Emingil Gülnur, Gürkan Ali, Tervahartiala Taina, Hernandez Marcela, Özgül Semiha, Sorsa Timo, Alassiri Saeed
School of Dentistry, Department of Periodontology, Ege University, İzmir 35100, Turkey.
Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki University Hospital, Helsinki 00014, Finland.
Dent J (Basel). 2019 Jan 20;7(1):9. doi: 10.3390/dj7010009.
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. 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. Significant improvements were observed in all clinical parameters in both groups over 12 months ( < 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 ( < 0.05). GCF MMP-8 and OPG levels significantly reduced in the SDD group compared to baseline ( < 0.05). GCF MMP-9 significantly decreased in both groups compared to baseline ( < 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 ( < 0.05). TRAP and MMP-13 could be detected in none of the samples. 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.
本随机、双盲、安慰剂对照、平行组研究的目的是，在12个月的时间里，比较亚抗菌剂量强力霉素（SDD）联合非手术牙周治疗与单纯非手术牙周治疗相比，对与临床结果相关的牙周组织分解潜在龈沟液（GCF）生物标志物的有效性。从30名随机分为SDD组或安慰剂组的牙周炎患者中收集GCF并记录临床参数。SDD组接受SDD（20毫克）每日两次，共3个月，外加龈下刮治和根面平整（SRP），而安慰剂组接受安慰剂胶囊每日两次，共3个月，外加SRP。在为期12个月的研究期间，每3个月对患者进行一次评估。每次就诊时，重复临床参数和GCF采样。通过免疫荧光微球测定法（IFMA）和酶联免疫吸附测定法（ELISA）测定基质金属蛋白酶（MMP）-8、MMP-9、MMP-13、髓过氧化物酶（MPO）、骨保护素（OPG）和抗酒石酸酸性磷酸酶-5（TRAP-5）。在12个月内，两组的所有临床参数均有显著改善（<0.0125），而与安慰剂组相比，SDD组的牙龈指数（GI）和牙周袋深度显著降低，临床附着增加（<0.05）。与基线相比，SDD组的GCF MMP-8和OPG水平显著降低（<0.05）。与基线相比，两组的GCF MMP-9均显著降低（<0.05）。SDD组在3个月和9个月时GCF MPO显著降低，而安慰剂组在6个月时显著降低（<0.05）。所有样本中均未检测到TRAP和MMP-13。目前的结果表明，与单纯非手术牙周治疗相比，牙周炎患者在非手术牙周治疗中辅助使用SDD三个月，在12个月的时间里可进一步改善临床牙周参数和牙周组织破坏的GCF标志物。辅助SDD治疗的有益效果可能与两种主要的牙周炎相关MMP，即MMP-8和-9及其潜在的氧化激活剂MPO水平降低有关。
