Minocycline Microspheres Research Articles

Management of peri-implantitis using local drug delivery among Indian patients.

It is of interest to compare 0.2% chlorhexidine gel, 0.2% chlorhexidine chip, minocycline microspheres and slow-release doxycycline gel and tetracycline fibers as drug delivery systems in the management of peri-implantitis. The study comprised of 105 Indian participants who had a minimum of one dental implant with a probing depth of 4 mm, along with exudate and/or bleeding upon probing along with the presence of potentially harmful germs. The use of minocycline microspheres and 0.2% chlorhexidine gel resulted in significant improvements in probing depths at 1 month, 3 months and 6 months and all treatments showed decline in the indicator bacteria. Thus, minocycline microspheres and 0.2% chlorhexidine gel is useful as an adjuvant for mechanical debridement in management of peri-implantitis.

Effects of Locally Delivered Minocycline Microspheres in Postmenopausal Female Patients with Periodontitis: A Clinical and Microbiological Study.

The postmenopausal period, due to low hormonal concentrations, can exert a negative influence on both periodontitis and osteoporosis evolution. The present study aimed to identify potential clinical and microbiological benefic effects of locally delivered minocycline microspheres (Arestin®) in post-menopausal female patients with moderate and severe periodontitis. Probing depth, clinical attachment levels and bleeding on probing index, along with BANA tests for Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola, were performed before and at 3 months after a combined treatment of scaling, root planing (SRP), and Arestin® placed in deep periodontal pockets. The association between SRP and Arestin® exerted significant improvements in terms of clinical periodontal parameters, as well as significant reductions in the red complex bacteria detection.

Microbiological Evaluation of Minocycline Microspheres on the Type and Number of Bacteria in the Treatment of Chronic Periodontitis Using Multiplex PCR and Viable Counting: An in-Vivo study

Microbiological Evaluation of Minocycline Microspheres on the Type and Number of Bacteria in the Treatment of Chronic Periodontitis Using Multiplex PCR and Viable Counting: An in-Vivo study

Bacterial resistance to minocycline after adjunctive minocycline microspheres during periodontal maintenance: A randomized clinical trial.

Despite widespread use, the impact of minocycline hydrochloride microspheres on the shifts of oral bacterial species resistant to minocycline remains unknown. This study aimed at examining the percentage and taxonomy of minocycline-resistant isolates in saliva and subgingival plaque samples before and after minocycline microspheres application in periodontitis patients during maintenance. Patients received supra- and sub-gingival debridement with (test) or without (control) minocycline microspheres application to sites with probing depth>4mm and were clinically monitored at baseline, 1, 3, and 6 months. Samples were collected at baseline, 1 and 6 months and analyzed via cultivation with or without 4μg/mL minocycline. Percentage of resistant strains was determined by colony counting and taxonomy by checkerboard DNA-DNA hybridization. Significant clinical changes were sought with the Mann-Whitney test and differences in percentage of resistant isolates with the Friedman and Mann-Whitney tests. Groups showed similar clinical improvements. Mean percentage of resistant isolates rose at 1 month and decreased at 6 months in saliva and plaque samples in test group (P<0.05) but remained unchanged in control group. Percentage of resistant isolates of Gemella morbillorum and Eubacterium saburreum increased significantly at 6 months in both groups. Antibiotic resistance by Aggregatibacter actinomycetemcomitans, Tannerella forsythia, and Porphyromonas gingivalis was either absent or infrequent. Minocycline microspheres result in transient selection of minocycline resistant species in saliva and subgingival plaque samples.

Minociclina como coadyuvante de la terapia periodontal, características y evidencia de su uso en odontología. Revisión bibliográfica.

La terapia antibiótica es usada como complementaria a laterapia mecánica en la enfermedad periodontal; sin embargo, su uso puede provocar efectos secundarios considerables, así como también no alcanzar la dosis necesaria para tratar la infección. En odontología, uno de los antibióticos usados en terapia periodontal es la minociclina, la cual presenta efectos adversos que limitan su uso, por lo que el desarrollo de sistemas de liberación controlada ha permitido su utilización. Durante esta revisión bibliográfica fueron analizados los resultadosdel uso de la minociclina a través de los dispositivos de liberación prolongada en el control de los microorganismos de la bolsa periodontal concluyendo que las microesferas de minociclina logran una mayor biodisponibilidad del medicamento usando bajas concentraciones de fármaco lo que reduce sus efectos adversos.

Locally delivered minocycline microspheres do not impair osseointegration of titanium implants in a rat femur model

BackgroundThe purpose of this study was to determine whether intramedullary administration of extended-release minocycline microspheres would affect osseointegration. MethodsTwenty-two rats were randomized to minocycline or saline femoral intramedullary injection followed by implantation of titanium alloy rods. Following euthanasia at four-weeks, pushout testing was performed and bone-volume-fraction assessed. ResultsPushout strength was marginally greater in minocycline-treated implants (122.5 ± 39.1 N) compared to saline (96.9 ± 26.1 N) (P = 0.098). No difference was observed in energy to maximum load, mean stiffness, or peri-implant bone-volume-fraction (P > 0.05). ConclusionsPeri-implant minocycline administration did not impair implant fixation strength or peri-implant bone-volume, supporting its potential utility as an adjunct to intramedullary implants.

Minocycline microspheres did not significantly improve outcomes after collagenase injection of tendon

BackgroundTetracycline antibiotics inhibit matrix metalloproteinases and pro-inflammatory cytokines implicated in the pathogenesis of tendinopathy, while microsphere formulations allow sustained release of drug contents. The purpose of this study was to evaluate the ability of a local minocycline microsphere injection to restore normal tendon properties in a rat model of collagenase-induced patellar tendinopathy. MethodsA total of 22 rats were randomly assigned to the control (n = 11) or minocycline (n = 11) group and received bilateral patellar tendon injections of collagenase. After 7 days, the minocycline group received the minocycline microsphere treatment and the control group received phosphate buffered solution. Pain was assessed via activity monitors and Von Frey filament testing. At 4 weeks post-collagenase injections, animals were euthanized. ResultsCage crossings significantly decreased among all rats 2–3 days following each injection period, however, tactile allodynia measures did not reflect this injury response. Biomechanical properties, interleukin-1 beta levels, and glycosaminoglycan content did not differ between groups. While not statistically significant, levels of leukotriene B4 were lower in the minocycline group compared to controls (p = 0.061), suggesting a trend. ConclusionsOur study further characterizes the collagenase model of tendinopathy by demonstrating no evidence of central sensitization with collagenase-induced injury. We found no adverse effect of intratendinous injections of minocycline-loaded poly-lactic-co-glycolic acid microspheres, although no therapeutic effect was observed. Future studies involving a more substantial tendon injury with a greater inflammatory component may be necessary to more thoroughly evaluate the effects of minocycline on tendon pathology.

Antimicrobial photodynamic therapy vs. local minocycline in addition to non-surgical therapy of deep periodontal pockets: a controlled randomized clinical trial.

To investigate the additional influence of either antimicrobial photodynamic therapy (aPDT; Helbo® Photodynamic Systems) or local application of minocycline microspheres (MC; Arestin, OraPharma) on clinical and microbiological healing results in deep periodontal pockets (PPD ≥6mm) following non-surgical periodontal therapy (SRP). Forty-five patients with chronic periodontitis were evaluated: test group aPDT + SRP (n=15), positive control group MC + SRP (n=15), and negative control group SRP-alone (n=15). Clinical and microbiological healing parameters were recorded in every patient for four experimental teeth at baseline, 6weeks, and 3, 6, and 12months. Wilcoxon signed-rank test and Mann-Whitney U test were used for statistical analysis (α=0.05). Significant improvements in clinical and microbiological parameters were found for all groups after 6weeks and 3, 6, and 12months. Differences between groups were not statistically significant. Changes after 12months [median (25/75%)] are as follows: reduction in PPD [mm]: aPDT + SRP 2 (1/3), MC + SRP 3 (1/4), SRP-alone 2 (1/3); percentage of residual BOP positive teeth [%]: aPDT + SRP 75 (25/100), MC + SRP 33.3 (0/50), SRP-alone 66.7 (25/75). Within the limitations of this study, neither the applied aPDT system nor MC showed a significant additional influence on clinical and microbiological healing outcomes in deep periodontal pockets compared to SRP alone. In deep periodontal defects, the efficacy of non-surgical periodontal treatment seems not to be improved by adjunctive use of antimicrobial photodynamic therapy or minocycline microspheres.

Local Minocycline Effect on Inflammation and Clinical Attachment During Periodontal Maintenance: Randomized Clinical Trial.

Minocycline microspheres (MMs) are being used to treat residual inflamed periodontal pockets during periodontal maintenance therapy (PMT), but evidence for efficacy from randomized clinical trials is lacking. The purpose of this study is to evaluate the effect of MMs plus scaling and root planing (SRP) on these sites. Sixty patients with chronic periodontitis on 6-month PMT intervals to be followed for 1 year were randomized (51 completed the study) into two statistically similar groups, SRP + MM (aged 66.8 years) and SRP alone (aged 67 years), to treat a ≥5 mm posterior interproximal pocket during PMT with a history of bleeding on probing (BOP). Group treatments were applied to the site at baseline and 6 months. Clinical attachment levels (CALs; primary outcome), probing depths (PDs), plaque, and BOP also were recorded at baseline and 6 and 12 months. In addition, gingival crevicular fluid was analyzed for an inflammation index ratio of interleukin (IL)-1β/IL-1 receptor antagonist (ra) using enzyme-linked immunosorbent assays. All clinical parameters improved significantly (P <0.005) from baseline in both groups with no differences between groups at any time point. CAL decreased 17% (0.9 ± 0.8 mm) and 13% (0.7 ± 0.9 mm) in SRP + MM and 11% (0.7 ± 1.1 mm) and 21% (1.2 ± 0.9 mm) in SRP at 6 and 12 months, respectively. The odds of having BOP decreased 90% (down to 38% of patients) and 95% (26%) in SRP + MM and 82% (42%) and 82% (41%) in SRP at 6 and 12 months, respectively. IL-1β/IL-1ra decreased a significant 61% (P = 0.009) only in SRP + MM at 6 months. SRP of inflamed moderate pockets during 6-month PMT, with or without MMs, improves CALs, along with PDs and BOP over a 1-year period. The use of MMs did not result in an additional benefit over SRP alone.

In vitro activity of taurolidine gel on bacteria associated with periodontitis.

The purpose of this in vitro study was to determine the antimicrobial activity of two different taurolidine gel formulations in comparison with minocycline microspheres. Three percent taurolidine gel (TLG3) and 2 % taurolidine gel (TLG2) were compared to minocycline microspheres (MINO) against single bacterial species and a 12-species-mixture. The antimicrobial activity was proven by determination of minimal inhibitory concentrations (MICs), killing assays, after exposure of the antimicrobials as well as within a biofilm. The MICs against the single species were between 0.5 and 2 mg/ml of taurolidine. MICs of the used mixed microbiota were 1.5 mg/ml (TLG3) and 4 mg/ml (TLG2). Fusobacterium nucleatum and Porphyromonas gingivalis were completely killed by 10 % TLG3 and TLG2 (equivalent to 3 and 2 mg/ml taurolidine) after 6 h. The mixture of 12 species was not completely killed by any of the test substances. Taurolidine gels showed a post-antimicrobial activity, however being less than that of MINO. On biofilms, taurolidine gels reduced concentration dependently the colony forming unit (CFU) counts (multi-species biofilms by 3.63 log10 after 100 % (30 mg/ml) of TLG3), reductions were 2.12 log10 after MINO (1000 μg/ml minocycline). Taurolidine gel formulations exert antimicrobial activity against bacteria associated with periodontal disease. Nevertheless, a complete elimination of biofilms seems to be impossible and underlines the importance of mechanical removal of biofilms prior to application of the antimicrobial. Taurolidine gels may represent a potential alternative for adjunctive topical antimicrobial treatment in periodontitis and infectious peri-implant diseases.

Antimicrobial Action of Minocycline Microspheres Versus 810‐nm Diode Laser on Human Dental Plaque Microcosm Biofilms

The purpose of this study is to investigate the antimicrobial effects of minocycline hydrochloride microspheres versus infrared light at 810 nm from a diode laser on multispecies oral biofilms in vitro. These biofilms were grown from dental plaque inoculum (oral microcosms) and were obtained from six systemically healthy individuals with generalized chronic periodontitis. Multispecies biofilms were derived using supra- and subgingival plaque samples from mesio-buccal aspects of premolars and molars exhibiting probing depths in the 4- to 5-mm range and 1- to 2-mm attachment loss. Biofilms were developed anaerobically on blood agar surfaces in 96-well plates using a growth medium of prereduced, anaerobically sterilized brain-heart infusion with 2% horse serum. Minocycline HCl 1 mg microspheres were applied on biofilms on days 2 and 5 of their development. Biofilms were also exposed on days 2 and 5 of their growth to 810-nm light for 30 seconds using a power of 0.8 W in a continuous-wave mode. The susceptibility of microorganisms to minocycline or infrared light was evaluated by a colony-forming assay and DNA probe analysis at different time points. At all time points of survival assessment, minocycline was more effective (>2 log10 colony-forming unit reduction) than light treatment (P <0.002). Microbial analysis did not reveal susceptibility of certain dental plaque pathogens to light, and it was not possible after treatment with minocycline due to lack of bacterial growth. The cumulative action of minocycline microspheres on multispecies oral biofilms in vitro led to enhanced killing of microorganisms, whereas a single exposure of light at 810 nm exhibited minimal and non-selective antimicrobial effects.

Anti‐infective therapy of peri‐implantitis with adjunctive local drug delivery or photodynamic therapy: 12‐month outcomes of a randomized controlled clinical trial

The objective of the study is to compare the clinical, microbiological and host-derived effects in the non-surgical treatment of initial peri-implantitis with either adjunctive local drug delivery (LDD) or adjunctive photodynamic therapy (PDT) after 12months. Forty subjects with initial peri-implantitis, that is, pocket probing depths (PPD) 4-6mm with bleeding on probing (BoP) and radiographic bone loss ≤2mm, were randomly assigned to two treatment groups. All implants were mechanically debrided with titanium curettes and with a glycine-based powder airpolishing system. Implants in the test group (N=20) received adjunctive PDT, whereas minocycline microspheres were locally delivered into the peri-implant pockets of control implants (N=20). At sites with residual BoP, treatment was repeated after 3, 6, 9 and 12months. The primary outcome variable was the change in the number of peri-implant sites with BoP. Secondary outcome variables included changes in PPD, clinical attachment level (CAL), mucosal recession (REC) and in bacterial counts and crevicular fluid (CF) levels of host-derived biomarkers. After 12months, the number of BoP-positive sites decreased statistically significantly (P<0.05) from baseline in both groups (PDT: 4.03±1.66-1.74±1.37, LDD: 4.41±1.47-1.55±1.26). A statistically significant (P<0.05) decrease in PPD from baseline was observed at PDT-treated sites up to 9months (4.19±0.55mm to 3.89±0.68mm) and up to 12months at LDD-treated sites (4.39±0.77mm to 3.83±0.85mm). Counts of Porphyromonas gingivalis and Tannerella forsythia decreased statistically significantly (P<0.05) from baseline to 6months in the PDT and to 12months in the LDD group, respectively. CF levels of IL-1β decreased statistically significantly (P<0.05) from baseline to 12months in both groups. No statistically significant differences (P>0.05) were observed between groups after 12months with respect to clinical, microbiological and host-derived parameters. Non-surgical mechanical debridement with adjunctive PDT was equally effective in the reduction of mucosal inflammation as with adjunctive delivery of minocycline microspheres up to 12months. Adjunctive PDT may represent an alternative approach to LDD in the non-surgical treatment of initial peri-implantitis.

Comparative evaluation of locally delivered minocycline and metronidazole in the treatment of periodontitis

Objective:The aim of this study was to evaluate and compare the efficacy of subgingivally delivered Minocycline microspheres and 25% Metronidazole gel when used as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis.Materials and Methods:A randomized, controlled, single center study was conducted involving 60 sites in 20 patients suffering from moderate to advanced chronic periodontitis. Each patient contributed three sites which were randomized to three treatment groups: SRP + insertion of Minocycline microspheres at day 1 (Group A), SRP + insertion of Metronidazole gel at day 1 and at day 7 (Group B), and SRP alone (Group C). Gingival index (GI), plaque index (PI), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded at day 1, 1 month, and 3 months post therapy.Results:All treatments showed significant reductions in PPD and CAL at 1 and 3 months when compared to baseline values (P < 0.001). At 3 months, sites treated with minocycline showed an additional reduction in PPD of 0.85 ± 0.03 mm, significantly greater than SRP alone. Differences in mean PPD reduction between Group B and Group C and between Group A and Group B were not significant. At 3 months, difference in CAL gain between Group A and C was 0.50 ± 0.45, which was statistically significant and between Group B and C was 0.35 ± 0.11, which was not found to be statistically significant (P = 0.20). Differences in relative CAL between Group A and Group B were also not found to be statistically significant (P = 0.53).Conclusion:The results concluded that treatment with Minocycline microspheres and Metronidazole gel improve PPD and CAL in patients with periodontitis compared to SRP alone.

Anti‐infective therapy of peri‐implantitis with adjunctive local drug delivery or photodynamic therapy: six‐month outcomes of a prospective randomized clinical trial

To compare the adjunctive clinical effects in the non-surgical treatment of peri-implantitis with either local drug delivery (LDD) or photodynamic therapy (PDT). Forty subjects with initial peri-implantitis, i.e. pocket probing depths (PPD) 4-6mm with concomitant bleeding on probing (BoP) and marginal bone loss ranging from 0.5 to 2mm between delivery of the reconstruction and pre-screening appointment were randomly assigned to two treatment groups. All implants underwent mechanical debridement with titanium curettes, followed by a glycine-based powder airpolishing. Implants in the test group (n=20) received adjunctive PDT, whereas minocycline microspheres were locally delivered into the peri-implant pockets of control implants (n=20). At sites with residual BoP, treatment was repeated after 3 and 6months. The primary outcome variable was the change in the number of sites with BoP. Secondary outcome variables were changes in PPD, in clinical attachment level (CAL), and in mucosal recession (REC). After 3months, implants of both groups yielded a statistically significant reduction (P<0.0001) in the number of BoP-positive sites compared with baseline (LDD: from 4.41±1.47 to 2.20±1.28, PDT: from 4.03±1.66 to 2.26±1.28). After 6months, complete resolution of mucosal inflammation was obtained in 15% of the implants in the control group and in 30% of the implants in the test group (P=0.16). After 3months, changes in PPD, REC, and modified Plaque Index (mPlI) were statistically significantly different from baseline (P<0.05). No statistically significant changes (P>0.05) occurred between 3 and 6months. CAL measurements did not yield statistically significant changes (P>0.05) in both groups during the 6-month observation time. Between-group comparisons revealed no statistically significant differences (P>0.05) at baseline, 3 and 6months with the exception of the mPlI after 6months. In cases of initial peri-implantitis, non-surgical mechanical debridement with adjunctive use of PDT is equally effective in the reduction of mucosal inflammation as with the adjunctive use of minocycline microspheres up to 6months. Adjunctive PDT may represent an alternative treatment modality in the non-surgical management of initial peri-implantitis. Complete resolution of inflammation, however, was not routinely achieved with either of the adjunctive therapies.

A Systematic Review of Clinical Efficacy of Adjunctive Antibiotics in the Treatment of Smokers With Periodontitis

The aim of this study is to systematically review the evidence of the efficacy of adjunctive antibiotic therapy to periodontal therapy in smokers with periodontitis. A search was conducted for randomized clinical trials (RCTs) with durations ≥6 months that compared periodontal therapy with and without adjunctive antibiotics for the treatment of periodontitis in smokers. Data sources primarily included PubMed with MeSH terms and free text as well as EMBASE, SCOPUS, and the Cochrane Central Register of Controlled Clinical Trials. In addition, a hand search of selected periodontal journals, bibliographies, and review articles was conducted. Independent reviewers were assigned to make independent searches and quality assessments (MA and DB) of the included studies, and disagreements were resolved by discussion. Five RCTs were selected for quantitative and qualitative assessments. Little evidence was found that supported the use of antibiotic therapy in conjunction with surgical periodontal therapy in smokers. With respect to non-surgical therapy, consistent improvements in clinical attachment level (CAL) gain and probing depth (PD) reduction was reported after the use of a 250-mg azithromycin tablet in one study. Adjunctive doxycycline gel and minocycline microspheres statistically improved CAL gain (in one RCT) and PD reduction (in one RCT), respectively. However, the risk of bias in all studies was estimated as high. Also, inadequate and inconsistent data precluded performing meta-analyses. The present systematic review concludes that the evidence for an additional benefit of adjunctive antibiotic therapy in smokers with chronic periodontitis is insufficient and inconclusive. Additional well-designed RCTs are required to assess the effect of antibiotics in conjunction with periodontal treatments in smokers.

Effect of a controlled release device containing minocycline microspheres on the treatment of chronic periodontitis: A comparative study.

Introduction:Adjunctive therapy with locally delivered antimicrobials has resulted in improved clinical outcomes. The aim of this study was to evaluate the efficacy and safety of locally administered minocycline microspheres (Arestin™) in the treatment of chronic periodontitis.Materials and Methods:A total of 60 sites from 15 patients in the age group of 35-50 years, who had periodontal pockets measuring 5-8 mm and had been diagnosed with chronic periodontitis, were selected for the study. The selected groups were randomly assigned to either the control group (group A) or the treatment/test group (group B). Only scaling and root planing were done at the base line visit for the control sites followed by local application of Arestin™ (1 mg). Clinical parameters such as plaque index, gingival index, and gingival bleeding index were recorded at baseline, day 30, day 90, and day 180 in the selected sites of both the groups. Probing pocket depth also was recorded at baseline, day 90, and day 180 for both the groups.Results:A statistically significant reduction was observed in both groups. Group B showed better results than Group A and these differences were statistically significant.Conclusion:The results of this study clearly indicate that treatment with scaling and root planing plus minocycline microspheres (Arestin™) is more effective and safer than scaling and root planing alone in reducing the signs of chronic periodontitis.

Mechanical and Repeated Antimicrobial Therapy Using a Local Drug Delivery System in the Treatment of Peri‐Implantitis: A Randomized Clinical Trial

Peri-implantitis is an inflammatory process caused by microorganisms affecting the tissues around an osseointegrated implant in function, resulting in a loss of supporting bone. Limited data exist regarding the treatment of peri-implantitis. The aim of this study was to assess the clinical and microbiologic outcome of repeated local administration of minocycline microspheres, 1 mg, in cases of peri-implantitis. Thirty-two subjects with at least one implant with a probing depth > or =4 mm combined with bleeding and/or exudate on probing and the presence of putative pathogenic bacteria were included in the study. At baseline, subjects were randomly assigned to receive local minocycline microspheres (17 subjects and 57 implants) or chlorhexidine gel (15 subjects and 38 implants) following debridement. Treatments were performed on three occasions: baseline and days 30 and 90. Follow-up examinations were conducted at 10 days and at 1, 3, 6, 9, and 12 months. The use of minocycline resulted in significant improvements in probing depths compared to chlorhexidine at days 30, 90, and 180 (P = 0.5, P = 0.01, and P = 0.04, respectively). For the deepest sites of the minocycline-treated implants, the mean probing depth reduction was 0.6 mm at 12 months. Regarding bleeding on probing, significant differences between groups, based on all four sites at the implants, were found at days 30, 90, 180, 270, and 360. Both treatments resulted in a marked reduction in the indicator bacteria. The use of a repeated local antibiotic as an adjunct to the mechanical treatment of peri-implantitis lesions demonstrated improvements in probing depths that were significantly different from controls and were sustained for 6 months. The adjunctive use of minocycline microspheres is beneficial in the treatment of peri-implant lesions, but the treatment may have to be repeated.

Local minocycline as an adjunct to surgical therapy in moderate to severe, chronic periodontitis

The aim of the study was to evaluate the effects of minocycline microspheres on periodontal probing depth reduction when used in combination with surgery in adults with moderate to severe, chronic periodontitis. Sixty patients with a minimum of one non-molar periodontal site > or =6 mm in two oral quadrants received either local minocycline microspheres at baseline, immediately following each of two surgical therapies (Weeks 2 and 3), and at Week 5 or surgery alone. The mean probing depth reduction at Week 25 at sites > or =5 mm at baseline was 2.51 mm in the test group and 2.18 mm in the control group. Smokers in the test group had a significantly greater probing depth reduction (2.30 mm) than smokers in the control group (2.05 mm). The number of sites with probing depth reductions of > or =2 and > or =3 mm were significantly higher in the test group than in the control group. Applications of local minocycline as an adjunct to surgery in adults with moderate to severe, chronic periodontitis were associated with statistically significant greater reductions in probing depth than surgery alone.

Mechanical Therapy With Adjunctive Minocycline Microspheres Reduces Red‐Complex Bacteria in Smokers

Smoking increases the risk for periodontal disease and reduces the healing response. We examined the antimicrobial and clinical effects of scaling and root planing (SRP) with and without minocycline HCl 1 mg microspheres (MM) relative to smoking status in subjects with periodontitis. A total of 127 subjects (46 never smokers, 44 former smokers, and 37 current smokers) with moderate to advanced periodontitis were randomized to receive MM + SRP (N = 62) or SRP alone (N = 65). Subgingival plaque samples collected at baseline and day 30 were examined for the presence of 40 periodontal bacteria by DNA probe analysis. MM + SRP reduced red-complex bacteria (RCB) numbers and proportions to a greater extent than SRP alone, irrespective of smoking status. RCB numbers were not reduced by SRP in current smokers. The difference in the reduction in numbers of RCB by SRP relative to MM + SRP in current smokers was statistically significant (P <0.05). Numbers and proportions of orange complex bacteria (OCB) were reduced in all groups treated with MM + SRP. Proportions of OCB increased in current smokers treated with SRP alone. In current smokers, MM + SRP significantly reduced probing depth (PD), increased clinical attachment level (CAL), and reduced bleeding on probing (BOP) to a greater extent than SRP alone (P <0.05). SRP alone was ineffective at reducing numbers or proportions of RCB or OCB in current smokers, whereas MM + SRP significantly reduced both. MM + SRP also improved PD, BOP, and CAL to a greater extent than SRP alone independent of smoking status.

Adjunctive local antibiotic therapy in the treatment of peri‐implantitis II: clinical and radiographic outcomes

To monitor over 12 months clinical and radiographic changes occurring after adjunctive local delivery of minocycline microspheres for the treatment of peri-implantitis. In 25 partially edentulous subjects, 31 implants diagnosed with peri-implantitis were treated. Three weeks after oral hygiene instruction, mechanical debridement and local antiseptic cleansing using 0.2% chlorhexidine gel, baseline (Day 0) parameters were recorded. Minocycline microspheres (Arestin) were locally delivered to each implant site with bone loss and a probing pocket depth (PPD) >or=5 mm. Rescue therapy with Arestin was allowed at Days 180 and 270 at any site exhibiting an increase in PPD>or=2 mm from the previous visit. The following clinical parameters were recorded at four sites/implant at Day 0, 10, 30, 60, 90, 180, 270 and 360: PPD, clinical attachment level (CAL), bleeding on probing (BOP) and plaque index (PlI). Six implants in six subjects were either rescued or exited because of persisting active peri-implantitis. Successful implants showed a statistically significant reduction in both PPD and percentage of sites with BOP between baseline and Day 360 (P<0.05). At mesial implant sites, the mean PPD reduction amounted to 1.6 mm (95% CI: 0.9-2.2 mm, P<0.001) and was accompanied by a statistically significant reduction of the BOP value (P<0.001). Binary regression analysis showed that the clinical parameters and smoking history could not discriminate between successfully treated and rescued or exited implants at any observation time point. Non-surgical mechanical treatment of peri-implantitis lesions with adjunctive local delivery of microencapsulated minocycline led to positive effects on clinical parameters up to 12 months.