Publication: Kronik periodontitiste başlangıç tedavisine yardımcı olarak kullanılan lokal antibiyotiklerin dişeti matriks metalloproteinazlar üzerine etkilerinin incelenmesi
Abstract
Bu çalışmada, kronik periodontitis (KP) hastalarında, başlangıç tedavisine destek olarak kullanılan lokal metronidazolün (ElyzolÒ) klinik parametreler ve dişeti matriks metalloproteinaz-8 (MMP-8) üzerine etkileri incelendi. Her yarım çenesinde sondalanabilir cep derinliği (SCD)ý 5 mm ve dişeti oluğu kanama indeksi (DOKİ)ý 3 olan, en az 3 adet tek köklü dişi bulunan, yaş ortalaması 44.98 ± 5.63 16 kadın, 4 erkek toplam 20 KP'li hasta rastgele 2 gruba ayrıldı. 1. gruba sadece diş yüzeyi temizliği ve kök yüzeyi düzleştirilmesi (SRP grubu), 2. gruba SRP+lokal metronidazol (SRP+Elyzol grubu) uygulandı. 0. ve 49. günlerde grupların plak indeksi (Pİ), DOKİ, SCD, rölatif ataşman seviyesi (RAS) ve dişeti kenarı konum değişikliği (DKKD) ölçüldü. Aynı günlerde SCDý 5 mm olan tek köklü dişlerin çevresinden ve ayrıca sağlıklı kontrol için protetik nedenlerle kron boyu uzatılması gereken, periodontal açıdan sağlıklı, yaş ortalaması 38.80 ± 4.66 olan 10 bireyden (S grubu) dişeti örnekleri alındı. Tedavi öncesi ve sonrasında dişeti dokusundaki MMP-8 varlığı ve boyanma yoğunluğu immünohistokimyasal yöntemle değerlendirildi. Klinik değerlendirmede hem SRP hem SRP+Elyzol grubunda tedavi öncesi ve sonrası tüm indeks ve ölçümlerde anlamlı grup içi değişimler saptandı. Gruplar arası karşılaştırmada ise Pİ ve DKKD değerlerinde farklılık bulunmazken, DOKİ ve SCD azalması ile ataşman kazancı açısından SRP+Elyzol grubu lehine anlamlı farklılıklar gözlendi (p<0.05). İmmünohistokimyasal değerlendirmede, tedavi öncesi SRP ve SRP+Elyzol gruplarına ait MMP-8 varlığı ve boyanma yoğunluğunun S grubundan daha fazla olduğu (p<0.01), tedavi sonrası grup içi azalmaların meydana geldiği ve bu azalmaların SRP grubunda anlamsız, SRP+Elyzol grubunda ise anlamlı olduğu belirlendi (p<0.05). Tedavi sonrası elde edilen değerlerde SRP+Elyzol ile S grubu arasında başlangıçta gözlenen farkın ortadan kalktığı, SRP ile S grubu arasındaki farkın ise korunduğu ve böylece lokal ilaçla desteklenen grupta elde edilen MMP değerlerinin sağlıklı gruba yaklaşarak sadece mekanik tedavi yapılan gruptan daha üstün sonuçlar verdiği saptandı. Bu araştırma kapsamındaki klinik ve immünohistokimyasal bulgular, SRP'ye destek olarak kullanılan lokal metronidazolün, tek başına uygulanan SRP'ye göre daha etkili olduğunu gösterdi. Evaluation the effects of local antibiotics used as an adjunctive to initial periodontal treatment on gingival matrix metalloproteinases in chronic periodontitis.
The objective of this study was to evaluate the effects of local metronidazole used as an adjunctive to initial periodontal treatment on clinical parameters and gingival tissue matrix metalloproteinase-8 (MMP-8) levels in chronic periodontitis (CP) patients. A total of 20 patients (16 female and 4 male, mean age of 44.98±5.63) with a probing pocket depth of (PPD)ý 5 mm and bleeding on probing (BOP)ý 3 in at least 3 single-rooted teeth within each quadrant were selected and divided into 2 groups randomly. The first group received SRP (SRP group) and the second group received adjunctive local metronidazole (SRP+Elyzol group) at 0 and 7 days. At 0 and 49 days, plaque index (PI), BOP, PPD, relative attachment level (RAL) and gingival recession (GR) have been measured. At the same days gingival specimens were collected from selected teeth with a PPDý 5 mm in the treatment groups and from 10 periodontally healthy patients (H group) (mean age of 38.80±4.66) who need crown-lengthening surgery for at least one of the single-rooted teeth for prosthodontic reasons. Immunohistochemical evaluation was carried to determine the presence of MMP-8 and its staining intensity in gingival tissue specimens. At the end of the observation period, statistically significant (p<0.001) improvements in clinical parameters were observed in the treatment groups. Intergroup comparisons revealed statistically significant differences for BOP, PPD and RAL parameters (p<0.05), except for PI and GR . Regarding immunohistochemical evaluation, pre-treatment MMP-8 presence in the SRP and SRP+Elyzol groups was significantly higher than the H group (p<0.01). Although the difference between the pre- and post-treatment levels was found to be significant in the SRP+Elyzol group (p<0.05), no statistically significant difference was observed in the SRP group. Post-treatment MMP-8 presence and staining intensity demonstrated insignificant differences between the groups SRP+Elyzol and H, whereas the difference between the SRP and H group was still evident. The immunohistochemical results of the SRP+Elyzol group became similar to the H group with decreasing MMP-8 presence and staining intensity. In conclusion, clinical and immunohistochemical results of the present study revealed that local metronidazole application combined with SRP is more effective than SRP alone.
The objective of this study was to evaluate the effects of local metronidazole used as an adjunctive to initial periodontal treatment on clinical parameters and gingival tissue matrix metalloproteinase-8 (MMP-8) levels in chronic periodontitis (CP) patients. A total of 20 patients (16 female and 4 male, mean age of 44.98±5.63) with a probing pocket depth of (PPD)ý 5 mm and bleeding on probing (BOP)ý 3 in at least 3 single-rooted teeth within each quadrant were selected and divided into 2 groups randomly. The first group received SRP (SRP group) and the second group received adjunctive local metronidazole (SRP+Elyzol group) at 0 and 7 days. At 0 and 49 days, plaque index (PI), BOP, PPD, relative attachment level (RAL) and gingival recession (GR) have been measured. At the same days gingival specimens were collected from selected teeth with a PPDý 5 mm in the treatment groups and from 10 periodontally healthy patients (H group) (mean age of 38.80±4.66) who need crown-lengthening surgery for at least one of the single-rooted teeth for prosthodontic reasons. Immunohistochemical evaluation was carried to determine the presence of MMP-8 and its staining intensity in gingival tissue specimens. At the end of the observation period, statistically significant (p<0.001) improvements in clinical parameters were observed in the treatment groups. Intergroup comparisons revealed statistically significant differences for BOP, PPD and RAL parameters (p<0.05), except for PI and GR . Regarding immunohistochemical evaluation, pre-treatment MMP-8 presence in the SRP and SRP+Elyzol groups was significantly higher than the H group (p<0.01). Although the difference between the pre- and post-treatment levels was found to be significant in the SRP+Elyzol group (p<0.05), no statistically significant difference was observed in the SRP group. Post-treatment MMP-8 presence and staining intensity demonstrated insignificant differences between the groups SRP+Elyzol and H, whereas the difference between the SRP and H group was still evident. The immunohistochemical results of the SRP+Elyzol group became similar to the H group with decreasing MMP-8 presence and staining intensity. In conclusion, clinical and immunohistochemical results of the present study revealed that local metronidazole application combined with SRP is more effective than SRP alone.