Vascular remodelling in chronic inflammatory periodontal disease

Periodontitis is a chronic inflammatory disease of the highly vascularised supporting tissues of the teeth. Little is known about the vascular changes in untreated advanced periodontitis, Using confocal immunofluorescence mic roscopy and morphometry, we defined and quantified vascular remodelling in this lesion. In the connective tissue subjacent to the altered epithelium l ining of the periodontal pocket, there was a significant increase in the nu merical density of vascular profiles, primarily accounted for by vessels gr eater than or equal to 25 mu m in diameter. In addition, Vascular basement membranes were thickened and there was accumulation of non-vascular basemen t membrane remnants. We investigated the distribution of major angiogenic g rowth factors in periodontitis using immunohistochemistry. Basic fibroblast growth factor, although consistently associated with blood vessels, showed no regional variation in its distribution. In contrast, there was a marked regional variation in the intensity of immunostaining for vascular endothe lial growth factor, with significantly reduced staining of the pocket epith elium. The changes in the vascularity of the periodontal connective tissues in untreated advanced periodontitis may be, in part, a consequence of alte red expression of angiogenic activity by the epithelium, In turn, this may reflect the epithelial response to microbial flora in the microenvironment of the periodontal pocket.