Local Delivery Of Tetracycline Research Articles

Controlled-release of tetracycline and lovastatin by poly(D,L-lactide-co-glycolide acid)-chitosan nanoparticles enhances periodontal regeneration in dogs.

Chronic periodontitis is characterized by inflammation of periodontal tissues, leading to bone resorption and tooth loss. The goal of treatment is to regenerate periodontal tissues including bone and cementum lost as a consequence of disease. The local delivery of tetracycline was proven to be effective in controlling localized periodontal infection without apparent side effects. Previous studies suggested that lovastatin has a significant role in new bone formation; however, the local delivery of lovastatin might enhance its therapeutic effects. A number of local delivery devices have been developed recently, including poly(d,l-lactide-co-glycolide acid) (PLGA) nanoparticles. The aim of this study was to develop a local delivery device, PLGA-lovastatin-chitosan-tetracycline nanoparticles, which allows the sequential release of tetracycline and lovastatin to effectively control local infection and promote bone regeneration in periodontitis. The size and microstructure of nanoparticles were examined by transmission electron microscopy, Nanoparticle Size Analyzer, and Fourier transform infrared spectroscopy. The release of tetracycline and lovastatin was quantified using a UV-Vis spectrophotometer. Furthermore, the cytotoxic effect and alkaline phosphatase activity of the nanoparticles in osteoblast cell cultures as well as antibacterial activity against periodontal pathogens were investigated. Finally, the bone regeneration potential of PLGA nanoparticles in three-walled defects in beagle dogs was investigated. The results indicated that PLGA-lovastatin-chitosan-tetracycline nanoparticles showed good biocompatibility, antibacterial activity, and increased alkaline phosphatase activity. The volumetric analysis from micro-CT revealed significantly increased new bone formation in defects filled with nanoparticles in dogs. This novel local delivery device might be useful as an adjunctive treatment in periodontal regenerative therapy.

Local delivery of tetracycline from γ-aminobutiric acid-silica networks thin films for preventing microbial colonization

The purpose of this study was to characterize and evaluate the citotoxicity and antimicrobial activity of γaminobutiric acid-silica/tetracycline network thin films prepared by Matrix Assisted Pulsed Laser Evaporation (MAPLE). Thin films were characterized by Infrared Microscopy (IRM), X-ray Diffraction (XRD), Transmision Electron Microscopy (TEM) and Scanning Electron Microscopy (SEM). TEM images showed an average size of gammaaminobutiric acid-silica network (γ-AA/SiO2) lower than 10 nm. Unlike the dropcast samples, IRM recorded on MAPLE films revealed a good distribution of monitored functional groups on the entire scanned surface. Besides a good homogeneity of the coatings, SEM analysis revealed aggregates typical for MAPLE deposition, randomly distributed on the surface with an average diameter of ~300 nm. The biological evaluation of MAPLE nanobiocoated surfaces evidenced a good biocompatibility and an enhanced antibiofilm effect against both Gram positive (Staphylococcus aureus) and Gram negative (Escherichia coli) tested strains. Our results recommend the use of γ-aminobutiric acid-silica networks as matrixes for controlled local delivery of antibiotics, with practical applications in developing improved medical surfaces for the prevention or reduction of surface-associated microbial infections.

Non-surgical management of chronic periodontitis with two local drug delivery agents-A comparative study

Background: The selective removal or inhibition of pathogenic microbes with locally delivered antimicrobials when combined with scaling and root planing is often an effective approach for the managment of chronic periodontitis. Aim: To compare the clinical efficacy of tetracycline fibers and a xanthan based chlorhexidine gel in the treatment of chronic periodontitis. Methods and materials: Thirty systemically healthy patients in the age group of 30-50 years suffering from generalized chronic moderate periodontitis were selected. For each subject, two experimental sites were chosen that had probing depth >5mm and were located in symmetric quadrants and the sites were randomized at split mouth level with one receiving tetracycline fibers and the other chlorhexidine gel. Plaque score, bleeding score, probing pocket depth and relative attachment level gain was recorded on day 0 and at the end of 3 months. Results and conclusion: In both groups, there was statistically highly significant reduction in all the clinical parameters i.e. plaque score, bleeding score and probing pocket depth and relative attachment level gain was seen at different time intervals. Local delivery of tetracycline and chlorhexidine is a safe, easy and efficacious method along with scaling and root planing in the treatment of chronic periodontitis. Inter-comparison of both local drug delivery agents with respect to clinical changes shows that tetracycline fibers are better than chlorhexidine gel for treatment of chronic periodontitis. Nevertheless, long term studies with more samples are suggested to further evaluate and compare the efficacy of both materials.

Local Delivery of Tetracycline does not Improve Clinical Outcomes

Original Article Meta-analysis of local tetracycline in treating chronic periodontitis. Pavia M, Nobile CG, Angelillo IF. J Periodontal 2003;74(6):916-32. Level of Evidence 1a Purpose To assess the clinical effectiveness of local delivery of tetracycline alone or as an adjunct to conventional mechanical therapy in patients with chronic periodontitis by conducting a meta-analysis of published studies Source of Funding Government Type of Study/Design Systematic review

Treatment of peri-implantitis by local delivery of tetracycline. Clinical, microbiological and radiological results.

The purpose of this study was to investigate the clinical, microbiological and radiological effects of peri-implantitis therapy by local delivery of tetracycline. In 25 partially edentulous patients, 30 implants with radiographic evidence of circumferential bone loss, and peri-implant probing depths > or =5 mm were treated with polymeric tetracycline HCl-containing fibers. Clinical and microbial parameters were recorded at baseline, and 1, 3, 6, and 12 months (M) after treatment. Standardized radiographs were obtained at baseline, M3, and one year after treatment. Two patients were discontinued from the study after 180 days because of persisting active peri-implantitis with pus formation. The remaining subjects showed a significant decrease of mean peri-implant probing depth from 6.0 to 4.1 mm (M1, P<0.001), which was maintained over 12 months. In comparison to baseline, the bleeding tendency was significantly reduced after one month, and thereafter (P<0.001). No significant recession of the mucosal margin was noted. The radiologically determined distance from the shoulder of the implant to the bottom of the bony defect decreased slightly, but not significantly, from 5.2 to 4.9 mm. At M1, M3 and M6, mean total anaerobic cultivable bacterial counts were significantly lower than at baseline (P<0.001). A significant decrease in frequency of detection was noted for Prevotella intermedia/nigrescens, Fusobacterium sp., Bacteroides forsythus, and Campylobacter rectus (P<0.01). Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Eikenella corrodens had very low baseline frequencies that could not be significantly suppressed further. In conclusion, therapy of peri-implantitis by local delivery of tetracycline had a positive effect on clinical and microbiological parameters.

Local delivery of tetracycline: from concept to clinical application.

This manuscript reviews the development over the last 20 years of the evidence supporting the clinical application of a controlled delivery device for the treatment of human periodontitis. The device is a monolithic ethylene vinyl-acetate fibre loaded with 25% w/w tetracycline HCI (tetracycline fibre). It releases tetracycline at a steady state rate of 2 microg/cm x h and results in the maintenance of essentially constant, highly-effective concentrations of tetracycline at the site of action. A series of controlled, randomised, single-blind, phase-III clinical trials including a total of 463 patients has indicated that: (1) tetracycline fibres result in significantly better outcomes than the scaling and root planing positive control; (2) combination of tetracycline fibres with subgingival mechanical debridement results in significant improvement over debridement alone. Evidence from these studies has led to approval of this treatment modality by the US Food and Drug Administration and by the European Union Regulatory Bodies. A clinical usage study involving 2711 subjects treated by 68 clinicians in Europe and North America indicated that the magnitude of the observed clinical outcomes is clinically relevant and that adverse events were rarely observed. A variety of clinical investigations aimed at the optimal incorporation of tetracycline fibres in a treatment strategy provide guidance in case selection. Cost of therapy and concerns of unnecessary usage of antibiotics should be considered. It is nonetheless concluded that combination of tetracycline fibres with mechanical debridement represents a documented treatment alternative, the application of which may offer clinical benefits to many patients.

Topographic distribution of black-pigmenting anaerobes before and after periodontal treatment by local delivery of tetracycline.

The purpose of this study was to determine the distribution of black-pigmenting Gram-negative bacteria in the dentition of 10 adult periodontitis patients before and after treatment by local delivery of tetracycline. The subjects were selected based on a screening for high counts of Porphyromonas gingivalis and multiple deep pockets. Subgingival microbial samples were taken from the mesial and distal aspect of every tooth (44 to 56 sites per patient) before treatment, and after one and two months. Therapy included full mouth scaling and root planing, chlorhexidine mouth rinsing and placement of tetracycline HCl fibers (Actisite) on all teeth. 63.4% of 524 baseline samples yielded total anaerobic viable counts > or = 10(6) CFU/ml; P. gingivalis was found in 59.2% and Prevotella intermedia in 56.9%. One month after treatment, the % of samples with > or = 10(6) CFU/ml was reduced to 9.4%, 5.3% were P. gingivalis- and 5.1% P. intermedia- positive. After 2 months, 9.6% samples yielded > or = 10(6) CFU/ml, 5.2% were P. gingivalis- and 9.4% P. intermedia- positive. 20 of the 39 sites with a persistence of P. gingivalis were located on second molars. Logistic regression models were utilized to explain the persistence of P. gingivalis, using site location and other clinical parameters as independent variables. These analyses indicated a strong association of site location, pocket depth and bleeding on sampling with persistence of P. gingivalis. The study shows that local delivery of tetracycline is highly effective in reducing the prevalence and proportions of black-pigmenting anaerobes within a dentition. Bleeding deep pockets of second molars have an increased risk for persistence of these anaerobes.

Periodontal therapy by local delivery of tetracycline

Periodontal therapy by local delivery of tetracycline

Periodontal therapy by local delivery of tetracycline

The present investigation assessed the feasibility of treating periodontal disease by controlled delivery of antibacterial agents from within periodontal pockets. Tetracycline-filled hollow fibers placed in the gingival sulcus were shown to have a dramatic effect both on the periodontal microflora and clinical manifestations of disease. Furthermore, it was found that drug-filled cellulose acetate hollow fibers are biologically compatible with the environment and can be manipulated by dental personnel to provide drug therapy with less than 1/1000 the amount of tetracycline that would have been used for systemic therapy. Of theoretical importance is the observation that virtual elimination of spirochetes from the gingival sulcus is possible by a single placement of tetracycline-filled hollow fibers, and spirochetes, once eliminated from a site, do not rapidly recolonize despite the persistence of viable organisms elsewhere in the mouth.