title: The effect of gingival retraction procedures on periodontal indices and crevicular fluid cytokine levels: a pilot study.
abstract: OBJECTIVE
  The purpose of this study was to examine the effects of placement of retraction cord subgingivally upon periodontal indices including plaque index (PI), gingival index (GI), pocket depth (PD), bleeding on probing (BOP), and attachment level (AL), as well as gingival crevicular fluid (GCF) and TNF-alpha levels.
  
  
  METHODS
  Ten teeth in 6 patients who were periodontally healthy were selected. These teeth had pocket depths of 3 mm or less, no evidence of significant loss of attachment, BOP, or plaque accumulation. The patients each received an oral prophylaxis. The following week, baseline measurements of periodontal indices and TNF-alpha were taken and the retraction cord was placed for 15 minutes. Following removal, the patients were dismissed. The periodontal indices measured included PI, GI, PD, BOP, and AL. In addition, the levels of TNF-alpha in GCF, were investigated. These measurements were made before gingival retraction as a baseline and on the 1st, 3rd, 7th, 14th, and 28th days post retraction.
  
  
  RESULTS
  A repeated measures ANOVA showed that TNF-alpha levels in GCF were significantly increased at all five intervals after gingival retraction compared to the baseline. The mean TNF-alpha level peaked at Day 1 (0.90 +/- 0.62), then declined at Days 3 (0.53 +/- 0.16), 7 (0.43 +/- 0.08), 14 (0.47 +/- 0.10), and 28 (0.43 +/- 0.08) but was still elevated 54% above baseline at Day 28, p < 0.01. The GI was significantly elevated at Day 1 (0.9 +/- 0.49), p < 0.01; Day 3 (0.53 +/- 0.32); and Day 7 (0.33 +/- 0.33), p < 0.05. Unlike TNF-alpha, GI recovered to the baseline by day 14. Other periodontal parameters, PI, PD, BOP, and AL were not significantly altered by the gingival retraction procedure.
  
  
  CONCLUSIONS
  This pilot study supports the previous research that gingival retraction causes an acute injury that heals clinically in 2 weeks as is indicated by the GI. It also provides the first evidence that gingival retraction results in an elevation of the proinflammatory cytokine, TNF-alpha, in GCF.
authors.affiliation: New Jersey Dental School, Newark, 07103, USA.
authors.forename: Jian
authors.initials: J
authors.lastname: Feng
authors.forename: Hoda
authors.initials: H
authors.lastname: Aboyoussef
authors.forename: Saul
authors.initials: S
authors.lastname: Weiner
authors.forename: Surendra
authors.initials: S
authors.lastname: Singh
authors.forename: John
authors.initials: J
authors.lastname: Jandinski
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D003764:Dental Materials / Q000009:adverse effects*; D005883:Gingival Crevicular Fluid / Q000737:chemistry*; D006801:Humans; D008875:Middle Aged; D010512:Periodontal Index; D010865:Pilot Projects; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
chemical_list: D003764:Dental Materials; D014409:Tumor Necrosis Factor-alpha