Assessment of the alkaline phosphatase level in gingival crevicular fluid, as a biomarker to evaluate the effect of scaling and root planing on chronic periodontitis: An in vivo study

The role of bone-specific biomarkers in chronic periodontitis diagnosis and treatment outcomes - a systematic review

Background The biomarkers of bone turnover may be vital for early detection of bone destruction in chronic periodontitis (CP). Lately, several new biochemical markers have been applied to estimate bone homeostasis.Objective The current review aims to evaluate the role of bone biomarkers in diagnosis and treatment outcomes of CP.Methods Literature search was conducted in databases like Medline (PubMed) and Scopus to include original research articles related to the role of bone biomarkers in CP. About 914 documents were identified through primary search, of which 11 original research articles were included.Results The most common bone biomarker applied in periodontal diagnosis was RANKL. Certain newer biomarkers like ICTP were also found to be useful in early detection of progressive CP.Conclusion The bone turnover biomarkers may serve as an adjunct to the traditional methods of periodontal diagnosis. They are vital in identifying the subjects at risk for future periodontal breakdown as well as in determining the therapeutic outcomes. Their applications in periodontal diagnosis is still in the developing stage and requires further investigation. With this background, the current systematic review evaluated the role of bone-specific biomarkers in CP diagnosis and treatment outcomes.

Alkaline phosphatase: a potential biomarker for stroke and implications for treatment

Stroke is the fifth leading cause of death in the U.S., with more than 100,000 deaths annually. There are a multitude of risks associated with stroke, including aging, cardiovascular disease, hypertension, Alzheimer's disease (AD), and immune suppression. One of the many challenges, which has so far proven to be unsuccessful, is the identification of a cost-effective diagnostic or prognostic biomarker for stroke. Alkaline phosphatase (AP), an enzyme first discovered in the 1920s, has been evaluated as a potential biomarker in many disorders, including many of the co-morbidities associated with stroke. This review will examine the basic biology of AP, and its most common isoenzyme, tissue nonspecific alkaline phosphatase (TNAP), with a specific focus on the central nervous system. It examines the preclinical and clinical evidence which supports a potential role for AP in stroke and suggests potential mechanism(s) of action for AP isoenzymes in stroke. Lastly, the review speculates on the clinical utility of AP isoenzymes as potential blood biomarkers for stroke or as AP-targeted treatments for stroke patients.

Evaluation of serum and salivary alkaline phosphatase levels in chronic periodontitis patients before and after nonsurgical periodontal therapy

Background:

The traditional method of diagnosing periodontitis includes the assessment of clinical parameters and radiographic aids to evaluate the periodontal tissue destruction. Saliva has the potential to be used as the diagnostic fluid for oral disease. This study aimed at comparing the quantitative levels of alkaline phosphatase (ALP) in saliva and serum before and after scaling and root planing in patients with chronic generalized periodontitis.

Materials and Methods:

A total number of 50 participants (40 with chronic generalized periodontitis and 10 periodontally healthy volunteers) of 30–50 years were included in the study. Clinical parameters such as simplified oral hygiene index (OHI-S), gingival index, probing depth, and clinical attachment loss (CAL) were measured, and then, saliva and blood sample collection was done and analyzed for ALP levels by spectrometry. The clinical parameters along with saliva and serum ALP levels were reevaluated after 30 days following Phase I periodontal therapy. The results were statistically analyzed using paired t-test and one-way ANOVA.

Results:

The saliva and serum ALP levels were significantly increased in patients with chronic generalized periodontitis with an increase in clinical parameters such as OHI-S, gingival index, probing depth, and CAL when compared with periodontally healthy individuals. The saliva and serum ALP levels were significantly decreased following Phase I periodontal, therapy along with improvement in clinical parameters.

Conclusion:

With the limitations of the present study, it could be concluded that ALP levels in saliva can be used for the diagnosis of active phase of periodontal disease and also for evaluation of the treatment outcomes following Phase I periodontal therapy.

Assessment of clinical efficacy of locally delivered 0.2% Thymoquinone gel in the treatment of periodontitis

Objectives

To evaluate the potential benefits of local application of Thymoquinone gel as an adjunctive to scaling and root planing (SRP) in subjects with chronic periodontitis.

Material and methods

Twenty subjects with 40 test sites were selected according to inclusion and exclusion criteria. They were further divided into 2 groups. Group I comprised of study subjects (Thymoquinone in addition to SRP) and Group II comprised of control subjects (only SRP). Clinical parameters such as Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth (PPD), Relative Attachment Level (RAL), were monitored at baseline and 6 weeks post operatively. Alkaline phosphatase (ALP) levels in gingival crevicular fluid (GCF) were evaluated at baseline and 6 weeks post operatively using microcapillaries. In addition antimicrobial efficacy of Thymoquinone was evaluated against 3 bacteria using antimicrobial strains.

Results

Statistically highly significant reduction was observed in PI, GI and PPD, rise in RAL and GCF ALP level in both the groups at 6 weeks from baseline. On comparison between Group I and Group II, former demonstrated statistically significant reduction in PPD, GCF-ALP levels and rise in RAL but statistically no significant differences were observed in PI and GI at 6 weeks. On microbiological assessment of 0.2% Thymoquinone gel, it was observed to be sensitive against P. gingivalis, A. actinomycetemcomitans and P. intermedia.

Conclusion

Significant changes in clinical and biochemical parameters were achieved in the current study. Hence, it is concluded that intracrevicular application of 0.2% Thymoquinone gel could be a beneficial adjunct to SRP in treating chronic periodontitis.

Matrix metalloproteinase-8 levels in oral samples as a biomarker for periodontitis in the Chinese population: an observational study

BACKGROUND

Clinical evaluation of periodontal inflammation does not fully reflect the disease activity. Extensive studies have been conducted out on gingival crevicular fluid (GCF) components that might serve as potential diagnostic markers for periodontitis, among which matrix metalloproteinase-8 (MMP-8) has shown to be promising, but there were no studies for individuals in China. The aim of this study was to compare clinical diagnostic parameters and levels of active MMP-8 (aMMP-8) in GCF and oral rinse samples from the Chinese patients with varying degrees of periodontal inflammation.

METHODS

GCF and oral rinse samples were obtained from 60 participants into two groups, a periodontitis group and a control group, specified by the presence and number of pocket depths or attachment loss. The aMMP-8 levels in GCF and oral rinse samples was quantified by ELISA using specific monoclonal antibodies. Logistic and linear regression models were employed for testing the correlation between aMMP-8 levels and periodontal condition, as well as diagnostic sensitivity and specificity.

RESULTS

Periodontitis group (mean = 24.84 ng/ml) exhibited significantly higher aMMP-8 levels than control group in GCF (p < 0.001). The aMMP-8 levels in oral rinse samples ranged from 0.05 to 2.18 ng/ml, but differences were not statistically significant between the two groups (p > 0.1). Receiver operating characteristic curve analysis showed a highest threshold of 6.66, with a corresponding sensitivity and specificity of 0.8 and 0.9, respectively.

CONCLUSIONS

Measuring aMMP-8 levels in GCF may have potentiality for complementary early diagnosis of periodontal disease and inflammation in the Chinese population.

A systematic review of biomarkers of gingival crevicular fluid: Their predictive role in diagnosis of periodontal disease status

The objective of the study was to conduct a systematic review of the literature so as to evaluate and summarize the diagnostic and prognostic potential of GCF. Included studies were systematically analyzed based on PRISMA (Preferred Reporting Items For Systematic Reviews and Meta Analyses) and studies were identified based on the-PICO (Glossary of evidence based terms 2007): 1)Patients with chronic periodontitis.2)Intervention- NSPT (Non-SurgicalPeriodontal therapy); NSPT + Chemotherapeutics.3)Comparison between treated v/s non treated sites.4)Outcomes measured: Analysis of variation in constituents of GCF. Electronic database search of Pubmed, Medline, Google Scholar and Scopus was performed using (MeSH) terms- Gingival Crevicular fluid and Cytokines, MMP's, NE, PGE-2, A2M, B2M, ALP, AST, Osteocalcin and Calprotectin. Articles published between year 2000-2016 were reviewed and were included based on inclusion and exclusion criteria. Based on this systematic review of literature, it can be concluded that analysis of constituents of GCF can be used as an effective and efficient diagnostic tool of periodontal diseases. These biomarkers in turn with their prognostic significance could act as a valuable tool in the combat of periodontal disease.

Effect of scaling & root planing on the activity of ALP in GCF & serum of patients with gingivitis, chronic and aggressive periodontitis: A comparative study

INTRODUCTION

Host response and environmental factors are known to modify periodontal status adversely. Presently serum, saliva, and GCF are being investigated for its biochemical constituents. GCF contains array of biochemical factors, offering potential use as a diagnostic or prognostic biomarker of the biologic state of the periodontium in health and disease. Alkaline phosphatase is produced locally in the periodontium and shows positive correlation with disease activity and PD. Present study was designed to analyze the levels of ALP in GCF and serum of patients with gingivitis, chronic & aggressive periodontitis before and after SRP & to compare the difference within the study groups.

METHODS

OPD patients grouped into: Gingivitis, Aggressive periodontitis & chronic periodontitis patients. Clinical parameters recorded for each patient prior to therapy. Pooled GCF samples collected using micro capillary tubes from the deepest pocket sites for each patient and stored at -70° C. Serum samples also collected and stored at -20° C. Each patient was subjected to scaling and root planing with two weeks maintenance recall. After 6 to 8 weeks GCF and serum samples collected again and all clinical parameters rerecorded. GCF and serum samples analyzed for levels of ALP by using para nitro phenol assay for the three groups.

RESULTS

ALP levels in GCF increased significantly during active phase of disease followed by statistically significant reduction after phase I therapy. Baseline levels of ALP in GCF was CP > AP > G with maximum reduction in GCF ALP after SRP in G > CP > AP group.

Identification of Gingival Crevicular Fluid Sampling, Analytical Methods, and Oral Biomarkers for the Diagnosis and Monitoring of Periodontal Diseases: A Systematic Review

Background. Several studies in the last decades have focused on finding a precise method for the diagnosis of periodontal disease in its early stages. Aim. To evaluate from current scientific literature the most common and precise method for gingival crevicular fluid (GCF) sample collection, biomarker analytical methods, and the variability of biomarker quantification, even when using the same analytical technique. Methodology. An electronic search was conducted on in vivo studies that presented clinical data on techniques used for GCF collection and biomarker analysis. Results. The results showed that 71.1%, 24.7%, and 4.1% of the studies used absorption, microcapillary, and washing techniques, respectively, in their gingival crevicular fluid collection. 73.1% of the researchers analyzed their samples by using enzyme-linked immunosorbent assay (ELISA). 22.6%, 19.5%, and 18.5% of the researchers included interleukin-1 beta (IL-1β), matrix metalloproteinase-8 (MMP-8), and tumor necrosis factor-alpha (TNF-α), respectively, in their studies as biomarkers for periodontal disease. Conclusion. IL-1β can be considered among the most common biomarkers that give precise results and can be used as an indicator of periodontal disease progression. Furthermore, paper strips are the most convenient and accurate method for gingival crevicular fluid collection, while enzyme-linked immunosorbent assay can be considered the most conventional method for the diagnosis of biofluids.

Gingival Crevicular Fluid as a Novel Potential Source of Biomarkers Distinguishes Pubertal from Post-Pubertal Subjects

Detection of pubertal growth peak is vital in orthodontic treatment timing and planning. Gingival crevicular fluid (GCF) contains abundant proteins from different sources and has been proven to be an ideal source of biomarkers. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF/MS) is an advanced technique that can detect low-molecular-weight peptides with high sensitivity and resolution. The aim of this research was to identify novel candidate biomarkers in GCF to help the diagnosis of pubertal growth peak by MALDI-TOF/MS. Results showed that the peak intensities of six peptides were significantly different between two groups: 1660.2 Da, 1783.0 Da, 2912.5 Da, 4178.6 Da, 5064.9 Da, and 6108.9 Da and are considered to be potential candidate biomarkers to identify pubertal growth peak. Further studies are needed to identify sequence information of these candidate biomarkers.

Comparative Evaluation of Efficacy of Three Different Herbal Toothpastes on Salivary Alkaline Phosphatase and Salivary Acid Phosphatase - A Randomized Controlled Trial

INTRODUCTION

Very few researches in the past have tried to evaluate the effect of herbal toothpaste on saliva and salivary constituents like alkaline phosphatase and acid phosphatase which play an important role in maintaining oral health.

AIM

To evaluate and compare the effect of three different herbal toothpastes on Salivary Alkaline Phosphatase (ALP) and salivary Acid Phosphatase (ACP).

MATERIAL AND METHODS

The present study was a preliminary study conducted among 45 dental students (15 subjects in each group) in the age group of 19-21 years. Subjects in each group were randomly intervened with three different herbal toothpastes respectively (Group A - Patanjali Dant Kanti, Group B - Himalaya Complete Care and Group C - Vicco Vajradanti). Unstimulated saliva sample were collected before and after brushing and salivary ACP and salivary ALP levels were assessed at an interval of one week each for a period of four weeks starting from day one. Compiled data was analyzed using chi square test, paired t-test and ANOVA based on the nature of the obtained data.

RESULTS

All the three toothpastes showed significant (p<0.001) reduction in ACP and ALP levels at each interval. For patanjali toothpaste, the mean reduction was in the range of 2.55 - 2.62 IU/L for ACP and 2.94 - 2.99 IU/L for ALP. For Himalaya toothpaste, the mean reduction was in the range of 1.39 - 1.47 IU/L for ACP and 1.55 - 1.61 IU/L for ALP. For Vicco toothpaste, the mean reduction was in the range of 2.46 - 2.50 IU/L for ACP and 2.64 - 2.77 IU/L for ALP. Patanjali and Vicco toothpaste were significantly effective in reducing the levels of salivary ACP and ALP more than Himalaya toothpaste (p<0.05).

CONCLUSION

Herbal toothpastes, especially Dant Kanti and Vicco Vajradanti, showed significant reduction in levels of ACP and ALP resulting in overall improvement towards the oral health.

Biomarker levels in gingival crevicular fluid of subjects with different periodontal conditions: A cross-sectional study

OBJECTIVE

To compare five biomarker levels in gingival crevicular fluid (GCF) in different tooth-sites of subjects with healthy periodontium, aggressive periodontitis and severe chronic periodontitis, and to evaluate the value of these biomarker levels for diagnosis of the type and activity of periodontitis.

MATERIALS AND METHODS

Prior to therapy, GCF samples were collected using filter paper strip at different tooth-sites of 10 subjects with healthy periodontium (H), 15 with severe chronic periodontitis (CP) and 15 with aggressive periodontitis (AgP). The strips were weighed and the periodontal clinical parameters were recorded. Levels of interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), and alkaline phosphatase (ALP) in GCF were assessed by enzyme-linked immunosorbent assay (ELISA).

RESULTS

The volumes of the GCF samples obtained in CP and AgP subjects were significantly higher than those from subjects with healthy periodontium (P<0.05). Levels of IL-6, TNF-α, CRP and ALP were significantly higher in the untreated disease sites in the CP and AgP groups compared to those in control sites in the H group, while IL-10 levels were lower in the CP and AgP groups than those in the control sites in the H group. However, the levels of all five biomarker levels showed significant correlation with the clinical parameters.

CONCLUSION

The measurement of five biomarker levels in GCF may facilitate overall screening of periodontitis patients in epidemiological studies and allow estimation of periodontitis activity.