International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064 Index Copernicus Value (2013): 6.14 | Impact Factor (2015): 6.391 Volume 5 Issue 4, April 2016 www.ijsr.net Licensed Under Creative Commons Attribution CC BY Non-Surgical Periodontal Therapy: An Aspect Frequently Overlooked Amit Mani 1 , P. P. Marawar 2 , Raju Anarthe 3 , Rosiline James 4 Department of Periodontology, Rural Dental College, Loni, MH Abstract: Non-surgical periodontal treatment was common 3000-4000 years ago according to analysis of Egyptian hieroglyphics and medical papyri. Even today, scaling and root planing (SRP) remains an essential part of successful periodontal therapy. SRP remains the ‘gold standard’ to which more recently developed therapeutic modalities must be compared. Inherent to the clinical evaluation of SRP are such concerns as manual versus sonic and ultrasonic instrumentation, control of sub-gingival bacterial populations, and removal of calculus, root smoothness and changes in various clinical parameters, e.g. probing depth, attachment levels, bleeding on probing and gingival inflammation. Local drug delivery is used as an adjunct to scaling and root planing. It refers to devices/composition and methods for treating diseases of the oral cavity using non bio degradable devices/composition which are biocompatible but are not bioerodable for releasing drugs in and around a periodontal pocket or a gingival sulcus . [1] This review approaches scaling and root planing and the main delivery systems for the administration of drugs to the periodontal pocket, their usefulness, and the advancement of these systems effectiveness as an adjunct to scaling and root planing in the non surgical periodontal therapy. Keywords: Scaling and root planing, local drug delivery, periocol, periochip 1. Introduction Periodontal disease is the number one chronic infectious disease in the world being the leading cause of tooth loss. It begins as painless infection in the gums that is caused by buildup of bacterial plaque. The treatment modalities that exist for the treatment of gingivitis and Periodontitis depends on the extent and severity, but the primary objective is to restore the gingival health by removing the local factors namely plaque, calculus etc. that provoke inflammation. Non-surgical periodontal therapy or NSPT is one of the management of gingival infection with scaling, root planing, antibiotics and other non surgical means . [2] Periodontitis is an inflammatory reaction of the tissues surrounding a tooth, usually resulting from the extension of gingival inflammation induced by the bacteria residing in the plaque biofilms on the subgingival tooth surface. This causes long junctional epithelium loss in the normally healthy sulcus, thereby developing periodontal pockets resulting in connective tissue attachment loss, formation of intrabony defects and ultimately the possibility of tooth loss. This multi factorial disease affecting up to 30-50% of the adult population, is associated with local as well as systemic symptoms. The chronic nature, as well as the complexity and variety of the associated subgingival bacterial biofilms, are responsible for the numerous virulence factors and inflammatory markers characteristic of chronic periodontitis. Mechanical removal of the biofilms has been the conventional approach to periodontitis therapy. Various local and systemic antibiotic regimens have been utilized in the treatment of periodontitis, but in most cases only slight improvements over mechanical debridement have been noted, along with concern about the development of increasing antibiotic resistance.[3] It has been shown over many studies that standard mechanical debridement can achieve about a one millimeter mean reduction in pocket depth, clinicians also need to consider other factors when treating patients with nonsurgical therapy, including the efficacy of plaque removal. Studies have shown that there is a decreasing efficacy in plaque removal with increasing pocket depth and this is associated with a corresponding decrease in treatment efficacy. [3] Use of local drug delivery devices as a monotherapy remains controversial since root planing alone often achieves a similar result. In general, use of local drug delivery devices should be reserved for sites in patients who fail to respond to mechanical instrumentation. There should be a balance in the use of antibiotics considering the risk of increasing antibiotic resistance. [3] Local delivery of antimicrobials has been investigated for the possibility of overcoming the limitations of conventional therapy. The use of sustained release formulations to deliver antibacterials to the site of infection (periodontal pocket) has recently gained interest. These products provide a long-term, effective treatment at the site of infection at much smaller doses. Biodegradable polymers are extensively employed in periodontal drug delivery devices because of their abundant source, lack of toxicity, and high tissue compatibility. A major advantage of natural polymers is that they do not affect periodontal tissue regeneration. [4] A controlled release drug delivery system for placement in the periodontal pocket comprises of micro particles or micro capsules, herein after referred to as micro particle, suspended in a pharmaceutically acceptable carrier medium. The micro particle is between 10 and 500 microns in size, and consists of an active agent dispersed within or encapsulated by a rate-controlling polymer matrix. Micro particles of this specification can be prepared by a variety of well-established techniques, for example solvent evaporation or spray-drying. The active agent may be one of a broad spectrum of drugs, including, antibiotics, anti-inflammatory agents, local anesthetics and so on. The polymer matrix may Paper ID: NOV162679 696