DEPARTMENT OF PERIODONTICS

TOPIC - LOCAL DRUG DELIVERY SYSTEM

NAME – ALKA RAI

ROLL NO – 2
(BDS FINAL YEAR)

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CONTENTS
 AIM

 INDICATIONS

 CONTRAINDICATION

 ADVANTAGES

 DISADVANTAGES

 LOCAL ADMINISTRATION OF ANTIBIOTIC AND ANTIMICROBIAL

AGENTS

 SUBGINGIVAL APPLIED AGENTS

 DOXYCYCLINE GEL (ARTIDOX)

 METRONIDAZOLE GEL

 CURRENTLY AVAILABLE LOCAL DRUG DELIVERY SYSTEM IN

PERIODONTAL THERAPY

 FREQUENTLY USED LOCAL ANTIMICROBAL WITH DOSAGE

SPECIFICATION

 CONCLUSION

 REFERENCES

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AIM
 To direct antimicrobials to infections sites. Maintaining effective levels of

drugs for sufficient period of time without eliciting any major side effects.

INDICATIONS
 As an adjunct in the treatment of few localized non responding sites in an
otherwise

 Controlled patient.

 In ailing and failing implant cases.

 In medically compromised patient where surgical procedure are not

recommended.

 Periodontal abscess.

 Periodontal maintenance therapy.

 Patient with gastrointestinal intolerance to systemic drug medication.

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CONTRAINDICATIONS
 Patient with history of allergy to a particular anti-microbial agent.

 In pregnancy and lactating period.

 Children under the age of 12 years.

 Patient with complete renal failure.

 Patient susceptible to infective endocarditis.

ADVANTAGES
 High concentration of sub gingival sites.

 Independent of patient compliance.

 Does not harm the symbiotic useful microflora of gastrointestinal tract.

 Systemic intolerance is bypassed.

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DISADVANTAGES
 Difficulty in placing of therapeutic concentration of the antimicrobial agent

in deeper sites.

 Has to be professionally placed or if manually placed, required manual

dexterity and patient compliance.

 Complete drug penetration is not possible and extra pocket sites are

unaffected.

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LOCAL ADMINISTRATION OF ANTIBIOTIC AND
ANTIMICROBIAL AGENTS

I. Vehicles For Local Delivery Of Chemotherapeutic Agents

Includes
• Dentifrices

• Mouth rinses

• Chewing gums

• Slow release devices

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II. Method Of Delivery Of Chemotherapeutic Agent Includes
• Keyes techniques

• Root biomodification

• Irrigation devices.

1. Home irrigation devices

- Supra gingival

- Sub gingival

- Marginal

2. Professional sub gingival devices

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SUBGINGIVAL APPLIED AGENTS

 I. Tetracycline Fibers (Actisite)

 Consists of a woven tube of polymer ethylene vinyl acetate.

 Saturated with 25% tetracycline hydrochloride.

 Marketed as 23cm length of 0.5mm diameter fibers.

 Flexible fiber is placed in overlapping pattern into periodontal pocket until it

fills pocket 1mm apical to gingival margin.

 Gingival margin is sealed with isocyanoacrylate.

 Postoperative instruction required:-

- patient do not brush of floss the specific area.

- rinse twice daily with chlorhexidine for two week.

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2. CHLORHEXIDINE CHIP (PERIOCHIP)
 2.5mg chlorhexidinegluconate.

 A biodegradable film of hydrolyzed gelatin.

 0.35mm in thickness and 4x5mm in height/width.

 It is self-retentive on contact with moisture, no adhesive or dressing

areneeded.

 Using cotton forceps to grasp the chip and inserted into pocket.

 Dimension of chip prevent placement in to small tortuous, pocket.

 Chlorhexidine released from chip in peak concentration (2007µg/ml) of 2

hours after placement and progressively decreases over 9 days (57µg/ml).

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 ADVANTAGES OF THE PERIO-CHIP
 Very easy and convenient to use. Takes seconds to place in any pocket.

 Highly effective, safe and well tolerated. Painless to the patient. In some

instances there may be minor discomfort in the first 24 hrs.

 No restrictions on eating or oral hygiene after chip insertion.

 All quadrants can be treated at the same visit.

 Does not affect taste or stain teeth.

 Maintains effective concentration of chlorhexidine in the pocket up to 10

days - 125µg/ml.

 Delivers effective dosage even to the base of the pocket.

 Reduces amount of pathogenic bacteria up to 100 days – 99% of sub

gingival microflora.

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DOXYCYCLINE GEL (ARTIDOX)
 It is a liquid biodegradable polymer.

 Hardens after a few minute following exposers to the fluid in periodontal

pocket.

 Delivery of syringe is attached to a 23-gauge blunt cannula and material is

injected into the periodontal pocket.

 Material is biodegradable no additional appointments for removal are

required and the patient is instructed to removal of any residual material

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with their tooth brush and dental floss at end of 1 week.

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METRONIDAZOLE GEL
 Contains 25% metronidazole in a glycerol mono-oleate and sesame oil base.

 Applied to pocket using a syringe with a blunt cannula.

 It is easy to place but may required multiple application to achieved

desirable results.

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 CURRENTLY AVAILABLE LOCAL DRUG
DELIVERY SYSTEM IN PERIODONTAL
THERAPY
Antimicrobial Product name Nature Dosage form
agent

1. Doxycycline Atridox® Biodegradable Mixture in syringe

2. Tetracycline ActisiteTM Nonresorbable Fibers

3. Metronidazole Elyzol Biodegradable Mixture in syringe

4.Chlorhexidine Periochip Biodegradable Chip device

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 FREQUENTLY USED LOCAL ANTIMICROBAL
WITH DOSAGE SPECIFICATION

Drug Dosage Release period in days

ActisiteTM 12.7mg 19 inch fiber of

diameter 0.5mm 10

Periochip 2.5mg of
chlorhexidinegluconate in 7
(4 x 5 x 3.5mm)chip

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CONCLUSION
 Considering various factors of cost effectiveness efficacy, potential

advantages and disadvantages it can be concluded that local drug delivery

could serve as a potent weapon in periodontal chemotherapy at and same

time valuable adjunct to mechanotherapy, but it is use as a monotherapy

agent.

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REFERENCES
 Carranza’s Clinical Periodontology 10th edition.

 Louis F. Rose and barian L. mealey (periodontics medicine, surgery and

implant)

 Dilip G. nayak (periodontology and oral implentology)

 Shantipriyareddy (clinical periodontology and periodontics) 4th edition.

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