HISTOPATHOLOGICAL CHANGES IN PERIODONTAL LIGAMENT OF CHRONIC PERIODONTITIS PATIENTS IN PESHAWAR

Abstract

Chronic periodontitis is a common disease of the supporting tissues of teeth, such as the PDL. This descriptive-analytical cross-sectional study aimed at comparing the histopathological alterations in PDL of fifty patients suffering from chronic periodontitis in Peshawar. Tissue samples were obtained from patients who had opted for extraction of their teeth and they were tested for inflammatory changes, orientation changes in collagen fibers, cementum resorption, vascular changes and fibroblast activity. The study also showed tissue damage and raised inflammatory responses, damage to collagen, loss of cementum and reduced fibroblast count. The findings in this study are alarming especially bearing in mind the outcomes of people diagnosed with chronic periodontitis and call for early get well care.

Introduction

Chronic periodontitis is one of the most common periodontal diseases which occur in the PDL, alveolar bone, and gingiva. It is commemorated by bacterial biofilm and leads to chronic periodontitis characterized by the loss of periodontal attachment and alveolar bone, tooth mobility, and ultimately tooth loss. It produces mediators like cytokines and enzymes which in return leads in degradation of the extracellular matrix. Periodontal diseases are prevalent in Pakistan due to the lack of proper oral hygiene and, therefore, the insufficient number of dental treatments. The management of this disease necessitates an analysis of histopathological changes in the PDL of people with CP in Peshawar.

Methodology

Fifty patients diagnosed with chronic periodontitis were selected for the current cross-sectional study at Sardar Begum Dental College, Peshawar. Only patients of either sex in the age group of 30 to 60 years were selected while patients having systemic diseases or those having received periodontal therapy in the past one year were excluded. Well characterized samples from sub gingival tissues were collected from root surface of the PDL at the time of tooth extraction. These samples were processed through 10% formalin before undergoing demineralized using 10% formic acid before being processed for paraffin sectioning. Samples were stained with H&E method. Therefore, parameters that included collagen fiber arrangement, inflammatory cell accumulation, cementum loss, vessel alterations, and fibroblast density were analyzed. Additional immunohistochemical staining for MMPs was also done to determine the effect of ECM degradation.

Results

Histopathological analysis of the PDL samples showed significant alterations:

Inflammatory infiltrates: For 50% of samples, moderate inflammation was observed and seen are lymphocytes and plasma cells.

Collagen fiber disorganization: 54% of the samples exhibited complete disorganization of collagen fibers.

Cementum resorption: Mild to severe resorption was documented in 64% of the samples.

Vascular changes: 80% percent of the samples studied exhibited characteristics of inflammation by showing increased blood vessel density.

Fibroblast depletion: Sample 72% revealed a reduction in the number of fibroblast count which shows impaired tissue repair capability.

Conclusion

The present study emphasises on the quantification of histopathological alterations in chronic periodontitis patients of periodontal ligament in Peshawar. Such inflammation, disorder of collagen fiber, cementum resorption, and the absence of fibroblasts support the idea that this disease is progressive. These observations correspond with other pathological changes observed in such investigations and stress the importance of timely primary and secondary diagnosis in the further destruction of tissues and tooth loss.