Last month, we discussed stages of periodontal disease, types of periodontal bone loss, and when to recommend advanced periodontal disease treatments. This column discusses the history and the growing variety of periodontal products/devices that can be used in periodontal pockets. November 1997 saw the first “perioceutic” approved by the U.S. Food and Drug Administration (FDA) for treatment of periodontal disease in dogs. A study done in 2002 found a single treatment of periodontal pockets with a doxycycline polymer can reduce periodontal pocket depth, increase reattachment, and reduce gingival inflammation.1 This product is similar to a human periodontal pocket treatment called Atridox. A study in beagles showed improved pocket depths when doxycycline polymer was placed compared to the delivery system of just polymer. In each animal, three teeth with multiple pockets (mean depth = 6.0 mm) were treated with a single application of either doxycycline polymer gel (experimental group) or the polymer alone without the doxycycline (control group). In one month, mean probing depth reduction was 2.4 mm, and this was maintained for four months (mean reduction = 2.5 mm).2 Figure 1. A periodontal curette is utilized to remove subgingival calculus and to debride the subgingival soft tissues. Photo courtesy Dr. John R. Lewis A 2 percent clindamycin hydrochloride gel was later introduced to the veterinary market. A 2011 study in the Journal of Veterinary Dentistry evaluated a clindamycin gel that has mucoadhesive properties (CHgel). A professional teeth cleaning procedure, including scaling and root planing, was done in dogs, with one group receiving CHgel following treatment. Periodontal health was determined before and after the procedure, including measurement of periodontal pocket depth, gingival index, gingival bleeding sites, and number of suppurating sites. There was a statistically significant decrease in periodontal pocket depth (19 percent), gingival index (16 percent), and the number of bleeding sites (64 percent) in 90 days in dogs receiving CHgel. Gingival cells in culture rapidly incorporated clindamycin and reached saturation within approximately 20 minutes.3 However, not all studies have found a favorable effect from the placement of doxycycline or clindamycin into periodontal pockets. A 2019 study in the Journal of the American Veterinary Medical Association suggested what you place into a periodontal defect is less important than what you remove from the periodontal pocket. The study compared improvements in values for periodontal disease indices in dogs following treatment with closed root planing (CRP) alone, CRP with concurrent 8.5 percent doxycycline hyclate gel application, and CRP with concurrent 2 percent clindamycin hydrochloride reverse-polymer hydrogel application. This randomized, blinded, controlled clinical trial enrolled 34 client-owned dogs with periodontal pockets measuring 3.5 to 5.5 mm deep. Dogs were randomly assigned to receive one of three treatments: CRP alone (n = 10) or CRP plus 8.5 percent doxycycline hyclate (12) or 2 percent clindamycin hydrochloride (12) gel applied within the periodontal pockets. Indices of periodontal disease severity were recorded before and 12 weeks after treatment, and outcomes were compared among treatment groups. Except for the gingivitis index, no significant differences were observed among the 3 treatment groups in the amount of improvement in periodontal disease indices following treatment. Adding doxycycline or clindamycin gel to CRP for the treatment of periodontal disease in dogs yielded no clinically relevant benefit over CRP alone during the 12-week follow-up period.4 Therefore, it is imperative to master the art of thorough ultrasonic scaling followed by root planing and gingival curettage. Several new products have recently hit the market. I will discuss one below, and next month, I will continue our discussion of periodontal pocket treatments, including products that may have osteoconductive or osteoinductive properties. Hyaluronic acid (HA) has been documented to support wound healing and modulate inflammation in diseased gingival tissues. Topical HA may be placed after scaling, root planing or flap debridement to support soft tissue healing and to modulate inflammation. HA is a naturally occurring glycosaminoglycan that contributes to extracellular matrix organization, cell migration, and tissue hydration. In animal studies, canine models have demonstrated the efficacy of HA as an adjunct to periodontal interventions, particularly in improving bone and soft tissue regeneration in controlled experimental settings. Figure 2. A composite filling instrument is used to gently pack doxycycline perioceutic into the periodontal pocket. Photo courtesy Dr. John R. Lewis Similarly, human studies have shown statistically significant improvements in periodontal outcomes, including probing depth, clinical attachment levels, and decreased periodontal inflammation, when HA is used as an adjunct to scaling and root planing or surgical procedures.5 John Lewis, VMD, DAVDC, FF-OMFS, practices veterinary dentistry and oral surgery at Veterinary Dentistry Specialists and teaches at Silo Academy Education Center, both located in Chadds Ford, Pa.
