Abstract
Periodontal therapy focuses on thorough removal of subgingival calculus and plaque products followed by the smoothing out of root surfaces. However, such conventional mechanotherapeutic approaches are inefficient with regard to microbial biofilm elimination from the space between the root and deep periodontal pockets. Therefore, local chemotherapeutic agents need to be applied. Local antimicrobial treatment is also considered a safer treatment, as it avoids systemic complications related to drug application. In this study, porous matrices consisting of gelatin (GE) and cellulose derivatives (carboxymethylcellulose (CMC) and hydroxyethyl cellulose (HEC)) were loaded with antimicrobial drug metronidazole (MTZ). The matrices’ structural morphology, physiochemical properties, swelling and degradation ratio, mechanical properties, and MTZ release from the matrices were analyzed. Additionally, cytotoxicity tests for fibroblast and osteoblast cell cultures (L929 and U2-OS, respectively) and antimicrobial activity assessments of MTZ-loaded matrices against anaerobic Bacteroides sp. Bacteria were performed. Finally, clinical application of HEC matrices into periodontal pockets was conducted. The applied matrices showed a high antibacterial efficacy and a moderate cytotoxicity in vitro. The clinical application of HEC dressings corresponded with the decrease of periodontal pockets’ depth and bleeding observed 1 month after a single application. The presented results show that intra-pocket application of metronidazole using manufactured matrices may serve not only as a support for a standard treatment in periodontal practice but also as an alternative to systemic drug administration in this setting. Clinical data were analyzed using a nonparametric Friedman’s ANOVA for dependent trials.
Highlights
IntroductionThe main purpose of periodontal treatment is to protect and regenerate diseased periodontal tissues
The main purpose of periodontal treatment is to protect and regenerate diseased periodontal tissues.Another aim of such treatments is to stop chronic inflammatory processes destroying periodontal tissue and leading to pathological pocket formation
In the case of all formulations used, the incorporated drug content was higher than 87%
Summary
The main purpose of periodontal treatment is to protect and regenerate diseased periodontal tissues. Another aim of such treatments is to stop chronic inflammatory processes destroying periodontal tissue and leading to pathological pocket formation. The basic method of periodontal infection treatment, referred to as scaling and root planning (SRP), relies on the elimination of subgingival bacterial deposits from the tooth surface by mechanical removal of the plaque [1,2]. This approach has limitations, mostly due to the inability of dental hand instruments to reach areas. SRP does not guarantee the elimination of anaerobic bacteria residing in the base of deep periodontal pockets as well as in the interstitial spaces, from where they are able to migrate into the tissues [2,3]
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