The Influence of Vitamin D Status on Periodontal Surgery Outcomes - A Prospective Analysis

Abstract

Introduction: Periodontal disease is characterized by alveolar bone loss resulting from the host immune response to bacterial insult. With its important role in bone maintenance and immunity, there is biologic rationale to suggest that a deficiency in vitamin D may negatively affect periodontal treatment outcomes. The purpose of this double-masked, prospective observational study was to evaluate the influence of vitamin D levels on surgical outcomes. Methods: Sixty-five patients (aged 30-85) with moderate to severe chronic periodontitis received flap surgery. Enrolled patients had ≥1 tooth with probing depth (PD) ≥6mm and bleeding on probing (BOP); this served as the surgical (SX) site. Serum 25-hydroxyvitamin D (25[OH]D) samples and gingival crevicular fluid (GCF) samples were collected immediately prior to surgery (baseline [BL]) and analyzed for bone metabolism biomarkers. PD, clinical attachment level (CAL) and BOP were recorded at BL, 3, 6 and 12 months after surgery. Radiographic bone level was evaluated at BL and at 12 months. Patients were then divided into vitamin D deficient (DEF, <20ng/mL) and sufficient (SUF, ≥20ng/mL) groups, and differences between groups were analyzed. Results: Fifty-one patients (DEF, n=13; SUF, n=38) reported for the 12-month follow up and no BL differences were noted between groups. SUF patients had significantly greater PD reduction compared to DEF patients at both 6 months (3.1 +/- 1.3 mm vs. 1.8 +/- 1.1mm, p=0.001) and 12 months (2.8 +/- 1.3mm vs. 1.8 +/- 1.1mm, p=0.01). Linear regression analysis revealed significant a correlation between 25[OH]D levels and PD reduction at 6 months (p=0.001) and 12 months (p=0.005), CAL gain at 6 months (p=0.02) and radiographic bone gain at 12 months (p=0.04). At 6 months, PD reduction was significantly correlated with BL GCF levels of IL-10 (p=0.02) and IL-6sR (p=0.04). At 12 months, CAL gain was significantly correlated with BL levels of IL-6sR in the GCF (p=0.03) and in the serum (p=0.005), and radiographic bone gain was significantly correlated with BL GCF levels of IL-10 (p=0.01). Additionally, significant positive correlations between serum 25[OH]D levels and BL GCF levels of MER (p<0.00001) and SDF-1 (p=5x10-11) were identified. Conclusions: These results suggest that a deficient vitamin D level at the time of periodontal surgery negatively affects clinical outcomes for up to 1 year.