2. LOCAL DRUG DELIVERY SYSTEM INTRODUCTION  Periodontal disease is associated with bacteria and treatment by chemotherapeutic agents appears to be appropriate  Chemotherapeutic agents may be administered  Delivered locally - Controlled release local delivery systems or  Systemically

3. Advantage  Route is safe and convenient route  Can produce longer duration of action  Offers noninvasive, painless, and simple application  Offers avoidance of GI tract problems  Bypasses the first pass metabolism by the liver

4. Disadvantages  More chair side time  Development of bacterial resistance  No effect on bacterial reservoirs  Hypersensitivity,  More expensive

5. Local drug delivery systems  Tetracycline fibers ( Actisite )  Doxycycline gel ( Atridox )  Minocycline microspheres ( Arestin )  Metronidazole gel ( Elyzol )  Chlorhexidine chip ( Periochip )

6. AGENTS USED IN LOCAL DRUG DELIVERY Antimicrobial Agent Product Tetracycline fibres Actisite MINOCYCLINE GEL dentomycin Minocycline microspheres, ointmentArestinperiocline Doxycycline polymer atridox Metronidazole gel elyzol Chlorhexidine chip periochip

7. Tetracycline Fibre (Actisite)  The first local delivery product available in the U.S.  ethylene/vinyl acetate copolymer fiber, diameter 0.5 mm, containing tetracycline, 12.7;  When packed into a periodontal pocket, it is well tolerated by oral tissues, and for 10 days it sustains tetracycline concentrations  Disadvantages  length of time required for placement (10 minutes or more per tooth)  need for a second appointment for removal  Development of resistant bacteria  Pregnant and nursing mothers

8. Subgingival Delivery of Doxycycline ( Atridox )  It is a gel system containing 10% doxycycline hyclate is contained within a syringe.  The tip of the cannula is introduced to the depth of the pocket and is expressed into the pocket until it just overfills the pocket.  It begins to harden on contact with the moisture in the pocket.

9. MINOCYLINE GEL AND OINTMENT ( periocline )  2% MINOCYCLINE hydrochloride  Once in a week for 4 consecutive weeks  Minocycline Microspheres (ARESTIN)  Antibiotic minocycline hydrochloride micro encapsulated in bio absorbable polymer of polyglycolide.  Maintain therapeutic drug conc 14 days

10. METRONIDAZOLE GEL(ELYZOL dental gel)  containing an oil - based metronidazole 25% dental gel  It is applied in viscous consistency to the pocket, where it is liquidized by the body heat and then hardens again forming crystals in contact with water.  Two 25% gel applications at a 1-week interval have been used

11. CHLORHEXIDINE CHIP (PERIOCHIP)  The chlorhexidine chip is a small bio – degradable film of hydrolysed gelatin into which had been incorporated 2.5 mg of Chlorhexidine gluconate.  The chip is bio - degradable and indicated for use in periodontal pockets that are 5 mm or more.  This delivery system releases chlorhexidine and maintains drug concentrations in the gingival crevicular fluid greater than 100 hg / ml for at least 7 days,