Association of Gingival Crevicular Fluid Cortisol/Dehydroepiandrosterone Levels With Periodontal Status

Background: The aim of the present study is to examine whether anxiety and depression scale scores change with regard to clinical periodontal status and to investigate the association between the levels of stress‐related hormones in gingival crevicular fluid (GCF) and extent/severity of periodontal disease. Methods: One hundred twenty participants who fulfilled the study inclusion criteria were chosen. Patients with chronic periodontitis (CP) and those with healthy periodontal tissues/mild gingivitis were included. The clinical examinations were performed on the day after the psychologic evaluations which included anxiety and depression measurements. GCF sampling was undertaken the following day. Commercially available enzyme‐linked immunosorbent assay kits were used to determine GCF cortisol and dehydroepiandrosterone (DHEA) levels. Study groups were assigned as follows: group 1, non‐periodontitis; group 2, localized CP; and group 3, generalized CP. Results: There were no significant differences with respect to age, sex, education, income level, occupation, or smoking history among the groups (P >0.05). There were no significant differences between the non‐periodontitis and CP groups for any of the psychosocial scales (P >0.05). Group 3 had significantly higher mean DHEA scores compared with group 1 (P <0.05); however, the median cortisol scores showed no statistically significant differences among the three groups (P >0.05). Conclusions: Anxiety/depression scores and GCF cortisol levels did not show any difference with regard to clinical periodontal status. However, a significant association was found between elevated levels of GCF DHEA and the severity of periodontitis.     

牙周治疗前后龈沟液中白细胞介素-6水平的变化

目的：探讨牙周洁利治对患牙龈沟液中IL-6水平的影响。方法：选取12例成人牙周炎患者的重度牙周炎换牙12颗,采集治疗前患牙的龈沟液并记录相关的临床指标。然后对患牙进行龈上洁治和龈下刮治,两周后,再次采集患牙的龈沟液并记录相关的临床指标。采用双抗体夹心ELISA法对牙周炎患牙龈沟液中IL-6水平进行检测。比较牙周洁刮治前后龈沟液中IL-6水平的差异。结果：经过牙周洁刮治,患牙龈沟中IL-6的水平明显降低,同时患牙的牙周临床指标也有明显的改善。结论：牙周基础治疗在缓解牙周炎患牙局部炎症的同时,也对患牙局部的IL-6水平产生明显影响。     

Elevated Cytokine Levels in Gingival Crevicular Fluid of Teeth with Apical Periodontitis

IntroductionBiomarkers assayed from gingival crevicular fluid (GCF) are a potential tool for endodontic diagnosis and for monitoring treatment response. This cross-sectional study measured cytokines in GCF from teeth with apical periodontitis and evaluated their relationship with preoperative pain and other clinical findings.MethodsParticipants presenting for root-end resection surgery due to apical periodontitis diagnosis (n = 56) underwent standardized clinical testing and completed preoperative questionnaires. GCF from diseased and control teeth were collected, processed, and analyzed. Mann-Whitney U and Wilcoxon tests were used to examine the cytokine levels in diseased compared to healthy control teeth. We also assessed the relationship of cytokine levels with clinical findings.ResultsInterleukins (IL)-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, interferon-γ, and tumor necrosis factor-⍺ (TNF-⍺) were detected in GCF. TNF-⍺ levels were significantly higher in GCF collected from diseased versus control teeth (P = .02) and increased IL-1β levels in diseased teeth were detected (P = .06). Lower IL-10 levels were observed in teeth with a sinus tract and/or swelling compared to teeth without a sinus tract and/or swelling (P = .08). Cytokine levels did not clearly relate to the presence of pain.ConclusionsElevated levels of proinflammatory cytokines, including TNF-⍺ and IL1- β, were detected in GCF from diseased teeth compared to the healthy controls. Additional studies are needed to further investigate the utility of these biomarkers for objectively evaluating periradicular pathology.     

Diabetes‐Associated Periodontitis Molecular Features in Infrared Spectra of Gingival Crevicular Fluid

Background: It has been established previously that infrared spectroscopy (IRS) can be used to identify periodontitis‐specific molecular signatures in gingival crevicular fluid (GCF) and to confirm clinical diagnoses. This follow‐up study is designed to assess whether this novel technique is also able to differentiate diseased from healthy sites in patients with diabetes mellitus (DM) by analyzing the molecular fingerprints embedded in the GCF. Methods: A total of 65 patients with DM with moderate‐to‐severe chronic periodontitis (CP) was recruited, and 15 individuals without DM (65 sites) without periodontal diseases were used as control. Clinical examination and GCF samples were taken from a total of 351 sites, including periodontitis (109), gingivitis (115), and healthy (127) sites. Corresponding absorption spectra of GCF samples were acquired and processed, and the relative contributions of key functional groups in the infrared spectra were identified and analyzed. The qualitative assessment of clinical relevance of these GCF spectra was interpreted with multivariate statistical analysis: linear discriminant analysis (LDA). Results: Spectral analysis revealed several molecular signatures representing vibrations in protein (amide I and II), lipid ester, and sugar moieties in the GCF of patients with DM with CP and non‐DM controls. The diagnostic accuracy for distinction between healthy and CP sites in patients with DM determined by LDA of GCF spectra was 95.3% for the training set of samples and 87.5% for the validation set. Additional LDA of GCF spectra from healthy sites of non‐DM controls and patients with DM revealed 100% diagnostic accuracy for the training set and 86.7% for the validation set. The regions robotically selected by LDA for the two analyses were slightly different in that first LDA identified major regions clustered with the side chain vibrations originating from protein and DNA contents, whereas the second was predominantly the glycation and protein components. Conclusion: IRS is a feasible method to differentiate disease‐specific molecular signatures in GCF in the presence of DM and to generate a complex biochemical profile of GCF to identify DM‐specific spectral features.     

龈沟冲洗液的蛋白质含量测定

本研究采用龈沟冲洗法检测牙周健康部位和疾病部位的龈沟液蛋白质含量，旨在分析蛋白捻民牙周病变的关系。结果表明 周炎组的龈沟因吸液量及总蛋白含量显著高于健康、龈沟炎组，健康与龈炎组的回吸液量几乎无差别。龈沟回吸液量和蛋白号含量均与临床指标－－出血指数、菌班指数、探诊深度、附着丧失显著相关，其中与探诊深度的相关性较大，提示龈沟洗法所得冲洗液量受牙周袋深度的影响，回吸液中蛋白含量随着临床炎症加重而升高，说     

Elevated Levels of a Disintegrin and Metalloproteinase 8 in Gingival Crevicular Fluid of Patients With Periodontal Diseases

Background: A disintegrin and metalloproteinase 8 (ADAM8) is involved in inflammation and is essential for osteoclastogenesis. Elevated ADAM8 levels are detected in human serum and other body fluids in several inflammatory conditions. Therefore, we hypothesized that ADAM8 levels are also raised in gingival crevicular fluid (GCF) of patients with periodontal diseases. Methods: Forty‐five patients with periodontal diseases (n = 15 for each group: the group of patients with gingivitis, the group with aggressive periodontitis [AgP], and the group with chronic periodontitis [CP]) and 15 volunteers who exhibited healthy gingiva were recruited. Four periodontal parameters, gingival index, plaque index, probing depth, and clinical attachment level, were recorded before GCF collection. The presence of ADAM8 in GCF was shown by immunoblotting using anti‐human ADAM8 polyclonal antibody against its prodomain, and the ADAM8 levels were measured by an enzyme‐linked immunosorbent assay. Results: Four immunoreactive bands at 120, 70, 50, and <30 kDa were detected in the groups of patients with periodontitis, whose intensities were stronger than those in the group of patients with gingivitis, consistent with significantly greater ADAM8 levels in both groups of patients, with either CP or AgP, than those in the group of patients with gingivitis and in the group that was healthy (P <0.001). Moreover, the ADAM8 levels correlated significantly with the four periodontal parameters (P <0.001), indicating that ADAM8 levels are positively associated with the degree of periodontal tissue inflammation and destruction. Conclusions: The ADAM8 levels are elevated in the GCF of patients with periodontal diseases, including gingivitis, CP, and AgP, in comparison to control participants who are healthy, and they correlate with four clinical parameters that reflect the degree of disease severity.     

Effects of Photodynamic Therapy on Clinical and Gingival Crevicular Fluid Inflammatory Biomarkers in Chronic Periodontitis: A Split‐Mouth Randomized Clinical Trial

Background: There are limited clinical experiments addressing the effects of photodynamic therapy (PDT) as an adjunct to conventional scaling and root planing (SRP) on clinical and biologic features of periodontitis. This trial compares the clinical parameters and cytokine profiles in gingival crevicular fluid of patients with moderate‐to‐severe chronic periodontitis (CP) who have been treated using SRP alone or SRP + PDT. Methods: Twenty‐two patients with two contralateral teeth affected with moderate‐to‐severe CP were selected. After SRP, the participants’ teeth were randomized to receive either no further treatment or a single application of PDT using a 638‐nm laser and toluidine blue. Although the change in probing depth was the primary outcome, bleeding on probing, clinical attachment level, gingival recession, interleukin‐1β, tumor necrosis factor (TNF)‐α, and matrix metalloproteinase 8 and 9 were also evaluated at baseline and 3 months postintervention. An oral rinse assay was also performed to determine the total levels of oral polymorphonuclear cells (PMNs) before and 3 months after the treatments. Results: Within each group, significant improvements (P <0.001) were found for all variables in 3‐month follow‐up compared with baseline. Only TNF‐α was significantly improved in the PDT + SRP versus SRP group. Total levels of PMNs were reduced for all patients compared with baseline levels (P <0.001). Conclusion: In patients with CP, a single application of PDT (using a 638‐nm laser and toluidine blue) did not provide any additional benefit to SRP in terms of clinical parameters or inflammatory markers 3 months following the intervention.     

Soluble Triggering Receptor Expressed on Myeloid Cells 1 (sTREM‐1) in Gingival Crevicular Fluid: Association With Clinical and Microbiologic Parameters

Background: Soluble triggering receptor expressed on myeloid cells 1 (sTREM‐1) belongs to the immunoglobulin superfamily and is involved in amplification of the inflammatory response to bacterial infection. This cross‐sectional study aims to investigate the levels of sTREM‐1 in gingival crevicular fluid (GCF) of individuals without periodontitis and with chronic periodontitis (CP) or generalized aggressive periodontitis (GAgP) and their association with the levels of key periodontal pathogens in subgingival plaque. Methods: GCF and subgingival plaque samples were obtained from healthy sites of participants without periodontitis (n = 20) and periodontitis sites of patients with CP (n = 22) and GAgP (n = 20). sTREM‐1 levels in GCF were measured by enzyme‐linked immunosorbent assay. Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, and Aggregatibacter actinomycetemcomitans levels in subgingival plaque were analyzed by quantitative real‐time polymerase chain reaction. Results: sTREM‐1 levels in GCF were higher in CP and GAgP than healthy sites by 3.6‐ and 4.4‐fold, respectively, with no significant differences between the two forms of periodontitis. Moreover, sTREM‐1 levels in GCF were positively correlated with site‐specific clinical periodontal parameters and levels of P. gingivalis, T. denticola, and T. forsythia, but not A. actinomycetemcomitans, in subgingival plaque. Conclusion: Increased GCF levels of sTREM‐1 at diseased sites and their positive correlation with clinical and microbiologic parameters strengthen the association of this inflammatory marker with periodontitis.     

The Gingival Crevicular Fluid Levels of Interleukin‐11 and Interleukin‐17 in Patients With Aggressive Periodontitis

Background: The balance (ratio) of anti‐inflammatory and proinflammatory cytokines is thought to play an important role in the pathogenesis of chronic periodontitis. Moreover, the imbalance of anti‐inflammatory/proinflammatory cytokines may modulate disease progression in aggressive periodontitis (AgP). This study aims to investigate the levels of interleukin (IL)‐11 and IL‐17 and their ratio in gingival crevicular fluid (GCF) in patients with AgP. Methods: This study included 20 patients with generalized AgP (GAgP) and 18 healthy controls (HC). For each patient, the values of clinical parameters, such as gingival index, plaque index, probing depth, and clinical attachment level, were recorded. Levels of IL‐11 and IL‐17 in GCF samples were evaluated using enzyme‐linked immunosorbent assay. The values of clinical parameters, cytokine levels, and the ratios of cytokines were evaluated. Results: The values of all the clinical parameters were significantly higher in the GAgP group than in the HC group (P <0.001). The total amount and concentration of IL‐11 and the concentration of the IL‐17 and IL‐11/IL‐17 ratio were significantly lower in the GAgP group than in the HC group (P <0.001). The total amount of IL‐17 was not significantly different between the groups (P = 0.317) Conclusions: The IL‐11/IL‐17 ratio was decreased in the GAgP group because of the decreased IL‐11 levels. The IL‐11/IL‐17 axis and the link between IL‐17 and neutrophil function disorders in AgP should be investigated to clarify the role of the IL‐11/IL‐17 axis and its balance and imbalance in the pathogenesis of AgP.     

The Profile of Inflammatory Cytokines in Gingival Crevicular Fluid around Healthy Osseointegrated Implants

Objective: Regardless of gingival health and subgingival microbiology, production of cytokines within peri‐implant tissues may be different from that of teeth. The objective of this study was to describe the peri‐implant levels of pro‐inflammatory cytokines and subgingival microbiology in clinically healthy sites. Materials and Methods: Subgingival plaque and gingival crevicular fluid (GCF) were obtained from 28 clinically healthy implants and 26 teeth selected from 24 individuals. Microbial composition was determined by selective anaerobic culture techniques. Pro‐inflammatory cytokines were quantified by flow cytometry analysis of GCF. The concentration of cytokines between implants and teeth were compared with the independent t‐test. Results: The concentration of cytokines was higher in GCF from healthy implants than in teeth. The profile of cytokines was characteristic of an innate immune response. A more frequent detection of periodontopathic bacteria was observed in teeth than implants. Cultivable levels of periodontopathic bacteria were similar between implants and teeth. Conclusions: Despite gingival tissue health and scarce plaque accumulation, the profile of inflammatory cytokines in implant crevicular fluid was distinctive of an innate immune response and in higher concentration than in teeth. Other than bacterial stimulus, intrinsic factors related to implants may account for more cytokine production than teeth.     

8‐Hydroxy‐Deoxyguanosine Levels in Gingival Crevicular Fluid and Saliva in Patients With Chronic Periodontitis After Initial Periodontal Treatment

Background: This study evaluates the effects of initial periodontal treatment on the gingival crevicular fluid (GCF) and salivary levels of 8‐hydroxy‐deoxyguanosine (8‐OHdG) as a marker of oxidative deoxyribonucleic acid (DNA) damage in patients with chronic periodontitis (CP). Methods: At baseline, clinical parameters were determined and GCF and saliva samples were obtained from 24 patients with CP and 24 individuals with clinically healthy periodontium. GCF, saliva samples, and clinical periodontal measurements were repeated at day 10, 1 month, and 3 months following initial periodontal therapy in patients with CP. 8‐OHdG levels of GCF and saliva samples were investigated by using an enzyme‐linked immunosorbent assay. Results: Statistically significant higher 8‐OHdG levels of GCF and a significant decrease after initial periodontal therapy were determined in the CP group (P <0.001). A significant positive correlation was found between 8‐OHdG levels of GCF and clinical periodontal measurements (P <0.001). However, salivary levels of 8‐OHdG did not differ between groups or during initial periodontal therapy (P >0.05). Conclusions: This study reveals that DNA injury and oxidative stress increase in tissue cells and especially in periodontal pockets in patients with CP, and the periodontal treatment results in a significant decrease of 8‐OHdG levels in the GCF samples. To the best of our knowledge, this study evaluates for the first time, 8‐OHdG levels in GCF, which is shown to be more useful as a biomarker than saliva. 8‐OHdG was found to be important and may reveal the severity of periodontal disease and the effect of periodontal therapy.     

不同牙周状态下龈沟液中瘦素水平的比较

目的:检测牙周健康者、慢性龈炎和慢性牙周炎患牙龈沟液中瘦素水平,为牙周炎的早期诊断提供客观指标。方法:选择牙周健康者、慢性龈炎和慢性牙周炎患者3组,治疗前记录牙周各项临床指标,并用Whatman^ 1号滤纸收集颊侧近远中牙周袋内GCF采用ELISA检测瘦素含量;同时收集血清进行瘦素水平的检测。结果:3组中慢性牙周炎组龈沟液中瘦素水平与牙周健康者龈沟液中瘦素水平比较有显著差异(P<0.05),慢性牙周炎组龈沟液中瘦素水平与慢性龈炎龈沟液中瘦素水平及慢性龈炎组龈沟液中瘦素水平与牙周健康者龈沟液中瘦素水平比较均无显著差异;牙周健康者、慢性龈炎和慢性牙周炎患者血液中瘦素水平比较均有显著差异(P<0.05)。血中的瘦素与临床指标PLI (P<0.01,r=0.593)、PD(P<0.05,r=0.920)、BI(P<0.05,r=0.862)、AL(P<0.05,r=0.846)均相关;龈沟液中的瘦素与临床指标PLI(P<0.01,r=0.813)、PD(P<0.05,r=0.962))、BI(P<0.05,r=0.720、AL(P<0.05,r=0.946)均相关。结论:龈沟液中瘦素水平可能是反映牙周组织状况的一项较为客观的指标。     

Origin of Galactose‐Deficient Immunoglobulin G in Gingival Crevicular Fluid in Periodontitis

Background: Periodontitis is a chronic inflammatory disease initiated by a synergistic and dysbiotic microbial community that elicits a gingival inflammatory response leading to tissue breakdown. Periodontitis shares many characteristics with other chronic inflammatory diseases, including abnormal glycosylation of immunoglobulin (Ig)G. The current authors have previously demonstrated that IgG from gingival crevicular fluid (GCF) of patients with chronic periodontitis contains galactose (Gal)‐deficient IgG. Methods: The origin of the aberrantly glycosylated IgG was determined by measuring levels of Gal‐deficient IgG in GCF and serum from patients with periodontitis and non‐periodontitis controls using lectin enzyme‐linked immunosorbent assay. The Ig‐producing cells and the proportion of cells producing Gal‐deficient IgG were immunohistochemically determined in gingival tissues from patients with periodontitis by fluorescence microscopy. The results were statistically evaluated and correlated with clinical data. Results: The results indicate that GCF of patients with periodontitis had higher levels of Gal‐deficient IgG compared with controls (P = 0.002). In gingival tissues, IgG was the dominant isotype among Ig‐producing cells, and 60% of IgG‐positive cells produced Gal‐deficient IgG. Moreover, the proportion of Gal‐deficient IgG‐producing cells directly correlated with clinical parameters of probing depth and clinical attachment loss (AL). Conclusion: These results suggest that the presence of Gal‐deficient IgG is associated with gingival inflammation and may play a role in the worsening of clinical parameters of periodontitis, such as AL.     

The Utility of Gingival Crevicular Fluid Matrix Metalloproteinase‐8 Response Patterns in Prediction of Site‐Level Clinical Treatment Outcome

Background: Different gingival crevicular fluid (GCF) matrix metalloproteinase (MMP)‐8 response patterns were studied among non‐smoking and smoking patients with chronic periodontitis (CP) and generalized aggressive periodontitis (GAgP) to test the utility of GCF MMP‐8 levels predicting the site‐level treatment outcome. Methods: Data from four independent longitudinal studies were combined. Altogether, the studies included 158 periodontal sites from 67 patients with CP and 32 patients with GAgP, and GCF samples were collected at baseline, after the treatment, and during the 6‐month maintenance period. All GCF samples were analyzed by immunofluorometric assay for MMP‐8. Different site‐level MMP‐8 response patterns were explored by the cluster analysis. Most optimal MMP‐8 cutoff levels were searched with receiver operating characteristic analyses, and the predictive utility of defined levels was tested. Results: Distinct types of MMP‐8 response patterns were found in both smokers and non‐smokers. MMP‐8 levels exceeding the optimal cutoff levels separately defined for smokers and non‐smokers indicated increased risk for compromised treatment outcome at baseline and during the maintenance period. Seventy‐one percent of non‐smokers (positive likelihood ratio of 4.22) and 88% of smokers (positive likelihood ratio of 5.00) with positive test results at both baseline and the maintenance period had compromised treatment outcome. The double‐positive result indicated 46% and 39% point risk increase for the compromised outcome, respectively. Conclusion: GCF MMP‐8 analysis with defined cutoff levels could be used to predict the site‐level treatment outcome and for longitudinal monitoring of the disease status during the maintenance period.     

成人牙周炎患者治疗前后龈沟液中谷胱甘肽过氧化物酶水平的变化

目的：了解谷胱甘肽过氧化物酶（ＧＰｘ）在牙周病变过程中的变化及其临床意义。方法：选择２３例成人牙周炎（ＡＰ）患者的４４颗患牙,记录临床指标ＧＩ、ＰＤ、ＡＬ,并测定治疗前后ＧＣＦ－ＧＰｘ水平。结果：ＧＣＦ－ＧＰｘ与ＰＤ、ＡＬ负相关（Ｐ〈０．０５,Ｐ,０．００５）,与ＧＩ无明显相关性。牙周治疗后临床指标均明显下降（Ｐ〈０．００１）,ＧＣＦ－ＧＰｘ水平明显上升（Ｐ〈０．００１）,但ＧＣＦ－ＧＰＸ水平的上     

Effect of Non‐Surgical Periodontal Treatment on Visfatin Concentrations in Serum and Gingival Crevicular Fluid of Patients With Chronic Periodontitis and Type 2 Diabetes Mellitus

Background : This study aims to assess visfatin concentrations in serum and gingival crevicular fluid (GCF) and investigate this relationship in patients with type 2 diabetes mellitus (T2DM) and chronic periodontitis (CP) before and after non‐surgical periodontal treatment. Methods: Fifty‐four patients with T2DM and CP were recruited. The patients were randomly divided into two groups: treatment and control. Serum and GCF visfatin concentrations and glycated hemoglobin (HbA1c) levels were measured by enzyme‐linked immunosorbent assay at different time points (at baseline and 3 and 6 months after non‐surgical periodontal treatment). Results: Serum and GCF visfatin concentrations showed no significant differences between the groups at baseline (t test, P >0.05). A significant decline of visfatin in the treatment group was found in serum and GCF 3 months after non‐surgical periodontal treatment (t test, P <0.01). Baseline and 3‐month HbA1c levels were not significantly different, but at 6 months, a statistically significant difference was detected (t test, P >0.05). Conclusions: The data suggest that non‐surgical periodontal treatment is helpful for glucose control, an effect that may be associated with reduced visfatin in patients with T2DM and periodontitis. Furthermore, the data suggest that visfatin may be considered an inflammatory marker for periodontal diseases.     

Increased Levels of Serum and Gingival Crevicular Fluid Monocyte Chemoattractant Protein‐1 in Smokers With Periodontitis

Background : Smoking alters the host response, including vascular function, neutrophil/monocyte activities, adhesion molecule expression, antibody production, and cytokine and inflammatory mediator release. Monocyte chemoattractant protein‐1 (MCP‐1) is involved in the activation and recruitment of inflammatory and immune cells to infected sites, thereby mediating a variety of pathophysiologic conditions. Estimation of serum and gingival crevicular fluid (GCF) MCP levels could be a reliable indicator of periodontal disease activity. Hence, the objective of this study is to analyze the serum and GCF MCP‐1 levels of smokers and never‐smokers with periodontitis and compare them with those in periodontally healthy individuals. Methods: A total of 90 participants (30 periodontally healthy individuals, 30 non‐smoking individuals with periodontitis, and 30 smokers with periodontitis) formed the study group. Serum and GCF samples were collected, and MCP‐1 levels were estimated using enzyme‐linked immunosorbent assay. Results: Mean MCP‐1 levels in serum and GCF were found to be highest in smokers with periodontitis, followed by the periodontitis group, and then by the healthy controls. The values were statistically significant (P <0.001). Conclusions: It can be concluded that the high levels of both serum and GCF MCP‐1 found in smokers could explain the severity of periodontitis in smokers. More longitudinal, prospective studies will help to verify the observations of the present study. Further research in this direction could reveal reliable markers to forecast the progression of periodontitis in high‐risk groups.     

Gingival Crevicular Fluid Matrix Metalloproteinase‐8 Levels Predict Treatment Outcome Among Smokers With Chronic Periodontitis

Background: Molecular biomarkers are needed for diagnostic use in periodontal diseases. The aim of this study is to explore different gingival crevicular fluid (GCF) matrix metalloproteinase‐8 (MMP‐8) patterns in smokers and non‐smokers with chronic periodontitis (CP) and test the utility of baseline GCF MMP‐8 levels in predicting categorically assessed treatment outcomes. Methods: The study population comprised 15 patients with CP (five non‐smokers and 10 smokers). GCF sampling of five to seven periodontal sites per patient was done at baseline, post‐treatment, and bimonthly during the maintenance period from 8 to 12 months. GCF MMP‐8 levels were measured with an immunofluorometric assay. MMP‐8 response patterns were explored by cluster analysis. The ability of baseline MMP‐8 levels to predict categorical treatment outcomes was analyzed with receiver operating characteristic curves. Results: GCF MMP‐8 response patterns could be clustered into two different site profiles among both smokers and non‐smokers. Smoker site profiles 1 and 2 had significantly different clinical attachment level and gingival recession changes by the end of the maintenance period. In smoker sites, baseline MMP‐8 levels significantly predicted the categorical treatment outcome. Conclusions: Baseline GCF MMP‐8 levels strongly predict how MMP‐8 levels behave during the maintenance period. In smoker sites, high baseline MMP‐8 levels indicate weak treatment response.     

The Role of Smoking and Gingival Crevicular Fluid Markers on Coronally Advanced Flap Outcomes

Background: This study evaluates possible effects of smoking on the following: 1) biochemical content in gingival crevicular fluid (GCF) samples from sites of gingival recession and saliva; and 2) clinical outcomes of coronally advanced flap (CAF) for root coverage. Methods: Eighteen defects in 15 patients were included in each of the smoker and non‐smoker groups. Baseline cotinine, basic fibroblast growth factor, vascular endothelial growth factor, platelet‐derived growth factor, interleukin (IL)‐8, IL‐10, IL‐12, tumor necrosis factor‐α, matrix metalloproteinase (MMP)‐8, MMP‐9, and plasminogen activator inhibitor‐1 levels were determined in GCF and saliva samples. CAF with microsurgery technique was applied. Plaque index, papilla bleeding index, recession depth (RD), recession width (RW), and root surface area were evaluated at baseline and postoperative months 1, 3, and 6. Probing depth, clinical attachment level (CAL), and keratinized gingival width (KGW) was recorded at baseline and month 6. Percentage of root coverage and complete root coverage were calculated at postoperative months 1, 3, and 6. Results: All biochemical parameters were similar in the two groups apart from the definite difference in salivary cotinine concentrations (P = 0.000). Compared with the baseline values, RD, RW, CAL, and root surface area decreased, and KGW increased, with no significant difference between the study groups. CAL gain, percentage of root coverage, and complete root‐coverage rates were similar in the study groups. Conclusion: Similar baseline biochemical data and comparably high success rates of root coverage with CAF in systemically and periodontally healthy smokers versus non‐smokers suggest lack of adverse effects of smoking on clinical outcomes.     

Resistin Levels in Gingival Crevicular Fluid of Patients With Chronic Periodontitis and Type 2 Diabetes Mellitus

Background: Resistin is associated with local and systemic inflammatory conditions with a direct correlation with type 2 diabetes mellitus (T2DM). The aim of this clinico‐biochemical study is to estimate and compare the levels of resistin in the gingival crevicular fluid (GCF) in health, chronic periodontitis (CP), and T2DM. Methods: Sixty patients (aged >35 years) who participated in this study were divided into four groups of 15 patients each: healthy individuals (group 1), patients with CP (group 2), patients with T2DM (group 3), and patients with T2DM and CP (group 4). The parameters assessed included plaque index (PI), gingival index (GI), probing depth (PD), periodontal index, body mass index, random blood sugar (RBS), and glycated hemoglobin (HbA1c). GCF (4 μL) was collected and analyzed for resistin levels using an enzyme‐linked immunosorbent assay. Results: Resistin was detected in the GCF of all patients. A significant difference was observed in GCF resistin concentrations from group 1 versus group 2 (P = 0.0093), group 3 (P = 0.0341), and group 4 (P = 0.0002); in group 2 versus group 4 (P = 0.0032); and in group 3 versus group 4 (P = 0.0008). When all the samples were analyzed together, GCF resistin levels positively correlated with GI, PD, PI, RBS, and HbA1c and were predictable with PD and HbA1c. Conclusions: Resistin levels are increased in CP and T2DM. Hence, GCF resistin levels may be considered as a potential inflammatory marker for periodontitis with T2DM.