Resolution of crevicular fluid leukocyte activity in patients treated for aggressive periodontal disease

Background: Enhanced neutrophil responses play a critical role in the activation of the innate immune system and causation of aggressive periodontitis (AgP). The hypothesis that comprehensive periodontal treatment expedites resolution of amplified leukocyte activity and facilitates the reconstitution of periodontal health was tested. Methods: Four different gingival crevicular fluid (GCF) markers from 14 patients were characterized prior to and at 3, 6, 12, 24, and 36 months after periodontal therapy. GCF myeloperoxidase (MPO), beta-N-acetyl-hexosaminidase (beta-NAH), and beta-glucuronidase (beta-G) were determined spectrophotometrically, and cathepsin D (CD) by liquid scintillation counting using [C-14] hemoglobin as substrate. The primary outcome was long-term stability of periodontal health. Results: In untreated AgP, GCF markers were significantly amplified (MPO: 1.9-fold; beta-NAH: 1.3-fold; beta-G: 1.7-fold; CD: 4.7-fold). Following periodontal therapy, the leukocyte activity was significantly dampened (0.3- to 0.5-fold), and paralleled with a sustained improvement of periodontal health (P <0.05). Thereafter and at 3 years, GCF leukocyte responses remained on a physiologic low level compatible to normal immune function. Conclusions: Comprehensive treatment of AP induces a downregulation of amplified crevicular neutrophil activity. The release of the innate immune system from exacerbating damage elicits a successful reconstitution of long-term periodontal health with no setbacks seen after 3 years.