Periodontal Status Post Liver Transplantation; clinical and immunological 10-year followup

Objectives: Liver transplantation patients were previously shown to manifest poor periodontal status, as a result of systemic and local factors leading to severe bone loss and periodontal breakdown. In this study, we were aiming to follow-up over the period of 10 years on the periodontal status of liver transplanted patients previously examined by us. Methods: 17 post liver transplant patients (12 females, 5 males) who were evaluated 10 years earlier (t0) were enrolled in the study (t1). Clinical, radiographic and immunological periodontal parameters were recorded for the Ramfjord index teeth and compared to the t0 results. Statistical analysis was conducted for all parameters comparing t1 and t0 using ANOVA. Results: While lower levels at t1 of plaque index, gingival index, clinical attachment level and mean gingival overgrowth scores failed to reach statistical significance, periodontal probing depth levels were significantly lower at t1 compared to t0 (2.43±0.18 mm vs. 3.35±0.22 mm respectively, p=0.001). This was accompanied by a decrease in interleukin (IL)-1beta levels over the years (11.8±2.44 pgr/sample for t1 vs. 22.31±4.7 pgr/sample t0, p=0.03), whereas levels of prostaglandin E2 (PGE2) and tumor necrosis factor (TNF)-alpha remained unchanged. Radiographic bone loss at t1 was significantly higher than at t0 (5.53mm vs. 4.28mm respectively, p=0.025). Conclusion: The tendency for improvement in clinical parameters accompanied by reduction of some immunological markers despite significant alveolar bone loss over 10 years highlights again the complexity of the periodontal - systemic health interactions affecting periodontal status. This improvement may partially be attributed to the patients' self awareness and their medical and dental consciousness.