New Method for Local Drug Delivery using Resorbable Base Material in Periodontal Therapy

为了从不同于传统方法的角度控制龈下菌斑，人们进行了一些研究。这些方法，使用中空纤维装置和丙烯酸树脂条似乎对改变牙周袋内的微生物群是有效的。然而，对于常规使用这些方法治疗牙周病，它们存在一些问题。这些方法的问题之一是要求在药物释放后将载体从口袋中取出。另一种是在牙周袋中缺乏载体的保持力。为了克服这些问题，我们发现了一种进入龈下菌斑的新方法。所使用的基础材料是羟丙基纤维素（HPC）。HPC与唾液或龈沟液接触后会缓慢溶解，并附着在牙齿表面和软组织上。使用这种含有四环素（TC）或氯己定（CH）的材料，以条的形式制备，已被发现可以直接将药物输送到牙周袋。研究了该方法对牙周袋微生物组成及临床症状的影响。临床参数的改变、探查深度的减少和探查时出血仅在给予TC的口袋中观察到。TC组和CH组龈下菌斑微生物组成均发生变化。比较全身给药与局部给药，对急性牙周炎患者系统或局部应用抗生素（四环素、二甲胺四环素）。给药7 d后，评估穿刺疼痛程度、穿刺出血及穿刺深度。因此，在地方和系统管理之间没有明显差异。

For the purpose of controlling the subgingival plaque in different ways from the conventional methods, several studies have been made. These methods, using hollow fiber devices and acrylic resin strips seem to be effective in changing the microflora in the periodontal pockets. However, for the routine use of these methods in the treatment of the periodontal disease, they have some problems. One of problems of these methods is to require the removal of the carrier from the pockets after the release of the drugs. The other is the lack of retension of the carrier in periodontal pockets. To overcome these problems, we found a new method for the access to the subgingival plaque. The base material used is made of hydroxypropylcellurose (HPC). HPC dissolves slowly in contact with the saliva or gingival crevicular fluid and adheres to both the tooth surface and the soft tissue. Using this material containing tetracycrine(TC) or chlorhexidine(CH) prepared in the form of strips, it has been found to be possible to deliver the drugs of directly to the periodontal pockets. Effects of this method on the microbial composition in periodontal pockets and clinical symptoms were studied. Changes of clinical parameter, reduction of probing depth and bleeding on probing were observed only in the pockets in which TC administrated. Changes of microbial composition of subgingival plaque were found both in TC and CH administrated pockets.To compare systemic administration with local drug administration, antibiotics (tetracycline, minocycline) applied systematically or locally to patients with acute periodontitis. Seven days after administration of antibiotics, degree of pain, bleeding on probing and probing depth were evaluated. As the result, no significant different were seen between local and systemic administration.