Efficacy+of+Local+Delivery+of+Antimicrobials+and++Antibiotics



In the treatment of generalized aggressive periodontitis the usage of CHX chip shows a decrease in CAL, PD, and Pus were reduced after baseline and until three months after treatment. However, the usage of CHX chip showed that between months three and six the PD did increase as well as showed a presence of Pus. The CX chip was placed in pocket depth of 5 mm or more.
 * 1. Chlorhexidine as an adjunct reduces probing depths LM # 11**

Arestin has been analyzed in an attempt to determine its efficacy as an adjunct to SRP and compared to SRP alone. In one study the SRP and arresting group had a 6.49% reduction in the red complex bacteria and the SRP group by itself had a 5.03% reduction. Also the SRP and Arestin group had a BOP reduction of 25.2 %, while the SRP group only reduced by 13.8%. Probing depth reduction was greater for the SRP and Arestin group. This demonstrates promising benefits of using arestin as an adjunct to SRP and has research to support it. However, the clinician will need to determine which patient will benefit from this procedure and make the patient aware that it is only a adjunct to SRP's. MC#3
 * 2. Arestin as an adjunct to SRP has a reduction on BOP and pobing depths. MC#3**

The combination has an additive effect suppressing A. a. Metronidazole targets obligate anaerobes and Amoxicillin targets facultative anaerobes.
 * 3. Combination therapy with Amoxicillin and Metronidazole provides excellent elimination of many organisms in adult and localized aggressive periodontitis. AP12**

Short-term effects on clinical parameters were found with the adjunctive use of locally delivered doxycycline, howerver repeated applications annually had no clinical or microbiologic effects beyond those achieved with mechanical debridement alone.
 * 4. The use of locally delivered Doxycycline as an adjunct to mechanical debridement shows short-term clinical effects but shows no increased benifits for long-term use. MT#18**

Studies have shown that when chlorhexidine is used as a adjunct with SRP both combined show clinical improvements such as a decrease in PD and increase in attachment level. However studies have shown that the use of subgingival chlorihexidine does not decrease BOP. There are several local delivery of antibiotics that can be used is a periodontial pocket and are effective when used as a adjunct to scaling and root planning. Requirements for treating periodontial disease include means for targeting anti-infective agent to infections sites as well as being able to maintain its localized concentration at effective levels of a sufficient time with having minimal or no side effects.
 * 5. The use of chlorhexidine placed subgingival after scaling and root planning can help reduce pocket depths. GE #6**

For example, aggressive periodontitis can best be targeted with amoxicillin and metronidazole. It is also recommended to place local antimicrobials after traditional methods of scaling and root planing have been unsuccessful. Sanguinarine comes from a blood root plant. Due to sanguinarine's side effect of burning mouth and due to it having less antimicrobial affects compared to other drugs, sanguinarine is not used as frequently
 * 6. There are a variety of different local delivered antimicrobials (including Chlorhexidine, Sanguinarine, Histatins, Tetracyclines, Metronidazole, Clindamycin, and Oxfloxacin); the antimicrobial chosen is dependent on the microorganism being targeted. TL #8**


 * 7. Subgingival minocycline has been shown to reduce levels of //P. gingivalis, P. intermedia, and A. actinomycetemcomitans// in controlled studies. MW 19**

Carranza's Clinical Periodontology cites a study that includes 642 teeth (1786 sites) with pockets of at least 5mm or greater were tested to show the effects of subgingival minocycline. There were 976 sites in the test group receiving minocycline, and 810 sites that received a placebo gel. Results showed a statistically significant drop in bacterial levels of //P. gingivalis, P. intermedia, and A. actinomycetemcomitans.//

The use of local antibiotics with SRP does show an improvement in PD compared to SRP alone. It is beneficial in lowering periodontal pathogens. The use of local antibiotics should be questioned as to which patient can benefit the most from this adjunct therapy. It is necessary to determines the pathogens causing the disease to provide the best chemotherapeutic. Not considering this may increase the risk of super infections or not clinical improvement. SR 14
 * 8. Consideration of periodontal pathogens is necessary to determine the best local antibiotic treatment.**

In order for any medication to be effective it must be able to reach the site of disease activity, it must have a bacteriostatic or bactericidal concentration, and it must be retained long enough to provide positive results. A bacterial etiology for periodontal disease provides an opportunity for an antimicrobial approach to treatment. Systemic therapy has demonstrated success in periodontal diseases such as aggressive periodontitis, where precise bacterial species have been identified. However, for generalized chronic periodontitis, systemic antibiotics have demonstrated low clinical effectiveness. In addition with repeated usage of systemic antibiotics patients may be at risk of producing antibiotic resistant’s.
 * 9. Local antibiotics as an adjunct therapy improve the outcome of periodontal therapy RK7**

Using locally delivered antibiotics in the pockets of patients with periodontal disease has been studied for 20 years. Several different chemotherapeutic agents have either been approved or are under investigation for use in treating periodontal disease. The efficacy is derived from the sustained release of the medication placed into the pocket which can maintain an effective concentration of the therapeutic agent for a prolonged amount of time. The drugs which have been studied are antimicrobials, antibiotics and antiseptics. The studies have compared the use of these medications with and without scaling and root planning. Collectively these studies have shown that the use of antimicrobials as an adjunct to scaling and root planning shows a significant increase in the reduction of probing depths, when compared to scaling and root planning alone. In addition the studies testing antimicrobials as a stand alone treatment for periodontal disease have also shown an increase in healing over a period of time.

Advantages: If an antibiotic can be delivered directly to the pocket, without the patient having to take systemic doses, there are far fewer side effects and fewer chances of resistant bacteria forming. In addition, with direct local delivery, the concentration of the antibiotic at the diseased site can be 100 times greater than taking the medication orally.

Disadvantages: The effectiveness of these products is somewhat controversial, and while there is usually some improvement, whether there are any long-term benefits has yet to be demonstrated.

In conclusion, the use of locally delivered antibiotics has been shown to display a positive response in patients with periodontal disease when used as an adjunct to scaling and root planning. However more research is needed to determine the length of the response.

References Finkelman, R, & Williams, R. (1998). Local delivery of chemotherapeutic agents in periodontal therapy: has its time arrived?. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9839850

These increased benefits are also present with antimicrobials such as the chlorhexidine chip and doxycycline gel. Use of chemotherapeutics as an adjunct may be beneficial to the patient with little to no side-effects when used as indicated.
 * 10. When scaling and root planing are combined with the subgingival placement of sustained-release vehicles, additional clinical benefits are possible, including further reduction in pockets depths, additional gain in clinical attachment level, and further decrease in inflammation. CE5**

11. Rinsing with .12% chlorohexidine rinse along with tetracycline-containing fiber placement have an effect of reducing bacteria. KT4
A few disadvantages is possible candidiasis and the length of time required for placement. A pro of tetracycline containing fibers is no antibiotic resistance, reduced BOP, pathogens and reduced probing depths. The gingivitis reducing capabilities of chlorohexidine further reduce supragingival bacteris.

12. Using 10% doxycycline (Atridox) using a syringe have demonstrated in the effectiveness compared to other treatments. Using the 10% doxycycline gel, there was an improvement in clinical attachments level, improvement in probing depths, and reduction in bleeding. Even though the differences have a small clinical value, statistically it was still significant. However, OHI and patient compliance in home care must be given reinforcement in addition to scaling and root planing and local delivery antimicrobial such as Atridox for long term success. LL#9.