Subgingival Delivery of Therapeutic Agents in the Treatment of Periodontal Diseases

Abstract

This article reviews the current status of controlled local delivery of antibacterial agents in the treatment of periodontitis. The principle of local intrapocket delivery of antibacterial agents and their delivery are discussed. The dosage forms include fibers, film/slabs, and injectable systems, some of which are degradable, while others are not and need to be removed at the termination of the treatment. The antibacterial agents used cover a range of antibiotics as well as antiseptics, and the composition of the delivery systems, their reported use, and the clinical results are summarized. The use of these systems in clinical practice is relatively recent, and therefore their application and integration into the dental office are not yet clearly defined. Clinical applications that have been tested are critically reviewed, and clinical situations in which controlled delivery of antibacterial agents may prove to be clinically useful are suggested for scientific evaluation.

The Antimicrobial Treatment of Periodontal Disease: Changing the Treatment Paradigm

“…Studies with the 25% tetracycline fiber (Goodson, 1994) and a biodegradable chlorhexidine film or chip (Soskolne, 1997) indicated that a seven-to 10-day treatment period is necessary to achieve a clinical result that lasts for several months.…”

Functionalised nanoscale coatings using layer-by-layer assembly for imparting antibacterial properties to polylactide-co-glycolide surfaces

“…Compared to systemic drug delivery, local administration in periodontology is considered to be more effective, since the pathogen-specific drug can be placed directly in the periodontal pocket achieving effective concentrations for a sufficiently long period of time. In addition, the risk of undesired side effects caused by high systemic doses or resistance development can be reduced [3,4]. It is therefore beneficial to use local delivery systems that control the release of their agents and guarantee lasting drug concentrations in the pocket in spite of high sulcular fluid rates [3].…”

<i>In vitro</i> evaluation of electrospun PLGA/PLLA/PDLLA blend fibers loaded with naringin for guided bone regeneration

“…A too-quick degradation of the blend fibers to lactic acid could lead to an acidosis and interfere with wound healing. The mechanical stability of the fiber mats is also essential to resist the mechanical stress caused by the high production of sulcus fluid 28) . By the way, the mechanical properties of the composite fiber membranes with naringin are better than that without naringin.…”

“…This may be due to strengthening by naringin, 6 Dent Mater J 2018; : -which acted as a crystal particle to enhance the polymer composite matrix 24) . Many resorbable drug delivery systems were developed during recent decades, such as drug loaded hydroxypropyl cellulose films 29) , which were first described by Noguchi et al, or drug carrying gels such as Elyzol ® (Dumex, Bad Vilbel, Germany) dental gel, based on melted glycerol mono-oleate 28,[30][31][32] . However, also for these systems, the periodontal milieu often poses the major problem that the required period of drug exposure (7 days) cannot be achieved 28,33) , let alone bone formation which would require several months.…”