A clinical and biochemical investigation on the effects of non-surgical periodontal treatment of chronic and aggressive periodontitis. A comparative study.
Citation:GAZAL, LUBNA BASHEIR, A clinical and biochemical investigation on the effects of non-surgical periodontal treatment of chronic and aggressive periodontitis: a comparative study, Trinity College Dublin. School of Dental Sciences, 2018
Final Lubna Alghazal thesis.docx (PhD thesis, final) 64.14Mb
Although Chronic (CP) and Aggressive Periodontitis (GAP) were classified in the 1999 world workshop and specific defining characteristics have been identified in this classification, clinically it is difficult to differentiate between the two groups. Additionally, earlier studies have extensively investigated how chronic periodontitis patients respond to non-surgical treatment, but only very few studies investigated this same response for GAP patients. Comparative studies are not only limited and underpowered but also heterogeneous in the way the two periodontitis groups are diagnosed. The aim of the study was to test the hypothesis of a different clinical and immunological response to non-surgical therapy in subjects with aggressive periodontitis when compared to the response of subjects with chronic periodontitis. Following examination, patients were diagnosed with either chronic periodontitis or generalized aggressive periodontitis. During the recruitment of patients, if the patient fulfilled the inclusion criteria, oral hygiene instructions along with smoking cessation advice was given. In suitable patients who agreed to participate in the study, a consent form was given for signing and a numerical code was assigned to them. In the same visit GCF samples were collected. The treatment commenced by performing scaling and root debridement, two quadrants at a time beginning with the right side quadrants. An initial recall visit was scheduled 6 weeks following therapy for oral hygiene reinforcement and re-evaluation was performed 3 months following the initial treatment. Two operators carried out the treatments and collected the specified data. The clinical measurements were done by one calibrated examiner to reduce any inter examiner bias. The GCF samples were collected preoperatively from the deepest pocket in each patient by using the gingival fluid collection strips also known as Perio-paper from the deepest pocket. Postoperative samples were also collected from the same site 3 months following completion of treatment. Analysis of the samples was done by using BD (CBA) Human Inflammatory Cytokine Kit and testing for IL-8, IL-6, IL-1β, IL-10, IL-12p70, TNFβ. Dependent t-tests (or the non-parametric equivalent) were used to compare the response to treatment within the same group, while independent t-test (or the non-parametric equivalent) were used to compare the difference in response to treatment in-between groups. Overall, both AP and CP patients showed notable improvements in clinical parameters in response to therapy and no significant differences were found between GAP and CP subjects. Furthermore, immunological profiles did not show significant differences between the two groups. However, clinical attachment loss was observed in the deep sites of the CP group. Comparing the two groups, no significant differences were observed between GAP and CP at baseline and 3months re-evaluation, apart from the significantly better CALs (Clinical Attachment Levels) in the GAP group following treatment. At baseline and in moderately deep pockets, CAL was higher in the CP group than in the GAP. Following treatment there was a statistical significant attachment gain for both groups but more marked in CP patients. No CAL gain was observed in the shallow and deep sites of the CP patients. Following the exclusion of smokers in both groups and on a patient level, CALs showed similar improvement with no statistical difference between groups. Immunological investigations demonstrated increased levels of IL-1β; in GAP as it was recorded to be twice as high as the concentration of IL-1β; in the CP group. However, both groups showed significant reduction after treatment with no statistical significant difference between CP and GAP samples.
Author: GAZAL, LUBNA BASHEIR
Publisher:Trinity College Dublin. School of Dental Sciences. Discipline of Dental Science
Type of material:Thesis
Availability:Full text available