Comparative analysis of gingival crevicular fluid in gingivitis and periodontitis

Relevance. Periodontal diseases, particularly gingivitis and periodontitis, remain a major challenge in modern dentistry because of their high prevalence, early clinical presentation, and established associations with several serious systemic diseases. In periodontitis, progressive breakdown of the gingival sulcus epithelial barrier allows periodontal pathogens to invade deeper periodontal tissues, triggering a cascade of destructive inflammatory responses.

Objective. To study and compare the clinical and proteomic characteristics of gingival crevicular fluid in periodontal health, gingivitis, and periodontitis and to identify key biomarkers associated with the risk of progression from reversible inflammation to irreversible tissue destruction.

Materials and methods. This non-blinded prospective comparative cohort study included 90 participants aged 21–65 years and was conducted from January 2024 to August 2025. Three groups were studied: periodontal health (n = 20), gingivitis (n = 20), and Stage III–IV periodontitis (n = 50). Periodontal indices and parameters were assessed, including the Gingival Index (GI), Plaque Index (PI), Papillary Bleeding Index (PBI), clinical attachment loss (CAL), and the Fuchs index. Gingival crevicular fluid (GCF) was analyzed by LC-MS/MS with label-free protein quantification (LFQ, MaxQuant). Statistical analysis included the Kruskal–Wallis test and Dunn’s post hoc test with Holm correction (p < 0.05).

Results. Progression from gingivitis to periodontitis was associated with a shift in the dominant pathogenic mechanisms: activation of innate immune factors gave way to uncontrolled tissue destruction mediated by the complement system, particularly complement factor B (CFB), and matrix metalloproteinase 9 (MMP-9). The identified panel of proteins — CFB, MMP-9, HBB, and CST4 — has considerable potential as an objective laboratory tool for differential diagnosis and risk assessment in periodontal disease progression.

Conclusion. Epithelial–mesenchymal transition (EMT) plays a key role in the pathogenesis of periodontitis and in periodontal tissue remodeling. During this process, epithelial cells lose polarity and intercellular contacts and acquire mesenchymal properties, thereby promoting cell migration and destruction of periodontal supporting tissues. Understanding the role of the epithelial barrier and EMT mechanisms is critical for distinguishing reversible inflammatory conditions from irreversible destructive disease states.

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