title: Early Healing Events after Periodontal Surgery: Observations on Soft Tissue Healing, Microcirculation, and Wound Fluid Cytokine Levels.
abstract: Early wound healing after periodontal surgery with or without enamel matrix derivative/biphasic calcium phosphate (EMD/BCP) was characterized in terms of soft tissue closure, changes of microcirculation, and expression of pro- and anti-inflammatory cytokines in gingival crevicular fluid/wound fluid (GCF/WF). Periodontal surgery was carried out in 30 patients (18 patients: application of EMD/BCP for regeneration of bony defects; 12 patients: surgical crown lengthening (SCL)). Healthy sites were observed as untreated controls. GCF/WF samples were collected during two post-surgical weeks. Flap microcirculation was measured using laser Doppler flowmetry (LDF). Soft tissue healing was evaluated after two weeks. GCF/WF levels of interleukin 1β (IL-1β), tumour necrosis factor (TNF-α), IL-6, and IL-10 were determined using a multiplex immunoassay. Surgery caused similar reductions of flap microcirculation followed by recovery within two weeks in both EMD/BCP and SCL groups. GCF/WF and pro-inflammatory cytokine levels were immediately increased after surgery, and returned only partially to baseline levels within the two-week observation period. Levels of IL-10 were temporarily reduced in all surgical sites. Flap dehiscence caused prolonged elevated levels of GCF/WF, IL-1β, and TNF-α. These findings show that periodontal surgery triggers an immediate inflammatory reaction corresponding to the early inflammatory phase of wound healing, and these inflammation measures are temporary in case of maintained closure of the flap. However, flap dehiscence causes prolonged inflammatory exudation from the periodontal wound. If the biological pre-conditions for periodontal wound healing are considered important for the clinical outcome, care should be taken to maintain primary closure of the flap.
authors.affiliation: Department of Periodontology, Witten/Herdecke University, 58455 Witten, Germany. dogan.kaner@uni-wh.de.
authors.forename: Doğan
authors.initials: D
authors.lastname: Kaner
authors.affiliation: Department of Periodontology, Witten/Herdecke University, 58455 Witten, Germany. mouaz.soudan@uni-wh.de.
authors.forename: Mouaz
authors.initials: M
authors.lastname: Soudan
authors.affiliation: Multi-Disciplinary Treatment Center, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China. z75301704@163.com.
authors.forename: Han
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Hochschule, University of applied sciences, 50670 Cologne, Germany. g.gassmann@praxishochschule.de.
authors.forename: Georg
authors.initials: G
authors.lastname: Gaßmann
authors.affiliation: Department of Periodontology, Witten/Herdecke University, 58455 Witten, Germany. anna-frederike.schoenhauser@uni-wh.de.
authors.forename: Anna
authors.initials: A
authors.lastname: Schönhauser
authors.affiliation: Department of Periodontology, Witten/Herdecke University, 58455 Witten, Germany. anton.friedmann@uni-wh.de.
authors.forename: Anton
authors.initials: A
authors.lastname: Friedmann
mesh_terms: D000368:Aged; D002130:Calcium Phosphates / Q000494:pharmacology; D016207:Cytokines / Q000378:metabolism*; D003710:Demography; D005260:Female; D005883:Gingival Crevicular Fluid / Q000378:metabolism*; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D010519:Periodontium / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D014945:Wound Healing
chemical_list: D002130:Calcium Phosphates; D016207:Cytokines; D014409:Tumor Necrosis Factor-alpha; C020243:calcium phosphate
keywords: cytokines; periodontal regeneration; periodontal surgery; surgical crown lengthening; wound healing