Abstract
BackgroundOxidative stress and matrix metalloproteinases -9 and -2 are involved in periodontal breakdown, whereas gingival crevicular fluid has been reported to reflect apical status. The aim of this study was to characterize oxidant balance and activity levels of MMP -2 and -9 in apical lesions and healthy periodontal ligament; and second, to determine whether potential changes in oxidant balance were reflected in gingival crevicular fluid from asymptomatic apical periodontitis (AAP)-affected teeth at baseline and after endodontic treatment.MethodsPatients with clinical diagnosis of AAP and healthy volunteers having indication of tooth extraction were recruited. Apical lesions and healthy periodontal ligaments, respectively, were homogenized or processed to obtain histological tissue sections. Matrix metalloproteinase -9 and -2 levels and/or activity were analyzed by Immunowestern blot, zymography and consecutive densitometric analysis, and their tissue localization was confirmed by immunohistochemistry. A second group of patients with AAP and indication of endodontic treatment was recruited. Gingival crevicular fluid was extracted from AAP-affected teeth at baseline, after endodontic treatment and healthy contralateral teeth. Total oxidant and antioxidant status were determined in homogenized tissue and GCF samples. Statistical analysis was performed using STATA v10 software with unpaired t test, Mann-Whitney test and Spearman's correlation.ResultsActivity of MMP-2 and MMP-9 along with oxidant status were higher in apical lesions (p < 0.05). Total oxidant status correlated positively with matrix metalloproteinase-2 and lesion size (p < 0.05). Gingival crevicular fluid showed significantly lower levels of total antioxidant status in diseased teeth at baseline compared to controls and endodontically-treated groups.ConclusionsApical lesions display an oxidant imbalance along with increased activity of matrix metalloproteinase-2 and -9 and might contribute to AAP progression. Oxidant imbalance can also be reflected in GCF from AAP-affected teeth and was restored to normal levels after conservative endodontic treatment. These mediators might be useful as potential biomarkers for chair-side complementary diagnostic of apical status in GCF.
Highlights
Asymptomatic apical periodontitis (AAP) corresponds to the inflammation and destruction of periradicular tissues caused by bacterial infection of dental pulp
Apical lesions and healthy periodontal ligament Matrix metalloproteinases (MMPs)-9 and MMP-2 enzymatic forms were detected by gelatin zymography in all tissue homogenates from apical lesions and healthy periodontal ligaments (Figure 2A)
Changes in gingival crevicular fluid (GCF) composition, involving higher gelatinase activity [16] and protein concentration, were reported in AAP in comparison to healthy controls [17]. These studies provide preliminary evidence supporting that GCF might reflect the health status of the apical tissues, as well as apical disease progression. In line with these reports, the present study shows the occurrence of an oxidant imbalance in apical lesions and in GCF from AAP teeth, whereas endodontic treatment appears to restore antioxidant status to its normal levels
Summary
Asymptomatic apical periodontitis (AAP) corresponds to the inflammation and destruction of periradicular tissues caused by bacterial infection of dental pulp. It is the most common consequence of untreated dental caries and leads frequently to tooth loss. Oxidative stress and matrix metalloproteinases -9 and -2 are involved in periodontal breakdown, whereas gingival crevicular fluid has been reported to reflect apical status. The aim of this study was to characterize oxidant balance and activity levels of MMP -2 and -9 in apical lesions and healthy periodontal ligament; and second, to determine whether potential changes in oxidant balance were reflected in gingival crevicular fluid from asymptomatic apical periodontitis (AAP)-affected teeth at baseline and after endodontic treatment
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