tetracycline-hydrochloride and Periodontal-Diseases

Antimicrobial agents, systemic and/or local, are thought by some to be effective agents for treating periodontal infections. Here the authors determine the costs and benefits of local delivery agents for treating periodontal disease. Applying this cost-benefit analysis to patient care, however, will depend upon a clinician's expertise and a patient's value system.

Topics: Administration, Topical; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Infective Agents, Local; Cellulose; Chlorhexidine; Cost-Benefit Analysis; Doxycycline; Drug Approval; Drug Costs; Drug Delivery Systems; Gels; Glycerides; Humans; Metronidazole; Microspheres; Minocycline; Periodontal Diseases; Randomized Controlled Trials as Topic; Research Design; Risk Assessment; Sesame Oil; Tetracycline; Treatment Outcome

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

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

To compare the treatment outcome of scaling and root planing (SRP) in combination with systemic antibiotics, local antibiotic therapy and/or periodontal surgery.. One hundred and eighty-seven patients were assigned to eight groups treated by SRP plus none, one, two or three adjunctive treatments and monitored for 24 months in a randomized controlled clinical trial using a 2 × 2 × 2 factorial design. Systemic amoxicillin + metronidazole (SMA), local tetracycline delivery (LTC) and periodontal surgery (SURG) were evaluated as adjuncts. Changes in clinical attachment level (CAL) and probing pocket depth (PPD) were statistically evaluated by ancova of main effects.. Effects of adjunctive therapy to SRP were minimal at 3 months. Between 3 and 6 months PPD reduction occurred particularly in patients receiving periodontal surgery. After 6 months, both CAL gain and PPD reduction reached a plateau that was maintained at 24 months in all groups. The 24-month CAL gain was improved by SMA (0.50 mm) while PPD was reduced by SMA (0.51 mm) and SURG (0.36 mm). Smoking reduced CAL gain and PPD reduction.. Patients receiving adjunctive therapies generally exhibited improved CAL gain and/or PPD reduction when compared with the outcome of SRP alone. Only additive, not synergistic effects of the various adjunctive therapies were observed.

Topics: Amoxicillin; Analysis of Variance; Anti-Infective Agents; Cellulose; Chemotherapy, Adjuvant; Chlorhexidine; Dental Scaling; Drug Combinations; Drug Delivery Systems; Female; Humans; Male; Metronidazole; Middle Aged; Oral Surgical Procedures; Periodontal Attachment Loss; Periodontal Diseases; Periodontal Index; Periodontal Pocket; Smoking; Tetracycline; Treatment Outcome

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

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

Topics: Administration, Topical; Anti-Bacterial Agents; Anti-Infective Agents, Local; Cellulose; Chlorhexidine; Delayed-Action Preparations; Doxycycline; Drug Delivery Systems; Humans; Minocycline; Periodontal Diseases; Tetracycline; Treatment Outcome

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