Local drug delivery in the treatment of furcation defects in periodontitis: a systematic review

Abstract

Objectives To evaluate the effect of subgingival administration of various antimicrobials and host-modulating agents in furcation defects as an adjunct to scaling and root planing (SRP) compared to SRP alone or combined with placebo. Methods A systematic review was carried out using MEDLINE-PubMed, Embase, and Scopus for articles up to October 2022 in addition to hand searches. All longitudinal studies that evaluated the effect of subgingival application of antimicrobial and host-modulating agents in furcation defects as adjuncts to SRP compared to SRP alone or SRP + placebo with at least 3 months of follow-up were eligible for inclusion. Results A total of eight studies were included. Superior clinical treatment outcomes were shown when alendronate, rosuvastatin, boric acid, simvastatin, and tetracycline (only at 3 months) were utilized in furcation defects in conjunction with SRP alone or SRP + placebo. Significant improvement was reported in radiographic bone defect depth and defect depth reduction when SRP was supplemented with alendronate, rosuvastatin, boric acid, and simvastatin. Conclusions Within the limitations of this review, the adjunctive subgingival administration of medications and host-modulating agents in furcation defects may confer additional clinical and radiographic benefits than non-surgical periodontal treatment alone. Future investigations are needed to confirm their long-term effectiveness. Clinical relevance Local host modulators and antimicrobials may be used supplementary to enhance the clinical and radiographic treatment outcomes of conventional periodontal therapy in furcation defects.

Enhanced immunomodulation and periodontal regeneration efficacy of subgingivally delivered progranulin‐loaded hydrogel as an adjunct to non‐surgical treatment for Class II furcation involvement in dogs

“…Two weeks after treatment, the SRP + BDNF/HMW‐HA group showed significant improvement in all clinical parameters compared to the SRP group or the SRP + HMW‐HA group (Sasaki et al, 2019). Furthermore, our results are also consistent with three recent reviews on the adjunctive effect of host modulators, which suggest that local delivery of host modulatory agents may provide additional clinical benefits to NSPT (Balta et al, 2021; Chatzopoulos et al, 2023; Donos et al, 2020).…”

“…Current evidence, although insufficient, suggests that local delivery of host modulatory agents (such as statin, alendronate, rosuvastatin, etc.) may further improve the short‐term clinical and radiographic outcomes when used as adjuncts to SRP (Balta et al, 2021; Chatzopoulos et al, 2023; Donos et al, 2020). Based on the relationship between periodontitis and the host immune response, local application of pro‐osteogenic and immunomodulatory agents appears to be a promising non‐surgical adjunctive therapy for SRP to simultaneously promote the resolution of inflammation and periodontal regeneration.…”

Enhancing osteogenic differentiation of MC3T3-E1 cells during inflammation using UPPE/β-TCP/TTC composites via the Wnt/β-catenin pathway

“… 41 TTC can inhibit inflammatory responses and cartilage resorption, thereby mitigating the infiltration and destruction of inflammatory cells and consequently mitigating bone destruction and bone defects. 42 Moreover, TTC can promote bone matrix synthesis, enhance bone cell function, and contribute to the reparation of bone defects caused by periodontitis. 43 According to the study by Zhao et al , 44 greater surface hydrophilicity in materials can lead to enhanced osteoblast differentiation.…”

A comparison of oral bacteriome isolated from periodontal pockets of participants with or without diabetes mellitus in Uganda: a case control study

“…More advanced surgical techniques using dentinal derivatives have demonstrated strong regenerative properties on the periodontal tissues which may be helpful even in patients with diabetes mellitus [ 25 ]. Antibiotics when used with mechanical therapy may confer additional benefits [ 28 ]. The choice of antimicrobial agents requires an insight in the type of bacteria associated with periodontitis in the patients suffering from diabetes mellitus.…”