ABSTRACT
Introduction:
Chronic periodontitis is an infectious disease which is multifactorial in etiology. The red complex bacteria have an enzyme capable of hydrolyzing the synthetic trypsin substrate, N-benzoyl-DL-arginine-2-napthylamide (BANA). Tetracycline as a bacteriostatic agent is used in the treatment of periodontitis.
Objective:
The aim of this study was to evaluate clinically and microbiologically the efficacy of tetracycline fibers in conjunction with scaling and root planning in chronic periodontitis patients.
Methodology:
A Split mouth clinical and microbiological randomized control study was done to compare the clinical effects of subgingivally delivered antimicrobial bioabsorbable controlled release 2 mg tetracycline fibers as an adjunct to scaling and root planning on one side and comparing the other side treated only with scaling and root planning only.
Result:
Showed both scaling and root planning and the use of tetracycline an adjunct with scaling and root planning are equally effective.
Conclusion:
It can be concluded that Scaling and root planing (SRP) with or without use of adjunct local drug delivery agent like tetracycline is effective in treating chronic periodontitis.
KEYWORDS: Chronic periodontitis, locally delivered tetracycline, scaling and root planning
INTRODUCTION
Chronic periodontitis is an infectious disease which is multifactorial in etiology.[1] Periodontal diseases are elicited by a complex of bacterial species that interact with host tissues and cells causing the release of a broad array of inflammatory cytokines, chemokines, and mediators, some of which lead to the destruction of the periodontal structures, including the tooth-supporting tissues, alveolar bone, and periodontal ligament.[2,3]
The requirements for treating periodontal disease include a means of targeting an anti-infective agent to infection sites and sustaining its localized concentration at effective levels for a sufficient time while concurrently evoking minimal or no side effects.[4]
MATERIAL AND METHODS
This study was conducted on 15 patients with Generalized Chronic Moderate periodontitis in the Department of Periodontology, New Horizon Dental College and Research Institute, Sakri, Bilaspur, Chhattisgarh.
Patients included were in the age group between 35 and 60 years, systemically healthy patients with at least 4 sites with a probing depth ranging from 5 to 7 mm, and who have not undergone any type of regenerative periodontal therapy 6 months prior to the initial examination and were without any antibiotic therapy in last 6 months.
Patients excluded were with known or suspected allergy to the tetracycline which is prescribed in this stud, who were having periodontal pockets less than 5 mm after initial prophylaxis, pregnant or lactating women, smokers, alcohol and drug abuser, and teeth with furcation involvement
METHODOLOGY
Study design
The present split-mouth clinical study comprised of a total of 15 patients (7 males, 8 females) with moderate chronic periodontitis. Out of the 15 patients included, 13 patients completed the study, 2 patients had to be excluded on account of their inability to provide follow-ups at 3 months.
Control site
Only SRP was done under local anesthesia. Coe-Pac was also placed at the control site to create a comparable subgingival environment.
Test site
Scaling and root planning was done under local anesthesia and tetracycline fibers were inserted
Measurement
It was done based on clinical and microbiological parameters. Clinical measurements were clinically monitored at baseline, one month and three months postoperatively.
Clinical parameters which were assessed were:
Gingival Index (Loe & Silness 1963)
Plaque index (Silness & Loe 1964)
Probing depth
Relative attachment level
Insertion of tetracycline fibers at test sites
After SRP, which was done on both the test and control sites, there was insertion of tetracycline fiber in the test site with the control site left without any further treatment modality, The fibers were moistened with normal saline and held with a tweezer and taken to test site. The insertion of the fiber was then carried out with the help of a UNC-15 Periodontal Probe through the gingival sulcus up till the base of the pocket was entirely filled up to the gingival margin dislodging of fibers periodontal dressing (Coe-Pac) was used.
Microbiological analysis
Samples were collected at baseline (immediately before treatment), one month and three months postoperatively. Subgingival plaque samples were obtain using Gracey curettes and then placed in a lower matrix of the BANA test strip.[5] The upper matrices were moistened with saline solution and the test strip is folded so that the two matrices come in contact. It was then incubated for 5 minutes at 55° Celsius temperature. The higher concentration of bacterial species leads to a darker shade of blue coloration of the strip. According to the result, the test was positive, weak positive, or negative.
RESULT
The mean value of the Plaque Index, gingival index, PPD, CAL, and even BANA strip showed insignificant values at baseline, one month and three months, in both groups Tables 1 and 2.
Table 1.
Shows paired samples t-test applied for relative attachment level for values obtained from control and test site from baseline to three months
| Mean | Std. Deviation | Std. Error Mean | 95% Confidence Interval of the Difference | t | Df | P | ||
|---|---|---|---|---|---|---|---|---|
|
| ||||||||
| Lower | Upper | |||||||
| Baseline - three months control site | 1.23000 | 0.92141 | 0.29138 | 0.57086 | 1.88914 | 4.221 | 9 | 0.002 |
| Baseline - three months test site | 1.76000 | 1.15393 | 0.36940 | 0.93453 | 2.54537 | 4.823 | 9 | 0.001 |
Table 2.
Shows paired samples t-test applied for BANA for values obtained from control and test site from baseline to three months
| Mean | Std. Deviation | Std. Error Mean | 95% Confidence Interval of the Difference | t | df | P | ||
|---|---|---|---|---|---|---|---|---|
|
| ||||||||
| Lower | Upper | |||||||
| Baseline - three months | -0.20000 | 0.63246 | 0.20000 | -0.65243 | 0.25243 | -1.000 | 9 | 0.343 |
| Baseline - three months | 0.90000 | 0.87560 | 0.27689 | 0.27364 | 1.52636 | 3.250 | 9 | 0.010 |
DISCUSSION
Scaling and root planning has been shown to be an effective treatment for chronic periodontitis. Although mechanical treatment significantly decreases the prevalence and levels of subgingival microorganisms, it does not necessarily eliminate all pathogens.[5]
Tetracycline has been incorporated into a variety of structures as hollow fibers, ethylene vinyl acetate copolymer fibers, ethyl cellulose fibers, acrylic strips, collagen preparations, and hydroxypropyl cellulose films..[6] Recently, new biodegradable local drug delivery system, PerioCol®-TC has been introduced for the treatment of gingival and periodontal diseases. The use of tetracycline hydrochloride (HCL) fibers as an adjunct to SRP has been extensively evaluated.,[7]
The decrease in the plaque values at one month when compared to baseline in both the groups can be attributed to the better compliance of the patients in maintaining the oral hygiene.
Decrease in the Gingival Index values at baseline could be attributed to the decrease in the gingival inflammation after the removal of local irritants.
A greater reduction of probing pocket depth (PPD) from baseline to three months seen in test sites as compared to control, though statistically insignificant may be attributed firstly to the beneficial effects of SRP on the soft tissues within the periodontal pocket leading to shrinkage and decrease in pocket depth.
The gain in attachment was seen from baseline to three months was more in test than controls though statistically non-significant. The crossover effect of medication is a possibility due to the split mouth design of the study which may have resulted in a beneficial effect of tetracycline even in untreated site.
The contradictory results in this study may be due to the fact that the PerioCol®-TC fibers used in the study released BANA Test may be negative in the presence of clinical disease due to poor sampling technique or the possibility of an infection involving non-BANA bacterial species.[8]
CONCLUSION
It can be concluded by stating that SRP with or without use of adjunct local drug delivery agent like tetracycline is effective in treating chronic periodontitis.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
- 1.Kalsi R, Vandana KL, Prakash S. Effect of local drug delivery in chronic periodontitis patients:A meta-analysis. J Indian Soc Periodontol. 2011;15:4–8. doi: 10.4103/0972-124X.92559. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Stanley C, Holt, Jeffre L, Ebersole Porphyromonas gingivalis, treponema denticola, and Tannerella forsythia:The _red complex_a prototype polybacterial pathogenic consortium in periodontitis. Periodontol 2000. 2008;38:72–122. doi: 10.1111/j.1600-0757.2005.00113.x. [DOI] [PubMed] [Google Scholar]
- 3.Andrade JS, Feres M, Figueiredo LC, Salvador SL, Cortelli SC. The ability of the BANA Test to detect different levels of P.gingivalis, T.denticola and T.forsythia Braz Oral Res. 2010;24:224–30. doi: 10.1590/s1806-83242010000200016. [DOI] [PubMed] [Google Scholar]
- 4.Teughels W, Quirynen M, Jakubovics N. Periodontal microbiology. In: Carranza FA, editor. Clinical Periodontology. 11th ed. Sauder: Elsevier; 2012. pp. 309–60. [Google Scholar]
- 5.Grisi DC, Salvador SL, Figueiredo LC, Souza SLS, Novaes AB, Jr, Grisi MFM. Effect of a controlled-release chlorhexidine chip on clinical and microbiological parameters of periodontal syndrome. J Clin Periodontol. 2002;29:875–81. doi: 10.1034/j.1600-051x.2002.291001.x. [DOI] [PubMed] [Google Scholar]
- 6.Sachdeva S, Agarwal V. Evaluation of commercially available biodegradable tetracycline fiber therapy fiber in chronic periodontitis. J Clin Periodontol. 2011;15:130–4. doi: 10.4103/0972-124X.84381. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Kornman KS, Karl EH. The effect of long term low dose tetracycline therapy on the subgingival microflora in refractory adult periodontitis. J Periodontol. 1982;53:604–10. doi: 10.1902/jop.1982.53.10.604. [DOI] [PubMed] [Google Scholar]
- 8.Friesen LR, Williams KB, Krause LS, Killoy WJ. Controlled local delivery of tetracycline with polymer strips in the treatment of periodontitis. J Periodontol. 2002;73:13–8. doi: 10.1902/jop.2002.73.1.13. [DOI] [PubMed] [Google Scholar]
