Periodontology Literature Review

ANTIMICROBIALS: FIBER DELIVERY

Ciancio, SG., Cobb, CM., and Leung M.: Tissue concentration and localization of tetracycline following site-specific tetracycline fiber therapy. J Perio, 63(10):849-853, 1992.

Purpose:

To evaluate the location of tetracycline (TCN) in tissue adjacent to periodontal pockets treated with TCN impregnated fibers and to find out if presurgical placement of fibers had any adverse effect on healing following periodontal surgery.

Materials and methods:

A total of 10 volunteers with 2 maxillary quadrants requiring similar periodontal surgery with 2 periodontal pockets in each quadrant >5 mm were included in this study. The quadrants were scaled and root planed (SRP). Three weeks after; an examination including probing depths (PD), attachment levels and bleeding on probing (BOP) was completed. The quadrants were randomly assigned to TCN fiber treatment or placebo. The fibers were placed on 2 non adjacent pockets. The patients were placed on chlorhexidine 0.12% (CHX) 2 times a day. The fibers were left in place for 7 days and removed on the day of the surgery. The periodontal surgery consisted of modified Widman flap. The tissue adjacent to the fiber was removed to be studied. High performance liquid chromatography (HPLC) was used to quantitative TCN. Light and ultraviolet fluoresce microscopy was used to determine depth of penetration. The sections that exhibited fluorescence were graded according to the depth of penetration: 0 = absent, 1= 0-9 microns, 2= 10-19 microns, and 3= 20+ microns. Wound healing was evaluated by judging the degree of tissue erythema. Attachment levels were measured at 3-4 months.

Results:

Two patients lost TCN fibers 5 days after placement. The remaining 8 patients retained the fibers. 3 months after the surgery, a comparison regarding probing depth between placebo and test favored TCN, but not statistically significant. Six months after treatment the mean PD decreased, 3.79 TCN and 3.04 placebo, but not statistically significant. The attachment gain at 3 and 6 months was similar. There was no significant difference. The HPLC showed mean tissue concentration of 52.55 ng/mg. The placebo quadrant showed trace amounts of TCN less than 10 ng/mg. The biopsy evaluation to determine the depth of tissue penetration showed the following results; score 3 2 sites, score 2 2 sites, score 1 3 sites. The Toludine test to determine intensity of inflammatory cell infiltrate showed slight to moderate inflammatory cell infiltrate in all specimens. Post-surgery healing in TCN sites; less tissue color and less edema at 7 days, but no differences between groups at 3 months.

Conclusion:

Use of TCN fibers pre-surgery does not interfere with wound healing process. There is no long term benefit with respect to increase in attachment levels or pocket reduction when compared to placebo.

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