Dunlap Tanya, Keller Duane C, Marshall Milton V, Costerton J William, Schaudinn Christoph, Sindelar Betty, Cotton John R
Perio Protect LLC, St. Louis, MO, USA.
J Clin Dent. 2011;22(5):149-58.
This study is a proof of concept to determine the efficacy of a custom-fabricated tray in placing antimicrobial and debriding agents in the periodontal pockets of persons with active gingival infections. Localized subgingival delivery of antimicrobial and antibiotic agents is routinely employed as adjunctive therapy for the treatment and management ofperiopathogens associated with periodontal disease. Because these delivery techniques often face time constraints and impose temporary restrictions on patient brushing and flossing, a custom-formed prescription dental tray can be used to deliver and maintain medications in periodontal pockets between office visits and without brushing or flossing restrictions. The ability of this tray to maintain sufficient concentrations of medication in the periodontal pockets to have a therapeutic effect is evaluated here with theoretical modeling and practical application.
Hydrogen peroxide is an oral debriding agent and oral wound cleanser with antimicrobial properties. The debriding effect of 1.7% hydrogen peroxide gel was tested in vitro on Streptococcus mutans biofilm using glass carriers for collection. Diffusion modeling tested the potential of the customized tray to place hydrogen peroxide gel into the sulcus in the presence of crevicular fluid flow. Changes in periodontal microflora with scanning electron microscopy analysis of in vivo paper point site sampling were analyzed before and after a thin ribbon of 1.7% hydrogen peroxide gel (approximately 0.7 gm) and a subtherapeutic dose (three drops) of Vibramycin (50 mg/5 ml) were placed via Perio Trays into periodontal pockets, ranging from 4-8 mm at daily prescribed intervals for two to five weeks.
In vitro results indicate that 1.7% hydrogen peroxide gel breaks down the exopolysaccharide slime and cell walls ofS. mutans, and begins to debride the cells from glass carriers within 10 minutes. Diffusion modeling indicates that hydrogen peroxide can penetrate into the deeper pockets (9 mm), but also its concentration in these deep pockets will increase over wearing time in the absence of degradation by peroxidases and catalase. Site sampling data confirm diffusion modeling results, with evidence that medication delivered with the prescription tray reduced subgingival bacterial loads and enhanced healing of corresponding oral tissues.
The prescription Perio Tray effectively placed medication in the gingival sulcus. Mathematical modeling indicated Perio Tray placement of hydrogen peroxide gel in periodontal pockets with depths up to 9 mm over 15 minutes treatment time was theoretically possible. Pathology reports reveal reductions in subgingival bacterial loads and improvements in pretreatment pocket depths of up to 8 mm after 1.7% hydrogen peroxide and Vibramycin Syrup were prescribed for use with the Perio Tray. The in vitro analysis indicating that hydrogen peroxide is the active and effective oral debriding agent needs to be confirmed with additional studies.
本研究是一项概念验证研究，旨在确定定制托盘在向患有活动性牙龈感染的人的牙周袋中放置抗菌和清创剂的效果。局部龈下递送抗菌剂和抗生素通常用作与牙周病相关的牙周病原体治疗和管理的辅助疗法。由于这些递送技术常常面临时间限制，并对患者刷牙和使用牙线施加临时限制，因此可以使用定制的处方牙科托盘在就诊期间在牙周袋中递送和维持药物，且不受刷牙或使用牙线的限制。在此通过理论建模和实际应用评估该托盘在牙周袋中维持足够药物浓度以产生治疗效果的能力。
过氧化氢是一种具有抗菌特性的口腔清创剂和口腔伤口清洁剂。使用玻璃载体收集，在体外测试1.7%过氧化氢凝胶对变形链球菌生物膜的清创效果。扩散模型测试了定制托盘在存在龈沟液流动的情况下将过氧化氢凝胶放入龈沟的潜力。在通过牙周托盘将一条1.7%过氧化氢凝胶（约0.7克）薄带和亚治疗剂量（三滴）的强力霉素（50毫克/5毫升）以每日规定的间隔放入4-8毫米深的牙周袋中两至五周之前和之后，通过扫描电子显微镜分析体内纸尖位点采样来分析牙周微生物群的变化。
体外结果表明，1.7%过氧化氢凝胶可分解变形链球菌的胞外多糖黏液和细胞壁，并在10分钟内开始从玻璃载体上清除细胞。扩散模型表明过氧化氢可以渗透到更深的牙周袋（可达9毫米），而且在没有过氧化物酶和过氧化氢酶降解的情况下，其在这些深牙周袋中的浓度会随着佩戴时间增加。位点采样数据证实了扩散模型结果，有证据表明用处方托盘递送的药物减少了龈下细菌载量并促进了相应口腔组织的愈合。
处方牙周托盘有效地将药物放置在龈沟中。数学模型表明，在15分钟的治疗时间内，理论上有可能通过牙周托盘将过氧化氢凝胶放置在深度达9毫米的牙周袋中。病理报告显示，在将1.7%过氧化氢和强力霉素糖浆与牙周托盘一起使用后，龈下细菌载量减少，治疗前牙周袋深度改善达8毫米。体外分析表明过氧化氢是一种有效的口腔清创剂，这一结果需要更多研究来证实。
