Gingival Crevicular Fluid, Salivary, and Serum Biomarkers Levels in Periodontal Treatment
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
      gingival crevicular fluid (GCF), saliva, and serum IL-26, IL-6, and IL-10 levels in stage III
      grade B periodontitis (SIII-GB-P) and C periodontitis (SIII-GC-P) patients. 25 periodontally
      healthy, 25 SIII-GB-P, and 25 SIII-GC-P participants were enrolled. At baseline, GCF, saliva,
      and serum samples were collected and the whole mouth clinical periodontal parameters were
      recorded. Periodontitis patients received non-surgical periodontal treatment (NSPT). Clinical
      parameters and samples were re-collected at 1 and 3 months after NSPT. GCF, saliva, and serum
      IL-26, IL-6, and IL-10 were analyzed by ELISA. Data were analyzed using appropriate
      statistical tests.
    

Detailed description: 
      Periodontitis is an inflammatory process that can result in tooth loss by destroying
      teeth-supporting tissues. Interleukin (IL) 26, is one of the recent members of the IL-10
      cytokine family. The elevated level of IL-26 expression is associated with inflammatory
      disorders.

      IL-6, a pro-inflammatory cytokine and is one of the important molecules in the regulation of
      inflammatory immune responses in periodontitis. IL-10, an anti-inflammatory cytokine, affects
      monocytes and macrophages and their immune mediator release.

      This study is the first controlled clinical study that examines the levels of IL-26 in GCF,
      saliva, and serum in two different periodontitis, and evaluates the situation before and
      after the treatment. The first hypothesis of this study GCF, salivary, and serum IL-26 and
      IL-6 levels will be high and GCF, salivary and serum IL-10 will be low in periodontitis
      groups, in contrast to the periodontal health the second hypothesis of this study is that
      after periodontal treatment, GCF, saliva, and serum IL-26 and IL-6 will decrease and GCF,
      saliva, and serum IL-10 will increase.

      Based on these hypotheses, the aim of the study is; to compare the levels of IL-26, IL-6, and
      IL-10 in GCF, saliva, and serum of healthy controls, SIII-GB-P, and SIII-GC-P subjects and to
      evaluate the effect of periodontal treatment.

      A total of 75 systemically healthy patients; 25 periodontally healthy, 25 SIII-GB-P, and 25
      SIII-GC-P were included in this study. The clinical periodontal examination, including
      measurement of probing depth (PD), clinical attachment level (CAL), bleeding on probing
      (BOP), gingival index (GI), and plaque index (PI) was performed at 6 sites per tooth, except
      the third molars. The presence of alveolar bone loss was assessed on the digital panoramic
      radiograph in each participant, which was supplemented with periapical radiographs if
      necessary.

      The periodontal status of each patient was evaluated by a single calibrated periodontist 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=25) 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 and exhibited no history of periodontitis. The periodontitis
      stage III patients had a minimum of 3 teeth apart from the first molars and incisors showing
      CAL ≥5 mm and PD ≥6 mm and showed no>4 teeth loss caused by periodontitis. The radiographic
      bone loss extends 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=25). If higher than 1.0, the patients were assigned to grade C (n=25).

      Treatment The periodontitis patients received conventional 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 treatment.

      GCF, Saliva and Serum Sampling Filter paper strips were used to collect GCF samples. In the
      healthy control group, GCF was collected from the interproximal sites of single-rooted and
      multiple rooted teeth from each quadrant. GCF was collected from the sites with PD ≥ 6 mm and
      radiographic bone loss in periodontitis groups. Selected sites were isolated with cotton
      rolls. The paper strip was removed after 30 sec after inserting the periodontal pocket. A
      total of 5 mL of unstimulated whole saliva was collected by the passive drool method in the
      morning. The saliva was collected over a period of 5 minutes with instructions to pool saliva
      on the floor of the mouth and passively drool it into a sterile glass beaker and samples are
      immediately transferred to a 2 mL polypropylene tube. 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. All the samples were stored at -80°C.

      Biomarker Immunoassays GCF, 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. GCF, serum, and salivary samples of IL-26, IL-10, and IL-6 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,
      the 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, the Mann-Whitney U test was performed. The Spearman's rank correlation test was
      used to detect the correlations of biochemical parameters with clinical parameters and each
      other in periodontitis group before and after treatment. All tests were performed at a
      significance level of p<0.05.
    

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