Commercial Local Pharmacotherapeutics and Adjunctive Agents for Nonsurgical Treatment of Periodontitis: A Contemporary Review of Clinical Efficacies and Challenges

Abstract

Periodontal infections tend to be site-specific, mostly confined to the periodontal pocket. With the surge of antibiotic-resistant bacteria, the trend is shifting towards other therapeutic modalities, especially locally delivered approaches that include other pharmacotherapeutic drugs and medical devices. This narrative review aimed to provide insights into the clinical efficacy of local drug delivery and adjunctive agents used in nonsurgical management of periodontitis. Electronic (PubMed/MEDLINE, CENTRAL, and EMBASE) and bibliographic searches of past systematic reviews were carried out to identify previous publications on the topic. Only relevant literature and randomized controlled trials published in English were selected. In addition, a literature review was developed based on the selected articles. Experimental drugs or agents were excluded. This review highlights the clinically proven and commercially available therapeutic agents related to the management of periodontal disease with comparisons of their clinical efficacies and challenges. A vast array of commercial local pharmacotherapeutic agents had been clinically tested, but the methodologies and clinical results varied within and between each agent used, causing difficulty in drawing conclusions and providing support to the superiority of one agent over another. Considering the benefit–cost ratio with the modest clinical results, the long-term usefulness of these agents remains debatable.

Efficacy of Xanthan-Based Chlorhexidine Gel on the Levels of Interleukin-1β in Chronic Periodontitis

“…A weighted mean difference (WMD) of 0.56 mm in PPD reduction and 0.53 mm CAL gain was seen in a review on the use of xanthan-based chlorhexidine gel (Chlosite®) as an adjunctive agent for nonsurgical treatment of periodontitis. [ 22 ] A recent systematic review by Zhao et al concluded that adjunctive placement of xanthan-based chlorhexidine gel (Chlosite®) at individual sites provided slight benefit in PPD reduction when compared with nonsurgical periodontal therapy (NSPT) alone. [ 23 ]…”

Combined release of antiseptic and antibiotic drugs from visible light polymerized biodegradable nanocomposite hydrogels for periodontitis treatment

“…Thus, the locally used antibiotic, and antiseptic intra-pocket drug delivery system ensure a higher concentration of active content in the gingival crevice fluid therefore advanced effectiveness, and better patient compliance could be achieved 35 . Different locally used drug delivery systems are developed from the strips, fibers, or microparticles, but next to the opportunities stay deficiencies into the individual types [36][37][38] . The local administrations provide benefits as the less drug needed but the usage of the appropriate dose is often a challenge in a real situation 39 .…”

Changes in clinical parameters following adjunctive local sodium hypochlorite gel in minimally invasive nonsurgical therapy (MINST) of periodontal pockets: a 6-month randomized controlled clinical trial

“…Additionally, in the last decades, a number of novel strategies encompassing the use of locally delivered antiseptic and/or antiinflammatory agents, antibiotics or photodynamic therapy, have been tested to enable a more accurate disruption and removal of the subgingival biofilm and to additionally improve the clinical outcomes and reduce the need for surgery [2,[9][10][11].…”