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Editorial

Dr. Parvez A. Khan

Authors : Dr. Parvez A. Khan .

Treatment for Chronic Periodontitis (Contd…)

Guided Tissue Regeneration (GTR) using PTFE membranes is favored by some dentists. GTR has a greater effect on probing measures of periodontal treatment than open flap debridement, including improved attachment gain, reduced pocket depth, less increase in gingival recession and more gain in hard tissue probing at re-entry surgery. However there is marked variability between studies and the clinical relevance of these changes is unknown. As a result, it is difficult to draw general conclusions about the clinical benefit of GTR.

Whilst there is evidence that GTR can demonstrate a significant improvement over conventional open flap surgery, the factors affecting outcomes are unclear from the literature and these might include study conduct issues such as bias. Another treatment for chronic periodontitis is Enamel matrix matrix derivative (EMD) is favored by some dentists despite its high cost. One year after its application, EMD significantly improves probing attachment levels (1.1 mm) and probing pocket depth reduction (0.9 mm) when compared to a placebo or control.

With the exception of significantly more postoperative complications in the GTR group, there was no evidence of clinically important differences between GTR and EMD. Another treatment line for chronic periodontitis is Adjunctive systemic antibiotic treatment.Systemic antibiotics such as amoxicillin or metronidazole are sometimes used in addition to debridement based treatments.Systemic antimicrobials in conjunction with scaling and root planning (SRP), can offer an additional benefit over SRP alone in the treatment of periodontitis, in terms of clinical attachment loss (CAL) and probing pocket depth (PPD) change, and reduced risk of additional CAL loss.

Locally delivered adjunctive antimicrobial treatment can also be used wherechemical antimicrobials may be used by the clinician to help reduce the bacterial load in the diseased pocket.Among the locally administered adjunctive antimicrobials, the most positive results occurred for tetracycline, minocycline, metronidazole, and chlorhexidine. Adjunctive local therapy generally reduced PD levels. Minocycline is typically delivered via slim syringe applicators. Chlorhexidineimpregnated chips are also available.

Hydrogen peroxide is a naturally occurring antimicrobial that can be delivered directly to the gingival sulcus or periodontal pocket using a custom formed medical device called a Perio Tray. Hydrogen peroxide gel was demonstrated to be effective in controlling the bacteria biofilm. Sub-antimicrobial doses of doxycycline (SDD) have been used to alter host response to the periodontal pathogens. This is believed to disrupt the action of matrix metalloproteinases and thus minimise host mediated tissue destruction. Lasersare increasingly being used in treatments for chronic periodontitis. However there is some controversy over their use.
 

Editor

Dr. Parvez A. Khan
Dr. Parvez A. Khan