Endodontic-periodontal locally delivered antibiotics

Abstract

Endodontic pathology is a bacterial disease. It is well established that periapical disease is the result of bacteria, their product, and the host response to them. Periradicular disease will occur after microorganisms and their metabolic products affect the periradicular tissue. Aim of using antibiotics as part of a treatment regimen is to achieve, within the periodontal environment, a concentration of the drug that is sufficient either to kill (bactericidal) or arrest the growth (bacteriostatic) of pathogenic microorganisms. There are two possible approaches to improve the drug action: sustained and controlled drug release to reduce or eliminate side effects by improving the therapeutic index and site-specific drug delivery to minimize systemic effects. These two strategies have been explored by the association of drugs with different vehicles, either naturals or synthetics. A wide variety of specialized local delivery systems (i.e.intrapocket devices) have been designed to maintain the antibiotic in the GCF (gingival crevicular fluid) at a concentration higher than the MIC (minimum inhibitory concentration). Fibres, films, strips and microparticles made of biodegradable or non-biodegradable polymers have been reported as effective methods to administer antibacterial agents for periodontal therapy. Together with these solid devices, semisolid adhesive or non-adhesive formulations have also been proposed.

Local Drug Delivery Systems for Vital Pulp Therapy: A New Hope

“…Chitosan/PLGA and degradable PLGA films have been introduced to the periodontal pocket as local drug delivery systems to transfer and/or release loaded agent(s)/drug(s), e.g., ipriflavone, and act against periodontal pathogens [ 47 , 48 ]. In addition to films, biodegradable or nonbiodegradable polymer strips have been reported to be an efficient method of administering antibacterials for periodontal treatments [ 49 ]. Drug-loaded strips, specifically with tetracycline hydrochloride and metronidazole, have been successfully used in patients with advanced periodontal pathosis, with tetracycline being more successful than metronidazole in the conducted investigations [ 50 ].…”

Piperine-Loaded In Situ Gel: Formulation, In Vitro Characterization, and Clinical Evaluation against Periodontitis

“…Apart from the systemic administration of drugs, localized drug delivery in the form of fibres, strips, films, and micro-particulate systems has been widely investigated for the management of periodontitis [18][19][20]. Nevertheless, they show limited success in the treatment of periodontitis because of poor patient compliance, poor adhesion properties, and limited retention time [21].…”

Nanomagnetic-mediated drug delivery for the treatment of dental disease

“…However, since the pulp is encased in hard tissues, targeting pulpal tissues with specific therapies is challenging. Systemic pharmacologic treatments are not effective because they do not effectively reach the pulp and topical drug delivery would be more concentrated, more beneficial and would have a more favorable side-effect profile 6 .…”