The clinical significance of local chemotherapies.

This paper discusses differences between statistical and clinical significance. It suggests nine factors to consider when assessing clinical significance of periodontal therapy. The article reviews the multicentre randomized clinical trials on the four antimicrobial local delivery systems commercially available in the USA (tetracycline fibre, chlorhexidine chip, doxycycline gel and minocycline microspheres) and assesses their data in relation to the nine factors for clinical significance.

Local delivery of antimicrobials: a new era in the treatment of adult periodontitis.

This article discusses the principles, products, and techniques currently available for local delivery of antimicrobials in the treatment of adult periodontitis. Four principles provide the scientific basis for the treatment of periodontitis: it is caused by bacteria; it cannot be cured, but it can be controlled; clinicians cannot remove all the plaque and calculus; and periodontitis reinfects. This article stresses how the local delivery of antimicrobials can help the clinician achieve the goals of arresting the disease and maintaining the disease in the arrested or controlled state.

Controlled local delivery of tetracycline with polymer strips in the treatment of periodontitis.

Background: Several antibacterial agents have been studied as a means to produce bactericidal or bacteriostatic activity as an adjunct to mechanical treatment of periodontal disease. The primary purpose of this study was to evaluate the efficacy of tetracycline strips administered singly or in multiples in conjunction with root planing, versus root planing alone, or to an untreated control. Secondary purposes were to compare gingival crevicular fluid (GCF) volume and GCF concentrations of tetracycline in pockets treated with strips; to evaluate strip insertion time; and to compare ease of placement for single or multiple strips.

An economic evaluation of a chlorhexidine chip for treating chronic periodontitis: the CHIP (chlorhexidine in periodontitis) study.

Background: The authors previously suggested that an adjunctive, controlled-release chlorhexidine, or CHX, chip may reduce periodontal surgical needs at little additional cost. This article presents an economic analysis of the CHX chip in general dental practice.

Methods: In a one-year prospective clinical trial, 484 chronic periodontitis patients in 52 general practices across the United States were treated with either scaling and root planing, or SRP, plus any therapy prescribed by treating, unblinded dentists; or SRP plus other therapy as above but including the CHX chip.

Utilisation of locally delivered doxycycline in non-surgical treatment of chronic periodontitis. A comparative multi-centre trial of 2 treatment approaches.

Aim: In the present 6-month multicentre trial, the outcome of 2 different approaches to non-surgical treatment of chronic periodontitis, both involving the use of a locally delivered controlled-release doxycycline, was evaluated.

Material And Methods: 105 adult patients with moderately advanced chronic periodontitis from 3 centres participated in the trial. Each patient had to present with at least 8 periodontal sites in 2 jaw quadrants with a probing pocket depth (PPD) of > or =5 mm and bleeding following pocket probing (BoP), out of which at least 2 sites had to be > or =7 mm and a further 2 sites > or =6 mm.

The effect of locally delivered controlled-release doxycycline or scaling and root planing on periodontal maintenance patients over 9 months.

Background: This research report evaluates clinical changes resulting from local delivery of doxycycline hyclate (DH) or traditional scaling and root planing (SRP) in a group of patients undergoing supportive periodontal therapy (SPT).

Methods: In all, 141 patients received either DH (67) or SRP (74) treatment in sites > or =5 mm on one-half of their dentition at baseline and month 4.

Results: Clinical results were determined at month 9.

A new horizon for the dental hygienist: controlled local delivery of antimicrobials.

All drugs and controlled local delivery systems must be approved by the Food and Drug Administration (FDA) prior to being marketed and used in clinical practice. These systems can only be used in the clinical office setting by the dentist or under his/her supervision. One controlled local antimicrobial delivery system, tetracycline fiber, has been on the market for several years.

The cost-effectiveness of a new chlorhexidine delivery system in the treatment of adult periodontitis.

Background: Periodontal treatment is costly. The authors assessed the potential economic impact of a new periodontal chemotherapeutic, testing the hypothesis that its adjunctive use would result in reduced periodontal surgical needs.

Methods: An economic model estimated treatment needs following two clinical trials of the adjunctive use of a chlorhexidine, or CHX, -containing chip compared with scaling and root planing, or SRP, alone.

Two multi-center studies evaluating locally delivered doxycycline hyclate, placebo control, oral hygiene, and scaling and root planing in the treatment of periodontitis.

Background: The clinical efficacy and safety of doxycycline hyclate (8.5% w/w) delivered subgingivally in a biodegradable polymer (DH) was compared to placebo control (VC), oral hygiene (OH), and scaling and root planing (SRP) in 2 multi-center studies.

Methods: Each study entered 411 patients who demonstrated moderate to severe periodontitis.

Assessing the effectiveness of locally delivered chlorhexidine in the treatment of periodontitis.

Background: Several multicenter random clinical trials have studied a second-generation easy-to-use chlorhexidine local delivery system to assess its effectiveness as an adjunct to scaling and root planing, or SRP.

Methods: The author reviews the pharmacokinetics of the local delivery system and two of the multicenter randomized clinical trials. One study evaluated 118 patients using split-arch design and the other study 447 patients using parallel design.

The time and ease of placement of the chlorhexidine chip local delivery system.

The first local delivery system for an antimicrobial agent was a nondegradable tetracycline-impregnated fiber introduced by Goodson et al in 1979. PerioChip, a biodegradable chip containing chlorhexidine, was recently approved by the Food and Drug Administration for the treatment of adult periodontitis. During several multicenter randomized clinical trials, this product, when used as an adjunct to scaling and root planing, was found to reduce probing depth and improve attachment level significantly more than scaling and root planing alone.

Effect of brushing with sonic and counterrotational toothbrushes on the bond strength of orthodontic brackets.

The purpose of this study was to evaluate the effect of brushing with both a sonic and mechanical counter rotary power toothbrush on the bond strength of orthodontic brackets. Forty-five extracted teeth were divided into three random groups and had orthodontic brackets bonded to them. One group was brushed with a counterrotational toothbrush, the Interplak, one group with a sonic toothbrush, the Sonicare, and a third group was not brushed and was held as a control.

The use of locally delivered chlorhexidine in the treatment of periodontitis. Clinical results.

Since the advent of a nondegradable controlled local delivery of antibiotics in 1979, several second generation systems have been developed. Second generation systems have attempted to improve on the early system. Chlorhexidine has been used effectively for over 30 years as an antiseptic.

Effect of brushing with sonic and counterrotational toothbrushes on the bond strength of full veneer crowns.

Statement Of Problem: Earlier studies on orthodontic brackets have shown a loss of bond strength after a sonic toothbrush was used.

Purpose: This in vitro study evaluated the difference in bond strength of single complete veneer crowns after being subjected to the equivalent of 2 years of brushing with sonic and counterrotational toothbrushes.

Material And Methods: Complete gold crowns were fabricated with a conventional indirect technique for 30 extracted, intact, prepared human premolar teeth.

Chemical treatment of periodontitis: local delivery of antimicrobials.

Periodontitis is a bacterial infection. It appears in a generalised form but more often appears in local areas in a patient's mouth or is reduced to localised areas by mechanical treatment. Periodontitis lends itself well to treatment by means of a controlled local delivery system using an antimicrobial agent.

Adjunctive use of a subgingival controlled-release chlorhexidine chip reduces probing depth and improves attachment level compared with scaling and root planing alone.

The present studies evaluated the efficacy of a controlled-release biodegradable chlorhexidine (CHX) (2.5 mg) chip when used as an adjunct to scaling and root planing on reducing probing depth (PD) and improving clinical attachment level (CAL) in adult periodontitis. Two double-blind, randomized, placebo-controlled multi-center clinical trials (5 centers each) were conducted; pooled data are reported from all 10 centers (447 patients).

The effects of an ultrasonic toothbrush on plaque accumulation and gingival inflammation.

The purpose of this study was to evaluate the effectiveness of an ultrasonic toothbrush to reduce plaque and gingival inflammation when compared to a manual toothbrush. 62 healthy adult patients with a plaque index of at least 2.0, a 50% bleeding index and at least 16 natural teeth participated in this study.

Controlled local delivery of antimicrobials in the treatment of periodontitis.

Five local delivery systems with five different antimicrobial agents have been discussed. All are capable of delivering high concentrations of their antimicrobial to the site of the periodontal infection. Although only one system, tetracycline fiber, is available in United States, two other systems, chlorhexidine chip and doxycycline polymer, may be available in the near future.

Laser irradiation of bone. I. An in vitro study concerning the effects of the CO2 laser on oral mucosa and subjacent bone.

The purpose of this study was twofold: first, to evaluate the histologic effects of CO2 laser irradiation on biopsies of porcine oral mucosa and underlying bone under conditions that simulate the applications of the laser during gingival surgery; and second, to evaluate the histologic effects on cortical bone following irradiation with increasing energy densities. Specimens consisting of mucosa and underlying bone were subjected to multiple passes of the laser beam in the same line of incision at energy densities ranging from 240 to 1,032 J/cm2. A second group of specimens consisting only of cortical bone was irradiated by a single pass of the laser at energy densities ranging from 40 to 2,062 J/cm2.

Histologic evaluation of soft tissue attachment to CO2 laser-treated root surfaces: an in vivo study.

There is little support in the dental literature to justify the use of lasers for periodontal root therapy. To the contrary, there are several in vitro studies suggesting potentially adverse effects when lasers are applied to root surfaces. The purpose of this study was to evaluate, in vivo, soft tissue attachment to root surfaces following CO2 laser irradiation.

Multi-center comparative evaluation of subgingivally delivered sanguinarine and doxycycline in the treatment of periodontitis. II. Clinical results.

The clinical safety and effectiveness of a subgingivally delivered biodegradable drug delivery system containing either 10% doxycycline hyclate (DH), 5% sanguinarium chloride (SC) or no agent (VC) was evaluated in a 9-month multi-center trial. The study was a randomized parallel design with 180 patients who demonstrated moderate to severe periodontitis. All patients had at least two quadrants with a minimum of four qualifying pockets > or = 5 mm that bled on probing.

Multi-center comparative evaluation of subgingivally delivered sanguinarine and doxycycline in the treatment of periodontitis. I. Study design, procedures, and management.

The design and conduct of a 9-month multi-center clinical trial to evaluate the safety and efficacy of subgingivally delivered 5% sanguinarium chloride (SC) and 10% doxycycline hyclate (DH) from a biodegradable drug delivery system in the treatment of adult periodontitis is described. The 3-group randomized study of 180 adults with moderate to severe periodontitis was a modified double-blind parallel design. One group received DH, one group received SC, and the other group received the vehicle control (VC).

Determination of energy density threshold for laser ablation of bacteria. An in vitro study.

The Nd:YAG and CO2 lasers have been shown to be bactericidal at relative low energy densities. However, at energy densities exceeding 120 J/cm2 (CO2) and 200 J/cm2 (Nd:YAG), laser irradiation also causes irreparable root surface damage. The purpose of this study was to determine, in vitro, the energy density threshold at which microbial ablation could be achieved while inflicting the least amount of damage to the root surfaces of human teeth.

Treatment of root fracture by CO2 and Nd:YAG lasers: an in vitro study.

The purpose of this in vitro study was to use scanning electron microscopy and polarized light microscopy to evaluate the feasibility of using either the CO2 laser or an Nd:YAG laser in combination with air/water surface cooling to effect fusion of fractured tooth roots. The experimental unit consisted of 81 single-rooted teeth, each with an induced root fracture. Fifty-six teeth that had been reapproximated in dental stone and 25 teeth that had been reapproximated with C-clamps were assigned to untreated control groups or groups for treatment using CO2 and Nd:YAG lasers.

Histologic evaluation of porcine skin incisions produced by CO2 laser, electrosurgery, and scalpel.

The purpose of this study was to histologically compare the healing of porcine skin incisions made by CO2 laser, electrosurgery, and conventional scalpel. Incisions were made on the dorsal thorax of two microswine at staggered time intervals allowing the harvest of specimens at 0, 4, 7, 14, and 21 days postsurgery at the time of sacrifice. Each of the following histologic zones were identified and measured for both laser and electrosurgery incisions: (1) zone of tissue ablation.