The Effect After The Minocycline-HCL Sustained Release Ointment Treatment Chronic Generalized Periodontitis With Advanced Loss Of Periodonta

BackgroundChronic periodontitis with advanced loss of periodonta, which is a bad type in adult populations, is a response to the over-growth of anaerobic organisms such as bacteroides and aerobic organisms such as spirochaetes, in the subgingival plaque. Treatment aimed at controlling periodontal disease should contain one or more antimicrobial components directed to the reduction and elimination of periodontopathic organisms.Nowadays, novel drug delivery systems are becoming very popular. Minocycline ointment is one type of local sustained release drug. Minocycline is a potent semisynthetic tetracycline analog with activity against a wide range of gram-positive and gram-negative organisms. It is a subgingival sustained release product containing antibiotic minocycline hydrochloride incorporated into a bioresorbable polymerfor professional subgingival administration into periodontal pockets. Minocycline has a broad spectrum of activity. It is bacteriostatic and exerts its antimicrobial activity by inhibiting protein synthesis.To test the activity of periodontitis is popular for research of periodontitis. Measuring ginglval crevicular fluid (GCF) volumes and running biological assays of fluid components is a important form of analysis. GCF volume used as a marker for diagnosing recent or current disease activity were comparable to GCF- ALP levels. The result of crevicular fluid volume test between periodontitis and gingivitis :it is much more the volume of GCF from periodontitis than gingivitis. Alkaline phosphatase (ALP) is a host enzyme that allows bone deposition by hydrolysing inorganic pyrophosphate, which is a potent inhibitor of the mineralization process. Periodontal cells, such as fibroblasts of the periodontal ligament (PDL) and osteoblasts of the alveolar bone, have ALP activity . The level of GCF -ALP and probe deepth are relative to bone loss.It is higher in the group of periodontitis than the normal and gingivitis. Source of ALP in GCF in both healthy and diseased conditions is thought to be neutrophils . Thus its level essentially reflects the extent of neutrophil influx into the gingival tissues and their migration through crevicular and junctional epithelia into the crevice. ALP enters GCF independently of fluid flow. This may be explained by the different factors involved in crevicular fluid flow and egress of PMNLs (the major source of ALP) from the blood stream. With hindsight, it seems logical that a marker of inflammation will not perform as well in the prediction of periodontal ligament and bone destruction as it does in predicting inflammatory change, ALP were significantly raised at active sites. It would now seem timely for dual marker systems to be evaluated in the hope of improving sensitivity and specificity values over individual marker systems. ALP enters GCF independently of fluid flow. This may be explained by the different factors involved in crevicular fluid flow and egress of PMNLs (the major source of ALP) from the blood stream. GCF flow is influenced by an acute inflammatory process resulting from increases in vascularity and vascular permeability in the region of insult. High alkalinephosphatase activity is shown in the periodontal ligament due to the constant renewal of this tissue or pathological circumstances.ObjectiveTo observe effect in Chronic Periodontitis With Advanced Loss of Periodonta after treated the minocycline-HCL sustained release unguent as local drug delivery in the periodontal pocket as the auxiliary treatment of periodontitis. When assessing the ability of a particular parameter to predict disease activity it is necessary to analyse data collected prior to the episode of the level of ALP in GCF^ pocket probe deepth > attachment loss.MethodsPatient Selection:28 previously untreated Chronic Generalized Periodontitis With Advanced Loss of Periodonta patients were recruited to this study and a rolling program of appointments was adopted.,17 male and 11 female, 38±15.6 age .Patients fitting any one of the following criteria were excluded from the study:1. Those with no any medical history deemed relevant to their periodontal condition.2. Those who hadn't taken any antimicrobial drug within 3 months of the initial visit.3. Those who hadn't taken any peridontol local treatment with in 3 month of the initial visit.4. Those patients who required regular medication for whatever reasons.5. Those patients who were not pregnant.6. No heart disease, hepatitis and bibulosity.7. The tooth which we choiced must have PD=4mm and AL=4mm.8. There are more than 20 tooth in mouth of a patient.Group and treatment method:A split mouth therapy design described by was used to compensate for the biological variability of individual patients. Each pair of teeth was divided randomly into two groups:the treatment group and the control group by random control singel-blind method. The most common form of initial treatment for periodontal disease is full mouth scaling and root planing (SRP), All treatment was performed by an experienced periodontist. The test group was treated with the minocycline-HCL sustained release unguent in the pocket once a week for 4 weeks, while the control group with nothing. GCF "T4^ ALP Gingival crevicular fluid(GCF) was collected on Periodontal special strips and sampled repeatedly by the interval of 20minutes,with intra-pocket method .To examine the level of alkaline phosphatase (ALP) in gingival crevicular fliud(GCF) after and before treatment. Probing attachment levels and recession levels were then recorded at 6 sites per tooth (buccally and lingually at the mesial, mid and distal aspects)Statistical analysis:Analysis of data was performed by software SPSS12.0 Results:1. The level of alkaline phosphatase (ALP) in gingival crevicular fliud(GCF) bothobviously decline after reatment between the test and the control group (P< 0.01) . The results of the test group were better than that of the control ones2. The level of PocketPprobing Depth both obviously decline after reatmentbetween the test and the control group (P<0.01) . The results of the test group were better than that of the control ones3. The levels of Probing Attachment Loss both obviously decline after reatmentbetween the test and the control group (F<0.01) . The results of the test group were better than that of the control ones4. The level of Gingival Index both obviously decline after reatment betweenthe test and the control group (P<0.01) . The results of the test group were better than that of the control onesConclusions:1. Both the basic treatment and minocycline-HCL periodontal sustained release unguent in the treatment of periodontits is better than the single basic treatment for the level of ALP in CGF. Minocycline hydrochloride is a subgingival sustained release product containing the antibiotic for the inflammation in periodontal pockets tissue. It has good antimicrobial activity .2. There is no change between the treatment group and the control group for Attachment Loss. Both the basic treatment and minocycline-HCL periodontal sustained release unguent in the treatment of Attachment Loss is no effect.3. In conclusion , the results suggest that the use of controlled topical application of SRS and tetracycline HCl may improve periodontal health and reduce the risk of disease progression in localized persistent or recurrent periodontitis. It is concluded that chips of tetracycline HCl may be a useful method, adjunct to routine mechanical methods of root debridement and also avoiding large oral doses of drug administration and related side-effects.