A 15-year study of osseointegrated implants in the treatment of the edentulous jaw

It has been recognized for some time that bacterial species exist in complexes in subgingival plaque. The purpose of the present investigation was to attempt to define such communities using data from large numbers of plaque samples and different clustering and ordination techniques. Subgingival plaque samples were taken from the mesial aspect of each tooth in 185 subjects (mean age 51 +/- 16 years) with (n = 160) or without (n = 25) periodontitis. The presence and levels of 40 subgingival taxa were determined in 13,261 plaque samples using whole genomic DNA probes and checkerboard DNA-DNA hybridization. Clinical assessments were made at 6 sites per tooth at each visit. Similarities between pairs of species were computed using phi coefficients and species clustered using an averaged unweighted linkage sort. Community ordination was performed using principal components analysis and correspondence analysis. 5 major complexes were consistently observed using any of the analytical methods. One complex consisted of the tightly related group: Bacteroides forsythus, Porphyromonas gingivalis and Treponema denticola. The 2nd complex consisted of a tightly related core group including members of the Fusobacterium nucleatum/periodonticum subspecies, Prevotella intermedia, Prevotella nigrescens and Peptostreptococcus micros. Species associated with this group included: Eubacterium nodatum, Campylobacter rectus, Campylobacter showae, Streptococcus constellatus and Campylobacter gracilis. The 3rd complex consisted of Streptococcus sanguis, S. oralis, S. mitis, S. gordonii and S. intermedius. The 4th complex was comprised of 3 Capnocytophaga species, Campylobacter concisus, Eikenella corrodens and Actinobacillus actinomycetemcomitans serotype a. The 5th complex consisted of Veillonella parvula and Actinomyces odontolyticus. A. actinomycetemcomitans serotype b, Selenomonas noxia and Actinomyces naeslundii genospecies 2 (A. viscosus) were outliers with little relation to each other and the 5 major complexes. The 1st complex related strikingly to clinical measures of periodontal disease particularly pocket depth and bleeding on probing.

Microbial complexes in subgingival plaque

Denitrification is a distinct means of energy conservation, making use of N oxides as terminal electron acceptors for cellular bioenergetics under anaerobic, microaerophilic, and occasionally aerobic conditions. The process is an essential branch of the global N cycle, reversing dinitrogen fixation, and is associated with chemolithotrophic, phototrophic, diazotrophic, or organotrophic metabolism but generally not with obligately anaerobic life. Discovered more than a century ago and believed to be exclusively a bacterial trait, denitrification has now been found in halophilic and hyperthermophilic archaea and in the mitochondria of fungi, raising evolutionarily intriguing vistas. Important advances in the biochemical characterization of denitrification and the underlying genetics have been achieved with Pseudomonas stutzeri, Pseudomonas aeruginosa, Paracoccus denitrificans, Ralstonia eutropha, and Rhodobacter sphaeroides. Pseudomonads represent one of the largest assemblies of the denitrifying bacteria within a single genus, favoring their use as model organisms. Around 50 genes are required within a single bacterium to encode the core structures of the denitrification apparatus. Much of the denitrification process of gram-negative bacteria has been found confined to the periplasm, whereas the topology and enzymology of the gram-positive bacteria are less well established. The activation and enzymatic transformation of N oxides is based on the redox chemistry of Fe, Cu, and Mo. Biochemical breakthroughs have included the X-ray structures of the two types of respiratory nitrite reductases and the isolation of the novel enzymes nitric oxide reductase and nitrous oxide reductase, as well as their structural characterization by indirect spectroscopic means. This revealed unexpected relationships among denitrification enzymes and respiratory oxygen reductases. Denitrification is intimately related to fundamental cellular processes that include primary and secondary transport, protein translocation, cytochrome c biogenesis, anaerobic gene regulation, metalloprotein assembly, and the biosynthesis of the cofactors molybdopterin and heme D1. An important class of regulators for the anaerobic expression of the denitrification apparatus are transcription factors of the greater FNR family. Nitrate and nitric oxide, in addition to being respiratory substrates, have been identified as signaling molecules for the induction of distinct N oxide-metabolizing enzymes.

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Cell biology and molecular basis of denitrification.

Matrix metalloproteinases (MMPs) are a family of nine or more highly homologous Zn(++)-endopeptidases that collectively cleave most if not all of the constituents of the extracellular matrix. The present review discusses in detail the primary structures and the overlapping yet distinct substrate specificities of MMPs as well as the mode of activation of the unique MMP precursors. The regulation of MMP activity at the transcriptional level and at the extracellular level (precursor activation, inhibition of activated, mature enzymes) is also discussed. A final segment of the review details the current knowledge of the involvement of MMP in specific developmental or pathological conditions, including human periodontal diseases.

Matrix Metalloproteinases: A Review

Role of Streptococcus mutans in human dental decay.

Bacteroides gingivalis, Bacteroides intermedius and Actinobacillus actinomycetemcomitans seem to be major pathogens in advancing periodontitis in man. First, these organisms are recovered in higher prevalence and proportions from progressive periodontitis lesions than from quiescent periodontal sites. Second, antibody levels against B. gingivalis and A. actinomycetemcomitans are markedly elevated in serum and gingival crevice fluid of periodontitis patients compared to normal controls. Third, B. gingivalis and B. intermedius elaborate potent proteases and A. actinomycetemcomitans various noxious substances which have the potential to perturb important host defenses and to disintegrate key constituents of the periodontal tissues. Monitoring these bacteria in advanced periodontal lesions may greatly assist the assessment of treatment efficacy and risk of further periodontal breakdown.

Bacteroides gingivalis, Bacteroides intermedius and Actinobacillus actinomycetemcomitans in human periodontal diseases

Relative distribution of bacteria at clinically healthy and periodontally diseased sites in humans

Teeth slated for extraction were evaluated with respect to their periodontal status and classified accordingly into five categories; namely normal, gingivitis, periodontitis, periodontosis and postperiodontosis. After processing, one approximal surface of each tooth was sampled at various levels in an apico-occlusal direction for light and electron microscopic study of the associated bacterial flora. In normal samples, the flora consisted of a relatively thin, adherent bacterial layer confined to the enamel surface. The cells were predominantly coccoid in shape with cell wall features compatible with those of Gram-positive organisms. Isolated filamentous or branching forms and some Gram-negative bacteria were noted on the surface of the more apical portion of the bacterial layer. No flagellated cells or spirochetes were present. Gingivitis samples yielded a relatively more voluminous and complex supragingival flora with relatively more filamentous bacteria and more cells with a Gram-negative cell wall ultrastructure. These samples also contained corncob formations on the surface of supragingival deposits, and flagellated cells with spirochetes within the predominantly Gram-negative flora of the sulcus bottom. Supragingival bacterial deposits of periodontitis samples were similar to those observed in gingivitis. The subgingival flora consisted of relatively fewer cells adherent to the root surface with a concomitant increase in the population of Gram-negative and flagellated cells, as well as spirochetes. The tissue side of the subgingival flora generally exhibited a distinctive concentration of "test-tube brush" formations, spirochetes of predominantly medium size, and assorted cell types peculiar to this region. A transitional flora generally separated the supra- from the subgingival microbial population. Periodontosis samples had a relatively sparse, predominantly Gram-negative flora. A unique electron-dense, lobulated cuticular deposit covered the majority of the samples studied. Postperiodontosis samples were much more similar in their microbial flora to the periodontitis group. The results suggest that (1) a certain microbial flora may be compatible with a state of periodontal health; (2) a different flora is associated with varying degrees of periodontal disease; (3) the structure and composition of the supragingival flora differs markedly from that of the subgingival flora; (4) with the exception of periodontis, the alterations of the microbial flora as periodontal disease increases inseverity parallel the changes described previously in the microbial population collected on artificial crowns during experimentally induced gingivitis. The use of the expressions "microbial flora" or "microbial population" is considered preferable to the terms "plaque", "materia alba", or "debris" in reference to the microbiota of the gingival sulcus region.

Structure of the microbial flora associated with periodontal health and disease in man. A light and electron microscopic study.

Effect of tetracycline and/or scaling on human periodontal disease. Clinical, microbiological, and histological observations.

Periodontitis is an inflammatory disease of the periodontium which is characterized by a progressive destruction of the tissues supporting the tooth. Its primary etiology is an ill-defined series of microbial infections which may be composed of only some of the more than 300 species of bacteria currently recognized in the oral cavity. The disease is currently considered to progress as periodic, relatively short episodes of rapid tissue destruction followed by some repair, and prolonged intervening periods of disease remission. Despite the apparent random distribution of episodes of disease activity, the resulting tissue breakdown exhibits a symmetrical pattern of alveolar bone loss and pocket formation which is common to several forms of periodontitis, although the distribution of the most affected teeth and surfaces may vary among diseases (e.g., juvenile periodontitis versus adult periodontitis or rapidly progressive periodontitis). Several reports have indicated that bacterial cells can be found in the pocket wall of periodontitis lesions. The translocation of bacteria into the tissues from the pocket environment is quite common, as evidenced by the common occurrence of bacteremias in patients with periodontitis following relatively minor events such as chewing and oral hygiene procedures. However, it is important to distinguish between the passive introduction of bacteria into periodontal tissues and frank invasion as might occur in an acute infection, since the pathological implications may be quite different.

Max A. Listgarten

Papers

Bacteroides gingivalis, Bacteroides intermedius and Actinobacillus actinomycetemcomitans in human periodontal diseases

Relative distribution of bacteria at clinically healthy and periodontally diseased sites in humans

Structure of the microbial flora associated with periodontal health and disease in man. A light and electron microscopic study.

Effect of tetracycline and/or scaling on human periodontal disease. Clinical, microbiological, and histological observations.

Pathogenesis of periodontitis.