 |
|
|
|
 |
Trijani Suwandi, drg, Sp. Perio
• Dentist, graduated from Faculty of Dentistry, Trisakti University, year 1993
• Graduated in Periodontics, Faculty of Dentistry, University of Indonesia, year 2003
• Lecturer in Periodontology Department, Faculty of Dentistry, Trisakti University, Jakarta, Indonesia
• Practice :
- Clinical Specialist in Periodontology, Dental Hospital Trisakti University, Jakarta, Indonesia.
Telp (+62 21) 5672731 ext. 1709
- Citra Garden 1 ext. AD-2 no. 15 West Jakarta. Telp (+62 21) 5403753
|
|
CLINICAL EFFECTS OF THE SUB GINGIVAL APPLICATION BETWEEN 25% METRONIDAZOLE GEL
AND 10% POVIDINE-IODINE AS ADJUNCTIVE THERAPY OF SCALING
AND ROOT PLANING IN CHRONIC PERIODONTITIS |
| Trijani Suwandi |
| Participant of Educational Program for Periodontic Specialist |
| Trijani Suwandi : Clinical effects of the subgingival application between 25% metronidazole gel and 10% povidine-iodine as adjunctive therapy of Scaling Root Planing (SRP) in Chronic Periodontitis. Journal of Dentistry University of Indonesia, 2003:10 (Special Edition), 669-674. |
|
|
|
|
This research indicates that among these three acts there are some bleeding reduction after the treatment supported by significant result (p < 0.01) because all of the acts done shows clinical recovery. Scaling and Root Planing is said to be the best basic therapy of Periodontal diseases. Apart from that, it is also influenced by the patients motivation to take care and clean their teeth and mouth regularly. The reduction of gingival bleeding towards patients treated with 25% metronidazole gel and 10% PVP-1 solution is greater than control or Scaling and Root Planing itself. It is accordance with the research done by Drisko (1996)9and Greenstein (2000)10 because in certain circumstances Scaling and Root Planing alone sometimes has limitations in reaching the basic pocket depth, especially in  5mm, using dental equipments. Besides that, teeth anatomy, such as bifurcation, can make the dental equipments difficult to reach the target area. The use of local anti microbial can eliminate bacterial causing Periodontal diseases. The reduction of gingival bleeding towards patients treated with 25% metronidazole gel is greater than those treated with 10% PVP-1 solution.
Furthermore, this research also indicated that the three acts have been able to reduce the pocket depth after the treatments with different significantly results (p = 0.001). This is because of that Scaling and Root Planing is a standard therapy. According to Greenstein (2000)10, Scaling and Root Planing can reduce average pocket depth of 1.29mm in 4-6mm pockets and 2.16mm in 7mm pockets. The reduction of pocket depth 25% metronidazole gel act is greater than only control act. This is an accordance with researches done by Stelzel and Flores de-Jacoby (1996)11 as well as Hitzig et al (1994)12. But it is different from the researches done by Pedrazzoli et al (1992)13, Ainamo (1992)14, Palmer et al (1998)15 due to different subject inclusions of the research, i.e. chronic periodontitis with pocket depth of 4-6mm.
The reduction of pocket depth in 10% PVP-1 act is greater than control (Scaling and Root Planing) itself. It is in accordance with researches done by Greenstein (2000)10 and Ervina (2002)15. It is, however, different from researches done by Rosling et al (1986)16 because the concentration of the solution used is 0.5%. At the average, the reduction of pocket depth in 25% metronidazole gel is greater than in 10% PVP-1 solution.
This research also shows that increasing attachment in the three acts are significantly different (p = 0.000) because Scaling and Root Planing is the best basic therapy in Periodontal. The increasing attachment in 25% metronidazole gel act or 10% PVP-1 act is greater than in control (Scaling and Root Planing) alone. This is accordance with Thomas et al’s research (1996)5.
In addition to this, this research of the three acts also indicates better recovery of the clinical effects, such as : having less gingival bleeding, reduction of pocket depth, and increasing attachment. It is because of the fact that if Scaling and Root Planing, as the basic standard therapy is well done effectively; it will result clinical recovery. The use of anti microbial as adjunctive therapy has been able to give better clinical effects than Scaling and Root Planing alone. This is supported by other researchers, such as irrigation of tetracycline and 10% PVP-1, which were done in Periodonsia Clinic of the Faculty of Dentistry in the University of Indonesia.15,17
The use of 25% metronidazole gel as the adjunctive therapy in Scaling and Root Planing has given better clinical result than only 10% PVP-1 solution. Therefore, 25% metronidazole gel is very effective to kill anaerob bacterial causing periodontal diseases, such as P.gingival, P.intermedia, B.forsythus, F.nucleatum, Selenomonas, Campylobacter.3,18 This gel can be directly applied into the periodontal pocket and after its contact with crevicular solution, metronidazole will directly crystallize and step by step it will be released so that it will reach biggest concentration in sulcus solution.1,2
According to Drisko (2001)19 and Pedrazzoli (1992)13 , after 8 hours contact the concentration of metronidazole will be very high reaching about 128 µg/mL which is about 100 times as many as minimal inhibitory factor of the most anaerob bacteria. Thus it can slow down > 90% sub gingival bacteria with the risk of non oral side effects, sensitivity and minimal resistance. After 24 hours, the concentration of metronidazole will be over MIC 50% to kill pathogen periodontal microbes/germs.2,3,20
Metronidazole works by stabbing the membrance of bacterial cells. It will attach DNA and destroy their helic structure of the molecules.20 The damaged DNA will make cells died and the result of this process will be able to kill anaerob microorganism immediately.
Povidone-iodine is a safe, cheap anti microbial which can be easily obtained. It doesn’t cause irritation, bacterial resistance, toxicity and stain; and its bactericidal effects can be gained in the concentration of 5-10%. Moreover, it doesn’t disturb the recovery process.7,11,21 The use of PVP as bactericidal is effective to kill periodontal pathogens, such as A.actinomycetemcomitans, P.gingivalis, P.intermedia, F.nucleatum, E.corrodens and S.intermedius besides its function as fungicide and virisida.11,21 Maruniak et al (1982, cit Greenstein 1999)6 stated that PVP-1 was more effective compared to H2O2, phenol compound, physiologic salt or chlorhexidine because PVP could kill microbial in five minutes.
PVP-1 can react strongly with double strings essential fatty acid in the walls of the cells and organelle membrane. After PVP-1 has interacted with the walls of the cells, it will form temporary or permanent pores which make cytoplasm loss and enzyme activity that binds directly with iodine. PVP-1 can make material coagulation of the nucleus without ruining the wall of the cells.6
|
|
|
|
|
|
|
|
