Evaluation of Non-Surgical Periodontal Treatment on Salivary Biomarkers in Patients Undergoing Bisphosphonate Therapy

Başak Karasu; Gönen Özcan; Sıla Çağrı İşler; Gülçin Akca; Ozlem Kaymaz; Sinem Bozkurt

doi:10.7126/cumudj.1411790

TR EN

Evaluation of Non-Surgical Periodontal Treatment on Salivary Biomarkers in Patients Undergoing Bisphosphonate Therapy

Abstract

Objectives: Similar mechanisms and risk factors are considered to involve in the progression of osteoporosis and periodontitis. Bisphosphonates present anti-inflammatory activity and inhibit the release of proinflammator cytokines. Therefore their use as an adjunct to non-surgical periodontal treatment has been introduced. This study aimed to evaluate the effect of non-surgical periodontal treatment and medical treatment of osteoporosis by bisphosphonates on the clinical outcomes and salivary levels of interleukine- 1 beta (IL-1β) , interleukine-17, (IL-17) and 8-Hydroxy-deoxyguanosine (8-OHdG). Materials and Methods: 25 postmenopausal women with periodontitis and osteoporosis (group 1), 25 systemically healthy patients with periodontitis (group 2) and 25 systemically and periodontally healthy individuals (group 3) were enrolled in this study. In the group 1, patients who used systemic alendronate once weekly (70 mg) for at least 3 months, were included. Clinical parameters (plaque index, gingival index, bleeding on probing, probing depth and clinical attachment loss) and saliva samples were analyzed at baseline, 1 month and 3 months after non-surgical therapy. Results: All clinical parameters were significantly higher in osteoporotic patients than in the systemically healthy group (p<0.05). Clinical parameters were significantly reduced at 1 and 3 months as compared to the baseline after the periodontal treatment for group 1 and 2 (p<0.05). The mean IL-1β, IL-17 and 8-OHdG levels were significantly higher in groups 1 and 2 compared to group 3 (p<0.001). 1- and 3-month evaluations revealed significant reductions in IL-1β, IL-17 and 8- OHdG compared to the baseline values in both group 1 and group 2 (p<0.05). Significantly higher 8-OHdG levels were noted in group 1 compared to group 2 at baseline. There was no significant difference in terms of clinical parameters and biomarkers between group 1 and 2 after periodontal therapy. Conclusions: Patients on BPs therapy seemed to be affected similarly by the initial periodontal treatment with regard to periodontal parameters and salivary biomarkers. Osteoporosis may play a role in periodontitis progression and lead to additional oxidative stress in periodontal tissues. Reductions in oxidative stress, inflammatory marker levels and clinical parameters following therapy demonstrate that non-surgical periodontal treatment is of utmost importance in osteoporosis patients. However bisphosphonates may not have a significant effect on clinical parameters in short term.

Keywords

References

1. Papapanou PN. Sanz M. Buduneli N. et al. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions. Journal of periodontology. 2018;89:S173-S182.
2. Gupta N. Gupta ND. Garg S. et al. The effect of type 2 diabetes mellitus and smoking on periodontal parameters and salivary matrix metalloproteinase-8 levels. Journal of oral science. 2016;58(1):1-6.
3. Hernández‐Vigueras S. Martínez‐Garriga B. Sánchez MC. et al. Oral microbiota. periodontal status. and osteoporosis in postmenopausal females. Journal of periodontology. 2016;87(2):124-133.
4. Von Wowern N. Klausen B. Kollerup G. Osteoporosis: a risk factor in periodontal disease. Journal of periodontology. 1994;65(12):1134-1138.
5. Yu B. Wang CY. Osteoporosis and periodontal diseases–An update on their association and mechanistic links. Periodontology 2000. 2022.
6. Heitz‐Mayfield L. Trombelli L. Heitz F. Needleman I. Moles D. A systematic review of the effect of surgical debridement vs. non‐surgical debridement for the treatment of chronic periodontitis. Journal of clinical periodontology. 2002;29:92-102.
7. Jiao J. Shi D. Cao Zq. et al. Effectiveness of non‐surgical periodontal therapy in a large Chinese population with chronic periodontitis. Journal of clinical periodontology. 2017;44(1):42-50.
8. Takane M. Sugano N. Ezawa T. Uchiyama T. Ito K. A marker of oxidative stress in saliva: association with periodontally-involved teeth of a hopeless prognosis. Journal of oral science. 2005;47(1):53-57.

9. Sezer U. Çiçek Y. Çanakçi CF. Increased salivary levels of 8-hydroxydeoxyguanosine may be a marker for disease activity for periodontitis. Disease Markers. 2012;32(3):165-172.
10. Konopka Ł. Pietrzak A. Brzezińska‐Błaszczyk E. Effect of scaling and root planing on interleukin‐1β. interleukin‐8 and MMP‐8 levels in gingival crevicular fluid from chronic periodontitis patients. Journal of periodontal research. 2012;47(6):681-688.
11. Kaushik R. Yeltiwar RK. Pushpanshu K. Salivary interleukin‐1β levels in patients with chronic periodontitis before and after periodontal phase I therapy and healthy controls: A case‐control study. Journal of Periodontology. 2011;82(9):1353-1359.
12. Ruggiero SL. Dodson TB. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaws-2014 update. Journal of Oral and Maxillofacial Surgery. 2014;12(72):2381-2382.
13. Pradeep AR. Kumari M. Rao NS. Naik SB. 1% alendronate gel as local drug delivery in the treatment of Class II furcation defects: a randomized controlled clinical trial. J Periodontol. 2013;84(3):307-315.
14. Sharma A. Pradeep AR. Clinical efficacy of 1% alendronate gel as a local drug delivery system in the treatment of chronic periodontitis: a randomized. controlled clinical trial. J Periodontol. 2012;83(1):11-18.
15. Koçer G. Nazıroğlu M. Çelik Ö. et al. Basic fibroblast growth factor attenuates bisphosphonate-induced oxidative injury but decreases zinc and copper levels in oral epithelium of rat. Biological trace element research. 2013;153(1):251-256.
16. Estilo CL. Van Poznak CH. Wiliams T. et al. Osteonecrosis of the maxilla and mandible in patients with advanced cancer treated with bisphosphonate therapy. The oncologist. 2008;13(8):911-920.
17. Marx RE. Sawatari Y. Fortin M. Broumand V. Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors. recognition. prevention. and treatment. J Oral Maxillofac Surg. 2005;63(11):1567-1575.
18. Akram Z. Abduljabbar T. Kellesarian SV. Abu Hassan MI. Javed F. Vohra F. Efficacy of bisphosphonate as an adjunct to nonsurgical periodontal therapy in the management of periodontal disease: a systematic review. Br J Clin Pharmacol. 2017;83(3):444-454.
19. Cheng R. Wu Z. Li M. Shao M. Hu T. Interleukin-1β is a potential therapeutic target for periodontitis: a narrative review. International journal of oral science. 2020;12(1):2.
20. Rahnama M. Jastrzębska I. Jamrogiewicz R. Kocki J. IL-1 α and IL-1 β levels in blood serum and saliva of menopausal women. Endocrine Research. 2013;38(2):69-76.
21. Tsang Y. Corbet E. Jin L. Subgingival glycine powder air‐polishing as an additional approach to nonsurgical periodontal therapy in subjects with untreated chronic periodontitis. Journal of Periodontal Research. 2018;53(3):440-445.
22. Sağlam M. Köseoğlu S. Taşdemir I. Erbak Yılmaz H. Savran L. Sütçü R. Combined application of Er: YAG and Nd: YAG lasers in treatment of chronic periodontitis. A split‐mouth. single‐blind. randomized controlled trial. Journal of periodontal research. 2017;52(5):853-862.
23. Yang X. Li C. Pan Y. The influences of periodontal status and periodontal pathogen quantity on salivary 8‐hydroxydeoxyguanosine and interleukin‐17 levels. Journal of periodontology. 2016;87(5):591-600.
24. Azman R. Lappin DF. MacPherson A. et al. Clinical associations between IL-17 family cytokines and periodontitis and potential differential roles for IL-17A and IL-17E in periodontal immunity. Inflammation research. 2014;63:1001-1012.
25. Cardoso C. Garlet GP. Crippa G. et al. Evidence of the presence of T helper type 17 cells in chronic lesions of human periodontal disease. Oral microbiology and immunology. 2009;24(1):1-6.
26. Gümüş P. Buduneli E. Bıyıkoğlu B. et al. Gingival crevicular fluid. serum levels of receptor activator of nuclear factor‐κB ligand. osteoprotegerin. and interleukin‐17 in patients with rheumatoid arthritis and osteoporosis and with periodontal disease. Journal of periodontology. 2013;84(11):1627-1637.
27. Jayakumar Sunandhakumari V. Sadasivan A. Koshi E. Krishna A. Alim A. Sebastian A. Effect of nonsurgical periodontal therapy on plasma levels of IL-17 in chronic periodontitis patients with well controlled type-II diabetes mellitus—A clinical study. Dentistry journal. 2018;6(2):19.
28. Canakci CF. Cicek Y. Yildirim A. Sezer U. Canakci V. Increased levels of 8-hydroxydeoxyguanosine and malondialdehyde and its relationship with antioxidant enzymes in saliva of periodontitis patients. European journal of dentistry. 2009;3(02):100-106.
29. Arunachalam R. Reshma AP. Rajeev V. Kurra SB. Prince MRJ. Syam N. Salivary 8-Hydroxydeoxyguanosine–a valuable indicator for oxidative DNA damage in periodontal disease. The Saudi Journal for Dental Research. 2015;6(1):15-20.
30. Balwant R. Simmi K. S C A. Effect of scaling and root planning on salivary 8-hydroxydeoxyguanosine levels: periodontitis. 2007.
31. Öngöz Dede F. Özden FO. Avcı B. 8‐hydroxy‐deoxyguanosine levels in gingival crevicular fluid and saliva in patients with chronic periodontitis after initial periodontal treatment. Journal of Periodontology. 2013;84(6):821-828.
32. Yalin S. Bagis S. Polat G. et al. Is there a role of free oxygen radicals in primary male osteoporosis? Clinical and experimental rheumatology. 2005;23(5):689.
33. Tai T-W. Chen C-Y. Su F-C. et al. Reactive oxygen species are required for zoledronic acid-induced apoptosis in osteoclast precursors and mature osteoclast-like cells. Scientific reports. 2017;7(1):1-12.
34. Löfman O. Larsson L. Toss G. Bone mineral density in diagnosis of osteoporosis: reference population. definition of peak bone mass. and measured site determine prevalence. Journal of clinical densitometry. 2000;3(2):177-186.
35. Organization WH. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: report of a WHO study group [meeting held in Rome from 22 to 25 June 1992]. World Health Organization; 1994.
36. Wang HL. Weber D. McCauley LK. Effect of long‐term oral bisphosphonates on implant wound healing: Literature review and a case report. Journal of periodontology. 2007;78(3):584-594.
37. Silness J. Löe H. Periodontal disease in pregnancy II. Correlation between oral hygiene and periodontal condition. Acta odontologica scandinavica. 1964;22(1):121-135.
38. Loe H. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand. 1963;21:533-551.
39. Graziani F. Cei S. Guerrero A. et al. Lack of short-term adjunctive effect of systemic neridronate in non-surgical periodontal therapy of advanced generalized chronic periodontitis: an open label-randomized clinical trial. J Clin Periodontol. 2009;36(5):419-427.
40. Corbella S. Alberti A. Donos N. et al. Efficacy of different protocols of non‐surgical periodontal therapy in patients with type 2 diabetes: A systematic review and meta‐analysis. Journal of Periodontal Research. 2024.
41. Tewari S. Narula SC. Singhal SR. Sharma RK. Effect of non‐surgical periodontal therapy along with myo‐inositol on high‐sensitivity C‐reactive protein and insulin resistance in women with polycystic ovary syndrome and chronic periodontitis: A randomized controlled trial. Journal of periodontology. 2017;88(10):999-1011.
42. Inönü E. Kayis SA. Eskan MA. Hakki SS. Salivary Del‐1. IL‐17. and LFA‐1 levels in periodontal health and disease. Journal of Periodontal Research. 2020;55(4):511-518.
43. Singh A. Sharma RK. Siwach RC. Tewari S. Narula SC. Association of bone mineral density with periodontal status in postmenopausal women. Journal of investigative and clinical dentistry. 2014;5(4):275-282.
44. Tezal M. Wactawski‐Wende J. Grossi SG. Ho AW. Dunford R. Genco RJ. The relationship between bone mineral density and periodontitis in postmenopausal women. Journal of Periodontology. 2000;71(9):1492-1498.
45. Rocha M. Nava LE. Vázquez de la Torre C. Sánchez-Márin F. Garay-Sevilla ME. Malacara JM. Clinical and radiological improvement of periodontal disease in patients with type 2 diabetes mellitus treated with alendronate: a randomized. placebo-controlled trial. J Periodontol. 2001;72(2):204-209.
46. Rocha ML. Malacara JM. Sánchez‐Marin FJ. de la Torre CJV. Fajardo ME. Effect of alendronate on periodontal disease in postmenopausal women: a randomized placebo‐controlled trial. Journal of Periodontology. 2004;75(12):1579-1585.
47. Lane N. Armitage GC. Loomer P. et al. Bisphosphonate therapy improves the outcome of conventional periodontal treatment: results of a 12-month. randomized. placebo-controlled study. J Periodontol. 2005;76(7):1113-1122.
48. Sharma A. Pradeep AR. Clinical efficacy of 1% alendronate gel in adjunct to mechanotherapy in the treatment of aggressive periodontitis: a randomized controlled clinical trial. J Periodontol. 2012;83(1):19-26.
49. Sheokand V. Chadha VS. Palwankar P. The comparative evaluation of 1% alendronate gel as local drug delivery system in chronic periodontitis in smokers and non smokers: Randomized clinical trial. J Oral Biol Craniofac Res. 2019;9(2):198-203.
50. Martínez-Maestre MÁ. González-Cejudo C. Machuca G. Torrejón R. Castelo-Branco C. Periodontitis and osteoporosis: a systematic review. Climacteric. 2010;13(6):523-529.
51. Brennan-Calanan R. Genco R. Wilding G. Hovey K. Trevisan M. Wactawski-Wende J. Osteoporosis and oral infection: independent risk factors for oral bone loss. Journal of dental research. 2008;87(4):323-327.
52. Javaid MA. Ahmed AS. Durand R. Tran SD. Saliva as a diagnostic tool for oral and systemic diseases. Journal of oral biology and craniofacial research. 2016;6(1):67-76.
53. Kaufman E. Lamster IB. Analysis of saliva for periodontal diagnosis: a review. Journal of clinical periodontology. 2000;27(7):453-465.
54. Wactawski‐Wende J. Hausmann E. Hovey K. Trevisan M. Grossi S. Genco RJ. The association between osteoporosis and alveolar crestal height in postmenopausal women. Journal of periodontology. 2005;76:2116-2124.
55. Mönkkönen J. Similä J. Rogers MJ. Effects of tiludronate and ibandronate on the secretion of proinflammatory cytokines and nitric oxide from macrophages in vitro. Life Sci. 1998;62(8):Pl95-102.
56. Bagan J. Sheth CC. Soria JM. Margaix M. Bagan L. Bisphosphonates‐related osteonecrosis of the jaws: a preliminary study of salivary interleukins. Journal of oral pathology & medicine. 2013;42(5):405-408.
57. Buduneli E. Buduneli N. Vardar-Sengül S. et al. Systemic low-dose doxycycline and alendronate administration and serum interleukin-1beta. osteocalcin. and C-reactive protein levels in rats. J Periodontol. 2005;76(11):1927-1933.
58. Molnar I. Bohaty I. Somogyine-Vari E. IL-17A-mediated sRANK ligand elevation involved in postmenopausal osteoporosis. Osteoporosis International. 2014;25(2):783-786.
59. Miricescu D. Totan A. Calenic B. et al. Salivary biomarkers: relationship between oxidative stress and alveolar bone loss in chronic periodontitis. Acta Odontologica Scandinavica. 2014;72(1):42-47.
60. Önder C. Kurgan Ş. Altıngöz SM. et al. Impact of non-surgical periodontal therapy on saliva and serum levels of markers of oxidative stress. Clinical oral investigations. 2017;21(6):1961-1969.
61. Bagan J. Sáez GT. Tormos MC. et al. Oxidative stress in bisphosphonate‐related osteonecrosis of the jaws. Journal of Oral Pathology & Medicine. 2014;43(5):371-377.
62. Karasu B. Cerrahi olmayan periodontal tedavinin bifosfonat tedavisi gören hastalardaki tükürük biobelirteç seviyelerine etkisinin incelenmesi. 2019.

Details

Primary Language

English

Subjects

Dental Therapeutics, Pharmacology and Toxicology , Periodontics

Journal Section

Research Article

Authors

Başak Karasu ^*
0000-0001-6537-9902
Türkiye

Gönen Özcan
0000-0001-6269-144X
Türkiye

Sıla Çağrı İşler
0000-0001-5419-9658
Türkiye

Gülçin Akca
0000-0002-8877-4144
Türkiye

Ozlem Kaymaz
0000-0003-1235-8117
Türkiye

Sinem Bozkurt
0000-0002-4518-0186
Türkiye

Publication Date

March 28, 2025

Submission Date

December 29, 2023

Acceptance Date

February 19, 2025

Published in Issue

Year 2025 Volume: 28 Number: 1

DOI

https://doi.org/10.7126/cumudj.1411790

IZ

https://izlik.org/JA56CN66CC

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Karasu B, Özcan G, İşler SÇ, Akca G, Kaymaz O, Bozkurt S (March 1, 2025) Evaluation of Non-Surgical Periodontal Treatment on Salivary Biomarkers in Patients Undergoing Bisphosphonate Therapy. Cumhuriyet Dental Journal 28 1 9–20.

Bifosfonat Tedavisi Gören Hastalarda Cerrahi Olmayan Periodontal Tedavinin Tükürük Biyobelirteçleri Üzerine Değerlendirilmesi

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Evaluation of Non-Surgical Periodontal Treatment on Salivary Biomarkers in Patients Undergoing Bisphosphonate Therapy

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