The Role of Smoking and Gingival Crevicular Fluid Markers on Coronally Advanced Flap Outcomes

• Autores: Basak Kaval, Diane E. Renaud, David A. Scott, Nurcan Buduneli
• Localización: Journal of periodontology, ISSN 0022-3492, Nº. 3, 2014
• Idioma: inglés
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• Resumen

  • Background: This study evaluates possible effects of smoking on the following: 1) biochemical content in gingival crevicular fluid (GCF) samples from sites of gingival recession and saliva; and 2) clinical outcomes of coronally advanced flap (CAF) for root coverage.

    Methods: Eighteen defects in 15 patients were included in each of the smoker and non-smoker groups. Baseline cotinine, basic fibroblast growth factor, vascular endothelial growth factor, platelet-derived growth factor, interleukin (IL)-8, IL-10, IL-12, tumor necrosis factor-?, matrix metalloproteinase (MMP)-8, MMP-9, and plasminogen activator inhibitor-1 levels were determined in GCF and saliva samples. CAF with microsurgery technique was applied. Plaque index, papilla bleeding index, recession depth (RD), recession width (RW), and root surface area were evaluated at baseline and postoperative months 1, 3, and 6. Probing depth, clinical attachment level (CAL), and keratinized gingival width (KGW) was recorded at baseline and month 6. Percentage of root coverage and complete root coverage were calculated at postoperative months 1, 3, and 6.

    Results: All biochemical parameters were similar in the two groups apart from the definite difference in salivary cotinine concentrations (P = 0.000). Compared with the baseline values, RD, RW, CAL, and root surface area decreased, and KGW increased, with no significant difference between the study groups. CAL gain, percentage of root coverage, and complete root-coverage rates were similar in the study groups.

    Conclusion: Similar baseline biochemical data and comparably high success rates of root coverage with CAF in systemically and periodontally healthy smokers versus non-smokers suggest lack of adverse effects of smoking on clinical outcomes.

    The coronally advanced flap (CAF) is one of the most widely used surgical techniques for root coverage.1-3 Percentage of root coverage with CAF varies from 70% to 99%, and the percentage of teeth with complete root coverage has been reported to be 24% to 95%.3 Patient-related, site-related, and technique-related factors play determining roles in the amount of root coverage obtained.4 Cigarette smoking is a patient-related factor that can affect the success rate of root-coverage procedures. Neither the nature nor the mechanisms of action of cigarette smoking on root coverage are fully understood. Various animal and human studies revealed that cigarette smoking damages vascular and immunologic systems and reduces self-healing capacity of periodontal tissues.5-11 Smokers tend to respond less favorably to periodontal treatment procedures.12,13 Smoking has been reported to affect host cytokine levels in biofluids.13,14 However, the exact mechanisms by which smoking exerts detrimental effects on periodontal tissues remain unclear.

    At present, there is no clear understanding of the pathology or the molecular events occurring in the periodontal microenvironment during the tissue breakdown process15 or wound healing after periodontal treatment. Wound healing in periodontium comprises complex events orchestrated by neutrophils, platelets, and macrophages. These cells are sources for the major cytokines, such as interleukins (ILs), tumor necrosis factor-alpha (TNF-?), growth factors, and matrix metalloproteinases (MMPs), all acting in tissue remodeling.

    CAF can be used alone or in combination with a connective tissue (CT) graft. Gingival thickness is the most critical determining factor for choosing the appropriate surgical technique because complete root coverage is closely related with initial thickness of gingiva. A threshold gingival thickness for complete root coverage has been suggested in some studies,1,16,17 but these studies vary in treatment procedure, measurement technique, and exact location of measurement of gingival thickness, as well as statistical handling of data. Therefore, no consensus exists so far on adequate baseline gingival thickness to achieve complete root coverage with CAF.

    Few studies have been published that were specifically designed to address the possible effects of smoking on the success of root coverage with CAF.18,19 The extant data suggest that smoking is associated with greater residual recession in a small number of individuals followed for up to 2 years after surgery.18,19 Furthermore, the underlying mechanisms are, essentially, unresolved.

    Therefore, the hypothesis that cigarette smoking has negative impacts on the outcomes of root coverage after CAF surgery in systemically healthy individuals with an initial gingival thickness of at least 0.8 mm and who practice optimal oral hygiene was tested. It was also hypothesized that baseline analysis of disease-related biomarkers would shed light on the underlying mechanisms of a possible effect.