Discussion
MINST
PERIODONTITIS, GENERALISED PERIODONTITIS
The current study estimated the effects of PACNs on the treatment of generalised periodontitis by analysing clinical and immunologic parameters. The results showed that adjunctive use of PACNs combined with MINST promoted additional beneficial effects on clinical and immunologic parameters. Adjunctive use of PACNs showed statistically significantly higher PPD reduction in moderate periodontal pockets.To the authors’ knowledge, this clinical study is the first randomised controlled clinical trial to evaluate the efficacy of locally derived PACNs in the treatment of generalised periodontitis. Until now, only 2 clinical studies have reported the investigation of clinical effects of systemically administered PACN nutritional supplements on periodontal health.Clinical research investigating nonsurgical periodontal therapy and adjunctive therapy agreed that locally derived adjuncts showed an additional benefit in clinical parameters.The results of the current study showed no statistically significant differences in BOP values after treatment between the groups. Collagen hydrogels release active substance (PACNs) and dissolve in periodontal pockets quite rapidly (resorption rate usually takes ≥4 weeks).MMPs are one of the most important proteinases, responsible for hydrolysis of components of the extracellular matrix, tissue remodeling, wound healing, and angiogenesis. MMPs can degrade almost all compounds of extracellular matrix and basal membrane, and their redundant activity can lead to periodontal tissue degradation.As mentioned earlier, preclinical studies have shown high antibacterial and anti-inflammatory capacities of PACNs.Our study focused on the analysis of MMP and TIMP proportions to predetermine the level of periodontal tissue destruction in patients with periodontitis. More than 2 decades ago, clinical trials suggested that MMP-3 and TIMP-1 levels may be an additional parameter for periodontal health evaluation.In addition, our study analysed MMP-3 and TIMP-1 changes in relation to nonsurgical periodontal therapy (MINST and MINST + PACNs). Results showed that MMP-3 values in saliva were reduced significantly more in the MINST + PACNs group than in the MINST group. This observation may suggest that additional use of PACNs in periodontal treatment decreases MMP-3 concentrations in saliva more than MINST alone. However, the analysis revealed that no statistically significant differences were observed in the change of TIMP-1 concentration between the groups.There are some limitations of this study. Because the clinical study was designed as a short-term trial (clinical reevaluation 8 weeks after the treatment), it is necessary to determine whether there were any long-term clinical results (at least 6 months after the treatment)