Context:Both gingivitis and periodontitis are due to the detrimental effects of the microbe-laden biofilm. The mainstay of periodontal treatment is, therefore, the disruption of this biofilm by scaling and root planing (SRP). Other treatment protocols such as systemic antimicrobials have been administered as adjuvants after scaling and root planning. However, due to antimicrobial resistance, as well as a shift of the flora from a symbiotic to a dysbiotic one, this mode of treatment has its shortcomings. Thus, local drug delivery has gained prominence as a therapeutic tool.Aims:The aim of this study is to compare the efficacy of subgingivally delivered probiotics as a monotherapy, in combination with tetracycline fibers, and tetracycline fibers alone after SRP.Settings and Design:This study was a parallel arm, randomized clinical and microbiological study. Thirty patients with chronic periodontitis aged between 20 and 50 years were selected from the outpatient ward of a tertiary referral care hospital in Hyderabad and equally divided into three groups.Materials and Methods:This study was conducted from January 2017 to February 2017 and ethical clearance was obtained from the institutional ethical committee.Statistical Analysis Used:Mean values and standard deviations were calculated for Plaque Index, Sulcular Bleeding Index (SBI), probing depth (PD), and microbial colony-forming units, for all the three groups at different time intervals. Paired “t-test” was used for intragroup comparison and Student's “t-test” for intergroup comparison. Results were regarded as statistically significant when P < 0.05.Results:Intragroup comparison yielded significant improvement in all the variables (P < 0.0001). However, intergroup comparison showed statistically significant differences pertaining to the PD (P < 0.001) and SBI only (P < 0.001), between Group A and Group B and Group B and Group C respectively.Conclusions:Group A and Group C showed better results than Group B.

Background:: Periodontitis is one of the most widespread oral diseases. Curcumin, a hydrophobic polyphenolic compound derived from the rhizomes of Curcuma longa has a great potential for biological and pharmacological activities. The introduction of local controlled delivery of curcumin directly into the periodontal pocket is a promising approach for the treatment of periodontitis. Objective:: The study has been designed to formulate intrapocket dental film loaded with curcumin to be used for insertion into the periodontal pockets and evaluate its clinical efficacy. Methods:: Curcumin dental films were prepared by the solvent casting technique using polymers such as Ethylcellulose, HPMC K4M, Eudragit RL 100, Chitosan with Dibutyl Phthalate and Poly Ethylene Glycol 400 as the plasticizer. The prepared films (CDF1-CDF16) were evaluated for various physicochemical parameters regarding established pharmaceutical procedures such as surface pH, folding endurance, tensile strength, swelling index, drug content, in-vitro drug release, antibacterial efficacy, stability studies, and clinical efficacy. Results:: Experimental parameters of the obtained film exhibited results within the desired limit. Fourier Transform Infrared Spectroscopy and Differential Scanning Calorimetry studies revealed the formulated film is stable during drug stability and are compatible between drugs and excipients. The surface morphology of the formulation using Scanning Electron Microscope images showed the presence of free drug particles on the surface causing a burst effect at the desired site. In-Vitro dissolution studies showed an initial burst release to achieve an immediate therapeutic level of drug in the periodontal pocket followed by a progressive fall and extended-release of the drug for 10 days. The therapeutics effects such as antibacterial activity of films on P. gingivalis are also observed. Furthermore, the clinical trials of formulation CDF16 on affected patients proved the therapeutic efficacy of the dental films showing a statistically significant (p < 0.05) decrease in the clinical markers of periodontitis, i.e. periodontal probing depth, plaque index, and sulcular bleeding index. Conclusion:: The experimental results suggest that Curcumin dental film is experimentally identified as a potential drug delivery device. Hence the use of curcumin dental film can be used for topical treatment of periodontal diseases and to achieve optimum therapeutic efficacy.

Periodontitis describes a group of related inflammatory diseases resulting in the destruction of the tissues that support the tooth. This disease results from the growth of diverse microflora (especially anaerobes) in the periodontal pockets and releases various bacterial enzymes, toxins, and stimulation of the body’s immune response. Scaling and Root planning is the basic treatment modality for periodontitis. Mechanical treatment is limited by physical impediments and biochemical considerations. Antimicrobial agents may be used as an adjunct to overcome the limitations of mechanical therapy. Nonsurgical controlled intrapocket delivery of antimicrobials in the treatment of periodontitis has been investigated for the possibility of overcoming the limitations of conventional therapy. Nonsurgical controlled release formulations to deliver antibacterial to the site of periodontal pocket are designed to be of low cost, nontoxic, biocompatible, biodegradable, greater stability, non-immunogenicity, and effective long-term treatment at the site of infection with reduced systemic dosing. A number of polymer based delivery systems like fibers, strips, films, chips, microparticles, nanoparticles, and nanofiber made from a variety of natural and synthetic materials have been successfully tested to deliver a variety of drugs. Periodontal pockets as a drug delivery platform for designing a suitable dental localized dosage form along with its potential advantage and limitations is reviewed here.

Periodontitis is one of the most widespread oral inflammatory infectious diseases affecting the oral cavity. This study aims to develop and characterize a more effective syringeable curcumin in situ gel for the treatment of periodontitis and evaluate its clinical effectiveness. Curcumin in situ gel was formulated by the cold method using temperature-sensitive (Poloxamer 188, 407), pH-sensitive (Carbopol 934P), and ion-sensitive (Gellan gum) polymers. Gel formulations including Poloxamer 407 and Carbopol 934P as independent factors for the selected response like viscosity and gelation temperature were optimized using central composite design (CCD). All the formulation evaluations were made to ascertain drug content, gelation temperature, viscosity, stability, and in vitro drug release. Appropriate physical characteristics for most formulations and their suitability for periodontitis were observed. Appropriate gelation temperature was found to range from 30.2 to 36.5 o C, with a pH of 6.14 to 7.25. The viscosity of the gel at 4 o C ranged from 12540 to 32400 centipoise. In all cases, the designed formulations were found to be successfully syringeable with a 21-gauge needle at cold temperature. Most of the formulations showed a greater correlation with the Higuchi equation, supporting the assumption that diffusion was the primary mechanism of drug release. Clinical study of the optimized gel formulation revealed a substantial reduction in the clinical markers of periodontitis. The study shows that curcumin in situ gel may be considered as a promising delivery mode for the safe and efficient treatment of periodontitis which substantially overcomes the drawbacks of conventional therapy.