This document provides an overview of local drug delivery for periodontal disease treatment. It discusses the historical perspective, objectives, indications, contraindications, advantages, and disadvantages of local drug delivery. Various drug delivery agents are also described, including Periochip, Atridox, Actisite, Arestin, and Elyzol. The document concludes that local drug delivery is a valuable adjunct to mechanical periodontal therapy but should not be used alone.

1. PREPARED BY:BHAVI
GANDHI
LOCAL DRUG DELIVERY
GUIDED BY : DR.MAYANK PARAMAR
DR.BANSARI SHAH
DR.MAYUR PARAMAR

2. Content:
 Introduction
 Historical perspective
 Objectives
 Indications
 Contraindications
 Advantages
 Disadvantages
 Classification
 Local drug delivery agents
 Conclusion

3. Introduction:
 Periodontal disease is associated with bacteria &
treatment by chemotherapeutic agents appears to
be appropriate
 Chemotherapeutic agents may be administered –
systemically or delivered locally.
 The term drug delivery covers a broad range of
techniques used to get therapeutic agents into
the human body.
 When drug is delivered as a conventional dosage
form such as a tablets, the dosing interval is
much shorter than half life of the drug resulting in
a no. of limitations associated with such a
conventional dosage forms.

4. Historical perspective:
 W.D.Miller in the 1880 suggested the use of an
antimicrobial mouthrinse to aid in fighting what
was then known as ‘pyorrhea alveolaris’
 The concept of targeted drug delivery had its
origin in the 1970’s based on the theory that if
one could substantially improve the cellular
specificity of a drug there would be an
accompanying significant improvement in the
therapeutic index;I,e,efficacy to side effects.
 Dr.Max Goodson (1979) first proposed the
concept of controlled release local delivery of
therapeutic agents for the treatment of
periodontitis.

5. Objective:
 The use of a local antimicrobial is to prevent or
control microbial induced inflammation in an
effective concentration & be maintained there
long enough for the desired effect to be
accomplished without causing any side effect.

6.  The limited efficacy of mouth rinsing & irrigation in
deep periodontal pocket led to the development of
alternative delivery systems.
 The main aim of the drug delivery system is to direct
antimicrobials to the infection sites & main effective
level of drugs for sufficient period of time without
eliciting any major side effects.
LOCAL DRUG DELIVERY
SYSTEM:

7. Indications:
 As an adjunct in the treatment of few localized non
responding sites in an otherwise controlled patient.
 In ailing & failing implant cases.
 In medically compromised patients where surgical
procedures are not recommended.
 Periodontal abscess.
 Periodontal maintenance therapy.
 Patient with gastrointestinal intolerance to systemic
drug medication.

8. Contraindications:
 Patients with history of allergy to a particular
antimicrobial agents
 In pregnancy & lactating periods.
 Children under the age of 12 years.
 Patients with complete renal failure.
 Patients susceptible to infective endocarditis.

9. Advantages:
 High concentration in subgingival sites.
 Independent of patient compliance
 Does not harm the symbolic useful microflora of
gastrointestinal tract.
 Systemic intolerance is bypassed.

10. Disadvantages:
 Difficulty in placing of therapeutic concentrations of
the antimicrobial agents in deeper sites.
 Has to be professionally placed or if manually
placed, requires manual dexterity & patient
compliance.
 Complete drug penetration is not possible & extra
pocket sites are unaffected.

11. Classification of local
antimicrobial therapy in
periodontics
• LANGER & PEPPAS (1988)
 Based on their mechanism of action
1.Diffusion controlled systems
-reservoirs (membrane devices)
-matrices (monolithic device)
2.Chemically controlled systems
-bio-erodible systems
-pendant chain systems
3.Swelling controlled systems
4.Magnetically controlled systems

12. LOCAL DELIVERY AGENTS
 Locally delivered antimicrobial agents are available
adjuncts to scaling & root planing & as aid in the
control of bacterial growth on barrier membrane.
 When placed into periodontal pockets, they reduced
the subgingival microflora, probing depths & clinical
sign of inflammation.
 A report on locally delivered agents prepared by the
American Academy of Periodontology stated “the
clinician’s decision to use locally delivered agents
should be based upon a consideration of clinical
findings, the patient’s dental & medical history,
scientific evidence, patient preference & advantages
& disadvantages of alternative therapies.”

13. Subgingival chlorhexidine:
 A resorable delivery system has been tested for
subgingival placement of chlorhexidine gluconate
with positive clinical results.
 Periochip is a small chip (4.0×5.0×0.35mm)
composed of a biodegradable hydrolyzed gelatin
matrix, cross-linked with glutaraldehyde & also
containing glycerin & water, into which 2.5mg of
chlorhexidine gluconate has been incorporated per
chip.
 This delivery system releases chlorhexidine &
maintains drug concentrations in the GCF greater
than 100µg/ml for at least 7 days, concentrations
well above the tolerance of most oral bacteria.

14.  Chips were placed in target sites with probing depth
of 5 to 8 mm at baseline that bled on probing & again
at 3 & 6 months if probing depth remained at 5mm or
greater.
 Sites in control subjects received either a placebo
chip(inactive) with scaling & root planing alone.
 Sites in test subject received either a chlorhexidine
chip (active) with scaling & root planing or scaling &
root planing alone.

15. Advantages of periochip:
 Very easy & convenient to use. Takes second to
place in any pocket.
 Highly effective, safe , well tolerated.
 Painless to the patient. In some instances there
may be minor discomfort in the first 24 hrs.
 No restrictions on eating or oral hygiene after chip
insertion.
 All quadrants can be treated at the some visit.
 Does not affect taste or stain teeth.
 Maintain effective- concentration of chlorhexidine
in the pocket up to 10 days-125µg/ml.
 Delivers effective dosage even to the base of the
pocket.

16. Subgingival doxycycline:
 A gel system using syringe with 10% doxycycline
(atridox) is available.

17. Tetracycline (Actisite)
 Fiber of 23 cm in length that has 12.7 mg
tetracycline hydrochloride.
 Pocket measuring ≥5 mm that bleed on probing.
 Fiber is inserted into the pocket.
 Some control saliva is needed.
 Should contact the pocket base.
 Surgical dressing is not necessary.
 Removed 7-1o days after placement.

18. Subgingival minocycline:
 A locally delivered, sustained release form of
minocycline is available.
 The 2%minocycline is encapsulated into
bioresorable microspheres in gel carrier.

19. Subgingival metronidazole:
 A topical medication 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 & then
hardens again, forming crystals in contact with water.
 As a precursor, the preparation contains
metronidazole-benzoate, which is converted into the
active substance by esterase in GCF.
 Two 25% gel application at a 1 week interval has
been used.

20. Antimicrobial
agent
Product name nature Dosage form
Doxycycline Atridox Biodegradable Mixture in syringe
Tetracycline Actisite Nonresorable Fibers
Metronidazole Elyzol Biodegradable Mixture in syringe
Minocycline Arestin
Dentamycin
Periocline
Biodegradable Mixture in syringe
Chlorhexidine Periochip Biodegradable Chip device
Local drug delivery system in
periodontal therapy

21. Frequently used local
Antimicrobials with dosage
specification
Drug Dosage Release periods in
days
Actisite 12.7 mg/9 inch fiber of
diameter 5mm
10
Atridox 10%
Periochip 2.5 mg of chlorhexidine
gluconate
7

22. Conclusion:
 Considering various factors of cost effectiveness ,
efficacy, potential advantages & disadvantages it can
be concluded that local drug delivery could serve as
a potent in periodontal chemotherapy & at the same
time a valuable adjunct to mechanotherapy , but its
use as a monotherapy agent.