Marwa Abdelhakim Gomaa1, Hoda Mohamed El Guindy1, Mohamed Abdallah Mahmoud1, Enas Arafa El-Zamrany2
1Faculty of Dentistry, Tanta University, Tanta, Egypt
2Faculty of Medicine, Tanta University, Tanta, Egypt
Summary
Background/Aim: To evaluate the effectiveness of combination therapy including subantimicrobial dose doxycycline (SDD) and locally delivered doxycycline (LD) as adjuncts to scaling and root planing (SRP) in the treatment of chronic periodontitis in patients with type 2 diabetes mellitus (T2DM). Material and Methods: Forty patients with controlled T2DM (HbA1c ≤7%) and chronic periodontitis were selected. They were randomly divided into two groups, twenty patients each: Test group (TG, n=20) patients was treated with combination therapy of full mouth SRP, LD gel 10% and SDD 20 mg twice daily for 6 months. Control group (CG, n=20) patients was treated with full mouth SRP only. The periodontal parameters were recorded at baseline, 3, 6 and 9 months and included periodontal probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP). Gingival crevicular fluid (GCF) samples were collected and a quantitative measurement of matrix metalloproteinase-8 (MMP-8) was carried out by using Enzyme-Linked Immunosorbent Assay (ELIZA) at baseline, 3, 6 and 9 months. Results: Statistically significant reduction in all clinical parameters (PPD, CAL, and BOP) was observed at TG over CG at 3, 6, and 9 months (p<0.05). Moreover, combination therapy provided significant reductions in the amount of GCF MMP-8 for the TG compared to CG at 3, 6, and 9 months evaluation period (p<0.05). Conclusions: Combination therapy including SRP, SDD, and LD, provided significantly greater clinical benefits than SRP alone in the treatment of chronic periodontitis in patients with controlled T2DM.
Keywords: Diabetes Mellitus; Gingival Crevicular Fluid; Matrix Metalloproteinase-8; Periodontal Therapy; Subantimicrobial Dose Doxycycline
Reference
1. Cowie CC, Rust KF, Byrd-Holt DD, Eberhardt MS, Flegal KM, Engelgau MM et al. Prevalence of diabetes and impaired fasting glucose in adults in the US population: National Health and Nutrition Examination Survey 1999-2002. Diabetes Care, 2006; 29:1263-1268.Google Scholar
2. Tibaldi JM. The future of insulin therapy for patients with type 2 diabetes mellitus. J Am Osteopath Assoc, 2013;113:S29-39.Google Scholar
3. Oliver RC, Brown LJ, Loe H. Periodontal diseases in the United States population. J Periodontol, 1998;69:269-278.Google Scholar
4. Nishimura F, Soga Y, Iwamoto Y, Kudo C, Murayama syndrome in diabetic patients. J Int Acad Periodontol, 2005;7:16-20.Google Scholar
5. Llambes F, Silvestre FJ, Hernandez-Mijares A, Guiha R, Caffesse R. The effect of non-surgical periodontal treatment with or without doxycycline on the periodontium of type 1 diabetic patients. J Clin Periodontol, 2005;32:915-920.Google Scholar
6. Delaissé JM, Engsig MT, Everts V, del Carmen Ovejero M, Ferreras M, Lund L et al. Proteinases in bone resorption: Obvious and less obvious roles. Clin Chim Acta, 2000;291:223-234.Google Scholar
7. Ingman T, Tervahartiala T, Ding Y, Tschesche H, Haerian A, Kinane DF et al. Matrix metalloproteinases and their inhibitors in gingival crevicular fluid and saliva of periodontitis patients. J Clin Periodontol, 1996;23:1127-1132.CrossrefGoogle Scholar
8. Sorsa T, Ingman T, Suomalainen K, Halinen S, Saari H, Konttinen YT et al. Cellular source and tetracycline inhibition of gingival crevicular fluid collagenase of patients with labile diabetes mellitus. J Clin Periodontol, 1992;19:146-149.Google Scholar
9. Correa FO, Gonçalves D, Figueredo CM, Gustafsson A, Orrico SR. The short term effectiveness of non-surgical treatment in reducing levels of Interleukin-1ß (IL-1ß) and proteases in gingival crevicular fluid from patients with type 2 diabetes mellitus and chronic periodontitis. J Periodontal, 2008;79:2143-2150.Google Scholar
10. Southerland JH, Taylor GW, Offenbacher S. Diabetes and periodontal infection: Making the connection. Clin Diabetes, 2008;4:171-178.Google Scholar
11. Grossi SG, Skrepcinski FB, DeCaro T, Robertson DC, Ho AW, Dunford RG et al. Treatment of periodontal disease in diabetics reduces glycated hemoglobin. J Periodontol, 1997;68:713-719.CrossrefGoogle Scholar
12. Gilowski L, Kondzielnik P, Wiench R, Płocica I, Strojek K, Krzemiński TF. Efficacy of short-term adjunctive subantimicrobial dose doxycycline in diabetic patientsrandomized study. Oral Diseases, 2012;18:763-770.CrossrefGoogle Scholar
13. Gaikwad SP, Gurav AN, Shete AR, Desarda HM. Effect of scaling and root planing combined with systemic doxycycline therapy on glycemic control in diabetes mellitus subjects with chronic generalized periodontitis: a clinical study. J Periodontal Implant Sci, 2013;43:79-86.Google Scholar
14. Preshaw PM, Hefti AF, Bradshaw MH. Adjunctive subantimicrobial dose doxycycline in smokers and nonsmokers with chronic periodontitis. J Clin Periodontal, 2005; 32:610-616.Google Scholar
15. Caton J, Ryan ME. Clinical studies on the management of periodontal diseases utilizing subantimicrobial dose doxycycline (SDD). Pharmacol Res, 2011;63:114-120.Web of ScienceCrossrefGoogle Scholar
16. Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J, 1975;25:229-235.Google Scholar
17. Ramfjord SP. The periodontal disease index (PDI). J Periodontol, 1967;38:602-610.CrossrefGoogle Scholar
18. Lee JY, Lee YM, Shin SY, Seol YJ, Ku Y, Rhyu IC, et al. Effect of subantimicrobial dose doxycycline as an effective adjunct to scaling and root planing. J Periodontol, 2004;75:1500-1508.CrossrefGoogle Scholar
19. Quirynen M, De Soete M, Dierickx K, van Steenberghe D. The intraoral translocation of periodontopathogens jeopardizes the outcome of periodontal therapy. A review of literature. J Clin Periodontol, 2001;28:499-507.CrossrefGoogle Scholar
20. Faria-Almeida R, Navarro A, Bascones A. Clinical and metabolic changes after conventional treatment of type 2 diabetic patients with chronic periodontitis. J Periodontol, 2006;77:591-598.Google Scholar
21. Deo V, Gupta S, Bhongade ML, Jaiswal R. Evaluation of subantimicrobial dose doxycycline as an adjunct to scaling and root planing in chronic periodontitis patients with diabetes: a randomized placebo controlled clinical trial. J Contemp Dent Pract, 2010;11:009-16.Google Scholar
22. Lima AF, Cury CC, Palioto DB, Duro AM, Silva RC, Wolff LF. Therapy with adjunctive doxycycline local delivery in patients with type 1 diabetes mellitus and periodontitis. J Clin Periodontol, 2004;31:648-653.Google Scholar
23. Machion L, Andia DC, Lecio G, Nociti FH Jr, Casati MZ, Sallum AW et al. Locally delivered doxycycline as an adjunctive therapy to scaling and root planing in the treatment of smokers: A 2-year follow-up. J Periodontol, 2006;77:606-613.Google Scholar
24. Golub LM, Wolff M, Roberts S, Lee HM, Leung M, Payonk GS. Treating periodontal diseases by blocking tissuedestructive enzymes. J Am Dent Assoc, 1994;125:163-169.Google Scholar
25. Walker CB, Godowski KC, Borden L, Lennon J, Nangó S, Stone C et al. The effects of sustained release doxycycline on the anaerobic flora and antibiotic-resistant patterns in subgingival plaque and saliva. J Periodontol, 2000;71:768-774.Google Scholar
26. Engebretson SP, Hey-Hadavi J. Sub-antimicrobial Doxycycline for Periodontitis Reduces Hemoglobin A1c in Subjects with Type 2 Diabetes: a Pilot Study. Pharmacol Res, 2011;64:624-629.Google Scholar
27. da Cruz GA, de Toledo S, Sallum EA, Sallum AW, Ambrosano GM, de Cássia Orlandi Sardi J et al. Clinical and laboratory evaluations of non-surgical periodontal treatment in subjects with diabetes mellitus. J Periodontol, 2008;79:1150-1157.CrossrefWeb of ScienceGoogle Scholar
28. Engebretson SP, Hyman LG, Michalowicz BS, Schoenfeld ER, Gelato MC, Hou W et al. The effect of nonsurgical periodontal therapy on hemoglobin A1C levels in persons with type 2 diabetes and chronic periodontitis: a randomized clinical trial. JAMA, 2013;310:2523-2532.Web of ScienceGoogle Scholar
29. Pérez-Losada FL, Jané-Salas E, Sabater-Recolons MM, Estrugo-Devesa A, Segura-Egea JJ, López-López J. Correlation between periodontal disease management and metabolic control of type 2 diabetes mellitus. A systematic literature review. Med Oral Patol Oral Cir Bucal, 2016;21:e440-446.Google Scholar
Balkan Journal of Dental Medicine, Volume 22, Issue 1, Pages 32–37, ISSN (Online) 2335-0245,DOI: https://doi.org/10.2478/bjdm-2018-0006.
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