Graduation Date

Summer 8-11-2023

Document Type

Thesis

Degree Name

Master of Science (MS)

Programs

Medical Sciences Interdepartmental Area

First Advisor

Rick Reinhardt, D.D.S. Ph.D.

Abstract

The purpose of this prospective cohort pilot study was to investigate the association of the periodontal status and inflammatory markers from the gingival crevicular and wound fluid with the healing outcomes following tooth extraction. The central research hypothesis is that extraction sites and the adjacent teeth that exhibit increased markers of inflammation, or decreased growth factors, at baseline or 2 weeks will be associated with reduced healing outcomes observed radiographically 3 months following surgery. Nine patients at the UNMC College of Dentistry who were seeking care to extract a posterior tooth due to advanced periodontal bone loss, non-restorable caries or fracture were recruited. Health history, periodontal indices including periodontal probing depth (PPD), recession (REC), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded on the tooth to be extracted and its neighboring teeth. Gingival crevicular fluid (GCF) was collected using collection strips from the tooth to be extracted and its neighboring teeth. Also, a limited cone beam computed tomography scan (CBCT) was taken. Routine atraumatic dental extraction under local anesthesia was completed. GCF from the neighboring teeth and wound fluid from the healing extraction socket were collected at 2 weeks. After 3 months a CBCT scan was taken. A multiplex immunoassay was used to measure nineteen analytes: fibroblast growth factor-2 (FGF-2), interleukin (IL)-1β, IL-4, IL-6, IL-10, IL-12 (p40), IL-12 (p70), IL-13, IL17A, IL-22, IL-27, tumor necrosis factor (TNF)-α, vascular endothelial growth factor A (VEGF-A), granulocyte macrophage colony-stimulating factor (GM-CSF), macrophage colony-stimulating factor (M-CSF), platelet derived growth factor (PDGF-AA), transforming growth factor alpha (TGF-α), interferon gamma (INF-y) and monocyte chemoattractant protein-1 (MCP-1) . Also, the post extraction ridge dimensions were measured as well as the radiodensity of the extraction socket.

The results revealed the following associations: 1. There was a positive correlation between a reduction in vertical ridge height over a 3-month period and the proinflammatory index IL-1β/IL-22 measured at 2 weeks (r=0.71, p=0.046). 2. A decrease in horizontal ridge width over 3 months was positively associated to baseline levels of INF-γ (r=0.83, p=0.01) and IL-12(p40) (r=0.81, p=0.01), as well as 2-week proinflammatory TNF-α (r=0.90, p=0.002). It was also negatively associated with baseline IL-6 (r=-0.71, p=0.046). 3. The average socket bone density after 3 months showed a positive correlation with baseline IL-12(p40) (r=0.72, p=0.04) and 2-week growth factors FGF (r=0.75, p=0.03), PDGF (r=0.71, p=0.049), VEGF (r=0.74, p=0.04), cytokines IL-6 (r=0.81, p=0.01) and IL-10 (r=0.81, p=0.01) and proinflammatory indices IL-1β/IL-22 (r=0.90, p=0.002) and IL-1β/TGF-α (r=0.98, p

These findings suggest that the presence of bone regeneration growth factors and a balanced inflammatory response during the early stages of wound healing are crucial for creating an environment conducive to timely placement of dental implants.

Comments

2023 Copyright, the authors

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