The utility of gingival crevicular fluid matrix metalloproteinase-8 response patterns in prediction of site-level clinical treatment outcome.
BACKGROUND
Different gingival crevicular fluid (GCF) matrix metalloproteinase (MMP)-8 response patterns were studied among non-smoking and smoking patients with chronic periodontitis (CP) and generalized aggressive periodontitis (GAgP) to test the utility of GCF MMP-8 levels predicting the site-level treatment outcome.


METHODS
Data from four independent longitudinal studies were combined. Altogether, the studies included 158 periodontal sites from 67 patients with CP and 32 patients with GAgP, and GCF samples were collected at baseline, after the treatment, and during the 6-month maintenance period. All GCF samples were analyzed by immunofluorometric assay for MMP-8. Different site-level MMP-8 response patterns were explored by the cluster analysis. Most optimal MMP-8 cutoff levels were searched with receiver operating characteristic analyses, and the predictive utility of defined levels was tested.


RESULTS
Distinct types of MMP-8 response patterns were found in both smokers and non-smokers. MMP-8 levels exceeding the optimal cutoff levels separately defined for smokers and non-smokers indicated increased risk for compromised treatment outcome at baseline and during the maintenance period. Seventy-one percent of non-smokers (positive likelihood ratio of 4.22) and 88% of smokers (positive likelihood ratio of 5.00) with positive test results at both baseline and the maintenance period had compromised treatment outcome. The double-positive result indicated 46% and 39% point risk increase for the compromised outcome, respectively.


CONCLUSIONS
GCF MMP-8 analysis with defined cutoff levels could be used to predict the site-level treatment outcome and for longitudinal monitoring of the disease status during the maintenance period.
*Institute of Dentistry, University of Helsinki, Helsinki, Finland.
Jussi M
JM
Leppilahti
*Institute of Dentistry, University of Helsinki, Helsinki, Finland.|†Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Helsinki, Finland.|‡Division of Periodontology, Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden.
Timo
T
Sorsa
§Department of Information and Computer Science, Aalto University, Helsinki, Finland.
Mikko A
MA
Kallio
*Institute of Dentistry, University of Helsinki, Helsinki, Finland.
Taina
T
Tervahartiala
‖Department of Periodontology, School of Dentistry, Ege University, İzmir, Turkey.
Gülnur
G
Emingil
‖Department of Periodontology, School of Dentistry, Ege University, İzmir, Turkey.
Buket
B
Han
*Institute of Dentistry, University of Helsinki, Helsinki, Finland.
Päivi
P
Mäntylä
D010520:Aggressive Periodontitis / Q000201:enzymology / Q000517:prevention & control / Q000628:therapy*; D015415:Biomarkers / Q000032:analysis; D055113:Chronic Periodontitis / Q000201:enzymology / Q000517:prevention & control / Q000628:therapy*; D016000:Cluster Analysis; D012534:Dental Scaling / Q000379:methods; D005500:Follow-Up Studies; D005544:Forecasting; D005883:Gingival Crevicular Fluid / Q000201:enzymology*; D005889:Gingival Recession / Q000201:enzymology / Q000517:prevention & control / Q000628:therapy; D006801:Humans; D008137:Longitudinal Studies; D020784:Matrix Metalloproteinase 8 / Q000032:analysis*; D009910:Oral Hygiene / Q000193:education; D017622:Periodontal Attachment Loss / Q000201:enzymology / Q000517:prevention & control / Q000628:therapy; D010514:Periodontal Pocket / Q000201:enzymology / Q000517:prevention & control / Q000628:therapy; D012372:ROC Curve; D016745:Root Planing / Q000379:methods; D012907:Smoking; D016896:Treatment Outcome
D015415:Biomarkers; C488762:MMP8 protein, human; D020784:Matrix Metalloproteinase 8
Aggressive periodontitis; chronic periodontitis; cluster analysis; gingival crevicular fluid; longitudinal studies; matrix metalloproteinase 8.