Comparative evaluation of efficacy of 10% povidone iodine gel with 2% metronidazole and 1% ornidazole with 0.25% chlorhexidine gel as local drug delivery system in adjunt to nonsurgical periodontal therapy in chronic periodontitis: A randomized, single blind, split-mouth study

Background: Periodontitis is a multi-factorial chronic inflammatory disease of attachment apparatus of teeth with microorganisms playing a major role. To address periodontal disease various strategies have been adopted to target these periodonto-pathogens. Various antimicrobial drugs (systemic as well as local) are effectively used to control the disease. However due to various side effects ofsystemic administration of the drugs like gastro intestinal disturbances, development of resistant organisms, high dosage of the drug required, local delivery of the drug is a better option as the drug is directly delivered at the site of infection with minimum dosage and maximum response achieved thus eliminating all the undesired effects of the drug. Aim: To evaluate the efficacy of 10% povidone iodine with 2% metronidazole and 1% ornidazole with 0.25% chlorhexidine gel as local delivery systems for the reduction in the pocket depth, changes in CAL, gingival inflammation. Materials and methods: A total of 20 patients diagnosed with mild- moderate chronic periodontitis were divided into two groups in a split-mouth study design - Group I and Group II with each group containing 20 sites with probing depth of >5 mm, CAL ?3 mm. In Group I, 10% povidine-iodine gel with 2% metronidazole was delivered inside the pocket and Group II, 1% ornidazole with 0.25% chlorhexidine was used as a local delivery system in adjunct to scaling and root planning. In both groups, medications were delivered at weekly interval for a period of 4 weeks. Baseline and 4 weeks measurements were done and compared for probing pocket depth (PPD), clinical attachment levels (CAL) and gingival inflammation. Results: The results obtained were statistically analyzed. Both groups showed statistically significant improvements in terms of clinical parameters. However, there was statistically insignificant difference when compared between the two groups. The results clearly demonstrate that both povidone iodine with metronidazole and ornidazole with chlorhexidine are also useful in controlling the acute phase of the periodontal disease in adjunct to scaling and root planning (SRP). Conclusion: Both drugs when used as an adjunct to scaling and root planning enhances probing pocket depth reduction, change in clinical attachment levels and gingival inflammation in mild- moderate chronic periodontitis cases.

Evaluation of efficacy of subgingival administration of 1% chlorhexidine gel as an adjunct to scaling and root planing in the treatment of chronic periodontitis - A clinical and microbiological study

Aim: The aim of the present study was to evaluate the clinical and microbiological effects of subgingival administration of 1% chlorhexidine gel (Chlorhexamed® 1% gel) in patients with chronic periodontitis. Settings and Design: The study was done in a parallel?arm design with a total of 30 patients with 60 sites suffering from chronic periodontitis. The patients were divided into control and experimental groups. Materials and Methods: The clinical parameters recorded were plaque index, gingival index, modified sulcular bleeding index, probing pocket depth and relative attachment level at baseline, 1 month and 3 month. Microbiological colony?forming units were assessed for Porphyromonas gingivalis, Fusobacterium nucleatum and Tannerella forsythia at baseline, 1 week, 1 month and 3 months. The control group received scaling and root planing (SRP) after baseline evaluation; however, the experimental group received the application of Chlorhexamed® gel within 48 hours after SRP. Then, the values obtained were subjected to statistical analysis. Results: Both groups showed significant improvement from the baseline to 3 months in all clinical and microbiological parameters. The experimental group showed better improvement in all parameters. Conclusion: The use of Chlorhexamed® gel has proven to be an efficacious adjunct with SRP in the treatment of chronic periodontitis.

Evaluation of Nanocurcumin Mouthwash as an Adjunctive Plaque Control Agent: A Clinical Pilot Study

The use of adjunctive plaque control methods such as mouthwashes has shown to be effective in prevention of plaque accumulation. The gold standard for mouthwashes is 0.2% chlorhexidine, however, various side effects compels researchers to divert towards herbal alternatives. Curcumin has been enhanced with nanotechnology to enhance its efficacy and water solubility. The aim of study was to compare the efficacy of 0.1% nanocurcumin mouthwash to 0.2% chlorhexidine gluconate as an adjunct to scaling and root planning in localized chronic periodontitis patient. In this randomized controlled clinical study, a total of 30 patients having localized mild to moderate periodontitis were included. The study population was divided into 2 groups by randomization protocol; Group A (n=15) was given 0.1% nanocurcumin mouthwash whereas Group B (n=15) was given 0.2% CHX mouthwash. Clinical parameters including Plaque index (PI), Modified Gingival Index (mGI) being recorded at baseline, 30th day and 45th day and Sulcular Bleeding Index (SBI), Periodontal Probing Depths (PPD), Clinical attachment levels (CAL) were recorded at baseline and 45th day. Subjective criteria included taste acceptability, burning sensation and dryness whereas objective criteria including ulcer formation, tongue and teeth staining were analyzed. Statistically significant improvement was observed in all clinical parameters when compared to baseline in both groups and difference was statistically non-significant on intergroup comparison. No adverse reaction was observed in both groups in terms of subjective and objective criteria. Within the limitations, it can be concluded that nanocurcumin can be a viable alternative to chlorhexidine to formulate a mouthwash

Comparative Evaluation of Ornigreat Gel and Placebo (Hexigel 0.25%) as a Local Drug Delivery System in Association with Scaling and Root Planing in Patients with Chronic Periodontitis – An In vivo Study

Aim: The aim of the study was to evaluate the comparative effect of Ornigreat gel and Hexigel as a local drug delivery system in association with scaling and root planing (SRP) in patients with chronic periodontitis. Materials and Methods: A double-blind trial was conducted to test the comparative efficacy of the two commercially available Ornigreat gel and Hexigel at Indira Gandhi Govt. Dental College and Hospital, Jammu. These indices were recorded at baseline (“0 day”), 15th day, 30th day, 60th day, and 90th day in 40 sites, >4 mm pockets in 11 patients among which 20 sites received Ornigreat gel and other 20 sites receive Hexigel following SRP were compared. Results: The results of the study showed that the combination of SRP and Ornigreat gel therapy was more effective in reducing the mean values of gingival index and sulcus bleeding index though not statistically significant, but the values of plaque index showed statistical significance on the 60th day and 90th day, and the probing pocket depths showed statistically significant difference from the 15th day to the 90th day at P < 0.05 in comparison with Hexigel. Conclusion: The Ornigreat gel could be an efficient local drug delivery system when used in adjunct to SRP in comparison with Hexigel.

Advances in drug delivery systems using fibrin glue / 中国药学杂志

Fibrin glue or fibrin sealant has been used surgically as sealant for hemostasis for decades. At the same time, due to the biocompatibility of fibrin glue, it has been studied as a hydrogel drug delivery system, applied in clinical practice and biomedical engineering, especially suitable for local drug delivery for anti-tumor, antibiosis, wound healing, nerve regeneration, and bone healing after fracture. In recent years, novel functional vehicles such as liposomes, microspheres, and nanoparticles have been researched for the feasibility of combined use with fibrin glue. Drugs can be directly sent to the positions that need treatment by using fibrin glue as carriers. Additionally it can extend the residence time of drugs at the administration site and reduce administration frequency. The fibrin glue drug delivery system can also decrease blood drug concentration to avoid systemic adverse effects. This review will highlight recent research of fibrin glue as a drug delivery system.

Efficacy of 10% whole Azadirachta indica (neem) chip as an adjunct to scaling and root planning in chronic periodontitis: A clinical and microbiological study.

Introduction: Anti‑microbial therapy is essential along with conventional therapy in the management of periodontal disease. Instead of systemic chemical agents, herbal products could be used as antimicrobial agents. Herbal local drug delivery systems are effective alternative for systemic therapy in managing the chronic periodontal disease. In this study, 10% neem oil chip was used as a local drug delivery system to evaluate the efficacy in the periodontal disease management. Materials and Methods: Twenty otherwise healthy patients with the bilateral periodontal probing depth of 5–6 mm were included in the study. After scaling and root planning (SRP), 10% nonabsorbable neem chip was placed in the pocket in one side of the arch. Other side was done with SRP only. Clinical parameters were recorded on the baseline, 7th day, and 21st day. Plaque samples were obtained for a microbiological study on the baseline and 21st day. Porphyromonas gingivalis strains were seen using quantitative and qualitative polymerase chain reaction assay. All results were statistically evaluated. Results: Clinical parameters showed statistically improved on the neem chip sites and presence of P. gingivalis strains were significantly reduced on the neem chip sites. Conclusion: Hence, 10% neem oil local delivery system delivers desired effects on P. gingivalis. Further research is needed to evaluate the neem oil efficacy on other periodontal pathogens.

Nature Itself Is The Best Medicine – Herbal Local Drug Delivery In Periodontitis.

Periodontal disease is a chronic inflammatory disease affecting the supporting structures of the teeth. It is multifactorial in origin which leads to many therapeutic modalities for its management. The use of natural therapies for all kinds of diseases is now being considered for the treatment of many chronic diseases. Herbal drugs in a suitable vehicle such as in the form of a local drug delivery system can be a good adjunct and alternative to conventional periodontal treatment.

Comparative evaluation of natural curcumin and synthetic chlorhexidine in the management of chronic periodontitis as a local drug delivery: A clinical and microbiological study.

Background of the Study: The aim of this study is to evaluate the efficacy of natural curcumin in the management of chronic periodontitis as local drug delivery in comparison to synthetic chlorhexidine, which is the gold standard. Materials and Methods: Thirty chronic periodontitis patients with an age range of 20–50 years with probing pocket depth (PPD) of 4–6 mm were included. Curcumin and chlorhexidine gel was applied in the contralateral disease sites at baseline and day 15. The clinical parameters like PPD, clinical attachment level (CAL), gingival index (Loe and Silness) and plaque index (Turesky Gillmore modification of Quigley Hein) were recorded and colony forming units (CFU) were assessed microbiologically at baseline, 15 and 30 days. Results: There was a significant reduction of the clinical parameters (PPD, CAL) and microbiological parameters CFU at 15 and 30 days for both the groups. Curcumin group showed a greater reduction in the clinical parameters when compared with chlorhexidine group. Both groups had a significant reduction in parameters when compared with baseline. Conclusion: Although curcumin has equivalent benefit to chlorhexidine, curcumin being an ayurvedic herb is an excellent alternative to chlorhexidine due to minimal side‑effects.

Clinical efficacy of subgingivally delivered 0.5% controlled release azithromycin gel in the management of chronic periodontitis.

Background: Recent developments suggest that the local delivery of antimicrobials into periodontal pockets can improve periodontal health. Azithromycin (AZM) has a wide antimicrobial spectrum of action toward anaerobic bacteria as well as Gram-negative bacilli. It is effective against periodontal pathogens such as Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis. Therefore, this study was undertaken to investigate the clinical effectiveness of AZM at 0.5% concentration in an indigenously prepared bioabsorbable controlled release gel as an adjunct to non-surgical mechanical therapy in the treatment of chronic periodontitis. Materials and Methods: Thirty sites in patients with chronic periodontitis and probing depth (PD) 4-6 mm were categorized randomly into two treatment groups: Scaling and root planing (SRP) plus 0.5% AZM gel (group 1) and SRP only (group 2). Clinical evaluation was undertaken using the Gingival Index (GI) of Loe and Silness and plaque was assessed using the Turesky et al. modification of Quigley Hein Index at baseline and 21 days. Pocket PD and clinical attachment level (CAL) were also measured. Statistical Analysis: Results were expressed as mean ± standard deviation and percentages and the data were analyzed using Statistical Package for Social Sciences (SPSS version 16.0, SPSS, Chicago, IL) software. Result: Both therapies resulted in significant improvements. Mean reduction in GI from baseline to 21 days was 1.20 ± 0.41 and 0.73 ± 0.45 in group 1 and group 2, respectively. Plaque Index also improved through the study period in both groups, i.e., 0.86 ± 0.51 in group 1 and 1.6 ± 0.97 in group 2. Mean PD reduced significantly with SRP plus AZM gel application in group 1, i.e., 2.1 ± 0.91 mm as compared to 1.0 ± 1.06 mm achieved with SRP alone. A significant gain in mean CAL gain was observed in the test group (1.8 ± 0.63 mm) as compared to control group (1.0 ± 1.06 mm). Conclusion: Although both treatment strategies seem to benefit patients, the adjunctive use of 0.5% of AZM showed significant results.

Effect of absorbent tetracycline-loaded membrane used in the reduction of periodontal pockets: an in vivo study

This clinical study evaluated the influence of scaling and root planning (SRP), with and without the use of tetracycline-loaded bovine absorbent membrane, in the reduction of periodontal pockets according to 3 parameters: probing pocket depth (PPD), bleeding on probing (BOP) and plaque index (PI). Twenty-four patients were selected totalizing 144 random teeth divided in 2 groups (n=72 teeth) - control (SRP) and experimental (SRP with tetracycline-loaded absorbent membrane). PPD, BOP and PI were determined before and 28 days after the treatment. In all patients, the PPD values at the end of the treatment were always lower than the baseline values. There was a reduction of the PI for both treatments, but it was more evident on the experimental group. In conclusion, the use of tetracycline-loaded absorbent membrane could result in a better prognosis compared to scaling and root planning after only 28 days of evaluation.

Este estudo clínico avaliou a influência da raspagem e alisamento radicular, com e sem a utilização de membrana absorvível de liberação de tetraciclina na redução de bolsa periodontal utilizando 3 parâmetros: sondagem da profundidade de bolsa, sangramento à sondagem e índice de placa. Vinte e quatro pacientes foram selecionados totalizando 144 dentes aleatoriamente divididos em 2 grupos (n=72 dentes) - controle (raspagem e alisamento radicular) e experimental (raspagem e alisamento radicular e utilização de membrana absorvível de liberação de tetraciclina). Antes da execução do tratamento foram determimados profundidade de bolsa, sangramento à sondagem e índice de placa. Os pacientes foram avaliados usando os mesmos parâmetros após 28 dias. Os valores da sondagem da profundidade de bolsa foram sempre menores no final do tratamento quando comparado ao início. Houve redução no índice de placa para as 2 formas de tratamento, apesar de ter sido mais evidente no grupo experimental. Concluiu-se que o uso da membrana absorvível de liberação de tetraciclina pode resultar em melhor prognóstico quando comparado apenas com a raspagem e alisamento radicular, após 28 dias de análise.

Delivery efficiency of periadventitial approach in comparison of intravascular delivery: an assessment of pharmacokinetics in porcine arteries / 中国介入影像与治疗学

Objective To investigate the delivery efficacy of periadventitial delivery of 125I-iododeoxyuridine (125I-IUdR) in comparison of intravascular delivery to determine the optimal delivery method for inhibiting post-angioplasty restenosis. Methods In 8 pigs, one side carotid, subclavian and iliac arteries of each pig were injured by balloon angioplasty with a 20% overstretches. Then, 4 mCi of 125I-IUdR was delivered at each targeted vessel with periadventitial method in 4 pigs (periadventitial group) and with intravascular method via a porous balloon catheter in other 4 pigs (intravascular group). The animals survived for 5 hours and the blood radioactivity was investigated prior to and hourly after procedure until sacrifice. The targeted vessels and renal arteries (for control) were harvested for gamma-counting and histological observation. Meanwhile, the radioactivity in thyroid, liver, bladder, small bowel and each kidney also were measured to determine the biodistribution of 125I. The activities of 125I presented in arterial and tissue specimens were compared between the two delivery groups. The targeted arteries were histologically observed and the ratio of intima to media (I∶M ratio) was calculated. Results The target arterial walls in the periadventitial group had 3.4 times as much of 125I radioactivity as in the intravascular group, respectively (P=0.038); the blood activity in intravascular group was significantly higher than periadventitial group immediate after procedure (P0.05). The mean I: M ratios in both groups were 0.05 without additional injury at the vessel wall. Conclusion The periadventitial delivery offered substantial advantage over intravascular approach with high local delivery efficacy. The apparent redistribution rate is more rapid following intravascular delivery.

A plastic anti-infective nano-HA drug delivery implant / 中华创伤骨科杂志

Objective To test the releasing property of a self-developed plastic drug delivery implant of anti-infective nano-hydroxyapatite(nano-HA)so as to provide a new local drug delivery system(LDDS)for treatment of osteomyelitis.Methods The nano-HA was used as the core carrier to load gentamicin(GM).It was coated with poly hydroxybutyrate-co-hydroxyvalerate /polyethylene glycol(PHBV/PEG)to prepare the nano-HA-PHBV/PEG-GM microspheres which were mixed with the fibrin sealant(FS)to develop a plastic implant.Then its antibacte rial and in vitro releasing properties were investigated.Results The plastic LDDS implant was found to have a fine drug delivery capability.The bacterial growth inhibition zone was found around the LDDS for 56 days in the antibacterial test.Three samples were soaked with liquid of PBS(phosphate buffered saline).The titer of GM released within the first day was 154.3 ?g/mL,and then the releasing maintained a slow level in the following days.After 49 days'releasing,the titer was 6.9 ?g/mL which was still higher than the MIC(2 ?g/mL)(minima l inhibitory concentration)of GM.Conclusion The plastic LDDS has a fine in vitro releasing property and may have a widespread application in treatment of osteomyelitis.

CLINICAL EFFECTS OF METRONIDAZOLE-DOXYCYCLINE GEL FOR TREATMENT OF PERIODONTTTIS / 解放军医学杂志

To evaluate the clinical effects of metronidazole-doxycycline gel for treatment of periodontitis, 18 adult patients with periodonti-tis, who had at least 4 mm of probing depth (PD) on the symmetric quadrant, were selected to participate in a randomised study with split-mouth design. Patients of the experimental group were given with metronidazole-doxycycline gel locally once a day for 7 days,while those of the control group were given with metronidazoce stilus. PD, PLI(plaque index), GI(gingival index), BI(bleeding index) were examined on days 0 and 7 of treatment. The results showed that all clinical parametres of the experimental group were better than those of the control group . Therefore, metronidazole-doxycycline gel is effective in the treatment of periodontitis.

The Adjunctive Effect of 30% Minocycline-Containing Polycaprolactone Strips on Nonsurgical Periodontal Therapy / 대한치주과학회지

This study was undertake to assess the effect of 30% minocycline containing polycaprolactone strip to adult periodontitis patient with respect to utility as a monotherapy, effectiveness of this drug device compared to scaling and root planning, and their ability to enhance scaling and root planning. 48 teeth of 12 adult patients who had at least one teeth qualifying pocket> or =4mm at each quadrant were enrolled in this study by split mouth design. All patients received supragingival scaling and oral hygiene instruction 2 weeks prior to the study. At baseline(time 0), enrolled tooth at each quadrant randomly assigned following one of 4 treatment modalities: root planing only(RP); root planing and placement of minocycline strip into pocket for a week(RP+MC); placement of minocycline strip into pocket for a week with out root planing(MC); 2 consecutive placement of minocycline strip into pocket for 2 weeks by one week(MCx2). Each teeth was evaluated at baseline and months 1, 3 and 6. Clinical indices included plaque index, bleeding on probing, probing pocket depth and clinical attachment level. Among 4 groups, RP+MC group showed the lowest percent site of bleeding on probing at 1, 3 and 6 months. Compared to baseline, all group showed significant reduction of pocket depth at 1, 3 and 6 months. The average pocket depth reduction in RP+MC sites was significantly greater than in the sites receiving RP, MC, and MCx2 at 3 months and in sites receiving MC and MCx2 at 6 months. The reduction in clinical attachment at the sites receiving RP+MC was significantly greater than in the sites receiving RP, MC, and MCx2 at 3 months. Between MC and MCx2 groups, no statistically significances was shown in reduction of pocket depth and clinical attachment level at all period examined. This result suggest that the use of 30% minocycline containing strip may improve periodontal health and may be an effective adjunct to conventional nonsurgical therapy in the treatment of adult periodontitis.

Slow-release local drug delivery effect of tetracycline loaded calcium sulfate / 대한치주과학회지

Periodontal disease is a bacterially caused by disease. To remove plaque and bacteria, it has been necessary to prescribe chemical drug to patient to subjugate therapeutic unvalue by mechanical scaling. As a patient on a high dosage of the antibiotics to maintain the effective concentration may produce unfavorable side effects, this decase demands the Slow-release local drug delivery system. The object of the experiment is to study on the slow-release local drug delivery effects of calcium sulfate compounded with tetracycline that mainly used in periodontal disease. Experimental groups were divided into four classes as follow: Group 1 : 10% tetracycline compounded modified calcium sulfate paste. Group 2 : compounded and hardened 10% tetracycline and calcium sulfate. Group 3 : compounded 10% tetracycline and calcium sulfate, used just before hardened. Group 4 : tetracycline-ethylene vinyl acetate fiber. In the four groups, release concentration, it's durability and the period of absorption by times are observed and concluded as follow: 1. An effective concentration(4microgram/ml) remained until 5 weeks in group 1, 9 days in group 2, 7 days in group 3, 15 days in group 4. 2. It was fully fused at 11.8 days average in group 2 and 14.8 days average in group 3. 3. There were no statistically significant results in tetracycline concentration until a week in group 2 and 3(p<0.05) These results suggest that tetracycline loaded calcium sulfate release sufficient tetracycline and fused in 11~14 days, so calcium sulfate is useful carrier as slow release local drug delivery system

Local intraluminal infusion of PLGA dexamethasone nanoparticles for prevention of restenosis after balloon angioplasty / 中国介入心脏病学杂志

Objective To evaluate the tissue compatibility of PLGA Nanoparticles and the effect of local intraluminal infusion of dexamethasone nanoparticles on restenosis after balloon angioplasty Methods PLGA nanoparticles were intraluminally administered after balloon injury in the rabbit iliac model Retention at different time points and biocompatibility of nanoparticles were evaluated Dexamethasone nanoparticles were also used in the same model to observe the effects on restenosis Results The PLGA nanoparticles apperaed to be fully biocompatible In the dexamethasone nanoparticles study, dexamethasone was presented in the treated segment for up to 14 days There is a significant reduction in intima/media ratio in treated animals compared with control Conclusion PLGA nanoparticles have good tissue compatibility Local administration of dexamethasone nanoparticles can retentate in vessel wall for more than 14 days and significantly decreased neointimal formation