Gül Atilla

... Page 2. Özer, Türkoğlu, Köse, Atilla 194 etkinliği ve bu oranın azalmasında ağız bakımı işlemlerinin ve hastanın idame tedavisi ile uyumunun önemi bilinmektedir.3,4 ... Page 4. Özer, Türkoğlu, Köse, Atilla 196 Tablo 1. Anket soruları ve cevapları Sorular Cevaplar ...

The levels of interleukin-1beta, tumour necrosis factor-alpha, and interleukin 6 in gingival crevicular fluid of phenytoin- treated patients (from sites exhibiting overgrowth and sites not exhibiting overgrowth) and control subjects were investigated. Six epileptic patients exhibiting severe phenytoin-induced gingival overgrowth, 12 patients with chronic gingivitis and 11 subjects with clinically healthy periodontium were included in the study. The cytokine levels were analysed by enzyme-linked immunosorbent assay and expressed as ng/2 sites. Wilcoxon signed-rank test, Kruskall-Wallis, Mann-Whitney U test and Spearman rank correlation were used for statistical analysis of the data. Overgrown sites showed significantly higher levels of interleukin-1beta compared to the healthy and gingivitis sites (p=0.0009, p=0.049

Background/aim: the effect of smoking on inflammatory biomarkers in gingival crevicular fluid (GCF) is well established in the presence of periodontal inflammation. However, it is not clear if smoking has an influence on matrix metalloproteinase (MMP) and growth factor levels in the GCF of periodontally healthy subjects. the aim of this study was to investigate GCF levels of MMP-1, MMP- 8, transforming growth factor (TGF)-?1, platelet-derived growth factor (PDGF)-AB, and vascular endothelial growth factor (VEGF) in smoking versus nonsmoking periodontally healthy subjects. Materials and methods: Thirty-two periodontally healthy subjects were included in this study. Probing depths, bleeding on probing, and plaque index was assessed. GCF levels of MMP-1, MMP-8, TGF-?1, PDGF-AB, and VEGF were analyzed by enzyme-linked immunosorbent assay. Results: No significant differences were observed in the distribution of demographic data between study groups. GCF total amount of PDGF-AB was signif...

Günümüzde çeşitli tekniklerle elde edilen farklı trombosit konsantrasyonları bulunmaktadır. Benzer isimlerle anılsa bile, bu konsantrasyonların biyolojik içerikleri farklıdır. Lökosit ve trombositten zengin fibrin (L-TZF), kan kaynaklı trombosit konsantrasyonları arasında en son geliştirilenidir. Herhangi bir antikoagülan ajana gerek duyulmadan hazırlanan L-TZF'nin eldesi kolaydır. L-TZF'nin biyolojisinde her ne kadar trombosit kaynaklı büyüme faktörleri önemli bir rol oynasa da, fibrin organizasyonu ve lökosit içeriği de diğer iki anahtar değişkenini oluşturur. Bu nedenle L-TZF, içeriğinde bulunan büyüme faktörleri ve hücreler sayesinde doğal yara iyileşmesini olumlu yönde etkiler. Yumuşak doku ve kemik iyileşmesi üzerindeki olumlu özellikleri nedeniyle günümüzde L-TZF'nin diş hekimliği alanında kullanım sıklığı giderek artmaktadırSeveral platelet concentrates are avaliable in different techniques; however, their biological contents vary from one to another. Leukocyte p...

Background: Oral and periodontal health status of the elderly should be known, in order to plan protective and essential treatment procedures. The aim of this present study is to determine the periodontal status, prevalence of caries and oral hygiene habits of elderly ...

hCAP18/LL-37 is an endogenous antibiotic having a role in innate immunity. The aim of the present study was to evaluate serum and gingival crevicular fluid (GCF) hCAP18/LL-37 levels in patients with generalized aggressive periodontitis (G-AgP). Twenty-six G-AgP patients, 24 gingivitis patients, and 25 healthy subjects were included in this study. Periodontal parameters including probing depth, clinical attachment level, plaque index, and papilla bleeding index were recorded. GCF and serum hCAP18/LL-37 levels were analyzed by enzyme-linked immunosorbent assay. GCF hCAP18/LL-37 level was significantly higher in G-AgP compared to others (p = 0.038, p < 0.001). Gingivitis patients had significantly higher GCF hCAP18/LL-37 levels than controls (p < 0.001). No significant differences were observed in serum hCAP18/LL-37 levels among the study groups (p = 0.524). While there were positive correlations between GCF hCAP18/LL-37 levels and periodontal parameters of sampling sites (p <...

Cyclophilin A (CypA) is able to regulate inflammatory responses and matrix metalloproteinase production via its interaction with extracellular matrix metalloproteinase inducer (EMMPRIN). EMMPRIN is the cell surface receptor of CypA. The aim of the present study was to evaluate the gingival crevicular fluid (GCF) CypA and EMMPRIN levels in patients with chronic periodontitis (CP), generalized aggressive periodontitis (G-AgP) and periodontally healthy controls. Twenty CP patients, 19 G-AgP patients and 20 healthy control subjects were included in the present study. All study participants were non-smokers. Full mouth clinical periodontal parameters including probing depth, clinical attachment level, plaque index, and papilla bleeding index were recorded. GCF CypA and EMMPRIN levels were analyzed by enzyme-linked immunosorbent assay. Data were analyzed statistically with parametric and non-parametric tests. GCF CypA total amount was higher in the G-AgP group compared to healthy controls...

Platelet-rich fibrin (PRF) has a controlled release of growth factors due to the fibrin matrix structure. Different centrifugation protocols were suggested for PRF preparation. Since the derivation method of PRF can alter its contents, in the present study it is aimed to investigate the cell contents and transforming growth factor beta-1 (TGF-β1), platelet-derived growth factor (PDGF-AB), vascular endothelial growth factor (VEGF), matrix metalloproteinase (MMP)-1 and-8 release from experimental PRF-type membranes obtained with different centrifugation times at 400 gravity. Three blood samples were collected from 20 healthy non-smoker volunteers. One tube was used for whole blood analyses. The other two tubes were centrifuged at 400 g for 10 minutes (group A) or 12 minutes (group B). Each experimental PRF-type membrane was placed in Dulbecco's Modified Eagle's Medium (DMEM)and at 1, 24 and 72 hours, TGF-β1, PDGF-AB, VEGF, MMP-1 and -8 release amounts were analysed by enzyme-l...

The aim of this study is to compare salivary and serum biomarker levels and degrees of matrix metalloproteinase (MMP) activation between patients with acute myocardial infarction (AMI) and systemically healthy patients (non-AMI) with similar periodontal conditions. A total of 92 patients (47 AMI and 28 non-AMI patients with gingivitis or periodontitis; and 17 systemically and periodontally healthy patients as a control group) were recruited. Clinical periodontal measurements were recorded; stimulated whole saliva and serum samples were collected. AMI patients were clinically examined within 3 to 4 days after admission to the coronary care unit. Saliva samples were analyzed for levels of MMP-8, MMP-7, and tissue inhibitor of matrix metalloproteinase (TIMP)-1. Serums were tested for MMP-8, MMP-9, TIMP-1, and TIMP-2 levels by immunofluorometric assay and enzyme-linked immunosorbent assay. Molecular forms and degree of activation of salivary MMP-8, MMP-9, and MMP-13 were analyzed by computer-scanned immunoblots. Total salivary MMP-8 assessed by immunofluorometric assay method and immunoblot densitometric units was higher in non-AMI than in AMI patients' saliva, but a significantly higher percentage of AMI patients' MMP-8 was activated polymorphonuclear leukocyte (PMN) type (P <0.001) regardless of periodontal diagnosis.Serum MMP-8, MMP-9, and TIMP-1 levels were significantly higher in AMI (for all markers and all comparisons,P <0.05). Characteristic for AMI was dominance of active PMN MMP-8 in saliva [corrected].

The aim of the present study was to investigate the effect of cyclosporine-A (CsA) medication on gingival crevicular fluid (GCF) LL-37, human neutrophil peptide (HNP)1-3 and adrenomedullin (ADM) levels. CsA-treated renal transplant recipients with GO (CsA GO+) and without GO (CsA GO-), tacrolimus-medicated renal transplant recipients (n = 20/group), systemically healthy subjects with gingivitis (n = 21) and individuals free of periodontal and systemic diseases (n = 20) were included in the present study. Periodontal parameters were recorded and GCF samples were obtained from the study participants. GCF LL-37, HNP1-3 and ADM levels were analyzed by enzyme-linked immunosorbent assay. GCF LL-37 total amount was higher at GO+ sites than the other study sites (p < 0.05). Total amount of GCF HNP1-3 was higher in immunosuppressive treatment groups than healthy and gingivitis groups, regardless of GO presence (p < 0.05). GCF ADM total amount was similar in all study groups. GCF volume, papillary bleeding index and hyperplastic index (p < 0.05) were significantly correlated with GCF LL-37 total amounts (p < 0.05), but not with GCF HNP1-3 and ADM total amount at GO+ sites (p > 0.05). Neutrophil infiltration due to extended inflammation might have increased GCF LL-37 levels at GO+ sites and contributed to the pathogenesis of CsA-induced GO.

The aim of the present study was to evaluate the therapeutic efficacy of vasoactive intestinal peptide (VIP), an immunoregulatory molecule, in experimental periodontitis. Sixty-three male Sprague-Dawley rats were divided into five groups: control; lipopolysaccharide (LPS); LPS + 0.1 nmol VIP; LPS + 1 nmol VIP; and LPS + 10 nmol VIP. Saline was injected into the gingiva of control rats on days 1, 3, and 5, whereas the other groups received injections of Escherichia coli LPS. VIP groups received intraperitoneal injections of relevant dosages on days 2, 4, 6, 8, and 10. The control and LPS groups were given saline instead of VIP in the same manner. On day 11, serum samples were obtained, and rats were sacrificed. Alveolar bone loss; serum levels of tumor necrosis factor-alpha, interleukin (IL)-1beta, -10, and -18, soluble receptor activator of nuclear factor-kappa B ligand (sRANKL), and osteoprotegerin (OPG); and the immune expression of RANKL and OPG were evaluated. The application of VIP caused a dose-dependent decline in alveolar bone loss compared to the LPS group, but the differences were not significant (P >0.05). A reduction in the histologic findings of inflammation was observed in all VIP groups. The 1- and 10-nmol VIP groups showed significantly lower serum sRANKL and OPG levels compared to the LPS group (P <0.05). The number of positively stained vessels for endothelial OPG was greater in the 1-nmol VIP group than in the LPS group (P <0.05). When periodontitis was induced by E. coli LPS, VIP downregulated the inflammatory response and inhibited alveolar bone loss, possibly by differentially regulating the tissue levels of RANKL and OPG.

The aim of this study was to evaluate histologically the following treatment of bilateral localized gingival recessions with coronally advanced flap (CAF) combined with platelet-rich fibrin (PRF) or subepithelial connective tissue graft (SCTG). Tissue samples were harvested from 14 subjects either 1 or 6 months after the surgeries. The 2-mm punch biopsies were obtained from the mid-portion of the grafted sites. Neutral buffered formalin fixed, paraffin-embedded 5-μm thick tissue sections were stained with hematoxylin eosin and Masson's trichrome in order to analyze the collagen framework, epithelium thickness and rete-peg length. Multiple sequential sections were cut from paraffin-embedded blocks of tissue and immunohistochemically prepared for detection of vascular endothelial growth factor, CD31 and CD34, for the assessment of vascularization. Rete peg formation was significantly increased in the sites treated with PRF compared to the SCTG group after 6 months (p < 0.05). On the contrary, the number of vessels was increased in the SCTG group compared to the PRF group after 6 months (p < 0.05). No statistically significant differences were observed in the collagen density. Staining intensity of CD31 increased in submucosal area of PRF group than SCTG group after 1 month. Higher staining intensity of CD34 was observed in the submucosal area of PRF group compared with SCTG group after 6 months. The results of the present study suggest that in histological evaluation because of its biological compounds, PRF results earlier vessel formation and tissue maturation compared to connective tissue graft. PRF regulated the vascular response associated with an earlier wound healing.

The aim of this cross-sectional study is to investigate gingival crevicular fluid (GCF) osteocalcin, cross-linked N-terminal telopeptide (NTx), and calprotectin levels in cyclosporin A (CsA)-induced gingival overgrowth (GO). Forty medicated patients with CsA including 20 with GO (CsA GO+), 10 without GO (CsA GO-), 10 with GO and chronic periodontitis (CsA CP) and 60 patients with CP alone, 20 patients with gingivitis, and 20 healthy patients were enrolled. Probing depth, clinical attachment level, plaque index, and papillary bleeding index were recorded. GCF calprotectin, osteocalcin, and NTx levels were analyzed by enzyme-linked immunosorbent assay. Parametric tests were used for statistical analysis. The CsA GO+ and CP groups had significantly lower GCF osteocalcin levels and osteocalcin/NTx ratio than the healthy group, whereas GCF osteocalcin levels and osteocalcin/NTx ratio in the gingivitis group were higher than the CsA GO+, CsA GO-, CsA CP, and CP groups (P <0.05). The CP group had elevated GCF calprotectin levels compared to the other study groups (P <0.05). The CsA GO+ and CsA GO- groups also had higher GCF calprotectin levels compared to the CsA CP, gingivitis, and healthy groups (P <0.05). Increased GCF calprotectin and decreased GCF osteocalcin levels in the CsA GO+ and CsA GO- groups might suggest that CsA plays a role on the levels of these markers. The similarity of GCF osteocalcin, NTx, and calprotectin levels in the CsA GO+ and CsA GO- groups might suggest that these molecules are not involved in the pathogenesis of GO.

... Gülnur Emingil 1 ,; Heidi Kuula 2 ,; Emma Pirilä 3 ,; Gül Atilla 1 ,; Timo Sorsa 2. ... is an essential part of several physiological and pathogenic processes, including several chronic inflammatory conditions, tumour invasion and wound healing (Terranova & Lyall 1986, O'Toole 2001). ...

... Gülnur Emingil 1 ,; Heidi Kuula 2 ,; Emma Pirilä 3 ,; Gül Atilla 1 ,; Timo Sorsa 2. ... is an essential part of several physiological and pathogenic processes, including several chronic inflammatory conditions, tumour invasion and wound healing (Terranova & Lyall 1986, O'Toole 2001). ...

The present study was undertaken to evaluate the oral health status and oral hygiene habits of dialysis patients. A total of 145 patients on dialysis were evaluated in two centres. Evaluation included oral examination of soft and hard tissues and completion of a questionnaire that was used to gather information about demographic, socioeconomic, medical and dental status and oral hygiene attitudes of patients. Awareness of the importance of oral health was also determined by four yes/no questions within this questionnaire. Of the 145 patients, 89 (61.4%) were presently candidates for renal transplantation. Nineteen patients (13.1%) were edentulous and nearly half of the patients (n=69, 47.6%) had 15 or fewer remaining teeth. Dentate patients who regularly brushed twice a day and flossed were few (n=18, 14.3%; n=3, 2.4%, respectively). In addition, plaque score was more than 50% in most of the dentate patients (93.7%). Gingival bleeding was reported by about two thirds of dentate patients (67.5%). None of the patients were referred to a dentist or were attending regular dental care. The percentage of patients who were aware of oral cavity-related infections and importance of oral hygiene following renal transplantation was very low (20.7% and 9.7%, respectively). Poor oral health, unsatisfactory daily oral hygiene habits and insufficient awareness of the importance of oral health is frequent among Turkish dialysis patients. Dentists and nephrologists should work in close cooperation in order to raise awareness and encourage regular dental controls.

Objectives: Increased host susceptibility of aggressive periodontitis patients might be caused by the combined effect of host immune responses, environmental factors and local contributing factors. LL-37 is an endogenous antibiotic having role in innate immunity during periodontal inflammation. In the present study, we aimed to investigate LL-37 levels in GCF of patients with generalized aggressive periodontitis. Methods: Nineteen generalized aggressive periodontitis, 21 gingivitis patients and 19 healthy subjects were included into the present study. Clinical periodontal parameters including probing pocket depth, clinical attachment level, plaque index, and papilla bleeding index were recorded. GCF samples were analyzed for evaluating LL-37 levels by enzyme-linked immunosorbent assay. Comparisons of clinical periodontal parameters for sampling sites were made by ANOVA or Kruskal-Wallis tests as appropriate, and post hoc two group comparisons were assessed by Dunnett T3 or Bonferron...

Objective: To evaluate the changes in subgingival microbiota induced by the increase in hormone levels over the one month of menstrual cycle in periodontally healthy and gingivitis female. Methods: This open cohort study included 24 gingivitis and 24 periodontally healthy women, having regular menstrual cycle. Women were evaluated at three times; on menstruation (ME), ovulation (OV) and premensturation (PM) phases of their cycle. Microbiological, clinical and hormonal variables were assessed in each time. Frequency detection and proportions were calculated. Absence/presence of bacteria were performed by a generalized linear mixed model and subsequent multiple comparisons. Results: Bleeding on probing was significantly higher in ME and OV than PM in gingivitis group (p=0.001 and p=0.001, respectively), whereas no significant differences were found between three phases of healthy group (p>0.05). Mean salivary estrogen levels were significantly higher in periodontally healthy than g...

Objective: Neutrophils express LL-37 antimicrobial peptide that contributes to maintaining the balance between health and disease. Smoking is a risk factor for periodontitis and it impairs neutrophil functions. The aim of the present study was to investigate gingival crevicular fluid (GCF) LL-37 levels in smoker versus non-smoker chronic periodontitis (CP) patients. Method: Thirty-one CP patients (16 smokers, 15 non-smokers) and thirty-one periodontally healthy subjects (16 smokers, 15 non-smokers) were included to the study. Periodontal parameters including probing depth, clinical attachment level, papilla bleeding index and plaque index were assessed in all study subjects. GCF LL-37 levels were analyzed by enzyme-linked immunosorbent assay. Result: Non-smoker patients with CP had significantly higher levels of GCF LL-37 compared to non-smoker subjects with periodontal health, however there was no significant difference between smoker patients with CP and smoker subjects with perio...

Objective: Decreased apoptosis play an important role in the pathogenesis of the cyclosporine A (CsA) induced gingival overgrowth (GO). Apoptosis triggered by Fas-FasL binding is involved in the regulation of the immune system. The aim of this study was to evaluate the relationship between the Fas, Fas ligand (FasL), and interleukin-6 (IL-6) gene polymorphisms and susceptibility to CsA-induced GO. Method: Genomic DNA was obtained from the blood of 120 renal transplant patients receiving CsA therapy; 51 with gingival overgrowth (GO+) and 69 with no sign of gingival overgrowth (GO-), and 52 tacrolimus medicated renal transplant patients without GO (TAC) The Fas -670A/G, FasL -843C/T and IL-6 -174G/C gene polymorphisms were evaluated using the polymerase chain reaction-restriction fragment length polymorphism method. Periodontal status was evaluated by measuring probing depth, plaque index, papilla bleeding and hyperplastic index. Result: The evaluation of the Fas, FasL and IL-6 genoty...

Gingival overgrowth (GO) encompasses a heterogeneous group of conditions with different primary etiologies. Objective: Identify biologic pathways that are altered in all forms of GO to reveal mechanisms driving gingival enlargement. Method: Gingival biopsies (n=23) were obtained from affected individuals with 4 genetically distinct forms of Hereditary Gingival Fibromatosis (HGF), individuals with drug induced GO (cyclosporine and calcium channel blocker) and controls without GO. Total gingival RNA was extracted with Trizol, RNA quality assessed with Agilent Bioanalyzer and gene expression determined with Codelink Whole Human Genome Arrays. Gene expression was analyzed using Geospiza Genesifter (V3.7) integrated gene ontology and pathway analysis. Protein-protein interactions were evaluated using STRING 9.0. Statistical analyses included t-test with multiple comparisons correction, ANOVA and gene expression thresholds (>20.0), adjusted p value cutoffs < 0.05. Result: 476 genes ...

Objectives: Chlorhexidine (CHX) has been effectively used in the treatment of gingival inflammation and can be considered as the gold standard for oral antiseptics. The aim of this study was to evaluate the therapeutic effectiveness of chlorhexidine mouthrinse on gingival inflammation and subgingival microbiota in addition to mechanical plaque control in a population with established gingivitis. Methods: Fifty gingivitis patients were randomized either to CHX or placebo groups. In addition to proper plaque control, CHX group rinsed with CHX twice a day, while placebo group rinsed with placebo mouthrinse twice a day for 4 weeks. Subgingival plaque samples were collected and clinical parameters including plaque index (PI), papilla bleeding index (PBI), calculus index and probing pocket depth (PPD) were recorded at baseline and repeated at 4 weeks. The amounts of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, Fusobacterium ...

Interleukin (IL)-6 family of cytokines including IL-6, oncostatin M (OSM), leukemia inhibitory factor (LIF) and IL-11 have fibrogenic features. The current study determined gingival crevicular fluid (GCF) levels of fibrosis-related IL-6 type cytokines in cyclosporine-A (CsA)-induced gingival overgrowth (GO). Eighty non-smoker participants were included (40 CsA-medicated renal transplant patients with GO (GO +;n=20) or without GO (GO-;n=20), 20 gingivitis, and 20 healthy). Probing depth and plaque, papilla bleeding and hyperplastic index scores were recorded. GCF samples were obtained from the mesio-buccal aspects of 2 teeth. GCF IL-6, IL-1β, OSM, LIF and IL-11 levels were analyzed by enzyme-linked immunosorbent assay (ELISA). GO+ and GO- groups had higher IL-6 total amounts than the healthy group (p<0.008). IL-1β total amounts of GO+ group were significantly higher than both healthy and GO- groups (p<0.008). OSM total amount was elevated in GO+ and GO- groups in comparison to both gingivitis and healthy groups (p<0.008). All groups had similar LIF and IL-11 total amount (p>0.008). Moderate positive correlations were detected between IL-6, IL-1β, OSM and IL-11 total amount in GCF and clinical parameters (p<0.05). IL-6 and OSM increases in GCF as a result of CsA usage or immunosuppressed state of patients irrespective of the severity of inflammation and presence of GO. IL-6 family of cytokines might not be directly involved in biological mechanisms associated with CsA-induced GO. Lack of an association between assessed IL-6 cytokines and CsA-induced GO might indicate distinct effects of these cytokines on fibrotic changes of different tissues.

The present study evaluated the efficacy of controlled-release delivery of chlorhexidine gluconate (CHX) on clinical parameters and on gingival crevicular fluid (GCF) matrix metalloproteinase (MMP)-8 levels in chronic periodontitis patients. Twenty patients with chronic periodontitis were screened for 6 months. Two interproximal sites were selected from mesial surfaces of anterior teeth with probing depths of 6 to 8 mm that bled on probing in each patient. There were at least 2 teeth between the selected sites. CHX chip was inserted into a randomly selected site following scaling and root planing (SRP+CHX), while the other selected site received only SRP in each patient. Probing depth (PD), clinical attachment level (CAL), plaque index (PI), and papilla bleeding index (PBI) were recorded at baseline and at 1, 3, and 6 months. GCF MMP-8 levels were analyzed at baseline; 2 and 10 days; and at 1, 3, and 6 months by immunofluorometric assay (IFMA). At baseline, there were no statistically significant differences in the mean PD, CAL, PBI, and PI scores between SRP+CHX and SRP alone groups. At 1, 3, and 6 months, all clinical parameters in each group significantly decreased (P <0.0167) when compared to baseline. The reduction of PD and improvement in CAL were higher in the SRP+CHX group compared to SRP alone at 3 and 6 months. However, the differences between the 2 groups were not statistically significant. PBI and PI scores were not significantly different between SRP+CHX and SRP alone groups at any visit. GCF MMP-8 levels were similar in both groups at baseline. Intragroup analysis showed significant decreases in the GCF MMP-8 level for the SRP+CHX group between baseline and 1, 3, and 6 months (P<0.01). Intergroup analysis demonstrated significantly lower mean levels of GCF MMP-8 at 1 month in the SRP+CHX group compared to the SRP alone group (P <0.05). These data suggest that CHX chip application following SRP is beneficial in improving periodontal parameters and reducing GCF MMP-8 levels for 6 months' duration. The use of a chairside MMP-8 dipstick periodontitis test might be a useful adjunctive diagnostic tool when monitoring the course of CHX chip treatment.

The present randomized, double-masked, placebo-controlled, parallel-arm study examines the impact of adjunctive subantimicrobial-dose doxycycline (SDD) on the local inflammatory response through cytokine and chemokine levels in gingival crevicular fluid (GCF) samples from patients with chronic periodontitis. Forty-six patients with chronic periodontitis received scaling and root planing with or without adjunctive SDD. GCF samples were collected and clinical parameters including probing depth, clinical attachment level, gingival index, and plaque index were recorded every 3 months for 12 months. GCF tumor necrosis factor-α, interleukin (IL)-6, IL-4, IL-10, IL-13, IL-17, macrophage inhibitory protein 1α, macrophage inhibitory protein 1β, monocyte chemoattractant protein 1, and regulated on activated normal T-cell expressed and secreted protein levels were determined by xMAP multiplex immunoassay. Significant improvements were observed in all clinical parameters in both groups over 12 months (P <0.0125), whereas the SDD group showed significantly better reduction in gingival index, probing depth, and gain in clinical attachment compared to the placebo group (P <0.05). Decrease in IL-6 in the SDD group was significantly higher compared to the placebo group at 6 and 9 months in deep pockets (P <0.05), whereas tumor necrosis factor-α was significantly reduced in moderately deep pockets (P <0.05). SDD resulted in a stable IL-4 and IL-10 response while reducing the monocyte chemoattractant protein 1 levels at 3 months (P <0.05). These results show that SDD, as an adjunct to non-surgical periodontal therapy, stabilizes the inflammatory response by promoting the suppression of proinflammatory cytokines and increasing the anti-inflammatory cytokines. The chemokine activity would account for the regulation of the inflammatory response to SDD therapy.

... Buduneli, Vardar, Atilla, Sorsa, Luoto, Baylas reduction of MMP levels in GCF follows successfulperi-odontal treatment.20,21,39 In agreement with previous reports, the significant reductions in GCF MMP-8 total amounts obtained on day 10 in both the meloxicam and placebo ...

The purpose of this investigation was to evaluate the effect of non-surgical periodontal treatment and adjunctive systemic minocycline therapy on the level of neutral protease activity in whole saliva of adults with periodontitis. A test group of 21 adult patients with moderate to severe periodontitis was compared to a control group of 5 adults with healthy periodontium. Four test groups were examined: 1) scaling and root planing (SRP), probing depth = 4 to 5 mm; 2) SRP, PD > or = 6 mm; 3) SRP and adjunctive systemic minocycline therapy, PD = 4 to 5 mm; 4) SRP and adjunctive systemic minocycline therapy, PD > or = 6 mm. Clinical parameters and levels of neutral protease in whole saliva were assessed at baseline and on the sixth week after the non-surgical periodontal treatment. Neutral protease activity was measured by spectrofluorimetric method. Statistical tests of Mann-Whitney and Spearman Rank correlation coefficient were used in the evaluation of the mean values of measurements. The mean values of protease activity were significantly higher in the test groups than in the control group at baseline. Six weeks after non-surgical therapy, patients with 4 to 5 mm probing depth had approximate values of protease activity comparable to the control group. Hence it can be argued that these patients did not need minocycline HCL as an adjunctive therapy. However, non-surgical therapy had limited effects on both clinical parameters and enzyme activities for subjects with > or = 6 mm probing depth; on the other hand, gingival inflammation and enzyme activities were reduced significantly by the usage of minocycline as adjunctive therapy in these patients. According to our results, neutral protease activity in saliva is related to probing depth and gingival bleeding index, and not related to age and epithelial cell number. For these reasons, systemic minocycline therapy might be useful as an adjunct to non-surgical therapy in the presence of deep pockets, especially for reinfected cases. Further investigations are needed to confirm this suggestion.

Matrix metalloproteinases (MMPs) play important roles in tissue destruction mechanisms of periodontitis. MMP-8 and -13 are the major collagenases that act in extracellular matrix degradation in periodontal tissues. MMP-14 is a membrane-type MMP, and laminin (Ln)-5 is a basal membrane component. The aim of the present study was to evaluate the effects of doxycycline and alendronate on gingival tissue expression of MMP-8, -13, and -14; tissue inhibitors of MMP (TIMP)-1; and Ln-5 gamma2 chain in experimental periodontitis induced by Escherichia coli endotoxin (LPS) in rats. Experimental periodontitis was induced by repeated injection of LPS. Forty-four adult male Sprague-Dawley rats were divided into five study groups: saline control, LPS, LPS + doxycycline, LPS + alendronate, and LPS + doxycycline + alendronate. Doxycycline and alendronate were given as a single agent or as combination therapy during the 7 days of the experimental study period. On day 7, the rats were sacrificed, and the gingival tissues were analyzed immunohistochemically for expression of MMP-8, -13, and -14, Ln-5 gamma2 chain, and TIMP-1. Alveolar bone loss was evaluated morphometrically under a stereomicroscope. Data were tested statistically by Kruskal-Wallis and Mann-Whitney tests and Spearman correlation analysis. Alveolar bone loss was significantly higher in the LPS, doxycycline, alendronate, and combination groups than in the saline control group (all P <0.01). MMP-8 expression was significantly higher in the LPS group than in the saline control group (P = 0.001). Individual administration of doxycycline or alendronate significantly decreased the expression of MMP-8 compared to LPS (P = 0.01). Combined drug administration reduced MMP-14 significantly compared to doxycycline (P = 0.004). No significant differences in Ln-5 gamma2 chain expression were found between the study groups (P >0.05). MMP-14 significantly correlated with the Ln-5 gamma2 chain in the LPS + alendronate group (P = 0.04) and with the amount of alveolar bone loss in the LPS + doxycycline + alendronate group (P = 0.03). Our findings suggest that alendronate and/or doxycycline may inhibit MMP-8 expression significantly; particularly, their combined administration may provide beneficial effects in periodontal treatment. Moreover, individual administration of alendronate and doxycycline results in significant increases in TIMP-1 expression in gingiva. However, these effects of combined low-dose doxycycline and alendronate on MMPs and TIMP should be verified by clinical human trials before these agents are used in dental practice.

The aim of the present study is to investigate gingival crevicular fluid (GCF) and plasma acute-phase cytokines, interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-11 (IL-11), oncostatin M (OSM), and leukemia inhibitory factor (LIF) levels in patients with different periodontal diseases. Eighty individuals were included in this study; 20 with chronic periodontitis (CP), 20 with generalized aggressive periodontitis (GAgP), 20 with gingivitis, and 20 classified as healthy (H). Probing depth, clinical attachment level, plaque index, and papilla bleeding index were recorded. Plasma and GCF IL-1β, IL-6, IL-11, OSM, and LIF levels were analyzed by enzyme-linked immunosorbent assay. CP and GAgP groups had significantly higher GCF IL-1β, IL-6, and IL-11 levels when compared with the H group (P <0.05). Conversely, GCF LIF levels of the CP and GAgP groups were lower than those of the H group (P <0.05). GCF OSM levels did not differ significantly among study groups. Plasma levels of all the cytokines studied were not significantly different among the study groups. Based on the present data, elevated IL-1β, IL-6, and IL-11 GCF levels, but not plasma levels, are suggested as reliable inflammatory biomarkers in periodontal diseases. Decreased LIF levels in diseased groups might reflect the possible beneficial effects of LIF in the modulation of inflammatory response in gingiva.

This study examines the efficacy of azithromycin in combination with non-surgical periodontal therapy on clinical and microbiologic parameters and gingival crevicular fluid (GCF) matrix metalloproteinases-8 (MMP-8) levels over 6 months in patients with severe generalized chronic periodontitis (CP). Twenty-eight of 36 patients with severe generalized CP were included in this randomized, double-masked, placebo-controlled, parallel-arm study. They were randomly assigned to azithromycin or placebo groups (500 mg, once daily for 3 days). Probing depth (PD), clinical attachment level, dichotomous presence or absence of supragingival plaque accumulation, and bleeding on probing were recorded. GCF samples were obtained from one single-rooted tooth with PD ≥ 6 mm, whereas microbiologic samples were collected from two single-rooted teeth with PD ≥ 6 mm. Microbiologic parameters were analyzed by quantitative real-time polymerase chain reaction for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Fusobacterium nucleatum, Prevotella intermedia, and total bacteria. GCF MMP-8 levels were determined by immunofluorescence assay. Azithromycin and placebo groups demonstrated similar but significant improvements in all clinical parameters (P <0.05). A. actinomycetemcomitans, P. gingivalis, T. forsythia, P. intermedia, and total bacteria significantly decreased over the 6-month period in both groups, whereas F. nucleatum was significantly reduced in all visits in the azithromycin group, with the levels also being lower compared with those of the placebo group (P <0.05). The azithromycin and placebo groups exhibited significant reduction in GCF MMP-8 levels at the post-treatment visit and at 2 weeks (P <0.05). On the basis of the present findings, it can be concluded that adjunctive azithromycin provides no additional benefit over non-surgical periodontal treatment on parameters investigated in patients with severe generalized CP.

Emingil G, Han B, Özdemir G, Tervahartiala T, Vural C, Atilla G, Baylas H, Sorsa T. The effect of azithromycin, as an adjunct to nonsurgical periodontal treatment, on microbiological parameters and gingival crevicular fluid biomarkers in generalized aggressive periodontitis. J Periodont Res 2012; 47: 729-739. © 2012 John Wiley & Sons A/S Background and Objective:  To study the effectiveness of azithromycin in combination with nonsurgical periodontal therapy on clinical and microbiological parameters, and on the MMP-8 and TIMP-1 levels in gingival crevicular fluid, over a 6-mo time-period in patients with generalized aggressive periodontitis.   Thirty-two patients with generalized aggressive periodontitis were included in this randomized, double-blind, placebo-controlled, parallel-arm study. They were randomly assigned to azithromycin or placebo groups (500 mg once daily for 3 d). Probing depth, clinical attachment levels, presence of bleeding on probing and plaque were recorded. Gingival crevicular fluid samples were obtained from one single-rooted tooth, while microbiological samples were obtained from two single-rooted teeth, all with a probing depth of ≥ 6 mm. Microbiological parameters were analyzed by quantitative real-time PCR for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Fusobacterium nucleatum, Prevotella intermedia and total bacteria. Gingival crevicular fluid biomarkers were determined by immunofluorometric assay and ELISA.   All clinical parameters improved, and microbiological parameters and gingival crevicular fluid MMP-8 levels significantly decreased, over the 6-mo period (p < 0.05); both groups demonstrated similar improvements. The azithromycin group presented a higher percentage of deep pockets resolved (probing depth reduction of ≥ 3 mm from baseline) compared with the placebo group at 1 mo (p < 0.05).   Adjunctive azithromycin therapy provides no additional benefit over nonsurgical periodontal treatment on clinical parameters, microbiological parameters and gingival crevicular fluid biochemical markers investigated in patients with generalized aggressive periodontitis.