The adjunctive use of SDD with SRP is more effective than SRP alone and may represent a new approach in the long-term management of AP.

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

The purpose of this study was to characterize, using the scanning electron microscope, the nature of root surfaces denuded by (1) root planing alone or (2) root planing plus citric acid treatment. Six teeth were extracted from three squirrel monkeys, and the coronal half of the root surface was planed to remove attached periodontal ligament fibers and cementum. Citric acid, pH 1, was topically applied to the denuded surfaces of 3 teeth. The surface of only root-planed specimens had an irregular surface which corresponded to a smear layer. Root surfaces that had received acid treatment after root planing exhibited funnel-shaped orifices of dentinal tubules, and intertubular zones with a fibrillar, mat-like morphology. The implications of the different root-surface characteristics are discussed.

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Previous studies indicated that connective tissue attachment to the root surface appeared to be dependent upon a chronologic healing sequence related to fibrin and collagen interactions. It was the purpose of the present study to try and substantiate this hypothesis by using histologic techniques designed to differentiate between fibrin and collagen during healing at the root surface interface. In four squirrel monkeys, 24 normal teeth were extracted and reimplanted after either (i) surgically denuding the coronal root surface of connective tissue fibers and cementum by root planing or, (ii) surgical denudation followed by topical application of citric acid (pH = 1; 3 minutes). Three specimens were available for histological analysis 1, 3, 7 and 21 days after reimplantation. Mallory's phosphotungstic acid hematoxylin staining technique was used to differentiate between fibrin and collagen. Epithelium migrated rapidly along the denuded, non-acid-treated, root surfaces, had reached the alveolar crest at 3 days, and was within the ligament space to the level of root denudation at 21 days. Epithelium did not migrate apically along denuded root surfaces treated with citric acid. At 1 and 3 days, inflammatory cells were enmeshed in a fibrin network which appeared to be attached to the root surface by arcade-like structures. At 7 and 21 days, the region had repopulated with connective tissue cells, and collagen fibers had replaced the fibrin. It was concluded that collagen fiber attachment to the root surface was preceded by fibrin linkage, and that the linkage process occurred as an initial event in the wound healing response.