Effect of quadrantwise versus full-mouth subgingival instrumentation on clinical and microbiological parameters in periodontitis patients: A randomized clinical trial

Role of periodontal treatment in pregnancy gingivitis and adverse outcomes: a systematic review and meta-analysis

BACKGROUND

Pregnancy gingivitis is a common oral health issue that affects both maternal and fetal health. This study aims to evaluate the effectiveness of periodontal treatment in preventing pregnancy gingivitis, preterm birth, and low birth weight through a systematic review and meta-analysis of randomized controlled trials (RCTs).

METHODS

A systematic review and meta-analysis were conducted following PRISMA guidelines. A comprehensive literature search was performed across CINAHL, Scopus, Cochrane, and PubMed/Medline databases from 2000 to the present. Study selection and data extraction were independently carried out by two reviewers. Statistical analyses, including heterogeneity tests, sensitivity analysis, and publication bias assessment, were conducted using RevMan 5.4 and R software.

RESULTS

A total of 13 studies were included. The meta-analysis indicated that periodontal treatment might have a potential effect on preventing pregnancy gingivitis, but this was not statistically significant (OR = 0.85, 95% CI [0.68, 1.06], I2 = 51%). Subgroup analysis revealed that periodontal treatment significantly reduced the rates of preterm birth and low birth weight in lower-quality studies, but no significant effects were observed in higher-quality studies. Sensitivity analysis and publication bias tests confirmed the stability and reliability of the results.

CONCLUSION

While lower-quality studies suggest that periodontal treatment may positively impact pregnancy gingivitis, preterm birth, and low birth weight, these effects were not supported by higher-quality evidence. Further well-designed RCTs are needed to confirm these findings and ensure their reliability. Periodontal treatment could potentially be considered as part of prenatal care to improve maternal oral health and pregnancy outcomes.

Elucidating the Role of HIF-1α/YAP Signaling Pathway in Regulating Inflammation in Human Periodontal Stem Cells: An in vitro Study

Background and Objective

Periodontitis is a chronic inflammatory disease caused by dental plaque accumulation, leading to damage of periodontal tissues and potential tooth loss. Understanding the mechanisms of periodontitis, particularly the role of hypoxia in inflammation, is critical for identifying novel therapeutic strategies. This study investigated the effects of the prolyl hydroxylase (PHD) inhibitor DMOG on pro-inflammatory cytokine expression in human periodontal ligament stem cells (hPDLSCs) and examined the involvement of the HIF-1α/YAP signaling path ay in modulating inflammation.

Materials and Methods

hPDLSCs were cultured and treated with lipopolysaccharide (LPS) to induce inflammation, followed by DMOG treatment. Cell proliferation was assessed using the CCK-8 assay, while ELISA and RT-qPCR evaluated the expression levels of HIF-1α, IL-1β, TNF-α, and YAP. YAP expression was knocked down using siRNA transfection to examine its effects on inflammatory cytokines.

Results

DMOG significantly increased HIF-1α expression while reducing IL-1β and TNF-α levels in LPS-treated hPDLSCs. 0.1 mmol/L DMOG inhibited cell proliferation after 72 hours (P < 0.001). ELISA results showed that HIF-1α concentrations in the LPS + DMOG group were significantly higher than in the LPS group (P < 0.01), while IL-1β and TNF-α levels were significantly reduced (P < 0.01). RT-qPCR confirmed these trends, showing reduced mRNA levels of IL-1β and TNF-α and increased YAP expression in the LPS + DMOG group (P < 0.0001). YAP knockdown via siRNA transfection reversed these effects, increasing IL-1β and TNF-α levels (P < 0.01) while significantly reducing HIF-1α expression (P < 0.05).

Conclusion

This study demonstrated that DMOG reduces inflammatory cytokine expression in hPDLSCs by stabilizing HIF-1α and activating the YAP signaling pathway. These findings provide a mechanistic basis for targeting the HIF-1α/YAP axis to control periodontal inflammation and support the potential of PHD inhibitors as therapeutic agents for periodontitis.

SIRT3 alleviates mitochondrial dysfunction and senescence in diabetes-associated periodontitis by deacetylating LRPPRC

Diabetes-associated periodontitis (DP) is recognized as an inflammatory disease that can lead to teeth loss. Uncontrolled chronic low-grade inflammation-induced senescence impairs the stemness of human periodontal stem cells (hPDLSCs). Sirtuin 3 (SIRT3), an NAD+-dependent deacetylase, is pivotal in various biological processes and is closely linked to aging and aging-related diseases. This study aims to explore the mechanism of SIRT3-related senescence and osteogenic differentiation of hPDLSCs under DP and explored the novelty therapeutic targets. Our study revealed that SIRT3 expression was markedly inhibited in periodontal ligament stem cells (PDLSCs) stimulated by high glucose and lipopolysaccharide. Both in vitro and in vivo, reduced SIRT3 expression accelerated cell senescence and impaired osteogenic differentiation of hPDLSCs. We demonstrated that SIRT3 binds to and deacetylates leucine-rich pentatricopeptide repeat-containing protein (LRPPRC), thereby modulating senescence. Additionally, we found that LRPPRC regulates senescence by modulating oxidative phosphorylation and oxidative stress. The activation of SIRT3 by honokiol significantly delayed senescence and promoted alveolar bone regeneration in mice after DP. Our findings indicate that the activation of SIRT3 negatively regulates hPDLSCs senescence by deacetylating LRPPRC, suggesting SIRT3 as a promising therapeutic target for DP.

Mesenchymal stem cell-derived extracellular vesicles in periodontal bone repair

Periodontitis is a chronic inflammatory disease that destroys tooth-supporting structures and poses significant public health challenges due to its high prevalence and links to systemic health conditions. Traditional treatments are effective in reducing the inflammatory response and improving the clinical symptoms of periodontitis. However, these methods are challenging to achieve an ideal treatment effect in alveolar bone repair. Mesenchymal stem cells (MSCs) represent a potential alternative for the treatment of periodontal bone defects due to their self-renewal and differentiation capabilities. Recent research indicates that MSCs exert their effects primarily through paracrine mechanisms. Mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) serve as pivotal mediators in intercellular communication, transferring microRNAs (miRNAs), messenger RNAs (mRNAs), proteins, and cytokines to recipient cells, thereby emulating the therapeutic effects of MSCs. In periodontitis, MSC-EVs play a pivotal role in immunomodulation and bone remodeling, thereby facilitating periodontal bone repair. As a cell-free therapy, MSC-EVs demonstrate considerable clinical potential due to their specialized membrane structure, minimal immunogenicity, low toxicity, high biocompatibility, and nanoscale size. This review indicates that MSC-EVs represent a promising approach for periodontitis treatment, with the potential to overcome the limitations of traditional therapies and offer a more effective solution for bone repair in periodontal disease. In this review, we introduce MSC-EVs, emphasizing their mechanisms and clinical applications in periodontal bone repair. It synthesizes recent advances, existing challenges, and future prospects to present up-to-date information and novel techniques for periodontal regeneration and to guide the improvement of MSC-EV therapy in clinical practice.

Extracellular Vesicles in Periodontitis: Pathogenic Mechanisms and Therapeutic Potential

Periodontitis is a prevalent yet frequently overlooked oral disease that is linked to a range of systemic conditions. Although basic treatment and periodontal surgery can alleviate the symptoms of periodontitis to a certain extent, the treatment of severe tissue defects or refractory cases is not effective. Extracellular vesicles (EVs) are subcellular lipid bilayer particles that come from a variety of sources and are prevalent in the biological fluids of vertebrates. They play a key role in intercellular communication by transporting multiple signaling molecules. Recent research has indicated that EVs derived from periodontal pathogens can trigger periodontitis, exacerbate the periodontal damage, and potentially disseminate to other parts of the body, leading to systemic conditions. Conversely, extracellular vesicles derived from dental stem cells (DSCs) have demonstrated the ability to regulate the local periodontal immune environment and foster the regeneration and repair of periodontal tissues, positioning them as a promising candidate for cell-free therapeutic approaches to periodontitis. This review aims to summarize the latest research on the involvement of EVs from different sources in the pathogenesis and treatment of periodontitis, especially to systematically elucidate the mechanism of EVs secreted by periodontal pathogens in periodontitis-related systemic diseases for the first time. By uncovering these complex regulatory processes, new and more effective therapeutic approaches can be explored in the battle against periodontitis and its associated systemic diseases.

Therapeutic effects of tripterygium glycosides on periodontitis: Exploring the role of ursolic acid and the RIPK3/NLRP3 signaling pathway

BACKGROUND

Periodontitis, a chronic inflammatory disease, poses challenges in treatment due to its complex etiology. Tripterygium glycosides (TGs), renowned for their immunosuppressive and anti-inflammatory capabilities, present a prospective therapeutic option for the management of periodontitis. This study delves into the therapeutic efficacy of TGs in periodontitis and reveals the fundamental mechanisms involved.

MATERIALS AND METHODS

Animal experiments were conducted to observe the therapeutic effects of TGs. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) technology was employed to identify the optimal components. Proteomic technology was used to identify differentially expressed proteins, followed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses. Molecular docking and experimental verification of core components and targets were also performed.

RESULTS

TGs markedly attenuated periodontal damage and alveolar bone resorption and significantly reduced the expression of inflammatory factors. Ursolic acid (UA) was identified as a crucial active ingredient. Among the signaling pathways, the nucleotide-binding oligomerization domain-like receptor (NLR) pathway was the most prominently enriched pathway. The binding of UA to receptor-interacting protein kinase 3 (RIPK3) was demonstrated to have therapeutic efficacy. In vitro experiments verified that UA exerts anti-inflammatory effects through the RIPK3/NLRP3 signaling pathway.

CONCLUSION

This study demonstrated that TGs effectively treat periodontitis by mitigating alveolar bone loss and suppressing inflammation. As the primary component of TGs, UA exerts therapeutic effects by inhibiting the expression of RIPK3, which in turn influences the activation of the NLRP3 inflammasome and the subsequent expression of downstream inflammatory factors. The findings of this study offer a theoretical foundation for the clinical application of TGs in the management of periodontitis.

Effect of Nonsurgical Mechanical Debridement With or Without Chlorhexidine Formulations in the Treatment of Peri-Implant Mucositis. A Randomized Placebo-Controlled Clinical Trial

OBJECTIVES

To evaluate the treatment of peri-implant mucositis (PM) using a nonsurgical submarginal peri-implant instrumentation (NSPI) with or without chlorhexidine (CHX) solutions.

METHODS

Fifty-six patients (28 per group) were randomly assigned to the test (NSPI + 0.12% mouthwash and subgingival CHX irrigation plus tongue brushing with 1% CHX gel) or the control group (NSPI + placebo mouthwash and subgingival placebo irrigation plus tongue brushing with placebo gel). At baseline, 1, 3, 6 months, bleeding on probing (BOP), probing pocket depth (PPD), modified gingival index (mGI), modified plaque index (mPlI), full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), and the proportions of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were recorded. The BOP reduction was set as a primary outcome. Data were analyzed to assess BOP reduction at a 6-month follow-up and to identify significant predictors of implant-site BOP through mixed generalized linear regression.

RESULTS

After 6 months in both groups, a significant reduction of BOP, PD, mPlI, mGI, FMBS, and FMPS was noted (p < 0.05). However, at 6 months, the test group was more effective than the controls in reducing median BOP (∆values control/test: 39.3% [95% CI 37.4-42.3] vs. 48.7 [95% CI 46.5-51.2], p = 0.044), as well as mPlI (p = 0.041) and the proportion of Treponema denticola (p = 0.039). Moreover, the implant-sites BOP reduction was significantly influenced by test treatment (p < 0.001), history of periodontitis (p = 0.003), and a high number of cigarettes/day (p = 0.002), the proportion of Porphyromonas gingivalis (p = 0.021) and Tannerella forsythia (p = 0.032).

CONCLUSIONS

NSPI + CHX showed better results compared to placebo in implant-sites BOP reduction. The high number of cigarettes/day and the proportion of Porphyromonas gingivalis and T. forsythia negatively influenced the BOP reduction in PM-treated patients.

Impact of Periodontitis and Oral Dysbiosis Metabolites in the Modulation of Accelerating Ageing and Human Senescence

Periodontitis, a chronic multifactorial inflammatory condition of the periodontium, is originated by a dysbiotic oral microbiota and is negatively correlated with several systemic diseases. The low-chronic burden of gingival inflammation not only exacerbates periodontitis but also predisposes individuals to a spectrum of age-related conditions, including cardiovascular diseases, neurodegenerative disorders, and metabolic dysfunction, especially related to ageing. In this regard, over the local periodontal treatment, lifestyle modifications and adjunctive therapies may offer synergistic benefits in ameliorating both oral and systemic health in ageing populations. Elucidating the intricate connections between periodontitis and senescence is important for understanding oral health's systemic implications for ageing and age-related diseases. Effective management strategies targeting the oral microbiota and senescent pathways may offer novel avenues for promoting healthy ageing and preventing age-related morbidities. This review will analyze the current literature about the intricate interplay between periodontitis, oral dysbiosis, and the processes of senescence, shedding light on their collective impact on the modulation and accelerated ageing and age-related diseases. Lastly, therapeutic strategies targeting periodontitis and oral dysbiosis to mitigate senescence and its associated morbidities will be discussed.

5.6% lidocaine aerosol anesthesia for supragingival ultrasonic scaling in patients with chronic periodontitis or dental plaque-induced gingivitis

The aim of this study was to evaluate the efficacy and patient satisfaction of lidocaine aerosol for pain management during periodontal scaling and root planning in patients with chronic periodontitis or dental plaque-induced gingivitis. This study specifically concentrated on comparing the effectiveness of lidocaine aerosol as a topical anesthetic against a placebo, assessing its impact on pain perception during the procedure. Additionally, the relationship between periodontal treatment and the reduction of oxidative stress markers in these patients was assessed. Eighty-six patients with chronic periodontitis or dental plaque-induced gingivitis were included. Notably, 5.6% lidocaine and placebo aerosols were randomly applied to the labial (buccal) and lingual (palatal) sides, approximately 3 mm from the gingival surface, with three sprays on each side, prior to supragingival ultrasonic scaling in these patients. In this controlled, double-blind study, the effectiveness of a 5.6% lidocaine aerosol in reducing pain during supragingival ultrasonic scaling was evaluated. The study involved 50 patients who divided into two groups: one receiving the lidocaine aerosol and the other a placebo. Pain was assessed using the Visual Analog Scale (VAS) and the Numeric Rating Scale (NRS). The results revealed a statistically significant reduction in pain scores in the lidocaine group compared with the placebo group. Specifically, the mean VAS score in the lidocaine group was 2.1 ± 1.3, compared with 5.6 ± 1.7 in the placebo group (P < 0.01). Similarly, the NRS scores were significantly lower in the lidocaine group (2.3 ± 1.2) compared with the placebo group (5.9 ± 1.8, P < 0.01). No adverse reactions were found in none of the groups. 5.6% lidocaine aerosol holds promise as an effective anesthetic option for reducing pain during supragingival ultrasonic scaling procedures in patients with chronic periodontitis or dental plaque-induced gingivitis. Chinese Clinical Trial Registry (No. ChiCTR2000029831, date: 2020-02-15).

Relationship between periodontitis and systemic diseases: A bibliometric and visual study

To provide a comprehensive and updated mapping of observational studies assessing the relationship between periodontitis and systemic diseases through a bibliometric and visual analysis. A search was conducted using the Web of Science database, covering the period 1989 to 2024. The Medical Subject Headings (MeSH) from the US National Library of Medicine was used to categorize systemic conditions, focusing on terms unrelated to stomatognathic diseases. The analysis included keyword co-occurrence mapping, co-authorship, bibliographic coupling, and co-citation analysis. Quality indicators such as silhouette score, modularity, and centrality were considered to assess the network's quality. The research strategy identified 6106 records, of which 1519 met the inclusion criteria. The analysis revealed that 46.73% of the literature on the topic was published in the last 5 years and that the annual publication trend peaked in 2023. Nutritional & Metabolic Diseases (n = 398), Cardiovascular Diseases (n = 335), Female Urogenital Diseases & Pregnancy Complications (n = 244), and Musculoskeletal Diseases (n = 182) were the most representative categories of systemic diseases associated with periodontitis. The most co-cited journals on the topic were the Journal of Periodontology (n = 1412), the Journal of Clinical Periodontology (n = 1343), the Journal of Dental Research (n = 940), and Periodontology 2000 (n = 849). The USA, China, Brazil, and Sweden were the countries that contributed the most to the number of publications. The analysis conducted in the present study revealed a growing trend of observational studies evaluating the association between periodontitis and systemic diseases, highlighting the negative impact of periodontitis on a plethora of systemic conditions and a rising translational interest in this relationship. With an aging population, periodontitis is expected to affect a growing number of people in the coming decades, presenting significant challenges to public health. Improved knowledge is, therefore, essential to enable more comprehensive care, preventive strategies, and optimal oral health for patients with periodontitis.

Single-Cell and Transcriptome Analysis of Periodontitis: Molecular Subtypes and Biomarkers Linked to Mitochondrial Dysfunction and Immunity

Background

Periodontitis represents an inflammatory disease with multiple contributing factors, affecting both oral and systemic health. The mechanisms linking mitochondrial dysfunction to immune responses in periodontitis remain unclear, limiting the development of individualized diagnostic and therapeutic approaches.

Objective

 This study aims to elucidate the roles of mitochondrial dysfunction and immune responses in the pathogenesis of periodontitis, identify distinct molecular subtypes, and discover robust diagnostic biomarkers to support precision medicine approaches.

Methods

Single-cell RNA sequencing and transcriptome data from periodontitis patients were analyzed to identify gene signatures linked to macrophages and mitochondria. Consensus clustering was applied to classify molecular subtypes. Potential biomarkers were identified using five machine learning algorithms and validated in clinical samples through qPCR and IHC.

Results

Four molecular subtypes were identified: quiescent, macrophage-dominant, mitochondria-dominant, and mixed, each exhibiting unique gene expression patterns. From 13 potential biomarkers, eight were shortlisted using machine learning, and five (BNIP3, FAHD1, UNG, CBR3, and SLC25A43) were validated in clinical samples. Among them, BNIP3, FAHD1, and UNG were significantly downregulated (p < 0.05).

Conclusion

This study identifies novel molecular subtypes and biomarkers that elucidate the interplay between immune responses and mitochondrial dysfunction in periodontitis. These findings provide insights into the disease's heterogeneity and lay the foundation for developing non-invasive diagnostic tools and personalized therapeutic strategies.

The interconnection between periodontitis and HIV-1 latency: Molecular mechanisms and therapeutic insights

Periodontitis is one of the major global public health problems associated with the occurrence and development of diverse systemic diseases, especially acquired immune deficiency syndrome (AIDS), necessitating further research and clinical attention. The persistence of HIV-1 latency poses a significant challenge to the attainment of a functional cure for AIDS, despite the introduction of highly active antiretroviral therapy (HAART). A similar mechanistic basis between periodontitis and HIV-1 latency has been revealed by many studies, suggesting possible mechanisms whereby periodontitis and HIV-1 latency may mutually influence each other. Therefore, we aimed to systematically summarize the current research on periodontitis and HIV-1 latency to investigate their potential correlations. This study revealed several common hubs for periodontitis and HIV-1 latency in the nuclear factor kappa-B (NF-κB) signaling pathway and other signaling pathways, including the Wnt/β-catenin pathway, bromodomain-containing protein 4 (BRD4), protein kinase C (PKC), the NOD-like receptor thermal protein domain associated protein 3 (NLRP3) inflammasome, programmed cell death protein 1 (PD-1), histone deacetylases (HDACs), and the phosphatidylinositol-3-kinase (PI3K)/protein kinase B (Akt)/mammalian target of rapamycin (mTOR) pathway. Furthermore, we will discuss the hypothesis that periodontal pathogens may represent the unifying mechanism elucidating the intricate interconnection between periodontitis and HIV-1 latency. This article presents a detailed and comprehensive overview of the relationship underlying periodontitis and HIV-1 latency in terms of molecular mechanisms, which may provide novel theoretical insight into the pathogenesis of periodontitis and HIV-1 latency and reveal suitable therapeutic targets for the two diseases.

The Biofilm Removal and Bactericidal Effect of an 810-nm High-Power Laser on an Orthodontic Bracket Surface: An In Vitro Study

Objective: The present study aimed to analyze the biofilm removal and bactericidal effect of laser treatment alone and laser combined with ultrasonic scaling on orthodontic brackets. It also assessed whether the use of a laser can improve the efficiency of biofilm removal and bactericidal effect compared with traditional ultrasonic instrumentation. Background Data: Streptococcus mutans (S. mutans) can lead to white spots and dental caries. Orthodontic brackets make teeth cleaning more difficult, and biofilms or bacteria on the surface of brackets worsen the oral environment, which may cause some oral diseases. Laser can be used for biofilm removal and killing bacteria on the surface of an object through thermal, photochemical, and pressure effects, which is widely used in the treatment of oral diseases. Methods: A total of 600 mandibular incisor brackets were collected for this study. Among these, 320 unused brackets were used for the S. mutans crystal violet assay (n = 160) and for S. mutans live/dead bacterial staining (n = 160). Another 280 brackets, obtained from patients who had undergone therapy for over two years, were used for the mature multispecies biofilms removal assay (n = 120) and multispecies bacterial live/dead bacterial staining (n = 160). Ultrasonic scaling, laser, and laser combined with ultrasonic scaling were applied to the labial surface of brackets covered by S. mutans biofilm or mature multispecies biofilms. Specifically, we used the following three methods: ultrasonic scaling for 10 sec without laser; 810-nm laser (Doctor Smile, Italy, LA5D0 001.1) with 0.3-mm spot size at total 21.2 kJ/cm2 for 10 sec; and 810-nm laser at total 10.6 kJ/cm2 for 5 sec, followed by ultrasonic scaling for 5 sec. The 810-nm diode laser removed biofilms with a power of 1.5 W and a power density of 2.12 kW/cm2. The S. mutans biofilm was examined using crystal violet assay, and scanning electron microscopy (SEM) was used for mature multispecies biofilms to evaluate the effect of the three methods on biofilm removal. Live/dead bacterial staining was used to examine the bactericidal effect on remaining biofilms by confocal laser scanning microscopy (CLSM). Results: For S. mutans biofilm, the optical density (OD) value and live/dead bacterial ratio in the laser and the laser combined with ultrasonic scaling groups were significantly lower than those in the ultrasonic scaling group (p < 0.05); moreover, the OD value and the live/dead bacterial ratio in laser treatment combined with ultrasonic scaling and laser treatment alone showed no significant difference (p > 0.05). For mature multispecies biofilms, the percentage of biofilm coverage after treatment was higher in the laser group than in the ultrasonic scaling group (p < 0.05) and lower in the laser combined with ultrasonic scaling group than in the ultrasonic scaling group (p < 0.05), and live/dead bacterial staining showed that laser treatment alone killed the most bacteria, followed by laser treatment combined with ultrasonic scaling, while ultrasonic scaling alone seldom killed bacteria. Conclusions: Laser treatment alone has a better bactericidal effect and can also remove more S. mutans biofilm than ultrasonic scaling alone, but it fails to remove more mature multispecies biofilms. Laser treatment combined with ultrasonic scaling can remove more S. mutans biofilm and mature multispecies biofilms than ultrasonic scaling alone and also has a better bactericidal effect than ultrasonic scaling alone on a bracket surface.

Impact of nonsurgical periodontal treatment on arterial stiffness outcomes related to endothelial dysfunction: A systematic review and meta-analysis

BACKGROUND

To assess the available evidence on whether nonsurgical periodontal treatment (NSPT) improves arterial stiffness outcomes in patients with periodontitis (PD).

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and population, intervention, comparison, outcomes, and study design (PICOS) question, electronic databases were screened for clinical interventional studies addressing the impact of NSPT on pulse wave velocity (PWV), carotid intima-media thickness (CIMT), and flow-mediated dilatation (FMD) outcomes in PD patients. Furthermore, the research strategy was implemented using a hand search. Studies were selected, and data were extracted by two independent reviewers. Random effects models were applied to perform a meta-analysis, and methodological index for nonrandomized studies (MINORS) and Cochrane Rob2 tools were used to assess the risk of bias.

RESULTS

Fifteen articles were finally included for qualitative synthesis. Among them, eight single-arm cohort studies met the final inclusion criteria for meta-analysis. The Rob2 analysis evidenced that one randomized clinical trial (RCT) had a low risk, three RCTs raised some concerns, and three RCTs had a high risk of bias, while the MINORS scores ranged from 9 to 14. The meta-analysis showed that NSPT significantly impacted FMD (p < 0.001) and CIMT (p = 0.004), while changes in PWV were not statistically significant. However, there was high heterogeneity among studies (I2 = 78% for FMD and I2 = 62% for CIMT).

CONCLUSION

Despite some beneficial effects on FMD and CIMT, due to study limitations, high heterogeneity, and risk of bias, it cannot be concluded that NSPT is effective in improving arterial stiffness. Therefore, further studies are necessary to achieve high-quality evidence on the effect of NSPT on arterial stiffness outcomes in PD patients.

TRIAL REGISTRATION

PROSPERO ID CRD42024501399.

PLAIN LANGUAGE SUMMARY

Periodontitis (PD) has been associated with alterations in arterial stiffness outcomes related to early endothelial dysfunction. Based on noninterventional studies, this meta-analysis indicates that nonsurgical periodontal treatment (NSPT) may reduce cardiovascular disease risk in patients with PD. The moderate evidence derived from the studies that were finally included showed that NSPT had beneficial effects on flow-mediated dilatation and carotid intima-media thickness, while this trend was not observed for pulse wave velocity. Moreover, the findings of the present meta-analysis were characterized by high heterogeneity and risk of bias and were derived from uncontrolled clinical trials or randomized clinical trials with limitations. Therefore, more studies with standardized protocols and homogeneous arterial stiffness outcomes are needed to elevate the quality of the present evidence.

Effect of nonsurgical periodontal therapy on salivary visfatin and serum lipid levels in obese patients with chronic periodontitis

Aim: Periodontal diseases are prevalent and can be exacerbated by conditions such as obesity. Understanding the impact of obesity on periodontal health is crucial for developing effective management strategies. This study aimed to evaluate the effect of nonsurgical periodontal therapy on salivary visfatin levels and serum lipid levels in chronic periodontitis patients with or without obesity. Methods: A total of 40 patients aged between 20 to 50 years were enrolled in the study. Group 1 (obese group) included 20 chronic periodontitis patients with obesity while Group 2 (non-obese group) included 20 chronic periodontitis patients without obesity. Gingival index (GI), probing depth (PD), clinical attachment level (CAL), salivary visfatin, and serum lipid levels were measured before and six weeks after nonsurgical periodontal therapy (NSPT). Statistical tests were done to analyze the data in the study. Results: Mean GI scores, mean PD scores, and mean CAL scores were significantly reduced before and 6 weeks after NSPT in both groups (p < 0.05). The mean salivary visfatin levels also demonstrated a statistically significant reduction between the obese and non-obese groups (p < 0.05). Similarly, the mean serum lipid levels significantly differed before and 6 weeks after NSPT in the obese group (p < 0.05). Conclusions: The current study suggests a significant correlation between GI, PD, CAL, salivary visfatin, and serum lipid levels in the obese group following NSPT.

Microbiological profile of patients with generalized gingivitis undergoing periodontal therapy and administration of Bifidobacterium animalis subsp. lactis HN019: A randomized clinical trial

OBJECTIVE

To evaluate the adjunctive use of the probiotic Bifidobacterium animalis subsp. lactis HN019 (B. lactis HN019) to conventional therapy on clinical and microbiological parameters in patients with generalized gingivitis.

METHODS

Sixty systemically healthy individuals with untreated generalized gingivitis were submitted to periodontal therapy and allocated to receive Placebo (n = 30) or Probiotic (n = 30) lozenges, twice a day for 8 weeks. Bleeding on Marginal Probing (BOMP) was evaluated at baseline, after 2 and 8 weeks. Supra and subgingival biofilm were obtained at baseline and 8 weeks post-therapy for analyses by 16S rRNA gene sequencing. Differences between therapeutic groups were analyzed by non-parametric tests (p<0.05).

RESULTS

The Placebo and Probiotic groups showed a significant reduction in BOMP at 8 weeks compared to baseline (p<0.05). The Probiotic group had a lower percentage of BOMP when compared with the Placebo group at 8 weeks (p<0.0001). Alpha and beta-diversity showed no statistical significance between groups and time points. At phylum level, no significant differences were observed between groups and time points. At genus level, an increase in the relative abundances of Bergeyella and Corynebacterium were significantly associated with a greater reduction in bleeding in the Placebo group and with less reduction in bleeding in the Probiotic group, respectively. At species level, Schaalia spp., Streptococcus gordonii, and Leptotrichia wadei increased in Placebo and decreased in the Probiotic group after treatment. Granulicatella adiacens decreased significantly after the probiotic therapy, while Saccharibacteria (TM7) spp., Solobacterium moorei, and Catonella morbi increased significantly. In the Placebo group, Bergeyella sp. HMT-322 was associated with a greater percentage of reduction in bleeding. In both groups, Actinomyces species were related to less reduction in bleeding.

CONCLUSION

The adjuvant use of B. lactis HN019 alongside conventional therapy enhanced the reduction in BOMP and promoted greater changes in the microbiological profile of patients with generalized gingivitis.

TRIAL REGISTRATION

The study was registered at Brazilian Clinical Trials Registry (ReBEC; protocol number: RBR-59v2yb).

Metabolic syndrome promotes resistance to aspirin in mitigating bone loss in murine periodontal disease

AIMS

This study aimed to investigate the protective effects of aspirin (ASA) on alveolar bone loss in a mouse model with metabolic syndrome (MetS) and concurrent periodontal disease (PD). Specifically, the study sought to determine whether ASA could mitigate bone loss in MetS and non-MetS animals with PD and explore the correlation between gingival nitric oxide (NO) levels and bone resorption.

MAIN METHODS

Newborn female Swiss mice were administered monosodium glutamate (MSG) (4 mg/g) during the initial 5 days of life to induce MetS (MetS group), while the control group (SAL) was administered saline. On the 60th day, PD was induced in both groups. Half of the animals were treated daily with ASA (40 mg/kg). MetS was characterized by the Lee index, blood glucose, and cardiovascular parameters. Maxillae were evaluated by microtomography and histopathology, showing significant bone loss after PD induction.

KEY FINDINGS

Animals with MetS exhibited higher alveolar bone loss than controls. SAL animals treated with ASA had less bone loss than their MetS counterparts. Gingival NO levels were elevated in animals with PD, and a strong correlation was found between NO levels and bone resorption. ASA reduced NO in non-MetS animals, but MetS animals were resistant to this effect.

SIGNIFICANCE

These findings suggest a protective mechanism of ASA against bone loss in non-MetS animals with PD, an effect that was not observed in MetS animals. Consequently, this study provides novel insights into the intricate relationship between MetS and PD in mice.

Association between cardiometabolic index (CMI) and periodontitis in US adults: analysis of NHANES data (2009-2014)

BACKGROUND

The cardiometabolic index (CMI) is a new predictor of obesity-related diseases, but its link to periodontitis is under-researched. This study aims to examine the potential association between the CMI and periodontitis.

METHODS

We conducted a cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) database (2009-2014) to examine the potential association between CMI and periodontitis. The study utilized a weighted multivariate logistic model to assess the association between TG, HDL-C, TG/HDL-C, obesity indices (BMI, WC, WHtR, CMI), and periodontitis, employing the area under the receiver operating characteristic curves (ROC) to estimate areas under the curve (AUC). Furthermore, generalized smooth curve fitting was conducted to examine the relationship between CMI and periodontitis. Finally, the study incorporated subgroup analysis and interaction tests to examine consistency across different populations.

RESULTS

TG/HDL-C, WHtR, and CMI were positively associated with periodontitis in the fully adjusted classification model. It was observed that for each unit increase in CMI, there was a corresponding 17.8% increase in the prevalence of periodontitis [1.178 (1.049, 1.322) 0.00562] and 18.7% increase in the prevalence of moderate/severe [1.187 (1.057, 1.334) 0.00376] in the fully adjusted model. When CMI was used as a categorical variable, the adjusted OR for periodontitis prevalence increased significantly with increasing CMI after adjusting for all potential covariates (T3 vs. T1: OR, 1.28 [1.06, 1.55], p < 0.05). The ROC analysis indicated that a larger area under the curve was found in the CMI [0.554 (0.538-0.570)] than in the WC [0.544 (0.528-0.560)] and WHtR [0.544 (0.528-0.561)]. Nonetheless, the discrepancy observed did not reach statistical significance (all p > 0.05). Further generalized smooth curve fitting and threshold effect models indicated a positive linear correlation between CMI and periodontitis. Moreover, there is no interactive association between TG/HDL-C, WHtR, CMI, and periodontitis.

CONCLUSIONS

This cross-sectional study revealed a positive relationship between CMI and periodontitis. Further prospective studies are warranted to validate our findings.

Reactive Oxygen Species-Responsive Pillararene-Embedded Covalent Organic Frameworks with Amplified Antimicrobial Photodynamic Therapy for the Targeted Elimination of Periodontitis Pathogens

Reactive oxygen species (ROS)-responsive drug delivery systems possess immense potential for targeted delivery and controlled release of therapeutics. However, the rapid responsiveness to ROS and sustained release of antibacterial drugs are often limited by the challenging microenvironment of periodontitis. Integrating ROS-responsive drug delivery systems with photocatalytic technologies presents a strategic approach to overcome these limitations. Herein, a pillararene-embedded covalent organic framework (PCOF) incorporating the antibacterial prodrug thioacetal (TA) has been developed to treat periodontitis. This drug-loaded nanoplatform, namely TA-loaded PCOF, utilizes the self-amplifying ROS property to enhance therapeutic efficacy. PCOFs demonstrate exceptional photosensitivity and ROS generation capabilities when employed as drug carriers. When exposed to ROS, TA within the nanoplatform was activated and cleaved into cinnamaldehyde (CA), a highly potent antibacterial compound. By leveraging visible light to activate the site-specific infection targeting, TA-loaded PCOF effectively alleviated periodontitis, thereby advancing the field of antibacterial drug delivery systems.

Effects of minimally invasive non-surgical therapy on C-reactive protein, lipoprotein-associated phospholipase A2, and clinical outcomes in periodontitis patients: A 1-year randomized, controlled clinical trial

BACKGROUND

Growing evidence suggests the type of periodontal treatment could differentially influence the reduction of key cardiovascular risk mediators in periodontitis patients. This randomized, controlled clinical trial compared the impact of minimally invasive non-surgical therapy (MINST) with quadrant-wise subgingival instrumentation (Q-SI) on C-reactive protein (CRP) together with lipoprotein-associated phospholipase A2 (Lp-PLA2) levels, and clinical periodontal outcomes in patients with periodontitis. Moreover, it was evaluated if baseline CRP levels impacted the efficacy of non-surgical periodontal therapy protocols.

METHODS

Forty-two periodontitis patients were enrolled and randomly treated by means of MINST (n = 21) or Q-SI (n = 21). The outcomes assessed were serum CRP and Lp-PLA2, and periodontal parameters (probing depth [PD], clinical attachment level [CAL], full-mouth bleeding score [FMBS]), at baseline and at follow-ups at 1, 3, and 6 months and at 1 year after treatment.

RESULTS

At 1 year, MINST significantly reduced, among others, mean PD (p = 0.007), mean CAL (p = 0.007), the number of pockets >4 mm (p = 0.011) and ≥6 mm (p = 0.005), and FMBS (p = 0.048) compared to Q-SI. Generalized multivariate analysis evidenced that high baseline CRP (p = 0.039) and FMBS (p = 0.046) levels, together with MINST treatment (p = 0.007) were significant predictors of PD reduction at 1-year follow-up. Moreover, the Jonckheere-Terpstra test showed that patients with high baseline CRP levels gained more benefits from MINST treatment at 1-year follow-up than they did from Q-SI.

CONCLUSION

Patients receiving MINST showed a greater reduction in CRP levels than patients with Q-SI after 1 year of follow-up. Moreover, patients with high baseline levels of CRP and Lp-PLA2 gained more benefits from the MINST approach at 1-year follow-up.

Association between high-density lipoprotein-related inflammation index and periodontitis: insights from NHANES 2009-2014

BACKGROUND

Periodontitis, a persistent inflammatory condition, significantly impairs individuals' overall quality of life. Lymphocyte-to-high-density lipoprotein cholesterol ratio (LHR), monocyte-to-high-density lipoprotein cholesterol ratio (MHR), neutrophil-to-high-density lipoprotein cholesterol ratio (NHR), and platelet-to-high-density lipoprotein cholesterol ratio (PHR) are new convenient and economical biomarkers. However, whether the above high-density lipoprotein-related inflammatory biomarkers are associated with periodontitis has rarely been investigated. Therefore, the research endeavor focused on uncovering potential relationships.

METHODS

The research encompassed a diverse and extensive sample, comprising 9,470 participants, selected from the National Health and Nutrition Examination Survey spanning the years 2009 to 2014. The association between high-density lipoprotein-related inflammatory biomarkers and periodontitis was explored utilizing a multivariable logistic regression model with weighted analysis. Additionally, the study employed smoothed curve fitting to explore potential nonlinear relationships. Further stratified analyses and interaction tests were performed.

RESULTS

This study indicated no apparent association between MHR and PHR with periodontitis, whereas LHR and NHR demonstrated a statistically significant positive relationship with the prevalence of periodontitis. In the fully adjusted model, participants belonging to the highest tertile of both LHR and NHR showed a notably higher likelihood of having periodontitis compared to those in the lowest tertile (LHR: OR = 1.22, 95% CI: 1.06, 1.39; NHR: OR = 1.27, 95% CI: 1.09, 1.49). Furthermore, smooth curve fitting was employed to investigate the potential nonlinear relationship between LHR, NHR, and periodontitis. The results indicated that there was a significant increase in the occurrence of periodontitis when Log2 (LHR) exceeded 1.01 and Log2(NHR) surpassed 2.16 (Log2(LHR): OR = 1.42; 95% CI: 1.19, 1.69; Log2(NHR): OR = 1.40; 95% CI: 1.15, 1.71). The subgroup analysis revealed that the associations between periodontitis and either LHR or NHR, separately, were more pronounced among individuals under the age of 50 and those without hypertension.

CONCLUSIONS

This cross-sectional study revealed a positive relationship between LHR、NHR and periodontitis, particularly when these indicators exceeded their thresholds. LHR and NHR may serve as potential inflammatory markers for identifying periodontitis, thereby facilitating early warning for both patients and dentists, and enabling early intervention in the oral environment. Besides, extensive prospective cohort investigations are essential to confirm and solidify this observation.

Role of CD86 on granulocyte in mediating the effect of Genus Roseburia on periodontitis

OBJECTIVES

This study aimed to explore the causal link between the gut microbiota and periodontitis, and to delineate and quantify the intermediary role of immune cells, so as to provide new insights into the pathogenesis, prevention and treatment of periodontitis.

MATERIALS AND METHODS

We employed a two-sample Mendelian randomization (MR) approach to analyze the genetic predictors of gut microbiota composition (covering 412 gut microbiota taxa and functions) and periodontitis (involving 4,784 cases and 272,252 controls) derived from genome-wide association study (GWAS) datasets. A subsequent two-step MR analysis was conducted to evaluate the extent to which immune cell traits (encompassing 731 immune cell characteristics) mediate the influence of gut microbiota on periodontitis risk.

RESULTS

Our analysis implicated nine gut microbiota taxa as causal factors in periodontitis susceptibility (p < 0.05). Notably, the Genus Roseburia was identified as exerting a protective effect against periodontitis, partially mediated through the upregulation of CD86 expression on granulocytes, with an 8.15% mediation effect observed.

CONCLUSIONS

Our findings establish a causal relationship between the gut microbiota and periodontitis, highlighting the protective role of Roseburia against this condition. A notable proportion of this protective effect is mediated via the upregulation of CD86 on granulocytes.

CLINICAL RELEVANCE

It can provide new ideas for the pathogenesis, prevention and treatment for periodontitis through exploring the causal link between the gut microbiota and periodontitis, and describing and quantifying the intermediary role of immune cells.

Early detection of cardiovascular risk markers through non-invasive ultrasound methodologies in periodontitis patients

Objectives

This narrative review aims to update the current evidence and offer insight into the new non-invasive ultrasound techniques used to early identify degenerative vascular changes in subjects with periodontitis and to investigate if these methodologies could be useful to identify subclinical cardiovascular disease (CVD) dysfunction in periodontitis patients and to monitor changes in CVD risk after periodontal treatment.

Methods

Studies examining the assessment of vascular endothelial function through the latest methodologies were analyzed. Systematic reviews, observational studies, and clinical trials in the English language were identified using PubMed, Web of Science, and Google Scholar databases with key search terms such as "periodontitis," "endothelial dysfunction (ED)," "arterial stiffness," and "periodontal therapy."

Results

Several mechanisms are involved in the association between periodontitis and CVD. The key players are periodontal bacteria and their toxins, which can enter the circulation and infiltrate blood vessel walls. The increase in proinflammatory molecules such as interleukins and chemokines, c-reactive protein, fibrinogen, and oxidative stress also plays a decisive role. In addition, an increase in parameters of ED, arterial stiffness, and atherosclerosis, such as carotid intima-media thickness, pulse wave velocity, and flow-mediated dilatation, has been shown in periodontal patients.

Conclusions

The literature today agrees on the association of periodontitis and CVD and the positive role of periodontal therapy on systemic inflammatory indices and cardiovascular outcomes. Hopefully, these non-invasive methodologies could be extended to periodontal patients to provide a comprehensive understanding of the CVD-periodontitis link from the perspective of a personalized medicine approach in periodontology.

Salivary microbial shifting in hypertensive patients with chronic periodontitis after scaling and root surface debridement

OBJECTIVES

This study aimed to evaluate the impact of scaling and root surface debridement (SRP) on salivary bacterial counts and systolic and diastolic blood pressure in hypertensive patients with chronic periodontitis, with a focus on clinical significance.

METHODS

An observational trial included 24 chronic periodontitis patients, eleven of them were hypertensive patients. Non-surgical periodontal treatment was administered to all patients, with clinical parameters including gingival index (GI), plaque index (PI), and probing pocket depth (PPD) recorded. Saliva samples were collected before and after SRP to quantify total bacterial counts and specific bacterial counts.

RESULTS

Two months following SRP, PI and PPD in every subject under study demonstrated good responses. In hypertension patients, the salivary bacterial count was significantly higher following SRP (P = 0.0221). The incidence of Porphyromonas gingivalis in hypertension patients significantly decreased after treatment (P = 0.0386). Despite this, there was no discernible decrease in blood pressure following treatment.

CONCLUSIONS

SRP alone was ineffective in reducing overall bacterial counts, but P. gingivalis levels responded favorably. Regular periodontal assessment is crucial for hypertensive individuals to mitigate cardiovascular risk.

CLINICAL SIGNIFICANCE

Periodontal therapy in hypertensive patients may improve oral health but might not significantly impact blood pressure. Regular periodontal evaluation is essential for managing cardiovascular risk in hypertension.

Association between serum neurofilament light chain and periodontitis

OBJECTIVES

The association between serum neurofilament light chain (sNfL) and periodontitis remains unclear, and there is a need to examine the contribution of serum albumin (SA) in this association. The objective of the study is to investigate the correlation between sNfLand periodontitis, while examining the potential mediator role of SA in this association.

METHODS

The study, which included 1218 participants from the 2013-2014 National Health and Nutrition Examination Survey (NHANES), aimed to evaluate the association between sNfL and periodontitis through weighted multivariable logistic regression analysis, restricted cubic spline (RCS) models, and stratified models. In addition, mediation analysis was used to investigate the role of SA in mediating this association.

RESULTS

The multivariable logistic regression models revealed that sNfL was significantly linked to periodontitis (model 1: odds ratio [OR], 3.08, 95% confidence interval [CI], 1.48 to 6.39, model 2: OR, 3.69; 95% CI, 1.73 to 7.90, model 3: OR, 3.58, 95% CI, 1.52 to 8.43). The RCS models suggested a linear relationship between sNfL and periodontitis. The stratified analysis revealed no significant moderating effects (p-value > 0.05). The mediation analysis demonstrated that SA mediated the correlation between sNfL and periodontitis, with a mediation proportion of 10.62%.

CONCLUSIONS

The results point to sNfL being a factor in the heightened risk of periodontitis. Additionally, SA may mediate the changes in periodontitis that are associated with sNfL.

CLINICAL RELEVANCE

sNfL may contribute to the development of periodontitis by mediating changes in SA in humans.

Insights and Advancements in Periodontal Tissue Engineering and Bone Regeneration

The regeneration of periodontal bone defects continues to be an essential therapeutic concern in dental biomaterials. Numerous biomaterials have been utilized in this sector so far. However, the immune response and vascularity in defect regions may be disregarded when evaluating the effectiveness of biomaterials for bone repair. Among several regenerative treatments, the most recent technique of in situ tissue engineering stands out for its ability to replicate endogenous restorative processes by combining scaffold with particular growth factors. Regenerative medicine solutions that combine biomaterials/scaffolds, cells, and bioactive substances have attracted significant interest, particularly for bone repair and regeneration. Dental stem cells (DSCs) share the same progenitor and immunomodulatory properties as other types of MSCs, and because they are easily isolable, they are regarded as desirable therapeutic agents in regenerative dentistry. Recent research has demonstrated that DSCs sown on newly designed synthetic bio-material scaffolds preserve their proliferative capacity while exhibiting increased differentiation and immuno-suppressive capabilities. As researchers discovered how short peptide sequences modify the adhesion and proliferative capacities of scaffolds by activating or inhibiting conventional osteogenic pathways, the scaffolds became more effective at priming MSCs. In this review, the many components of tissue engineering applied to bone engineering will be examined, and the impact of biomaterials on periodontal regeneration and bone cellular biology/molecular genetics will be addressed and updated.