Periodontal disease can be treated either by surgical or nonsurgical methods depending on probing pocket depth. More emphasis is given to non-surgical methods which include Scaling & root planning (SRP), the adjunctive use of medicaments, mouthwashes or patient administered irrigation systems with cannulas or syringes. The local application of antimicrobials that are effective against periodontopathogens, reduce the pocket depth and hopefully the need for surgery. The aim of the present study was to find out the clinical efficacy of minocycline microspheres (ArestinTM) as an adjunct to SRP in the management of localized periodontitis patients over a period of 6 months.
Materials and Methods: Minocycline microspheres (ArestinTM by Orapharma Inc, Warminster, PA, USA) is a subgingival sustained-release minocycline hydrochloride incorporated into a bioresorbable polymer, (poly glycolide-lactide). Each unit dose catridge delivers 1 mg minocycline. Tooth was taken as the randomisation unit. Either buccal/labial, mesial, distal or palatal surfaces were taken. 12 sites were treated with Arestin plus SRP (Test group). 12 similar sites were treated with SRP only (Control group). Clinical parameters like probing pocket depth, clinical attachment level, gingival index, sulcus bleeding index were recorded at baseline and at 1.5, 2.5, 3.5, 4.5 & 6 months. Supra gingival scaling and clinical measurements were done for both test and control groups at each recall visits.
Results and conclusion: The results of the study can be concluded that when used as an adjunct to mechanical debridement, the subgingival application of minocycline microspheres (ArestinTM) is more efficacious than SRP alone in the treatment of localized periodontitis patients.
The periodontal disease represents a group of localized microbial induced infections. Around 300 or 400 bacterial species are found in the human sub gingival plaque samples. Out of these 10-20 species may play a role in the pathogenesis of periodontal disease. There is considerable evidence implicating facultative and obligate anaerobic bacteria as the primary cause of periodontal disease .1,2,3,4 Perodontal pathogens produce a variety of enzymes and toxins that can damage the tissues and initiate inflammation.5
Periodontal disease can be treated either by surgical or nonsurgical methods depending on the probing pocket depth and nature of the disease. More emphasis is given to non-surgical methods which include scaling & root planning (SRP), adjunctive use of medicaments, mouthwashes or patient administered irrigation systems with cannulas or syringes. Various antimicrobial agents have been tested as irrigants including chlorhexidine, iodine, sanguinarine and essential oils. The disadvantages of these methods include inability to maintain adequate concentration of the drug in the periodontal pocket and require patient compliance and dexterity.
The initial attempt to utilize controlled delivery for the management of periodontitis is the work of Goodson et al in which tetracycline was delivered to the periodontal pocket via hollow dialysis tube.6 More recent development has focused on injectable systems, which offer greater ease of use. Eg: 25% metronidazole gel, 2% Minocycline gel, films and microspheres, 35% tetracycline hydrochloride gel and 10% doxycycline gel.
Tetracyclines comprise a group of broad-spectrum antibiotics in the management of periodontal diseases. Minocycline, a semi synthetic tetracycline has the most marked substantivity and greater lipid solubility than tetracycline along with the features of tetracycline like antibacterial activity, and anticollagenase activity. Therefore, minocycline is one of the most suitable antibiotics for controlling periodontal disease especially for local therapy.
In this clinical trial an attempt has been made to evaluate the effects of local delivery of sustained release Minocycline microspheres (ArestinTM), as an adjunct to SRP in the management of localized periodontitis.
Aims and objectives
To find out the clinical efficacy of Minocycline microspheres (ArestinTM) as an adjunct to SRP in the management of localised periodontitis as measured by reduction in probing depth.
Materials and Methods
Minocycline microspheres (ArestinTM by Orapharma Inc,Warminster, PA, USA) is a subgingival sustained-release minocycline hydrochloride incorporated into a bioresorbable polymer, (poly glycolide-lactide). Each unit dose cartridge delivers 1 mg minocycline. Arestin’s microspheres are bioadhesive, bioresorbable polymer in powder form produced by microencapsulation process. Once Arestin is inserted, it immediately adheres to the periodontal pocket. Crevicular fluid hydrolyses the polymer causing water-filled channels which provide “escape routes” for the encapsulated antibiotic for sustained release. The active drug diffuses through the channels and eventually, the microspheres themselves are fragmented through polymer hydrolysis and completely bioresorbed. ArestinTM can be administered quickly right after SRP and no anesthesia is needed.
Study population comprised of patients with chronic periodontitis.
Criteria for patient selection
Study setting and period: Government Dental College, Trivandrum; one year -2002.
Study was done under the approval of Human Ethics Committee, Medical College, Trivandrum.
All the patients after randomisation had received supra gingival scaling using ultrasonic instruments. Oral hygiene instructions were given. After 1 week patients were recalled for evaluation of periodontal status. Tooth was taken as the randomisation unit. Either buccal/labial, mesial, distal or palatal surfaces were taken. If more than one surface was involved, it was not taken for the study. 12 sites each were treated in the test and control group.
After selection of the appropriate sites, clinical parameters at base line, like probing pocket depth (PPD), clinical attachment level (CAL), gingival index (GI), sulcus bleeding index (SBI) were recorded. For standardisation of probing measurements, impressions were made and customised acrylic occlusal stents prepared. The stents covered the occlusal surface of the teeth and extended on the buccal and lingual surfaces. The groove that was prepared provided the reproducible alignment for the periodontal probe. The base of the stent served as the reference point for measurements like PPD and CAL which was measured with William’s graduated probe.