuncts to scaling and root planing in patients with GAgP.. After initial therapy and full-mouth scaling and root planing (SRP), 30 patients were randomly assigned to 1 of 2 antibiotic treatment groups. Probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded with an automated probe prior to SRP at baseline (BL) and 15, 30, 41, and 54 weeks later. Three months after SRP, the patients were treated with amoxicillin/clavulanic acid (500 mg tid; SRP + AUG group) or with local tetracycline fiber in pockets with PD > or =5 mm (SRP + TCF group).. In both treatment groups, PD decreased significantly from BL to week 54 (6.2+/-1.5 mm to 4.7+/-1.4 mm for SRP + TCF and 6.5+/-1.4 mm to 4.2+/-0.6 mm for SRP + AUG). However, there was no statistically significant difference between the 2 groups in pocket reduction. Similarly, in both treatment groups, there were small but significant gains in CAL from BL to week 54 (12.0+/-1.8 mm to 11.3+/-1.8 mm for SRP + TCF and 12.3+/-1.5 mm to 11.2+/-1.2 mm for SRP + AUG). The difference in CAL gain between the 2 groups was not statistically significant. At the final examination, both groups showed significant PD reduction and CAL gain (P <0.001) compared to BL. The frequency and percentage of bleeding sites decreased significantly in both groups. At week 54, this decrease was significantly greater in the SRP + AUG group (31.67% for SRP + TCF versus 3.85% for SRP + AUG).. These results indicate that the local delivery of tetracycline by a fiber or the systemic administration of amoxicillin/clavulanic acid given 3 months after scaling and root planing produced similar clinical outcomes over the 9-month observation period.

Topics: Administration, Oral; Administration, Topical; Adult; Aggressive Periodontitis; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Dental Scaling; Drug Therapy, Combination; Humans; Periodontal Index; Periodontitis; Statistics, Nonparametric; Tetracycline

Whether adjunctive tetracycline fibers can provide an additive effect to scaling and root planing in treating non-responsive sites in maintenance subjects is still controversial. Recolonization of the bacteria from untreated sites or from the extracrevicular region may explain the insignificant response to local therapy. The purpose of the present study was to evaluate the microbiological response of sites treated with tetracycline fibers combined with scaling and root planing.. The study was conducted in a split-mouth design. Thirty patients on maintenance therapy having at least 2 non-adjacent sites in separate quadrants with probing depths between 4 to 8 mm with bleeding on probing, or aspartate aminotransferase enzyme levels > 800 microIU in the gingival crevicular fluid, were treated with scaling and root planing plus tetracycline fibers or with scaling and root planing only. Subgingival plaque samples were collected at baseline, and 1, 3, and 6 months following treatment. A. actino-mycetemcomitans, C. rectus, B. forsythus, E. corrodens, F. nucleatum, P. gingivalis, and P. intermedia were detected by culture, immunofluorescence, or PCR technique.. There was a reduction of total bacterial cell count, as well as of certain periodontal pathogens, following treatment. The prevalence of A. actinomycetemcomitans, B. forsythus, and P. gingivalis and the mean proportions of C. rectus, P. intermedia, F. nucleatum, and P. gingivalis decreased after therapy, but there was no statistically significant difference between the 2 treatment groups with respect to bacterial proportions or the number of positive sites. Besides, the pathogens could not be eliminated from the periodontal pocket, and recolonization of the pocket was noted at 3 months post-treatment.. Bacteria located within the cheek, tongue mucosa, saliva, or untreated sites may contribute to reinfection of the pockets and explain the insignificant response to local tetracycline therapy.

Topics: Adult; Aggregatibacter actinomycetemcomitans; Analysis of Variance; Anti-Bacterial Agents; Bacteria, Anaerobic; Bacteroides; Campylobacter; Colony Count, Microbial; Dental Plaque; Eikenella corrodens; Female; Fusobacterium nucleatum; Humans; Male; Microbial Sensitivity Tests; Multivariate Analysis; Periodontitis; Porphyromonas gingivalis; Prevotella intermedia; Secondary Prevention; Tetracycline

Scanning electron microscopy (SEM) was used to evaluate root surface characteristics of human teeth affected with periodontitis following periodontal instrumentation and topical application of tetracycline HCl (TTC-HCl; pH 1.6; 4 min). Specimens were randomly assigned to periodontal instrumentation alone (control 1); periodontal instrumentation plus TTC-HCl (test 1); periodontal instrumentation plus trypsin solution after extraction (control 2); and periodontal instrumentation plus TTC-HCl plus trypsin solution after extraction (test 2). Tetracycline solution was applied with a cotton pellet. Twenty-two single root periodontitis affected human teeth scheduled for extraction were selected. Mucoperiosteal flaps were raised, root surfaces were mechanically and chemically treated, flaps were repositioned and maintained in place for 20 min. Teeth were extracted, rinsed and placed in cold phosphate buffer solution (PBS) and control 2 and test 2 groups were treated with trypsin solution. Specimens were examined using SEM. Smear layer was successfully removed, exposing dentinal tubules; however, fibrin network formation in situ was not improved by application of TTC-HCl.

Topics: Anti-Bacterial Agents; Blood Coagulation; Fibrin; Humans; Periodontitis; Smear Layer; Tetracycline

The purpose of this study was to compare the clinical efficacy of scaling and root planing alone versus tetracycline fiber therapy used adjunctively with scaling and root planing in the treatment of nonresponsive active periodontitis in patients under supportive periodontal therapy. Thirty patients who were receiving supportive treatment and had at least two nonadjacent periodontitis sites with a probing depth of between 4 and 8 mm and bleeding on probing, or had aspartate aminotransferase (AST) levels above 800 microIU in the gingival crevicular fluid in separate quadrants participated in this study. For each patient, the test sites were treated with scaling and root planing plus tetracycline fibers while the control site was treated with scaling and root planing only. Probing depths, clinical attachment levels, gingival recession, AST levels, and bleeding on probing were recorded and subgingival plaque samples were collected at baseline and 1, 3, and 6 months following treatment. At 3 months after treatment, there was a reduction of bleeding on probing and probing depth, and a gain of clinical attachment in both test and control sites. The mean reduction in probing depth of the test sites was 1.38 mm and the attachment gain was 0.8 mm after 6 months. The clinical response obtained at 3 months following therapy was maintained throughout the 6-month follow-up period. However, there were no statistically significant differences between sites treated with scaling and root planing alone and those treated with combined tetracycline therapy. Most of the reductions of probing depths in the fiber group were attributed to gingival recession. The present study did not confirm the efficacy of adjunctive tetracycline fibers in treating nonresponsive sites in maintenance subjects with regard to probing depth reduction or clinical attachment gain. Reinfection of the pockets from untreated sites and extra-crevicular regions may explain the insignificant response to local tetracycline therapy.

Topics: Adult; Anti-Bacterial Agents; Dental Scaling; Female; Humans; Male; Multivariate Analysis; Periodontal Dressings; Periodontitis; Tetracycline

The present study was performed to assess and compare the clinical healing and the microbiological findings following local application of metronidazole or tetracycline to augment subgingival scaling in previously untreated adult periodontitis sites. Eighteen patients with moderate to severe adult periodontitis at single-rooted teeth were selected. In each patient, 3 interproximal sites having comparable root anatomy, probing depth > or =5 mm and bleeding on probing were randomly assigned to 1 of 3 treatment groups: 1) two sessions of subgingival scaling and root planing; 2) similar to 1, with each treatment supplemented with a 25% metronidazole sustained release gel; 3) similar to 1 with each treatment supplemented with a 3% tetracycline ointment. The treatments were performed by 1 operator and the clinical variables probing depth, attachment level, and bleeding on probing were evaluated at baseline, 3 months and 6 months by a second blinded examiner. The microbiological findings were evaluated using a commercial test kit. The average probing depth reduction for the 3 groups at 6 months was 1.5 mm and the average gain of clinical attachment was 0.8 mm. There were no significant differences between the effects following topical application of the metronidazole gel or the tetracycline ointment. Scaling and root planing alone appeared as effective as the drug augmented regimens, although there was a weak but non-significant tendency for better results in sites treated with the antibiotic drugs. Actinobacillus actinomycetemcomitans was generally not detected; Prevotella intermedia was not significantly reduced, while Porphyromonas gingivalis was significantly reduced in all treatment groups. It was concluded that the augmentative effect of the metronidazole gel and the tetracycline ointment was comparable but small compared to scaling and root planing alone. The clinical importance of such small augmentation effects should be further evaluated.

Topics: Administration, Topical; Adult; Aged; Aggregatibacter actinomycetemcomitans; Analysis of Variance; Anti-Bacterial Agents; Antitrichomonal Agents; Chemotherapy, Adjuvant; Dental Scaling; Double-Blind Method; Gels; Humans; Metronidazole; Middle Aged; Ointments; Outcome Assessment, Health Care; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Prevotella intermedia; Root Planing; Statistics, Nonparametric; Tetracycline

The aim of this randomized single-blind multicenter controlled clinical trial was to clinically evaluate the effectiveness of adjunctive local controlled drug delivery in the control of bleeding on probing in mandibular class II furcations during maintenance care. 127 patients presenting with a class II mandibular furcation with bleeding on probing were included in the study. They had been previously treated for periodontitis and were participating in supportive care programs in periodontal specialty practices. Treatments consisted of scaling and root planing with oral hygiene instructions (control) and scaling and root planing and oral hygiene combined with local controlled drug delivery with tetracycline fibers (test). The following outcomes were evaluated at baseline and 3 and 6 months after therapy at the furcation site: bleeding on controlled force probing (BOP), probing pocket depth (PD) and clinical attachment levels (CAL). Levels of oral hygiene and smoking status were also assessed. Both test and controls resulted in significant improvements of BOP and PD at 3 and 6 months. The test treatment, however, resulted in significantly better improvements: BOP decreased by 52% in the control group and by 70% in the test group at 3 months; at 6 months, however, the difference was no longer significant. The test treatment resulted in a 0.5 mm greater reduction of PD than the control at 3 months, the improvement was highly significant but its duration did not extend until the 6 months evaluation. No differences were observed in terms of changes in CAL. These data indicate that addition of tetracycline fibers to mechanical therapy alone resulted in improved control of periodontal parameters during periodontal maintenance of class II mandibular furcations. Short duration of the effect, however, requires further investigations to optimize conservative treatment of these challenging defects.

Topics: Adult; Anti-Bacterial Agents; Combined Modality Therapy; Dental Scaling; Drug Implants; Female; Follow-Up Studies; Furcation Defects; Gingival Hemorrhage; Humans; Male; Mandible; Middle Aged; Oral Hygiene; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Root Planing; Single-Blind Method; Smoking; Tetracycline; Treatment Outcome

The purpose of this study was to evaluate the safety and clinical efficacy of controlled-release tetracycline-containing fibers in patients with refractory periodontitis versus the preceding classical treatment. One hundred twenty-one sites in 20 patients were followed from baseline to 6 months after fiber insertion. Each selected site was > or = 5 mm deep and bled on probing. All 20 patients had at least one site > or = 7 mm which bled on probing. Those pockets remained after intense and repeated conventional therapy (scaling and root planing and often surgery), often including the use of systemic antibiotics. This treatment period, the so-called control period, preceded the experimental period by at least 3 years, when the fibers were placed. Both treatments (in control and test period) were performed in the Department of Periodontology at the University Hospital in Leuven. At the start of the experimental period, all pockets > or = 5 mm were treated by the placement of fibers impregnated with 25% tetracycline. The fibers were removed after 10 days. Probing depth, clinical attachment level, gingival recession, and bleeding on probing were recorded at baseline, and at 1, 3, and 6 months following treatment. Analysis of data from all sites indicated that a significant decrease in probing depth and gain in attachment were present at all follow-up visits. The mean probing depth reduction for sites > or = 7 mm was 3.2 mm at month 6, with a gain in attachment of 2.7 mm, while this was -1.0 mm and -1.9 mm, respectively, during the preceding control period. The fraction of bleeding pockets was reduced from 77% to 27% and from 80% to 77% during the experimental and control periods, respectively. No significant adverse side-effects were observed, except for a transient redness at fiber removal in 2 sites. Fiber insertion appeared to be time-consuming even when the operator was familiarized with the procedure. The results of this study prove that tetracycline-impregnated fibers can reduce probing depth significantly for a period of 6 months in patients not responding to thorough and repeated classical periodontal treatment.

Topics: Administration, Topical; Adult; Aged; Anti-Bacterial Agents; Delayed-Action Preparations; Dental Scaling; Drug Carriers; Female; Follow-Up Studies; Gingival Hemorrhage; Gingival Recession; Humans; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Root Planing; Safety; Tetracycline

The purpose of this controlled case series was to assess the adjunctive efficacy of controlled topical tetracycline HCl application in the treatment of infection associated periimplant mucositis or mucosal hyperplasia. Eight patients with at least 2 endosseous implants showing clinical signs of periimplant mucosal hyperplasia or mucositis were enrolled. All implants received supra- and subgingival scaling, with half of the implants receiving adjunctive controlled local delivery of tetracycline HCl (test). Control implants did not receive any other therapy aside from scaling. Clinical parameters were assessed at baseline, 4, and 12 weeks. Scaling plus controlled local delivery of tetracycline HCl markedly reduced periimplant mucosal hyperplasia in 4 of 5 test implants and demonstrated a trend towards a reduction of bleeding on probing scores. Scaling alone had no effect on mucosal hyperplasia in the 2 control implants presenting with this condition nor bleeding on probing scores. In both groups, plaque index scores were slightly reduced at 4 weeks but returned to baseline values at 12 weeks, whereas pocket probing depths, clinical attachment levels, and probing bone levels remained unchanged during the course of the trial. The observed trends suggest that scaling plus controlled local delivery of tetracycline HCl may have beneficial effects. Randomized controlled trials employing a sample size high enough to reach sufficient statistical power are needed to definitively assess the efficacy of controlled local tetracycline HCl delivery on periimplant diseases.

Topics: Administration, Topical; Aged; Anti-Bacterial Agents; Combined Modality Therapy; Dental Implants; Dental Plaque Index; Dental Scaling; Evaluation Studies as Topic; Female; Humans; Hyperplasia; Male; Middle Aged; Mouth Mucosa; Periodontal Index; Periodontitis; Prosthesis-Related Infections; Tetracycline

This clinical study evaluated the reinfection incidence by Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and Prevotella intermedia (Pi) in periodontal pockets following scaling and root planing (SRP) and intra-pocket irrigation with antimicrobial agents in a patient population who did not receive supportive maintenance therapy. The number of target organisms was determined utilizing DNA probes. Forty-one (41) inflamed pockets > or = 5 mm with attachment loss and containing at least one target species were selected in 6 adult patients. Following a baseline clinical and bacterial examination, all patients received thorough SRP. In addition, 1 to 2 teeth in each patient were randomly assigned to each of the following 4 treatment modalities: 1) control group, no irrigation; 2) saline group, irrigation with 2 cc of 0.85% saline; 3) tetracycline group, irrigation with 2 cc of aqueous tetracycline HCl, 50 mg/ml (5%); and 4) chlorhexidine group, irrigation with 2 cc, respectively. All selected sites were non-adjacent. No additional therapy was rendered during the entire 1-year observation period. Clinical parameters and microbial analyses were recorded again at 1 week, and 1, 3, 6, 9, and 12 months post-treatment. The effect of antimicrobial irrigation on the reinfection rate of sites by Aa, Pg, and Pi was compared with that of the control groups (1 and 2) by ANOVA. No statistically significant differences were observed among the irrigation treatment groups with regard to any of the clinical or bacterial parameters studied. Therefore, the 4 treatment groups were combined into a single group whereby the rate of bacterial repopulation following extensive scaling and root planing could be ascertained. The infection incidence of sites at baseline (of total sites), 1 week and 12 months (of sites originally infected at baseline) was 14/41, 3/14, and 7/14 for Aa; 33/41, 6/33, and 12/33 for Pg; and 37/41, 3/37, and 12/37 for Pi, respectively. Thus, half or fewer of the originally infected sites became reinfected at 12 months despite lack of maintenance therapy. The results suggest that 1) a single episode of pocket irrigation with antimicrobial agents following thorough scaling and root planing did not affect the rate of repopulation of periodontal pockets by the tested pathogens; 2) thorough scaling and root planing has a lasting suppressive effect on selected periodontal pathogens for the majority of sites in patients with adult periodontiti

Topics: Adult; Aged; Aggregatibacter actinomycetemcomitans; Analysis of Variance; Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Colony Count, Microbial; Dental Scaling; DNA Probes; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Prevotella intermedia; Recurrence; Root Planing; Tetracycline; Therapeutic Irrigation

The aim of this controlled clinical trial was to assess the effect on healing following tetracycline (TTC) conditioning and fibrin-fibronectin sealing system (FFSS) application in association with flap debridement surgery (FDS) in 11 patients under treatment for moderate to severe periodontitis. Selection criteria included the presence of two bilateral, homologous, non-molar, interproximal sites with probing depth > or = 5 mm. The areas bilateral to the trial sites were matched for number and type of the teeth, and similar periodontal involvement. After initial therapy, a split-mouth design was used in which one area was treated by flap debridement surgery alone (control), and the contralateral area was treated following surgery with a 4-minute burnishing application of 100 mg/ml TTC solution and FFSS (test). Fibrin glue was applied with a syringe on the demineralized root surfaces and surrounding bone margins. Healing by primary intention was encouraged by flap repositioning with interrupted sutures left in place for 14 days. A monthly maintenance recall program was followed. Patients were clinically evaluated at baseline and 6 months and the following measurements were taken: gingival index, plaque control record, clinical attachment level, probing depth, recession, bleeding on probing. Statistical evaluation indicated that both approaches resulted in significant probing depth reduction and clinical attachment gain. However, the differences in healing between the test and control groups were not clinically nor statistically significant. These results suggest there is no additional benefit with TTC demineralization and topical FFSS application in conjunction with flap debridement surgery.

Topics: Adult; Decalcification Technique; Dental Plaque Index; Female; Fibrin Tissue Adhesive; Humans; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Index; Periodontitis; Statistics, Nonparametric; Subgingival Curettage; Tetracycline; Tooth Root; Treatment Outcome; Wound Healing

The purpose was to evaluate the use of demineralized freeze-dried bone allograft reconstituted with 50 mg/ml tetracycline hydrochloride in the treatment of intrabony periodontal defects. Fifteen systemically healthy patients (12 females, 3 males; aged 35 to 61) with moderate-advanced periodontitis were treated. Patients had 3 osseous defects with probing depths (PD) > 5 mm after initial therapy. Each site in each subject was randomly assigned to one of the following groups: 1) demineralized freeze-dried bone allograft reconstituted with 50 mg/ml tetracycline (DFDBA + TCN); 2) demineralized freeze-dried bone allograft alone (DFDBA); or 3) debridement only (D). Clinical measurements were taken the day of surgery, 6 months, and 1 year. Standardized radiographs were taken at baseline and 1 year and were evaluated by computer assisted densitometric image analysis (CADIA). Clinical measurements included gingival recession, PD, clinical attachment level, and mobility. Osseous defect measurements were taken at baseline and at the 1 year reentry. No adverse healing responses occurred. The results showed that all patients had a statistically significant improvement in probing depth and attachment level at 1 year. Osseous measurements showed bone fill of 2.27 mm (51.6%) for the DFDBA + TCN group, 2.20 mm (52.4%) for the DFDBA group, and 1.27 mm (32.8%) for the D group. Defect resolution was 77.3% for the DFDBA + TCN group, 77.9% for the DFDBA group, and 63.8% for the D group. The mean CADIA values were 5.04 for the DFDBA + TCN group, 6.79 for the DFDBA group and 2.78 for the D group. The CADIA values did not correlate with the clinical parameters. Although the grafted groups showed greater bone fill and defect resolution, there was no statistically significant difference in any of the clinical parameters between the treatment groups. This study suggests that there is no significant benefit from reconstituting the allograft with 50 mg/ml of tetracycline hydrochloride.

Topics: Absorptiometry, Photon; Adult; Alveolar Bone Loss; Anti-Bacterial Agents; Bone Transplantation; Debridement; Decalcification Technique; Female; Follow-Up Studies; Freeze Drying; Gingival Recession; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Tetracycline; Tooth Mobility; Transplantation, Homologous; Wound Healing

35 patients receiving regular supportive periodontal therapy (SPT) and showing signs of localized persistent or recurrent periodontitis were enrolled in the study. Within 1 week after SPT, each patient had a tetracycline HCl loaded ethylene vinyl acetate co-polymer fiber placed into the periodontal pocket of 1 randomly selected tooth with persistent or recurrent periodontitis (test); the fiber was removed after 9.5+/-2.0 days. A non-adjacent tooth with persistent or recurrent periodontitis in a separate quadrant, which received no further treatment, served as a control. A total of 28 patients completed the 6-month study. Compared to control teeth, in test teeth at 6 months significantly (p<0.01) lower scores were found for gingival index, pocket probing depths, and PMN elastase-alpha1-proteinase inhibitor concentrations in gingival crevicular fluid. With the exception of plaque index scores, test teeth demonstrated significant reductions from baseline to 6 months in all parameters (p<0.05). Conversely, all parameter measurements in control teeth, except bleeding on probing, showed no significant difference between baseline and 6-month values. The results suggest that the use of controlled topical application of tetracycline HCl may improve periodontal health and reduce the risk of disease progression in localized persistent or recurrent periodontitis. Moreover, the effects of this application appear to be sustained for at least 6 months.

Topics: Administration, Topical; alpha 1-Antitrypsin; Anti-Bacterial Agents; Combined Modality Therapy; Dental Implants; Disease Progression; Female; Follow-Up Studies; Gingival Crevicular Fluid; Gingival Hemorrhage; Humans; Leukocyte Elastase; Male; Middle Aged; Neutrophils; Pancreatic Elastase; Periodontal Index; Periodontal Pocket; Periodontitis; Polyvinyls; Recurrence; Tetracycline

A controlled clinical trial was carried out to compare the clinical effect of combined antimicrobial-mechanical treatment modalities on moderate-to-deep periodontal pockets in patients with adult periodontitis. Twelve patients having at least three nonadjacent sites of periodontitis were included in the split-mouth study. Gingival Index, Plaque Record, bleeding on probing, probing depth, attachment level, and recession depth were recorded immediately before treatment. In the control site, supragingival and subgingival scaling was performed with an ultrasonic scaler. One experimental site received supplemental irrigation with 15 mL of a 100-mg/mL tetracycline solution, while the other received a tetracycline-loaded fiber after mechanical instrumentation. Fibers were left in place for 10 days. Reevaluation 30 and 60 days after treatment showed that all three treatment modalities were effective in improving clinical parameters. No adjunctive effect on the healing response was obtained by augmenting mechanical debridement with tetracycline.

Topics: Administration, Topical; Adult; Analysis of Variance; Anti-Bacterial Agents; Chi-Square Distribution; Dental Plaque Index; Dental Scaling; Female; Humans; Male; Middle Aged; Oral Hygiene; Periodontal Index; Periodontal Pocket; Periodontitis; Polyvinyls; Tetracycline; Therapeutic Irrigation; Treatment Outcome; Ultrasonics

The purpose of this investigation was to evaluate the clinical efficacy of controlled-release tetracycline fiber therapy in adult periodontitis patients. One hundred-twenty-two (122) adult patients from 3 dental centers were enrolled at baseline for this study. each patient provided at least one site in each of four quadrants that was > or = 5 mm and bled on probing. One or two such sites were selected as test sites and were randomly assigned to receive one of four treatments: scaling and root planing (S), scaling and root planing plus tetracycline fiber for 10 days (SF), fiber therapy alone for 10 days (F), or two 10-day serial fiber applications (FF). After treatment, no periodontal maintenance or supportive care was provided until the end of this 12-month study. Probing depth (PD), clinical attachment level (CAL), plaque, and bleeding on probing (BOP) were measured at baseline and at 1, 3, 6, 9, and 12 months following treatment. Repeated PD and CAL measurements were taken at three locations within each site and averaged for each site. One hundred-sixteen (116) subjects completed the study. All treatments resulted in similar improvements in clinical parameters compared to baseline and were equally effective in the treatment of periodontitis as measured by probing depth reduction, clinical attachment level gain, and reduction of bleeding on probing. The clinical response, established primarily by 3 months following therapy, was generally sustained in all treatment groups for 12 months without the benefit of supportive maintenance therapy.

Topics: Adult; Aged; Anti-Bacterial Agents; Combined Modality Therapy; Delayed-Action Preparations; Dental Plaque; Dental Scaling; Drug Implants; Female; Follow-Up Studies; Gingival Hemorrhage; Humans; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Reproducibility of Results; Root Planing; Single-Blind Method; Tetracycline

Scanning electron microscopy was used to evaluate surface characteristics of periodontitis-exposed instrumented human cementum and dentin surfaces following topical application of tetracycline HCl (TTC). Specimens were randomly assigned to application of sterile saline for 1 minute (control); TTC (10 mg/ml) for 1 minute and 4 minutes, respectively; and TTC (100 mg/ml) for 1 minute and 4 minutes, respectively. Solutions were applied with a cotton pellet using a burnishing technique. Control specimens exhibited an amorphous irregular surface smear layer. TTC treatment of cementum for 1 minute resulted in a relatively debris-free, nonhomogeneous surface. The 4-minute application resulted in a surface exhibiting a densely fibrillar, mat-like texture. Dentin specimens conditioned for 1 minute showed a smooth surface with many tubule openings partially occluded by debris. The 4-minute treatment exposed a 3-dimensional network of intertubular and peritubular collagen fibrils. No consistent morphologic differences were observed between cementum or dentin specimens treated with TTC at concentrations of 10 and 100 mg/ml, respectively. The results suggest that topical application of TTC produces morphologic alterations of periodontitis-exposed cementum and dentin that appear related to application interval rather than concentration of the drug.

Topics: Actin Cytoskeleton; Administration, Topical; Adult; Anti-Bacterial Agents; Collagen; Dental Cementum; Dentin; Humans; Microscopy, Electron, Scanning; Middle Aged; Periodontitis; Smear Layer; Tetracycline

In a 12-month multi-center study of 116 adult periodontitis subjects, six putative periodontal pathogens were monitored by DNA probe methods in a subset of 31 subjects. Monitored species included Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Fusobacterium nucleatum (Fn), Eikenella corrodens (Ec), Campylobacter rectus (Cr), and Actinobacillus actinomycetemcomitans (Aa) with an average detection limit of 1.8 x 10(4) bacterial colony forming units/sample. The microbiological response to four periodontal treatments was studied, one treatment in each quadrant; scaling and root planing (S), scaling and root planing with tetracycline (TC) fiber (SF), a single application of TC fiber (F) and two serial applications of TC fiber (FF). Generally two sites were sampled in each quadrant, however, in some quadrants only one site was selected. These treatments were evaluated at baseline; immediately following therapy; and post-treatment at 1, 3, 6, and 12 months. The study was conducted with a split-mouth design with no maintenance therapy over a 12-month period. At baseline, 70.8% of sites had detectable Fn; 42.9% Pg; 63.5% Pi; 29.7% Ec; 28.3% Cr; and 5.5% Aa. No significant differences were seen in baseline proportions of these species between centers. Numbers and proportions of detectable pathogens (with the exception of Pg) exhibited a triphasic temporal response: a precipitous initial decrease immediately following therapy; a rise in proportions in the 1- to 3-month post-therapy period; and a spontaneous decline in the absence of therapy over the 3- to 12-month period.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Bacteria; Campylobacter; Colony Count, Microbial; Combined Modality Therapy; Delayed-Action Preparations; Dental Scaling; DNA Probes; Drug Implants; Eikenella corrodens; Female; Follow-Up Studies; Fusobacterium nucleatum; Humans; Male; Middle Aged; Periodontitis; Porphyromonas gingivalis; Prevotella intermedia; Root Planing; Single-Blind Method; Tetracycline

The purpose of this investigation was to examine periodontal disease recurrence from 3 to 12 months following various treatments with scaling and root planing and controlled-release tetracycline fibers. One-hundred-twenty-two (122) adult volunteers with at least one bleeding pocket > or = 5 mm in each of four quadrants were enrolled in this study. One or two such sites in each quadrant were selected as test sites. Quadrants were randomly assigned to receive one of four treatments: scaling and root planing (S); scaling and root planing plus tetracycline fiber for 10 days (SF); fiber therapy alone for 10 days (F); or fiber therapy alone for 20 days (FF). After treatment, no supportive care was provided during the 12-month study period. Probing depth (PD), attachment loss (AL), plaque, and bleeding on probing were measured at baseline, and at 1, 3, 6, 9, and 12 months after treatment. PD and AL measures were taken at three locations within each site and averaged for each site. Disease recurrence was defined as > or = 1 mm mean attachment loss at a site during the 3- to 12-month period. One-hundred-sixteen (116) subjects completed the study. Sites treated with SF experienced significantly (P < 0.05) less disease recurrence (4%) than S, F, or FF (9%, 10%, and 12%, respectively). Results of this study suggest that, compared to S, F, or FF, scaling and root planing in conjunction with tetracycline fiber therapy for 10 days can significantly reduce disease recurrence 3 to 12 months following treatment in the absence of supportive care.

Topics: Adult; Anti-Bacterial Agents; Combined Modality Therapy; Delayed-Action Preparations; Dental Plaque; Dental Scaling; Drug Implants; Follow-Up Studies; Gingival Hemorrhage; Humans; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Recurrence; Root Planing; Single-Blind Method; Tetracycline

Controlled local delivery of antibiotics has been shown to reduce periodontopathic micro-organisms with minimal side-effects. Clinical studies in our laboratory have shown that 25% tetracycline HCl delivered from poly(D,L-lactide/glycolide) film strips (25 TTC-PLGA) released therapeutic concentrations of tetracycline for 10 days. The present pilot study compared the intracrevicular delivery of 25% tetracycline HCl incorporated in these biodegradable film strips to scaling and root planing (SRP) in 10 adult periodontitis patients, who in spite of therapy and regular supportive periodontal treatment (SPT), continued to possess 5 bleeding periodontal pockets at least 5 mm deep. Sites were randomly selected to receive the following treatments: (1) 25 TTC-PLGA, (2) control strips without TTC (PLGA), (3) SRP, and (4) untreated control. Film-strip retention was augmented with a suture/cement technique, followed by strip removal after 2 weeks. Clinical parameters and subgingival bacterial morphotypes (darkfield analysis) were evaluated over time (0, 2.4, 8, 12, 26 weeks). Results indicated that, compared to baseline, 25 TTC-PLGA film strips caused significant (p < or = 0.01): (1) probing depth reduction for 26 weeks, (2) a clinical attachment level gain for 12 weeks, (3) lower %s of spirochetes for 4 weeks and motile rods for 8 weeks (p < or = 0.05), and (4) an accompanying increase in cocci for 4 weeks. In the scaled and root planed sites, probing depth was the only finding that demonstrated a significant change from baseline (p < or = 0.01). Controls and PLGA showed isolated reductions in probing depth and % of motile organisms. From these findings, applications of intracrevicular 25 TTC-PLGA, when compared to scaling and root planing, appears to have an enhanced antibacterial effect and a similar clinical effect in SPT patients. The results of this study indicate further investigation of 25 TTC-PLGA film strips should be undertaken using more subjects and sophisticated microbiological and clinical measurements.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacteria; Biocompatible Materials; Colony Count, Microbial; Delayed-Action Preparations; Dental Scaling; Drug Carriers; Drug Delivery Systems; Female; Gingiva; Gingival Crevicular Fluid; Gingival Hemorrhage; Humans; Lactic Acid; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Pilot Projects; Polyglycolic Acid; Polylactic Acid-Polyglycolic Acid Copolymer; Polymers; Root Planing; Spirochaetales; Tetracycline

Clinical effects of root surface demineralization during flap surgery were evaluated in ten patients with rapidly progressive periodontitis. Following initial periodontal therapy, flap surgery was conducted on the anterior segments. Test sites received conditioning with tetracycline solution for 5 minutes, whereas control sites were only rinsed with sterile saline solution. Following either treatment, improvement was observed on all clinical measures. However, apart from gingival index assessments, there was not a statistically significant difference in the improvement observed between test and control groups; the only significant difference was observed in gingival index scores at the second and fourth weeks. These differences in gingival index, which are not reflected in plaque index scores, imply that tetracycline has been absorbed on root surfaces and released in biologically active form for up to 4 weeks; but attachment level measurements demonstrate that tetracycline conditioning of the root surfaces during flap surgery has no additional regenerative benefit, or at least none detectable by clinical means.

Topics: Absorption; Adult; Anti-Bacterial Agents; Gingivoplasty; Humans; Periodontal Attachment Loss; Periodontal Index; Periodontitis; Statistics, Nonparametric; Subgingival Curettage; Surgical Flaps; Tetracycline; Tooth Root; Wound Healing

The present study was conducted on 14 quadrants from seven solicited patients. After initial phase of plaque control, six different clinical parameters were recorded and scaling and root planning performed. In each of the seven patients two Modified Widman flaps were done. One served as a control and the other as experimental in which irrigation by Tetracycline-Hcl solution 100 mg/ml for 5 minutes was performed. On comparing the two treatment modalities the tetracycline-Hcl root conditioning showed a better improvement in all the clinical parameters tested. Tetracycline irrigation gave less bacterial counts than the control group right after irrigation, however after two weeks the bacterial counts increased again and were insignificantly different in the two groups.

Topics: Adult; Aged; Anti-Bacterial Agents; Chemotherapy, Adjuvant; Colony Count, Microbial; Dental Plaque; Dental Scaling; Humans; Middle Aged; Periodontitis; Surgical Flaps; Tetracycline; Tissue Conditioning, Dental

The purpose of this study was to compare the efficacy of scaling and root planing (S and RP) alone versus tetracycline fiber therapy used adjunctively with S and RP in the treatment of localized recurrent periodontitis sites in maintenance patients. A total of 113 patients receiving regular supportive periodontal therapy (SPT) were treated with whole mouth S and RP. Two non-adjacent sites in separate quadrants were selected in each patient for monitoring based on criteria that the sites were 5 to 8 mm deep and had a history of bleeding on probing. The chosen sites were randomly assigned to one of the two treatment groups. Probing depth (PD), bleeding on probing (BOP), and clinical attachment level (CAL) were measured at baseline and 1, 3, and 6 months. At 1, 3 and 6 months, adjunctive fiber therapy was significantly better in reducing PD (P < 0.05) and reducing BOP (P < 0.05) than S and RP alone. At 6 months, fiber therapy was significantly better in promoting clinical attachment gain (P < 0.05) than S and RP alone. Overall, these results indicate that fiber therapy significantly enhanced the effectiveness of S and RP in the management of localized recurrent periodontitis sites, in patients receiving regular supportive periodontal treatment.

Topics: Arizona; Colorado; Connecticut; Delayed-Action Preparations; Dental Scaling; Female; Humans; Longitudinal Studies; Male; Middle Aged; Multivariate Analysis; Periodontal Index; Periodontitis; Root Planing; Tetracycline; Texas; Treatment Outcome; Wisconsin

The clinical effects of subgingivally placed 1% chlorhexidine gel (w/w) and 40% tetracycline (w/w) paste in periodontal pockets of 22 adult periodontitis patients were studied. The 2 agents were applied following scaling and root planing in pockets exceeding 4 mm. The patients were randomly divided into 3 groups: (a) scaling and root planing (SCRP) only, the control group; (b) corsodyl gel+SCRP; (c) Tetracycline paste+SCRP. Gel or paste were gently applied using a syringe with a blunt needle until the selected pocket was overfilled. Evaluations were made of clinical parameters including the plaque index (PI), gingival index (GI), bleeding index (GI-S), probing pocket depths, probing attachment levels and position of the gingival margin. The results suggested that all the treatment modalities were effective in producing statistically significant improvements in clinical parameters. It was concluded that the conventional treatment modalities were essential in the treatment of periodontal diseases, but in view of the structure of the periodontal pocket and adjacent complex root surface, subgingival drug application in certain cases, might also provide adjunctive improvement.

Topics: Administration, Topical; Adult; Analysis of Variance; Chlorhexidine; Dental Plaque Index; Dental Scaling; Female; Humans; Male; Middle Aged; Periodontal Index; Periodontal Pocket; Periodontitis; Root Planing; Tetracycline

Nine patients with refractory periodontitis were selected for this study. Each patient had undergone surgery once or twice in the previous five years and had been on three-month recall for clinical examination and scaling. During the maintenance phase of therapy and despite regular scaling, each patient had additional pocket formation that was either localized or generalized. Pocket depths in each patient were recorded and scaling was carried out. Three months later the patients were examined, and again no improvement was observed in the pocket depths. This time all patients were scaled again, and 250 mg tetracycline every six hours for 20 days as well as 250 mg metronidazole every eight hours for seven days were systemically administered. After an additional three months, patients were again examined and pocket depths measured. The latter examination disclosed that the clinical condition of the gingiva, as shown by bleeding and exudate, had improved. The pocket depths had also been reduced. The scaling-alone mean pocket depths were 4.93 mm, whereas the scaling-plus-antibiotic measurements were reduced to 2.78 mm. The difference was significant (p = 0.01).

Topics: Adult; Chronic Disease; Dental Scaling; Drug Therapy, Combination; Female; Humans; Male; Metronidazole; Middle Aged; Periodontitis; Tetracycline

This clinical study evaluated the survival rates of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia in periodontal pockets following scaling and root planing and intra-pocket irrigation with antimicrobial agents in patients with moderate and severe periodontitis. The number of target organisms was determined utilizing DNA probes. Adult periodontitis patients were selected on the basis that the subgingival flora contained at least one of the target organisms. Forty-eight (48) inflamed pockets > or = 5 mm in depth with probing attachment loss and containing at least one of the target species were then selected in 7 adult patients who harbored these bacteria. Following baseline clinical and bacterial examination, all patients received thorough scaling and root planing. In addition, 1 or 2 teeth in each patient which harbored the target flora at baseline were randomly assigned to each of the following 4 treatment modalities: 1) control group, no irrigation; 2) saline group, irrigation with 2 cc of physiologic saline; 3) tetracycline group, irrigation with 2 cc of aqueous tetracycline hydrochloride, 50 mg/ml (5%); and 4) chlorhexidine group, irrigation with 2 cc 0.12% chlorhexidine. All selected sites (5 to 8 per patient) were nonadjacent teeth. Clinical parameters and microbial analysis were recorded again at one week, and one month post-irrigation. The survival rate of the target microorganisms was determined and the effect of irrigation with antimicrobial agents on this microflora was compared with the control groups (1 and 2).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aggregatibacter actinomycetemcomitans; Bacteroides; Chlorhexidine; Colony Count, Microbial; Dental Plaque Index; Dental Scaling; DNA Probes; DNA, Bacterial; Female; Humans; Male; Middle Aged; Periodontal Index; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Root Planing; Tetracycline; Therapeutic Irrigation

Thirty-one patients with chronic adult periodontitis participated in this long-term private practice study. Sixty-one sites with moderate (4-6 mm, n = 21) or deep (> or = 7 mm, n = 40) periodontal pockets and bleeding on probing were treated with an antibiotic-releasing fiber, Actisite (Periodontal Therapeutic System) (tetracycline hydrochloride). Scaling/root planing (SRP) was performed on all teeth 3 weeks before start of the study, and on most teeth immediately before fiber insertion. Monolithic fibers loaded with 25% tetracycline hydrochloride were inserted in periodontal pockets, where they were retained for a mean of 6.7 days, at which point they were removed. Patients were evaluated at 1, 3, and 6 months after treatment; subgroups were also evaluated at normalized 12-month (10 patients, 20 sites) and 24-month (13 patients, 20 sites) time points. Sites showed a mean probing depth reduction of 2.5 mm at 6 months, and 2.2 mm at 24 months, with the deepest sites showing the greatest reduction. Bleeding on probing was 100% at baseline, 34% at 3 months, and 50% at 6 months. Attachment gains in 18 patients (25 sites) were 2.4 mm at 1 month, 3.0 mm at 3 months, and 2.5 mm at 6 months. Fibers were well tolerated; no adverse effects from treatment were noted. These results indicate that use of tetracycline fiber plus SRP clearly reduced the clinical signs of periodontal disease and maintained or improved attachment for up to 24 months in sites previously refractory to treatment.

Topics: Adult; Aged; Anti-Bacterial Agents; Drug Delivery Systems; Female; Humans; Male; Middle Aged; Periodontal Pocket; Periodontitis; Tetracycline; Treatment Outcome

Topics: Anti-Bacterial Agents; Dental Scaling; Drug Delivery Systems; Humans; Periodontitis; Root Planing; Tetracycline

The purpose of this investigation was to inspect and characterize the subgingival root surface after a 10-day exposure in vivo to 25% tetracycline hydrochloride by weight in an ethylene vinyl acetate copolymer fiber matrix with and without root planing therapy. The root surfaces were examined by fluorescent-light microscopy (FLM), scanning electron microscopy (SEM), and energy dispersive spectroscopy (EDS). Thirty-two teeth were selected for study, 4 from each of 8 patients. The teeth of each patient were randomly assigned to one of four treatment groups: non-treated control (C), scaling and root planing only (RP), tetracycline-impregnated fiber only (F), and scaling and root planing with tetracycline-impregnated fiber application (RP/F). SEM revealed a visible reduction in the subgingival microbial flora in both the F and RP/F treatment groups in comparison with the C group specimens. Many of the residual bacteria observed in F and RP/F specimens appeared non-viable, exhibiting obvious loss of membrane integrity. In contrast, the RP specimens exhibited randomly distributed areas of residual subgingival plaque and calculus with newly developing plaque fronts; the plaque fronts undoubtedly having formed during the 10 days post-therapy. All RP/F specimens exhibited an incomplete removal of adsorbed root surface pellicle and demineralization of the subsequently exposed root surface. EDS analysis of large crystals adhering to root surfaces of F and RP/F specimens revealed high chloride peaks, suggesting the presence of residual tetracycline. FLM examination of F and RP/F treated specimens showed a superficial penetration of tetracycline into the root surface of about 10 microns. Areas of demineralized root showed slight tetracycline penetration into exposed dentinal tubules.

Topics: Adsorption; Adult; Bacteria; Dental Calculus; Dental Pellicle; Dental Plaque; Dental Scaling; Drug Implants; Electron Probe Microanalysis; Female; Humans; Male; Microscopy, Electron, Scanning; Microscopy, Fluorescence; Periodontitis; Polyvinyls; Root Planing; Tetracycline; Tooth Root

Topics: Adult; Analysis of Variance; Bacterial Infections; Chi-Square Distribution; Clindamycin; Dental Implants; Double-Blind Method; Female; Humans; Male; Microbial Sensitivity Tests; Periodontitis; Prosthesis-Related Infections; Tetracycline

In vitro tests in our laboratory have shown that 40% tetracycline HCl in a white petrolatum carrier (TTC-WP) has potential as a sustained release, autodissipating system. The present study tested subgingival placement of TTC-WP via syringe in vivo. Quadrants (2 diseased sites in each) in 9 patients with moderate/severe periodontitis were randomly assigned to receive the following treatments: (1) TTC-WP; (2) WP only; (3) scaling and root planing; (4) untreated control. TTC release into gingival crevicular fluid (GCF) over time (baseline, 1, 8, 24, 72 and 168 h) was measured using an agar diffusion bioassay. Clinical parameters and subgingival bacterial morphotypes (darkfield analysis) were also evaluated over time (baseline, 2, 4, 8, 12 weeks). Results indicated that TTC-WP was easily placed into periodontal pockets and biologically effective TTC was released into GCF for at least 3 days (mean concentration = 115.8 +/- 43.1 micrograms/ml at 3 days). TTC-WP reduced probing pocket depths and bleeding on probing relative to baseline measurements for 8-12 weeks post-treatment, and reduced %s of motile rods and spirochetes, with an accompanying increase in cocci, for 2-8 weeks. Similar effects were noted in the scaled and root-planed sites, but for a longer duration. TTC-WP and WP were clinically dissipated after 2 weeks and no adverse tissue reactions were observed. From these findings, subgingival TTC-WP cannot replace scaling and root planing therapy, but has characteristics useful in subgingival plaque control.

Topics: Administration, Topical; Adult; Aged; Bacteria; Delayed-Action Preparations; Dental Plaque; Drug Carriers; Gingiva; Gingival Crevicular Fluid; Gingival Hemorrhage; Humans; Middle Aged; Periodontal Pocket; Periodontitis; Petrolatum; Tetracycline

Over a period of 14 days we have treated 27 after special criterious selected patients with 250 mg OTC three times/day. We compared these results with those of 25 patients--of a placebo-group. The analysis included clinical and microbiological parameters. It could be pointed out, that the OTC-therapy results in a significant improvement of the examined parameters stile 6 months after starting with the therapy.

Topics: Adolescent; Adult; Female; Humans; Longitudinal Studies; Male; Periodontitis; Tetracycline

The present study was undertaken to compare the efficacy of two antibiotics, spiramycin and tetracycline, with a placebo when used adjunctively with scaling and root planing in the treatment of advanced adult chronic periodontitis. This was a double-blind, parallel, randomized trial with one factor (drug) at three levels. Ninety-six patients (mean age 46 +/- 1) were randomly assigned into one of three groups. All groups were scaled and root planed with each respective group receiving either spiramycin, tetracycline, or a placebo for 2 weeks. Two sites with probing depth of at least 7 mm were evaluated and the following clinical parameters were measured at baseline, 2, 8, 12, and 24 weeks: plaque index, bleeding on probing, crevicular fluid, probing depth, and change in the attachment level. The changes in the subgingival bacteria were monitored also using a differential staining technique. Seventy-nine patients completed the study. At the end of 24 weeks, although all three groups had shown clinical improvement when compared to the baseline data, there were no significant intergroup differences in any of the clinical parameters measured. While the proportion of spirochetes were significantly decreased (P less than 0.05) at 2- and 8-week intervals in both tetracycline and spiramycin groups (26% to 0.04% and 28% to 0.04%, respectively), compared to the placebo group (30% to 7%), only in the spiramycin group was the proportion of spirochetes significantly lower than the placebo group at the 24-week interval (3% and 11%, respectively). At week 24, the proportion of spirochetes in the tetracycline group had rebounded to 7%, which was not significantly different from the placebo group.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Chronic Disease; Clinical Trials as Topic; Dental Plaque Index; Dental Prophylaxis; Dental Scaling; Double-Blind Method; Humans; Middle Aged; Periodontal Index; Periodontitis; Placebos; Spiramycin; Spirochaetales; Tetracycline

Tetracycline-containing cross-linked collagen film (TC film), or tetracycline-free placebo film, were locally applied 4 times, at 1-week intervals, to 33 teeth with periodontal pockets larger than 4 mm, in 11 patients with periodontal disease. The clinical and microbiological effects are summarized, as follows. In the group treated with the TC film, (1) the clinical indices were significantly decreased at the 4th and 7th weeks in comparison with those at the beginning of treatment. In particular, this group showed a significant decrease in the incidence of bleeding as compared with the placebo group at the 4th week. (2) Total counts of bacteria in the periodontal pockets showed an obvious tendency to decrease with time. The proportion of black-pigmented bacteroides was significantly decreased at the 4th and 7th weeks when compared with the pretreatment value. The extent of decrease in the proportion of spirochetes at both the 4th and 7th weeks was significant compared with the placebo group and the pretreatment value.

Topics: Bacteroides; Chronic Disease; Collagen; Drug Carriers; Female; Gingival Hemorrhage; Humans; Male; Middle Aged; Periodontal Pocket; Periodontitis; Spirochaetales; Tetracycline

The purpose of this study was to evaluate the duration of therapeutic effect after administration of the collagen film immobilized tetracycline (TC film). TC film or tetracycline non-immobilized placebo film was applied one time to the periodontal pocket (greater than or equal to 4 mm) of five periodontitis patients (20 teeth). The clinical and microbiological effects are summarized as follows: The group that received TC film continued to show significantly low values for bleeding upon probing the pocket depth for 3 and 4 weeks, respectively, after administration, but there was no significant difference in the plaque index or gingival index when compared with the group that received a placebo film. In the TC film group, the density of microorganisms and the proportion of motile rods and spirochetes were also significantly decreased 3 weeks after administration. These findings suggest that topically administered TC film remains both clinically and bacteriologically effective for 2 to 3 weeks.

Topics: Administration, Topical; Adult; Bacteria; Collagen; Delayed-Action Preparations; Dental Plaque; Dental Plaque Index; Female; Gingiva; Humans; Periodontal Index; Periodontal Pocket; Periodontitis; Placebos; Tetracycline

This study was designed to compare both clinical and microbiological changes during the treatment of advanced periodontal disease with mechanical debridement, with or without the adjunctive use of either spiramycin or tetracycline. The study, which included 96 patients with advanced periodontitis, was performed as a controlled double-blind parallel randomized trial. All patients received thorough scaling and root planing as well as adjunctive placebo or spiramycin or tetracycline. Probing depth measurements, attachment level changes, plaque level, gingival crevicular fluid, bleeding on probing and microbiological evaluation were carried out at baseline, 2-, 8-, 12- and 24-week visits. Seventy-nine patients (24 placebo, 27 tetracycline and 28 spiramycin) completed the study. At 24 weeks there were no intergroup differences in the improvement of any of the clinical parameters. Spiramycin was the only antibiotic which produced a significantly greater decrease in the proportion of spirochaetes than the placebo group at the 24-week visit. It was concluded that mechanical debridement alone was sufficient in decreasing the subgingival bacteria to a level which would result in the return to periodontal health. The study was not long enough to determine whether or not the difference in spirochaete level was an indication that the spiramycin group would have maintained the benefits of treatment for a longer time.

Topics: Adult; Chronic Disease; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Leucomycins; Male; Periodontitis; Random Allocation; Tetracycline

This investigation was conducted on seven individuals referred for treatment of moderate adult periodontitis. Twenty-eight sites with an average probing depth of 5.6 +/- 0.9 mm were evaluated. One tooth per jaw quadrant was randomly assigned to receive one of the following treatments: (I) no treatment, i.e., control; (II) saline irrigation; (III) tetracycline irrigation and (IV) scaling and root planing (SC/RP). A plaque control program was instituted one week prior to the experimental period and reinforced throughout the eight-week study. Irrigation was performed every 48 hours during the first two weeks of the experiment for Groups II and III, and the single treatment of SC/RP was carried out immediately following the baseline examination for Group IV. Clinical and microbiologic changes were monitored every two weeks using plaque and gingival indices, gingival fluid flow, probing depths, bleeding on probing and dark-field microscopic examination of the subgingival microbial flora. The tetracycline and SC/RP treatment modalities resulted in statistically significant clinical and microbiological improvements when compared with the control. Tetracycline irrigation alone and SC/RP alone had a similar effect in changing the subgingival microflora from one associated with disease to one associated with health. Thus, these treatment modalities are effective methods of producing statistically significant alterations in the subgingival microflora. The property of substantivity may contribute to the sustained duration of the effect of locally delivered tetracycline.

Topics: Adult; Bacteria; Dental Scaling; Humans; Middle Aged; Periodontal Index; Periodontal Pocket; Periodontitis; Tetracycline; Tooth Root

The aim of the present study was to analyze the effect of systemic antimicrobial therapy and mechanical plaque control in patients with recurrent periodontal disease. 9 patients volunteered for the combined therapy. At a baseline examination they were randomly distributed into 2 groups, one given tetracycline therapy for 2 weeks and the other metronidazole therapy for 1 week. A mechanical plaque control program comprising oral hygiene training, professional cleaning of all teeth and subgingival debridement at diseased sites was carried out at the baseline examination and at all recall visits, i.e. once every month during the first 6 months and then after 9, 12, and 18 months. The results demonstrated clinically and microbiologically that a combination of an initial antimicrobial and a continuous systematic mechanical plaque control program may be a valuable therapeutic approach in a strictly selected group of refractory patients. Recurrent periodontal lesions which still displayed severe inflammation despite renewed conventional therapy showed a marked reduction in probing depths, bleeding and suppuration from the pockets, and further, a reduced presence of spirochetes and motile rods during the trial. The results indicate that the level and longevity of success is also related to whether or not self-performed oral hygiene measures are sufficiently carried out. No superior effect of the combined program could be observed in cooperating patients receiving tetracycline as compared with those given metronidazole.

Topics: Adult; Aged; Bacteria; Combined Modality Therapy; Dental Plaque; Dental Prophylaxis; Female; Humans; Male; Metronidazole; Middle Aged; Periodontitis; Recurrence; Tetracycline

The objective of this study was to test the efficacy of scaling and root planing with or without adjunctive tetracycline therapy in the treatment of periodonitis in humans. The presence of plaque, gingival inflammation, probing depths and attachment levels was assessed for all teeth in 12 patients with chronic, advanced periodontitis. After an initial examination all patients were given detailed oral hygiene instructions. The teeth in one-half of each arch were then scaled and root planed. The teeth in the contralateral half were not treated. Six patients were given tetracycline (1 gm/day) during the first and second weeks and the seventh and eighth weeks of the trial. The study thus included four different treatment groups: 1) no treatment, 2) scaling and root planing alone, 3) tetracycline administration alone, and 4) scaling and root planing combined with tetracycline administration. All patients were reexamined at 8 and 25 weeks subsequent to the initiation of therapy. Both PlI and GI scores decreased significantly in all groups. The GI scores were significantly lower in the scaled and root planed areas as compared to the contralateral sides at both the 8- and 25-week examinations. The PlI score was lower in the scaled and root planed areas only at the 25-week interval. The gingival probing depths were reduced in all groups. A significantly greater decrease in probing depth, however, was noted in scaled and root planed areas. There was a trend to gain of attachment in the treated areas but the magnitude of the gain was very small. The findings of the trail also revealed that the administration of tetracycline had only a minor effect on the parameters examined.

Topics: Adult; Clinical Trials as Topic; Dental Plaque; Dental Prophylaxis; Dental Scaling; Female; Humans; Male; Oral Hygiene; Periodontal Index; Periodontitis; Root Canal Therapy; Tetracycline

Topics: Adolescent; Adult; Aged; Bromelains; Cellulitis; Clinical Trials as Topic; Drug Combinations; Drug Tolerance; Female; Focal Infection, Dental; Humans; Male; Middle Aged; Periodontal Diseases; Periodontitis; Tetracycline

Periodontitis is an inflammatory condition that results in pocket formation, gingival recession, and tooth loss by gradually destroying the periodontium. An alternate therapeutic approach that can address these problems is required due to the prohibitive cost of periodontal therapy, unfavorable antibiotic side effects, the advent of novel bacterial strains, and the resistance of those strains. The primary goal of our study was to assess Nigella sativa's (N. sativa) antibacterial effectiveness against Porphyromonas gingivalis (P. gingivalis) utilizing seed extract.. Six individuals with periodontitis, both male and female, between the ages of 30 and 50, were enrolled in the study. Each patient's medical and dental histories were documented. Then, anaerobic procedures were conducted in the microbiology lab to find P. gingivalis development. The specimens were all then cultured.. At 12.5 mg/ml concentration, P. gingivalis did not show any zone of inhibition (ZOI). However, N. sativa, at a concentration of 25 mg/ml, demonstrated a ZOI of 6.2 mm against P. gingivalis. Similarly, at 50 mg/ml, it showed a ZOI of 8.4 mm. Tetracycline as a positive control demonstrated a ZOI of 14.1 mm against P. gingivalis. Although N. sativa samples had somewhat less antibacterial activity than tetracycline samples, it was discovered that N. sativa had noticeable antibacterial activity against P. gingivalis.. This study's findings suggest that N. sativa can be utilized against periodontitis as an adjunct to scaling since it has high antibacterial action against P. gingivalis.

Topics: Adult; Anti-Bacterial Agents; Female; Humans; Male; Middle Aged; Nigella sativa; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Tetracycline

The aim of this research was to assess the binding of fibrin clot to the teeth affected by periodontal disease following exposure to different root conditioning agents.. A total of 60 human teeth with a solitary root that were subjected to extraction following severe periodontal disease were used as study samples in this research. Two analogous grooves were prepared on the proximal radicular surface of every sample employing a diamond-tapered fissure bur using an aerator handpiece beneath abundant irrigation. Every sample was assigned to one of the following groups: • Group I: Tetracycline hydrochloride solution • Group II: Ethylenediaminetetraacetic acid (EDTA) gel • Group III: Biopure MTAD™ Subsequent to conditioning, the samples were rinsed for 3 minutes with phosphate-buffered saline (PBS) and permitted to air-dry for 20 minutes. A drop of fresh human whole blood procured from a hale and hearty volunteer was coated onto the dentin blocks in all three groups. A scanning electron microscope under 5000× magnification at 15 kV was used to examine the samples. Kruskal-Wallis test and Mann-Whitney U test were performed to procure the inter- and intragroup assessments Results: The greatest fibrin clot union was noted in the EDTA gel group at 2.86 ± 0.14 in pursuit by Biopure MTAD™ group at 2.39 ± 0.08 as well as tetracycline hydrochloride solution group at 1.82 ± 0.10. A statistically significant difference was noted between the investigational groups (. This research arrived at a conclusion that the dentinal surfaces subjected to conditioning with EDTA gel group as well as coated with human whole blood resulted in appreciably superior fibrin clot bonding to dentin vs Biopure MTAD™ as well as the tetracycline hydrochloride solution group.. Connective tissue attachment subsequent to surgical procedures causing the adhesion of a fibrin clot to the radicular surface as a result of initial wound healing processes is directly related to periodontal regeneration. It depends on biocompatibility for the fibrin clot and the periodontal pathosis-affected radicular surface to stick together, which can be procured with the aid of a variety of root conditioning measures in course of periodontal treatment.

Topics: Cell Adhesion; Dentin; Edetic Acid; Fibrin; Humans; Microscopy, Electron, Scanning; Periodontitis; Smear Layer; Tetracycline; Thrombosis; Tooth Root

Periodontitis compromises the integrity and function of tooth-supporting structures. Although therapeutic approaches have been offered, predictable regeneration of periodontal tissues remains intangible, particularly in anatomically complex defects. In this work, personalized and defect-specific antibiotic-laden polymeric scaffolds containing metronidazole (MET), tetracycline (TCH), or their combination (MET/TCH) were created via electrospinning. An initial screening of the synthesized fibers comprising chemo-morphological analyses, cytocompatibility assessment, and antimicrobial validation against periodontopathogens was accomplished to determine the cell-friendly and anti-infective nature of the scaffolds. According to the cytocompatibility and antimicrobial data, the 1:3 MET/TCH formulation was used to obtain three-dimensional defect-specific scaffolds to treat periodontally compromised three-wall osseous defects in rats. Inflammatory cell response and new bone formation were assessed by histology. Micro-computerized tomography was performed to assess bone loss in the furcation area at 2 and 6 weeks post implantation. Chemo-morphological and cell compatibility analyses confirmed the synthesis of cytocompatible antibiotic-laden fibers with antimicrobial action. Importantly, the 1:3 MET/TCH defect-specific scaffolds led to increased new bone formation, lower bone loss, and reduced inflammatory response when compared to antibiotic-free scaffolds. Altogether, our results suggest that the fabrication of defect-specific antibiotic-laden scaffolds holds great potential toward the development of personalized (

Topics: Anti-Bacterial Agents; Bone Regeneration; Fusobacterium nucleatum; Materials Testing; Metronidazole; Microbial Sensitivity Tests; Particle Size; Periodontitis; Porphyromonas gingivalis; Prevotella intermedia; Tetracycline; Tissue Scaffolds

The novel solvent-free process to formulate long-acting microparticles of tetracycline hydrochloride (TH) using hot melt extrusion granulation process coupled with size reduction using comil for the treatment of periodontitis was investigated using hydrogenated castor oil (HCO) as hydrophobic matrix former. The microparticles were characterized for micromeritics, drug diffusion, SEM studies, and stability analysis by DSC, FTIR, and proton NMR. Xanthan gum gel was used as delivery vehicles to administer microparticles inside periodontal pockets. The microparticles were sterilized using gamma radiation; delivery vehicle was sterilized using gamma radiation and autoclave process. Microparticles were evaluated for microbial load as per compendial guidelines. Optimized composition was evaluated for clinical parameters such as plaque index, gingival index, probing pocket depth, and clinical attachment level. Based on the statistical analysis of the data, the micromeritic properties and drug diffusion profiles vary based on the concentration of HCO in the formulation. SEM images reflect the surface properties prior and post drug diffusion studies, which indicates that release takes place predominantly by diffusion of TH through HCO matrix. DSC studies indicate no change in the respective spectra of initial and stability samples. FTIR studies indicate possibility of hydrogen bonding. Proton NMR data suggests characteristic peaks of TH being retained in the stability samples, indicating stable composition. Gamma radiation has led to significant reduction in viscosity of xanthan gum solution over autoclave. Clinical studies indicated statistical improvements in the formulation compared to baseline results, indicating the efficacy of the formulation in the treatment of periodontitis.

Topics: Anti-Bacterial Agents; Drug Compounding; Excipients; Humans; Hydrophobic and Hydrophilic Interactions; Lipids; Particle Size; Periodontal Pocket; Periodontitis; Tetracycline; Viscosity

The overprescription and improper use of antibiotics have contributed to the evolution of bacterial resistance, making it urgent to develop alternative therapies and agents with better efficacy as well as less toxicity to combat bacterial infections and keep new resistance from developing. In this work, a novel light-activable nano-antibiotic platform (TC-PCM@GNC-PND) was constructed by the incorporation of gold nanocages (GNC) and two thermosensitive gatekeepers, phase-change materials (PCM) and thermosensitive polymer poly(

Topics: Animals; Anti-Bacterial Agents; Doxorubicin; Drug Delivery Systems; Drug Liberation; Gold; Hot Temperature; Humans; Infrared Rays; Nanostructures; Periodontitis; Polymethacrylic Acids; Rats; Rats, Sprague-Dawley; Tetracycline

A dual local drug delivery system (DDS) composed of calcium phosphate bioceramic nanocarriers aimed at treating the antibacterial, anti-inflammatory, and bone-regenerative aspects of periodontitis has been developed. Calcium-deficient hydroxyapatite (CDHA, Ca/P = 1.61) and tricalcium phosphate (β-TCP) were prepared by microwave-accelerated wet chemical synthesis method. The phase purity of the nanocarriers was confirmed by x-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FT-IR), while the transmission electron microscopy (TEM) confirmed their nanosized morphology. CDHA was selected as carrier for the antibiotic (tetracycline) while TCP was chosen as the anti-inflammatory drug (ibuprofen) carrier. Combined drug release profile was studied in vitro from CDHA/TCP (CTP) system and compared with a HA/TCP (BCP) biphasic system. The tetracycline and ibuprofen release rate was 71 and 23% from CTP system as compared to 63 and 20% from BCP system. CTP system also showed a more controlled drug release profile compared to BCP system. Modeling of drug release kinetics from CTP system indicated that the release follows Higuchi model with a non-typical Fickian diffusion profile. In vitro biological studies showed the CTP system to be biocompatible with significant antibacterial and anti-inflammatory activity. In vivo implantation studies on rat cranial defects showed greater bone healing and new bone formation in the drug-loaded CTP system compared to control (no carrier) at the end of 12 weeks. The in vitro and in vivo results suggest that the combined drug delivery platform can provide a comprehensive management for all bone infections requiring multi-drug therapy.

Topics: 3T3 Cells; Animals; Anti-Bacterial Agents; Anti-Inflammatory Agents; Biocompatible Materials; Bone Regeneration; Calcium Phosphates; Delayed-Action Preparations; Disease Models, Animal; Drug Delivery Systems; Female; Hydroxyapatites; Ibuprofen; Mice; Nanoparticles; Periodontitis; Rats; Tetracycline

Controlled drug release is a process in which a predetermined amount of drug is released for longer period of time, ranging from days to months, in a controlled manner. In this study, novel drug delivery devices were fabricated via blend electrospinning and coaxial electrospinning using poly lactic glycolic acid (PLGA), gum tragacanth (GT) and tetracycline hydrochloride (TCH) as a hydrophilic model drug in different compositions and their performance as a drug carrier scaffold was evaluated. Scanning electron microscopy (SEM) results showed that fabricated PLGA, blend PLGA/GT and core shell PLGA/GT nanofibers had a smooth and bead-less morphology with the diameter ranging from 180 to 460 nm. Drug release studies showed that both the fraction of GT within blend nanofibers and the core-shell structure can effectively control TCH release rate from the nanofibrous membranes. By incorporation of TCH into core-shell nanofibers, drug release was sustained for 75 days with only 19% of burst release within the first 2h. The prolonged drug release, together with proven biocompatibility, antibacterial and mechanical properties of drug loaded core shell nanofibers make them a promising candidate to be used as drug delivery system for periodontal diseases.

Topics: Anti-Bacterial Agents; Bacteria; Cell Proliferation; Cells, Cultured; Drug Carriers; Electrochemical Techniques; Fibroblasts; Humans; Lactic Acid; Nanofibers; Nanotechnology; Particle Size; Periodontitis; Polyglycolic Acid; Polylactic Acid-Polyglycolic Acid Copolymer; Porosity; Tetracycline; Tissue Engineering; Tissue Scaffolds; Tragacanth

Tetracyclines are used to treat a range of oral conditions. Their efficacy in the treatment of periodontitis is well established, and they are authoritatively recommended in the management of avulsed teeth. There is a growing evidence base to support the use of tetracycline to treat recurrent aphthous stomatitis, but its use in white spongy naevus is limited to a handful of case reports. The mechanism of action in these conditions is either unknown or indicated to be through the inhibition of matrix metalloproteinases (MMP). The use of a single agent to treat diverse oral conditions has important implications for oral medicine.

Topics: Anti-Bacterial Agents; Hamartoma; Humans; Matrix Metalloproteinase Inhibitors; Mouth Diseases; Periodontitis; Stomatitis, Aphthous; Tetracycline; Tooth Avulsion

Most of the tissue destruction in periodontal disease is caused by the patient's inflammatory response. Classical approaches to controlling inflammation rely on attempts to eliminate pathogenic bacteria that incite the inflammatory response through mechanical or chemical means. This approach still has a place in treating periodontal inflammation today. Emerging and future approaches will rely more on modifying the inflammatory response itself, by limiting the activity of proinflammatory pathways and by amplifying pathways that resolve inflammation.

Topics: Anti-Infective Agents, Local; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Bone Density Conservation Agents; Dental Scaling; Diphosphonates; Gingivitis; Humans; Inflammation Mediators; Oral Hygiene; Periodontitis; Tetracycline

The aim of this study was to compare subgingival irrigation with tetracycline hydrochloride (TTC-HCL) as adjunctive treatment to scaling and root planning (SRP) on induced periodontitis in rats.. In 60 rats, periodontal disease was ligature-induced at the mandibular left first molar. After 7 days, the ligature was removed and all animals were submitted to SRP, and divided into 2 groups according to the following treatment: C (n=30) - subgingival irrigation with 1 mL of saline; T (n=30) - subgingival irrigation with 1 mL of TTC-HCL (50 mg/mL). Ten animals in each group were euthanized at 7, 15 and 30 days posttreatment. The histometric values were statistically analyzed (p<0.05).. In the histometric analysis, at 7, 15 and 30 days, Group T (0.72 ± 0.05 mm², 0.57 ± 0.14 mm², 0.62 ± 0.07 mm²), showed less bone loss (p<0.05) than Group C (1.35 ± 0.25 mm²; 1.40 ± 0.31 mm²; 1.29 ± 0.27 mm²), respectively.. Subgingival irrigation with TTC-HCL was an effective adjunctive treatment for periodontal disease induced in rats.

Topics: Analysis of Variance; Animals; Anti-Bacterial Agents; Combined Modality Therapy; Dental Scaling; Male; Periodontitis; Rats; Rats, Wistar; Root Planing; Tetracycline; Therapeutic Irrigation; Time Factors

This study evaluated the occurrence of enteric bacteria and pseudomonads resistant to tetracycline and β-lactams in the oral cavity of patients exhibiting gingivitis (n=89), periodontitis (n=79), periodontally healthy (n=50) and wearing complete dentures (n=41). Microbial identification and presence of resistance markers associated with the production of β-lactamases and tetracycline resistance were performed by using biochemical tests and PCR. Susceptibility tests were carried out in 201 isolates of enteric cocci and rods. Resistance to ampicillin, amoxicillin/clavulanic acid, imipenem, meropenem and tetracycline was detected in 57.4%, 34.6%, 2.4%, 1.9% and 36.5% of the isolates, respectively. β-lactamase production was observed in 41.2% of tested microorganisms, while the most commonly found β-lactamase genetic determinant was gene blaTEM. Tetracycline resistance was disseminated and a wide scope of tet genes were detected in all studied microbial genus.

Topics: Adult; Anti-Bacterial Agents; beta-Lactam Resistance; beta-Lactamases; beta-Lactams; Biomarkers; Denture, Complete; Enterobacteriaceae; Female; Genes, Bacterial; Gingivitis; Humans; Male; Mouth; Periodontitis; Polymerase Chain Reaction; Pseudomonas; Tetracycline; Tetracycline Resistance

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

A study was conducted to evaluate in vitro the effect of root surface conditioning with basic fibroblast growth factor (b-FGF) on morphology and proliferation of fibroblasts. Three experimental groups were used: non-treated, and treated with 50 microg or 125 microg b-FGF/ml. The dentin samples in each group were divided into subgroups according to the chemical treatment received before application of b-FGF: none, or conditioned with tetracycline-HCl or EDTA. After contact with b-FGF for 5 min, the samples were incubated for 24 h with 1 ml of culture medium containing 1 x 10(5) cells/ml plus 1 ml of culture medium alone. The samples were then subjected to routine preparation for SEM, and random fields were photographed. Three calibrated and blind examiners performed the assessment of morphology and density according to two index systems. Classification and regression trees indicated that the root surfaces treated with 125 microg b-FGF and previously conditioned with tetracycline-HCl or EDTA presented a morphology more suggestive of cellular adhesion and viability (P = 0.004). The density of fibroblasts on samples previously conditioned with EDTA, regardless of treatment with b-FGF, was significantly higher than in the other groups (P < 0.001). The present findings suggest that topical application of b-FGF has a positive influence on both the density and morphology of fibroblasts.

Topics: Cell Adhesion; Cell Proliferation; Cell Shape; Cells, Cultured; Chelating Agents; Dentin; Edetic Acid; Fibroblast Growth Factor 2; Fibroblasts; Humans; Periodontitis; Protein Synthesis Inhibitors; Regression Analysis; Tetracycline; Tooth Root

The present in vitro study has been designed to establish and compare the effects of citric acid, EDTA, and tetracycline HCl on human periodontally diseased roots on the structure, attachment, and orientation of V79 (primary Chinese hamster lung fibroblasts) cells and human periodontal ligament fibroblasts (HPDL).. Commercially available V79 cells and HPDL derived from healthy human third molars were used in this study. These fibroblasts were left in solution for seven days in order to attain confluence. Forty single-rooted teeth were obtained from patients diagnosed with periodontitis. The crown part was removed under constant irrigation and the root was split vertically into two equal halves, thus, yielding 80 specimens. Following scaling and root planing, the specimens were washed with phosphate buffered saline (PBS) and kept in 50 microg/ml gentamycin sulphate solution for 24 hours. The root pieces were then treated as follows: citric acid at pH 1, 24% EDTA, or with a 10% solution of tetracycline HCl and were then placed in V79 fibroblast cultures and HPDL cultures. The specimens were harvested after four weeks and were fixed in 2.5% glutaraldehyde in PBS before preparation for scanning electron microscopy (SEM).. The behavior of V79 cells was similar to that of human periodontal ligament cells on root conditioned surfaces. V79 and HPDL showed a healthy morphology on root surfaces treated with citric acid and EDTA and a relatively unhealthy appearance on root surfaces treated with tetracycline HCl and distilled water (control group).. The results suggest the use of citric acid and EDTA as root conditioning agents favorably affects the migration, attachment, and morphology of fibroblasts on human root surfaces, which may play a significant role in periodontal healing and regeneration.

Topics: Animals; Anti-Bacterial Agents; Cell Adhesion; Cell Line, Transformed; Cell Proliferation; Chelating Agents; Citric Acid; Cricetinae; Cricetulus; Dental Etching; Edetic Acid; Fibroblasts; Humans; Microscopy, Electron, Scanning; Periodontal Ligament; Periodontitis; Regeneration; Smear Layer; Surface Properties; Tetracycline; Tooth Root

Topics: Anti-Bacterial Agents; Dental Devices, Home Care; Drug Delivery Systems; Female; HIV Infections; Humans; Occlusal Splints; Periodontitis; Temporomandibular Joint Disorders; Tetracycline

The hypothesis that nifedipine-induced gingival enlargement in periodontitis patients can be treated with the adjunctive use of tetracycline (TCN) fibers was tested in this study.. Ten patients (mean age 66 +/- 4 years) with chronic periodontitis combined with nifedipine-induced gingival enlargement participated. Full mouth recordings of clinical parameters (probing depth, clinical attachment level, bleeding on probing, presence or absence of plaque) were assessed at baseline and gingival enlargement was estimated from casts. Participants were instructed in proper oral hygiene and received supragingival scaling before being reassessed 1 month later. They subsequently received full-mouth scaling and root planing followed by the immediate placement of TCN fibers in all pockets >5 mm. Clinical parameters were reassessed at 3, 6, and 12 months after completion of treatment.. TCN fiber placement was well tolerated by patients. All clinical parameters recorded displayed significant improvements after treatment, and they were preserved for the 12-month experimental period. A significant reduction of the percentage of pockets >5 mm was noticed after treatment. The reduction of enlargement was still observed at 12 months despite patients not achieving optimal oral hygiene.. Placement of tetracycline fibers as an adjunct to mechanical treatment is an option for the non-invasive therapy of nifedipine-induced gingival enlargement in periodontitis patients whose general medical condition and concomitant ailments do not favor a surgical approach.

Topics: Aged; Analysis of Variance; Anti-Bacterial Agents; Calcium Channel Blockers; Gingival Overgrowth; Humans; Male; Nifedipine; Periodontitis; Tetracycline

A novel drug delivery system for the treatment of periodontitis was developed using two components. The first was tetracycline base loaded into the microtubular excipient halloysite, which was coated with chitosan to further retard drug release. Encapsulation efficiencies of 32.5% were achieved with the loading procedure, with tetracycline base showing in vitro release for up to 50 days in simulated gingival crevicular fluid. The second component developed was a vehicle for the drug loaded coated halloysite, which was primarily based on the thermoresponsive polymer, poloxamer 407. A concentration of 20% was chosen with the thermoresponsivity of the system modified using PEG 20,000 so that the mobile product at room temperature would gel by temperature rise following syringing into a periodontal pocket. Retention of the overall system in the pocket was further improved by the addition of octyl cyanoacrylate (OCA). The thermoresponsivity of the poloxamer 407 system proved to be sensitive to the presence of added excipients with the levels of PEG 20,000 and OCA requiring modification in the presence of the halloysite component. A final formulation was developed which consisted of 200 mg of halloysite double loaded with tetracycline base and coated with chitosan, suspended in 1 ml of poloxamer 407 20% (w/w), PEG 20,000 0.5% (w/w), OCA 1.0% (w/w), water to 100%, adjusted to pH 4. The syringeability of this formulation at various temperatures was evaluated to ensure ease of delivery to the periodontal pocket. A stability study was performed to examine the change in thermoresponsivity over time, with the final formulation found to be stable for at least 9 months when stored at room temperature (approximately 20 degrees C). This formulation offered ease of delivery to the periodontal pocket and sustained release of the antibiotic for up to 6 weeks. The formulation had preliminary in vivo testing performed in dogs to determine levels of drug release, antimicrobial activity and retentive ability of the product. A wound pocket creation model was developed for the purposes of the trial. The product was easy to deliver to the pockets with application times of less than 1 min. Results showed the product was retained in the pocket for up to 6 weeks with effective tetracycline levels released locally over this time period, which achieved good antibacterial activity.

Topics: Aluminum Silicates; Animals; Chemistry, Pharmaceutical; Clay; Dogs; Drug Delivery Systems; Male; Mouth; Periodontal Pocket; Periodontitis; Poloxamer; Tetracycline

The current research study is based on the design and development of a sol-gel biodegradable controlled-release formulation for use in the treatment of periodontal diseases. Glycerylmonooleate (GMO) was used as a main composition in the gel base. The influence of various additives, e.g., glycerylmonostearate (GMS), methylcellulose (MC), surfactants, and triglycerides, in GMO formulations on rheologic and swelling properties and release characteristics was described. It was demonstrated that the surfactants and triglycerides affected rheologic behavior, whereas GMS and MC influenced both rheologic and swelling properties of the bases. The release study revealed that drug released from the gel bases depended on the square root of time. The kinetics can be explained by the Higuchi's diffusion theory. Some polyols could enhance drug release from the gel. The stability results suggested that the dental gels obtained should be kept in the low temperature range.

Topics: Anti-Bacterial Agents; Delayed-Action Preparations; Drug Stability; Excipients; Gels; Glycerides; Periodontitis; Rheology; Solubility; Technology, Pharmaceutical; Temperature; Tetracycline

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

Two different PCR-based molecular approaches, a commercial kit for detection of A. actinomycetemcomitans, P. gingivalis, P. intermedia, B. forsythus and T. denticola (Amplimedical "Paradonthosis") and a home-made multiplex PCR for A. actinomycetemcomitans, P. gingivalis and B. forsythus were compared for monitoring the efficacy of different dental treatments on localized persistent periodontal pockets. 44 sites were randomized in two treatment groups: mechanical treatment (22 control sites) and in conjunction with the application of tetracycline fibres (22 experimental sites). 40/44 sites were found positive with both tests for A. actinomycetemcomitans, P. gingivalis and B. forsythus pretheraphy. P. intermedia was detected alone in only three sites during the follow-up, while T. denticola. was always associated with the other pathogens. 20 sites were positive in conventional cultures for one to three of the pathogens. PCR-based approaches provided a sensitive and reliable method for identification and monitoring treatment of periodontal pathogens.

Topics: Actinobacillus Infections; Aggregatibacter actinomycetemcomitans; Bacteroides; Bacteroides Infections; DNA, Bacterial; Humans; Middle Aged; Periodontitis; Polymerase Chain Reaction; Pseudomonas; Pseudomonas Infections; Tetracycline

The hypothesis was tested that bacterial susceptibilities in aggressive periodontitis change upon administration of systemic antibiotics as adjuncts to periodontal therapy.. In 23 subjects (average age 38.9+/-6.7 years) with aggressive periodontitis, microbial parameters were assessed prior to and 1 year after completion of comprehensive mechanical/surgical and systemic antimicrobial therapy. Following identification of five selected pathogens with the Rapid ID 32 A system, their susceptibilities towards amoxicillin/clavulanate potassium, metronidazole, and tetracycline were examined with the E-test. Antibiotics were administered according to the test results, and the minimal inhibitory concentrations (MIC90) were reevaluated after 1 year. Statistical analysis was performed on a patient basis, with the site data used for evaluation of the MIC levels.. Bacterial MIC levels remained constant among the three antibiotic treatment groups compared with baseline. Mean MIC90 values ranged from <0.02 to 0.11 microg/ml (amoxicillin/clavulanate potassium), <0.02 to 0.27 microg/ml (metronidazole), and <0.02 to 0.11 microg/ml (tetracycline). Observed changes in susceptibility were attributed to the elimination of single bacterial taxa in the subgingival environment after antibiotic therapy. There were no statistically significant differences in clinical parameters among the treatment groups. Single tetracycline MICs were 1.5- to 6-fold enhanced compared to amoxicillin/clavulanate potassium and metronidazole.. The periodontal pathogens investigated prior to and 1 year after periodontal therapy are tested sensitive to the antimicrobial agents. In aggressive periodontitis, changes in bacterial susceptibility upon the administration of systemic antibiotics are associated with the limited number of isolates tested following therapy.

Topics: Adult; Aggregatibacter actinomycetemcomitans; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Combined Modality Therapy; Dental Plaque; Drug Resistance, Bacterial; Drug Therapy, Combination; Female; Follow-Up Studies; Gram-Negative Bacteria; Humans; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Periodontal Diseases; Periodontitis; Pilot Projects; Statistics, Nonparametric; Tetracycline

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

A variety of treatment modalities have been proposed for the management of peri-implantitis. These are mostly based on empiric experience and use the systemic administration of an antibiotic in conjunction with surgical intervention. To ensure decontamination of the affected implant surface(s), chemical and/or mechanical debridement is used. For textured implant surfaces, detoxification using implantoplasty could also give favorable results when used as part of the procedure. Two cases are reported in which implants developed localized peri-implantitis lesions. Implantoplasty followed by topical tetracycline decontamination was used in conjunction with guided bone regeneration. In both cases, the procedures were effective in arresting disease and regenerating lost bone. These results suggest that the technique holds promise and should be investigated further.

Topics: Adult; Anti-Bacterial Agents; Bone Regeneration; Decontamination; Dental Implantation, Endosseous; Dental Implants; Dental Polishing; Female; Guided Tissue Regeneration, Periodontal; Humans; Male; Middle Aged; Periodontitis; Surface Properties; Tetracycline

The aim of this study was to determine the distribution patterns of Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans in periodontitis patients after standard mechanical periodontal therapy, and to evaluate the effect of additional local antibiotic therapy, given to all teeth with cultural evidence of these bacteria.. 17 patients were included. 852 separate subgingival microbial samples were taken from the mesial and distal aspect of every tooth in 17 subjects at baseline. 46 of these samples, from 10 positive subjects, showed cultural evidence for P. gingivalis. 82 samples, from 5 subjects, were A. actinomycetemcomitans-positive. Three subjects showed no evidence for persistence of A. actinomycetemcomitans or P. gingivalis. In the other 14 subjects, all A. actinomycetemcomitans- or P. gingivalis-positive teeth were treated with tetracycline fibers (ACTISITE(R)). Sub-gingival microbial samples were again taken from two sites of every tooth, 1 month after fiber removal. 89% of the initially P. gingivalis-positive sites were now negative, but 16 previously negative sites now tested positive. 77% of the initially A. actinomycetemcomitans-positive sites were now negative, but 5 previously negative sites now tested positive. The teeth with persisting P. gingivalis or A. actinomycetemcomitans were again treated with fibers. Two sites of every tooth were once more sampled after 1 month. At this time, 5 subjects still showed cultural evidence of P. gingivalis at a total of 19 sites, and 4 subjects were positive for A. actinomycetemcomitans in a total of 27 sites. These 9 patients were finally submitted to systemic antibiotic therapy (3 x 250 mg metronidazole plus 3 x 375 mg amoxicillin/d for 7 days). Despite of all efforts, P. gingivalis was again detected 3 months later in isolated sites in 3 subjects, and A. actinomycetemcomitans could be cultivated from one single site.. Therapy with tetracycline fibers guided by microbiological diagnosis effectively reduced P. gingivalis and A. actinomycetemcomitans locally, but was unable to completely eradicate the target organisms. Additional systemic antibiotic therapy further reduced P. gingivalis and A. actinomycetemcomitans. The observed persistence patterns suggest that reemergence of A. actinomycetemcomitans was due to recolonization, whereas the strikingly reproducible local reemergence of P. gingivalis in some sites indicated failed eradication.

Topics: Administration, Topical; Aggregatibacter actinomycetemcomitans; Amoxicillin; Anti-Bacterial Agents; Cellulose; Colony Count, Microbial; Humans; Logistic Models; Metronidazole; Periodontitis; Porphyromonas gingivalis; Tetracycline

In summary, the present commentary proposes a hypothesis that alveolar bone remodeling and bone loss in periodontitis, periodontal surgery, and in orthodontic tooth movement is triggered by a common "strain relaxation" signaling pathway of gingival and periodontal fibroblasts. The abrupt splitting, degradation, or relaxation of collagen fibers in the marginal periodontium produces a "strain relaxation" signal in the local fibroblasts which reside on these fibers, activating an ECM-integrin-cytoskeleton pathway. A cascade of cellular reactions which lead to osteoclastic bone resorption starting on the inner aspect (periodontal) of the alveolar bone then persists. A novel therapeutic approach is suggested here by using locally delivered drugs intervening in the cell contractile apparatus.

Topics: Alveolar Bone Loss; Animals; Anti-Bacterial Agents; Collagen; Dental Stress Analysis; Fibroblasts; Humans; Matrix Metalloproteinase Inhibitors; Matrix Metalloproteinases; Periodontitis; Periodontium; Signal Transduction; Stress, Mechanical; T-Lymphocytes; Tensile Strength; Tetracycline

The semisolid consistency of poly(ortho esters) (POEs) containing tetracycline free base allows direct injection in the periodontal pocket and shows sustained and almost constant in vitro release in phosphate buffer, pH 7.4 at 37 degrees C, for up to 14 days. Total polymer degradation concomitant with drug release was obtained. Formulations containing 10% or 20% (wt/wt) tetracycline were evaluated in a panel of 12 patients suffering from severe and recurrent periodontitis. In the first trial including 6 patients, single-rooted teeth and molar teeth with furcations were treated immediately after scaling and root planing. Patients tolerated both formulations well, experienced no pain during application, and showed no signs of irritation or discomfort during the observation period. However, retention of the formulation was minimal in this first study. An improved clinical protocol followed in the second study (stopping bleeding after scaling and root planning) prolonged the retention of the formulations in the inflamed periodontal pockets. For up to 11 days, tetracycline concentrations in the gingival crevicular fluid were higher than the minimum inhibitory concentration of tetracycline against most periodontal pathogens.

Topics: Adult; Biodegradation, Environmental; Chemistry, Pharmaceutical; Delayed-Action Preparations; Drug Carriers; Drug Delivery Systems; Humans; Periodontal Pocket; Periodontitis; Polymers; Tetracycline

Twenty four human teeth, extracted due to severe periodontitis were used in the present Following extraction, the border between healthy and diseased was marked with a small dental bur. The portions of diseased roots were either untreated or were treated with ultrasonic scaling or tetracycline hydrochloride, or ultrasonic scaling followed by tetracycline hydrochloride. Human gingival fibroblasts were then added to the roots so treated and were allowed to incubate for 72 h and examined by scanning electron microscopy. There were a significantly greater number of fibroblasts attached to specimens treated with ultrasonic scaling and ultrasonic scaling followed by root demineralization. No cells were could be seen on the untreated surfaces whether or not root surface conditioning was used.

Topics: Anti-Bacterial Agents; Cell Adhesion; Dental Scaling; Fibroblasts; Gingiva; Humans; Microscopy, Electron, Scanning; Periodontitis; Random Allocation; Smear Layer; Tetracycline; Tooth Root; Ultrasonic Therapy

This prospective study was designed to investigate amoxicillin-resistant oral anaerobes, and to identify their beta-lactamase-encoding genes. Three subgingival bacterial samples were collected from 12 patients suffering from periodontitis. One to seven beta-lactamase-producing strains were obtained from each patient, mostly belonging to the Prevotella genus (Bacteroides eggerthii, 2/35 strains; Prevotella sp., 33/35 strains). PCR assays were used to detect cfxA and cepA/cblA, the genes encoding class A/group2e beta-lactamases previously described in the Bacteroides fragilis group. The present investigation confirmed the role of Prevotella species as beta-lactamase producers in periodontal pockets. Additionally, this PCR screening showed (1): the high prevalence of CfxA beta-lactamase production by aminopenicillin-resistant Prevotella (32/33: 97.0% positive strains) vs. cepA/cblA (1/33: 3.0% positive strains), and (2) the presence of cfxA in the periodontal reservoir in the absence of antimicrobial therapy during the previous 6 months.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; beta-Lactamases; Drug Resistance, Bacterial; Drug Therapy, Combination; Erythromycin; Fimbriae Proteins; Genes, Bacterial; Humans; Membrane Proteins; Penicillin Resistance; Penicillins; Periodontal Pocket; Periodontitis; Phenotype; Polymerase Chain Reaction; Prevotella; Prospective Studies; Tetracycline; Tetracycline Resistance

The scanning electron microscope was used to evaluate the dentin surface of diseased teeth subjected to two methods of conditioning with tetracycline hydrochloride (TTC) for 1 and 4 minutes respectively. Five groups of twelve specimens each received root planing (control); were immersed in TTC for 1 and 4 minutes; and burnished in TTC for 1 and 4 minutes. Control specimens exhibited an amorphous irregular surface smear layer. TTC, irrespective of the method used, was effective in removing the smear layer. Immersion in TTC for 1 minute revealed obstructed dentinal tubules, while burnishing for 1 minute revealed the presence of collagen fibrils. The 4-minute application of TTC, irrespective of the conditioning method used, showed wide exposed dentinal tubules. No significant difference between Groups III, IV, and V was noted (p>0.05).

Topics: Analysis of Variance; Decalcification Technique; Dentin; Dose-Response Relationship, Drug; Fibrillar Collagens; Humans; Microscopy, Electron, Scanning; Periodontitis; Root Planing; Smear Layer; Statistics, Nonparametric; Tetracycline; Time Factors; Tooth Root

A conceptually novel periodontal drug delivery system (DDS) is described that is intended for treatment of microbial infections associated with periodontitis. The DDS is a composite wafer with surface layers possessing adhesive properties, while the bulk layer consists of antimicrobial agents, biodegradable polymers, and matrix polymers. The wafers contain poly(lactic-co-glycolic acid) as the main bioerodible component used in the bulk layer and ethyl cellulose applied as a matrix polymer enabling diffusion-controlled release. Starch and other polymers in combination with AgNO(3) serve as coatings adhesive to the teeth. In vitro experiments demonstrate that the wafers are capable of zero-order release of antimicrobial agents such as silver nitrate, benzylpenicillin, and tetracycline, for over 4 weeks.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Cellulose; Cross-Linking Reagents; Drug Delivery Systems; Excipients; Gingiva; Lactic Acid; Microscopy, Electron, Scanning; Penicillin G; Penicillins; Periodontitis; Polyethylene Glycols; Polyglycolic Acid; Polylactic Acid-Polyglycolic Acid Copolymer; Polymers; Silver Nitrate; Tetracycline

In the present study both the short- and the long-term effects were evaluated of a treatment that, during the phase of basic therapy, included administration of systemic tetracycline and non-surgical intervention.. 35 adult human subjects with advanced periodontitis, 19 females and 16 males, aged between 24 and 60 years, were included in a test group. 80 age- and sex-matched adult periodontitis subjects were recruited for a control group (42 females and 38 males). A baseline examination included assessment of the following parameters: number of teeth, plaque, bleeding on probing, probing attachment level, probing pocket depth. In radiographs, the distance between the cemento-enamel junction and the alveolar bone crest was determined at all interproximal sites. The subjects were given oral hygiene instruction. The members of the test group were provided with tablets with 250 mg of tetracycline hydrochloride and were instructed to take 1 tablet 4x per day for a period of 3 weeks. No antibiotic was given to the subjects in the control group. During the 3-week interval, all participants received 4-6 sessions of non-surgical periodontal therapy. All subjects were subsequently enrolled in a maintenance care program and were provided with supportive periodontal therapy (SPT) 3-4x per year. Clinical re-examinations were performed after 1, 3, 5 and 13 years.. The present investigation demonstrated that tetracycline administered during a 3-week period concomitant with non-surgical treatment enhanced the outcome of mechanical therapy. At the re-examination 1 year after active therapy, there was in the test group an average gain in probing attachment that was almost 3x higher than the gain that occurred in an age and sex matched Control group. Re-examinations after 3, 5, and 13 years of SPT disclosed that this short-term benefit was not maintained in the longer perspective.. The beneficial effect of systemically administered tetracycline on probing attachment level occurred in the first year post-therapy. Annual rates of probing attachment level change from 1 to 13 years did not differ between groups.

Topics: Adult; Alveolar Bone Loss; Anti-Bacterial Agents; Case-Control Studies; Combined Modality Therapy; Dental Plaque Index; Dental Scaling; Female; Follow-Up Studies; Gingival Hemorrhage; Humans; Longitudinal Studies; Male; Middle Aged; Oral Hygiene; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Periodontitis; Root Planing; Statistics as Topic; Tablets; Tetracycline; Treatment Outcome

The purpose of this study was to investigate the clinical, microbiological and radiological effects of peri-implantitis therapy by local delivery of tetracycline. In 25 partially edentulous patients, 30 implants with radiographic evidence of circumferential bone loss, and peri-implant probing depths > or =5 mm were treated with polymeric tetracycline HCl-containing fibers. Clinical and microbial parameters were recorded at baseline, and 1, 3, 6, and 12 months (M) after treatment. Standardized radiographs were obtained at baseline, M3, and one year after treatment. Two patients were discontinued from the study after 180 days because of persisting active peri-implantitis with pus formation. The remaining subjects showed a significant decrease of mean peri-implant probing depth from 6.0 to 4.1 mm (M1, P<0.001), which was maintained over 12 months. In comparison to baseline, the bleeding tendency was significantly reduced after one month, and thereafter (P<0.001). No significant recession of the mucosal margin was noted. The radiologically determined distance from the shoulder of the implant to the bottom of the bony defect decreased slightly, but not significantly, from 5.2 to 4.9 mm. At M1, M3 and M6, mean total anaerobic cultivable bacterial counts were significantly lower than at baseline (P<0.001). A significant decrease in frequency of detection was noted for Prevotella intermedia/nigrescens, Fusobacterium sp., Bacteroides forsythus, and Campylobacter rectus (P<0.01). Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Eikenella corrodens had very low baseline frequencies that could not be significantly suppressed further. In conclusion, therapy of peri-implantitis by local delivery of tetracycline had a positive effect on clinical and microbiological parameters.

Topics: Administration, Topical; Alveolar Bone Loss; Anti-Bacterial Agents; Bacteria, Anaerobic; Biocompatible Materials; Cellulose; Colony Count, Microbial; Dental Implants; Drug Delivery Systems; Female; Gram-Negative Bacteria; Humans; Linear Models; Male; Periodontitis; Prosthesis-Related Infections; Radiography; Statistics, Nonparametric; Tetracycline

A field study using five different private periodontal practices was conducted; it compared two microbiologic culture samples simultaneously secured from the same sites within 23 individual patients and submitted for bacterial identification and antibiotic sensitivity testing to two separate laboratories. The results from the two laboratories were often different. In no instance did both laboratories agree on the presence of identical bacterial species. When only bacteria above threshold levels were compared, agreement was found in only nine of 23 cases. When examining antibiotic sensitivity, using 100% kill of all tested pathogens as the ideal, agreement between the two laboratories was poor. The laboratories agreed on the use of amoxicillin 17% of the time, tetracycline 26% of the time, and metronidazole 48% of the time. The use of amoxicillin and metronidazole in combination yielded a 78% agreement when the results of both laboratories were combined. It would appear from the data that the empirical use of amoxicillin-metronidazole combination therapy may be more clinically sound and cost effective than culturing and antibiotic selection based on the results of culture from any single microbiologic testing laboratory.

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Bacteria; Bacteriological Techniques; Bacteroides; Campylobacter; Cost-Benefit Analysis; Drug Combinations; Drug Resistance, Microbial; Humans; Laboratories, Dental; Metronidazole; Middle Aged; Penicillin Resistance; Penicillins; Peptostreptococcus; Periodontitis; Porphyromonas gingivalis; Prevotella intermedia; Reproducibility of Results; Tetracycline; Tetracycline Resistance

The AB Biodisk Etest showed that 106 (100%) and 98 (92%) isolates of Eikenella corrodens were susceptible to amoxicillin and tetracycline, respectively. Twenty-three (68%) Prevotella intermedia isolates and 14 (67%) Prevotella nigrescens isolates were susceptible to amoxicillin. Seventy-nine percent of the P. intermedia isolates and 67% of the P. nigrescens isolates were susceptible to tetracycline. A higher percentage of beta-lactamase-producing isolates of P. intermedia and P. nigrescens were identified with selective agar containing amoxicillin than with nonselective agar.

Topics: Amoxicillin; Anti-Bacterial Agents; Culture Media; Eikenella corrodens; Humans; Microbial Sensitivity Tests; Penicillins; Periodontitis; Prevotella; Prevotella intermedia; Tetracycline

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

To longitudinally determine if early therapeutic intervention, based on a positive neutral protease activity (NPA) assay score could effectively arrest the progress of periodontal disease destruction.. 63 periodontal sites which had previously undergone probing attachment loss were identified from among 31 previously treated adult periodontitis patients who were monitored during periodontal maintenance for an average of 3 yrs. Clinical levels of gingival inflammation and attachment levels and NPA assay data were collected at the beginning of each maintenance visit. When a site tested negative with the assay, routine Supportive Periodontal Therapy (SPT) was followed during the same appointment, while sites exhibiting a positive NPA score received more aggressive periodontal treatment.. During the study period, 51 of 63 sites displayed at least one positive NPA score. Our protocol of administering periodontal treatment rendered at the visit showing a positive NPA score revealed that only 1 of the 51 sites lost > or = 1 mm attachment during the study period. The remaining 50 positive assay sites showed an overall gain of > or = 1 mm of probing attachment over the course of the study. 12 of 63 sites consistently tested negative for neutral protease enzyme activity and remained stable, although 9 of these sites exhibited bleeding on probing (BOP) at least once during this study. Initial group mean probing attachment measurements were 5.6 mm for NPA negative and 5.7 mm for NPA positive sites.

Topics: Adult; Aged; Analysis of Variance; Anti-Bacterial Agents; Anti-Infective Agents, Local; Biocompatible Materials; Cellulose; Chlorhexidine; Dental Plaque; Dental Scaling; Drug Delivery Systems; Endopeptidases; Female; Follow-Up Studies; Gingival Crevicular Fluid; Gingival Hemorrhage; Gingivitis; Humans; Longitudinal Studies; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Diseases; Periodontitis; Reproducibility of Results; Root Planing; Subgingival Curettage; Tetracycline

The study on the sensitiveness of slow-growing anaerobes bacteria to antibiotics is delicate when you consider the technical motives that make it difficult to transpose the standard methods frequently used in microbiological laboratories. The three main methods used to determine susceptibility to antibiotics are: disk-diffusion test, antibiotics containing microdilution plates and ATB ANA (bioMérieux). The aim of this study is to compare the effectiveness of each of these methods on severe anaerobes bacteria isolated in sub-gingival flora of patients suffering from developing periodontitis (rapidly progressive periodontitis, refractory periodontitis, active stage of adult chronic periodontitis). The observed bacteria are: Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, Campylobacter rectus, Peptostreptococcus micros. Antibiotics used are: ampicilline, amoxicilline, tetracycline, erythromycine, metronidazole. The comparison of the minimal inhibitory concentrations (M.I.C) of each of these methods has permitted to show a strict correlation in the results observed with these three methods, if only the growth of the severe anaerobes bacteria on agar medium does not exceed 72 hours.

Topics: Adult; Amoxicillin; Ampicillin; Anti-Bacterial Agents; Bacteria, Anaerobic; Campylobacter; Chronic Disease; Diffusion; Drug Resistance, Bacterial; Erythromycin; Fusobacterium nucleatum; Gingiva; Humans; Metronidazole; Microbial Sensitivity Tests; Penicillins; Peptostreptococcus; Periodontitis; Porphyromonas gingivalis; Prevotella intermedia; Recurrence; Tetracycline; Time Factors

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 selection of antibiotic resistance genes during antibiotic therapy is a critical problem complicated by the transmission of resistance genes to previously sensitive strains via conjugative plasmids and transposons and by the transfer of resistance genes between gram-positive and gram-negative bacteria. The purpose of this investigation was to monitor the presence of selected tetracycline resistance genes in subgingival plaque during site specific tetracycline fiber therapy in 10 patients with adult periodontitis.. The polymerase chain reaction (PCR) was used in separate tests for the presence of 3 tetracycline resistance genes (tetM, tetO and tetQ) in DNA purified from subgingival plaque samples. Samples were collected at baseline, i.e., immediately prior to treatment, and at 2 weeks, and 1, 3, and 6 months post-fiber placement. The baseline and 6-month samples were also subjected to DNA hybridization tests for the presence of 8 putative periodontal pathogenic bacteria.. PCR analysis for the tetM resistance gene showed little or no change in 5 patients and a decrease in detectability in the remaining 5 patients over the 6 months following tetracycline fiber placement. The results for tetO and tetQ were variable showing either no change in detectability from baseline through the 6-month sampling interval or a slight increase in detectability over time in 4 of the 10 patients. DNA hybridization analysis showed reductions to unmeasurable levels of the putative periodontal pathogenic bacteria in all but 2 of the 10 patients.. These results complement earlier studies of tet resistance and demonstrate the efficacy of PCR monitoring for the appearance of specific resistance genes during and after antibiotic therapy.

Topics: Adult; Base Sequence; Cellulose; Dental Plaque; DNA Probes; DNA, Bacterial; Drug Delivery Systems; Female; Genes, Bacterial; Gingiva; Humans; Male; Molecular Sequence Data; Periodontitis; Polymerase Chain Reaction; Sequence Analysis, DNA; Tetracycline; Tetracycline Resistance; Time Factors

Topics: Anti-Bacterial Agents; Humans; Periodontitis; Tetracycline

Topics: Anti-Bacterial Agents; Humans; Periodontitis; Tetracycline; Tetracycline Resistance

In the present study, the antibiotic susceptibility of most prevalent micro-organisms in advanced periodontitis patients was evaluated. In 56 patients, pooled subgingival plaque samples were taken from the deepest site of each quadrant and were cultivated anaerobically. From each patient, the 4 most frequently encountered types of bacterial colonies were subcultured and identified (Rapid ID 32 A). From all bacterial species identified in the 224 subcultures, the 4 most prevalent were used for susceptibility testing to tetracycline, metronidazole and amoxicillin/clavulanate using the E Test. The most prevalent microorganisms were Fusobacterium nucleatum (38/214), Peptostreptococcus micros (33/214), Prevotella oralis (33/214) and Porphyromonas gingivalis (32/214). Regarding antibiotic susceptibility it could be shown that minimal inhibitory concentration (MIC) in all cases was below antibiotic concentrations achievable in gingival crevicular fluid. However, antibiotic resistance was seen in 3 to 29% of the investigated microorganisms.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteria, Anaerobic; Biofilms; Dental Plaque; Drug Resistance, Microbial; Female; Fusobacterium nucleatum; Gingival Crevicular Fluid; Humans; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Peptostreptococcus; Periodontal Index; Periodontitis; Porphyromonas gingivalis; Prevotella; Tetracycline; Tetracycline Resistance

The aim of the present study was to analyze the composition of subgingival microflora in patients with refractory periodontitis and to evaluate the antimicrobial sensitivity of isolated periodontopathic microorganisms to different antibiotics.. Eleven subjects with a mean age of 46.4 years were selected for the present study. All had been treated for periodontal disease in the past. After further disease progression patients were included in this study. Eight subgingival plaque samples per patients were collected for cultural analysis.. "Black pigmenting anaerobic bacilli" were the pathogenic microorganisms more frequently isolated. The findings from antibiotic susceptibility test showed that high number of bacteria associated with refractory periodontitis resulted resistant to erythromycin, metronidazole and tetracycline. The most effective antibiotics were ciprofloxacin, amoxicillin-metronidazole and amoxicillin-clavulanic acid.. Microbiological analysis and antibiotic susceptibility test should be considered important tools in the management of patients with poor clinical response to conventional periodontal treatment.

Topics: Anti-Bacterial Agents; Bacteria, Anaerobic; Erythromycin; Gingiva; Humans; Metronidazole; Mouth Mucosa; Periodontitis; Prevalence; Tetracycline

Antibiotic resistance has been increasingly described among bacterial species colonizing periodontal pockets, particularly in Prevotella and Porphyromonas spp. strains producing beta-lactamases, and frequently associated with resistance to tetracycline and erythromycin. These resistance genes may be carried on motile genetic elements, or transposons, capable of interspecies and intergeneric transmission among bacterial strains colonizing a same ecological niche. The aim of this prospective study was to determine the resistance profile of Actinobacillus actinomycetemcomitans and the prevalence of A. actinomycetemcomitans strains producing beta-lactamases in periodontal pockets.. Fifty strains of A. actinomycetemcomitans were isolated from 42 patients with adult periodontitis. No patient had periodontal or antibiotic therapy in the previous 6 months. Bacterial samples were collected from periodontal pockets > or =5 mm, appropriately diluted, inoculated onto selective medium (chocolate blood agar with bacitracin 75 microg/ml and vancomycin 5 microm/ml) and incubated for 5 days at 37 degrees C in air with 5% CO2. After conventional identification, susceptibility testing to 11 antibiotics was performed by the broth dilution method, in trypticase soy broth supplemented with yeast extract, hemin, and 0.1% NaHCO3 to maintain microaerophilic conditions in the microtitration plate wells by CO2 formation.. No strain demonstrated resistance to amoxicillin, amoxicillin-clavulanic acid combination, pristinamycin, or ciprofloxacin at the breakpoint, but 40% of the strains were slightly resistant to penicillin G, and 4% were resistant to erythromycin, 90% to spiramycin, 18% to clarythromycin, 4% to tetracycline, 72% to metronidazole, and 12% to ornidazole. Amoxicillin, followed by tetracycline and erythromycin, was the most effective antibiotic on A. actinomycetemcomitans. The phenotypic research of a beta-lactamase was negative for all the strains tested.. In this work, most A. actinomycetemcomitans strains were resistant to metronidazole, but the amoxicillin-metronidazole association may be of interest against subgingival anaerobic and capnophilic mixed flora. Pristinamycin and ciprofloxacin appeared as effective alternative monotherapies against A. actinomycetemcomitans. The threat of beta-lactam antibiotic resistance related to beta-lactamase production is currently not a problem with A. actinomycetemcomitans as it has been reported in oral anaerobes.

Topics: Adult; Aggregatibacter actinomycetemcomitans; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; beta-Lactamases; Ciprofloxacin; Drug Resistance, Microbial; Erythromycin; Humans; Metronidazole; Microbial Sensitivity Tests; Ornidazole; Periodontal Pocket; Periodontitis; Species Specificity; Spiramycin; Tetracycline; Virginiamycin

The purpose of the present investigation was to use baseline clinical and laboratory parameters to distinguish subjects refractory to conventional periodontal therapy. Baseline clinical, microbial and host parameters were compared in 61 successfully-treated and 27 refractory subjects. Refractory subjects showed mean full-mouth attachment level (AL) loss and/or >3 sites with new AL loss >2.5 mm within 1 year after both scaling and root planing and surgery with systemic tetracycline. Successfully-treated subjects showed mean AL gain and no sites with new AL loss >2.5 mm after either regimen. Gingival redness, bleeding on probing, suppuration, supragingival plaque accumulation, pocket depth and AL were measured at 6 sites per tooth in each subject. The levels of 40 subgingival taxa were determined in subgingival plaque samples from up to 28 sites in each subject using checkerboard DNA-DNA hybridization. Serum antibody (Ab) to 85 subgingival species was determined using checkerboard immunoblotting. Levels of serum IgG2 and Gm23 allotype were measured using radial immunodiffusion; FcgammaRIIa and FcgammaRIIIb receptor haplotypes were determined using PCR and allele specific oligonucleotide probes. Odds ratios of a subject being refractory were determined by comparing measured parameters in the 2 subject groups using univariate and multivariate techniques. 17 of 151 clinical, microbial and immunological variables were significant using chi2 analysis after adjusting for multiple comparisons. For example, the odds ratios of a subject being refractory were 12.2, 5.4 and 6.9 if the subject had Ab >50 microg/ml to >9 species; S. constellatus counts >2.4% of the total DNA probe count or >2.1% of sites with AL >6 mm. The 17 significant predictor variables were used in logistic regression and discriminant analyses. Similar variables were selected using both analyses including the number of serum Ab to subgingival species >50 microg/ml, % S. constellatus in plaque samples and % sites with attachment loss >6 mm. In the logistic regression analysis model, the odds ratios associated with >9 species exhibiting >Ab 50 microg/ml, >2.1% of sites with AL >6 mm and >2.4% S. constellatus in plaque were 8.7, 6.8 and 2.4, respectively, after adjusting for other variables in the model. Discriminant analysis using these variables provided sensitivity, specificity, positive and negative predictive values of 0.66, 0.92, 0.80 and 0.85 respectively. Refractory periodontitis subjects coul

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Chi-Square Distribution; Dental Plaque; Dental Scaling; Discriminant Analysis; DNA, Bacterial; Female; Humans; Logistic Models; Male; Middle Aged; Odds Ratio; Periodontal Attachment Loss; Periodontitis; Predictive Value of Tests; Sensitivity and Specificity; Tetracycline; Treatment Failure

The purpose of this investigation was to compare the clinical parameters and the site prevalence and levels of 40 subgingival species in successfully treated and refractory periodontitis subjects. 94 subjects received scaling and root planing and if needed, periodontal surgery and systemically administered tetracycline. 28 refractory subjects showed mean full mouth attachment loss and/or > 3 sites showing attachment loss > 2.5 mm within 1 year post-therapy. 66 successfully treated subjects showed mean attachment level gain and no sites with attachment loss > 2.5 mm. Baseline subgingival plaque samples were taken from the mesial aspect of each tooth and the presence and levels of 40 subgingival taxa were determined using whole genomic DNA probes and checkerboard DNA-DNA hybridization. The mean levels and % of sites colonized by each species (prevalence) was computed for each subject and differences between groups sought using the Mann-Whitney test. Most of the 40 species tested, including Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola and Bacteroides forsythus, were equally or less prevalent in the refractory group. Prevotella nigrescens was significantly more prevalent in successfully treated subjects, while refractory subjects harbored a larger proportion of Streptococcus species, particularly Streptococcus constellatus. The odds of a subject being refractory was 8.6 (p < 0.001) if S. constellatus constituted > or = 3.5% of the total DNA probe count. Since few microbiological differences existed between treatment outcome groups using DNA probes to known species, the predominant cultivable microbiota of 33 subgingival samples from 14 refractory subjects was examined. 85% of the 1649 isolates were identified using probes to 69 recognized subgingival species. The remaining unidentified strains were classified by analyzing 16S rRNA gene sequences. Many sequenced isolates were of taxa not considered a common part of the oral microbiota such as Acinetobacter baumanni, Gemella haemolysans, Enterococcus faecalis, Staphylococcus warneri, Pseudomonas aeruginosa and novel species in the genera Bartonella, Ralstonia, Neisseria, Eubacterium, Rothia, Gordona, Gemella, Corynebacterium, Leptotrichia, and Actinomyces. Refractory subjects constituted a heterogeneous group based on their subgingival microbiota. As a group, they did not harbor more of the "classic" periodontopathogens, although elevated proportions of S. constellatus wer

Topics: Adult; Anti-Bacterial Agents; Bacteria; Bacterial Typing Techniques; Dental Scaling; DNA, Bacterial; Gram-Positive Bacteria; Humans; Middle Aged; Periodontal Index; Periodontitis; RNA, Ribosomal, 16S; Subgingival Curettage; Tetracycline; Treatment Failure

Tissue remodeling is a dynamic state in which a balance is achieved between the proteolytic breakdown and synthesis of the extracellular matrix. Type I collagen is a major component of the gingival connective tissue (GCT) and the periodontal ligament (PDL) throughout development, while type XII collagen has been found in the mature forms of these tissues. The purpose of this study was to investigate the effects of periodontitis on the expression of type I and XII collagen and subsequently to investigate the effects of doxycycline (DOXY) and chemically modified non-antimicrobial tetracycline (CMT-1) on the expression of these molecules in this model. Adult barrier-raised male Sprague-Dawley rats were inoculated with Porphyromonas gingivalis obtained from humans to create the experimental periodontitis. The animals with the P. gingivalis-induced periodontitis were then split into the following groups: Group A served as infected untreated controls (PGI group); group B was treated with doxycycline (DOXY group); and group C was treated with chemically modified tetracycline-1 (CMT-1 group). Group D contained uninfected animals that served as uninfected controls (NIC group). The expression of type I and XII collagen mRNAs was examined by in situ hybridization in each group, with the co-expression of these molecules representing mature and functional gingival connective tissue. In the NIC group, cells hybridized with digoxygenine-labeled cDNA probes encoding rat alpha2(I) or alpha1(XII) collagens were found distributed uniformly throughout the periodontal connective tissue. The PGI group showed little hybridization in the areas of infection, while both the DOXY and CMT-1 groups showed co-expression of the alpha2(I) and alpha1(XII) probes in the GCT and coronal part of the PDL. This study demonstrates that doxycycline and CMT-1 moderate or reduce the inhibitory effects of periodontal infection on the expression of type I and type XII collagen mRNAs. These results suggest that doxycycline and a form of non-antimicrobial tetracycline, chemically modified tetracycline-1, can reduce periodontal destruction by reversing the inhibitory effect of periodontal infection on collagen synthesis.

Topics: Affinity Labels; Animals; Anti-Bacterial Agents; Bacteroidaceae Infections; Collagen; Connective Tissue; Digoxigenin; Disease Models, Animal; DNA Probes; DNA, Complementary; Doxycycline; Extracellular Matrix; Gene Expression Regulation; Gingiva; In Situ Hybridization; Male; Matrix Metalloproteinase Inhibitors; Periodontal Ligament; Periodontitis; Porphyromonas gingivalis; Protease Inhibitors; Rats; Rats, Sprague-Dawley; RNA, Messenger; Tetracycline

The purpose of this investigation was to compare the levels of serum IgG antibody to 85 subgingival species in 32 refractory periodontitis, 56 successfully treated, and 33 periodontally healthy subjects. Refractory subjects showed mean full mouth attachment loss and/or >3 sites showing attachment loss >2.5 mm within 1 year after 2 treatment modalities, scaling and root planing and surgery plus systemically administered tetracycline. Successfully-treated subjects showed mean attachment level gain and no sites with attachment loss >2.5 mm, 1 year post-therapy. Periodontally healthy subjects exhibited no pocket or attachment level >3 mm, and no evidence of progressing attachment loss during 1 year of monitoring. Baseline serum was obtained from each subject and tested against 85 subgingival species, including reference strains and strains isolated from refractory subjects, using checkerboard immunoblotting. Significance of differences in levels of serum antibody among groups were sought using the Kruskal-Wallis test. Refractory subjects constituted a heterogeneous group based on their serum antibody response to subgingival species. Some individuals had antibody reactions to many subgingival species, while other subjects showed fewer or low numbers of responses. On average, refractory subjects exhibited higher numbers and levels of serum antibody reactions to a wide range of subgingival species than successfully treated or periodontally healthy subjects. Differences in serum antibody among clinical groups were more striking at higher threshold levels of antibody (>50 microg/ml and > 100 microg/ml). The data showed that a subject was 10.1 x more likely to be refractory if the subject exhibited antibody reactions with >9 subgingival species at >50 microg/ml (p<0.001, after adjusting for multiple comparisons). Serum antibody to a subset of the test species differed among the clinical groups. Porphyromonas gingivalis, Bacteroidesforsythus, and some strains isolated from refractory subjects (a novel Neisseria sp., Enterococcus faecalis, Prevotella loescheii and Prevotella oulora) elicited high serum antibody in the successfully treated and refractory subjects. High levels of serum antibody to a Microbacterium lacticum-like organism, Streptococcus oralis, Streptococcus constellatus, Actinobacillus actinonmycetemcomitans serotype c and Haemophilus aphrophilus significantly increased the likelihood of a subject being refractory to conventional periodontal therapy.

Topics: Adult; Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Antibodies, Bacterial; Bacteroides; Combined Modality Therapy; Dental Scaling; Disease Progression; Enterococcus faecalis; Female; Follow-Up Studies; Gingiva; Haemophilus; Humans; Immunoblotting; Immunoglobulin G; Male; Middle Aged; Neisseria; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Prevotella; Root Planing; Streptococcus; Streptococcus oralis; Tetracycline

The aims of the present study were to assess radiographically the effects of scaling/root planing combined with antibiotic therapy using tetracycline fibers (TCF): (I) on alveolar bone density and linear descriptors and (II) on supracrestal soft tissue density. 19 subjects with generalized adult periodontitis (with at least 20 teeth present, at least 4 teeth with pockets >4 mm and bleeding upon controlled force probing) and high cultural counts of Porphyromonas gingivalis were recruited from a pool of 57 patients. The full mouth treatment group (FT) consisted of 10 patients, who underwent a full mouth supra-gingival scaling and prophylaxis treatment and were instructed to rinse 2x daily with a 0.1% chlorhexidine solution. 1 week later, tetracycline-hydrochloride-containing fibers (Actisite periodontal fiber) were applied around all teeth. After 7-12 days, the fibers were removed and all teeth were scaled and root planed under local anaesthesia. The chlorhexidine rinsing continued for another 2 months. In 9 subjects (local treatment group LT), 2 teeth with periodontal lesions with pocket probing pepth (PPD) > or =5 mm were treated by placement of tetracycline fibers, which remained in place for 7 to 12 days. Upon removal of the fibers, scaling and root planing was performed on these 2 teeth, while the rest of the dentition remained untreated, and no chlorhexidine rinse was applied. 2 of the untreated teeth revealing similar periodontal lesions were chosen to represent sites affected by untreated periodontitis (NT). In this group, a limited local treatment was performed (2 teeth) with the inherent potential for recolonization from the untreated pocket sites. Standardized periapical radiographs were obtained from the 4 monitored sites within each patient at baseline (before treatment) and 2 and 6 months thereafter. One radiograph was exposed in a standard way for bone assessment. The second radiograph was underexposed, at about a 1/5 of the original exposure time to allow the evaluation of soft tissue. Mean changes in the linear parameters and changes in density (CADIA) observed at multiple sites within each patient and treatment group were used as the best estimate of treatment outcome. Over the observation period of 6 months, a significant difference in bone height changes was found between the untreated sites (median loss -0.29 mm) and the sites from full-mouth treated patients (median gain 0.24 mm, p=0.008). When comparing the baseline to the 6 months ra

Topics: Adult; Alveolar Bone Loss; Alveolar Process; Anti-Bacterial Agents; Anti-Infective Agents, Local; Bone Density; Chlorhexidine; Colony Count, Microbial; Combined Modality Therapy; Dental Scaling; Drug Implants; Evaluation Studies as Topic; Follow-Up Studies; Gingival Hemorrhage; Humans; Image Processing, Computer-Assisted; Mouthwashes; Periodontal Pocket; Periodontitis; Periodontium; Porphyromonas gingivalis; Radiography; Root Planing; Tetracycline

The ecosystem of the dental plaque in periodontal diseases is very complex: the study of such micro-organisms, which are mostly strict anaerobes, requires the use of specific techniques under conditions of strict anaerobiosis. The aim of the present study was to design a rapid method to evaluate the activity of antimicrobials on mixed bacterial plaque of subjects with periodontal diseases. The study was carried out using a computerised instrument generally used for simultaneous diagnostic tests with aerobic bacteria. Operative and methodological modifications were made to obtain conditions of strict anaerobiosis and the balanced growth of all the microbial forms present in the mixed cultures of the plaque. Penicillins and cephalosporins were active on all the samples, whereas colistin, gentamicin, kanamycin and nalidixic acid showed no activity. Clindamycin, tetracycline, erythromycin and penicillin G were effective only against some samples. The activity of the antimicrobials towards isolated strains was analogous to that towards the corresponding mixed culture.

Topics: Adult; Anaerobiosis; Anti-Bacterial Agents; Anti-Infective Agents; Bacteria, Anaerobic; Cephalosporins; Clindamycin; Colistin; Dental Plaque; Drug Resistance, Microbial; Ecology; Erythromycin; Female; Gentamicins; Gingivitis; Humans; Kanamycin; Kanamycin Resistance; Male; Microbial Sensitivity Tests; Middle Aged; Nalidixic Acid; Penicillin G; Penicillin Resistance; Penicillins; Periodontitis; Tetracycline; Tetracycline Resistance

The last 25 years have brought unprecedented advances to our understanding of periodontal disease. Consider that in 1970 periodontitis was believed to effect most individuals over the age of 35 years, to progress steadily in an individual once initiated until teeth were lost, to be the primary cause of tooth loss in adults, to be caused by the bacterial mass accumulating on the tooth surface and subgingivally, and to involve the host in some fashion or another. In the 25 years since then, impressive research advances in the epidemiology of periodontal disease, the specific bacterial etiology of periodontal disease and the immunoinflammatory mediators of periodontal tissue destruction have greatly altered our view of periodontal disease. Thus, given these research advances in the understanding of periodontitis, what may the future hold for improved diagnosis and treatment of periodontal disease? Impressive research into new ways to diagnose the periodontal diseases is well underway. Investigators are seeking new ways to diagnose an individual's degree of risk for periodontal disease initiation, susceptibility to disease progression, level of disease "activity" and the likely response to treatment and recurrence of active disease. New diagnostic tests should greatly advance our ability to more accurately and specifically diagnose periodontal disease. The future also looks promising for new treatment strategies to slow or arrest periodontal disease progression. The bacterial specificity of periodontal disease etiology revealed since 1970 has logically led to the use of antibiotics in periodontitis treatment. In the late 1980s the concept of locally delivering antibiotics to the periodontal pocket was introduced, and subsequent clinical trials have indicated that it is possible to reduce pocket depth and inflammation with tetracycline locally delivered to the periodontal pocket. Likely, we have barely scratched the surface in studying the efficacy of locally delivery antimicrobial agents to alter the progression of periodontal disease. As new agents are developed and better delivery systems to the periodontal pocket are developed, the future should see a variety of antimicrobial agents available which can slow periodontal disease progression. The future also holds promise for slowing periodontal disease progression by blocking inflammatory pathways important in periodontal tissue destruction. Clinical trials of flubiprofen, naproxen and ketoprofen indicate th

Topics: Adult; Animals; Anti-Bacterial Agents; Anti-Infective Agents, Local; Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Bacterial Physiological Phenomena; Disease Models, Animal; Disease Progression; Disease Susceptibility; Drug Delivery Systems; Enzyme Inhibitors; Forecasting; Humans; Inflammation Mediators; Matrix Metalloproteinase Inhibitors; Periodontal Diseases; Periodontitis; Recurrence; Risk Factors; Technology, Dental; Tetracycline; Tooth Loss

The purpose of this study was to assess the clinical effect of treatment aimed to suppress Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis below detection level and Prevotella intermedia below 5% of the cultivable periodontal pocket flora. Sixteen patients and a total of 111 periodontal pockets with probing depth > or = 6 mm were included in the study. Twelve patients and a total of 77 sites completed the 5-year study. The results demonstrated clinical improvement of probing depth and gain of clinical attachment level of 3.4 mm and 1.2 mm, respectively. Treatment to eliminate indicator bacteria continued for 3 years before the aim was fulfilled. In order to eliminate A. actinomycetemcomitans from a majority of the sites, a combination of surgery and generalized tetracycline treatment was performed. A recolonization or regrowth of the indicator bacteria exceeding detection levels took place in several sites. The presence of A. actinomycetemcomitans. P. gingivalis, and P. intermedia, alone or in combination, correlated with attachment level change on the individual level. No such correlation was obtained by using presence of plaque, bleeding on probing, or three other bacteria (Campylobacter rectus, Eikenella corrodens, and Fusobacterium nucleatum) not used as treatment goal markers.

Topics: Adult; Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Colony Count, Microbial; Decision Making; Dental Plaque Index; Dental Scaling; Humans; Longitudinal Studies; Middle Aged; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Prevotella intermedia; Regression Analysis; Tetracycline; Treatment Outcome

Sixteen patients with advanced periodontitis (more than 3 sites with a probing depth > or = 6 mm) were treated with the aim of eliminating Actinobacillus actinomyce-temcomitans and Porphyromonas gingivalis and reducing Prevotella intermedia below 5% of the total viable count. The patients were followed clinically and microbiologically for over 5 years and showed a highly individual pattern with respect to presence of indicator bacteria, type of treatment needed to accomplish treatment goals, clinical response, and bacterial and disease recurrencies. The results of this study suggest that presence of the indicator bacteria in microbial samples taken after treatment may identify patients at risk for recurrent periodontitis.

Topics: Adult; Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Colony Count, Microbial; Dental Scaling; Follow-Up Studies; Humans; Middle Aged; Periodontitis; Porphyromonas gingivalis; Prevotella intermedia; Recurrence; Risk Factors; Subgingival Curettage; Tetracycline

Treatment with the tetracycline HCL-containing (Actisite infinity) fiber has been shown to improve clinical measures of periodontitis, as well as reduce the number of sites infected with putative periodontal pathogens. In this study, we examined the effect of the tetracycline fiber on biochemical mediators of the host's inflammatory response in gingival crevicular fluid (GCF). The total amount of the lysosomal enzyme beta-glucuronidase (beta G), considered a marker of primary granule release from polymorphonuclear leukocytes and interleukin-1 beta, a cytokine with important proinflammatory effects, were examined in GCF. Patients with localized recurrent periodontitis were followed over a 16 week period. Treated teeth (Tx), teeth adjacent to treated teeth (ADJ) and control teeth (Cx) were studied. Following fiber therapy, the Tx teeth displayed statistically significant reductions in mean probing depth, depth of the deepest site and bleeding on probing over the 16 weeks of the trial. Significant reduction in the depth of the deepest site was also seen for the ADJ teeth over 16 weeks. Total beta G in GCF was reduced for the Tx teeth comparing baseline to 16 weeks, but no significant changes were observed for the ADJ or Cx teeth. Prior to treatment, total beta G for the Tx teeth was 211 +/- 49 U (mean +/- standard error), versus 146 +/- 174 U for the ADJ teeth and 121 +/- 33 U for the Cx teeth. 16 weeks treatment, the mean values for these 3 categories of teeth were comparable (Tx = 95 +/- 20 U, ADJ = 93 +/- 42 U and Cx = 103 +/- 29 U). For the Tx teeth, the maximum reduction in total beta G following therapy occurred at 6 weeks (65%). Total IL-1 beta was significantly reduced for the Tx teeth at 3 and 6 weeks, but rebounded at 16 weeks. In contrast to what was seen for beta G, the maximum reduction in total IL-1 beta for the Tx teeth was observed at 3 weeks (68%). These data suggest that host mediators associated with increased risk for active disease are reduced following tetracycline fiber therapy. Future studies will determine the relative importance of a reduced microbial challenge versus a tetracycline-mediated direct modification of the host response to account for the reduction in the host inflammatory response in GCF following tetracycline fiber therapy.

Topics: Anti-Bacterial Agents; Cytoplasmic Granules; Drug Implants; Female; Follow-Up Studies; Gingival Crevicular Fluid; Gingival Hemorrhage; Glucuronidase; Humans; Inflammation Mediators; Interleukin-1; Lysosomes; Male; Middle Aged; Neutrophils; Periodontal Pocket; Periodontitis; Recurrence; Risk Factors; Tetracycline; Time Factors

The purpose of this study was to determine the distribution of black-pigmenting Gram-negative bacteria in the dentition of 10 adult periodontitis patients before and after treatment by local delivery of tetracycline. The subjects were selected based on a screening for high counts of Porphyromonas gingivalis and multiple deep pockets. Subgingival microbial samples were taken from the mesial and distal aspect of every tooth (44 to 56 sites per patient) before treatment, and after one and two months. Therapy included full mouth scaling and root planing, chlorhexidine mouth rinsing and placement of tetracycline HCl fibers (Actisite) on all teeth. 63.4% of 524 baseline samples yielded total anaerobic viable counts > or = 10(6) CFU/ml; P. gingivalis was found in 59.2% and Prevotella intermedia in 56.9%. One month after treatment, the % of samples with > or = 10(6) CFU/ml was reduced to 9.4%, 5.3% were P. gingivalis- and 5.1% P. intermedia- positive. After 2 months, 9.6% samples yielded > or = 10(6) CFU/ml, 5.2% were P. gingivalis- and 9.4% P. intermedia- positive. 20 of the 39 sites with a persistence of P. gingivalis were located on second molars. Logistic regression models were utilized to explain the persistence of P. gingivalis, using site location and other clinical parameters as independent variables. These analyses indicated a strong association of site location, pocket depth and bleeding on sampling with persistence of P. gingivalis. The study shows that local delivery of tetracycline is highly effective in reducing the prevalence and proportions of black-pigmenting anaerobes within a dentition. Bleeding deep pockets of second molars have an increased risk for persistence of these anaerobes.

Topics: Administration, Topical; Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Colony Count, Microbial; Dental Scaling; Drug Implants; Gingival Hemorrhage; Gram-Negative Anaerobic Bacteria; Humans; Logistic Models; Middle Aged; Molar; Mouthwashes; Periodontal Pocket; Periodontitis; Pigmentation; Porphyromonas gingivalis; Prevotella intermedia; Root Planing; Tetracycline

Actisite (tetracycline hydrochloride) periodontal fiber is a 23 cm monofilament containing 12.7 mg tetracycline HCl homogeneously dispersed in a polymer. This product is indicated as an adjunct to scaling and root planing to reduce pocket depth and bleeding on probing in patients with adult periodontitis. The sustained-release system, placed in the periodontal pocket for 10 d, releases the antibiotic through mechanisms of diffusion and osmosis. A study was conducted in 13 patients with moderate to severe adult periodontitis to evaluate the amount of tetracycline HCl released during therapy (based on residual drug content). Fibers placed in the pocket remained in place for an average of 9 d. Each patient had 1-4 teeth treated with fiber therapy. At the termination of therapy samples from 29 teeth were retrieved and analyzed. The amount of matrix polymer was used as an internal standard for the quantitation of tetracycline, eliminating any uncertainties with respect to recovery or contamination. An average of 31% (SD 9%) of the tetracycline HCl content was released from the fiber during the treatment period. No single fiber had less than 50% of the original drug remaining. The study demonstrated that a substantial amount of the tetracycline remains in the Actisite fiber at removal (about 70%), which indicates that substantial drug concentrations are maintained in the pocket for the duration of treatment.

Topics: Administration, Topical; Adult; Aged; Anti-Bacterial Agents; Chromatography, High Pressure Liquid; Combined Modality Therapy; Delayed-Action Preparations; Dental Scaling; Diffusion; Drug Carriers; Female; Gingival Hemorrhage; Humans; Male; Middle Aged; Osmosis; Periodontal Pocket; Periodontitis; Polyvinyls; Root Planing; Tetracycline

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

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Child; Drug Delivery Systems; Fees, Dental; Female; Health Care Costs; Humans; Middle Aged; Periodontal Pocket; Periodontitis; Practice Management, Dental; Pregnancy; Tetracycline

Bacterial flora has resisted the conventional treatment in a segment of patients with adult periodontitis, creating an interest in adjunctive chemotherapeutic treatment modalities. Tetracycline hydrochloride periodontal fiber, a locally delivered antibiotic therapy, is indicated as an adjunct to scaling and root planing. This form of treatment has demonstrated a reduction in bleeding on probing and periodontal pocket depths. Clinicians have found the fiber placement technique challenging, and a considerable percentage of fibers become dislodged during the course of the 10-day treatment period. This article clarifies the treatment protocol and presents an alternative placement technique for tetracycline fiber. It simplifies the procedure for the clinician and aids in fiber retention. The learning objective of this article is to familiarize the reader with the technique and the materials utilized for site-specific tetracycline hydrochloride fiber therapy. A clinical case is used to illustrate the procedure.

Topics: Adult; Anti-Bacterial Agents; Chronic Disease; Drug Delivery Systems; Humans; Periodontal Pocket; Periodontitis; Polyvinyls; Tetracycline

Topics: Anti-Bacterial Agents; Child; Child, Preschool; Contraindications; Dental Care for Children; Humans; Pediatric Dentistry; Periodontal Dressings; Periodontitis; Polyvinyls; Tetracycline

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

Poly(ortho esters) prepared by the condensation of 1,2,6-hexanetriol and an alkyl orthoacetate are viscous, semisolid materials at room temperature that can be injected using a blunt needle. When tetracycline was incorporated into these materials, complete release occurred within about 24 hours, but when small amounts of Mg(OH)2 were incorporated into the polymer release could be extended to many weeks, and a loading of 0.5 wt% resulted in sustained release of about 10 days. When adhesion was tested using bovine teeth, cohesive failure of the pure polymer occurred at a force of about 392 mN cm-2 and cohesive failure of a polymer incorporating 10 wt% tetracycline and 1 wt% (Mg(OH)2 occurred at about 118 mN cm-2. The combination of injectability, dentoadhesiveness and ability to control accurately the release of incorporated antibiotics makes these materials promising candidates for bioerodible delivery systems useful in the treatment of periodontitis. Toxicological studies are currently in progress.

Topics: Acetates; Animals; Biodegradation, Environmental; Cattle; Delayed-Action Preparations; Disease Models, Animal; Drug Delivery Systems; In Vitro Techniques; Magnesium Hydroxide; Periodontitis; Polyesters; Tetracycline; Tooth

Topics: Administration, Topical; Adult; Delayed-Action Preparations; Drug Delivery Systems; Humans; Periodontitis; Recurrence; Tetracycline

Three case reports of treatment of the failing implant are presented. The implants were immobile but had lost a significant amount of osseous support. The cause of failure was determined to be a combination of bacterial and occlusal traumatogenic insult. The defects were debrided and the implant surface was detoxified with tetracycline. Decalcified freeze-dried bone allograft was implanted in the osseous defects and covered with expanded polytetrafluoroethylene material in accordance with principles of guided tissue regeneration. The barrier membrane was removed 6 to 8 weeks after placement. Eight months to 1 year posttreatment, all sites demonstrated a substantial reduction in probing depth, a gain in clinical attachment, and bone fill of the defects adjacent to the implant.

Topics: Aged; Alveolar Bone Loss; Anti-Bacterial Agents; Bone Transplantation; Dental Implants; Dental Occlusion, Traumatic; Female; Granulation Tissue; Guided Tissue Regeneration, Periodontal; Humans; Male; Middle Aged; Periodontitis; Prosthesis Failure; Prosthesis-Related Infections; Tetracycline; Wound Healing

Eighty isolates of Actinobacillus actinomycetemcomitans from 30 Brazilian periodontitis patients were examined to determine the distribution of biotypes and in vitro antimicrobial susceptibility. Seventy-seven percent of the isolates belonged to biotype X. All A. actinomycetemcomitans isolates were susceptible to cefoxitin, imipenem and tetracycline.

Topics: Adolescent; Adult; Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Antitrichomonal Agents; Bacterial Typing Techniques; Cefoxitin; Cephamycins; Clindamycin; Dental Plaque; Drug Resistance, Microbial; Erythromycin; Female; Humans; Imipenem; Lincomycin; Male; Metronidazole; Microbial Sensitivity Tests; Penicillin G; Penicillins; Periodontitis; Tetracycline; Thienamycins

The occurrence of Mitsuokella dentalis in periodontitis was determined by culture and DNA probe detection. Subgingival paper-point samples from 480 periodontitis patients were transported in VMGA III, plated onto brucella agar with 5% sheep blood and incubated anaerobically for 7 days. Presumptive identification was based on a colony morphology resembling a water drop and biochemical characteristics. DNA probe detection was performed on paper-point samples using a digoxigenin-labeled cellular M. dentalis DNA probe in a dot-blot assay. Culture and DNA probe identified M. dentalis in 18.1% and in 80.7% of the study patients, respectively. M. dentalis isolates produced phosphatases, galactosidase, glucosidase and acetylglucosaminidase and showed high in vitro sensitivity to metronidazole. This study revealed that M. dentalis is a constituent of the pathogenic microbiota in human periodontitis. The periodontopathic potential of the organism is unknown.

Topics: Adolescent; Adult; Age Distribution; Aged; Amoxicillin; Anti-Bacterial Agents; Bacteroides; Ciprofloxacin; Cross-Sectional Studies; DNA Probes; Drug Resistance, Microbial; Female; Humans; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Penicillins; Periodontal Pocket; Periodontitis; Sex Factors; Tetracycline; Tetracycline Resistance

Controlled drug delivery of antibiotics in the periodontal pocket is a scientifically tested clinical reality. Application of pharmacokinetic principles allows effective suppression of the pathogenic microflora, which, in turn, results in resolution of inflammatory signs. In the cases presented, tetracycline fibers were employed as a supplement to mechanical therapy and oral hygiene in a variety of clinical situations. Outcomes included depression of periodontal pathogens, reduction of bleeding on probing, decrease in probing pocket depths, and increase in probing attachment levels. A novel therapeutic approach based on root planing for debridement, local drug delivery for control of the pathogens, and oral hygiene for preventing recolonization is discussed.

Topics: Adult; Delayed-Action Preparations; Drug Delivery Systems; Female; Furcation Defects; Humans; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Tetracycline

Topics: Animals; Bacteroidaceae Infections; Bone Resorption; Collagenases; Doxycycline; Enzyme Activation; Gelatinases; Gingiva; Male; Matrix Metalloproteinase Inhibitors; Metalloendopeptidases; Pancreatic Elastase; Periodontitis; Porphyromonas gingivalis; Rats; Rats, Sprague-Dawley; Tetracycline

Studies have indicated the heterogeneity of periodontal diseases and have suggested several pathogens that may play important etiologic roles. The risk associated with individual pathogens or combinations of pathogens has been assessed, and diagnostic tests have been developed for their detection in clinical practice. Strategies are being devised to improve treatment by using appropriate agents to control different periodontal infections.

Topics: Aggregatibacter actinomycetemcomitans; Amoxicillin; Analysis of Variance; Bacteroides; Humans; Periodontal Diseases; Periodontitis; Porphyromonas gingivalis; Risk Factors; Tetracycline

Campylobacter rectus (formerly Wolinella recta) in periodontitis lesions was studied relative to age and sex distribution, relationship to disease-active periodontitis, response to periodontal debridement and in vitro antimicrobial susceptibility. Subgingival C. rectus was collected with paper points, transported in VMGA III and plated onto nonselective enriched brucella blood agar and Hammond's selective medium for C. rectus, both incubated anaerobically. C. rectus was recovered from 80% of 1654 periodontitis patients. Although the organism showed similar age and sex occurrence, its proportional recovery in culture-positive adults was inversely related to increasing age (r = 0.999, P < 0.001). The organism was positively associated (summary odds ratio = 2.95) with disease activity in a 24-month longitudinal study of 93 adult periodontitis patients on maintenance therapy. C. rectus decreased from 8.2% to 0.7% following local periodontal debridement of 20 culture-positive adult periodontitis patients. The organism exhibited high in vitro susceptibility to therapeutic levels of tetracycline hydrochloride, metronidazole, penicillin G and ciprofloxacin. These findings further delineate the epidemiology and potential pathogenic role of C. rectus in human periodontitis.

Topics: Adolescent; Adult; Age Distribution; Aged; Campylobacter; Chi-Square Distribution; Ciprofloxacin; Cross-Sectional Studies; Female; Humans; Longitudinal Studies; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Odds Ratio; Penicillin G; Periodontal Pocket; Periodontitis; Sensitivity and Specificity; Sex Distribution; Subgingival Curettage; Tetracycline; Time Factors

The distribution of serotypes of beta-hemolytic streptococci was examined in 718 periodontitis patients. Subgingival samples were obtained with paper points from the 3 deepest lesions in each patient, transported in VMGA III, plated onto brucella agar with 5% sheep blood and incubated anaerobically for 7 days. Serotyping and speciation were performed with Meritec-Strep Beta-Hemolytic Streptococcus Grouping Set and the Analytab 20S Streptococcus System. Beta-hemolytic streptococci were recovered from 33.7% of patients and averaged 10.5% of the total viable counts in culture-positive subjects. The organisms occurred with higher prevalence in patients 35 years or older than in younger patients. The predominant serotypes were F (62.9%), non-typeable (18.1%), B (6.9%), C (6.9%) and G (5.2%). 100% of beta-hemolytic streptococci were sensitive to penicillin, but less than 5% were sensitive to tetracycline, metronidazole or ciprofloxacin. Beta-hemolytic streptococci may contribute to inflammatory periodontal disease and may interfere with healing after therapy.

Topics: Adolescent; Adult; Age Factors; Aged; Ciprofloxacin; Colony Count, Microbial; Cross-Sectional Studies; Female; Hemolysis; Humans; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Penicillin G; Periodontitis; Prevalence; Serotyping; Streptococcus; Tetracycline

This study compared the surface characteristics of periodontally diseased single-rooted human teeth extracted after treatment with either tetracycline HCl or citric acid solutions. The study group was comprised of 30 teeth from 22 patients with advanced periodontal disease extracted before the start of periodontal therapy. Diseased surfaces were identified, outlined, and root planed by hand curet or finishing bur. The teeth were sectioned and solutions of tetracycline HCl or citric acid (pH 1) were applied to the surfaces with cotton pellets for 5 minutes. Extracted teeth were processed and root surface samples then examined by scanning electron microscope. The surfaces of both acid-treated sets of specimens differed considerably from specimens treated with root planing alone, regardless of root planing method. Acid-treated specimens exhibited dentinal tubules exposed by the removal of the smear layer, surfaces devoid of the debris normally present in root planed-only specimens, and the dense network of collagen fibers that make up the dentin structure. Although differences were seen in surface depressions and fiber-like structures among some specimens, the tetracycline HCl and citric acid solutions produced comparable morphologic characteristics.

Topics: Acid Etching, Dental; Adult; Citrates; Citric Acid; Cuspid; Dental Scaling; Dentin; Humans; Microscopy, Electron, Scanning; Periodontitis; Root Planing; Smear Layer; Surface Properties; Tetracycline; Tooth Root

Previous in vitro studies have suggested that tetracycline-HCl (TTC-HCl) is adsorbed and actively released from root dentin. The aim of the current study was to evaluate the binding to and release of TTC-HCl from human root dentin surfaces in vivo, and to evaluate the clinical utility of TTC-HCl irrigation as an adjunct to scaling and root planing. Experiment I utilized two contralateral mandibular single-rooted teeth which were examined in four adults with severe generalized periodontitis. One tooth in each patient was carefully scaled and root planed, under local anesthesia, and the other used as an unscaled control. Each subgingival root surface was irrigated for 5 min with an aqueous TTC-HCl solution at a concentration of 100 mg/ml. Gingival crevicular fluid samples were collected on paper strips for the next three weeks. The TTC-HCl concentrations in each sample were determined by the inhibition zone of B. cereus cultured on agar plates. The TTC-HCl concentrations in gingival crevicular fluid collected 15 min after irrigation were 3100 +/- 670 micrograms/ml from the scaled lesions and 4700 +/- 1300 micrograms/ml from the unscaled root surfaces. The antibiotic concentrations decreased logarithmically over the next 7 days; 1500 +/- 270 micrograms/ml and 1100 +/- 330 micrograms/ml at 2 h, 880 +/- 350 micrograms/ml and 1300 +/- 360 micrograms/ml at 6 h and 19 +/- 5 micrograms/ml and 31 +/- 26 micrograms/ml at 1 week for scaled and unscaled root surfaces, respectively. Results for week two and three indicated an average of over 8 micrograms/ml.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Topical; Adult; Combined Modality Therapy; Dental Plaque; Dental Plaque Index; Dental Scaling; Dentin; Epithelial Attachment; Female; Gingival Crevicular Fluid; Gingivitis; Humans; Male; Middle Aged; Periodontal Index; Periodontal Pocket; Periodontitis; Root Planing; Tetracycline; Therapeutic Irrigation; Tooth Root

While subgingival scaling and root planing are effective at removing plaque, the use of periodic subgingival irrigation with a antimicrobial solution could be a useful adjunct. This paper initially discusses the management of inflammatory periodontal diseases in general, covering current mechanical therapy and chemical antimicrobials, before describing pulsed oral irrigation in more detail.

Topics: Chlorhexidine; Dental Devices, Home Care; Gingivitis; Humans; Metronidazole; Mouthwashes; Oral Hygiene; Periodontitis; Tetracycline; Therapeutic Irrigation

The purpose of the study was to validate the Epsilometer test (E-test) method for antimicrobial susceptibility testing of selected periodontopathic microorganisms using the agar dilution method as a standard. The E-test has been developed to provide a direct quantification of antimicrobial susceptibility of microorganisms. The device consists of a predefined, continuous, and exponential gradient of antibiotic concentrations immobilized along a rectangular plastic test strip. After 48 hours incubation a drop-shaped inhibition zone intersects the graded test strip at the inhibitory concentration (IC) of the antibiotic. Twenty-two subgingival plaque samples from periodontitis sites were plated on trypticase soy agar supplemented with 5% rabbit blood or 5% sheep blood and trypticase soy agar supplemented with vancomycin and bacitracin. A total of 60 strains of key periodontal pathogens (Prevotella intermedia, Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Eikenella corrodens, Campylobacter rectus, and Capnocytophaga) isolated from 22 sites of 12 patients were studied. The antibiotics tested were clindamycin, metronidazole, tetracycline, ciprofloxacin, cefoxitin, and ampicillin at concentrations above and below the achieved blood or gingival crevicular fluid levels. As a standard reference the minimal inhibitory concentrations (MICs) were determined using the agar dilution method. MICs were compared with ICs determined using the E-test method. The results showed an agreement ranging from 67% to 100%; sensitivity ranging from 75% to 100%; predictability ranging from 56% to 100% and specificity ranging from 33% to 96%. The E-test ICs for ampicillin, cefoxitin, and metronidazole against the Gram-negative capnophilic and microaerophilic rods and the black-pigmented anaerobic rods ICs for ampicillin, clindamycin, metronidazole, and tetracycline showed a high percentage of agreement with the agar dilution MICS.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aggregatibacter actinomycetemcomitans; Ampicillin; Anti-Bacterial Agents; Bacteria; Bacteroides; Bacteroides fragilis; Campylobacter; Capnocytophaga; Cefoxitin; Ciprofloxacin; Clindamycin; Clostridium perfringens; Dental Plaque; Eikenella corrodens; Female; Humans; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Peptostreptococcus; Periodontal Diseases; Periodontitis; Porphyromonas gingivalis; Tetracycline

Mammalian interstitial collagenases (E.C.3.4.24.7) are considered as key initiators of collagen degradation in periodontal diseases. However, the cellular sources of collagenases present in gingival crevicular fluid have not been completely clarified. Resident fibroblasts and epithelial cells as well as infiltrating neutrophils and monocyte/macrophages are potential sources of the enzymes. We have recently found significant differences in tetracycline inhibition between human neutrophil and fibroblast interstitial collagenases. To address the cellular source of collagenase present in gingival crevicular fluid in 2 distinct periodontal diseases, we studied the tetracycline inhibition of collagenase in gingival crevicular fluid of patients with localized juvenile periodontitis and adult periodontitis. Gingival crevicular fluid samples were collected from deep (greater than 5 mm) periodontal pockets and assayed for collagenase in the presence of 0-1000 microM doxycycline as well as a chemically modified tetracycline devoid of antimicrobial activity (4-de-dimethylaminotetracycline). The drug concentration required to inhibit 50% of collagenase activity (IC50) in localized juvenile periodontitis gingival crevicular fluid was 280 microM for doxycycline and 470 microM for 4-de-dimethylaminotetracycline. Significantly lower values, 10-20 microM, were obtained for collagenase in gingival crevicular fluid of patients with adult periodontitis. We propose that systemic tetracycline levels are efficient inhibitors of collagenase in gingival crevicular fluid in affected sites of patients with adult periodontitis but not of patients with localized juvenile periodontitis and that the fibroblast type interstitial collagenase is the predominant collagenase type in gingival crevicular fluid in affected sites of patients with localized juvenile periodontitis and the neutrophil collagenase in adult periodontitis gingival crevicular fluid.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aggressive Periodontitis; Child; Fibroblasts; Gingival Crevicular Fluid; Humans; Matrix Metalloproteinase 1; Microbial Collagenase; Neutrophils; Periodontitis; Tetracycline

The antibiotic resistance of the subgingival microbiota was studied by 3 approaches. First, we assessed the ability of subgingival isolates taken following therapy to grow on media containing tetracycline (TC). Higher percentages of TC-resistant organisms appeared at TC fiber-treated periodontal sites and within the saliva 1 week after treatment as compared with pre-treatment levels. By 1 month, the percentage of TC-resistant organisms had returned to levels comparable to those seen before treatment. In the second approach, subgingival isolates taken following therapy were grown on media without antibiotics, and isolates were selected for Gram-stain and cell morphology determination. This study indicated that subgingival sites became colonized with gram-positive cocci in the same time period that an increase of TC-resistant isolates was observed in the first study. This may account for the transient increase in TC resistance, because many gram-positive cocci are intrinsically resistant to TC. In the third approach, the antibiotic resistance of subgingival gram-negative species was determined. The predominant cultivable microbiota of 9 sites from 3 subjects were isolated immediately before and 6 months after TC fiber treatment. Gram-negative rods were characterized and tested for sensitivity to TC (minimum inhibitory concentration [MIC] 1-128 micrograms/ml), penicillin at 80 micrograms/ml, and erythromycin at 8 micrograms/ml. None of the gram-negative rods were resistant to TC (MIC greater than or equal to 16 micrograms/ml), either before or after treatment. Before treatment 98% of the gram-negative rods were susceptible to TC at 1-2 micrograms/ml and after therapy 88% were susceptible.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Bacteria, Anaerobic; Drug Implants; Drug Resistance, Microbial; Humans; Microbial Sensitivity Tests; Periodontal Pocket; Periodontitis; Saliva; Tetracycline; Tetracycline Resistance

This study investigated the effects of root planing and/or the placement of acrylic strips containing chlorhexidine, metronidazole or tetracycline on the composition and antimicrobial susceptibility of the subgingival flora in chronic periodontitis. 101 periodontal pockets from 73 patients were entered into 6 treatment groups which were, chlorhexidine, metronidazole or tetracycline strips, root planing, root planing followed by metronidazole strips and a control, no treatment group. Total anaerobic counts and anaerobe/aerobe ratios were estimated from samples taken before treatment and 1, 2, 4, 8 and 12 weeks after treatment. In addition, a more detailed analysis of the effects of the treatments on the subgingival flora was carried out on 12 pockets in 12 patients. Tetracycline strips, metronidazole strips and root planing and metronidazole strips were more effective than chlorhexidine strips in causing reductions in total anaerobic count and anaerobe/aerobe ratio. However, the changes in microbial parameters rebounded to approach baseline levels 4 weeks after treatment. Chlorhexidine caused no detectable changes in the composition of the subgingival microflora, while metronidazole had a variable effect. Tetracycline appeared to effect major shifts in the composition of the microflora of treated pockets but caused a marked selection of tetracycline-resistant organisms.

Topics: Acrylic Resins; Adult; Bacteria; Bacteria, Aerobic; Bacteria, Anaerobic; Chlorhexidine; Chronic Disease; Colony Count, Microbial; Combined Modality Therapy; Delayed-Action Preparations; Drug Implants; Drug Resistance, Microbial; Humans; Metronidazole; Periodontal Pocket; Periodontitis; Root Planing; Tetracycline

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

In periodontitis, root surface alterations have been observed in the cementum due to the presence of toxic substances mainly endotoxins of various microorganisms. Elimination of endotoxins from diseased root surfaces by root planing and demineralisation procedures seem to be essential for new attachment procedures. In this study the effects of citric acid and tetracycline HCl on periodontally involved root surfaces which had been scaled and root planed were evaluated by scanning electron microscopy. Our results showed that scaled, root planed and citric acid treated surfaces were relatively even with many dentinal tubules. The planed and tetracycline HCl treated root surfaces, however showed an irregular cemental surface with some debris, whilst the control surfaces found to be irregular with a considerable amount of debris.

Topics: Citrates; Citric Acid; Dentin; Humans; Microscopy, Electron, Scanning; Periodontitis; Root Planing; Surface Properties; Tetracycline; Tooth Root

Topics: Amoxicillin; Drug Combinations; Humans; Metronidazole; Periodontitis; Spiramycin; Tetracycline

The conditioning of root surfaces with saturated solutions of citric acid or tetracycline is unpredictable in facilitating new attachment, perhaps due to the low pH of these solutions which may be denaturing the organic matrix of the root as well as demineralizing the surface. The purpose of the present study was to compare the effects of a saturated solution of citric acid (pH = 1) with that of a 0.5% solution of tetracycline HCl (pH = 3.2) on radicular dentin with regard to the removal of the smear layer, exposure of dentinal tubule openings, and demineralization of the peritubular dentin. 10 bovine incisors were used in this study. The crowns and apical 1/3 of the root were resected and the resulting root segments were then frozen in icy freon. The cementum was fractured off of the root to produce a fracture-exposed, non-instrumented dentin surface. This fracture-exposed dentin surface was divided into 4 specimens, the 1st being a fracture-exposed, non-instrumented dentin control specimen (FE). After removal of the (FE) specimen from the root segment, the remainder of the fracture-exposed dentin surface was thoroughly root planed and then subdivided into the 3 remaining specimens. One of these specimens served as the root planed dentin surface (RP); another specimen (CA) was immersed in saturated citric acid (pH = 1) for 5 min and then washed in water for 5 min; the final specimen (T) was immersed in a 0.5 mg/ml solution of tetracycline HCl for 5 min and rinsed in water for 5 min.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Antacids; Cattle; Citrates; Citric Acid; Dentin; Drug Evaluation, Preclinical; Hydrogen-Ion Concentration; Periodontitis; Root Planing; Tetracycline

The in vitro release of amoxycillin with clavulanic acid from acrylic strips at initial concentrations of 30, 40 and 50 per cent w/w was monitored using a double-beam ultraviolet spectrophotometer and compared with release of tetracycline hydrochloride. Highest levels of the antibacterial agents were released during the first 24 h period. Therapeutic levels of the drugs continued to be released during the subsequent 9 day period and were shown to be biologically active. Furthermore, for amoxycillin with clavulanic acid, an initial concentration of 40 per cent gave the highest level of release on day 10; while, for tetracycline, 50 per cent provided the highest level of release. Local application of 40 per cent amoxycillin with clavulanic acid incorporated into acrylic strips placed in periodontal pockets in patients with established periodontitis produced a marked change in the subgingival microflora as monitored by dark-field microscopy and cultural techniques. These changes in the subgingival flora were concomitant with elimination of bleeding on probing at the treated sites and were still evident 3 weeks after removal of the acrylic strips. The sensitivity of Bacteroides gingivalis (syn. Porphyromonas gingivalis) and Bacteroides intermedius (syn. Prevotella intermedia) isolated before and after treatment to amoxycillin with clavulanic acid remained unchanged.

Topics: Acrylic Resins; Amoxicillin; Anti-Bacterial Agents; Bacteroides; beta-Lactamase Inhibitors; Clavulanic Acid; Clavulanic Acids; Delayed-Action Preparations; Diffusion; Drug Implants; Enzyme Inhibitors; Evaluation Studies as Topic; Humans; Multivariate Analysis; Periodontal Pocket; Periodontitis; Tetracycline

The effects of tetracycline and amoxycillin with clavulanic acid on the clinical parameters and subgingival flora of eight patients with rapidly progressive periodontitis was assessed. Subjects received either tetracycline 250 mg four times daily or amoxycillin 250 mg with clavulanic acid 125 mg three times daily for a period of 2 weeks together with subgingival scaling and root planning. Both treatment regimens produced significant reductions in bleeding on probing and probing pocket depths which were still present 16 weeks after the antibiotic therapy. A significant reduction in the mean percentage of black-pigmented Bacteroides spp., Fusobacterium nucleatum and anaerobic corroding bacilli was also obtained. Both treatment regimens were equally effective in reducing the clinical parameter and altering the subgingival flora. The MIC values for Bacteroides gingivalis (Porphyromonas gingivalis). Bacteroides intermedius (Prevotella intermedia) and F. nucleatum to amoxycillin with clavulanic acid remained constant throughout the period of investigation. The MIC values of these organisms to tetracycline increased.

Topics: Amoxicillin; Anti-Bacterial Agents; Bacteria, Anaerobic; Bacteroides; beta-Lactamase Inhibitors; Clavulanic Acid; Clavulanic Acids; Drug Combinations; Enzyme Inhibitors; Female; Fusobacterium; Gram-Negative Bacteria; Humans; Male; Periodontitis; Tetracycline

The concentration of tetracycline in the gingival fluid was measured in the periodontal pocket following placement of controlled drug delivery monolithic fibers and subgingival irrigation. Following subgingival irrigation with 1% and 10% tetracycline HCl solution, concentrations decayed exponentially with half times of 4.2 and 12.2 h, respectively. Tetracycline fibers maintained a constant average concentration of 1590 micrograms/ml in periodontal pockets over a 10-day period. The observed concentrations were in agreement with those expected from a steady-state model based on release rate characteristic of the fibers and gingival fluid flow rate. After removal of the delivery system, tetracycline concentrations decreased exponentially with half time of 4.5 h. These data describe the delivery characteristics of tetracycline-loaded ethylene vinyl acetate fibers as zero-order for 10 d; following removal, an exponential washout was observed.

Topics: Adult; Delayed-Action Preparations; Drug Carriers; Drug Implants; Female; Gingival Crevicular Fluid; Gingivitis; Humans; Male; Microscopy, Electron, Scanning; Middle Aged; Periodontal Pocket; Periodontitis; Polyvinyls; Tetracycline; Therapeutic Irrigation

We evaluated new attachment following treatment of experimental periodontitis in a canine model. Periodontal destruction was induced over an 8-month period using silk ligatures and a soft diet, and this remained stable for 170 days before surgery. After surgical scaling and root planing of eight bicuspid teeth, the apical end of the pockets was estimated using an occlusal stent and a periodontal probe, then marked with a blade. The root surfaces of three bicuspids were treated with citric acid for 3 min, and tetracycline salt was applied to the root surfaces of two teeth. The remaining three bicuspids served as controls. Postoperatively, no attempts were made to improve oral hygiene, and on day 48 light microscopic examination of biopsy materials revealed new attachment in all treated teeth. However, in some sections new cementum and new collagen formation was much more extensive and complete in both groups of experimental teeth than in the control teeth.

Topics: Animals; Citrates; Citric Acid; Connective Tissue; Dental Cementum; Dogs; Periodontitis; Periodontium; Subgingival Curettage; Surgical Flaps; Tetracycline; Tooth Root; Wound Healing

Topics: Adult; Chi-Square Distribution; Dental Scaling; Humans; Molar; Oral Hygiene; Periodontitis; Tetracycline; Tooth Root

The purpose of the present study was to evaluate the effects of subgingival irrigations with tetracycline as a supplement to mechanical plaque control and root debridement on clinical conditions of periodontal furcation pockets. 20 subjects with molar teeth having furcation pockets of varying depths and different grades of furcation involvement served for the study. Following oral hygiene instruction and root debridement at baseline, test teeth were irrigated subgingivally by a professional with a solution of 50 mg/ml of tetracycline, and control teeth with saline every 2nd week for 3 months. Records of dental plaque, bleeding on probing, probing depth and probing attachment level were obtained at 0, 1, 2, 3, 6, 9 and 12 months. The results failed to demonstrate any significant differences between test and control teeth for any of the subgroups of furcation sites at any observation interval. It is suggested that future studies may need to be performed over longer periods of time, and that the antimicrobial agents may need to be administered in vehicles, which provide prolonged periods of active subgingival concentrations.

Topics: Debridement; Dental Plaque; Humans; Molar; Oral Hygiene; Periodontal Index; Periodontal Pocket; Periodontitis; Tetracycline; Therapeutic Irrigation; Tooth Root

Strips containing tetracycline hydrochloride or metronidazole 25% in polyhydroxybutyric acid as a biodegradable polymer matrix, showed sustained release in simulated gingival fluid pH 6.6 at 37 degrees C. When evaluated in patients suffering from advanced periodontal disease, the greatest response to therapy was observed with tetracycline hydrochloride strips inserted into periodontal pockets at four-day intervals for 16 days, compared with an untreated control group. A reduction in plaque index, gingival index and pocket depth was observed. A favourable alteration occurred in the microbial flora of treated pockets with an increase in the proportion of cocci and decrease in gram-negative rods, fusiforms and spirochetes. Metronidazole strips or root-planning tended not to be as effective. The clinical improvement produced by each treatment was not maintained when treatment was terminated.

Topics: Administration, Topical; Calorimetry, Differential Scanning; Dental Plaque; Gingiva; Humans; Metronidazole; Periodontal Diseases; Periodontitis; Solubility; Tetracycline

For the purpose of applying a local drug delivery system to periodontal therapy, atelocollagen preparations with immobilized tetracycline (TC) were prepared by modifying the form of the collagen, the concentration of the immobilized TC, and the time of the cross-link process with glutaraldehyde. The course of the TC release from the collagen preparations into an aqueous solution was determined in relation to time. The preparations were also inserted into periodontal pockets, and the amount of TC remaining in the pocket was determined daily. The results obtained were as follows: 1) The degree of drug release could be controlled to some extent by adjusting the TC concentration and the time of the cross-link process; and 2) an amount of TC exceeding the effective dose in the gingival crevicular fluid was present in the periodontal pocket even 10 days after the insertion of TC fixed in the cross-linked processed collagen film in the periodontal pockets.

Topics: Bacteria; Collagen; Delayed-Action Preparations; Drug Carriers; Gingival Crevicular Fluid; Humans; Periodontal Pocket; Periodontitis; Tetracycline

Refractory chronic periodontitis of 16 patients was treated by root planing and adjunctive tetracycline hydrochloride therapy. The antibiotic was taken orally one hour before root planing and continued for six days at a dosage of 250 mg six hourly. The clinical data for each patient were recorded as the number of probing depths in each of the 1-3 mm, 4-6 mm and 7-10 mm ranges. The Multivariate Analysis of Variance (MANOVA) procedure for repeated measurements was used to analyse the data. The results demonstrated that the number of sites with probing depths of 4-6 mm and 7-10 mm associated with incisors, canines, premolars and molars decreased with a corresponding increase in the number of sites in the 1-3 mm range. Incisor and canine teeth showed a better response to treatment than premolars, which responded better than molars. The cases were followed for varying periods of time from six months to two years following antibiotic therapy. The probing depth reduction achieved following root planing and tetracycline hydrochloride therapy was maintained during this review period.

Topics: Administration, Oral; Adult; Chronic Disease; Female; Gingival Recession; Humans; Male; Middle Aged; Periodontal Pocket; Periodontitis; Subgingival Curettage; Tetracycline; Tooth Root

This paper reports the successful treatment of the periodontal component of the Papillon-Lefèvre syndrome in 2 siblings. Treatment consisted of extractions of periodontally-involved teeth under antibiotic therapy. The exogenous source of the suspected pathogenic A. actinomycetemcomitans in this family, identified as a pet dog, was also treated with antibiotics. Assessments of monocyte function and levels of serum antibodies against A. actinomycetemcomitans were performed prior to an immediately after treatment. Microbiological screening of subgingival dental plaque of the PLS patients as well as the rest of the household members, including the dog, was performed every month during the study period. Remission of the rapidly destructive periodontitis, as well as an earlier-described monocyte dysfunction in these two PLS patients occurred concomitantly with the eradication of A. actinomycetemcomitans from the family. 15 months after this treatment, the children still had no signs of periodontitis or of A. actinomycetemcomitans infection. The legitimacy with which PLS is defined as a disease entity is discussed and questioned.

Topics: Actinobacillus; Child; Female; Gingiva; Humans; Keratoderma, Palmoplantar; Male; Papillon-Lefevre Disease; Periodontitis; Tetracycline; Tooth Extraction

Tetracycline-resistant organisms isolated from six patients with periodontal disease included Bacteroides spp., Eubacterium spp., Fusobacterium nucleatum, Neisseria perflava-N. sicca, Peptostreptococcus anaerobius, Veillonella parvula, and facultative streptococci. All but the Bacteroides spp. and Eubacterium spp. hybridized with the TetM determinant. An additional 417 bacterial strains were screened, and 4% of both the oral streptococci and the Fusobacterium spp. hybridized with the TetM probe.

Topics: Adult; Bacteria, Anaerobic; Blotting, Southern; DNA, Bacterial; Genes, Bacterial; Humans; Neisseria; Nucleic Acid Hybridization; Periodontal Pocket; Periodontitis; Tetracycline; Tetracycline Resistance

Topics: Adolescent; Adult; Age Factors; Bone Resorption; Gingival Pocket; Humans; Mouth; Nutrition Disorders; Periodontal Splints; Periodontitis; Tetracycline; Tooth Exfoliation

Niridazole, metronidazole and tetracycline were compared for their activity against subgingival bacteria from patients with chronic periodontitis. Niridazole was consistently more effective than the other drugs against obligate anaerobes and exhibited some activity against facultative organisms. It was concluded that niridazole has potential for topical use in chronic periodontitis.

Topics: Bacteria, Anaerobic; Dental Plaque; Humans; Metronidazole; Niridazole; Periodontal Pocket; Periodontitis; Tetracycline

The present study in the beagle dog was performed to analyze whether micro-organisms from a subgingival microbiota could be translocated into or had the potential to invade the pocket epithelium and the gingival connective tissue during a phase of rapid breakdown of the attachment apparatus. An attempt was also made to assess whether tetracycline therapy suppressed the subgingival microbiota and changed the size and quality of the lesions in the gingival tissue. 5 inbred beagle dogs were used. Throughout the period of experimentation, the animals were fed a soft diet permitting gross accumulation of plaque and calculus. No mechanical plaque control measures were performed during the course of the study. On day 0, a 120-day period of periodontal tissue breakdown was initiated at the right mandibular 3rd and 4th premolars by tying cotton floss ligatures around the neck of these teeth. The process of tissue breakdown at the mandibular left 3rd and 4th premolars was started 30 days later. The ligatures were replaced once every 2 weeks during the subsequent 4-month period. On experimental day 120, the first biopsy was performed and gingival tissue sections prepared for light and electron microscopic assessment of a series of histometric characteristics. On day 120, a 30-day period of tetracycline (per os) administration was initiated. Each dog was given a dose of 500 mg tetracycline twice daily. On day 150, the biopsy procedure was repeated in the mandibular left premolar regions.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Bacteria; Bacterial Physiological Phenomena; Connective Tissue; Dogs; Epithelial Attachment; Gingiva; Periodontal Pocket; Periodontitis; Tetracycline

A pathologically migrated maxillary central incisor tooth with a poor periodontal prognosis was treated successfully with conventional periodontal therapy. After almost 4 years, an extensive periodontal lesion developed on the same tooth and extraction was recommended. The patient did not comply and the acute symptoms disappeared after the administration of 1 gm of Tetracycline a day for 2 weeks. Although no definitive periodontal therapy was done, complete resolution of the lesion occurred with the healing of the structures of the periodontium and a dramatic reduction in mobility of the tooth. Antibacterial therapy could be an effective means of treating some periodontal lesions once a more exact and direct association is established between the various clinical forms of periodontitis and specific periodontal or groups of pathogens.

Topics: Female; Humans; Incisor; Middle Aged; Periodontitis; Recurrence; Tetracycline; Tooth Migration; Tooth Mobility

Topics: Bacteria; Chlorhexidine; Delayed-Action Preparations; Humans; Periodontal Pocket; Periodontitis; Tetracycline

Topics: Humans; Periodontitis; Tetracycline

Topics: Adult; Female; Humans; Incisor; Periapical Abscess; Periodontal Pocket; Periodontitis; Root Canal Therapy; Surgical Flaps; Tetracycline; Tooth Root

Topics: Adult; Aged; Bacteria; Bicarbonates; Dental Plaque; Dental Scaling; Female; Humans; Hydrogen Peroxide; Long-Term Care; Male; Middle Aged; Periodontal Pocket; Periodontitis; Sodium; Sodium Bicarbonate; Sodium Chloride; Tetracycline; Tooth Root

Topics: Adult; Combined Modality Therapy; Delayed-Action Preparations; Drug Implants; Female; Humans; Malocclusion; Patient Care Planning; Periodontitis; Tetracycline; Tooth Movement Techniques

Several methods have been used to deliver antimicrobial drugs into periodontal pockets. This study was concerned with the development of acrylic in strip form for such an application. Initially the release of chlorhexidine acetate from cold cured acrylic strips into water, was measured spectrophotometrically over a 15 day period. The release of chlorhexidine was highest on day 1, was reduced considerably by day 2 and then fell progressively to day 15. With the exception of the release on day 1 there was little difference in daily release from drug admixtures between 40 to 80 per cent. Comparison of the release of chlorhexidine, metronidazole and tetracycline demonstrated a similar release pattern for metronidazole and chlorhexidine but the daily release of tetracycline was considerably less. A bioassay indicated that all drugs were released in active form. In a clinical study chlorhexidine, tetracycline and metronidazole rods were placed in periodontal pockets for 2-3 days and the effects monitored by dark field microscopy. All drugs produced a proportional increase in cocci and marked reductions in other organisms, notably the curved and motile rods and spirochaetes. The effects of metronidazole and tetracycline were greater than those of chlorhexidine. A second clinical study compared the effects of metronidazole and tetracycline strips placed for 2 weeks. Clinically, both treatment methods had immediate effects upon pocketing, bleeding on probing and crevicular flow, which for metronidazole were maintained to the 3-month follow-up period. For tetracycline, the bleeding and crevicular flow were significantly reduced and maintained to the 3-month period but the initial pocket reduction returned to baseline levels by 3 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acrylic Resins; Anti-Bacterial Agents; Bacteria; Bacterial Physiological Phenomena; Bacteroides; Chlorhexidine; Delayed-Action Preparations; Drug Implants; Humans; In Vitro Techniques; Metronidazole; Periodontal Pocket; Periodontitis; Random Allocation; Tetracycline

Topics: Administration, Topical; Adult; Bacteria; Double-Blind Method; Female; Humans; Male; Middle Aged; Periodontitis; Tetracycline

64 sites with probing pocket depth greater than or equal to 6 mm from 11 patients were treated with plaque control instruction and one episode of root planning. Subsequently, selected sites in each patient were irrigated with either chlorhexidine, tetracycline, saline or served as non-irrigated control sites. Irrigation immediately followed instrumentation, and was repeated every 2 weeks for 24 weeks. Healing was monitored at 8, 16, and 24 weeks clinically and at 7, 15, and 23 weeks with subgingival washings for determination of % as well as total number of spirochetes. The following changes were apparent from comparing pooled site means at 24 weeks with pretreatment data: (1) bleeding sites decreased from 62 of 64 sites initially to 22 of 64 at 24 weeks; (2) spirochetes decreased from 34% to 2%; (3) probing pocket depths decreased from 7.6 to 4.7 mm; (4) probing attachment levels showed a gain of 1.2 mm. The improvement of the chlorhexidine and tetracycline irrigated sites was similar to that of the saline irrigated and non-irrigated control sites. Thus, biweekly chlorhexidine, tetracycline or saline irrigation of deep pockets did not appear to augment the effects of non-surgical periodontal therapy.

Topics: Adult; Aged; Chlorhexidine; Debridement; Dental Scaling; Female; Humans; Male; Middle Aged; Oral Hygiene; Periodontal Pocket; Periodontitis; Spirochaetales; Subgingival Curettage; Tetracycline; Therapeutic Irrigation; Tooth Root

In the management of chronic periodontitis, there has been a renewed interest in the local delivery of antimicrobial drugs into periodontal pockets. This study assessed the effects of the acrylic strip delivery system containing chlorhexidine, metronidazole or tetracycline on subgingival microflora assessed by dark field microscopy. Strips containing 40% chlorhexidine, metronidazole or tetracycline were placed for 2 to 3 days into pockets greater than 6 mm which bled on probing. Plaque samples were obtained before and after treatment and counts of morphological and motile groups of organisms were made by dark field microscopy. Prior to treatment, the dark field microscopic counts were similar to those previously reported for diseased sites with motile bacteria, in particular spirochaetes, present in high numbers. Following treatment, all 3 antimicrobial drugs produced a significant increase in the proportion of cocci and significant decreases in all other types of organisms. Motile organisms, in particular, were markedly reduced and spirochaetes could not be recovered from some sites treated with metronidazole and tetracycline. Metronidazole was significantly more effective than tetracycline or chlorhexidine on spirochaetes. The results indicate that acrylic strips may be useful in the management of chronic periodontitis as an adjunct to routine mechanical methods.

Topics: Acrylic Resins; Administration, Topical; Bacteria; Chlorhexidine; Dental Plaque; Humans; Metronidazole; Periodontal Pocket; Periodontitis; Tetracycline

Topics: Bacteria; Bicarbonates; Humans; Hydrogen Peroxide; Oral Hygiene; Periodontitis; Sodium Bicarbonate; Sodium Chloride; Tetracycline

Topics: Bacterial Physiological Phenomena; Humans; Periodontal Diseases; Periodontitis; Tetracycline

Actinobacillus actinomycetemcomitans is an oral bacterium which is being encountered with increasing frequency in infective endocarditis. This organism occurs in high numbers in periodontitis lesions of patients with localized juvenile periodontitis (periodontosis). It is present infrequently, and only in low numbers in most other individuals. Its common resistance to penicillin, erythromycin and vancomycin represents a clinical problem in patients at risk of developing endocarditis after dental treatment. However, the high activity of tetracyclines against A. actinomycetemcomitans may be useful in prophylactic endocarditis considerations by allowing a suppression of the organism prior to the institution of recommended prophylactic protocols. In this study, we determined the effect of systemic tetracycline-HCl therapy (1 gm/day) on the oral A. actinomycetemcomitans population in five localized juvenile periodontitis patients who were heavily infected with the organism. A. actinomycetemcomitans could not be detected in samples of subgingival and supragingival dental plaque and cheek mucosal surfaces following 14 days of administration of systemic tetracycline. The organism was still undetectable 3 weeks after therapy but it reappeared at a few oral sites at week 8 post-treatment. On the basis of this data, it is proposed that the prophylactic endocarditis therapy of patients with high numbers of penicillin-resistant A. actinomycetemcomitans include a two-stage approach: first, the systemic administration of tetracycline for 14 days, and second, institution of a conventional prophylactic protocol during the time of dental treatment.

Topics: Actinobacillus; Actinobacillus Infections; Adolescent; Dental Plaque; Endocarditis, Bacterial; Female; Humans; Male; Mouth Diseases; Periodontitis; Tetracycline

For the purpose of developing controlled delivery devices for periodontal therapy which would release over several days, six fiber types made of tetracycline-loaded biocompatible polymers were manufactured and tested. Polyethylene, polypropylene, polycaprolactone, polyurethane and cellulose acetate propionate all released their drug load within 1 day. Ethylene vinyl acetate fibers, however, provided in vitro sustained release for periods up to 9 days. A bioassay was designed to measure levels of tetracycline achieved by local delivery which used growth inhibition of Bacillus cereus as a measure of the amount of tetracycline in measured volumes of gingival sulcus fluid on filter paper strips. By this assay, fibers made from 25% loaded ethylene vinyl acetate established initial concentrations of approximately 500 micrograms/ml. The measurement of tetracycline concentration resulting from the placement of these fibers into deep periodontal pockets as a packing material provided indication that concentrations of greater than 50 micrograms/ml could be maintained for months by weekly to monthly replacement. These studies indicate that monolithic fibers made of tetracycline-loaded ethylene vinyl acetate have characteristics which could prove useful as the basis of a tetracycline delivery system for the treatment of periodontal disease.

Topics: Delayed-Action Preparations; In Vitro Techniques; Periodontal Pocket; Periodontitis; Pharmaceutical Vehicles; Polymers; Polyvinyls; Tetracycline; Time Factors

The minimal inhibitory concentrations of Rodogyl (composite tablet of metronidazole and spiramycin), metronidazole-spiramycin mixture, spiramycin, metronidazole, and tetracycline were determined for selected putative periodontopathic microorganisms. Rodogyl was active against almost all strains, including Bacteroides species and the anaerobic spirochetes. Synergism of the component drugs in the Rodogyl combination was noted against Propionibacterium species. Spiramycin activity against Actinomyces species was enhanced in the presence of metronidazole.

Topics: Bacteria; Drug Combinations; Humans; Leucomycins; Metronidazole; Microbial Sensitivity Tests; Periodontitis; Spiramycin; Tetracycline

Twenty patients were selected for antibiotic treatment due to poor response to conventional therapy. Ten patients were evaluated after taking 250 mg/day of tetracycline for 2 to 7 years. Ten other patients who had been on tetracycline for at least 2 years were evaluated 6 months to 2 years after stopping the antibiotic. Subgingival plaque was cultured anaerobically on nonselective media (ETSA) and ETSA with 1 microgram/ml of tetracycline HCl. Pocket depth, plaque and gingivitis were scored. Those patients on tetracycline had no bleeding on probing despite residual pockets ranging from 3 to 7 mm. Gram-negative anaerobic rods made up to 49.8% of the microflora of these patients, with Fusobacterium nucleatum dominating. B. melaninogenicus, and B. gingivalis were not detected in the samples. Five of ten patients off tetracycline bled on probing and had pocket depths in the same range as those on tetracycline. The microflora of tetracycline-off sites was predominately Gram-negative rods (63.1% with B. gingivalis and F. nucleatum 7.3% and 3.1% of the flora respectively). In tetracycline-on samples 76.6% of the isolates were resistant to 1 microgram/ml of tetracycline compared to 25.9% in the patients off tetracycline and 7.1% resistant organisms in 14 untreated control samples from periodontitis patients not exposed to any long-term tetracycline therapy. Long-term, low-dose tetracycline was associated with a healthy clinical condition and diverse Gram-negative anaerobic flora resistant to the antibiotic. After discontinuing tetracycline the clinical and bacterial status was more characteristic of disease.

Topics: Adult; Bacteria; Dental Plaque; Follow-Up Studies; Humans; Periodontitis; Tetracycline; Time Factors

Topics: Alveolar Process; Animals; Dogs; Drug Evaluation, Preclinical; Periodontitis; Radiography; Tetracycline

The microflora of periodontal pockets and some histopathological characteristics of adjacent tissues from individuals with clinical signs of juvenile periodontitis were studied. Adult individuals with ordinary, rapidly advancing periodontitis served as controls. All of the patients had been referred for specialist treatment. Using criteria defined by Baer (19z1), the patients were assigned to one juvenile periodontitis (eight patients), one post-juvenile periodontitis (seven patients) and one adult periodontitis group (seven patients). Only lesions around the first molars and central incisors were studied. Bacterial samples were obtained from each site and were examined by darkfield microscopy and different morphological forms identified. The soft tissue of the diseased sites was excised. The biopsies were placed in a fixative, cut in 1-mm-thick blocks and embedded in Epon. In semithin sections the infiltrated connective tissue (ICT) was identified and the ICT portion further processed for electron microscopy. The numeric and volumetric densities of different cells and structures of the ICT were determined using a morphometric point-counting procedure. The results showed that juvenile periodontitis lesions are associated with a subgingival microflora, the composition of which is different from that of adult periodontitis. Thus, in patients belonging to the adult periodontitis and post-juvenile periodontitis groups, motile microorganisms dominated the subgingival plaque samples, whereas deep pockets in juvenile periodontitis lesions contained a flora dominated by coccoid cells and straight non-motile rods. The most pronounced difference in the composition of ICT between the juvenile on one hand and the post-juvenile and adult periodontitis lesions on the other, was related to the amount of extracellular structures. Thus, in post-juvenile and adult periodontitis lesions, collagen and residual tissue made up around 50% of the infiltrate. In the juvenile periodontitis lesions, however, extracellular structures occupied only around 20% of the volume. In the ICT of the juvenile periodontitis sites, around 70% of the volume was occupied by plasma cells and blast cells. The corresponding figures for the post-juvenile and adult periodontitis sites were 50 and 30%.

Topics: Adolescent; Adult; Bacteria; Connective Tissue; Female; Humans; Male; Periodontitis; Periodontium; Tetracycline

The effects of tetracycline on the subgingival streptococcal flora of periodontal patients were examined. Before antibiotic treatment, tetracycline-resistant isolates were obtained from 24 to 25 patients. In most patients, the proportion of the subgingival flora resistant to tetracycline increased after 2 weeks of therapy (1,000 mg of tetracycline/day) and then decreased after the cessation of treatment. Cultural conditions used for primary isolation were designed to favor the growth of facultative streptococci. Consequently, the majority (99%) of resistant isolates were identified as streptococci. Among 407 tetracycline-resistant Streptococcus isolates chosen for further classification, 9 species were identified, with S. sanguis (63%) and S. mitis (19%) predominating. There were no significant differences in the distribution of species isolated before and after treatment and after the cessation of tetracycline treatment. Plasmids were isolated from only 23 of 121 resistant streptococcal strains examined, suggesting that tetracycline resistance is not plasmid mediated in the majority of these oral streptococci.

Topics: DNA, Bacterial; Drug Resistance, Microbial; Humans; Periodontal Pocket; Periodontitis; R Factors; Species Specificity; Streptococcus; Tetracycline

Topics: Adult; Aged; Anti-Bacterial Agents; Dental Plaque; Diabetes Mellitus; Erythromycin; Female; Humans; Hypoglycemic Agents; Insulin; Male; Microbial Sensitivity Tests; Middle Aged; Periodontal Pocket; Periodontitis; Staphylococcus; Tetracycline

Samples of subgingival plaque were collected from periodontal patients receiving two different tetracycline treatment regimens following conventional periodontal therapy. Four patients had received an oral dose of 1000 mg/day for 2 weeks and nine had received 1000 mg/day for 1 week followed by 250 mg/day for extended time periods. The latter regimen is similar so that commonly prescribed for the chronic skin disease, acne vulgaris. Taxonomic characterization of plaque isolates indicated that the predominant organisms cultured from both treatment groups were species of Streptococcus and the branching, filamentous Gram-positive rods, Actinomyces and Rothia. A much greater microbial complexity was observed among the flora isolated from patients taking 250 mg/day. The latter group harbored many of the fastidious Gram-negative organisms presently implicated in the etiology of periodontal disease. All bacterial strains isolated were tested for resistance to tetracycline by replica-plating cultures on an agar medium containing two-fold dilutions of the antibiotic. Streptococcus, Veillonella and Neisseria were the bacterial genera found to be consistently resistant to tetracycline, with minimum inhibitory concentrations as high as 128 micrograms/ml. Among the Actinomyces, selection for antibiotic resistance was common only within a single species, A. odontolyticus. However, A viscosus strains isolated at 54% of the subgingival flora from one patient did demonstrate an intermediate resistance level, growing on concentrations up to 8 micrograms/ml. Tetracycline resistance was shown by a variety of Gram-negative rods isolated from the low dosage group. Although a minimum number of patients were studied, extensive microbial analyses of the predominating subgingival bacteria indicated that the goal of tetracycline therapy was achieved during the 2-week therapy period at 1000 mg/day.

Topics: Actinomyces; Bacteria; Dental Plaque; Gingiva; Humans; Microbial Sensitivity Tests; Periodontal Index; Periodontitis; Streptococcus; Tetracycline; Time Factors

The present investigation was undertaken to determine the influence of systemically administered tetracycline on periodontitis in the rat. Thirty Sprague-Dawley rats were arranged into two groups, one group received 21 mg of tetracycline hydrochloride each day for 10 weeks in the drinking water. Periodontitis was induced in the maxillary left segment with a 0.008 inch stainless steel ligature wire and by modifying the normal diet with sucrose. The direct microscopic and histometric measurements obtained were analyzed for statistical significance, which revealed the following: 1. Tetracycline-treated animals demonstrated significantly less resorption of the buccal alveolar bone. There were no statistical differences however, in the amount of alveolar bone resorption palatally or interdentally. 2. Tetracycline-treated animals demonstrated significantly less apical migration of the junctional epithelium on the distal root of the maxillary first molar tooth. 3. Tetracycline-treated animals demonstrated significantly fewer inflammatory cells. In conclusion, long term systemic administration of tetracycline in the rat may be of value in reducing the amount of tissue destruction in experimentally induced periodontitis.

Topics: Administration, Oral; Alveolar Process; Animals; Dental Plaque; Epithelial Attachment; Gingiva; Male; Periodontitis; Rats; Tetracycline

The present investigation assessed the feasibility of treating periodontal disease by controlled delivery of antibacterial agents from within periodontal pockets. Tetracycline-filled hollow fibers placed in the gingival sulcus were shown to have a dramatic effect both on the periodontal microflora and clinical manifestations of disease. Furthermore, it was found that drug-filled cellulose acetate hollow fibers are biologically compatible with the environment and can be manipulated by dental personnel to provide drug therapy with less than 1/1000 the amount of tetracycline that would have been used for systemic therapy. Of theoretical importance is the observation that virtual elimination of spirochetes from the gingival sulcus is possible by a single placement of tetracycline-filled hollow fibers, and spirochetes, once eliminated from a site, do not rapidly recolonize despite the persistence of viable organisms elsewhere in the mouth.

Topics: Delayed-Action Preparations; Drug Evaluation; Drug Implants; Gingival Crevicular Fluid; Humans; Periodontal Pocket; Periodontitis; Spirochaetales; Tetracycline

Topics: Administration, Topical; Bacteria; Dental Plaque; Dental Scaling; Dosage Forms; Gingiva; Humans; Oral Hygiene; Periodontal Index; Periodontal Pocket; Periodontitis; Subgingival Curettage; Tetracycline

The present results showed that maarked and long-lasting changes in the subgingival microflora associated with periodontal disease could be achieved by a single course of periodontal treatment. Immediately following therapy, the total number of subgingival organisms decreased 10- to 100-fold and the proportions of cultivable Gram negative organisms and anaerobic organisms generally decreased 3- to 4-fold or more. After treatment, most periodontal pockets were populated by a scant microflora predominated by facultative Actinomyces and Streptococcus species. The kinetics of the subgingival bacterial recolonization revealed that the total cell counts and the proportions of spirochetes and Capnocytophaga species did not reach their pretreatment levels even after 6 months. Other Gram negative anaerobic species returned to pretreatment proportions after 3 to 6 months. Several Gram positive species exhibited higher posttreatment than pretreatment proportions throughout the 6 months study. The microbiological shifts paralleled significant changes in the clinical status of the periodontal tissues. Following therapy, the periodontal pocket depths decreased generally 1 to 4 mm, the gingival inflammatory index, the gingival fluid flow, and the suppurative index were generally lower, and nine of 33 test pockets examined showed apposition of alveolar bone. The microbiological and clinical changes described were exhibited by two patients treated with periodontal scaling and root planing alone and by two patients treated with the adjunctive use of systemic tetracycline therapy. In two other patients, mechanical periodontal therapy only slightly reduced the total number of subgingival organisms and the proportions of spirochetes and other Gram negative anaerobic rods. A shift in the subgingival microbial composition was achieved in these two patients after tetracycline therapy. The following model for treatment of periodontal disease is proposed: (1) Conventional therapy including thorough periodontal scaling and root planing; (2) Monitoring the subgingival flora and the clinical course; and (3) Use of antimicrobial therapy in refractory cases. Further studies are needed to develop means for rapid identification of refractory patients, and to determine the optimal antimicrobial agent, the optimal route of administration, and the optimal dosage regime.

Topics: Actinomyces; Adolescent; Adult; Bacteria; Cell Count; Dental Prophylaxis; Dental Scaling; Drug Resistance, Microbial; Female; Fusobacterium; Humans; Male; Middle Aged; Oral Hygiene; Periodontal Index; Periodontitis; Subgingival Curettage; Tetracycline; Veillonella

Between 1957 and 1976, 1386 patients with odontogenous abscesses in the area of the mouth, jaw, and face were treated on an in-patient basis at the Hospital for Jaw Surgery (Nordwestdeutschen) in Hamburg. The catamneses of these patients were evaluated noting the localization and frequency of each abscess, the age and sex distribution of the patients, and the possible teeth responsible for the abscess. Any pathogens demonstrated were carefully recorded. The degree of sensitivity and/or resistance of the various groups of pathogens were also included in the study, particularly streptococcus and staphylococcus. Uncritical and undifferentiated administration of antibiotic therapy for pyogenic inflammations in the area of the mouth, jaw, and face is not to be recommended.

Topics: Ampicillin; Enterobacteriaceae; Germany, West; Hospitalization; Humans; Penicillin Resistance; Penicillins; Periapical Abscess; Periodontal Abscess; Periodontitis; Staphylococcus aureus; Streptococcus; Tetracycline

Topics: Adult; Chronic Disease; Dental Prophylaxis; Dental Scaling; Female; Gingiva; Humans; Male; Oral Hygiene; Periodontitis; Tetracycline

Topics: Erythromycin; Humans; Periodontitis; Tetracycline

Topics: Ampicillin; Anti-Bacterial Agents; Cephalexin; Enterococcus faecalis; Erythromycin; Humans; In Vitro Techniques; Lincomycin; Microbial Sensitivity Tests; Penicillin G; Periapical Abscess; Periapical Tissue; Periodontitis; Pulpitis; Tetracycline

Topics: Anesthesia, Conduction; Anesthesia, Dental; Drainage; Humans; Penicillins; Periodontitis; Pulpitis; Root Canal Filling Materials; Root Canal Therapy; Tetracycline; Triamcinolone

Topics: Adult; Bone Marrow Transplantation; Humans; Ilium; Male; Periodontitis; Postoperative Care; Preoperative Care; Tetracycline; Transplantation, Autologous

Topics: Anti-Bacterial Agents; Azoles; Bacteria; Cellulitis; Chloramphenicol; Chlortetracycline; Citrates; Colistin; Erythromycin Ethylsuccinate; Humans; Indophenol; Maxilla; Methods; Oxytetracycline; Penicillin Resistance; Penicillins; Periapical Abscess; Periodontitis; Phenols; Staphylococcus; Streptomycin; Tetracycline

Topics: Carbohydrates; Child; Child, Preschool; Clubfoot; Dental Caries; Erythema; Extremities; Female; Humans; Male; Periodontitis; Tetracycline; Tooth Discoloration