The Effect of Periodontal Therapy in Chronic Periodontitis Patients With and Without Acute Myocardial Infarction
Condition: Myocardial Infarction; Chronic Periodontitis
MeSH terms: Periodontitis; Chronic Periodontitis; Myocardial Infarction; Infarction
Study type: Interventional

Summary: 
      The aim of this study was to evaluate the effects of periodontal treatment on gingival
      crevicular fluid (GCF) levels of Neopterin(N) and vascular cell adhesion molecule (VCAM-1) in
      chronic periodontitis(CP) patients with acute myocardial infarction(AMI) in comparison to
      systemically healthy CP patients. The investigators' hypothesized that severe CP may play a
      role in initiating or exacerbating MI and there is an increased risk for AMI among
      systemically healthy persons affected with severe CP.
    

Detailed description: 
      There are no studies specifically addressing the altered GCF profile concurrent with the
      onset of myocardial infarction acutely (i.e. in the first 24h) and no data are currently
      available about GCF Neopterin and VCAM-1 levels in AMI patients with chronic periodontitis.
      The present study aimed to assess whether GCF levels of CP patients with AMI have an
      alteration in GCF levels of Neopterin and VCAM-1, also assessed whether these alterations
      might be related to treatment of existing periodontitis in AMI patients. A total of 60
      subjects (20 CP patients with AMI, 20 systemically healthy CP patients and 20 healthy
      controls) were included.GCF samples were analyzed baseline and after 3 and 6 months, probing
      pocket depth(PD), clinical attachment level (CAL),bleeding on probing (BOP) , gingival and
      plaque (PI) indices were recorded. Neopterin and VCAM-1 levels (concentration and total
      amount) were determined by enzyme linked immunosorbent assay (ELISA). Baseline periodontal
      examination of AMI patients and 24-48h GCF collection was carried out in their hospital bed
      under sufficient illumination using artificial light. Within a time period of 2 months after
      the proceeding infarction, none of the patients had received periodontal treatment. AMI
      patients underwent periodontal therapy after the stabilization of their condition with the
      consent from same cardiologist. Periodontal disease was diagnosed based on the 1999
      classification system developed by Armitage, and a preoperative periapical radiograph was
      taken that provided baseline data in Faculty of Dentistry. Clinical index scores and GCF
      sampling were recorded before, 3 and 6 months after the periodontal treatment. All selected
      patients underwent a 2- to 4-week initial therapy, which included comprehensive proper plaque
      control program, scaling, subgingival curettage and root planning in Department of
      Periodontology. In all patients a periodontal reevaluation was performed 4 weeks after phase
      I therapy, to confirm the suitability of the sites for periodontal surgery. Mucoperiosteal
      flap operation was performed in cases where needed. The blood samples for serum were
      centrifuged for 10 min at 11.00RPM separating the serum from the cells. The serum samples
      were then immediately divided into 0.2-0.5ml aliquots and stored at -80°C until required for
      analysis. Samples were assayed for N and VCAM-1 using quantitative enzyme immunoassays.

      Micro-centrifuge tubes, containing periopaper strips with absorbed GCF sample, were allowed
      to reach room temperature and eluted using a centrifugal method.17 After centrifugation, the
      strips were removed and the fluid was assayed by ELISA for N and soluble VCAM-1.The levels of
      N and sVCAM-1 in serum and GCF samples were measured using ELISA kit , . The ELISA procedures
      were carried out according to the manufacturer's instructions.
    

Intervention name(s): Periodontal examination; GCF sampling; phase I therapy
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): periodontal examination included the assessment of plaque index (PI), gingival index(GI), probing depth (PD), bleeding on probing (BOP) and clinical attachment level (CAL).
All subjects underwent a periodontal examination performed by the same periodontitis (ZTÇ) Prior to the study, the examiner was calibrated for reproducibility of PD and CAL measurements; GCF samples were collected using commercially available periopaper . The sample site was gently air-dried and all supragingival plaque was removed. The area was carefully isolated with cotton rolls and a saliva ejector was used to prevent the samples from being contaminated by saliva. The paper strips were inserted into the pockets until slight resistance was felt and left in place for 30s.; comprehensive proper plaque control program, scaling, subgingival curettage and root Phase I Periodontal Therapy planning
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Screening
Keywords: Periodontitis; Periodontal-systemic disease; Cardiovascular diseases; Gingival crevicular fluid; Acute myocardial infarction; Neopterin; Vascular cell adhesion molecule-1