Correlation of the Hydrolysis of Benzoyl-Arginine Naphthylamide (BANA) by Plaque with Clinical Parameters and Subgingival Levels of Spirochetes in Periodontal Patients

Recent studies have shown that the extent of hydrolysis by plaque of the trypsin substrate, N-benzoyl-DL-arginine-2-naphthylamide (BANA), correlates with the numbers and proportions of spirochetes in subgingival plaque samples, and appears to be an indicator of clinical disease. In this study, BANA hydrolysis by subgingival plaque was evaluated in a blind manner for its ability to reflect both clinical parameters and subgingival levels of bacteria and spirochetes. Subgingival plaque samples were collected from periodontally healthy and diseased sites in 23 untreated periodontal patients and in 13 treated and maintained periodontal patients. In untreated patients, BANA hydrolysis was statistically associated with the total number of spirochetes and bacteria in the plaque sample, but in the treated patients BANA hydrolysis was statistically associated only with the spirochetes. Most BANA-positive reactions in both patient groups were from the sites which were clinically diseased and high in spirochetes. The majority of the negative reactions for BANA hydrolysis in both patient groups was among the sites which were periodontally healthy and low in spirochetes. Specificity and sensitivity of the test were above 80% for disease status in untreated patients. The predictive value of a positive and negative test was above 83%. Slightly lower sensitivity, specificity, and predictive values were found in the treated group. The BANA reaction appears to be an accurate and simple indicator of both clinical disease status and plaque levels of spirochetes in individual tooth sites in untreated and treated periodontal patients.