Host response modulation in the management of periodontal diseases.
OBJECTIVE
To review the biological mechanisms and clinical utility of therapeutic modulation of the host response in the management of periodontal diseases.


METHODS
A search of MEDLINE-PubMed was performed up to and including December 2004. The search was limited to in vitro, experimental animal and clinical studies published in English. The selection criteria included all levels of available evidence: systematic reviews, randomised-controlled clinical trials, controlled clinical trials, prospective and retrospective cohort studies and case reports of human and experimental animal studies.


RESULTS
Six targets for non-microbial chemotherapeutic intervention were identified. Clinical trials have demonstrated the ability of non-steroidal anti-inflammatory drugs to slow periodontal disease progression. However, recently reported serious adverse effects preclude the use of cyclooxygenase-2 inhibitors as an adjunct to periodontal therapy. Adjunctive use of subantimicrobial dose doxycycline to non-surgical periodontal therapy is beneficial in the management of chronic periodontitis over 12 months. Controversial data exist on the effects of bisphosphonate administration as an adjunct to periodontal therapy. Evidence on modulation of other host mediators including lipoxins, cytokines and nitric oxide synthase is limited to animal research.


CONCLUSIONS
After validation in long-term clinical trials, adjunctive host modulation therapy may prove advantageous in the management of periodontal diseases.
Salvi
Giovanni E
GE
University of Berne, School of Dental Medicine, Berne, Switzerland. giovanni.salvi@zmk.unibe.ch
Lang
Niklaus P
NP
D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D016718:Arachidonic Acid / Q000037:antagonists & inhibitors; D016723:Bone Remodeling / Q000187:drug effects; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D012534:Dental Scaling; D006801:Humans; D018836:Inflammation Mediators / Q000627:therapeutic use*; D044045:Lipoxins / Q000502:physiology; D061965:Matrix Metalloproteinase Inhibitors; D020782:Matrix Metalloproteinases / Q000378:metabolism; D019001:Nitric Oxide Synthase / Q000037:antagonists & inhibitors / Q000378:metabolism; D010518:Periodontitis / Q000188:drug therapy* / Q000378:metabolism; D011480:Protease Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D018121:Receptors, Cytokine / Q000187:drug effects
D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors; D018836:Inflammation Mediators; D044045:Lipoxins; D061965:Matrix Metalloproteinase Inhibitors; D011480:Protease Inhibitors; D018121:Receptors, Cytokine; D016718:Arachidonic Acid; D019001:Nitric Oxide Synthase; D020782:Matrix Metalloproteinases