Background: Conventional periodontal treatment is inadequate in controlling the periodontal biofilm. This is due to the nature and size of the bacteria, biofilm adaptive and reproductive capacity and an inability to mechanically remove the bacteria. The composition at the beginning of conventional treatment is the same as at the end.
Method: Management involving a direct medication delivery of hydrogen peroxide, oxygen and an antioxidant (Perio Tray, Perio Protect LLC St. Louis, MO) was evaluated by scanning electron microscopy imagery (SEM) and DNA analysis to determine what bacteria were present before, during and after treatment. The biofilm by SEM analysis was changed in the number of bacteria while the DNA analysis demonstrated changes in the biofilm constituency.
Results: The biofilm composition shifted from predominantly Gram negative obligate anaerobes before treatment to Gram positive anaerobes, Gram positive and negative facultative anaerobes and aerobic bacteria during the first month to the end of treatment. There was a –log2 to a –log4 change in the number of bacteria during the course of the treatment.
Conclusion: This study indicates that direct medication delivery of medicaments with a custom formed tray modifies the biofilm from a more virulent anaerobic to a less virulent aerobic composition and reduces the number of pathogens. Fewer bacteria that are less virulent should provide better treatment results.
Keywords: Biofilm, periodontal disease, direct medication delivery, DNA analysis, SEM analysis, perio tray, perio gel