New Local Drug Delivery with Antibiotic in the Nonsurgical Treatment of Periodontitis—Pilot Study

Abstract

Combination of the classical subgingival instrumentation (scaling and root planing procedure, SRP) with an antibiotic administered to periodontal pockets in a suitable medium is a promising alternative protocol of nonsurgical periodontal treatment. It enables obtaining the long-term minimum drug concentration inhibiting the development of periopathogens. Objectives: Clinical and microbiological evaluation of periodontal pockets two months after single application of a gel containing piperacillin and tazobactam (Gelcide)® in relation to the nonsurgical treatment procedure (SRP). Materials and methods: Ten patients aged 24–56 years (mean 39.5) with chronic periodontitis, nonsmokers with acceptable oral hygiene and no classical exclusion criteria were qualified for treatment. In the maxilla area, SRP was performed and the assessed gel was inserted to two randomly selected adjacent periodontal pockets. Clinical evaluation included the assessment of bleeding on probing (BoP), pocket depth (PD), and clinical attachment loss (CAL) at six measurement points. A microbiological examination with the use of PET deluxe diagnostic kit in the drug-administered pockets and symmetrically in two pockets on the other side of the dental arch was performed. The examination was conducted before the treatment and two months later. Results: Two months after the treatment, a significant improvement in all analyzed clinical parameters was observed. However, the extent of this improvement did not differ significantly between the compared treatment methods. No statistically significant differences were found in the number of bacteria before and after the treatment, except for a significant decrease in the number of Micromonas micros (2957 vs. 589, p = 0.028) and a higher number of the green complex bacteria Capnocytophaga gingivalis (5439 vs. 2050, p = 0.041) after antibiotic had been used. Conclusion: No significant clinical and microbiological differences were found after additional administration of gel with piperacillin and tazobactam in relation to SRP in the preliminary study.

A Placebo-Controlled Trial to Evaluate Two Locally Delivered Antibiotic Gels (Piperacillin Plus Tazobactam vs. Doxycycline) in Stage III–IV Periodontitis Patients

“…To our knowledge, the present study is the only clinical trial comparing the clinical and microbiological effects of Gelcide ® vs. a widely used SRD gel and a placebo for severe periodontitis treatment published so far. The present study identified similar improvements in clinical periodontal outcomes in 64 subjects treated with SI with or without a one-time administration of a locally delivered antibiotic at 6 months; as with other trials on LDD, the similarities of the results between test and control groups represent the main issue that has been identified in this research [ 16 , 44 ]. The purpose of the present study was to compare the effects of two locally delivered antibiotic gels (piperacillin plus tazobactam vs. doxycycline) at the end of SI in stage III–IV periodontitis patients.…”

“…The present treatment protocol included one round of application of piperacillin plus tazobactam, in periodontal pockets evaluated at 3–6 months after the application. Similar protocols of one local adjunctive application have been evaluated in the literature [ 16 , 44 ].…”

“…SRP, more recently renamed as subgingival instrumentation (SI) (by The EFP S3 level Clinical Practice Guideline (European Federation of Periodontology)) [ 14 ], is considered to be the gold standard in the nonsurgical treatment of periodontitis [ 15 , 16 , 17 , 18 , 19 ]. Several factors may influence its effectiveness and success, including the presence of deep periodontal pockets [ 20 , 21 ] and furcation damage [ 22 , 23 , 24 ].…”

“…In such cases, the use of local antibiotic agents as an adjunct to SI may prove to be beneficial. Combining traditional SI with intrapocket antibiotic application is one of the potential alternative procedural protocols that allows for the acquisition of long-term minimum concentration of the drug inhibiting periopathogen development [ 16 ].…”

“…According to the manufacturer, over the course of 8 to 10 days, the components of Gelcide ® are gradually released at quantities that are higher than the minimal inhibitory concentration. The coating is permeable, but it is insoluble to fluid, protecting the pocket from exposure to bacteria in the oral cavity and from further irritation and infection [ 16 ].…”