Enzymatic treatment of periodontal lesions

Abstract

From a review of the significant literature on enzymatic debridement of human tissue, it appears that the enzyme trypsin is especially promising in the treatment of periodontal disease because of its ability to digest dead tissue and fibrin clots without adversely affecting normal tissue or normal healing processes. The removal of necrotic protein by this means may allow the humoral elements of de­ fense to promote tissue repair. The etiology of periodontal disease is somewhat obscure and complex, and is viewed controversially. Local, systemic and psychosomatic factors are individually or collectively involved in the etiology of this disease. Gingivitis and periodontitis, inflammatory processes of the gingiva and periodontium respectively,1 are stated to have essentially the same etiology. Vin­ cent’s infection, although classified as a type of infective gingivitis,2’ 3 may be de­ fined as a syndrome manifesting necrosis and ulceration of the gingiva and charac­ terized by the presence of the fusobacterium and Borrelia vincenti* Periodon­ tosis is a degenerative disease of the investing and supporting structures of the teeth in which inflammation is thought not to be a direct factor.5 Inflammation of the periodontal tissues, however, is a secondary factor which may be super­ imposed on the degenerative process of periodontosis.6 The local treatment of periodontal dis­ ease is directed essentially toward aiding the inflammatory process by the removal of existing injurious agents of exogenous origin, such as bacterial, mechanical, chemical or radiation irritants.5 Enzy­ matic debridement is an adjunct to local treatment by which both macroscopic and microscopic nonviable elements are removed. It is probable that the effectiveness of enzymatic lysis in the treatment of gingi­ vitis will vary in accordance with the severity of the inflammation of the gingiva. Vincent’s infection, acute necro­ tizing gingivitis, should be favorably in­ fluenced by enzymatic therapy. Since in periodontitis the sulcus epithelium is ulcerated,5 enzymatic debridement should assist in repair of these tissues. Periodon­ tosis may show considerable slough and cellular debris as the result of a severe secondary inflammatory reaction; in that case, debridement may be of value by re­ moving these cellular irritants.