Dr. Ralph Merkle is an internationally respected computer scientist whose research is based on the fact that diseases in the human body (including dentistry) do not originate at the tissue level but rather at the cellular and molecular levels. The damage from these disease processes is observed at the tissue level. Dr. Merkle’s principles have found their way into dentistry with nano technology as relates to implant surfaces and composite resins. In dentistry a lot of what we do is aimed at wreck repair (root canal therapy, periodontal surgery, repair of decay, replacement of missing teeth etc) at the tissue level with mechanical instruments. At P3 Dental Technologies we are extending Dr. Merkle’s principles into the appropriate adjunctive use of chemotherapeutic agents in the management of periodontitis and peri implantitis. Intervention at the cellular molecular levels mandates the prudent use of adjunctive pharmaceuticals as an important part of the treatment process. In order to properly use chemotherapeutic agents, we as clinicians must understand the basic science involved with this technology. Some of these principles are discussed below:
All normal physiological processes in the dental environment require a neutral pH (7.0) for maintenance, repair and regeneration of soft and hard tissues (gingivae and alveolar bone). All three tetracycline powders (tetracycline hcl, doxycycline, minocycline) are extremely acidic in native form. A neutral pH encourages growth of protective bacteria. An acidic pH encourages the growth of pathogenic periodontal bacteria. Most manufacturers of LAA simply use one of the native tetracyclines in unmodified acidic pH. P3 formulations are buffered to a neutral pH, thus creating an environment conducive to maintenance, repair and regeneration of periodontal tissues.
Collagenase is a harmful enzyme associated with periodontal breakdown. Collagen which is produced by fibroblasts forms the basic structure for periodontal soft and hard tissues. In periodontitis, there is a high concentration of collagenase in the environment thus blocking normal maintenance, repair and regeneration of periodontal tissues. In order for normal physiological processes to occur, the excess collagenase must be removed. P3 is a potent neutralizer of the harmful enzyme collagenase.
Substantivity is defined as the prolonged association between a material (eg P3) and a substrate (eg alveolar bone, roots of teeth). In order for any LAA to be effective, it must remain in contact with the bacterial pathogens for at least 48 hours. P3 binds (not bonds) to the calcium in bone and root surfaces and is slowly released over a period of many days, more than meeting the minimum 48 hour requirement.
An exact concentration of active ingredient (antibiotic) is required for a LAA to be effective. By design, the tetracyclines are bacteriostatic at the proper concentration. If the concentration is lower than this, the LAA is not effective. If the concentration is higher than this, the tetracyclines convert to bactericidal. When bacteriostatic and bactericidal antibiotics are mixed, they cancel each other and there is NO antimicrobial effect. Realizing the importance of proper concentration, all P3 products are guaranteed to be a proper concentration for intended bacteriostatic effect.
WATER BASED VS OIL BASED FORMULATIONS
Pharmacological suspensions are either water based or oil based. Water based suspensions are much more difficult to manufacture. If an oil based LAA is introduced into the periodontal pocket, there will be separation between the water based crevicular fluid and oil based LAA. This separation will block the LAA from the desired function. All P3 formulations are water based in order to be homogenous with the periodontal pocket which contains water based crevicular fluid.
In order to maintain or regenerate alveolar bone, there must be an abundance of readily available free calcium in the environment . All P3 LAA formulations are supersaturated with calcium to encourage alveolar bone maintenance and/or regeneration.