Chronic periodontitis, Local drug delivery, Periodontal pocket, Scaling and root planing
Citation Information :
Abraham A, Raghavan R, Joseph A, Devi MS, Varghese M, Sreedevi P. Evaluation of Different Local Drug Delivery Systems in the Management of Chronic Periodontitis: A Comparative Study. J Contemp Dent Pract 2020; 21 (3):280-284.
Aim: The present study aimed to assess the use of various local drug delivery systems in the management of chronic periodontitis. Materials and methods: A total of 60 patients aged around 30–55 years were included. The subjects who were enrolled under took a phase I therapy that included scaling and root planing (SRP). Patients who satisfied the conditions for selection to enter the trial were assigned randomly to three groups, with each group consisting of 20 participants as follows: group I: controlled-release drugs-chlorhexidine gel, group II: metronidazole gel, group III: tetracycline fibers. The plaque index (PI), gingival index (GI), and periodontal pocket depth (PPD) were recorded after 1st week as the baseline data and were recorded again after 15 days and 30 days post-baseline. Results: The mean GI scores were 1.32 ± 0.10, 0.88 ± 0.16, and 0.76 ± 0.12, at baseline, 15 days, and 30 days, respectively, in group I. In group II, the mean GI score reduced to 1.09 ± 0.83 at 30 days from 1.48 ± 0.27 at baseline. Likewise, in group III the mean GI score reduced to 0.90 ± 0.62 at 30 days from 1.38 ± 0.06 at baseline. All the groups demonstrated a statistically significant difference at various intervals. The mean PI score decreased to 0.90 ± 0.78 at 15 days from 1.46 ± 0.22 at baseline in group III. A statistically significant difference at different intervals was seen in group III only. In all groups, the intergroup comparison of PPD was found to be statistically significant. Conclusion: This study demonstrated that although thorough SRP is an effective treatment method for elimination of chronic periodontal pockets, improved results can be obtained by adjunctive use of locally administered chlorhexidine gel, metronidazole gel, and tetracycline fibers. Clinical significance: The use of the adjunctive local drug delivery system along with mechanical cleansing in the treatment of periodontal pockets in chronic periodontitis is therapeutically beneficial.
Dodwad V, Vaish S, Mahajan A, et al. Local drug delivery in periodontics: a strategic intervention. Int J Pharm Pharm Sci 2004;4(4):30–34.
Greenstein G. Nonsurgical periodontal therapy in 2000: a literature review. J Am Dent Assoc 2000;131(11):1580–1592. DOI: 10.14219/jada.archive.2000.0087.
Bonito AJ, Lux L, Lohr KN. Impact of local adjuncts to scaling and root planing in periodontal disease therapy: a systematic review. J Periodontol 2005;76(8):1227–1236. DOI: 10.1902/jop.2005.76.8.1227.
Paul TP, Emmatty R, Pulikkottil JJ, et al. Comparative evaluation of sustained release collagen device containing 5% metronidazole (metrogene) along with and without scaling and root planing at regular intervals with treatment of chronic periodontitis: a case control study. J Int Oral Health 2015;7(6):18–22.
Nandini N, Dodwad V, Arora K. Comparative evaluation of 1% curcumin solution and 0.2% chlorhexidine irrigation as an adjunct to scaling and root planing in management of chronic periodontitis: a clinico-microbiological study. J Pharma Biomed Sci 2012;14:1–6.
Reddy S, Bhowmick N, Singh S, et al. A comparison of chlorhexidine and tetracycline local drug delivery systems in management of persistent periodontal pockets—a clinical study. Int J Appl Dent Sci 2016;2(3):11–15.
Heasman PA, Heasman L, Stacey F, et al. Local delivery of chlorhexidine gluconate (PerioChip TM) in periodontal maintenance patients. J Clin Periodontol 2001;28(1):90–95. DOI: 10.1034/j.1600-051x.2001.280114.x.
Slots J. Research, science and therapy committee. Systemic antibiotics in periodontics. J Periodontol 2004;75:1553–1565. DOI: 10.1902/jop.2004.75.11.1553.
Jeong SN, Han SB, Lee SW, et al. Effects of tetracycline-containing gel and a mixture of tetracycline and citric acid-containing gel on non-surgical periodontal therapy. J Periodontol 1994;65(9):840–847. DOI: 10.1902/jop.19126.96.36.1990.
Soares PB, de Menezes HH, Naves MM, et al. Effect of absorbent tetracycline-loaded membrane used in the reduction of periodontal pockets: an in vivo study. Braz Dent J 2009;20(5):414–418. DOI: 10.1590/S0103-64402009000500010.
Mizrak T, Güncü GN, Caglayan F, et al. Effect of a controlled-release chlorhexidine chip on clinical and microbiological parameters and prostaglandin E2 levels in gingival crevicular fluid. J Periodontol 2006;77(3):437–443. DOI: 10.1902/jop.2006.050105.
Anitha V, Rajesh P, Shanmugam M, et al. Comparative evaluation of natural curcumin and synthetic chlorhexidine in the management of chronic periodontitis as a local drug delivery: a clinical and microbiological study. Indian J Dent Res 2015;26(1):53–56. DOI: 10.4103/0970-9290.156806.
Stelzel M, Flores de Jacoby L. Topical metronidazole application compared with subgingival scaling. A clinical and microbiological study on recall patients. J Clin Periodontol 1996;23(1):24–29. DOI: 10.1111/j.1600-051X.1996.tb00500.x.
Mohamed Haris PM, Panickal DM. Role of metronidazole as a local drug delivery in the treatment of periodontitis: a review. Int J Oral Health Med Res 2017;3(6):141–145.
Griffiths GS, Smart GJ, Bulman JS, et al. Comparison of clinical outcomes following treatment of chronic adult periodontitis with subgingival scaling or subgingival scaling plus metronidazole gel. J Clin Periodontol 2000;27(12):910–917. DOI: 10.1034/j.1600-051x.2000.027012910.x.
Friesen LR, Williams KB, Krause LS, et al. Controlled local delivery of tetracycline with polymer strips in the treatment of periodontitis. J Periodontol 2002;73(1):13–19. DOI: 10.1902/jop.2002.73.1.13.
Perinetti G, Paolantonio M, Cordella C, et al. Clinical and microbiological effects of subgingival administration of two active gels on persistent pockets of chronic periodontitis patients. J Clin Periodontol 2004;31(4):273–281. DOI: 10.1111/j.1600-051x.2004.00481.x.
Drisko CL, Cobb CM, Killoy WJ, et al. Evaluation of periodontal treatments using controlled-release tetracycline fibers: clinical response. J Periodontol 1995;66(8):692–699. DOI: 10.1902/jop.19188.8.131.522.
Banodkar AB, Rao J. A comparative study of periodontal treatment using tetracycline impregnated collagen fibers as compared to scaling and root planing alone-a clinical and microbiological study. J Indian Dent Assoc 2011;5:1044–1046.
Wilson Jr TG, McGuire MK, Greenstein G, et al. Tetracycline fibers plus scaling and root planing versus scaling and root planing alone: similar results after 5 years. J Periodontol 1997;68(11):1029–1032. DOI: 10.1902/jop.19184.108.40.2069.
Jeffcoat MK, Bray KS, Ciancio SG, et al. Adjunctive use of subgingival controlled release chlorhexidine chip reduces probing depth and improves attachment level compared with scaling and root planing alone. J Periodontol 1998;69(9):989–997. DOI: 10.1902/jop.19220.127.116.119.