Clinical and Biochemical Effect of Smoking on Non-surgical Periodontal Treatment in Periodontitis Grade III Stage C Patients

Periodontal disease is an inflammatory process that can result in tooth loss and also is considered a modifying factor for systemic health. In bone tissue, bone resorption by osteoclasts and bone formation by osteoblasts are repeated continuously. Osteoclasts are multinucleated cells that derive from monocyte-/macrophage-lineage cells and resorb bone. In contrast, osteoblasts mediate osteoclastogenesis by expressing receptor activator of nuclear factor-kappa B ligand (RANKL), which is expressed as a membrane-associated cytokine. Osteoprotegerin (OPG) is a soluble RANKL decoy receptor that is predominantly produced by osteoblasts and which prevents osteoclast formation and osteoclastic bone resorption by inhibiting the RANKL-RANKL receptor interaction. IL-34 shares vital functions of M-CSF, and manages myeloid cell survival, differentiation, and proliferation.

This study is the first controlled clinical study that examines the levels of RANKL, OPG and IL-34 in saliva and serum in smoker and non-smoker periodontitis, and evaluates the situation before and after the treatment. The first hypothesis of this study; in smoker periodontitis group, salivary and serum RANKL, OPG and IL-34 levels will be high, in contrast to the non-smoker periodontitis and periodontal healthy group. The second hypothesis of this study is that after periodontal treatment, saliva and serum RANKL and IL-34 levels will decrease, saliva and serum OPG will increase. Based on these hypotheses, the aim of the study is; to compare the levels of RANKL, OPG and IL-34 in saliva and serum of healthy controls, P-III-C, and P-III-CS subjects and to evaluate the effect of periodontal treatment.

A total of 60 systemically healthy patients; 20 periodontally healthy, 20 P-III-C, 20 P-III-CS were included in this study. The whole mouth clinical periodontal examination included measurement of probing depth (PPD), clinical attachment level (CAL), presence of bleeding on probing (BOP), gingival index (GI), and plaque index (PI) at 6 sites per tooth, except the third molars. The presence and type of the alveolar bone loss were assessed on the digital panoramic radiograph in each participant, which was supplemented with periapical radiographs if necessary.

Periodontal status of each patient was evaluated by a single calibrated periodontists with a manual probe. The diagnosis of periodontitis or periodontally health was determined according to the 2017 World Workshop on Classification of Periodontal and Peri-Implant Diseases and Conditions.

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