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.

Stem cell‐like populations and immunoregulatory molecules in periodontal granulation tissue

“…Whether this is an early indication of changes within the GT to an anti‐inflammatory and wound healing cytokine profile is unclear. Anti‐inflammatory cytokine levels fall immediately after and remain depressed for several days following periodontal flap surgery, while levels of IL‐1β and TNF‐α are increased during the initial phases of wound healing . Anti‐inflammatory cytokines have been shown to play a key role in the disease process, and along with the proinflammatory cytokines, they are implicated in the healing process .…”

Healing Process with the use of a New Resorbable Synthetic Membrane

“…In the hemostasis phase (i) the volume of the graft occupies the space and thus reduces the volume of the blood clot, and in doing so, the number of viable cells that reside within the site. This phenomenon in the cleaning inflammatory phase leads to a reduction in the products of the macrophages degradation, which are important mediators for the conversion towards the proliferation phase (ii) [28]. In the regeneration phase (iii), angiogenesis, being the essential element in the production of the collagen matrix, may be disturbed by the barrier effect of the membrane.…”

Effect of two post‐surgical cleansing protocols on early periodontal wound healing and cytokine levels following osseous resective surgery: A randomized controlled study

“…Since it is known that the total amount of cytokines varies based on the volume of GCF, the concentration instead of the total amount was considered . For the present study, IL‐1β and IL‐8 were chosen as two pro‐inflammatory cytokines involved in early inflammatory processes related to wound healing . IL‐1β induces periodontal inflammation and controls the extracellular matrix degradation activity of the plasminogen activator system during inflammation and wound healing .…”

“…Surgical procedures trigger metabolic and immunologic reactions that lead to a rise in pro‐inflammatory cytokines . It has been demonstrated that evaluation of cytokine levels in wound fluids is a sensitive and specific assessment of inflammation .…”

“…It has been demonstrated that evaluation of cytokine levels in wound fluids is a sensitive and specific assessment of inflammation . Specifically, mediators such as interleukin (IL)‐1β and IL‐8 are crucial for post‐surgical wound healing . IL‐1β induces periodontal inflammation, upregulates adhesion molecules on endothelial cells, stimulates chemokine production and induces the expression of other mediators that amplify the inflammatory response .…”