Impact of N-terminal pro-B-type natriuretic peptide and related inflammatory biomarkers on periodontal treatment outcomes in patients with periodontitis: An explorative human randomized-controlled clinical trial.

BACKGROUND N-terminal portion of the B-type natriuretic propeptide (NT-proBNP) has potentially been shown to play an important role in the development of periodontitis and cardiovascular disease (CVD). This study evaluated the efficacy of periodontal treatment on NT-proBNP and related CVD biomarkers and explored whether subjects harboring high NT-proBNP at baseline showed increased clinical benefits with the non-surgical periodontal treatment performed with full-mouth scaling and root planing (FM-SRP) at 6-month follow-up. METHODS Forty-eight patients with stage III periodontitis were randomized to receive minimal standard oral care (SOC) (n = 24) or FM-SRP (n = 24) protocol. Clinical periodontal parameters (probing depth, clinical attachment loss, bleeding on probing), serum NT-proBNP, α1-antitrypsin, C-reactive protein (hs-CRP), endothelial cell-specific molecule-1 (ECM-1), and neutrophil gelatinase-associated lipocalin (NGAL) concentrations were assessed at baseline and at 1-, 3-, and 6- month follow-up. RESULTS At 6 months, FM-SRP was more effective than SOC in reducing periodontal parameters and mean proportions of NT-proBNP (p = 0.004), hs-CRP (p = 0.003), α1-antitrypsin (p = 0.012), ECM-1 (p = 0.014), and NGAL (p = 0.045). At 6-month follow-up, the reduced NT-proBNP, α1-antitrypsin, hs-CRP, ECM-1, and NGAL levels were significantly correlated with the extent of periodontitis (p < 0.05). Furthermore, the analysis of variance analysis evidenced that, at 6-month follow-up, FM-SRP significantly impacted the reduction of NT-proBNP, hs-CRP, ECM-1, and NGAL. Moreover, high levels of NT-proBNP, hs-CRP, ECM-1, and NGAL at baseline significantly influenced the efficacy of periodontal treatment positively. CONCLUSION In this study, FM-SRP was more effective than SOC in reducing clinical variables and NT-proBNP levels, although subjects who harbored high NT-proBNP concentrations at baseline showed greater clinical benefits of periodontal treatment at 6-month follow-up.

[1]  A. Sculean,et al.  Resolution of peri-implant mucositis at tissue-and bone-level implants: A 6-month prospective controlled clinical trial. , 2023, Clinical oral implants research.

[2]  L. Ghiadoni,et al.  Acute-phase response following one-stage full-mouth versus quadrant non-surgical periodontal treatment in subjects with comorbid type 2 diabetes: A randomized clinical trial. , 2022, Journal of clinical periodontology.

[3]  A. Alibrandi,et al.  Impact of periodontitis on gingival crevicular fluid miRNAs profiles associated with cardiovascular disease risk. , 2022, Journal of periodontal research.

[4]  F. Yan,et al.  Periodontitis may impair the homeostasis of systemic bone through regulation of gut microbiota in ApoE-/- mice. , 2022, Journal of clinical periodontology.

[5]  I. Needleman,et al.  Full-mouth treatment modalities (within 24 hours) for periodontitis in adults. , 2022, The Cochrane database of systematic reviews.

[6]  F. Narin,et al.  Gingival crevicular fluid lipocalin-2 and semaphorin3A in stage III periodontitis: Non-surgical periodontal treatment effects. , 2022, Journal of periodontal research.

[7]  A. Maggioni,et al.  Total NT-proBNP, a novel biomarker related to recurrent atrial fibrillation , 2021, BMC Cardiovascular Disorders.

[8]  M. Lopes-Virella,et al.  Inhibition of acid sphingomyelinase by imipramine abolishes the synergy between metabolic syndrome and periodontitis on alveolar bone loss. , 2021, Journal of periodontal research.

[9]  A. Radaic,et al.  Clinical study showing a lower abundance of Neisseria in the oral microbiome aligns with low birth weight pregnancy outcomes , 2021, Clinical Oral Investigations.

[10]  A. Alibrandi,et al.  Periodontitis activates the nlrp3 inflammasome in serum and saliva. , 2021, Journal of periodontology.

[11]  M. Emdin,et al.  Biomarkers for the diagnosis and management of heart failure , 2021, Heart Failure Reviews.

[12]  A. Alibrandi,et al.  Analysis of galectin-3 levels as a source of coronary heart disease risk during periodontitis. , 2021, Journal of periodontal research.

[13]  Yong Yang,et al.  Biomechanical properties of acellular scar ECM during the acute to chronic stages of myocardial infarction. , 2021, Journal of the mechanical behavior of biomedical materials.

[14]  M. Santamaria,et al.  Clinical, radiographic and patient-centered outcomes after use of enamel matrix proteins for the treatment of intrabony defects in patients with aggressive periodontitis: A 12-month multicenter clinical trial. , 2020, Journal of periodontology.

[15]  A. Alibrandi,et al.  Independent impact of periodontitis and cardiovascular disease on elevated soluble urokinase-type plasminogen activator receptor levels. , 2020, Journal of periodontology.

[16]  Z. Yetkin Ay,et al.  Increase in serum and salivary neutrophil gelatinase-associated lipocalin levels with increased periodontal inflammation , 2020, Journal of applied oral science : revista FOB.

[17]  Gayathri Kumar,et al.  Evaluation of Endocan and Tumor Necrosis Factor-α as Inflammatory Biomarkers in Type 2 Diabetes and Periodontal Disease. , 2020, Genetic testing and molecular biomarkers.

[18]  H. Tse,et al.  A randomized controlled trial of the effects of non-surgical periodontal therapy on cardiac function assessed by echocardiography in type 2 diabetic patients. , 2020, Journal of clinical periodontology.

[19]  W. Teughels,et al.  Adjunctive effect of systemic antimicrobials in periodontitis therapy. A systematic review and meta-analysis. , 2020, Journal of clinical periodontology.

[20]  B. Loos,et al.  Endpoints of active periodontal therapy , 2020, Journal of clinical periodontology.

[21]  J. Derks,et al.  Subgingival Instrumentation for Treatment of Periodontitis. A Systematic Review. , 2019, Journal of clinical periodontology.

[22]  B. Kjellström,et al.  Associations among Periodontitis, Calcified Carotid Artery Atheromas, and Risk of Myocardial Infarction , 2019, Journal of dental research.

[23]  Y. Leira,et al.  Brain natriuretic peptide serum levels in periodontitis , 2018, Journal of periodontal research.

[24]  Z. Babaloo,et al.  Evaluation of Clinical Periodontal Indices and Serum Interleukin-27 by One-stage Full-mouth Disinfection and Quadrant Scaling and Root Planing in Periodontitis. , 2018, The journal of contemporary dental practice.

[25]  K. Kornman,et al.  Staging and grading of periodontitis: Framework and proposal of a new classification and case definition , 2018, Journal of periodontology.

[26]  S. Solomon,et al.  Natriuretic Peptides as Biomarkers of Treatment Response in Clinical Trials of Heart Failure. , 2018, JACC. Heart failure.

[27]  Á. Avezum,et al.  Associations between tooth loss and prognostic biomarkers and the risk for cardiovascular events in patients with stable coronary heart disease. , 2017, International journal of cardiology.

[28]  U. Balli,et al.  Effect of Non‐Surgical Periodontal Treatment on Gingival Crevicular Fluid and Serum Endocan, Vascular Endothelial Growth Factor‐A, and Tumor Necrosis Factor‐Alpha Levels , 2017, Journal of periodontology.

[29]  Z. Bartoszewicz,et al.  Plasmatic NT-proBNP concentrations in patients with coexistent periodontal disease and congestive heart failure: pilot studies. , 2016, Kardiologia polska.

[30]  N. Mickuvienė,et al.  Relationship and prognostic importance of thyroid hormone and N-terminal pro-B-Type natriuretic peptide for patients after acute coronary syndromes: a longitudinal observational study , 2016, BMC Cardiovascular Disorders.

[31]  H. Worthington,et al.  Full-mouth treatment modalities (within 24 hours) for chronic periodontitis in adults. , 2015, The Cochrane database of systematic reviews.

[32]  L. Chow,et al.  Comparing serum levels of cardiac biomarkers in cancer patients receiving chemotherapy and subjects with chronic periodontitis , 2012, Journal of Translational Medicine.

[33]  V. Baelum,et al.  Effects of periodontal therapy on systemic markers of inflammation in patients with metabolic syndrome: a controlled clinical trial. , 2012, Journal of periodontology.

[34]  M. Emdin,et al.  When the heart is burning: amino-terminal pro-brain natriuretic peptide as an early marker of cardiac involvement in active autoimmune rheumatic disease. , 2011, International journal of cardiology.

[35]  H. Yoshie,et al.  The effect of periodontal treatment on serum leptin, interleukin-6, and C-reactive protein. , 2010, Journal of periodontology.

[36]  D. Moher,et al.  CONSORT 2010 Explanation and Elaboration: updated guidelines for reporting parallel group randomised trials , 2010, BMJ : British Medical Journal.

[37]  Francesco D'Aiuto,et al.  Treatment of periodontitis and endothelial function. , 2007, The New England journal of medicine.

[38]  C. Frampton,et al.  Introduction of Metoprolol Increases Plasma B-Type Cardiac Natriuretic Peptides in Mild, Stable Heart Failure , 2006, Circulation.

[39]  R. Genco,et al.  Response to Periodontal Therapy in Diabetics and Smokers. , 1996, Journal of periodontology.

[40]  M. Quirynen,et al.  Full- vs. Partial-mouth Disinfection in the Treatment of Periodontal Infections: Short-term Clinical and Microbiological Observations , 1995, Journal of dental research.

[41]  M. Serdar,et al.  Endocan (ESM-1) levels in gingival crevicular fluid correlate with ICAM-1 and LFA-1 in periodontitis. , 2020, Brazilian oral research.

[42]  A. Sculean,et al.  Effects of non-surgical periodontal therapy on periodontal laboratory and clinical data as well as on disease activity in patients with rheumatoid arthritis , 2018, Clinical Oral Investigations.

[43]  N. V. Pozdin,et al.  [The NT-proBNP in saliva and blood serum in norm and under periodontitis.] , 2018, Klinicheskaia laboratornaia diagnostika.