The subgingival microflora and gingival crevicular fluid cytokines in refractory periodontitis

Abstract

Refractory periodontitis manifests as a rapid, unrelenting, progressive loss of attachment despite the type and frequency of therapy. This study examined possible relationships between cytokine levels in gingival crevicular fluid (GCF), occurrence of specific periodontopathic microflora, and disease activity in patients with refractory periodontitis. Refractory periodontitis patients (7 male and 3 female) were selected on the basis of history and longitudinal clinical observations. In each patient, 2 teeth with pocket depths greater than 6 mm were selected and individual acrylic stents were fabricated with reference grooves for each site. The sites were examined at both baseline and 3 months later. The pattern and amount of alveolar bone resorption were assayed by quantitative digital subtraction radiography. Pocket depth and attachment loss were measured with a Florida Probe. The gingival index was measured at 4 sites around each sample tooth. Sites were divided into active sites (> or = 2.1 mm loss of attachment in 3 months) or inactive sites (< or = 2.0 mm loss of attachment in 3 months). The distribution and prevalence of the predominant microflora in active and inactive sites were compared using anaerobic culture and indirect immunofluorescence. Interleukin-1 beta, 2, 4, 6 and tumor necrosis factor-alpha (TNF-alpha) levels in gingival crevicular fluid (GCF) were quantified by ELISA. Prevotella intermedia and Eikenella corrodens significantly decreased in inactive sites but remained the same in active sites after 3 months. The active sites revealed significantly higher GCF levels of IL-2 and IL-6 than inactive sites at both baseline and at 3 months. IL-1 beta was also significantly greater in active sites than in inactive sites at 3 months. Alveolar bone loss in active sites correlated with increased GCF levels of IL-1 beta and IL-2. These results suggest that GCF levels of IL-1 beta, IL-2 and IL-6 and P. intermedia and E. corrodens in subgingival plaque may serve as possible indicators of disease activity in refractory periodontitis.

Interleukin-1 gene polymorphisms and periodontal status in a Spanish population

“…This discrepancy may result from the use of different sampling methods and/or ELISA kits. GCF IL-1β concentrations were almost 2-fold higher (p<0.05) in our PD patients than in the healthy controls, consistent with reports of a strong relationship between IL-1β and periodontal inflammation (26,(28)(29)(30)(31). Masada et al (32), in a study of 15 patients with moderate-to-severe PD, found that their elevated GCF IL-1α and IL-1β concentrations were reduced with periodontal treatment.…”

Increased IL-6 Levels in Peri-Implant Crevicular Fluid Correlate with Peri-Implantitis

“…High amounts of IL-6 were detected in patients with periodontitis (21,22), in active sites of refractory periodontitis (23), as well as in sites undergoing orthodontic movement, emphasizing the important role of IL-6 in the bone remodeling process (24). IL-6 was observed to correlate with the severity of periodontal disease (25), which may indicate that IL-6 could be a diagnostic marker for sites of active periodontal disease (26).…”

<A NAME="top"></A>Papel de la IL-6 y TNF-alfa en la enfermedad periodontal

“…Reinhardt y cols 27 encontraron niveles significativamente mayores en FGC de IL-6 en localizaciones de pacientes con periodontitis refractaria que en sujetos estables. Lee y cols 28 encontraron niveles significativamente mayores de IL-6 en FGC en localizaciones activas que inactivas, tanto en baseline como a los 3 meses. Geivelis y cols 29 observaron una correlación positiva entre sangrado gingival e IL-6, y entre profundidad de sondaje e IL-6 en pacientes con periodontitis.…”