Vardar Saynur, Baylas Haluk, Huseyinov Afig
Department of Periodontology, School of Dentistry, Ege University, Izmir, Turkey.
J Periodontol. 2003 Jan;74(1):57-63. doi: 10.1902/jop.2003.74.1.57.
The purpose of the present study was to evaluate the effect of a relatively selective cyclooxygenase (COX)-2 inhibitor (nimesulide) and non-selective COX-1/COX-2 inhibitor (naproxen) used as an adjunct to non-surgical (scaling and root planing [SRP]) periodontal therapy in chronic periodontitis patients on the gingival tissue (GT) levels of prostaglandin (PG)E2 and PGF2alpha.
Thirty patients with chronic periodontitis were divided into 3 groups of 10 each. One group received 100 mg of nimesulide; one received 275 mg of naproxen sodium; and the third group received placebo tablets in a 2 x 1 regimen for 10 days as an adjunct to SRP. GT samples were obtained before drug intake and on day 10. Plaque index (PI) and papillary bleeding index (PBI) scores were recorded at baseline, day 10, and at 3 months; probing depth (PD) and clinical attachment level (CAL) were recorded at baseline and at 3 months. The levels of PGE2 were detected using an enzyme immunoassay (EIA), and the levels of PGF2alpha were analyzed by radioimmunoassay (RIA). Differences among and within the groups were assessed using non-parametric statistical analysis. Ten periodontally healthy individuals served as controls.
All 3 groups showed statistically significant reductions in PBI and PI on day 10 and at 3 months (P < 0.02), and in PD and CAL at 3 months (P < 0.02, P < 0.05, respectively). In the naproxen group, GT PGE2 levels exhibited a significant decrease (P < 0.05). However, the decrease of GT PGE2 levels in the nimesulide group was insignificant (P > 0.05), while a significant increase was observed in the placebo group (P < 0.05) on day 10. Both the nimesulide and naproxen groups showed a significant decrease (P<0.05) in PGF2alpha level, while the placebo group showed a significant increase (P<0.05).
Nimesulides, relatively selective COX-2 inhibitors, may have additional inhibitory effects on GT PGF2alpha levels in the first week following non-surgical periodontal treatment. However, nimesulide has an insignificant effect on reducing PGE2 levels in gingival tissue. The determination of GT levels of COX-1 and COX-2 enzymes as well as PGE2 and PGF2alpha in long-term studies may provide further support for the adjunctive use of selective COX-2 inhibitors in treatment of chronic periodontitis.
本研究旨在评估相对选择性环氧化酶（COX）-2抑制剂（尼美舒利）和非选择性COX-1/COX-2抑制剂（萘普生）作为辅助手段，用于慢性牙周炎患者非手术性（龈下刮治和根面平整[SRP]）牙周治疗时，对牙龈组织（GT）中前列腺素（PG）E2和PGF2α水平的影响。
30例慢性牙周炎患者被分为3组，每组10例。一组服用100mg尼美舒利；一组服用275mg萘普生钠；第三组服用安慰剂片，采用2×1方案，共10天，作为SRP的辅助治疗。在服药前和第10天采集GT样本。在基线、第10天和3个月时记录菌斑指数（PI）和龈乳头出血指数（PBI）评分；在基线和3个月时记录探诊深度（PD）和临床附着水平（CAL）。使用酶免疫测定法（EIA）检测PGE2水平，通过放射免疫测定法（RIA）分析PGF2α水平。组间和组内差异采用非参数统计分析进行评估。10名牙周健康个体作为对照。
所有3组在第10天和3个月时PBI和PI均有统计学显著降低（P<0.02），3个月时PD和CAL也有降低（分别为P<0.02，P<0.05）。在萘普生组中，GT的PGE2水平显著降低（P<0.05）。然而，尼美舒利组GT的PGE2水平降低不显著（P>0.05），而安慰剂组在第10天观察到显著升高（P<0.05）。尼美舒利组和萘普生组的PGF2α水平均显著降低（P<0.05），而安慰剂组则显著升高（P<0.05）。
相对选择性COX-2抑制剂尼美舒利在非手术性牙周治疗后的第一周，可能对GT的PGF2α水平有额外的抑制作用。然而，尼美舒利对降低牙龈组织中PGE2水平的作用不显著。在长期研究中测定GT中COX-1和COX-2酶以及PGE2和PGF2α的水平，可能为选择性COX-2抑制剂辅助治疗慢性牙周炎提供进一步支持。
