EFFECTIVENESS OF MATRIX METALLOPROTEINASES INHIBITORS FOR PREVENTIVE TREATMENT OF GENERALIZED PERIODONTITIS
Authors: Titovska S.O. 
Published: June 2022

Generalized periodontitis is one of the most widespread human stomatological diseases; it is diagnosed in 11.0 % of the world's population. Despite the recognition of the microbial factor as leading in its etiopathogenesis, antimicrobial treatment of gingivitis, added with removal of dental plaque, does not prevent the further development of periodontitis. Dysbacteriosis causes inflammation which leads to an increase of proteolysis products. They are a nutrient medium for periodontal pathogenic microflora, they contribute to its growth. So, the use of anti-inflammatory drugs, such as matrix metalloproteinase inhibitors, is promising for preventive treatment of generalized periodontitis.

The aim of the work is to conduct a clinical trial of complex treatment which includes matrix

metalloproteinase inhibitors in patients with diffuse gingivitis and generalized periodontitis of chronic course.

Materials and methods of the research. 60 patients with chronic course of diffuse gingivitis and generalized periodontitis of initial, I and II stages, were treated. The effectiveness of the treatment was evaluated in the early and distant term (after 1 year) according to data of the clinical and radiological examination, computer tomography, biochemical examination of oral fluid for matrix metalloproteinases-8 and -9 (MMP-8, -9) and immunohistochemical study of gingival biopsies for cytoplasmic expression of matrix metalloproteinase-1 (MMP-1).

Results of the research. According to the data of the clinical examination, complete elimination of inflammatory symptoms in periodontal tissues was achieved in 93.3% of patients in the comparison group in 12-14 days and in 96.7% in the base group in 10-12 days. In patients in whom the developed therapeutic scheme was used, the best dynamics of the index assessment of the state of hygiene, gingiva and periodontal complex was established. The main difference between the research groups was the preservation of obtained results in 1 year after treatment in patients of the base group (p ˂ 0.05). In particular, a year later, the results of bone mineral density measurement for patients of the base group did not change from baseline, while in the comparison group there was their significant decrease (p ˂ 0.05), indicating the progression of inflammatory-destructive process in periodontal tissues.

After treatment, a significant reduction in the level of MMP-8 and MMP-9 in the oral fluid of patients of both groups was achieved (p ˂ 0.05). In patients of the base group, in contrast to the comparison, these results were the same in the distant term (p ˂ 0.05). When assessing the cytoplasmic expression of MMP-1 in epithelial and stromal cells after treatment, zero result was in 96.7% of patients in the base group and in 80.0% – in the comparison group, and after 1 year – in 90.0% vs 63.3% respectively.

It should be noted that the differences between the base and comparison groups were most observed for patients with gingivitis and generalized periodontitis of initial stage without destructive processes in periodontal tissues. It suggests the greatest effectiveness of the proposed treatment in the early stages of pathological process.

Thus, based on the fact that the activity of matrix metalloproteinases characterizes the course of the inflammatory process in periodontal tissues, a decrease in their level according to biochemical and immunohistochemical studies in the base group against the comparison indicates a better anti-inflammatory effect of the developed treatment to prevent the progression of generalized periodontitis.

Conclusion. The obtained results allow recommending the use of matrix metalloproteinase inhibitors as a preventive pathogenetic treatment for the patients with chronical course of gingivitis and generalized periodontitis of the initial stage, to inhibit the inflammatory component of the pathological process.

Prospects for further research. It should be studied the indication for repeated courses of matrix metalloproteinase inhibitors in patients with periodontal disease.