Umut Balli

Gingival Crevicular Fluid Levels of Sclerostin, Osteoprotegerin, and Receptor Activator of Nuclear Factor-κB Ligand in Periodontitis.

BACKGROUND To investigate changes in the levels and relative ratios of sclerostin, osteoprotegerin (OPG), and receptor activator of nuclear factor-κB ligand (RANKL) in the gingival crevicular fluid (GCF) of patients with periodontitis after non-surgical periodontal treatment. METHODS Fifty-four individuals (27 healthy controls and 27 patients with chronic periodontitis [CP]) were enrolled in the study. Periodontitis patients received non-surgical periodontal therapy. GCF sampling and clinical periodontal parameters were assessed before and 6 weeks after therapy. Sclerostin, OPG, and RANKL levels were measured by enzyme-linked immunosorbent assay, and their relative ratios were calculated. RESULTS Total amounts and concentrations of sclerostin were significantly higher in patients with CP than in healthy individuals (P <0.025) and decreased after treatment (P <0.05). The RANKL/OPG ratio was significantly lower in healthy individuals than in patients with periodontitis before and after treatment (P <0.025), but no significant difference was observed in patients with periodontitis after treatment (P >0.05). The sclerostin/OPG and sclerostin/RANKL ratios were significantly lower in healthy individuals than in patients with periodontitis before and after treatment (P <0.025) and decreased in patients with periodontitis after treatment (P <0.05). CONCLUSIONS The GCF sclerostin level may be more reliable than the RANKL/OPG ratio as a diagnostic and prognostic marker of periodontal disease and treatment outcome. Regulation of sclerostin levels may aid the development of new therapeutic strategies for the treatment of periodontal disease.

Assessment of periostin levels in serum and gingival crevicular fluid of patients with periodontal disease

BACKGROUND AND OBJECTIVE Periostin, a secreted adhesion molecule essential for periodontal tissue integrity, is highly expressed in the periodontal ligament and plays a critical role in tooth and bone development. The purpose of this study was to investigate periostin levels in the gingival crevicular fluid and serum of patients with periodontal disease and compare them with those of healthy individuals. MATERIAL AND METHODS Eighty individuals (41 males and 39 females; age range: 25-48 years) were enrolled in the study. Individuals were divided into three groups following clinical and radiographic examinations: the periodontal-healthy group (n = 20), gingivitis group (n = 30) and chronic periodontitis group (n = 30). Gingival crevicular fluid and serum samples were collected and periostin levels were determined using the enzyme-linked immunosorbent assay. RESULTS The total amount and concentration of periostin decreased in gingival crevicular fluid with the progression and severity of the disease from healthy controls to gingivitis and to chronic periodontitis groups and differed significantly (p < 0.05). However, there was no significant difference in serum periostin concentration within all groups (p > 0.05). Periostin in gingival crevicular fluid negatively correlated with the gingival index in the periodontal disease groups, whereas it is inversely correlated with the clinical attachment level only in the periodontitis group (p < 0.05). When all the clinical groups were examined together, the periostin concentration negatively correlated with clinical attachment level and gingival index; moreover, total periostin positively correlated with periostin concentration and clinical attachment level (p < 0.05). CONCLUSIONS The periostin levels in gingival crevicular fluid decreased proportionally with the progression and severity of periodontal disease, and negatively correlated with the clinical parameters. Within the limits of the study, the periostin level in gingival crevicular fluid can be considered a reliable marker in the evaluation of periodontal disease susceptibility and activity.

Concentrated growth factor in the treatment of adjacent multiple gingival recessions: a split‐mouth randomized clinical trial

AIM The aim of this study was to determine the clinical effect of concentrated growth factor (CGF) in combination with coronally advanced flap (CAF) compared to CAF alone for the treatment of multiple adjacent gingival recessions (GRs). MATERIALS AND METHODS Twenty patients with a total of 119 Miller Class I and II GRs in the maxilla were included to this study. Recessions were randomly treated according to a split-mouth design by means of CAF + CGF (test; 60 defects) or CAF (control; 59 defects). Clinical outcomes were evaluated at baseline and 6 months after surgery. RESULTS The mean root coverage (MRC) was 82.06% and 86.67%, complete root coverage (CRC) was 45.8% (27/59) and 56.7% (34/60) for CAF and CAF + CGF, respectively at 6th month. Statistically no difference was demonstrated between the two groups in terms of recession depth (RD), MRC and CRC at 6th month. The increase in width of keratinized gingiva (KGW) and gingival thickness (GT) were statistically significant in the CAF + CGF group compared to the CAF group at 6th month. CONCLUSIONS The use of CGF in combination with CAF did not provide additional benefits in RD, CRC and MRC. This study suggests that use of CGF + CAF may increase the success of GRs because of a significant increase in KGW and GT.

Assessment of Vascular Endothelial Growth Factor and Matrix Metalloproteinase-9 in the Periodontium of Rats Treated With Atorvastatin

BACKGROUND The aim of this study is to examine, for the first time, the role of systemic and local atorvastatin application on periodontium using histomorphometric and immunohistochemical analysis during and after experimental periodontitis induction with or without the presence of microbial dental biofilm. METHODS One hundred ten male Wistar rats were used. Silk ligatures were placed around the cervical area of the mandibular first molars; rats in the healthy control group received no ligatures (n = 10). In experimental periodontitis groups (n = 90), systemic and local atorvastatin and saline were administered in three different periods; the control periodontitis group (n = 10) received no treatment. Histomorphometric analysis, which included alveolar bone area, alveolar bone level, and attachment loss, and immunohistochemical analysis, which included immunoreactivity of vascular endothelial growth factor (VEGF) and matrix metalloproteinase (MMP)-9, were performed after the rats were sacrificed at the end of the experimental procedure. RESULTS There was a greater increase in alveolar bone area and VEGF immunoreactivity, as well as a greater decrease in alveolar bone and attachment loss and MMP-9 immunoreactivity, with systemic and local atorvastatin application during and after induction of experimental periodontitis. Local atorvastatin application showed better results on periodontium with regard to alveolar bone findings. CONCLUSIONS Systemic and local atorvastatin application showed beneficial effects on periodontium during and after induction of experimental periodontitis. Within the limits of this study, it can be concluded that atorvastatin, which is used for hypercholesterolemia treatment, can also be used as a protective and therapeutic agent for periodontal disease.

Biochemical Analysis of Pentraxin 3 and Fibrinogen Levels in Experimental Periodontitis Model

Objective. Pentraxin 3 (PTX3), newly discovered inflammation marker, is a member of acute-phase proteins. The hypothesis, synthesis of gingival tissue and serum PTX-3 increases in the experimental periodontitis model (with 10-day and 40-day periods), was tested by detecting gingival tissue and serum PTX-3 levels in rats with experimental periodontitis. Methods. Thirty rats were randomly divided into three groups of ten animals each: ligature-induced experimental periodontitis groups (with 10-day (Group1) and 40-day periods (Group2)) and healthy group (Group3). At the end of experimental period, rats were sacrificed, and radiological and histomorphometric analyses were performed on the mandibles. PTX3 levels were measured in gingival tissue and serum samples using ELISA. Plasma fibrinogen levels were measured according to the nephelometric method. Results. Significant alveolar bone resorption and periodontal inflammation were evident in periodontitis groups. Levels of PTX3 in gingival tissue were statistically higher in Group 1 than those in groups 2 and 3 (P < 0.01). No significant difference was found in serum PTX3 levels between experimental periodontitis and control groups (P > 0.05). Plasma fibrinogen levels were significantly increased in the experimental periodontitis groups (P < 0.001). Conclusion. PTX3 seems to be associated with tissue destruction in earlier periods of inflammatory periodontal disease, contrary to the fibrinogen findings.

Assessment of MMP-1, MMP-8 and TIMP-2 in experimental periodontitis treated with kaempferol

Purpose The objective of this study was to investigate the effect of a dietary flavonoid, kaempferol, which has been shown to possess antiallergic, anti-inflammatory, anticarcinogenic, and antioxidant activities on the periodontium by histomorphometric analysis and on gingival tissue matrix metalloproteinase-1 (MMP-1), MMP-8, and tissue inhibitor of metalloproteinase-2 (TIMP-2) by biochemical analysis of rats after experimental periodontitis induction. Methods Sixty Wistar rats were randomly divided into six groups of ten rats each, and silk ligatures were placed around the cervical area of the mandibular first molars for 15 days, except in the healthy control rats. In the experimental periodontitis groups, systemic kaempferol (10 mg/kg/2d) and saline were administered by oral gavage at two different periods (with and without the presence of dental biofilm) to all rats except for the ten non-medicated rats. Alveolar bone area, alveolar bone level, and attachment level were determined by histomorphometric analysis, and gingival tissue levels of MMP-1, MMP-8, and TIMP-2 were detected by biochemical analysis. Results Significantly greater bone area and significantly less alveolar bone and attachment loss were observed in the kaempferol application groups compared to the control groups (P<0.05). In addition, gingival tissue MMP-1 and -8 levels were significantly lower in the kaempferol application groups compared to the control groups and the periodontitis group (P<0.001). There were no statistically significant differences in TIMP-2 levels between the kaempferol and saline application groups (P>0.05). Conclusions Kaempferol application may be useful in decreasing alveolar bone resorption, attachment loss, and MMP-1 and -8 production in experimental periodontitis.

Ankaferd blood stopper enhances healing after osseous grafting in patients with intrabony periodontal defects.

BACKGROUND AND OBJECTIVE The aim of this clinical study were to compare the clinical efficacy of ankaferd blood stopper (ABS) when used in combination with autogenous cortical bone graft (ACB) in the treatment of intrabony periodontal defects. MATERIAL AND METHODS The study was planned as a split-mouth design. Fifteen patients with chronic periodontitis at 30 sites (six men, nine women; 42 ± 7 years) were included. Treatment sites had probing pocket depths (PPD) of ≥ 6 mm and osseous defect depths of ≥ 4 mm as radiographically assessed. Following the initial periodontal therapy, patients were randomly assigned to two treatments in contralateral areas of the dentition: ACB + ABS or ACB alone. At baseline and 6 mo after surgery, clinical parameters of plaque index, gingival index, PPD, clinical attachment level and gingival recession (GR) were recorded. The primary outcome variable was the change in clinical attachment level between baseline and 24 wk after surgery. Gingival crevicular fluid samples were collected immediately before surgery and at 2, 4, 6, 12 and 24 wk after the surgery. Gingival crevicular fluid volume was calculated and vascular endothelial growth factor levels in gingival crevicular fluid were measured. RESULTS PPD decreased, clinical attachment level improved and gingival index decreased significantly in response to both modes of treatment (p < 0.05). Both treatment modalities resulted in a significant gain in radiographic bone levels compared to baseline (p < 0.05). Intergroup comparisons showed that there was a significantly higher gain in clinical attachment level in the ABS/ACB group compared to ACB group (p < 0.05) with significantly less GR (p < 0.05). Similarly, vascular endothelial growth factor concentration in gingival crevicular fluid was significantly higher in the ABS/ACB group at postoperative weeks 2 and 4 compared to the ACB group (p < 0.01). CONCLUSIONS The findings suggest that ABS enhances the soft tissue healing during the periodontal defect fill by the ACB by stimulating angiogenesis and vascular endothelial cell function, prevents GR and thereby increases the clinical attachment gain.

Levels of vaspin and omentin-1 in gingival crevicular fluid as potential markers of inflammation in patients with chronic periodontitis and type 2 diabetes mellitus

The aims of the present study were to determine the levels of vaspin and omentin-1 in gingival crevicular fluid (GCF) in patients with chronic periodontitis (CP) with and without type 2 diabetes mellitus (T2DM), and to evaluate GCF vaspin and omentin-1 levels after non-surgical periodontal therapy. The study included 60 subjects: 15 systemically and periodontally healthy individuals, 15 periodontally healthy patients with T2DM, 15 systemically healthy patients with CP, and 15 patients with both CP and T2DM. GCF and clinical periodontal parameters were examined at the baseline and 6 weeks after periodontal therapy. Levels of vaspin, omentin-1 and tumor necrosis factor-alpha (TNF-α) were measured by ELISA, and their relative ratios were calculated. GCF vaspin and TNF-α levels were significantly higher in the CP groups than in the periodontally healthy groups (P < 0.008) and decreased after therapy in the former (P < 0.025). GCF omentin-1 levels were significantly lower in the CP groups than in the periodontally healthy groups (P < 0.008) and increased after therapy in the former (P < 0.05). Statistically significant positive correlations were found between the total amount of vaspin and TNF-α, glycated hemoglobin (HbA1c), clinical attachment level and gingival index, whereas the level of omentin-1 was negatively correlated with these parameters in all groups (P < 0.05). We found that non-surgical periodontal therapy influenced the GCF levels of both vaspin and omentin-1 in the CP groups. Our results suggest that the levels of vaspin and omentin-1 in GCF could have potential application as inflammatory markers of diabetes, periodontal disease and treatment outcome. (J Oral Sci 58, 379-389, 2016).

The levels of visceral adipose tissue-derived serpin, omentin-1 and tumor necrosis factor-α in the gingival crevicular fluid of obese patients following periodontal therapy

The aim of this clinical study was to determine levels of visceral adipose tissue-derived serpin (vaspin), omentin-1, and tumor necrosis factor-alpha (TNF-α) in the gingival crevicular fluid (GCF) of obese and non-obese periodontitis patients following nonsurgical periodontal therapy. Seventy-six subjects were separated into four groups according to periodontal and anthropometric measurements: a periodontal-healthy group, a chronic periodontitis (CP) group, a periodontal-healthy with obesity group, and a CP with obesity group. Nonsurgical periodontal treatment was administered to periodontitis patients. Before treatment and at 6 weeks after treatment, GCF samples were analyzed and clinical periodontal parameters were examined. Enzyme-linked immunosorbent assays were used to measure the levels of vaspin, omentin-1, and TNF-α. Obese and non-obese CP patients displayed higher levels of vaspin and TNF-α (P < 0.008), which declined following treatment (P < 0.025), and lower omentin levels (P < 0.008), which increased after treatment (P < 0.025). There was a negative correlation between the total amount of vaspin and omentin-1 in all groups. Obese and non-obese patients had opposing levels of vaspin and omentin-1 in the GCF; therefore, these may represent diagnostic and prognostic indicators of periodontal disease and therapeutic outcome.(J Oral Sci 58, 465-473, 2016).

The effect of infliximab on bone healing in osteoporotic rats

Purpose: The aim of this study was to evaluate the effect of the infliximab on autogenous-mediated bone regeneration and resorption of autogenous graft in the ovariectomised rat model. Materials and methods: Forty rats underwent ovariectomy and 6 weeks later the animals were randomly assigned to four groups. Critical size defects were created in each rat calvarium. In the control group (C), the flap was closed without any further action. In the only infliximab group (In), the flap was closed without any further action. After the operation, intravenous infliximab was injected. In the autogenous graft group (Ag), autogenous bone was applied in to the defect. In autogenous graft + infliximab group (Ag+In), autogenous graft was placed on the defect. After the operation, intravenous infliximab was injected. The animals were sacrificed at 4 weeks. Bone formation was assessed by micro-computed tomography (micro-CT) scans and stereological analysis. Results: The mean new bone volume was the greatest in Ag+In group (1.76 ± 0.20), followed by the Ag group (1.51 ± 0.05) (statistically significant difference at P <0.05). The lowest new bone was found in the control group (1.05 ± 0.09), however no difference was observed from the In group (1.14 ± 0.08) (P >0.05). Besides there was a statistically significant difference between the Ag+In group (1.00 ± 0.05) and Ag group (0.74 ± 0.04) in terms of the graft volume (P <0.05). Conclusion: This study, despite its limitations, showed that infliximab has a beneficial effect for prevent graft resorption and bone regeneration in osteoporotic rats.