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Gingival crevicular fluid levels ofaspartate amino transferase,sulfide ions and N -benzoyl-DL-arginine-2-naphthylamide indiabetic patients with chronicperiodontitisYucekal-Tuncer B, Uygur C, Firatli E. Gingival crevicular fluid levels of aspartateamino transferase, sulfide ions and N-benzoyl- DL -arginine-2-naphthylamide indiabetic patients with chronic periodontitis. J Clin Periodontol 2003; 30: 1053–1060.r Blackwell Munksgaard, 2003.

Abstract

Background: The aim of this study is to analyze the correlations between plaqueindex (PlI), gingival index (GI), probable pocket depth (PPD), clinical attachment

level (CAL), aspartate aminotransferase (AST), N -benzoyl-DL-arginine-2-

naphthylamide (BANA) and sulfide ion activity (SIA) of diabetic patients with chronicperiodontitis with regard to disease activity detected by AST levels.

Material and Methods: A total of 95 sites from eight diabetic patients with chronic

periodontitis and 74 sites from eight systemically healthy patients with chronicperiodontitis were enrolled in the study. The patients had no history of periodontaltreatment or any antibiotic therapy during the last 6 months and were nonsmokers. All

the sites selected for the study had a CAL of at least 2 mm. Gingival crevicular fluidvolumes (GCFV) were measured in all sites.

Results: According to the result of AST analysis, 45 sites were AST positive and 50were AST negative in the diabetic group and 36 sites were AST positive and 38 were

AST negative in the control group. There was a significant correlation between BANAhydrolysis and PPD in both diabetic and control groups, but no correlation betweenPPD and AST levels. A significant correlation was observed between AST-positive

sites and GI, but not between GI and BANA hydrolysis. In both groups, the correlation

between SIA and BANA hydrolysis was significant, but no correlation was revealedbetween SIA and AST levels in either diabetic or control groups.

Conclusion: The GCF metabolites had significant correlations with periodontallydiseased sites in patients with chronic periodontitis, whether diabetic or systemically

healthy, and may help to confirm clinical findings.

Key words: aspartate amino transferase;BANA; crevicular fluid; diabetes mellitus;periodontitis; sulfide ion

Accepted for publication 10 March 2003

Periodontitis is an inflammatory diseasecharacterized by the destruction of periodontal ligament and alveolar bone(Listgarten 1986, Van Dyke et al. 1993).It was suggested that the nature of

periodontitis has an episodicity, inwhich active and stable periods fol-lowed each other successively (Hirsh-feld & Wasserman 1978, McFall 1982,Lindhe et al. 1983, Buckley & Crowley

1984, Chambers et al. 1984, Socranskyet al. 1984, Lang et al. 1986, Jenkinset al. 1988, Persson & 990).

Recent research is focused on mea-suring the periodontal disease activity

B. Yucekal-Tuncer, C. Uygurand E. Firatli

Department of Periodontology, School of

Dentistry, Istanbul University, Isthanbul,

Turkey

J Clin Periodontol 2003; 30: 1053–1060 Copyright r Blackwell Munksgaard 2003Printed in Denmark. All rights reserved

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and susceptibility in periodontal sites byobjective diagnostic methods (Fine &Mandel 1986). Commonly used clinicalparameters or evaluations from radio-graphs can describe the history of periodontal disease, but they are notadequate diagnostic indicators of pre-

sent or future periodontal deterioration(Goodson et al. 1984, Lindhe et al.1989a, b, Persson & Page 1992). There-fore, new diagnostic methods to detectdisease-active or stable sites have beeninnovated.

The detection of some biochemicalmarkers can provide current informationabout tissue destruction (Persson &Page 1992). Since most periodontitistypes are site-specific, one approach isto measure substances present in gingi-val crevicular fluid (GCF) that maycorrelate with levels of disease activity

and tissue destruction (Last et al. 1985,Offenbacher et al. 1986). Among thesemarkers, aspartate aminotransferase(AST) enzyme has been extensivelystudied in both animal and humanmodels (Tsalikis et al. 2001). It is anenzyme normally confined to the cell,which is released to the GCF upon celldeath in the active phase of periodontaldisease (Smith 1979). Recently, a chair-side test has been developed, based onthe measurement of levels of AST inGCF (Smith et al. 1998).

Although microorganisms and their

products found in dental plaque com-prise the primary etiological agentsresponsible for periodontal disease(Listgarten 1986, Van Dyke et al.1993), metabolic disturbances in theperiodontal tissues may lower the re-sistance to infections and thus influencethe initiation, development and progres-sion of inflammatory periodontal dis-ease (Firatli et al. 1996, Firatli 1997).Diabetes mellitus is such a metabolicdisorder that affects 2–10% of thepopulation and is characterized byneuropathies, nephropathies, macro-

and microangiopathies (Rylander et al.1986, Katz et al. 1991, Unal et al. 1993,Firatli et al. 1994). In this study, ASTlevels were compared with N -benzoyl-DL-arginine-2-naphthylamide (BANA)and sulfide ion activity (SIA) levels.BANA, which is a synthetic peptide, ishydrolyzed by a trypsin-like proteasereleased from Gram-negative bacteria(Laughon et al. 1982). This hydrolyticenzyme activity is detectable in sub-gingival sites. By using a chairsidedetection system (PerioscanTM, GenesisLabs, Inc., Minneapolis, MN, USA), it

is possible to detect indirectly thepresence of Porphyromonas gingivalis,Treponema denticola and Bacteroides

forsythus in subgingival plaque samples(Loesche et al. 1987, 1990, 1992,Schmidt et al. 1988). In addition, wealso used Diamond Probes (Diamond

General Development Corp., MI, USA)to measure sulfide ion concentrationwithin the pockets, which may give usindirect information about the presenceor absence of the activity of Gram-negative bacteria (Fine & Mandel 1986,Kerry et al. 1997). Since patients withinsulin-dependent diabetes mellitus(IDDM) represent a high-risk group of patients, who are more likely thanothers to develop periodontal diseases(Ervasti et al. 1985, Rylander et al.1986, Bacic et al. 1988, Hugoson et al.1989), the aim of this study is to analyze

the correlations between plaque index(PlI), gingival index (GI), probablepocket depth (PPD), clinical attachmentlevel (CAL), AST, BANA and SIA of diabetic patients with chronic period-ontitis with regard to disease activitydetected by AST levels.

Their correlation with each other andwith clinical indices will be investi-gated. Also, AST levels will be com-pared with BANA and SIA levels.

Material and Methods

Subjects and test sites

A total of 95 sites from eight IDDMpatients with chronic periodontitis and74 sites from eight systemically healthypatients with chronic periodontitis wereenrolled in the study. They had nohistory of periodontal treatment or anyantibiotic therapy during the last 6months and were nonsmokers. All thesites selected for the study had a CAL of at least 2 mm (CAL X2 mm). The PPDmeasurements ranged from 2 to 8 mm.The number of sites selected from each

subject ranged from 9 to 12 according tothe criteria of CAL. All the sites in bothgroups were located on separate teeth.AST-positive and AST-negative period-ontal sites were selected according tothe result of AST analysis. PlI (Silness& Loe 1964), GI (Loe & Silness 1963),PPD and CAL were measured in allsites.

Periodontal examination

All clinical periodontal examinationswere performed by the same examiner.

Patients were given a thorough period-ontal examination, including PlI (Sil-ness & Loe 1964), GI (Loe & Silness1963), PPD and CAL. PlI and GI weredetermined and recorded at six sites(mesiobuccal, midbuccal, distobuccal,mesiolingual, midlingual, distolingual)

with a manual periodontal probe. ThePlI was determined in a scale from 0 to3 using the following criteria: (0) noplaque; (1) plaque disclosed after run-ning the periodontal probe along thegingival margin; (2) visible moderateplaque; (3) heavy plaque. The GI wasdetermined in a scale from 0 to 3 usingthe following criteria: (0) no visualsigns of inflammation in gingiva; (1)slight change in colour and texture, nobleeding on probing (mild gingivitis);(2) visual inflammation and bleedingtendency from the gingival margin right

after probing (moderate gingivitis); and(3) overt inflammation with a tendencyto spontaneous bleeding (severe gingi-vitis). The scores from the six areas of each tooth were added and divided bysix to give the mean value of each tooth.

PPD measurements were obtainedwith a constant pressure probe (Boro-dontic Periodontal Probe, Hu FriedyChicago, IL, USA) (25 N/cm2). PPDwas measured as the distance from thegingival margin to the location of the tipof the periodontal probe inserted intothe pocket with constant probing force.

CALs were determined by measuringthe distance from the cemento-enamel junction (CEJ) to the location of theinserted probe tip. PPD and CAL werealso measured at six sites on each tooth.

Method of sampling

The identified test sites were isolatedwith cotton wool rolls, air dried for 2 sand sampled in the following order so asto minimize trauma to the gingivalsulcus. Initially, a 30 s collection of

GCF using paper strips supplied withthe Perimonitor kit (Hawe Perimonitor,Hawe Neos Dental, Bioggio, Switzer-land) was placed in the periodontalpocket. The collected GCF was mea-sured with Periotron 6000. Next PlI, GI,PPD and CAL were recorded with aconstant pressure probe. The subgingi-val plaque sample was collected care-fully with a sterile dental excavator in asingle stroke. Finally, gingival sulciand/or periodontal pockets were probedwith Diamond Probes to measure thesulfide ion concentration.

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Analysis of GCF for AST

The collection and subsequent analysis of GCF for AST levels were performedaccording to the manufacturer’s instruc-tions. The experimental sites were airdried for 2 s prior to collection and a paperstrip, supplied by the manufacturer, was

inserted into the gingival sulcus and/orperiodontal pocket for 30 s. Samples wereplaced in separate wells on the test tray,following the addition of appropriatereagents, and the tray was incubated atroom temperature (241C) for 14 min priorto the evaluation. A positive reaction (i.e.X800IU of AST activity) was scored if the colour change was equal to or lighter(pinker) than the positive control well; anegative result (4800 IU of AST activity)was scored if the colour change wasdarker (more violet) than the positivecontrol well. Test and control wells were

read by an examiner unaware of theclinical condition of the sites under study.

Analysis of plaque samples for BANA

hydrolysis

The subgingival plaque sample wasplaced at the Perioscan reagent cardand the test was performed according tothe manufacturer’s instructions. A posi-tive site was identified by a dark bluecolour and the results were expressed aseither positive or negative. The analysiswas assessed at the chairside by anindependent examiner unaware of theclinical condition of the sites examined.

Diamond Probes analysis

The response of each probe used inthese evaluations was calibrated prior touse in a series of synthetic sulcus fluidsthat contained specific concentrations of sulfide. Periodontal pockets wereprobed in a similar manner as routinemeasurements of pocket depths withDiamond Probes, which is a modified

‘‘Michigan 0’’ style, disposable dentalprobe incorporating a silver sulfidesensor. When an audio tone was heardfrom the electronic unit (digitally mini-mum 0–maximum 5), the probe waspassed through any structure within thepocket to see if the pitch of the tonecould be maximized.

Statistical analysis

The groups were compared with eachother by the Mann–Whitney U -test andthe correlations for each parameter were

evaluated by Pearson’s correlation rank test with a confidence limit of po0.05.w2 test was used to quantitate the

association between GCF metabolites.Statistical analyses were performed byusing the SPSS program.

Results

A summary of mean patient values forfull-mouth clinical indices is shown inTable 1. The clinical, gingival crevicu-lar fluid volumes (GCFV) and SIAfindings for the 169 sites in bothdiabetic and control patients are shownin Table 2.

The mean values for clinical, GCFVand SIA findings of diabetic and controlpatients were compared in Table 3.Also, the mean values of diabetic and

control patients with respect to theAST level (4800 IU) were com-pared in Table 4. Statistical evaluationrevealed that in both comparisons, PlI,GI and PPD measurements of thediabetic patients were significantlyhigher when compared with the control

patients.When the mean values of all sites(Table 5) and AST-positive sites (Table6) of diabetic and control groups werecompared, PlI, GI, PPD and CALmeasurements of the diabetic patientswere significantly higher in both statis-tical comparisons. As a result, both inpatient-based (Tables 3 and 4) and site-based analyses (Tables 5 and 6), the PlI,GI and PPD measurements of thediabetic group were significantly higher,whereas the CAL measurement of the

Table 1. Mean patient values for clinical findings

Parameter Control patients Diabetic patients

PlI 1.7270.29 1.9070.13

GI 1.6570.46 1.9770.26

PPD (mm) 2.5670.59 2.7770.62CAL (mm) 3.1170.84 3.3371.08

Mean7standard deviation.

PlI, plaque index; GI, gingival index; PPD, probable pocket depth; CAL, clinical attachment level.

Table 2. Site values for clinical, GCFV and SIA findings

Parameter Control sites Diabetic sites

number of sites 74 95

mean PlI 1.4770.55 1.9170.29mean GI 1.3470.56 1.9570.37

mean PPD (mm) 2.4371.41 3.6271.39

mean CAL (mm) 3.3571.62 4.0771.52mean GCFV (periotron unit) 109.31754.71 88.67738.22

mean SIA (unit of sulfide) 0.6370.56 0.8971.31


GCFV, gingival crevicular fluid volumes; SIA, sulfide ion activity; PlI, plaque index; GI, gingival

index; PPD, probable pocket depth; CAL, clinical attachment level.

Table 3. Comparison of mean values for clinical, GCFV and SIA findings of diabetic and controlpatients (patient-based analysis)

Parameter Control patients (n5 8) Diabetic patients (n5 8)

PlI 1.4070.39 1.9170.16n

GI 1.2870.33 1.9570.20n

PPD (mm) 2.2970.97 3.6270.82n

CAL (mm) 3.1871.19 4.0770.99

GCFV (periotron unit) 111.89739.21 88.68719.14

SIA (unit of sulfide) 0.5570.37 0.88 71.05


PlI, plaque index; GI, gingival index; PPD, probable pocket depth; CAL, clinical attachment level;

GCFV, gingival crevicular fluid volumes; SIA, sulfide ion activity.n po0.05.

Sulcular AST, BANA and sulfide levels in IDDM 1055

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diabetic group was higher in only thesite-based analyses.

The parameters of the diabetic groupwere compared according to the ASTlevels in Table 7. Statistical evaluationrevealed significant differences of GCFVand SIA levels between AST-positive

and AST-negative sites, whereas onlythe GCFV level was significantly dif-ferent in the control group (Table 8).

The correlations between PPD andBANA or AST activity in both diabeticand control groups are shown in Figs. 1and 2, respectively. There was a sig-nificant correlation between BANA hydro-lysis and PPD (r 25 0.61, p5 0.005;r 250.51, p5 0.001) in both groups, butno correlation between PPD and ASTlevels ( p50.18 and 0.47). Therewas a significant correlation betweenAST-positive sites ( p50.005) and GI

(Table 9), but not between GI andBANA hydrolysis ( p5 0.2).The relationships between SIA and

AST levels or BANA hydrolysis in thediabetic and control groups are shown inFigs. 3 and 4, respectively. In both groups,the correlation between SIA and BANAhydrolysis was significant (r 25 0.58,

p5 0.001; r 25 0.50, p5 0.001), butno correlation was revealed betweenSIA and AST levels in either thediabetic or control group ( p5 0.44 and0.24, respectively).

According to the result of AST

analysis, 45 sites were AST positiveand 50 were AST negative in thediabetic group and 36 sites were ASTpositive and 38 were AST negative inthe control group. There was no sig-nificant difference between the ASTlevels at the diabetic and control sites.Analysis of the relationship betweenBANA hydrolysis at the diabetic andcontrol sites examined also demon-strated no significant difference ( p>0.05,w2 test) (Table 10).

In addition to these data, furtheranalysis was obtained about the rela-

tionship between the total plaque pro-tease activity, which is the BANAhydrolysis, and AST levels at both thediabetic (Table 11) and control (Table12) sites. The only significant result wasthe association of BANA-negative siteswith AST-negative sites in the diabeticgroup ( p5 0.03, w2 test).

Of further interest, we compared theperiodontal pockets that bled on probingwith the pockets that did not bleed onprobing in only AST-positive sites of both groups. GI, PPD, CAL and SIAlevels revealed significant differences of

Table5 . Comparison of mean values for clinical, GCFV and SIA findings of all sites in diabetic

and control groups (site-based analysis)

Parameter Control sites (n5 74) Diabetic sites (n5 95)

PlI 1.4770.55 1.9170.29n

GI 1.347

0.56 1.957

0.37

n

PPD (mm) 2.4371.41 3.6271.39n

CAL (mm) 3.3571.62 4.0771.52n


SIA (unit of sulfide) 0.6370.56 0.8971.31


GCFV, gingival crevicular fluid volumes; SIA, sulfide ion activity; PlI, plaque index; GI, gingival

index; PPD, probable pocket depth; CAL, clinical attachment level.n po0.05.

Table6 . Comparison of mean values for clinical, GCFV and SIA findings of AST-positive sitesin diabetic and control groups (site-based analysis)

AST positive Control sites (n5 36) Diabetic sites (n5 45)

PlI 1.5670.56 1.8970.32n

GI 1.4770.65 270.43n

PPD (mm) 2.5671.54 3.8271.59n

CAL (mm) 3.5871.75 4.3871.67n

GCFV (periotron unit) 123.78752.43 102.38741.59SIA (unit of sulfide) 0.7170.65 171.21


GCFV, gingival crevicular fluid volumes; SIA, sulfide ion activity; AST, aspartate aminotransfer-

ase; PlI, plaque index; GI, gingival index; PPD, probable pocket depth; CAL, clinical attachment

level.n po0.05.

Table7 . Comparison of clinical, GCFV and SIA findings of AST-positive and AST-negative

sites in the diabetic group

Parameter AST positive (n5 45) AST negative (n5 50)

PlI 1.8970.32 1.9270.27

GI 270.43 1.9070.30

PPD (mm) 3.8271.59 3.4471.16

CAL (mm) 4.3871.67 3.8071.34GCFV (periotron unit) 102.38741.59 76.34730.35n

SIA (unit of sulfide) 171.21 0.7971.40n




level.n po0.05.

Table4 . Comparison of mean values for clinical, GCFV and SIA findings of diabetic and controlpatients with respect to the AST level (4800 IU) (patient-based analysis)

AST positive Control patients (n5 8) Diabetic patients (n5 8)

PlI 1.3770.37 1.8770.21n

GI 1.2970.39 2.0170.35n

PPD (mm) 2.3271.30 3.8470.98n

CAL (mm) 3.3971.45 4.3871.12

GCFV (periotron unit) 124.25742.46 103.58728.68SIA (unit of sulfide) 0.5570.41 0.9870.89




level.n po0.05.


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bleeding sites of the diabetic group(Table 13), whereas only the GI mea-surement was significant in the controlgroup (Table 14).

Discussion

Much attention has been focused ondefining reliable indicators or methods

for distinguishing disease-active andstable sites to identify individuals witha high risk of periodontal destruction.Identifying sites at risk may provide anadvantage in rational treatment and indisease preventive strategy. For allpatients suffering from periodontal dis-ease, the clinical use of chairside tests inroutine controls will be useful to detectthe status of the disease. However, asthis study was performed to assess the

relationship between clinical indicesand certain chairside tests at one clinicalvisit, it may not therefore assess therelationship between these clinical find-ings with disease activity. This studyinvestigated the relationship of a marker

Table8 . Comparison of clinical, GCFV and SIA findings of AST-positive and AST-negativesites in the control group

Parameter AST positive (n5 36) AST negative (n5 38)

PlI 1.5670.56 1.3970.55

GI 1.4770.65 1.2170.41

PPD (mm) 2.5671.54 2.3271.28CAL (mm) 3.5871.75 3.1371.47

GCFV (periotron unit) 123.78752.43 95.60753.94n





level.n po0.05.

0

10

20

30

40

50

6070

80

90

100

1 2 3 4 5 6 7 8

AST activity BANA hydrolysis

% s

i t e s p o s i t

i v e

Pocket depth (mm)

Fig. 1. Correlation between pocket depthand aspartate aminotransferase (AST) and

N -benzoyl-DL-arginine-2-naphthylamide(BANA) levels in the diabetic group.

Table9 . Correlation between GI, AST and BANA hydrolysis in all sites

GI % AST positivesites (all sites)

% BANA positivesites (all sites)

1 43 73

2 48 69

3 100 29

correlation (r 2) 0.54 0.13

p-value 0.005 0.2

GI, gingival index; AST, aspartate aminotransferase; BANA, N -benzoyl-DL-arginine-2-naphthylamide.

0

10

20

30

40

50

60

70

80

90

100

1 2 3 4 5 6 7 8


% s

i t e s p o s i t i v e

Pocket depth (mm)

Fig. 2. Correlation between pocket depthand aspartate aminotransferase (AST) and

N -benzoyl-DL-arginine-2-naphthylamide(BANA) levels in the control group.

0

10

20

30

40

50

60

70

80

90

100

0 4 4.53.52.521.50.5 3

% s

i t e s p o s i t i v e

Sulphide ion activity

(unit of sulphide)

1


Fig. 4. Correlation between sulfide ion ac-tivity and aspartate aminotransferase (AST)and N -benzoyl-DL-arginine-2-naphthylamide(BANA) levels in the control group.

Table 10. Relationship between diabetic sites

and control sites with AST levels (4800IU)and BANA hydrolysis

Parameter Control

sites

Diabetic

sites

AST positive 36 45AST negative 38 50

BANA positive 27 27

BANA negative 47 68

AST, aspartate aminotransferase; BANA, N -

benzoyl-DL-arginine-2-naphthylamide.

0

10

20

3040

50

60

70

80

90

100

0 4 4.53.52.521.50.5 3

% s

i t e s

p o s i t i v e

Sulphide ion activity(unit of sulphide)

1


Fig. 3. Correlation between sulfide ion ac-tivity and aspartate aminotransferase (AST)and N -benzoyl-DL-arginine-2-naphthylamide(BANA) levels in the diabetic group.


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of tissue destruction (AST) with thesimultaneous presence of plaque pro-tease activity (BANA) and the presenceof SIA in periodontal pockets.

A study provides evidence that in-creased levels of AST in crevicular fluidmay reflect active tissue destruction inthe periodontium in ligature-inducedperiodontitis in the beagle dog (Cham-bers et al. 1984). A similar correlation is

reported in humans between progressingperiodontitis lesions and GCF AST levels(Chambers et al. 1991, Imrey et al. 1991).

The AST activity in GCF has beenshown to correlate with the severity of gingival inflammation and with activesites, as detected by longitudinal assess-ment (3 months) of CAL (Persson &Page 1990, Persson et al. 1990, Cham-bers et al. 1991). In this study, there wasno significant correlation between AST-positive sites and PPD in both groups.However, the correlation between theGI and the number of AST-positive sites

was significant ( p5 0.005), suggestingthat AST activity may be indicative of soft tissue changes occurring within thegingival tissues rather than deeper-seated changes in the periodontium asreported by other workers (Smith et al.1998).

Statistical analysis revealed signifi-cant differences of GCFV and SIAlevels between the AST-positive andAST-negative sites of diabetic patientswith chronic periodontitis, whereas onlythe GCFV was significantly different inthe control group. This suggests an

increased SIA in AST-positive sites of dia-betic patients, which appears to support

the data that the changing microflora, asa characteristic of diabetes mellitus, canbe a modifying factor in the destructivepotential of periodontitis.

The data showed a statistically sig-nificant correlation between increasingprobing depth and a positive BANA test(Loesche et al. 1987, 1990, 1992,Schmidt et al. 1988, Bretz et al. 1989).This significant positive relationshipbetween BANA hydrolysis and PPDwas also confirmed in this study. In bothdiabetic and control groups, these find-ings support the potential microbial

proteolytic enzyme activity in period-ontal pockets. We were, however, un-able to show a significant correlationbetween BANA hydrolysis and GI.

Studies have reported the severity of gingival inflammation, GCFV and thepotential of H2S release from this fluidto have a positive correlation (Fine &Mandel 1986). In this study, the corre-lation between SIA and BANA hydro-lysis was significant in both groups. Asa result, we were able to detect at leastone of the three periodontal pathogenswith the BANA test, which were in fact

one of the main sources of sulfide ion.Both the BANA score and SIA level

findings may be considered to indicatethe changing microflora in the subgingi-val area and the release of more sulfidefrom both bacteria and host cells inchronic periodontitis patients, whetherdiabetic or systemically healthy.

Of further interest, we compared theperiodontal pockets that bled on probingwith the pockets that did not bleed onprobing, and it was interesting to findout that this correlation was significantwith only the GI measurement in thecontrol group, whereas bleeding period-ontal pockets were significantly corre-

lated with GI, PPD, CAL and SIA levelsin AST-positive sites of diabetic pa-tients, which indicate the severity of periodontal disease being more destruc-tive in diabetic patients. Previously, itwas demonstrated that the severity of periodontal destruction increases due tothe duration and poor control of dia-betes mellitus (Unal et al. 1993, Firatliet al. 1994, 1996, Firatli 1997).

In order to clarify the results of thetwo groups, patient- and site-basedanalyses were carried out. When thediabetic and control groups were com-

Table11. Relationship between AST levelsand BANA hydrolysis at the diabetic sites

examined

Parameter BANA

positive

BANA

negative

AST positive 18 27AST negative 9 41

AST, aspartate aminotransferase; BANA, N -

benzoyl-DL-arginine-2-naphthylamide.

Table 13. Comparison of periodontal pockets that bled on probing with the pockets that did notbleed on probing in the diabetic group

AST positive Bleeding pockets Non-bleeding pockets

PlI 1.7970.58 1.4170.50

GI 2.2170.43 170n

PPD (mm) 3.5771.87 1.9170.81n

CAL (mm) 4.5072.14 371.15n

GCFV (periotron unit) 138.71760.15 114.27745.80SIA (unit of sulfide) 1.0770.83 0.4870.36n


AST, aspartate aminotransferase; PlI, plaque index; GI, gingival index; PPD, probable pocket depth;

CAL, clinical attachment level; GCFV, gingival crevicular fluid volumes; SIA, sulfide ion activity.n po0.05.

Table12. Relationship between AST levels

and BANA hydrolysis at the control sites

examined

Parameter BANApositive

BANAnegative

AST positive 12 24

AST negative 15 23

AST, aspartate aminotransferase; BANA,

N -benzoyl-DL-arginine-2-naphthylamide.

Table 14. Comparison of periodontal pockets that bled on probing with the pockets that did notbleed on probing in the control group

AST positive Bleeding pockets Non-bleeding pockets

PlI 1.8870.33 270

GI 2.1070.30 170n

PPD (mm) 3.8071.65 470.82CAL (mm) 4.4171.73 470.82




AST, aspartate aminotransferase; PlI, plaque index; GI, gingival index; PPD, probable pocket depth;

CAL, clinical attachment level; GCFV, gingival crevicular fluid volumes; SIA, sulfide ion activity.n po0.05.


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pared, the scores of PlI, GI and PPDfindings of the diabetic group weresignificantly higher in both groups of analyses; however, only in site-basedanalysis in addition to these findings,CAL measurement was also signifi-cantly elevated in the diabetic group as

a result of periodontal disease beingmore destructive in this group of patientscompared with systemically healthypatients with chronic periodontitis.

In conclusion, we believe that thisstudy emphasizes the difficulties in thesimultaneous detection of several hostand microbial factors involved in dis-ease process. The GCF metabolites hadsignificant correlations with periodon-tally diseased sites in patients withchronic periodontitis, whether they werediabetic or systemically healthy. Althoughthese chairside tests may be useful in

routine control of these patients, andmay help to confirm clinical findings,the need for more studies still exists.

Acknowledgments

This work was supported by TheResearch Fund of Istanbul University,Project number: B-350/09022000.

Our thanks are due to Dr. WalterLoesche for supplying the BANA sys-tem and to Diamond General Develop-ment Corp. for supplying the DiamondProbes.

Zusammenfassung

Sukusfluid-Titer von Aspartat-Amino-Tansfer-

ase, Sulfid-Ionen und N-Benzoyl- DL -Arginin-2-

Naphthylamid bei diabetischen Patienten mit

chronischer Parodontitis

Grundlagen: Das Ziel dieser Studie war es, bei

diabetischen Patienten mit chronischer Paro-

dontitis die Korrelation zwischen Plaque-Index

(PlI), Gingiva-Index (GI), sondierbarer Taschen-

tiefe (PPD), klinischem Attachmentniveau (CAL),

Aspartat-Amino-Transferase (AST), N -Benzoyl-DL

-Arginin-2-Naphthylamid (BANA) und Sulfid-

Ionen-Aktivitat (SIA) in Bezug auf die Erkran-

kungsaktivitat, die durch AST-Titer nachgewie-sen wurde zu analysieren.

Material und Methoden: Eine Gesamtanzahl

von 95 Stellen von 8 diabetischen Patienten mit

chronischer Parodontitis und 74 Stellen von 8

systemisch gesunden Patienten mit chronischer

Parodontitis wurden in der Studie berucksich-

tigt. Die Patienten hatten keine fruhere Par-

odontalbehandlung oder irgendeine Antibioti-

katherapie wahrend der letzten 6 Monate und

waren Nichtraucher. Alle fur die Studie ausge-

wahlten Stellen hatten ein klinisches Attach-

mentniveau von wenigstens 2 mm. Die Volumina

des gingivalen Sulkusfluids (GCFV) wurden

an allen Stellen gemessen.

Ergebnisse: Entsprechend der Ergebnisse der

AST-Analyse waren in der diabetischen Gruppe

45 Stellen AST-positiv und 50 AST-negativ

sowie in der Kontrollgruppe 36 Stellen AST-

positiv und 38 AST-negativ. Sowohl in der

diabetischen als auch in der Kontrollgruppe gab

es eine signifikante Korrelation zwischen

BANA-Hydrolyse und PPD, aber keine Korre-

lation zwischen PPD und AST-Titern. Es wurdeeine signifikante Korrelation zwischen AST-

positven Stellen und dem GI beobachtet, jedoch

nicht zwischen GI und BANA-Hydrolyse. In

beiden Gruppen war die Korrelation zwischen

SIA und BANA-Hydrolyse signifikant, aber es

zeigte sich weder bei den diabetischen noch bei

den Kontrollpatienten eine Korrelation zwischen

SIA und AST-Titern.

Schlussfolgerung: Bei Patienten mit chron-

ischer Parodontitis, unabhangig davon ob dia-

betisch oder systemisch gesund, hatten die

GCF-Metabolite signifikante Korrelationen mit

parodontal erkrankten Stellen.

Re sume

Contexte: le but de cette etude est d’analyser

les correlations entre l’indice de plaque (PlI),

l’indice gingival (GI), la profondeur de poche

au sondage (PPD), le niveau clinique d’attache

(CAL), l’aspartate amino transferase (AST), le

N -benzoyl-DL-arginine-2-naphthylamide

(BANA) et l’activite des ions sulphide (SIA)

des patients diabetiques atteints de parodontite

chronique concernant l’activite de la maladie

determinee par les niveaux d’AST.

Materiel & Methodes: Un total de 95 sites

chez 8 patients diabetiques atteints de parodon-

tites chroniques et 74 sites chez 8 sujets sains

atteints de parodontite chronique furent enroles

dans cette etude. Les patients n’avaient pas

d’historique de traitement parodontal ou de

traitement antibiotique pendant les derniers 6

mois et ne fumaient pas. Tous les sites

selectionnes pour l’etude avaient des niveaux

d’attache d’au moins 2 mm. Les volumes de

fluides gingival (GCFV) furent mesures sur tous

les sites.

Resultats: Selon le resultat de l’analyse de

l’AST, 45 sites etaient positifs au test AST et 50

etaient negatifs. Dans le groupe diabetique

contre 36 sites positives et 38 sites negatifs

dans le groupe controle. Il y avait une

correlation significative entre l’hydrolyse au

BANA et la PPD dans les deux groupes, maisaucune correlation entre PPD et les niveaux

d’AST. Une correlation significative etait

visible entre les sites positifs a l’AST et le GI,

mais pas entre le GI et l’hydrolyse BANA.

Dans les deux groupes, la correlation entre SIA

et l’hydrolyse BANA etait significative, mais

aucune correlation n’etait notable entre SIA et

les niveaux d’AST dans aucun des groupes.

Conclusion: Les metabolites du GCF ont des

correlations significatives avec les sites au

parodonte malade chez les patients atteints de

parodontite chronique qu’ils soient diabetiques

ou en bonne sante, et cela pourrait aider a la

confirmation des decouvertes cliniques.

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Address:

E. Firatli

Department of Periodontology

School of Dentistry

Istanbul University

Capa 34390 Istanbul

Turkey

Fax: 190 216 346 1390

E-mail: [email protected]


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