The aim of the presented research is to improve the effectiveness of complex treatment of generalized periodontitis by using matrix metalloproteinase inhibitors.
At the first stage of the work, 90 persons aged 32-45 years were examined, including 30 persons with intact periodontal tissues, 30 patients with diffuse catarrhal gingivitis and generalized periodontitis of the initial degree and 30 ones with chronic generalized periodontitis of I-II severity. Periodontal status was assessed using clinical indices and bone mineral density according to computed tomography data. The method of enzyme-linked immunosorbent assay (ELISA) was used to determine the concentration of matrix metalloproteinases MMP-2, MMP-3, MMP-8, MMP-9, MMP-13, tissue inhibitor of metalloproteinases TIMP-1, interleukins-1β, -6 and -4, bone metabolism markers – tartrate-resistant acidic phosphatase and bone alkaline phosphatase, osteocalcin – in the oral fluid.
At the second stage of the research, for comparison of immunohistochemical indexes of expression of markers of apoptosis and inflammation in the tissues of the marginal periodontium in normal conditions and during the progression of the pathological process, 40 persons aged 32-45 years were studied. They were 30 patients with chronic generalized periodontitis of I-II severity and 10 clinically healthy persons. For morphological examination, gingival bioptates were used, which were put into 4% solution of neutral formalin for a day and poured into paraffin. Histological sections with a thickness of 4.0-6.0 microns were applied to adhesive slides. After their deparaffinization and rehydration, antigens were demasked in the citrate buffer with pH 6.0 at 121 ° C for 8 minutes. The activity of endogenous peroxidase was suppressed with 3 % hydrogen peroxide for 20 minutes. It was studied cytoplasmic expression of markers СОХ-2, caspase-3 and intranuclear expression of markers MMP-1 and p 21 (in inflammatory infiltrate), p 53 and Bcl-2 (in gingival epithelium).
As a result of 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 was important 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.
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.
