Abstract
A controlled-release device (CRD) containing chlorhexidine gluconate, such as PerioCol™CG (Eucare Pharmaceuticals Pvt. Ltd,, Chennai, India), for subgingival application has little reported data with clinical as well as antimicrobial efficacy. This study evaluated clinical and subgingival microbial changes on using indigenously developed PerioCol™CG as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. Forty posterior first molar sites having probing pocket depth ≥5 mm were selected and divided into two groups, with 20 sites in each group, in a split-mouth design. Group A (test site) was treated with SRP and PerioCol™CG, while group B (control site) was treated with SRP alone. Subgingival microbial samples were collected at baseline and 1 month after the initial SRP, while probing depth (PD), clinical attachment level (CAL) and gingival index (GI) were recorded at baseline, after 1 month and after 3 months. Microbial detection of Porphyromonas gingivalis (P. gingivalis) and Tannerella forsythia (T. forsythia) was done by means of polymerase chain reaction (PCR). A significant improvement was observed in all clinical measures in sites treated with PerioCol™CG as compared to the control sites during the study period. Also, there was a statistically significant reduction in the proportion of occurrence of P. gingivalis and T. forsythia after intervention in test sites as compared to control sites. Our data suggest that SRP combined with subgingival administration of PerioCol™CG has a significantly better and prolonged effect compared to SRP alone on the PD, clinical attachment loss and elimination of periodontopathogens.
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References
Pihlstrom BL, Michalowicz BS, Johnson NW (2005) Periodontal diseases. Lancet 366(9499):1809–1820
Nishihara T, Koseki T (2000) Microbial etiology of periodontitis. Periodontol 36:14–26
Haffajee AD, Cugini MA, Dibart S, Smith C, Kent RL Jr, Socransky SS (1997) The effect of SRP on the clinical and microbiological parameters of periodontal diseases. J Clin Periodontol 24(5):324–334
Golub LM, Lee HM, Lehrer G, Nemiroff A, McNamara TF, Kaplan R, Ramamurthy NS (1983) Minocycline reduces gingival collagenolytic activity during diabetes. Preliminary observations and a proposed new mechanism of action. J Periodontal Res 18(5):516–526
Ardila CM, Granada MI, Guzmán IC (2010) Antibiotic resistance of subgingival species in chronic periodontitis patients. J Periodontal Res 45(4):557–563
Feres M, Figueiredo LC, Soares GMS, Faveri M (2015) Systemic antibiotics in the treatment of periodontitis. Periodontol 2000 67(1):131–186
Goodson JM, Hogan PE, Dunham SL (1985) Clinical responses following periodontal treatment by local drug delivery. J Periodontol 56(11 Suppl):81–87
Kalsi R, Vandana KL, Prakash S (2011) Effect of local drug delivery in chronic periodontitis patients: A meta-analysis. J Indian Soc Periodontol 15(4):304–309
Zanatta FB, Antoniazzi RP, Rösing CK (2010) Staining and calculus formation after 0.12% chlorhexidine rinses in plaque-free and plaque covered surfaces: a randomized trial. J Appl Oral Sci 18(5):515–521
Zijnge V, Ammann T, Thurnheer T, Gmür R (2012) Subgingival biofilm structure. Front Oral Biol 15:1–16
Socransky SS, Haffajee AD, Cugini MA, Smith C, Kent RL Jr (1998) Microbial complexes in subgingival plaque. J Clin Periodontol 25(2):134–144
Löe H (1967) The Gingival Index, the Plaque Index and the Retention Index Systems. J Periodontol 38(6):Suppl:610–616
Sharma A, Inagaki S, Honma K, Sfintescu C, Baker PJ, Evans RT (2005) Tannerella forsythia-induced alveolar bone loss in mice involves leucine-rich-repeat BspA protein. J Dent Res 84(5):462–467
Killoy WJ (1998) The use of locally delivered chlorhexidine in the treatment of periodontitis. Clinical results. J Clin Periodontol 25(11 Pt 2):953–958, discussion 978–979
Soskolne WA, Chajek T, Flashner M, Landau I, Stabholtz A, Kolatch B, Lerner EI (1998) An in vivo study of the chlorhexidine release profile of the PerioChip in the gingival crevicular fluid, plasma and urine. J Clin Periodontol 25(12):1017–1021
Jeffcoat MK, Bray KS, Ciancio SG, Dentino AR, Fine DH, Gordon JM, Gunsolley JC, Killoy WJ, Lowenguth RA, Magnusson NI, Offenbacher S, Palcanis KG, Proskin HM, Finkelman RD, Flashner M (1998) Adjunctive use of a subgingival controlled-release chlorhexidine chip reduces probing depth and improves attachment level compared with scaling and root planing alone. J Periodontol 69(9):989–997
Paolantonio M, D’Angelo M, Grassi RF, Perinetti G, Piccolomini R, Pizzo G, Annunziata M, D’Archivio D, D’Ercole S, Nardi G, Guida L (2008) Clinical and microbiologic effects of subgingival controlled-release delivery of chlorhexidine chip in the treatment of periodontitis: a multicenter study. J Periodontol 79(2):271–282
Heasman PA, Heasman L, Stacey F, McCracken GI (2001) Local delivery of chlorhexidine gluconate (PerioChip) in periodontal maintenance patients. J Clin Periodontol 28(1):90–95
Grisi DC, Salvador SL, Figueiredo LC, Souza SL, Novaes AB, Grisi MF (2002) Effect of a controlled-release chlorhexidine chip on clinical and microbiological parameters of periodontal syndrome. J Clin Periodontol 29(10):875–881
Kaldahl WB, Kalkwarf KL, Patil KD, Dyer JK, Bates RE Jr (1988) Evaluation of four modalities of periodontal therapy. Mean probing depth, probing attachment level and recession changes. J Periodontol 59(12):783–793
Carvalho J, Novak MJ, Mota LF (2007) Evaluation of the effect of subgingival placement of chlorhexidine chips as an adjunct to scaling and root planing. J Periodontol 78(6):997–1001
Mizrak T, Güncü GN, Caglayan F, Balci TA, Aktar GS, Ipek F (2006) Effect of a controlled-release chlorhexidine chip on clinical and microbiological parameters and prostaglandin E2 levels in gingival crevicular fluid. J Periodontol 77(3):437–443
Azmak N, Atilla G, Luoto H, Sorsa T (2002) The effect of subgingival controlled-release delivery of chlorhexidine chip on clinical parameters and matrix metalloproteinase-8 levels in gingival crevicular fluid. J Periodontol 73(6):608–615
Gonzales JR, Harnack L, Schmitt-Corsitto G, Boedeker RH, Chakraborty T, Domann E, Meyle J (2011) A novel approach to the use of subgingival controlled-release chlorhexidine delivery in chronic periodontitis: a randomized clinical trial. J Periodontol 82(8):1131–1139
Kumar AJ, Ramesh Reddy BV, Chava VK (2014) Effect of chlorhexidine chip in the treatment of chronic periodontitis. J Nat Sci Biol Med 5(2):268–272
Daneshmand N, Jorgensen MG, Nowzari H, Morrison JL, Slots J (2002) Initial effect of controlled release chlorhexidine on subgingival microorganisms. J Periodontal Res 37(5):375–379
Medaiah S, Srinivas M, Melath A, Girish S, Polepalle T, Dasari AB (2014) Chlorhexidine chip in the treatment of chronic periodontitis—a clinical study. J Clin Diagn Res 8(6):ZC22–ZC25
Kuyyakanond T, Quesnel LB (1992) The mechanism of action of chlorhexidine. FEMS Microbiol Lett 100(1–3):211–215
Corbin A, Pitts B, Parker A, Stewart PS (2011) Antimicrobial penetration and efficacy in an in vitro oral biofilm model. Antimicrob Agents Chemother 55(7):3338–3344
Dahlén G, Manji F, Baelum V, Fejerskov O (1992) Putative periodontopathogens in “diseased” and “non-diseased” persons exhibiting poor oral hygiene. J Clin Periodontol 19(1):35–42
van Winkelhoff AJ, Loos BG, van der Reijden WA, van der Velden U (2002) Porphyromonas gingivalis, Bacteroides forsythus and other putative periodontal pathogens in subjects with and without periodontal destruction. J Clin Periodontol 29(11):1023–1028
Ximénez-Fyvie LA, Haffajee AD, Socransky SS (2000) Comparison of the microbiota of supra- and subgingival plaque in health and periodontitis. J Clin Periodontol 27(9):648–657
Mysak J, Podzimek S, Sommerova P, Lyuya-Mi Y, Bartova J, Janatova T, Prochazkova J, Duskova J (2014) Porphyromonas gingivalis: major periodontopathic pathogen overview. J Immunol Res 2014:476068
Potempa J, Pike R, Travis J (1997) Titration and mapping of the active site of cysteine proteinases from Porphyromonas gingivalis (gingipains) using peptidyl chloromethanes. Biol Chem 378(3-4):223–230
Curtis MA, Kuramitsu HK, Lantz M, Macrina FL, Nakayama K, Potempa J, Reynolds EC, Aduse-Opoku J (1999) Molecular genetics and nomenclature of proteases of Porphyromonas gingivalis. J Periodontal Res 34(8):464–472
Moncla BJ, Braham P, Hillier SL (1990) Sialidase (neuraminidase) activity among gram-negative anaerobic and capnophilic bacteria. J Clin Microbiol 28(3):422–425
Socransky SS, Haffajee AD, Smith C, Dibart S (1991) Relation of counts of microbial species to clinical status at the sampled site. J Clin Periodontol 18(10):766–775
Tanner AC, Strzempko MN, Belsky CA, McKinley GA (1985) API ZYM and API An-Ident reactions of fastidious oral gram-negative species. J Clin Microbiol 22(3):333–335
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The authors declare that there are no conflicts of interest in this study.
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All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Pattnaik, S., Anand, N., Chandrasekaran, S.C. et al. Clinical and antimicrobial efficacy of a controlled-release device containing chlorhexidine in the treatment of chronic periodontitis. Eur J Clin Microbiol Infect Dis 34, 2103–2110 (2015). https://doi.org/10.1007/s10096-015-2459-x
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DOI: https://doi.org/10.1007/s10096-015-2459-x