Response to intracrevicular controlled delivery of 25% tetracycline from poly(lactide/glycolide) film strips in SPT patients.
Controlled local delivery of antibiotics has been shown to reduce periodontopathic micro-organisms with minimal side-effects. Clinical studies in our laboratory have shown that 25% tetracycline HCl delivered from poly(D,L-lactide/glycolide) film strips (25 TTC-PLGA) released therapeutic concentrations of tetracycline for 10 days. The present pilot study compared the intracrevicular delivery of 25% tetracycline HCl incorporated in these biodegradable film strips to scaling and root planing (SRP) in 10 adult periodontitis patients, who in spite of therapy and regular supportive periodontal treatment (SPT), continued to possess 5 bleeding periodontal pockets at least 5 mm deep. Sites were randomly selected to receive the following treatments: (1) 25 TTC-PLGA, (2) control strips without TTC (PLGA), (3) SRP, and (4) untreated control. Film-strip retention was augmented with a suture/cement technique, followed by strip removal after 2 weeks. Clinical parameters and subgingival bacterial morphotypes (darkfield analysis) were evaluated over time (0, 2.4, 8, 12, 26 weeks). Results indicated that, compared to baseline, 25 TTC-PLGA film strips caused significant (p < or = 0.01): (1) probing depth reduction for 26 weeks, (2) a clinical attachment level gain for 12 weeks, (3) lower %s of spirochetes for 4 weeks and motile rods for 8 weeks (p < or = 0.05), and (4) an accompanying increase in cocci for 4 weeks. In the scaled and root planed sites, probing depth was the only finding that demonstrated a significant change from baseline (p < or = 0.01). Controls and PLGA showed isolated reductions in probing depth and % of motile organisms. From these findings, applications of intracrevicular 25 TTC-PLGA, when compared to scaling and root planing, appears to have an enhanced antibacterial effect and a similar clinical effect in SPT patients. The results of this study indicate further investigation of 25 TTC-PLGA film strips should be undertaken using more subjects and sophisticated microbiological and clinical measurements.
Department of Surgical Specialities/Periodontics, University of Nebraska Medical Center, College of Dentistry, Lincoln 68583-0740, USA.
G I
GI
Maze
R A
RA
Reinhardt
R K
RK
Agarwal
J K
JK
Dyer
D H
DH
Robinson
L M
LM
DuBois
G J
GJ
Tussing
C R
CR
Maze
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000032:analysis; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D001672:Biocompatible Materials; D015169:Colony Count, Microbial; D003692:Delayed-Action Preparations; D012534:Dental Scaling; D004337:Drug Carriers; D016503:Drug Delivery Systems; D005260:Female; D005881:Gingiva; D005883:Gingival Crevicular Fluid / Q000737:chemistry; D005884:Gingival Hemorrhage / Q000188:drug therapy / Q000382:microbiology / Q000628:therapy; D006801:Humans; D019344:Lactic Acid; D008297:Male; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000188:drug therapy / Q000382:microbiology / Q000628:therapy; D010514:Periodontal Pocket / Q000188:drug therapy / Q000382:microbiology / Q000628:therapy; D010518:Periodontitis / Q000188:drug therapy* / Q000382:microbiology / Q000628:therapy; D010865:Pilot Projects; D011100:Polyglycolic Acid; D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D011108:Polymers; D016745:Root Planing; D013144:Spirochaetales / Q000187:drug effects / Q000302:isolation & purification; D013752:Tetracycline / Q000008:administration & dosage* / Q000032:analysis
D000900:Anti-Bacterial Agents; D001672:Biocompatible Materials; D003692:Delayed-Action Preparations; D004337:Drug Carriers; D011108:Polymers; D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D011100:Polyglycolic Acid; D019344:Lactic Acid; D013752:Tetracycline