The effect of adjunctive chlorhexidine mouthrinse on clinical parameters and gingival crevicular fluid cytokine levels in untreated plaque-associated gingivitis

Objective and design:  To examine the effectiveness of chlorhexidine mouthrinse (CHX) in addition to daily plaque control on gingival inflammation. Methods:  Fifty gingivitis patients were randomized to CHX or placebo groups. In addition to proper plaque control, CHX group rinsed with CHX, while placebo group rinsed with placebo mouthrinse for 4 weeks. Gingival crevicular fluid (GCF) samples were collected and clinical parameters including plaque index (PI), papillary bleeding index (PBI), calculus index and probing depth (PD) were recorded at baseline and repeated at 4 week. GCF IL-1α, IL-1β, IL-1Ra, and IL-8 levels were determined by ELISA. Results:  Whole mouth clinical parameters were significantly improved in both groups at 4 weeks. CHX group showed greater reduction in the mean PI scores than placebo at 4 weeks (p < 0.05). GCF IL-8 levels of anterior sites significantly reduced in CHX and placebo group at 4 weeks (p < 0.05). GCF IL-1α, IL-1β, IL-1Ra levels remained unchanged at 4 weeks in both groups. GCF cytokine levels of CHX group were similar to those of placebo at 4 weeks. Conclusions:  Within the limitations of this study, CHX mouthrinse as adjuncts to daily plaque control could be useful in management of plaque-associated gingivitis, although ineffective on GCF cytokine levels. Received 13 June 2008; returned for revision 9 July 2008; received from final revision 19 July 2008; accepted by C. Kasserra 19 August 2008     

米诺环素局部用药对牙周炎患者龈沟液中超氧化物歧化酶活性的影响

目的： 比较应用米诺环素软膏治疗前后牙周炎患者临床指标及龈沟液中超氧化物歧化酶(SOD)活性的变化。方法：成人牙周炎患者30例，分成2组，实验组常规牙周治疗+米诺环素软膏，对照组仅给予常规牙周治疗，记录两组治疗前后牙龈指数（GI）、牙周探诊深度（PD）、附着丧失(AL)； 并用放射免疫法检测两组龈沟液SOD活性。结果：（1）治疗后，试验组牙龈指数（GI）、牙周探诊深度（PD）均明显低于对照组（P<0.05，P<0.01）；而治疗前两组比较，上述指标未见显著差别。 （2）治疗前，实验组龈沟液SOD活性与对照组比较无显著差别（P>0.05），而治疗后，实验组龈沟液SOD活性显著高于对照组 (P<0.05)。结论：米诺环素局部用药可显著降低牙周炎患者牙龈指数（GI）、牙周探诊深度（PD）并提高龈沟液SOD活性。     

Cathepsin B in gingival crevicular fluid of adult periodontitis patients: Identification by immunological and enzymological methods

Cathepsin B (EC 3.4.22.1), a typical lysosomal cysteine proteinase was identified immunologically with anti-human cathepsin B antibody in inflammatory exudate, gingival crevicular fluid (GCF) of adult periodontitis patients. The sensitive enzyme immunoassay (EIA) system initially developed, was rarely influenced by the presence of endogenous, cysteine proteinase inhibitors, cystatin(s), indicating that it is possible to quantify the gross amount of cathepsin B including free enzyme forms and enzyme-inhibitor complex forms using this EIA system. The cathepsin B levels in, GCF as determined by EIA and the activity measured with Z-Arg-Arg-MCA showed positive and significant correlation with various clinical parameters. Immunoblotting analysis revealed that the molecular form was a 29 kDa mature enzyme. More than 95% of Z-Arg-Arg-MCA hydrolytic activity in each GCF sample was inhibited by CA-074, specific inhibitor of cathepsin B. These results strongly suggested that the gross amount of cathepsin B in GCF as well as its activity level is closely associated with the severity of the disease and that cathepsins B play an important role in the pathogenesis of periodontitis.accepted by W. B. van den Berg     

IgG and IgA subclass mRNA-bearing plasma cells in periodontitis gingival tissue and immunoglobulin levels in the gingival crevicular fluid

The humoral immune response, especially the production of IgG and IgA, is considered to have a protective role in the pathogenesis of periodontal disease, but the precise mechanisms are still unknown. In order to determine local IgG and IgA production, we investigated the presence of human IgG and IgA subclass mRNA-bearing plasma cells within periodontal tissue by in situhybridization using digoxigenin-labelled oligonucleotide probes in 24 gingival biopsy samples (pocket depth>5 mm) which were obtained from eight patients with adult periodontitis. Furthermore, we examined IgG and IgA subclass proteins and digested IgA1 Fab portions in the gingival crevicular fluid (GCF), corresponding to the sites from which the tissues were taken, by ELISA. IgG and IgA subclass mRNA-expressing cells were detected in all serial formalin-fixed/paraffin-embedded gingival tissue sections sampled. Plasma cells showed strong cytoplasmic staining with a high contrast and a good retention of morphology with these probes. IgG1 mRNA-expressing cells were predominant (mean 63%) and IgG2 mRNA-expressing cells were present at around 23% of total IgG plasma cells, while IgG3 and IgG4 mRNA-expressing cells were present to a much lesser extent (3% and 10%, respectively). Similar proportions of IgG subclass proteins in GCF were detected, which were also consistent with ‘normal’ serum levels. In terms of IgA subclass, IgA1 mRNA-positive cells were predominant (mean 65.1%, P<0.001). In contrast, IgA2 protein in the GCF samples were detected at higher concentrations than IgA1 (P<0.001). The ratio of total IgG to IgA mRNA-positive plasma cells was ≈7.5:1. There was a good correlation between the amounts of IgG subclass proteins in GCF and the number of IgG subclass mRNA-positive cells in the same sites, but not between IgA subclass proteins and the number of IgA subclass mRNA-positive cells. These data suggest that IgG and IgA subclass proteins can be locally produced in the periodontitis gingiva. In addition, as we detected IgA1 Fab fragments in GCF, this is further confirmation that secreted IgA1 protein in GCF may be digested by periodontal bacteria.     

The relationship between periodontal status and alkaline phosphatase levels in gingival crevicular fluid in men with hypergonadotropic hypogonadism

PURPOSE: The aim of this preliminary study was to determine the possible relationship between alkaline phosphatase (ALP) levels in the gingival crevicular fluid (GCF) and periodontal disease in men with hypergonadotropic hypogonadism (HH). MATERIALS AND METHODS: A total of 41 patients were divided into four groups. 9 with HH and periodontitis (P/HH), 11 with HH and gingivitis (G/HH), 12 with systemically healthy and periodontally healthy (H/C) and 9 with systemically healthy and periodontitis (P/C). The clinical evaluation of patients was based on the following parameters; the plaque index (PI), gingival index (GI), probing depths (PD) and attachment level (AL). The levels of ALP in the GCF were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: No significant difference could be detected in the mean clinical parameter data between the P/HH and P/C groups (p > 0.05). The periodontitis patients in both groups (P/C and P/HH) had higher mean probing depths than the H/C and G/HH patients (p < 0.001). The concentrations and total amounts of ALP in the GCF were significantly higher in both periodontitis groups compared to healthy and gingivitis groups (p < 0.01). The serum ALP levels were significantly higher in the P/HH group when compared to the other groups (p < 0.001). CONCLUSION: The findings of this study suggested that HH could be implicated as a contributing factor to the progress of periodontal disease.     

两种冠边缘设计对龈沟液中MMP-8及其组织抑制剂-1水平的影响

目的:探讨两种冠边缘设计对龈沟液(GCF)中基质金属蛋白酶-8(MMP-8)及其组织抑制剂-1(TIMP-1)水平的影响.方法:收集行烤瓷熔附金属全冠修复的患者16例(26颗牙),分为龈下组(8例,14颗牙)和平龈组(8例,12颗牙).分别于修复前、修复后1个月、3个月、6个月时收集两组受试牙的GCF,应用ELISA法测定GCF中MMP-8及TIMP-1的含量.结果:以修复前GCF中MMP-8和TIMP-1的含量为基线,龈下组GCF中MMP-8的含量在修复后1个月时明显高于基线水平(P＜0.05),修复后3个月时持续升高,在修复后6个月时开始下降,但仍高于基线水平(P＜0.05).而平龈组GCF中MMP-8的含量在修复后1个月、3个月时有所升高,但与基线水平比较差异无显著性,在修复后6个月时下降,恢复至基线水平.龈下组和平龈组GCF中TIMP-1的含量在修复后1个月、3个月、6个月时,均呈逐渐升高的趋势,两组在修复后各时间点TIMP-1的含量均明显高于基线水平(P＜0.05).组间比较,平龈组修复后各时间点GCF中MMP-8的含量均明显低于龈下组(P＜0.05);而TIMP-1的含量则均明显高于龈下组(P＜0.05).结论:冠边缘平龈设计可能更有利于MMP-8/TIMP-1系统在牙周组织中更新、代谢和改建过程中的表达作用,以及牙龈组织的健康.     

牙周基础治疗对慢性牙周炎患者非刺激性全唾液、龈沟液及血清中基质金属蛋白酶-9水平的影响

目的 评估慢性牙周炎患者经牙周基础治疗前后的非刺激性全唾液、龈沟液及血清中基质金属蛋白酶-9 （MMp-9）水平,探讨其作为牙周炎诊断及预后标志物的可能性.方法 酶联免疫吸附试验（ELISA）检测20名牙周炎患者治疗前、后及20名健康人非刺激性全唾液、龈沟液及血清中MMP-9的水平,并记录牙周袋探诊深度（PD）、临床附着丧失（CAL）和出血指数（BI）.结果 ①除CAL外,经牙周基础治疗6周后慢性牙周炎患者的临床指标明显改善[CAL治疗前（5.50±1.97） mm,治疗后（5.50±1.97） mm,P=1.000;PD治疗前（7.05±1.81） mm,治疗后（4.23±1.06） mm,P=0.000;BI治疗前3.75±0.44,治疗后0.20±0.41,P=0.000）;②治疗后非刺激性全唾液、龈沟液及血清中MMP-9水平明显降低,与治疗前相比差异具有统计学意义[非刺激性全唾液MMP-9水平治疗前（22.89±5.28）ng/mL,治疗后（18.11±7.19） ng/mL,P=0.003;龈沟液MMP-9水平治疗前（41.80±2.90） ng/mL,治疗后（35.71±4.49） ng/mL,P=0.000;血清MMP-9水平治疗前（6.67±5.318） ng/mL,治疗后（2.47±2.713） ng/mL,P=0.004];③除血清外,牙周炎患者治疗前后的非刺激性全唾液和龈沟液中MMP-9水平仍高于健康对照组,其差异有统计学意义[非刺激性全唾液水平为（6.78±3.02）ng/mL,龈沟液为（30.20±3.64） ng/mL,与治疗前后比较P=0.000;健康对照组血清MMP-9水平（1.18±0.88） ng/mL,与治疗前、后比较P =0.004、P=0.055].结论 非刺激性全唾液中MMP-9的表达水平可能成为慢性牙周炎的检测指标之一,可能为临床诊治提供参考依据.     

Effect of nonsurgical periodontal therapy on crevicular fluid and serum glutathione peroxidase levels

Background: Plasma glutathione peroxidase (eGPx) is an important selenium containing antioxidant in human defense against oxidative stress. While crevicular fluid (GCF) eGPx levels and its association with periodontal disease is well documented, there is no data on correlation of GCF and serum eGPx levels in chronic periodontitis. Hence this study was undertaken to further probe into the role of oxidative stress in periodontal diseases and effect of nonsurgical periodontal therapy (NSPT) by correlating GCF and serum levels of eGPx. Materials and methods: Thirty subjects (16-Males and 14-Females; age: 30–38 years) participated in the study. The subjects were divided, based on gingival index, probing pocket depth and clinical attachment level into: Healthy (group-1, n=10), Gingivitis (group-2, n=10) and Periodontitis (group-3, n=10). Chronic periodontitis patients after NSPT constituted group 4. GCF and serum samples collected from each subject were quantified for eGPx levels using Enzyme linked Immunosorbent Assay. Results: The mean eGPx concentrations increased from health (14.01 ng/μl and 78.26 ng/ml) to gingivitis (22.86 ng/μl and 90.44 ng/ml) and then to periodontitis (29.89 ng/μl and 103.43 ng/ml), in GCF and serum respectively. After NSPT, there was statistically significant reduction in eGPx concentration in GCF and serum (19.41 ng/μl and 85.21 ng/ml). Further, all the GCF eGPx values showed a positive correlation to that of serum eGPx level. Conclusion: Thus, increased eGPx concentration in GCF can be considered as an indicator of local increase in oxidative stress. While, increase in serum eGPx levels indicates that periodontal disease can also lead to increased oxidative stress at the systemic level.     

正畸力作用下人龈沟液MMP-9及TIMP-1的水平变化及意义

目的:探讨正畸力作用下龈沟液内基质金属蛋白酶-9(MMP-9)及金属蛋白酶组织抑制因子-1(TIMP-1)水平的动态变化及其临床意义.方法:选择口腔科门诊就诊接受正畸治疗的患者20例.随机分成2组(A、B组),每组10人.分别施加100 g、250 g的远中移动的初始力,在加力前0周及加力后1、2、3、4、5、6、7周...     

The effects of the initial treatment phase and of adjunctive low-dose doxycycline therapy on clinical parameters and MMP-8, MMP-9, and TIMP-1 levels in the saliva and peripheral blood of patients with chronic periodontitis

Introduction The treatment of periodontal disease can consist of bacterial plaque reduction, risk factor elimination, and metalloproteinase inhibitor medication. The level of matrix metalloproteinases (MMPs) are regulated by endogenous tissue inhibitors of metalloproteinases (TIMPs) as well as therapeutic low-dose doxycycline. The aim of the study was to evaluate the effect of the initial phase of periodontal treatment and the effect of doxycycline on clinical parameters and the MMP-8, MMP-9, and TIMP-1 concentrations in the saliva and peripheral blood of patients with chronic periodontitis. Materials and Methods The study group consisted of 33 patients with chronic periodontitis. Conventional periodontal treatment (scaling and root planing) was conducted on all the patients and doxycycline (20 mg orally) was administered twice daily for three months. Thirty-three controls received the conventional treatment only. Clinical scores (PI, BI, PD, CAL) were recorded before and three months after the treatment. MMP-8, MMP-9, and TIMP-1 concentrations in saliva and peripheral blood were measured by ELISA before and after the treatment of 20 patients from the study group and 13 of the controls. Results The application of doxycycline 20 mg resulted in significant improvement in clinical parameters compared with the conventional periodontal treatment. Doxycycline did not produce significant reductions in MMP-8 and MMP-9 levels in saliva observed after the conventional treatment. The study revealed increases in the TIMP-1 concentration and the MMP-8/TIMP-1 and MMP-9/TIMP-1 ratios in saliva and blood after treatment with doxycycline. Conclusions The study confirmed the modulating effect of doxycycline on the host response in chronic periodontitis.     

牙周基础治疗对糖尿病患者血清和龈沟液中肿瘤坏死因子-α的影响

目的 观察牙周基础治疗对2型糖尿病伴牙周炎患者血清及龈沟液中肿瘤坏死因子-α(TNF-α)的浓度、临床牙周状态、血糖控制的影响.方法 选取2型糖尿病伴牙周炎患者60例,随机分做牙周基础治疗组(观察组)和不做牙周基础治疗组(对照组),每组各30人.分别在治疗前、治疗后1个月和3个月记录所有患者牙周临床指数:探诊深度(PD),附着丧失(AL)及菌斑指数(PLI),并检测糖化血红蛋白(HbAlc)及血清及龈沟液中TNF-α的含量.结果 观察组中PD、PLI和龈沟液中TNF-α含量在治疗后1个月和3个月时均显著降低(P＜0.05),AL和血清中HbAlc及TNF-α含量仅在治疗后3个月显著降低(P＜0.05).对照组的PD,AL,PLI,HbAlc,龈沟液及血清中TNF-α的差异无统计学意义(P＞0.05).结论 牙周基础治疗有助于2型糖尿病伴牙周炎患者的血糖控制,牙周状态改变和血清及龈沟液中TNF-α含量下降.     

负压创面疗法对慢性创面肉芽组织生长及白细胞介素-6的影响

目的研究负压创面疗法对慢性创面血管内皮细胞、增生期细胞及白细胞介素-6的影响。方法将40例慢性创面患者随机分为负压治疗组与常规治疗组。观察两组创面肉芽组织生长情况,并于治疗后1、4、7、14d取创面组织进行HE染色和免疫组化染色,观察血管内皮细胞（标志物采用兔抗人八因子抗原）和增生期细胞（标志物采用鼠抗人Ki-67抗原）数目,负压治疗组于上述时间点收集创面引流液,应用酶联免疫吸附试验法测定自细胞介素-6的含量。结果负压治疗组患者的治疗时间明显缩短,肉芽组织生长迅速,内皮细胞及增生期细胞数较常规治疗组显著增高（P〈0．05）,负压治疗组白细胞介素石迅速下降。结论负压创面疗法能促进创面肉芽组织生长,加速内皮细胞生成,刺激细胞增生,降低创面白细胞介素-6含量。     

The effect of leukocyte-platelet-rich fibrin on bone morphogenetic protein-2 and insulin-like growth factor-1 levels in patients with chronic periodontitis: a randomized split mouth clinical trail

The present study evaluates the effects of leukocyte-platelet-rich fibrin (L-PRF) combined with open flap debridement (OFD) on clinical parameters and growth factors levels (GFL) in chronic periodontitis (CP) patients. This trial was registered at clinicaltrials.gov as NCT02594605. 16 patients (32 sites) with chronic periodontitis who had at least two areas of horizontal bone loss, were treated with OFD alone or L-PRF with OFD (OFD?+?L-PRF). GFL in gingival crevicular fluid (GCF) were analyzed at baseline, 1?week, 2?weeks and 4?weeks after operation. Probing depth (PD) and clinical attachment level (CAL) were measured at baseline and 6?months postoperatively. PD reduction and CAL gain were significantly higher in the OFD?+?L-PRF sites than in OFD sites. OFD?+?L-PRF group showed significantly increased bone morphogenetic protein-2 and insulin-like growth factor-1 at 2?weeks compared with baseline. L-PRF combined with OFD significantly increases GFL and thus, it enhances the periodontal healing on CP patients.