Insights from Gingival Crevicular Fluid in Periodontics and Orthodontics
Explore the diverse collection methods and diagnostic applications of gingival crevicular fluid (GCF) in periodontics, orthodontics, and implantology.
Multiple options exist for the noninvasive collection of gingival crevicular fluid (GCF), including the use of pre-weighed twisted threads, absorption method, microcapillary pipetting, and washing method.1,2 The use of pre-weighed twisted threads involves placing threads into the gingival crevice around the tooth, where the fluid is collected. The threads are weighed to determine the amount of fluid collected.1 The absorption method uses paper strips that are dipped into the sulcus.1,2 This is the least traumatic, most efficient, and easiest way to obtain a GCF sample.2 With the microcapillary pipetting method, the pipette remains in the fluid for approximately 10 minutes, and the resulting levels of each biomarker indicate the severity of periodontitis.2 The washing method, which is not common due to its high rate of contamination, extracts GCF through the injection of two needles, which can lacerate the tissue and contaminate the GCF sample with blood.1
The use of more than one biomarker to determine inflammation activity in periodontal diseases is highly recommended.1,2 The two preferred cytokines for determining inflammation in the periodontium are IL-1β and MMP-8.2 Conversely, more research is needed to determine the most reliable and accurate technique that can be used as the universal standard.2 Additionally, it is unclear how stress and genetic differences among different ethnic groups affect the biomarkers in GCF.
Diagnostic Use in Orthodontics
The diagnostic use of GCF testing also aids orthodontic therapy. During orthodontic treatment, teeth are moved through a controlled mechanical force, which creates a biological reaction in the periodontium.3 This biological reaction is reflected in the patient’s GCF levels.3 The specific biomarkers of bone alkaline phosphatase and osteoprotegerin create a new understanding of bone growth and remodeling.4 Bone deposition-related biomarkers, including MMP-8, can be used as a guide in identifying the results of orthodontic forces in the periodontal ligament and alveolar bone.4
A study with prepubertal participants used alkaline phosphatase as a biomarker in GCF to determine the activity of active alveolar bone formation during a retention phase of rapid maxillary expansion.4 The research revealed an increase of alkaline phosphatase activity in the GCF during month 3 and month 6.4 This confirmed that alkaline phosphatase can be used as a diagnostic method for assessing orthodontic movement, as it was found to be more active in sites of movement.4
An advantage of using GCF as a biomarker in orthodontics is ease of testing; additionally, quick sample testing avoids the use of radiographic exposure.5 However, further research regarding GCF biomarkers’ clinical applicability is needed to confirm its diagnostic accuracy.5
Applications in Implantology
In patients with dental implants, GCF, called peri-implant fluid, can be collected from implant sites to determine its profile and note specific markers. When compared to mildly inflamed sites, GCF shows higher levels of neutral proteases at moderately to severely inflamed implant sites.1 Moreover, IL-1β levels in these sites have been shown to be approximately three times higher than levels found in healthy sites.1 Future studies that focus on the equilibrium of chemistry changes in GCF could aid in early detection of peri-implant diseases.
References
- Subbarao KC, Nattuthurai GS, Sundararajan SK, Sujith I, Joseph J, Syedshah YP. Gingival crevicular fluid: an overview. J Pharm Bioallied Sci. 2019;11:135.
- Majeed ZN, Philip K, Alabsi AM, Pushparajan S, Swaminathan D. Identification of gingival crevicular fluid sampling, analytical methods, and oral biomarkers for the diagnosis and monitoring of periodontal diseases: a systematic review. Dis Markers. 2016;2016:1804727.
- Kasuma N, Oenzil F, Darwin E, Sofyan Y. The analysis of matrix metalloproteinase-8 in gingival crevicular fluid and periodontal diseases. Indian J Dent Res.2018;29:450–454.
- Perinetti G, Franchi L, Castaldo A, Contardo L.Gingival crevicular fluid protein content and alkaline phosphatase activity in relation to pubertal growth phase. Angle Orthod. 2012;82:1047–1052.
- de Aguiar MC, Perinetti G, Capelli J. The gingival crevicular fluid as a source ofbiomarkers to enhance efficiency of orthodontic and functional treatment of growing patients. Biomed Res Int. 2017;3:1–7.
This information originally appeared in Rivera M, Apolinar S, Smith M. Gingival crevicular fluid as a biomarker for periodontal disease. Decisions in Dentistry. 2021;7(4):40–43.
