This document discusses local drug delivery for periodontal disease. It begins by outlining the disadvantages of non-surgical mechanical therapy and systemic antibiotic therapy. It then introduces the concept of local drug delivery proposed by Goodson in 1979 to limit drugs to target sites at high concentrations over time. Local delivery mechanisms control drug release and maintain effective local concentrations. Drugs used include tetracycline, minocycline, doxycycline, metronidazole, azithromycin, and chlorhexidine. Commercially available local delivery products are described. Newer trends incorporate vesicular systems, nanoparticles, and alternative drugs like statins. Local delivery provides advantages over other therapies like limiting systemic exposure while effectively treating periodontal infections.

1. LOCAL DRUG DELIVERY
little add-on for a
healthy gum

2. To explore….
• INTRODUCTION
• DISADVANTAGES OF NON-SURGICAL MECHANICAL THERAPY
• DISADVANTAGES OF SYSTEMIC ANTIBIOTIC THERAPY
• EMERGENCE OF LOCAL ANTIMICROBIAL THERAPY
• LOCAL DRUG DELIVERY
• MECHANISM OF ACTION
• CLASSIFICATION
• DRUG DELIVERY SYSTEMS
• DRUGS USED AS LLD
• COMMERCIALLY AVAILABLE
• NEWER TRENDS
• PROS&CONS
• SUMMARY
• CONCLUSION

3. INTRODUCTION
• Periodontitis is an inflammatory condition affecting
the supporting structures of the teeth. Local factors
such as plaque, calculus and sub gingival microbial
flora are responsible for progression of periodontitis

4. NON SURGICAL MECHANICAL
THERAPY
bacteria found in dentine tubules, lacunae
and concavities
Root sensitivity
multi-rooted teeth with furcation
involvement.
patient compliance

5. SYSTEMIC ANTIMICROBIAL THERAPY
• Adverse drug reactions
• anti-microbial resistance
• Limited use in medically compromised
patients
• Drug interactions

6. EMERGENCE OF LOCAL DRUG
DELIVERY
• GOODSON in 1979 introduced the concept of
local drug delivery
• Proposed three concepts
site
concentration
time

7. Local drug delivery
sustained
release
device
Limiting the
drug to its
target site
High
concentration
at target site
an adjunct to
scaling and root
planing
safely used in
medically
compromised
patients

8. MECHANISM OF ACTION
Control
release of
drug
Sustaining its
localized
concentration
at effective
levels
Application of
substantive
drug
establishes
drug reservoir
Slowly
released to
counteract
the clearance
by GCF flow

9. CLASSIFICATION
• Based on the duration of medicament release
(Greenstein and Tonetti 2000)
 Sustained release devices
 Controlled release devices
• Based on degradability
 Degradable devices
 Non-biodegradable devices

10. DELIVERY SYSTEMS
• Fiber Systems
• Gel delivery system
• Synthetic polymer chips
• Collagen fiber vehicle

11. DRUGS USED AS LOCAL DRUG
DELIVERY AGENTS
• Tetracycline
• Minocycline
• Doxycycline
• Metronidazole
• Azithromycin
• chlorhexidine

12. COMMERCIALLY AVAILABLE PRODUCTS
AGENT PRODUCT AVAILABLE
minocycline Dentomycin gel (2% Minocycline) Arestin
(2% Minocycline)
Periocline (2.1%w/v Minocycline)
Tetracycline Actisite (25%w/v tetracycline Hcl)
Periodontal plus AB(2mg of Tetracycline in
25mg of collagen)
doxycycline Atridox (10% Doxycycline)
metronidazole Elyzol (25% Metronidazole)
chlorhexidine Periochip (2.5mg Chlorhexidine) Periocol
CG (2.5mg Chlorhexidine) Chlosite (1.5%
Chlorhexidine)

13. MINOCYCLINE
Application technique using resorbable polymer
microspheres(Nakagawa et al.1991;Jarrold et
al 1994;Goodson et al 2007)

14. TETRACYCLINE
• Fiber packed into periodontal pocket
• Secured with a thin layer of cyanoacrylate
adhesive
• Left in place for 7-12 days
• Local concentration of drug in excess of
1300mg/L

15. DOXYCYCLINE
• Two-syringe mixing system for controlled
release of 10%doxycycline(ATRIDOX)
syringe1
Delivery
vehicle,flowable
bioabsorbale poly(DL-
lactide)dissolved in N-
methyl-2-pyrrolidone
syringe2
Doxycycline hyclate
powder

16. METRONIDAZOLE
• ELYZOL DENTAL GEL- semi-solid suspension
25%metronidazole benzoate in a mixture of
glyceryl mono-oleate and sesame oil
Viscous consistency in
the pocket
Liquidized in the body
heat and hardens
Crystals (in contact with
water)

17. Chlorhexidine
• Gelatin chips, varnishes and a xanthan gel.
• PERIOCHIP(4×5×0.35mm) –biodegradable
hydrolyzed gelatin matrix with 2.5mg
chlorhexidine gluconate

18. Newer trends
Local delivery agents
• Vesicular system
• Nano-particle system
Local delivery drugs
• Alendronate
• Statins
• Taurolidine
• Chitosan
• Ipriflavone

19. Local delivery agents
• Vesicular systems(Robinson et al.)
 mimic the bio-membranes in terms of structure and bio-behavior (Jain et
al., 2008)
 microscopic lipid based vesicles
 liposome used as local drug delivery
system include CARBOPOL(Minocycline
hydrochloride,doxycycline),PEG(doxycycline)

20. • Nanoparticle system
 1 nm -100 nm nanoparticles can access sites
unreachable for other devices .
 polymeric nanoparticles, nanofibres,
liposomes, quantum dots, and nanocomposites/nanogels.
 Dendrimers are polymeric constructs known
for their defined structures, versatility in
drug delivery and high functionality
.

21. ADVANTAGES OF NEWER DELIVEY
SYSTEMS
VESICULAR SYSTEM NANO-PARTICLE SYSTEM
biocompatible, biodegradable,
nontoxic, nonimmunogenic, high
stability
Highly dispersible in aqueous
medium, offer controlled release rate
and enhanced stability.
The submicrometric liposomes
penetrated deep into dentinal
tubules(Di Turi et al. (2011))
A uniform drug distribution for
prolonged time period is obtained
thus decreasing the dosage frequency
Formation of new bone and fibers
(Di et al. (2013))
Polymersomes enter early
endosomes of cells and release drug
by disassembling due to low
ph,thereby,not invading host cells

22. Newer local delivery drugs
• Simvastatin (Pradeep et al)
bone regeneration by participating directly in
osteoblast activation
• Taurolidine(Zollinger et al)
10 mg/ml taurolidine prevented completely
biofilm formation of P. gingivalis
• Alendronate (Veena et al.)
1% alendronate gel resulted in probing depth
reduction, clinical attachment level gain and improved
bone fill as compared to placebo gel

23. • Chitosan(Ikinci et al.)
partially or fully deacetylated chitin
fully biodegradable and biocompatible
natural polymer, and can be used as an
antibacterial and antifungal agent
a regenerative effect on periodontia
and also accelerates the formation of
osteoblasts

24. • Ipriflavone (7-isopropoxy iso-flavone)[ Min et
al., Perugini et al.,]
synthetic isoflavone derivative that acts
primarily to supp ress bone resorption.

25. HERBAL EXTRACTS AS LOCAL DRUG
AGENT
• Harungana madagascariensis (Moulari et al)
• Aloe Vera(Virdi et al.)
• Eucalyptus, neem leaf and bloodroot
• Green tea (Hattarki SA [2013], Kudva P [2010])
• Tea tree oil( Elgendy[2015])
• Curcumin (Nagasri M [2013],Behal R [2010])
• Oak (Yaghini[2014])
• Coriander( Yaghini[2014])
• Babul( Phogat M [2014])
• Bakul (Phogat M [2014])
• Pomegranate (Phogat M [2014])
studies with higher evidence
on ayurvedic and herbal
medications are required to
provide concrete evidence on
their usage

26. PROSPROS CONS
Limit drug at the target site Difficulty in placing in deeper pockets and
furcation areas
No risk of antibiotic resistance Patient compliance
Controlled release of antimicrobial agent
Minimizing the exposure of total body to
the drug
Brief exposure of the target microbes to
the applied antimicrobial agent

27. SUMMARY
Local anti-microbial agents enhance the periodontal health when used as an adjunct to SRP
rather than as monotherapies
Results of systemic review and meta-analysis show that local drug delivery can be used as an
adjunct to mechanical therapy

28. CONCLUSION
• Local anti-microbial therapy is an adjunct to
SRP and never a replacement therapy .
• All anti-microbial therapy should be preceded
by thorough non-surgical mechanical therapy
• As mentioned in the systematic review, local
drug delivery is a valuable adjunct to
mechanical therapy for desired output.

29. References
• Local Drug Delivery Modalities in Treatment of Periodontitis: A Review
Jyoti I Pattanshetti, Ila Tiwari, Guljot Singh, Fatima Tazyeen, Anuj Singh Parihar, Neha Khare
• Advanced drug delivery approaches against periodontitis
Deeksha Joshi, Tarun Garg, Amit K. Goyal & Goutam Rath
• LOCAL DRUG DELIVERY IN PERIODONTICS Ankur Singh Rajpoot, Anuj Singh Parihar
• carranza’s clinical periodontology
• Clinical periodontology and implant dentistry by nikalaus p Lang

30. THANK YOU