Locally delivered antimicrobials in the management of periodontitis: a critical review of the evidence for their use in practice.
Plaque bacteria are the primary initiators of periodontal disease in susceptible persons and therapy is largely based on mechanical bacterial biofilm disruption. Patients' response to periodontal treatment is unpredictable and periodontal stability is not always achieved. Locally delivered antimicrobials (LDAs) may be used as adjuncts to mechanical therapy in treatment of recalcitrant deep (> or = 5mm), active, non-responding sites, providing the patient's oral hygiene is adequate. Their use as a monotherapy cannot be justified. The literature reveals that LDAs are safe and that they achieve statistically significant, yet clinically modest, gains in clinical attachment and reductions in pocket depths.


CONCLUSIONS
It has been suggested that LDAs may improve the clinical outcome in the treatment of recurrent and refractory cases of periodontitis when used as an adjunct to scaling and root surface instrumentation. This paper examines and discusses the evidence.
Hussein
Iyad
I
Dundee Dental Hospital and School, Dundee, UK.
Ranka
Meena
M
Gilbert
Angela
A
Davey
Kevin
K
D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003131:Combined Modality Therapy / Q000379:methods; D004343:Drug Implants / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage / Q000009:adverse effects; D010518:Periodontitis / Q000188:drug therapy*; D013752:Tetracycline / Q000008:administration & dosage / Q000009:adverse effects
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D004343:Drug Implants; D008795:Metronidazole; D013752:Tetracycline