种植体周围龈沟液标记物的研究进展

种植体周围炎(peri-implantitis),是发生在正常行使功能的骨性结合种植体周围组织的慢性进展性炎症,能使牙槽骨丧失形成种植体周围袋,当骨结合区完全吸收后,种植体会松动脱落,导致种植失败.与自然牙一样,种植体周围也存在着龈沟.种植体周围龈沟液是否具有与自然牙龈沟液相似的特征,是否可以反映种植体周围组织的变化,正逐渐为学者们所重视.本文就种植体龈沟液中相关标记物的研究进展做一综述.     

唾液和龈沟液内牙周病标记物研究进展

细菌是牙周病始动因子已经明确,细菌毒力因子主要是一些酶类,可以直接损伤宿主组织;或使宿主组织释放生物因子导致宿主组织损伤。由于测定生物体液炎症因子水平能很好地反映炎症活动性,许多与牙周病发病机制有关的研究通常以检查唾液和龈沟液中的生化和免疫标记物为基础,来反应     

龈沟液中与牙周病有关的细胞因子的研究进展

牙周病时龈沟液内含有多种可作为诊断指标的细胞因子,由于取样简单无创,且能重复取样,易为患者所接受。因此,近年来学者们对龈沟液内的细胞因子在牙周炎活动期的诊断﹑治疗及疗效评价中作用的研究很多。本文对龈沟液中与牙周病有关的细胞因子的研究进展作一综述。     

牙周病活动期的生化标记物

目前,牙周病诊断的常规手段是临床检查和X线检查。二者对既往病史和牙周健康现状易做出判定,但在筛选有潜在牙周降解危险因素的患者和患病部位时,它们提供的依据有限。牙周病的生化标记物是一群牙周组织活动性破坏相关因子,来源于致病因子和宿主相互作用过程中产生的异常的生化物质,是判定牙周病活动状态和预后的较敏感的指标。本文就此对近几年的研究进展做一综述。     

牙周病活动期的生化标记物

目前，牙周病诊断的常规手段是临床检查和X线检查，二者对既往病史和牙周健康现状易做出判定，但在筛选有潜在牙周降解危险因素的患者和患病部位时，它们提供的依据有限。牙周病的生化标记物是一群牙周组织活动性破坏相关因子，来源于致病因子和宿主相互作用过程中产生的异常的生化物质，是判定牙周病活动状态和预后的较敏感的指标。本文就此对近几年的研究进展做一综述。     

Glycosaminoglycans in human gingival crevicular fluid as indicators of active periodontal disease

The glycosaminoglycans (GAG) in gingival crevicular fluid (GCF) were investigated by cellulose-acetate electrophoresis of samples from individual sites of defined conditions variously affecting the tissues of the periodontium. The non-sulphated GAG, hyaluronic acid, was present in all samples and was the only major band from sites of chronic gingivitis. An additional sulphated GAG band identified by enzymic digestions as chondroitin-4-sulphate, was detected in GCF from sites of untreated-advanced periodontitis. Initial samples from sites of early periodontitis and juvenile periodontitis yielded a similar additional band which was not detected, however, in samples collected after either surgery to eliminate deep pockets or daily subgingival irrigation with a chlorhexidine solution. Sulphated GAG was also present in fluid from the control situations, i.e. of teeth either undergoing orthodontic movement or showing evidence of trauma from occlusion, and from healing tooth-extraction wounds. Thus the presence of such a component in GCF correlates with those clinical conditions in which degradative changes are occurring in the deeper-periodontal tissues. The electrophoretic profile of GAG in a sample of GCF may be a sensitive laboratory method of indicating active phases of destructive periodontal disease at individual sites.     

IgG subclasses in gingival crevicular fluid from active versus stable periodontal sites

Since IgG subclasses are common immunoglobulins associated with the periodontium and have different biological characteristics, these subclasses were measured in gingival crevicular fluid (GCF) from periodontally active (greater than or equal to 2 mm clinical attachment loss within three months of sample) versus clinically similar but stable or healthy sites. A sandwich enzyme-linked immunosorbent assay (ELISA) using monoclonal antibodies was performed to quantitate IgG subclass and albumin concentrations in serum and interproximal GCF samples from at least one each of the three disease categories from each of 20 periodontal maintenance patients. Although much variability existed among sites, mean IgG1 (p less than 0.05) and IgG4 (p less than 0.01) concentrations were higher in GCF from active periodontitis areas than stable sites, even though both had similar clinical characteristics. When IgG subclass concentrations were adjusted per mg albumin, both IgG1 and IgG4 levels in GCF from active sites were still significantly elevated over stable areas (p less than 0.05). Mean adjusted concentrations in GCF were generally greater than in serum, especially for IgG4 (active site GCF:serum = 24.2:1). GCF IgG4 concentrations may be useful as an indicator of the immunopathological changes which occur in active periodontitis.     

Calprotectin in gingival crevicular fluid correlates with clinical and biochemical markers of periodontal disease

Clinical and biochemical markers of periodontal disease have been used for precise objective diagnosis of periodontal inflammation. Interleukin 1beta (IL-1beta) and prostaglandin E2 (PGE2), inflammatory factors, levels in gingival crevicular fluid (GCF) of patients with periodontal disease are elevated and have been studied as biochemical markers. The levels of calprotectin, a leukocyte protein, in body fluids of patients with some inflammatory diseases are raised. Recently, we detected calprotectin in GCF and its concentrations in periodontal pockets were higher than those in healthy gingival crevices. In this study, we investigated the correlations between GCF calprotectin levels and clinical indicators (probing depth and bleeding on probing, BOP), and the IL-1beta or PGE2 levels in GCE Probing depth and BOP at 130 sites of 110 subjects with periodontal or other oral diseases were examined, then GCF samples were collected and their calprotectin, IL-1beta and PGE2 were determined by ELISA. The calprotectin level correlated positively with the probing depth and was significantly higher at BOP-positive than BOP-negative sites. There were significant, positive correlations between the calprotectin and IL-1beta or PGE2 concentrations. These results indicate that the calprotectin level in GCF correlates well with clinical and biochemical markers of periodontal disease and suggest that calprotectin may be useful for evaluating the extent of periodontal inflammation.     

Leptin levels in gingival crevicular fluid in periodontal health and disease

BACKGROUND AND OBJECTIVE: A high concentration of leptin is associated with healthy gingival tissue, and the concentration of leptin decreases as periodontal disease progresses. However, to date, the leptin concentration in gingival crevicular fluid has not been documented. Hence, the present study was carried out to explore the presence of leptin in gingival crevicular fluid in periodontal health and disease, and to probe further into its possible role in periodontal disease progression. MATERIAL AND METHODS: A total of 45 adult patients were selected, based on their body mass index, for the study. They were categorized into three groups of 15 patients each, based on their periodontal tissue status, as follows: group I (clinically healthy gingiva with no loss of attachment); group II (chronic gingivitis with no loss of attachment); and group III (chronic periodontitis). Gingival crevicular fluid samples of 1 microL were collected extracrevicularly using white color-coded 1-5 microL calibrated volumetric microcapillary pipettes from one site in each person, and samples were analyzed for leptin using a commercially available enzyme-linked immunosorbent assay kit. RESULTS: The concentration of leptin in gingival crevicular fluid of patients in group I (2292.69 pg/mL) was statistically higher (p < 0.05) than in those of groups II (1409.95 pg/mL) and III (1071.89 pg/mL). This suggests a negative correlation of gingival crevicular fluid leptin concentration with clinical attachment loss (p < 0.05). CONCLUSION: As periodontal tissue destruction increased, there was a substantial decrease in gingival crevicular fluid leptin concentration. This observation extends our knowledge of the protective role of leptin in periodontal health.     

Five parameters of gingival crevicular fluid from eight surfaces in periodontal health and disease

Volume and amounts of myeloperoxidase (MPO), lactoferrin (LF), aryl sulfatase (AS) and lactate dehydrogenase (LDH) were measured in gingival crevicular fluid (GCF) collected from the mesial and distal proximal surfaces of the premolars and first and second molars of 3 subject groups. Group assignment was based on subject mean gingival index (GI) and probing depth (PD) of sampled sites as follows: healthy, GI less than or equal to 0.5, PD less than or equal to 3.0; disease 1, GI greater than or equal to 1.0, PD greater than or equal to 3.0 mm; disease 2, PD greater than or equal to 4.0 mm. Attachment loss (ATL) of most sites in the 3 groups was: healthy, 0-1 mm; disease 1, 1-2 mm; and disease 2, 4-9 mm. GCF volume differed among surfaces and teeth in each of the 3 groups. The greater amount of GCF collected from posterior locations was not related to the GI and PD. Differences with sampling location in amounts of GCF constituents were restricted to MPO and LF. Most of these differences (greater amounts at posterior sites) were associated with more severe disease. Variability in amount and composition of GCF collected from different sites, therefore, should be considered in experiments which include quantitation of GCF parameters. The ratio of MPO in disease group 2 to disease group 1 was greater than similar ratios for GCF volume and LF, AS and LDH. The quantity of MPO was the only measure which differed between the 2 disease groups at all surfaces. MPO thus appears to have the greatest potential, among the measured parameters, to serve as a marker for advanced periodontal disease.     

Elastase in gingival crevicular fluid from smokers and non-smokers with chronic inflammatory periodontal disease

OBJECTIVE: To compare elastase concentrations in gingival crevicular fluid (GCF) from individual sites of smokers and non-smokers.
MATERIALS AND METHODS: Twelve pairs of smokers and non-smokers with untreated, moderate to advanced chronic inflammatory periodontal disease were matched for gender, age, ethnicity and the clinical and radio-graphic extent of disease. Durapore filter strip samples were collected over 30 s from two mesiopalatal sites on upper left posterior teeth. Samples were analysed for: I) polymorphonuclear neutrophil leucocyte (PMNL) cell counts; 2) PMNL elastase-αI-antitrypsin complex in the GCF supernatant by ELISA; and 3) functional elastase, free or bound to α2-macroglobulin, estimated from activity against N-tert-butoxycarbonyI-alanyl-prolyl-nor-valylg-chlorothiobenzyl ester in supernatant and lysates of GCF PMNLs.
RESULTS: There were no differences in disease parameters between groups except that bleeding on probing was less extensive in smokers (P< 0.001). Cell counts and elastase content of crevicular PMNLs showed no differences between groups. Lower concentrations of elastase were found in GCF supernatants from smokers than non-smokers. This difference was observed for functional elastase (mean [s.d.] = 30.21 [17.60] against 73.77 [75.26] ng μI^-1, P <0.05) and elastase complexed with αl-antitrypsin (8.97 [6.54] ng μl^-1 against 25.71 [22.07] ng μI^-1, P < 0.001).
CONCLUSIONS: Smokers have lower elastase concentrations in GCF than non-smokers. Further investigation is required to elucidate the underlying cause and its relationship with periodontal disease.     

Lactoferrin and other markers from gingival crevicular fluid and saliva before and after periodontal treatment

OBJECTIVES: The aim of the study was to verify (i) if crevicular fluid defence variables reflect the changes after surgical periodontal treatment and (ii) if they are in correspondence with changes of these variables in the unstimulated and stimulated whole saliva. MATERIAL AND METHODS: For 12 male and 13 female volunteers with chronic periodontitis lactoferrin concentration as well as the lysozyme and peroxidase activities were determined in crevicular fluid as well as in unstimulated and stimulated saliva before and 14 days after surgical periodontal treatment by a minimal invasive flap technique. RESULTS: The lactoferrin concentrations decreased significantly in the crevicular fluid eluting solution from 1.63 to 1.23 mg/l reflecting a decrease in the total amount collected, in unstimulated saliva from 10.54 to 8.96 mg/l, and in stimulated saliva from 9.00 to 7.11 mg/l after treatment. No significant change could be found for lysozyme. Peroxidase activity was significantly reduced from 269.06 to 186.15 U/l only in the crevicular fluid. CONCLUSION: The results of this study suggest that (i) the defence factor lactoferrin is suitable for monitoring of periodontal treatment results and (ii) changes of the lactoferrin concentration in crevicular fluid are related with significant changes in unstimulated and stimulated saliva.     

Calcitonin gene-related peptide in gingival crevicular fluid in periodontal health and disease

The aims of the present study were to investigate whether calcitonin gene-related peptide (CGRP) was present in gingival crevicular fluid in both periodontal health and disease and to study the relationship with periodontal inflammation. Gingival crevicular fluid (GCF) was collected from a healthy, a gingivitis and a periodontitis site in 18 subjects with periodontitis and from a healthy site in 19 subjects without periodontitis. The volume of GCF was measured and each sample subsequently analysed for CGRP by radioimmunoassay. In subjects with periodontitis, CGRP immunoreactivity (CGRP-IR) was not detected in any periodontitis sites, nor in 67% of gingivitis and 28% of periodontally-healthy sites. The total amount of CGRP-IR was significantly elevated in periodontally healthy (p=0.0015) and gingivitis (p=0.027) compared with periodontitis sites. CGRP-IR was present in 89% of the healthy sites sampled in control subjects at comparable levels to those in healthy sites in periodontitis subjects. It is concluded that in periodontal inflammation, particularly in deep pockets, constituents of GCF process and degrade CGRP.