Effect of phase I therapy on salivary carboxy terminal telopeptide of type I collagen in chronic periodontitis patients
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S. Aravind Kumar. Effect of phase I therapy on salivarycarboxy terminal telopeptide of type I collagen in chronic
periodontitis patients. IAIM, 2021; 8(4): 69-74.
Original Research Article
Effect of phase I therapy on salivary
carboxy terminal telopeptide of type I
collagen in chronic periodontitis patients
S. Aravind Kumar*
Assistant Professor, Department of Dentistry, Apollo Institute of Medical Sciences and Research,
Chittoor, India
*
Corresponding author email: aravindmds@gmail.com
International Archives of Integrated Medicine, Vol. 8, Issue 4, April, 2021.
Available online at http://iaimjournal.com/
ISSN: 2394-0026 (P) ISSN: 2394-0034 (O)
Received on: 20-03-2021 Accepted on: 05-04-2021
Source of support: Nil Conflict of interest: None declared.
How to cite this article: S. Aravind Kumar. Effect of phase I therapy on salivary carboxy terminal
telopeptide of type I collagen in chronicperiodontitis patients. IAIM, 2021; 8(4): 69-74.
Abstract
Background: Salivary biomarkers are extensively studied in various fields of dentistry. Carboxy
terminal telopeptide of type I collagen (CTX), a degradation product that is a marker of bone
resorption is released into tissues during the periodontal disease process and reaches the saliva via
GCF. Changes in salivary CTX levels can be used to detect and monitor periodontal disease activity.
Aim of the study: The present study aimed to analyze the effect of phase I therapy in chronic
periodontitis subjects by evaluating the salivary CTX levels and to compare and correlate the salivary
CTX levels with clinical parameters.
Materials and methods: This study was conducted in Aravind Dental Hospital. (for 3 months).
Salivary CTX levels were determined in patients with chronic periodontitis, n=25 (study group), and
healthy controls (n=20) using Enzyme-linked Immunosorbent Assay (ELISA). The salivary CTX
levels were compared and correlated with clinical parameters namely PI, GBI, PPD, CAL before and
after phaseI therapy.
Results: There was a statistically significant increase in salivary CTX levels in the study group when
compared to the control group (p0.05).
Conclusion: In the present study, there was a significant difference in salivary CTX levels between
the groups, and a significant decrease in these levels was observed after phase I therapy in the study
group. This signifies that the detection of CTX in saliva may be useful to detect individuals at risk,
periodontal disease activity, and its response to periodontal therapy.
Page 69S. Aravind Kumar. Effect of phase I therapy on salivarycarboxy terminal telopeptide of type I collagen in chronic
periodontitis patients. IAIM, 2021; 8(4): 69-74.
Key words
Carboxy terminal telopeptide of type I collagen (CTX), Bone resorption, Markers, Chronic
periodontitis.
Introduction clinical parameters namely Plaque index (PI),
The presence of active periodontal disease with Gingival bleeding index (GBI), Probing
continuing attachment loss threatens the oral pocket depth (PPD), Clinical attachment level
health, comfort, and function of the patient. If (CAL) before and after phaseI therapy.
the disease activity could be determined,
therapeutic measures may be fashioned for Inclusion criteria
individual patients. Recently, the field of Systemically healthy subjects.
Periodontics has advanced dramatically in Age: 30 – 40 years.
different ways to assess sites and individuals Gender: Both males and females.
with active disease [1]. Proteolytic enzymes play Patients with generalized chronic
a major role in the destruction of periodontium periodontitis with a minimum of 20
during the disease process. These enzymes teeth.
(collagenases, proteases, aminopeptidases, etc.) Exclusion criteria:
and their breakdown products are considered as History of any systemic illness.
markers of periodontal disease activity [2]. History of systemic antibiotics or anti-
During the initial phase of bone resorption, the inflammatory drugs during the past 6
pH at the site is acidic. As a result, cathepsin K months.
(cysteine protease) released from the osteoclasts Pregnancy, lactation, and menopause.
attacks the type I collagen at multiple sites, Patients who smoke or use tobacco in
including several sites in the helical region. any form.
CTX is generated by cathepsin K, but ICTP is History of any periodontal treatment
destroyed by this enzyme. ICTP is generated by during the past 1year.
the action of MMP’s such as MMP – 9 and MMP
– 12 [3]. Thus ICTP is termed as CTX – MMP. The selected subjects were divided into 2 groups
CTX is considered as the most specific and based on the following criteria: Group I – Control
sensitive marker to monitor metabolic bone group (n=20) Group II – Study group (n=25).
diseases and physiological bone turnover. It can The present study is an interventional study.
be detected from samples by Enzyme-linked Saliva samples were collected at baseline in both
Immunosorbent Assay (ELISA) using highly the groups and after Phase, I therapy in group II.
specific monoclonal antibodies. Unstimulated, Hence group II was further classified into Group
whole saliva represents a pooled sample of all II A – before Phase I therapy Group II B – after
periodontally diseased sites. Hence, saliva was Phase I therapy. In addition, subjects should meet
used to analyze the level of this biomarker in the following criteria: Should have good oral
generalized chronic periodontitis patients [4]. hygiene throughout the periodontal treatment.
Absence of any lesions in the oral cavity.
Materials and methods Clinical Attachment Level was measured from
This study was conducted in Aravind Dental the Cemento – Enamel Junction (CEJ) to the base
Hospital (for 3 months). Salivary CTX levels of the pocket in millimeters using William’s
were determined in patients with chronic Periodontal Probe. Three measurements were
periodontitis, n=25 (study group), and healthy made on the buccal aspect and three on the
controls (n=20) using Enzyme-linked lingual aspect of each tooth – a total of six sites
Immunosorbent Assay (ELISA). The salivary per tooth (Mesiobuccal, Midbuccal, Distobuccal,
CTX levels were compared and correlated with Mesiolingual, Midlingual, and Distolingual). If
Page 70S. Aravind Kumar. Effect of phase I therapy on salivarycarboxy terminal telopeptide of type I collagen in chronic periodontitis patients. IAIM, 2021; 8(4): 69-74. the gingival margin is located on the anatomic parameter and salivary CTX level. In the present crown, the level of the attachment was study, P-value
S. Aravind Kumar. Effect of phase I therapy on salivarycarboxy terminal telopeptide of type I collagen in chronic
periodontitis patients. IAIM, 2021; 8(4): 69-74.
Table – 1: Clinical correlation parameters group I and group II A.
GROUP MEAN S.D P-VALUE
PI I 0.26 0.22
II A 2.58 0.15 0.000**
GBI (%) I 15.57 6.06
II A 96.22 2.54 0.000**
PPD (MM) I 2.84 0.53
II A 6.27 0.93 0.000**
CAL (MM) I 0.00 0.00
II A 6.93 0.64 0.000**
** < 0.01 – HIGHLY SIGNIFICANT *0.05-0.01 – SIGNIFICANT $ >0.05 – NOT
SIGNIFICANT
Table – 2: Comparison of salivary CTX between group I andgroup II A.
Group I Group IIA P-value
CTX (pg/ml) Mean S.D Mean S.D
38.39 6.22 152.98 16.74 0.000**
The mean salivary CTX levels were current disease status [5]. Moreover, they are not
152.98±16.74 pg/ml in the study group and reliable for identifying individuals with
38.78±6.22 pg/ml in the control group. There progressing disease activity. Biomarkers of
was a high statistically significant difference disease activity facilitate earlier detection of
in salivary CTX levels between the study and the disease and help in monitoring therapy outcomes
control group. A highly significant difference [6]. Recently, salivary markers have been
(pS. Aravind Kumar. Effect of phase I therapy on salivarycarboxy terminal telopeptide of type I collagen in chronic periodontitis patients. IAIM, 2021; 8(4): 69-74. potentially useful in detecting individuals at risk. was obtained [13]. On the evaluation of salivary Stimulated whole saliva is less suitable for CTX levels in the study group before and after diagnostic applications because the foreign phase, I therapy highly significant difference substances used to stimulate saliva tend to (p
S. Aravind Kumar. Effect of phase I therapy on salivarycarboxy terminal telopeptide of type I collagen in chronic
periodontitis patients. IAIM, 2021; 8(4): 69-74.
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