19Nov 2019

SYNTHESIS AND EVALUATION OF A MUCO - ADHESIVE HYDROGEL CONTAINING DOXYCYCLINE AND METRONIDAZOLE FOR LOCAL DRUG DELIVERY FOR THE TREATMENT OF PERIODONTITIS

  • Department of Periodontics, College of Dental Sciences, Davangee, Karnataka, India
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Background: The current knowledge and understanding of Periodontitis shows that the best chance for clinical improvement may be obtained from implementing complementary strategies like the reduction of the bacterial burden, host modulation, and risk factor modification that targets different aspects of the periodontal balance. The reduction of bacterial burden by Scaling and root planing is the cornerstone of treatment and can be augmented by the use of local antimicrobials with or without host modulation. The aim of the present study was to synthesize and evaluate a muco-adhesive hydrogel matrix carrying 1% Metronidazole (a local antimicrobial) and 2% Doxycycline (a host modulating agent) in the treatment of Periodontitis. Methodology: A chitosan based hydrogel containing 1% metronidazole and 2% doxycycline was synthesized and evaluated for Minimum Inhibitory Concentration (MIC). Twenty Periodontitis patients with at least one site of probing pocket depth 5-7 mm were selected and randomly divided in to control and test groups. Full mouth Scaling and root planning was done in all 20 patients at the first visit and the baseline clinical parameters were recorded. Only the test group patients received intra-pocket delivery of the hydrogel containing 1% metronidazole and 2% doxycycline. All Patients were recalled after 14 days and 30 days for assessment of clinical parameters. Results: The Minimum Inhibitory Concentration of the prepared hydrogel against the prime periodontal pathogens, Porphyromonas gingivalis, Tanerella forsythia, Fusobacterium nucleatum, Prevotella intermedia was found to be as low as 0.4?g/ml. Both groups showed a statistically significant decrease in gingival index scores. However, test group patients showed a significantly higher reduction in probing pocket depths and gingival index scores when compared to the control group. There was no significant improvements in clinical attachment levels in both groups. Conclusion: In this study, the prepared hydrogel containing doxycycline and metronidazole showed the potential to be used as a local drug delivery agent as an adjunct to scaling and root planing in the treatment of Periodontitis. However, future studies with larger sample size and longer duration are needed to explore the efficacy of the gel.

  1. Chen, S. C., Wu, Y. C., Mi, F. L., Lin, Y. H., Yu, L. C., & Sung, H. W. (2004). A novel pH-sensitive hydrogel composed of N, O-carboxymethyl chitosan and alginate cross-linked by genipin for protein drug delivery.?Journal of Controlled Release,?96(2), 285-300.
  2. de Abreu, F. R., & Campana-Filho, S. P. (2009). Characteristics and properties of carboxymethylchitosan.?Carbohydrate Polymers,?75(2), 214-221.
  3. Gad, H. A., Kamel, A. O., Ezzat, O. M., El Dessouky, H. F., & Sammour, O. A. (2017). Doxycycline hydrochloride-metronidazole solid lipid microparticles gels for treatment of periodontitis: development, in-vitro and in-vivo clinical evaluation.?Expert opinion on drug delivery,?14(11), 1241-1251.
  4. Golub, L. M., Lee, H. M., Ryan, M. E., Giannobile, W. V., Payne, J., & Sorsa, T. (1998). Tetracyclines inhibit connective tissue breakdown by multiple non-antimicrobial mechanisms.?Advances in dental research,?12(1), 12-26.
  5. Golub, L. M., Ramamurthy, N. S., McNamara, T. F., Greenwald, R. A., & Rifkin, B. R. (1991). Tetracyclines inhibit connective tissue breakdown: new therapeutic implications for an old family of drugs.?Critical Reviews in Oral Biology & Medicine,?2(3), 297-321.
  6. Golub, L. M., Suomalainen, K., & Sorsa, T. (1992). Host modulation with tetracyclines and their chemically modified analogues.?Current opinion in dentistry,?2, 80-90.
  7. Greenstein, G. (2005). Changing periodontal concepts: treatment considerations.?Compendium of continuing education in dentistry (Jamesburg, NJ: 1995),?26(2), 81-2.
  8. Jepsen, S., Deschner, J., Braun, A., Schwarz, F., & Eberhard, J. (2011). Calculus removal and the prevention of its formation.?Periodontology 2000,?55(1), 167-188.
  9. L?fmark, S., Edlund, C., & Nord, C. E. (2010). Metronidazole is still the drug of choice for treatment of anaerobic infections.?Clinical infectious diseases,?50(Supplement_1), S16-S23.
  10. Sedlacek, M. J., & Walker, C. (2007). Antibiotic resistance in an in vitro subgingival biofilm model.?Oral microbiology and immunology,?22(5), 333-339.
  11. Nastri, L., De Rosa, A., De Gregorio, V., Grassia, V., & Donnarumma, G. (2019). A New Controlled-Release Material Containing Metronidazole and Doxycycline for the Treatment of Periodontal and Peri-Implant Diseases: Formulation and In Vitro Testing.?International journal of dentistry,?2019.
  12. Novak, M. J., Dawson, D. R., Magnusson, I., Karpinia, K., Polson, A., Polson, A., ... & Powala, C. (2008). Combining host modulation and topical antimicrobial therapy in the management of moderate to severe periodontitis: a randomized multicenter trial.?Journal of periodontology,?79(1), 33-41.
  13. Papapanou, P. N., Sanz, M., Buduneli, N., Dietrich, T., Feres, M., Fine, D. H., ... & Greenwell, H. (2018). Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions.?Journal of periodontology,?89, S173-S182.
  14. Preshaw, P. M. (2008). Host response modulation in periodontics.?Periodontology 2000,?48(1), 92-110.
  15. Larsen, T. (2002). Susceptibility of Porphyromonas gingivalis in biofilms to amoxicillin, doxycycline and metronidazole.?Oral microbiology and immunology,?17(5), 267-271.
  16. Tonetti, M. S., Greenwell, H., & Kornman, K. S. (2018). Staging and grading of periodontitis: Framework and proposal of a new classification and case definition.?Journal of clinical periodontology,?45, S149-S161.
  17. Winkelhoff, A. J. V., Rams, T. E., & Slots, J. (1996). Systemic antibiotic therapy in periodontics.?Periodontology 2000,?10(1), 45-78.

[Shashi Kiran S and Narayan N Valavalkar (2019); SYNTHESIS AND EVALUATION OF A MUCO - ADHESIVE HYDROGEL CONTAINING DOXYCYCLINE AND METRONIDAZOLE FOR LOCAL DRUG DELIVERY FOR THE TREATMENT OF PERIODONTITIS Int. J. of Adv. Res. 7 (Nov). 1031-1037] (ISSN 2320-5407). www.journalijar.com

Dr. Shashi Kiran S
Department of Periodontics, College of Dental Sciences, Davangere, Karnataka, India

DOI:

Article DOI: 10.21474/IJAR01/10110      
DOI URL: https://dx.doi.org/10.21474/IJAR01/10110

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