American Academy of Periodontology Statement on LocalDelivery of Sustained or Controlled Release Antimicrobialsas Adjunctive Therapy in the Treatment of Periodontitis*
Sustained or controlled release local delivery (e.g.,smokers,patientswithaggressiveperiodonti-
antimicrobial agents (LDAs) are available for
tis, or who are medically compromised). Additional
use as adjuncts to scaling and root planing
studies are also needed to further define the thera-
(SRP) in the treatment of periodontitis. These prod-
peutic value of LDAs in different phases of treatment
ucts are placed into periodontal pockets in order to
(active versus maintenance). The long-term benefits
reduce subgingival bacterial flora and clinical signs
are unknown because most studies are limited to 9
of periodontitis. This therapy cannot correct ana-
tomical deformities caused by the disease process.
Thorough SRP is highly effective in the treatment
Use of LDAs can deposit a high level of the active
of chronic periodontitis and is the standard approach
agent in the periodontal pocket, and the delivery
to non-surgical periodontal therapy. Clinicians may
vehicle facilitates prolonged drug delivery.
consider the use of LDAs in chronic periodontitis
Recent systematic reviews report that modest
additional probing depth (PD) reductions in the range
When localized recurrent and/or residual PD ‡5
of 0.25 mm to 0.5 mm were achieved when LDAs
mm with inflammation is still present following
were used as an adjunct to SRP in pockets ‡5 mm.
However, even when the differences were statisti-cally significant, the additional improvement in PD
Therapies other than LDAs should be considered
was a fraction of the reported mean 1.45 mm PD
reduction achieved by SRP alone. Effects on clinical
Multiple sites with PD ‡5 mm exist in the same
attachment level gains were smaller and statistical
significance less common. In many studies, repeated
The use of LDAs has failed to control periodontitis
LDA applications were compared to a single episode
of SRP. It should be noted that these reviews included
Anatomical defects are present (e.g., intrabony
a number of antimicrobial agents not currently sold
in the United States. Antimicrobial agents for local
The clinician’s decision to use LDAs should be
delivery currently sold in the United States include:
based upon a consideration of clinical findings, the
ArestinÒ (1 mg minocycline microspheres), AtridoxÒ
patient’s dental and medical history, scientific evi-
(10% doxycycline hyclate in a bioabsorbable polymer),
dence, patient preferences, and advantages and
and PerioChipÒ (2.5 mg chlorhexidine in gelatin
disadvantages of alternative therapies.
The existing data appear insufficient to conclude
that adjunctive sustained or controlled release LDA
Bonito AJ, Lux L, Lohr KN. Impact of local adjuncts
treatment can either reduce the need for surgery or
to scaling and root planing in periodontal disease ther-
improve long-term tooth retention, or is cost effec-
apy: A systematic review. J Periodontol 2005;76:1227-1236.
tive. Additional studies are needed to support the use
Hanes PJ, Purvis JP. Local anti-infective therapy: Phar-
of LDAs in special sites (e.g., periodontal abscesses,
macological agents. A systematic review. Ann Periodontol
furcations, peri-implantitis) and special populations
*This statement was developed under the direction of the Task Force onLocal Delivery of Antimicrobials as Adjunct Therapy and approved by theBoard of Trustees of the American Academy of Periodontology in May2006.
An accurate breast cancer prognosis, or breast cancer sur-Our goal was to predict survival for each individual. Wevivability prediction, is important as it often guides thehad two approaches: predicting a discrete survival statustreatment course of action, ability to claim additional fi-based on time since diagnosis and other features, and pre-nancial support from the government, actions of
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