Gingival Crevicular Fluid Cytokines in Moderate and Deep Sites of Stage III Periodontitis Patients in Different Rates of Clinical Progression

Abstract

Clinical criteria are inappropriate to measure the degree of susceptibility to progression of periodontal damage. Thus, the aim of this study was to assess whether gingival crevicular fluid (GCF) levels of cytokines could discriminate patients suffering from stage III periodontitis with moderate (Grade B) and rapid rates of progression (Grade C) prior to and 6 months after non-surgical periodontal treatment. GCF samples were obtained from moderate and deep sites of 20 patients diagnosed as Grade B and 20 patients as grade C stage III periodontitis and analyzed for interleukin (IL)-1β, IL-9, tumor necrosis factor (TNF)-α, and vascular endothelial growth factor (VEGF) using a high-sensitivity Bio-Plex Suspension Array System. At baseline, higher IL-1β but lower IL-9 GCF levels were observed in moderate sites of the grade C compared to the grade B group. In spite of comparable clinical improvement, this difference maintained after treatment, suggesting a residual pro-inflammatory state. In deep sites, no differences were observed between periodontitis groups except for VEGF levels that decreased more in Grade B periodontitis at 6 months post-therapy. A mathematical model was constructed to identify Grade C periodontitis patients based on the subjects' GCF levels of IL-1β and IL-9, which achieved an area under the receiver-operating characteristic (ROC) curve of 0.94. This study can contribute to the early assessment of risk of future breakdown in periodontitis patients.

Keywords: angiogenesis; gingival crevicular fluid; inflammation mediators; periodontal/therapy; periodontitis.

Figure 1

Box-and-whisker plots showing the total amount of interleukin (IL)-1β in gingival crevicular fluid of moderate (A) and deep pocket sites (B) in subjects with grade B and grade C stage III periodontitis before (pre) and after non-surgical periodontal therapy (post). Horizontal line represents the median with the box representing the 25th and 75th percentiles, and the whiskers denote the 5th and 95th percentiles. * p < 0.05, ** p < 0.01.

Figure 2

Box-and-whisker plots showing the total amount of tumor necrosis factor (TNF)-α in gingival crevicular fluid of moderate (A) and deep pocket sites (B) in subjects with grade B and grade C stage III periodontitis before (pre) and after non-surgical periodontal therapy (post). Horizontal line represents the median with the box representing the 25th and 75th percentiles, and the whiskers denote the 5th and 95th percentiles. * p < 0.05, ** p < 0.01.

Figure 3

Box-and-whisker plots showing the total amount of vascular endothelial growth factor (VEGF) in gingival crevicular fluid of moderate (A) and deep pocket sites (B) in subjects with grade B and grade C stage III periodontitis before (pre) and after non-surgical periodontal therapy (post). Horizontal line represents the median with the box representing the 25th and 75th percentiles, and the whiskers denote the 5th and 95th percentiles. * p < 0.05, ** p < 0.01.

Figure 4

Box-and-whisker plots showing the total amount of IL-9 in gingival crevicular fluid of moderate (A) and deep pocket sites (B) in subjects with grade B and grade C stage III periodontitis before (pre) and after non-surgical periodontal therapy (post). Horizontal line represents the median with the box representing the 25th and 75th percentiles, and the whiskers denote the 5th and 95th percentiles. ** p < 0.01.

Figure 5

Receiver operating characteristic (ROC) curve for IL-1β amount in moderate pocket sites comparing stage III periodontitis patients with rapid (Grade C) versus moderate (Grade B) rates of progression.