Azmak Nezih, Atilla Gül, Luoto Hanne, Sorsa Timo
Department of Periodontology, Faculty of Dentistry, Ege University, Izmir, Turkey.
J Periodontol. 2002 Jun;73(6):608-15. doi: 10.1902/jop.2002.73.6.608.
The present study evaluated the efficacy of controlled-release delivery of chlorhexidine gluconate (CHX) on clinical parameters and on gingival crevicular fluid (GCF) matrix metalloproteinase (MMP)-8 levels in chronic periodontitis patients.
Twenty patients with chronic periodontitis were screened for 6 months. Two interproximal sites were selected from mesial surfaces of anterior teeth with probing depths of 6 to 8 mm that bled on probing in each patient. There were at least 2 teeth between the selected sites. CHX chip was inserted into a randomly selected site following scaling and root planing (SRP+CHX), while the other selected site received only SRP in each patient. Probing depth (PD), clinical attachment level (CAL), plaque index (PI), and papilla bleeding index (PBI) were recorded at baseline and at 1, 3, and 6 months. GCF MMP-8 levels were analyzed at baseline; 2 and 10 days; and at 1, 3, and 6 months by immunofluorometric assay (IFMA).
At baseline, there were no statistically significant differences in the mean PD, CAL, PBI, and PI scores between SRP+CHX and SRP alone groups. At 1, 3, and 6 months, all clinical parameters in each group significantly decreased (P <0.0167) when compared to baseline. The reduction of PD and improvement in CAL were higher in the SRP+CHX group compared to SRP alone at 3 and 6 months. However, the differences between the 2 groups were not statistically significant. PBI and PI scores were not significantly different between SRP+CHX and SRP alone groups at any visit. GCF MMP-8 levels were similar in both groups at baseline. Intragroup analysis showed significant decreases in the GCF MMP-8 level for the SRP+CHX group between baseline and 1, 3, and 6 months (P<0.01). Intergroup analysis demonstrated significantly lower mean levels of GCF MMP-8 at 1 month in the SRP+CHX group compared to the SRP alone group (P <0.05).
These data suggest that CHX chip application following SRP is beneficial in improving periodontal parameters and reducing GCF MMP-8 levels for 6 months' duration. The use of a chairside MMP-8 dipstick periodontitis test might be a useful adjunctive diagnostic tool when monitoring the course of CHX chip treatment.
本研究评估了葡萄糖酸氯己定（CHX）控释给药对慢性牙周炎患者临床参数及龈沟液（GCF）基质金属蛋白酶（MMP）-8水平的疗效。
筛选20例慢性牙周炎患者，为期6个月。在每位患者的前牙近中面选择两个探诊深度为6至8mm且探诊出血的邻面部位。所选部位之间至少间隔2颗牙。在每位患者中，洁治和根面平整（SRP）后，将CHX芯片随机插入一个选定部位（SRP+CHX），而另一个选定部位仅接受SRP治疗。在基线、1、3和6个月时记录探诊深度（PD）、临床附着水平（CAL）、菌斑指数（PI）和龈乳头出血指数（PBI）。通过免疫荧光测定法（IFMA）在基线、2天和10天以及1、3和6个月时分析GCF MMP-8水平。
基线时，SRP+CHX组和单纯SRP组的平均PD、CAL、PBI和PI评分无统计学显著差异。在1、3和6个月时，与基线相比，每组的所有临床参数均显著降低（P<0.0167）。在3和6个月时，SRP+CHX组的PD降低和CAL改善程度高于单纯SRP组。然而，两组之间的差异无统计学意义。在任何就诊时，SRP+CHX组和单纯SRP组的PBI和PI评分均无显著差异。两组在基线时GCF MMP-8水平相似。组内分析显示，SRP+CHX组在基线至1、3和6个月期间GCF MMP-8水平显著降低（P<0.01）。组间分析表明，与单纯SRP组相比，SRP+CHX组在1个月时GCF MMP-8的平均水平显著降低（P<0.05）。
这些数据表明，SRP后应用CHX芯片有助于在6个月内改善牙周参数并降低GCF MMP-8水平。在监测CHX芯片治疗过程时，使用椅旁MMP-8试纸条牙周炎检测可能是一种有用的辅助诊断工具。
