The effect of a selective cyclooxygenase-2 inhibitor (celecoxib) on chronic periodontitis.

BACKGROUND: Non-steroidal anti-inflammatory agents inhibit the production of cyclooxygenase (COX) products and can attenuate bone loss. In this double-masked, placebo-controlled, randomized clinical trial, the efficacy of celecoxib (COX-2 inhibitor) was evaluated in conjunction with scaling and root planing (SRP) in subjects with chronic periodontitis (CP). METHODS: A total of 131 subjects were randomized to receive SRP and either celecoxib (200 mg) or placebo every day for 6 months. Clinical outcomes were assessed every 3 months for 12 months as mean changes from baseline. Primary efficacy parameters included clinical attachment level (CAL) and probing depth (PD). Secondary outcomes included percentages of tooth sites with CAL loss or gain > or =2 mm, changes in bleeding on probing (BOP), plaque index, and mobility. Prior to analysis, tooth sites were grouped based on baseline PD as shallow (1 to 3 mm), moderate (4 to 6 mm), or deep (> or =7 mm). RESULTS: Mean PD reduction and CAL gain were greater in the celecoxib group, primarily in moderate and deep sites, throughout the study (PD: 3.84 mm versus 2.06 mm, P <0.001; CAL: 3.74 mm versus 1.43 mm, P <0.0001 for deep sites at 12 months). The celecoxib group also exhibited a greater percentage of sites with > or =2 mm CAL gain and fewer sites with > or =2 mm CAL loss. Both groups showed improved plaque control and BOP scores. Demographic, social, and behavioral factors did not affect treatment outcomes. CONCLUSIONS: Celecoxib can be an effective adjunctive treatment to SRP to reduce progressive attachment loss in subjects with CP. Its beneficiary effect persisted even at 6 months postadministration. However, given the increased cardiovascular risks associated with the use of this drug, close patient supervision and strict adherence to dosage and administration guidelines established by the Unites States Food and Drug Administration are of paramount importance.

Effects of platelet concentrate on palatal wound healing after connective tissue graft harvesting.

BACKGROUND: Platelet concentrate (PC) is known to contain growth factors that stimulate cellular proliferation and differentiation. In this double-blind, placebo-controlled, randomized study, the objective was to determine whether PC accelerated connective tissue graft (CTG) wound healing and maintained donor site tissue thickness. METHODS: Twenty healthy adult subjects with multiple bilateral gingival recessions were treated with CTGs and PC combined with CTGs. The donor sites were treated with PC and placebo. Clinical wound healing was observed for an average of 6 weeks. Biopsies were taken from donor sites and submitted for histology and immunohistochemical analysis for type I and III collagens. Palatal tissue thickness, post-surgical complications, and pain level were evaluated. Wilcoxon, Cronbach, one-sample t, and paired-sample t tests were used to assess statistical significance at P <0.05. RESULTS: PC-treated palatal donor sites were 1.10 mm thicker than control sites. PC-treated recipient sites showed accelerated clinical healing compared to controls. PC did not accelerate donor site clinical healing. No significant statistical differences in complication occurrence and perceived pain levels were found between control and PC-treated sites. Biopsy samples revealed that during healing, PC-treated sites contained lower concentrations of inflammatory cells, more type I mature collagen, and less type III immature collagen than control sites. CONCLUSIONS: PC may accelerate wound healing and hasten the regeneration of palatal donor tissue. PC did not influence complication occurrences or mediate pain level. PC has the potential to shorten the treatment time for patients who need multiple CTG procedures.