Abstract
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.
Highlights
Type 2 diabetes mellitus (T2DM) and periodontal disease are common chronic diseases in adults
Patients of the control group (CG) received only scaling and root planing (SRP), oral hygiene instructions (OHI) and the results showed significant reduction in probing depth (PD) and gain of clinical attachment level (CAL) beside the improvements of gingival inflammation at 3, 6, and 9 months compared to the baseline
These findings were consistent with the results of previously reported studies that have been evaluated the efficiency of conventional SRP in patients with T2DM and chronic periodontitis which has been revealed a significant improvement of clinical periodontal parameters including PD,CAL, and BOP9,20
Summary
Type 2 diabetes mellitus (T2DM) and periodontal disease are common chronic diseases in adults. Both diseases are highly prevalent in the world population and constituting a global public health burden. Diabetes affects more than 150 million individuals worldwide and this incidence is increased annually[1]. By the year 2030, it was estimated that about 366 million people worldwide will have diabetes[2]. More than one in three people worldwide over 30 years of age will have periodontitis[3]. Diabetes mellitus and periodontal disease are assumed to share a common pathogenesis that involves an enhanced inflammatory host response[4]. Investigations have shown that diabetics with long history of diabetes mellitus and poor metabolic control are more likely to have severe periodontal destruction and alveolar bone loss than non-diabetics[5]
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