Drug Delivery Systems for Periodontitis

Drug Delivery Systems for Periodontitis2.0 LITERATURE SURVEY2.1 TECHNIQUEPeriodontitis, a disease involving supportive structures of the teeth prevails in all groups, ethnicities, races and both genders. It is a localised inflammatory response caused by bacterial infection of a periodontal theca associated with subgingival plaque. periodontal diseases include conditions such(prenominal) as chronic periodontitis, aggressive periodontitis and necrotizing periodontitis. Aggressive forms of periodontitis piece of ass be localized or generalized. Antibacterial agents have been used rough-and-readyly in the management of periodontal infection. The effectiveness of mechanical debridement of plaque and repeated topical and systemic administration of antibacterial agents are limited due to the lack of approachability to periodontopathic organisms in the periodontal pocket. Systemic administration of do drugss leads to therapeutic concentrations at the site of infection, but for short peri ods of time, forcing repeated dosing for longer periods. Local delivery of antimicrobials has been investigated for the possibility of overcoming the limitations of formulaic therapy. The use of bare burning release formulations to deliver antibacterials to the site of infection (periodontal pocket) is gaining interest. These products provide a long-term, effective give-and-take at the site of infection at oftentimes smaller doses. (Kaplish et al. 2013)Formulation and development of a gel based topical dosage form for antimicrobial drug will be proved to be worthwhile like ability to deliver drug more selectively to a specific site, avoidance of gastro-intestinal incompatibility, providing utilization of drugs with short biological half-life, improving physiological and pharmacological response and provide suitability for self medication. (Basavaraj et al. 2012)2.1.1 Periodontal Local Drug DeliveryGoodson et al in 1979 first proposed the concept of controlled delivery in the t reatment of periodontitis. The effectiveness of this form of therapy is that, it reaches the base of periodontal pocket and is maintained for an adequate time for the antimicrobial effect to occur. These delivery systems are also called sustained release, controlled-release, prolonged release, timed release, slow release, sustained action, prolonged action or extended action. There are distinct phases in a periodontal treatment plan where a dental practitioner can use this sustained release device.They are as followsAs an adjunct to Scaling and Root planning.Periodontal maintenance therapy Recurrent periodontitis usually involves only a few teeth. These sites are ideal for the treatment with this device.For whom surgery is not an option or those who renounce surgical treatmentSustained release device is a less invasive treatment option and it requires less time compared to surgical treatment. (Kaplish et al. 2013)2.1.1.1 Types of local drug delivery devicesSustained released device s These are delivery systems whose action lasts less than 24 hours therefore require multiple applications. It follows the first order kinetics.Controlled delivery devices These are the devices which follows nothing order kinetics and whose actions last longer than 24 hours, thereby decreasing the number applications. (Greenstein et al. 2000)2.1.1.2 Advantages of local drug delivery systemProvides drug in an effective concentration that can be maintained there long enough for the desired effect to be accomplished without causing any side effect.It can attain upto 100 fold higher concentration of an antimicrobial agent in subgingival site compared with a systemic therapy.Broad spectrum antibiotics which cannot be employed systemically because of some sideeffects can be safely employed locally with minimum side effects.Superinfection and drug resistance are rare. It also reduces the risk of developing drug disgusting microbial populations at non oral body sites.The potentials of daily drug placement into periodontal pockets as a part of home self care outgrowth can be performed by a compliant patient.This route may employ antimicrobial agents not suit fitted for systemic administration such as various broad spectrum antiseptics solutions. e.g. chlorhexidineImprove the patient compliance. (Slots et al. 1996 and Chadha et al. 2012)2.1.1.3 Disadvantages of local delivery systemInaccessible and deeper pocket areas, furcations cannot be completely dealt with antimicrobial agents.Time consuming and laborious, if many sites are involved.Non-sustained local delivery is limited by an only brief exposure of targeted microorganisms to applied antimicrobial agent.Connective tissue associated plaque and extra pocket oral surfaces dont get affected by local drug delivery which may be responsible for recurrence of disease in treated areas.Difficulty in placing therapeutic concentration of antimicrobial agent into deeper parts of periodontal pockets and furcations lesions .Personal application of antimicrobial agents by patients as a part of their home self-care procedure is frequently compromised by the patients lack of adequate manual dexterity, limited understanding of periodontal anatomy and sad compliance and performance with recommended procedures. (Axelsson 1999)2.1.1.4 Local drug delivery systems for treating periodontitisVarious local drug delivery system for treating periodontitis-Fibers, Film, Injectable systems, Gels, Strips and compacts, Vesicular systems, Microparticle system, Nanoparticle system and so onInjectable drug delivery systemsInjectable systems are particularly attractive for the delivery of antibiotic agents into the periodontal pocket. The application can be easily and rapidly carried out, without pain, by using a syringe. Thus, the cost of the therapy is considerably reduced compared to devices that need time to be placed and secured. Moreover, an injectable delivery system should be able to fill the pocket, thus reachi ng a large proportion of pathogens. Two types of injectable drug delivery systems have been studied in periodontal diseases- biodegradable (1) microparticles and (2) gels. (Kaplish et al. 2013)1. Microparticles /MicrospheresThese are controlled release drug delivery system which comprises of drug-containing microparticles or microspheres, between 10 and 500 microns in size, suspended in a pharmaceutically acceptable attack aircraft carrier medium, and are capable ofmaintaining an effective level of drug in the periodontal pocket for a period of one to thirty days. They are spherical free flowing particles consisting of proteins or synthetic polymers. Non-biodegradable as well as biodegradable materials have been investigated for the preparation of microspheres.There are two types of microspheresa) Microcapsules.b) Micromatrices.In microcapsules entrapped substance is intelligibly surrounded by distinct capsule wall and in micromatrices entrapped substance is dispersing throughout the microspheres matrix. Solid biodegradable microspheres incorporating a drug dispersed or turn through particle matrix have the potential for the controlled release of drug. They are made from polymeric, waxy, or other protective materials (i.e. biodegradable synthetic polymers and modified congenital products). (Chaudhari et al. 2010)Advantages of microspheresConstant and prolonged therapeutic effect.Reduction in dosing frequency and thereby improve the patient compliance.They could be injected into the body due to the spherical shape and smaller size.Better drug utilization will improve the bioavailability and reduce the incidence or intensity of adverse effects.Microsphere morphology allows a controllable variability in degradation and drug release.