The Adjunctive Effect of Tenoxicam During Non-Surgical Periodontal Treatment on Clinical Parameters and Gingival Crevicular Fluid Levels of MMP-8 and TNF-alpha in Patients with Chronic Periodontitis - Randomized, Double-Blind Clinical Trial

Abstract

Background. Matrix metalloproteinases (MMPs) and cytoldnes play a role of extracellular matrix degradation and remodelling, and are significantly involved in the course of periodontal disease. Objectives. The purpose of this study was to evaluate the adjunctive effect of administering an oxicam non-steroidal anti-inflammatory drug (NSAID), tenoxicam, during non-surgical (phase 1) periodontal treatment on clinical parameters and gingival crevicular fluid (GCF) levels of MMP-8 and TNF-alpha in subjects with chronic periodontitis. Material and Methods. A total of 32 subjects with chronic periodontitis were randomized into two groups: 1) phase I periodontal treatment + NSAID and 2) phase I periodontal treatment + placebo. Phase I periodontal therapy consisted of scaling and root planning (SPR), which was provided by a single therapist masked with respect to group assignment. Patients in group 1 received a systemic NSAID (20 mg tenoxicam tablet once daily for 10 days). Clinical measures and GCF samples were obtained immediately prior to periodontal treatment and 30 days afterwards from all subjects. Clinical measures included a plaque index, gingival index, gingival bleeding time index, probing depth, and clinical attachment level. The MMP-8 and TNF-alpha levels in the GCF were assayed using an enzyme-linked immunosorbent assay. Results. With the exception of clinical attachment level, all clinical measures showed a significant (p < 0.05) improvement following non-surgical treatment in both the NSAID and placebo groups. A significant decrease in MMP-8 levels (p < 0.05) was observed at post-treatment in the NSAID group but not in the placebo group (p > 0.05). Treatment exhibited no effect on TNF-alpha levels (p > 0.05). There was also no statistically significant difference in clinical measurements after treatment between the two groups (p > 0.05). Moreover, the post treatment MMP-8 level in group 1 was statistically significant higher than the placebo group (p < 0.05). Conclusions. The adjunctive administration of tenoxicam during phase I periodontal treatment decreases MMP-8 levels in gingival crevicular fluid in patients with chronic periodontitis. But no benefits were observed