Antimicrobial therapy in periodontitis: the use of systemic antimicrobials against the subgingival biofilm

OBJECTIVES This study aims to assess the potential of a mixture of three antibiotics (TreVitaMix, TVM) as an intracanal dressing to disinfect the outer root surface by applying a new in vitro model. MATERIALS AND METHODS Fifty freshly extracted bovine roots were endodontically treated. Forty samples were then thoroughly scaled, mounted to petri dishes, gas sterilized, and randomly allocated to four groups (n = 10/group) according to their intracanal medication: sterile saline (NaCl; control, A); the TVM carrier material alone, i.e., propylene glycol (PG; B); TVM (C); and calcium hydroxide (D). In an additional group (E), the cementum was not removed and TVM was placed. Petri dishes were filled with Fastidious Anaerobe Agar, inoculated with Fusobacterium nucleatum suspension and then anaerobically incubated during 48-h intervals at 37°C up to 192 h. Inhibition zones around the roots were then measured after each incubation period (mm(2)). RESULTS Only teeth inoculated with the TVM dressing showed inhibition at all time points, whereas the other treatments showed no peri-radicular growing inhibition. Presence of cementum had no negative effect on disinfection (p = 0.9320). CONCLUSION TVM was able to penetrate through the dentine and inhibit the bacterial growth of F. nucleatum up to 192 h. CLINICAL RELEVANCE TVM might have the potential to sustainably disinfect the outer root surface in perio-endo lesions and serve as an adjunctive antimicrobial agent. Declaration of interests:The authors declare they have no conflicts of interest. AbstractObjectives To assess the potential of a mixture of three antibiotics (TreVitaMix, TVM) as an intracanal dressing to disinfect the outer root surface applying a new in vitro model. Materials and MethodsFifty freshly extracted bovine roots were endodontically treated. Forty samples were then thoroughly scaled, mounted to petri dishes, gas sterilized and randomly allocated to four groups (n=10/group) according their intracanal medication: Sterile saline NaCl (control, A), the TVM carrier material alone, i.e. propylene glycol (PG; B), TVM (C) and calcium hydroxide (D). In an additional group (E), the cementum was not removed and TVM was placed. Petri dishes were filled with Fastidiuos Anaerobe Agar, inoculated with F. nucleatum suspension and then anaerobically incubated during 48 h intervals at 37°C up to 192 h. Inhibition zones around the roots were then measured after each incubation period (mm 2 ).Results Only teeth inoculated with the TVM dressing showed inhibition at all time points, whereas the other treatments showed no peri-radicular growing inhibition. Presence of cementum had no negative effect on the disinfection (p = 0.9320).Conclusion TVM was able to penetrate through dentine and inhibit the bacterial growth of F. nucleatum up to 192 h.Clinical relevance TVM might have the potential to sustainably disinfect the outer root surface in perio-endo lesions and serve as an adjunctive antimicrobial agent.

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“…Therefore mechanical disruption of the biofilm is mandatory for successful antibacterial therapy [51].…”

Section: Discussionmentioning

confidence: 99%

Endodontic drug delivery for root surface disinfection: a laboratory feasibility evaluation

et al. 2015

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“…In periodontitis, the body responds to bacterial challenge with an elevated inflammatory response wherein tissue break down occurs, leading to the clinical sign of periodontitis. Host modulation therapy offers the potential for down-regulating the destruction aspects and up-regulating protective aspects of the host response to the bacterial challenge to enhance the opportunities for wound healing and periodontal stability [44]. Sub-antimicrobial-dose doxycycline (SDD) has an anticollagenolytic action for which the adjunct use of it with nonsurgical therapy was proposed in the treatment of aggressive, severe chronic and refractory periodontitis cases.…”

Section: Teeth With and Teeth Without Furcation Involvementmentioning

confidence: 99%

“…The systemic antibiotics including clindamycin [46], Augmentin [41], tetracycline [39], metronidazole [47] are found to be effective in treating refractory cases. Periodontitis being an infectious disease caused by groups of bacteria acting alongside the immune system cannot kill all the bacteria; therefore, a combination of amoxicillin and metronidazole has been proposed to treat refractory cases by Herrera et al [44].…”

Section: Annals Of Clinical and Laboratory Researchmentioning

confidence: 99%

“…Antimicrobial therapy: Adjunctive systemic antimicrobial therapy along with nonsurgical periodontal therapy is probably the most effective way to manage refractory cases [44]. Mechanical periodontal therapy disrupts the bacterial biofilm and enhances antimicrobial effect of antibiotics so it may be productive to use antibiotics as an adjunct to mechanical therapy in generalized non-responsive cases [45].…”

Section: Annals Of Clinical and Laboratory Researchmentioning

confidence: 99%

“…A sub-antimicrobial dose of doxycycline has anticollagenolytic activity [44][45][46][47][48][49] and therefore provides the rationale for its use in smokers. Evidence suggests that adjunctive use of SDD along with nonsurgical therapy could…”

Section: Teeth With and Teeth Without Furcation Involvementmentioning

confidence: 99%

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Deliberations on Non-Surgical Periodontal Therapy

Sadiq¹,

Heglund²

2017

Ann Clin Lab Res

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Non-surgical periodontal therapy remains the gold standard for resolution of dental plaque biofilm induced oral disease. This therapy involves patient oral home care on a daily basis for success. In incidents of NSPT failure, more than just patient compliance should be considered. Periodontal disease is a multi-factorial disease and needs to be considered in multi-modal therapeutic regimens. Practitioner's deliberations around failures after NSPT ought to evaluate the very nature of disease, the biology inherent in tooth to gum interactions, and the rather limited means of addressing such factors.

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Supportive periodontal therapy (SPT) for maintaining the dentition in adults treated for periodontitis

Manresa

Sanz-Miralles

Twigg

et al. 2018

Cochrane Database of Systematic Reviews

121

118

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Antimicrobial therapy in periodontitis: the use of systemic antimicrobials against the subgingival biofilm

Cited by 291 publications

References 130 publications

Endodontic drug delivery for root surface disinfection: a laboratory feasibility evaluation

Endodontic drug delivery for root surface disinfection: a laboratory feasibility evaluation

Deliberations on Non-Surgical Periodontal Therapy

Supportive periodontal therapy (SPT) for maintaining the dentition in adults treated for periodontitis

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