Treating periodontal diseases with tetracycline-impregnated fibers: Data and controversies
The author reviews data on the efficacy of t-fibers and addresses controversies in their use in perio therapy. He feels that when t-fibers are used in conjunction with root planing in cases of adult periodontitis, the improvement beyond the mechanical instrumentation is marginal. The use of t-fibers as a therapy by itself does not provide a substantial improvement beyond root planing. However, in nonresponding sites, the t-fibers may be advantageous. The long-term alteration of pocket micro flora was not significantly different between sites receiving root planing or sites with both root planing and t-fibers. T-fibers did not eliminate actinobacillus actinomycetemcomitans in patients with juvenile periodontitis, possibly because of a decrease in antagonistic benign pocket bacteria. The author also feels that Actisite has been inappropriately labeled by the FDA in that it is to be used in conjunction with scaling and root planing. This is because the literature shows that periodontitis can be treated with conventional therapy without antibiotics and that antibiotics should be reserved for patients who do not respond to conventional therapy. Actisite should be reserved for patients with recurrent periodontitis or refractory sites.
The author also feels that studies need to be done on the development of resistant strains by t-fibers and to compare long-term efficacy of local vs. systemic drug delivery. Other antibiotics (augmentin, metronidazole, etc.) have been used successfully in treating patients who do not respond to conventional therapy. We should not assume that tetracycline is the universally accepted drug of choice for treatment of periodontal disease. In conclusion, there are still many issues that must be resolved about the potential usefulness of t-fibers. [C.S.]
Greenstein, G., Compendium, 16:448,1995