As a follow up to the post discussing the use of systemic antibiotics in the treatment of periodontal disease, I decided to discuss the use of localized delivery antibiotics and chemotherapeutics in periodontal therapy.
Localized delivery antibiotics or chemotherapeutics
Hanes and Purvis (Hanes & Purvis 2003) published an interesting meta-analysis on local anti-infective therapy. The results of their analysis showed beneficial clinical outcome for certain populations (such as smokers) for almost all locally delivered chemicals except chlorhexidine chips, later confirmed by Carvalho (Carvalho et al 2007) study. The formulation that has been proven most efficient is doxycycline microspheres. This compound has been used for patient in maintenance (Borgen et al 2003) showing good results for the first application. No difference was found, compared to control, for the subsequent applications. This would suggest that if a patient in maintenance shows progression of attachment loss (AL) and increase of probing pocket depth (PPD) regardless of the localized therapy, surgery should be considered as subsequent treatment option. A similar finding was the outcome of a recent study from Tomasi (Tomasi et al 2008). In fact, in this study, doxycycline was used for sites that did not respond to SRP and did not show any clinical benefit. The findings of this study reinforce the idea that there is a limit to the outcome of non-surgical therapy, behind which the addition of antibiotics has not been proven helpful. In conclusion:
I would consider the use of localized doxycycline in patients undergoing maintenance that present with a burst of loss of attachment.
If the patient should show similar clinical signs at the next recall appointment I would consider other treatment modalities. I would also consider the use of localized doxycycline during initial therapy in patient that might present localized deep pockets and other risk factors, in particular smoking (Machion et al 2006).