tetracycline-hydrochloride and Periodontal-Pocket

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 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

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

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

A clinical and microscopical (SEM) investigation has been carried out on the biocompatibility of cellulose acetate fiber tetracycline with 25% of tetracycline hydrochloride (Actisite R). A subject with advanced periodontal disease was selected and a pocket of 8 mm of PD was chosen. A segment of fiber was inserted into the pocket for 8 days. After removal, PD and GI clinical parameters were detected and the fiber removed was analyzed at the scanning electronic microscope. The results showed clinical signs of inflammation after removal of fiber. SEM analysis showed macrophagic reaction, a typical sign of inflammatory response to material. The study suggests the need of more biocompatible materials, easier to use as delivery system of antibiotics in the treatment of periodontal disease.

Topics: Adult; Anti-Bacterial Agents; Biocompatible Materials; Cellulose; Delayed-Action Preparations; Drug Combinations; Drug Delivery Systems; Drug Evaluation; Humans; Male; Microscopy, Electron, Scanning; Periodontal Pocket; Tetracycline

Topics: Anti-Bacterial Agents; Cellulose; Dental Plaque; Drug Carriers; Drug Implants; Humans; Periodontal Pocket; Polyvinyls; Tetracycline