Local antimicrobial therapies in periodontal disease

Periodontal therapy has the primary aim of halting periodontal disease progression. Clinical trials over the years have indicated that meticulous scaling and root planing in conjunction with a patient's proper plaque control can arrest periodontitis, but this therapy is not always completely effective and thus adjunctive therapies need to be considered. Local delivery of antibacterial agents into periodontal pockets has been extensively developed and investigated since the late 1970s and many systems have been designed to maintain high levels of antimicrobial agents in the crevicular fluid with minimal systemic uptake. More recently subgingival antimicrobial delivery systems have become available to the practising periodontist for clinical use. These systems, employ different antimicrobial agents but also different delivery systems which influence the concentration of available drug over time. The dental profession is confused by the wide variety of available slow release subgingival antimicrobial devices on the market and clearly comparative independent assessment of these therapies is needed. This review will summarise the findings of a comparative study on three commonly available periodontal local delivery antimicrobial systems on sites with previously unsuccessful mechanical therapy. The slow release devices studied adjunctively with root planing were: Actisite, Dentomycin and Elyzol, compared to root planing alone. Substantivity of an antimicrobial system is the ability of the system to maintain an effective concentration of drug over time which may be the most significant difference between the three delivery systems rather than the type of antimicrobial drug used. Although all three locally applied antimicrobial systems seem to offer some benefit over scaling and root planing alone, a treatment regime of scaling and root planing plus tetracycline fibre placement gave the greatest reduction in probing pocket depth over the six months after treatment.