Effect of Periodontal Therapy on Biomarkers in Periodontitis
Condition: Periodontal Health; Periodontitis
MeSH terms: Periodontitis
Study type: Interventional

Summary: 
      The present study aimed to assess the effect of non-surgical periodontal treatment on serum
      and salivary MMP-8, MAF, MIP-1α, M-CSF, and IL34 levels in periodontitis stage III grade B
      (P-III-B) and C (P-III-C) patients. 20 periodontally healthy, 20 P-III-B and 25 P-III-C
      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 MMP-8, MAF, MIP-1α, M-CSF,
      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. Matrix metalloproteinase (MMP)-8 is the
      major collagenase of periodontal tissue breakdown. Macrophage-activating factor (MAF) can
      activate macrophages. M-CSF is known to modulate disease and inflammation and to play an
      important role in bone destruction. 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 MIP-1α, MAF,
      MMP-8, M-CSF, IL-34 in saliva and serum in two different periodontitis, and evaluates the
      situation before and after the treatment. The first hypothesis of this study; in
      periodontitis group, salivary and serum MIP-1α, MAF, MMP-8, M-CSF, IL-34 levels will be high,
      in contrast to the periodontal healthy group. The second hypothesis of this study is that
      after periodontal treatment, saliva and serum MIP-1α, MAF, MMP-8, M-CSF, IL-34 levels will
      decrease. Based on these hypotheses, the aim of the study is; to compare the levels of
      MIP-1a, MAF, MMP-8, M-CSF, IL-34 in saliva and serum of healthy controls, P-III-B, and
      P-III-C subjects and to evaluate the effect of periodontal treatment.

      A total of 65 systemically healthy patients; 20 periodontally healthy, 20 P-III-B, 25 P-III-C
      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. Periodontally healthy individuals (n=20) in the control group had no sites with
      PD >3 mm and CAL >2 mm and also no radiographic evidence of alveolar bone loss. BOP was <10%
      in the whole mouth. Healthy group also exhibited no history of periodontitis. The
      periodontitis stage III patients had a minimum three teeth apart from the first molars and
      incisors showing CAL ≥5 mm and PD ≥6 mm and showed no>4 teeth loss because of periodontitis.
      Radiographic bone loss extending from coronal to middle third or beyond. Radiographic bone
      loss was determined from the tooth showing the most severe bone loss as a percentage of root
      length. If the values of bone loss %/age were between 0.25 and 1.0, the patients were
      assigned to grade B (n=20). If higher than 1.0, the patients were assigned to grade C (n=25)

      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 MMP-8 , M-CSF*, MIP-1α*, MAF ,
      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: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: periodontitis; periodontal treatment