Reproducibility of Probing Depth Measurements Using a Constant-Force Electronic Probe: Analysis of Inter- and Intraexaminer Variability

Diagnostic measures for monitoring and follow-up in periodontology and implant dentistry

This review discusses the role of diagnostic measures in the lifelong management of periodontal disease and peri-implant complications. After active treatment, these conditions require regular monitoring of the supporting structures of teeth and dental implants to assess bone and soft tissue health over time. Several clinical measures have been developed for the routine assessment of periodontal and peri-implant tissues, including periodontal and peri-implant probing, bleeding on probing, intraoral radiography, biomarker analysis, and microbiological testing. This review highlights the evolution of diagnostic practices, integrating traditional methods with emerging technologies such as resonance frequency analysis and ultrasound imaging to provide a holistic view of peri-implant health assessment. In addition to objective measurements, patient risk factors are considered. The goals of periodontal and peri-implant maintenance are to control disease activity and stabilize tissues through supportive care, which includes diagnostic measures at follow-up visits. This enables clinicians to monitor treatment outcomes, assess health status, and detect recurrence or progression early through routine evaluation, allowing additional interventions, including adjustment of supportive therapy intervals, to further improve and maintain periodontal and peri-implant stability over time.

Modulating the sEH/EETs Axis Restrains Specialized Proresolving Mediator Impairment and Regulates T Cell Imbalance in Experimental Periodontitis

Epoxyeicosatrienoic acids (EETs) and other epoxy fatty acids are short-acting lipids involved in resolution of inflammation. Their short half-life, due to its metabolism by soluble epoxide hydrolase (sEH), limits their effects. Specialized proresolving mediators (SPMs) are endogenous regulatory lipids insufficiently synthesized in uncontrolled and chronic inflammation. Using an experimental periodontitis model, we pharmacologically inhibited sEH, examining its impact on T cell activation and systemic SPM production. In humans, we analyzed sEH in the gingival tissue of periodontitis patients. Mice were treated with sEH inhibitor (sEHi) and/or EETs before ligature placement and treated for 14 d. Bone parameters were assessed by microcomputed tomography and methylene blue staining. Blood plasma metabololipidomics were carried out to quantify SPM levels. We also determined T cell activation by reverse transcription-quantitative PCR and flow cytometry in cervical lymph nodes. Human gingival samples were collected to analyze sEH using ELISA and electrophoresis. Data reveal that pharmacological sEHi abrogated bone resorption and preserved bone architecture. Metabololipidomics revealed that sEHi enhances lipoxin A4, lipoxin B4, resolvin E2, and resolvin D6. An increased percentage of regulatory T cells over Th17 was noted in sEHi-treated mice. Lastly, inflamed human gingival tissues presented higher levels and expression of sEH than did healthy gingivae, being positively correlated with periodontitis severity. Our findings indicate that sEHi preserves bone architecture and stimulates SPM production, associated with regulatory actions on T cells favoring resolution of inflammation. Because sEH is enhanced in human gingivae from patients with periodontitis and connected with disease severity, inhibition may prove to be an attractive target for managing osteolytic inflammatory diseases.

Antineoplastic therapy in childhood cancer patients presents a negative impact in the periodontal tissues: a cohort study

OBJECTIVES

To investigate the effect of antineoplastic therapy (AT) in the periodontal tissues of childhood cancer (CC) patients.

MATERIALS AND METHODS

Seventy-two individuals were divided into CC (n=36) and healthy individuals (control group-CG, n=36). Demographics, hygiene habits, CC type, and AT were collected. Salivary flow and the presence and concentration of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia, and Fusobacterium nucleatum were analyzed. Clinical evaluation included plaque (PI) and gingival indexes (GI), periodontal probing depth (PPD), and clinical attachment level (CAL). Patients were classified into periodontal health, gingivitis, or periodontitis. Descriptive statistics, T test, Mann-Whitney test, chi-square, Fisher's exact test, and two-way analysis of variance were used (p<0.05).

RESULTS

The mean age of the patients was similar (CC 12.0±3.9 years and CG 12.0±4.0 years). In the CC group, all patients underwent chemotherapy and nine radiotherapy. Color/race, income, and family education showed significant differences between groups. There was no difference between groups in salivary flow. Higher levels of Fusobacterium nucleatum were seen in CC (p=0.02). Significant difference between groups was found for PI (CC: 30.5%, CG: 22.6%), GI (CC: 28.8%, CG: 17.3%), PPD (CC: 1.77 mm, CG: 1.61 mm), and CAL (CC: 1.77 mm, CG: 1.57 mm), periodontal health (CC: 3, CG: 7), gingivitis (CC: 16, CG: 24), or periodontitis (CC: 17, CG: 5).

CONCLUSION

AT in CC patients presents a negative impact in the periodontal and microbiological parameters.

CLINICAL RELEVANCE

Childhood cancer individuals showed worse periodontal parameters and higher levels of Fusobacterium nucleatum in the saliva when compared to healthy individuals.

Patients with type 2 diabetes and severe periodontitis harbor a less pathogenic subgingival biofilm than normoglycemic individuals with severe periodontitis

BACKGROUND

Whether, and to what extent, diabetes mellitus (DM) can affect the subgingival biofilm composition remains controversial. Thus, the aim of this study was to compare the composition of the subgingival microbiota of non-diabetic and type 2 diabetic patients with periodontitis using 40 "biomarker bacterial species."

METHODS

Biofilm samples of shallow (probing depth [PD] and clinical attachment level [CAL] ≤3 mm without bleeding) and deep sites (PD and CAL ≥5 mm with bleeding) of patients with or without type 2 DM were evaluated for levels/proportions of 40 bacterial species by checkerboard DNA-DNA hybridization.

RESULTS

A total of 828 subgingival biofilm samples from 207 patients with periodontitis (118 normoglycemic and 89 with type 2 DM) were analyzed. The levels of most of the bacterial species evaluated were reduced in the diabetic compared with the normoglycemic group, both in shallow and in deep sites. The shallow and deep sites of patients with type 2 DM presented higher proportions of Actinomyces species, purple and green complexes, and lower proportions of red complex pathogens than those of normoglycemic patients (P < 0.05).

CONCLUSIONS

Patients with type 2 DM have a less dysbiotic subgingival microbial profile than normoglycemic patients, including lower levels/proportions of pathogens and higher levels/proportions of host-compatible species. Thus, type 2 diabetic patients seem to require less remarkable changes in biofilm composition than non-diabetic patients to develop the same pattern of periodontitis.

Newly identified pathogens in periodontitis: evidence from an association and an elimination study

We assessed the level of evidence for the presence of new periodontal pathogens by (i) comparing the occurrence of non-classical periodontal taxa between healthy vs. periodontitis patients (Association study); (ii) assessing the modifications in the prevalence and levels of these species after treatments (Elimination study). In the Association study, we compared the prevalence and levels of 39 novel bacterial species between periodontally healthy and periodontitis patients. In the Elimination study, we analyzed samples from periodontitis patients assigned to receive scaling and root planing alone or with metronidazole+ amoxicillin TID/ 14 days. Levels of 79 bacterial species (39 novel and 40 classic) were assessed at baseline, 3 and 12 months post-therapy. All samples were analyzed using Checkerboard DNA-DNA hybridization. Out of the 39 novel species evaluated, eight were categorized as having strong and four as having moderate association with periodontitis. Our findings suggest strong evidence supporting Lancefieldella rimae, Cronobacter sakazakii, Pluralibacter gergoviae, Enterococcus faecalis, Eubacterium limosum, Filifactor alocis, Haemophilus influenzae, and Staphylococcus warneri, and moderate evidence supporting Escherichia coli, Fusobacterium necrophorum, Spiroplasma ixodetis, and Staphylococcus aureus as periodontal pathogens. These findings contribute to a better understanding of the etiology of periodontitis and may guide future diagnostic and interventional studies.

Evaluation of IL-4, MIP-1α, and MMP-9 gene expression levels in peri-implant tissues in peri-implantitis

This case-control study evaluated the gene expression levels of interleukin (IL)-4, macrophage inflammatory protein type 1 alpha (MIP-1α), and metalloproteinase (MMP)-9, factors involved in the formation of giant cells in healthy peri-implant tissue and peri-implantitis. Thirty-five subjects (15 healthy and 20 with peri-implantitis), who met the inclusion and exclusion criteria, were included in this study. The peri-implant tissue biopsies were subjected to total RNA extraction, DNAse treatment, and cDNA synthesis. Subsequently, the reaction of real-time PCR was performed to evaluate the gene expression levels of IL-4, MIP-1α, and MMP-9 concerning the reference gene. IL-4 gene expression showed higher (18-fold) values in the Peri-Implantitis Group of Patients when compared with the Healthy (Control) Group (p<0.0001). Although MIP- 1α and MMP-9 gene expression levels were higher in diseased implants, they showed no significant differences (p=0.06 and p=0.2337), respectively. Within the limitations of this study, the results showed that in tissues affected by peri-implantitis, only levels of Il-4 were increased when compared with tissues in the control group.

A Systematic Review and Meta-Analysis on the Efficacy of Locally Delivered Adjunctive Curcumin (Curcuma longa L.) in the Treatment of Periodontitis

This meta-analysis intended to assess evidence on the efficacy of locally delivered curcumin/turmeric as an adjunctive to scaling and root planing (SRP), on clinical attachment level (CAL) and probing pocket depth (PPD), compared to SRP alone or in combination with chlorhexidine (CHX). RCTs were identified from PubMed, Cochrane Library, BASE, LIVIVO, Dentistry Oral Sciences Source, MEDLINE Complete, Scopus, ClinicalTrials.gov, and eLibrary, until August 2022. The risk of bias (RoB) was assessed with the Cochrane Risk of Bias tool 2.0. A random-effects meta-analysis was performed by pooling mean differences with 95% confidence intervals. Out of 827 references yielded by the search, 23 trials meeting the eligibility criteria were included. The meta-analysis revealed that SRP and curcumin/turmeric application were statistically significantly different compared to SRP alone for CAL (-0.33 mm; p = 0.03; 95% CI -0.54 to -0.11; I2 = 62.3%), and for PPD (-0.47 mm; p = 0.024; 95% CI -0.88 to -0.06; I2 = 95.5%); however, this difference was considered clinically meaningless. No significant differences were obtained between patients treated with SRP and CHX, compared to SRP and curcumin/turmeric. The RoB assessment revealed numerous inaccuracies, thus raising concerns about previous overestimates of potential treatment effects.

Myocardial infarction risk is increased by periodontal pathobionts: a cross-sectional study

To establish the role of periodontal pathobionts as a risk factor for myocardial infarction, we examined the contribution of five periodontal pathobionts and their virulence genes' expressions to myocardial injury (Troponin-I) and coronary artery disease burden (SYNTAX-I scores) using hierarchical linear regression. Pathobiont loads in subgingival-plaques and intra-coronary-thrombi were compared. Troponin-I release increased with one 16S rRNA gene copy/ng DNA of Porphyromonas gingivalis (β = 6.8 × 10^-6, 95% CI = 1.1 × 10^-7-2.1 × 10^-5), one-fold increased expressions of fimA (β = 14.3, 95% CI = 1.5-27.1), bioF-3 (β = 7.8, 95% CI = 1.1-12.3), prtH (β = 1107.8, 95% CI = 235.6-2451.3), prtP (β = 6772.8, 95% CI = 2418.7-11,126.9), ltxA (β = 1811.8, 95% CI = 217.1-3840.8), cdtB (β = 568.3, 95% CI = 113.4-1250.1), all p < 0.05. SYNTAX-I score increased with one 16S rRNA gene copy/ng DNA of Porphyromonas gingivalis (β = 3.8 × 10^-9, 95% CI = 3.6 × 10^-10-1.8 × 10^-8), one-fold increased expressions of fimA (β = 1.2, 95% CI = 1.1-2.1), bioF-3 (β = 1.1, 95% CI = 1-5.2), prtP (β = 3, 95% CI = 1.3-4.6), ltxA (β = 1.5, 95% CI = 1.2-2.5), all p < 0.05. Within-subject Porphyromonas gingivalis and Tannerella forsythia from intra-coronary-thrombi and subgingival-plaques correlated (rho = 0.6, p < 0.05). Higher pathobiont load and/or upregulated virulence are risk factors for myocardial infarction.Trial registration: ClinicalTrials.gov Identifier: NCT04719026.

A cross-sectional study assessing the relationship between non-alcoholic fatty liver disease and periodontal disease

The risk factors for non-alcoholic fatty liver disease (NAFLD) progression are not completely known. Porphyromonas gingivalis infection is a risk factor for systemic diseases. We investigated the association of P. gingivalis infection with the risk of non-alcoholic steatohepatitis progression. Here, hematological tests, periodontal examination, and saliva collection were performed for 164 patients with NAFLD. P. gingivalis was identified in saliva using polymerase chain reaction. Hepatic steatosis and stiffness were evaluated using vibration-controlled transient elastography (VCTE) and magnetic resonance imaging. In patients with NAFLD, P. gingivalis positivity (P. gingivalis ratio ≥ 0.01%) in saliva correlated with liver stiffness determined using magnetic resonance elastography (MRE; p < 0.0001). A P. gingivalis ratio of 0.01% corresponds to 100,000 cells/mL and indicates the proportion of P. gingivalis in the total number of bacteria in the oral cavity. Patients with NAFLD and advanced fibrosis on MRE showed significantly elevated endotoxin activity; those who had > 10 periodontal pockets with depths ≥ 4 mm had significantly increased hepatic stiffness on both VCTE and MRE.

Adjuvant use of multispecies probiotic in the treatment of peri-implant mucositis: A randomized controlled trial

AIM

This randomized placebo-controlled clinical trial evaluated the effects of multispecies probiotic containing Lactobacillus rhamnosus HN001™, Lactobacillus paracasei Lpc-37®, and Bifidobacterium animalis subsp lactis HN019™ as an adjunct to mechanical debridement (MD) on changes in bleeding on probing (BOP) in edentulous patients with peri-implant mucositis (PiM).

MATERIALS AND METHODS

Patients were randomly assigned to test (probiotic) or control (placebo) groups. All sites with PiM received MD and topical gel application (probiotic or placebo) at baseline and 12 weeks. After initial MD, patients consumed probiotic or placebo capsules twice a day for 12 weeks. Clinical (modified sulcus bleeding index [mSBI]; modified plaque index [mPI]; probing depth [PD]; and BOP) and immunological parameters were collected at baseline and after 12 and 24 weeks. Data were statistically analysed (p < .05).

RESULTS

Thirty-six patients with PiM were recruited. The test group presented higher prevalence (p < .05) of cases of restored peri-implant health at 24 weeks than did the control group (72.2% and 33.3%, respectively). No significant difference was observed between test (n = 18) and control (n = 18) groups for mPI and PD. mSBI %-score 0 was higher in the test group than in the control group at 24 weeks (p < .05). When compared with baseline, both groups presented reduced BOP at 12 and 24 weeks (p < .05). BOP was lower in the test group than in the control group at 12 (mean difference = -14.54%; 95% confidence interval [CI] = -28.87 to 0.22; p = .0163) and 24 (mean difference = -12.56%; 95% CI = -26.51 to 1.37; p = .0090) weeks. At 24 weeks, only the test group presented lower levels of interleukin (IL)-1β, IL-6, IL-8, and tumour necrosis factor (TNF)-α than those at baseline (p < .05).

CONCLUSIONS

The multispecies probiotic (administered locally and systemically) containing L. rhamnosus HN001™, L. paracasei Lpc-37®, and B. lactis HN019™ as an adjunct to repeated MD promotes additional clinical and immunological benefits in the treatment of PiM in edentulous patients (ClinicalTrials.gov NCT04187222).

Salivary Microbial Dysbiosis Is Associated With Peri-Implantitis: A Case-Control Study in a Brazilian Population

Background and Objectives

The aim of this study was to examine the salivary microbiome in healthy peri-implant sites and those with peri-implantitis.

Methods

Saliva samples were collected from 21 participants with healthy peri-implant sites and 21 participants with peri-implantitis. The V4 hypervariable region of the 16S rRNA gene was sequenced using the Ion Torrent PGM System (Ion 318™ Chip v2 400). The NGS analysis and composition of the salivary microbiome were determined by taxonomy assignment. Downstream bioinformatic analyses were performed in QIIME (v 1.9.1).

Results

Clinical differences according to peri-implant condition status were found. Alpha diversity metrics revealed that the bacterial communities of participants with healthy peri-implant sites tended to have a richer microbial composition than individuals with peri-implantitis. In terms of beta diversity, bleeding on probing (BoP) may influence the microbial diversity. However, no clear partitioning was noted between the salivary microbiome of volunteers with healthy peri-implant sites or volunteers with peri-implantitis. The highest relative abundance of Stenotrophomonas, Enterococcus and Leuconostoc genus, and Faecalibacterium prausnitzii, Haemophilus parainfluenzae, Prevotella copri, Bacteroides vulgatus, and Bacteroides stercoris bacterial species was found in participants with peri-implantitis when compared with those with healthy peri-implant sites.

Conclusion

Differences in salivary microbiome composition were observed between patients with healthy peri-implant sites and those with peri-implantitis. BoP could affect the diversity (beta diversity) of the salivary microbiome.

Clinical Evaluation of a New Electronic Periodontal Probe: A Randomized Controlled Clinical Trial

Precise measurements of periodontal parameters (such as pocket depths: PPD, gingival margins: GM) are important for diagnosis of periodontal disease and its treatment. Most examiners use manual millimeter-scaled probes, dependent on adequate pressure and correct readouts. Electronic probes aim to objectify and facilitate the diagnostic process. This randomized controlled trial compared measurements of a standard manual (MP) with those of an electronic pressure-sensitive periodontal probe (EP) and its influence on patients' acceptance and practicability. In 20 patients (2436 measuring points) PPD and GM were measured either with MP or EP by professionals with different levels of experience: dentist (10 patients), 7th and 10th semester dental students (5 patients each). Time needed was measured in minutes and patients' subjective pain was evaluated by visual analogue scale. Differences were analyzed using the generalized estimating equations approach (GEE) and paired Wilcoxon tests. Mean PPD varied with ΔPPD 0.38 mm between both probes, which was significant (p < 0.001), but GM did not (ΔREC 0.07 mm, p = 0.197). There was a statistically significant correlation of both probes (Spearman's rho correlation coefficient GM: 0.674, PPD: 0.685). Differences can be considered robust (no deviation in either direction). The comparison of time needed and pain sensitivity did not result in statistically significant differences (p > 0.05).

Microbiological and clinical evaluation of ultrasonic debridement with/without erythritol air polishing during supportive periodontal therapy in arches with full-arch fixed implant-supported prostheses: protocol for a randomised controlled trial

INTRODUCTION

Implant-supported prostheses are often successfully used in edentulous patients. However, the incidences of peri-implant mucositis and peri-implantitis increase over time. The accumulation of pathogenic bacteria adjacent to prostheses can induce peri-implant disease. Plaque removal is recommended to prevent and manage peri-implant diseases. The purpose of this study is to compare the plaque removal efficacy of ultrasonic debridement with/without erythritol air-polishing powder around implants and bridges in patients with full-arch fixed implant-supported prostheses as well as the effects of these two methods on the rates of peri-implant mucositis and peri-implantitis, and the submucosal microbiota composition over 5 years in patients undergoing supportive periodontal therapy.

METHODS AND ANALYSIS

We plan to enrol 10 edentulous (maxilla and/or mandible) patients seeking full-arch fixed implant-supported prostheses. The study will use a split-mouth model in which contralateral quadrants are randomly assigned to two groups. Group 1: one contralateral quadrant of full-arch fixed implant-supported prostheses will undergo ultrasonic debridement combined with erythritol air-polishing powder. Group 2: a separate contralateral quadrant of full-arch fixed implant-supported prostheses will undergo ultrasonic debridement. The 5-year trial will involve a total of 10 re-examinations per participant. The mucosal conditions around the implants will be recorded at 6-month intervals after restoration. Peri-implant submucosal plaque will be collected at each re-examination, and the bacterial flora will be analysed by 16s ribosomal RNA gene sequencing. X-ray examinations will be conducted at 12-month intervals to evaluate the marginal bone level around implants.

ETHICS AND DISSEMINATION

This prospective single-centre, randomised controlled trial (PKUSSIRB-202054045) has been approved by the Ethics Committee of Stomatology School and Hospital of Peking University. Data will be registered with the International Clinical Trials Registry Platform. Additionally, we will disseminate the results via publication in scientific journals.

TRIAL REGISTRATION NUMBER

ChiCTR-2000032431.

Comparing the efficiency of Er,Cr:YSGG laser and diode laser for the treatment of generalized aggressive periodontitis

BACKGROUND

This study aims to determine the effects of Er,Cr:YSGG and diode laser treatments on IL-1β, IL-8, and TNF-α levels in patients with generalized aggressive periodontitis.

METHODS

Twenty-six generalized aggressive periodontitis patients were enrolled in the study. We performed three treatment models: "scaling and root planning (SRP-only)," "SRP + Er,Cr:YSGG laser," and "SRP + diode laser." Each experimental quadrant was randomly allocated to the control group or the test group. The IL-1β, IL-8, and TNF-α levels were analyzed with an enzyme-linked immune-sorbent assay.

RESULTS

When the baseline and post-treatment IL-1β, IL-8, and TNF-α levels were compared, the most significant difference was observed in the SRP + Er,Cr:YSGG group and the least difference was observed in the SRP-only group.

CONCLUSIONS

The use of Er,Cr:YSGG laser as an addition to the conventional mechanical periodontal treatment was found to be more successful than the diode laser + SRP use in aggressive periodontitis treatment.

Periodontal therapy on the oral health-related quality of life of obese and non-obese individuals

Oral diseases such as periodontitis can have a more negative influence on the quality of life of obese than in normal-weight patients. The objective of the present study was to assess the impact of one-stage full-mouth disinfection (OSFMD) therapy on the oral health-related quality of life (OHRQL) of obese and non-obese individuals with periodontitis. Fifty-five obese and thirty-nine non-obese patients were evaluated. The questionnaires oral impacts on daily performance (OIDP) and oral health and quality of life (OHQoL) were given to all patients at baseline and 6 months after periodontal treatment by the OSFMD protocol. For statistical analysis, Chi-square, the two-factor repeated-measures ANOVA, and correlation tests were used. At baseline, mean global OHQoL and OIDP scores were similar for both groups (p > 0.05). At 6 months, OSFMD resulted in OHQoL and OIDP global scores improvements in both groups (p < 0.05), with no significant difference between groups. The most impaired activity at baseline was eating and cleaning teeth for both groups. Periodontal parameters were associated with worse values in the OHQoL and OIDP questionnaires only in obese patients. In conclusion, OSFMD yielded similar improvements in overall OHRQL in both obese and non-obese individuals. Periodontal parameters were associated with a worse quality of life in obese patients. Periodontal treatment can be an important component to improve the OHRQL of obese individuals, and clinicians should expect similar results as those obtained with non-obese patients.

Clinical, microbiological, and immunological effects of systemic probiotics in periodontal treatment: study protocol for a randomized controlled trial

BACKGROUND

The association of scaling and root planing (SRP) with systemic metronidazole (MTZ) plus amoxicillin (AMX) has shown to be an effective treatment protocol, particularly for periodontitis stages III and IV, generalized. More recently, probiotics have also been suggested as a promising adjunctive treatment for periodontal diseases due to their antimicrobial and anti-inflammatory properties. Therefore, the aim of this randomized clinical trial (RCT) is to evaluate the clinical, microbiological, and immunological effects of probiotics as adjuncts to SRP alone or with MTZ+AMX in the treatment of periodontitis.

METHODS

Subjects with periodontitis are being randomly assigned to receive (i) SRP alone, or with (ii) two probiotic lozenges/day for 90 days (Prob), (iii) MTZ (400 mg) and AMX (500 mg) thrice a day (TID) for 14 days (MTZ+AMX), or (iv) Prob and MTZ+AMX. Subjects are being monitored for up to 12 months post-treatment. Nine subgingival plaque samples per patient are being collected at baseline and at 3, 6, and 12 months post-therapy and analyzed by checkerboard DNA-DNA hybridization for 40 bacterial species. Peripheral blood and gingival crevicular fluid (GCF) of four randomly selected periodontal sites will be analyzed by means of a multiplex fluorescent bead-based immunoassay for 17 cyto/chemokines.

STATISTICAL ANALYSES

The significance of differences in each group (over the course of the study) will be sought using repeated measures ANOVA or Friedman tests and among groups (at each time point) using either ANOVA/ANCOVA or Kruskal-Wallis tests, depending on normality of the data. The chi-square test will be used to compare differences in the frequency of subjects achieving the clinical endpoint for treatment (≤ 4 sites with PD ≥ 5 mm) at 1 year and of self-perceived adverse effects. A stepwise forward logistic regression analysis will be performed in order to investigate the impact of different predictor variables on the percentage of patients achieving the clinical endpoint for treatment. The Number Needed to Treat (NNT) with different treatment protocols will be also calculated. Statistical significance will be set at 5%.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03733379. Registered on November 7, 2018.

Levels of Gene Expression of Immunological Biomarkers in Peri-Implant and Periodontal Tissues

This study compared the gene expression of the immunoinflammatory markers interleukin (IL)-6, IL-1ß, and tumor necrosis factor alpha (TNF-α), the matrix metalloproteinases (MMP)-1, -2, -8, and -9, and the tissue inhibitors of matrix metalloproteases (TIMP)-1 and -2 in the gingival tissue of individuals with periodontal and peri-implant disease. The study population included individuals with four periodontal statuses: periodontal health (PH group, n = 20); periodontitis (P group, n = 20); peri-implant health (PIH group, n = 20), and peri-implantitis (PI group, n = 20). Gingival biopsies were collected from one tooth per patient according to the inclusion criteria of each group. The mRNA levels of IL-6, IL-1ß, TNF-α, MMP-1, MMP-2, MMP-8, MMP-9, TIMP-1, and TIMP-2 were evaluated by qPCR. The levels of IL-1ß were significantly higher in the PI group when compared to the other groups (p < 0.05), while the levels of IL-6 were significantly higher in the groups with periodontal and peri-implant disease when compared with the healthy groups (p < 0.05); however, the levels of IL-6 did not differ between the PI and P groups (p > 0.05). For all other studied biomarkers, no significant differences were observed between groups (p > 0.05). IL-6 and IL-1ß presented higher levels of mRNA in diseased periodontal and peri-implant tissues. However, the expression of metalloproteinases and their inhibitors did not differ between the different periodontal statuses.

Comparison of peri-implant submucosal microbiota in arches with zirconia or titanium implant-supported fixed complete dental prostheses: a study protocol for a randomized controlled trial

Background

The success rate of implant-supported prostheses for edentulous patients is relatively high. However, the incidence of biological complications, especially peri-implant mucositis and peri-implantitis, increases yearly after the placement of prostheses. The accumulation of pathogenic bacteria adjacent to a prosthesis is the main cause of biological complications. Titanium, one of the classical materials for implant-supported prostheses, performs well in terms of biocompatibility and ease of maintenance, but is still susceptible to biofilm formation. Zirconia, which has emerged as an appealing substitute, not only has comparable properties, but presents different surface properties that influence the adherence of oral bacteria. However, evidence of a direct effect on oral flora is limited. Therefore, the aim of the present study was to assess the effects of material properties on biofilm formation and composition.

Methods

The proposed study is designed as a 5-year randomized controlled trial. We plan to enroll 44 edentulous (mandible) patients seeking full-arch, fixed, implant-supported prostheses. The participants will be randomly allocated to one of two groups: group 1, in which the participants will receive zirconia frameworks with ceramic veneering, or group 2, in which the participants will receive titanium frameworks with acrylic resin veneering. Ten follow-up examinations will be completed by the end of this 5-year trial. Mucosal conditions around the implants will be recorded every 6 months after restoration. Peri-implant submucosal plaque will be collected at each reexamination, and bacteria flora analysis will be performed with 16S rRNA gene sequencing technology in order to compare differences in microbial diversity between groups. One week before each visit, periodontal maintenance will be arranged. Each participant will receive an X-ray examination every 12 months as a key index to evaluate the marginal bone level around the implants.

Discussion

The current study aims to explore the oral microbiology of patients following dental restoration with zirconia ceramic frameworks or titanium frameworks. The features of the microbiota and the mucosal condition around the two different materials will be evaluated and compared to determine whether zirconia is an appropriate material for fixed implant-supported prostheses for edentulous patients.

Trial registration

International Clinical Trials Registry Platform (ICTRP) ChiCTR2000029470. Registered on 2 February 2020. http://www.chictr.org.cn/searchproj.aspx?

Cytokine profiles of healthy and diseased sites in individuals with periodontitis

OBJECTIVE

The aims of this study were: 1) to compare the levels of cytokines between healthy and diseased sites, in patients with untreated periodontitis; 2) to correlate cytokine levels with each other and with key periodontal pathogens, in healthy and diseased sites.

METHODS

Paired gingival crevicular fluid (GCF) samples were obtained from two healthy (probing depth (PD) and clinical attachment level (CAL) ≤3 mm without bleeding) and two diseased sites (PD and CAL ≥5 mm with bleeding on probing [BoP]) of patients with generalized stage III/IV grade B/C periodontitis. GCF levels of eighteen cytokines and subgingival levels of seven periodontal pathogens were assessed by multiplex immunoassay and qPCR, respectively.

RESULTS

A total of 112 subjects and 448 GCF samples were analyzed. The GCF levels of GM-CSF, IL-17, IL-1β, IL-2, IL-21, IL-23 and TGF-β were significantly higher in the diseased than in the healthy sites (p < 0.05). Levels of IL-8 and MIP-1α were significantly higher in the healthy than in the diseased sites (p < 0.05). In the healthy sites, IL-8 and MIP-1α formed an independent cluster of cytokines and, MIP-1α positively correlated with Porphyromonas gingivalis (p < 0.05). In deep sites, smoking negatively associated with GM-CSF, IL-10, IL-17, IL-23, IL-5, IL-6, IL-7, IL-8 and MIP-1α levels (p < 0.05).

CONCLUSIONS

Diseased sites exhibited increased levels of T helper 17-related cytokines and TGF-β while healthy sites presented increased levels of the chemokines, IL-8 and MIP-1α. Patients with periodontitis may not only have inflammation in diseased deep sites, but also present significant hidden subclinical inflammation in their shallow clinically healthy sites.

DC-STAMP and TACE Levels are Higher in Patients with Periodontitis

Although periodontitis is one of the commonest infectious inflammatory diseases in humans, the mechanisms involved with its immunopathology remain ill understood. Numerous molecules may induce inflammation and lead to bone resorption, secondary to activation of monocytes into osteoclasts. TACE (TNF-α converting enzyme) and DC-STAMP (dendritic cell-specific transmembrane protein) appear to play a role on bone resorption since TACE induces the release of sRANKL (soluble receptor activator of nuclear factor kappa-β ligand) whereas DC-STAMP is a key factor in osteoclast induction. The present study evaluated the levels of TACE and DC-STAMP in patients with and without periodontitis. Twenty individuals were selected: 10 periodontally healthy participants undergoing gingivectomy for esthetic reasons and 10 diagnosed with periodontitis. Protein levels of such molecules in gingival tissue were established using Western blotting. Protein levels of both TACE and DC-STAMP were higher in the periodontitis group than in the control group (p<0.05; Student t-test). In conclusion, TACE and DC-STAMP protein levels are elevated in patients with periodontitis, favoring progression of bone resorption.

The effect of inadequate access to peri-implant hygiene on marginal bone level. A 4-year cohort prospective study

OBJECTIVE

The objective of this four-year cohort prospective study was to evaluate the effect of inadequate access to peri-implant hygiene on marginal bone level (MBL).

MATERIAL AND METHODS

Forty-one partially edentulous patients (16 males and 25 females, aged 49.8 ± 11.9 years) who had implants with at least one year in function were selected. Patients were clinically and radiographically evaluated at three different times: baseline (T0), 2-year (T1), and 4-year (T2) follow-up intervals. At baseline, implants were classified and allocated into two groups: those presenting adequate access (ACC) and inadequate access (no-ACC) to peri-implant hygiene. A linear mixed-effects model for clustered longitudinal data was used to analyze MBL, probing depth (PD), plaque index (PI), and bleeding on probing (BoP).

RESULTS

Of 131 implants, 74 were considered as having ACC, and 57 as having no-ACC at T0. Implants in the no-ACC group presented a statistically greater mean MBL measurement at T2 than implants in the ACC group (p = .011). In the no-ACC group, a significant reduction in PD from T0 to T1 (p = .019) and from T0 to T2 (p = .010) was observed. Regardless of the group, PI significantly increased at both T1 (p = .00001) and T2 (p = .00004). Regardless of time, the prevalence of BoP was significantly higher in the no-ACC group than in the ACC group (p = .012).

CONCLUSION

Inadequate access to peri-implant hygiene frequently resulted in more peri-implant inflammation and MBL over time. Proper accessibility to peri-implant hygiene should be carefully considered during planning of implant restoration, and patients properly motivated into maintenance care.

Clinical and microbiological evaluation of non-surgical periodontal therapy in obese and non-obese individuals with periodontitis: a 9-month prospective longitudinal study

Objective Obesity is a chronic disease that negatively affects an individual's general and oral health. The present study aimed to compare the clinical and microbiological effects of non-surgical periodontal therapy with the full mouth disinfection (FMD) protocol on obese and non-obese individuals at 9 months post-therapy. Methodology This clinical study was first submitted and approved by the Ethics Committee. Fifty-five obese patients and 39 non-obese patients with periodontitis were evaluated. The full-mouth periodontal clinical parameters, clinical attachment level (CAL), probing depth (PD), gingival index (GI), and plaque index (PI), were monitored at baseline, 3, 6, and 9 months after periodontal treatment with full mouth disinfection (FMD) protocol. The mean count of Tannerella forsythia , Porphyromonas gingivalis , Treponema Denticola , and Aggregatibacter actinomycetemcomitans was determined by quantitative polymerase chain reaction on subgingival biofilm samples. Demographic data were assessed by Chi-square test. For clinical and microbiological parameters, two-factor repeated-measures ANOVA was used. Results In both groups, periodontal therapy using the one-stage full-mouth disinfection protocol significantly improved CAL, PD, GI, and PI (p<0.05). Obese and non-obese patients equally responded to non-surgical periodontal therapy (p>0.05). Microbial count found no major differences (p>0.05) between obese and non-obese individuals who had undergone non-surgical periodontal therapy. Conclusions Obesity did not affect the clinical and microbiological outcomes of non-surgical periodontal therapy.

Preliminary findings on the possible role of B-lymphocyte stimulator (BLyS) on diabetes-related periodontitis

The possible role of B-cell growth and differentiation-related cytokines on the pathogenesis of diabetes-related periodontitis has not been addressed so far. The aim of this study was to evaluate the effects of diabetes mellitus (DM) on the gene expression of proliferation-inducing ligand (APRIL) and B-lymphocyte stimulator (BLyS), two major cytokines associated to survival, differentiation and maturation of B cells in biopsies from gingival tissue with periodontitis. Gingival biopsies were obtained from subjects with periodontitis (n = 17), with periodontitis and DM (n = 19) as well as from periodontally and systemically healthy controls (n = 10). Gene expressions for APRIL, BLyS, RANKL, OPG, TRAP and DC-STAMP were evaluated using qPCR. The expressions APRIL, BLyS, RANKL, OPG, TRAP and DC-STAMP were all higher in both periodontitis groups when compared to the control group (p < 0.05). Furthermore, the expressions of BLyS, TRAP and RANKL were significantly higher in the subjects with periodontitis and DM when compared to those with periodontitis alone (p < 0.05). The mRNA levels of BLyS correlated positively with RANKL in the subjects with periodontitis and DM (p < 0.05). BLyS is overexpressed in periodontitis tissues of subjects with type 2 DM, suggesting a possible role of this cytokine on the pathogenesis DM-related periodontitis.

The Buffalo OsteoPerio Studies: Summary of our findings and the unique contributions of Robert J. Genco, DDS, PhD

Purpose

Robert ("Bob") Genco was a member of the research team that established the Buffalo Osteoporosis and Periodontal Disease (OsteoPerio) study. Here we detail the scientific discoveries emanating from this enduring collaboration.

Study cohorts

OsteoPerio is ancillary to the Women's Health Initiative Observational Study (WHI-OS). WHI-OS is a longitudinal study of 93,000 postmenopausal women aged 50-79 enrolled at 40 U.S. centers (enrolled 1993-1998). OsteoPerio enrolled 1342 women 3 years later (1997-2001) from the Buffalo WHI-OS participants to study the association of osteoporosis and periodontal disease. OsteoPerio has 5-year (N=1026) and 17-year (N=518) follow-up examinations.

Participants

In addition to information on health status from the WHI-OS, OsteoPerio further included comprehensive oral examinations assessing probing pocket depth, clinical attachment loss, gingival bleeding, alveolar crestal height, and DMFT. Systemic bone density (measured by DXA), blood, saliva and plaque also were collected at all three visits.

Summary

Findings from these studies are summarized here.

Correlation of periodontal and microbiological evaluations, with serum levels of estradiol and progesterone, during different trimesters of gestation

Our purpouse was to identify quantitatively and qualitatively the subgingival flora in different gestational trimesters, compared to non-pregnant women; evaluating the correlations between epidemiological characteristics, clinical diagnosis, microbiological findings and levels of estradiol and progesterone. 52 pregnant women divided into 3 groups, according to the gestational trimester and 15 non-pregnant patients, without hormonal contraceptives, were evaluated. Plaque index (PI), gingival index (GI), probing depth (PD) and clinical attachment level (CAL) were evaluated. Subgingival biofilm samples were processed by the qPCR technique and the serum levels of estradiol and progesterone quantified by chemiluminescence. Clinical diagnosis during gestation was correlated with the total bacterial count. A higher prevalence of Tannerella forsythia (Tf) was identified in first trimester of pregnancy and this periodontopathogen was correlated with the diagnosis of gingivitis among pregnant women. Porphyromonas gingivalis (Pg) showed a positive correlation with progesterone levels in the first trimester. High prevalence of periodontopathogens was noticed in this population. Clinical diagnosis in gestation was positively correlated with the total amount of bacteria, without influence of the hormonal levels or the epidemiological factors evaluated. The presence of Tf favored occurrence of gingivitis during pregnancy and the progesterone levels in the first trimester enhanced the growth of Pg.

Effects of Er,Cr:YSGG and Diode Lasers on Clinical Parameters and Gingival Crevicular Fluid IL-1β and IL-37 Levels in Generalized Aggressive Periodontitis

Aim

The objective of the current study is to analyze the correlation between cytokine levels and periodontal parameters in aggressive periodontitis patients before and after periodontal treatment that was performed by using two different laser therapies.

Materials and Methods

Twenty-six generalized aggressive periodontitis patients were treated with three different methods (SRP, SRP+diode laser, and SRP+Er,Cr:YSGG laser) applied to three different half-jaws in the same patients. Pre- and posttreatment clinical periodontal parameters and GCF IL-1β and IL-37 levels were measured.

Results

There was a statistically significant decrease (p < 0.05) between pretreatment and posttreatment clinical periodontal parameters and IL-1β and IL-37 levels. When the reduction rates of IL-37 and IL-1β levels after treatment were evaluated, the decrease in IL-37 and IL-1β levels after treatment was lowest in the SRP group and highest in the SRP+Er,Cr:YSGG group. In addition, the amount of decrease in IL-1β in SRP+diode and SRP+Er,Cr:YSGG groups was found to be higher than that in IL-37. Furthermore, there was a positive correlation between IL-37 and IL-1β in all groups (p < 0.01).

Conclusion

Er,Cr:YSGG laser is more effective than diode laser for the treatment of aggressive periodontitis. IL-37 and IL-1β are cytokines that function together and thus must be evaluated together.

Effects of a full-mouth disinfection protocol on the treatment of type-2 diabetic and non-diabetic subjects with mild-to-moderate periodontitis: one-year clinical outcomes

OBJECTIVES

This study compared the clinical effects of a full-mouth disinfection (FMD) protocol for the treatment of mild-to-moderate periodontitis in type 2 diabetic and non-diabetic subjects for up to 1 year. Secondary aim was to evaluate the effects of this therapy on the salivary levels of periodontal pathogens between diabetics and non-diabetics.

MATERIAL AND METHODS

Twenty-six type 2 diabetic subjects and 28 non-diabetic subjects with mild-to-moderate periodontitis received full-mouth scaling and root planing within 24 h, application of chlorhexidine digluconate (CHX) gel in pockets and tongue plus CHX rinses for 14 days. Clinical monitoring was performed at baseline, 3, 6, and 12 months post-therapy. Salivary levels of red complex bacterial species were evaluated at baseline, 6, and 12 months post-therapy by qPCR.

RESULTS

Intention-to-treat analyses were performed for seven diabetics and three non-diabetics that did not return for the 12-month evaluation. Most clinical parameters improved significantly at 3, 6, and 12 months post-therapies for both groups (p < 0.05). Overall, there were no significant differences in clinical parameters between groups after therapy (p > 0.05). At 1 year, 39.3% and 50.0% of the non-diabetic and diabetic subjects, respectively, achieved the desired clinical endpoint for treatment (≤ 4 sites with probing depth ≥ 5 mm) (primary outcome variable) (p > 0.05). FMD did not promote changes in the salivary levels of pathogens in either of the groups (p > 0.05). Levels of T. forsythia were lower in diabetic than in non-diabetic subjects at 6 months post-therapy (p < 0.05).

CONCLUSIONS

Type 2 diabetic subjects and systemically healthy subjects with mild-to-moderate periodontitis responded similarly to the proposed FMD protocol for up to 1 year.

CLINICAL RELEVANCE

There is a general thought that diabetics do not answer as well as non-diabetics to periodontal treatments. However, this study showed that diabetics and non-diabetics respond equally to the FMD protocol.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02643771.

Etiology and Measurement of Peri-Implant Crestal Bone Loss (CBL)

The etiology of peri-implant crestal bone loss is today better understood and certain factors proposed in the past have turned out to not be of concern. Regardless, the incidence of crestal bone loss remains higher than necessary and this paper reviews current theory on the etiology with a special emphasis on traditional and innovative methods to assess the level of crestal bone around dental implants that will enable greater sensitivity and specificity and significantly reduce variability in bone loss measurement.

Cytokine Levels and Human Herpesviruses in Saliva from Clinical Periodontal Healthy Subjects with Peri-Implantitis: A Case-Control Study

This study evaluated the presence of cytokines (IL-1β, IL-2, IL-4, IL-6, MCP-1, MIP-1α, MIP-1β, and TNF-α) and human herpesvirus (HSV1, HSV2, EBV, CMV, VZV, HHV6, HHV7, and HHV8) in saliva samples taken from subjects with and without peri-implantitis. Forty-two periodontally healthy subjects were divided according to peri-implant condition: healthy and peri-implantitis groups. The clinical parameters as probing depth, clinical attachment level, plaque index, gingival bleeding, bleeding on probing, and suppuration were evaluated. For cytokine detection, multiplex analysis was performed, and PCR assay was used to identify herpesviruses. No significant differences were found in cytokine levels between groups (p > 0.05). The presence of herpesvirus was 1.97-fold higher in patients with peri-implantitis (odds ratio, CI 0.52-7.49). The association of the presence or absence of herpesvirus with the salivary markers was statistically significant for MIP-1β (p = 0.0087) and TNF-α (p = 0.0437) only in the peri-implantitis group. The presence of herpesviruses in patients with peri-implantitis suggests the development of a proinflammatory environment, which is characterized by increased expression of MIP-1β and TNF-α in saliva.

Can different stages of leprosy treatment influence the profile of oral health? Oral status in leprosy

BACKGROUND

The aim of study was to evaluate the oral health status, salivary flow and halitosis among individuals diagnosed with leprosy as compared with healthy subjects.

MATERIAL AND METHODS

A sample of 160 individuals was allocated into four groups, as follows: (G1) individuals with complete leprosy treatment; (G2) individuals diagnosed with leprosy and under multi-drug therapy; (G3) individuals diagnosed with leprosy not yet under treatment; and (G4) healthy individuals. Then individuals were submitted to periodontal clinical examination (visible plaque index, bleeding index, depth of probing and clinical attachment level); DMFT index (decayed-missing-filled teeth index); evaluation of salivary flow and halitosis using a halimeter equipment (Interscan Corp, Chatsworth, CA, USA).

RESULTS

The data were analyzed using Kruskal-Wallis and chi-square tests. The mean DMFT was found to be higher than 6.6, which is considered very high, with no significant difference between groups (P>0.05). As for salivary flow, 76.2% of the subjects presented normal flow rates, while 10% and 13.7% showed low and very low salivary flow rates, respectively, with hyposalivation being mostly observed in Groups 1 and 2. The highest prevalence of noticeable odor was found in healthy individuals (G4), and the most prevalent periodontal diagnosis was gingivitis (63.1%) in Group 3 (individuals with leprosy not yet under multi-drug therapy) followed by periodontitis (25%) in Group 1 (individuals who had completed leprosy treatment).

CONCLUSIONS

It was observed that individuals with a history of leprosy present poor oral health similar to that of systemically healthy individuals.

Genetic Association with Subgingival Bacterial Colonization in Chronic Periodontitis

Chronic periodontitis is the most prevalent form of inflammatory destructive bone disease and has been affecting humans since antiquity. Evidence suggest that genetic factors can highly influence periodontitis risk, modulating disease elements such as the susceptibility to microbial colonization and the nature of subsequent host-microbe interaction. Several single-nucleotide polymorphisms (SNPs) have been associated with the occurrence of periodontitis, but the full range of genetic influence in periodontitis outcomes remains to be determined. In this context, this study comprises an analysis of possible correlation between periodontitis-related genetic variants with changes in the subgingival microbiological pattern performed in a Brazilian population (n = 167, comprising 76 chronic periodontitis patients and 91 healthy subjects). For the genetic characterization, 19 candidate SNPs were selected based on the top hits of previous large genome wide association studies (GWAS), while the subgingival microbiota was characterized for the presence and relative quantity of 40 bacterial species by DNA-DNA checkerboard. The case/control association test did not demonstrate a significant effect of the target SNPs with the disease phenotype. The polymorphism rs2521634 proved significantly associated with Tannerella forsythia, Actinomyces gerencseriae, Fusobacterium periodonticum, and Prevotella nigrescens; rs10010758 and rs6667202 were associated with increased counts of Porphyromonas gingivalis; and rs10043775 proved significantly associated with decreased counts of Prevotella intermedia. In conclusion, we present strong evidence supporting a direct connection between the host’s genetic profile, specifically rs2521634, rs10010758, rs6667202, and rs10043775 polymorphisms, and the occurrence of chronic periodontitis-associated bacteria.

The ideal time of systemic metronidazole and amoxicillin administration in the treatment of severe periodontitis: study protocol for a randomized controlled trial

Background

The combination of systemic metronidazole (MTZ) and amoxicillin (AMX) with scaling and root planing (SRP) has shown to be an effective periodontal treatment. However, some essential issues associated with the use of these antibiotics remain unanswered, such as the ideal time of administration during the course of periodontal treatment. Although these agents are often prescribed after the healing phase of the SRP procedure, there is biological plausibility to support its use in conjunction with the mechanical treatment. However, to date, no placebo controlled randomized clinical trial (RCT) has directly compared these two protocols. Therefore, the aim of this RCT is to compare the clinical, microbiological and immunological effects of the adjunctive systemic MTZ + AMX administered in different phases of the treatment of severe periodontitis.

Methods

Subjects with severe periodontitis (n = 180) are being randomly assigned into three groups (n = 60/group): (i) SRP-only (control group), SRP in combination with 400 mg MTZ + 500 mg AMX, starting (ii) at the first SRP session (active phase group), or (iii) after 3 months of its completion (healing phase group). All volunteers are receiving clinical and microbiological evaluation at baseline, 3, 6 and 12 months, and immunological assessment at baseline and 12 months post-therapy. Nine subgingival biofilm samples are being collected per subject and analyzed for counts and proportions of 40 bacterial species by checkerboard DNA-DNA hybridization, and six gingival crevicular fluid samples are being collected and analyzed for the levels of 20 chemokines by multiplex immunoassay. The primary outcome variable is the number of volunteers reaching the clinical endpoint for treatment (≤ 4 sites with probing depth ≥5 mm) at 1 year post-therapy. Differences in clinical, microbiological and immunological parameters among groups and over time will be evaluated using analysis of variance, analysis of covariance and the Chi-square and Tukey tests. Microbiological and immunological analyses will be performed using adjustments for multiple comparisons. Statistical significance will be set at 5%.

Trial registration

ClinicalTrials.gov, NCT02954393. Registered on 3 November 2016.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2540-8) contains supplementary material, which is available to authorized users.

Using NMR in saliva to identify possible biomarkers of glioblastoma and chronic periodontitis

Nowadays there is increasing interest in identifying–and using–metabolites that can be employed as biomarkers for diagnosing, treating and monitoring diseases. Saliva and NMR have been widely used for this purpose as they are fast and inexpensive methods. This case-control study aimed to find biomarkers that could be related to glioblastoma (GBL) and periodontal disease (PD) and studied a possible association between GBL and periodontal status. The participants numbered 130, of whom 10 were diagnosed with GBL and were assigned to the cases group, while the remaining 120 did not present any pathology and were assigned to the control group. On one hand, significantly increased (p < 0.05) metabolites were found in GBL group: leucine, valine, isoleucine, propionate, alanine, acetate, ethanolamine and sucrose. Moreover, a good tendency to separation between the two groups was observed on the scatterplot of the NMR. On the other hand, the distribution of the groups attending to the periodontal status was very similar and we didn´t find any association between GBL and periodontal status (Chi-Square 0.1968, p = 0.91). Subsequently, the sample as a whole (130 individuals) was divided into three groups by periodontal status in order to identify biomarkers for PD. Group 1 was composed of periodontally healthy individuals, group 2 had gingivitis or early periodontitis and group 3 had moderate to advanced periodontitis. On comparing periodontal status, a significant increase (p < 0.05) in certain metabolites was observed. These findings along with previous reports suggest that these could be used as biomarkers of a PD: caproate, isocaproate+butyrate, isovalerate, isopropanol+methanol, 4 aminobutyrate, choline, sucrose, sucrose-glucose-lysine, lactate-proline, lactate and proline. The scatter plot showed a good tendency to wards separation between group 1 and 3.

Exactitud del sondaje periodontal según observadores y tipos de sondas periodontales

Introducción: las sondas periodontales son de alta sensibilidad para determinar la pérdida de inserción clínica y son utilizadas en el diagnóstico periodontal. Uno de los factores más críticos al considerar su uso, es el reconocimiento de la posición de las marcas en los diversos modelos de sondas, pues pueden in uir en el registro de las medidas del sondaje periodontal. Objetivo: evaluar la exactitud del sondaje periodontal, según tres tipos de sondas y observadores. Metodología: se diseñaron bloques de madera con perforaciones que simularon cavidades para realizar el son- daje periodontal. Participaron cinco evaluadores quienes midieron las perforaciones usando tres tipos de sondas (Organización Mundial de la Salud -OMS, Universidad de North Carolina -UNC y Universidad de Michigan). La concordancia de mediciones, entre observadores, se realizó mediante promedios y márgenes de error. La exacti- tud de las mediciones de las sondas se evaluó, siguiendo el promedio de distancias obtenidas respecto a los valores reales de las perforaciones. Resultados: el promedio de medición con la sonda OMS fue de 64,12mm; con la sonda UNC: 64,9mm y con la sonda Michigan de 66,2mm, respecto al valor real que fue de 65,5mm. El margen de error para las sondas OMS, UNC y Michigan fue de 4,05mm; 2,89mm y 3,76mm, respectivamente. La concordancia interobservador con la sonda UNC fue del 99% con una exactitud del 60%. Conclusión: la sonda periodontal con mayor exactitud, respecto al patrón real, fue la sonda UNC, seguida de la sonda Michigan y, luego, la sonda OMS. 

The combined and individual impact of diabetes and smoking on key subgingival periodontal pathogens in patients with chronic periodontitis

BACKGROUND AND OBJECTIVE

Comprehension of the similarities and differences in the composition of the subgingival microbiota of patients with diabetes mellitus (DM), smokers or smokers with DM is an important step in developing therapies specific for these groups at risk for periodontitis. Therefore, the aim of this study was to compare the combined and individual effects of DM and smoking on the levels and prevalence of key subgingival periodontal pathogens in patients with chronic periodontitis.

MATERIAL AND METHODS

One hundred patients with generalized chronic periodontitis were allocated into one of the following groups: DM (n = 25, non-smokers with type 2 DM); S (n = 25, non-diabetic smokers); SDM (n = 25, smokers with type 2 DM); and control (n = 25, non-diabetic non-smokers). Two subgingival biofilm samples from healthy sites (probing depth and clinical attachment level ≤3 mm and no bleeding) and 2 from diseased sites (probing depth and clinical attachment level ≥5 mm and bleeding on probing) were analyzed by quantitative polymerase chain reaction for Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Eubacterium nodatum, Parvimonas micra, Fusobacterium nucleatum ssp. and Prevotella intermedia.

RESULTS

There were no differences among groups in the mean counts of the bacterial species studied, considering all sampled sites (healthy plus diseased sites). There were also no differences among groups regarding the prevalence of any bacteria species in healthy and diseased sites (P > .05). The mean P. micra count was significantly higher in the healthy sites of both smoking groups, than in those of the control group (P < .05).

CONCLUSION

The subgingival levels and prevalence of the bacterial species studied are not significantly different in subjects with chronic periodontitis presenting DM, smokers or smokers with DM. In addition, DM and smoking, jointly and individually, do not considerably affect the subgingival levels of target periodontal pathogens in patients with chronic periodontitis.

Evaluation of an Electronic Periodontal Probe Versus a Manual Probe

INTRODUCTION

Diagnosis of periodontal diseases requires reco-rding of clinical and periodontal variables. Possible measurement errors in recording the periodontal findings are dependent on the measurement method.

AIM

The purpose of the trial was to investigate an electronic, pressure-calibrated probe compared with a standard, manual measurement probe used to take periodontal variables.

MATERIALS AND METHODS

The study included 25 subjects suffering from periodontal disease. Their findings were taken by two users on a randomized basis using a standard probe and an electronic, pressure calibrated probe, at an interval of 24 hours. The recorded clinical variables contained Pocket Depth (PD), Attachment Level (AL), Bleeding on Probing (BOP), the complete time needed to take the findings and the sensation of pain experienced by a Visual Analogue Scale (VAS). The data were statistically analyzed using the paired t-test.

RESULTS

The measurement values (24 patients) for PD (p=0.03) and BOP (p=0.01) indicated a significant difference (paired t test, p>0.05), while there was no statistical difference for AL (p=0.064). A classification of PD into groups of 1-3mm, 4-6mm and ≥7mm showed that the manual method measured higher values than the electronic method (p=0.001). The measurement values did not reveal any significant differences (p>0.05) with respect to the total time needed to take findings and the measurement time for PD/AL. There was a significant difference (Wilcoxon-test, p<0.05) in VAS values (p=0.048) and in terms of the time needed to record the findings for BOP (p=0.004).

CONCLUSION

It can be assumed that the electronic probe should mainly be used in the supportive periodontal therapy. Present study showed that the use of a standard manual probe is essential to review conspicuous or unclear measurement values, or when treating deep pockets higher than 7mm.

Does obesity influence the subgingival microbiota composition in periodontal health and disease?

AIM

To evaluate whether obesity affects the subgingival microbial composition of patients with periodontal health or chronic periodontitis (CP).

MATERIALS AND METHODS

Based on periodontal parameters, body mass index and waist-hip ratio, 166 patients were allocated into one of the following groups: Normal weight (NW) patients with periodontal health (n = 44), NW patients with CP (n = 40), obese patients with periodontal health (n = 40) and obese patients with CP (n = 42). Six subgingival biofilm samples per patient were analysed for their content of 40 bacterial species using checkerboard DNA-DNA hybridization.

RESULTS

Obese patients with CP harboured higher levels and/or higher proportions of several periodontal pathogens than those with NW and CP, including Aggregatibacter actinomycetemcomitans, Eubacterium nodatum, Fusobacterium nucleatum ss vincentii, Parvimonas micra, Prevotella intermedia, Tannerella forsythia, Prevotella melaninogenica and Treponema socranskii. The proportions of most of these pathogens, as well Campylobacter rectus and Eikenella corrodens, were more increased in the diseased sites of the obese patients than in those with NW. Furthermore, the healthy sites of the obese patients, presenting or not CP, also exhibited higher proportions of some of the pathogens than patients with NW.

CONCLUSIONS

Obesity is associated with increased levels and proportions of periodontal pathogens, especially in patients with CP.

Evaluation of new chlorhexidine- and cetylpyridinium chloride-based mouthrinse formulations adjunctive to scaling and root planing: pilot study

OBJECTIVE

To compare the effect of two newly formulated chlorhexidine (CHX) and cetylpyridinium chloride (CPC) mouthrinses after scaling and root planing (SRP) in terms of clinical, microbiological, patient-based variables and adverse events, with a positive control with the same active components, already marketed and tested.

METHODS

A pilot, randomized clinical trial, double-blind, parallel design with 1-month follow-up was conducted. Chronic periodontitis patients requiring non-surgical periodontal therapy were enrolled and randomly assigned to: (i) SRP and test-1 (new reformulation: 0.12% CHX and 0.05% CPC); (ii) SRP and test-2 (new formulation: 0.03% CHX and 0.05% CPC); or (iii) SRP and positive control (commercial product: 0.12% CHX and 0.05% CPC). All variables were evaluated at baseline and 1 month after SRP. Quantitative variables were compared by means of anova or Kruskal-Wallis test and qualitative variables by chi-square or McNemar tests.

RESULTS

Thirty patients (10 per group) were included. After 1 month, there were significant differences among groups in plaque levels (P = 0.016) as test-1 showed less sites with plaque than test-2 (31.15% [standard error-SE 2.21%] versus 49.39% [SE 4.60%), respectively). No significant differences were found for global patient perception of the product or in adverse effects. Test groups showed better results in levels and proportions (P = 0.022) of Capnocytophaga spp.

CONCLUSIONS

Within the limitations of this pilot study, it can be concluded that the newly formulated 0.12% CHX and 0.05% CPC mouthrinse showed larger plaque level reductions, without showing more adverse effects, when compared to the other two mouthrinses, after SRP.

Periodontal and Microbiological Profile of Intensive Care Unit Inpatients

INTRODUCTION

The bidirectional relationship between the periodontal diseases and systemic diseases was attributed to the focal infection concept. The aims of this study were to assess the periodontal and microbiological profile of intensive care unit (ICU) inpatients submitted to orotracheal intubation, and classify them regarding gender, age group, ethnic, hospitalization reason and period, nosocomial infection occurrence, and death.

MATERIALS AND METHODS

Inpatients were assessed, distributed into toothed and toothless groups. The periodontal clinical condition was assessed 24 hours after the ICU admission through plaque index, gum index, probing depth, and clinical level of insertion. All microbiological samples were collected on the 6th day of admission. These samples were collected from different intraoral sites, depending on the group: In the toothed group, samples were collected from gingival sulcus and in the toothless group, from buccal mucosa and tongue. Identification for Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and Tannerella forsythia (Tf) was accomplished and analyzed, using absolute quantification and specific primer pairs through an amplification system with probes.

RESULTS

Forty subjects composed the sample: Gender characterized by 60% of male, 27.5% of all patients were older than 60, and 22.5% were hospitalized due to cerebrovascular accident. Regarding hospitalization period, 55% of patients were hospitalized for 6 days and 70% of them died during the period of hospitalization. Of inpatients, 40% presented periodontal disease and 100% presented dental biofilm on assessed sites. When assessing the microbiota, statistical significance was observed between Aa, Pg, and Tf, for both toothed and toothless group (p < 0.0001).

CONCLUSION

Large quantities of Aa were found in samples of toothless inpatients, a fact that suggests that the oral environment, even without teeth, presents favorable conditions for bacterial biofilm formation with a related pathogenic potential.

CLINICAL SIGNIFICANCE

The dental biofilm may comprise pulmonary pathogen colonies, promoting a perfect environment for their growth and development, facilitating the colonization of the lower airways, as well as colonization by bacteria originally from the oral cavity.

Alterations in plaque accumulation and gingival inflammation promoted by treatment with self-ligating and conventional orthodontic brackets

OBJECTIVE

The aim of the present study was to evaluate, comparatively, the periodontal response during orthodontic treatment performed with self-ligating and conventional brackets.

METHODS

Sixteen Caucasian individuals of both sexes, aged between 12 and 16 years old and in permanent dentition were selected. Eight individuals were treated with conventional brackets installed on the lower dental arch and self-ligating brackets on the upper arch. Another eight individuals received self-ligating brackets in the lower arch and conventional brackets in the upper arch. The subjects received material and instructions for oral hygiene. Visible plaque index (VPI), gingival bleeding index (GBI) and clinical attachment level (CAL) were evaluated just after installation of orthodontic appliances, and 30, 60 and 180 days later. Mann-Whitney test was used to compare differences between groups (self-ligating and conventional), two-way ANOVA followed by Tukey's test was used to assess CAL at each site of each tooth. Significance level was set at 5%.

RESULTS

No significant changes were found with regard to the assessed parameters (VPI, GBI and CAL) in either one of the systems.

CONCLUSION

No significant changes were found with regard to the periodontal response to orthodontic treatment for the variables assessed and between subjects receiving passive self-ligating and conventional brackets. All individuals had received oral hygiene instructions and had their periodontal conditions monitored.

Comparative evaluation of probing depth and clinical attachment level using a manual probe and Florida probe

Background:

To compare and evaluate the intra- and inter-examiner efficacy and reproducibility of the first-generation manual (Williams) probe and the third-generation Florida probe in terms of measuring pocket probing depth (PD) and clinical attachment level (CAL).

Materials and Methods:

Forty subjects/4000 sites were included in this comparative, cross-sectional study. Group- and site-wise categorizations were done. Based on gingival index, PD, and CAL, patients were divided into four groups, i.e., periodontally healthy, gingivitis, mild to moderate periodontitis, and severe periodontitis. Further, based on these parameters, a total of 4000 sites, with 1000 sites in each category randomly selected from these 40 patients, were taken. Full mouth PD and CAL measurements were recorded with two probes, by Examiner 1 and on Ramfjord teeth by Examiner 2.

Results:

Full mouth and Ramfjord teeth group- and site-wise PD obtained with the manual probe by both the examiners were statistically significantly deeper than that obtained with the Florida probe. The full mouth and Ramfjord teeth mean CAL measurement by Florida probe was higher as compared to manual probe in mild to moderate periodontitis group and sites, whereas in severe periodontitis group and sites, manual probe recorded higher CAL as compared to Florida probe.

Conclusion:

Mean PD and CAL measurements were deeper with the manual probe as compared to the Florida probe in all the groups and sites, except for the mild-moderate periodontitis group and sites where the CAL measurements with the manual probe were less than the Florida probe. Manual probe was more reproducible and showed less interexaminer variability as compared to the Florida probe.

Expression of SOFAT by T- and B-lineage cells may contribute to bone loss

A novel T cell-secreted cytokine, termed secreted osteoclastogenic factor of activated T cells (SOFAT) that induces osteoclastic bone resorption in a RANKL-independent manner, has been described. Our group have previously reported that SOFAT is highly expressed in gingival tissues of patients with chronic periodontitis suggesting a putative role in the bone loss associated with periodontal disease. The aim of the present study was to identify other potential cellular sources of SOFAT in the bone resorptive lesions of patients with periodontal disease. Gingival tissues were biopsied from systemically healthy subjects without periodontal disease (n=5) and patients with chronic periodontitis (n=5), and the presence of SOFAT was analyzed by immunohistochemistry and immunofluorescence staining. The present data demonstrated marked SOFAT staining in diseased periodontal tissues that was predominantly associated with the lymphocytic infiltration of gingival tissues. Notably, in addition to CD3+ T cells, B‑lineage cells including plasma cells also exhibited strong staining for SOFAT. As SOFAT has not previously been reported in B‑lineage cells, splenic T cells and B cells were further purified from BALB/c mice and activated using CD3/CD28 and lipopolysaccharide, respectively. SOFAT was quantified by reverse transcription‑quantitative polymerase chain reaction and was shown to be significantly expressed (P<0.05) in both activated T cells and B cells compared with unstimulated cells. These data support a putative role of SOFAT in the bone loss associated with chronic periodontal disease. In addition, to the best of our knowledge, this study demonstrates for the first time that in addition to T cells, B-lineage cells may also be a significant source of SOFAT in inflammatory states.