Evaluation of two local drug delivery systems as adjuncts to mechanotherapy as compared to mechanotherapy alone in management of chronic periodontitis: A clinical, microbiological, and molecular study

Abstract

Background:Modern concepts of treating inflammatory periodontal disease aim at changes in the subgingival ecosystems within the periodontal pockets to alter the complex microbial community into a microbiota compatible with good periodontal health. Systemic antimicrobial therapy, although effective, involves a relatively high dose with repeated intakes over a prolonged period of time to achieve the required inhibitory concentrations in the sulcular fluid. The adjunctive use of local drug delivery may provide a beneficial response, especially in specific areas where conventional forms of therapy might fail. The aim of this study was to compare the efficacy of two local drug delivery systems, one containing metronidazole and the other containing tetracycline hydrochloride as adjuncts to mechanotherapy in the treatment of chronic periodontitis.Materials and Methods:There were three groups that were labeled as group A (Scaling + Tetracycline), group B (Scaling + Metronidazole), and group C (Scaling alone). A microbiological analysis was carried out to determine the efficacy of these systems in changing the pathogenic flora in deep pockets. In addition, a multiplex polymerase chain reaction was carried out to confirm the presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis (Pg), and Tannerella forsythensis in the flora associated with chronic periodontitis.Results:There was clinical improvement in groups A and B, which correlated with an improvement in the microbiological parameters; these results were sustained for 90 days following therapy. In Group C, the flora showed a shift towards baseline at the end of 90 days.Conclusions:According to this study, both the local antibiotic therapies resulted in greater improvement in microbiological parameters when used as an adjunct to mechanotherapy as compared to mechanotherapy alone.

In vivo evaluation of a metronidazole-containing gel for the adjuvant treatment of chronic periodontitis: preliminary results

“…Our results demonstrated a reduction in the mean total counts of microorganisms in the subgingival microbiota after the proposed therapies. Similar results after scaling and root planing and antimicrobial therapy have been observed [22][23][24][25]. Intragroup analyses revealed a significant reduction in the total number of all bacterial species 7 days after gel application.…”

Effect of controlled-release PeriochipTM on clinical and microbiological parameters in patients of chronic periodontitis

“…This increases the chances of development of resistance, alteration of commensal flora, and increased potential for adverse effects. [1314151617] Local administrations, therefore, provide a useful answer to these problems and are developed to deliver therapeutic levels of antibacterial agents directly into the pocket with no systemic side effects; however, the important factor in the success of this treatment is the ability to control and to prolong the release rate of the therapeutic agent from the device. [2]…”

Multilevel analysis of bacterial counts from chronic periodontitis after root planing/scaling, surgery, and systemic and local antibiotics: 2-year results

“…In smokers, adjunctive local doxycycline caused greater reduction in the frequency of P. gingivalis after initial and supportive therapy compared to conventional treatment (10). Two local drug delivery systems, one containing MET, the other TET hydrochloride, gave both improvements in microbiological parameters of chronic periodontitis (11). The improvement was greater when the local antibiotic therapies were used as an adjunct to mechanotherapy and the results were sustained 90 days following therapy.…”