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Analysis of Daytime Variations in Gingival CrevicularFluid: A Circadian Periodicity?Autores: Sevim Günday, Ali Orkun Topcu, Esra Ercan, Nermin YamalikLocalización: Journal of periodontology, ISSN 0022­3492, Nº. 3, 2014, págs. 47­56Idioma: inglésResumen

Background: Volumetric alterations in gingival crevicular fluid (GCF) are widely accepted to be associated with periodontalhealth/disease. The volume/flow of GCF was shown to be affected by an array of methodological factors. However, relativelylimited information is available on whether GCF is subject to circadian rhythm. The main aim of the present study is to assessthe possible presence/absence of GCF circadian rhythm. The impact of the sampling technique on daytime volumetricvariations is also analyzed.

Methods: The possible daily volumetric variations of GCF with 2­hour intervals (from 08:00 to 18:00 hours) were assessed in 100tooth sites and 600 GCF samples. Only maxillary incisors were included to eliminate any potential volumetric differences dueto tooth dimensions. To analyze the potential impact of sampling technique on GCF volume and daytime variations, at one sitemodified intracrevicular sampling technique (MIST) was used, whereas the contralateral site was sampled with a deepintracrevicular sampling technique (DIST). Clinical periodontal parameters of the GCF sites were also recorded.

Results: No significant daily variations in GCF volume could be detected. Higher volumetric measures were observed ininflamed subgroups compared with healthy subgroups (P <0.05). MIST was equivalent to DIST with regard to mean GCFvolumes and the possible daytime volumetric alterations.

Conclusions: Within the limits of the present study, it can be suggested that daytime variations did not have significant impacton GCF volume. The sampling methodology had no apparent impact on the circadian periodicity of GCF.

Gingival crevicular fluid (GCF) is defined as a specific serum­originating biologic fluid found in periodontal microenvironmentand can be harvested from the gingival sulcus of natural teeth.1,2 The flow of GCF is widely accepted as one of the indicators ofperiodontal health/disease status, as it has the capacity to reflect the cellular response within the periodontium created by bothserum and gingival sulcus components.2 Such features are likely to make GCF a reliable tool for better understanding thepathogenesis of periodontal diseases and also for developing susceptible/specific tests for definitive periodontal diagnosis.3Studies analyzing the volumetric features, enzymatic profile, or cytokine profile of GCF have emphasized the diagnosticpotential of GCF as either an early indicator of changes in periodontal health status or a non­invasive prognostic tool.1,4 It hasbeen well demonstrated that GCF volume is affected by an array of factors, including mechanical stimulation, smoking, sexhormones, periodontal therapy, drugs, and circadian periodicity. Volumetric properties of GCF are important because they canaffect the findings of concentration­based GCF studies; therefore such factors are a specific concern when considering theimprovement of the reliability of GCF­related research.2,5­7 In a number of studies, smoking has been demonstrated to cause atransient but remarkable increase in GCF flow.5,8,9 During the periods of puberty, ovulation, and pregnancy, an increase in theproduction of sex steroid hormones and a subsequent increase in GCF flow was observed in women.6 Further, GCF productionwas shown to increase during the healing period after periodontal surgery.10 Since Eisenberg et al.11 detected metronidazole inGCF, Bader and Goldhaber12 showed that tetracyclines are excreted through GCF, and Ho et al.7 recently observed thatazithromycin decreases GCF volume, drug usage has been accepted as affecting the results of studies on GCF.

Mechanical stimulation has been demonstrated to increase the flow of GCF.2,13 While harvesting GCF, collecting the fluidwithout triggering the flow of this biologic fluid is a crucial methodological step because the fluid collected from the sulcus isvery limited and GCF flow can be easily affected by mechanical irritation.2,14 Many GCF collection methods (gingivalwashing, intracrevicular washing, micropipettes, twisted threads placed around and into the sulcus, absorbent paper strips, etc.)are available.2 However, collecting GCF using standardized absorbent paper strips is the preferred methodology using eitherintracrevicular or extracrevicular sampling methods.13 In extracrevicular sampling methods, the paper strip is placed at or overthe entrance of the gingival sulcus to minimize the mechanical irritation that may alter the actual flow of the fluid.13 Theintracrevicular method can be further subdivided depending on whether the strip is inserted just at the entrance of the crevice orperiodontal pocket (orifice technique),15 inserted to the base of the pocket or until minimum resistance is felt (deep

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intracrevicular technique),16 or inserted exactly 1 mm into the pocket (modified intracrevicular technique).17 Differenttechniques of intracrevicular sampling have been widely applied by other investigators.18­22 Circadian periodicity is anotherfactor with the potential to determine the volume/flow of GCF.2 However, little and inconsistent information is available onwhether GCF is subject to circadian rhythm.23,24 Bissada et al.23 suggested that GCF actually exhibits a clear circadianperiodicity. Similar findings were observed in a study by Bergmann and Deinzer,25 who reported daytime variations ofinterleukin­1? levels in GCF. In earlier studies, Suppipat et al.24 and Deinzer et al.21 demonstrated that variation in time of daydid not influence the flow rate of this biologic fluid. Further, Deinzer et al.21 claimed circadian periodicity was associated withthe irritation from GCF sampling.

The first aim of the present study is to assess the possible circadian rhythm of GCF, and the second aim to comparativelyanalyze the potential impact of modified intracrevicular and deep intracrevicular methodology of GCF sampling on circadianperiodicity.