Novel 20% doxycycline-loaded PLGA nanospheres as adjunctive therapy in chronic periodontitis in type-2 diabetics: randomized clinical, immune and microbiological trial.

OBJECTIVE: This study evaluated the clinical, microbiological, and immunological results of poly lactic-co-glycolic acid (PLGA) nanospheres containing 20% doxycycline (DOXY) in the treatment of type-2 diabetic patients (DM-2) with chronic periodontitis (CP). MATERIAL AND METHODS: A parallel, double-blind, randomized, placebo-controlled clinical trial was conducted in DM-2 presenting severe and generalized CP. All patients received one-stage full-mouth ultrasonic debridement (FMUD) and they were randomly divided into two groups: PLAC (n = 20)-local application of placebo PLGA nanospheres, and DOXY (n = 20)-local application of doxycycline-loaded nanospheres; both in six non-contiguous sites. Clinical, metabolic (fasting plasma glucose level-FPG and glycated hemoglobin-HbA1c), cytokine pattern (multiplexed bead immunoassay) and microbiological assessments were performed at baseline, and 1, 3, and 6 months after treatment. RESULTS: Both groups showed clinical improvement in all parameters after treatment (p < 0.05). Deep pockets showed improvements in bleeding on probing-BoP (3 and 6 months), PD (at 3 months), and CAL gain (at 1 and 3 months) favoring DOXY (p < 0.05). The percentage of sites presenting PD reduction and CAL gain ≥ 2 mm was higher in DOXY at 3 months (p < 0.05). DOXY group exhibited a significant increase in the levels of anti-inflammatory interleukin (IL)-10 and a reduction in IL-8, IFN-y, IL-6, and IL-17 (p < 0.05), significant reduction in periodontal pathogens (p < 0.05), and a lower mean percentage of HbA1C at 3 months (p < 0.05). CONCLUSION: DOXY nanospheres may be considered a potential adjunct to mechanical debridement in the therapy of periodontitis in DM-2, offering additional benefits in deep pockets, improving the cytokine profile, and reducing periodontal pathogen levels. CLINICAL RELEVANCE: The use of locally applied doxycycline nanospheres may represent an adjunctive therapeutic approach in the treatment of periodontal disease in type-2 diabetic patients, achieving additional benefits in the local modulation of cytokines, microbial reduction, and clinical parameters, especially in deep pockets.

Subgingival triclosan-polydimethylsiloxane gel as an adjunct to scaling and root planing.

PURPOSE: To evaluate the influence of a triclosan-polydimethylsiloxane-containing gel when used as an adjunct to scaling and root planing on the treatment of chronic periodontal disease. METHODS: A 3-month, double-blind, randomized parallel design clinical trial was performed in 20 subjects with chronic periodontitis. The subjects, presenting at least three anterior sites with probing depth (PD) +/- 5 mm and bleeding on probing (BoP), were randomly assigned to two experimental groups: Group SRP-T: scaling/root planing plus test gel application (triclosan 1% + polydimethylsiloxane 13%) or Group SRP: scaling/root planing plus control gel application (polydimethylsiloxane 13%). Immediately following mechanical therapy, each assigned gel was applied to the selected sites and once a week during the following 3 weeks. Re-examinations were carried out on days 45 and 90 after the last irrigation. RESULTS: Significant reductions in PD and clinical attachment level (CAL) were observed for both groups in both periods (P < 0.05). However, SRP-T showed lower means of PD than SRP at Day 45 (3.60 +/- 0.87 versus 4.77 +/- 1.38, respectively, P = 0.035) and CAL at both 45 days (4.63 +/- 1.17 versus 6.07 +/- 1.43, P = 0.023) and 90 days (4.45 +/- 1.19 versus 5.91 +/- 1.37, P = 0.021). No differences were found for bleeding on probing, plaque index and gingival recession (P > 0.05) between groups.

Locally delivered doxycycline as an adjunctive therapy to scaling and root planing in the treatment of smokers: a 2-year follow-up.

BACKGROUND: The aim of this clinical study was to evaluate the association of locally delivered doxycycline 10% with scaling and root planing in the periodontal treatment of smokers during a 2-year period. METHODS: Forty-eight chronic periodontitis patients, presenting a minimum of four pockets (>or=5 mm) that bled on probing on anterior teeth were included. Patients were randomly assigned to receive one of the following treatments: scaling and root planing (SRP) and scaling and root planing followed by local application of doxycycline (SRP-D). Assigned treatments were performed at baseline and at 12 months. Clinical parameters, including probing depth (PD) and relative attachment level (RAL), were recorded at baseline; 45 days; 3, 6, and 12 months (retreatment); 45 days following retreatment; and at 15, 18, and 24 months. RESULTS: In initially deep pockets (>or=7 mm), SRP-D showed greater PD reduction than SRP at 6 and 18 months (mean difference between groups of 1.18 and 1.73 mm, respectively; P <0.05) and greater RAL gain in all periods after 3 months (mean difference between groups of 1.16, 1.99, and 1.78 mm, at 6, 18, and 24 months, respectively; P <0.05). Also, the proportion of sites showing >or=2 mm PD reduction was greater for SRP-D at 6 months (81.2% x 50.8%; P <0.001) and at 24 months (65.5% x 46.5%; P = 0.01). As for RAL gain, this proportion was 34.4% and 18.1% for SRP-D and SRP at 24 months, respectively (P = 0.008). CONCLUSION: The use of locally delivered doxycycline may constitute an important adjunct for the active and supportive treatments of severe periodontal disease in smokers.