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Paternò Holtzman L, Valente NA, Vittorini Orgeas G, Copes L, Discepoli N, Clementini M. Change in clinical parameters after subgingival instrumentation for the treatment of periodontitis and timing of periodontal re-evaluation: A systematic review and meta-analysis. J Clin Periodontol 2024. [PMID: 38706227 DOI: 10.1111/jcpe.13985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 02/21/2024] [Accepted: 03/21/2024] [Indexed: 05/07/2024]
Abstract
AIM To evaluate the changes in periodontal parameters (reduction in probing pocket depth [PPD], gain in clinical attachment level [CAL] and reduction in full-mouth bleeding on probing [BoP]) after subgingival instrumentation of periodontal pockets at different time points in systemically healthy patients suffering from periodontitis. MATERIALS AND METHODS Four databases were searched for RCTs that carried out subgingival instrumentation in periodontal pockets and evaluated PPD at a minimum of two consecutive time points other than baseline. The analysis was conducted for both all pocket depths and stratified for initially shallow (4-5 mm) and deep (≥6 mm) pockets and data were extracted for various time points, 1-2, 3-4 and 5-6 months. Weighted mean effects (WMEs) were calculated with 95% confidence interval (CI) and predictive intervals were calculated. RESULTS Twenty-nine RCTs were identified, and all of them were included in the meta-analysis. The results showed that for both shallow and deep pockets there was a small though clinically meaningful change between 1- to 2-month and 3- to 4-month time points and between these and 5-6 months. CONCLUSIONS In systemically healthy patients, the greater part of reduction in PPD and gain in CAL occurs within the first 1-2 months after subgingival instrumentation. However, additional benefits in terms of pocket depth reduction occur beyond these early time points.
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Affiliation(s)
- Lucrezia Paternò Holtzman
- Department of Periodontology and Prosthodontics, George Eastman Dental Hospital, Policlinico Universitario Umberto I, Rome, Italy
| | - Nicola Alberto Valente
- Division of Periodontology, School of Dental Medicine, Department of Surgical Sciences, Faculty of Medicine, Università degli Studi di Cagliari, Cagliari, Italy
| | | | - Luca Copes
- Department of Periodontology, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola Discepoli
- Department of Medical Biotechnologies, Unit of Periodontology, University of Siena, Siena, Italy
| | - Marco Clementini
- UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
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Kruse TN, Seeley KE, Bapodra-Villaverde P, Less EH, Junge RE. CLINICAL FINDINGS OF DENTAL DISEASE AND POTENTIAL CONTRIBUTING FACTORS IN PYGMY SLOW LORISES ( NYCTICEBUS PYGMAEUS) UNDER HUMAN CARE. J Zoo Wildl Med 2024; 54:757-765. [PMID: 38251999 DOI: 10.1638/2022-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 01/23/2024] Open
Abstract
Dental disease is a common finding in pygmy slow lorises (Nycticebus pygmaeus) under human care, but the etiology is not fully understood. The small oral cavity in this species can make diagnosis of dental disease difficult. This retrospective study evaluated medical records and diet and husbandry protocols from 18 participating institutions with the objective of describing the signalment, clinical signs, physical exam findings, tooth type, tooth location, diagnostics used, and treatments performed to help guide care for dental disease. In addition, the study aimed to identify potential contributing factors to dental disease in this species. Of 59 animals with medical records evaluated, 42 (71.2%) had dental disease: 19 (44.2%) males, 20 (46.5%) females, and 3 (9.3%) without gender documented. Average age at onset of dental disease was 7.6 yr in males and 9 yr in females. Multiple lorises with dental disease (n = 12; 28.6%) had no premonitory clinical signs, and dental disease was found incidentally on examination. On dental examination, 30 lorises (71.4%) had evidence of gingivitis. In 13 cases skull radiographs were taken, but the majority of images (n = 8; 61.5%) were nondiagnostic for pathologic dental changes. A small proportion of cases with dental abnormalities (n = 4; 9.5%) were diagnosed using computed tomography. In total, 175 teeth were extracted from 31 patients; molars were the most frequently extracted tooth (n = 55; 31.4%). No substantial differences in diets were noted among many of the participating institutions, and not all slow lorises evaluated developed dental disease (n = 17; 28.8%). This retrospective study provides clinical findings on slow loris dental disease and guidance for the veterinary care and management of slow lorises under human care.
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Toledano-Osorio M, de Luna-Bertos E, Toledano M, Manzano-Moreno FJ, García-Recio E, Ruiz C, Osorio R, Sanz M. Doxycycline-doped collagen membranes accelerate in vitro osteoblast proliferation and differentiation. J Periodontal Res 2023; 58:296-307. [PMID: 36585537 DOI: 10.1111/jre.13091] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/04/2022] [Accepted: 12/13/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate the effect of doxycycline- and dexamethasone-doped collagen membranes on the proliferation and differentiation of osteoblasts. BACKGROUND Collagen barrier membranes are frequently used to promote bone regeneration and to boost this biological activity their functionalization with antibacterial and immunomodulatory substances has been suggested. METHODS The design included commercially available collagen membranes doped with doxycycline (Dox-Col-M) or dexamethasone (Dex-Col-M), as well as undoped membranes (Col-M) as controls, which were placed in contact with cultured MG63 osteoblast-like cells (ATCC). Cell proliferation was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium (MTT) assay and differentiation by measuring the alkaline phosphatase (ALP) activity using spectrophotometry. Real-time quantitative polymerase chain reaction was used to study the expression of the genes: Runx-2, OSX, ALP, OSC, OPG, RANKL, Col-I, BMP-2, BMP-7, TGF-β1, VEGF, TGF-βR1, TGF-βR2, and TGF-βR3. Scanning electron microscopy was used to study osteoblast morphology. Data were assessed using one-way analysis of variance or Kruskal-Wallis tests, once their distribution normality was assessed by Kolmogorov-Smirnov tests (p > .05). Bonferroni for multiple comparisons were carried out (p < .05). RESULTS Osteoblast proliferation was significantly enhanced in the functionalized membranes as follows: (Col-M < Dex-Col-M < Dox-Col-M). ALP activity was significantly higher on cultured osteoblasts on Dox-Col-M. Runx-2, OSX, ALP, OSC, BMP-2, BMP-7, TGF-β1, VEGF, TGF-βR1, TGF-βR2, and TGF-βR3 were overexpressed, and RANKL was down-regulated in osteoblasts cultured on Dox-Col-M. The osteoblasts cultured in contact with the functionalized membranes demonstrated an elongated spindle-shaped morphology. CONCLUSION The functionalization of collagen membranes with Dox promoted an increase in the proliferation and differentiation of osteoblasts.
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Affiliation(s)
- Manuel Toledano-Osorio
- Faculty of Dentistry, University of Granada, Colegio Máximo de Cartuja s/n, Granada, Spain.,Medicina Clínica y Salud Pública PhD Programme, Granada, Spain
| | - Elvira de Luna-Bertos
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain.,Instituto Investigación Biosanitaria, IBS, Granada, Spain
| | - Manuel Toledano
- Faculty of Dentistry, University of Granada, Colegio Máximo de Cartuja s/n, Granada, Spain
| | - Francisco Javier Manzano-Moreno
- Instituto Investigación Biosanitaria, IBS, Granada, Spain.,Biomedical Group (BIO277), Department of Stomatology, School of Dentistry, University of Granada, Granada, Spain
| | - Enrique García-Recio
- Instituto Investigación Biosanitaria, IBS, Granada, Spain.,Biomedical Group (BIO277), Department of Nursing, Faculty of Nursing, Campus de Melilla, University of Granada, Granada, Spain
| | - Concepción Ruiz
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain.,Instituto Investigación Biosanitaria, IBS, Granada, Spain.,Institute of Neuroscience, Centro de Investigación Biomédica (CIBM), Parque de Tecnológico de la Salud (PTS), University of Granada, Granada, Spain
| | - Raquel Osorio
- Faculty of Dentistry, University of Granada, Colegio Máximo de Cartuja s/n, Granada, Spain
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
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Çelen S, Öngöz Dede F, Avşar C. Role of Inhibitor SMADs in Stage 3 Grade B periodontitis before and after periodontal treatment. J Periodontal Res 2021; 57:41-51. [PMID: 34581437 DOI: 10.1111/jre.12935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/01/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to examine the levels of transforming growth factor-beta (TGF-β) and inhibitory-Smads (I-Smads) in saliva and gingival crevicular fluid (GCF) in patients with Stage 3 Grade B periodontitis before and after non-surgical periodontal treatment. BACKGROUND Recently, it has been stated that Smads play an active role in all conditions where TGF-β is involved, including periodontal inflammation. METHODS Twenty healthy participants (control) and 20 patients with Stage 3, Grade B periodontitis were recruited. GCF and saliva samples and clinical periodontal recordings were investigated at the baseline and 1 month after treatment. TGF-β and I-Smads (Smads 6 and 7) were determined by ELISA. RESULTS Salivary Smad6 and Smad7 levels were significantly lower in the periodontitis group than healthy controls (p < .05), while there was no difference in salivary TGF-β levels between groups at baseline (p > .05). The total amounts and concentrations of GCF TGF-β, Smad6, and Smad7 were significantly lower in the periodontitis group than healthy controls at baseline (p < .05), and then decreased in concentration levels with treatment (p < .001). Positive correlations were found between total amounts and concentrations of GCF TGF-β, Smad6, and Smad7 (p < .05). CONCLUSION Our findings revealed that Smad6 and Smad7 in GCF and saliva decreased in periodontitis and then increased after periodontal treatment. Our study suggests that I-Smads act in parallel with TGF-β in periodontal inflammation and may have a role in the development of periodontitis.
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Affiliation(s)
- Selman Çelen
- Department of Periodontology, Faculty of Dentistry, Ordu University, Ordu, Turkey
| | - Figen Öngöz Dede
- Department of Periodontology, Faculty of Dentistry, Ordu University, Ordu, Turkey
| | - Candeğer Avşar
- Faculty of Medicine, Department of Medical Biochemistry, İzmir Katip Çelebi University, İzmir, Turkey
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Systematic review and meta-analysis on the adjunctive use of host immune modulators in non-surgical periodontal treatment in healthy and systemically compromised patients. Sci Rep 2021; 11:12125. [PMID: 34108528 PMCID: PMC8190303 DOI: 10.1038/s41598-021-91506-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/10/2021] [Indexed: 01/13/2023] Open
Abstract
Considering the central role of inflammation in the pathogenesis of periodontitis, the combination of NSPT with different agents that can modulate the host immune-inflammatory response has been proposed to enhance the outcomes of NSPT. The aim of this paper is to systematically review the literature on the efficacy of systemic host modulators (HMs) as adjuncts to non-surgical periodontal therapy (NSPT) in improving pocket depth (PD) reduction and clinical attachment level (CAL) gain in healthy and systemically compromised patients. RCTs with ≥ 3 months follow-up were independently searched by two reviewers. Meta-analysis was performed when ≥ 3 studies on the same HM were identified. The quality of the evidence was rated according to the GRADE approach to rate the certainty of evidence. 38 articles were included in the qualitative assessment and 27 of them were included in the meta-analysis. There is low/very low evidence that the adjunctive use of sub-antimicrobial dose of doxycicline, melatonin and the combination of omega-3 and low dose aspirin (in type 2 diabetic patients) to NSPT would improve PD and/or CAL. Conflicting evidence is available on the efficacy of probiotics. Future studies controlling for confounding factors, using composite outcomes to define the endpoint of therapy and considering not only the patient- but also as the site-specific effect of systemic HMs are warranted. The dosage, posology and long-term effect of HMs still need to be clarified, also in association to the presence of systemic conditions potentially affecting the response to HMs administration.
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Donos N, Calciolari E, Brusselaers N, Goldoni M, Bostanci N, Belibasakis GN. The adjunctive use of host modulators in non-surgical periodontal therapy. A systematic review of randomized, placebo-controlled clinical studies. J Clin Periodontol 2021; 47 Suppl 22:199-238. [PMID: 31834951 DOI: 10.1111/jcpe.13232] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/10/2019] [Accepted: 12/01/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Considering the role of the inflammatory host response in the pathogenesis of periodontitis, different host modulators have been proposed to enhance the outcomes of non-surgical periodontal therapy (NSPT), but their efficacy has not been fully clarified. OBJECTIVES This systematic review investigated the efficacy of host modulators combined with NSPT in reducing probing pocket depth (PPD) in periodontitis patients. MATERIALS AND METHODS Placebo-controlled RCTs with ≥6 months follow-up were searched. Meta-analysis was conducted when ≥5 studies using the same host modulator were identified. RESULTS Fifty eight studies met the inclusion criteria. After 6 months, local administration of 1.2% statin gels as adjuncts to NSPT significantly improved PPD reduction (1.83 mm) in infrabony defects and systemic administration of sub-antimicrobial dose doxycycline (SDD) in addition to NSPT improved PPD reduction of deep pockets. Administration of probiotics conferred limited clinical benefits. Local bisphosphonate and metformin gels showed potential for clinical use in infrabony defects, which needs to be confirmed. CONCLUSIONS Local delivery of statins in infrabony defects and systemic SDD for deep pockets may confer additional clinical benefits to NSPT. Their long-term effectiveness and safety need to be confirmed in independent multi-centred studies. Further studies are needed to confirm the benefit of other host modulators.
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Affiliation(s)
- Nikolaos Donos
- Centre for Oral Immunobiology & Regenerative Medicine & Centre for Oral Clinical Research, Barts and The London School of Medicine & Dentistry, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK
| | - Elena Calciolari
- Centre for Oral Immunobiology & Regenerative Medicine & Centre for Oral Clinical Research, Barts and The London School of Medicine & Dentistry, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK
| | - Nele Brusselaers
- Centre of Translational Microbiome Research, Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, Stockholm, Sweden
| | - Matteo Goldoni
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Nagihan Bostanci
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Georgios N Belibasakis
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Adjunctive Effects of a Sub-Antimicrobial Dose of Doxycycline on Clinical Parameters and Potential Biomarkers of Periodontal Tissue Catabolism. Dent J (Basel) 2019; 7:dj7010009. [PMID: 30669541 PMCID: PMC6473443 DOI: 10.3390/dj7010009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/18/2018] [Accepted: 01/08/2019] [Indexed: 01/22/2023] Open
Abstract
Objectives: The aim of the present randomized, double-blind, placebo-controlled, parallel-arm study was to examine the effectiveness of a sub-antimicrobial dose of doxycycline (SDD) in combination with nonsurgical periodontal therapy, compared to nonsurgical periodontal therapy alone, on potential gingival crevicular fluid (GCF) biomarkers of periodontal tissue catabolism related to the clinical outcomes over a 12-month period. Materials and Methods: GCF was collected and clinical parameters were recorded from 30 periodontitis patients randomized either to an SDD or placebo group. The SDD group received SDD (20 mg) b.i.d for 3 months plus scaling and root planing (SRP), while the placebo group was given placebo capsules b.i.d for 3 months plus SRP. The patients were evaluated every 3 months during the 12-month study period. At each visit, clinical parameters and GCF sampling were repeated. Matrix metalloproteinase (MMP)-8, MMP-9, MMP-13, myeloperoxidase (MPO), osteoprotegerin (OPG), and tartrate-resistant acid phosphatase-5 (TRAP-5) were determined by IFMA and ELISA. Results: Significant improvements were observed in all clinical parameters in both groups over 12 months (p < 0.0125) while the SDD group showed significantly better reduction in gingival index (GI) and pocket depth and a gain in clinical attachment compared to the placebo group (p < 0.05). GCF MMP-8 and OPG levels significantly reduced in the SDD group compared to baseline (p < 0.05). GCF MMP-9 significantly decreased in both groups compared to baseline (p < 0.05). GCF MPO significantly decreased at 3 and 9 months in the SDD group, while it significantly decreased at 6 months in the placebo group (p < 0.05). TRAP and MMP-13 could be detected in none of the samples. Conclusions: The present results indicate that three months of adjunctive usage of SDD to nonsurgical periodontal therapy compared to nonsurgical periodontal therapy alone in periodontitis patients results in further improvement of clinical periodontal parameters and GCF markers of periodontal tissue breakdown over a 12-month period. Beneficial effects of adjunctive SDD therapy is likely to be related to the reduced levels of two major periodontitis-associated MMPs, MMP-8 and -9, and their potential oxidative activator MPO.
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Escobar GF, Abdalla DR, Beghini M, Gotti VB, Rodrigues Junior V, Napimoga MH, Ribeiro BM, Rodrigues DBR, Nogueira RD, Pereira SADL. Levels of Pro and Anti-inflammatory Citokynes and C-Reactive Protein in Patients with Chronic Periodontitis Submitted to
Nonsurgical Periodontal Treatment. Asian Pac J Cancer Prev 2018; 19:1927-1933. [PMID: 30051674 PMCID: PMC6165634 DOI: 10.22034/apjcp.2018.19.7.1927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim to compare the levels of IFN-γ, TGF-β and C-reactive protein (CRP) in healthy patients (HP) and chronic periodontitis patients (CP) before and seven days after the last session of Non-Surgical Periodontal Treatment (NSPT). Materials and Methods 40 subjects were divided into two groups: healthy (n= 20), and with chronic periodontitis (n = 20). Serum and gingival crevicular fluid (GCF) were collected from each patient and quantified for IFN-γ, TGF-β and CRP using the enzyme-linked immunosorbent assay (ELISA). Results IFN-γ was found to be higher in the GCF of the CP group before NSPT in relation to the HP group (p<0.05), and it had significant higher levels after seven days of NSPT (p<0.05). The levels of TGF-β in the GCF of CP patients before NSPT were significantly higher when compared to HP (p<0.05), but they decreased after seven days of NSPT (p>0.05). Serum CRP levels did not show statistical difference between CP and HP before or after NSPT. Conclusion Therefore, our results demonstrated for the first time that NSPT causes early exacerbation of the immune response at the local level represented by increased levels of IFN-γ and decreased levels of TGF-β in the gingival crevicular fluid after seven days of treatment.
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Kim SE, Kim TH, Park SA, Kim WT, Park YW, Ahn JS, Jeong M, Kim MY, Seo K. Efficacy of horse chestnut leaf extract ALH-L1005 as a matrix metalloproteinase inhibitor in ligature-induced periodontitis in canine model. J Vet Sci 2018; 18:245-251. [PMID: 27515267 PMCID: PMC5489472 DOI: 10.4142/jvs.2017.18.2.245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/28/2016] [Accepted: 07/21/2016] [Indexed: 11/20/2022] Open
Abstract
Matrix metalloproteinases (MMPs) are the main proteinases associated with periodontal tissue destruction and remodeling. Therefore, inhibition of host-derived MMPs has a key role in the prevention and reduction of periodontitis progression. Horse chestnut (Aesculus hippocastanum L.) extracts have been used as treatments for inflammatory disease, traditionally. This study assessed the clinical effect as a MMP inhibitor of horse chestnut leaf extract ALH-L1005 on periodontitis. ALH-L1005 was obtained from horse chestnut leaf and its MMP inhibitory activities estimated. Periodontitis was induced in beagles assigned to 4 groups and medicated for 6 weeks: low dose test (LT; ALH-L1005, 100 mg/kg/day), high dose test (HT; ALH-L1005, 200 mg/kg/day), positive control (PC; doxycycline, 10 mg/kg/day), or negative control (NC; placebo). Before and after administration, clinical indices of the teeth and MMP quantity in gingival tissues using zymography were measured. Clinical conditions of the LT, HT, and PC groups were significantly improved after 6 weeks. In zymographic evaluations, gelatinolytic and caseinolytic activities were suppressed in LT, HT, and PC groups but not in the NC group. The results suggest that ALH-L1005 could be an effective agent for clinical prevention and treatment of periodontitis by inhibiting the gelatinase and collagenase activities, which can detach periodontal ligaments from alveolar bone.
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Affiliation(s)
- Se Eun Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
| | - Tae Hyun Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
| | - Shin Ae Park
- Department of Veterinary Surgery, College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
| | - Won Tae Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
| | - Young Woo Park
- Department of Veterinary Surgery, College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
| | - Jae Sang Ahn
- Department of Veterinary Surgery, College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
| | - Manbok Jeong
- Department of Veterinary Surgery, College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
| | | | - Kangmoon Seo
- Department of Veterinary Surgery, College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
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Geisinger ML, Geurs NC, Ogdon D, Reddy MS. Commentary: Targeting Underlying Biologic Mechanisms in Selecting Adjunctive Therapies to Improve Periodontal Treatment in Smokers: A Commentary. J Periodontol 2017; 88:703-710. [PMID: 28440743 DOI: 10.1902/jop.2017.170098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Despite well-established evidence that cigarette smoking is the largest modifiable risk factor for periodontal disease and has many deleterious health effects, treatment of periodontal disease in smokers remains a challenge of periodontal therapy. A recent meta-analysis revealed that adjunctive use of local delivery of antimicrobials, but not systemic antibiotic usage, with non-surgical periodontal therapy resulted in improvement in clinical periodontal parameters. Further evaluation of the current literature reveals that host modulation therapy may also result in clinical benefit in smokers. These findings may be tied to the underlying pathophysiology of periodontal disease progression in smokers and suggest that focused therapies that target known mechanisms of action are critical to the success of proposed treatments.
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Affiliation(s)
- Maria L Geisinger
- Department of Periodontology, University of Alabama at Birmingham, Birmingham, AL
| | - Nicolaas C Geurs
- Department of Periodontology, University of Alabama at Birmingham, Birmingham, AL
| | - Dorothy Ogdon
- Lister Hill Library, University of Alabama at Birmingham
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Mallikarjun S, Rao A, Rajesh G, Shenoy R, Pai M. Antimicrobial efficacy of Tulsi leaf (Ocimum sanctum) extract on periodontal pathogens: An in vitro study. J Indian Soc Periodontol 2016; 20:145-50. [PMID: 27143825 PMCID: PMC4847459 DOI: 10.4103/0972-124x.175177] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 11/04/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Periodontitis is an infection of the periodontal complex with severe forms of disease associated with specific bacteria colonizing the subgingival area. Widespread use of drugs has resulted in the emergence of side effects, uncommon infections, and resistance. Plant medicine like Tulsi has been used in many clinical conditions, and it appears to be a suitable alternative to manage conditions affecting the oral cavity. Hence, the objective was to assess the in vitro antimicrobial activity of Tulsi leaves extract (Ocimum sanctum) on periodontal pathogens with doxycycline as standard, as doxycycline has been used as an adjunct to nonsurgical therapy in periodontitis patients. MATERIALS AND METHODS Ethanolic extract of Tulsi was prepared by cold extraction method. Extract was diluted with an inert solvent, dimethyl formamide, to obtain five different concentrations (0.5%, 1%, 2%, 5%, and 10%). Doxycycline was used as a positive control and dimethyl formamide, as a negative control. The extract and controls were subjected to the microbiological investigation against Aggregatibacter actinomycetemcomitans, Prevotella intermedia, and Porphyromonas gingivalis. Agar well diffusion method was employed to determine the concentration at which Tulsi gave an inhibition zone, similar to doxycycline. Data were analyzed using one-way analysis of variance and Tukey post-hoc test was used for inter- and intra-group comparisons. RESULTS At 5% and 10% concentrations, Tulsi extracts demonstrated antimicrobial activity against A. actinomycetemcomitans, similar to doxycycline with similar inhibition zones (P > 0.05). P. gingivalis and P. intermedia, however, exhibited resistance to Tulsi extract that showed significantly smaller inhibition zones (P < 0.05). CONCLUSIONS Tulsi demonstrated effective antimicrobial property against A. actinomycetemcomitans, suggesting its possible use as an effective and affordable "adjunct" along with the standard care in the management of periodontal conditions. However, further research assessing the toxicity, durability, and other assessments followed by clinical trials is necessary to explore the potential of Tulsi in combating oral conditions.
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Affiliation(s)
- Sajjanshetty Mallikarjun
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India
| | - Ashwini Rao
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India
| | - Gururaghavendran Rajesh
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India
| | - Ramya Shenoy
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India
| | - Mithun Pai
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India
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12
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Ramos UD, Ayub LG, Reino DM, Grisi MF, Taba M, Souza SL, Palioto DB, Novaes AB. Antimicrobial photodynamic therapy as an alternative to systemic antibiotics: results from a double-blind, randomized, placebo-controlled, clinical study on type 2 diabetics. J Clin Periodontol 2016; 43:147-55. [DOI: 10.1111/jcpe.12498] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Umberto D. Ramos
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology; School of Dentistry of Ribeirao Preto; University of Sao Paulo; Ribeirão Preto SP Brazil
| | - Lauro G. Ayub
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology; School of Dentistry of Ribeirao Preto; University of Sao Paulo; Ribeirão Preto SP Brazil
| | - Danilo M. Reino
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology; School of Dentistry of Ribeirao Preto; University of Sao Paulo; Ribeirão Preto SP Brazil
| | - Márcio F.M. Grisi
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology; School of Dentistry of Ribeirao Preto; University of Sao Paulo; Ribeirão Preto SP Brazil
| | - Mário Taba
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology; School of Dentistry of Ribeirao Preto; University of Sao Paulo; Ribeirão Preto SP Brazil
| | - Sérgio L.S. Souza
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology; School of Dentistry of Ribeirao Preto; University of Sao Paulo; Ribeirão Preto SP Brazil
| | - Daniela B. Palioto
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology; School of Dentistry of Ribeirao Preto; University of Sao Paulo; Ribeirão Preto SP Brazil
| | - Arthur B. Novaes
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology; School of Dentistry of Ribeirao Preto; University of Sao Paulo; Ribeirão Preto SP Brazil
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Polak D, Martin C, Sanz-Sánchez I, Beyth N, Shapira L. Are anti-inflammatory agents effective in treating gingivitis as solo or adjunct therapies? A systematic review. J Clin Periodontol 2015; 42 Suppl 16:S139-51. [DOI: 10.1111/jcpe.12340] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2014] [Indexed: 02/02/2023]
Affiliation(s)
- David Polak
- Department of Periodontology; Hebrew University-Hadassah Faculty of Dental Medicine; Jerusalem Israel
| | - Conchita Martin
- Department of Stomatology IV; Area of Orthodontics; Complutense University of Madrid; Madrid Spain
| | - Ignacio Sanz-Sánchez
- Department of Stomatology; Area of Periodontics; Complutense University of Madrid; Madrid Spain
| | - Nurit Beyth
- Department of Prosthodontics; Hebrew University-Hadassah Faculty of Dental Medicine; Jerusalem Isreal
| | - Lior Shapira
- Department of Periodontology; Hebrew University-Hadassah Faculty of Dental Medicine; Jerusalem Israel
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14
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Keestra JAJ, Grosjean I, Coucke W, Quirynen M, Teughels W. Non-surgical periodontal therapy with systemic antibiotics in patients with untreated aggressive periodontitis: a systematic review and meta-analysis. J Periodontal Res 2014; 50:689-706. [DOI: 10.1111/jre.12252] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2014] [Indexed: 12/24/2022]
Affiliation(s)
- J. A. J. Keestra
- Department of Oral Health Sciences, Periodontology; KU Leuven & University of Leuven; Leuven Belgium
- Department of Periodontology; University Hospitals Leuven; Leuven Belgium
| | - I. Grosjean
- Department of Oral Health Sciences, Periodontology; KU Leuven & University of Leuven; Leuven Belgium
- Department of Periodontology; University Hospitals Leuven; Leuven Belgium
| | - W. Coucke
- Department of Clinical Biology; Scientific Institute of Public Health; Brussels Belgium
| | - M. Quirynen
- Department of Oral Health Sciences, Periodontology; KU Leuven & University of Leuven; Leuven Belgium
- Department of Periodontology; University Hospitals Leuven; Leuven Belgium
| | - W. Teughels
- Department of Oral Health Sciences, Periodontology; KU Leuven & University of Leuven; Leuven Belgium
- Department of Periodontology; University Hospitals Leuven; Leuven Belgium
- Fund for Scientific Research Flanders (FWO), Egermontstraat; Brussels Belgium
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Keestra JAJ, Grosjean I, Coucke W, Quirynen M, Teughels W. Non-surgical periodontal therapy with systemic antibiotics in patients with untreated chronic periodontitis: a systematic review and meta-analysis. J Periodontal Res 2014; 50:294-314. [PMID: 25142259 DOI: 10.1111/jre.12221] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The purpose of this meta-analysis is to evaluate the effectiveness of different systemic antibiotics in combination with scaling and root planing (SRP) when compared to SRP alone in patients with untreated chronic periodontitis. BACKGROUND Although chronic periodontitis is mostly treated without adjunctive systemic antibiotics, some recent meta-analyses have shown clinical benefit for some systemic antibiotics when used as an adjunct to SRP. However, there is a wide variety of systemic antibiotic regimens used today. It remains unclear if the selected type of systemic antibiotic influences the magnitude of clinical benefit. MATERIAL AND METHODS The MEDLINE-PubMed database was searched from their earliest records through May 16, 2013. Several journals were hand searched and some authors were contacted for additional information. Outcome measures analysed were mean bleeding on probing change, mean clinical attachment level gain and mean probing pocket depth reduction. Extracted data were pooled using a random effect model. Weighted mean differences were calculated and heterogeneity was assessed. RESULTS The search yielded 281 abstracts. Ultimately, 95 studies were selected, describing 43 studies meeting the eligibility criteria. Systemic antibiotics showed a significant (p < 0.05) additional pocket depth reduction for moderate (at 3 mo 0.27 mm ± 0.09, at 6 mo 0.23 mm ± 0.10 and at 12 mo 0.25 mm ± 0.27) and deep pockets (at 3 mo 0.62 mm ± 0.17, at 6 mo 0.58 mm ± 0.16 and at 12 mo 0.74 mm ± 0.30). Statistically, no specific type of antibiotic was superior over another. However, when analysing the clinical data for initially moderate pockets or deep pockets, some trends became apparent. CONCLUSION Systemic antibiotics combined with SRP offer additional clinical improvements compared to SRP alone. Although there were no statistically significant differences, there was a trend that for initially moderate and deep pockets, metronidazole or metronidazole combined with amoxicillin, resulted in clinical improvements that were more pronounced over doxycycline or azithromycin. Additionally, there was a trend that the magnitude of the clinical benefit became smaller over time (1 year).
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Affiliation(s)
- J A J Keestra
- Department of Oral Health Sciences, Periodontology, KU Leuven & University of Leuven, Leuven, Belgium; Department of Periodontology, University Hospitals Leuven, Leuven, Belgium
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Shehwaro N, Langlois AL, Gueutin V, Gauthier M, Casenave M, Izzedine H. [Doxycycline or how to create new with the old?]. Therapie 2014; 69:129-41. [PMID: 24926631 DOI: 10.2515/therapie/2013069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 09/26/2013] [Indexed: 11/20/2022]
Abstract
Tetracyclines are broad-spectrum antibiotics that interfere with protein synthesis. They were first widely prescribed by dermatologists in the early 1950s in the treatment of acne. More recently, their biological actions on inflammation, proteolysis, angiogenesis, apoptosis, metal chelation, ionophoresis, and bone metabolism were studied. Matrix metalloproteinases (MMPs) are a family of proteolytic enzymes that degrade components of the extracellular matrix (ECM). MMPs have direct or indirect effects on the vascular endothelium and the vascular relaxation/contraction system. The therapeutic effects of tetracyclines and analogues were studied in rosacea, bullous dermatoses, neutrophilic diseases, pyoderma gangrenosum, sarcoidosis, aortic aneurysms, cancer metastasis, periodontitis and autoimmune diseases autoimmune diseases such as rheumatoid arthritis and scleroderma. In addition, downregulation of MMP using doxycycline could be beneficial in reducing vascular dysfunction mediated by MMPs and progressive damage of the vascular wall. We review the nonantibiotic properties of doxycycline and its potential clinical applications.
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Suchak A, Soory M. Anabolic potential of bone mineral in human periosteal fibroblasts using steroid markers of healing. Steroids 2013; 78:462-7. [PMID: 23438414 DOI: 10.1016/j.steroids.2013.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 01/21/2013] [Accepted: 02/11/2013] [Indexed: 10/27/2022]
Abstract
A deproteinized natural cancellous bone mineral (B) was studied in a cell culture model for its anabolic potential using two radiolabelled steroid substrates, 14C-testosterone (14C-T) and 14C-4-androstenedione (14C-4-A) independently; in the presence or absence of the anti-androgen finasteride (F) and minocycline (M). Culture medium was assayed for the biologically active metabolite 5 alpha-dihydrotestosterone (DHT) a marker of regenerative potential and wound healing. Confluent monolayer cultures of human periosteal fibroblasts were incubated in Eagle's minimum essential medium with each of the substrates 14C-T and 14C-4-A. Incubations were performed with previously established optimal concentrations of B5 (milligrams/ml), M25 (μg/ml) and F5 (μg/ml) alone and in combination (n=6) for 24h. The eluent was solvent extracted with ethyl acetate (2 ml x 2) and subjected to TLC in a benzene/acetone solvent system (4:1 v/v) for separation of metabolites; they were quantified using a radioisotope scanner. The yield of DHT was increased over controls in response to B and M with both substrates 14C-T and 14C-4-A by 1.7, 1.8-fold and 1.7, 1.6-fold respectively (n=6; p<0.001; one way ANOVA). Combined incubations of B and M resulted in similar yields. F inhibited DHT yields with both radiolabelled substrates by 2-3-fold (n=6; p<0.001) which was overcome by a combined incubation of F+B to values similar to those of controls (p<0.01). Documented pro-anabolic effects of minocycline were applicable as a standard for confirmation of responses to B. Significant increases in yields of DHT in response to B and M with both substrates indicate their anabolic potential in periosteal fibroblasts with implications for wound healing.
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Affiliation(s)
- A Suchak
- Formerly at King's College London Dental Institute, Periodontology, King's College Dental Hospital, Denmark Hill, London SE5 9RW, UK
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Souza SLS, Andrade PF, Silva JS, Tristão FSM, Rocha FA, Palioto DB, Grisi MFM, Taba M, Novaes AB. Effects of Antimicrobial Photodynamic Therapy on Transforming Growth Factor-β1 Levels in the Gingival Crevicular Fluid. Photomed Laser Surg 2013; 31:65-71. [DOI: 10.1089/pho.2012.3328] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sérgio L. S. Souza
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Patrícia F. Andrade
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - João S. Silva
- Department of Immunology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Fabrine S. M. Tristão
- Department of Immunology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Fernanda A. Rocha
- Department of Immunology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Daniela B. Palioto
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Marcio F. M. Grisi
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Mário Taba
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Arthur B. Novaes
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Muthukuru M, Sun J. Doxycycline counteracts bone morphogenic protein 2-induced osteogenic mediators. J Periodontol 2012; 84:656-65. [PMID: 22799755 DOI: 10.1902/jop.2012.120338] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Microbial colonization during wound healing may exaggerate the inflammatory response and could adversely affect the outcome of periodontal regeneration. Bone morphogenic proteins (BMPs) directly augment bone regeneration. Interestingly, inhibitors of tissue collagenases, such as sub-antimicrobial-dose doxycycline, also indirectly promote hard-tissue regeneration. In this study, it is hypothesized that BMP2-mediated bone regeneration would be positively affected by simultaneous treatment of sub-antimicrobial-dose doxycycline. METHODS Human periodontal ligament (PDL) cells were stimulated with: 1) 10 ng/mL BMP2; 2) 1 μg/mL doxycycline; or 3) a combination of the two. The expressions of alkaline phosphatase, osteocalcin, osteonectin, and osteopontin were analyzed along with in vitro mineralized nodule formation and calcium accumulation. RESULTS BMP2 was a potent inducer of osteocalcin/osteopontin (statistically significant at P <0.01) and osteonectin in PDL cells relative to stimulation with doxycycline. However, doxycycline relative to BMP2 (statistically significant at P <0.001) upregulated the expression of alkaline phosphatase and in vitro mineralized nodule formation. Contrary to expected results, combined BMP2 and doxycycline induced a statistically significant (P <0.001) downregulation of alkaline phosphatase, osteocalcin, osteonectin/osteopontin, and in vitro mineralized nodule formation compared to stimulation with either BMP2 or doxycycline alone. CONCLUSIONS Combined treatment of BMP2 and doxycycline in PDL cells counteracts the osteogenic mediators. Molecular interaction of growth factors should be explored before using a combination of these biologic molecules. It is important and clinically relevant to determine whether tetracycline and its other derivatives also counteract BMP functions. Animal models should be used to confirm these in vitro results.
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Affiliation(s)
- Manoj Muthukuru
- Department of Periodontics, University of Washington, Seattle, WA, USA.
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Mdala I, Haffajee AD, Socransky SS, de Blasio BF, Thoresen M, Olsen I, Goodson JM. Multilevel analysis of clinical parameters in chronic periodontitis after root planing/scaling, surgery, and systemic and local antibiotics: 2-year results. J Oral Microbiol 2012; 4:JOM-4-17535. [PMID: 22545190 PMCID: PMC3337750 DOI: 10.3402/jom.v4i0.17535] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 04/03/2012] [Indexed: 12/16/2022] Open
Abstract
AIM Find the periodontal treatment that best maintained clinical results over time evaluated by changes in pocket depth (PD) and clinical attachment level (CAL). METHODS 229 patients with chronic periodontitis from USA (n=134) and Sweden (n=95) were randomly assigned to eight groups receiving (1) scaling+root planing (SRP) alone or combined with (2) surgery (SURG)+systemic amoxicillin (AMOX)+systemic metronidazole (MET); (3) SURG+local tetracycline (TET); (4) SURG; (5) AMOX+MET+TET; (6) AMOX+MET; (7) TET; and (8) SURG+AMOX+MET+TET. Antibiotics were given immediately after SRP. Plaque, gingival redness, bleeding on probing, suppuration, PD, and CAL were recorded at baseline and after 3, 6, 12, 18, and 24 months. Treatment effects were evaluated by linear multilevel regression and logistic multilevel regression models. We considered only data from sites with a baseline PD of at least 5 mm of 187 patients completing the study. RESULTS Surgically treated patients experienced most CAL loss. Adjunctive therapy including SURG was most effective in reducing PD. Combining SURG with AMOX, MET, and TET gave significant clinical benefits. Past and current smoking habits were significant predictors of deeper PD. Only current smoking was a significant predictor of CAL loss. Bleeding, accumulation of plaque, gingival redness, and suppuration were significant predictors of further CAL loss and deeper PD. CONCLUSIONS Both surgical and non-surgical therapies can be used to arrest chronic periodontitis. SURG+AMOX+MET+TET gave best maintenance of clinical results.
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Affiliation(s)
- Ibrahimu Mdala
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Anne D. Haffajee
- Department of Periodontology, The Forsyth Institute, Cambridge, MA, USA
| | | | | | - Magne Thoresen
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Ingar Olsen
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - J. Max Goodson
- Center for Clinical and Translational Research, The Forsyth Institute, Cambridge, MA, USA
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Goodson JM, Haffajee AD, Socransky SS, Kent R, Teles R, Hasturk H, Bogren A, Van Dyke T, Wennstrom J, Lindhe J. Control of periodontal infections: a randomized controlled trial I. The primary outcome attachment gain and pocket depth reduction at treated sites. J Clin Periodontol 2012; 39:526-36. [PMID: 22512461 DOI: 10.1111/j.1600-051x.2012.01870.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2012] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare the treatment outcome of scaling and root planing (SRP) in combination with systemic antibiotics, local antibiotic therapy and/or periodontal surgery. MATERIAL AND METHODS One hundred and eighty-seven patients were assigned to eight groups treated by SRP plus none, one, two or three adjunctive treatments and monitored for 24 months in a randomized controlled clinical trial using a 2 × 2 × 2 factorial design. Systemic amoxicillin + metronidazole (SMA), local tetracycline delivery (LTC) and periodontal surgery (SURG) were evaluated as adjuncts. Changes in clinical attachment level (CAL) and probing pocket depth (PPD) were statistically evaluated by ancova of main effects. RESULTS Effects of adjunctive therapy to SRP were minimal at 3 months. Between 3 and 6 months PPD reduction occurred particularly in patients receiving periodontal surgery. After 6 months, both CAL gain and PPD reduction reached a plateau that was maintained at 24 months in all groups. The 24-month CAL gain was improved by SMA (0.50 mm) while PPD was reduced by SMA (0.51 mm) and SURG (0.36 mm). Smoking reduced CAL gain and PPD reduction. CONCLUSION Patients receiving adjunctive therapies generally exhibited improved CAL gain and/or PPD reduction when compared with the outcome of SRP alone. Only additive, not synergistic effects of the various adjunctive therapies were observed.
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Geisinger ML, Holmes CM, Geurs NC, Vassilopoulos PJ, Reddy MS. Host Modulation for Smokers Undergoing Periodontal Maintenance: A Review of Current Evidence. Clin Adv Periodontics 2011; 1:54-60. [PMID: 32698548 DOI: 10.1902/cap.2011.100008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 02/10/2011] [Indexed: 11/13/2022]
Abstract
Focused Clinical Question In patients presenting with generalized moderate to severe chronic periodontitis and continuing to smoke, does host modulation improve the maintenance of alveolar bone support and clinical attachment level? Clinical Scenario A 45-year-old woman with a 25-pack-year history of smoking presents for comprehensive periodontal therapy including four quadrants of regenerative surgery and is now receiving supportive care at 3-month intervals. Clinical examination reveals excellent oral hygiene, and the patient resists a referral for smoking cessation. The patient is anxious about the potential for tooth loss. See Figures 1 to 3 for clinical presentation.
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Affiliation(s)
- Maria L Geisinger
- Department of Periodontology, University of Alabama at Birmingham School of Dentistry, Birmingham, AL
| | - Carolyn M Holmes
- Lister Hill Library, University of Alabama at Birmingham, Birmingham, AL
| | - Nicolaas C Geurs
- Department of Periodontology, University of Alabama at Birmingham School of Dentistry, Birmingham, AL
| | - Philip J Vassilopoulos
- Department of Periodontology, University of Alabama at Birmingham School of Dentistry, Birmingham, AL
| | - Michael S Reddy
- Department of Periodontology, University of Alabama at Birmingham School of Dentistry, Birmingham, AL
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Sgolastra F, Petrucci A, Gatto R, Giannoni M, Monaco A. Long-term efficacy of subantimicrobial-dose doxycycline as an adjunctive treatment to scaling and root planing: a systematic review and meta-analysis. J Periodontol 2011; 82:1570-81. [PMID: 21417590 DOI: 10.1902/jop.2011.110026] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Subantimicrobial-dose doxycycline (SDD) is widely used as an adjunctive treatment to scaling and root planing (SRP), but its long-term effectiveness remains controversial. The purpose of this systematic review was to assess the actual evidence of the effectiveness of SRP + SDD compared to SRP + placebo in the treatment of chronic periodontitis. METHODS A literature search of electronic databases was performed for articles published through November 1, 2010. Several dental journals were screened during the manual search, and authors were contacted for missing information. The systematic review and meta-analysis were conducted according to the Quality of Reporting of Meta-Analyses statement and recommendations of the Cochrane Collaboration. The methodologic quality of the studies was determined via a Consolidated Standards of Reporting Trials-based assessment. Clinical attachment levels, probing depths, plaque and gingival indices, and gingival crevicular fluid levels were compared between baseline and the end of follow-up. Data were extracted and pooled using a random-effect model. The weighted mean difference was reported with the 95% confidence interval. Heterogeneity was assessed using the χ(2)-based Q-statistic method and I(2) measurement. P <0.05 was considered statistically significant. RESULTS After applying inclusion and exclusion criteria, three randomized placebo-controlled clinical trials were entered into the meta-analysis. These studies had similar treatment designs, SDD dosage regimens (20 mg twice daily for 3 months), and post-treatment follow-up lengths (9 months). Significant differences were observed for all investigated clinical parameters in favor of the SRP + SDD group. CONCLUSION The meta-analysis results seemed to support the long-term effectiveness of adjunctive SDD therapy; however, future studies are needed to confirm these findings.
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Affiliation(s)
- Fabrizio Sgolastra
- Department of Health Sciences, School of Dentistry, University of L'Aquila, L'Aquila, Italy.
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Caton J, Ryan ME. Clinical studies on the management of periodontal diseases utilizing subantimicrobial dose doxycycline (SDD). Pharmacol Res 2010; 63:114-20. [PMID: 21182947 DOI: 10.1016/j.phrs.2010.12.003] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Periodontitis, the most common chronic inflammatory condition known to mankind, is a disease that results in the destruction of tooth supporting tissues. Periodontitis is initiated by a bacterial biofilm on the tooth surface below the gingival margin. Until fairly recently it was assumed that the bacteria were the primary cause of tissue destruction, however, a large body of research has revealed that it is the patient's immune response that is actually responsible for the majority of the breakdown of tooth supporting tissues. Contemporary thinking suggests that successful, long term management of chronic periodontitis may combine both local mechanical and antimicrobial strategies to reduce the microbial bio-burden along with modulation of the host, patient's excessive, immuno-inflammatory response to the bacterial exposure known as host modulatory therapy (HMT). Based on extensive literature documenting the enzymatic inhibition and related anti-inflammatory properties of the tetracyclines, a new drug was developed as a host modulatory agent and approved by the United States Food and Drug Administration (FDA) for use as an adjunct to conventional scaling and root planing for the treatment of chronic periodontitis. A subantimicrobial dose of doxycycline (SDD) at 20 mg (Periostat(®)) has been found to be a safe and effective adjunct when taken twice daily for at least 3 months and up to 24 months in randomized placebo controlled clinical trials. Periostat(®) is currently the only FDA approved inhibitor of the matrix metalloproteinases implicated in the plaque-induced pathologic degradation of connective tissue collagen of the periodontal supporting structures. This review paper begins with a brief description of the disease process known as periodontitis followed by an extensive review of the Phase I-IV clinical trial data that established the safety and efficacy of sub-antimicrobial dose doxycycline (SDD) as an adjunct to scaling and root planing for the treatment of periodontitis.
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Affiliation(s)
- Jack Caton
- Department of Periodontology, Eastman Institute for Oral Health, University of Rochester, 625 Elmwood Avenue, Rochester, NY 14620, USA.
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Hanes PJ, Krishna R. Characteristics of inflammation common to both diabetes and periodontitis: are predictive diagnosis and targeted preventive measures possible? EPMA J 2010; 1:101-16. [PMID: 23199045 PMCID: PMC3405308 DOI: 10.1007/s13167-010-0016-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 01/24/2010] [Indexed: 11/21/2022]
Abstract
Diabetes and periodontitis are chronic inflammatory disorders that contribute to each others' severity and worsen each others' prognosis. Studies have shown that patients with diabetes are at increased risk of developing periodontitis, and that diabetics with untreated periodontitis have more difficulty controlling serum glucose. Periodontal treatment that reduces gingival inflammation aids in the control of hyperglycemia. Periodontitis is accompanied by gingival bleeding and the production of an inflammatory exudate termed gingival crevicular fluid (GCF) that arises from the inflamed gingival tissues surrounding the teeth. GCF contains byproducts of connective tissue degradation, enzymes from host and bacterial cells, cytokines and other inflammatory mediators, and has been studied for screening blood glucose and for biomarkers of both diabetes and periodontitis. This review focuses on the inter-relationship between diabetes and periodontitis and the biomarkers common to both these diseases that may enable earlier detection, targeted preventive measures and individualized therapeutic intervention of these chronic conditions.
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Affiliation(s)
- Philip J. Hanes
- Department of Periodontics, Medical College of Georgia School of Dentistry, Augusta, GA 30912 USA
| | - Ranjitha Krishna
- Department of Periodontics, Medical College of Georgia School of Dentistry, Augusta, GA 30912 USA
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Marcaccini AM, Meschiari CA, Zuardi LR, de Sousa TS, Taba M, Teofilo JM, Jacob-Ferreira AL, Tanus-Santos JE, Novaes AB, Gerlach RF. Gingival crevicular fluid levels of MMP-8, MMP-9, TIMP-2, and MPO decrease after periodontal therapy. J Clin Periodontol 2010; 37:180-90. [DOI: 10.1111/j.1600-051x.2009.01512.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Matrix metalloproteinases are a family of ubiquitous endopeptidases playing a role in many different physiological and pathological processes in the skin. They are also involved in cutaneous ageing. This review summarizes the features and regulation of these enzymes and presents an overview of the molecular mechanisms of both intrinsic and extrinsic skin ageing presents. The role of matrix metalloproteinases in skin ageing is discussed in detail.
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Affiliation(s)
- Miklós Sárdy
- Department of Dermatology and Allergology, Ludwig-Maximilians University, München, Germany
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29
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Braun A, Dehn C, Krause F, Jepsen S. Short-term clinical effects of adjunctive antimicrobial photodynamic therapy in periodontal treatment: a randomized clinical trial. J Clin Periodontol 2008; 35:877-84. [DOI: 10.1111/j.1600-051x.2008.01303.x] [Citation(s) in RCA: 193] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Emingil G, Atilla G, Sorsa T, Tervahartiala T. The effect of adjunctive subantimicrobial dose doxycycline therapy on GCF EMMPRIN levels in chronic periodontitis. J Periodontol 2008; 79:469-76. [PMID: 18315429 DOI: 10.1902/jop.2008.070165] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of the present randomized, double-masked, placebo-controlled, parallel-arm study was to examine the effectiveness of a 3-month regimen of subantimicrobial dose doxycycline (SDD) in combination with scaling and root planing compared to scaling and root planing alone on levels of gingival crevicular fluid (GCF) extracellular matrix metalloproteinase inducer (EMMPRIN) in patients with chronic periodontitis. METHODS GCF samples were collected, and clinical parameters, including probing depth (PD), clinical attachment level, gingival index (GI), and plaque index, were recorded. Thirty chronic periodontitis subjects were randomized to receive SDD or placebo. The SDD group received SDD (20 mg, twice a day) for 3 months plus scaling and root planing, whereas the placebo group took placebo capsules twice a day for 3 months and received scaling and root planing. The subjects were reevaluated at 3 and 6 months. At each visit, all clinical parameters were measured and GCF was sampled. GCF EMMPRIN levels were determined by Western immunoblotting assay. Intragroup comparisons were tested by the Friedman test followed by the Wilcoxon signed-rank test to analyze the significance of changes over time. The Mann-Whitney test was used to determine differences between the SDD and placebo groups. RESULTS Significant improvements were observed in all clinical parameters in the SDD group over the 6-month study period (P <0.025). The SDD group showed a significantly greater reduction in mean PD scores at 6 months and in mean GI scores at 3 and 6 months than the placebo group (P <0.05). From baseline to 6 months, the GCF EMMPRIN levels were reduced significantly in the SDD group (P <0.025). The GCF EMMPRIN level in the SDD group was significantly lower than that of the placebo group at 3 and 6 months (P <0.05). CONCLUSIONS SDD therapy in combination with scaling and root planing reduced GCF EMMPRIN levels and improved clinical periodontal parameters in subjects with chronic periodontitis. The ability of SDD to downregulate, in vivo, the GCF levels of EMMPRIN, a unique upregulator of matrix metalloproteinase expression, is one of its beneficial host-modulatory properties. These results expand the usefulness of SDD therapy as an adjunct to scaling and root planing in the long-term management of periodontal disease.
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Affiliation(s)
- Gülnur Emingil
- Department of Periodontology, School of Dentistry, Ege University, Bornova, Izmir, Turkey.
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Gürkan A, Emingil G, Çınarcık S, Berdeli A. Post-treatment effects of subantimicrobial dose doxycycline on clinical parameters and gingival crevicular fluid transforming growth factor-β1in severe, generalized chronic periodontitis. Int J Dent Hyg 2008; 6:84-92. [DOI: 10.1111/j.1601-5037.2007.00268.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gomes P, Santos J, Fernandes M. Cell-induced response by tetracyclines on human bone marrow colonized hydroxyapatite and Bonelike. Acta Biomater 2008; 4:630-7. [PMID: 18291737 DOI: 10.1016/j.actbio.2007.12.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Revised: 11/21/2007] [Accepted: 12/18/2007] [Indexed: 10/22/2022]
Abstract
Semi-synthetic tetracyclines are commonly used antibiotics that also seem to play an important role in the modulation of the immuno-inflammatory imbalance, verified in several bone diseases. The association of a therapeutic agent (that prevents bacterial infection and induces tissue formation) to a biomaterial aiming to repair/regenerate bone defects could contribute to a more predictable clinical outcome. The present study intends to evaluate the proliferation and functional activity of osteoblast-induced human bone marrow cells, cultured on the surface of hydroxyapatite (HA) and Bonelike, in the presence of therapeutic concentrations of doxycycline and minocycline. First passage bone marrow cells were cultured for 35 days on the surface of HA and Bonelike discs, in the absence or presence of 1 microg ml(-1) doxycycline and minocycline. Cultures performed in standard tissue culture plates were used as control. Doxycycline or minocycline induced cell proliferation and increased the extent of matrix mineralization in osteoblastic cell cultures established in the three substrates. Also, an improved biological behavior was verified in seeded Bonelike compared with HA. The results suggest that the local delivery of tetracyclines might associate the antimicrobial activity in implant-related bone infection with an eventual induction of osteoblastic proliferation and maintenance of the characteristic biological activity of these cells.
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Reinhardt RA, Stoner JA, Golub LM, Wolff MS, Lee HM, Lee HM, Meinberg TA, Lynch JC, Ryan ME, Sorsa T, Payne JB. Efficacy of sub-antimicrobial dose doxycycline in post-menopausal women: clinical outcomes. J Clin Periodontol 2007; 34:768-75. [PMID: 17716312 PMCID: PMC2157554 DOI: 10.1111/j.1600-051x.2007.01114.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To determine the clinical efficacy of a 2-year continuous sub-antimicrobial dose doxycycline (SDD; 20 mg bid) in post-menopausal, osteopenic, oestrogen-deficient women on periodontal maintenance. MATERIALS AND METHODS One-hundred and twenty-eight subjects were randomized to SDD (n=64) or placebo (n=64). Clinical measurements were performed at posterior interproximal sites at baseline and every 6 months during this 2-year randomized, double-blind, placebo-controlled clinical trial with adjunctive, no-cost 3-4-month periodontal maintenance. Statistical analyses of secondary outcomes from this clinical trial used Generalized Estimating Equations in primarily intent-to-treat analyses. RESULTS For the placebo group, 3.4% of the sites showed improvement in clinical attachment levels (CAL) and 2.7% had progressive loss in CAL; for the SDD group, 5.0% of the sites showed an improvement in CAL and 2.2% had progressive loss in CAL. This difference (2.1% of sites) was more favourable in the SDD group than in the placebo [odds ratio (OR)=0.81 [corrected] 95% confidence interval (CI): 0.67-0.97, p=0.03] in these well-maintained patients, whereas probing depths, bleeding on probing and supragingival plaque did not differ significantly between groups (p>0.2). However, in exploratory subgroup analysis of non-smokers, SDD showed reduced bleeding versus placebo (27%versus 33%; p=0.05). In protocol-adherent subjects, the odds of bleeding were 34% lower for SDD (p=0.05). CONCLUSIONS Analyses of secondary outcomes of this clinical trial indicated that SDD may be of benefit in reducing progressive attachment loss in post-menopausal females; additional research is needed to confirm these findings. Protocol registered at (ClinicalTrials.gov). Identifier:NCT00066027.
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Affiliation(s)
- Richard A Reinhardt
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE 68583-0740, USA.
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Haffajee AD, Torresyap G, Socransky SS. Clinical changes following four different periodontal therapies for the treatment of chronic periodontitis: 1-year results. J Clin Periodontol 2007; 34:243-53. [PMID: 17309596 DOI: 10.1111/j.1600-051x.2006.01040.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare clinical changes occurring in chronic periodontitis subjects receiving SRP alone or with systemically administered azithromycin, metronidazole or a sub-antimicrobial dose of doxycycline. MATERIAL AND METHODS 92 chronic periodontitis subjects were randomly assigned to receive SRP alone (N=23) or combined with 500 mg azithromycin per day for 3 days (N=25), 250 mg metronidazole tid for 14 days (N=24) or 20 mg doxycycline bid for 3 months (N=20). Gingival redness, bleeding on probing, suppuration, pocket depth and attachment level were measured at baseline and 3, 6 and 12 months post therapy. The significance of changes in clinical parameters within groups over time was sought using the Friedman test and among groups using ANCOVA or the Kruskal Wallis test. RESULTS All groups showed clinical improvements at 12 months, with subjects receiving adjunctive agents showing a somewhat better response. Sites with initial pocket depth > 6 mm showed significantly greater pocket depth reduction and greater attachment gain in subjects receiving metronidazole or azithromycin than subjects in the other groups. Some subjects showed attachment loss at 12 months in each group ranging from 15% to 39% of subjects in the SDD and SRP only groups respectively. CONCLUSION This study, demonstrated that periodontal therapy provides clinical benefits and that antibiotics provide a clinical benefit over SRP alone, particularly at initially deeper periodontal pockets.
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Affiliation(s)
- Anne D Haffajee
- Department of Periodontology, The Forsyth Institute, 140 The Fenway, Boston, MA 02115, USA.
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Kirkwood KL, Cirelli JA, Rogers JE, Giannobile WV. Novel host response therapeutic approaches to treat periodontal diseases. Periodontol 2000 2007; 43:294-315. [PMID: 17214846 PMCID: PMC2570321 DOI: 10.1111/j.1600-0757.2006.00166.x] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Keith L Kirkwood
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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Tjäderhane L, Hotakainen T, Kinnunen S, Ahonen M, Salo T. The effect of chemical inhibition of matrix metalloproteinases on the size of experimentally induced apical periodontitis. Int Endod J 2007; 40:282-9. [PMID: 17298412 DOI: 10.1111/j.0143-2885.2007.01223.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To determine the effect of matrix metalloproteinase (MMP) inhibition on periapical lesion formation in a rat model. METHODOLOGY The pulp chambers of mandibular fist molars of adult SD rats were exposed to be infected by oral microbes. The experimental group was fed 20 mg kg(-1) MMP-inhibitor chemically modified tetracycline-3 (CMT-3) daily in an oral gavage and the controls were fed the vehicle. After 2 and 4 weeks, the mandibles (n = 10 in both groups at both times) were radiographed, decalcified and subjected to histological analysis. Extension of necrosis in first molar distal root canals was measured from the histological sections, and periapical lesion sizes in the same roots were determined from radiographs and histological sections. Mann-Whitney U-test was used for the statistical analysis. RESULTS There was a statistically significant difference in the extension of necrosis in root canals between 2 and 4 weeks in the control group (P < 0.05), but not with MMP inhibition. Radiographically, MMP inhibition increased the periapical lesion size by 70% and 34% after 2 and 4 weeks respectively (P < 0.05 in after 2 weeks). In histological measurements, lesion size increased with MMP inhibition by 26% and 8% after 2 and 4 weeks respectively. CONCLUSIONS MMP inhibition affects pulpal and periapical inflammation, increasing the rate of spreading of necrosis in root canals and the rate of periapical lesion formation.
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Affiliation(s)
- L Tjäderhane
- Institute of Dentistry, University of Helsinki, Helsinki, Finland.
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Gürkan A, Emingil G, Cinarcik S, Berdeli A. Gingival crevicular fluid transforming growth factor-β1 in several forms of periodontal disease. Arch Oral Biol 2006; 51:906-12. [PMID: 16787634 DOI: 10.1016/j.archoralbio.2006.04.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Accepted: 04/25/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Transforming growth factor-beta(1) (TGF-beta(1)) has significant effects on periodontal host response regulation. Limited knowledge on the role of TGF-beta(1) in various periodontal disease types and particularly in advanced periodontitis forms warranted the present study. The aim of the present study was to evaluate the gingival crevicular fluid (GCF) TGF-beta(1) levels in patients with different forms of periodontal disease. METHODS GCF TGF-beta(1) levels were investigated in 32 chronic periodontitis (CP), 30 generalized aggressive periodontitis (G-AgP), 15 gingivitis patients and 16 periodontally healthy subjects. Periodontal status was evaluated by measuring probing depth, clinical attachment loss, plaque and bleeding on probing. TGF-beta(1) levels were analyzed by enzyme-linked immunosorbent assay. The results were expressed in terms of total amount (pg) and concentration (pg/microl). RESULTS G-AgP and CP groups had significantly elevated GCF TGF-beta(1) total amount compared to healthy group (p<0.008). Moreover, GCF TGF-beta(1) total amount of G-AgP group was significantly higher than that of gingivitis group (p<0.008). G-AgP and CP groups had similar GCF TGF-beta(1) total amount (p>0.008). Significant correlation was found between GCF TGF-beta(1) total amount and all clinical periodontal parameters (p<0.05). CONCLUSIONS The results of the present study suggest contribution of TGF-beta(1) to the pathogenesis of advanced chronic and aggressive periodontitis. TGF-beta(1) may thus be one of the components modulating exaggerated host response together with other major mediators of inflammation.
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Affiliation(s)
- Ali Gürkan
- Ege University, School of Dentistry, Department of Periodontology, Bornova-35100, Izmir, Turkey.
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. NS, . HA, . AM, . HG, . AR, . MHH. Evaluation of Long-Term Usage of Low Dose Doxycycline after Periodontal Surgery in Patients with Chronic Periodontitis. INT J PHARMACOL 2006. [DOI: 10.3923/ijp.2006.467.470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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