Attachment Loss Research Articles

KNOWLEDGE & ATTITUDE OF GENERAL DENTIST, REGARDING PERIODONTAL DISEASE DIAGNOSIS, TREATMENT PROTOCOL AND PERIODONTAL SPECIALIST REFERRAL

Objectives: To assess the knowledge, attitudes, and practices of general dentists regarding periodontal disease diagnosis, treatment strategies, and referrals to specialists.Materials and Methods: A cross-sectional survey was conducted among 185 dentists in Peshawar, utilizing a pre-customized, closed-ended questionnaire through convenience sampling technique. The survey included practitioners from dental government and private teaching hospitals as well as independent clinics, encompassing both genders and any age. Informed consent was incorporated into the questionnaire. Exclusion criteria were undergraduate students, house surgeons, and periodontists. Data were collected using the questionnaire based on participants' understanding of periodontal diseases, diagnostic frequency, referral practices, and treatment approaches.Results: Most dentists favored scaling as the primary treatment for bleeding on probing (n=149, 80.54%) and identifi ed loss of attachment as the cause of tooth mobility (n=158, 85.41%). The study revealed a significant association between years of experience and various aspects of periodontal care, including referral practices (p=0.047), diagnostic accuracy (p=0.018), and treatment strategies (p=0.05). Despite a recognized link between poor oral hygiene and periodontal diseases, the referral rate to periodontists was notably low (10.27%). Conclusion: General dentists exhibit defi ciencies in knowledge concerning the causes, referral processes, and the importance of specialized care in periodontology.

Developing a Prediction Model for Periodontal Disease Using Ordinal Random Forest

Background: Periodontitis, a common inflammatory disease affecting oral health, is a major public health concern. Early detection of this disease is highly important in order to achieve less invasive and less costly treatment. The ordinal nature of different levels of periodontitis is usually not considered in many studies. It is often recognized and used as a nominal variable, in which case some information related to the ordinal nature is ignored. The aim of this study was to use continuation ratio logistic and ordinal random forest (RF) models to predict the three stages of periodontitis. Methods: Overall, this study evaluated 300 patients referred to the Periodontology Department of Hamadan University, western Iran, between September 2016 and June 2018. The performance of continuous ratio logistic and ordinal forest models was evaluated using the same set of training and test data to predict different types of periodontitis (gingivitis, localized, and generalized periodontitis) based on input variables. Accuracy, kappa, gamma, Somers’d, and precision were utilized for comparison. Results: The results confirmed the higher predictive ability of the ordinal RF model compared to the logistic continuation ratio model for all scoring indices (accuracy of 0.87 vs. 0.80). Alveolar bone loss, attachment loss, probing pocket depth, simplified oral hygiene index, and plaque index were identified as the most important variables. Conclusion: Due to the ordinal nature of different levels of periodontal disease, the use of accurate prediction models such as ordinal RF is suggested since they can take into account the ordinal nature of the response in predicting and evaluating the effect of important variables. Ordinal RF is a well-suited machine learning technique for developing accurate predictive models of periodontal disease risk.

A Rose by Any Other Name: The Long Intricate History of Localized Aggressive Periodontitis.

This review addresses the recent World Workshop Consensus Conference (WWCC) decision to eliminate Localized Aggressive Periodontitis (LAgP) in young adults as a distinct form of periodontitis. A "Consensus" implies widespread, if not unanimous, agreement among participants. However, a significant number of attendees were opposed to the elimination of the LAgP classification. The substantial evidence supporting a unique diagnosis for LAgP includes the (1) incisor/molar pattern of disease, (2) young age of onset, (3) rapid progression of attachment and bone loss, (4) familial aggregation across multiple generations, and (5) defined consortium of microbiological risk factors including Aggregatibacter actinomycetemcomitans. Distinctive clinical signs and symptoms of LAgP are presented, and the microbial subgingival consortia that precede the onset of signs and symptoms are described. Using Bradford-Hill guidelines to assess causation, well-defined longitudinal studies support the unique microbial consortia, including A. actinomycetemcomitans as causative for LAgP. To determine the effects of the WWCC elimination of LAgP on research, we searched three publication databases and discovered a clear decrease in the number of new publications addressing LAgP since the new WWCC classification. The negative effects of the WWCC guidelines on both diagnosis and treatment success are presented. For example, due to the localized nature of LAgP, the practice of averaging mean pocket depth reduction or attachment gain across all teeth masks major changes in disease recovery at high-risk tooth sites. Reinstating LAgP as a distinct disease entity is proposed, and an alternative or additional way of measuring treatment success is recommended based on an assessment of the extension of the time to relapse of subgingival re-infection. The consequences of the translocation of oral microbes to distant anatomical sites due to ignoring relapse frequency are also discussed. Additional questions and future directions are also presented.

Efficacy of different protocols of non-surgical periodontal therapy in patients with type 2 diabetes: A systematic review and meta-analysis.

The aim of the present systematic review of the literature and meta-analysis was to evaluate the efficacy of different protocols of NSPT without any adjunctive therapy in subjects with type 2 diabetes, by considering clinical and patient-centered outcomes. For the purposes of the study randomized controlled clinical trials with more than 3-month follow-up were searched in MEDLINE, EMBASE, and Cochrane Central. Then the articles were screened for inclusion and considered based on the protocols adopted, the outcome measure, follow-up, and the level of glycemic control. A total of 23 articles about 22 studies were included. NSPT was more effective than just oral hygiene measures/no treatment in reducing periodontal probing depth (PPD) and clinical attachment loss (CAL) at 3 months (0.47 mm [0.29-0.65 mm] and 0.50 mm [0.24-0.76 mm], respectively) and 6 months (0.56 mm [0.28-0.84 mm] and 0.45 mm [0.13-0.77 mm], respectively for PPD and CAL) follow-up (very low and low level of evidence). The meta-analysis found no evidence of a difference between full-mouth disinfection versus quadrant protocol clinical outcomes (very low level of evidence). One study found no evidence of a difference in periodontal clinical response between good versus poor glycemic control. Based on the results of the present research NSPT protocols could be considered more efficacious than others in terms of clinical outcomes in subjects with type 2 diabetes. Moreover, NSPT resulted in efficacious improvement of periodontal parameters and HbA1c levels compared to no treatment or oral hygiene instructions alone.

Impact of Tocopherol Supplementation on Clinical Parameters of Periodontal Disease: A Systematic Review and Meta-Analysis.

Background and Objectives: The significance of periodontal disease as a public health issue prompts the exploration of effective treatments, including the potential use of tocopherol (Vitamin E) due to its anti-inflammatory and antioxidant properties. Materials and Methods: The PICO statement (Population, Intervention, Comparator, Outcome) was as follows: In patients with periodontal disease, does tocopherol (Vitamin E) supplementation compared to no supplementation or insufficient Vitamin E intake improve clinical outcomes such as gingival inflammation, pocket depth, and clinical attachment levels? This study searched through PubMed, Scopus, and Web of Science up to June 2024 focused on studies involving human subjects with various forms of periodontal disease, analyzing the impact of tocopherol through dietary or supplementary intake. Primary outcomes evaluated included improvements in gingival inflammation, pocket depth, and clinical attachment levels, with data synthesis conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Quality assessment and risk of bias were meticulously performed for the included observational studies and randomized controlled trials. Results: The meta-analysis incorporated 8 studies that were used for data extraction, totaling 12,832 patients, revealing a heterogeneous response to tocopherol supplementation, with a pooled odds ratio for efficacy in reducing periodontal disease severity at about 0.97 (95% CI: 0.96-0.98). Noteworthy findings indicated a statistically significant increase in clinical attachment loss and pocket depth with odds ratios ranging from 1.15 to 9.33 when Vitamin E was insufficient. However, the considerable heterogeneity (I2 = 88.35%) underscores variations in tocopherol's effectiveness across different populations and study designs. Conclusions: While tocopherol supplementation shows a modest benefit in managing periodontal disease, particularly in reducing clinical attachment levels and pocket depth, the variability in outcomes emphasizes the necessity for more research to establish standardized treatment protocols and dosages.

The anti-inflammatory effect of a magnoliae cortex and Zea mays L. extract mixture in a canine model of ligature-induced periodontitis

BackgroundPeriodontitis is common in dogs. It is characterized by destruction of the supporting tissues of the teeth due to the host-immune response triggered by plaque. Magnoliae cortex and Zea mays L. extract showed anti-inflammatory and anti-microbial effects, respectively. This study aimed to evaluate improvement in periodontitis following the administration of Magnoliae cortex and Zea mays L. extract in dogs. Periodontitis was experimentally induced in 10 beagle dogs. Five dogs were administered 40 mg of Magnoliae cortex extract and 20 mg of Zea mays L. extract orally once per day for 2 months (MZ group), whereas the other group received empty gelatin capsules (control group). Periodontal clinical parameters, complete blood count, serum chemistry parameters, and tissue inflammatory cytokines and chemokine expression were assessed before and after combined oral extracts administration.ResultsThe complete blood count and serum chemistry results of all dogs were within normal ranges. Gingival inflammation in MZ group was significantly better than that in the control group at 4 and 8 weeks post-medication (PM; p < 0.05). The periodontal pocket depth and clinical attachment loss at 8 weeks PM in the MZ group were significantly lower than the baseline values (p < 0.05). The incidence of bleeding on probing in the MZ group was significantly lower than that in the control group at 4 weeks PM (p < 0.05). Throughout the medication period, the percentages of CD4 + and CD8 + T cells were higher and lower, respectively, in the MZ group. However, these differences were only significant at 8 weeks PM. The expression of the inflammatory cytokines IL-1β, IL-6, IL-17, and TNF-α and the chemokine IL-8 in the inflamed tissues was lower in the MZ group, and the two groups showed a significant difference in TNF-α expression.ConclusionsCombined administration of Magnoliae cortex and Zea mays L. extract improved the clinical symptoms of periodontal disease in dogs. This beneficial effect may be partly due to the inhibitory effects of these extracts on the inflammatory response.

Soluble urokinase plasminogen activator receptor (suPAR) is a potential biomarker of stage III-IV, grade C periodontitis through the impact of post-radiotherapy on head and neck cancer patients

BackgroundThe urokinase-type plasminogen activator receptor (uPAR) plays an essential function in leukocytes and endothelial homeostasis and, therefore, in the development of chronic periodontitis.MethodsThe study enrolled 150 participants, 50 chronic periodontitis with head and neck cancer post radiotherapy (CP + HNC post-RT) patients, 50 chronic periodontitis (CP) without HNC patients, and 50 healthy controls. Clinical Attachment Loss (CAL), Probing Pocket Depth (PPD), Plaque Index (PI), and Gingival Bleeding Index (GBI) were recorded. An enzyme-linked immunosorbent assay (ELISA) was constructed to quantify serum (suPAR) levels.ResultsStage and grade of periodontitis were stage III-IV, grade C in patients (CP + HNC post-RT), stage I-III, grade A/B in patients (CP without HNC), and absent in (healthy). Chronic periodontitis with HNC post-RT patients presented a significantly higher proportion of suPAR levels (506.7 pg/ml) compared to chronic periodontitis without HNC and healthy controls (423.08 pg/ml and 255.9 pg/ml), respectively. A significant positive correlation was found between serum suPAR levels and CAL, PPD, PI, and GBI in the periodontal disease groups. ROC results of suPAR (AUC = 0.976 for CP + HNC post-RT, AUC = 0.872 for CP without HNC). Hyposalivation appeared in patients (CP + HNC post-RT; 0.15 [0.11–0.23] ml/min, P = 0.001) and (CP without HNC; 0.30 [0.25–0.41] ml/min, P = 0.001), compared to healthy controls; 0.35 [0.28–0.54] ml/min, P = 0.001).ConclusionThe study showed a significant elevation in serum suPAR levels in CP + HNC post-RT patients compared to the CP without HNC and control groups.Clinical trial registrationThe study was registered retrospectively; clinicaltrials.gov identifier: NCT06529588. Date of registration: July 31, 2024 https://clinicaltrials.gov/study/NCT06529588.

Do all individuals benefit equally from non-surgical periodontal therapy? Secondary analyses of systematic review data.

This study aimed to assess the variability and treatment effect heterogeneity in response to non-surgical periodontal therapy (NSPT). Data from randomized controlled trials included in two recent systematic reviews on the effect of NSPT on mean clinical attachment loss (CAL), mean probing pocket depth (PPD), percentage of sites with bleeding on probing (%BOP), PPD ≤3 mm (%PD ≤3 mm), and C-reactive protein levels (CRP) at 3-12-month follow-up among adults with systemic diseases or conditions were used. In these trials, the control arms received no treatment, hygiene advice, or supragingival scaling. The Bayesian meta-regression models were utilized to assess the variability ratios between NSPT and control groups. Data from 36 trials on mean PPD, 32 trials on mean CAL, eight trials on %PD ≤3 mm, 31 trials on %BOP and 19 trials on CRP were used. Variability in mean CAL and CRP was approximately 10% higher in the NSPT arms than in the control arms, hinting that there may be room for treatment effect heterogeneity. Instead, variability in mean PPD, %BOP, and %PD ≤3 mm was lower in the NSPT arms than in the control arms. Potential treatment effect heterogeneity in response to NSPT was observed for CRP and mean CAL. However, substantial measurement error in CAL and natural variation in CRP may contribute to these findings. Conversely, treatment effect heterogeneity appears less pronounced for mean PPD, %BOP, and %PD ≤3 mm, potentially due to greater treatment effects in patients with more severe periodontitis and reduced measurement error in these parameters.

Changes and Roles of IL-6, hsCRP, and proCT in Patients with Chronic Periodontitis in Head and Neck Cancer Pre/Post Radiotherapy

Background: Head and neck cancer (HNC) patients frequently undergo radiotherapy as a standalone treatment or in combination with chemotherapy. Radiotherapy is associated with adverse effects, including detrimental impacts on periodontal health, which increase the risk of periodontitis. Objective: To investigate the clinical significance of interleukin-6 (IL-6), high-sensitive C-reactive protein (hsCRP), and procalcitonin (proCT) as prognostic indicators. Methods: 150 participants were divided into three groups: (n=50, HNC post-RT) patients with head and neck cancer who had radiation treatment six months ago (n=50, HNC pre-RT), and individuals with periodontal health as the control group (n=50). Probing pocket depth (PPD), clinical attachment loss (CAL), gingival bleeding index (GBI), plaque index (PI), and hyposalivation were meticulously recorded. To quantify serum concentrations of IL-6, hs-CRP, and proCT, an electrochemiluminescence immunoassay (eCLIA) was used. Results: Serum levels of IL-6, hsCRP, and proCT were significantly elevated in two groups of patients with chronic periodontitis with head and neck cancer post-radiotherapy (CP+HNC post-RT) and patients with chronic periodontitis with HNC pre-radiotherapy (CP+HNC pre-RT) compared to a control group. ROC analysis demonstrated the diagnostic accuracy of IL-6, hsCRP, and proCT for both clinical cases. Furthermore, all clinical periodontal index scores (CAL, PPD, PI, and GBI) were significantly elevated compared to a control group. Conclusions: HNC post-RT patients presented significantly higher serum IL-6, hs-CRP, proCT, and periodontal score levels than HNC pre-RT.

Inflammation indices in association with periodontitis and cancer.

Inflammation is a complex physiological process that plays a pivotal role in many if not all pathological conditions, including infectious as well as inflammatory diseases, like periodontitis and autoimmune disorders. Inflammatory response to periodontal biofilms and tissue destruction in periodontitis is associated with the release of inflammatory mediators. Chronic inflammation can promote the development of cancer. Persistence of inflammatory mediators plays a crucial role in this process. Quantification and monitoring of the severity of inflammation in relation to cancer is essential. Periodontitis is mainly quantified based on the severity and extent of attachment loss and/or pocket probing depth, in addition with bleeding on probing. In recent years, studies started to investigate inflammation indices in association with periodontal diseases. To date, only few reviews have been published focusing on the relationship between blood cell count, inflammation indices, and periodontitis. This review presents a comprehensive overview of different systemic inflammation indices, their methods of measurement, and the clinical applications in relation to periodontitis and cancer. This review outlines the physiological basis of inflammation and the underlying cellular and molecular mechanisms of the parameters described. Key inflammation indices are commonly utilized in periodontology such as the neutrophil to lymphocyte ratio. Inflammation indices like the platelet to lymphocyte ratio, platelet distribution width, plateletcrit, red blood cell distribution width, lymphocyte to monocyte ratio, delta neutrophil index, and the systemic immune inflammation index are also used in hospital settings and will be discussed. The clinical roles and limitations, relationship to systemic diseases as well as their association to periodontitis and treatment response are described.

Bmi‐1 alleviates alveolar bone resorption through the regulation of autophagy

AbstractBackgroundB‐cell‑specific Moloney MLV insertion site‐1(Bmi‐1)is a crucial osteopenic target molecule. The aim of this study is to explore the effects of Bmi‐1 on alveolar bone resorption and the underlying mechanisms in vitro and vivo.MethodsA Bmi‐1‐knockout (Bmi‐1−/−) mouse model was used to investigate the effect of Bmi‐1 on alveolar bone metabolism, with micro‐computed tomography imaging, histology, and immunohistochemistry staining. Furthermore, we utilized a ligature‐induced experimental periodontitis model to examine the impact of Bmi‐1‐knockdown (Bmi‐1±) on inflammatory alveolar bone resorption. Finally, we stimulated human periodontal ligament stem cells (hPDLSCs) with lipopolysaccharide (LPS) to explore the potential mechanism of Bmi‐1 overexpression in the process of osteogenesis.ResultsCompared with wild‐type mice, Bmi‐1−/− mice demonstrated more alveolar bone resorption by inhibiting osteogenesis, which was characterized by decreases in Runt‐related transcription factor 2 and type 1 collagen formation. In addition, Bmi‐1−/− mice had lower levels of autophagy markers such as Parkin and LC3, but higher levels of inflammation‐related factors such as interleukin (IL)‐6 and IL‐1β in periodontal tissues. In addition, Bmi‐1‐knockdown aggravated ligature‐induced alveolar bone loss. Under in vitro inflammatory conditions, Bmi‐1 overexpression stimulated osteoblast differentiation and inhibited the production of inflammatory factors, as well as the autophagy and apoptosis in hPDLSCs stimulated with LPS. When 3‐methyladenine (3‐MA), an autophagy inhibitor, was added, the osteogenic effect of Bmi‐1 was further enhanced.ConclusionsBmi‐1 alleviates alveolar bone resorption by regulating autophagy, indicating that it could be a potential target for periodontitis prevention and treatment.Plain Language SummaryPeriodontitis is a chronic inflammatory disease, which leads to progressive destruction of periodontal tissues, manifested as periodontal pocket formation, loss of periodontal attachment and alveolar bone resorption. Currently, there is a lack of effective treatments to regenerate damaged periodontal tissues. Therefore, it is of great clinical significance to explore new mechanisms of periodontitis and effective intervention targets. B‐cell‑specific Moloney MLV insertion site‐1 (Bmi‐1) is involved in the regulation of the cell cycle, DNA damage repair, autophagy, bone metabolism, tumor, and other physiopathological processes. Autophagy, as an important mechanism of intracellular self‐regulation, plays an indispensable role in the destruction and repair of periodontal tissues. The aim of this study was to investigate the role of Bmi‐1 on periodontal tissues and its intrinsic mechanism. The results revealed that Bmi‐1 regulates autophagy to protect periodontal tissues, suggesting that it may be a potential target for the prevention and treatment of periodontitis.

Using precision periodontal health care chart (PPHCC) to improve periodontal health.

Developing a Precision Periodontal Health Care Chart (PPHCC) in the electronic dental record (EDR) system and evaluating its clinical usability and effects on clinical outcomes. A survey with ten questions based on the System Usability Scale (SUS) and six questions about assessing clinical impact was used to evaluate the satisfaction of periodontitis patients and care providers with PPHCC before and after non-surgical periodontal therapy (NSPT). The clinical outcomes, including probing depth (PD), interdental clinical attachment loss (CAL), and bleeding on probing (BOP), in patients who used PPHCC (PC) were compared to those in patients without using PPHCC (control). The associations between risk assessments included in PPHCC and clinical outcomes of NSPT were also analyzed. The mean scores of SUS questions at the initial periodontal examination were 74.26 ± 18.89 (n = 37) for patients and 88.31 ± 14.14 (n = 37) for care providers. The mean scores of SUS questions at re-evaluation were 74.84 ± 17.78 (n = 16) for patients and 89.63 ± 13.48 (n = 20) for care providers. The changes in the percentages of teeth with interdental CAL 1-2mm (p = 0.019) and CAL 3-4mm (p = 0.026) at the re-evaluation visit were significantly different between the PC and control groups, but the other parameters were not. Both patients and care providers were satisfied with using PPHCC in the clinic. However, the short-term clinical outcomes in the PC group were similar to those in the control group. PPHCC, as a tool for delivering clinical and educational information, can motivate patients to control periodontitis and assist clinicians in making a personalized treatment plan.

Serum vitamin D concentration is inversely associated with matrix metalloproteinase‐9 level in periodontal diseases

AbstractBackgroundThe aim of this study was to investigate the potential association between vitamin D deficiency and matrix metalloproteinase‐9 (MMP‐9) levels in gingival crevicular fluid (GCF) across various periodontal health and disease statuses.MethodsA total of 200 volunteers were divided into two groups according to serum vitamin D concentration (25(OH)D &lt; 10 ng/mL and 25(OH)D ≥ 10 ng/mL). Periodontal health status was determined based on a full‐mouth periodontal examination and radiographic evaluation. Participants in both groups were categorized according to periodontal diagnoses, encompassing periodontal health, gingivitis, and periodontitis. Following sampling, the MMP‐9 levels in GCF were determined by the enzyme‐linked immunosorbent assay (ELISA) method.ResultsThe GCF MMP‐9 levels were found to be higher in individuals with serum 25(OH)D &lt; 10 ng/mL, in both the healthy and gingivitis and periodontitis groups, compared to those with 25(OH)D ≥ 10 ng/mL. Nevertheless, a statistically significant distinction was observed exclusively within the gingivitis and periodontitis groups. Correlation analysis and robust regression analyses provided additional evidence supporting the predictive role of periodontal disease status and vitamin D concentration in local MMP‐9 levels. These associations remained significant after adjusting for age and sex in robust regression analysis (p = 0.002). Furthermore, the inclusion of periodontal clinical parameters in the regression analysis revealed notable associations of clinical attachment loss with local MMP‐9 levels, along with periodontal disease status and serum vitamin D concentration (p &lt; 0.001).ConclusionThe findings of our study suggest a potential mechanistic relationship between serum vitamin D levels and periodontitis.PLAIN LANGUAGE SUMMARYVitamin D deficiency is a widespread issue globally due to urban living, less outdoor time, seasonal changes, aging, and sunscreen use, leading to inadequate sun exposure. Low vitamin D levels are linked to several health problems, including hypertension, diabetes, heart diseases, and periodontal diseases, which affect the gums and bones around teeth and can cause tooth loss if untreated. Although the link between vitamin D and periodontal disease is unclear, it may involve the enzyme matrix metalloproteinase‐9 (MMP‐9). Our study examined 200 people, dividing them into two groups based on vitamin D levels. We assessed their gum health and measured MMP‐9 levels in their gingival crevicular fluid, a liquid that seeps out from the tiny space between gums and teeth. We found that people with lower vitamin D levels had higher MMP‐9 levels, especially those with gum disease. Our analysis showed that both vitamin D levels and gum health significantly impact MMP‐9 levels, with gum health being the more influential factor. Maintaining good gum health and adequate vitamin D levels is crucial for managing MMP‐9, an enzyme critical for tissue remodeling during healing and inflammation. However, excessive MMP may rapidly destroy periodontal tissues.

Association of crown-root ratio and tooth survival in Chinese patients with advanced periodontitis: An 11-year retrospective cohort study

IntroductionPeriodontitis is a chronic multifactorial inflammatory disease which eventually lead to tooth loss (TL). Therefore, a retrospective study was conducted to evaluate the status of tooth survival within 11 years after non-surgical periodontal treatment (NSPT) and to analyze the risk factors especially crown-root ratio (CRR) that affected TL in Chinese with advanced periodontitis. Methods3481 teeth of 131 subjects who underwent NSPT were examined retrospectively within a mean follow-up period of 11.6 years. The association of risk factors including clinical and radiographic parameters with TL was assessed using univariate and multivariate Cox regression analyses. Smooth curve fitting and segmented regression model were conducted to show the nonlinear relationship and the threshold effect between CRR and the risk of TL. Results347 teeth were lost in 97 patients in this study. Male, diabetes mellitus, heavy-smoker, molar, probing depth (PD), attachment loss (AL), bleeding on probing (BOP), tooth mobility, and radiographic bone loss were significantly associated with tooth loss (P < 0.05). A nonlinear relationship between CRR and the risk of TL was found, with different turning point values between molars and non-molars (1.9 vs. 2.76). ConclusionsThe findings based on practice-based clinical and radiographic data do suggest a nonlinear relationship between CRR and the survival of teeth, and provide evidence to help clinicians to determine the prognosis of teeth for patients with advanced periodontitis. Clinical SignificanceBased on clinical and radiographic data, this study provides an individualized basis for clinicians to judge the dental prognosis of patients with advanced periodontitis according to the different tooth sites.

Scaffolds in periodontal regeneration- A brief review

The periodontium constitutes the supportive framework of a tooth, comprising the integration of the periodontal ligament, cementum, gingiva, and alveolar bone. The periodontium's health is compromised by the infiltration of bacteria due to local or systemic factors. Untreated periodontal disease can lead to the loss of attachment and eventual tooth loss, necessitating effective therapy. Tissue engineering is a multidisciplinary approach that combines engineering techniques with life sciences principles to generate biological substitutes for damaged tissues, aiming to restore, maintain, or enhance their function. In recent years, various scaffolding technologies have emerged, transitioning from monophasic to multi-phasic/bioactive scaffold systems, with the goal of three-dimensional regeneration of periodontal tissue rather than mere promotion of healing. This review discusses tissue engineering principles, materials, and recent advancements in scaffold design for periodontal tissue regeneration, along with their efficacy tested both in vitro and in vivo.

Nutrition and Periodontitis: A Cross-Sectional Study from a Practice-Based Research Network.

Despite clinical interventional studies on the influence of diet on periodontal inflammatory parameters, there has been no practice-based cross-sectional study from a German population to date that has conducted both a comprehensive dental and periodontal examination and a thorough validated assessment of dietary behavior. Therefore, the aim of this pilot study was to evaluate, in a proof of concept, whether there is a correlation between the overall periodontal inflammatory surface area (PISA), periodontal clinical parameters (pocket probing depths (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), furcation involvement (FI), tooth mobility (TM)), and the dietary behavior of patients with periodontal disease when utilizing a practice-based research network. The primary outcome was the correlation between the periodontal inflammatory surface (PISA) and the dietary assessment data. The practice-based research network, consisting of eight Master's graduates, recruited patients who met the inclusion and exclusion criteria and performed a periodontal examination together with the assessment of dietary behavior using a digital version of the validated retrospective dietary recall (DEGS/RKI). Statistical analyses included linear regression models adjusted for age and smoking and unpaired t-tests, conducted using STATA 17.0 with a significance level of 5%. In addition, the data obtained were classified according to the currently recommended amounts of daily intake. A total of 1283 teeth were analyzed, with 60.25% (773 teeth) requiring treatment. The average PISA was 753.16 mm2 (SD ± 535.75 mm). Based on dietary guidelines, the studied population consumed excessive amounts of extrinsic sugars and fats, while their fiber and legume intake was insufficient. The intake of certain nutrients, including water-soluble fibers, specific fatty acids, vitamins (D, B1, B2, B6, and B12), iron, and zinc, was associated with reduced PISA, PPD, CAL, and BOP. Within the limits of the current study, including its cross-sectional design and cohort size, the outcomes demonstrated the influence of nutrition on periodontal health.

Evaluating the Efficacy of Resveratrol-Containing Mouthwash as an Adjunct Treatment for Periodontitis: A Randomized Clinical Trial.

To evaluate the effectiveness of resveratrol mouthwash as an adjunct to nonsurgical periodontal treatment of periodontitis. This study was a randomized, double-blind clinical trial study. The study included 57 participants with periodontitis. Clinical parameters (plaque index [PI], bleeding on probing [BOP], probing pocket depth [PPD], and clinical attachment loss [CAL]) were examined at the baseline visit, after 7 days, and after 30 days of using resveratrol mouthwash as an adjunct to nonsurgical periodontal treatment. The salivary levels of (interleukin [IL]-6) and RANKL (receptor activator of nuclear factor-kappa B ligand) were measured and compared before and after treatment. The participants answered the visual analog scale-based assessment questionnaire at the last visit. A one-way ANOVA (analysis of variance) test was used to compare the means of multiple groups (test, positive control, negative control) at baseline and after treatment. A paired t-test was also used to compare the means of a single group before and after treatment. In addition, Tukey's multiple comparisons test was used to identify specific pairwise differences between the three groups after finding significant differences with ANOVA. The Chi-square test was also used to compare the distribution of categorical variables like sex between the groups. All interventions significantly reduced PI, BOP, PPD, and CAL, but resveratrol and chlorhexidine had a higher significant effect than placebo except for CAL without a significant difference between them. All mouthwashes significantly reduced the salivary concentration of IL-6. However, resveratrol and chlorhexidine had a significantly higher effect than placebo, while the concentration of RANKL was decreased in all groups without a significant difference between them. The participants' responses to the mouthwash questionnaire showed that resveratrol and chlorhexidine had the same feedback without significant differences. Resveratrol-containing mouthwash could be used as an alternative to chlorhexidine as an adjunct to nonsurgical periodontal treatment of periodontitis.

Precision Medicine in Periodontics: A Literature Review.

Periodontitis, a widespread health issue, requires effective prevention and management strategies due to its increasing prevalence and detrimental social consequences. The chronic inflammation associated with periodontitis also exacerbates systemic conditions, emphasizing the need for advanced approaches in addressing this public health concern. The traditional methods of periodontal diagnosis, which primarily rely on clinical indicators such as pocket depth, clinical attachment loss, mobility, and radiographic measurements of alveolar bone loss, have limitations in guiding therapy due to the intricate and multifaceted nature of periodontal diseases. Precision periodontics is the amalgamation of genomics, bioinformatics, and advanced technology, mainly biomarkers reflecting a precise patient-centered treatment. However, implementing this approach in periodontology is new due to the lack of validated periodontal biomarkers for diagnostic use. This article explores the foundations of personalized therapy in periodontal diagnosis. It discusses the current state and prospects of periodontal biomarkers as a crucial step toward realizing a precision approach in periodontal practice.

Longitudinal association between dentition status and gait speed among older Brazilian adults: SABE cohort study

BackgroundOral health has been associated with general health conditions, but few longitudinal studies evaluated the effect of dentition status on gait speed.ObjectiveThis study aimed to investigate the longitudinal association between different time-varying measures of dentition status (i.e., number of teeth, the presence of periodontal pockets and the functional impact of oral health) and gait speed (outcome) in older Brazilian adults.Materials and methodsThis was a prospective study using data from the Health, Well-being and Aging cohort study (SABE) from 2006, 2010 and 2015. The gait speed was the dependent variable and the independent variables of interest were dentition status evaluated using the number of teeth, use of dental prostheses, presence of periodontal pocket, clinical attachment loss and self-perceived poor functional oral health. Dentition status measures were obtained through clinical oral examinations, performed by trained dentists using standardized criteria proposed by the World Health Organization. Self-perceived poor functional oral health was evaluated using the functional domain of the Geriatric Oral Health Assessment Index. The longitudinal effect of dentition status on gait speed was evaluated using mixed-effects linear models. The effect of the number of teeth/periodontal pocket/attachment loss on gait speed change over time was evaluated by including an interaction term between these variables. The effect of periodontal pocket was tested only among dentate individuals.ResultsData for the complete sample included 3,306 observations from 1,964 individuals. The analyses for dentate individuals included 1,883 observations from 1,149 individuals. There was a positive association between the number of teeth and mean gait speed. Individuals using dental prostheses also had higher means of gait speed than those without dental prostheses. Gait speed was lower among individuals with periodontal pockets and with attachment loss. No interaction was found between any of the indicators of dentition status and time.ConclusionGait speed was associated with dentition status and this association was constant over time.

Assessment of oral hygiene habits and periodontal status of patients during and after orthodontic treatment

OBJECTIVE: This study evaluated the relationship between orthodontic treatment, oral hygiene practices, and periodontal health in individuals undergoing or completed orthodontic treatment. MATERIALS AND METHOD: Systemically healthy patients undergoing or completed stable orthodontic treatment were included in the study. The periodontal status of 142 participants was determined using a comprehensive oral hygiene questionnaire and clinical oral examinations to assess various periodontal indices. Chi-square and t-tests were used for statistical analyses to compare periodontal status metrics between groups. RESULTS: Statistical analyses revealed no significant differences between oral hygiene habits, periodontal indices, or periodontal status between the ongoing treatment (OT) and post-orthodontic treatment (PT) groups (p&amp;gt;0.05). However, significant differences were noted in attachment level, dental visit frequency, and reasons for visits between the OT and PT groups (p&amp;lt;0.05). While participants generally showed similar oral hygiene awareness and practices, differences arose in toothbrushing times during orthodontic treatment and adherence to orthodontist recommendations. CONCLUSION: This study investigated the effect of OT on oral health and concluded that OT did not change oral hygiene habits but affected attachment levels. Orthodontists should consistently guide patients on oral hygiene and managing clinical attachment loss. In these cases, the patient should be referred to a periodontist when necessary.