Changes In Gingival Crevicular Fluid Volume And Flow Rate During Orthodontic Treatment

Background: Gingival crevicular fluid (GCF) is regarded as a promising medium for detection of periodontal disease activity. bone loss is a major feature of periodontal disease, although we are unable to determine the time of this bone loss and therefore periodontal disease activity. During orthodontic treatment small forces are applied, resulting in bone remodeling which allows tooth movement. Orthodontic model may be used as a preliminary stage in evaluating gingival crevicular fluid role in bone turnover. Aims: To detect GCF and to monitor it's volume and flow rate following orthodontic activation, and to determine at what stage inflammation and bone resorption reach their maximum. Materials and methods: GCF samples were collected from 10 adult orthodontic patients (mean age = 22.3 , range 20-24year) on 3,7,10,14,21,28,35 days after activation of orthodontic appliance, from the tooth surface where bone resorption was expected to occur. A total of 330 GCF sample were collected using filter paper strip, the volume measured by weighing. Results: An insignificant increase in GCF volume and flow rate was noted in the tenth day after activation of the orthodontic appliance activation,. At 35 days GCF reached its minimum flow rate. There was considerable variation between subjects and between the same subject on different days Conclusion: Increase in GCF volume and flow rate reflects the effect of orthodontic adjustment rather than oral hygiene, as there were no clinical inflammatory changes during the period of orthodontic treatment studied. J o u r n a l D e n t a l a n d O r a l I m p l a n t s ISSN NO: 2473-1005 RESEARCH ARTICLE DOI : 10.14302/issn.2473-1005.jdoi-15-921 Corresponding Author : Dr. Najwa Nassrawin; Dental Department, king Hussein Medical Center, Royal Medical Services. Jordan-Amman, P.O. box 1438, Al Jubieha. E-mail: najwanass@yahoo.com Running title : Gingival crevicular fluid orthodontic treatment


Introduction
Detection of an indicator of active phases of tissue destruction, particularly that of the alveolar bone during periodontal disease is the dream of dental investigators.
The It is widely considered that GCF is formed as a blood infiltrate, with some metabolic elements and host cells from the gingival crevice environment(5) . GCF reflects disease severity and considered with Il-β a better marker of gingival inflammation in comparison with periodontal pocket depth and bleeding on probing (6).
GCF volume and flow rate are indicators of changes in vascular permeability which occurs in the early stages of inflammation (4). It may be representative of the early signs of inflammation (2,5) . The outflow of this exudates helps to clean the dentogingival space of non-adherent microbes, and to reduce the concentrations of their toxins and metabolic byproducts (7).  (9). Collection of GCF by filter paper strip is affected by many factors like contamination with saliva and plaque (10,11,12), also by any mechanical irritation like mastication, tooth brushing(13), sampling time (14) and smoking (15,16) Evaluation amount of GCF collected by filter paper strip by many ways, but the best was introduced by using Periotron. It allowed accurate determination of GCF volume and subsequently laboratory investigation of the sample composition. Three models of Periotron have been produced (600, 6000, 8000), and each has been shown to be an efficient means of measuring the volume of fluid collected n filter paper strip (2).
When a small orthodontic force is applied to teeth for an adequate period of time an inflammatory event has taken place in the periodontium resulting in bone remodeling that provides the movement of teeth.
In order to develop biological strategy for enhancing this movement of teeth in bone, the underlying mechanism of bone resorption and apposition should be understood in detail (17) .
When small orthodontic forces applied for a prolonged period of time inflammatory events occur within the periodontium resulting in the release of inflammatory mediators (18) The aims of this study are: to monitor the GCF flow rate and volume and to determine at what stage GCF production reach the maximum level following orthodontic activation.

Study Design
Each experimental period was run from appliance activation to the next period of activation 4-8 weeks. In order to examine the effect of the appliance activation on the GCF levels. Ten subjects were examined and samples were collected on 7 occasions over 6 weeks. Samples were collected 3, 7, 10, 14, 21, 28, and 35 days after activation of orthodontic appliance.

Subjects Selection
The subjects who participated in this investigation, who were undergoing orthodontic treatment. The inclusion criteria were presence of fixed orthodontic appliance without any kind of extractions, no signs of gingivitis or periodontitis, probing depths should not more than 3mm in the whole dentition, plaque score Ethical approval for the study had been obtained according Eastman Dental Institute and London Hospital.
All suitable subjects were given a verbal and written explanation of the study and a written consent was obtained. Ten subjects (6 females and 4 male) with mean age 20 years were available for sampling. The small number of the subjects was due to the frequency of sampling, and this was also, the reason for selecting subjects from amongst the staff. Sites of collection were isolated with cotton rolls and a saliva ejector. High volume aspiration was used close to the area of collection in order to prevent any salivary contamination. Using a periodontal probe, the tooth surface was cleaned of any plaque or debris, without disturbing the gingiva.

Collection of GCF and sampling protocol
The f.p.s. was placed at the entrance of the gingival crevice. Prior to GCF sampling each site was assessed for gingival color and the presence of plaque using standard clinical indices (19) . After the GCF was collected, probing was performed using a William periodontal probe (0.5 mm tip diameter) and the tendency of the gingival tissues to bleed following probing was noted. Analysis of variance revealed no statistically significant differences (P= 0.140) between the volumes collected on any of the days (Table 2). Similarly paired ttest between day 10 and day 7 (P= 0.32), and between days 10 and 35 (P= 0.09) also showed no statistically significant differences.  following orthodontic appliance adjustment.   (Table 4). Further paired t-test between days 10 and 35 (P= 0.77) showed no statistically significant differences.