Periodontal disease is associated with bacteria and local drug delivery systems provide a way to administer chemotherapeutic agents directly into the site of infection via controlled release systems. Local delivery offers advantages over systemic administration like longer duration of action and avoidance of GI issues. Common locally delivered drugs used to treat periodontal disease include tetracycline fibers, doxycycline gel, minocycline microspheres, metronidazole gel, and chlorhexidine chips, each of which has a different drug component and controlled release mechanism. Local delivery provides sustained therapeutic drug levels at the site over periods ranging from one week to two weeks.

1. LOCAL DRUG DELIVERY
IN THE TREATMENT OF
PERIODONTAL DISEASES

2. LOCALDRUGDELIVERYSYSTEM
INTRODUCTION
 Periodontal disease is associated with bacteria and treatment by
chemotherapeutic agents appears to be appropriate
 Chemotherapeutic agents may be administered
 Delivered locally -Controlled release local delivery systems or
 Systemically

3. Advantage
 Route is safe and convenient route
 Can produce longer duration of action
 Offers noninvasive, painless, and simple application
 Offers avoidance of GI tract problems
 Bypasses the first pass metabolism by the liver

4. Disadvantages
 More chair side time
 Development of bacterial resistance
 No effect on bacterial reservoirs
 Hypersensitivity,
 More expensive

5. Local drug delivery systems
 Tetracycline fibers (Actisite)
 Doxycycline gel (Atridox)
 Minocycline microspheres (Arestin)
 Metronidazole gel (Elyzol)
 Chlorhexidine chip (Periochip)

6. AGENTS USED IN LOCAL DRUG DELIVERY
Antimicrobial Agent Product
Tetracycline fibres Actisite
MINOCYCLINE GEL dentomycin
Minocycline microspheres,
ointment
Arestin
periocline
Doxycycline polymer atridox
Metronidazole gel elyzol
Chlorhexidine chip periochip

7. Tetracycline Fibre (Actisite)
 The first local delivery product available in the
U.S.
 ethylene/vinyl acetate copolymer fiber,
diameter 0.5 mm, containing tetracycline, 12.7;
 When packed into a periodontal pocket, it is
well tolerated by oral tissues, and for 10 days it
sustains tetracycline concentrations
 Disadvantages
 length of time required for placement (10
minutes or more per tooth)
 need for a second appointment for removal
 Development of resistant bacteria
 Pregnant and nursing mothers

8. SubgingivalDeliveryofDoxycycline (Atridox)
 It is a gel system containing 10% doxycycline hyclate is
contained within a syringe .
 The tip of the cannula is introduced to the depth of the
pocket and is expressed into the pocket until it just
overfills the pocket.
 It begins to harden on contact with the moisture in the
pocket.

9. MINOCYLINEGELANDOINTMENT(periocline)
 2% MINOCYCLINE hydrochloride
 Once in a week for 4 consecutive weeks
 Minocycline Microspheres (ARESTIN)
 Antibiotic minocycline hydrochloride micro encapsulated in
bio absorbable polymer of polyglycolide.
 Maintain therapeutic drug conc 14 days

10. METRONIDAZOLE GEL(ELYZOL dental gel)
 containing an oil-based metronidazole 25% dental gel
 It is applied in viscous consistency to the pocket, where it is liquidized
by the body heat and then hardens again forming crystals in contact
with water.
 Two 25% gel applications at a 1-week interval have been used

11. CHLORHEXIDINE CHIP (PERIOCHIP)
 The chlorhexidine chip is a small bio – degradable film of
hydrolysed gelatin into which had been incorporated 2.5mg
of Chlorhexidine gluconate.
 The chip is bio-degradable and indicated for use in
periodontal pockets that are 5mm or more.
 This delivery system releases chlorhexidine and maintains
drug concentrations in the gingival crevicular fluid greater
than 100 hg/ml for at least 7 days,