Host-derived biomarkers in gingival crevicular fluid for complementary diagnosis of apical periodontitis

Abstract

Apical periodontitis (AP) develops as a result of the host’s immune inflammatory response to pulpal infection of the dental root canals that leads to the generation of an apical lesion of endodontic origin (ALEO) and potentially to systemic metabolic alterations. Misdiagnosed ALEO is not infrequent due to the lack of diagnostic tools to differentiate apical lesions of different natures. Despite the conservative endodontic treatment shows a high success rate, there are refractory cases that can not be identified early enough during follow up. This evidences the need to develop complementary diagnostic tools, such as oral fluid biomarker analysis. Gingival crevicular fluid (GCF) is a serum transudate that becomes an exudate under inflammatory conditions, carrying molecules from local periodontal tissues and general circulation than can be harvested non-invasively. We aimed to review the available literature analyzing GCF composition in AP patients to evaluate whether GCF has any potential for complementary diagnosis. To the date, only few studies addressing changes of GCF components in AP are available. Most studies support GCF modifications in specific components in AP-affected teeth, suggesting that it might reflect periapical inflammation. GCF has potential for diagnostic tool, treatment follow-up and eventually to assess systemic comprise.

Keywords: Gingival crevicular fluid; Periapical periodontitis; Biomarkers; Diagnosis; Prognosis

Core tip: The hallmark of Apical periodontitis (AP) is the development of an apical lesion of endodontic origin and can potentially lead to systemic alterations. Avoiding misdiagnosis and follow up are among the main challenges in its clinical management. The current review addresses the studies evaluating gingival crevicular fluid (GCF) composition in AP patients reported in the literature. Specific components vary in AP-affected teeth, supporting that GCF has potential for complementary diagnosis and treatment follow-up.