Periodontics: Locally Delivered Antimicrobials in Chronic Periodontitis

Locally Delivered, Controlled-Release Antimicrobials

• Chronic periodontitis is a bacterial infection, and the focus of nonsurgical periodontal therapy is to combat infection.
• Controlled-release delivery systems have been developed to deposit antimicrobials directly into the periodontal pocket and maintain effective concentrations of the drug for an extended period.

Chlorhexidine-Based Products

• The chlorhexidine chip is a small chip that contains 2.5 mg of chlorhexidine gluconate in a resorbable, biodegradable matrix of hydrolyzed gelatin.
• The chip is stored at 20° to 25° C (68° to 77°F).

Surgical Therapy

• Pocket sites that do not respond adequately to nonsurgical therapy and evidence residual probing depth with inflammation are often treated with follow-up surgical therapy.
• The adjunctive use of locally delivered, controlled-release antimicrobials can improve clinical outcomes after periodontal surgery in regenerative and non-regenerative settings.

Peri-Implantitis

• Peri-implantitis is an inflammatory disease process that is initiated by local microorganisms and affects the tissues surrounding an implant.
• There is a potential rationale for the use of locally delivered, controlled-release antimicrobials for the treatment of peri-implantitis.

Tobacco Smoking

• Smoking is a risk factor for the development or progression of periodontitis and can limit the effectiveness of periodontal therapy.
• The adjunctive use of locally delivered, controlled-release antimicrobials can enhance the efficacy of SRP in smokers.

Doxycycline-Based Products

• Doxycycline gel is a subgingival, controlled-release delivery product composed of a two-syringe mixing system.
• Doxycycline gel is indicated for the treatment of chronic adult periodontitis for a gain in clinical attachment, reduction in probing depth, and reduction of bleeding on probing.

PerioCol-TC

• PerioCol-TC is a product that contains fish type I collagen impregnated with tetracycline hydrochloride.
• PerioCol-TC releases tetracycline in vitro for 8 to 10 days and is indicated for the treatment of adult periodontitis as an adjunct to SRP for pockets more than 5 mm deep.

Adverse Effects and Cautions

• There is a potential for hypersensitivity reactions.
• The fibers are packaged as a strip containing four individually packed and separable sterile product packs.
• The fiber biodegrades in the periodontal pocket within 7 days and should be retained with a periodontal dressing or covered with a dental adhesive for 10 days.