Gullapelli Pranavi, Koduganti Rekha R
Department of Periodontics, Panineeya Mahavidyalaya Institute of Dental Sciences & Research Centre, Hyderabad, IND.
Cureus. 2023 Dec 22;15(12):e50968. doi: 10.7759/cureus.50968. eCollection 2023 Dec.
Background Periodontitis, a chronic inflammatory disease, is triggered by the plaque biofilm culminating in periodontal attachment loss, bone loss, and tooth loss. Diabetes, a globally prevalent disease, causes an increased inflammatory response to the microflora associated with periodontitis. It has been observed that the link between these two diseases is bidirectional. Tissue repair is impaired in diabetic patients with periodontitis. Local drug delivery systems selectively target the inflamed sites contrary to systemic antibiotics which lead to resistance and many other adverse effects. Probiotics aid in the growth of beneficial microorganisms and have immunomodulatory effects on the host. Tetracyclines have anti-collagenase properties and reduce the bacterial load, curbing the progression of periodontitis. Interleukin (IL) 1β, a strong marker of periodontal tissue destruction, plays a pivotal role in inflammation, immune regulation, and bone resorption in periodontitis. This study evaluated and compared the benefits of probiotics and tetracycline fibers when used as adjunctive tools after scaling and root planing (SRP) on IL1β levels in type 2 diabetic patients with periodontitis. Methodology A total of 36 patients participated in this study. Group I included 12 patients with periodontitis and uncontrolled diabetes (HbA1c levels >7). After SRP, six patients received tetracycline fibers (IA), and six patients received probiotics (1B) as locally delivered agents. Group II included 12 patients with periodontitis and diabetes under control (HbA1c levels 6-7%). After SRP, six patients received tetracycline fibers (IIA), and six patients received probiotics (IIB) as locally delivered drugs (test groups). Group III, the control group, included 12 patients with periodontitis only, wherein a placebo was used as a local drug delivery (LDD) after SRP. The clinical parameters, such as plaque index, gingival index, and probing pocket depth, were recorded preoperatively and at eight and 12 weeks after non-surgical periodontal therapy. IL1β levels were assessed by enzyme-linked immunosorbent assay at baseline and six weeks after SRP. Results On intra and intergroup comparison, all groups showed improvement in both the clinical and biochemical parameters but significant results were seen in Group IIA (p < 0.01) when compared to the other groups. Conclusions Group II (well-controlled diabetics) performed significantly better than the other groups, which was followed by Group III. The use of LDDs as adjunctive tools after SRP was not beneficial in Group I (uncontrolled diabetics).
牙周炎是一种慢性炎症性疾病，由菌斑生物膜引发，最终导致牙周附着丧失、骨质流失和牙齿脱落。糖尿病是一种全球流行的疾病，会导致对与牙周炎相关的微生物群的炎症反应增加。据观察，这两种疾病之间的联系是双向的。患有牙周炎的糖尿病患者的组织修复受损。与会导致耐药性和许多其他不良反应的全身用抗生素不同，局部给药系统可选择性地靶向炎症部位。益生菌有助于有益微生物的生长，并对宿主具有免疫调节作用。四环素具有抗胶原酶特性，可减少细菌载量，抑制牙周炎的进展。白细胞介素（IL）-1β是牙周组织破坏的一个重要标志物，在牙周炎的炎症、免疫调节和骨吸收中起关键作用。本研究评估并比较了在对2型糖尿病牙周炎患者进行龈上洁治和根面平整（SRP）后，使用益生菌和四环素纤维作为辅助手段对IL-1β水平的影响。
共有36名患者参与了本研究。第一组包括12名患有牙周炎且糖尿病未得到控制（糖化血红蛋白水平>7）的患者。在SRP后，6名患者接受四环素纤维（IA），6名患者接受益生菌（1B）作为局部给药制剂。第二组包括12名患有牙周炎且糖尿病得到控制（糖化血红蛋白水平6-7%）的患者。在SRP后，6名患者接受四环素纤维（IIA），6名患者接受益生菌（IIB）作为局部给药药物（试验组）。第三组为对照组，包括12名仅患有牙周炎的患者，在SRP后使用安慰剂作为局部给药（LDD）。在非手术牙周治疗前以及治疗后8周和12周记录临床参数，如菌斑指数、牙龈指数和探诊袋深度。在基线和SRP后6周通过酶联免疫吸附测定法评估IL-1β水平。
在组内和组间比较中，所有组的临床和生化参数均有改善，但与其他组相比，IIA组有显著结果（p<0.01）。
第二组（糖尿病得到良好控制的患者）的表现明显优于其他组，其次是第三组。在第一组（糖尿病未得到控制的患者）中，SRP后使用LDD作为辅助手段并无益处。
