Use of Antimicrobial Containing Acrylic Strips in the Treatment of Chronic Periodontal Disease

Abstract

Local antimicrobial therapy has been considered for use in the treatment of chronic periodontal disease. This study evaluated chlorhexidine, metronidazole, and tetracycline delivered into periodontal pockets in an acrylic resin vehicle and compared the results with root planed and untreated sites over a three-month follow-up period. One site per patient where pocketing greater than or equal to 6 mm associated with a single rooted tooth was randomly allocated to one of the five possible regimens. Baseline and follow-up measurements included probing depth, loss of attachment, bleeding on probing, crevicular fluid flow, and dark-field microscopy of a subgingival plaque sample. Intratreatment evaluations revealed no significant changes in any parameter for untreated sites. Significant improvements in many parameters occurred with all four therapies although the magnitude and duration were greater in metronidazole and root planing groups. The more important intertreatment comparisons indicated that most treatments produced significant benefits compared with the control group; however, again these were greater with metronidazole and root planing. Furthermore, significantly greater effects were noted for metronidazole and root planing compared with tetracycline and more particularly chlorhexidine. It is concluded that some locally delivered antimicrobials alone may be useful in the treatment of chronic periodontal disease. However, at this time local antimicrobial therapy should be considered as adjunctive to conventional debridement techniques.

The Antimicrobial Treatment of Periodontal Disease: Changing the Treatment Paradigm

“…However, when a thin ethylcellulose film containing 20% metronidazole was placed in the pockets, it too was ejected and needed to be anchored to the tooth with a dollop of glass-ionomer cement (Loesche et al, 1996). Likewise, acrylic films containing various antimicrobial agents had to be secured with a periodontal dressing (Addy et al, 1988). In practice, then, non-biodegradable delivery systems need some type of retention mechanism to keep them in place.…”

“…However, it may be that the differences observed are really due to characteristics of the vehicle, which determines the bioavailability of agents such as chlorhexidine. Thus, the apparent ineffectiveness of chlorhexidine in the acrylic strips (Addy et al, 1988) should not be compared with its apparent effectiveness in the biodegradable delivery system For a systemic agent to be effective, it has to be efficiently absorbed in the intestines, circulate in the vascular system to penetrate the extravascular space, and enter the pocket via the gingival crevicular fluid. If the GCF flow is about 20 jLL/hr (Goodson, 1994), this means that, in a 6-mm pocket, about 480 [iL of GCF containing from 1 to 5 pg of the agent arrives per day to do battle with the 100,000,000 bacteria that are adhering to the tooth.…”

“…An indication that this is possible was observed when the plaque levels of institutionalized teenagers with mental handicaps could be suppressed for a year in the absence of toothbrushing, by applications of a 5% kanamycin paste to the dento-gingival surfaces at five-week intervals (Loesche and Nafe, 1973). Also, in some studies, pocket sites that received only the antimicrobial agent showed improvement comparable with that found in sites receiving scaling and root planing (Lindhe et al, 1983;Addy et al, 1988 are measured before and after treatment. The attachment level prior to treatment for a given pocket is exactly 5.5 mm, halfway between the 5-mm and 6-mm markings on the periodontal probe.…”

Subgingival Delivery of Therapeutic Agents in the Treatment of Periodontal Diseases

“…Addy et al (1982) described formulations which delivered, in vitro, therapeutic levels of all three drugs over a 14-day period. In later studies (Yeung et al, 1983;Addy and Langeroudi, 1984;Addy et al, 1988), they showed various degrees of clinical efficacy, but this system has not been developed for clinical use.…”

Untitled

“…These delivery systems can locally provide inhibitory concentrations toward the periodontal pathogens of the drug for several days. Periodontal fibers, [4] strips, [5] and gels [6] were already studied.…”