When to place Arestin, now or in six weeks?

April 21, 2005
Should we wait until the six-week evaluation point before using Arestin as an adjunctive therapy?

Dear RDH eVillage:

"I am aware that OraPharma recommends the placement of Arestin at each scaling and root planing appointment in pockets of 5 mm or greater. However, it seems like it would be better to see how well the patient heals on their own and place Arestin at the six-week re-evaluation if those areas haven't healed. What do you suggest?"

Wondering in California

Dear Wondering in California:

Thank you for your question. This is not the first time that waiting until the six-week appointment to place Arestin has been suggested. In fact, at first it seems to make really good sense to let the host immune response have a chance to work and see how well the patient heals on their own.

The challenge in instrumenting a pocket of 5mm or greater is achieving a biologically acceptable root surface and/or sulcus, which allows the body to heal the "wound" completely. Since we know as clinicians that this is never possible, the question becomes why not place Arestin in the site?

The JP Institute recommends the placement of Arestin (in pockets 5mm or greater) at each open-ended therapy appointment following thorough mechanical removal of calculus and biofilm with a blended approach using both hand and microultrasonic instrumentation. This will maximize the patient's immune system by diminishing the migrating planktonic bacteria into the healing site. The external time released supply of minocycline will actually aid in the wound healing process and assist the patient in the goal of disease remission.

Additionally, the JP Institute recommends placing Arestin multiple times in stubborn sites. In keeping with a medical model, it is often necessary to treat an infection with antibiotics more than once, sometimes even a different type, to assist the immune system to get the infection under control. Since periodontal disease is affected by so many contributing factors, it is in the patient's best interest for each clinician to use whatever adjunctive therapies are available. Very often when using adjunctive therapies like Arestin, the patient will heal even faster that we first thought.

Lynell Ciranna, RDH, BS, RD, a clinical dental hygienist and registered dietitian, serves as the Scientific Advisor, Curriculum Development and Research, for The JP Institute and as Product Consultant for AcquaMed Technologies. Lynell is also a practice coach, and instructor. Lynell welcomes comments at (800) 946-4944 or [email protected].