Cytokine and MMP Levels in Gingival Crevicular Fluid in the Treatment of Localized Gingival Recessions

Cytokine (IL-1ß) and Matrix Metalloproteinase (MMP) Levels in Gingival Crevicular Fluid After Use of Platelet Rich Fibrin or Connective Tissue Graft in the Treatment of Localized Gingival Recessions

The main objective of this study was to evaluate the matrix metalloproteinase (MMP)-8, and -9, tissue inhibitor of matrix metalloproteinase and interleukin-1beta levels in gingival crevicular fluid during the early and late stages of healing for gingival recession sites treated by coronally advanced flap plus platelet rich fibrin (PRF) compared to CAF plus connective tissue graft. As PRF consists of several growth factors, it may enhance the healing potential of soft tissues, the investigators hypothesized that using PRF in the treatment of gingival recessions might regulate inflammation and promote wound healing.

Study Overview

• Status: Completed
• Conditions: Gingival Recession
• Intervention / Treatment: Procedure: Connective tissue graft; Procedure: Platelet Rich Fibrin

Detailed Description

The aim of this study was to evaluate the effect of PRF by assessing gingival crevicular fluid (GCF) levels of MMP-8, MMP-9, tissue inhibitor of matrix metalloproteinase (TIMP-1) and interleukin-1beta (IL-1β) during the early and late stages of healing following coronally advanced flap (CAF) plus PRF or CAF plus connective tissue graft (CTG) treatment.

Primary outcome variables were biochemical parameters, such as: GCF MMP-8, -9, TIMP-1 and IL-1β levels. The secondary outcome variables were change in gingival recession expressed as recession reduction in millimeters at follow-up visits.

Sample size has been estimated in 24 subjects per treatment groups. Random allocation of the treatment sites to test (CAF+ PRF) and control (CAF + SCTG) groups will be performed using a computerized selection of random numbers for allocation of the study groups.

Biochemical parameters: GCF samples were obtained from each recession defect in each subject immediately prior to treatment of recessions and at 10 days, 1 month, 3 months and 6 months after surgery.

Periodontal parameters including probing depth (PD), clinical attachment level (CAL), and gingival recession parameters including recession depth (RD), recession width (RW), and keratinized tissue width (KTW),were assessed by a calibrated examiner. At baseline and at 6 months, PD, RD, RW and KTW were evaluated by clinical assessment.

Follow-up of subjects: 6 months.

• Study Type: Interventional
• Enrollment (Actual): 24
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • İzmir, Turkey, 35100
    • Ege University School of Dentistry Department of Periodontology

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Similar bilateral Miller Class I or II localized gingival recessions at least ≥ 2 mm located on incisors, canines or premolars on both jaws
• Identifiable cementoenamel junction
• Age ≥ 18 years
• Presence of tooth vitality and absence of restorations and superficial caries in the area to be treated
• No periodontal surgical treatment in the previous 24 months on the involved sites
• Sufficient palatal donor tissue for the indicated SCTG.

Exclusion Criteria:

• Smoking
• Patients with a pregnancy or lactation period or self-reported history of antibiotic medication within three months
• Molar, mobile or teeth with crown or filling were also excluded.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: DIAGNOSTIC
• Allocation: RANDOMIZED
• Interventional Model: SINGLE_GROUP
• Masking: SINGLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
ACTIVE_COMPARATOR: Connective tissue graft; Connective tissue graft Soft tissue harvested from palatum of the subjects.	Procedure: Connective tissue graft; gingival recession treated with connective tissue graft
EXPERIMENTAL: Platelet Rich Fibrin; Autogenous platelet and leukocyte fibrin material was obtained from blood.	Procedure: Platelet Rich Fibrin; gingival recession treated with platelet rich fibrin

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Change from Baseline in MMP-8 gingival crevicular fluid level at 10 days, 1, 3 and 6 months	Baseline, 10 days, 1, 3 and 6 months
Change from Baseline in MMP-9 gingival crevicular fluid level at 10 days, 1, 3 and 6 months	Baseline, 10 days, 1, 3 and 6 months
Change from Baseline in TIMP-1 gingival crevicular fluid level at 10 days, 1, 3 and 6 months	Baseline, 10 days, 1, 3 and 6 months
Change from Baseline in IL-1beta gingival crevicular fluid level at 10 days, 1, 3 and 6 months	Baseline, 10 days, 1, 3 and 6 months

Secondary Outcome Measures

Outcome Measure	Time Frame
Gingival recession depth	6 months

Collaborators and Investigators

• Sponsor: Ege University
• Investigators: Principal Investigator: Gülnihal Eren, PhD. Dr., Ege University School of Dentistry

Study record dates

Study Major Dates

• Study Start: October 1, 2012
• Primary Completion (ACTUAL): September 1, 2013
• Study Completion (ACTUAL): October 1, 2013

Study Registration Dates

• First Submitted: February 14, 2015
• First Submitted That Met QC Criteria: March 2, 2015
• First Posted (ESTIMATE): March 5, 2015

Study Record Updates

• Last Update Posted (ESTIMATE): March 5, 2015
• Last Update Submitted That Met QC Criteria: March 2, 2015
• Last Verified: March 1, 2015

More Information

Terms related to this study

• Keywords: Gingival recession; cytokine; connective tissue; gingival crevicular fluid; matrix metalloproteinase; fibrin
• Additional Relevant MeSH Terms: Stomatognathic Diseases; Periodontal Diseases; Mouth Diseases; Gingival Diseases; Periodontal Atrophy; Gingival Recession
• Other Study ID Numbers: Ege Uni School of Dentistry