Showing papers in "Journal of Clinical Periodontology in 2013"

Inflammatory mechanisms linking periodontal diseases to cardiovascular diseases

Abstract: Aims: In this article, inflammatory mechanisms that link periodontal diseases to cardiovascular diseases are reviewed. Methods: This article is a literature review. Results: Studies in the literature implicate a number of possible mechanisms that could be responsible for increased inflammatory responses in atheromatous lesions due to periodontal infections. These include increased systemic levels of inflammatory mediators stimulated by bacteria and their products at sites distant from the oral cavity, elevated thrombotic and hemostatic markers that promote a prothrombotic state and inflammation, cross-reactive systemic antibodies that promote inflammation and interact with the atheroma, promotion of dyslipidemia with consequent increases in pro-inflammatory lipid classes and subclasses, and common genetic susceptibility factors present in both disease leading to increased inflammatory responses. Conclusions: Such mechanisms may be thought to act in concert to increase systemic inflammation in periodontal disease and to promote or exacerbate atherogenesis. However, proof that the increase in systemic inflammation attributable to periodontitis impacts inflammatory responses during atheroma development, thrombotic events or myocardial infarction or stroke is lacking.

A review of the evidence for pathogenic mechanisms that may link periodontitis and diabetes.

Abstract: Aims: To review the evidence for the molecular and cellular processes that may potentially link periodontal disease and diabetes. The pathogenic roles of cytokines and metabolic molecules (e.g. glucose, lipids) are explored and the role of periodontal bacteria is also addressed. Paradigms for bidirectional relationships between periodontitis and diabetes are discussed and opportunities for elaborating these models are considered.Methods: Database searches were performed using MeSH terms, keywords, and title words. Studies were evaluated and summarized in a narrative review. Results: Periodontal microbiota appears unaltered by diabetes and there is little evidence that it may influence glycaemic control. Small-scale clinical studies and experiments in animal models suggest that IL-1b, TNF-a, IL-6, OPG and RANKL may mediate periodontitis in diabetes. The AGE-RAGE axis is likely an important pathway of tissue destruction and impaired repair in diabetesassociated periodontitis. A role for locally activated pr...

Clinical and microbiological effects of Lactobacillus reuteri probiotics in the treatment of chronic periodontitis: a randomized placebo-controlled study

Abstract: Aim: The aim of this randomized placebo-controlled clinical trial was to evaluate the effects of Lactobacillus reuteri-containing probiotic lozenges as an adjunct to scaling and root planing (SRP). Material and Methods: Thirty chronic periodontitis patients were recruited and monitored clinically and microbiologically at baseline, 3, 6, 9 and 12 weeks after therapy. All patients received one-stage full-mouth disinfection and randomly assigned over a test (SRP + probiotic, n = 15) or control (SRP + placebo, n = 15) group. The lozenges were used two times a day for 12 weeks. Results: At week 12, all clinical parameters were significantly reduced in both groups, while there was significantly more pocket depth reduction (p < 0.05) and attachment gain (p < 0.05) in moderate and deep pockets; more Porphyromonas gingivalis reduction was observed in the SRP + probiotic group. Conclusions: The results indicate that oral administration of L. reuteri lozenges could be a useful adjunct to SRP in chronic periodontitis.

Radiographic evaluation of different techniques for ridge preservation after tooth extraction: a randomized controlled clinical trial

Abstract: OBJECTIVE: To evaluate the radiographic changes of the alveolar ridge following application of different ridge preservation techniques 6 months after tooth extraction. MATERIALS AND METHODS: Four treatment modalities were randomly assigned in 40 patients: β-tricalcium-phosphate-particles with polylactid coating (β-TCP), demineralized bovine bone mineral with 10% collagen covered with a collagen matrix (DBBM-C/CM), DBBM-C covered with an autogenous soft-tissue graft (DBBM-C/PG) and spontaneous healing (control). Cone-beam computed tomography scans were performed after treatment and 6 months later. RESULTS: After 6 months, the vertical changes ranged between -0.6 mm (-10.2%) for control and a gain of 0.3 mm (5.6%) for DBBM-C/PG on the lingual side, and between -2.0 mm (-20.9%) for β-TCP and a gain of 1.2 mm (8.1%) for DBBM-C/PG on the buccal side. The most accentuated ridge width changes were recorded 1 mm below the crest: -3.3 mm (-43.3%, C), -6.1 mm (-77.5%, β-TCP), -1.2 mm (-17.4%, DBBM-C/CM) and -1.4 mm (-18.1%, DBBM-C/PG). At all three levels, DBBM-C with either CM or PG was not significantly differing (p > 0.05), while most other differences between the groups reached statistical significance (p < 0.05). CONCLUSIONS: Application of DBBM-C, covered with CM or PG, resulted in less vertical and horizontal changes of the alveolar ridge as compared with controls 6 months after extraction.

Evidence that periodontal treatment improves diabetes outcomes: a systematic review and meta-analysis.

Abstract: Context: The effect of periodontal therapy on diabetes outcomes has not been established. Objective: This update examines the effect of periodontal treatment on diabetes outcomes.

Epidemiology of association between maternal periodontal disease and adverse pregnancy outcomes – systematic review

Abstract: Background: and objectives: There is still debate regarding potential relationships between maternal periodontitis during pregnancy and adverse pregnancy outcomes. The aim of this systematic review was to synthesize the available epidemiological evidence on this association.Data sources: Combined electronic and hand search of MEDLINE, EMBASE, WEB OF SCIENCE and Cochrane Central Register databases.Study eligibility criteria: Original publications reporting data from cross-sectional, case-control or prospective cohort epidemiological studies on the association between periodontal status and preterm birth, low birthweight (LBW) or preeclampsia. The search was not limited to publications in English. All selected studies provided data based on professional assessments of periodontal status, and outcome variables, including preterm birth (<37 weeks gestation), LBW (<2500 g), gestational age, small for gestational age, birthweight, pregnancy loss or miscarriage, or pre-eclampsia.Participants: Pregnant women with...

Evidence that periodontal treatment improves biomarkers and CVD outcomes.

Abstract: Aim: The aim of this review was to critically appraise the evidence on the impact of periodontal treatment of cardiovascular diseases (CVDs) biomarkers and outcomes. Methods: A systematic search was performed in Cinhal, Cochrane, Embase and Medline for relevant articles up to July 2012. Duplicate screening and reference hand searching were performed. Data were then summarized and evidence graded in tables. Results: The search resulted in: (a) no evidence on the effects of periodontal therapy on subclinical atherosclerosis, serum levels of CD40 ligand, serum amyloid A and monocyte chemoattractant protein-1, (b) limited evidence on the effects of periodontal therapy on arterial blood pressure, leucocyte counts, fibrinogen, tissue necrosis factor-a, sE-selectin, von Willebrand factors, d-dimers, matrix metalloproteinases, oxidative stress and CVD events, and (c) moderate evidence suggesting a negligible effect of periodontal therapy in reducing interleukin-6 and lipids levels, whilst a positive effect in reducing serum C-reactive protein levels and improving endothelial function. Conclusions: Periodontal therapy triggers a short-term inflammatory response followed by (a) a progressive and consistent reduction of systemic inflammation and (b) an improvement in endothelial function. There is however limited evidence that these acute and chronic changes will either increase or reduce CVD burden of individuals suffering from periodontitis in the long term.

Periodontal bacterial invasion and infection: contribution to atherosclerotic pathology

Abstract: Objective: The objective of this review was to perform a systematic evaluation of the literature reporting current scientific evidence for periodontal bacteria as contributors to atherosclerosis. Methods: Literature from epidemiological, clinical and experimental studies concerning periodontal bacteria and atherosclerosis were reviewed. Gathered data were categorized into seven “proofs” of evidence that periodontal bacteria: 1) disseminate from the oral cavity and reach systemic vascular tissues; 2) can be found in the affected tissues; 3) live within the affected site; 4) invade affected cell types in vitro; 5) induce atherosclerosis in animal models of disease; 6) non-invasive mutants of periodontal bacteria cause significantly reduced pathology in vitro and in vivo; and 7) periodontal isolates from human atheromas can cause disease in animal models of infection. Results: Substantial evidence for proofs 1 to 6 was found. However, proof 7 has not yet been fulfilled. Conclusions: Despite the lack of evidence that periodontal bacteria obtained from human atheromas can cause atherosclerosis in animal models of infection, attainment of proofs 1 to 6 provides support that periodontal pathogens can contribute to atherosclerosis.

A systematic review on the effects of local antimicrobials as adjuncts to subgingival debridement, compared with subgingival debridement alone, in the treatment of chronic periodontitis.

Abstract: Aims: To update the existing scientific evidence on the efficacy of local antimicrobials as adjuncts to subgingival debridement in the treatment of chronic periodontitis. Material and Methods: Fifty-six papers were selected, reporting data from 52 different investigations. All the studies reported changes in probing pocket depth (PPD) and clinical attachment level (CAL) and most in plaque index (PlI) and/or bleeding on probing (BOP). Meta-analyses were performed with the data retrieved from the studies fulfilling the inclusion criteria. Results: The overall effect of the subgingival application of antimicrobials was statistically significant (p = 0.000) for both changes in PPD and CAL with a weighted mean difference (WMD) of 0.407 and 0.310 mm respectively. No significant differences occurred for changes in BOP and PlI. Subgingival application of tetracycline fibres, sustained released doxycycline and minocycline demonstrated a significant benefit in PPD reduction (WMD between 0.5 and 0.7 mm). The rest of the tested outcomes demonstrated a high heterogeneity. The local application of chlorhexidine and metronidazole showed a minimal effect when compared with placebo (WMD between 0.1 and 0.4 mm). Conclusions: The scientific evidence supports the adjunctive use of local antimicrobials to debridement in deep or recurrent periodontal sites, mostly when using vehicles with proven sustained release of the antimicrobial.

Salivary biomarkers of oral health: a cross-sectional study.

Abstract: Aim Saliva is a useful diagnostic fluid for oral-related diseases. Monitoring salivary biomarkers for oral and systemic diseases could become an important complement to clinical examinations in epidemiological surveys. Recent findings indicate that it is possible to detect biomarkers for oral diseases within saliva samples. The aim of this study was to investigate if known salivary biomarkers could be used for epidemiological studies for detection of periodontitis. Materials and Methods A randomly selected sample of adults (20–89 years) living in Southern Sweden were invited to participate. Four hundred and fifty-one individuals were examined clinically using standard examination procedures. Stimulated saliva samples were collected and analysed for concentrations of IL-1β, -6, -8, lysozyme, matrix metalloproteinases (MMP)-8 and tissue inhibitor of metalloproteinase (TIMP)-1 using ELISA, immunofluorometric assay or Luminex assays. Results Patients with severe periodontitis presented with elevated salivary concentrations of IL-1β (p < 0.001) and MMP-8 (p < 0.001). In addition, the MMP-8/TIMP-1 ratio was significantly higher in the severe periodontitis group (p < 0.001). Smokers compared with non-smokers showed slightly lower concentrations of IL–8 (p < 0.05) and MMP-8 (p = 0.052). Conclusion This investigation shows that IL-1β, MMP-8 and the ratio of MMP-8/TIMP-1 could be used as markers of periodontal disease in larger patient populations.

Treatment of multiple adjacent Miller class I and II gingival recessions with a Modified Coronally Advanced Tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: a randomized, controlled clinical trial

Abstract: BACKGROUND A newly developed collagen matrix (CM) of porcine origin has been shown to represent a potential alternative to palatal connective tissue grafts (CTG) for the treatment of single Miller Class I and II gingival recessions when used in conjunction with a coronally advanced flap (CAF). However, at present it remains unknown to what extent CM may represent a valuable alternative to CTG in the treatment of Miller Class I and II multiple adjacent gingival recessions (MAGR). The aim of this study was to compare the clinical outcomes following treatment of Miller Class I and II MAGR using the modified coronally advanced tunnel technique (MCAT) in conjunction with either CM or CTG. METHODS Twenty-two patients with a total of 156 Miller Class I and II gingival recessions were included in this study. Recessions were randomly treated according to a split-mouth design by means of MCAT + CM (test) or MCAT + CTG (control). The following measurements were recorded at baseline (i.e. prior to surgery) and at 12 months: Gingival Recession Depth (GRD), Probing Pocket Depth (PD), Clinical Attachment Level (CAL), Keratinized Tissue Width (KTW), Gingival Recession Width (GRW) and Gingival Thickness (GT). GT was measured 3-mm apical to the gingival margin. Patient acceptance was recorded using a Visual Analogue Scale (VAS). The primary outcome variable was Complete Root Coverage (CRC), secondary outcomes were Mean Root Coverage (MRC), change in KTW, GT, patient acceptance and duration of surgery. RESULTS Healing was uneventful in both groups. No adverse reactions at any of the sites were observed. At 12 months, both treatments resulted in statistically significant improvements of CRC, MRC, KTW and GT compared with baseline (p 0.05). At test sites, GT values changed from 0.8 ± 0.2 to 1.0 ± 0.3 mm, and at control sites from 0.8 ± 0.3 to 1.3 ± 0.4 mm (p < 0.05). Duration of surgery and patient morbidity was statistically significantly lower in the test compared with the control group respectively (p < 0.05). CONCLUSIONS The present findings indicate that the use of CM may represent an alternative to CTG by reducing surgical time and patient morbidity, but yielded lower CRC than CTG in the treatment of Miller Class I and II MAGR when used in conjunction with MCAT.

Tooth loss and periodontitis by socio-economic status and inflammation in a longitudinal population-based study

Abstract: AIM To examine the associations between factors of socio-economic status (SES), systemic inflammation and the progression of periodontitis and incidence of tooth loss. MATERIAL AND METHODS Data of 2566 participants from the Study of Health in Pomerania (SHIP) with a 5-year follow-up were analysed. We evaluated attachment loss and tooth loss with regard to social variables including education, income, marital status and related risks such as smoking and obesity. RESULTS Socio-economic factors were associated with the progression of attachment level and tooth loss during the follow-up period. Low education and low income were associated with tooth loss (incidence risk ratio IRR 1.63, p < 0.001 and 1.25, p < 0.001 respectively) and also progression of mean clinical attachment level (p < 0.010 and p = 0.046 respectively). SES as well as smoking and obesity were also associated with increased levels of C-reactive protein (CRP) with effect modifications between SES factors and CRP, also between gender and marital status. Tooth loss was associated with disadvantageous SES, particularly under conditions of high CRP levels (p < 0.001). CONCLUSIONS The progression of periodontal disease is influenced by socio-economic factors. Effect modifications of socio-behavioural factors by CRP indicate that under conditions of systemic inflammation adverse SES effects may be aggravated.

Treatment of gingival recession defects with a coronally advanced flap and a xenogeneic collagen matrix: a multicenter randomized clinical trial

Abstract: Aim To evaluate the clinical outcomes of the use of a xenogeneic collagen matrix (CM) in combination with the coronally advanced flap (CAF) in the treatment of localized recession defects. Material & Methods In a multicentre single-blinded, randomized, controlled, split-mouth trial, 90 recessions (Miller I, II) in 45 patients received either CAF + CM or CAF alone. Results At 6 months, root coverage (primary outcome) was 75.29% for test and 72.66% for control defects (p = 0.169), with 36% of test and 31% of control defects exhibiting complete coverage. The increase in mean width of keratinized tissue (KT) was higher in test (from 1.97 to 2.90 mm) than in control defects (from 2.00 to 2.57 mm) (p = 0.036). Likewise, test sites had more gain in gingival thickness (GT) (0.59 mm) than control sites (0.34 mm) (p = 0.003). Larger (≥3 mm) recessions (n = 35 patients) treated with CM showed higher root coverage (72.03% versus 66.16%, p = 0.043), as well as more gain in KT and GT. Conclusions CAF + CM was not superior with regard to root coverage, but enhanced gingival thickness and width of keratinized tissue when compared with CAF alone. For the coverage of larger defects, CAF + CM was more effective.

Genome‐wide association study of chronic periodontitis in a general German population

Abstract: Aim To identify loci associated with chronic periodontitis through a genome-wide association study (GWAS). Materials and Methods A GWAS was performed in 4032 individuals of two independent cross-sectional studies of West Pomerania (SHIP n = 3365 and SHIP-TREND n = 667) with different periodontal case definitions. Samples were genotyped with the Affymetrix Genome-Wide Human SNP Array 6.0 or the Illumina Human Omni 2.5 array. Imputation of the HapMap as well as the 1000 Genome-based autosomal and X-chromosomal genotypes and short insertions and deletions (INDELs) was performed in both cohorts. Finally, more than 17 million SNPs and short INDELs were analysed. Results No genome-wide significant associations were found for any periodontitis case definition, regardless of whether individuals aged >60 years where excluded or not. Despite no single SNP association reached genome-wide significance, the proportion of variance explained by additive effects of all common SNPs was around 23% for mean proximal attachment loss. Excluding subjects aged >60 years increased the explained variance to 34%. Conclusions No single SNPs were found to be genome-wide significantly associated with chronic periodontitis in this study.

Comprehensive microbiological findings in peri-implantitis and periodontitis.

Abstract: Aim The microbial differences between peri-implantitis and periodontitis in the same subjects were examined using 16S rRNA gene clone library analysis and real-time polymerase chain reaction. Materials and methods Subgingival plaque samples were taken from the deepest pockets of peri-implantitis and periodontitis sites in six subjects. The prevalence of bacteria was analysed using a 16S rRNA gene clone library and real-time polymerase chain reaction. Results A total of 333 different taxa were identified from 799 sequenced clones; 231 (69%) were uncultivated phylotypes, of which 75 were novel. The numbers of bacterial taxa identified at the sites of peri-implantitis and periodontitis were 192 and 148 respectively. The microbial composition of peri-implantitis was more diverse when compared with that of periodontitis. Fusobacterium spp. and Streptococcus spp. were predominant in both peri-implantitis and periodontitis, while bacteria such as Parvimonas micra were only detected in peri-implantitis. The prevalence of periodontopathic bacteria was not high, while quantitative evaluation revealed that, in most cases, prevalence was higher at peri-implantitis sites than at periodontitis sites. Conclusions The biofilm in peri-implantitis showed a more complex microbial composition when compared with periodontitis. Common periodontopathic bacteria showed low prevalence, and several bacteria were identified as candidate pathogens in peri-implantitis.

Periodontitis and chronic kidney disease: a systematic review of the association of diseases and the effect of periodontal treatment on estimated glomerular filtration rate.

Abstract: Aim The aim of this systematic review (SR) was to evaluate the association between periodontitis and chronic kidney disease (CKD) and the effect of periodontal treatment (PT) on the estimated glomerular filtration rate (eGFR). Methods MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched up to and including September 30, 2012 to observational (S1) and interventional (S2) studies on the association of periodontitis with CKD. Studies were considered eligible for inclusion if they reported the eGFR. Search was conducted by two independent reviewers. The methodological quality of the observational studies was assessed using the Newcastle-Ottawa Scale (NOS) adapted for this review, and the Cochrane's Collaboration risk of bias assessment tool. A random-effects odds-ratio meta-analysis was conducted to estimate the degree of association between periodontitis and CKD. Results Search strategy identified 2456 potentially eligible articles, of which four cross-sectional, one retrospective, and three interventional studies were included. Four S1, 80.0% reported some degree of association between periodontitis and CKD. Similarly, such an outcome was supported by pooled estimates (OR: 1.65, 95% Confidence Interval: 1.35, 2.01, p < 0.00001, χ2 = 1.70, I2 = 0%). All interventional studies found positive outcomes related to treatment. Conclusion There is quite consistent evidence to support the positive association between periodontitis and CKD, as well as the positive effect of PT on eGFR.

Adjunctive photodynamic therapy to non‐surgical treatment of chronic periodontitis: a systematic review and meta‐analysis

Abstract: Aim To investigate the efficacy of antimicrobial photodynamic therapy (aPDT) adjunctive to scaling root planing (SRP) in patients with chronic periodontitis. Methods A meta-analysis was conducted according to the PRISMA statement and Cochrane Collaboration recommendations. Two independent reviewers performed an extensive literature search and manual search on seven databases. Mean differences (MD) and 95% confidence intervals (CI) were calculated for clinical attachment level (CAL) gain and probing depth (PD) reduction. The I2 test was used for inter-study heterogeneity. Publication bias was examined by Egger's regression test and the trim-and-fill method. Results Sensitivity analysis of 14 randomized clinical trials (RCTs) revealed differences in PD reduction (MD 0.19, 95% CI 0.07–0.31, p = 0.002) and CAL gain (MD 0.37, 95% CI 0.26–0.47, p < 0.0001) in favour of SRP + aPDT, with no evidence of heterogeneity. Subgroup analysis revealed the absence of heterogeneity in RCTs, with high risk of bias for PD reduction and CAL gain. No evidence of publication bias was detected. Conclusions The use of adjunctive aPDT to conventional SRP provides short-term benefits. The evidence to support its clinical medium/long-term efficacy is insufficient. Further high-quality RCTs are needed to investigate the influence of potential confounders on the efficacy of adjunctive aPDT.

Subgingival microbiome in smokers and non-smokers in periodontitis: an exploratory study using traditional targeted techniques and a next-generation sequencing

Abstract: Aim To compare the results of two targeted techniques to an open-ended technique in periodontitis patients, differentiated on the basis of smoking habit. Materials & Methods Thirty periodontitis patients (15 smokers and 15 non-smokers) provided subgingival plaque samples for 16S rRNA gene amplicon sequencing, culturing and quantitative polymerase chain reaction (qPCR). Results No differences were found in the composition of the subgingival microbiome between smokers and non-smokers with culture and qPCR. With pyrosequencing, operational taxonomic units (OTUs) classified to genera Fusobacterium, Prevotella and Selenomonas were more abundant in smokers, while OTUs belonging to the genera Peptococcus and Capnocytophaga were more abundant in non-smokers. Principal coordinate analysis identified two clusters; one was composed mainly of smokers (80%) and revealed significantly lower taxonomic diversity, higher attachment loss and higher proportion of the genera Fusobacterium, Paludibacter and Desulfobubus. Conclusion In periodontitis, there is a difference in the composition of the subgingival microbiome between smokers and non-smokers, as revealed by pyrosequencing. This difference was not identified by the targeted techniques. Low taxonomic diversity was associated with higher disease severity, especially in smokers. This supports the hypothesis of the ecological microbial-host interaction in the severity of periodontal disease.

Gingival labial recessions in orthodontically treated and untreated individuals: a case control study

Abstract: OBJECTIVES To evaluate the long-term development of labial gingival recessions during orthodontic treatment and retention phase. MATERIAL AND METHODS In this retrospective case-control study, the presence of gingival recession was scored (Yes or No) on plaster models of 100 orthodontic patients (cases) and 120 controls at the age of 12 (T12 ), 15 (T15 ), 18 (T18 ), and 21 (T21 ) years. In the treated group, T12 reflected the start of orthodontic treatment and T15 - the end of active treatment and the start of retention phase with bonded retainers. Independent t-tests, Fisher's exact tests and a fitted two-part "hurdle" model were used to identify the effect of orthodontic treatment/retention on recessions. RESULTS The proportion of subjects with recessions was consistently higher in cases than controls. Overall, the odds ratio for orthodontic patients as compared with controls to have recessions is 4.48 (p < 0.001; 95% CI: 2.61-7.70). CONCLUSIONS Within the limits of the present research design, orthodontic treatment and/or the retention phase may be risk factors for the development of labial gingival recessions. In orthodontically treated subjects, mandibular incisors seem to be the most vulnerable to the development of gingival recessions.

Influence of periodontal disease, Porphyromonas gingivalis and cigarette smoking on systemic anti-citrullinated peptide antibody titres.

Abstract: Background Anti-citrullinated protein antibody (ACPA) responses may precede clinical onset of rheumatoid arthritis. Porphyromonas gingivalis peptidylarginine deiminase can citrullinate proteins possibly inducing autoimmunity in susceptible individuals. Aim To determine whether periodontitis, carriage of P. gingivalis, smoking and periodontal therapy influence ACPA titres. Methods Serum and plaque samples were collected from 39 periodontitis patients before and after non-surgical periodontal treatment, and from 36 healthy subjects. Carriage of P. gingivalis was determined by PCR of plaque DNA. ACPA was determined by anti-cyclic citrullinated peptide (CCP) enzyme-linked immunosorbent assay (ELISA). Anti-P. gingivalis titres were determined by ELISA. Results Untreated periodontitis patients had higher anti-CCP antibody titres than healthy controls [three patients (8%) greater than manufacturer suggested assay diagnostic threshold (5 Assay Units/AU) versus none (0%); mean ± SEM: 1.37 ± 0.23 versus 0.40 ± 0.10 AU, p < 0.0001]. Periodontitis patients who smoked demonstrated lower anti-P. gingivalis (15956 ± 4385 versus 2512 ± 1290 Units/ml, p < 0.05), but similar anti-CCP than non-smoking periodontitis patients (smokers: 1.31 ± 0.35; non-smokers: 1.41 ± 0.32 AU). Healthy smokers demonstrated elevated anti-CCP titres (0.75 ± 0.19 AU), at levels between healthy non-smokers (0.15 ± 0.05 AU) and non-smoker periodontitis patients. Six months after periodontal treatment, there were significant reductions in anti-CCP (non-smokers p < 0.05) and anti-P. gingivalis (all participants p < 0.01). Conclusion In subjects with periodontitis, P. gingivalis infection may be responsible for inducing autoimmune responses that characterize rheumatoid arthritis.

Periodontitis and systemic diseases: a record of discussions of working group 4 of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases

Abstract: Background: There has been an explosion in research into possible associations between periodontitis and various systemic diseases and conditions. Aim: To review the evidence for associations between periodontitis and various systemic diseases and conditions, including chronic obstructive pulmonary disease (COPD), pneumonia, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome and cancer, and to document headline discussions of the state of each field. Periodontal associations with diabetes, cardiovascular disease and adverse pregnancy outcomes were not discussed by working group 4. Results: Working group 4 recognized that the studies performed to date were largely cross-sectional or case-control with few prospective cohort studies and no randomized clinical trials. The best current evidence suggests that periodontitis is characterized by both infection and pro-inflammatory events, which variously manifest within the systemic diseases and disorders discussed. Diseases with at least minimal evidence of an association with periodontitis include COPD, pneumonia, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome and cancer. The working group agreed that there is insufficient evidence to date to infer causal relationships with the exception that organisms originating in the oral microbiome can cause lung infections. Conclusions: The group was unanimous in their opinion that the reported associations do not imply causality, and establishment of causality will require new studies that fulfil the Bradford Hill or equivalent criteria. Precise and community-agreed case definitions of periodontal disease states must be implemented systematically to enable consistent and clearer interpretations of studies of the relationship to systemic diseases. The members of the working group were unanimous in their opinion that to develop data that best inform clinicians, investigators and the public, studies should focus on robust disease outcomes and avoid surrogate endpoints. It was concluded that because of the relative immaturity of the body of evidence for each of the purported relationships, the field is wide open and the gaps in knowledge are large.

Implant decontamination during surgical peri-implantitis treatment: a randomized, double-blind, placebo-controlled trial

Abstract: Aim The objective of this randomized, double-blind, placebo-controlled trial was to study the effect of implant surface decontamination with chlorhexidine (CHX)/cetylpyridinium chloride (CPC) on microbiological and clinical parameters. Material & Methods Thirty patients (79 implants) with peri-implantitis were treated with resective surgical treatment consisting of apically re-positioned flap, bone re-contouring and surface debridement and decontamination. Patients were randomly allocated to decontamination with 0.12% CHX + 0.05% CPC (test-group) or a placebo-solution (without CHX/CPC, placebo-group). Microbiological parameters were recorded during surgery; clinical and radiographical parameters were recorded before (pre-) treatment (baseline), and at 3, 6 and 12 months after treatment. Results Nine implants in two patients in the placebo-group were lost due to severe persisting peri-implantitis. Both decontamination procedures resulted in significant reductions of bacterial load on the implant surface, but the test-group showed a significantly greater reduction than the placebo-group (log 4.21 +/- 1.89 versus log 2.77 +/- 2.12, p = 0.006). Multilevel analysis showed no differences between both groups in the effect of the intervention on bleeding, suppuration, probing pocket depth and radiographical bone loss over time. Conclusion Implant surface decontamination with 0.12% CHX + 0.05% CPC in resective surgical treatment of peri-implantitis leads to a greater immediate suppression of anaerobic bacteria on the implant surface than a placebo-solution, but does not lead to superior clinical results. The long-term microbiological effect remains unknown.

Four-year follow-up of combined surgical therapy of advanced peri-implantitis evaluating two methods of surface decontamination.

Abstract: Objectives To investigate the impact of two surface decontamination methods on the long-term outcomes following combined surgical resective/regenerative therapy of advanced peri-implantitis lesions. Material and Methods Seventeen patients (n = 17 combined supra- and intrabony-defects) completed the 48 months follow-up observation following access flap surgery, granulation tissue removal and implantoplasty at bucally and supracrestally exposed implant parts. The remaining unmodified implant surface areas were randomly treated using either (i) an Er:YAG laser (ERL), or (ii) plastic curets + cotton pellets + sterile saline (CPS), and augmented with a natural bone mineral + collagen membrane. Results At 48 months, CPS-treated sites tended to reveal higher reductions in mean BOP (CPS: 85.2 ± 16.4% versus ERL: 71.6 ± 24.9%) and CAL values (CPS: 1.5 ± 2.0 mm versus ERL: 1.2 ± 2.0 mm) when compared with the ERL group. In both groups, clinical outcomes were not directly influenced by the initial defect configuration. Conclusion The 4-year clinical outcomes obtained following combined surgical resective/regenerative therapy of advanced peri-implantitis were not influenced by the method of surface decontamination.

Effects of smoking cessation on the outcomes of non-surgical periodontal therapy: a systematic review and individual patient data meta-analysis

Abstract: Aim: To conduct an individual patient data (IPD) meta-analysis to assess the effect of smoking cessation (SC) on clinical outcomes following the non-surgical periodontal treatment in patients with chronic periodontitis. Methods: MEDLINE, EMBASE and CENTRAL were searched up to, and including, August 2012. Prospective cohort studies of at least 6 months’ duration were included if the participants met the following criteria: (1) smokers who had expressed an interest in quitting the habit; and (2) a diagnosis of periodontitis. Search was conducted by two independent reviewers. IPD meta-analyses were undertaken using multiple linear or Poisson regression to evaluate the impact of SC on five different dependent variables. Results: Of 2455 potentially eligible articles, two studies were included. The two studies found that SC seems to promote additional beneficial effects in reducing probing depths (PD) and improving attachment level following non-surgical periodontal treatment. The IPD approach allowed data combination but it might not have usefully added strength to the data in this review. Conclusion: SC seems to be an important component of periodontal therapy, and smokers should be encouraged to quit as part of their overall periodontal management; however, only a limited base of evidence was available for analysis.

Salivary type I collagen degradation end-products and related matrix metalloproteinases in periodontitis.

Abstract: Aim Type I collagen degradation end-products and related matrix metalloproteinases (MMPs) were examined aiming to detect potential markers of periodontitis in saliva, with high sensitivity and specificity. Materials and Methods The salivary concentrations of MMP-8, MMP-9 and MMP-13, tartrate-resistant acid phosphatase serum type 5b, C-terminal cross-linked telopeptide of type I collagen (CTx), N-terminal cross-linked telopeptide of type I collagen (NTx) and cross-linked carboxyterminal telopeptide of type I collagen were analysed in 230 subjects. Oral health examination included panoramic radiography. Results The concentrations of MMP-8, MMP-9 and MMP-13 in saliva were higher in subjects with generalized periodontitis than in controls. Of the tested salivary markers, MMP-8 was the only marker capable of differentiating subjects with severe alveolar bone loss from those with slight bone loss (p < 0.001). The association between the salivary MMP-8 levels and periodontitis remained significant after the adjustment with age, gender and smoking. In addition, significant correlations were found between the tested markers and periodontal parameters. Conclusion Enzymes and end-products of type I collagen degradation have different associations with each other and with periodontal status that may reflect their roles in the cascade leading to alveolar bone loss. MMP-8 is a strong biomarker candidate for detecting alveolar bone destruction.

Identification of periodontitis associated changes in the proteome of whole human saliva by mass spectrometric analysis.

Abstract: AIM Interest in human saliva proteomics for disease-specific biomarker screening increased in the last decade. We used whole saliva samples from periodontally healthy and diseased subjects with chronic periodontitis to screen for disease-associated differences in the protein pattern. MATERIAL AND METHODS We selected 20 periodontally healthy and 20 periodontally diseased subjects from the population-based cross-sectional Study of Health in Pomerania (SHIP-2 and SHIP-Trend). Saliva collection was performed with commercially available Salivette(®) (Sarstedt, Numbrecht, Germany). Whole saliva proteins were analysed after trichloroacetic acid (TCA) precipitation and proteolytic digestion with trypsin by LC-MS/MS. MS-data were analysed and quantified using the Rosetta Elucidator software package. RESULTS In whole saliva we identified 344 human protein groups across all samples. For label free quantitation we only considered 152 proteins identified with more than one unique peptide. In total, 20 proteins showed 1.5-fold difference in abundance between controls and patients (p < 0.05); the majority of these proteins showed higher abundance in the periodontally diseased subjects. Functional annotation of proteins linked the periodontally diseased status with acute phase response and inflammatory processes. CONCLUSION Label free proteomic analysis of whole saliva is a powerful tool to characterize the periodontal disease status and differentiate between healthy and periodontally diseased subjects.

Detection of oral bacterial DNA in synovial fluid

Abstract: Objectives As periodontal bacteria might be involved in the aetiology of rheumatic diseases, we analysed synovial fluid obtained from patients with rheumatoid arthritis (RA) and controls for the presence of DNA of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, and Treponema denticola. Methods In all, 42 patients suffering from RA (mean age 53.8 ± 16.7 years, 40.4% females) and 114 controls with no rheumatic diseases (mean age 56.1 ± 15.2 years, 52.4% females) were included. DNA from synovial fluid was isolated by QiaAmp kit (Qiagen, Hilden, Germany). Polymerase chain reactions (PCRs) specific for the 16S rRNA genes of the above specified bacteria were developed. Subgingival bacterial colonization was analysed using micro-Ident(®) test (HAIN-Diagnostik, Nehren, Germany). Results In patients with RA DNA of P. gingivalis was detected in synovial fluid more often than in controls (15.7% versus 3.5%, p = 0.045). More patients than controls harboured DNA from P. gingivalis in both, oral plaque and synovial fluid (11.9% versus. 0.9%, p = 0.030). Among the patients group the number of missing teeth was correlated with the number of joints with movement restrictions caused by RA. Conclusions DNA of periodontopathogens can be found in synovial fluid and oral bacteria may play a role in the pathogenesis of arthritis.

Bayesian network meta-analysis of root coverage procedures: ranking efficacy and identification of best treatment.

Abstract: Aims The aim of this work was to conduct a Bayesian network meta-analysis (NM) of randomized controlled trials (RCTs) to establish a ranking in efficacy and the best technique for coronally advanced flap (CAF)-based root coverage procedures. Material and Methods A literature search on PubMed, Cochrane libraries, EMBASE, and hand-searched journals until June 2012 was conducted to identify RCTs on treatments of Miller Class I and II gingival recessions with at least 6 months of follow-up. The treatment outcomes were recession reduction (RecRed), clinical attachment gain (CALgain), keratinized tissue gain (KTgain), and complete root coverage (CRC). Results Twenty-nine studies met the inclusion criteria, 20 of which were classified as at high risk of bias. The CAF+connective tissue graft (CTG) combination ranked highest in effectiveness for RecRed (Probability of being the best = 40%) and CALgain (Pr = 33%); CAF+enamel matrix derivative (EMD) was slightly better for CRC; CAF+Collagen Matrix (CM) appeared effective for KTgain (Pr = 69%). Network inconsistency was low for all outcomes excluding CALgain. Conclusion CAF+CTG might be considered the gold standard in root coverage procedures. The low amount of inconsistency gives support to the reliability of the present findings.

Biologic width dimensions – a systematic review

Abstract: BACKGROUND: Consideration of the biologic width in restorative dentistry seems to be important for maintaining periodontal health. OBJECTIVE: To evaluate the dimensions of the biologic width in humans. MATERIALS AND METHODS: A systematic literature search was performed for publications published by 28 September 2012 using five different electronic databases; this search was complemented by a manual search. Two reviewers conducted the study selection, data collection, and validity assessment. The PRISMA criteria were applied. From 615 titles identified by the search strategy, 14 publications were included and six were suitable for meta-analyses. RESULTS: Included studies were published from the years 1924 to 2012. They differed with regard to measurements of the biologic width. Mean values of the biologic width obtained from two meta-analyses ranged from 2.15 to 2.30 mm, but large intra- and inter-individual variances (subject sample range: 0.2 - 6.73 mm) were observed. The tooth type and site, the presence of a restoration and periodontal diseases/surgery affected the dimensions of the biologic width. Pronounced heterogeneity among studies regarding methods and outcome measures exists. CONCLUSIONS: No universal dimension of the biologic width appears to exist. Establishment of periodontal health is suggested prior to the assessment of the biologic width within reconstructive dentistry.

Salivary IL-1β and PGE2 as biomarkers of periodontal status, before and after periodontal treatment

Abstract: Aim Interleukin-1β (IL-1β) and prostaglandin E2 (PGE2) are key inflammatory mediators involved in periodontitis. The purpose was to compare their salivary concentrations in relation to periodontal status and their changes after periodontal treatment, to determine their use as non-invasive diagnostic tools. Materials and Methods In this study, 74 subjects grouped in periodontally healthy, mild, moderate and severe periodontitis, according to clinical attachment level (CAL) and probing pocket depth (PPD) served as participants. IL-1β and PGE2 were determined in unstimulated whole saliva by enzyme-linked-immunosorbent assay (ELISA). Results Interleukin -1β increased with the severity of periodontitis with a large effect size in prediction of CAL (η2 = 0.35, p = 0.0001). PGE2 showed an increment in mild periodontitis and another in moderate. A significant effect size was also found between PGE2 and PPD (η2 = 0.12, p = 0.003). Both mediators decreased after periodontal treatment. With a selected threshold of 212 pg/ml, salivary IL1-β predicted periodontitis with 78% sensitivity and 100% specificity. With a selected threshold of 121 pg/ml, salivary PGE2 predicted periodontitis with 78% sensitivity and 91% specificity. Conclusion The high sensitivity and specificity of salivary IL-1β and PGE2 in identifying periodontitis suggest a potential use as biomarkers for diagnosis of periodontitis presence and severity.