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Host modulation therapy with anti-inflammatory agents.

Philip M Preshaw

    Periodontology 2000
    |December 2, 2017
    PubMed
    Summary

    Host modulation therapy aims to reduce inflammation in periodontal disease. While some treatments show promise, like subantimicrobial dose doxycycline, further research is needed to confirm their safety and effectiveness in clinical practice.

    Area of Science:

    • Periodontal medicine
    • Host-pathogen interactions
    • Inflammatory response modulation

    Background:

    • Host modulation therapy adjuncts conventional periodontal treatment by targeting destructive inflammatory responses.
    • Previous investigations with nonsteroidal anti-inflammatory drugs showed reduced alveolar bone resorption but were limited by adverse effects.
    • Subantimicrobial dose doxycycline (SMDD) is the only licensed host response modulator for periodontitis, inhibiting matrix metalloproteinases.

    Purpose of the Study:

    • To review the current landscape of host modulation therapies for periodontitis.
    • To evaluate the efficacy and safety of existing and potential adjunctive treatments.
    • To identify future directions for developing novel host response modulators.

    Main Methods:

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  • Review of existing literature on host modulation therapy in periodontitis.
  • Analysis of evidence for nonsteroidal anti-inflammatory drugs and subantimicrobial dose doxycycline.
  • Assessment of anti-cytokine therapies and emerging pro-resolving mediators.

    • Main Results:

    • Nonsteroidal anti-inflammatory drugs demonstrated potential but were limited by significant side effects.
    • Subantimicrobial dose doxycycline has shown clinical benefits in trials, but real-world efficacy is undetermined.
    • Anti-cytokine therapies are not viable for periodontitis due to risks, cost, and lack of human trials.

    Conclusions:

    • Current host modulation therapies for periodontitis have limitations regarding safety and efficacy.
    • Pro-resolving lipid mediators and small molecule biologicals represent promising avenues for future periodontal therapy.
    • Extensive research is required to establish the safety and efficacy of novel host response modulators.