ABSTRACT
The subgingival microbiologic composition of diseased periodontal sites was evaluated by darkfield microscopy before and after scaling or local delivery of tetracycline. A standardized sampling and counting method using a crevicular washing technique was developed to determine both numbers and proportions of morphotypes using darkfield microscopy. Tetracycline-loaded hollow fibers established an initial intrasulcular concentration of 200,000 micrograms/ml, which decreased exponentially to 15 micrograms/ml in 24 hours. Repetitive intrasulcular placement of these fibers at periodontitis sites produced an incremental reduction in bacterial counts over a 10-day period. Monolithic fibers made of ethylene vinyl acetate loaded with 25% tetracycline hydrochloride provided sustained release for 10 days under in vitro test conditions. Ten patients were treated in a study comparing the effects of these fibers with scaling. Fibers were placed subgingivally to fill pockets to their probable depth and covered with a periodontal dressing which was maintained for 10 days. The average intrasulcular tetracycline concentration measured at the end of the 10-day period was 643 micrograms/ml. At these sites, total counts, spirochetes, motile rods and nonmotile rods were significantly reduced immediately following treatment. Total counts were depressed to levels near the detection limit of darkfield microscopy. In comparison, scaling produced much smaller alterations of darkfield counts which were not statistically significant.
Subject(s)
Periodontal Diseases/drug therapy , Tetracycline/administration & dosage , Adult , Bacteria/isolation & purification , Dental Scaling , Drug Implants , Equipment Design , Humans , Microscopy/methods , Middle Aged , Periodontal Diseases/microbiology , Periodontal Pocket/drug therapy , Periodontal Pocket/metabolism , Periodontal Pocket/microbiology , Pilot Projects , Tetracycline/metabolism , Time FactorsABSTRACT
A method for the detection of prostaglandin E (PGE) in crevicular fluid has been developed which provides a sensitive, noninvasive technique for measurement of local concentrations of this mediator of inflammation. Assay sensitivity sufficient for the detection of 4 picograms of PGE2 was achieved by utilizing a high-affinity anti-PGE2 antibody, a solid-state second antibody and low isotope concentrations. The method permits detection of concentrations equivalent to 10(-8) M PGE2 in 1 microliter of crevicular fluid. Crevicular fluid PGE (CFPGE) concentrations were determined in samples from 12 patients with periodontal disease. Patients with periodontitis had significantly higher mean CFPGE concentrations than patients with gingivitis (179.5 +/- 51.4 pg/microliter vs 32.1 +/- 15.5 pg/microliter, mean +/- SEM). Periodontitis sites were selected on the basis of clinical and radiographic evidence of periodontal destruction. Some sites displayed low CFPGE levels, while others had CFPGE concentrations which were elevated tenfold, suggesting the presence of both inactive and active periodontal lesions. CFPGE levels greater than 100 pg/microliter were positively associated with gingival erythema and pain on probing.
