Efficacy+of+Local+Delivery+of+Antimicrobials

= = = Efficacy of Local Delivery of Antimicrobials =

= = // Arestin -Diem // //Arestin is local delivered antibiotic that contains 2% Minocycline Hydrocholride. It was developed by OralPharma Inc. and accepted by the FDA in 2001. Arestin is used in conjunction with SRP significantly reduce tissue damage from scaling, pocket depth, and gingivitis. It is used best in the maintainance phase of preventive treatment and treat chronic periodontitis. Contraindication: Children, pregnant women or nursing women

New Study Shows Standard Therapy For Gum Disease is Significantly More Effective When Combined With Local Antibiotics (200 7). The free library. Retrieved Feburary 28, 2009, from// [|//http://www.thefreelibrary.com/New+Study+Shows+Standard+Therapy+For+Gum+Disease+is+Significantly...-a0168060612//]

Another study on the efficacy of Arestin in adjunction with SRP stated that there is no different between using or not using Arestin on reducing A. a., P. intermedia, P. gingivalis. Arestin help in healing process, but it does not inhibit the bacteria that are associated with periodontal disease.

Cortelli, J et. al. (2008). A double-blind randomized clinical trial of subgingival minocycline for chronic periodontitis. Journal of Oral Science, 50//(3), 259-265.//

Kelli- Atridox is 10% doxycycline hyclate and is used in the treatment of chronic periodontal disease. It is a locally applied antibiotic that is placed into periodontal pocket. Atridox is a gel applied with a syringe into the pocket and has the ability to adapt to root morphology. It then flows to the bottom of the pocket and fills the spaces between teeth and gums. After it is applied it then hardens into a waxy like substance. The antibiotic (doxycycline)has a slow controlled release for the next 21 days. Atridox does not need to be removed because it is bioabsorbable. Also, you can use a single syringe on multiple sites. Info obtained from: www.ATRIDOX.com

Stacy - SRP alone has shown to reduce pocket dept, increase clinical attachment level and decrease BOP. Subgingival irrigation of the periodontal pocket is thought to decrease the bacteria present in the pocket, promote healing after SRP, and possibly decrease pocket depth. Research indicates that subgingival irrigation has not proven to be effective at these things. It is shown to be effective in decreasing bacteria present in the pocket, short term. However, after time, without good OH care the bacteria levels will return. Subgingival irrigation may be most beneficial when SRP is not ideal due to anatomy or other factors.

Evidence has shown supragingival irrigation is effective in reducing gingivitis when combined with effective tooth brushing. Studies have shown a reduction in gingival inflammation ranging from 6.5 to 54 percent.

Reference: Greenstein, G. (2000). Nonsurgical periodontal therapy in 2000: A literature review. Journal of the American Dental Association, 131(11) 1580-1592. Wennstrom, J.L., Heijl, L., Dahlen, G., and Grondahl, K. (1986). Periodic subgingival antimicrobial irrigation of periodontal pockets. Journal of Clinical Periodontology, 14(9) 541-550.

Reina: Although the American Academy of Periodontology’s stance on the use of local delivery of sustained or controlled release antimicrobials as adjunctive therapy in the treatment of periodontitis is that there is no clinical significance that the treatment can either reduce the need for surgery, improve long-term tooth retention, or is cost effective, many dental offices still use them. It has been shown that inflammation decreases but chronically returns. Having the patient pay a fee that is not covered by insurance for placement of an antimicrobial agent may cause the patient to create a better homecare regimen for himself/herself. Also, to prevent of dental caries, antimicrobial control of the dental plaque flora may be used as an adjunct to the application of fluorides and to sugar restriction Schaeken, M. J., & De Haan, P. (1989, February). Effects of sustained-release chlorhexidine acetate on the human dental plaque flora. Journal of Dental Research//,// 68 //(2), 119-123. There have been several animal studies and case reports that have investigated guided bone regeneration for the possibility of new bone to act as barriers around failing implants. Can the use of a local antibiotic combined with a polymer be used as a barrier? Research has shown that the approach of prolonged delivery of an antimicrobial agent has been used only for periodontal disease, not for the treatment of peri-implantitis. The underlying cause of peri-implantitis is not due to the bacteria but due to implant placement which affects the bone surrounding the implant, increased pocket depth, presence of exudate, and bone loss. Buchter, A., Meyer, U., Kruse-Losler, B., Joos, U., & Kleinheinz, J. (2004, October). Sustained release of doxycycline for the treatment of peri-implantitis: Randomised controlled trial.// The British Journal of Oral and Maxillofacial Surgery//,// 42 //(5), 439-444.

Jackie Local delivery of antimicrobial/antibiotics agents are used to aid in the treatment of gingivitis and periodontal disease, and it is only an adjuntive therapy to aid in the control of these periodontal conditions. Proper mechanical removal of the causative agent is the key factor to control periodontal disease. Part of these treatment should include laboratory tests to assess the correct drug to be used in order to kill the specific pathogen in the periodontal pocket. More studies need to be conducted to provide a more reliable results on the use of local delivery of antimicrobial and antibiotics agents to treat periodontal disease. Gupta, R., Pnadit, N., Aggarwal, S., Verman, A. (2008). Comparative evaluation of subgingival deliver 10% doxycycline Hyclate and xanthan-based chlorhexidine gels in the treatment of chronic periodontitis.// Journal of Contemporary Dental Practice, (9) //7, 025-032.

Maria: According to the AAP, subgingival application of antimicrobials in conjunction with SRP has little effect on pocket reduction of 5mm or greater compared to SRP alone. However, a study conducted by Perrson et al. (2006) found that subgingival application of minocycline hydrochloride (Arestin) was effective in significantly reducing the bacterial count of A.a following application of Arestin and SRP in pockets ranging 5 to 8 mm. Researchers concluded that Arestin was effective only in accelerating healing following SRP. Participants in this study returned for re-evaluation of periodontal pockets 3 months later and the researchers found lower bacterial counts of T. forsythia, P. gingivalis and T. denticola. Researchers then concluded that Arestin was effective in maintaining the periodontal pockets of 5mm or greater, but had no significant effect in pocket reduction.

Persson, G., Rutger, S., Salvi, G., Heitz-Mayfield, L. & Lang, N.P. (August, 2006). Antimicrobial therapy using a local drug delivery system (Arestin) in the treatment of periodontal patients and peri-implantitis. Clinical Oral Implants Research, 17(4), 386-393.//

Marcia: I found a chart though the California Dental Association that goes through clinical guidelines for the periodontal therapy utilizing antimicrobials. First is diagnosis followed by microbial analysis if needed and if a specific periodontal infection is discovered, screening and possible    treatment of family members is indicated. In addition, oral hygiene instruction should be performed and continually reinforced. Third CHX (used more as a antiseptic; when used as an antimicrobial having a low bactericidal activity) used b.i.d x14 days; scaling and root planning and the use of betadine (antimicrobial). Then antibiotics are used if indicated, next step is re- evaluation (4- 6 weeks). If inflammation is resolved pt. is placed on 3-4 month re-care appt. If inflammation continues then surgical therapy and additional debridement will be preformed followed by betadine and CHX then on a 4-6 re-eval. If inflammation is resolved pt is on a 3-4 month re- care appt. If inflammation has not resolved another microbial analysis will be done and continue therapy of OHI.

Jorgensen, M. G., & Slots, S. (2000). Responsible use of antimicrobials in periodontics. Journal of the California Dental Association. Received on April 10, 2008 from http://www.cda.org/library/cda_member/pubs/journal/jour0300/index.html

Jennifer: Efficiency of Locally Delivered Antibiotics (LAD) is a very controversial subject. The LADs reduce the amount of subgingival microflora for a period of time. The American Academy of Periodontology (AAP) has done studies which have shown that the pocket decrease when using these LADs is actually quit minimum. The criteria for use is when refractory periodontal disease is present. The LADS should not be used in infa boney defects, because studies and knowledge have shown that LADs can not resolve anatomical defects. Ultimately it is up to the clinician and the patient to weigh the pros and cons toward the delivery of LADS.

Dorinda: Antimicrobials are a antimicrobial placed in the periodontal pocket and release over time. It is used in conjunction with scaling and root planning. In the American Academy of Periodontology statement regarding this topic suggests that the local delivered antimicrobial agents do not cause a significant benefit to the periodontal pocket, thus suggesting it unnecessary for patients. American Academy of Periodontology Statement on Local Delivery of Sustained or Controlled Release Antimicrobials as Adjuntive Therapy in the Treatment of Periodontitis. (May, 2006). Academy Report

Noo: In dentistry, antimicrobial are commonly prescribed for the treatment of periodontitis and in people who have weakened immune systems o other serious medical conditions. They are given to supplement the beneficial effects of scaling and root planning, a common treatment for periodontal disease. Although many forms of periodontal disease are successfully treated using this combined approach, other situations may require additional treatment, including systemic antibiotics. Local delivery of antimicrobial is selected first in periodontal therapy. The reason is the concern about bacteria becoming resistant to the effects of antibiotics due to overuse. Radvar and his team used local antimicrobial delivery systems that are available for 6 months study to evaluate the efficacy of antimicrobials on the persistent periodontal lesions. The study showed most forms of periodontitis can be successfully treated by local agents. Bogren and his team conducted 3 consecutive years on patients after scaling and root planning. The study showed the pocket depth have been decreased 1-2 mm and the periodontal problems have been improved. Radvar, M, Ehsan,N., Mellati, n., Habibi,M., (2009) Improvement of periodontal parameters in treated quadrants after periodontal therapy. //Journal of Periodontology 80//:4, 565-571 Bogren,a., teles,R., torresyap, G., Haffajee, A., Socransky, S., and Wennstrom,J., (2008). Loacally delivered Doxycycline during supportive periodontal therapy: A 3 year study. //Journal of Periodontology// //79//: 5, 827-835

Both locally delivered antibiotics and systemic antibiotics can be helpful in treating periodontal disease when combined with SRP. The studies that I have read stated that both local and systemic antibiotics have their benefits and can help to reduce bacteria in the pockets but there are disadvantages to both. One of the main disadvantages that comes to mind is the possibility of a bacterial resistance being developed. I think that more thorough studies need to be done to better find out if one or the other (systemic or locally delivered antibiotics) is better in treating periodontal disease.
 * Britney**

Resources: Greenstein, G. The role of supra- and subgingival irrigation in the treatment of periodontal diseases. (2005). Journal of Periodontology, 76, 2015-2027.

Kaner, D., Bernimoulin, J. P., Hopfenmuller, W., Keleber, B. M., and Friedmann, A. (2007). Controlled-delivery chlorohexidine chip versus amoxicillin/metronidazole as adjunctive antimicrobial therapy for generalized aggressive periodontitis: a randomized controlled clinical trial. Journal of Clinical Periodontology, 34(10), 880-891. Both locally delivered antibiotics and systemic antibiotics can be helpful in treating periodontal disease when combined with SRP. The studies that I have read stated that both local and systemic antibiotics have their benefits and can help to reduce bacteria in the pockets but there are disadvantages to both. One of the main disadvantages that comes to mind is the possibility of a bacterial resistence being developed. I think that more thurough studies need to be done to better find out if one or the other (systemic or localy delivered antibiotics) is better in treating periodontal disease.
 * Britney**

Resources: Greenstein, G. The role of supra- and subgingival irrigation in the treatment of periodontal diseases. (2005). Journal of Periodontolgy, 76, 2015-2027.

Kaner, D., Bernimoulin, J. P., Hopfenmuller, W., Keleber, B. M., and Friedmann, A. (2007). Controlled-delivery chlorohexidine chip versus amoxicillin/metronidazole as adjunctive antimicrobial therapy for generalized aggressive periodontitis: a randomized controlled clinical trial. Journal of Clinical Periodontology, 34(10), 880-891.