Bülent Kurtiş

Effects of Scaling and Root Planing and Subantimicrobial Dose Doxycycline on Gingival Crevicular Fluid Levels of Matrix Metalloproteinase-8, -13 and Serum Levels of HsCRP in Patients With Chronic Periodontitis

BACKGROUND This study evaluates the efficacy of subantimicrobial dose doxycycline (SDD) in conjunction with scaling and root planing (SRP) on gingival crevicular fluid (GCF) levels of matrix metalloproteinase (MMP)-8 and -13 and on serum levels of high-sensitivity C-reactive protein (HsCRP) in patients with chronic periodontitis (CP). METHODS A total of 41 patients with CP and 17 healthy individuals were included in this randomized controlled trial. CP patients were randomly distributed into two groups. Study groups were established as Group I with SRP+placebo, Group II with SRP+SDD, and Group III as control. All CP patients received two regimens of SRP and Group II patients also received SDD for 6 weeks. At baseline and 6 weeks, GCF and blood were collected and clinical indices were recorded. The HsCRP level was assayed in the plasma on a nephelometer. The GCF levels of MMPs were assayed by an enzyme-linked immunosorbent assay. RESULTS Statistically significant differences in plaque index, gingival index (GI), probing depth (PD), GCF volumes, GCF MMP levels, and serum levels of HsCRP between pre-treatment and post-treatment were noted in both groups. Between groups there was a statistically significant decrease in PD, GI, and GCF levels of MMP-8 favoring the group receiving SDD adjunctive to SRP (P <0.05). CONCLUSION In this study, greater improvement was detected for PD, GI, and GCF levels of MMP-8 when using SRP+SDD compared to SRP+placebo.

Gingival Crevicular Fluid Prostaglandin E2 and Thiobarbituric Acid Reactive Substance Levels in Smokers and Non-Smokers With Chronic Periodontitis Following Phase I Periodontal Therapy and Adjunctive Use of Flurbiprofen

BACKGROUND It has been established that smoking is an important risk factor for the initiation and progression of chronic periodontitis (CP). This study investigates the effects of phase I periodontal therapy and adjunctive flurbiprofen administration on prostaglandin E2 (PGE2 ) and thiobarbituric acid reactive substance (TBARS) levels in gingival crevicular fluid (GCF) samples from smoker and non-smoker patients with CP. METHODS Twenty-one non-smoker and 21 smoker patients with CP were divided into four groups according to treatment modalities. Group 1 (non-smokers with CP) and group 3 (smokers with CP) patients received daily 100-mg flurbiprofen tablets in a 2 × 1 regimen for 10 days together with scaling and root planing (SRP). Patients in group 2 (non-smokers with CP) and group 4 (smokers with CP) received placebo tablets in a 2 × 1 regimen for 10 days together with SRP. Plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment level (CAL) measurements were recorded and GCF samples were collected at baseline and on day 10 of drug intake from each sampling area by a single examiner who was unaware of the treatment modality. Assays for GCF PGE2 and TBARS were carried out by an enzyme-linked immunosorbent assay and fluorometric method, respectively. RESULTS All groups showed statistically significant reductions in PI and GI scores following the phase I periodontal treatment on day 10 (P <0.05), but no statistical differences were observed in PD and CAL scores after the therapy. In groups 1 and 2, the reduction of GCF PGE2 and TBARS levels were not significant after the therapy compared to baseline levels. In group 3, GCF PGE2 and TBARS levels exhibited a statistically significant decrease (P <0.05) after the therapy. Group 4 showed significant reductions (P <0.05) in GCF PGE2 levels after the therapy. No statistically significant reductions were observed in group 4 with regard to GCF TBARS levels. When groups 1 and 3 were compared according to GCF TBARS levels after the therapy, a more statistically significant reduction was observed in group 3 (P = 0.001). CONCLUSION These results suggest that additional flurbiprofen administration may have more inhibitory effects on GCF levels of PGE2 and TBARS in the groups of smokers compared to non-smokers with CP.

Effects of Low-Dose Doxycycline and Bisphosphonate Clodronate on Alveolar Bone Loss and Gingival Levels of Matrix Metalloproteinase-9 and Interleukin-1β in Rats With Diabetes: A Histomorphometric and Immunohistochemical Study

BACKGROUND Bisphosphonates (BPs) and low-dose doxycycline (LDD) have been shown to inhibit bone resorption and to improve the levels of proinflammatory mediators and destructive enzymes in gingival tissues, respectively. The purpose of this study is to evaluate the effect of mono and combined BP clodronate and LDD therapies in reducing gingival levels of matrix metalloproteinase-9 (MMP-9), interleukin-1β (IL-1β), and alveolar bone loss in rats with diabetes. METHODS Fifty adult Wistar rats were divided into five study groups as follows: 1) group 1 = diabetes control; 2) group 2 = diabetes + periodontitis; 3) group 3 = diabetes + periodontitis + LDD; 4) group 4 = diabetes + periodontitis + clodronate; and 5) group 5 = diabetes + periodontitis + LDD + clodronate. LDD and clodronate were given as a single agent or as combination therapy during the 7 days of the post-experimental periodontitis period. On day 7, the rats were sacrificed, the mobility of the tooth was recorded, and block biopsies were removed. The gingival tissues were analyzed histologically and immunohistochemically for expression of MMP-9 and IL-1β. Alveolar bone loss was evaluated morphometrically under a light microscope. Data analysis was performed statistically by Kruskal-Wallis and post hoc Tukey and Spearman correlation tests. RESULTS Alveolar bone loss was significantly greater in groups 2 through 5 than group 1 (P <0.05) but was not significantly different among groups 2 through 5 (P >0.05). Animals with periodontitis (group 2) expressed significantly higher levels of MMP-9 and IL-1β compared with those without periodontitis (group 1) (P <0.05). MMP-9 expression was significantly lower in group 3 than groups 1, 2, and 5 (P <0.05). IL-1β expression was significantly lower in the groups 1, 3, 4, and 5 than 2 (P <0.01) but was not significantly different among groups 1, 3, 4, and 5. Positive correlations were found between alveolar bone loss and density of inflammation (ρ = 0.319, P = 0.021) and between MMP-9 and IL-1β (ρ = 0.418, P = 0.002), respectively. CONCLUSION Our findings suggest that ligature-induced periodontitis in animals with diabetes results in significantly higher levels of MMP-9 and IL-1β expression in gingiva. The use of mono and combined clodronate and LDD administrations may significantly reduce levels of MMP-9 and IL-1β expression. However, drug administration did not affect alveolar bone levels during the study period.

Double-application of platelet-rich plasma on bone healing in rabbits

Objective: Platelet-rich plasma (PRP) is considered to enhance bone formation especially at early stages of wound healing, depending on the limited and short life-span of platelets and growth factors. The aim of this study was to evaluate efficacy of double-application of PRP (DA-PRP) on bone healing in a rabbit calvarial defect model. Study design: Twenty-eight rabbits, each had two surgically prepared calvarial bone defects (10mm diameter), were included in this study and randomly divided into six groups. Defects (n=56) were treated with single-application of PRP (SA-PRP)(n=10), SA-PRP and beta-tricalciumphosphate (SA-PRP+TCP)(n=10), DA-PRP (n=8), DA-PRP and beta-tricalciumphosphate (DA-PRP+TCP)(n=8), beta-tricalciumphosphate (TCP)(n=10) or left empty (Control)(n=10). Animals were sacrificed at 30 days postoperatively. Results: The new bone (NB%) and defect fill (DF%) percentages were calculated from histological slides by image-analyzer software and statistically analysed. All test groups showed higher NB% than control, but differences among all groups were insignificant. The TCP treated groups had significantly higher DF% than groups treated without TCP, however the DF% differences between control, SA-PRP and DA-PRP or TCP, SA-PRP+TCP or DA-PRP+TCP were insignificant. Conclusion: Although new bone formation was histomorphologically remarkable at double-application PRP groups, statistical analyses of the histomorphometric data revealed no significant difference. Key words: Platelet-Rich Plasma, double application, bone formation, wound healing.

Short term effects of non-surgical periodontal treatment on gingival crevicular fluid levels of tissue plasminogen activator (t-PA) and plasminogen activator inhibitor 2 (PAI-2) in patients with chronic and aggressive periodontitis §

OBJECTIVE The purpose of this study was to evaluate the gingival crevicular fluid (GCF) levels of tissue type plasminogen activator (t-PA) and plasminogen activator inhibitor 2 (PAI-2) in aggressive periodontitis (AgP), chronic periodontitis (CP) and periodontally healthy control subjects, before (BT) and after (AT) the non-surgical periodontal treatment. DESIGN Systemically healthy 12 CP and 13 AgP patients and 20 control subjects were included in this study. Plaque index, gingival index, probing depth and clinical attachment levels were recorded and GCF samples were collected BT and AT. Assays for GCF t-PA and PAI-2 levels were carried out by an enzyme linked immunosorbent assay (ELISA). The χ(2), Wilcoxon and Mann-Whitney U tests and Spearman correlation coefficient were used for data analyses. RESULTS Statistically significant reductions in clinical index scores were noted in both periodontitis groups after treatment. No significant differences were detected in GCF levels of t-PA and PAI-2 between CP and AgP groups at either BT or AT. There was a statistically significant decrease in GCF PAI-2 levels in CP after therapy (p<0.01). GCF t-PA levels in CP and AgP groups exhibited significant correlations with PD and CAL measurements at both BT and AT (p<0.01). CONCLUSION Significant decrease was detected for GCF PAI-2 levels in CP and clinical parameters in both CP and AgP by non-surgical periodontal treatment.

OSTEOCALCIN AND OSTEONECTIN EXPRESSION AFTER DOUBLE-APPLICATION OF PLATELET-RICH PLASMA IN RABBITS

Purpose: Platelet-rich plasma (PRP) is a novel method for transferring autogenous growth factors to the wound area. The aim of this study was to evaluate the efficacy of double-application of PRP (DA-PRP) on bone healing in rabbit cranial defects by examining osteonectin (ON) and osteocalcin (OC) expression. Materials and Methods: Twenty-eight rabbits, each with two surgically prepared calvarial bone defects, were included in this study and divided into six groups: The defects (N=56) were treated with either a single-application of PRP (SA-PRP) (n=10), a combination of SA-PRP and betatricalciumphosphate (SA-PRP+β-TCP) (n=10), only DAPRP (n=8), both DA-PRP and beta-tricalciumphosphate (DA-PRP+β-TCP) (n=8), only beta-tricalciumphosphate (β-TCP) (n=10), or controls (n=10). The animals were sacrificed at 30th day postoperatively and samples were immunohistochemically examined for ON and OC expressions. Results: It was determined that DA-PRP did not significantly improve the ON and OC percentages achieved by SA-PRP or the controls. The three groups treated with β-TCP showed a higher percentage of ON than those treated without β-TCP (p<0.05). The β-TCP treated groups and SA-PRP group demonstrated higher OC percentage than DA-PRP and control groups (p<0.05). Conclusion: The present findings suggest that DAPRP did not have a significant effect on the healing of non-critical size rabbit cranial bone defects.

Evaluation of peri-implant crevicular fluid prostaglandin E2 levels in augmented extraction sockets by different biomaterials.

Abstract Objectives: This study compares peri-implant crevicular fluid (PICF) prostaglandin E2 (PGE2) levels, clinical parameters and implant stability quotient (ISQ) values around implants placed in augmented extraction sockets. Materials and methods: The sockets (24 in total) were randomly augmented using either EMD or Bio-Oss Collagen. Implant placements were performed after three months of healing. ISQ readings were evaluated at three points: at the time of surgery, at the first month and at the third month. PICF was collected for PGE2 evaluation after the first and the third months of implant surgery. Results: After the first month, a higher level of PICF PGE2 was observed in the EMD group than in the Bio-Oss Collagen group, and this increase was of statistical significance; however, at the third month there was no statistically significant difference in PICF PGE2 levels between the two groups. For implants placed in EMD sites, ISQ values were statistically higher at the third month than at the first month, while no significant differences in ISQ value were detected between the first and third months in Bio-Oss Collagen sites. Conclusions: The results of this research suggest that both EMD and Bio-Oss Collagen are effective treatment modalities for stimulating the formation of new bone at extraction sites prior to implant surgery.