Arestin Antibiotic Maira Garcia Sarita Patel Oral Health Product Research & Presentation [Dental Health Education - Winter 2019]
What is Arestin? Arestin (minocycline hydrochloride) is a professionally applied subgingival ● sustained-release product into periodontal pockets. ● Each cartridge contains 1 mg of minocycline hydrochloride (active ingredient), which look like tiny bead-like particles.
Indications ● Use as an adjunct to SRP procedures to reduce pocket depth in patients with periodontitis. ● Tetracycline class of antibiotics; broad-spectrum.
Contraindications
Antimicrobial photodynamic therapy vs. local minocycline in addition to non-surgical therapy of deep periodontal pockets: a controlled randomized clinical trial (1) Published Dec 2016 Type of study: Controlled Randomized Clinical Trial Research question: Does Arestin and Antimicrobial photodynamic therapy decrease deep periodontal pockets? Study population: 18 subjects from Germany
Article 1 (cont) Inclusion criteria: Age ≥35 years with minimum of 16 residual teeth, untreated generalized moderate to severe chronic periodontitis Exclusion criteria: Heavy smokers (≥10 cigarettes/day), uncontrolled medical conditions, use of systemic antibiotics during the last 3 months, periodontal treatment during the last 3 months, pregnant or lactating females, aggressive periodontitis
Article 1 (cont) 1. All three groups had SRP 2. Antimicrobial photodynamic therapy test group (aPDT + SRP) 3. Arestin Control group (MC + SRP) Each patient contributed four experimental teeth: one tooth of each quadrant with the deepest periodontal pocket but at least with PPD = 6 mm and bleeding upon probing. Assessments were taken at 6 weeks, 3 months, 6 months, and 12 months after active periodontal therapy.
Article 1 (cont) Results ● 6 weeks and 6 months the aPDT + SRP group and the MC + SRP group showed a higher reduction in bleeding scores than the SRP-alone group ● 12 months bleeding scores increased in the aPDT + SRP group and the SRP alone group while low levels were maintained in the MC +SRP group.
Article 1 (cont) Conclusion All three treatment achieved statistically significant clinical and microbiological ● improvements over time. However, additional use of aPDT or minocycline failed to show any significant additional positive effects compared to SRP alone in deep periodontal pockets.
Antimicrobial therapy using local drug delivery system (Arestin) in the treatment of peri-implantitis. I: Microbiological outcomes (2) Type of study: Clinical case series Research question: Will using Arestin help in treating peri-implantitis? Study population: 25 subjects in Switzerland that had peri-implantitis
Article 2 (cont) Exclusion criteria: Inclusion criteria: Pregnant or lactating ● Ages 35-75 ● ● Local or systemic antibiotics in ● 2 mm bone loss around implant the past 6 months ● Probing depth greater than or ● Uses anti-inflammatory drugs equal to 5 mm Allergic to tetracycline ● ● If they required premedication with antibiotics
Article 2 (cont) Results: Actinomyces ● actinomycetemcomitans was no longer present after Day 90. Pocket depths were reduced and ● maintained for up to 9 months. Successful treatment!
Article 2 (cont) Conclusion: The study reduced the total bacterial load. ● ● The impact on A. actinomycetemcomitans was higher than for other pathogens. ● Also showed lower level of other pathogens, such as, T. forsythia, P. gingivalis, and T. denticola.
Video (3) https://www.youtube.com/watch?v=WMzFV6wtelA (until 3:10)
Two-Year Randomized Clinical Trial of Adjunctive Minocycline Microspheres in Periodontal Maintenance (4) Published April 19, 2018 Type of Study: Randomized Clinical Trial Research question: Will Arestin work in addition to SRP’s? Study population: 60 subjects that have periodontitis, BOP, and >5mm pockets.
Article 3 (cont) Inclusion criteria: 40-85 years of age with deep probing depths, BOP, and inflammation. Drop rate of 16% Exclusion criteria: Some subjects had inadequate experimental sites, medications. Participants had full-mouth periodontal maintenance therapy, along with SRP + MM (arestin) and SRP All measurements were performed at baseline, 6-month, 12-month, 18-month, and 24-month appointments.
Article 3 (cont) Results: ● 5 subjects were below the inclusion of ≥ 5mm. Some had to have teeth extracted. 48 patients had probing depths ≤ 4mm except for one 5-7 mm posterior ● interproximal site with BOP ● Both the SRP+MM and SRP groups each demonstrated significantly reduced Probing pocket depth and CAL from baseline to 24 months.
Article 3 (cont) ● No differences in vertical bone loss between groups at experimental sites.
Article 3 (cont) Conclusion The current study does not allow for the conclusion that scaling and root planing with minocycline microspheres and scaling and root planing alone are equivalent therapies. Improvement in BOP, probing depths, and clinical attachment levels over 24 months. Repeated application of minocycline microspheres was not found to enhance scaling and root planing results.
Comparison of Periochip (chlorhexidine gluconate 2.5 mg) and Arestin (Minocycline hydrochloride 1 mg) in the management of chronic periodontitis (5) Type of study: Comparative study Research question: Will Chlorhexidine or Arestin work better in managing chronic periodontitis? Study population: 20 subjects (12 males, 8 females) Group 1: periodontal pockets on left side were given Periochip Group 2: right side pockets were given Arestin
Article 4 (cont) Exclusion criteria: Inclusion criteria: ● Local or systemic antibiotic ● Ages 30-50 therapy in the past month Systemic disease ● Probing depth 5-8 mm ● BOP on selected teeth ● Adverse reactions to test ● ● No caries or restorations on agents selected teeth ● Anticoagulant therapy Pregnant or lactating ● Effective OH ● ● Smokers
Article 4 (cont) Intervention: Arestin. Patients were recalled after 6 weeks and 3 month intervals. Comparison: Periochip to Arestin in the management of chronic periodontitis.
Article 4 (cont) Results: Reduction in all parameters in both the groups at 6 weeks and 3 months. Conclusion: Both the drugs were equally effective in reduction of plaque and gingival ● scores. ● It was further observed that Arestin resulted in better results at 6 weeks while Periochip showed better results at 3 months.
Demo
References 1. Tabenski L, Moder D, Cieplik F, et al. Antimicrobial photodynamic therapy vs. local minocycline addition to non-surgical therapy of deep periodontal pockets: a controlled randomized clinical trial. Clin Oral Invest. 2016 Nov 23 [cited 2019 Jan 12]21:2253–2264. In: Dentistry & Oral Sciences Source [Internet]. Ipswich (MA): EBSCOhost. Available from: https://ezproxyfh.fhda.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=27909894&site=ehost-live 2. Persson GR, Salvi GE, Heitz-Mayfield LJ, et al. Antimicrobial therapy using local drug delivery system (Arestin) in the treatment of peri-implantitis. I: Microbiological outcomes. Clin Oral Implants Res. 2006 Aug [cited 2019 Feb 16];17(4):386-393. In: Dentistry & Oral Sciences Source [Internet]. Ipswich (MA): EBSCOhost. Available from: https://ezproxyfh.fhda.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=16907769&site=ehost-live 3. OraPharma Official. (2016). [Youtube video]. Available from: https://www.youtube.com/watch?v=WMzFV6wtelA 4. Killeen A, Harn J, Jensen J, et al. Two-Year Randomized Clinical Trial of Adjunctive Minocycline Microspheres in Periodontal Maintenance. The Journal of Den. 2018 Apr [cited 2019 Jan 20];93(4). In: MEDLINE [Internet]. Ipswich (MA): EBSCOhost. Available from: https://ezproxyfh.fhda.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=30143550&site=ehost-live 5. Jhinger N, Kapoor D, Jain R. Comparison of Periochip (chlorhexidine gluconate 2.5 mg) and Arestin (Minocycline hydrochloride 1 mg) in the management of chronic periodontitis. Indian J Dent. 2015 Jan-Mar [cited 2019 Feb 16];6(1):20-26. In: PubMed Central [Internet]. Bethesda (MD): National Library of Medicine (US). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4357074/
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