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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.


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