الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Local delivery of antimicrobial drugs had resulted in good clinical outcomes along with scaling and root planing. Recently, a local anti‑infective treatment for periodontitis has been introduced that delivers a formulation of NTZ gel to the periodontal pocket.
A minimally invasive approach in the management of periodontitis is administering an antimicrobial agent into the pocket, which is biodegradable and provides an appropriate antimicrobial level for a sustained period.
An important benefit of systemic antibiotic administration lies in the fact that the active substance reaches all the periodontal pockets and other oral niches colonized by the bacteria. The disadvantages of systemic antibiotic administration include possible side effects, which can range from mild gastrointestinal symptoms to allergic reactions.
The use of local delivery methods to administer antibiotics offers a novel approach to the management of periodontal ”localized” infections. The primary advantage is that smaller doses of topical agents can be delivered inside the pocket, avoiding the side effects of systemic antibacterial agents while increasing the exposure of target microorganisms to higher concentrations and, therefore, more therapeutic levels of the medication.
Recently, a local anti‑infective treatment for periodontitis has been introduced that delivers a formulation of NTZ gel to the periodontal pocket in a biodegradable liquid polymer that solidifies on contact with the gingival crevicular fluid.
Nitazoxanide gel is an effective means of reducing the clinical signs of moderate periodontitis.
Nitazoxanide exhibits broad-spectrum activity against anaerobic bacteria. NTZ is a noncompetitive inhibitor of pyruvate (an output of metabolism of glucose) oxidation by ferredoxin/flavodoxin oxidoreductases (PFORs) enzyme to generate energy in anaerobic bacteria.
Ferredoxin/flavodoxin oxidoreductases (PFORs) are present in all obligate periodontal anaerobic bacteria, such as P. ginigvalis, P. intermedia.
Nitazoxanide (NTZ) gel is a class of antimicrobials that works by targeting the activated form of Thiamine pyrophosphate (TPP) (Vitamin cofactor of PFOR and related enzymes) and not the enzymes themselves.
Nitazoxanide might be the first example of an antimicrobial that targets the “activated cofactor” of an enzymatic reaction rather than its substrate or catalytic sites, a novel mechanism that may escape mutation-based drug resistance.
The present study was carried out to evaluate and compare the efficacy of local delivery of nitazoxanide (NTZ) gel in adjunct to scaling and root planing in the treatment of moderate periodontitis.
A randomized, controlled clinical trial was performed on a total number of forty patients with moderate periodontitis. The forty patients were divided into two groups; group (1), control group, which comprised twenty patients treated with scaling and root planing (SRP) only, and group (2), study group, which comprised twenty patients treated with scaling and root planing (SRP) and local delivered sustained-release NTZ gel.
The two groups showed a significant reduction in all clinical parameters after six months (Modified gingival index, Bleeding index, Probing pocket depth, and Clinical attachment loss.). However, the NTZ gel group showed better results than the control group.
These results also showed there was no statistically significant difference between the two groups at baseline, while at three and six months follow-up periods, there was a statistically significant difference in PPD, CAL, BOP, and MGI between the two groups (p ≤ 0.05). Moreover there were statistically significant differences in the decrease in PPD, CAL, BOP, and MGI from baseline to six months between the two groups. The test group showed more decrease in all parameters than the control group (p0.05).