Role of Salivary MMP-8 in Early Periodontitis Diagnosis and Prevention: A Systematic Review and Meta-analysis

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Aim: Periodontitis is a significant public dental health issue as it is an irreversible destructive process of the periodontium and a leading cause of tooth loss among adults worldwide. Early diagnosis of periodontitis is crucial to prevent irreversible damage. Salivary matrix metalloproteinase-8 (MMP-8) has emerged as a promising biomarker for early-stage periodontitis. However, systematic evaluations are necessary to validate the reliability of MMP-8 level measurements before integrating this biomarker into routine dental practice. Methods: A systematic review of studies comparing various salivary laboratory measurement techniques for MMP-8 levels in individuals with periodontitis, gingivitis, and healthy controls was performed. Fifteen search terms, relevant to the topic of the systematic review were employed. Inclusion criteria were studies which compared patients aged over 18 years with gingivitis or periodontitis to healthy patients and assessed salivary MMP-8 levels and studies which reported the correlation between salivary MMP-8 and clinical attachment loss, bleeding on probing and periodontal pocket depth. Additionally, the correlation coefficients between MMP-8 values and other clinical periodontal parameters was investigated. Pooled mean differences (MD) with 95% confidence intervals (CIs) were calculated between the studied groups. Results: Analysis of 20 eligible studies revealed that patients with periodontitis had significantly higher MMP-8 levels (MD=271.3 ng/ml, CI: 194.4-352.1). Similarly, patients with gingivitis exhibited higher salivary MMP-8 levels compared to healthy individuals (MD=122.8 ng/ml, CI: 64.2-181.5). Moreover, MMP-8 levels were notably higher in periodontitis cases compared to gingivitis (MD=112.0 ng/ml, CI: 56.2-167.9). Correlation assessment indicated a strong association between salivary MMP-8 and probing pocket depth (PPD), bleeding on probing (BOP), and clinical attachment loss (CAL). Conclusion: Measuring salivary MMP-8 levels is a reliable method for differentiating between periodontal health and disease. Implementing salivary MMP-8 measurement in routine dental check-ups could revolutionise periodontitis prevention, treatment, and follow-up, ultimately enhancing public dental health outcomes. This novel biomarker holds the potential to facilitate early diagnosis and timely intervention, reducing the prevalence of severe periodontitis and its associated tooth loss.

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