Periodontitis
Conditions
Keywords
Smoking, Macrophage Polarization, M1/M2 Macrophages, iNOS, Arginase-1, Periodontal Inflammation, Periodontal Disease
Brief summary
This observational case-control study investigates the effect of smoking on macrophage polarization in the pathogenesis of periodontitis. Adult participants who were either systemically healthy smokers or non-smokers, and who met the clinical criteria for periodontal health or periodontitis, were included. Gingival tissue samples were collected during periodontal procedures performed after completion of Phase I periodontal therapy, and the expression levels of macrophage polarization markers (iNOS and Arginase-1) were analyzed using ELISA. In addition, comprehensive clinical periodontal measurements-including probing pocket depth, clinical attachment level, bleeding on probing, Plaque Index, and Gingival Index-were recorded to evaluate the relationship between smoking status, inflammatory burden, and macrophage phenotype. The study aims to clarify how smoking modulates the balance between M1 and M2 macrophage responses in periodontal tissues.
Detailed description
Periodontitis is a chronic inflammatory disease in which macrophage polarization plays a key regulatory role in the host immune response. Smoking is a well-established risk factor that alters inflammatory pathways and immune cell behavior. This study was designed to examine how smoking influences macrophage polarization-specifically the balance between M1 (iNOS-mediated) and M2 (Arginase-1-mediated) phenotypes-in periodontal tissues. Systemically healthy adult participants were recruited and categorized into four groups based on smoking status and periodontal condition: (1) healthy non-smokers, (2) periodontitis non-smokers, (3) healthy smokers, and (4) periodontitis smokers. Gingival tissue samples (approximately 2×2 mm) were collected during periodontal surgical procedures performed after completion of Phase I periodontal therapy, immediately stored at -80 °C, and processed for biochemical analysis. Comprehensive clinical periodontal measurements-including probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), Plaque Index (PI), and Gingival Index (GI)-were recorded on the same day to evaluate periodontal status and inflammatory burden. ELISA was used to quantify iNOS and Arginase-1 levels in gingival tissues. The primary objective of this study is to determine whether smoking shifts the macrophage phenotype toward a more pro-inflammatory M1 profile or suppresses M2-associated regulatory pathways in the context of periodontitis. The findings are expected to contribute to a better understanding of smoking-related alterations in periodontal immune mechanisms.
Interventions
OTHERSmoking Exposure
Exposure to cigarette smoking, defined as smoking ≥10 cigarettes per day. Participants were classified as smokers or non-smokers based on self-reported smoking status.
Sponsors
Suleyman Demirel University
Study design
Observational model
CASE_CONTROL
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Inclusion criteria
* The study population consisted of volunteer participants aged 18-65 years who were referred to the Department of Periodontology at Süleyman Demirel University Faculty of Dentistry for periodontal treatment and who met the inclusion criteria without violating any
Exclusion criteria
.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Gingival Arginase-1 Level | At the time of periodontal surgery following completion of Phase I periodontal therapy. | Concentration of Arginase-1 in gingival tissue biopsies measured by ELISA (ng/mg tissue). |
| Gingival iNOS Level | At the time of periodontal surgery following completion of Phase I periodontal therapy. | Concentration of inducible nitric oxide synthase (iNOS) in gingival tissue biopsies measured by ELISA (ng/mg tissue). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Bleeding on Probing (BOP) | Immediately prior to periodontal surgery, following completion of Phase I periodontal therapy. | Bleeding on probing percentage calculated as the proportion of bleeding sites to total sites examined. |
| Probing Pocket Depth (PPD) | Immediately prior to periodontal surgery, following completion of Phase I periodontal therapy. | Mean probing pocket depth (mm) recorded at six sites per tooth using a periodontal probe. |
| Gingival Index (GI) | Immediately prior to periodontal surgery, following completion of Phase I periodontal therapy. | Gingival inflammation assessed using the Löe and Silness Gingival Index. Gingival Index scores were recorded at four surfaces per tooth and scored on a scale from 0 to 3, where 0 indicates normal gingiva and 3 indicates severe gingival inflammation. Higher scores indicate worse gingival status. |
| Plaque Index (PI) | Immediately prior to periodontal surgery, following completion of Phase I periodontal therapy. | Dental plaque accumulation assessed using the Silness and Löe Plaque Index. Plaque scores were recorded at four surfaces per tooth and scored on a scale from 0 to 3, where 0 indicates no plaque and 3 indicates abundant plaque accumulation. Higher scores indicate worse plaque status. |
| Clinical Attachment Level (CAL) | Immediately prior to periodontal surgery, following completion of Phase I periodontal therapy. | Clinical attachment level (mm) recorded at six sites per tooth using a periodontal probe. |
Countries
Turkey (Türkiye)
Outcome results
None listed