Showing papers in "Journal of Periodontology in 2007"
TL;DR: This classification defines severeperiodontitis and moderate periodontitis in terms of PD and CAL to enhance case definitions and further demonstrates the importance of thresholds ofPD and CAL and the number of affected sites when determining prevalence.
Abstract: Many definitions of periodontitis have been used in the literature for population-based studies, but there is no accepted standard. In early epidemiologic studies, the two major periodontal diseases, gingivitis and periodontitis, were combined and considered to be a continuum. National United States surveys were conducted in 1960 to 1962, 1971 to 1974, 1981, 1985 to 1986, 1988 to 1994, and 1999 to 2000. The case definitions and protocols used in the six national surveys reflect a continuing evolution and improvement over time. Generally, the clinical diagnosis of periodontitis is based on measures of probing depth (PD), clinical attachment level (CAL), the radiographic pattern and extent of alveolar bone loss, gingival inflammation measured as bleeding on probing, or a combination of these measures. Several other patient characteristics are considered, and several factors, such as age, can affect measurements of PD and CAL. Accuracy and reproducibility of measurements of PD and CAL are important because case definitions for periodontitis are based largely on either or both measurements, and relatively small changes in these values can result in large changes in disease prevalence. The classification currently accepted by the American Academy of Periodontology (AAP) was devised by the 1999 International Workshop for a Classification of Periodontal Diseases and Conditions. However, in 2003 the Centers for Disease Control and Prevention and the AAP appointed a working group to develop further standardized clinical case definitions for population-based studies of periodontitis. This classification defines severe periodontitis and moderate periodontitis in terms of PD and CAL to enhance case definitions and further demonstrates the importance of thresholds of PD and CAL and the number of affected sites when determining prevalence.
1,135 citations
TL;DR: The techniques for reconstruction of bony defects that are reviewed in this paper include the use of particulate bone grafts and bone graft substitutes, barrier membranes for guided bone regeneration, autogenous and allogenic block grafts, and the application of distraction osteogenesis.
Abstract: Background: The advent of osseointegration and advances in biomaterials and techniques have contributed to increased application of dental implants in the restoration of partial and completely edentulous patients. Often, in these patients, soft and hard tissue defects result from a variety of causes, such as infection, trauma, and tooth loss. These create an anatomically less favorable foundation for ideal implant placement. For prosthetic-driven dental implant therapy, reconstruction of the alveolar bone through a variety of regenerative surgical procedures has become predictable; it may be necessary prior to implant placement or simultaneously at the time of implant surgery to provide a restoration with a good long-term prognosis. Regenerative procedures are used for socket preservation, sinus augmentation, and horizontal and vertical ridge augmentation.Methods: A broad overview of the published findings in the English literature related to various bone augmentation techniques is outlined. A comprehensi...
648 citations
TL;DR: PRP is a rich source of growth factors and promoted significant changes in monocyte-mediated proinflammatory cytokine/chemokine release and lipoxin A(4) (LXA(4)) generation, suggesting that PRP may suppress cytokine release, limit inflammation, and, thereby, promote tissue regeneration.
Abstract: Background: Platelet-rich plasma (PRP) promotes regeneration of bone, presumably through the action of concentrated growth factors. However, it is not clear how PRP affects the inflammatory response. The purpose of this study was to analyze the growth factors in PRP and to study the effects of PRP on monocyte cytokine release and lipoxin A4 (LXA4) generation.Methods: PRP was prepared from healthy donors. Platelet-derived growth factor (PDGF)-AB, PDGF-BB, transforming growth factor-β1, insulin-like growth factor-I, fibroblast growth factor-basic (FGF-b), epidermal growth factor (EGF), vascular endothelial growth factor, interleukin-12 (p40/70), and regulated on activation, normal T-cell expressed and secreted (RANTES) levels were evaluated by enzyme-linked immunosorbent assay and bead-based multiplexing. Peripheral blood monocytes were isolated and cultured with or without PRP. Cytokine, chemokine, and LXA4 levels as well as monocyte chemotactic migration were analyzed.Results: Growth factors were increase...
449 citations
TL;DR: periodontal disease with elevated bacterial exposure is associated with CHD events and early atherogenesis (CIMT), suggesting that the level of systemic bacterial exposure from periodontitis is the biologically pertinent exposure with regard to atherosclerotic risk.
Abstract: Background: Recent meta-analyses reported a weak association between periodontal disease (PD) on clinical examination and cardiovascular disease (CVD). Systemic bacterial exposure from periodontitis, which correlates poorly with the clinical examination, has been proposed as the more biologically pertinent risk factor. The purpose of this study was to review and analyze the association between PD with elevated systemic bacterial exposure and CVD. Methods: We searched in the PubMed, Cochrane Controlled Trials Register, EMBASE, and SCOPUS databases for all literature examining PD and CVD. From 10 selected publications, we extracted 12 cohort (N = 5) and cross-sectional (N = 7) studies and included 11 of these in a meta-analysis. With stratified analyses, this resulted in 14 analyses of coronary heart disease (CHD; N = 7), stroke (N = 4), and carotid intima-medial thickening (CIMT; N = 3) as a measure of early atherosclerosis. Systemic bacterial exposure was measured by periodontal bacterial burden (N = 1), periodontitis-specific serology (N = 12), or C-reactive protein (N = 1). Results: Periodontal disease with elevated markers of systemic bacterial exposure was associated strongly with CHD compared to subjects without PD, with a summary odds ratio of 1.75 (95% confidence interval (CI): 1.32 to 2.34; P < 0.001). This group was not associated with CVD events or with stroke but was associated with a significant increase in mean CIMT (0.03 mm; 95% CI: 0.02 to 0.04). Conclusion: Periodontal disease with elevated bacterial exposure is associated with CHD events and early atherogenesis (CIMT), suggesting that the level of systemic bacterial exposure from periodontitis is the biologically pertinent exposure with regard to atherosclerotic risk. J Periodontol 2007;78:2289-2302.
306 citations
TL;DR: Within the limitations of this systematic review, the majority of studies showed a positive relationship between stress/psychological factors and periodontal disease, however, in the future, well-designed and more representative studies should be considered to confirm these factors as a risk for periodonta disease.
Abstract: Background Clinical observations and epidemiologic studies suggest that some negative life events and psychological factors may contribute to an increased susceptibility to periodontal disease. The aim of the present study was to systematically review the evidence from case-control studies, cross-sectional studies, and prospective clinical trials reporting on the influence of stress and psychological factors on periodontal disease. The focused question addressed in this systematic review was whether the scientific evidence is enough to consider stress and psychological factors as risk factors for periodontal disease. Methods A literature search was conducted using two databases (MEDLINE and the Cochrane Oral Health Group specialist trials register) in addition to searching reference lists of original and review articles. The search strategy used was the combination of the terms: "stress," "periodontal disease," and "psychosocial disorders." Studies were selected if they were published in dental journals between January 1, 1990 and April 1, 2006; only human studies and studies with adults and middle-aged subjects were included. Suitable variables included control for the potential effect of confounding factors, adequate criteria to define periodontal disease, adequate criteria for establishing stress, and methodologic quality. Only English-language articles were considered, and unpublished data were not sought. Two reviewers independently extracted information regarding quality and study characteristics in duplicate. The studies were assessed regarding their methodologic characteristics, statistical analysis, characteristics of the periodontal outcome measures, and psychological measurements. Results Of the 58 articles identified in the search, 10 were excluded because they were reviews and 34 did not comply with the selection criteria. Fourteen articles (seven case-control studies, six cross-sectional studies, and one prospective clinical trial) were included in the analysis; their quality and main study characteristics were assessed according to the criteria preestablished in the protocol of the study. With regard to the results of the studies, 57.1% found a positive outcome between psychosocial factors/stress and periodontal disease, 28.5% observed a positive outcome for some characteristics and a negative outcome for others, and 14.2% found a negative outcome. Conclusions Within the limitations of this systematic review, the majority of studies showed a positive relationship between stress/psychological factors and periodontal disease. However, in the future, well-designed and more representative studies should be considered to confirm these factors as a risk for periodontal disease.
253 citations
TL;DR: New BGI classifications create categories with distinct biologic phenotypes based upon DNA checkerboard analyses of eight plaque bacteria, serum immunoglobulin G (IgG) titers to 17 bacteria, and the gingival crevicular fluid levels of 16 inflammatory mediators.
Abstract: Background: A molecular epidemiologic study provided the opportunity to characterize the biology of the biofilm–gingival interface (BGI) in 6,768 community-dwelling subjects.Methods: Disease classifications and multivariable models were developed using clinical, microbial, inflammatory, and host-response data. The purpose was to identify new clinical categories that represented distinct biologic phenotypes based upon DNA checkerboard analyses of eight plaque bacteria, serum immunoglobulin G (IgG) titers to 17 bacteria, and the gingival crevicular fluid (GCF) levels of 16 inflammatory mediators. Five BGI clinical conditions were defined using probing depths (PDs) and bleeding on probing (BOP) scores. Subjects with all PDs ≤3 mm were grouped as BGI-healthy (14.3% of sample) or BGI-gingivitis (BGI-G, 15.1%). Subjects with one or more PDs ≥4 mm [deep lesion (DL)] were divided into low BOP (18.0%), moderate BOP (BGI-DL/MB, 39.7%), and severe BOP (BGI-DL/SB, 12.9%).Results: Subjects with BGI-G had increased lev...
247 citations
TL;DR: Radiologic and clinical indicators of periodontal destruction were increased in individuals with poorly controlled type 2 diabetes mellitus and low SES aggravated theperiodontal condition in Individuals with T2D.
Abstract: Background: The association among periodontal conditions, socioeconomic status (SES), and diabetes has been reported. However, there is a lack of published data comparing periodontal conditions among individuals with poorly controlled type 2 diabetes mellitus (T2D). The aim of the present study was to compare the periodontal conditions and SES between subjects with T2D and non-diabetic controls.Methods: A total of 75 (31 males and 44 females) individuals with T2D (62 poorly controlled and 13 well-controlled) and 99 non-diabetic patients (healthy controls; 51 males and 48 females) participated in the study. Plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were investigated. Random blood glucose level was recorded. Premolar and molar marginal bone loss (MBL) was measured digitally on scanned orthopantomograms.Results: Individuals with poorly controlled T2D had increased MBL in molars and maxillary premolars (P <0.05) compared to individuals with well-controlled T2D. PI, BOP, and PD of 4 ...
242 citations
TL;DR: P PDT and SRP showed similar clinical results in the non-surgical treatment of aggressive periodontitis, and plaque scores were reduced and remained low throughout the study.
Abstract: Background: The treatment of aggressive periodontitis has always presented a challenge for clinicians, but there are no established protocols and guidelines for the efficient control of the disease.Methods: Ten patients with a clinical diagnosis of aggressive periodontitis were treated in a split-mouth design study to either photodynamic therapy (PDT) using a laser source with a wavelength of 690 nm associated with a phenothiazine photosensitizer or scaling and root planing (SRP) with hand instruments. Clinical assessment of plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and relative clinical attachment level (RCAL) were made at baseline and 3 months after treatment with an automated periodontal probe.Results: Initially, the PI was 1.0 ± 0.5 in both groups. At the 3-month evaluation, the plaque scores were reduced and remained low throughout the study. A significant reduction of GI and BOP occurred in both groups after 3 months (P <0.05). Th...
204 citations
TL;DR: The significant presence of periopathogenic microorganisms or their products in human placentas of women with preeclampsia may suggest a possible contribution of perypathogenic bacteria to the pathogenesis of this syndrome.
Abstract: Background: Periodontal disease is a chronic inflammatory infectious disease that may act as a focus of infection. Preeclampsia is a pregnancy-specific hypertensive disorder that often leads to maternal morbidity and mortality. Acute atherosis, the placental lesion of preeclampsia, shares many histopathological features with atherosclerosis. Recently, chronic infection was linked to the initiation of atherosclerosis. Oral pathogens have been detected in atherosclerotic plaques, where they may play a role in the development and progression of atherosclerosis. The purpose of the present study was to explore the possibility that periopathogenic bacteria may translocate into the placental tissues of women with preeclampsia.Methods: Samples were taken from 16 placentas obtained from cesarean sections of women with preeclampsia and from 14 age-matched healthy pregnant women. Polymerase chain reaction was used to detect Actinobacillus actinomycetemcomitans, Fusobacterium nucleatum ssp., Porphyromonas gingivalis,...
198 citations
TL;DR: Piezoelectric bone surgery appears to be more efficient in the first phases of bone healing; it induced an earlier increase in BMPs, controlled the inflammatory process better, and stimulated bone remodeling as early as 56 days post-treatment.
Abstract: Background: Most dental implants are positioned using a drilling surgery technique. However, dentistry recently experienced the implementation of piezoelectric surgery. This technique was introduced to overcome some of the limitations involving rotating instruments in bone surgery. This study used biomolecular and histologic analyses to compare the osseointegration of porous implants positioned using traditional drills versus the piezoelectric bone surgery technique.Methods: Porous titanium implants were inserted into minipig tibias. Histomorphology and levels of bone morphogenetic protein (BMP)-4, transforming growth factor (TGF)-β2, tumor necrosis factor-alpha, and interleukin-1β and -10 were evaluated in the peri-implant osseous samples.Results: Histomorphological analyses demonstrated that more inflammatory cells were present in samples from drilled sites. Also, neo-osteogenesis was consistently more active in bone samples from the implant sites that were prepared using piezoelectric bone surgery. Mor...
198 citations
TL;DR: The presence of microbial invasion of the amniotic cavity by P. gingivalis could indicate a role for periodontal pathogenic bacteria in pregnant women with a diagnosis of threatened premature labor.
Abstract: Background: Epidemiologic and randomized controlled studies have shown that periodontal diseases may be associated with preterm labor and delivery of infants with low birth weights. The purpose of the present study was to determine the presence of microbial invasion of the amniotic cavity by periodontopathic bacteria in pregnant women with a diagnosis of threatened premature labor.Methods: A periodontal examination and collection of amniotic fluid and subgingival plaque samples were performed on women identified as having threatened premature labor (preterm premature rupture of membranes without clinical infection or labor and preterm labor with intact membranes) and a gestational age ranging between 24 and 34 weeks. Samples collected from amniotic fluid and from the four deepest periodontal pockets in each patient were pooled in prereduced transport fluid and cultured. Porphyromonas gingivalis was identified primarily by colony morphology under stereoscopic microscope and rapid biochemical tests. Amnioti...
TL;DR: It may be concluded that soft and hard tissue integration was influenced mainly by surface hydrophilicity rather than by microtopography.
Abstract: Background: The aim of the present study was to investigate the effects of surface hydrophilicity and microtopography on soft and hard tissue integration at non-submerged titanium implants.Methods: Implantation of conventional sand-blasted large grit and acid-etched (SLA) and chemically modified SLA (modSLA) titanium implants with differently structured transmucosal surfaces (SLA implants: machined [M-SLA] or SLA [SLA-SLA]; modSLA implants: mod acid-etched [modA] [modA-modSLA] or modSLA [modSLA-modSLA]) was performed bilaterally in the upper and lower jaws of 15 beagle dogs. The animals were sacrificed after 1, 4, 7, 14, or 28 days. Tissue reactions were assessed histomorphometrically and immunohistochemically using monoclonal antibodies to transglutaminase II (angiogenesis) and osteocalcin.Results: Although the junctional epithelium commonly was separated from M-SLA and SLA-SLA implants by a gap, the epithelial cells appeared to be in close contact with modA-modSLA surfaces after 14 days of healing. More...
TL;DR: The buccal plate of the dentate maxilla and mandible ranged from 1.6 to 2.2 mm in thickness, with the thinnest area in the lower anterior region and the thickest Area in the upper posterior region.
Abstract: Background: A critical component of treatment planning in dental implant therapy is the amount of available bone. Thick cortical plates have been the primary way to achieve primary implant stability. However, information about cortical bone thickness in various regions of the maxilla and mandible is largely missing. Hence, it was the purpose of this cadaver study to determine an average cortical bone thickness in different tooth locations. Methods: To determine the average thickness of buccal and lingual plates, 28 cadaver heads (68% male and 32% female) with an average age of 73.1 years were measured at various locations correlating to molar (M), premolar (PM), and anterior (A) regions. Edentulous and dentate regions also were recorded. Results: Average buccal cortical thicknesses were 1.69 mm (M), 1.43 mm (PM), and 1.04 mm (A) in the edentulous maxilla; 2.06 mm (M), 1.78 mm (PM), and 1.36 mm (A) in the edentulous mandible; 2.23 mm (M), 1.62 mm (PM), and 1.59 mm (A) in the dentate maxilla; and 1.98 mm (M), 1.20 mm (PM), and 0.99 mm (A) in the dentate mandible. Average lingual cortical thicknesses were 2.06 mm (M), 1.60 mm (PM), and 1.36 mm (A) in the edentulous maxilla; 2.39 mm (M), 1.88 mm (PM), and 1.66 mm (A) in the edentulous mandible; 2.35 mm (M), 2.0 mm (PM), and 1.95 mm (A) in the dentate maxilla; and 2.51 mm (M), 1.92 mm (PM), and 1.24 mm (A) in the dentate mandible. Conclusions: The average cortical thickness of the buccal plates ranged from 1.0 to 2.1 mm in the edentulous maxilla and mandible, with the thinnest area in the anterior maxilla and the thickest area in the posterior mandible. The buccal plate of the dentate maxilla and mandible ranged from 1.6 to 2.2 mm in thickness, with the thinnest area in the lower anterior region and the thickest area in the upper posterior region.
TL;DR: The developed methods allow for highly accurate and reproducible static measurements of tooth-supporting alveolar bone following preclinical situations of bone destruction or regeneration, suggesting that 3-D measurements may provide better alveolars bone analysis than conventional 2-D methods.
Abstract: Background: Micro-computed tomography (micro-CT) offers significant potential for identifying mineralized structures. However, three-dimensional (3-D) micro-CT of alveolar bone has not been adapted readily for quantification. Moreover, conventional methods are not highly sensitive for analyzing bone loss or bone gain following periodontal disease or reconstructive therapy. The objective of this investigation was to develop a micro-CT methodology for quantifying tooth-supporting alveolar bone in 3-D following experimental preclinical situations of periodontitis or reconstructive therapy.Methods: Experimental in vivo bone loss or regeneration situations were developed to validate the micro-CT imaging techniques. Twenty mature Sprague-Dawley rats were divided into two groups: bone loss (Porphyromonas gingivalis lipopolysaccharide-mediated bone resorption) and regenerative therapy. Micro-CT and software digitized specimens were reconstructed three-dimensionally for linear and volumetric parameter assessment o...
TL;DR: Systemic delivery of OPG-Fc inhibits alveolar bone resorption in experimental periodontitis, suggesting that RANKL inhibition may represent an important therapeutic strategy for the prevention of progressive alveolars bone loss.
Abstract: Background: Prevention of alveolar bone destruction is a clinical challenge in periodontal disease treatment. The receptor activator of nuclear factor-kappa B ligand (RANKL) inhibitor osteoprotegerin (OPG) inhibits osteoclastogenesis and suppresses bone resorption.Methods: To study the effects of RANKL inhibition on alveolar bone loss, an experimental ligature-induced model of periodontitis was used. A total of 32 rats were administered human OPG-Fc fusion protein (10 mg/kg) or vehicle by subcutaneous delivery twice weekly for 6 weeks. Negative or positive controls received no treatment or disease through vehicle delivery, respectively. Biopsies were harvested after 3 and 6 weeks, and mandibulae were evaluated by microcomputed tomography (μCT) and histology. Serum levels of human OPG-Fc and tartrate-resistant acid phosphatase-5b (TRAP-5b) were measured throughout the study by enzyme-linked immunosorbent assay (ELISA). Statistical analyses included analysis of variance (ANOVA) and Tukey tests.Results: Huma...
TL;DR: Both devices confirmed the initial decreases in implant stability that occur following placement and identified an increase in stability during the first 6 weeks of functional loading.
Abstract: Background: Resonance frequency analysis (RFA) provides a non-invasive assessment of implant stability. The established RFA device uses electronic technology, whereas a recently developed device uses magnetic technology. The goal of this clinical trial was to evaluate the ability of the magnetic RFA device to detect changes in stability during early healing following implant placement and to determine whether the implant stability quatient (ISQ) values obtained correlated with those made with the electronic device.Methods: RFA assessments were performed using electronic- and magnetic-based devices on 34 non-submerged titanium dental implants in 17 patients. Each patient received two implants in the posterior maxilla or mandible. Implant stability was measured at placement and weekly until week 6, when implants received provisional crowns, and at 12 weeks, when definitive crowns were cemented. During each visit, measurements were taken three times and averaged to obtain a single representative ISQ for each...
TL;DR: When used as an adjunct to unsupervised oral hygiene, EO provides an additional benefit with regard to plaque and gingivitis reduction as compared to a placebo or control.
Abstract: Background: The purpose of this study was to review the literature on the effects of a mouthrinse containing essential oils (EO) on plaque and parameters of gingival inflammation.Methods: The MEDLINE and Cochrane Central Register of Controlled Trials were searched up to and including December 2006 to identify appropriate studies. The primary outcome measure was gingivitis. Secondary parameters were plaque and, when reported, staining.Results: Independent screening of titles and abstracts of 566 papers resulted in 11 publications that met the criteria of eligibility. In all studies, EO was used as an adjunct to regular daily toothbrushing. A statistically significant reduction in overall gingivitis was noted compared to the control (weighted mean difference [WMD]: −0.32, 95% confidence interval [CI]: −0.46 to −0.19, P <0.00001; test for heterogeneity: P <0.00001, I2 = 96.7%). For interproximal sites the use of the test mouthrinse resulted in significantly more gingivitis reduction compared to control mouth...
TL;DR: The tissue pattern appeared composed by residual ABB particles in close contact to the newly formed bone after 9 years, demonstrating both a high level of osteoconductivity and a "biomimetic" behavior over the long term.
Abstract: Background: Anorganic bovine bone (ABB) has been shown to have osteoconductive properties and no inflammatory or adverse responses as grafting materials used in sinus augmentation procedures. Despite these successful results, histologic data in humans over the long-term period are scarce. The purpose of this study was to analyze the histomorphometric data 9 years after surgery in a case of maxillary sinus augmentation using ABB. Methods: The histologic evaluation was performed in five different thin sections of the specimen, comparing histomorphometric measures for newly formed bone, marrow spaces, biomaterial particles remnants, and number of osteocytes embedded in both trabecular bone and bone tissue near the ABB. The investigation was carried out by means of scanning electron microscopy and brightfield and circularly polarized light microscopy. Results: We observed a mean amount of newly formed bone of 46.0% – 4.67%, ABB remnants of 16.0% – 5.89%, and marrow spaces of 38.0% – 8.93%. The osteocyte index was 4.43 for bone around ABB and 3.27 in the trabecular bone at a distance from the particles. Conclusions: After 9 years, the tissue pattern appeared composed by residual ABB particles in close contact to the newly formed bone. The bone mineralized matrix around the ABB had collagen fibers randomly oriented and more osteocytes embedded. The results demonstrate both a high level of osteoconductivity and a ‘‘biomimetic’’ behavior over the long term. J Periodontol 2007;78:955-961.
TL;DR: After 2 months of healing, comparison of the BIC values showed a statistically significant greater mean BIC for test SEIs than for controls, which included shortening of the implant healing period and earlier loading protocols.
Abstract: Background: Placement of dental implants in the posterior maxilla has been associated with higher rates of failure that are due, in part, to the poor bone quality of this region. The purpose of the present study was the histologic and histomorphometric evaluation of the bone around a new implant surface treatment created by a deposition of nanometer-sized calcium phosphate particles added to the dual acid-etched surface.Methods: One custom-made 2 × 10-mm site evaluation implant (SEI) with this novel treatment surface (test) and one SEI with the dual acid-etched surface without treatment (control) were placed in the posterior maxilla of 15 patients. All SEIs were retrieved after 2 months and evaluated under confocal laser scanning microscopy (CLSM) and by light microscopy for histomorphometric analysis of the bone–implant contact (BIC).Results: Histologic observations in control SEIs showed formation of new bone around the implant surface; however, it was not always in direct contact with the entire perime...
TL;DR: Therapeutics that antagonize inflammatory cytokines are used therapeutically to downregulate immune-mediated pathology in conditions such as RA and may have broader implications for individuals with systemic diseases in which inflammation and autoimmunity predominate.
Abstract: Chronic diseases, such as periodontal disease (PD) and rheumatoid arthritis (RA), are characterized by a robust immune response resulting in unresolved inflammation. Inflammation is mediated by proinflammatory cytokines; recently, a novel subset of T-helper (Th) cells was identified that plays a crucial role in inflammation and autoimmune disease. This population secretes several proinflammatory cytokines, including the novel cytokine interleukin (IL)-17, and, hence, has been termed "Th17." Inflammatory cytokines are implicated in the progression of localized chronic infections, such as PD, and in serious systemic pathologies, such as diabetes, chronic obstructive pulmonary disease, and cardiovascular disease. IL-17 mediates inflammation through a receptor (IL-17R) composed of two subunits, IL-17RA and IL-17RC. Drugs that antagonize inflammatory cytokines are used therapeutically to downregulate immune-mediated pathology in conditions such as RA, although not all patients respond well to this approach. Therefore, identification of potential novel therapeutic targets, such as the IL-17 signaling complex, may be clinically relevant for mitigating inflammatory pathology. However, the manner in which such a therapeutic may influence the onset and progression of PD is poorly understood. Therapeutics that antagonize inflammatory cytokines ameliorate inflammation and bone loss and may have broader implications for individuals with systemic diseases in which inflammation and autoimmunity predominate.
TL;DR: The absence of putative pathogenic bacteria in internal mammary arteries, and their presence in a high percentage of atherosclerotic coronary arteries support the concept that periodontal organisms are associated with the development and progression of Atherosclerosis.
Abstract: Background: Chronic infections, such as periodontitis, have been associated with an increased risk for atherosclerosis and coronary artery disease. The aim of this study was to investigate biopsy samples of coronary and internal mammary arteries for the presence of putative pathogenic bacteria (Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Prevotella intermedia, and Tannerella forsythensis), Chlamydia pneumoniae, and human cytomegalovirus (CMV).Methods: Patients with a diagnosis of coronary artery disease were included in the study. Fifteen coronary arteries with atherosclerosis and 15 internal mammary arteries without clinically assessable atherosclerotic degeneration were investigated. Both groups of specimens were obtained during coronary artery bypass grafting surgery. In all cases, the coronary and mammary artery specimens were taken from the same patient. The detection of periodontal pathogens, C. pneumoniae, and CMV was done by polymerase chain reaction analysis.Results: Bacterial...
TL;DR: Non-surgical periodontal therapy can reduce the risk for preterm births in mothers who are affected by periodontitis, and a multiple regression model showed a significant effect ofperiodontal treatment on birth outcomes.
Abstract: Background: There is convincing evidence to suggest that infections affecting the mother during pregnancy may produce alterations in the normal cytokine- and hormone-regulated gestation, which could result in preterm labor, premature rupture of membranes, and preterm birth (PTB). Studies in the late 1990s associated periodontitis with preterm low birth weight (PLBW) deliveries, and this may have similar pathogenic mechanisms as other maternal infections. This study determined the effect of non-surgical periodontal therapy on pregnancy outcome.Methods: A total of 200 pregnant women with periodontitis were randomly assigned to treatment and control groups. Detailed data about previous and current pregnancies were obtained. All women received a full-mouth periodontal examination, including oral hygiene index-simplified, bleeding index, and clinical attachment level. The women in the treatment group received non-surgical periodontal therapy during the gestational period, and those in the control group receive...
TL;DR: This case suggests that patients under long-term oral bisphosphonate use should be treated with caution and well-controlled, prospective clinical trials on the effect of oral bisPhosphonates on bone are warranted to determine which patients may be at risk for such complications.
Abstract: Background: Bisphosphonates suppress osteoclast activity, and their intravenous use has been reported in hundreds of cases to be associated with osteonecrosis in the jaw. Little is known of the risks associated with long-term use of oral bisphosphonates despite their use for >10 years by an oral mode of delivery for the treatment of osteopenia, osteoporosis, and Paget's disease of bone. The purpose of this report is to review the literature associated with bisphosphonate use that could impact bone healing and to report a case of bone necrosis in a patient on long-term oral bisphosphonates.Methods: A Medline search was carried out to find relevant articles from both medical and dental literature between 1960 and 2006. A patient, who had been taking an oral bisphosphonate for >10 years, developed unexplained clinical signs of bone necrosis after routine dental implant placement. This case was followed, documented, and the treatment of the osteonecrosis described.Results: A summary of how bisphosphonates may...
TL;DR: A history of oral bisphosphonate use for a mean period of 3.3 years was not found to be a contributing factor to the development of osteonecrosis following implant placement in intact ridges or tooth extraction with immediate implant placement.
Abstract: Background: The development of bisphosphonate-associated osteonecrosis in patients with a history of intravenous bisphosphonate therapy is a significant cause of concern in clinical periodontal practice. The role of oral bisphosphonates in the development of bisphosphonate-associated osteonecrosis is less clear. This article documents the results of treatment of patients with a history of oral bisphosphonate therapy in two private periodontal practices. The study was a retrospective analysis of case records of patients treated as part of routine periodontal and implant treatment.Methods: Patients with a history of oral bisphosphonate therapy of various durations were treated with implant placement and restoration or tooth extraction, immediate placement, and restoration. These patients were followed for 12 to 24 months after implant placement. The incidence of hard and soft tissue complications, including the development of osteonecrosis, was noted.Results: No osteonecrosis was noted immediately postopera...
TL;DR: The purpose of this report is to review relevant literature and propose a new periodontal prognostication system that is influenced by more evidence-based factors and may be more useful for patient management.
Abstract: Prognosis is an integral part of the periodontal practice because it directly influences treatment planning. However, there is limited direct evidence in the literature regarding the assignment of periodontal prognosis. There are several important concepts to consider in developing a system of periodontal prognosis. Traditional systems are based on tooth loss and may have limited use for patient management. On the other hand, prognosis can be based on stability of the periodontal supporting apparatus, which is influenced by more evidence-based factors and may be more useful for patient management. Other important concepts include the timing of the projection (short and long term) and the consideration of individual teeth versus the overall dentition. Historically, several authors have formulated and investigated their own prognostication systems. Results were variable, but they generally showed that systems based on tooth loss were unpredictable over the long term. Therefore, the purpose of this report is to review relevant literature and propose a new periodontal prognostication system.
TL;DR: The results demonstrated that IL-1beta, -6, and -8 and TNF-alpha play a significant role during the early stage of tooth movement but not during the linear stage, and the periodontal system stabilizes at a new physiological homeostasis as indicated by the downregulation of the early-phase PICs.
Abstract: Background: Orthodontic treatment induces a distortion of the extracellular matrix of the periodontium, resulting in alterations in cytoskeletal configuration. Cytokines are known to facilitate this process by inducing cellular proliferation, differentiation, and stimulation of periodontal remodeling. The aim of the present study was to measure a panel of proinflammatory cytokines (PICs) in crevicular fluid (GCF) samples during tooth movement of short and long durations.Methods: Twelve patients (11 to 27 years of age) participated in this study: six patients each for tooth movement of short and long duration. GCF sampling was done at different times, ranging from 24 hours to 4 months after force application. The profiles of PICs were analyzed with a multiplex technique.Results: PICs were elevated significantly in the early stage of tooth movement but at different time points. Interleukin (IL)-1β and -6 and tumor necrosis factor-alpha (TNF-α) reached significant levels at 24 hours; IL-8 reached a significa...
TL;DR: Rapid detection and quantification of periodontal pathogens in mouthwash samples are possible by real-time PCR, which is significantly less time-consuming than subgingival sampling with paper points.
Abstract: Background: Saliva has been studied for the presence of subgingival pathogens in periodontitis patients. With the anaerobic culture technique, the discrepancy between salivary recovery and subgingival presence has been significant, which makes this approach not suitable for practical use in the microbial diagnosis of periodontitis patients. The real-time polymerase chain reaction (PCR) technique represents a very sensitive technique to detect and quantify bacterial pathogens. The aim of the study was to compare the presence and numbers of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythensis, Prevotella intermedia, and Micromonas micros in subgingival plaque and mouthwash samples by the anaerobic culture and real-time PCR techniques. Methods: Pooled subgingival plaque samples and 10-ml mouthwash samples were collected from 21 adult patients with periodontitis and analyzed by quantitative anaerobic culture and real-time PCR for A. actinomycetemcomitans, P. gingivalis, T. forsythensis, P. intermedia, and M. micros. Results: The detection frequency of A. actinomycetemcomitans, P. gingivalis, and T. forsythensis in subgingival plaque was identical by culture and real-time PCR and was higher for P. intermedia and M. micros by real-time PCR. The highest detection frequencies for the target bacteria were found in mouthwash samples by real-time PCR. The additional value of the real-time PCR to detect target bacteria was 38% for P. gingivalis, 73% for T. forsythensis, 77% for P. intermedia, and 71% for M. micros. The sensitivity to detect target species in mouthwash by real-time PCR was 100% for all test species except for P. intermedia (93.8%). Conclusions: Rapid detection and quantification of periodontal pathogens in mouthwash samples are possible by real-time PCR. The procedure is significantly less time-consuming than subgingival sampling with paper points. This approach to detect major periodontal pathogens in mouthwash samples may simplify microbial diagnosis in periodontitis patients and may be used to monitor periodontal treatment.
TL;DR: Oral injections of LPS derived from the periodontal pathogen A. actinomycetemcomitans can induce severe alveolar bone loss and proinflammatory cytokine production in rats by 8 weeks.
Abstract: Background: Bacterial constituents, such as Gram-negative derived lipopolysaccharide (LPS), can initiate inflammatory bone loss through induction of host-derived inflammatory cytokines. The aim of this study was to establish a model of aggressive inflammatory alveolar bone loss in rats using LPS derived from the periodontal pathogen Actinobacillus actinomycetemcomitans.Methods: Eighteen female Sprague-Dawley rats were divided into LPS test (N = 12) and saline control (N = 6) groups. All animals received injections to the palatal molar gingiva three times per week for 8 weeks. At 8 weeks, linear and volumetric alveolar bone loss was measured by micro-computed tomography (μCT). The prevalence of inflammatory infiltrate, proinflammatory cytokines, and osteoclasts was assessed from hematoxylin and eosin, immunohistochemical, or tartrate-resistant acid phosphatase (TRAP)-stained sections. Statistical analysis was performed.Results: A. actinomycetemcomitans LPS induced severe bone loss over 8 weeks, whereas con...
TL;DR: The results suggested the possibility that the IL-23/IL-17 immune response was present within chronically inflamed gingiva and may be an important factor in the chronic nature of the disease.
Abstract: Background: The presence of interleukin (IL)-23 has not been reported within inflamed gingiva, so we evaluated its concentration within gingiva from normal sites and sites of chronic periodontal disease.Methods: Gingiva was obtained prior to extraction of teeth. It was grouped based on clinical attachment loss (CAL): 0 to 2 mm (normal-slight), 3 to 4 mm (moderate), and >5 mm (severe). Tissues were solubilized, and IL-12, -23, -6, -17, and -1β; interferon-gamma (IFN-γ); and tumor necrosis factor-alpha (TNF-α) concentrations were assessed by enzyme-linked immunosorbent assay. Data were compared by factorial analysis of variance, post hoc Tukey test, and Pearson correlation test. Groups were defined as significantly different when P <0.05.Results: The gingival concentrations of IL-23, -17, -1β, and -6 and IFN-γ were significantly greater at moderate CAL sites than at normal-slight CAL sites. Gingival concentrations of IL-23, -1β, -17, and -6 and TNF-α were significantly greater at severe CAL sites than at no...
TL;DR: These papers highlight activities of an independent periodontal disease surveillance workgroup convened by the Division of Oral Health (DOH), Centers for Disease Control and Prevention (CDC), in collaboration with the American Academy of Periodontology, to examine the feasibility of using self-reported measures for population-based surveillance of periodontic disease in the United States.
Abstract: This supplement contains papers presented at the 2006 International Association of Dental Research (IADR) symposium entitled “Development of Self-Reported Measures for Population-Based Surveillance of Periodontitis.” These papers highlight activities of an independent periodontal disease surveillance workgroup convened by the Division of Oral Health (DOH), Centers for Disease Control and Prevention (CDC), in collaboration with the American Academy of Periodontology, to examine the feasibility of using self-reported measures for population-based surveillance of periodontal disease in the United States. This workgroup was convened in 2003 as part of a CDC periodontal disease surveillance project.