017.HMT for periodontium

1. Dr Jaffar Raza Syed Page 1
HMT for Periodontium
Host modulatory therapy is a treatment concept that aims to reduce tissue
destruction and stabilize or even regenerate the periodontium by modifying or
down regulating destructive aspects of the host response and up regulating
protective or regenerative responses
Periodontopathic microorganisms  disease initiation and progression 
microbial challenge consisting of antigens, lipopolysaccharides (LPS) and other
virulence factors  Activation of host responces

2. Dr Jaffar Raza Syed Page 2
Activation of host has both protective and destructive aspects.
Protective aspects
--recruitment of neutrophils,
--production of protective antibodies,
--release of various anti-inflammatory cytokines  TGF- β, IL-4, IL-10 and IL-12
destructive aspects
--pro-inflammatory cytokines, (e.g. IL-1, IL-6, TNF- α),
--Matrix Metalloproteinases (proteases)
--prostaglandin E2 (PGE2)
--promote extracellular matrix destruction stimulate bone resorption.

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Host Modulatory Agents
Various HMT have been developed or proposed to block pathways responsible
for periodontal tissue breakdown
A. Inhibition of Matrix metalloproteinases (MMPs):
Through Chemically Modified Tetracyclines (CMTs)
B. Inhibition of Arachidonic acid metabolites Through NSAIDs
a. COX – 1 inhibitors: Indomethacin, Naproxen, Flurbiprofen
b. COX – 2 inhibitors: Rofecoxib
c. COX and LOX inhibitors: Triclosan, Topical Ketoprofen
d. LOX inhibitors: Lipoxins

4. Dr Jaffar Raza Syed Page 4
C. Modulation of bone metabolism:
a. Bisphosphonates
b. Hormone replacement therapy (HRT)
c. Calcium supplementation
D. Regulation of immune and inflammatory responses:
a. Suppressing proinflammatory cytokines
(IL-1, TNF-α receptor antagonists)
b. Nitric Oxide inhibition
c. Generation of protective antibodies through vaccines
d. Infusion/supplementary anti-inflammatory cytokines IL-4 and IL-10

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--The use of HMT as an adjunct may be particularly useful in susceptible, high
risk patients (e.g. smoking, diabetes, genetic predisposition) FDA has recently
approved subantimicrobial dose doxycycline (Periostat™ 20 mg bid) for
systemic administration as an adjunct to scaling and root planning in the
treatment of chronic periodontitis.
--Main effect of HMT  inhibits MMPs