Modulação da resposta do hospedeiro em periodontia: uma revisão

Abstract

Recent studies in the pathogenesis of periodontal disease led to a major paradigm shift in the way we see the progression of periodontal disease, ie, it is now recognized that the main component of the destruction of soft and hard tissue found in the periodontitis occurs as a result of activation defense mechanisms of host immune-inflammatory response in the presence of plaque. The importance of inflammatory host response in the pathogenesis of periodontal disease presents the opportunity to explore new treatment strategies for periodontitis by means of modulation of host response. The modulation of host response in periodontal context refers to the modulation or modification of the harmful aspects of the host inflammatory response that develops in periodontal tissues in response to the challenge presented by chronic subgingival plaque. A variety of classes of drugs has been evaluated as modulators of host response, including non-steroidal anti-inflammatory (NSAID), bisphosphonates, Tetracyclines and pro-resolving lipid mediators. By reviewing the available literature revealed the following: that systemic NSAIDs has been widely discussed as potential modulators of host response, but adverse effects preclude its use as an adjuvant to periodontal treatment. The use of bisphosphonates as modulators of host responses is not recommended due to the controversial data obtained from studies in animals and humans, and recently the use of these drugs are related to osteonecrosis of the jaw. Subantimicrobial dose doxycycline (SDD) is the only drug currently has data proving its effectiveness and safety for use as modulating the response of host response in periodontal being approved for such use in the USA and the UK. Pro-resolving lipid mediators have remarkable efficacy in the prevention and treatment of periodontitis induced in animals, but it is necessary that it be demonstrated in clinical trials in humans.