Is obesity a possible modifier of periodontal disease as a chronic inflammatory process? A case-control study

BACKGROUND AND OBJECTIVE

This cross-sectional case-control study was conducted to provide a comparative evaluation of clinical periodontal measurements, together with serum levels of certain bioactive peptides and inflammatory cytokines, in relation to obesity. For this purpose, clinical periodontal measurements and the levels of serum leptin, adiponectin, interleukin-6 (IL-6), C-reactive protein and soluble intercellular adhesion molecule-1 of obese female individuals and their nonobese counterparts were compared.

MATERIAL AND METHODS

Sixty obese (body mass index (BMI) > 30) and 31 nonobese (BMI < 30) female subjects were recruited for the present study. Before any periodontal intervention, serum samples were obtained and full-mouth clinical periodontal measurements were recorded at six sites per tooth. ELISA was used for the biochemical analysis. Data were tested statistically.

RESULTS

Clinical attachment level was significantly higher in the obese group compared with the nonobese control group (p < 0.05). Serum levels of leptin and IL-6 were significantly higher in the obese group (p < 0.05). BMI correlated with the serum levels of inflammatory molecules (p < 0.05), but not with clinical periodontal parameters, in the obese group.

CONCLUSION

In conclusion, obesity does not seem to have a prominent effect on clinical periodontal parameters but it does have many correlations with circulating inflammatory molecules. As suggested in the literature, increased levels of leptin and IL-6 in the obese group might be one explanation for a possible relationship between obesity and periodontal disease. A prospective study is warranted to clarify, in greater detail, the effects of obesity on periodontal health.

The frequency of periodontal infrabony defects on panoramic radiographs of an adult population seeking dental care

By means of panoramic radiography (PR), the frequency and location of interproximal infrabony defects (IPIDs), their relationship with age, gender and remaining teeth were studied in 416 individuals seeking dental care. The presence/absence of IPIDs and the defect depths were evaluated on mesial and distal surfaces of a total of 8,964 teeth. One or more infrabony defects were recorded on 23% of the PRs (96 individuals, 152 IPIDs). The frequency of infrabony defects < or = 3 mm, 3-5 mm and > or =5 mm was 12.5%, 9.6% and 3.6% respectively. The number of infrabony defects > or = 5 mm was significantly lower than infrabony defects in < or =3 mm and 3-5 mm groups (p<0.05). The difference between the frequency of IPIDs among two genders was non-significant (20.6% for females, 26.8% for males). The IPIDs were most prevalent in the oldest group (>50 years), which also presented with significantly more missing teeth (p<0.05). The most frequent locations for IPIDs were maxillary and mandibulary molar teeth.

Tumor Necrosis Factor-α-converting Enzyme (TACE) Levels in Periodontal Diseases

Tumor necrosis factor-α-converting enzyme (TACE) is a metalloprotease which can shed several cytokines from the cell membrane, including receptor activator of NF-κB ligand (RANKL). This study aimed to investigate the hypothesis that TACE would be elevated in the gingival crevicular fluid (GCF) of persons with periodontitis. Total TACE amounts in GCF were higher in persons with chronic and aggressive periodontitis than in those with gingivitis or in healthy persons. TACE concentrations in GCF were higher in persons with chronic and aggressive periodontitis than in those with gingivitis, although not significantly higher than in healthy persons. Persons with chronic periodontitis receiving immunosuppressive treatment exhibited over 10-fold lower TACE levels than the other periodontitis groups. TACE was positively correlated with probing pocket depth, clinical attachment levels, and RANKL concentrations in GCF. In conclusion, the increased GCF TACE levels in persons with periodontitis and their positive correlation with RANKL may indicate an association of this enzyme with alveolar bone loss, and may warrant special attention in future therapeutic approaches.

Differential expression of receptor activator of nuclear factor-?B ligand and osteoprotegerin mRNA in periodontal diseases

BACKGROUND AND OBJECTIVE

Receptor activator of nuclear factor-kappaB ligand (RANKL) is responsible for the induction of osteoclastogenesis and bone resorption, whereas its decoy receptor, osteoprotegerin, can directly block this action. Because this dyad of cytokines is crucial for regulating the bone remodelling process, imbalances in their expression may cause a switch from the physiological state to enhanced bone resorption or formation. This study investigated the mRNA expression of RANKL and osteoprotegerin, as well as their relative ratio, in the gingival tissues of patients with various forms of periodontal diseases.

MATERIAL AND METHODS

Gingival tissue was obtained from nine healthy subjects and 41 patients, who had gingivitis, chronic periodontitis, generalized aggressive periodontitis, and chronic periodontitis and were receiving immunosuppressant therapy. Quantitative real-time polymerase chain reaction was employed to evaluate the mRNA expression of RANKL and osteoprotegerin in these tissues.

RESULTS

Compared with healthy individuals, patients in all periodontitis groups, but not those with gingivitis, exhibited stronger RANKL expression and a higher relative RANKL/osteoprotegerin ratio. In addition, osteoprotegerin expression was weaker in patients with chronic periodontitis. When patients with generalized aggressive periodontitis and chronic periodontitis were compared, the former exhibited stronger RANKL expression, whereas the latter exhibited weaker osteoprotegerin expression, and there was no difference in their relative ratio. When chronic periodontitis patients were compared with chronic periodontitis patients receiving immunosuppressant therapy, osteoprotegerin, but not RANKL, expression was stronger in the latter.

CONCLUSION

This study demonstrates that RANKL and osteoprotegerin expression are differentially regulated in various forms of periodontitis, and the relative RANKL/osteoprotegerin ratio appears to be indicative of disease occurrence. This information may confer diagnostic and therapeutic value in periodontitis.

Gingival crevicular fluid matrix metalloproteinase-13 levels and molecular forms in various types of periodontal diseases

BACKGROUND

The purpose of this study was to evaluate the levels, molecular forms and activation degree of matrix metalloproteinase-13 (MMP-13) in the gingival crevicular fluid (GCF) of patients with periodontal diseases and to correlate these findings with periodontal clinical parameters.

METHODS

Sixty one subjects participated in this study as healthy (n = 18), gingivitis (n = 17), aggressive periodontitis (AgP; n = 15) and chronic periodontitis (CP; n = 11) groups. Clinical measurements and GCF samples were obtained from each subject. The molecular forms of MMP-13 in GCF samples were analyzed by Western immunoblotting method. Differences among the groups were assessed using non-parametric statistical analysis.

RESULTS

In the CP group, levels of 29-30 kDa fragment of MMP-13, total MMP-13, and activated form of MMP-13 were significantly higher than in the healthy, gingivitis and AgP groups. GCF levels of all molecular forms of MMP-13 in AgP group were similar to those of healthy and gingivitis groups. Total and activated MMP-13 levels were positively correlated with all clinical parameters. 29-30 kDa fragment levels of MMP-13 were also positively correlated with papillary bleeding index and plaque index.

CONCLUSION

These results indicate that elevated GCF MMP-13 levels may play an important role in the pathogenesis of CP. These data demonstrate, for the first time, pathologically activated and elevated MMP-13 in GCF.

Oral giant pyogenic granulomas associated with facial skin hemangiomas (Sturge-Weber syndrome)

This is a case report of two patients, aged 26 and 22, who suffered from congenital hemangioma on their faces and pronounced gingival overgrowth localized parallel to extraoral lesions. Prior to surgical intervention the hygienic conditions were improved in several sessions by means of professional preventive treatment and oral hygiene instructions. Histologic examination of both cases revealed a highly vascularized pattern of pyogenic granuloma. One of the cases was associated with a pregnancy. These patients can be classified as Sturge-Weber syndrome. Postsurgical treatment consisted of efficient plaque control and adequate oral prophylaxis sessions every 3 months. The large gingival overgrowth was not observed to recur in 2 and 4 years, respectively, of follow-up.

The treatment of a localized osseous sequestrum with porous bone mineral in combination with a collagen membrane and resorbable bone pins

The ultimate goal of periodontal therapy should not be limited to the establishment and maintenance of periodontal health. The potential regeneration of the hard and soft periodontal tissues lost due to disease also should be considered. This case presentation evaluated a new surgical technique for the treatment of a variety of localized bone defects, utilizing porous bone mineral in combination with collagen membrane and resorbable bone pins.

Effectiveness of periodontal therapy in patients with drug-induced gingival overgrowth. Long-term results

BACKGROUND

Drug-induced gingival overgrowth (DGO) is one of the well-recognized side effects of cyclosporin A (CsA) or nifedipine (Ni). After surgical periodontal therapy, the incidence of DGO recurrence is not known. The aim of this study was to evaluate the results of surgical periodontal therapy in patients receiving CsA or Ni and who exhibit severe long-term DGO. In addition, the relationship between various variables and the recurrence of severe DGO after periodontal surgery was investigated.

METHODS

A total of 38 patients, 22 with CsA-induced DGO and 16 with Ni-induced DGO, were included in this study. At baseline, patients received initial periodontal therapy, after which either the upper or lower anterior segment in each patient was surgically treated. Surgical periodontal therapy consisted of the flap technique with a 90 degrees gingivectomy incision. Following surgery, patients were placed on a maintenance therapy recall program and were monitored for 18 months. Patients were seen once a month for the first 3 months and once every 3 months for the following 15 months. Plaque index (PI), papilla bleeding index (PBI) and DGO scores in the treated segments were recorded at each recall appointment. Attendance at recall appointments was also noted for each patient.

RESULTS

Recurrence of severe DGO was observed in 13 of the 38 patients (34%) 18 months following periodontal surgery. Multiple regression analysis indicated that age, gingival inflammation, and attendance at recall appointments were significant determinants of the recurrence of severe DGO.

CONCLUSIONS

This study suggests that regular re-motivation and professional care at frequent recall appointments after periodontal surgery are of great importance in patients receiving CsA or Ni. By maintaining periodontal health, the life quality of these patients may be raised.

Reattachment of a subgingivally fractured central incisor tooth fragment: report of a case

A case report of a 9-year-old boy with a fractured maxillary right incisor and ulcerated pulp at the fracture line is presented. On satisfactory completion of a root canal filling one week later, the access cavity was restored with glass ionomer cement. The fragment was reattached by a light activated hybrid composite during the flap surgery. Tetracycline hydrochloride was applied on open root surface for a better healing.