Aim: To evaluate the effectiveness of subantimicrobial-dose doxycycline (SDD) as an adjunct to scaling and root planing (SrP) treatment against the nitrosative stress of moderate to advanced chronic periodontitis. Methods: Adults with untreated chronic periodontitis (n=174) were randomly administered SrP+SDD (n=87) (20 mg of doxycycline twice daily) or SrP+placebo (n=87) treatment for 3 months. At baseline and after 3 months, the probing depths (PD), bleeding on probing (bOP) and clinical attachment level (CAl) were measured, and a gingivomucosal biopsy was collected to assay the induction of nitric oxide synthase (inOS) and 3-nitrotyrosine (3nT), and blood was collected to assay for total nitrites and nitrates (nO x ) and 3nT. Results: Compared to baseline, at the completion of treatment, significant decreases in the levels of tissue inOS and 3nT and serum nO x and 3nT were observed in both groups. SrP+SDD yielded a greater reduction in the gingivomucosal and serum nitrosative stress markers than did SrP+placebo. PD, bOP, and CAl reduction were correlated with the nitrosative stress parameters. Conclusion: On a short-term basis, SDD therapy may be used as an adjunct to SrP treatment against nitrosative stress in moderate to advanced chronic periodontitis.

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This study confirms that fractal analysis was a good method to assess the complex morphological changes and correlations with the nitro-oxidative stress in PI. Short-term low-dose IBU treatment consistently improved gingival status and reduced systemic nitro-oxidative stress.

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It has been shown that fractal and multifractal analysis of tissue images as a non-invasive technique could be used to measure contrasting morphologic changes within human gingival cells and tissues and can provide detailed information for investigation of healthy and diseased gingival mucosa from patients with GCP.