J Orofac Sci, 2(2)2010                                          Journal of                                          OROFAC...
J Orofac Sci, 2(2)2010Three Gingival Retraction Cords :1. Plain retraction cord -Ultrapack2. Retraction cord with O.197mg ...
J Orofac Sci, 2(2)2010Activity was calibrated as follows :                                                                ...
J Orofac Sci, 2(2)2010their respective reagents. Accurate quantification of               CONCLUSION :volume of Gingival c...
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A comparison of gingival inflammation related to retraction cords using biochemical analysis of gingival crevicular fluid


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A comparison of gingival inflammation related to retraction cords using biochemical analysis of gingival crevicular fluid

  1. 1. J Orofac Sci, 2(2)2010 Journal of OROFACIAL SCIENCESOriginal ResearchA Comparison of Gingival Inflammation Related to Retraction Cords Using BiochemicalAnalysis of Gingival Crevicular Fluid.Krishna Kishore. Ka*, Sampath Anchea, Swetha Hima Bindu. Oaa Department of prosthodontics, SIBAR Institute of Dental sciences, Guntur, Andhrapradesh, India.ARTICLE INFO ABSTRACTArticle History : AIM : This study was aimed to determine the clinical magnitude of theReceived : 11 June 2010 inflammatory response to gingival retraction procedures by using different typesReceived in revised form : 14 July 2010 of retraction.Accepted : 11 August 2010 MATERIALS AND METHOD : The study was performed on 10 dentulousKey Words : patients with normal healthy gingival Condition and 3 gingival retraction cordsGingival Retraction Cords, Plane retraction cord-ultrapack retraction cord impregnated with 10%Healthy Gingiva, aluminium chloride-Novo retraction cord and retraction cord impregnatedGingival Crevicular Fluid, with 0.197mg per cm racemic epinephrine -Racord and were comparativelyFilter Paper Strips, analyzed for gingival inflammation in all patients.Inflammatory Response. Preweighed filter paper strips were used to collect Crevicular fluid samples were collected at ‘0’, 1, 24 hours after retraction. RESULTS : Results showed Inflammatory response to plain retraction cord when compared to the inflammatory response to impregnated retraction cords. Both Aluminum chloride and epinephrine retraction cords showed similar response. ©2010 SIDS.All Rights ReservedINTRODUCTION : One of the most important bio-mechanical But most of impression material used in the fixed partialrequirements of tooth preparation for the successful fixed prosthodontics do not flow in the gingival crevice orrestoration is the gingival finish line preparation. displaces the gingival tissue. Therefore gingival tissue Construction of the fixed partial prosthesis needs exact displacement is required to get clean, dry, debris free fieldduplication of the prepared tooth and finish lines by the for the impression and to evaluate depth and uniformityappropriate impression procedures. For these purpose, at of the margins of the preparation.least O.15mm to O.75mm of root surface beyond the MATERIALS AND METHOD :gingival finish line should be recorded in the impression. This Study was performed on 10 edentulous patients* Corresponding author : with normal healthy gingiva in the age group 20-30 yrsDr. Krishna Kishore. K randomly selected. Oral prophylaxis was performed 3Professor Department of Prosthodontics weeks before retraction procedure and were given oralSIBAR Institute of Dental Sceiences,Guntur, Andhra Pradesh, India. hygiene instructions in order to ensure healthy gingivalobr.bindu@gmail.com condition during retraction procedure. 33
  2. 2. J Orofac Sci, 2(2)2010Three Gingival Retraction Cords :1. Plain retraction cord -Ultrapack2. Retraction cord with O.197mg per cm racemic epinephrine -Racord3. Retraction cord with 10% Aluminium chloride- Novo Retraction cord Fig.3: electronic weighing machine Fig.1: Retraction Procedure were used, they were with the same diameter. retractionwas done in 11,21,24 respectively in all patients. Racordin 21,novo in11 and plain retraction in 24 wereemployed.(Fig- 1) Crevicular fluid samples were collectedusing preweighed filter papers (Fig.2)–Whatman filterpaper no-3 of approximately equal size. Samples werecollected at the 0, before retraction 1 and 24 hrs afterretraction .The filter papers1 were weighed in an electronicweighing machine (Fig.3) with accuracy of 0.0001 gm. Fig. 4: Biochemical Analysis KitsGingival crevicular fluid was diluted with 220µl of biochemical analysis kits by the sigma diagnostics, fornormal saline and shaked vigorously with the vortex mixer diagnosis of lactate dehtdrogenase and Ranbaxyfor 30 sec and then kept in VDRL rotator for 3,0 minutes diagnostics for diagnosis of Asparate amino Transferase.and the sample was mixed again for 30 sec in vortex mixer The procedure for the both enzymes was done byfor complete elution & centrifuges using a refrigerated placing the reaction mixture ( sample with reagent) in acentrifuge at 4 Úc with 5000 rpm for 5 minutes (Fig.4) pipette and maintained at 30 and placed in cuvetSpecific enzyme test was analyzed for the samples using chamber of simadzu UV 1601 scanning spectrophotometer. (Fig.5). Fig.2 : Collection of samples Fig.5: Scanning Spectrophotometer 34
  3. 3. J Orofac Sci, 2(2)2010Activity was calibrated as follows : TABLE : 2 ∆ A per minute of G.C.F.x CHANGE IN GINGIVAL FLUID WITH TIME A PAIRED t-TEST control value x dilution factor Retraction Cords Changes 0-1 hour Enzyme activity = Wt of fluid in mg Mean S.D. t-value A per minute of control Epinephrine Cord 0.17 0.11 5.07 *** The results were statistically analyzed by using student AI. Chloride Cord 0.16 0.08 6.00 ***“t” test analysis and ANOVA analysis and results were Plain Cord 0.14 0.05 8.57condensed and described *** Changes 0-24 hour Changes 1-24 hourRESULTS : Mean S.D. t-value Mean S.D. t-value The ANOVA analysis revealed the following. 1.77 0.11 0.0 3.5 The mean fluid volume at 0 hour was statistically 0.06 0.11 9 N.S. *insignificant. 0.09 0.07 2.16 0.16 0.08 6.00 A statistically significant difference in fluid volume N.S. ***was noted at one hour with p value being 0.001 level. 2.23 0.06 0.1 1.96 0.08 0.11 N.S 0 N.S. This can be readily explained by the fact that fluidvolume collected from the sulci retracted with plain cord DISCUSSION :is more than the fluid collected from sulci retracted withaluminium chloride and epinephrine. The use of gingival crevicular fluid flow measurements for the evaluation of gingival health and the effects of The gingival fluid volumes recorded at 24 hours various materials on gingival tissues has become widelyshowed less statistical significance with p value of 0.008 accepted, that the gingival fluid is an objective andlevel. This shows that the fluid volume have returned to quantitative measure of gingival inflammation.near normal values or near 0 hour value. IRA .B. Lamster et al (1985), Rutger person2 et al TABLE : I (1990) has stressed the reliability of these enzymes as CHANGE IN GINGIVAL FLUID WITH TIME markers of gingival inflammation, although most of their O Hour 1 Hour 24 Hour studies were aimed at identifying progression of gingivalRetraction Cords Mean S.D. Mean S.D. Mean S.D. disease. These enzyme markers are reliable to identifyEpinephrine cord 0.92 0.155 0.75 0.127 0.86 0.155 inflammatory response to gingival retraction procedure.AI. Chloride cord 0.87 0.142 0.71 0.120 0.78 0.103 T.E. Donovan AN3 et aI, (1985) in his review ofPlain cord 0.87 0.14 1.01 0.129 0.95 0.085 medicaments with gingival retraction cords, stressed theF- Value 0.376 16.94 6.32 superiority of aluminium chloride retraction cord overP- Value 0.69 0.0001 0.008 epinephrine impregnated cord. Not Significant Significant Significant In this study 0.197mg per cm of racemic epinephrine4 ANOVA (Analysis of Variance) impregnated cord (Racord), 10% aluminium chloride5 A paired t -test performed to analyze gingival fluid impregnated cord (Nova), Plain cord (ultra pack) werevolume change between 0 hour, 1 hour and 24 hour shows compared in each of the ten healthy young patients 6,there is highly significant change between 0 hour (i.e. where oral Prophylaxis was performed three weeks beforebefore retraction) and 1 hour after retraction with and oral Hygiene instructions were given. 11, 21 & 24p<O.OO1 level. were selected for the retraction procedure. The fluid volume change between 1 hour and 24 hour After the samples are collected according to the aboveafter retraction is of less significance with a p value of mentioned method spectrophotometric assay was< 0.05 level and fluid volume change from 0 hour to 24 performed on each fluid sample for both Asparate aminohours is also not significant. transferase7 and Lactate dehydrogenase after dilution with 35
  4. 4. J Orofac Sci, 2(2)2010their respective reagents. Accurate quantification of CONCLUSION :volume of Gingival crevicular fluid8 and quantificationof enzyme levels in these sample are recorded. These To conclude there is an increased inflammatoryvalues were statistically evaluated and the results are response to plain retraction cord when compared to theconscientiously reported. inflammatory response to impregnated retraction cords. Both aluminium chloride & epinephrine retraction cords Retraction cords impregnated with aluminium showed similar inflammatory response suggesting thatchloride and epinephrine9, the gingival fluid volume any of these may be used for prosthetic impressiondecreases after one hour when compared with volumes technique. The study has limitations in that, other enzymerecorded prior to insertion of retraction cords and indicators of inflammation like ß-glucuronidase have notreturned to near normal levels when recorded after 24 been tested and histologic proof is not available. It ishours. suggested that future studies done in larger sample group The plain retraction cord causes increase in gingival will further throw light on this subjectcrevicular fluid volume 1 hour after retraction when REFERENCES :compared with 0 hour recording, indicating the retraction 1. William JMA, Griffiths GS, Cruits MA. Selection of a filter papercords were acting as stimulus and increase transudate flow. with optimum properties for the collection of gingival crevicularThe volume returned to near normal levels when recorded fluid. J.Periodontol. Res. 1988;23: 33-38.after 24 hours. 2. Rutger G Person. Relationship between levels of aspirate Enzyme activity recorded at 0 hour, 1 hour and 24 aminotransferase in gingival crevicular fluid and gingival inflammation. J periodontol. Res. 1990;25:17-24.hours indicate that there is a quantitative increase of bothlactate dehydrogenase and aspartate amino transferase 3. Donovan TE. Review and Survey of medicaments used withwhich is seen at 1 hour following retraction cord insertion gingival retraction cords. J Prosthet Dent 1985;53:525-531.and which returned to near normal value after 24 hours. 4. Shapiro L, Goldman HM, Bloom A. Sulcular exudates flow in gingival inflammation. J.Periodontol 1979;50:301. Insertion of plain retraction cord resulted in 5. Runyan DA. Fluid absorbency of retraction cords after soakingcomparatively more enzyme activity. Both aluminium in aluminium chloride solution. J Prosthet Dent 1988;60:676-chloride and epinephrine impregnated retraction cords 678.increased enzyme activity, though at lesser levels than plain 6. Loe H, Silness J.Tissue reaction to string packs used in fixedretraction cords indicating lesser tissue damage. restoration. J. Prosthet. Dent.1963;13(2):379. This study relies on quantification of enzyme levels 7. Donald A. Chambers. A longitudinal study of asparatein gingival crevicular fluid collected from pre-weighed, aminotransferase in human gingival crevicular fluid. J Periodontprecut filter paper to estimate tissue damage and Res 1991;26: 65-74.inflammatory response. A simultaneous histologic study 8. Buchanan WT, Thayer KE. Systemic effects of epinephrineis proposed to correlate enzyme activity and histologic impregnated cord in fixed denture prosthodontics.tissue response to critically assess the results of this study. J.Am.Dent.Assoc. 1982;104(3): 482.A larger sample population, consecutive measurements 9. Anthony LA, Forgia A.B. Mechanical chemical andand histologic assessment will greatly improve the electrosurgical tissue retraction for fixed prosthesis. J Prosthet Dent 1964;14:1107-1114.significance and accuracy of this study to assess hostresponse to gingival retraction procedures. 36