LONGITUDINAL EVALUATION OF ELASTASE AS A MARKER FOR THE PROGRESSION OF PERIODONTITIS

TO DETERMINE WHETHER ELASTASE LEVELS in gingival crevicular fluid (GCF ) could serve as a marker for the progression of periodontitis, we mon itored GCF elastase and periodontal status in selected sites in 32 per iodontally healthy volunteers and 31 periodontitis patients at interva ls over a 6-month period. Clinical measurements included plaque index, gingival index, bleeding on probing, suppuration, probing depth, clin ical attachment level, and relative attachment level measured with an automated disk probe. GCF elastase, detected by reaction with a fluore scent substrate, was assessed visually against fluorescence standards and quantitatively with a fluorometer. Bone loss was detected by subtr action radiography of standardized vertical bite-wing radiographs at b aseline and 6 months. Mean visual elastase scores (VES) and quantitati ve elastase measurements were significantly higher (P < 0.001) in site s from periodontitis patients than in sites from healthy volunteers. W hen bone loss was used as the criterion for disease progression, signi ficantly higher (P < 0.001) visual and quantitative GCF elastase level s were found at progressing sites than in nonprogressing sites in the periodontitis patients. The odds ratios (OR) for the event of developi ng bone loss with positive 4-minute and 8-minute VES tests were 4.2 (P < 0.001) and 7.4 (P < 0.001), respectively. When corrected for the te ndency of progressing sites to be clustered within a subpopulation of patients, the OR for developing bone loss with the (I-minute and 8-min ute VES tests were 3.1 (P < 0.007) and 4.9 (P < 0.001), respectively. These data indicate that sites with high levels of elastase are at sig nificantly greater risk for progressive bone loss as assessed by digit al subtraction radiography.