The effect of nonsurgical periodontal treatment on serum and gingival crevicular fluid markers in patients with atherosclerosis.

BACKGROUND AND AIMS: The aim of this study is to compare patients with atherosclerosis and chronic periodontitis and patients who are systemically healthy and chronic periodontitis using alteration of adrenomedullin (ADM), chemokine (C-C motif) ligand 28 (CCL-28), white blood cell levels, platelet levels, high-density lipoprotein, low-density lipoprotein, high-sensitivity C-reactive protein, creatinine, and fibrinogen. MATERIALS AND METHODS: Totally, 40 patients were involved in study; a test group of 20 patients with atherosclerosis-chronic periodontitis and a control group of 20 patients who were nonatherosclerosis-chronic periodontitis. Nonsurgical periodontal treatment was offered to all patients, in whom systemic markers of atherosclerosis were measured in serum; ADM and CCL-28 biomarkers were measured in gingival crevicular fluid. RESULTS: Systemic markers of atherosclerosis, ADM, and CCL-28 levels have changed significantly in the test group compared to the control group after nonsurgical periodontal treatment. CONCLUSIONS: Treatment of local inflammation and reduction of systemic inflammatory markers are believed to lower the diagnostic criteria for atherosclerosis as well. It is possible to conclude that nonsurgical periodontal treatment of chronic periodontitis, which is a risk factor for atherosclerosis, has a positive effect on the atherosclerosis prognosis.

Gingival crevicular fluid levels of human beta-defensin-2 and cathelicidin in smoker and non-smoker patients: a cross-sectional study.

BACKGROUND AND OBJECTIVE: Cathelicidin (LL-37) and human ß-defensin-2 (hBD-2) are antimicrobial peptides that have additional functions in innate immunity. The purpose of this study was to evaluate LL-37 and hBD-2 levels in the following patient groups: non-smoker patients with gingivitis (G), smoker patients with gingivitis (SG), non-smoker patients with generalized aggressive periodontitis (AgP) and smoker patients with generalized aggressive periodontitis (SAgP). MATERIAL AND METHODS: A total of 80 patients, including 20 G, 20 SG, 20 AgP and 20 SAgP were enrolled in the study. Clinical periodontal parameters, including periodontal status were assessed by measuring bleeding on probing, plaque index, gingival index, probing depth and clinical attachment loss. Enzyme-linked immunosorbent assays were done to quantify LL-37 and hBD-2 levels in gingival crevicular fluid. RESULTS: Clinical periodontal parameters were found to have no statistically significant differences between the SAgP and AgP groups or between the SG and G groups. LL-37 and hBD-2 levels were significantly lower in G patients than in other groups. LL-37 and hBD-2 levels in the gingival crevicular fluid of SAgP patients were significantly higher than in other groups. LL-37 and hBD-2 levels in SG patients were also significantly higher than in G patients. CONCLUSIONS: Epithelial cells in contact with microorganisms release LL-37 and hBD-2 to eliminate them. The release response of LL-37 and hBD-2 formed against microorganisms can change depending on factors such as smoking, which activates the nicotinic receptors present on epithelial surfaces. This interaction can increase the release of LL-37 and hBD-2. Smoking may also affect the capillary tissues and reduce leukocytic chemotaxis. The increased number of colonized microorganisms may lead to higher levels of LL-37 and hBD-2 release in the tissues of smokers than in non-smokers.

Comparison of peri-implant crevicular fluid levels of adrenomedullin and human beta defensins 1 and 2 from mandibular implants with different implant stability quotient levels in nonsmoker patients.

BACKGROUND AND OBJECTIVE: To achieve satisfactory osseointegration, primary stability and healthy peri-implant tissue must be available. In this study, our objective was to compare the adrenomedullin, human beta-defensin (hBD)-1 and hBD-2 levels in implants with different implant stability quotient (ISQ) values and with different peri-implant tissue health values in the peri-implant crevicular fluid. MATERIAL AND METHODS: Thirty patients with 60 endosseous osseointegrated implants were included in this study. Following the completion of the osseointegration process, these implants were divided into two main groups: a group of 15 implants with peri-implantitis (peri-implantitis: 40 ≤ ISQ ≤ 80 peri-implantitis, n = 15) and a group of 45 implants with healthy peri-implant tissue. The healthy peri-implant tissue group was further divided into three subgroups according to their ISQ values (Healthy-60: 60 ≤ ISQ ≤ 70, healthy peri-implant, n = 15; Healthy-80: 71 ≤ ISQ ≤ 80, healthy peri-implant, n = 15; and Healthy-100: 81 ≤ ISQ ≤ 100, healthy peri-implant, n = 15). The levels of adrenomedullin, hBD-1 and hBD-2 in the peri-implant crevicular fluid were assessed using ELISAs. RESULTS: When the peri-implant clinical measurements were compared within groups, they were found to be highest in the peri-implantitis group and lowest in the Healthy-100 group. The adrenomedullin, hBD-1 and hBD-2 levels in the peri-implant crevicular fluid of the peri-implantitis group were found to be significantly higher than those in the Healthy-60, Healthy-80 and Healthy-100 groups. When only the healthy peri-implant tissue groups were evaluated, the adrenomedullin, hBD-1 and hBD-2 levels in the peri-implant crevicular fluid of the Healthy-60 group were found to be significantly higher than those in the Healthy-80 and Healthy-100 groups. The lowest adrenomedullin, hBD-1 and hBD-2 levels were observed in the Healthy-100 group. CONCLUSION: In cases of peri-implantitis, higher adrenomedullin, hBD-1 and hBD-2 levels were observed. These results indicate the presence of a tissue response to prevent the creation of a pathological environment in the peri-implant tissue. In groups with healthy peri-implant tissues, the ISQ value decreases as the adrenomedullin, hBD-1 and hBD-2 levels increase. This condition is thought to be caused by increased dental plaque accumulation and bone resorption in addition to increased lateral implant movements and colonization of microorganisms in the microcavities between the implant elements.

Gingival crevicular fluid adrenomedullin level in individuals with and without diabetes mellitus type 2.

BACKGROUND AND OBJECTIVE: Adrenomedullin, an antimicrobial peptide, has biological applications in many tissues, but its main attribute is its ability to lower arterial pressure. The plasma adrenomedullin level is elevated in pathophysiological conditions such as arterial hypertension, acute coronary syndrome, renal diseases, diabetes mellitus and periodontal diseases. The aim of this study was to compare the amounts of adrenomedullin in the gingival crevicular fluid of periodontally healthy individuals, individuals with chronic periodontitis, periodontally healthy individuals with diabetes mellitus type 2 and individuals with chronic periodontitis and diabetes mellitus type 2. MATERIAL AND METHODS: Eighty-four individuals were included in this study: 21 periodontally healthy individuals; 21 individuals with chronic periodontitis; 21 periodontally healthy individuals with diabetes mellitus type 2; and 21 individuals with chronic periodontitis and diabetes mellitus type 2. An ELISA was performed to measure the adrenomedullin levels in gingival crevicular fluid. RESULTS: Groups with diabetes mellitus type 2 (periodontally healthy individuals and individuals with chronic periodontitis) had significantly higher periodontal clinical indices than did nondiabetes mellitus groups (periodontally healthy individuals and individuals with chronic periodontitis). The group of individuals with chronic periodontitis and diabetes mellitus type 2 had a significantly higher total adrenomedullin level compared with the other groups. Also, a significantly higher total adrenomedullin level was found in diabetes mellitus type 2 groups (periodontally healthy individuals and individuals with chronic periodontitis) compared with nondiabetes mellitus groups (periodontally healthy individuals and individuals with chronic periodontitis). CONCLUSIONS: An increased adrenomedullin level was found in individuals with chronic periodontitis and also in individuals with diabetes mellitus. It is thought that the effect of diabetes mellitus on the pathogenesis of chronic periodontitis could have been achieved through antimicrobial peptides such as adrenomedullin, or that increased adrenomedullin was released in individuals with diabetes mellitus in order to ensure no further periodontal tissue loss.

Comparison of CCL28, interleukin-8, interleukin-1ß and tumor necrosis factor-alpha in subjects with gingivitis, chronic periodontitis and generalized aggressive periodontitis.

BACKGROUND AND OBJECTIVE: Cytokines produced by various cells are strong local mediators of inflammation. Mucosa-associated epithelial chemokine (CCL28), interleukin-8 (IL-8), interleukin-1beta (IL-1ß) and tumor necrosis factor-alpha (TNF-α) are major cytokines that play important roles in the periodontal inflammatory process. In this study we aimed to compare the levels of CCL28, IL-8, IL-1ß and TNF-α in the gingival crevicular fluid of both periodontally healthy subjects and in subjects diagnosed with gingivitis, chronic periodontitis and generalized aggressive periodontitis. MATERIAL AND METHODS: A total of 84 subjects participated in the study: 21 subjects had gingivitis, 21 subjects had chronic periodontitis, 21 subjects had generalized aggressive periodontitis and 21 were periodontally healthy. The levels of CCL28, IL-8, IL-1ß and TNF-α were analyzed using enzyme-linked immune sorbent assay (ELISA). RESULTS: The total levels of CCL28 and IL-8 in the gingival crevicular fluid of the generalized aggressive periodontitis group (324.74 ± 42.62 pg/30 s, 487.62 ± 49.21 pg/30 s) were significantly higher than those of the chronic periodontitis group (268.81 ± 28.64 pg/30 s, 423.65 ± 35.24 pg/30 s), the gingivitis group (146.35 ± 17.46 pg/30 s, 310.24 ± 48.20 pg/30 s) and the periodontally healthy group (92.46 ± 22.04 pg/30 s, 148.41 ± 24.64 pg/30 s). Similarly, the total levels of IL-1ß and TNF-α in the generalized aggressive periodontitis group (110.23 ± 9.20 pg/30 s, 1284.46 ± 86.32 pg/30 s) were significantly higher than those in the chronic periodontitis group (423.65 ± 35.24 pg/30 s, 82.64 ± 9.12 pg/30 s), the gingivitis group (52.10 ± 7.15 pg/30 s, 824.24 ± 44.68 pg/30 s) and the periodontally healthy group (36.44 ± 8.86 pg/30 s, 628.26 ± 34.61 pg/30 s). CONCLUSION: CCL28, IL-8, IL-1ß and TNF-α may play key roles in the host response to inflammation in periodontal diseases. As the severity of periodontal diseases increases, destruction of periodontal tissues also increases. Inflammation is one among many factors that trigger periodontal tissue destruction. Identification of the mediators that influence the development and progression of inflammation in periodontal diseases may be very important in understanding the prognoses of periodontal diseases.

Gingival crevicular fluid levels of human beta-defensins 1 and 3 in subjects with periodontitis and/or type 2 diabetes mellitus: a cross-sectional study.

BACKGROUND AND OBJECTIVE: Human ß-defensins (hBDs) have a strong antibacterial action against various microorganisms, especially periodontal pathogens. The aim of this study was to compare the total levels of hBD-1 and hBD-3 in the gingival crevicular fluid of healthy patients with gingivitis (HG), healthy patients with chronic periodontitis (HP), patients with type 2 diabetes mellitus (DM) and gingivitis (DM2G) and patients with type 2 DM and chronic periodontitis (DM2P). MATERIAL AND METHODS: A total of 80 patients were included: 20 HG, 20 HP, 20 DM2G and 20 DM2P. The levels of hBD-1 and hBD-3 in gingival crevicular fluid were measured using ELISA. RESULTS: The DM2P group had significantly higher periodontal clinical parameters at sites from which gingival crevicular fluid was collected compared with the other groups. The HG group had significantly lower periodontal clinical parameters within the gingival crevicular fluid-collected sites than did the HP, DM2G and DM2P groups. The gingival crevicular fluid of the DM2P group had significantly higher levels of total hBD-1 and hBD-3 than did that of the other groups; the hBD-1 and hBD-3 levels were significantly higher in the gingival crevicular fluid of the DM2G group than in that of the the non-DM type 2 groups (HG and HP). The gingival crevicular fluid of the HP group had significantly higher levels of total hBD-1 and hBD-3 in comparison with that of the HG group. CONCLUSION: As a result of the observed vascular and cell activity changes that occur within patients diagnosed with DM, periodontal diseases become more severe. These changes hinder the migration and the ability of chemotactic factors and leukocytes to protect periodontal tissues from the effects of microorganisms. In order to eliminate microorganisms, the epithelial cells in patients with DM may release more hBD-1 and hBD-3 into the gingival crevicular fluid. Determining the amount of hBD-1 and hBD-3 in the gingival crevicular fluid of patients with and without DM will help to elucidate the relationship among hBD-1, hBD-3, DM and periodontal disease.

Evaluation of beta-2 microglobulin and alpha-2 macroglobulin levels in patients with different periodontal diseases.

BACKGROUND: Beta-2 microglobulin (B2M) and alpha-2 macroglobulin (A2M) play key roles in the immune system. The aim of this study was to compare B2M and A2M levels in patients with different periodontal diseases. METHODS: Eighty patients (20 periodontally healthy, 20 with gingivitis, 20 with chronic periodontitis and 20 with generalized aggressive periodontitis) were enrolled in the study. The analysis of B2M and A2M was performed on gingival crevicular fluid (GCF) using an enzyme-linked immunosorbent assay in GCF. RESULTS: The total levels of B2M and A2M were statistically lower in the periodontally healthy group than in the other groups (p < 0.05) and significantly higher in the generalized aggressive periodontitis group compared to the other groups (p < 0.05). CONCLUSIONS: B2M and A2M play key roles in the balance between periodontal health and disease. It is proposed that tissues release B2M and A2M to stop inflammation and inhibit the proliferation of microorganisms and this may be the reason for the high levels of B2M and A2M in the generalized aggressive periodontitis and chronic periodontitis groups. B2M and A2M are assumed to be user-friendly and cost-effective markers for periodontal disease to identify asymptomatic diseases.