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.