Clinical evaluation of thermoresponsive and mucoadhesive Chitosan in situ gel containing Levofloxacin and Metronidazole in the treatment of periodontal pockets – A split-mouth, clinical study

Abstract

ObjectivesRecently, mucoadhesive formulations have become popular as drug delivery for periodontal pocket and oral mucosa. The objective of this study was to evaluate the clinical efficacy of thermoresponsive and mucoadhesive chitosan in situ gel in treatment of chronic periodontitis. MethodsVehicle and medicated in situ gel containing Levofloxacin and Metronidazole was applied in ten systemically healthy subjects (20–50 yrs) with chronic periodontitis adjunctive to scaling and root planing (SRP) in comparison to SRP alone. Clinical parameters were plaque index (PI), gingival index (GI), and bleeding on probing (BoP), which were recorded at baseline and 15th, 30th, 60th, and 90th days, as well as probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession (GR), which were recorded at baseline and 30th, 60th, and 90th days. ResultsThe results suggested that changes in clinical parameters were significant from baseline for all groups on the 90th day. On the 90th day, PI was 0.7±0.48, 0.4±0.51, and 0.3±0.48; GI was 0.6±0.051, 0.5±0.52, and 0.3±0.48; BoP was 0.5±0.52, 0.3±0.48, and 0.2±0.42; PPD reduction was 2.5±0.52mm, 3.4±0.69mm, and 4.6±0.51mm; CAL gain was 1.2±0.42mm, 2.6±0.84mm, and 3.8±0.42mm; and GR was 1.1±0.73mm, 1.0±0.00mm, and 0.5±0.52mm for SRP, vehicle, and medicated in situ gel groups, respectively. Reduction in PPD and gain in CAL was also significant after comparison between the treatment groups. ConclusionVehicle and medicated in situ gel showed better clinical outcomes as compared to SRP alone, which could be attributed to the presence of chitosan that is not only effective in treatment of periodontitis but also acts as a good carrier to deliver drug into periodontal pockets.