Refractory periodontitis manifested in progressive attachment loss in a rapid and unrelenting manner regardless of the type or frequency of therapy applied.
The purpose of this study was to evaluate the relation between the level of cytokines in GCF and periodontopathic microflora with disease progression of refractory periodontitis. Selection of patients with refractory periodontitis(7 males, 3
females)
were made by long term clinical observation including conventional clinical history and parameters. Teeth that showed pocket depth greater than 6mm were selected as sample teeth. Subjects were examined at baseline and after 3 months. Prior to
baseline
test, individual acrylic stent was fabricated. Reference grooves were made on each sample tooth site. Pocket depth and attachment loss were measured by Florida Probe. Gingival index was measured at 4 sites in each sample teeth. Disease activity
was
defined as attachment loss of ≥ 2.1m, as determined by sequential probing and tolerance method. The pattern and amount of alveolar bone resorption was observed with quantitative digital subtraction image processing radiography. Morphological
analysis
of subgingival bacteria was taken by phase contrast microscopy. Predominant cultivable bacterial distribution and frequency were compared between disease-active and disease-inactive site using immunofluorescence microscopy and selective microbial
culturing. Levels of interleukin-1β, 2, 4, 6 and TNF-α in GCF and blood serum samples were quantified by ELISA technique. In active sites, P. intermedia was significantly increased to compare with inactive site. IL-1β, IL-2, IL-6 and TNF-α in
GCF
were increased in active sites, and IL-2 in serum was increased in active patients significantly. Moreover, the level of IL-1β, IL-2, and IL-6 in GCF were significantly higher in active sites than that of inactive sites during 3 months period.
Alveolar
bone loss in active site was positively correlated with IL-1β, IL-2 in GCF.
These results demonstrate that IL-2 in serum, IL-1β, IL-2, IL-6 and TNF-α in GCF, P. intermedia might be used as possible predictors of disease activity in refractory periodontitis before it is clinically expressed as attachment loss and
quantitative
alveolar bone change.
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