Clinical Attachment Loss Research Articles

Effects of initial periodontal therapy on the formation of neutrophil extracellular traps in gingival crevicular fluid in patients with severe periodontitis.

This study aimed to observe the effects of initial periodontal therapy on the level of neutrophil extracellular traps (NETs) in gingival crevicular fluid (GCF) of patients with severe periodontitis and to analyze the factors related to the formation of NETs. Thirty-one patients with stage Ⅲ-Ⅳ periodontitis were recruited. Clinical periodontal parameters, including plaque index (PLI), gingival index (GI), probing depth (PD), and clinical atta-chment loss (CAL), were recorded before and 6-8 weeks after initial periodontal therapy. Levels of NETs in GCF were detected by immunofluorescence staining. Quantities of total bacteria, Porphyromonas gingivalis (P. gingivalis), Aggregatibacter actinomycetemcomitans (A. actionomycetemcomitans) and Prevotella intermedia (P. intermedia)in unattached subgingival plaque were determined by real-time quantitative PCR, and levels of tumor necrosis factor-α (TNF-α) and interleukin-8 (IL-8) in GCF were explored by enzyme-linked immunosorbent assay. In addition, the correlations between the level of NETs and the above indicators were analyzed. After initial periodontal therapy, the level of NETs in GCF, PLI, GI, PD, and CAL; quantities of total bacteria, P. gingivalis, A. actinomycetemcomitans, and P. itermedia; and levels of IL-8 and TNF-α significantly decreased (P<0.05). We observed strong positive correlations between the level of NETs and PLI, GI, PD, CAL, the amount of total bacteria, P. gingivalis, TNF-α, and IL-8 (P<0.05). Initial periodontal therapy might decrease the level of NETs in GCF from patients with severe periodontitis, which might be positively correlated with the quantities of P. gingivalis andthe levels of TNF-α and IL-8 in GCF.

Low folate biomarker concentrations are associated with increase the risk and severity of periodontitis in adults: A cross-sectional study based on the National Health and Nutrition Examination Survey 2009-2014.

We sought to test the hypothesis that adult folate biomarker concentrations are negatively associated with the risk and severity of periodontitis. Data were pooled from the National Health and Nutrition Examination Survey (NHANES) 2009 to 2014. A total of 9252 dentate adult subjects aged 30 years and older who received a periodontal examination and had complete folate biomarker data were included in the analysis. Both logistic regression and linear regression models were built to analyze the associations between folate biomarker concentrations and periodontitis, followed by multisubgroup and sensitivity analyses. In addition, restricted cubic spline models were applied to observe the shape of the associations. We found negative associations between serum folate and periodontitis status (odds ratio [OR] = 0.775, 95% CI: 0.691-0.869), periodontal probing depth (PPD) (β = -0.048, 95% CI: -0.069 to -0.027), and clinical attachment loss (CAL) (β = -0.061, 95% CI: -0.098 to -0.025). A negative association was also found between red blood cell folate and periodontitis status (OR = 0.727, 95% CI: 0.613-0.861), PPD (β = -0.055, 95% CI: -0.086 to -0.024), and CAL (β = -0.084, 95% CI: -0.128 to -0.040). Subgroup and sensitivity analyses showed robust results. Restricted cubic spline models demonstrated significant linearity for associations. Folate biomarker concentrations were negatively associated with periodontitis in adults aged 30 years and older, indicating that folate may have a restrictive effect on the risk and severity of periodontitis. This finding may provide a clinical target for preventive and interventional measures to promote periodontal nutrition and health.

Patient-Reported Outcomes Following Systemic Antibiotic Adjunct to Nonsurgical Treatment of Periodontitis: A Randomized Controlled Clinical Trial.

Considering the importance of patient-centered care, we aimed to evaluate the impact of systemic antibiotics on oral health-related quality of life during nonsurgical periodontal treatment. This controlled trial addresses a gap in understanding how systemic antibiotics influence patient-reported outcomes, focusing on Stage III periodontitis. Sixty-one adults participated in a double-blind, randomized clinical trial, with participants divided into two groups: the test group, which received antibiotics, and the control group. All the participants received nonsurgical periodontal treatment. We conducted follow-up assessments at one and 3 months posttreatment, including recording clinical parameters and administering the Oral Health Impact Profile-14 (OHIP-14) questionnaire. The results showed a notable improvement in the quality of life for patients in the test group compared to the control group at 1 month (p value = 0.012) and 3 months (p value = 0.014) after treatment. While there were improvements in pocket probing depth, gingival index, and clinical attachment loss in both groups, it is worth noting that only bleeding on probing exhibited a significant improvement in the test group after 3 months compared to the control group (p value = 0.008). In summary, incorporating systemic antibiotics alongside nonsurgical periodontal treatments appears to bring about positive outcomes for individuals dealing with Stage III periodontitis during nonsurgical treatment, ultimately enhancing their oral health-related quality of life. Iranian Registry of Clinical Trials (IRCT Id): IRCT20201221049786N1.

Five-Year Results of One-Piece Zirconia Oral Implants Supporting Three-Unit Fixed Dental Prostheses.

The purpose of the present prospective case series was to investigate the clinical and radiological outcome of one-piece zirconia implants fabricated from 3Y-TZP with a moderately roughened endosseous surface (Sa = 1.24 μm) to support three-unit fixed dental prostheses (FDP) after five years in function. Twenty-seven patients received a total of 54 implants in a one-stage surgery with immediate provisionalization. Peri-implant bone loss was assessed using standardized radiographs. Additionally, soft-tissue parameters were analyzed. Statistical analyses were conducted using linear mixed regression models and Wilcoxon Signed Rank tests (p < 0.05). All patients participated in an annual maintenance program. Eighteen implants were lost up to the 5-year follow-up, resulting in a cumulative survival rate of 66.67%. The mean marginal bone loss of the remaining implants amounted to 1.89 mm. Probing depth, clinical attachment loss, and bleeding on probing increased from prosthesis insertion to the 5-year follow-up, while the plaque index showed no significant changes during the same period. The investigated one-piece zirconia implant showed low survival rates as compared to previously reported survival rates of one-piece zirconia or two-piece titanium implants. Implant failure was attributed to peri-implantitis, leading to the necessity of implant removal. The implant is not commercially available.

Prevalence of the oral pathogen Filifactor alocis and its FtxA toxin related to clinical parameters and presence of Aggregatibacter actinomycetemcomitans

The Gram-positive organism Filifactor alocis is implicated in multiple oral diseases including periodontitis, and approximately 50% of known strains encode and produce a recently identified repeat-in-toxin (RTX) protein, FtxA, partly homologous to the Aggregatibacter actinomycetemcomitans leukotoxin. By assessing a longitudinal Ghanaian study population of adolescents, we recently identified a possible correlation between F. alocis levels, ftxA gene carriage, and progression of clinical attachment loss (CAL). To extend knowledge on the possible significance of F. alocis and its FtxA in periodontal disease, we have in the present work analyzed saliva samples in an independent cohort of periodontitis (n=156), collected at two private periodontal specialist practices in Perth, Western Australia. The present results corroborate that high loads of F. alocis and the presence of its ftxA gene together are associated with parameters of periodontal tissue destruction and severity. Moreover, among the individuals carrying A. actinomycetemcomitans, a majority also exhibited an ftxA-positive F. alocis, supporting the notion of the synergistic behavior of these two species. This emphasizes that F. alocis and its ftxA are involved in the pathogenesis of periodontitis and may have ecological roles, with diagnostic and prognostic implications for the disease.

High Mobility Group Box-1 (HMGB1)/microRNA-155 Axis in the Pathogenesis of Type 2 Diabetes Mellitus Associated Periodontitis: A Case Control Study

Aim: To evaluate the role of the high mobility group box-1 (HMGB1)/miR-155 axis in the pathogenesis of stage III/IV periodontitis with and without type 2 diabetes mellitus (T2DM). Materials and Methods: A total of 48 patients were assigned into four groups (12 per group): group 1: systemically and periodontally healthy (PH), group 2: systemically healthy with stage III/IV periodontitis (PD), group 3: PH with T2DM (PH + T2DM), group 4: stage III/IV periodontitis with T2DM, HbA1c ≤ 7 (PD + T2DM). Site-specific plaque index (SS-PI), gingival index (SS-GI), mean probing pocket depth (M-PPD) and clinical attachment loss (M-CAL) were recorded. Gingival tissue samples were analysed for HMGB1 and miR-155 gene expression by real-time polymerase chain reaction. Results: The miR-155 fold change (FC) increased by 10.29, 8.1 and 5.6 times in groups 4, 3 and 2, respectively. Intergroup comparison of miR-155 FC showed a significant difference between the groups ( p &lt; .05). HMGB1 FC increased by 6.5, 5.9 and 5.23 times in groups 4, 2 and 3, respectively, with no significant difference ( p &gt; .05). miR-155 FC is positively and significantly correlated with M-PPD (group 1, 2 and total sample), site-specific plaque score (SS-PS) (group 4) and SS-GI (total sample). miR-155 could discriminate periodontal health from T2DM + PD based on area under the curve 0.82 ( p &lt; .05) with 83.3% sensitivity, 75% specificity, 76.9% positive and 81.8% negative predictive value and 79.2% diagnostic accuracy. Conclusion: miR-155 is significantly upregulated in the diseased periodontium both in the presence and absence of T2DM. Further, miR-155 could be a potential diagnostic biomarker for diabetes-associated PD. However, the significance of HMGB1 and the HMGB1-miR155 axis in the aetiology of diabetes-associated PD is still unclear and warrants additional investigation.

Tissue-invasive Pathogens in Periodontitis Patients and Their Correlation with Pro-inflammatory Markers: An Analytical Case-control Study.

Tissue-invasive bacteria have been proposed to be a crucial factor in the etiopathogenesis of periodontitis, with the probable interaction of tissue-invasive bacteria with the innate immune response through inflammasomes, perpetuating periodontal attachment loss. This study aims to reveal the correlation between such tissue-invasive bacteria in upregulating inflammasomes and pro-inflammatory cytokines. This study recruited a total of 10 patients with stage III/IV and grade C periodontitis based on the bone loss to age ratio. Patient sites were grouped into group I: healthy sites with no clinical attachment loss (CAL); group II (mild-to-moderate): 1-4 mm of CAL; group III: severe (≥ 5 mm of CAL). Tissue samples were collected in these sites during periodontal flap surgery and assessed for both the bacterial genomic DNA and assessed for the upregulation of pro-inflammatory markers NOD-like receptor - Pyrin domain containing protein 3 (NLRP3), Human AIM2, Human Pro-TNFα, Human Pro-IL-1β, Human Pro-IL 6 and Human glyceraldehyde-3-phosphate dehydrogenase (GAPDH) genes. The levels of NLRP3, AIM2, and pro-inflammatory cytokine levels were all higher in the severe sites when compared with the other two sites. The tissue invasive bacterial phylotypes in these sites were thereafter compared with the levels of the pro-inflammatory markers in the various groups. The fold changes in the pro-inflammatory markers evaluated in this study all hovered around 1, indicating not much difference in the upregulation of these markers of inflammation. Statistically, significant correlation between bacterial phenotypes in the healthy sites group and the pro-interleukin-6 (IL-6) cytokine expression was observed (r = 0.68; p < 0.04). This study has highlighted the presence of tissue-invasive bacteria in sites with or without CAL. The fact that these healthy sites, after non-surgical therapy, have comparable levels of pro-inflammatory markers in the tissues may be explained by immune priming, by tissue- invasive periodontal pathogens. Tissue-invasive bacteria are present in periodontally healthy sites too, and non-surgical periodontal therapy is inadequate to eliminate them. Greater importance should be given to the soft tissue walls of the periodontal pocket in clinical management of periodontitis. How to cite this article: Victor DJ, Anandan NS, Appukuttan D, et al. Tissue-invasive Pathogens in Periodontitis Patients and Their Correlation with Pro-inflammatory Markers: An Analytical Case-control Study. J Contemp Dent Pract 2024;25(10):992-996.

The Use of Connective Tissue Graft Wall as an Adjunct to Regenerative Treatment for Deep Intrabony Defects Associated with Gingival Recession: A Retrospective Case Series with 5-Year Follow-up.

The adjunctive use of connective tissue grafts (CTGs) in the periodontal regeneration of intrabony defects has been proposed to prevent or limit postoperative gingival recession. However, there is limited evidence regarding the long-term clinical performance of this approach. This article presents the five-year follow-up outcomes of a combination therapy using CTG, bone substitutes, and biologics for the treatment of deep intrabony defects associated with gingival recession. Twelve healthy, non-smoking patients with 12 deep intrabony defects participated in the study. These patients had a mean clinical attachment loss (CAL) of 9.9 ± 2.1 mm, a mean probing depth (PPD) of 7.8 ± 1.5 mm, and a mean buccal recession (REC) of 2.3 ± 1.8 mm at baseline, before= undergoing the described treatment regimen. After five years, the mean clinical attachment level (CAL) gain was 5.7 ± 3.2 mm (p < 0.001), the mean reduction in probing pocket depth (PPD) was 5.1 ± 1.6 mm (p < 0.001), and the mean reduction in recession (REC) was 1.2 ± 2.1 mm (p = 0.07) Ninety-one percent of sites achieved CAL gain of ≥3 mm and PPD ≤ 4 mm. Compared to baseline, 7 out of 12 sites showed a REC reduction of ≥1 mm, while three sites remained stable, and two sites experienced an increase in gingival recession depth of 1 and 2 mm respectively. Within the limitations of this case series, periodontal regenerative therapy incorporating the adjunctive use of CTG showed to be effective for treating deep non-contained periodontal intrabony defects and respectively stabilize or slightly improve the gingival margin over five years.

Gingival crevicular fluid level of tumor necrosis factor-alpha as a valuable biomarker for estimation of the efficacy of adjunctive antimicrobial photodynamic therapy in stage II-IV periodontitis: a systematic review and meta-analysis.

This systematic review and meta-analysis aimed to assess the gingival crevicular fluid (GCF) level of tumor necrosis factor-alpha (TNF-alpha) as a valuable inflammatory cytokine for estimation of the efficacy of adjunctive antimicrobial photodynamic therapy (aPDT) in stage II-IV periodontitis patients. This review was conducted in accordance with the PRISMA statements, and registered in PROSPERO (CRD42022321211). An electronic search was conducted for articles comparing the efficacy of aPDT versus scaling and root planing (SRP) published up until June 2023. The mean GCF level of TNF-alpha and clinical attachment loss (CAL) with 95% confidence interval (CI) were pooled and compared between the groups using a random-effect model after 1-2, 4-5, 12-13, and ≥ 24 weeks. The I2 test was applied to assess the heterogeneity of the findings, and publication bias was evaluated by visual inspection of the funnel plot symmetry. Analysis of 11 studies indicated a significant difference in GCF level of TNF-alpha at the 1-2, 12-13 and ≥ 24-week follow-ups in patients treated with aPDT + SRP. However, at the 4-5-week follow-up, the results were significant in favor of the control group (mean difference = -0.17, 95% CI = -1.86-152, P < 0.00001). Despite the limitations of the included studies, aPDT can decrease the GCF level of TNF-alpha inflammatory biomarker for a longer period of time than SRP alone in grade II-IV periodontitis. However, further investigations are required to assess the efficacy of higher frequency of aPDT applications.

Evaluation of leukocyte-platelet rich fibrin as an antibiotic slow-release biological device in the treatment of moderate periodontitis: a randomized controlled clinical trial

BackgroundPeriodontitis is a chronic inflammatory disease caused by the accumulation of biofilm. Antimicrobials have been used as adjuncts to non-surgical periodontal therapy. However, systemic antibiotics often require large dosages to achieve suitable concentrations at the disease site. Leukocyte platelet-rich fibrin (L-PRF) is a promising bio-material, with antimicrobial, anti-inflammatory, and wound-healing enhancement effects. This study aimed to evaluate the efficacy of L-PRF as a locally sustained released device for metronidazole antimicrobial.MethodsTwenty-four patients with eighty periodontal pockets had moderate periodontitis with attachment loss of 3–4 mm, and probing depth ≤ 5, which was equally divided into two groups: Group (I) underwent scaling and root planing with intra-pocket application of L-PRF loaded with Metronidazole, while Group (II) was treated by scaling and root planing with intra-pocket application of L-PRF alone. Microbiological measurements were taken at baseline and after one month to analyze the relative count of Porphyromonas gingivalis (P. gingivalis) using real time PCR. Clinical parameters were measured at baseline and after 1, 3, and 6 months. These parameters included probing depth (PD), clinical attachment loss (CAL), plaque index (PI), modified gingival index (MGI), and bleeding index (BI).ResultsMicrobiological and clinical findings revealed that both treatment methods resulted in a reduction in P. gingivalis counts, in addition to improvements in the clinical parameters: PD reduction, CAL gain, PI reduction, BI decrease and MGI reduction compared to baseline. However, L-PRF-metronidazole group showed superior results in the studied parameters over the study period. Nonetheless, there was no statistically significant improvement. (p < .001).ConclusionThe intra-pocket application of both L-PRF loaded with Metronidazole and L-PRF alone contributed to the successful treatment of moderate periodontitis.Trial registrationNCT06153706 (http://www.clinical-trials.gov/); 1/12/2023, retrospective registration.

COMPARATIVE EVALUATION OF THE PERIODONTAL STATUS AND SERUM PARAMETERS IN NORMAL BODY MASS INDEX AND OBESE CHILDREN

Objective: Childhood obesity is a growing global health concern, with established associations to both systemic and oral health complications. This study aimed to compare periodontal status and inflammatory biomarkers between obese and non-obese children. Materials and methods: Fifty-two children (26 obese, 26 non-obese) were included, with key parameters such as Plaque Index (PI), Bleeding on Probing (BOP), Probing Depth (PD), and Clinical Attachment Loss (CAL) assessed to evaluate periodontal health. Paraclinical indicators including fibrinogen, C-reactive protein (CRP), and vitamin D (25(OH)D) levels were also measured. Results and Discussion: Results demonstrated that obese children exhibited significantly higher values for PI, BOP, PD, and CAL, indicating poorer periodontal health. Elevated serum fibrinogen and CRP levels, coupled with lower vitamin D levels in obese children, underscored a state of chronic inflammation and potential nutrient deficiency associated with obesity. Conclusion: These findings highlight the need for a multidisciplinary approach to managing obesity and promoting oral health, suggesting that early intervention in dietary and lifestyle factors could mitigate these risks.

Periodontal disease and serum uric acid levels in the absence of metabolic syndrome: is there a link? A study on a sample of Cameroonian adults

BackgroundThe relationship between serum uric acid level (SUA) and periodontal diseases (PD) is still controversial, and few studies have been carried out in population with no element of metabolic syndrome especially in sub-Saharan Africa. The aim of this study was to assess the relationship between PD and SUA in Cameroonian adults not suffering from metabolic syndrome.MethodsWe carried out a cross-sectional study including Cameroonians aged over 18 years recruited in the general population and free of metabolic syndrome elements. They were assessed for frequency of consumption of purine-rich foods, periodontal indices (plaque index, gingival index, calculus index, pocket depth and clinical loss of attachment), and SUA. The diagnosis of PD was based on the American Academy of Periodontology criteria revised in 2015, and hyperuricemia was defined for values exceeding 70 and 60mg/L in men and women respectively. Comparison of SUA means was performed with the ANOVA test. Association between hyperuricemia and PD were evaluated using Fischer's exact test. The threshold of significance was 0.05.ResultsOne hundred and seventy-four participants were included (57.5% women, mean age 29 (10.39) years). The frequencies of PD were 75.9%, gingivitis (59.1%) and periodontitis (40.1%). Hyperuricemia was found in 20.45% of people with PD, with no difference in frequency comparing with those without PD. The frequency of consumption of purine-rich foods was similar in individuals with and without PD. Serum uric acid levels were not different in individuals with and without PD, and differed among periodontal indices only for calculus index, where SUA were higher in participants with the highest score (p=0.026). We found no association between hyperuricemia and PD.ConclusionIn individuals without elements of metabolic syndrome, hyperuricemia affects one in five people with PD. There appears to be no link between SUA and overall periodontal status in this population. Further studies are needed to better understand the salivary interaction between uric acid and periodontium in our population.

ASSESSING THE IMPACT OF ACIDIC DRINKS ON THE STRUCTURAL INTEGRITY OF ENAMEL AND THEIR CONSEQUENCES FOR DENTAL AESTHETICS

Aim of the study: This study seeks to evaluate the detrimental effects of acidic beverages on tooth structure and overall dental health, with a particular focus on comparing the extent of damage at a microscopic level. While it is widely understood that acidic drinks are harmful to teeth, the precise scale of the damage is often underestimated. By examining the degree of harm caused by prolonged exposure to acidic substances, this research aims to increase awareness of the cumulative effects that sugary and acidic beverages have on dental health and aesthetics over time. Materials and methods: The teeth used in this study were obtained from private practice, from patients diagnosed with Stage 3 or 4 periodontitis. These teeth were deemed unsuitable for prosthetic treatment due to excessive clinical attachment loss (CAL) or advanced tooth mobility (grade 2 or 3). Following extraction, the teeth were preserved in artificial saliva for a maximum of 20 days.The experiment involved a sample of 30 teeth, each of which was submerged in a different beverage for a duration of 24 hours The beverages used in this study were Sprite, lime juice, apple vinegar, and white wine. Following the 24-hour exposure, the teeth were documented, and photographs were taken. The enamel surface of the teeth was then analyzed under a Scanning Electron Microscope (SEM) to examine the extent of acid-induced damage in detail. Additionally, the density of the two halves of each tooth was compared using a Diagnodent pen (KaVo) to further assess the impact of the acidic beverages. Results: The results of this study will contribute to a deeper understanding of enamel erosion caused by acidic beverages, offering valuable insights for both dental professionals and individuals aiming to protect their enamel from deterioration. Conclusions: In conclusion, the excessive and frequent consumption of acidic beverages results in irreversible enamel demineralization, leading to aesthetic concerns such as white spots, discoloration, surface roughness, and an increased risk of tooth sensitivity or loss. Additionally, the method of consumption—particularly the tendency to a prolonged the contact between these beverages and the dental structure—exacerbates the potential for damage. To minimize these effects, it is imperative to reduce both the frequency of acidic drink intake and the duration of their contact with the teeth. Effective management of acidic beverage consumption is essential for preserving oral health and maintaining dental aesthetics.

Association between Porphyromonas gingivalis in subgingival plaque and coronary artery disease: A case-control study.

Periodontitis is a chronic inflammatory disease of the supporting tissue surrounding the teeth. The disease is caused by specific bacteria, such as Porphyromonas gingivalis, which lead to the destruction of periodontal ligaments and alveolar bone. The study aimed to evaluate the relationship between the prevalence of P. gingivalis in subgingival plaque and coronary artery disease (CAD). Fifty patients with CAD and 50 healthy controls (non-CAD) participated in this case-control study. The periodontal health in the groups was evaluated through the assessment of the pocket depth (PD), clinical attachment loss (CAL) and bleeding on probing (BoP). The presence of P. gingivalis in subgingival plaque samples was determined through real-time polymerase chain reaction (RT-PCR). The data was analyzed using the χ2 test and the Mann-Whitney U test. The mean PD was 3.30 ±1.55 mm and 3.56 ±0.97 mm in CAD patients and non-CAD subjects, respectively (p = 0.028). No significant differences were observed in the CAL (p = 0.858) and BoP (p = 1.000) between the groups. The RT-PCR results revealed the presence of P. gingivalis 16S rDNA in 32% and 22% of the subgingival plaque of patients with CAD and non-CAD, respectively, with a mean concentration of 7.7 × 106. No statistically significant association was observed between the prevalence of P. gingivalis and CAD (p = 0.260). The results of the multiple logistic regression analysis showed an association between CAD and male sex (p = 0.004, odds ratio (OR): 4.163), as well as age (p = 0.011, OR: 1.067). The findings of this study indicated that there is no statistically significant correlation between the prevalence of P. gingivalis in subgingival plaque and CAD.

Ten-year changes of periodontitis grading using direct and indirect evidence: a retrospective evaluation.

To evaluate two methods for assessing the changes in periodontitis grading in patients undergoing supportive periodontal therapy 10 years (T10) after retrospective baseline grading. The periodontitis grade of 51 supportive periodontal therapy patients was assessed using indirect evidence as the primary criterion for periodontitis progression at baseline and T10 (radiographic bone loss/age index, periodontitis phenotype). Grading at T10 was also performed using the direct evidence for periodontitis progression (clinical attachment loss over the previous 5 years). The use of indirect evidence for periodontal progression at baseline and T10 was defined as method 1 to assess the changes in periodontitis grading. The use of indirect evidence at baseline and direct evidence at T10 was defined as method 2. Changes in periodontitis grading using methods 1 and 2 were evaluated (Wilcoxon signed-rank test). Agreement between methods 1 and 2 was assessed (Cohen kappa). Indirect baseline grading revealed five grade B and 46 grade C patients. The indirect grading at T10 revealed 17 grade B and 34 grade C patients. The direct T10-grading classified all patients as grade C. Method 1 led to an overall improvement in periodontitis grading after 10 years of supportive periodontal therapy (P = .0030), whereas method 2 led to a deterioration (P = .0369). The comparison between methods 1 and 2 showed that they led to different results in terms of grading (Cohen kappa = 0.116208). Periodontitis grading may change during supportive periodontal therapy. Using indirect or direct evidence as the primary grading criterion during supportive periodontal therapy may lead to different results.

Evaluation of the association between periodontal disease and total cancer risk: A cross-sectional study.

The body is in a continuous state of inflammatory burden due to local and systemic inflammation, which is triggered in periodontal tissues in response to microorganisms. A number of studies have linked periodontitis to systemic diseases such as diabetes mellitus, cardiovascular disease and respiratory disease. Periodontal inflammation acts as a focus of infection, which can cause detrimental effects on distant target organs. In some cases, it may lead to tumor progression in various cancers. The aim of the study was to evaluate the correlation between periodontal disease (PD) and its potential role as a risk factor for the development of systemic cancer and its metastasis. A single-center, cross-sectional study was conducted, including 66 patients with different systemic malignancies (group 1, the test group) and 66 healthy individuals (group 2, the control group). Group 1 was further subdivided into 2 categories: M0, comprising patients without metastases (n = 34); and M1, comprising patients with distant metastases (n = 32). The number of missing teeth, Greene and Vermilion's simplified oral hygiene index (OHI-S), probing pocket depth (PPD), Löe and Silness' bleeding on probing (BoP), clinical attachment loss (CAL), and Ramfjord's periodontal disease index (PDI) were recorded. Appropriate statistical tests were performed to analyze the data. A p-value <0.05 was considered statistically significant. The differences between the PDI, CAL and PPD values in both group 1 and group 2 were found to be statistically significant (p = 0.000). In M0 and M1, no statistically significant differences were observed between any of the parameters. The odds ratios (ORs) between group 1 and group 2 for CAL and PDI were 3.986 and 4.286, respectively. The ORs for M0 and M1 with regard to CAL and the mean number of teeth lost were 0.373 and 0.188, respectively. The findings of the study indicate a significant association between the overall risk of cancer and PD. In cases of known systemic malignancies, no significant correlation has been identified between PD and the risk of metastasis.

Periodontitis in Patients Undergoing Coronary Angiography: A Cross-Sectional Study.

Background Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide, with coronary artery disease (CAD) being the primary contributor. Periodontitis, a common non-communicable disease, has been associated with an increased risk of CVD. Previous studies have suggested a link between the severity of periodontitis and the degree of coronary artery obstruction. Objective This study aims to investigate the correlation between the severity of periodontitis and coronary artery stenosis, as measured by the SYNTAX score I (Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery), and to examine the association between severe periodontitis and other coronary pathologies, such as diffuse coronary disease and coronary thrombosis. Materials and methods An observational cross-sectional study was conducted at the Second Cardiology Clinic, University Multiprofile Hospital for Active Treatment "St. Marina", Varna, Bulgaria, from December 2021 to January 2024. A total of 199 patients aged 45-64 years, indicated for coronary angiography, were included. Periodontal assessment included measuring probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BoP), and plaque index (PI). Subgingival plaque samples were analyzed for periodontal pathogens. Coronary angiography was performed, and the SYNTAX score I was calculated to assess the severity of coronary artery stenosis. Statistical analyses, including chi-square tests and Spearman's correlation, were conducted to evaluate the associations. Results Among the 199 participants, 74.9% had severe periodontitis (stage III and IV). A weak but statistically significant correlation was found between mean CAL, periodontitis stage, and the SYNTAX score I (p < 0.01 and p < 0.05, respectively), indicating that more severe forms of periodontitis were associated with greater coronary artery stenosis. No correlation was observed between the presence of periodontal pathogens or the total microbial count and the SYNTAX score I. Additionally, no association was found between severe periodontitis and other coronary conditions, such as diffuse coronary disease and thrombosis. Conclusion This study provides new insights into the relationship between periodontal infection and coronary artery disease. Our findings suggest that severe periodontitis is significantly associated with a higher frequency and more complex coronary lesions, as indicated by the SYNTAX score I. However, no link was observed between specific periodontal pathogens and coronary stenosis. These results underscore the importance of early diagnosis and management of periodontal infections in patients with CAD, highlighting the potential benefits of an integrated approach to managing cardiovascular and periodontal health. Further studiesare needed to explore these associations in more depth.

Salivary advanced glycated end products, their receptors, and aMMP-8 in periodontitis patients with varying glycemic levels: A cross-sectional study.

Advanced glycation end products (AGE) and their receptors (RAGE) have been implicated in developing periodontal complications in diabetic patients. This study aimed to identify salivary AGE, RAGE, soluble RAGE (sRAGE), and active-matrix metalloproteinase-8 (aMMP-8) levels at varying glycemic levels in periodontitis patients. Ninety-eight participants were categorized into uncontrolled DM-PD group (n=27)-periodontitis patients with uncontrolled Type 2 diabetes mellitus (T2DM) (glycated hemoglobin [HbA1c] ≥7%); controlled DM-PD group (n=33)-periodontitis patients with controlled T2DM (HbA1c 5.7%-6.9%); SH-PD group (n=18)-systemically healthy periodontitis patients; and SH-PH group (n=20)-systemically and periodontally healthy individuals. HbA1c along with the periodontal parameters bleeding on probing (BoP), periodontal probing depth (PPD), clinical attachment loss (CAL), number of missing teeth, and periodontal inflamed surface area (PISA) were estimated. Enzyme-linked immunosorbent assay (ELISA) was used for analyzing salivary AGE, RAGE, sRAGE, and aMMP-8. Multiple linear regression analysis was conducted to develop predictive models for HbA1c based on relevant predictor variables. Periodontitis participants with uncontrolled T2DM exhibited significantly higher BoP, PPD, CAL, number of missing teeth, and PISA, along with elevated AGE, RAGE, and aMMP-8, compared to other groups (p<0.01). A significant positive association was observed between RAGE and HbA1c levels (p<0.01). Among the predictors, BoP (p=0.046) and CAL (p<0.001) demonstrated a significant positive effect on salivary AGE. PPD was positively associated with RAGE (p<0.05), and BoP was negatively associated with salivary sRAGE levels (p=0.038). Salivary biomarkers like RAGE and aMMP-8 exert a potential role in monitoring periodontal health and glycemic control in T2DM patients. Advanced glycation end products (AGE) and their receptors (RAGE) have been implicated in developing periodontal complications in diabetic patients. This study aimed to identify salivary AGE, RAGE, soluble RAGE (sRAGE), and aMMP-8 levels at varying glycemic levels in periodontitis patients. Ninety-eight participants were categorized into Group 1 (n=27)-periodontitis patients with uncontrolled Type 2 diabetes mellitus (T2DM); Group 2 (n=33)-periodontitis patients with controlled T2DM; Group 3 (n=18)-systemically healthy periodontitis patients; and Group 4 (n=20)-systemically and periodontally healthy individuals. Enzyme-linked immunosorbent assay (ELISA) was used for analyzing salivary AGE, RAGE, sRAGE, and aMMP-8. The study revealed that participants with uncontrolled T2DM and severe periodontitis exhibited significantly higher levels of salivary AGE, RAGE, and aMMP-8, along with increased periodontal parameters, compared to controlled T2DM and systemically healthy groups. Conversely, salivary sRAGE levels were significantly lower in the uncontrolled T2DM group. The study also found significant associations between salivary RAGE levels and glycated hemoglobin (HbA1c), as well as between aMMP-8, AGE, and clinical periodontal parameters. The findings of this study highlight the potential clinical utility of salivary biomarkers, particularly RAGE and aMMP-8, as noninvasive diagnostic and monitoring tools to evaluate glycemic control and periodontal health in individuals with diabetes.

The impact of fixed and removable dental prostheses on the periodontal health of abutment teeth: A Retro-Prospective Comparative Study

IntroductionPeriodontal disease is the most prevalent oral condition worldwide, resulting from a prolonged inflammatory reaction triggered by the buildup of dental plaque. Many studies have concluded that there is a strong association between periodontal health and tooth restorations, as the periodontium must be healthy for the restoration to last. Aimto evaluate the impact of fixed and removable dental prostheses on the periodontal health of abutment teeth. MethodologyThis was a retro-prospective cohort study of 112 abutment teeth collected from 34 patients who received a total of 47 fixed (81 abutments) and 14 removable (31 abutments) dental prostheses treated by senior dental students under supervision during the past two years. Patients were recalled for clinical and radiographic examinations to assess periodontal parameters of abutments, including pocket depth (PD), clinical attachment loss (CAL), presence of plaque, and bleeding on probing (BOP), and to evaluate fixed and removable prostheses. ResultsMost of the prostheses were fixed (72.32 %), and most of them were bridges (60.71 %) located in the anterior region of the mouth (58.56 %). The study findings showed a significant increase (mean = 0.46 mm) in clinical attachment loss after prosthesis placement (p < 0.01), while no significant difference was observed in pocket depth (p = 0.062). Furthermore, there was a significant increase in plaque at the follow-up visit compared to the baseline visit (p < 0.01) for only the fixed dental prostheses. There was no significant difference between fixed and removable prostheses regarding their impact on the periodontal health of abutments. ConclusionThe study found that abutment teeth had increased clinical attachment loss after receiving dental prostheses, highlighting the need for regular maintenance and patient education to maintain periodontal health.

The Association of Periodontitis and different BMI categories with Serum Chemerin Levels -: An Observational Case-Control Study

Background: Chemerin is a adipocytes, epithelial cells, endothelium, fibroblasts, and keratinocytes - derived chemotactic protein. This research was focused on possible connections between glycerin in serum, different body mass indexes (BMI), and appearance of the periodic disease. It is speculated that the findings of our work will help to deepen our comprehension of the interplay of adipokines, obesity, and periodontitis.The purpose of this endeavor is to establish the connections between serum chemerin, the value of BMI, and periodontitis to investigate the association between the indexes associated with the increase in obesity and the onset or aggravation of this disease. Methods: A total of 118 individuals volunteered to be a part of this research. serum obtained before the clinical investigations was the serum sample taken. participants were distributed into six groups: First group (C): 30 subjects with a normal BMI (18.5-24.9 kg/m^2) and a healthy periodontium; second group (Ov): 30 subjects with an overweight BMI (25–29.9 kg/m^2) and a healthy periodontium; third group (Ob): 30 subjects with an obesity BMI (≥ 30) and a healthy periodontium; fourth group (P): 30 periodontitis patients with a normal BMI (18.5-24.9 kg/m^2); fifth group (P+Ov): 30 periodontitis patients with an overweight BMI (25–29.9 kg/m^2) and sixth group (P+Ob): 30 periodontitis patients with obesity BMI (≥ 30). Evaluation of probe debut (PPD), clinical attachment loss (CAL), and bleeding upon probing (BOP) were the methods used in the periodontal test. Results: The findings of the study point out periodontal patients, and in particular, higher body mass index-filled serum levels of chemerin. Among all the study groups, patients with combined very severe obesity and periodontitis (P+Ob) were found to have the highest chemerin levels in their serum. Chemerin (C) of the control group with a weight within the normal range and a healthy area of periodontium was lower in reach. Conclusions: The results suggested that chemerin might be a good indicator biomolecule, which would provide information about the disease progress and deterioration, not only in the cases of overweight subjects but most probably in every person affected. may have a healing effect as its inflammatory effect could be counteracted.