Effects Of Non-surgical Periodontal Treatment With Or Without Periocline On Chronic Periodontitis And Serum Level Of Tumor Tumor Necrosis Factor-α

BackgroundPeriodontitis is a chronic infectious disease involving periodontal supporting tissue. Dental plaque biofilm is the initiator of the disease, the pathogenic bacteria in the biofilm, such as Porphyromonas gingivalis, Prevotella intermedius etc. cause inflammatory destruction of the periodontal tissues including gingivae, periodontal membrane, alveolar bone and cementum, and lead to immunological defense reactions of the human host to periodontal pathogenic bacteria. Immunological defense reactions mainly include the inflammatory cell infiltration, release of inflammatory cytokines and mediators, such as Interleukin-1β, matrix metalloproteinase and tumor necrosis factor-a, which leading to further tissue injuries in the periodontal pathological process. Tumor necrosis factor-a is a protein produced by mononuclear cells and T-cells, having various functions involved in inflammation stimulation and immune responses of a variety of cells.Periodontitis has been regarded as an important risk factor of a variety of systemic diseases, such as diabetes and coronary heart disease. Although the specific mechanism for the mutual relationship between them has not been completely understood, a large amount of studies have confirmed that periodontitis is closely related to systemic diseases and tumor necrosis factor-a and other cytokines play a key role in the mechanism of the relationship between periodontitis and the systemic diseases.Study purposeTo provide the experimental evidences for investigating the relationship between chronic periodontitis and the systemic diseases, a group of chronic periodontitis were treated with non-surgical periodontal therapy with or without local application of minocycline hydrochloride ointment, periodontal status and serum level of TNF-a before and3-month after treatment were compared and analysed.Subjects and methods1. Case collectionThirty subjects with moderate to severe periodontitis aged28-50coming to Periodontics Department, Foshan Stomatology Hospital, from March2011to July2012, were selected. Inclusion criteria:①Remaining teeth in the mouth≥15, each quadrant remaining teeth≥3;②Teeth with PD≥4mm, and CAL≥3mm≥1/3of the total number;③At least2teeth PD>4mm, CAL>3mm distributed in two different quadrants;④Good compliance, voluntarily participated and able to cope with the entire treatment observation. Exclusion criteria:②Having received periodontal treatment in the past six months;②Having received antibiotics treatment in the past six months or taken non-steroid anti-inflammatory drug in the past three months;③Having received surgery in the past one month;④Suffering systemic diseases, such as diabetes, cardiovascular disease or hepatitis;⑤Smokers;⑥The pregnant or breast-feeding women;⑦Allergic to tetracycline. The subjects were divided into two groups:non-surgical periodontal therapy with local application of minocycline hydrochloride ointment group and non-surgical periodontal therapy without local application of minocycline hydrochloride ointment group through the complete random method, adopting SAS9.1software to generate a set of random numbers (n=30) and adopting the random number generated by SAS9.1. Based on full understanding of the experimental method, the subject voluntarily filled out the questionnaire and informed consent, otherwise were excluded.2. Periodontal intervention measuresPeriodontal intervention treatment was conducted for all the subjects, including oral hygiene education, full mouth scaling, root planing, occlusal adjustment, removal of the teeth that could not be retained. Supragingival ultrasonic scaling and manual subgingival scaling were completed by the same operator at twice within two weeks. Before the periodontal intervention treatment, both groups experienced PD value check and serum TNF-a concentration detection. After the treatment of scaling and root planning, half of the subjects were applied locally with minocycline hydrochloride ointment(Periocline, a product of Japanese SUN-STAR INC), i.e., a special needle was used to gently insert into the bottom of the periodontal pocket along its wall, insert the gel and slowly withdraw until the drug overflows to the gingival margin, the local application of minocycline hydrochloride ointment were repeated once a week for8weeks. The subject was ordered not to gargle in half and hour. Other half of the subjects without local application of minocycline hydrochloride ointment were also checked once a week for8weeks treated with saline irrigation, oral hygiene instruction. Venous blood samples were collected for all the subjects before and three months after the treatment.3. Periodontal clinical indicators and systemic inflammatory factor indicatorsThe subject’s periodontal pocket depth and serum tumor necrosis factor-a concentration were measured and recorded at the baseline and after three months respectively.4. Statistical AnalysisThis study conducted3-level mixed effect analysis of the effect before and after the treatment (PD difference) of the basic treatment group and the basic treatment+local application group, namely, locus:Level1, tooth:Level2, individual:Level3. SAS9.1software was used for data analysis. After PD baseline adjustment, the fixed effect results were obtained, the results of before and after treatment within the group, and the treatment results between two groups were compared and analyzed. With P <0.05as of statistical significance, the bilateral standard a=0.05.Results1.30moderate to severe periodontitis subjects were selected from Periodontics Department, Foshan Stomatology Hospital, a questionnaire was filled by each subject. All the subjects received oral examination. The subjects were reminded of further consultation one day in advance and6of them delayed but made up in not more than two days. No case was missed, and the clinical data were complete. None of them had any local application discomfort.2. Based on inclusion criteria/exclusion criteria,30subjects were included, average age (36.13±5.7), males accounted for56.7%(17/30), female accounted for43.3%(13/30), male to female ratio:close to1:1. Each group consisted of15subjects. The non-surgical treatment group:7women,8men, average age (35.60±6.30); the non-surgical treatment+local application group:6women,9men, average age (37.33±4.62).All the15subjects in both groups completed the whole observation period respectively. In order to ensure the comparability between the two groups, an equalization test was conducted on the age, gender, the number of remaining teeth and periodontal pocket depth which might influence the effect. The results showed that there was no significant difference (P>0.05) in age, gender, the number of remaining teeth and periodontal pocket depth between two groups at baseline.3. The results of the clinical examination showed that there was no significant difference (P>0.05) of average periodontal probing depth between two groups at baseline. The average probing depth of the two groups varied over time. The average probing depth of the non-surgical treatment group decreased to3.30±1.65mm after treatment, that of the non-surgical treatment+local application group deceased to2.83±1.16mm after treatment. After treatment, the average probing depth of both groups decreased significantly. And the reductions of the average probing depth between two groups was also statistically significant, indicating that there was significant difference between groups in terms of reducing the periodontal probing depth.In periodontal treatment, the greater the periodontal pocket depth is, the greater the change will be. In this study, the subjects in two groups were divided into the two sub-groups of PD4-7mm and PD≥7mm to compare the changes between different periodontal pocket depths after treatment. After "Baseline PD4-7mm" level treatment, the basic treatment group had its periodontal probing depth change to4.19±1.36mm, of statistical significance (P<0.05) compared with that before treatment. After "Baseline PD≥7mm level treatment, the periodontal probing depth changed to5.96±1.69, of statistical significance (P<0.05) compared with that before treatment. After "Baseline PD4-7mm level treatment, the non-surgical treatment+local application group had its periodontal probing depth change to3.51±1.09mm, of statistical significance (P<0.05) compared with that before treatment. The difference between Baseline PD4-7mm level periodontal probing depth changes of the two groups was statistically significant (P<0.05), and the difference between Baseline PD≥7mm level periodontal probing depth change was also statistically significant (P<0.05). Members of the non-surgical treatment+local application group had their average clinical attachment level topical group accept the non-surgical treatment baseline PD4-7mm and greater than equal to7mm periodontitis prevalence parts on the average measured clinical attachment level measured at the periodontal location of Baseline PD4-7mm and≥7mm higher that that of the basic treatment group, which showed that local application had more significant therapeutic effect for deeper periodontal pocket.4. After periodontal intervention treatment, the non-surgical treatment group had its serum TNF-α concentration dropped to6.68±0.59ng/L, that of the non-surgical treatment+local application group dropped to5.51±0.39ng/L. The changes of the serum TNF-α concentrations of the two groups were statistically significant (P<0.05), indicating that the periodontal non-surgical treatment could improve periodontium and reduce serum TNF-α concentration, and the non-surgical treatment+local application group had its change more significant (P<0.05) than that of the non-surgical treatment group. ConclusionsIn order to study the relationship between periodontitis and the overall systemic disease, the impact of non-surgical periodontal treatment with or without minocycline hydrochloride ointment local application on the periodontal status and the serum THF-a level were investigated. Randomized controlled clinical intervention longitudinal design was undertaken. The following conclusions were reached:1. Non-surgical periodontal basic treatment improves periodontal clinical indicators and with minocycline hydrochloride ointment local application has more significant effect, particularly for the sites with PD>4mm.2. Non-surgical periodontal treatment reduces serum TNF-a concentrations and with minocycline hydrochloride ointment local application has more significant effects.