Clinical Effect of the Subantimicrobial Dose of Doxycycline ( SDD ) on the Chronic Periodontitis

만성치주염 환자에 대한 저용량 독시싸이클린의 임상적 효과

  • Kim, Yoon-Sik (Department of Periodontology, College of Dentistry, Yonsei University, Research Institute for Periodontal regeneration) ;
  • Paik, Jeong-Won (Department of Periodontology, College of Dentistry, Yonsei University, Research Institute for Periodontal regeneration) ;
  • Kim, Chang-Sung (Department of Periodontology, College of Dentistry, Yonsei University, Research Institute for Periodontal regeneration) ;
  • Choi, Seong-Ho (Department of Periodontology, College of Dentistry, Yonsei University, Research Institute for Periodontal regeneration) ;
  • Kim, Chong-Kwan (Department of Periodontology, College of Dentistry, Yonsei University, Research Institute for Periodontal regeneration)
  • 김윤식 (연세대학교 치과대학 치주과학교실, 치주조직 재생연구소) ;
  • 백정원 (연세대학교 치과대학 치주과학교실, 치주조직 재생연구소) ;
  • 김창성 (연세대학교 치과대학 치주과학교실, 치주조직 재생연구소) ;
  • 최성호 (연세대학교 치과대학 치주과학교실, 치주조직 재생연구소) ;
  • 김종관 (연세대학교 치과대학 치주과학교실, 치주조직 재생연구소)
  • Published : 2002.06.30

Abstract

Periodontal disease is a complex infectious disease caused by bacteria in the oral mucosa, which results in gingival inflammation, breakdown of periodontal tissues, bone resorption, and finally tooth loss. Mechanical plaque control methods-scaling and root planing are effective methods to stop the progression of such periodontal disease. It was reported that subantimicrobial dose of doxycycline(SDD) regimen could improve clinical conditions of periodontal tissues without causing the overgrowth of opportunistic organisms that was a typical antibiotic side effect. Therefore pharmacological therapy, used in conjunction with mechanical therapy could be considered a useful treatment modality in the treatment of chronic periodontal disease. In this study, 30 patients diagnosed as moderate to advanced chronic periodontitis were divided into 2 groups. In this double-blind, placebo-controlled study, the patients were administered 20mg doxycycline capsule or placebo capsule b.i.d. for 4months, after scaling and root planing. Clinical parameters-bleeding on probing, pocket depth and clinical attachment level were compared and evaluated between these groups at periods of first visit, 1 month, 2 months, 3 months, 4 months. The results were as follows ; 1. In case of moderate periodontitis, pocket depth showed significant reduction after treatment in both the control & experiment groups, when compared with the baseline values(p<0.01), but in case of advanced periodontitis, only the experiment group showed significant reduction after treatment when compared with the baseline values(p<0.05). Statistically significant reduction in pocket depth was observed in the experiment group compared to the control group(p<0.05). 2. In case of moderate periodontitis, clinical attachment level showed significant reduction after treatment in both the control & experiment groups, when compared with the baseline values(p<0.01), but in case of advanced periodontitis, only the experiment group showed significant reduction after treatment when compared with the baseline values(p<0.05). Statistically significant reduction in clinical attachment level was observed in the experiment group compared to the control group(p<0.05). 3. Bleeding on probing improved after treatment in both the groups. In case of moderate periodontitis, the experiment group showed statistically significant reduction of bleeding on probing when compared with the control group at 1 and 4 months after treatment(p<0.05). In case of advanced periodontitis, treatment resulted in statistically significant reduction of bleeding on probing in both the groups(p<0.05). These results indicate that the use of subantimicrobial dose of doxycycline is a useful supplement to mechanical treatment for periodontal patients in ameliorating the clinical parameters such as periodontal pocket, attachment level, and bleeding on probing.

Keywords

References

  1. Dongari-Bagtzoglou AI, Ebersole JL. Production of inflammatory mediators and cytokines by human gingival fibroblasts following bacterial challenge. J Periodont Res. 1996;31:90-98 https://doi.org/10.1111/j.1600-0765.1996.tb00469.x
  2. Ingman T, Tervahartiala T, Ding Y, Tscherche 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
  3. Birkedal-Hansen H. The role of cytokine and inflammatory mediators in tissue destruction. J Periodontol Res. 1993;28:500-510 https://doi.org/10.1111/j.1600-0765.1993.tb02113.x
  4. Birkedal-Hansen H. The role of matrix metalloproteinses in human periodontal diseases. J Periodontol 1993;64:474-484
  5. Genco RJ. Host response in periodontal disease, current concept, Mechanism of connective tissue matrix destruction in Periodontitis. J Periodontol 1992;63:338-355 https://doi.org/10.1902/jop.1992.63.4s.338
  6. Page RC. The role of inflammatory mediators in the pathogenesis of periodontal disease. J Periodont Res. 1991;26:230-242 https://doi.org/10.1111/j.1600-0765.1991.tb01649.x
  7. Badersten A, Nilveus R, Egelberg J. Effect of nonsurgical periodontal therapy II. Severely advanced periodontitis. J Clin Periodontol 1984;11:63-76 https://doi.org/10.1111/j.1600-051X.1984.tb01309.x
  8. Caffesse R.G., Sweeney P.L. and Smith B.A. Scaling and root planing with and without periodontal flap surgery. J Clin Periodontol 1986;13:205-211 https://doi.org/10.1111/j.1600-051X.1986.tb01461.x
  9. Pascale D, Gordon J, Lamster I, Mann P, Seiger M. and Arndt W. Concentration of doxycycline in human gingival fluid. J Clin Periodontol 1986;13:841 https://doi.org/10.1111/j.1600-051X.1986.tb02240.x
  10. Slots J, Rams TE. Antibiotics in periodontal therapy: Advantages and disadvantages. J Clin Periodontol 1990;17:479-493 https://doi.org/10.1111/j.1365-2710.1992.tb01220.x
  11. Newman H.N. Modes of application of antiplaque chemicals. J ClinPeriodontol 1986;13:965
  12. 권영혁, 박지원, 허익, 박준봉. 치근면 활택술후 2% minocyline gel의 치료효과. 대한치주과학회지, 1998;28:531-543
  13. 박지원, 권영혁, 이만섭, 박준봉, 허익. 국소약물송달제제가 성인형 치주염의치료에 미치는 효과. 대한치주과학회지, 1999;29:371-385
  14. 조규성, 류동현, 서종진, 최성호, 채중규, 김종관. 치근활택술과 Tetracycline fiber 적용의 임상적 효과. 대한치주과학회지, 1998;28:389-400
  15. 최성호, 현석주, 구현서, 서종진, 조규성, 채중규, 김종관. 성인성 치주질환에서 미노클린 국소송달제 효과에 관한 연구. 대한치주과학회지, 1998;28:193-203
  16. Demirel K, Baer PN, McNamara TF. Topical application of doxycycline on periodontally involved root surfaces in vitro: Comparative analysis of substantivity on cementum and dentin. J Periodontol 1991;62:312-316 https://doi.org/10.1902/jop.1991.62.5.312
  17. Drisko C, Cobb C, Killoy R, et al. Clinical response to tetracycline fiber periodontal therapy. J Dent. Res. abstract 1994;73:306
  18. Lindhe J, Liljenberg B, Adielson B. and Borjesson I. Use of metronidazole as a probe in the study of human periodontal disease. J Clin Periodontol 1983;10:100 https://doi.org/10.1111/j.1600-051X.1983.tb01271.x
  19. Osterberg S.K., Williams B.L. and Jorgensen J. Long-term effects of tetracycline on the subgingival microflora. J Clin Periodontol 1979;6:133 https://doi.org/10.1111/j.1600-051X.1979.tb02192.x
  20. Golub L.M., Goodson J.M., Lee H.M., Vidal A.M., McNamara T.F. and Ramamurthy N.S. Tetracyclines inhibit tissue collagenases effects of ingested low-dose and local delivery systems. J Periodontol 1985;56:93-97
  21. Kornman KS, Karl EH. The effect of long-term low-dose tetracycline therapy on the sub gingival microflora in refractory adult periodontitis. J Periodontol 1982;53:604-610 https://doi.org/10.1902/jop.1982.53.10.604
  22. Lindhe J, Liljenberg B. and Adielsson B. Effect of long term tetracycline therapy on human Periodontal disease. J Clin Periodontol 1983;10:590-601 https://doi.org/10.1111/j.1600-051X.1983.tb01297.x
  23. Newman M.G., Korman K.S., Doherty F.M. A 6-month multi-center evaluation of adjunctive tetracycline fiber therapy used in conjuction with scaling and root planing patients : clinical results. J Periodontol 1994;65:685 https://doi.org/10.1902/jop.1994.65.7.685
  24. Caton J, Ciancio S, et al. Treatment with subantimicrobial dose doxycycline improves the efficacy of scaling and root planing in patients with adult periodontitis. J Periodontol 2000;71:521-532 https://doi.org/10.1902/jop.2000.71.4.521
  25. Golub L.M., Ramamurthy N., et al. Tetracyclines inhibit tissue collagenase activity: a new mechanism in the treatment of periodontal disease. J Periodont Res. 1984;19:651-655 https://doi.org/10.1111/j.1600-0765.1984.tb01334.x
  26. Gloub L.M, Sorsa T, Lee H.M, et al. Doxycycline inhibits neutrophil(PMN)-type matrix metalloproteinases in human adult periodontitis gingiva. J Clin Periodontol 1995;22:100-109 https://doi.org/10.1111/j.1600-051X.1995.tb00120.x
  27. 정성념, 한수부. 저용량독시싸이클린 투여가 당뇨환자 및 성인성 치주염 환자의 치은열구액내 효소 활성도에 미치는 영향에 관한 비교연구. 대한치주과학회지, 1997;27:701-722
  28. Golub LM, Ciancio S, Ramamurthy NS, Leung M, McNamara TF. Low-dose docycycline therapy: effect on gingival and crevicular fluid collagenase activity in humans. J Periodont Res. 1990;25:321-330 https://doi.org/10.1111/j.1600-0765.1990.tb00923.x
  29. Bouwsma O, Payonk G, Baron H, Sipos T. Low-dose doxycycline effects on clinical parameters in adults in adult periodontitis(abstract). J Dent Res. 1992;71(Spec. Issue):245(Abstr.1119)
  30. Caton J, Blieden T, Adams D, Crout R, Hefti A, Killoy W, et al. Subantimicobial doxycycline therapy for periodontitis . J Dent Res. 1997;76(SpecIss):177(abstr.1307)
  31. Rifkin BR, Vernillo AT, Golub LM. Blocking periodontal disease progression by inhibiting tissue destructive enzyme: A potential therapeutic role for tetracyclines and their chemically-modified analogs. J Periodontol 1993;64:819-827 https://doi.org/10.1902/jop.1993.64.8s.819
  32. Axelsson P, Lindhe J. Effect of controlled oral hygiene procedures on caries and periodontal disease in adults. J Clin Periodontol 1978;5:133-151 https://doi.org/10.1111/j.1600-051X.1978.tb01914.x
  33. Braatz L, Garrett S, Claffey N and Egelbverg J. Antimicrobial irrigation of deep pockets to supplement non-surgical periodontal therapy II. Daily irrigation. J Clin Periodontol 1985;12:630 https://doi.org/10.1111/j.1600-051X.1985.tb00934.x
  34. Ciancio S.G. Chemothrapeutics in Periodontics. Dent. Clin. Nor. Am. 1980;24:813
  35. Genco R.J. Antibiotics in the treatment of human periodontal disease. J Periodontol 1981;52:545 https://doi.org/10.1902/jop.1981.52.9.545
  36. Lee W, Aitken S, Kulkami G, Birek P, Overall CM, Sodek J, MeCulloch CAG. Collagenase activity in recurrent periodontitis: relationship to disease progression and doxycycline therapy. J Periodont Res. 1991;26:479-485 https://doi.org/10.1111/j.1600-0765.1991.tb01798.x
  37. Ciancio S, Ashley R. Safety and efficacy of sub-antimicrobial dose doxycycline therapy in patients with adult periodontitis. Adv. Dent. Res. 1998;12:27-31 https://doi.org/10.1177/08959374980120011501
  38. Ellison S.A. Oral bacteria and periodontal disease. J Dent. Res. Supplement No. 2 1970;49:198
  39. Goodson J.M., Hogan P. and Dunham S. Clinical responses following periodontal treatment by local drug delivery. J Peridontol 1985;56:81 https://doi.org/10.1902/jop.1985.56.11s.81
  40. Newman H.N., Yeung F.I.S., Wan Yusof W.Z.A.B. and Addy M. Slow release metronidazole and simplified mechanical oral hygiene regimen in the control of chronic periodontitis. J Clin Periodontol 1984;11:576 https://doi.org/10.1111/j.1600-051X.1984.tb00910.x
  41. Pihlstrom BL, McHugh RB, Oliphant TH, Ortiz -Campos C. Comparison of surgical and nonsurgical treatment of periodontal disease. A review of current studies and additional results after 6 and 1/2 years. J Clin Periodontol 1983;10:524-541 https://doi.org/10.1111/j.1600-051X.1983.tb02182.x
  42. 김종관, 채중규, 조규성, 문익상. 치석 제거술이 임상지표 및 치은연하 치태분포에 미치는 영향. 대한치주과학회지, 1990;2:43-52
  43. 조종희, 김상목, 김병옥, 한경윤. 테트라사이클린계 약물이 치은섬유아세포내 MMP-3의 활성도에 미치는 영향. 대한치주과학회지, 1999;29:677-691