Publication: Başlangıç periodontal tedavinin tip II Diabetes Mellitus’lu hastaların metabolik kontrolü üzerindeki etkisinin değerlendirilmesi
Abstract
Bu çalışmada, Tip II diabetes mellitus (DM) ve kronik periodontitis (KP) tanısı konmuş hastalarda başlangıç periodontal tedavinin ve bu tedaviye ek olarak sistemik doksisiklin (DOK) kullanımının klinik parametreler, DM'nin metabolik kontrolü (HbA1c), dişeti dokusu lipid peroksidasyon (LPO) ve glutatyon (GSH) seviyeleri ile dişeti oluğu sıvısı (DOS) interleukin-1ß (IL-1ß) seviyesi üzerindeki etkileri incelendi. Her bir yarım çenesinde, en az bir bölgesinde sondalanabilir cep derinliği (SCD) ý 5 mm ve dişeti oluğu kanama indeksi (DOKİ) ý 3 olan 3 adet tek köklü dişi bulunan 20 DM + KP'li hasta rastgele 2 gruba ayrıldı. 1. gruba diş yüzeyi temizliği ve kök yüzeyi düzleştirilmesi (SRP), 2. gruba SRP + sistemik DOK uygulandı. Hastalardan 0. ve 49. günlerde plak indeks (Pİ), dişeti oluğu kanama indeksi (DOKİ), SCD, rölatif ataşman seviyesi (RAS) ve HbA1c seviyeleri ölçüldü. Sıfırıncı günde SCD ý 5 mm ve DOKİ ý 3 olan tek köklü dişler bölgesinden, 49. günde başlangıç özellikleri benzer bölgelerden ve protetik nedenlerle periodontal cerrahi uygulanan sistemik ve periodontal açıdan sağlıklı 10 bireyden (3. grup) dişeti örnekleri ve DOS elde edildi. Dişeti örneklerindeki LPO ve GSH biyokimyasal yöntemle, DOS'ındaki IL-1ß enzyme linked immunosorbent assay yöntemiyle araştırıldı. Klinik değerlendirmede, her iki grupta klinik indeks ve ölçümlerde anlamlı değişimler gözlendi (p < 0.01). Gruplar arası karşılaştırmada ise fark istatistiksel olarak anlamsızdı (p > 0.05). Biyokimyasal incelemede, HbA1c değerinin grup içi ve gruplar arası kıyaslamasında anlamlı bir farklılık bulunmadı (p > 0.05). Her iki tedavi grubunda da dişeti LPO ve GSH seviyeleri tedavi sonrasında anlamlı değişimler gösterdi (p < 0.01). Gruplar arası karşılaştırmada ise farklılık gözlenmedi (p > 0.05). SRP ve SRP + DOK gruplarında DOS hacmi (p < 0.01, p < 0.05) ve DOS IL-1b toplam miktarındaki (p < 0.01, p < 0.05) azalma anlamlı idi. DOS IL-1b konsantrasyonunda ise anlamlı farklılık elde edilmedi (p > 0.05). DOS ile ilgili hiçbir parametrede 2 tedavi grubu arasında anlamlı fark bulunmadı (p > 0.05). Periodontal tedavi ile birlikte çalışma gruplarının klinik ve laboratuvar parametreleri sağlıklı grubun parametrelerine yaklaştı. Bu araştırma kapsamındaki klinik ve laboratuvar bulgular Tip II DM + KP'li hastalarda SRP'ye destek olarak kullanılan DOK'in tek başına SRP'ye göre bir üstünlüğünün olmadığını gösterdi. Yapılan periodontal tedaviler ile DM'un metabolik kontrolünün sağlanamaması bundan sonra gerçekleştirilecek olan çalışmalarda diyet ve stres gibi çevresel, periferik kan ve dokudaki hücrelerin fenotip ve fonksiyon değişiklikleri gibi çok sayıda birbirini etkileyen faktörlerin dikkate alınması gerektiğini göstermektedir. Evaluation of the Effects of Initial Periodontal Therapy on Metabolic Control in Patients with Type II Diabetes Mellitus
This study investigated the effects of initial periodontal therapy alone and combined with adjunctive use of systemic doxycycline (DOC) on clinical parameters, metabolic control (HbA1c), gingival tissue lipid peroxidation (LPO) and glutathione (GSH) levels, and gingival crevicular fluid (GCF) interleukin-1ß (IL-1ß) level in patients with chronic periodontitis (CP) and type II diabetes mellitus (DM). A total of 20 CP + DM having probing pocket depth (PPD) ý 5 mm and sulcus bleeding index (SBI) ý 3 in at least 3 single-rooted teeth within each quadrants were divided into 2 groups randomly. The first group received scaling and root planing (SRP) and the second group received SRP combined with the use of systemic DOC. Plaque index (PI), SBI, PPD, relative attachment level (RAL) and HbA1c were measured at 0 and 49 days. At the same time points, gingival tissue and GCF samples were collected from periodontal sites of the selected teeth with PPD ý 5 mm and SBI ý 3 in the treatment groups and from healty sites of 10 medically and periodontally healthy subjects (3rd group) who were undergone surgery for prosthodontic reasons. Biochemical methods were used for detection of LPO and GSH in gingival tissue specimens and enzyme linked immunosorbent assay was performed to measure IL-1ß levels in GCF samples. Clinical evaluation revealed statistically significant improvements in all clinical parameters of both treatment groups (p < 0.01). Inter-group comparisons did not reveal any statistically significant difference (p > 0.05). Regarding biochemical evaluation, no statistically significant differences were observed at the inter- and intra-group comparisons of the HbA1c levels. Gingival tissue LPO and GSH levels showed significant changes in both treatment groups after therapy (p < 0.01). There was no significant difference between the groups (p > 0.05). Furthermore, significant reductions were observed in the SRP and SRP + DOC groups regarding GCF volume (p < 0.01, p < 0.05, respectively) and total amount of IL-1ß in GCF (p < 0.01, p < 0.05). However, the difference in the concentration of IL-1ß in GCF between the treatment groups was not significant (p > 0.05) In addition, no significant differences were found between the groups in any GCF related parameter (p > 0.05). It was concluded that clinical and laboratory results of this study demonstrated no superior effect of systemic DOC usage combined with SRP in comparison with SRP alone in CP + DM patients. Clinical and laboratory parameters of study groups after periodontal therapy were comparable with those of healty group. The finding, that metabolic control was not achieved with periodontal therapies performed, shoved that future studies should take into account several factors including diet, stress, and phenotypic and fuctional changes of cells present in blood and tissues.
This study investigated the effects of initial periodontal therapy alone and combined with adjunctive use of systemic doxycycline (DOC) on clinical parameters, metabolic control (HbA1c), gingival tissue lipid peroxidation (LPO) and glutathione (GSH) levels, and gingival crevicular fluid (GCF) interleukin-1ß (IL-1ß) level in patients with chronic periodontitis (CP) and type II diabetes mellitus (DM). A total of 20 CP + DM having probing pocket depth (PPD) ý 5 mm and sulcus bleeding index (SBI) ý 3 in at least 3 single-rooted teeth within each quadrants were divided into 2 groups randomly. The first group received scaling and root planing (SRP) and the second group received SRP combined with the use of systemic DOC. Plaque index (PI), SBI, PPD, relative attachment level (RAL) and HbA1c were measured at 0 and 49 days. At the same time points, gingival tissue and GCF samples were collected from periodontal sites of the selected teeth with PPD ý 5 mm and SBI ý 3 in the treatment groups and from healty sites of 10 medically and periodontally healthy subjects (3rd group) who were undergone surgery for prosthodontic reasons. Biochemical methods were used for detection of LPO and GSH in gingival tissue specimens and enzyme linked immunosorbent assay was performed to measure IL-1ß levels in GCF samples. Clinical evaluation revealed statistically significant improvements in all clinical parameters of both treatment groups (p < 0.01). Inter-group comparisons did not reveal any statistically significant difference (p > 0.05). Regarding biochemical evaluation, no statistically significant differences were observed at the inter- and intra-group comparisons of the HbA1c levels. Gingival tissue LPO and GSH levels showed significant changes in both treatment groups after therapy (p < 0.01). There was no significant difference between the groups (p > 0.05). Furthermore, significant reductions were observed in the SRP and SRP + DOC groups regarding GCF volume (p < 0.01, p < 0.05, respectively) and total amount of IL-1ß in GCF (p < 0.01, p < 0.05). However, the difference in the concentration of IL-1ß in GCF between the treatment groups was not significant (p > 0.05) In addition, no significant differences were found between the groups in any GCF related parameter (p > 0.05). It was concluded that clinical and laboratory results of this study demonstrated no superior effect of systemic DOC usage combined with SRP in comparison with SRP alone in CP + DM patients. Clinical and laboratory parameters of study groups after periodontal therapy were comparable with those of healty group. The finding, that metabolic control was not achieved with periodontal therapies performed, shoved that future studies should take into account several factors including diet, stress, and phenotypic and fuctional changes of cells present in blood and tissues.