Locally Delivered Tetracycline Fibres in the Treatment of Chronic Periodontitis

Background: Chronic periodontitis is a highly prevalent and recurrent form of periodontal disease and locally delivered tetracycline fibres are considered to exert tremendous benefits for its treatment. Aim: The aim of the study was to observe the clinical results of locally delivered tetracycline fibres in the treatment of chronic periodontitis. Materials and Methods: Patients aged 35-54 years diagnosed with chronic periodontitis of both gender fulfilling the inclusion criteria were selected. A sample size of 30 was calculated and total number of 60 posterior sites were selected. These sites were divided into two sets in a split mouth design as control sites treated with SRP alone and test sites treated with SRP plus tetracycline fibres. Results: A combination of scaling, root planing and local drug delivery in the form of tetracycline fibres resulted in added benefits in the control of chronic periodontitis on the basis of the clinical findings from this study. Conclusion: This study further adds to the evidence that tetracycline fibres as locally delivered agent are safe and effective adjunct to scaling and root planing, and can produce significant clinical benefits when compared to scaling and root planing alone in the treatment of chronic periodontitis.


INTRODUCTION
Chronic periodontitis is an infectious disease resulting from inflammation within the supporting tissues of the teeth characterised by progressive attachment and bone loss. 1 It is the most common form of periodontitis which is associated with an accumulation of plaque and calculus with slow to moderate rates of disease progression. 2 There is growing interest in localised antimicrobial therapy because of the site-specific nature of periodontal infections, greater subgingival concentrations of antimicrobial agent, and reduced side-effects compared to systemic antibiotics. 3 The periodic use of local drug delivery helps to minimise bleeding and stabilise attachment levels, thereby reducing probing pocket depth. Thus, it appears to hold sound promise in periodontal therapy allowing better control and management of periodontal diseases. Various locally delivered chemotherapeutic agents available are: tetracycline fibres (Actisite), metronidazole gel (Elyzol), minocycline gel and minocycline microspheres (Arestin), chlorhexidine chip (Perio Chip) and doxycycline hyclate (Atridox) to name a few. 4 Tetracycline group is among the most widely used drugs to treat periodontal diseases. Factors that may play a role in the efficacy of tetracyclines in the subgingival area include substantivity, whereby tetracycline strongly adsorbs to and then is released from tooth surfaces while retaining its antimicrobial activity. 5 This study was performed with an aim to evaluate the efficacy of locally delivered tetracycline fibres in the treatment of chronic periodontitis.

MATERIALS AND METHODS
A non-randomised clinical trial with split mouth study design was used for the study. A total number of 30 subjects

RESULTS
Results of the study are summarised in Table 1  The mean gingival scores reduced from baseline at subsequent follow-up visits at both control and test sites.
However, comparison between two sites did not reveal any statistically significant difference highlighting that local delivery of tetracycline fibres along with SRP does not produce significant reduction in gingival index scores compared to SRP alone ( Table 2). Table 3, pocket depth was same in both the study sites at baseline. Following treatment with SRP alone and SRP with tetracycline fibres, there was reduction in    Similarly, GI also showed significant reduction in scores from baseline to three months for both treatment groups as observed by Goodson et al 9 and Minabe et al. 10 Radvar et al 11 found 80% reduction in sites that bled on probing during the course of their study. Adjunctive fibre therapy was significantly better in reducing GI than SRP alone at one, three, and six months as observed by Newman et al. 12 Flemmig et al 13 also found significantly lower scores for GI at six months.

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In the present study, intra-group observation showed highly significant (P<0.001) reduction in probing pocket depth from baseline to three months in both groups in consistent with the study conducted by Vandekerckhove et al, 14 Kinane et al, 15 and Gonçalves et al. 16 Current study was in accordance with Vandekerckhove et al 14 where an analysed data from all sites indicated significant decrease in probing pocket depth.
A significant gain in clinical attachment level was also obtained from baseline to three months in both the treated sites (P<0.001), differences observed were similar to that of Goodson et al, 9 Minabe et al, 10 Newman et al, 12 and Radvar et al. 11 Minabe et al 10  to promote an attachment of fibroblasts to root surfaces. [18][19][20][21][22] Tonetti et al 23   Though the local drug delivery system used in the study is safe and effective treatment modality, further longitudinal studies utilising larger sample size and even encompassing the analysis of microbiological and radiographic parameters are recommended for supporting the findings of this study.