Citation Information :
Jalaluddin M, Shivakumar S, Arora SS, Kumari D, Jayachandran M, Gopakumar R, Vinothkumar TS. Clinical Assessment of the Effectiveness of Three Different Controlled-release Drugs in the Management of Chronic Periodontitis: An In vivo Study. World J Dent 2022; 13 (3):234-238.
Aim: The aim of the current research was to evaluate the efficiency of metronidazole gel, tetracycline fibers, and chlorhexidine chip agents in the treatment of chronic periodontitis.
Materials and methods: A total of 60 healthy patients free from systemic diseases and having chronic generalized periodontitis were chosen for the purpose of this study. The subjects thus included were subjected to phase I therapy consisting of scaling and root planning performed over two visits by a single clinician, following which oral hygiene advice was rendered. A week after phase I management, the subjects were called again and re-evaluated to verify the chosen criteria. Subjects who were thus elected based on the inclusion criteria were assigned at random to one of the three investigational groups as (20 subjects in each group) Group A: Metronidazole, Group B: Tetracycline fibers, Group C: Chlorhexidine Chip. The follow-up after 1 week was regarded as the baseline appointment. Documentation of the gingival index, plaque index as well as the periodontal pocket depth (PPD) during the baseline appointment, plus after 1 month and 3 months after baseline was done and subjected to statistical analysis.
Results: The highest reduction of the gingival index (GI) values was noted with the use of chlorhexidine chip (0.88 ± 0.07 and 0.82 ± 0.11) in pursuit by tetracycline fibers (0.96 ± 0.13 and 0.88 ± 0.10) plus the metronidazole investigational group (1.02 ± 0.04 and 0.98 ± 0.10), respectively. Highest reduction of the PI values was noted with the use of tetracycline fibers (0.82 ± 0.14 and 0.76 ± 0.02) in pursuit by chlorhexidine chip (0.88 ± 0.18 and 0.94 ± 0.06) as well as metronidazole investigational group (1.18 ± 1.08 and 1.06 ± 0.21), respectively. The greatest reduction in PPD from 5.78 ± 0.14 to 3.14 ± 0.10 was noted with use of tetracycline fibers.
Conclusion: The current research, amid its limitations arrived at a conclusion that although a thorough scaling as well as root planning (SRP) is efficient in managing consistent periodontal pockets, superior results can be attained by employing topically delivered metronidazole gel, tetracycline fibers as well as chlorhexidine chips as adjuncts to the management strategy employed.
Clinical significance: Multiple chemical substances may be utilized subgingivally as a management strategy to augment the efficiency of nonsurgical mechanical periodontal treatment. Topical drug delivery systems into the periodontal pocket show potential as a treatment strategy to attain superior clinical results when employed as an adjunctive form of therapy to the traditional nonsurgical periodontal management techniques. Rigorous research labors at this time, concentrate on evolution of novel techniques for efficient management.
Anarth R, Kale P, Mani A, et al. Local drug delivery in periodontitis: an innovative treatment modality . Int J Pharm Sci Res 2021;12(9):4616–4625. DOI: 10.13040/IJPSR.0975-8232.12(9).4616-25
Vyas SP, Sihorkar V, Mishra V. Controlled and targeted drug delivery strategies towards intraperiodontal pocket diseases. J Clin Pharm Ther 2000;25(1):21–42. DOI: 10.1046/j.1365-2710.2000.00261.x
Vaidya P, Thomas M, Dixit A. Treatment of chronic periodontitis using chlorhexidine gel as an adjunct to scaling and root planning: a clinical study. J Indian Dent Assoc 2011;5:966–968. https://scholar.google.com/scholar_lookup?journal=J+Indian+Dent+Association&title=Treatment+of+Chronic+Periodontitis+using+Chlorhexidine+Gel+as+an+Adjunct+to+Scaling+and+Root+Planing++A+Clinical+Study&author=P+Vaidya&author=M+Thomas&author=A+Dixit&volume=5&publication_year=2011&pages=962-5&
Ramesh A, Prakash AP, Thomas B. Local drug delivery in periodontal diseases-a review NUJHS 2016;6(1):74–79. https://www.researchgate.net/publication/321608762_Ramesh_A_Prakash_AP_Thomas_B_Local_drug_delivery_in_periodontal_diseases_A_review_NUJHS_2016_6174-79
Kalsi R, Vandana KL, Prakash S. Effect of local drug delivery in chronic periodontitis patients: a meta-analysis. J Indian Soc Periodontol 2011;15:304–309. DOI: 10.4103/0972-124x.92559
Chaturvedi TP, Srivastava R, Srivastava AK, et al. Evaluation of metronidazole nanofibers in patients with chronic periodontitis: a clinical study. Int J Pharm Investig 2012;2(4):213–217. DOI: 10.4103/2230-973X.107007
Jeffcoat MK, Bray KS, Ciancio SG, et al. Adjunctive use of a subgingival controlled release chlorhexidine chip reduces probing depth and improves attachment level compared with scaling and root planing alone. J Periodontol 1998;69(9):989–997. DOI: 10.1902/jop.19126.96.36.1999
Vaish S, Dodwad V, Mahajan A, et al. Evaluation of clinical efficacy of 0.2% chlorhexidine irrigation, 1.5% chlorhexidine gel and 2.5mg biodegradable chlorhexidine chip as an adjunct to scaling and root planing in the management of Chronic Periodontitis. J Dent Specialities 2016;4(2):142–146. https://www.ipinnovative.com/journals/JDS/article-details/3009/volume/106/issue/272
Heasman PA, Heasman L, Stacey F, et al. Local delivery of chlorhexidine gluconate (PerioChipTM) in periodontal maintenance patients. J Clin Periodontol 2001;28(1):90–95. DOI: 10.1034/j.1600-051x.2001.280114.x
Reddy S, MGS P, Bhowmick N, et al. A comparison of chlorhexidine and tetracycline local drug delivery systems in management of persistent periodontal pockets- a clinical study. Int J Appl Dent Sci 2016;2(3):11–15. http://www.oraljournal.com/vol2issue3/pdf/2-2-30.1.pdf
Friesen LR, Williams KB, Krause LS, et al. Controlled local delivery of tetracycline with polymer strips in the treatment of periodontitis. J Periodontol 2002;73(1):13–19. DOI: 10.1902/jop.2002.73.1.13
Perinetti G, Paolantonio M, Cordella C, et al. Clinical and microbiological effects of subgingival administration of two active gels on persistent pockets of chronic periodontitis patients. J Clin Periodontol 2004;31:273–281. DOI: 10.1111/j.1600-051x.2004.00481.x
Drisko CL, Cobb CM, Killoy WJ, et al. Evaluation of periodontal treatments using controlled–release tetracycline fibers: clinical response. J Periodontol 1995;66:692–699. DOI: 10.1902/jop.19188.8.131.522
Sharma NK, Prasad A. Evaluation of efficacy of tetracycline as a local drug delivery system in the treatment of chronic periodontitis as an adjunct to scaling and root planing – a clinical and microbiological study. Int J Contemp Med 2017;4(5):998–1003. https://www.ijcmr.com/uploads/7/7/4/6/77464738/ijcmr_1429_june_16.pdf
Mohamed Haris PM, Panickal DM. Role of metronidazole as a local drug delivery in the treatment of periodontitis: a review. Int J Oral Health Med Res 2017;3:141–145. http://www.ijohmr.com/upload/Role%20of%20Metronidazole%20as%20a%20local%20drug%20delivery%20in%20the%20treatment%20of%20periodontitis_%20a%20review.pdf
Griffiths GS, Smart GJ, Bulman JS, et al. Comparison of clinical outcomes following treatment of chronic adult periodontitis with subgingival scaling or subgingival scaling plus metronidazole gel. J Clin Periodontol 2000;27:910–917. DOI: 10.1034/j.1600-051x.2000.027012910.x
Lecic J, Cakic S, Janjic Pavlovic O, et al. Different methods for subgingival application of chlorhexidine in the treatment of patients with chronic periodontitis. Acta Odontol Scand 2016;74:502–507. DOI: 10.1080/00016357.2016.1206964
Ma L, Diao X. Effect of chlorhexidine chip as an adjunct in non-surgical management of periodontal pockets: a meta-analysis Ma and Diao BMC Oral Health 2020;20:262. DOI: 10.1186/s12903-020-01247-8