Periodontal Diagnosis Research Articles

Hermansky-Pudlak syndrome type 2: A rare cause of severe periodontitis in adolescents-A case study.

Background and aimsHermansky-Pudlak syndrome (HPS) is an autosomal recessive disorder characterized by oculocutaneous albinism (OCA) and platelet storage pool deficiency. The HPS-2 subtype is distinguished by neutropenia, and little is known about its periodontal phenotype in adolescents. AP3B1 is the causative gene for HPS-2. A 13-year-old Chinese girl presented to our department suffering from gingival bleeding and tooth mobility. Her dental history was otherwise unremarkable. Suspecting some systemic diseases as the underlying cause, the patient was referred for medical consultation, a series of blood tests, and genetic tests. In this case study, periodontal status and mutation screening of one HPS-2 case are presented.MethodsBlood analysis including a complete blood count (CBC) and glycated hemoglobin levels were measured. Platelet transmission electron microscopy (PTEM) was performed to observe the dense granules in platelets. Whole-exome sequencing (WES) and Sanger sequencing were performed to confirm the pathogenic variants.ResultsA medical diagnosis of HPS-2 was assigned to the patient. Following the medical diagnosis, a periodontal diagnosis of “periodontitis as a manifestation of systemic disease” was assigned to the patient. We identified novel compound heterozygous variants in AP3B1 (NM_003664.4: exon7: c.763C>T: p.Q255*) and (NM_003664.4: exon1: c.53_56dup: p.E19Dfs*21) in this Chinese pedigree with HPS-2.ConclusionThis case study indicates the importance of periodontitis as a possible indicator of underlying systemic disease. Systemic disease screening is needed when a young patient presents with unusual, severe periodontitis, as the oral condition may be the first of a systemic abnormality. Our work also expands the spectrum of AP3B1 mutations and further provides additional genetic testing information for other HPS-2 patients.

Advanced Glycation End Product (AGE) and Soluble Receptor of AGE (sRAGE) Levels in Relation to Periodontitis Severity and as Putative 3-Year Outcome Predictors in Patients Undergoing Coronary Artery Bypass Grafting (CABG).

Tissue concentrations of advanced glycation end product (AGE) and peripheral soluble receptor of AGE (sRAGE) levels may be associated with periodontitis severity. Both parameters and periodontitis might serve as outcome predictors for patients undergoing coronary artery bypass grafting (CABG). This study aimed to investigate possible associations between periodontitis and AGE/sRAGE. Ultimately, we wanted to examine whether AGE, sRAGE, and severe periodontitis are associated with the incidence of new cardiovascular events within 3 years of follow-up after CABG. Ninety-five patients with coronary vascular disease (CVD) (age 69 years, 88.3% males) needing CABG surgery were included. Periodontal diagnosis was made according to the guidelines of the “Centers for Disease Control and Prevention (CDC)” (2007) and staged according to the new classification of periodontal diseases (2018). AGE tissue concentrations were assessed as skin autofluorescence (sAF). sRAGE levels were determined by using a commercially available enzyme-linked immunoabsorbance assay (ELISA) kit. Univariate and multivariate baseline and survival analyses were carried out with Mann–Whitney U test, Chi² test, Kaplan–Meier curves with Log-Rank test, and logistic and Cox regression. sAF was identified as an independent risk indicator for severe periodontitis with respect to the cofactors age, gender, plaque index, and diabetes (adjusted odds ratio [OR] = 2.9, p = 0.028). The degree of subgingival inflammation assessed as a percentage of sites with bleeding on probing (BOP) was inversely correlated with sRAGE concentration (r = −0.189, p = 0.034). Both sAF (Hazard Ratio [HR] = 2.4, p = 0.004) and sRAGE (HR = 1.9, p = 0.031) increased the crude risk for new adverse events after CABG. The occurrence of severe periodontitis trends towards a higher risk for new cardiovascular events (HR = 1.8, p = 0.115). Applying multivariate Cox regression, only peripheral arterial disease (adjusted HR = 2.7, p = 0.006) and history of myocardial infarction (adjusted HR = 2.8, p = 0.010) proved to be independent risk factors for cardiovascular outcome. We conclude that sAF may represent a new, independent risk indicator for severe periodontitis. In contrast, sAF, sRAGE, and severe periodontitis were not independent prognostic factors for postoperative outcome in patients undergoing CABG.

Enzymatic measurement of short-chain fatty acids and application in periodontal disease diagnosis.

Periodontal disease is a chronic inflammatory condition caused by periodontal pathogens in the gingival sulcus. Short-chain fatty acids (SCFAs) produced by causal bacteria are closely related to the onset and progression of periodontal disease and have been reported to proliferate in the periodontal sulcus of patients experiencing this pathology. In such patients, propionic acid (C3), butyric acid (C4), isobutyric acid (IC4), valeric acid (C5), isovaleric acid (IC5), and caproic acid (C6), henceforth referred to as [C3-C6], has been reported to have a detrimental effect, while acetic acid (C2) exhibits no detrimental effect. In this study, we established an inexpensive and simple enzymatic assay that can fractionate and measure these acids. The possibility of applying this technique to determine the severity of periodontal disease by adapting it to specimens collected from humans has been explored. We established an enzyme system using acetate kinase and butyrate kinase capable of measuring SCFAs in two fractions, C2 and [C3-C6]. The gingival crevicular fluid (GCF) and saliva of 10 healthy participants and 10 participants with mild and severe periodontal disease were measured using the established enzymatic method and conventional gas chromatography-mass spectrometry (GC-MS). The quantification of C2 and [C3-C6] in human GCF and saliva was well correlated when using the GC-MS method. Furthermore, both C2 and [C3-C6] in the GCF increased with disease severity. However, while no significant difference was observed between healthy participants and periodontal patients when using saliva, [C3-C6] significantly differed between mild and severe periodontal disease. The enzymatic method was able to measure C2 and [C3-C6] separately as well as using the GC-MS method. Furthermore, the C2 and [C3-C6] fractions of GCF correlated with disease severity, suggesting that this method can be applied clinically. In contrast, the quantification of C2 and [C3-C6] in saliva did not differ significantly between healthy participants and patients with periodontal disease. Future studies should focus on inflammation rather than on tissue destruction.

Periodontal diagnosis and treatment planning - An assessment of the understanding of the new classification system.

Substantial variations are seen among clinicians in the diagnosis and treatment planning of periodontal diseases. Accurate diagnosis and treatment planning are fundamental requirements for effective outcome-based patient care. The aim of this study was to evaluate the understanding of the American Academy of Periodontology and the European Federation of Periodontology 2017 periodontal disease classifications in diagnoses and treatment plans across four study groups. The study recruited at least 20 participants in each of the four study groups. These included 1) Periodontal faculty and residents at Indiana University School of Dentistry (IUSD-PF) 2) IUSD general practice faculty (IUSD-GPF), 3) private practice periodontists (PPP), and 4) general practitioners (GP). The participants were provided with 10 HIPPA de-identified case records and a link to a survey. The survey comprised five demographic questions and two questions on diagnosis and treatment plan for each case along with a fixed list of responses. The responses were then compared against gold standards that were determined by a group of three board-certified periodontists. Overall, for diagnostic questions, GP (69%) were correct significantly less often than IUSD-PF (86%, p<0.001), IUSD-GPF (79%, p=0.002), and PPP (80%, p=0.001). No significant differences (p>0.05) in the overall correct treatment plan responses were found among the four groups (IUSD-PF: 69%, IUSD-GPF: 62%, PPP: 68%, and GP: 60%). The multi-rater kappas for with-in-group agreement on overall diagnosis ranged from 0.36 (GP) to 0.55 (IUSD-PF) and on overall treatment plan ranged from 0.32 (IUSD-GPF) to 0.42 (IUSD-PF). Overall agreement for diagnosis and treatment plans among the four groups was relatively low and none of the groups were statistically different from each other (p>0.05). Regular participation in calibration sessions may lead to more accurate adoption of the 2017 periodontal classification and thereby help provide consistent diagnosis and treatment.

Diagnosis and treatment planning using the 2017 classification of periodontal diseases among three dental schools.

The American Academy of Periodontology and the European Federation of Periodontology developed a new classification system for periodontal diseases in 2017. The next step in its widespread implementation involves training dental students to improve consistency in clinical decisions. This study conducted in 2020-2021 aimed to evaluate knowledge in periodontal diagnosis and treatment planning using the new classification, among first, second, third- and fourth-year dental students at Indiana University School of Dentistry (IUSD), University of Texas School of Dentistry at Houston (UTSD), and University of Louisville School of Dentistry (ULSD). A minimum of 20 dental students per class year from each of the three schools participated. Ten HIPPA de-identified case records and a questionnaire with a fixed list of answer options, comprising two demographic questions and two questions on diagnosis and treatment planning of each case, were presented to the participants. A group of three board-certified periodontists established the answers for all cases which were used to score the appropriateness of diagnosis and treatment planning among the participants. A total of 263 students participated. Overall, 22.6% of IUSD responses, 25.2% of UTSD, and 27.6% of ULSD responses were correct for diagnosis (no statistically significant differences). For the treatment plan, 64.9% of IUSD responses, 66.2% of UTSD, and 68.9% of ULSD responses were correct (no statistically significant differences). Based on the findings from our study, we suggest that additional training be considered to improve the understanding of the 2017 classification of periodontal and peri-implant diseases among dental students.

High-resolution ultrasonography of gingival biomarkers for periodontal diagnosis in healthy and diseased subjects.

To determine the capacity of ultrasonographic image-based measurements of gingival height and alveolar bone level for monitoring periodontal health and disease. Sixteen subjects were recruited from patients scheduled to receive dental care and classified as periodontally healthy (n = 10) or diseased (n = 6) according to clinical guidelines. A 40-MHz ultrasound system was used to measure gingival recession, gingival height, alveolar bone level, and gingival thickness from 66 teeth for comparison to probing measurements of pocket depth and clinical attachment level. Interexaminer variability and comparison between ultrasound measurements and probing measurements was performed via Bland-Altman analysis. Gingival recession and its risk in non-recessed patients could be determined via measurement of the supra- and subgingival cementoenamel junction relative to the gingival margin. Interexaminer bias for ultrasound image analysis was negligible (<0.10 mm) for imaged gingival height (iGH) and 0.45 mm for imaged alveolar bone level (iABL). Diseased subjects had significantly higher imaging measurements (iGH, iABL) and clinical measurements (probing pocket depth, clinical attachment level) than healthy subjects (p < 0.05). Subtraction of the average biologic width from iGH resulted in 83% agreement (≤1 mm difference) between iGH and probing pocket depth measurements. Ultrasonography has an equivalent diagnostic capacity as gold-standard physical probing for periodontal metrics while offering more detailed anatomical information.

Molecular biomarker research in periodontology: A roadmap for translation of science to clinical assay validation.

The number of studies that aims to apply host‐ or microbe‐derived biochemical biomarkers to periodontal disease diagnosis has increased significantly during the last three decades. The biochemical markers can reflect the presence, severity, and activity of periodontal diseases; however, heterogeneities in applied laboratory methods, data presentation, statistical analysis, and data interpretation prevent the translation of candidate host‐ or microbe‐derived biochemical biomarkers to clinical assay validation. Here, we propose a roadmap for making the research outcomes comparable and re‐analysable with the ultimate goal of translating research to clinical practice. This roadmap presents reporting recommendations for host‐ or microbe‐derived biochemical biomarker studies in periodontology. We aim to make essential elements of the research work (including diagnostic criteria, clinical endpoint definitions, participant recruitment criteria, sample collection and storage techniques, biochemical and microbiological detection methods, and applied statistical analysis) visible and comparable.

Matrix-assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry (MALDI-TOF MS) for subgingival bacteriome identification in a group of treated periodontitis patients: a case series

Abstract Periodontitis is a chronic multifactorial polymicrobial infection, characterized by profound modifications of the composition and proportion of the subgingival microbiota. Microbiological laboratory tests are sometimes used in periodontal diagnosis and monitoring of treatment, but both conventional cultivation methods and molecular techniques have some major drawbacks. Therefore, other performant bacterial identification methods must be considered. The aim of the current study was to use Matrix-assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry (MALTI-TOF MS) analysis in association with bacterial culture method to evaluate the modifications of the subgingival bacterial composition in periodontitis patients, before and after cause-related subgingival therapy. Subgingival plaque samples were collected from periodontal pockets before and after subgingival mechanical instrumentation and adjunctive local antimicrobial applications and were cultured in aerobic and anaerobic conditions. Microbial colonies were further assessed using MALDI-TOF-MS. A total of 36 bacterial strains were isolated from a group of 16 patients. All species from the orange complex were identified by MALDI-TOF MS. A marked reduction of detection frequency was observed in most bacterial strains, including the orange complex after cause-related periodontal treatment. The results of this study indicate that MALDI-TOF MS could be considered an accurate method for oral microbial identification and the cause-related periodontal treatment is useful for reducing the microbial burden.

Integrating Image Analysis and Dental Radiography for Periodontal and Peri-Implant Diagnosis

The recent change in classification of periodontal and peri-implant diseases includes objective evaluation of intra-oral radiographs and quantification of bone loss for disease staging and grading. Assessment of the progression of periodontal disease requires deduction of bone loss longitudinally, and its interpretation as (1) a percentage in relation to tooth root and (2) as a function of the patient's age. Similarly, bone loss around dental implants, after accounting for initial remodeling, is central for determining diagnosis, severity, and progression of peri-implantitis. Bone gain secondary to periodontal regeneration can be measured using standardized dental radiographs and compared to baseline morphology to determine treatment success. Computational image analysis, including machine learning (ML), has the potential to develop and automate quantitative measures of tooth, implant, bone volumes, and predict disease progression. The developed algorithms need to be standardized while considering pre-analytic, analytic, and post-analytic factors for successful translation to clinic. This review will introduce image analysis and machine learning in the context of dental radiography, and expand on the potential for integration of image analysis for assisted diagnosis of periodontitis and peri-implantitis.

Prevalence of Bone Loss in Mandibular Future Abutment Teeth among Diabetic and Non-Diabetic Patients: A Retrospective Case-Control Study

Objective: This study aimed to compare the prevalence of bone loss in lower permanent premolars and canines, which can serve as abutments for future prostheses, among diabetic and non-diabetic patients. Materials and Methods: In this retrospective case-control study, records of patients who visited the dental clinics of Imam Abdulrahman Bin Faisal University were used. Inclusion criteria were the presence of a complete periodontal chart, full mouth radiographs, and past medical history (presence of DM, hypertension, and/or coronary heart disease). The criteria for exclusion were the reporting of malignancy, pregnancy, breastfeeding, or taking of the medications that affect bone turnover, periodontal surgery within the past year, absence of radiographs with good quality, and antibiotic use within 3 months prior to the dental visit. Demographical data, including gender and age, past medical history (diabetic state), and periodontal diagnosis, were collected. The severity of periodontal disease, radiographic bone loss (RBL), and its pattern were also assessed. Results: Out of 400 records, 363 patient files were included. Of those, almost 36% were males and 64% were females. The patients’ age was ranging from 16 to 82 years. About 34% of the patients were diagnosed with generalized periodontitis while 22% had localized periodontitis. With regards to the severity of the cases, the prevalence was equally distributed between mild (37%) and moderate periodontitis (38%), while 25% were diagnosed with severe periodontitis. A total of 22% of the patients were diabetic, which showed an increase in the severity of bone loss by an average of 31% across the selected teeth (mandibular canines and premolars). The pattern of bone loss was higher in the mandibular incisors, followed by the canines and the premolars. Multiple regression models showed that non-diabetics were significantly less likely to have bone loss in all the selected teeth and the male patients had 2 times the likelihood of having bone loss. Although the mandibular canines have the highest root length in the mandible, they were the most affected by bone loss in diabetic patients with periodontitis. Conclusion: Results of this study suggested that mandibular premolars were the teeth least affected by bone loss in both, diabetic and non-diabetic groups. Therefore, they can be considered the most suitable teeth to be used as abutments for the future prosthesis.

Assessment of masticatory function in the differential diagnosis of Stage IV periodontitis: A pilot diagnostic accuracy study.

After diagnosis of periodontitis is made, detection of Stage IV cases is critical for appropriate management that may call for interdisciplinary care. This study aims to identify and assess the accuracy of a simple screening approach for practice and surveillance of Stage IV periodontitis. Masticatory function assessments by both validated self-reported masticatory dysfunction questionnaire and dual-color chewing gum mixing ability test (index test) were conducted in 214 consecutive patients, followed by a full-mouth periodontal examination. Periodontal diagnosis was based on the 2017 World Workshop classification of periodontal diseases (reference standard). Multivariate logistic regression and area under the receiver operating characteristic curve (AUROC) analyses were performed. Overall, the individual patient-reported masticatory dysfunction questions showed low to moderate accuracy for predicting Stage IV periodontitis. The objective measures of masticatory function by calculating the variance of hue from the chewing gum test performed better with an AUROC of 0.840. A diagnostic approach based on age, self-report of altered food type intake, and chewing gum test results exhibited excellent performance for predicting Stage IV periodontitis (sensitivity: 89.7%; specificity:76.3%; AUROC:0.912). Once the presence of periodontitis has been established, a simple diagnostic approach that does not require specialized workforce, complex, or lengthy assessment allows identification of patients with Stage IV periodontitis. This is important as these patients require specific case work up and interdisciplinary care pathways. Additional studies are required to validate the findings in multiple populations.

The role of bone-specific biomarkers in chronic periodontitis diagnosis and treatment outcomes - a systematic review.

Background The biomarkers of bone turnover may be vital for early detection of bone destruction in chronic periodontitis (CP). Lately, several new biochemical markers have been applied to estimate bone homeostasis.Objective The current review aims to evaluate the role of bone biomarkers in diagnosis and treatment outcomes of CP.Methods Literature search was conducted in databases like Medline (PubMed) and Scopus to include original research articles related to the role of bone biomarkers in CP. About 914 documents were identified through primary search, of which 11 original research articles were included.Results The most common bone biomarker applied in periodontal diagnosis was RANKL. Certain newer biomarkers like ICTP were also found to be useful in early detection of progressive CP.Conclusion The bone turnover biomarkers may serve as an adjunct to the traditional methods of periodontal diagnosis. They are vital in identifying the subjects at risk for future periodontal breakdown as well as in determining the therapeutic outcomes. Their applications in periodontal diagnosis is still in the developing stage and requires further investigation. With this background, the current systematic review evaluated the role of bone-specific biomarkers in CP diagnosis and treatment outcomes.

Relationship between Undernutrition and Periodontal Diseases among a Sample of Yemeni Population: A Cross-Sectional Study.

Undernutrition is an inadequate supply of energy and nutrients. Periodontal diseases (PDs) are defined as a broad form of chronic inflammatory disease of the gingiva, bone, and ligaments supporting the teeth. This study aimed to reveal the relationship between undernutrition, using body mass index (BMI) and serum albumin level (Alb), and PDs in a sample of Yemeni population. A cross-sectional study was conducted at dental teaching clinics at the Faculty of Dentistry, Sana'a University. Of 1920 patients who attended clinics, only 229 matched the study criteria. Oral examination was performed to assess the periodontal clinical parameter measurements. BMI and Alb were measured. Participants of both genders were involved, with a slight increase in males (n = 134, 58.5%), and most of the study sample was in the age group of 18–35 years (n = 209, 91.3%). Regarding habits, only 18.2% (n = 43) of patients were smokers and about half of the participants (n = 136, 59.4%) were khat chewers. Most cases had mild undernutrition according to BMI (n = 139, 60.7%) and normal Alb level (n = 213, 93%). Regarding the periodontal diagnosis, most of the participants were diagnosed with gingivitis (n = 186, 81.2%). BMI and albumin level were nonsignificantly associated with PDs. PDs were statistically significant with the participant's age, gender, level of education, and smoking (P > 0.05). However, BMI, khat chewing, and albumin level were nonsignificant factors of periodontal diseases among Yemeni participants (P > 0.05). In both genders, variables such as age of the patients, smoking, khat chewing, and PDs were nonsignificantly associated with BMI. This study showed that the majority of the participants had been diagnosed with gingivitis, but there was not an association between PDs and undernutrition. This paper is presented on research square URL // https://www.researchsquare.com/article/rs-429796/v1 with DOI 10.21203/rs.3.rs-429796/v1.

The inverse association between a fish consumption biomarker and gingival inflammation and periodontitis: A population-based study.

AimThe metabolite 3‐carboxy‐4‐methyl‐5‐propyl‐2‐furanpropionic acid (CMPF) is a fatty fish–intake biomarker. We investigated the association between plasma levels of CMPF in relation to gingival inflammation and periodontitis case definition, as well as the extent and severity variables.Materials and MethodsThe Malmö Offspring Study is a population‐based study, and the Malmö Offspring Dental Study (MODS) is its dental arm, including periodontal charting. Plasma CMPF was measured using liquid chromatography–mass spectrometry and studied in relation to periodontal diagnosis and parameters using multivariable linear or logistic regression modelling adjusting for age, sex, education, body mass index, fasting glucose, and smoking.ResultsMetabolite data were available for 922 MODS participants. Higher CMPF levels were associated with less gingival inflammation (β = −2.12, p = .002) and lower odds of severe periodontitis (odds ratio [OR] = 0.74, 95% confidence interval [CI]: 0.56 to 0.98). Higher CMPF levels were also associated with more teeth (β = 0.19, p = .001), lower number of periodontal pockets (≥4 mm) (β = −1.07, p = .007), and lower odds of having two or more periodontal pockets of ≥6 mm (OR = 0.80, 95% CI: 0.65 to 0.98) in fully adjusted models.ConclusionsCMPF, a validated biomarker of fatty fish consumption, is associated with less periodontal inflammation and periodontitis. Residual confounding cannot be ruled out, and future studies are warranted.

Recent Advances of Point-of-Care Devices Integrated with Molecularly Imprinted Polymers-Based Biosensors: From Biomolecule Sensing Design to Intraoral Fluid Testing.

Recent developments of point-of-care testing (POCT) and in vitro diagnostic medical devices have provided analytical capabilities and reliable diagnostic results for rapid access at or near the patient’s location. Nevertheless, the challenges of reliable diagnosis still remain an important factor in actual clinical trials before on-site medical treatment and making clinical decisions. New classes of POCT devices depict precise diagnostic technologies that can detect biomarkers in biofluids such as sweat, tears, saliva or urine. The introduction of a novel molecularly imprinted polymer (MIP) system as an artificial bioreceptor for the POCT devices could be one of the emerging candidates to improve the analytical performance along with physicochemical stability when used in harsh environments. Here, we review the potential availability of MIP-based biorecognition systems as custom artificial receptors with high selectivity and chemical affinity for specific molecules. Further developments to the progress of advanced MIP technology for biomolecule recognition are introduced. Finally, to improve the POCT-based diagnostic system, we summarized the perspectives for high expandability to MIP-based periodontal diagnosis and the future directions of MIP-based biosensors as a wearable format.

Active MMP-8 point-of-care (PoC)/chairside enzyme-test as an adjunctive tool for early and real-time diagnosis of peri-implantitis.

ObjectiveThe aim of this study was to investigate the utility of the active matrix metalloproteinase (aMMP‐8)‐point‐of‐care (PoC) test as a quantitative real‐time chair‐side diagnostic tool for peri‐implant diagnosis, as well as assess the potentially developing and ongoing risk relative to the traditional clinical methods.BackgroundCurrent peri‐implant and periodontal disease diagnoses rely on clinical and radiological examinations. This case‐control study investigated the applicability of aMMP‐8‐PoC immunotest for quantitative real‐time diagnosis and monitoring of dental implants in health and disease.MethodsSixty‐eight patients visiting a specialist clinic for maintenance following dental implant placement underwent assessment of their peri‐implant health. aMMP‐8‐PoC peri‐implant sulcular fluid (PISF) lateral‐flow immunotests were performed using ImplantSafe® technology quantitated by ORALyzer®. In addition, the PISF samples were analyzed for total MMP‐8, calprotectin, and interleukin (IL)‐6 by enzyme‐linked immunosorbent assays (ELISA), aMMP‐8 by western immunoblot, and MMP‐2 and MMP‐9 by gelatin zymography.ResultsThe aMMP‐8‐PoC test promptly recorded and reflected peri‐implant disease, differentiating it clearly from health. X‐ray findings (bone loss > 2 mm), peri‐implant pocket depth ≥ 3 mm, and bleeding on probing were significantly more prevalent among implants positive for the aMMP‐8‐PoC test. aMMP‐8/ORALyzer analysis was more precise in recording disease than total MMP‐8, calprotectin, IL‐6, MMP‐2, and MMP‐9.ConclusionsThe aMMP‐8‐PoC test can be conveniently implemented to alert for and detect active collagenolysis affecting peri‐implant tissues, both in the early and advanced stages of the disease. Active and fragmented MMP‐8 exhibits a strong and significant association with peri‐implantitis as compared to total MMP‐8 and other biomarkers and can be utilized as the POC/chairside biomarker of choice in the new classification of peri‐implantitis.

Cone-Beam Computed Tomography in Periodontal Diagnosis and Treatment Planning

AbstractDiagnosis of periodontal disease depends on conventional clinical parameters. In periodontitis with extensive bone defects, radiographs play a crucial role in arriving at a proper diagnosis. The emergence of cone-beam computed tomography (CBCT) became a boon in oral radiology. Limitations of conventional two-dimensional (2D) radiographs include inadequate visualization of bone defects, lamina dura, and furcation involvement. CBCT generates 3D images of anatomical structures necessary for the periodontal diagnosis of furcation involvement, intrabony defects, and implant placement. CBCT, thus, imparts various potential applications in the field of periodontics which serves to arrive at better diagnostic conclusions.

Self-reported questionnaire on periodontal condition validated for use in Brazil.

There is a current expectation of instruments for periodontal condition surveillance worldwide. The present study aimed to validate the Oral Health Questions Set B (OHQB) for the Brazilian Portuguese and evaluate its temporal stability. This is a sequential mixed-method investigation. After the forward-backward translation process to the Brazilian Portuguese, the OHQB Brazil (OHQB-Br) was applied to 156 participants (39.5 ± 14.14 years; 51.9% males). In sequence, through a full-mouth six-sites/teeth examination and in accordance with the original instrument, the periodontal diagnosis was obtained (March 2020). In January 2021, the OHB-BR was reapplied (n = 71). Ordinal alpha and McDonald's omega tested the internal consistency of the OHQB-Br. Temporal stability was investigated [Spearman correlation, intraclass correlation coefficient (ICC), and the Bland-Altman]. The concurrent validity was also verified, considering the periodontal clinical diagnosis (Kruskal Wallis). The ordinal alpha (0.69) and McDonald's omega (0.73) coefficients showed an adequate internal consistency of the OHQB-Br. The OHQB-Br temporal stability was high, as demonstrated by the Spearman coefficient (0.80) and ICC (0.79) and by the Bland-Altman plot. A concurrent validity showed a direct relationship between the OHQB-Br and the clinical condition of no periodontitis, mild, moderate, and severe periodontitis (p < 0.05). Because the OHQB-Br shows internal validity, temporal stability, and adequately identifies periodontal health and moderate/severe periodontitis, the instrument might represent an important tool, at the public level or other settings, for periodontal surveillance in Brazil.

Development and testing of a mobile application for periodontal diagnosis

BackgroundThe new classification of periodontal diseases introduced a new set of rules for periodontal diagnosis. The objective of this study was to develop and test the implementation of a mobile device application for periodontal diagnosis. Material and MethodsAn integral algorithm that included periodontal health / related conditions and periodontitis was developed based on the classification of periodontal diseases of 2018. A mobile application for Android implementing the algorithm was developed using the framework MIT App Inventor. Once the app was debugged for glitches and performance of the algorithm, it was tested with 20 voluntary dental students, postgraduate students of periodontology, and professors in an academic setting. Participants were asked to determine the diagnosis of 10 predetermined clinical cases using two strategies: diagnosis based on knowledge and with the PerioSmart app. The results were tabulated, and the concordance rate was calculated. ResultsIn general, the use of the PerioSmart application had a better concordance rate than diagnosis based on knowledge. In particular, the mobile app was better in determining the type of diagnosis, stage/grade of periodontitis, and with better efficiency. ConclusionsThe mobile device application demonstrated efficiency and good concordance rate and therefore can improve the periodontal diagnosis. Key words:Mobile application, periodontal diagnosis, periodontitis, gingivitis.

Enhanced Periodontal Debridement with Periodontal Endoscopy (Perioscopy) for Diagnosis and Treatment in Periodontal Therapy

The perioscope, which was only recently introduced, has greatly improved the removal of subgingval calculus during periodontal therapy. A fibre-optic periodontal endoscope was created to aid in the imaging of subgingival tissues and to improve periodontal disease diagnosis and treatment. Scaling and root planing have the goal of completely removing plaque and calculus from root surfaces. While this is unachievable, the agreed end-point during periodontal instrumentation is a smooth, glassy root surface. This has frequently led in over instrumentation and excessive cementum removal. Cement removal has been judged unnecessary in most cases. The removal of plaque, calculus, and endotoxin adhered to the root surface is critical. The easiest way to clean root surfaces is to use powered instruments sparingly. Due to a lack of visibility, excessive cementum removal occurs during hand instrumentation. The ability to visibly debride roots using endoscopic technology can improve success rates in a more conservative and minimally invasive manner. The perioscopy device was created to visualise the subgingival region for diagnosis, but it has since been altered to help with periodontitis therapy. The perioscope is a small camera that is encased in a sleeve and inserted under the gingival sulcus or pocket for subgingivally visualisation and instrumentation. This technique gives the greatest conservative approach to non surgical and surgical periodontal care because it enables superb magnified visualisation of the root surface and ensures the total or near complete elimination of the bacterial infection. The aim of this brief review was to provide knowledge about periodontal endoscopy, its implementation in day today practice.