Espressione di biomarcatori specifici del cemento nel fluido crevicolare gengivale a diversi intervalli di guarigione dopo la rigenerazione parodontale: studio prospettico controllato

Aim: Periodontal regeneration requires full knowledge of the timing and quantity of expression of cell signaling proteins that guide the formation of new periodontal tissues. Levels of cytokines, chemokines, and angiogenic biomarkers within the gingival crevicular fluid and in periodontal wound fluid have been studied in clinical trials to assess the ongoing angiogenesis, connective tissue, and bone formation activities during wound-healing phases. In clinical practice, the evaluation of cementogenesis by analysis of wound fluid can be useful to predict the success of periodontal regeneration and to support the development of further regenerative approaches. Cementum protein-1 (CEMP-1) and Cementum attachment protein (CAP) are found to be a tissue-specific protein for cementum and are believed to regulate the biological activity of cementum and periodontal cells. The aim of the present study was to assess if regenerative periodontal surgery might affect levels of CEMP-1 and CAP in periodontal wound fluid during initial healing. Materials and Methods: In 8 patients, who met the inclusion criteria,11 intrabony periodontal defects ≥3mm associated with periodontal pockets >5mm were treated with regenerative therapy. Each patient also contributed 1 healthy site as a control. The surgical technique involved a minimally invasive approach with papilla preservation and use of deproteinized bovine bone and amelogenins. Crevicular fluid sampling was performed before surgery, at 15 days, at 3, 4, 6, 8 weeks. Clinical and radiographic data were recorded at T0 and 6 months. CEMP-1 and CAP levels were detected by indirect enzyme-linked immunosorbent assay technique. Results: The repeated measures-ANOVA for CEMP-1 concentration levels in the treated tooth throughout the treatment shows a statistically significant difference between the values (F[5, 50]=6.50, p <.001). In addition, trend analysis confirms a linear trend, indicating a consistent pattern of change over time (t = 3.964, p = .003). No statistically significant difference was found between CEMP-1 concentrations in the treated tooth and in the control (p = .831, and p = 123, respectively). The repeated measures-ANOVA for the CAP concentration levels in the treated tooth throughout the treatment shows a statistically significant difference between the values (F[5, 50]=3.38, p = .005). There is both a statistically significant difference in CAP concentrations in treated teeth between BL and W8 (p = .007) and a linear trend in trend analysis (t = 5.261, p < .001). A statistically significant difference could be observed between CAP concentrations between BL-treated and control sites (p =.014). Conclusions: The results – in terms of differences between the concentrations between the various samples obtained from the test sites, and between BL and W8 values – suggest that the concentration of CEMP-1 in the treated tooth may reflect the response to treatment. However, despite this observable variation, the lack of a direct correlation between this variation and clinical improvement of the treated tooth may limit the usefulness of CEMP-1 as an indicator of therapeutic success. On the contrary - regarding CAP - we were able to observe both the same differences in terms of concentration previously described for CEMP-1, with in addition, a relationship between the reduction of differences in CAP levels and the clinical data of improvement; this framework would support the hypothesis that CAP can be a reliable indicator of therapeutic efficacy.