Myocardial Infarction, Chronic Periodontitis
Conditions
Keywords
Periodontitis, Periodontal-systemic disease, Cardiovascular diseases, Gingival crevicular fluid, Acute myocardial infarction, Neopterin, Vascular cell adhesion molecule-1
Brief summary
The aim of this study was to evaluate the effects of periodontal treatment on gingival crevicular fluid (GCF) levels of Neopterin(N) and vascular cell adhesion molecule (VCAM-1) in chronic periodontitis(CP) patients with acute myocardial infarction(AMI) in comparison to systemically healthy CP patients. The investigators' hypothesized that severe CP may play a role in initiating or exacerbating MI and there is an increased risk for AMI among systemically healthy persons affected with severe CP.
Detailed description
There are no studies specifically addressing the altered GCF profile concurrent with the onset of myocardial infarction acutely (i.e. in the first 24h) and no data are currently available about GCF Neopterin and VCAM-1 levels in AMI patients with chronic periodontitis. The present study aimed to assess whether GCF levels of CP patients with AMI have an alteration in GCF levels of Neopterin and VCAM-1, also assessed whether these alterations might be related to treatment of existing periodontitis in AMI patients. A total of 60 subjects (20 CP patients with AMI, 20 systemically healthy CP patients and 20 healthy controls) were included.GCF samples were analyzed baseline and after 3 and 6 months, probing pocket depth(PD), clinical attachment level (CAL),bleeding on probing (BOP) , gingival and plaque (PI) indices were recorded. Neopterin and VCAM-1 levels (concentration and total amount) were determined by enzyme linked immunosorbent assay (ELISA). Baseline periodontal examination of AMI patients and 24-48h GCF collection was carried out in their hospital bed under sufficient illumination using artificial light. Within a time period of 2 months after the proceeding infarction, none of the patients had received periodontal treatment. AMI patients underwent periodontal therapy after the stabilization of their condition with the consent from same cardiologist. Periodontal disease was diagnosed based on the 1999 classification system developed by Armitage, and a preoperative periapical radiograph was taken that provided baseline data in Faculty of Dentistry. Clinical index scores and GCF sampling were recorded before, 3 and 6 months after the periodontal treatment. All selected patients underwent a 2- to 4-week initial therapy, which included comprehensive proper plaque control program, scaling, subgingival curettage and root planning in Department of Periodontology. In all patients a periodontal reevaluation was performed 4 weeks after phase I therapy, to confirm the suitability of the sites for periodontal surgery. Mucoperiosteal flap operation was performed in cases where needed. The blood samples for serum were centrifuged for 10 min at 11.00RPM separating the serum from the cells. The serum samples were then immediately divided into 0.2-0.5ml aliquots and stored at -80°C until required for analysis. Samples were assayed for N and VCAM-1 using quantitative enzyme immunoassays. Micro-centrifuge tubes, containing periopaper strips with absorbed GCF sample, were allowed to reach room temperature and eluted using a centrifugal method.17 After centrifugation, the strips were removed and the fluid was assayed by ELISA for N and soluble VCAM-1.The levels of N and sVCAM-1 in serum and GCF samples were measured using ELISA kit , . The ELISA procedures were carried out according to the manufacturer's instructions.
Interventions
PROCEDUREPeriodontal examination
periodontal examination included the assessment of plaque index (PI), gingival index(GI), probing depth (PD), bleeding on probing (BOP) and clinical attachment level (CAL). All subjects underwent a periodontal examination performed by the same periodontitis (ZTÇ) Prior to the study, the examiner was calibrated for reproducibility of PD and CAL measurements
PROCEDUREGCF sampling
GCF samples were collected using commercially available periopaper . The sample site was gently air-dried and all supragingival plaque was removed. The area was carefully isolated with cotton rolls and a saliva ejector was used to prevent the samples from being contaminated by saliva. The paper strips were inserted into the pockets until slight resistance was felt and left in place for 30s.
PROCEDUREphase I therapy
comprehensive proper plaque control program, scaling, subgingival curettage and root Phase I Periodontal Therapy planning
Sponsors
Ankara University
Gazi University
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SCREENING
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
39 Years to 74 Years
Healthy volunteers
Yes
Inclusion criteria
* None of the patients had received periodontal treatment during the past 6 months and none had received antibiotic medication during the past 3 months. * AMI+CP and CP groups were regarded as suitable for the study if they were affected by CP and had at least 16 teeth, including at least four molars in different quadrants at least two periodontal pocket at least 5mm in depth, with a minimum of 2mm attachment loss. * Patients, who met the AMI diagnostic criteria, with or without persistent ST-segment elevation
Exclusion criteria
* Patients with neoplasias, liver cirrhosis, HIV infection, chronic renal failure, hypo or hyperparathyroidism, diabetes mellitus, chronic inflammatory diseases (rheumatoid arthritis, systemic lupus erythematosus, multiple sclerosis, and Chron's Disease
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Concentration and total amount of serum and GCF VCAM-1 and Neopterin | Change from baseline concentration and total amount of serum&GCF sVCAM-1 and Neopterin at 6months. | Using the standards included with the Enzyme-Linked ImmunoSorbent Assay (ELISA) kit. The concentrations of Neopterin and sVCAM-1 were expressed as ng/ml. Total amounts were also calculated by multiplying concentrations and GCF volumes(ml) and expressed as ng. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Clinical attachment level(CAL) | Baseline, 3 and 6 months after initial periodontal treatment | CAL was calculated as the distance from cemento-enamel junction to bottom of gingival sulcus. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Plaque Index | Baseline, 3 and 6 months after initial periodontal treatment | Plaque Index were calculated as a sum of mean scores by each examined tooth divided by the number of evaluated teeth. |
| Gingival Index | Baseline, 3 and 6 months after initial periodontal treatment | Gingival Index were calculated as a sum of mean scores by each examined tooth divided by the number of evaluated teeth. |
| Probing Depth | Baseline, 3 and 6 months after initial periodontal treatment | PD was recorded as the distance from the gingival margin to the most apical part of the sulcus. |
| Bleeding on probing | Baseline, 3 and 6 months after initial periodontal treatment | BOP is a widely used criterion to diagnose inflammation |
Outcome results
None listed