Advanced Chronic Periodontitis Research Articles

Orthodontic treatment of a middle-aged patient with periodontally compromised dentition accompanied by pathologic tooth migration.

Orthodontic treatment in patients with periodontally compromised dentition often presents challenges, necessitating special considerations. This case report describes treatment of a 52-year-old female patient with advanced chronic periodontitis and pathologic tooth migration through an interdisciplinary orthodontic-periodontal approach. By integrating comprehensive periodontal treatment with strategic use of miniscrew-assisted rapid palatal expansion (MARPE) and careful consideration of the applied force systems, both functional and esthetic concerns were addressed without causing adverse periodontal side effects. This highlights the importance of thoughtful treatment planning and integration of periodontal care during orthodontic tooth movement in treating individuals with reduced periodontal health for successful and esthetically pleasing results.

MicroRNAs in Gingival Crevicular Fluid: An Observational Case-Control Study of Differential Expression in Periodontitis.

microRNAs (miRNAs) present in the gingival crevicular fluid (GCF) of patients with chronic periodontitis may serve as biomarkers of periodontal disease. The aim of this study was to perform a miRNA-sequencing study of all miRNAs present in GCF, comparing miRNA expression level profiles between advanced chronic periodontitis (CP) patients and healthy subjects (HS). GCF samples were collected from the single-rooted teeth of patients with severe CP (n = 11) and of HS (n = 12). miRNAs were isolated from GCF using an miRNeasy Serum/Plasma kit(Qiagen GmbH, Hilden, Germany). Reverse transcription polymerase chain reaction (qRT-PCR) was used to determine the expression levels of miRNA candidates involved in periodontal pathogenesis. Of all the sequenced miRNAs, miR-199, miR-146a, miR-30a, and miR-338 were identified as best representing the CP patient samples. The validation study identified miR-199 as the most powerful biomarker used to define periodontitis. Upon sequencing all known miRNAs in GCF for the first time, we uncovered several potential biomarkers to define periodontitis. Identifying miRNAS in the GCF using high-throughput approaches will clarify the role of these molecules in periodontitis and provide biomarkers with potential applications.

Comparative evaluation of the effectiveness of bioresorbable collagen membrane in combination with deproteinized bovine bone matrix xenograft (DBBM), and advanced platelet rich fibrin membrane in combination with deproteinized bovine bone matrix xenograft for periodontal regeneration

Introduction: Periodontitis is a chronic, multifactorial, inflammatory disease that leads to gradual loss of bone and periodontal attachment. Thus, periodontal surgery is required according to severity of diseases. The goal of periodontal reconstructive surgery is to regenerate soft and hard tissues destroyed during periodontal disease. Aim: To compare the effectiveness of bioresorbable collagen membrane in combination with Deproteinized Bovine Bone Matrix xenograft (group A); and Advanced Plasma rich fibrin(A-PRF) membrane in combination with Deproteinized Bovine Bone Matrix xenograft (group B) in the treatment of human infrabony defects. Methods: This randomised controlled trial will be carried out at the periodontics outpatient department. We will choose 24 patients with moderate to advanced chronic periodontitis who are otherwise systemically healthy. Infrabony defects will be treated by open flap debridement using bovine-derived xenograft and bioresorbable collagen membrane (group A) and open flap debridement using bovine-derived xenograft and A-PRF after the completion of first therapy (group B). At baseline and six months after undergoing periodontal surgery, probing pocket depth, clinical attachment level, radiographic bone fill, gingival recession, oral hygiene status, and gingival health will be measured. Expected results: It is suggested that Bioresorbable Collagen Membrane in combination with Deproteinized Bovine Bone Matrix xenograft will show better results as compared to Advanced Platelet Rich Fibrin Membrane with Deproteinized Bovine Bone Matrix Xenograft. Clinical trial registry of India (CTRI): REF/2023/05/066732. Protocol version: v1 (12/05/23)

Comparative analysis of the effect of 4MATRIX with and without PRF on regeneration of infrabony periodontal pockets

AimThe aim was to compare the effect in improvement of periodontal pocket depth (PPD) and clinical attachment level (CAL) between application of 4MATRIX and 4 MATRIX combined with PRF in advanced periodontal disease during follow-up of 6, 12 and 18 months. MethodsThirty patients of both genders aged 25–50 years were included. The patients were clinically and radiologically diagnosed with generalized advanced chronic periodontitis with the presence of periodontal pockets with a depth of ≥ 5 mm bilaterally in the upper jaw. Both sides were treated with a flap intervention in all patients. On one side a bone substitute 4MATRIX was applied, and the other side was treated with an application 4MATRIX and PRF. The clinical assessment and measurements were performed in four stages, immediately before the intervention, and then 6, 12 and 18 months after the intervention. PPD and CAL were determined in all four timepoints. ResultsPPD was the highest at zero time before the surgery for both groups and was 5.56 ± 0.28 mm. In the postoperative follow-up period, the PPD value decreased gradually with the lowest average value of 5.10 ± 0.18 mm after 18 months in Group I and 4.67 ± 0.13 mm in Group II (p < 0.001, respectively). Moreover, comparing the values of PPD at 6, 12 and 18 months after the surgery, a significant difference was found between the patients from the 4MATRIX vs 4MATRIX + PRF (p < 0.001 respectively). The postoperative follow-up period showed a decrease in CAL value with the lowest value after 18 months. A significant difference in CAL was found between the four measurement times (p < 0.001, respectively). The average level of CAL was the highest before surgical treatment in both groups. The intergroup analysis of CAL after 18 months in group I (4MATRIX) was 5.27 ± 0.17 mm and in group II 4.10 ± 0.14 mm (p < 0.001). ConclusionTreatment of adult patients with advanced chronic periodontitis with periodontal pockets of ≥ 5 mm bilaterally in the upper jaw using 4MATRIX and 4MATRIX + PRF showed improvement of PPD and lower CAL loss after 18 months of the treatment. In the group treated with 4MATRIX + PRF patients showed the highest improvement in PPD and CAL loss. The analysis of treatment with 4MATRIX and 4MATRIX + PRF showed the lowest values after 18 months of the treatment.

Severe chronic periodontitis is not common in Acromegaly: Potential protective role of gingival BMP-2

Background/aimAdvanced chronic periodontitis is observed rarely in acromegaly. Periodontal tissue including the alveolar bone is seemed to be spared from the systemic metabolic derangements of bone in this patient population. Chronic elevation of growth hormone, IGF-1, and bone morphogenetic proteins may play a role in periodontal tissue regeneration in acromegalics. In this study, we aimed to evaluate the potential roles of local gingival bone morphogenetic proteins (BMP) in periodontal tissue pathology in acromegaly.Materials and methodsThirty-five patients with acromegaly and 22 healthy subjects were recruited. All the participants were examined by the same periodontologist for the diagnosis of periodontal diseases. BMP-2 and -4 were studied in gingival crevicular fluid.ResultsGingival BMP-2 and BMP-4 levels were similar in acromegaly and control groups in general, with and without chronic periodontitis. For all the participants, gingival BMP-2 levels were statistically lower in those participants with chronic periodontitis then those without periodontitis (29.4 ± 11.2 vs. 41.2 ± 23.2, respectively, p = 0.027). Causal relation between the gingival BMP levels and periodontal tissue health status was tested with one way ANOVA which revealed a significant difference between gingival BMP-2 levels in those with different degrees of periodontal tissue pathology (p = 0.025). When analyzed separately, gingival BMP-2 levels revealed a causal relation with the degree of periodontal pathology with borderline significance only in patients with acromegaly (p = 0.057).ConclusionAcromegaly is a disease with an unexpectedly low frequency of advanced periodontitis, irrespective of the long disease duration and pathognomonic oral manifestations. BMP-2 might have a protective role against chronic advanced periodontitis in these patients.

Influence of Chronic Periodontitis on the Long-Term Mortality and Cardiovascular Events in Kidney Transplant Recipients.

Chronic periodontitis (CP) is associated with cardiovascular disease and mortality in different populations. The aim of this study was to examine an association of CP with hard endpoints in patients after kidney transplantation during a 15-year follow-up period. Study group consist of 117 patients (77M/40F, median age 44 years) divided into two subgroups: those with initially advanced CP (CPITN 3–4) and those with no or moderate CP (CPITN 0–2). All cardiovascular events, graft losses, and re-transplantations were recorded. All deaths were noted and verified, including those occurred after the return to dialysis therapy, the causes of death were identified. Cox regression with Firth’s penalized maximum likelihood models were used for data analysis. During the observation period, 49 deaths occurred. Advanced CP (n = 35) was not associated with overall mortality but was associated with increased risk of death with functioning graft (DWFG) [HR 3.54 (1.20–10.45); p < 0.05]. Risk of graft loss was not associated with CP status. In conclusion, an advanced CP was independently associated with increased risk of DWFG, but not all-cause or cardiovascular mortality after renal transplantation.

“Prevalence and distribution of bone defects associated with moderate and severe periodontitis patients”

AimAs periodontal disease is major public dental health problem and knowledge of the osseous defects is useful to arrive at diagnosis, to assess prognosis and to plan the treatment. The purpose of this study was to analyze the prevalence and distribution of different forms of bone defects in Indian population. Material and methodsThe study population comprised of forty four patients with moderate to advanced chronic periodontitis. A total sample of 1041 teeth were explored surgically and classified as the primary level of classification system made for the study. ResultsAmong 1010 defects the prevalence of bone defects was 97%. Mandibular posteriors had highest occurrence of craters, they accounted for half of the total craters in the present study population. Majority of other bone defects were found in posterior segments than the anterior segments. Grade IV furcation involvement was not present for the present study sample. ConclusionThe present study supports the contention that the form of alveolar bone defects reflects the original morphology of the alveolar bone.

Gingival crevicular fluid levels of visfatin in patients with chronic periodontitis and polycystic ovary syndrome.

ObjectiveRecently, the association between periodontal diseases and polycystic ovary syndrome (PCOS) has been established, and it has been revealed that visfatin levels increase in chronic periodontitis (CP) and PCOS. However, there was no study comparing the mean visfatin levels between advanced CP and PCOS. Therefore, the probable role of visfatin linking these diseases remains unknown, and this study was conducted to address this gap.MethodsIn this age- and weight-matched case-control study (cases with PCOS disease and controls without it), 110 female participants were divided into 4 groups based on clinical findings. The 1st group participants had both PCOS and advanced CP (n=30), 2nd group participants had only PCOS (n=25), 3rd group participants had only advanced CP (n=23), and 4th group comprised of healthy participants (n=32). Enzyme-linked immunosorbent assay was used to investigate visfatin levels in the gingival crevicular fluid (GCF). Data were collected and analyzed using Stata software (version 11).ResultsThe results revealed the significant effect of both PCOS and advanced CP on visfatin levels in the GCF (P<0.05).ConclusionAccording to the results of this study, the visfatin level in the GCF could be the probable link of association between PCOS and advanced CP.

Loss of alveolar bone density in postmenopausal, osteopenic women is associated with circulating levels of gelatinases

To determine whether circulating levels of two matrix metalloproteinases, MMP-2 and MMP-9, are associated with loss of alveolar bone density (ABD) or height (ABH), or with progression of periodontitis (relative clinical attachment level [RCAL]), among postmenopausal women with local and systemic bone loss. This study was planned as part of a 2-year randomized, double-blind, placebo-controlled, clinical trial examining efficacy/safety of subantimicrobial dose doxycycline (20mg bid) in postmenopausal osteopenic women. This study examines whether serum levels of gelatinases are associated with local changes in the periodontium. A sample of 113 women received periodontal maintenance for moderate to advanced chronic periodontitis and consented to analysis of stored serum biomarkers. Posterior vertical bitewings were taken, and serum collected, at baseline, one, and 2years. ABD was determined by computer-assisted densitometric image analysis (CADIA), ABH by the Hausmann etal (1992, J Periodontol 63, 657) method, and RCAL by Florida Probe (every 6months). MMPs were measured densitometrically on gelatin zymograms using denatured type I collagen as substrate and purified MMP-2 (72kDa) and MMP-9 (92kDa) as standards. Evidence of worsening in the periodontium at a tooth site was defined as a change from baseline of, for ABD, at least 14 densitometric units (for subcrestal locations) or 17 units (for crestal locations); of at least 0.4mm for ABH; and of at least 1.5mm for RCAL. Logistic regression models, while accounting for clustering, compared the odds of worsening in ABD, ABH, or RCAL, after 2years of observation, between groups defined by baseline and concurrent levels of serum gelatinases. Changes in ABH and RCAL were not associated with circulating levels of MMP-2 or MMP-9. However, elevated odds of ABD loss over 24months were associated, among smokers, with both baseline and concurrent levels of MMP-9 in the middle and highest tertile, and with concurrent levels of MMP-2 in the middle (but not the highest) tertile. Elevated odds of ABD loss were also associated, among women within 5years of menopause, with baseline levels of MMP-2 in the highest tertile. Among postmenopausal osteopenic women, loss of ABD was associated, in smokers, with elevated circulating levels of MMP-9 and MMP-2. In those within 5years of menopause, ABD loss was associated with elevated circulating levels of MMP-2.

Oral Doxycycline as an alternative initial treatment for desquamative gingivitis

Oral Doxycycline as an alternative initial treatment for desquamative gingivitis

Rotary Instrument in Non-Surgical Treatment of Chronic Periodontal Disease: Clinic Randomized Study

Objective: The aim of this study is to compare the efficacy of rotary instruments vs hand scalers in non-surgical periodontal therapy, studying the variation of periodontal health indexes. Materials and Methods: Forty patients (age between 30 and 70 years) with advanced chronic periodontitis, that were recruited for the study, were divided into two groups; control group and test group. Control patients were treated with hand scalers while test group patients were treated with rotary instruments. Periodontal indexes were evaluated at baseline and after 3 months. Results: Nonsignificant differences were found at 12 weeks follow up for all the parameters between test and control groups. Conclusions: Within their limits, the results indicate that different instruments can be effective in removing calculus and endotoxins. This requisite is mandatory for a proper periodontal healing. The reasons for clinicians to use diamond-coated instruments are related to a faster procedure, and the clinical evidence of a smooth root surface. The clinicians’ ability remains one of the most important variables that could affect periodontal therapy.

PR076: The evaluation of the concentration of MMP‐8 in GCF of patients with chronic advanced periodontitis. The comparison of two different methods

PR076: The evaluation of the concentration of MMP‐8 in GCF of patients with chronic advanced periodontitis. The comparison of two different methods

Effectiveness of Enamel Matrix Derivative in Conjunction with Particulate Autologous Bone in the Treatment of Noncontained Intrabony Defects: A 2-Year Prospective Case Series.

This case series evaluated the healing of deep intrabony defects treated with a combination of enamel matrix derivative and autologous particulate bone harvested from the buccal and lingual/palatal cortical plate with a Piezosurgery device. A total of 15 defects with a predominantly one- or two-wall component were consecutively treated in 15 patients with advanced chronic periodontitis. In all selected sites, the three-wall component was ≤ 25% of the total defect depth. Clinical and radiographic parameters were recorded at baseline and 12 and 24 months postoperatively. All defects showed favorable clinical and radiographic outcomes at the 24-month follow-up. The probing depth reduction was 4.4 ± 1.6 mm, and more than 50% of the defects presented clinical attachment level gain of at least 5 mm. The bone fill was 3.1 ± 1.6 mm.

Non-Surgical Periodontal Therapy Impact on Progression of Chronic Periodontitis and Prevention of Further Tooth Loss

Objective: Prevention of tooth loss and maintaining favorable periodontal status are the ultimate goals of periodontal therapy. The aim of this study was to evaluate the effectiveness of non-surgical periodontal therapy and supportive periodontal care in arresting the progression of chronic periodontitis and in preventing tooth loss. Materials and methods: Periodontal charts, self-reported medical history, and two interleukin-1 (IL-1) polymorphism genotypes of 100 patients were obtained from the University of Pittsburgh School of Dental Medicine Dental Registry and DNA Repository after screening 4,825 subjects. We used tooth loss (TL) and clinical attachment loss (CAL) as outcomes of disease affection in our analysis. In our study, we have included third molars, teeth lost during active periodontal treatment (APT), and those lost during the supportive periodontal program. All subjects had at least 12 months of follow-up. Fisher’s exact test was used to investigate the association between tooth loss and different risk factors. Paired t-test was conducted to detect the difference in means of CAL at baseline and at final assessment. Results: There were 59 patients (36 males and 23 females with an average age of 52 years) that lost at least one tooth during supportive periodontal care. Tooth mortality rate declined by more than half in patients who enrolled in a supportive periodontal program for six years compared to those who dropped out after one year (0.52 vs. 3.4 teeth/patient/year, respectively). Increased risk of tooth loss was found to be associated with diabetes (p=0.01), as well as high blood pressure (p<0.0001). We did not find an association between tooth loss and polymorphisms in interleukin IL-1α/IL-1β (rs1800587, p=0.36 and rs1143634, p=0.51, respectively). During the first and the second year of supportive periodontal treatment, the clinical attachment loss decreased by 0.36 mm and 0.34 mm, respectively (p=0.025 and p=0.0697), when compared to baseline measurements. Moreover, a slight increase in CAL was found in the group of patients who attended regular periodontal maintenance program for six years (p=0.037, difference of 0.38 mm in comparison to the baseline measurement). Conclusion: Our findings suggested that supportive periodontal therapy is effective for the long-term preservation of teeth and the stability of periodontal tissue in patients with advanced chronic periodontitis.

Virulence genes in biofilm producer Enterococcus faecalis isolates from root canal infections.

Enterococcus faecalis is occurring in opportunistic infections involving the oral cavity. This study aimed to evaluate the presence of E. faecalis virulence genes in dental root canal isolates recovered from advanced chronic periodontitis patients. One hundred E. faecalis isolated from dental root canal during July 2015 to Oct 2016. After analysis of biofilm formation by the semi-quantitative determination in 96-well flat bottom polystyrene plates, the presence of asa, esp, efaA, ace, ebpR, gel and hyl gene were studied by PCR. Gelatinase and hemolytic activity were detected by phenotypic methods. Ninety-one percent of isolates had ebpR gene, 85% ace, 82% efaA, 81% gel, 56% esp, 33% asa1, 2% hyl and 0% cyl gene. Evaluation of biofilm formation by microtiter plate method presented 49% of the isolates as strong biofilm producer, 42% displayed moderate biofilm formation, and 10 % weak or no biofilm was observed. asa1, efaA, esp, and ebpR positive isolates had significantly higher biofilm formation than negative isolates, while no significant differences were found when comparing ace-positive and - negative isolates. Present study showed that the ace genes do not seem to be necessary nor sufficient for the production of biofilm in Enterococcus faecalis but the presence of asa1, efaA, esp, and ebpR correlates with increased biofilm formation of dental root canal isolates.

The effect of low-level diode laser on COX-2 gene expression in chronic periodontitis patients.

Adjunctive treatments to scaling and root planing (SRP) such as lasers, have been utilized in the treatment of chronic periodontitis, mainly aiming to suppress and eliminate the bacteria, as well as enhancing the healing response. Eighty gingival papilla biopsy samples were obtained from 60 patients diagnosed with chronic advanced periodontitis; randomly assigned to three treatment groups (n = 20), as well as 20 subjects with no periodontal disease [group A]. Group B received SRP on a single quadrant/day for four consecutive days. On day 5, all quadrants were rescaled. Groups C and D received the same treatment as group B plus laser application with the low-level diode laser (630-670 nm, 1.875 J/cm2) for five and ten consecutive days, respectively. Papilla biopsies were obtained from subjects and evaluated by RT-PCR for expression of COX-2. The values in the control group were 0.028 0.014 and baseline values for the examined groups were 0.16 0.18. Significantly decreased level of COX-2 expression for groups C and D was found after treatment, while lowest average expression was found in the group that had the 10 laser treatments supplemental to SRP (0,035 0,014). The results of this study show suppression of COX-2 in gingival tissue after low-level laser treatment as adjunct to SRP.

THE IMPACT OF OMEGA-3 FATTY ACIDS COMBINED WITH INITIAL PERIODONTAL THERAPY ON SALIVARY VISFATIN AND TNF-Α LEVELS IN CHRONIC PERIODONTITIS PATIENTS

Recent investigations have demonstrated the positive therapeutic effects of omega-3 polyunsaturated fatty acids (PUFAs) on several chronic inflammatory diseases such as rheumatoid arthritis, chronic inflammatory bowel diseases and periodontitis. The objective of the present study was to evaluate the impact of omega-3 PUFAs in conjunction with initial periodontal therapy (IPT) on periodontal clinical parameters and salivary markers in patients with chronic periodontitis. Thirty four systemically healthy individuals with advanced chronic periodontitis were enrolled and randomly assigned into two groups. The control group (IPT, n=17) was treated with IPT alone whereas the test group (IPT+omega-3, n=17) was treated with IPT and daily dietary supplementation of omega-3 PUFAs (in the form of 2 grams of fish oil capsules per day) for three months. Clinical parameters were recorded at baseline and 3 months following therapy for both groups. Saliva samples were collected at the same time points and analyzed for visfatin and tumor necrosis factor-α (TNF-α). After 3 months, clinical periodontal parameters of advanced chronic periodontitis were significantly improved in both groups. The omega-3 group showed significant greater pocket depth (PD) reduction and clinical attachment (CAL) gain compared to the control group after therapy. Salivary TNF-α levels showed a statistically significant decrease in the omega-3 group at 3 months compared to the control group. Salivary visfatin levels were reduced significantly at 3 months in both groups without any significant variation. It was concluded that dietary supplementation with omega-3 PUFAs could be a potential viable adjunct to IPT that significantly improves all periodontal parameters and reduces salivary visfatin and TNF-α levels in advanced chronic periodontitis. Interestingly, salivary visfatin could be a useful periodontal biomarker to monitor responses to periodontal therapy.

Concentration of MMP-8 and IL-1β in gingival crevicular fluid in patients with chronic and aggressive periodontitis.

Modern research confirms the role of inflammatory mediators in the pathomechanism of periodontal tissue destruction. The aim of the study was to determine concentrations of MMP-8 and IL-1β in gingival crevicular fluid (GCF) in patients with advanced chronic and aggressive periodontitis. The authors measured the concentrations of the above inflammatory mediators in gingival crevicular fluid of deep pockets (PD ≥ 6 mm) and shallow pockets (PD 4-5 mm) in 33 patients with advanced chronic periodontitis and in 16 patients with aggressive periodontitis. The control group consisted of 16 individuals with healthy periodontium. In all patients levels of MMP-8 and IL-1β in GCF were determined with the ELISA method. The study showed significantly higher concentrations of MMP-8 and IL-1β in GCF of both deep and shallow pockets in patients with periodontitis compared to healthy subjects. No difference in concentrations of the tested mediators was observed with reference to diagnosis of aggressive periodontitis (AP) or chronic periodontitis (CP).

Clinical evaluation of platelet rich plasma when combined with an alloplastic bone graft material in the treatment of intrabony periodontal defects

Introduction: For periodontal regeneration, various modalities are available; among these,use of growth factors is a developing area for clinicians and researchers, as they stimulate cells responsible for periodontal regeneration. Growth factor is a general term used to denote a class of naturally occurring proteins that function in the body to promote the mitogenesis (proliferation), directed migration, and metabolic activity of cells. Platelet-rich plasma (PRP) is a new application and is a storage vehicle for growth factors, especially platelet-derived growth factor and transforming growth factor-b both of which influence bone regeneration. Aim: The aim of this study was to examine the clinical efficacy of autologous PRP combined with an alloplastic bone graft material (hydroxyapatite and β-tricalcium phosphate [HA/β-TCP], (Ossifi™)) in the treatment of three-wall intrabony periodontal defects. Materials and Methods: Twenty-four patients (15 females and 9 males with age ranging from 28 years to 47 years) with moderate to advanced chronic periodontitis with three-wall intrabony defects were selected for the study. All patients were divided into two groups, i.e., “Group-I” and “Group-II;” 12 patients in each group. “Group-I” was control group with patients treated with HA/β-TCP with saline and “Group-II” was test group entitled to patients who were treated with PRP + HA/β-TCP. Clinical parameters recorded were bleeding on probing, probing depth, and clinical attachment level. Furthermore, the radiographic parameters included depth of intrabony defects, calculated as the difference of distances between cementoenamel junction (CEJ) to the bony defect and CEJ to the alveolar crest. Results and Conclusion: Combination of PRP with alloplastic bone graft material, i.e., test Group-II (PRP + HA/β-TCP), showed a better result than control Group-I (saline + HA/β-TCP) in the treatment of intrabony defects.

Chronic Periodontitis Exacerbated by Occlusal Trauma: Report of A Case and Revision of Literature

Occlusal trauma has been associated with periodontal disease 100 years ago, but only observationally. Since the 1930s, the effect of excessive occlusal forces on the periodontium has been evaluated at the pre-clinical level. At first, studies on animal and human autopsy material showed no association between occlusal discrepancies and periodontal destruction. However, in the last 10 years new evidence has emerged that today allows us to establish a relationship between both clinical entities. The latest review on the subject published in 2015, states that at the moment there is a lack of strong evidence to assume a relation of cause/effect between periodontitis and excessive occlusal forces. The objective of this study is to report a clinical case related to a patient with no previous medical history, with an oral diagnosis of an advanced chronic periodontitis, in which the existing occlusal trauma was recognized as a possible accelerating and/or aggravating factor. In addition there is an update of the focused theme.