GRANULOCYTE ELASTASE IN GINGIVAL CREVICULAR FLUID - IMPROVED MONITORING OF THE SITE-SPECIFIC RESPONSE TO TREATMENT IN PATIENTS WITH DESTRUCTIVE PERIODONTITIS

In 13 patients with severe destructive periodontitis, the response to periodontal therapy was estimated by granulocyte elastase level in gin gival crevicular fluid (GCF). 62 sites were classified according to ch anges of probing depths (PD) and quantitative bone height (BH%) before and after 5-year regular maintenance treatment: (i) 17 consistently h ealthy sites with no changes of PD and BH%; (ii) 6 initially healthy s ites with deterioration in PD and BH%; (iii) 14 diseased sites with im provement in PD and BH%; (iv) 25 diseased sites with no improvement in PD and BH%. GCF was collected by an intracrevicular washing system. T he released elastase in the supernatants (EA-S) and the cell-bound ela stase in the pellets (EA-P) were determined with a low molecular weigh t substrate specific for granulocyte elastase. The ratio of EA-S and E A-P (S/P-ratio) was used as a relative measure of elastase released by the granulocytes present. The sites classified as diseased with no im provement or initially healthy but deteriorating, had significantly hi gher EA-S, EA-P and S/P-ratios than the consistently healthy sites or diseased but improving sites (p<0.01). Both EA-S and S/P-ratio showed strongly positive correlations with the current levels of gingival inf lammation and periodontal destruction (p<0.001). The present study sug gests that increased elastase level is associated with disease progres sion, and may be used to monitor the response to longitudinal maintena nce therapy.