Publication: Periodontal hastalıklar bireylerde serbest oksijen radikalleri, Tumor Necrosis Factor-alfa ve nötrofil fonksiyonlarının incelenmesi
Abstract
Bu çalışmada, kronik periodontitisli (KP) ve generalize agresif periodontitisli (GAgP) hastalara uygulanan başlangıç tedavisi, başlangıç tedavisine destek olarak sistemik kombine antibiyotik (metronidazol+amoksisilin/ potasyum klavulanat) ve antioksidan ilaç (A+C+E vitamini+Selenyum+Bakır+Çinko+Manganez) kullanımının klinik parametreler, dişeti oluğu sıvısında (DOS) serbest oksijen radikalleri (SOR), dişeti örneklerinde SOR, tumour necrosis factor-? (TNF-?) ve myeloperoksidaz (MPO) enzimi üzerine etkileri incelendi ve sağlıklı kontrol grubu ile karşılaştırıldı. Her yarım çenesinde sondalanabilir cep derinliği (SCD)ý5 mm ve dişeti oluğu kanama indeksi (DOKİ)ý3 olan, en az 2 adet tek köklü dişi bulunan, yaş ortalaması 46.27 ± 9.23 8 kadın, 6 erkek 14 KP'li ve yaş ortalaması 32.27 ± 2.23 10 kadın, 4 erkek 14 GAgP'li toplam 28 hasta kendi gruplarında rastgele 3 tedavi grubuna ayrıldı. Tüm hastaların 2 zıt yarım çenesine sadece diş yüzeyi temizliği ve kök yüzeyi düzleştirilmesi uygulandı (SRP grubu) ve sonra her 2 hastalık grubuna ait bireyler 7'şer kişilik 2 alt gruba ayrılarak 7 hastanın diğer yarım çenelerine SRP ve kombine antibiyotik (AB) tedavisi (SRP+AB grubu), diğer 7 hastaya SRP ve antioksidan (AO) (SRP+AO grubu) tedavisi uygulandı. 0. gün, 6. ve 12. haftalarda grupların plak indeksi (Pİ), DOKİ, SCD ve rölatif ataşman seviyesi (RAS) ölçüldü, SCDý5 mm, DOKİý3 olan bölgelerden DOS ve dişeti örnekleri alındı. Sağlıklı kontrol grubu için protetik nedenlerle kron boyu uzatılması gereken, periodontal açıdan sağlıklı, yaş ortalaması 34.60 ± 7.55 olan 10 bireyden DOS ve dişeti örnekleri alındı. Tedavi öncesi ve sonrasında DOS- ve dişeti-SOR düzeyi biyokimyasal yöntemle, dişeti-TNF-? ve -MPO varlığı ve boyanma yoğunluğu immünohistokimyasal yöntemle değerlendirildi. Klinik değerlendirmede, tüm hasta ve tedavi gruplarında klinik indeks ve ölçümlerde anlamlı grup içi değişimler (p<0.05, p<0.001) gözlendi. Tedavi grupları arası karşılaştırmada ise farklılık bulunamadı (p>0.05). KP ve GAgP'li hastalık grupları karşılaştırıldığında DOKİ dışında fark bulunmadı (p>0.05). Biyokimyasal değerlendirmede, KP ve GAgP'li ilaç gruplarında dişeti-SOR düzeylerinde anlamlı (p<0.05), SRP gruplarında ileri derecede anlamlı (p<0.01) azalmalar olduğu, gruplar arası karşılaştırmada istatistiksel anlamlı fark olmadığı (p>0.05) belirlendi. DOS-SOR düzeyi incelendiğinde, KP ve GAgP'li ilaç gruplarında anlamlı (p<0.05), KP/ SRP grubunda ileri derecede anlamlı (p<0.01) ve GAgP/ SRP grubunda çok ileri derecede anlamlı (p<0.0001) azalmanın olduğu saptandı. KP'de gruplar arasında fark olmadığı, GAgP gruplarında GAgP/ SRP+AB tedavi grubu lehine ileri derecede anlamlı fark olduğu belirlendi (p<0.01). KP ve GAgP birbiriyle karşılaştırıldığında, DOS-SOR'da fark yokken, dişeti-SOR değerleri açısından GAgP/ SRP+AO grubu lehine daha fazla anlamlı azalma saptandı (p<0.05). Klinik veriler ve dişeti-SOR düzeyi korelasyonunda, Pİ, DOKİ ve SCD ile dişeti-SOR düzeyi arasında güçlü ilişki saptandı. İmmünhistokimyasal değerlendirmede, hem KP, hem de GAgP'de her 3 tedavi grubunda dişeti-TNF-? ve -MPO varlığı ve boyanma yoğunluğu anlamlı (p<0.05) azaldı, ancak ilaç gruplarında kuvvetli immünreaktivite saptanmazken, SRP gruplarında azalmış olarak saptandı. Dişeti-SOR, -TNF-? ve -MPO düzeyi korelasyonunda, tedavi öncesi -TNF-? ve -MPO düzeyi ile tedavi sonrası süperoksit radikali düzeyi arasında ilişki saptandı. Bu çalışmanın sonuçları, akut cevap hücreleri olan polimorfnüveli lökosit fonksiyonu ile ilişkili SOR, TNF-? ve MPO'nun hem KP, hem de GAgP patogenezinde rol oynadığı ve rutin uygulanan SRP işlemleri ile bu mediyatörlerin azaldığı ve destek AB ve AO tedavilerin fark meydana getirmediğini gösterdi.
TEZ KONU BAŞLIĞI EXAMINATION OF FREE OXYGEN RADICALS, TUMOR NECROSIS FACTOR-? AND NEUTROPHIL FUNCTIONS AT PERIODONTALLY DISEASED PATIENTS Adı ve Soyadı: Özlem Gür Uğurlu Danışmanın Adı: Elvan Efeoğlu Doktora Periodontoloji SUMMARY The objective of this study was to evaluate the effects of systemic combined antibiotics (AB) and anti-oxidant (AO) drugs used as an adjunctive to initial periodontal treatment on clinical parameters and gingival tissue- and gingival crevicular fluid (GCF)-free oxygen radicals (FR's) and gingival tissue-tumour necrosis factor-? (TNF-?) and myeloperoxidase levels in chronic periodontitis (CP) and generalised aggressive periodontitis (GAgP) patients. A total of 28 patients (14 CP patients; 8 female and 6 male, mean age of 46.27 ± 9.23 and 14 GAgP patients; 10 female and 4 male, mean age of 32.27 ± 2.23) with a probing pocket depth of (PPD)ý5 mm and sulcus bleeding index (SBI)ý3 in at least 2 single-rooted teeth within each quadrants were examined and divided into 3 groups randomly. All patients received SRP on their contrary quadrants (SRP Group), then all were divided into 2 groups each of seven patients. Seven of each groups received SRP+combined AB (SRP+AB group) and the others received SRP and AO (SRP+AO group). At baseline, 6. and 12. weeks after therapy, plaque index (PI), BOP, PPD and relative attachment level (RAL) have been measured. At the same day GCF and gingival specimens were collected from selected teeth with PPDý5 mm and SBIý3 and from 10 periodontally healthy patients (mean age of 34.60 ± 7.55) who need crown-lengthening for one of the single-rooted teeth for prosthodontic reasons served as the healthy controls (Control group). Biochemical evaluations were carried to determine the level of FR's in GCF and gingival tissue specimens, ımmunohistochemical evaluations were carried to determine the presence of TNF-? and MPO and their staining intensity in gingival tissue specimens. At the end of the observation period, statistically significant (p<0.0001) improvements in clinical parameters were observed in the treatment groups. Intergroup comparisons between groups did not reveal statistically significant differences for all clinical parameters (p>0.05). Regarding biochemical evaluation, post-treatment gingival-FR's level in CP/ SRP+AB and CP/ SRP+AO demonstrated significant differences (p<0.05) and very significant differences in CP/ SRP group. Intergroup comparisons between groups did not reveal any differences for all FR's level (p>0.05). GAgP/ SRP+AB and GAgP/ SRP+AO groups demonstrated significant differences (p<0.05), GAgP/ SRP groups revealed very significant differences (p<0.01). Although differences between the pre- and post-treatment levels were found to be significant, the SRP+AO groups revealed more differences but not statistically significantly (p>0.05). Post-treatment GCF-FR's level in CP/ SRP+AB and CP/ SRP+AO demonstrated significant differences (p<0.05) and very significant differences in CP/ SRP group (p<0.01). Intergroup comparisons between groups did not reveal any differences for all FR's level (p>0.05). GAgP/ SRP+AB and GAgP/ SRP+AO groups demonstrated significant differences (p<0.05), GAgP/ SRP groups revealed very significant differences (p<0.05). Intergroup comparisons between groups revealed significant differences (p<0.01) between FR's level for GAgP/ SRP+AB group. Regarding immunohistochemical evaluation, post-treatment TNF-? presence and staining intensity demonstrated statistically significant difference in all groups of CP and GAgP (p<0.05), intergroup observations revealed that SRP+AO groups are better than the others but these differences were not significant. Similarly, post-treatment MPO presence and staining intensity demonstrated statistically significant difference in all groups of CP and GAgP, intergroup observations revealed that SRP+AB groups are better than the others but these differences were not significant.. In conclusion, clinical, biochemical and immunohistochemical results of the present study revealed that systemic AB and AO drugs using combined with SRP is more effective than SRP alone.
TEZ KONU BAŞLIĞI EXAMINATION OF FREE OXYGEN RADICALS, TUMOR NECROSIS FACTOR-? AND NEUTROPHIL FUNCTIONS AT PERIODONTALLY DISEASED PATIENTS Adı ve Soyadı: Özlem Gür Uğurlu Danışmanın Adı: Elvan Efeoğlu Doktora Periodontoloji SUMMARY The objective of this study was to evaluate the effects of systemic combined antibiotics (AB) and anti-oxidant (AO) drugs used as an adjunctive to initial periodontal treatment on clinical parameters and gingival tissue- and gingival crevicular fluid (GCF)-free oxygen radicals (FR's) and gingival tissue-tumour necrosis factor-? (TNF-?) and myeloperoxidase levels in chronic periodontitis (CP) and generalised aggressive periodontitis (GAgP) patients. A total of 28 patients (14 CP patients; 8 female and 6 male, mean age of 46.27 ± 9.23 and 14 GAgP patients; 10 female and 4 male, mean age of 32.27 ± 2.23) with a probing pocket depth of (PPD)ý5 mm and sulcus bleeding index (SBI)ý3 in at least 2 single-rooted teeth within each quadrants were examined and divided into 3 groups randomly. All patients received SRP on their contrary quadrants (SRP Group), then all were divided into 2 groups each of seven patients. Seven of each groups received SRP+combined AB (SRP+AB group) and the others received SRP and AO (SRP+AO group). At baseline, 6. and 12. weeks after therapy, plaque index (PI), BOP, PPD and relative attachment level (RAL) have been measured. At the same day GCF and gingival specimens were collected from selected teeth with PPDý5 mm and SBIý3 and from 10 periodontally healthy patients (mean age of 34.60 ± 7.55) who need crown-lengthening for one of the single-rooted teeth for prosthodontic reasons served as the healthy controls (Control group). Biochemical evaluations were carried to determine the level of FR's in GCF and gingival tissue specimens, ımmunohistochemical evaluations were carried to determine the presence of TNF-? and MPO and their staining intensity in gingival tissue specimens. At the end of the observation period, statistically significant (p<0.0001) improvements in clinical parameters were observed in the treatment groups. Intergroup comparisons between groups did not reveal statistically significant differences for all clinical parameters (p>0.05). Regarding biochemical evaluation, post-treatment gingival-FR's level in CP/ SRP+AB and CP/ SRP+AO demonstrated significant differences (p<0.05) and very significant differences in CP/ SRP group. Intergroup comparisons between groups did not reveal any differences for all FR's level (p>0.05). GAgP/ SRP+AB and GAgP/ SRP+AO groups demonstrated significant differences (p<0.05), GAgP/ SRP groups revealed very significant differences (p<0.01). Although differences between the pre- and post-treatment levels were found to be significant, the SRP+AO groups revealed more differences but not statistically significantly (p>0.05). Post-treatment GCF-FR's level in CP/ SRP+AB and CP/ SRP+AO demonstrated significant differences (p<0.05) and very significant differences in CP/ SRP group (p<0.01). Intergroup comparisons between groups did not reveal any differences for all FR's level (p>0.05). GAgP/ SRP+AB and GAgP/ SRP+AO groups demonstrated significant differences (p<0.05), GAgP/ SRP groups revealed very significant differences (p<0.05). Intergroup comparisons between groups revealed significant differences (p<0.01) between FR's level for GAgP/ SRP+AB group. Regarding immunohistochemical evaluation, post-treatment TNF-? presence and staining intensity demonstrated statistically significant difference in all groups of CP and GAgP (p<0.05), intergroup observations revealed that SRP+AO groups are better than the others but these differences were not significant. Similarly, post-treatment MPO presence and staining intensity demonstrated statistically significant difference in all groups of CP and GAgP, intergroup observations revealed that SRP+AB groups are better than the others but these differences were not significant.. In conclusion, clinical, biochemical and immunohistochemical results of the present study revealed that systemic AB and AO drugs using combined with SRP is more effective than SRP alone.