Local Drug Delivery in the Treatment of Periodontal Diseases: Assessing the Clinical Significance of the Results

Background: Local drug delivery can be used in the management of periodontal patients. However, statistically significant responses to therapy recorded in clinical trials may not be clinically significant. Methods: Controlled clinical trials were selected that assessed the capability of local drug delivery to improve periodontal health. Results: Several local drug delivery systems employed as monotherapies improved periodontal health and provided results that were not statistically significantly different than attained with scaling and root planing (SRP) alone. In contrast, many local drug delivery devices when used as adjuncts to SRP provided a statistically significant enhancement of parameters commonly used to monitor periodontal status. However, mean improvements with respect to probing depth reduction or gain of clinical attachment were often limited to tenths of millimeters. Several devices also achieved specific criteria that can be used to identify clinically significant findings (e.g., number of sites with probing depth reduction ≥2 mm). However, there are conflicting data with respect to the ability of local drug delivery to enhance results of SRP at deep probing sites, and there is limited information relative to its capability to inhibit disease progression or enhance osseous repair in infrabony defects. Conclusion: The decision to use local drug delivery during active treatment or maintenance should be based upon clinical findings, responses to therapy recorded in the literature, desired clinical outcomes, and the patient's dental and medical history.