RESUMO
OBJECTIVES: The aim of the present randomized, double-blind, placebo-controlled, parallel-arm study was to examine the effectiveness of a sub-antimicrobial dose of doxycycline (SDD) in combination with nonsurgical periodontal therapy, compared to nonsurgical periodontal therapy alone, on potential gingival crevicular fluid (GCF) biomarkers of periodontal tissue catabolism related to the clinical outcomes over a 12-month period. Materials and Methods: GCF was collected and clinical parameters were recorded from 30 periodontitis patients randomized either to an SDD or placebo group. The SDD group received SDD (20 mg) b.i.d for 3 months plus scaling and root planing (SRP), while the placebo group was given placebo capsules b.i.d for 3 months plus SRP. The patients were evaluated every 3 months during the 12-month study period. At each visit, clinical parameters and GCF sampling were repeated. Matrix metalloproteinase (MMP)-8, MMP-9, MMP-13, myeloperoxidase (MPO), osteoprotegerin (OPG), and tartrate-resistant acid phosphatase-5 (TRAP-5) were determined by IFMA and ELISA. Results: Significant improvements were observed in all clinical parameters in both groups over 12 months (p < 0.0125) while the SDD group showed significantly better reduction in gingival index (GI) and pocket depth and a gain in clinical attachment compared to the placebo group (p < 0.05). GCF MMP-8 and OPG levels significantly reduced in the SDD group compared to baseline (p < 0.05). GCF MMP-9 significantly decreased in both groups compared to baseline (p < 0.05). GCF MPO significantly decreased at 3 and 9 months in the SDD group, while it significantly decreased at 6 months in the placebo group (p < 0.05). TRAP and MMP-13 could be detected in none of the samples. Conclusions: The present results indicate that three months of adjunctive usage of SDD to nonsurgical periodontal therapy compared to nonsurgical periodontal therapy alone in periodontitis patients results in further improvement of clinical periodontal parameters and GCF markers of periodontal tissue breakdown over a 12-month period. Beneficial effects of adjunctive SDD therapy is likely to be related to the reduced levels of two major periodontitis-associated MMPs, MMP-8 and -9, and their potential oxidative activator MPO.
RESUMO
A Terapia de Modulação do Hospedeiro (TMH) com dose subantimicrobiana de Doxiciclina (DSD) tem o objetivo de complementar o tratamento periodontal convencional atuando na diminuição dos processos destrutivos da resposta imunoinflamatória e no aumento dos processos protetivos e regenerativos. O objetivo desta revisão da literatura é descrever os principais aspectos da TMH e avaliar, sob o ponto de vista clínico, a eficácia da DSD como tratamento coadjuvante à terapia periodontal convencional em pacientes portadores de periodontite crônica. Para tanto, foram realizadas buscas na base de dados PubMed e foram incluídos artigos indexados a partir do ano 2000 que abordavam o tema proposto. Para avaliação da eficácia clínica foram selecionados 6 estudos clínicos duplo-cegos, randomizados, placebo-controlados, com grupos paralelos, em pacientes com periodontite crônica e sem condições sistêmicas que pudessem influenciar o curso da doença periodontal. Os estudos clínicos selecionados mostraram uma capacidade superior da TMH com DSD na melhoria dos parâmetros clínicos e dos marcadores biológicos da periodontite quando comparados com o tratamento convencional sozinho
The Host Modulation Therapy (HMT) with subantimicrobial dose Doxycycline (SDD) is intended to complement the conventional periodontal treatment acting on reducing destructive processes of the immunoinflammatory response and increasing protective and regenerative processes. The purpose of this review is to describe the main aspects of HMT and evaluate, from a clinical point of view, the efficacy of SDDas an adjunct to conventional periodontal therapy in patients with chronic periodontitis. For this purpose, searches were conducted in PubMed database and articles indexed from 2000 that addressed the proposed theme were included. To evaluate the clinical efficacy, 6 double-blind, randomized, placebo-controlled, parallel-group clinical trial sin patients with chronic periodontitis and without systemic conditions that could influence the course of the periodontal disease, were selected. The selected clinical studies showed a superior ability of HMT with SDD in improving clinical parameters and biological markers of periodontitis when compared to conventional treatment alone.