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Dean of Dentistry and Professor of Restorative Dentistry, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4BW, UK
Local drug delivery systems (LDDs) are mainly used as adjuncts to root surface instrumentation (RSI) in the management of periodontal disease. A range of antibacterial agents have been used for this purpose and include the tetracyclines, chlorhexidine, metronidazole, azithromycin, clarithromycin and moxifloxacin. More recently, other non-antibacterial agents have been incorporated into local delivery devices and include simvastatin, metformin and alendronate. This paper will review the effectiveness of such agents when used as an adjunct to conventional non-surgical periodontal therapy.
Clinical Relevance: The benefits of adjunctive use of local drug delivery in the management of periodontal disease will be discussed.
Article
Chlorhexidine gluconate is active against a broad spectrum of microbes. The CHX molecule, owing to its positive charge, reacts with the microbial cell surface, destroys the integrity of the cell membrane, penetrates into the cell, precipitates the cytoplasm, and the bacterial cell dies.
In the early 1980s, the first slow release device containing CHX incorporated into a non-degradable matrix was introduced. A second generation slow release device was formulated and this is now available as the product PerioChip®. The chip is rounded at one end for insertion into periodontal pockets. Its physico-chemical properties are shown in Table 1. One PerioChip® is inserted into a periodontal pocket with a probing pocket depth (PD) greater than or equal to 5 mm. Up to 8 PerioChips® may be inserted at different sites in a single visit. Treatment is recommended once every three months in pockets with PD remaining greater or equal to 5 mm. The periodontal pocket should be isolated and the surrounding area dried prior to chip insertion up to its maximum depth. The PerioChip® does not need to be removed as it biodegrades completely and releases CHX over a 7–10 day period.
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