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New Products Update
© 2000 (regarding any printed use)
There are a variety of new products designed for periodontal therapy. Since some may have some strong marketing to consumers being done, there can be some distortion regarding how well these may work. In the eyes of the product manufacturers, their products may be great. However, we as periodontal clinicians frequently do not share the same level of confidence in these products that their manufacturers do. The following is an attempt to discuss new periodontal products from the periodontal clinician's perspective.
Local Delivery Drugs
"Local Delivery Drugs" are those drug products which can be placed directly down into the periodontal "gum pockets" (a "pocket" is where the gum detachment from the tooth is greater than 3mm and is infected). These medications are designed to kill the bacteria in the "pockets" or to keep them from growing and multiplying. These products can not penetrate into the gum tissues where the bacteria may have penetrated in aggressive and severe gum disease. This is a clear shortcoming regarding "local delivery therapy".
"Local Delivery Therapy" is in my opinion a "compromise" treatment. It has some benefit in those cases where the "gum pockets" would otherwise be untreatable. These "untreatable" pockets do exist when the bone loss is so severe that even with surgery there is no reasonably predictable outcome that is favorable. There are 2 major "local delivery products" being sold to periodontists. They are Atridox and the Periochip. My experience with Periochip has been such that I don't use it. I did not find that it significantly improved the health of the gums when it was used. It was also difficult to keep down in a periodontal "pocket".
Atridox has provided a better gum tissue response when it has been used in my practice. Atridox is a gel which is "squirted" into a pocket and this gel carries the antibiotic, doxycycline, which can kill some of the bacteria in the pocket. Even though these bacteria my repopulate the pocket over a period of time, I have seen significant gum tissue shrinkage to the point that I recommend Atridox on those compromised "pockets" that are found in some cases of severe periodontitis.
Oral Antibiotics
Oral antibiotics have been used for years to enhance the results of root planing (non-surgical periodontal therapy). Significantly improved healing can result from this approach with an antibiotic cost that is not very great (under $20.00). A new product, Periostat, is on the market and has gotten a lot of marketing in the media. Periostat is a "low-dosage" antibiotic which works not on the bacteria, but on the enzyme, collagenase which is produced in a gum infection. Collagenase destroys healthy gum tissue. If the Periostat stops the production or reduces the effect of collagenase, then, in theory, there should be no gum disease. The clinical research which supports this product is not very large. The results that they are claiming are not significantly better than what can be obtained with other oral antibiotics which kill the bacteria. However, the cost of Periostat could run from $1.00 - $2.00 per day and need to be taken indefinitely. I do not use Periostat since the other oral antibiotics are more cost-effective and don't require that they be taken for the long time periods that Periostat would require.
Bone Regeneration
There are two main bone regeneration products which have significant promise. They are EMDOGAIN and Pepgen -P- 15. Both of these products have good potential to help re-grow bone in certain type of bone-loss defects! Not all lost bone can be re-grown. There are, however, certain cases where the bone is lost in a pattern where some of the bone can be regenerated. However, these cases are the minority. Most of the bone loss that occurs from periodontal disease can not be regenerated!!!
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