A 4‐quadrant comparative study of periodontal treatment using tetracycline‐containing drug delivery fibers and scaling

Abstract

The present study describes results on selected clinical and microbiological parameters obtained by periodontal treatment with ethylene vinyl acetate fibers containing 25% by weight tetracycline hydrochloride placed into the periodontal pocket alone or in combination with scaling. Supragingival plaque control was maintained throughout the study by weekly professional cleaning and 0.2% chlorhexidine mouthrinses. Controls included untreated sites and sites treated by conventional scaling alone in a 4-quadrant split-mouth design. The experiment was conducted on 95 teeth from 10 subjects with periodontal pockets greater than or equal to 6 mm which initially bled on probing. All treatments resulted in changes indicative of effective therapy. Pocket depth was reduced, bleeding on probing decreased and gingival index scores decreased. Parallel to the clinical changes, all treatments reduced total bacterial numbers, % black-pigmented Bacteroides, motile bacteria, non-motile rods, and produced a proportionate increase in cocci. Fiber therapy with or without scaling reduced bacterial counts by approximately 2 orders of magnitude when evaluated at 62 days post-therapy. The combination of fiber therapy with scaling was particularly effective, suggesting a possible synergy between these forms of therapy. The combined therapy eliminated bleeding on probing, and black-pigmented Bacteroides, and produced the greatest mean reduction in pocket depth.

Use of Membranes Containing 20% Chlorhexidine and 40% Doxycycline for Treatment of Chronic Periodontal Pockets.

“…In Table 7 Mean and standard deviation of the percentage of cocci in the treatment and control groups at the baseline (Visit 0) and at each visit up to 10 w (Visit 4) have also been supported by the results of another clinical in vivo study , by Heijl et al [35], who compared the effectiveness of tetracycline-containing drug delivery fibers and scaling after a period of 62 d. Fiber therapy with or without scaling reduced bacterial counts by approximately two orders of magnitude. According to these results, the combination of fiber therapy with scaling eliminated bleeding on probing and produced the greatest mean reduction in pocket depth.…”

Subgingival Delivery of Therapeutic Agents in the Treatment of Periodontal Diseases

“…The prototype for the use of fiber-like devices to deliver drugs to the periodontal pocket was first introduced by Goodson et al (1983), using cellulose acetate dialysis tubing. Although this system was unable to sustain therapeutic levels of tetracycline hydrochloride (Goodson et al, 1985), chlorhexidine gluconate , or metronidazole (Wan Yusof et al, 1984) for sufficient time to be clinically useful, it led to the development of a commercially available delivery system (Actisite®, Alza Corporation, Palo Alto, CA), based on a monolithic ethylene vinyl acetate fiber, that delivers tetracycline hydrochloride (Goodson et at., , 1985(Goodson et at., , 1991aTonetti et al, 1990;Heijl et al, 1991). Published data from two multicenter studies (Goodson et al, 1991b;Newman et al, 1994) show that the treatment of periodontal pockets with this system resulted in significant reductions in pocket probing depths and bleeding on probing and significant increases in attachment levels compared with the other treatment modalities tested.…”

“…In the majority of studies which have been carried out on pockets with probing pocket depths (PPD) . 5 mm, an adjunctive effect has been demonstrated when compared with scaling and root planing alone (Goodson et al, 1985(Goodson et al, , 1991bHeijl et al, 1991;van Steenberghe et al, 1993;Drisko et al, 1995;Soskolne et al, 1996). The mean improvement in PPD resulting from the adjunctive effect compared with the scaling and root planing (SRP) controls ranged between 0.28 mm and 0.46 mm over a clinical follow-up time of 2-12 months (for summary, see Table 1).…”

Advanced drug delivery approaches against periodontitis

“…Combination of fiber therapy with scaling abolished bleeding on probing and blackpigmented Bacteroides and resulted in highest mean reduction in pocket depth Heijl et al (1991) Tetracycline hydrochloride…”