Effect of Smoking on Periodontal Therapy in Periodontitis
Condition: Periodontal Diseases; Smoking
MeSH terms: Periodontitis; Periodontal Diseases
Study type: Interventional

Summary: 
      The present study aimed to assess the effect of smoking on non-surgical periodontal treatment
      on serum and salivary RANKL, OPG and IL34 levels in periodontitis stage III grade C (P-III-C)
      patients. 20 periodontally healthy, 20 P-III-C and 20 P-III-C with smoking (P-III-CS)
      participants were enrolled. At baseline, serum and saliva samples were collected and the
      whole mouth clinical periodontal parameters were recorded. Periodontitis patients received
      non-surgical periodontal treatment. Clinical parameters were re-measured and samples were
      re-collected at 1 and 3 months after treatment. Serum and salivary RANKL, OPG and IL34 levels
      were analyzed by ELISA. Data were analyzed using appropriate statistical tests.
    

Detailed description: 
      Periodontal disease is an inflammatory process that can result in tooth loss and also is
      considered a modifying factor for systemic health. In bone tissue, bone resorption by
      osteoclasts and bone formation by osteoblasts are repeated continuously. Osteoclasts are
      multinucleated cells that derive from monocyte-/macrophage-lineage cells and resorb bone. In
      contrast, osteoblasts mediate osteoclastogenesis by expressing receptor activator of nuclear
      factor-kappa B ligand (RANKL), which is expressed as a membrane-associated cytokine.
      Osteoprotegerin (OPG) is a soluble RANKL decoy receptor that is predominantly produced by
      osteoblasts and which prevents osteoclast formation and osteoclastic bone resorption by
      inhibiting the RANKL-RANKL receptor interaction. IL-34 shares vital functions of M-CSF, and
      manages myeloid cell survival, differentiation, and proliferation.

      This study is the first controlled clinical study that examines the levels of RANKL, OPG and
      IL-34 in saliva and serum in smoker and non-smoker periodontitis, and evaluates the situation
      before and after the treatment. The first hypothesis of this study; in smoker periodontitis
      group, salivary and serum RANKL, OPG and IL-34 levels will be high, in contrast to the
      non-smoker periodontitis and periodontal healthy group. The second hypothesis of this study
      is that after periodontal treatment, saliva and serum RANKL and IL-34 levels will decrease,
      saliva and serum OPG will increase. Based on these hypotheses, the aim of the study is; to
      compare the levels of RANKL, OPG and IL-34 in saliva and serum of healthy controls, P-III-C,
      and P-III-CS subjects and to evaluate the effect of periodontal treatment.

      A total of 60 systemically healthy patients; 20 periodontally healthy, 20 P-III-C, 20
      P-III-CS were included in this study. The whole mouth clinical periodontal examination
      included measurement of probing depth (PPD), clinical attachment level (CAL), presence of
      bleeding on probing (BOP), gingival index (GI), and plaque index (PI) at 6 sites per tooth,
      except the third molars. The presence and type of the alveolar bone loss were assessed on the
      digital panoramic radiograph in each participant, which was supplemented with periapical
      radiographs if necessary.

      Periodontal status of each patient was evaluated by a single calibrated periodontists with a
      manual probe. The diagnosis of periodontitis or periodontally health was determined according
      to the 2017 World Workshop on Classification of Periodontal and Peri-Implant Diseases and
      Conditions.

      Treatment

      The recruited periodontitis patients received conventional quadrant scaling and root planning
      (SRP) under local anesthesia in a total of 4 sessions in two weeks. SRP was performed by the
      same periodontist using ultrasonic inserts and manual periodontal curettes. Re-evaluations
      were performed at 1 and 3 months following the completion of the SRP. No periodontal
      intervention was carried out in the periodontally healthy controls.

      Saliva and Serum Sampling A total of 5 mL of unstimulated whole saliva was collected by
      passive drool method between 9:00 and 10:00 am. The participants were advised to avoid food
      consumption for three hours before sample collection. The participants were seated upright
      and saliva was collected over a period of 5 minutes with instructions to pool saliva in the
      floor of the mouth and passively drool it into a sterile glass beaker. Then saliva samples
      are immediately transferred to a 2 mL polypropylene tube and stored at -80°C. A total of 5 mL
      of blood was collected from the antecubital fossa by venepuncture method. Serum was isolated
      from the blood by centrifuging at 5000 rpm for 10 minutes followed by its rapid transfer to a
      sterile polypropylene tube and storage at -80°C.

      Biomarker Immunoassays Saliva and serum samples were thawed on ice. The saliva samples were
      centrifuged at 5.000 rpm for 15 minutes at room temperature, and supernatants were
      immediately used for assays. Serum and salivary samples of RANKL, OPG and IL-34 in were
      measured by ELISA using commercial kits.

      Statistical Analysis All statistical analyses were carried out with the standard statistical
      software package. For the intra-group comparisons, if the data were not normally disturbed,
      Friedman test and the Dunn test with the Bonferroni correction were used to analyze the
      change between baseline and 1 month and 3 months after treatment. For inter-group
      comparisons, Mann-Whitney U test for normally and non-normally disturbed data. The Spearman's
      rank correlation test was used to detect the correlations of biochemical parameters with
      clinical parameters and each others in diseased group before and after treatment. All tests
      were performed at significance level of P <0.05.
    

Intervention name(s): Non-surgically performed scaling and root planing
Intervention type(s): Procedure
Intervention description(s): Treatment of patients with periodontitis was performed using manual and ultrasonic instruments.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Periodontitis; Smoking; Periodontal treatment