Effect of tobacco smoking on neutrophil activity following periodontal surgery

Background: Tobacco smoking has considerable negative effects on the outcome of periodontal treatment. The reason for the inferior therapeutical effect might be related to an altered neutrophil activity in terms of elastase and/or matrix metallo-proteinase-8 (MMP-8), as well as in the protease inhibitor alpha-1-antitrypsin (alpha-1-AT) and alpha-2-macroglobul in (alpha-2-MG) activities. The aim of the present study, therefore, was to elucidate the effect of tobacco smoking on gingival crevicular fluid (GCF) levels of these substances following surgical treatment. Methods: The study population included 15 smoking and 15 non-smoking patients with moderate to severe periodontitis receiving surgical treatment. Clinical examinations and collection of GCF were done prior to surgery and 1 and 5 weeks following treatment. The elastase activity was measured with a chromogenic low-molecular substrate and the levels of a-l-AT, a-2-MG, and MMP-8 with enzyme-linked immunosorbent assay. Results: The results showed unaltered levels of alpha-1-AT, alpha-2-MG, and MMP-8 in smokers following surgery. In non-smokers, the levels of alpha-1-AT and alpha-2-MG increased, whereas MMP-8 levels decreased. The levels of elastase remained unaltered in both smokers and non-smokers. Conclusions: These results indicate that in the presence of smoking, the levels of alpha-1-AT, alpha-2-MG, and MMP-8 remained unaltered during the recovery period following surgical treatment. This is interpreted as a possible interference of smoking with the treatment response and may, in part, explain the clinical evidence of an inferior treatment outcome in smokers.