Rakmanee, T.; (2009) Wound healing and growth mediators in aggressive periodontitis. Doctoral thesis , UCL (University College London).

Abstract

There is little definitive information about the outcome of guided tissue regeneration (GTR) and access flap surgery (AF) in aggressive periodontitis (AgP) patients. This study is the first randomised controlled trial to assess the clinical and radiographic outcomes of both treatments, using 18 AgP patients. The results showed that both therapies were effective in the treatment of intrabony defects in AgP patients, although no significant differences between them could be demonstrated. To determine whether changes in the production of specific wound healing mediators are associated with the successful outcome of periodontal surgery, gingival crevicular fluid (GCF) was collected from affected (GTR and AF sites) and healthy non-affected control areas at various times post-surgery and the components analysed. In contrast to previous studies using conventional enzyme-linked immunosorbent assay (ELISA) which measures only one mediator, the present study developed, validated and then successfully utilised a multiplex-bead-assay (MBA) to simultaneously measure multiple growth factors in small volumes of GCF. These included angiopoietin-1 (Ang-1), vascular-endothelial growth-factor (VEGF), bone morphogenetic protein-2 (BMP-2), osteoprotegerin (OPG), tissue-inhibitor of matrix metalloproteinase-1 (TIMP-1), basicfibroblast growth-factor (bFGF), keratinocyte growth-factor (KGF) and platelet-derived growth-factor-AB (PDGF-AB). GCF volumes were found to significantly increase at all sites 3-7 days post-surgery but thereafter declined to baseline levels except for the GTR sites, which remained elevated even at 42±3 days. Increased amounts of the 8 mediators were observed in the GCF of all groups compared with the baseline pre-surgery, with the GTR group having significantly more Ang-1, OPG and TIMP-1 at 3-5 days and BMP-2 at 7±1 days postsurgery. The GCF at the GTR sites also contained significantly greater amounts of Ang-1, VEGF, BMP-2 and OPG compared with the unaffected control sites, but there were no significant differences in the amounts of any of the mediators between the GTR and AF groups. Notably, the amount of KGF and the concentration of PDGF-AB in GCF were found to be significantly associated with a successful clinical outcome at both 6 and 12 months following GTR surgery. In conclusion, although the clinical outcomes did not differ significantly between the 2 surgical treatments of the AgP patients, each therapy was found to differentially affect the profiles of the mediators in GCF post-operatively. Moreover, the new MBA which was developed here was capable of successfully measuring multiple components in small volumes of GCF, indicating that this technique might also be of value in assessing the specific molecular changes in other healing wound fluids, and thus possibly a useful prognostic indicator of the outcome of clinical intervention.

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