Impact of scaling and root planing on C-reactive protein levels in gingival crevicular fluid and serum in chronic periodontitis patients with or without diabetes mellitus

Abstract

Purpose: The present study was conducted to evaluate the impact of scaling and root planing (SRP) on the C-reactive protein (CRP) levels of gingival crevicular fluid (GCF) and serum in chronic periodontitis patients with type 2 diabetes mellitus (T2DM-CP) or without type 2 diabetes mellitus (NDM-CP).

Methods: Forty-eight human participants were divided into two groups: an experimental (T2DM-CP) group (group I, n=24) comprising chronic periodontitis patients with random blood sugar ≥200 mg/dL and type 2 diabetes mellitus, and control (NDM-CP) group (group II, n=24) of those with chronic periodontitis and random blood sugar <200 without T2DM for the study. All subjects underwent nonsurgical periodontal therapy (NSPT) including complete SRP and subgingival debridement. Periodontal health parameters, plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), GCF volume (GCF vol), GCF-CRP, random blood glucose (RBS), glycated hemoglobin, and systemic inflammatory markers, serum CRP, total leukocyte count (TLC), neutrophil count (Neutr) and lymphocyte count (Lymph), were evaluated at baseline, 1 month, and 3 months after SRP.

Results: NSPT resulted in statistically significant improvement in periodontal health parameters (PI, GI, PPD, CAL, GCF vol), CRP levels in serum as well as GCF of both groups I and II. The mean improvement in periodontal health parameters (PI, GI, PPD, CAL, GCF vol), CRP levels in serum and GCF was greater in group I than group II after NSPT. There was nonsignificant increase in GCF-CRP, TLC, Lymph, and RBS, and a significant increase in Neutr and Serum CRP in group II at 1 month. The Serum CRP level of 20 out of 24 group II patients had also increased at 1 month.

Conclusions: The CRP levels in both GCF and serum were higher in T2DM-CP patients than in NDM-CP patients. Although there was a significant improvement in both the groups, greater improvement was observed in both GCF and serum samples of T2DM-CP patients.

Keywords: C-reactive protein; Chronic periodontitis; Diabetes mellitus; Root planning.

Figure 1

Gingival crevicular fluid C-reactive protein (GCF-CRP) analysis: collection of GCF sample at baseline (A), 1 month (B), and 3 months (C) after scaling and root planing (D) high sensitivity C-reactive protein (CRP) enzyme-linked immunosorbent assay kit (Biotron Diagnostic, Hemet, California, USA) reagents (E) antibody coated microtitre wells (F) standard solutions (G) GCF sample in plastic vial (H) CRP sample diluents (I) retrieval of CRP sample diluents (J).

Figure 2

Gingival crevicular fluid C-reactive protein (GCF-CRP) analysis addition of CRP sample diluents to plastic vial containing GCF sample (A) addition of solution in the microtitre well (B) microtitre well in the microtitre plate (C) sample kit in incubator (D) distilled water (E) addition of distilled water in microtitre well (F) retrieval of CRP conjugate (G) retrieval of tetramethylbenzidine reagent (H) retrieval of stop solution (I) microtitre well kept in enzyme-linked immunosorbent assay reader (J).

Figure 3

Serum C-reactive protein (CRP) estimation CRP Turbilatex kit (A) reagents (B) reagent R1 in auto-pipette (C) reagent R1 added to test tube containing sample (D) contents in test tube aspirated in semi-auto-analyzer (E) readings with graph in semi-auto-analyzer (F).