Keywords :
Chronic periodontitis, Local drug delivery, Nonsurgical periodontal therapy, Scaling and root planing
Citation Information :
Hatila S, Sunnanguli G, Jayachandran M, Gopakumar R, Devi KB, Kamil MA. Comparative Assessment of the Effect of Three Various Local Drug Delivery Medicaments in the Management of Chronic Periodontitis. J Contemp Dent Pract 2023; 24 (3):162-167.
Aim: The aim of this study was to evaluate the efficacy of three different local drug delivery medications in the treatment of chronic periodontitis.
Materials and methods: Sixty participants, aged 30–55 years, were involved in the current research. Participants who fulfilled the inclusion criteria entered the study and were allocated at random to one of the three groups, each comprising 20 patients as: group A: Scaling and root planing (SRP) with local application of doxycycline gel, group B: SRP with local application of tetracycline fibers, and group C: SRP with local application of chlorhexidine gel. The plaque index (PI), the gingival index (GI), and periodontal pocket depth (PPD) were documented at baseline visit (prior to local drug delivery), and these indices were again documented 30 and 90 days post-local drug delivery.
Results: At baseline, GI score for doxycycline gel use decreased from 1.38 ± 0.05 to 0.94 ± 0.02, 1.36 ± 0.11 to 0.76 ± 0.19 for tetracycline fibers use, as well as from 1.38 ± 0.10 to 0.84 ± 0.21 for chlorhexidine gel use post 90 days. The PI value at baseline for doxycycline gel use lessened from 1.26 ± 0.01 to 1.02 ± 0.06, 1.30 ± 0.14 to 0.82 ± 0.16 for tetracycline fibers use, as well as 1.30 ± 0.22 to 0.98 ± 0.11 for chlorhexidine gel use post 90 days. At baseline, PPD values for doxycycline gel use decreased from 5.88 ± 0.24 to 3.72 ± 0.11, tetracycline fibers use lessened from 5.90 ± 0.09 to 3.02 ± 0.06, as well as for chlorhexidine gel group from 5.82 ± 0.18 to 3.44 ± 0.16 post 90 days.
Conclusion: Within the limitations of the current research, it may be inferred that tetracycline fibers exhibited somewhat superior enhancement to chlorhexidine as well as doxycycline gel.
Clinical significance: Local administration of antibacterial agents in continued or regulated delivery arrangement is employed to augment the actions of nonsurgical periodontal management, and it may be likely to attain gingival well-being by eliminating the requirement for invasive methods with the aid of local drug delivery arrangements. Chosen elimination or prohibition of microbial pathogens with locally administered antibacterial agents coupled with SRP is an efficient move toward treatment of chronic periodontitis.
Pradeep AR, Sagar SV, Daisy H. Clinical and microbiologic effects of subgingivally delivered 0.5% azithromycin in the treatment of chronic periodontitis. J. Periodontol 2008;79(11):2125–2135. DOI: 10.1902/jop.2008.070589.
Srivastava R, Verma PK, Tandon P, et al. Chlorhexidine chip and tetracycline fibers as adjunct to scaling and root planing – A clinical study. Braz J Oral Sci 2009;8(4):201–205. DOI: 10.20396/bjos.v8i4.8642081
Kalsi R, Vandana KL, Prakash S. Effect of local drug delivery in chronic periodontitis patients: A meta-analysis. J Indian Soc Periodontol 2011;15(4):304–309. DOI: 10.4103/0972-124X.92559.
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. https://www.jpbms.info/index.php?option=com_docman&task=doc_details&gid=361&Itemid=41.
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.
Pathak T, Gupta B, Tiwari V, et al. A comparative study to evaluate the effectiveness of subgingivally delivered antimicrobial bio-absorbable controlled release 0.5% azithromycin gel and 2 mg tetracycline hydrochloride fibres as an adjunct to scaling and root planing in the treatment of chronic periodontitis. Int J Prev Clin Dent Res 2018;5(2):46–52. http://www.ijpcdr.com/pdf/2018/April-June/10_DR_SAURAV_SHARMA_final%20manuscript_OA.pdf.
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
Unsal E, Akkaya M, Walsh TF. Influence of a single application of subgingival chlorhexidine gel or tetracycline paste on the clinical parameters of adult periodontitis patients. J Clin Periodontol 1994;21(5):351–355. DOI: 10.1111/j.1600-051x.1994.tb00725.x.
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.1994.65.9.840.
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.1995.66.8.692.
Nitesh Kumar Sharma, Anushree Prasad. Evaluation of efficacy of tetracycline as a local drug delivery system in the treatment of chronic periodontitis as an adjunct to scaling and root planing – A clinical and microbiological study. Int J Contemp Med Res 2017;4(5):998–1003. https://www.ijcmr.com/uploads/7/7/4/6/77464738/ijcmr_1429_june_16.pdf.
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.
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.1998.69.9.989.
Al Hulami H, Babay N, Awartani F, et al. The effect of locally delivered doxycycline as an adjunctive therapy to scaling and root planing in smokers. Saudi Dent J 2011;23(3):143–148. DOI: 10.1016/j.sdentj.2011.04.001
Javali MA, Vandana KL. A comparative evaluation of atrigel delivery system (10% doxycycline hyclate) Atridox with scaling and root planing and combination therapy in treatment of periodontitis: A clinical study. J Indian Soc Periodontol 2012;16(1):43–48. DOI: 10.4103/0972-124X.94603.
Tonetti MS, Lang NP, Cortellini P, et al. Effects of a single local doxycycline administration adjunctive to mechanical debridement in patients with persistent/recurrent periodontitis but acceptable oral hygiene during supportive periodontal therapy. J Clin Periodontol 2012;39(5):475–482. DOI: 10.1111/j.1600-051X.2012.01864.x.
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.