The use of crevicular fluid prostaglandin E2 levels as a predictor of periodontal attachment loss

Abstract

Longitudinal data were collected over a period of at least 18 months and up to 3 years on 41 adult periodontitis patients (AAP Type III and IV). Ramfjord attachment level measurements and sampling of crevicular fluid (CF) at each tooth were repeated every 3 months. A mean full mouth CF prostaglandin E 2 (MCF‐PGE) value was determined for each patient at each visit. The three‐month monitoring was continued until a single site demonstrated a statistically and clinically significant attachment loss (ALOSS) episode. Results indicated that in ALOSS patients the MCF‐PGE was significantly elevated at the ALOSS visit as compared to previous levels. Furthermore, the sites which had the ALOSS had elevated levels as compared to the contralateral no ALOSS control sites (305.6±56.5 vs. 65.7±6.89 ng/ml, mean ± SEM). One month following treatment the CF‐PGE level dropped to 16.9±3.4 ng/ml at the ALOSS sites. Since the MCF‐PGE level increases preceding the attachment loss episode, reaches a maximum at the sites which actually undergo ALOSS, and subsides following treatment, the possibility of using the MCF‐PGE level to predict an oncoming future ALOSS episode was examined. The ALOSS patients had a MCF‐PGE level of 113.4±9.0 ng/ml 6 months prior to the ALOSS episode, which was significantly higher than the no ALOSS patients’MCF‐PGE level of 50.1±7.1. Analysis of MCF‐PGE levels as a screening test indicate that this measurement has a high degree of sensitivity, specificity, and a predictive value of 0.92–0.95. Thus, this method has significant merit as a diagnostic tool to determine if a patient is in a state of remission or about to undergo an attachment loss episode.