Name of the Procedure:

Localized Delivery of Antimicrobial Agents via a Controlled Release Vehicle into Diseased Crevicular Tissue (D4381)
Common Names: Antibiotic Arestin Placement, Localized Antimicrobial Therapy

Summary

This procedure involves placing a controlled-release antibiotic directly into the pockets around teeth affected by gum disease. This helps to reduce bacteria and inflammation in a targeted area without systemic antibiotic administration.

Purpose

This procedure is primarily used to treat periodontal disease, a severe gum infection that can damage the soft tissue and bone that supports teeth. The goal is to reduce bacterial load, inflammation, and pocket depth to prevent further deterioration of gum health.

Indications

• Chronic periodontitis with deep pockets.
• Signs of gum infection such as redness, swelling, and bleeding gums.
• Patients showing resistance to standard scaling and root planing treatments.
• Presence of specific pathogenic bacteria identified through oral diagnostics.

Preparation

• Patients should maintain good oral hygiene leading up to the procedure.
• No fasting is required.
• Complete oral examination and possibly a periodontal charting.
• Scaling and root planing often precede this procedure to clean the affected area.

Procedure Description

1. The practitioner cleans the area around the affected gum tissue.
2. A gel or powder form of the antimicrobial agent is placed into the periodontal pocket.
3. The antimicrobial is delivered using specialized tools to ensure it reaches the targeted area.
4. The antimicrobial agent then releases steadily over a period to control infection.

Typically, no anesthesia or sedation is necessary for this procedure as it is relatively painless.

Duration

The procedure usually takes about 15-30 minutes, depending on the number of sites treated.

Setting

This procedure is performed in a dental clinic or periodontal specialist's office.

Personnel

• Dentist or periodontist specializing in gum treatments.

Risks and Complications

• Local irritation to the gum tissue.
• Rare allergic reactions to the antimicrobial agent.
• Possible alteration in taste or minor gingival discomfort.
• Incomplete eradication of bacteria might require additional treatment.

Benefits

• Targeted reduction of bacterial load.
• Decreased pocket depth and inflammation.
• Reduced risk of tooth loss and further periodontal damage.
• Improvement in overall oral health may be noticed within a few weeks.

Recovery

• Patients might experience mild discomfort or irritation.
• Avoid flossing the treated areas for up to 10 days.
• Maintain good oral hygiene but follow specific instructions from the dentist.
• Regular follow-up visits to monitor progress.

Alternatives

• Systemic antibiotics: Pros include addressing widespread infection; cons include potential systemic side effects and antibiotic resistance.
• Scaling and root planing: Effective for less severe cases but might not be sufficient for deep infections.
• Surgical intervention: More invasive with longer recovery but necessary for advanced cases.

Patient Experience

During the procedure, patients might feel mild discomfort but generally not pain. Post-procedure, there may be minor irritation at the treated site. Pain management typically includes over-the-counter pain relievers. Good oral hygiene and adherence to post-treatment care instructions are essential for effective recovery. Regular follow-ups ensure the treatment is successful and complications are managed promptly.