Mystery and misery of locally-delivered drug therapy in periodontics. Historical concepts and current state.

The primary objective is to critically analyze approaches to local therapy for periodontal disease, particularly in light of its well-established systemic implications. We specifically address common misconceptions and overestimations regarding the potential of local treatments in contrast to their actual clinical effectiveness. Historically, the therapeutic approach to periodontitis has concentrated on local intervention within periodontal pockets. Local drug delivery systems show potential for targeting periodontal infections with high drug concentrations while minimizing systemic side effects. This could potentially help overcome the challenges posed by microbial biofilms. However, evidence suggests that periodontitis is not a disease affecting only confined areas of a dentition. Currently, in the presence of multiple deep pockets, local therapy is less cost-effective than systemic antibiotics due to the costs of products and the extensive professional chair time required for their application. Isolated deep pockets in otherwise stable dentitions are often caused by problems that cannot be resolved with antimicrobial agents. Finally, recurrent biofilm formation in residual pockets during the maintenance phase can be addressed through suitable physical rather than chemical procedures.