ARESTIN® is an antibiotic, minocycline hydrocloride, which is manufactured into microspheres. It is placed inside gum pockets with the expectation that it will kill the bacteria that cause gum disease. Because of the way that it is manufactured into microshperes, it can last inside the gum pocket for up to 21 days. OraPhrama who manufactures ARESTIN® claims that it will help reduce gum pockets when used in combination with deep cleaning (scaling and root planing).
Although ARESTIN® is used widely throughout the dental community, it has only made minor in roads with the periodontal community. Why is this? Well, lets look at some of the data behind this product.
The primary study used by OraPharma for their claims was performed on 748 patients. These patients had full mouth deep cleanings. One group of patients received ARESTIN® in gum pockets 5mm or greater and the other group (control group) did not. The gum pockets were measured at 1, 3, 6 and 9 months following the deep cleaning. There data suggests that using ARESTIN® statistically reduced gum pocketing compared to the control group. So far so good, so whats the issue?
Here is the problem: people with gum disease or who have been treated for gum disease need to have professional cleanings at least every three months. This is irrefutable in the periodontal literature. What we know is that these patients experience progression of gum disease if they are not keeping up with that schedule.
The ARESTIN® study is not valid because it did not follow that model whereby these patients should have had cleanings at 3, 6 and 9 months, not just measurements. Its more than likely there would have been no difference in these two groups had there been adjunctive cleanings at 3 and 6 months.
Furthermore, even in their own studies gum pockets greater than 6mm to begin with had less than a 1mm reduction at 9 months. Gum pockets are considered problematic at 5mm. Thus if you start with a 7mm gum pocket and you end up with a 6mm pocket you still have problems.
ARESTIN® is typically not covered by insurance so it is an out of pocket expense. As a patient I believe you are much better off investing in extra cleanings, every 3 months, vs having ARESTIN® placed in your gum pockets. The effect of a professional cleaning vs just an Antibiotic is like comparing an Atom bomb to a fire cracker, and this is also documented throughout the literature.
ARESTIN® is not without its applications, when used properly. It may be beneficial in trying to maintain 5mm gum pockets to prevent gum surgery. This would be if you had isolated / localized 5mm gum pockets.
It can also be useful around dental implants where the interface of the implant is deep below the gum margin. Sometimes this can lead to gingivitis and ARESTIN® is useful to help control that.
For gum pockets greater than 5mm conventional periodontal therapy is much more therapeutic and cost effective than ARESTIN®, and should be the first line of defense.
I have a lot of 4 mm and 5 mm gum pockets and I’ve been getting deep cleanings every 3 months for about 5 years. About 2 years ago, a hygienist recommended Arrestin for a single pocket of 8 mm. I happily chose to have it done. The pocket did shrink, but I don’t know how much. (I should find out next time.) But even if it shrunk only 1 mm I still consider it a benefit. I don’t notice a difference, but that tooth never bothered me. I have other teeth where I can smell bacteria when I floss if I haven’t flossed in 18 hours or so. I have a couple of questions. If I have the Arrestin treatment on that same tooth again, will there be further benefit? And should I have arrestin on the teeth that get the bacterial build up after 18 hrs of not flossing? Thanks!
From a Periodontist’s perspective a 7mm gum pocket is still unacceptable and requires active treatment to get it reduced. That could involve more deep cleaning or surgery. Using Arrestin as an active treatment is nonsense. It would only make sense to do that if you weren’t a candidate for surgery or deep cleaning as a result of a medical condition. I would recommend a consultation with your dentist and or a consultation with a Periodontist for your treatment options.
Hi again,
Thanks for your reply. I’m sorry I didn’t check back until now. I was at the dentist yesterday and the pocket that had the arrestin treatment is now 3 mm. When I said to the hygienist that maybe I should get arrestin in all my pockets she made a face. I’m not sure of the current depth of the rest of my pockets. (I shoulda asked), but maybe they’ve shrunk. For the past few visits the hygienist has said that I didn’t need to have irrigation with antibiotic after the cleanings because there was little to no bleeding. So I’m hoping this is a good sign. I usually floss after every meal so might this explain the lack of bleeding? I actually have a small callous on one of my fingers from flossing.
I would like to know who wrote the article “Is Arrestin a therapeutic treament for reducing gum pockets?”
I did
Dr. Wasserstein
I went to my new dentist today and had a deep cleaning performed. She recommended that I needed 10 injections of Arestin after my deep cleaning for my pockets that were 5 and 6. She charged me 45.00 for each delivery with was a total of 450.00 not including the deep cleaning fees. I have good dental insurance but I still had to pay out of pocket 840.00. I dont feel that this dentist was honest and I feel that she ripped me off. 🙁 Do you think that was procedure can really help me with those deep pockets? I think I need a second opinion.
Hello, sorry about the late post. Unfortunately, your story is not unique. There are too many instances where dentists are using this product indiscriminately with expectations that are even beyond the manufacturers own research.
I believe the best advise I can give you and the most diplomatic thing to say is as follows:
WHENEVER A PATIENT IS IN DOUBT ABOUT ANY RECOMMENDED TREATMENT IT BEHOOVES THEM TO SEEK A SECOND OPINION BY ANOTHER DOCTOR OR IDEALLY A SPECIALIST IN THAT ENDEAVOR WHO IS NOT PART OF THE ORIGINAL DOCTOR’S PRACTICE.
When it comes to using Arestin, especially in a situation like yours, I would recommend a second opinion by a Periodontist.
I recently had an evaluation by my dentist and hygienist re: the depth of my pockets. Compared to 3 months ago, they were pleased to find less depth — from 6-7 to now 4-5; and also much fewer areas – basically limited to between two teeth on lower left and right. Nevertheless, the dentist recommended a deep cleaning soon INCLUDING the Arrestin injection. The co-pay would be $800 (similar to your patient comment above); and he added “the deep cleaning would not be too effective without the injection”. I am skeptical about even getting the cleaning at this time, and that’s where I need the advice. I am probably dead-set against the injection at all – given what I’ve been reading, but would get that 2nd periodontal opinion before I shut that door — but again, what is your opinion re: doing the cleaning alone?
Thank you!
David
Deep cleanings will be beneficial. Dont waste your money on Arrestin.
While Arestin does have the benefit of reducing pocket depth (by 34%) it’s more than that–it’s about a reduction in the bacteria that you CANNOT physically get (no hygienist can) that remains on the teeth or in the tissue after SRP…try scraping out a jar of peanut butter–I don’t care how good of a job you do, you can’t get it all…SRP is the same way–the hygienist just physically can’t get it all, not to mention the bacteria in the tissue…it is also about increased healing of the tissue and a reduction in BOP…I understand as a Periodontist your goal is surgery–and 99.9% of your patients are probably going to need exactly that, but for your perio maintenance patients that still present with BOP or deeper pockets, or for those patients that aren’t good candidates for surgery (either physically, psychologically, or financially), then Arestin can be an extremely viable adjunct therapy to SRP–it has never been touted as a stand alone therapy…
Hi Joe, Thank you for your comments. By the manufacturer’s own study, patients that received Arestin had less than 1mm improvement in pocket depths 5mm or greater. They had a greater reduction in pockets less than 5mm which I assume is where you are quoting 34%. But lets be clear – patients with periodontal pockets 5mm or less are treated successfully with conventional therapy, scaling and root planing and routine periodontal maintenance cleanings. There are mounds of literature which support that. So if you are working with a patient that has generalized pocketing 5mm or less what is the benefit of using Arestin in the first place? The answer is there is no expected benefit only increased cost to the patient. Now lets take it a step further. If you are dealing with a patient with moderate to severe pocketing 5 mm+ and based on the expected benefits as reported by the manufacturer that you will achieve less than 1mm of reduction then what do you hope to accomplish by using Arestin. In other words if you are starting with moderate to severe pocketing and you are going to end up with moderate to severe pocketing by using Arestin then why use it in the first place? You still have a patient at periodontal risk.
Finally lets look at how Arestin was studied. The patients had a professional cleaning. Then, half of those patients got Arestin and the other half got a placebo. 9 months later the patients were evaluated for the results. This was not realistic to begin with most people need their teeth cleaned every 6 months. Periodontal patients should have their teeth cleaned every 3 months and scaling and root planing. So why didn’t the manufacturer study the use of Arestin in a normal protocol where patients were getting their teeth cleaned every 3 to 6 months? The answer is they wouldn’t have had a result in the first place because the simple act of frequent teeth cleaning with or without scaling and root planing would have masked any minuscule difference the Arestin would have made.
The reduction in bacteria from a periodontal pocket comes by mechanically removing the plaque and calculus from the root and crown of the tooth. I encourage you to read my other articles on this site. When you do the math with Arestin there is no rationale to use the product in the first place; If you are starting with pockets 5mm or less you will resolve most of these with scaling and root planing alone. If you are starting with 5mm+ if you get a result with the scaling and root planing it will be due to that and not because you used Arestin based on the manufacturer’s own data.
If you have a patient that only wants their teeth cleaned every 9 months and has pockets 5mm or less Arestin may be useful for that situation. Arestin would never be a viable adjunctive treatment to scaling and root planing, that would be the same as saying a firecracker is adjunctive to an atom bomb.
The benefit of using Arestin with Scaling and root planing would be about the same benefit as using a firecracker with an atom bomb. The firecracker wont be too helpful in that situation. The same goes for Arestin.