Literature Report: Custom Tray Application of Peroxide Gel as an Adjunct to SRP
The Journal of Clinical Dentistry has published a recently completed study showing the positive effectiveness of using customized trays in the treatment of patients with moderate to advanced periodontitis.
The primary treatment for periodontal disease has been traditional scaling and root planing, followed by surgery if necessary. The delivery of antimicrobial medicaments via customized treatment trays is a new idea that is finding continued acceptance and validation.
The Journal of Clinical Dentistry has published a recently completed study showing the positive effectiveness of using customized trays in the treatment of patients with moderate to advanced periodontitis, showing demonstrated statistically significant clinical improvements in pocket depths and bleeding when compared with scaling and root planing alone. The study was supported by Perio Protect, LLC. Study title is “Custom Tray Application of Peroxide Gel as an Adjunct to Scaling and Root Planing in the Treatment of Periodontitis: A Randomized, Controlled Three-Month Clinical Trial.”
The study points out the limitations of SRP due to restricted vision, the challenges of removing all bacteria from grooves, furcations, dentinal tubules and soft tissues, along with the constant introduction and regeneration of viable bacterial populations following active SRP therapy. These are among the many reasons which necessitate frequent intervals for the patients with active periodontal disease or pocket depths of any significance. An added perspective is the known systemic threats due to bacteremia risks imposed with active traditional therapy, especially in patients with already compromised health issues.
All of these patients benefit from antimicrobial therapy taking an adjunctive chemotherapeutic approach to assist in the halting of the perio inflammatory process. These newer measures now include local delivery of bacteriostatic antibiotics such as doxycycline (Atridox®)and minocycline (Arestin®), as well as bactericidals such as chlorhexidine gluconate (Periochip®).
Each of these locally delivered antimicrobials have their advantages and disadvantages, including home care restrictions, biofilm resistance, allergies and sensitivities, and resistant microorganisms or commensal organisms, and limitations on continued usage.
Peroxides have been utilized to subdue and treat oral biofilms for many years and enjoy a long-term safety record. Peroxides break down into oxygen water, making anaerobic bacterial populations especially vulnerable to their oxygenating effects.
The problem with delivering perioxide antimicrobials has not been in their effectiveness as an antimicrobial agent, but in the relative inability to deliver them to the subgingival arena where the true battle of the biofilm and the inflammatory challenge lives. This is due to both the nature of deep inaccessible pockets as well as the outward fluid flow characteristics of the sulcular fluid. Overcoming the positive outward fluid pressure and moving medicaments “upstream” against this flow has been an ongoing problem.
This study population of 31 qualifying adults with chronic periodontal disease, showed the effectiveness of a prescription tray delivery of 1.7% hydrogen peroxide gel to treat periodontal disease. Quoting from the study we read “The results of this study demonstrated that the peroxide/prescription tray treatment regimen in combination with SRP was statistically significantly more effective than traditional SRP therapy alone in reducing pocket depths and bleeding both two weeks and 10 weeks after SRP. Moreover, the effectiveness of the peroxide/prescription tray system was manifested at all sites throughout the mouth, and encompassed both initial shallow (≤ 5 mm) and deep (>5 mm) periodontal pockets.”
Interestingly, the study also showed that using this regimen for two weeks prior to SRP, it significantly reduced pocket depths and bleeding without mechanical intervention.
Ref: J Clin Dent 2012;23:48-56
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