Systemic MMP inhibition for periodontal wound repair: results of a multi-centre randomized-controlled clinical trial.

AIM: This multi-centre, prospective, controlled trial was designed to examine the biological response of the matrix metalloproteinase(MMP) inhibitor subantimicrobial dose doxycycline (SDD) combined with access flap surgery on periodontal wound repair in patients with chronic severe periodontitis. MATERIAL AND METHODS: Seventy subjects were enrolled into a 12-month, randomized, placebo-controlled, double-masked trial to evaluate disease response to 6 months therapy and "wash-out" of either placebo+surgery or SDD (20 mg b.i.d.)+surgery. Primary outcome measure included clinical attachment levels (CAL) and secondary outcomes included probing depth (PD), bleeding on probing (BOP), as well as gingival crevicular fluid bone marker assessment [collagen telopeptides (ICTP)]. These measurements were taken at baseline through 12 months post-surgery and drug administration. RESULTS: Patients treated with SDD and surgery demonstrated stronger reductions in PD in surgically-treated sites of >or=7 mm as well as gains in CAL (p<0.004). Furthermore, SDD+surgery resulted in short-term reductions in ICTP levels compared with placebo. Rebounds in ICTP levels and clinical parameters occurred when SDD was withdrawn. CONCLUSIONS: The results from this multi-centre study suggests that SDD in combination with surgery improves the short-term response of periodontal therapy by reducing PD, increasing CAL gain and inhibiting early stage bone resorption.

Modulation of the host response in periodontal therapy.

This paper was prepared by the Research, Science, and Therapy Committee of the American Academy of Periodontology to provide the dental profession an overview of current and potential methods to modulate the host response in the treatment of periodontal diseases. Specifically, it discusses components of periodontal disease pathogenesis (i.e., immune and inflammatory responses, excessive production of matrix metalloproteinases and arachidonic acid metabolites, and regulation of bone metabolism) and their modulation.

Biological mediators for periodontal and bone regeneration.

In the past 25 years, significant advances in treatment have occurred in the area of periodontal and bone regeneration. Novel regenerative therapies have emerged based on an increased understanding of embryonic development and wound healing at the cellular and molecular level. Two approaches that have demonstrated significant regenerative potential include the administration of enamel matrix proteins and growth and differentiation factors. Current data regarding the use of enamel matrix proteins support their safety and efficacy. The use of recombinant growth and differentiation factors has been validated in preclinical and clinical trials. A new era of regenerative therapies has emerged, using biological mediators combined with scaffold materials to stimulate cellular processes required for the regeneration of oral tissues. The clinical application of these therapies will be to either replace or augment traditional regenerative treatments.

The challenge of treating periodontal patients who smoke--the efficacy of Arestin.

Smoking is considered a risk factor for periodontitis and an impediment to treatment. The current studies evaluated the efficacy of the local administration of 1 mg minocycline hydrochloride encapsulated in a bioresorbable polymer in periodontal pockets of > or = 5 mm in all three studies. Two hundred and seventy one patients who smoked were enrolled in the two single blind controlled studies (data pooled) with efficacy compared to scaling and root planing (SRP) and 71 smokers were enrolled in an open label study. In the three studies SRP was performed at baseline and the unit dose minocycline administered at baseline, three and six months. Efficacy and safety were measured at one, three, six, and nine months. Adjunctive treatment resulted in statistically significant pocket depth reduction in both studies in these smokers. In the controlled studies the difference in probing depth reduction between the adjunctive therapy group and the SRP alone group was statistically significant at one, three, six, and nine months. No serious adverse events were recorded in any of the studies.