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Wei S, Lin T, Sáenz-Ravello G, Gao H, Zhang Y, Tonetti MS, Deng K. Diagnostic accuracy of salivary active matrix metalloproteinase (aMMP)-8 point-of-care test for detecting periodontitis in adults: A systematic review and meta-analysis. J Clin Periodontol 2024; 51:1093-1108. [PMID: 38763168 DOI: 10.1111/jcpe.14000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/26/2024] [Accepted: 04/24/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVE To determine the accuracy of salivary active matrix metalloproteinase (aMMP)-8 point-of-care test (POCT) for detecting periodontitis in adults, through meta-analysis. MATERIALS AND METHODS Diagnostic studies evaluating the accuracy of salivary/oral rinse aMMP-8 POCT for detecting periodontitis in adults, when compared with clinical examination, were considered eligible. A comprehensive search was performed up to 31 August 2023 through five databases. Quality Assessment of Diagnostic Accuracy Studies 2 was utilized to evaluate the methodological quality of the included articles. Meta-analysis was performed using Bayesian bivariate hierarchical model and subgroup analysis. RESULTS From 368 screened studies, 6 studies (4 cross-sectional and 2 longitudinal studies) were included in the meta-analysis. Overall, the pooled sensitivity and specificity of salivary aMMP-8-POCT for detecting periodontitis were 0.63 (95% CI: 0.41-0.82) and 0.84 (95% CI: 0.65-0.95), respectively. Subgroup analyses revealed that the 95% CI for oral fluid types, predefined diagnostic thresholds and the POCT systems largely overlapped, indicating that the differences between them may not be significant. CONCLUSION Salivary aMMP-8 POCT shows fair accuracy for detecting periodontitis. The diagnostic accuracy cannot be significantly influenced by the types of oral fluids, predefined diagnostic thresholds or the specific POCT systems used. More research is needed to confirm the clinical utility and implementation of aMMP-8 POCT in the diagnosis of periodontitis.
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Affiliation(s)
- Shimin Wei
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco School of Dentistry, San Francisco, California, USA
| | - Tingting Lin
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Gustavo Sáenz-Ravello
- Center for Surveillance and Epidemiology of Oral Diseases, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Hanqi Gao
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yong Zhang
- First Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Maurizio S Tonetti
- Shanghai PerioImplant Innovation Center, Department of Oral Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ke Deng
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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2
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Xanthopoulou V, Räisänen IT, Sorsa T, Tortopidis D, Sakellari D. Diagnostic value of aMMP-8 and azurocidin in peri-implant sulcular fluid as biomarkers of peri-implant health or disease. Clin Exp Dent Res 2024; 10:e883. [PMID: 38853451 PMCID: PMC11163026 DOI: 10.1002/cre2.883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 03/08/2024] [Accepted: 03/17/2024] [Indexed: 06/11/2024] Open
Abstract
OBJECTIVE The objective of this study was to investigate the effectiveness of testing for active matrix metalloproteinase-8 (aMMP-8) by a quantitative point-of-care (PoC), chairside lateral flow immunotest and azurocidin, in the peri-implant sulcular fluid (PISF), as biomarkers for the presence or absence of peri-implant diseases. BACKGROUND Current research indicates that proinflammatory cytokines and extracellular matrix-degrading enzymes may be of value to diagnose and predict peri-implant disease initiation and progression, but more data are needed. METHODS Eighty patients with implants were recruited. PISF samples were collected and quantitatively analyzed for aMMP-8 (chairside) and azurocidin with ELISA. Radiographic assessments and clinical indices (probing depth, probing attachment level, bleeding on probing, and plaque) were recorded after sampling. Kruskal-Wallis test and pairwise post hoc Dunn-Bonferroni test were used to relate aMMP-8 levels and azurocidin levels to clinical parameters. The diagnostic ability of aMMP-8 (ng/mL) and azurocidin was analyzed by receiver operator curve analysis. Area under the curve (AUC) was calculated and the Spearman's rho, and the coefficient of determination (R2) were used to calculate the correlations between aMMP-8, azurocidin, and periodontal parameters. RESULTS Statistically significant differences were observed for aMMP-8 levels but not for azurocidin between healthy implants, implants with mucositis, and those with peri-implantitis (13.65 ± 7.18, 32.33 ± 21.20, and 73.07 ± 43.93 ng/mL, respectively), (Kruskall-Wallis test p < .05). The aMMP-8 test with a threshold of 20 ng/mL has a sensitivity of 71.7% and a specificity of 77.8% to identify peri-implantitis and healthy implants, respectively. AUC was found to be 0.814, and the accuracy of the method reaches 73.8%. Above a cutoff value of 33.7 ng/mL of aMMP-8, the accuracy of the test to detect peri-implantitis reaches 77.5% in relation to 62.5% of BoP from the same site. CONCLUSION Taken collectively, present data indicate that the aMMP-8 PoC lateral flow immunotest can be a beneficial, adjunctive diagnostic quantitative tool for real-time screening for peri-implant diseases.
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Affiliation(s)
- Vithleem Xanthopoulou
- Department of Preventive Dentistry, Periodontology and Implant Biology, Dental SchoolAristotle University of ThessalonikiThessalonikiGreece
- Present address:
Aristotle University of ThessalonikiAgiou Dimitriou54124Greece
| | - Ismo T. Räisänen
- Department of Oral and Maxillofacial Diseases, Head and Neck CenterUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Timo Sorsa
- Department of Oral and Maxillofacial Diseases, Head and Neck CenterUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
- Division of Periodontology, Department of Dental MedicineKarolinska InstitutetStockholmSweden
| | - Dimitrios Tortopidis
- Department of Prosthodontics, Dental SchoolAristotle University of ThessalonikiThessalonikiGreece
| | - Dimitra Sakellari
- Department of Preventive Dentistry, Periodontology and Implant Biology, Dental SchoolAristotle University of ThessalonikiThessalonikiGreece
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Zalewska EA, Ławicka R, Grygorczuk P, Nowosielska M, Kicman A, Ławicki S. Importance of Metalloproteinase 8 (MMP-8) in the Diagnosis of Periodontitis. Int J Mol Sci 2024; 25:2721. [PMID: 38473967 DOI: 10.3390/ijms25052721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/13/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Periodontitis is a complex condition. Left untreated, it leads to tooth loss and the need for prosthetic treatment. The incidence of periodontitis is steadily increasing, so new methods are being sought to aid in the diagnosis of the disease. Among the methods postulated is the determination of concentrations of bioactive compounds which include extracellular matrix metalloproteinases (MMPs). These enzymes are present in various structural elements of the stomatognathic system. The most promising enzyme of this group appears to be metalloproteinase 8 (MMP-8). MMP-8 assays are performed in gingival fluid or saliva, and MMP-8 levels have been shown to be higher in patients with periodontitis compared to healthy subjects and correlated with some clinical parameters of the condition and the severity of the disease. In addition, the preliminary usefulness of this enzyme in evaluating the effectiveness of periodontal treatment and doxycycline therapy has been demonstrated. Determination of the active form of MMP-8 (aMMP-8) in oral rinse fluid using off-the-shelf assays shows the highest potential. Despite reports about aMMP-8 and promising data on the role of MMP-8 in periodontal diagnosis, a clear determination of the usefulness of this enzyme requires further research.
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Affiliation(s)
| | - Renata Ławicka
- The "Karedent" Dental Clinic, Bukowskiego 1/u3, 15-006 Bialystok, Poland
| | - Piotr Grygorczuk
- The "Karedent" Dental Clinic, Bukowskiego 1/u3, 15-006 Bialystok, Poland
| | - Magdalena Nowosielska
- Department of Gerostomatology, Medical University of Białystok, Akademicka 3, 15-267 Bialystok, Poland
| | - Aleksandra Kicman
- Department of Aesthetic Medicine, Medical University of Białystok, Akademicka 3, 15-267 Bialystok, Poland
| | - Sławomir Ławicki
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Białystok, Waszyngtona 13a, 15-269 Bialystok, Poland
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Alhammadi A, Koippallil Gopalakrishnan AR, Saqan R, Badran Z, Al Kawas S, Rahman B. Salivary macrophage chemokines as potential biomarkers of gingivitis. BMC Oral Health 2023; 23:77. [PMID: 36747174 PMCID: PMC9903476 DOI: 10.1186/s12903-023-02787-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE The present study aimed to analyze the salivary levels of macrophage-activating factor (MAF), macrophage-chemotactic factor (MCF), and macrophage migration inhibitory factor (MIF) in healthy and gingivitis patients, and to correlate between the concentrations of these chemo attractants with the intensity of gingival inflammation clinically. METHODS Sixty saliva specimens were collected from periodontally healthy (n = 30), and gingivitis patients (n = 30). Bleeding on probing (BOP), Visible Plaque Index (VPI), and Simplified Modified Gingival Index (SMGI) were recorded through clinical examination. Salivary MAF, MCF, and MIF concentrations were assayed using enzyme-linked immunosorbent assays (ELISA). Statistical analysis was performed using SPSS (version 28). Total mean score for each biomarker was determined, and descriptive bivariate statistics were conducted to characterize the levels of biomarkers among the study groups. The difference in the biomarker levels among the study groups were analyzed by independent sample t test and one-way ANOVA. The diagnostic ability of the biomarkers was further tested by ROC curve analysis. RESULTS Salivary levels of MAF was not significantly different between periodontally healthy individuals and gingivitis patients. The difference in MCF and MIF levels between patients with gingivitis and those with healthy periodontium was statistically significant (p 0.05 and p 0.001, respectively). When examined across the various stages of disease progression, MIF showed statistically significant difference among the three biomarkers (p 0.05). ROC curve analysis further revealed that area under the curve (AUC) for MIF has a better diagnostic capacity than MCF (AUC 0.981 vs. 0.673). CONCLUSIONS Our results suggest that MIF could be considered as a potential salivary biomarker for gingivitis.
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Affiliation(s)
- Amna Alhammadi
- grid.412789.10000 0004 4686 5317Master of Dental Surgery in Periodontics, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - Aghila Rani Koippallil Gopalakrishnan
- grid.412789.10000 0004 4686 5317Wound Healing and Oral Diagnostic Research Group-Sharjah Institute of Medical Research, University of Sharjah, Sharjah, UAE
| | - Roba Saqan
- grid.412789.10000 0004 4686 5317Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
| | - Zahi Badran
- grid.412789.10000 0004 4686 5317Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - Sausan Al Kawas
- grid.412789.10000 0004 4686 5317Department of Oral and Craniofacial Health Science, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - Betul Rahman
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE.
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Lähteenmäki H, Tervahartiala T, Räisänen IT, Pärnänen P, Mauramo M, Gupta S, Sampson V, Rathnayake N, Heikkinen AM, Alassiri S, Gieselmann DR, Frankenberger R, Sorsa T. Active MMP-8 point-of-care (PoC)/chairside enzyme-test as an adjunctive tool for early and real-time diagnosis of peri-implantitis. Clin Exp Dent Res 2022; 8:485-496. [PMID: 35118828 PMCID: PMC9033547 DOI: 10.1002/cre2.537] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/12/2021] [Accepted: 12/14/2021] [Indexed: 01/03/2023] Open
Abstract
Objective The aim of this study was to investigate the utility of the active matrix metalloproteinase (aMMP‐8)‐point‐of‐care (PoC) test as a quantitative real‐time chair‐side diagnostic tool for peri‐implant diagnosis, as well as assess the potentially developing and ongoing risk relative to the traditional clinical methods. Background Current peri‐implant and periodontal disease diagnoses rely on clinical and radiological examinations. This case‐control study investigated the applicability of aMMP‐8‐PoC immunotest for quantitative real‐time diagnosis and monitoring of dental implants in health and disease. Methods Sixty‐eight patients visiting a specialist clinic for maintenance following dental implant placement underwent assessment of their peri‐implant health. aMMP‐8‐PoC peri‐implant sulcular fluid (PISF) lateral‐flow immunotests were performed using ImplantSafe® technology quantitated by ORALyzer®. In addition, the PISF samples were analyzed for total MMP‐8, calprotectin, and interleukin (IL)‐6 by enzyme‐linked immunosorbent assays (ELISA), aMMP‐8 by western immunoblot, and MMP‐2 and MMP‐9 by gelatin zymography. Results The aMMP‐8‐PoC test promptly recorded and reflected peri‐implant disease, differentiating it clearly from health. X‐ray findings (bone loss > 2 mm), peri‐implant pocket depth ≥ 3 mm, and bleeding on probing were significantly more prevalent among implants positive for the aMMP‐8‐PoC test. aMMP‐8/ORALyzer analysis was more precise in recording disease than total MMP‐8, calprotectin, IL‐6, MMP‐2, and MMP‐9. Conclusions The aMMP‐8‐PoC test can be conveniently implemented to alert for and detect active collagenolysis affecting peri‐implant tissues, both in the early and advanced stages of the disease. Active and fragmented MMP‐8 exhibits a strong and significant association with peri‐implantitis as compared to total MMP‐8 and other biomarkers and can be utilized as the POC/chairside biomarker of choice in the new classification of peri‐implantitis.
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Affiliation(s)
- Hanna Lähteenmäki
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Taina Tervahartiala
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ismo T Räisänen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pirjo Pärnänen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matti Mauramo
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Pathology, Haartman Institute and HUSLab, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Shipra Gupta
- Unit of Periodontics, Oral Health Sciences Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Victoria Sampson
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nilminie Rathnayake
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna-Maria Heikkinen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Saeed Alassiri
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Periodontics and Community Dental Sciences, King Khalid University, Abha, Saudi Arabia
| | | | - Roland Frankenberger
- Department for Operative Dentistry, Endodontics, and Pediatric Dentistry, Philipps University Marburg and University Hospital Giessen and Marburg, Marburg, Germany
| | - Timo Sorsa
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
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6
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Nędzi-Góra M, Górska R, Górski B. The utility of gingival crevicular fluid matrix metalloproteinase-8 provides site-specific diagnostic value for periodontal grading. Cent Eur J Immunol 2021; 46:236-243. [PMID: 34764793 PMCID: PMC8568025 DOI: 10.5114/ceji.2021.107031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/11/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Matrix metalloproteinase-8 (MMP-8), and its active form aMMP-8, was identified as a potential biomarker of periodontal tissue destruction. It is present at different concentrations in various oral fluids. MATERIAL AND METHODS Gingival crevicular fluid (GCF) samples were collected from periodontal pockets ≥ 6 mm of 24 untreated patients using paper points and clinical parameters were recorded. 12 subjects were diagnosed with periodontitis stage III grade B, and 12 others with periodontitis stage III grade C. After thorough preparations, samples were collected following manufacturers' instructions and analyzed using a commercially available test system for aMMP-8 evaluation (aMMP-8 Test) and Periotron 8000 together with Quantikine kits for assessment of total MMP-8 concentration (controls). Microbiological evaluation of the same pockets was carried out using real-time polymerase chain reaction. RESULTS Concentrations of both total MMP-8 and aMMP-8 in GCF were higher in the case of periodontitis grade C, compared to periodontitis grade B, but reached statistical significance only in the case of total MMP-8 (77.17 ng/ml and 18.73 ng/ml respectively; p = 0.0104). Positive correlations were found between total MMP-8 and aMMP-8 levels and the prevalence of Fusobacterium nucleatum, mean probing pocket depth of all pockets, % of pockets ≥ 6 mm, as well as probing pocket depth of pocket from which GCF samples were collected. CONCLUSIONS GCF concentration levels of both total MMP-8 and aMMP-8 correlated with severity of periodontal destruction, whereas total MMP-8 appeared to be a preferable method for differentiation of periodontal grading. However, the aMMP-8 Test was easier and more convenient to handle.
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Affiliation(s)
| | - Renata Górska
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Bartłomiej Górski
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Warsaw, Poland
- The Chair and Department of Periodontology, Medical University of Lublin, Lublin, Poland
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7
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Deng K, Pelekos G, Jin L, Tonetti MS. Diagnostic accuracy of a point-of-care aMMP-8 test in the discrimination of periodontal health and disease. J Clin Periodontol 2021; 48:1051-1065. [PMID: 33998040 PMCID: PMC8362205 DOI: 10.1111/jcpe.13485] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/29/2021] [Accepted: 04/22/2021] [Indexed: 12/17/2022]
Abstract
Aim To assess the diagnostic utility of an oral rinse active matrix metalloproteinase‐8 (aMMP‐8) point‐of‐care test (POCT) for differentiating periodontal health, gingivitis, as well as different stages and grades of periodontitis. Materials & Methods The aMMP‐8 index test was undertaken in 408 consecutive adults, followed by a full‐mouth periodontal examination. The reference standard was the 2017 World Workshop classification of periodontal diseases. Sensitivity, specificity, and the area under the receiver operating characteristic curve (AUROC) were assessed. Results 68.6% of the participants were diagnosed with periodontitis, including Stages I (15.9%), II (15.9%), III (29.7%) and IV (7.1%). A positive aMMP‐8 POCT was associated with periodontitis after adjusting for age, gender, tobacco smoking and systemic diseases, while it was unable to differentiate among the stages/grades of periodontitis and between gingivitis/periodontal health. This test showed a sensitivity of 33.2% and a specificity of 93.0% for detecting periodontitis (threshold level >10 ng/ml). The levels of aMMP‐8 adjusted by the number of teeth present (aMMP‐8/NTP) performed better for periodontitis (sensitivity: 67.1%; specificity: 68.8%). Notably, aMMP‐8/NTP were strongly predictive for Stage IV periodontitis (threshold level =0.4312 ng/ml) (sensitivity: 89.7%; specificity: 73.6%; and AUROC: 0.856). The test performance greatly improved in combination with age and smoking, with a sensitivity of 82.5%, a specificity of 84.4%, and an AUROC of 0.883. Conclusion This aMMP‐8 POCT is able to detect periodontitis with better specificity than sensitivity across the spectrum of its severity. This test may be useful for periodontal screening in conjunction with subject characteristics and/or other sensitive screening tools. Further validation studies are needed.
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Affiliation(s)
- Ke Deng
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.,Department of Oral Implantology, Shanghai Ninth People Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology; National Center of Stomatology; National Clinical Research Center of Oral Diseases; Shanghai key Laboratory of Stomatology, Shanghai, China
| | - George Pelekos
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Lijian Jin
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Maurizio S Tonetti
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.,Department of Oral Implantology, Shanghai Ninth People Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology; National Center of Stomatology; National Clinical Research Center of Oral Diseases; Shanghai key Laboratory of Stomatology, Shanghai, China.,European Research Group on Periodontology, Genova, Italy
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8
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Zhang Y, Kang N, Xue F, Qiao J, Duan J, Chen F, Cai Y. Evaluation of salivary biomarkers for the diagnosis of periodontitis. BMC Oral Health 2021; 21:266. [PMID: 34001101 PMCID: PMC8130171 DOI: 10.1186/s12903-021-01600-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/29/2021] [Indexed: 01/14/2023] Open
Abstract
Background Salivary interleukin (IL)-1β, matrix metalloproteinase (MMP)-8, pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP) and Porphyromonas gingivalis (Pg) are related to periodontitis. This study aimed to investigate the diagnostic potential of these biomarkers and to build a prediction panel for diagnosing periodontal disease. Methods A total of 80 participants were enrolled in a cross-sectional study and divided into healthy (n = 25), gingivitis (n = 24), and periodontitis (n = 31) groups based on their periodontal exam results. A full mouth periodontal examination was performed and unstimulated saliva was collected. Salivary IL-1β, MMP-8, ICTP, and Pg were assessed using enzyme-linked immunosorbent assay (ELISA) and quantitative real time PCR (qPCR). Their potentials for diagnosing periodontal disease were analyzed and combined prediction panels of periodontal disease were evaluated. Results As a single marker, IL-1β showed the best diagnostic value of the four markers evaluated and exhibited an area under the curve (AUC) value of 0.88 with 90% sensitivity and 76% specificity for discriminating periodontitis subjects from healthy subjects, an AUC value of 0.80 with 83% sensitivity and 76% specificity for discriminating gingivitis subjects from healthy subjects and an AUC value of 0.66 with 68% sensitivity and 64% specificity for differentiating periodontitis subjects from gingivitis subjects. The combination of IL-1β, ICTP, and Pg exhibited the highest efficacy for discriminating periodontitis subjects from healthy subjects (AUC = 0.94) and gingivitis subjects (AUC = 0.77). The combination of IL-1β and MMP-8 exhibited the best ability to discriminate gingivitis from healthy subjects (AUC = 0.84). Conclusions Salivary IL-1β, MMP-8, ICTP, and Pg showed significant effectiveness for diagnosing periodontal disease. The combination of IL-1β, ICTP, and Pg can be used to discriminate periodontitis subjects from healthy subjects and gingivitis subjects, and the combination of IL-1β and MMP-8 can be used to discriminate gingivitis subjects from healthy subjects.
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Affiliation(s)
- Yong Zhang
- Department of First Clinical Division, Peking University School and Hospital of Stomatology and National Center of Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, People's Republic of China
| | - Ni Kang
- Department of Periodontology, Peking University School and Hospital of Stomatology and National Center of Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, No.22 South Avenue Zhongguancun, Beijing, 100081, People's Republic of China.,Central Laboratory, Peking University School and Hospital of Stomatology and National Center of Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, People's Republic of China
| | - Fei Xue
- Department of First Clinical Division, Peking University School and Hospital of Stomatology and National Center of Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, People's Republic of China
| | - Jing Qiao
- Department of First Clinical Division, Peking University School and Hospital of Stomatology and National Center of Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, People's Republic of China
| | - Jinyu Duan
- Department of First Clinical Division, Peking University School and Hospital of Stomatology and National Center of Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, People's Republic of China
| | - Fan Chen
- Department of Stomatology, People's Hospital of Peking University, No.11 Beijing Xizhimen South Street, Beijing, 100044, People's Republic of China.
| | - Yu Cai
- Department of Periodontology, Peking University School and Hospital of Stomatology and National Center of Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, No.22 South Avenue Zhongguancun, Beijing, 100081, People's Republic of China. .,Central Laboratory, Peking University School and Hospital of Stomatology and National Center of Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, People's Republic of China.
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9
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Kim HD, Lee CS, Cho HJ, Jeon S, Choi YN, Kim S, Kim D, Jin Lee H, Vu H, Jeong HJ, Kim B. Diagnostic ability of salivary matrix metalloproteinase-9 lateral flow test point-of-care test for periodontitis. J Clin Periodontol 2021; 47:1354-1361. [PMID: 32841379 DOI: 10.1111/jcpe.13360] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 08/03/2020] [Accepted: 08/17/2020] [Indexed: 12/20/2022]
Abstract
AIM This cross-sectional study aimed to examine the diagnostic ability of salivary matrix metalloproteinase (MMP)-9 lateral flow test (LFT) point-of-care (POC) kit and develop an algorithm for diagnosis of periodontitis. MATERIALS AND METHODS Through Seoul National Dental Hospital, 137 participants (46 LFT negatives, 91 LFT positives) were recruited. For salivary diagnostics, 150 μl of the unstimulated saliva was applied to LFT-POC kit. To make a diagnosis of periodontitis, stage II-IV in modified new international classification system was used. Covariates encompassing age, sex, smoking and obesity were evaluated through face-to-face interview. Enzyme-linked immunosorbent assay was used for quantification of salivary MMP-9. To develop a diagnostic algorithm, multivariable logistic regression analysis was used. Receiver operating characteristic curve was applied for evaluating diagnostic ability. RESULTS Diagnostic ability of salivary MMP-9 LFT-POC test was 0.82 (sensitivity of 0.92, specificity of 0.72) in total participants. Diagnostic algorithm using POC test resulted in a response equation, that is algorithm score = -3.675 + 2.877*LFT + 0.034*age + 0.121*sex + 0.372*smoking + 0.192*obesity. Diagnostic ability of the algorithm was 0.88 (sensitivity of 0.92, specificity of 0.85) with cut-off score of 0.589. CONCLUSIONS Salivary MMP-9 LFT-POC kit showed appropriate diagnostic ability for periodontitis and would be an efficient tool for screening of periodontitis.
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Affiliation(s)
- Hyun-Duck Kim
- Department of Preventive and Social Dentistry, School of Dentistry, Seoul National University, Seoul, Korea.,Dental Research Institute, Seoul National University, Seoul, Korea
| | - Chang-Soo Lee
- Department of Chemical Engineering, College of Engineering, Chungnam National University, Daejeon, Korea
| | - Hyun-Jae Cho
- Department of Preventive and Social Dentistry, School of Dentistry, Seoul National University, Seoul, Korea.,Dental Research Institute, Seoul National University, Seoul, Korea
| | - Sumin Jeon
- Dental Research Institute, Seoul National University, Seoul, Korea.,Department of Oral Biology and Immunology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Young-Nim Choi
- Dental Research Institute, Seoul National University, Seoul, Korea.,Department of Oral Biology and Immunology, School of Dentistry, Seoul National University, Seoul, Korea
| | - SungTae Kim
- Department of Periodontology, Seoul National University Dental Hospital, Seoul, Korea
| | - DanHee Kim
- Department of Preventive and Social Dentistry, School of Dentistry, Seoul National University, Seoul, Korea
| | - Hyun Jin Lee
- Department of Preventive and Social Dentistry, School of Dentistry, Seoul National University, Seoul, Korea
| | - Huong Vu
- Department of Preventive and Social Dentistry, School of Dentistry, Seoul National University, Seoul, Korea
| | - Hee-Jin Jeong
- Department of Bio and Chemical Engineering, HongIk University, Sejong-Si, Korea
| | - ByungGee Kim
- School of Chemical and Biological Engineering, Seoul National University, Seoul, Korea
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10
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Martínez REM, Herrera JLA, Pérez RAD, Mendoza CA, Manrique SIR. Frequency of Porphyromonas gingivalis and fimA genotypes in patients with periodontitis and systemic lupus erythematosus. Lupus 2020; 30:80-85. [PMID: 33115372 DOI: 10.1177/0961203320969983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of this study was to determine and compare the distribution of fimA genotypes of Porphyromonas gingivalis (P. gingivalis) in systemic lupus erythematosus (SLE) patients compared with control subjects. MATERIAL AND METHODS This observational cross-sectional study included 281 patients divided into two groups. Group 1 (G1) consisted of 162 control subjects (30-54 years old) and, group 2 (G2) included 119 subjects (10-69 years old) diagnosed with SLE. The presence of P. gingivalis was detected by PCR. DNA sequences in acquired plaque samples were identified using P. gingivalis specific sequences and further analyzed to differentiate their fimA genotypes using six sets of fimA genotype-specific primers. RESULTS The presence of periodontitis (PE) was similar in both groups; similar measurements were obtained regarding clinical attachment loss (CAL) (G1 1.76 ± 0.72 vs. G2 1.95 ± 0.76). G2 showed the highest frequency of P. gingivalis (94.95%). FimA genotype II is considered the most virulent and, was the most frequently found in the SLE group (53.09%). CONCLUSION The genotypes associated with PE are more frequently detected in SLE, which could make them susceptible to develop PE.
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Affiliation(s)
| | - José Luis Ayala Herrera
- Master Program in Advanced Dentistry, Faculty of Dentistry, Autonomous University of San Luis Potosí, San Luis Potosí, México.,School of Dentistry, Universidad De La Salle Bajío, León, México
| | - Rubén Abraham Domínguez Pérez
- Laboratory of Multidisciplinary Dentistry Research, Facultad de Medicina, Universidad Autónoma de Querétaro. Santiago de Queretaro, Queretaro, México.,Regional Unit of Rheumatology and Osteoporosis at Central Hospital "Dr. Ignacio Morones Prieto", Faculty of Medicine, San Luis Potosí, México
| | - Carlos Abud Mendoza
- Ingenieria Biomédica, Facultad de Tecnologías de la Información, Universidad de la Salle, Bajío, León Guanajuato, México
| | - Solange Ivette Rivera Manrique
- Ingenieria Biomédica, Facultad de Tecnologías de la Información, Universidad de la Salle, Bajío, León Guanajuato, México
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11
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Gul SS, Abdulkareem AA, Sha AM, Rawlinson A. Diagnostic Accuracy of Oral Fluids Biomarker Profile to Determine the Current and Future Status of Periodontal and Peri-Implant Diseases. Diagnostics (Basel) 2020; 10:E838. [PMID: 33081038 PMCID: PMC7603129 DOI: 10.3390/diagnostics10100838] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/10/2020] [Accepted: 10/16/2020] [Indexed: 02/06/2023] Open
Abstract
Severe periodontitis is ranked as the sixth most prevalent disease affecting humankind, with an estimated 740 million people affected worldwide. The diagnosis of periodontal diseases mainly relies upon assessment of conventional clinical parameters. However, these parameters reflect past, rather than current, clinical status or future disease progression and, likely, outcome of periodontal treatment. Specific and sensitive biomarkers for periodontal diseases have been examined widely to address these issues and some biomarkers have been translated as point-of-care (PoC) tests. The aim of this review was to provide an update on PoC tests for use in the diagnosis and management of periodontal diseases. Among the PoC tests developed so far, active matrix metalloproteinase-8 has shown promising results in terms of diagnostic and prognostic values. However, further studies are required to increase the sensitivity and specificity via combining more than one biomarker and merging these test kits with periodontal risk assessment tools. Furthermore, the validity of these test kits needs to be investigated by applying the results in further independent studies and the impact on these test kits', together with the results of risk factors for periodontal diseases, such as diabetes and smoking, also needs to be examined.
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Affiliation(s)
- Sarhang S. Gul
- College of Dentistry, Periodontics Department, University of Sulaimani, Sulaymaniyah 1124–30, Iraq;
| | - Ali A. Abdulkareem
- Department of Periodontics, College of Dentistry, University of Baghdad, Baghdad 10011, Iraq;
| | - Aram M. Sha
- College of Dentistry, Periodontics Department, University of Sulaimani, Sulaymaniyah 1124–30, Iraq;
| | - Andrew Rawlinson
- Academic Unit of Restorative Dentistry, School of Clinical Dentistry, University of Sheffield, Sheffield S10 2TA, UK;
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12
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Räisänen IT, Umeizudike KA, Pärnänen P, Heikkilä P, Tervahartiala T, Nwhator SO, Grigoriadis A, Sakellari D, Sorsa T. Periodontal disease and targeted prevention using aMMP-8 point-of-care oral fluid analytics in the COVID-19 era. Med Hypotheses 2020; 144:110276. [PMID: 33254580 PMCID: PMC7492808 DOI: 10.1016/j.mehy.2020.110276] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/02/2020] [Accepted: 09/12/2020] [Indexed: 02/06/2023]
Abstract
Periodontal disease is a chronic multifactorial infectious and inflammatory disease associated with several chronic systemic diseases, such as diabetes, cardiovascular diseases (CVD), chronic obstructive pulmonary disease, hypertension, Alzheimer’s disease and so on. These same systemic diseases have been associated with severe COVID-19 infections. Several recent studies have suggested hypotheses for the potential association between periodontal disease and severe COVID-19. Periodontal disease is also one of the most prevalent diseases globally. All this supports the importance of good oral health, also in the COVID-19 era. Thus, new strategies and approaches to identify patients at risk of periodontal disease could be beneficial to enhance secondary prevention, especially if targeted to COVID-19 risk groups. Diagnostic biomarkers for periodontal disease have been researched extensively. Potential biomarkers in oral fluid with currently available rapid non-invasive point-of-care technology, such as aMMP-8, could help to extend screening and identification of patients at risk for periodontal disease also to situations and places where professional dental expertise and equipment are limited or unavailable. i.e., nursing and care homes, and rural and distant places. The oral fluid point-of-care technologies could also be useful in the hands of medical professionals (diabetes, CVD, etc.) to identify patients at risk for undiagnosed periodontal disease and to refer them to a dentist for examination and evaluation. Finally, if there is a causality between periodontal disease and severe COVID-19 infections, these point-of-care oral fluid biomarker technologies could possibly also help in the assessment of the risk of deterioration and complications.
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Affiliation(s)
- Ismo T Räisänen
- Department of Oral and Maxillofacial Diseases, Helsinki University and University Hospital, Helsinki, Finland.
| | - Kehinde A Umeizudike
- Department of Preventive Dentistry, Faculty of Dental Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Pirjo Pärnänen
- Department of Oral and Maxillofacial Diseases, Helsinki University and University Hospital, Helsinki, Finland
| | - Pia Heikkilä
- Department of Oral and Maxillofacial Diseases, Helsinki University and University Hospital, Helsinki, Finland
| | - Taina Tervahartiala
- Department of Oral and Maxillofacial Diseases, Helsinki University and University Hospital, Helsinki, Finland
| | - Solomon O Nwhator
- Department of Preventive and Community Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Andreas Grigoriadis
- Department of Periodontology, 424 General Army Hospital, Thessaloniki, Greece; Department of Preventive Dentistry, Periodontology, and Implant Biology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitra Sakellari
- Department of Preventive Dentistry, Periodontology, and Implant Biology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Timo Sorsa
- Department of Oral and Maxillofacial Diseases, Helsinki University and University Hospital, Helsinki, Finland; Department of Oral Diseases, Karolinska Institutet, Huddinge, Sweden
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13
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Sorsa T, Alassiri S, Grigoriadis A, Räisänen IT, Pärnänen P, Nwhator SO, Gieselmann DR, Sakellari D. Active MMP-8 (aMMP-8) as a Grading and Staging Biomarker in the Periodontitis Classification. Diagnostics (Basel) 2020; 10:diagnostics10020061. [PMID: 31979091 PMCID: PMC7168924 DOI: 10.3390/diagnostics10020061] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 12/16/2022] Open
Abstract
The aim of this study was to investigate the utility of incorporating active matrix metalloproteinase-8 (aMMP-8) as a biomarker into the new periodontitis classification system (stage/grade) presented in 2018. This study included 150 Greek adults aged 25-78, of whom 74 were men and 76 women. Participants were tested with an aMMP-8 point-of-care mouthrinse test, after which a full-mouth clinical examination was performed to assess their periodontal and oral health. The aMMP-8 levels in mouthrinse were significantly lower among healthy patients compared with patients in more severe periodontitis stages and grades (Kruskal-Wallis test and Dunn-Bonferroni test for pairwise post-hoc comparisons; p < 0.01 and p < 0.05, respectively). Furthermore, aMMP-8 levels were less correlated with plaque levels than bleeding on probing (BOP) (Spearman's rho = 0.269, p < 0.001; Spearman's rho = 0.586, p < 0.001); respectively). Thus, aMMP-8 was more robust to the confounding effects of oral hygiene than traditional periodontal parameter bleeding on probing. The aMMP-8 point-of-care mouthrinse test can be utilized as an adjunctive and preventive diagnostic tool to identify periodontal disease, classified by stage and grade, and ongoing periodontal breakdown chairside in clinical practice in only 5 min. Overall, integrating aMMP-8 into the new periodontitis classification system seems beneficial.
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Affiliation(s)
- Timo Sorsa
- Department of Oral and Maxillofacial Diseases, Head and Neck Center, University of Helsinki and Helsinki University Hospital, P.O. Box 63 (Haartmaninkatu 8) FI-00014, 00100 Helsinki, Finland
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Correspondence: (T.S.); (I.T.R.)
| | - Saeed Alassiri
- Department of Oral and Maxillofacial Diseases, Head and Neck Center, University of Helsinki and Helsinki University Hospital, P.O. Box 63 (Haartmaninkatu 8) FI-00014, 00100 Helsinki, Finland
| | - Andreas Grigoriadis
- Department of Preventive Dentistry, Periodontology and Implant Biology, Dental School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- 424 General Army Hospital, 54124 Thessaloniki, Greece
| | - Ismo T. Räisänen
- Department of Oral and Maxillofacial Diseases, Head and Neck Center, University of Helsinki and Helsinki University Hospital, P.O. Box 63 (Haartmaninkatu 8) FI-00014, 00100 Helsinki, Finland
- Correspondence: (T.S.); (I.T.R.)
| | - Pirjo Pärnänen
- Department of Oral and Maxillofacial Diseases, Head and Neck Center, University of Helsinki and Helsinki University Hospital, P.O. Box 63 (Haartmaninkatu 8) FI-00014, 00100 Helsinki, Finland
| | - Solomon O. Nwhator
- Department of Preventive & Community Dentistry, Faculty of Dentistry, College of Health Sciences, Obafemi Awolowo University, Ile-Ife 220104, Osun State, Nigeria
| | - Dirk-Rolf Gieselmann
- Institute for Molecular Diagnostics (IMOD), Bonner Str. 84, 42697 Solingen, Germany
| | - Dimitra Sakellari
- Department of Preventive Dentistry, Periodontology and Implant Biology, Dental School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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