Prediction and diagnosis of attachment loss by enhanced chemiluminescent assay of crevicular fluid alkaline phosphatase levels

Abstract

The current study aimed to apply a novel enhanced chemiluminescence assay in the analysis of gingival crevicular fluid (GCF) alkaline phosphatase (ALP) levels from patients with untreated adult periodontitis. 3666 sites in 25 patients were monitored prior to and after attachment loss was detected with a Florida disc probe. Parameters assessed were, relative attachment level, probing pocket depth, occurrence of bleeding on probing (single episode), GCF volume (microliter), total ALP levels (microIU/30 s sample time) and ALP concentration (IU/l). After recruiting patients to the study, all measures were taken at baseline and 3 months later, prior to the institution of non-surgical periodontal therapy at active sites. Thresholds for determining attachment loss were calculated using a modification of the tolerance method. The mesio-buccal sites of all teeth had GCF samples collected. The size of individual patient thresholds used to define whether attachment loss had occurred, was dependent upon the discomfort felt by that patient during electronic probing, with a positive correlation existing between discomfort on probing (10 cm visual analogue scale) and threshold size (R = 0.52, p < 0.049). A total of 274 sites (7.5%) experienced attachment loss of which 39 sites had GCF samples available for analysis. Total ALP levels were significantly higher at baseline for sites that progressed to attachment loss than paired controls (p < 0.003), but all other parameters showed no differences (p > 0.1). There were significant increases in total ALP levels and GCF volumes for active sites between baseline and 3 month measures (p < 0.01), but not for control sites or test site ALP concentration (p > 0.8). The diagnostic accuracy for GCF ALP as a predictor of future attachment loss (threshold 900 microIU/30 s) was 64%, with +ve and -ve predictive values of 62% and 68%. When a threshold of 1300 microIU/30 s was selected for ALP as a marker of recent or currently active disease, diagnostic accuracy and +ve/-ve predictive values were 77% and 77%/76%, respectively. These results indicate that total GCF ALP levels may serve as a predictor of future or current disease activity.

Fluid Exudates From Inflamed Bone-Anchored Hearing Aids Demonstrate Elevated Levels of Cytokines and Biomarkers of Tissue and Bone Metabolism

“…The fluid flowing through the crevice is termed gingival crevicular fluid (GCF) and has been the subject of extensive research (10). Indeed, increases in GCF volume can be observed before clinical signs of inflammation (13). Consistent with inflamed gingival tissues within the oral cavity, inflamed BAHAs yielded significantly more fluid exudate than noninflamed fixtures, and this correlated with the clinical severity of the inflammation.…”

Gingival Crevicular Fluid as a Novel Potential Source of Biomarkers Distinguishes Pubertal from Post-Pubertal Subjects

“…GCF originates mainly from serum and contains abundant proteins from different sources, including host-derived enzymes, degradation products of periodontal tissue, and secreted substances of subgingival bacteria flora [9]. Since its capability of reflecting a host reaction to periodontal inflammation with a site-specific characteristic, GCF has been proven to be an ideal source of biomarkers indicating periodontal diseases [10,11,12] and orthodontic tooth movement [13,14,15]. Some studies have proven that the level of alkaline phosphatase (ALP) in human GCF increased in close relation to a pubertal growth spurt and appears to be a valid source of biomarkers, which provides us with a new possibility of discovering protein biomarkers for pubertal growth spurt [5,6,7].…”

The Relationship between Periodontal Status and Alkaline Phosphatase Levels in Gingival Crevicular Fluid in Men with Hypergonadotropic Hypogonadism

“…ALP has been found in various periodontal tissues13,14 and its serum level can be used as an indicator of bone formation 12. Studies have revealed that ALP can often be measured in the gingival crevicular fluid (GCF) to examine its relations to periodontal conditions and disease activity 15-18. Ishikawa and Cimasoni19 demonstrated that enzyme levels in the GCF were 3 times higher than those in the serum and significant correlation was shown between the ALP concentration in the GCF and the pocket depth.…”