Periodontal treatment in controlled and uncontrolled diabetic subjects: clinical, glycemic and cytokine and bone resorption related factors evaluations.

Abstract

The aims of this study will be: 1- to compare the levels of cytokines and bone resorption related factors (RANKL, OPG, TNF-alpha, IL-4, IFN-gamma, IL-23 and IL-17) in gingival crevicular fluid from type 2 diabetic subjects with chronic periodontitis before and at 3 and 6 months after non-surgical periodontal therapy; 2- to evaluate in these subjects and experimental times, the effects of this therapy on glycemic control (levels of glycated hemoglobin and plasma glucose fasting ) and periodontal clinical parameters; 3- to correlate the glycemic, clinical and immunological parameters. Forty subjects with chronic periodontitis and type 2 diabetes mellitus will be included in this study. First, peripheral blood samples from all subjects will be analyzed for glycated hemoglobin and plasma glucose fasting. Based on the levels of glycated hemoglobin, the subjects will be divided into one of the following groups: Controlled diabetic subjects (n=20): glycated hemoglobin levels between 4.5% and 8%; Uncontrolled diabetic subjects (n=20): glycated hemoglobin levels higher than 8%. The subjects will be submitted to periodontal clinical examinations and gingival gingival fluid sampling to assess the total amounts and concentrations of RANKL, OPG, TNF-alpha, IL-4, IFN-gamma, IL-23 and IL-17 by ELISA. Subsequently, all subjects will be submitted to non-surgical periodontal therapy, including supragingival plaque control and scaling and root planing. Glycated hemoglobin, clinical and immunological evaluations will be also performed at 3 and 6 months after treatment. The intra-group comparisons (before and after treatment) for immunological, glycemic and clinical data will be sough by Friedman test or ANOVA. The inter-group comparisons (controlled x uncontrolled) will be sough by Mann-Whitney or t Student tests in all experimental times. Spearman's analysis was used to test the possible correlations between glycemic, clinical and immunological data. The significance level established for all analyses will be 5% (p< 0.05).