Publication: Kronik periodontitiste başlangıç tedavisine yardımcı olarak kullanılan sistemik antibiyotiklerin dişeti matriks metalloproteinazlar üzerine etkilerinin incelenmesi
Abstract
Bu çalışmada, kronik periodontitisli (KP) hastaların başlangıç tedavisine yardımcı olarak kullanılan sistemik metronidazol (NidazolÒ) ve doksisiklinin (TetradoxÒ) klinik parametreler ve matriks metalloproteinaz-8 (MMP-8) üzerine etkileri immünohistokimyasal olarak incelendi. Her yarım çenesinde sondalanabilir cep derinliği (SCD) ý5 mm ve dişeti oluğu kanama indeksi (DOKİ) ý3 olan en az 3 adet tek köklü dişi bulunan, yaş ortalaması 44.60 ± 6.63 olan 21 erkek 9 kadın toplam 30 KP'li hasta rasgele 3 gruba ayrıldı. 1. gruba diş yüzeyi temizliği ve kök yüzeyi düzleştirilmesi (SRP), 2. gruba SRP + sistemik metronidazol, 3. gruba SRP + sistemik doksisiklin uygulandı. 0. ve 49. günlerde grupların plak indeksi (Pİ), DOKİ, SCD, rölatif ataşman seviyesi (RAS) ve dişeti kenarı konum değişikliği (DKKD) ölçüldü. Aynı günlerde SCD ý5 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 (4. grup) dişeti örnekleri alındı. İmmünohistokimyasal incelemede, dişeti dokusundaki total MMP-8 değerleri tedavi öncesi ve tedavi sonrası semikantitatif olarak değerlendirildi. Klinik parametreler tüm çalışma gruplarında benzer ve anlamlı grup içi değişimler gösterirken, gruplar arası karşılaştırmada Pİ, RAS ve DKKD değerlerinde farklılık saptanmadı. Ancak DOKİ için 1. ve 2. grup arasında, SCD için 1. ve 2. grup ile 1. ve 3. grup arasında anlamlı farklılıklar gözlendi (sırasıyla p<0.01, p<0.01, p<0.05). İmmünohistokimyasal değerlendirmede, 1., 2. ve 3. gruplardaki tedavi öncesi MMP-8 varlığı ve boyanma yoğunluğunun 4. gruptan daha fazla olduğu (p<0.05), tedavi sonrası grup içi azalmaların 1. grupta anlamsız (p>0.05), 2. ve 3. grupta ise anlamlı olduğu belirlendi (p<0.05, p<0.01). Tedavi sonrası elde edilen azalmalarda 1.-2., 1.-3. ve 1.-4. grupları arasında anlamlı farklılıklar bulunduğu (p<0.05), 2.-4., 3.-4. ve 2.-3. grupları arasında ise fark olmadığı (p>0.05) belirlendi. Bu araştırmada, SRP'ye destek olarak kullanılan sistemik metronidazol ve doksisiklinin, tek başına uygulanan SRP'ye göre klinik düzelme ve MMP-8 varlığını baskılamada daha etkili olduğunu göstermiştir. SRP'ye destek olarak kullanılan sistemik doksisiklin ile metronidazol gruplarındaki veriler ise birbirlerine üstünlüklerini destekler nitelikte bulunmamıştır. EFFECTS OF SYSTEMIC ANTIBIOTICS USED AS ADJUNCTIVES TO INITIAL PERIODONTAL TREATMENT ON GINGIVAL TISSUE MATRIX METALLOPROTEİNASE LEVELS IN CHRONIC PERIODONTITIS.
A number of systemic antibiotic regimens have been tried as adjuncts to the mechanical treatment of the periodontal diseases. The objective of this study was to evaluate the effects of systemic antibiotics used as adjunctives to initial periodontal treatment on clinical parameters and gingival tissue matrix metalloproteinase-8 (MMP-8) levels in chronic periodontitis (CP) patients. A total of 30 patients (21 male and 9 female, mean age of 44.60±6.63) with evidence of CP probing pocket depth (PPD)ý5 mm and bleeding on probing (BOP)ý3 in at least 3 single-rooted teeth within each quadrants were selected, divided into 3 groups randomly and received scaling and root planing (SRP) at 0 and 7 days. Groups received: (1) SRP; (2) systemic metranidazole combined with SRP; (3) systemic doxycycline combined with SRP. At 0. and 49. days, plaque index (PI), BOP, PPD, relative attachment level (RAL) and gingival recession (GR) have been measured for each group. At the same day gingival specimens were collected from selected teeth with PPDý5 mm in the treatment groups. 10 periodontally healty patients (mean age of 38.80±4.66) who need crown-lengthening procedure for one of their single-rooted teeth for prosthodontic reasons were selected as the healthy control group. Evaluations were carried out for gingival MMP-8 levels before and after treatment. At the end of the observation period, statistically significant (p<0.001) improvements in clinical parameters were observed in each group. Statistically significant differences were also observed between the groups (1-2) for BOP, between the groups (1-2) and (1-3) for PPD values (p<0.01, p<0.01, p<0.05, respectively). Regarding immunohistochemical evaluation, pre-treatment MMP-8 levels of the 1., 2. and 3. groups were significantly higher than the 4. group (p<0.05). Although the differences between the pre- and post-treatment levels were found to be significant in the groups 2 and 3 (p<0.05, p<0.01, respectively), no statistically significant difference was observed in the group 1. Post-treatment MMP-8 levels demonstrated significant differences between the groups (1-2), (1-3) and (1-4) while no differences were detected between the groups (2-4), (3-4) and (2-3). In conclusion, clinical and immunohistochemical results of the present study revealed that adjunctive systemic metronidazole or doxycycline application combined with SRP is more effective than SRP alone. No marked difference was observed between the combined groups.
A number of systemic antibiotic regimens have been tried as adjuncts to the mechanical treatment of the periodontal diseases. The objective of this study was to evaluate the effects of systemic antibiotics used as adjunctives to initial periodontal treatment on clinical parameters and gingival tissue matrix metalloproteinase-8 (MMP-8) levels in chronic periodontitis (CP) patients. A total of 30 patients (21 male and 9 female, mean age of 44.60±6.63) with evidence of CP probing pocket depth (PPD)ý5 mm and bleeding on probing (BOP)ý3 in at least 3 single-rooted teeth within each quadrants were selected, divided into 3 groups randomly and received scaling and root planing (SRP) at 0 and 7 days. Groups received: (1) SRP; (2) systemic metranidazole combined with SRP; (3) systemic doxycycline combined with SRP. At 0. and 49. days, plaque index (PI), BOP, PPD, relative attachment level (RAL) and gingival recession (GR) have been measured for each group. At the same day gingival specimens were collected from selected teeth with PPDý5 mm in the treatment groups. 10 periodontally healty patients (mean age of 38.80±4.66) who need crown-lengthening procedure for one of their single-rooted teeth for prosthodontic reasons were selected as the healthy control group. Evaluations were carried out for gingival MMP-8 levels before and after treatment. At the end of the observation period, statistically significant (p<0.001) improvements in clinical parameters were observed in each group. Statistically significant differences were also observed between the groups (1-2) for BOP, between the groups (1-2) and (1-3) for PPD values (p<0.01, p<0.01, p<0.05, respectively). Regarding immunohistochemical evaluation, pre-treatment MMP-8 levels of the 1., 2. and 3. groups were significantly higher than the 4. group (p<0.05). Although the differences between the pre- and post-treatment levels were found to be significant in the groups 2 and 3 (p<0.05, p<0.01, respectively), no statistically significant difference was observed in the group 1. Post-treatment MMP-8 levels demonstrated significant differences between the groups (1-2), (1-3) and (1-4) while no differences were detected between the groups (2-4), (3-4) and (2-3). In conclusion, clinical and immunohistochemical results of the present study revealed that adjunctive systemic metronidazole or doxycycline application combined with SRP is more effective than SRP alone. No marked difference was observed between the combined groups.