Periodontal reaction induced by the clinical steps of metalloceramic crowns considering how the renin-angiotensin system influences treatment and salivation

Author(s)

Isadora Prado Cano

• Document type: Doctoral Thesis
• Press: Bauru.
• Institution: Universidade de São Paulo (USP). Faculdade de Odontologia de Bauru (FOB/SDB)
• Defense date: 2022-11-30

Examining board members

Carlos Ferreira dos Santos; Estevam Augusto Bonfante; Joni Augusto Cirelli; Sergio Luis Scombatti de Souza

• Advisor: Carlos Ferreira dos Santos

Abstract

The aims of this research were to determine if the clinical steps involved in fixed tooth-supported prosthodontics affect the local expression of inflammatory markers and provoke clinically relevant periodontal reactions. Also, to analyze if pharmacological blockage of the renin-angiotensin system (RAS) in hypertensive patients influences the periodontal reaction and salivary secretion. The sample consisted of 26 patients who needed pre-molar rehabilitation with tooth-supported metalloceramic single crowns. Two groups were divided: the control, with normotensive and systemically healthy patients (n=17) and the experimental (n=9) with hypertensive patients in treatment with angiotensin receptor blockers or angiotensin converting enzyme inhibitors. Pro and anti-inflammatory cytokines in gingival crevicular fluid in different phases of the clinical steps were evaluated: 1) 30 days after scaling and root planning, 2) 2 days and 3) 15 days after temporary crown cementation, 4) 2 days, 5) 15 days and 6) 6 months after metalloceramic crown cementation. The same analyses were equally taken in the contralateral tooth as a control from the same patient (named as healthy). Salivary flow rate was determined considering stimulated (SSF) and non-stimulated (NSSF) secretions in the first appointment, without clinical interventions. Total protein was dosed from SSF samples. Each cytokine quantification was registered as medium and standard deviation, followed by normality tests. The most appropriate statistical analysis for each situation was taken, considering the significance level of 5% for all tests. The results indicated that prosthetic crowns cementation increased total protein and inflammatory cytokines [interleukin (IL)-1, IL-6] when the abutment tooth was compared to its respective control. When TIME was considered, IL-4 (anti-inflammatory), Vascular Endothelial Growth Factor (VEGF) and IL-8 (pro-inflammatory) expressions decreased, and IL-10 (anti-inflammatory) expression increased. Comparing clinical measurements, the abutment tooth of the experimental group presented lower probing depth and keratinized gingival margin; in this case, pro-inflammatory cytokines were delayed (IL-1) and attenuated (RANTES). SSF was similar between the studied groups, but NSSF tended to be reduced in patients using anti-hypertensive drugs; however, the difference did not reach statistical significance (p = 0,067). No difference was noticed comparing salivary total protein values. It can be concluded that rehabilitation with full metalloceramic crown mildly affects local expression of pro and anti-inflammatory cytokines in gingival crevicular fluid altering markers related to gingivitis without important alterations related to periodontitis after 6 months of its cementation. RAS blockage delayed and attenuated clinical and biochemical inflammatory signs around the abutment tooth. Also, there are signs of NSSF decrease caused by anti-hypertensive drugs related to RAS. (AU)

• FAPESP's process: 19/10344-5 - Periodontal reaction induced by the clinical steps of metalloceramic crowns considering how the renin-angiotensin system influences treatment and salivation
• Grantee: Isadora Prado Cano
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)