Effects of minimally invasive non-surgical therapy on C-reactive protein, lipoprotein-associated phospholipase A2, and clinical outcomes in periodontitis patients: A 1-year randomized, controlled clinical trial

IF 4.2 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of periodontology Pub Date : 2024-05-02 DOI:10.1002/JPER.23-0518

Gaetano Isola, Paolo Pesce, Alessandro Polizzi, Antonino Lo Giudice, Marco Cicciù, Frank A. Scannapieco

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Abstract

Background

Growing evidence suggests the type of periodontal treatment could differentially influence the reduction of key cardiovascular risk mediators in periodontitis patients. This randomized, controlled clinical trial compared the impact of minimally invasive non-surgical therapy (MINST) with quadrant-wise subgingival instrumentation (Q-SI) on C-reactive protein (CRP) together with lipoprotein-associated phospholipase A₂ (Lp-PLA₂) levels, and clinical periodontal outcomes in patients with periodontitis. Moreover, it was evaluated if baseline CRP levels impacted the efficacy of non-surgical periodontal therapy protocols.

Methods

Forty-two periodontitis patients were enrolled and randomly treated by means of MINST (n = 21) or Q-SI (n = 21). The outcomes assessed were serum CRP and Lp-PLA₂, and periodontal parameters (probing depth [PD], clinical attachment level [CAL], full-mouth bleeding score [FMBS]), at baseline and at follow-ups at 1, 3, and 6 months and at 1 year after treatment.

Results

At 1 year, MINST significantly reduced, among others, mean PD (p = 0.007), mean CAL (p = 0.007), the number of pockets >4 mm (p = 0.011) and ≥6 mm (p = 0.005), and FMBS (p = 0.048) compared to Q-SI. Generalized multivariate analysis evidenced that high baseline CRP (p = 0.039) and FMBS (p = 0.046) levels, together with MINST treatment (p = 0.007) were significant predictors of PD reduction at 1-year follow-up. Moreover, the Jonckheere–Terpstra test showed that patients with high baseline CRP levels gained more benefits from MINST treatment at 1-year follow-up than they did from Q-SI.

Conclusion

Patients receiving MINST showed a greater reduction in CRP levels than patients with Q-SI after 1 year of follow-up. Moreover, patients with high baseline levels of CRP and Lp-PLA₂ gained more benefits from the MINST approach at 1-year follow-up.

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微创非手术疗法对牙周炎患者 C 反应蛋白、脂蛋白相关磷脂酶 A2 和临床疗效的影响：为期一年的随机对照临床试验

背景越来越多的证据表明，牙周治疗的类型会对牙周炎患者主要心血管风险介质的降低产生不同程度的影响。这项随机对照临床试验比较了微创非手术疗法（MINST）和四维龈下器械治疗（Q-SI）对牙周炎患者C反应蛋白（CRP）、脂蛋白相关磷脂酶A2（Lp-PLA2）水平和临床牙周疗效的影响。此外，该研究还评估了基线 CRP 水平是否会影响非手术牙周治疗方案的疗效。评估的结果包括基线时、治疗后 1、3、6 个月和 1 年的随访时的血清 CRP 和 Lp-PLA2 以及牙周参数（探诊深度 [PD]、临床附着水平 [CAL]、全口出血评分 [FMBS]）。结果与 Q-SI 相比，MINST 在治疗 1 年后显著降低了平均 PD（p = 0.007）、平均 CAL（p = 0.007）、4 mm（p = 0.011）和≥6 mm（p = 0.005）牙槽数以及 FMBS（p = 0.048）等指标。广义多变量分析表明，高基线 CRP（p = 0.039）和 FMBS（p = 0.046）水平以及 MINST 治疗（p = 0.007）是随访 1 年时 PD 下降的重要预测因素。此外，Jonckheere-Terpstra 检验表明，基线 CRP 水平高的患者在 1 年随访时从 MINST 治疗中获得的益处比从 Q-SI 治疗中获得的益处更大。此外，CRP 和 Lp-PLA2 基线水平较高的患者在 1 年的随访中从 MINST 方法中获益更多。

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