Cytological analysis of the periodontal pocket in patients with aggressive periodontitis and chronic periodontitis

Fixed Prosthetic Restorations and Periodontal Health: A Narrative Review

Periodontal health plays an important role in the longevity of prosthodontic restorations. The issues of comparative assessment of prosthetic constructions are complicated and not fully understood. The aim of this article is to review and present the current knowledge regarding the various technical, clinical, and molecular aspects of different prosthetic biomaterials and highlight the interactions between periodontal health and prosthetic restorations. Articles on periodontal health and fixed dental prostheses were searched using the keywords “zirconium”, “CAD/CAM”, “dental ceramics”, “metal–ceramics”, “margin fit”, “crown”, “fixed dental prostheses”, “periodontium”, and “margin gap” in PubMed/Medline, Scopus, Google Scholar, and Science Direct. Further search criteria included being published in English, and between January 1981 and September 2021. Then, relevant articles were selected, included, and critically analyzed in this review. The margin of discrepancy results in the enhanced accumulation of dental biofilm, microleakage, hypersensitivity, margin discoloration, increased gingival crevicular fluid flow (GCF), recurrent caries, pulp infection and, lastly, periodontal lesion and bone loss, which can lead to the failure of prosthetic treatment. Before starting prosthetic treatment, the condition of the periodontal tissues should be assessed for their oral hygiene status, and gingival and periodontal conditions. Zirconium-based restorations made from computer-aided design and computer-aided manufacturing (CAD/CAM) technology provide better results, in terms of marginal fit, inflammation reduction, maintenance, and the restoration of periodontal health and oral hygiene, compared to constructions made by conventional methods, and from other alloys. Compared to subgingival margins, supragingival margins offer better oral hygiene, which can be maintained and does not lead to secondary caries or periodontal disease.

Cytomorphometric Analysis of Inflammation Dynamics in the Periodontium Following the Use of Fixed Dental Prostheses

Cytomorphometry is used in the sampling of biological materials and diagnostic procedures. The use of cytological studies in periodontal diseases is not well described in the literature. Our study aimed to quantitatively assess the inflammation dynamics using cytomorphometric analysis of the periodontium before and after the use of fixed dental prostheses. Following ethics approval, a total of 105 subjects were divided in 3 groups as gingivitis (n = 23), periodontitis (n = 58), and healthy periodontium (control) (n = 24). The fixed dental prostheses (crowns and fixed partial dentures) were fabricated from cobalt-chrome metal-ceramic prostheses using the conventional method (C/M-CoCr), cobalt-chrome metal-ceramic prostheses by the computer-aided design and computer-aided manufacturing (CAD/CAM) technique (C/C-CoCr), and zirconia-based ceramic prostheses by the CAD/CAM technique (C/C-Zr) among subjects with gingivitis and periodontitis. The gingival crevicular fluid (GCF) was obtained from subjects before and after the use of the prostheses. The total count of epithelial cells and the connective tissue cells or polymorphonuclear neutrophils (PMNs) in GCF were studied using cytomorphometric analysis. The Statistical Package Tor the Social Sciences (SPSS), Version 20 (IBM Company, Chicago, IL, USA) was used to analyze the results and the significance level was set at p = 0.05. The data for before and after the use of the prostheses were compared using independent t-Tests. Similarly, the results after the use of prostheses in gingivitis, periodontitis, and control in each type of prostheses were compared using One-way ANOVA with post hoc using Scheffe. The total epithelial cells and the PMNs were determined along with the epithelium/leukocyte index. Regardless of the prostheses type used, no significant change in the parameters was identified among patients with a healthy periodontium, before and after prosthetic treatment. In all study groups, a statistically increase (p value < 0.05) was observed in the oral epithelial cell counts and a statistically decrease (p < 0.05) in the PMNs count following the use of the fixed prostheses. Data on cytomorphometric analysis could enable the selection of the most appropriate prostheses for use in patients with periodontal pathologies. When choosing prostheses, changes in the composition of GCF could be considered as a useful criterion for their use.

Assessment and comparison of nuclear changes seen in gingivitis and periodontitis using fluorescent microscopy

INTRODUCTION AND OBJECTIVES

The objective of this study was to observe the evolution of genotoxicity (micronucleation, binucleation and multinucleation) from normal to periodontally compromised gingival epithelium (gingivitis and periodontitis) and to compare the severity of damage.

METHODS AND MATERIAL

45 participants formed 3 different categories; a control group of 15 healthy subjects, 15 subjects with gingivitis and 15 with chronic periodontitis. Smears were collected from all the gingiva and stained with acridine orange stain. A total of 500 cells were evaluated under fluorescent microscopy for nuclear abnormalities such as micronuclei, binucleation and multinucleation. The statistical analysis used was one way ANOVA and posthoc Tukey test.

RESULTS AND CONCLUSION

A statistically significant difference was observed when the age of the 3 groups were compared (p=0.002); the control group were younger than those with chronic periodontitis or gingivitis. With respect to genotoxic changes, the differences for binucleation (p=0.002) and multinucleation (p<0.001) were statistically significant thus suggesting advanced damage in the nucleus. Such changes in genotoxicity could be of help to a clinician in determining prognosis.

Differential profiles of soluble and cellular toll like receptor (TLR)-2 and 4 in chronic periodontitis

Chronic periodontitis is a common inflammatory disease initiated by a complex microbial biofilm and mediated by the host response causing destruction of the supporting tissues of the teeth. Host recognition of pathogens is mediated by toll-like receptors (TLRs) that bind conserved molecular patterns shared by large groups of microorganisms. The oral epithelial cells respond to most periodontopathic bacteria via TLR-2 and TLR-4. In addition to the membrane-associated receptors, soluble forms of TLR-2 (sTLR-2) and TLR-4 (sTLR-4) have been identified and are thought to play a regulatory role by binding microbial ligands. sTLR-2 has been shown to arise from ectodomain shedding of the extracellular domain of the membrane receptor and sTLR-4 is thought to be an alternate spliced form. Many studies have previously reported the presence of elevated numbers of viable exfoliated epithelial cells in the saliva of patients with chronic periodontitis. The objective of this study was to investigate the potential value of salivary sTLR-2 and sTLR-4 together with the paired epithelial cell-associated TLR-2/4 mRNA as diagnostic markers for chronic periodontitis. Unstimulated whole saliva was collected after obtaining informed consent from 40 individuals with either periodontitis or gingivitis. The sTLR-2 and sTLR4 in saliva was measured by enzyme-linked immunosorbent assay. The TLR-2 and TLR-4 transcript in the epithelial cells in saliva was measured by real time polymerase chain reaction. While levels of sTLR-2 exhibited an inverse correlation, sTLR-4 positively correlated with clinical parameters in the gingivitis cohort. Interestingly, both correlations were lost in the periodontitis cohort indicating a dysregulated host response. On the other hand, while the sTLR-2 and the paired epithelial cell associated TLR-2 mRNA exhibited a direct correlation (r2 = 0.62), that of sTLR4 and TLR-4 mRNA exhibited an inverse correlation (r2 = 0.53) in the periodontitis cohort. Collectively, assessments of salivary sTLR2 and sTLR4 together with the respective transcripts in the epithelial cells could provide clinically relevant markers of disease progression from gingivitis to periodontitis.