Trends in Laboratory Diagnostic Methods in Periodontology

Comparing periodontitis biomarkers in saliva, oral rinse and gingival crevicular fluid: A pilot study

AIM

To explore the feasibility of screening for periodontitis by measuring biomarkers, namely total proteolytic activity (TPA), matrix metalloproteinase (MMP)-8, chitinase, lysozyme or their combination, in saliva, oral rinse and gingival crevicular fluid (GCF).

MATERIAL AND METHODS

Subjects were recruited among healthy/gingivitis individuals and untreated periodontitis patients in Academic Centre for Dentistry Amsterdam (ACTA). All participants donated samples of unstimulated whole saliva, oral rinse and GCF. The protein concentrations and MMP-8 levels were determined by ELISA. Enzymatic activities were measured using appropriate fluorogenic substrates.

RESULTS

In oral rinse samples, periodontitis patients (n = 19) exhibited significantly higher concentrations of MMP-8 and TPA than controls (n = 20). MMP-8 in combination with chitinase explained 88% of the variance and assigned a subject to control or periodontitis group, with best accuracy (87.2%) in oral rinse.

CONCLUSIONS

The combination of MMP-8 and chitinase in the current oral rinse procedure has the potential to discriminate periodontitis from periodontal health/gingivitis.

Mechanical Debridement with Antibiotics in the Treatment of Chronic Periodontitis: Effect on Systemic Biomarkers-A Systematic Review

In this systematic review, we assessed the effectiveness of systemic antibiotics as an adjunctive therapy to mechanical debridement in improving inflammatory systemic biomarkers, as compared to mechanical debridement alone, among adults with chronic periodontitis. We searched relevant electronic databases for eligible randomized controlled trials. Two review authors independently screened, extracted data, and assessed risk of bias. We conducted meta-analysis, assessed heterogeneity, and assessed certainty of evidence using GRADEPro software. We included 19 studies (n = 1350 participants), representing 18 randomized controlled trials and found very little or no impact of antibiotics on inflammatory biomarkers. A meta-analysis of eight studies demonstrated a mean reduction of 0.26 mm in the periodontal pockets at three months (mean difference [MD] −0.26, 95%CI: −0.36 to −0.17, n = 372 participants, moderate certainty of evidence) in favor of the antibiotics. However, results from five studies reporting clinical attachment level (mm) yielded little or no difference at three months (MD −0.16, 95% CI: −0.35 to 0.03, n = 217 participants) between antibiotic and placebo groups. There is little or no evidence that adjunctive systemic antibiotics therapy improves inflammatory systemic biomarkers, compared to mechanical debridement alone, among adults with chronic periodontitis.

Egg yolk immunoglobulin interactions with Porphyromonas gingivalis to impact periodontal inflammation and halitosis

Porphyromonas gingivalis is a pathogenic Gram-negative anaerobic bacterium that colonizes the subgingival region of gums. These bacteria can invade periodontal tissues, form plaques, and produce volatile sulfur compounds (VSC) and volatile organic compounds (VOC). Egg yolk immunoglobulin (IgY) that was specifically produced in egg yolks after chickens were challenged with P. gingivalis could control and prevent oral diseases caused by P. gingivalis. The releases of P. gingivalis offensive metabolic odors in vitro and in vivo were determined using a Halimeter and GCMS. With IgY bacterial growth was inhibited, and the relative amounts of VOC and VSC were decreased. The scores for the oral health index and the levels of IL-6 and TNF-α are also decreased. All treatment groups showed significant anti-inflammatory effects, which strongly suggests that specifically IgY against P. gingivalis may be an effective treatment for the prevention and protection of periodontal inflammation and halitosis.

Egg yolk immunoglobulins' impact on experimental periodontitis caused by Porphyromonas gingivalis

BACKGROUND

Periodontitis is a chronic inflammatory disease caused by Porphyromonas gingivalis that leads to a series of periodontal tissue injuries. Egg yolk immunoglobulins (IgY) is procuded in egg yolk and inhibits P. gingivalis.

OBJECTIVE

The aim was to evaluate the effect of IgY on experimental periodontitis caused by P. gingivalis.

METHODS

The second molars of rats were ligatured using medical 5-0 silk and smeared with P. gingivalis to induce experimental periodontitis. Then, the rats were smeared with 2 mL IgY solutions or 0.9% NaCl in the oral cavity for up to 4 wk. The scores for gingival index, plaque index and probe on bleeding, the levels of IL-6 and TNF-α, X-ray radiography and histology were used to determine the efficacy of the IgY on experimental periodontitis.

RESULTS

The clinical indices improved; the levels of IL-6 and TNF-α were significantly (p< 0.05) decreased; the X-rays and histomorphological observations suggested that the periodontal inflammation and periodontitis were alleviated compared to the control.

CONCLUSIONS

IgY showed significant effects on anti-inflammatory, anti-coaggregation activity, and protected against alveolar bone loss. Therefore, it had a beneficial effect on preventing experimental periodontitis caused by P. gingivalis.

Influence of diameter of fiber membrane scaffolds on the biocompatibility of hPDL mesenchymal stromal cells

This study evaluated the influence in the biocompatibility of human periodontal ligament (hPDL) mesenchymal stromal cell onto poly lactic-acid (PLA) films and PLA fiber membrane. Fiber scaffold was prepared via air jet spinning (AJS) from PLA solutions (6, 7, and 10%) and analyzed using SEM, AFM and FTIR. Biocompatibility was evaluated by adhesion, proliferation and cell-material interaction. PLA film exhibited a smooth and homogenously surface topography in comparison with random orientation of PLA fiber with roughness structure where diameter size depends on PLA solution. Moreover, cell adhesion; proliferation and cell-material interaction has the best respond on random orientation nanofiber of 10, followed by 7, and 6% of PLA in comparison with PLA films. It could be concluded that AJS is an attractive alternative technique for manufacture fiber scaffolds with a tunable random orientation geometry of fibers that allow to produce interconnected porous formed by nanometric fiber diameter structures that could be a potential scaffold for periodontal tissue engineering applications.

Correlative analysis of plasma and urine neopterin levels in the pre- and post-menopausal women with periodontitis, following nonsurgical periodontal therapy

Context:

Periodontitis is an inflammatory condition which is distinguished by the devastation of the supported tooth structures. In such inflammatory conditions, some biomarkers such as neopterin will be secreted and elevated in the body fluids, which can be used as a diagnostic marker for the present and future disease activity.

Aims:

Assessment of the neopterin as a biomarker in inflammatory conditions such as menopause and periodontitis.

Settings and Design:

A cross-sectional interventional study.

Materials and Methods:

Sixty female individuals with a mean age of 40–60 years with chronic periodontitis were included in this study. All were categorized into two groups of thirty each, depending on their menstrual history: Group I – thirty premenopausal women and Group II – thirty postmenopausal women. Urine and plasma were collected from both groups to estimate neopterin levels. ELISA kit was used to assess the neopterin levels at baseline and after 3 months of nonsurgical periodontal therapy (NSPT).

Statistical Analysis Used:

IBM SPSS version 21 software.

Results:

A significant depreciation in the mean values of all the parameters from baseline to 3 months (P < 0.001), in the intragroup analysis, was observed. Plasma (0.006) and urine (0.004) reduction was seen.

Conclusions:

In both the groups, in 3 months after NSPT, decreased neopterin levels were found, suggesting that the NSPT is the definitive therapy. Further, suggesting that, neopterin levels in the plasma and urine can be used as an index to identify the periodontal inflammation and destruction.

Mandibular regeneration after immediate load dental implant in a periodontitis patient: A clinical and ultrastructural case report

RATIONALE

In this case study, we characterized from radiographic, morphological and elemental point of view the mandibular reconstruction that occur in patients affects by periodontitis after application of endosseous titanium implants. In particular, we verified that the bone load applied by titanium implant was able to induce the mandibular osteogenic reconstruction.

PATIENT CONCERN

A 57-year-old female active smoker with no contraindications for dental implants and 3 unstable dental prostheses, underwent open surgery for the application of endosseous titanium implants (BANP IMPLANT S.R.L., Milan, MI, Italy) with Immediate load dental implant technique. At the time of presentation, patient was under treatment β- beta-adrenergic agents.

DIAGNOSES

Patient was affected by grade II periodontitis according to Armitage classification.

INTERVENTATION

Patient underwent open surgery for the application of endosseous titanium implants (BANP IMPLANT S.R.L., Milan, MI, Italy) with Immediate load dental implant technique. Implant placement was performed under local anesthesia after premedication with diazepam (0.2 mg/kg), given orally 30 minutes before surgery. After crestal incision, a meticulous cleaning of the oral cavity was carried out. We removed necrotic tissues and all inflammatory residues. Then, the bone cavity was extended gradually, according to the intended implant diameter. Inserted titanium implants were placed 8-12 mm subcrestally.

OUTCOMES

We demonstrated that the bone load applied by titanium implant was able to induce the mandibular osteogenic reconstruction in a periodontitis patient.

LESSONS

This case study can lay the foundation to improve understanding of the relationship between the immediate load dental implant and the mandibular regeneration.

Comparative Evaluation of Salivary Neopterin Levels and Its Effects to Periodontal Therapy in Pre- and Post-Menopausal Women

OBJECTIVES

Neopterin is a valuable diagnostic biomarker, which is elevated in inflammatory conditions like periodontitis, that is characterized by destruction of the supporting structures of the teeth. Among the biomarkers, neopterin occurs in body fluids, and acts as a diagnostic marker for present and future disease activity.

METHODS

Thirty female subjects with chronic periodontitis, mean age 50 years (40-60 years) were included in this study. Depending upon their menstrual history, subjects were categorized into two groups of fifteen each. Group I 15 pre-menopausal women, and Group II 15 post-menopausal women. Saliva was collected, and neopterin levels were assessed by enzyme-linked immunosorbent assay in both the groups, at base line and after three months of nonsurgical periodontal therapy (NSPT). Periodontal parameters like pocket probing depth (PD) and Russell's periodontal disease index (PDI) were assessed before treatment as well as after three months of scaling and root planning.

RESULTS

Intra group analysis showed significant markdown in the mean values of all the parameters from baseline to three months (P < 0.001), for all patients. The intergroup comparison, from baseline to 3 months also showed no significant change in PD and PDI values, but there was a statistically significant difference in the salivary neopterin levels (P = 0.04).

CONCLUSIONS

Neopterin levels were found to be reduced in three months after NSPT in both the groups, suggesting that the NSPT is the gold standard therapy, and also that neopterin levels in saliva can be used as an indicator to identify periodontal inflammation and destruction.