PerioChip: A Significant Adjunct Therapy for SRP?

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Dr. P asks:

PeriochipPerio treatments are often an unpredictable. After a common SRP protocol (scaling and root planing) for reduction of pocket depth in patients with adult Periodontitis, I have used various products available in the market. I recently have been introduced to Periochip (DexcellPharma) and I would like to know what my colleagues have experienced with this product. Technique? Results? Indications? Thanks.

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9 Responses to “ PerioChip: A Significant Adjunct Therapy for SRP? ”

  • Jeffrey Hoos DMD June 7th, 2007

    It is so interesting that active ingredient in Peirochip is CHX. I am wondering if that is still the gold standard for subgingival treatment as a releasing agent or has Arestin become the standard.

  • Tom McGivern RDH, BS June 8th, 2007

    I disagree that Arestin is the Gold standard in time released Locally Apllied Antimicrobials. I have used all the LAA’s on the market as a Clinical Dental Hygienist. I have always had great results with CHX rinse and with the PerioChip. It has less barriers preventing me from using this product. I don’t need to shake anything to mix 100 times or need a special syringe to inject the LAA. The ease of placement especially now that the PerioChip doesn’t need to be refrigerated and can be stored at room temperature. The room Temperature allows for spontaneous placement for an isolated pocket as opposed to waiting for the product to somewhat thaw allowing it to be more plyable during placement into the pocket. The fact that PerioChip is bacteriolcidal as opposed to Arestin and other LAA’s taht are bacterialstatic. The PerioChip is not effected by bacterial resistance and doesn’ create an environment for growth of opportunistic organisms.
    I think there is more bang for your perio treatment Dollar for the doctor and patient with Perio Chip.
    Tom McGivern RDH, BS.

  • Paul Renton-Harper June 13th, 2007

    I would find it hard to characterise Arestin as teh Gold Standard due to lack of sufficient clinical evidence. However, it is my prefered locally delivered antimicrobial. I must however take issue with some of Tom’s comments, especially on PerioChip. On the queston of bacteriostatic vs bacteriocidal, whilst CHx is indeed bacteriocidal, at the concentrations that should be achieved with Arestin, this is going to be bacteriocidal also (Tetracyclines are of course bacteriostatic at the levels normally achieved with oral administration). Chlorhexidine by it’s very nature is very reactive and will bind to a number of things (SLA in toothpaste is of course the obvious example) and this will affect it’s effectiveness in the periodontal pocket. I would think that this will result in most of the initial release from PerioChip being inactivated. However, you do get the sustained release afterwards so should get some activity from that. My main criticism would be that the clinicals show such poor pocket resolution. If you look at the control groups the effect of treatment is modest to say the least (and I’m sure that Tom gets better results than they did). To find a small benefit is perhaps not surprising with PerioChip in the light of this.
    On the quetsion of thawing, I must say that when I used PerioChip I did not freeze it, just refrigerate and could use it pretty quickly on removing from the fridge. Personal preference of course but I didn’t like the ‘newer’ more solid form as much!
    Just my 2c worth and no doubt others will disagree!

    Paul Renton-Harper
    Specialist in Periodontics

  • Jack Smith July 19th, 2007

    Paul, thank you for sharing your experience. Are yoy still using Periochip?

  • Frank Nelson DDS July 20th, 2007

    another great use of arrestin in perimplant infections. I have saves some implants with arrestin placement with early healing infection.
    pretty miraculous results, frankly.
    fmn

  • NM August 19th, 2007

    I don’t think the clinicals have ever shown a statisticly significant reduction in pocket depth with either medicament. However, I believe empirically that there is less inflamation and less bleeding post-Arrestin than with Periochip or no LAA

  • Paul Renton-Harper August 30th, 2007

    Sorry Jack to take so long to reply…

    No I don’t use PerioChip anymore. For locally delivered antimicrobial I use Arestin exclusively now. Whilst I wouldn’t say I use a lot of systemics, I do find them an important part of my armamentarium and am increasingly using the MicroIdentPlus test from Advanced Dental Diagnostics to get a handle on the flora and an antimicrobial recommendation.

  • jerry Drury September 23rd, 2007

    Remember none of the local antimicrobials are designed to remove calculus and definitively reduce probing depths. Studies clearly show that calculus and biofilm removal are near impossible to predictably remove beyond a probing depth of 4mm, especially in molar and fucation area. They can be used to temporarily reduce bacterial load, but are not the answer for most patients with moderate to advanced disease. Also chlorihexidine binds with subgingival proteins reducing its effectivness as an antmicrobial.

  • John Lenart October 11th, 2007

    Good discussion on the efficacy of locally applied antimicrobials. Dr. Renton-Harper is right about bacteriostatic and -cidal properties of minocycline, the active ingredient in ARESTIN. We have found that same thing occurs with the administration of ARESTIN.

    The gold standard title ARESTIN has earned should also be rolled over to the standard of care title. I say that due to many volumes of market research by dental publications and our own showing ARESTIN has more than 95% market share of the LAA marketplace. That doesn’t mean it should be used inappropriately, but when dental professionals determine an LAA is required, 95% of the time they will reach for ARESTIN. The research shows that the ease-of-use and handling is the main reasons, as well as sound clinical information and the support OraPharma provides for the product.

    Anyway, off my soapbox. Also, for anyone that reads this, I want to disclose that I am the product director for ARESTIN here at OraPharma and would hope others on this post who are also have interests in other companies to also disclose that here so people know our biases.

    Regards,

    John Lenart
    Product Director, ARESTIN

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