Clinical, microbiological and immunological features associated with the treatment of active periodontosis lesions

Abstract

Clinical, microbiological and immunological factors were examined using data from a subject with periodontosis. The subject was monitored at bimonthly intervals of 26 mo. at 6 sites/tooth for redness, plaque, suppuration, bleeding on probing, pocket depth and attachment level. Using attachment level measurements and the tolerance method of analysis, sites with active disease and control (inactive) sites of equal pocket depth were selected. Subgingival plaque samples were taken from these sites for predominant cultivable and darkfield evaluation before, and 5 and 13 mo. after treatment by Widman flap surgery and systemic tetracycline. From each of 5 sites monitored before and after treatment, 50 isolates were characterized and, if possible, identified. Active sites showed 2-6 mm of attachment loss prior to therapy and gained 2-9 mm of attachment after therapy. The control sites gained 0-1 mm of attachment after therapy. Bleeding on probing was significantly reduced after treatment. Plaque accumulation increased significantly in the sampled sites. Similar changes were seen in the remaining sites. The proportions of Actinobacillus actinomycetemcomitans and Selenomonas sputigena were elevated in active sites; proportions of Bacteroides intermedius were elevated in control sites. At 5 mo. after treatment, proportions of A. actinomycetemcomitans, S. sputigena and Eikenella corrodens were significantly decreased in the previously active sites and proportions of B. intermedius and E. corrodens were significantly decreased in the control sites. At 13 mo. after therapy, the proportions of Fusobacterium nucleatum and Capnocytophaga sp. had increased. Multiple linear regression analysis was used to examine models which could predict the outcome (attachment level change in the previous monitoring period). The proportions of A. actinomycetemcomitans and S. sputigena, which were associated with destruction, coupled with the proportions of Streptococcus sanguis II and Campylobacter concisus, which were associated with gain, could predict prior attachment level change with an r2 of 0.93. Humoral antibody response to A. actinomycetemcomitans and S. sputigena significantly increased in a period in which multiple actively breaking down sites were detected. Antibody responses to 20 other species tested did not significantly change during the course of monitoring. Crevicular fluid and tissue levels of antibody to A. actinomycetemcomitans were elevated in 5 of 6 active destructive lesions prior to therapy. Surgical and tetracycline therapy diminished the local antibody response to A. actinomycetemcomitans to levels found in serum.