Locally delivered antimicrobials: clinical evidence and relevance

Periodontitis is a common oral infection and inflammatory condition. Following treatment, residual or persistent periodontal inflammation is associated with disease progression and tooth loss. Cumulative evidence from clinical trials and meta-analyses support a complementary medical-mechanical model that combines locally delivered antimicrobials with scaling and root planing for the treatment of chronic periodontitis. Accordingly, greater pocket depth reductions and/or attachment level gains occur in patients treated with adjunctive locally administered antimicrobials (eg, tetracycline, chlorhexidine, doxycycline, and minocycline). These responses are clinically relevant because they are accompanied by a higher probability of patient maintenance or pocket resolution. Recent trials also indicate that locally administered antimicrobials may enhance the effects of periodontal surgical therapy and may reduce the signs of peri-implantitis. The consistency of these findings supports the use of locally administered antimicrobials for managing dental patients with chronic periodontitis.