Periodontitis Patients Research Articles

The Treatment of Severe Periodontitis Using a Local Antiseptic Desiccant and Subgingival Mechanical Instrumentation: A Pilot Study.

This randomized, split-mouth, controlled clinical study assessed the additional clinical benefits of a local desiccant antimicrobial agent (HY) combined with subgingival mechanical instrumentation (SRP) vs. SRP alone in treating severe periodontitis. Patients with stages III and IV periodontitis received full-mouth periodontal examinations at baseline and after a three-month follow-up. Two randomly selected hemiarches in each periodontitis patient were treated with SRP plus HY and were included in the test group, while the other two hemiarches received only SRP and were included in the control group. In thirty patients, the analyses of the evolution of the periodontal parameters over time showed statistically significant mean differences for the probing depths and clinical attachment level values resulting from all the examined sites, as well as from the interproximal sites (p < 0.001) in both the test and control groups. The intergroup comparisons of the same four parameters showed no significant differences (p = 0.322, p = 0.36, p = 0.516, and p = 0.509, respectively). Based on these study results, no additional benefits were obtained after HY subgingival applications.

TNF-αand OSX mRNA of salivary small extracellular vesicles in periodontitis: a pilot study.

This cross-sectional study explored extracellular vesicle (EV)-derived gene expression of markers for bone turnover and pro-inflammatory cytokines in periodontal disease. Whole unstimulated saliva was collected from fifty-two participants (18 healthy, 13 gingivitis and 21 stages III/IV periodontitis), from which small extracellular vesicles (sEVs) were enriched using the size-exclusion chromatography (SEC) method, and characterised by morphology, EV-protein, and size distribution, using transmission electron microscopy (TEM), enzyme-linked immunosorbent assay (ELISA), and Nanoparticle Tracking Analysis (NTA), respectively. Bone turnover markers and pro-inflammatory cytokines in salivary sEVs were evaluated using RT-qPCR. Salivary sEVs morphology, mode, size distribution and particle concentration were comparable between healthy, gingivitis, and periodontitis patients. A CD9+ subpopulation was significantly higher in periodontitis-derived salivary sEVs compared to healthy. The detection of sEVs mRNA for osterix (OSX) and tumour necrosis factor-alpha (TNFα) was significantly decreased and increased, respectively, in periodontitis compared to healthy controls, with good discriminatory power for periodontitis diagnosis [area under the curve (AUC) >0.72]. Our study demonstrated that salivary sEVs mRNAs may serve as a potential non-invasive biomarker source for periodontitis diagnosis.

Multiplexed LC-MS/MS quantification of salivary RNA modifications in periodontitis.

To analyse the salivary epitranscriptomic profiles as periodontitis biomarkers using multiplexed mass spectrometry (MS). The field of epitranscriptomics, which relates to RNA chemical modifications, opens new perspectives in the discovery of diagnostic biomarkers, especially in periodontitis. Recently, the modified ribonucleoside N6-methyladenosine (m6A) was revealed as a crucial player in the etiopathogenesis of periodontitis. However, no epitranscriptomic biomarker has been identified in saliva to date. Twenty-four saliva samples were collected from periodontitis patients (n = 16) and from control subjects (n = 8). Periodontitis patients were stratified according to stage and grade. Salivary nucleosides were directly extracted and, in parallel, salivary RNA was digested into its constituent nucleosides. Nucleoside samples were then quantified by multiplexed MS. Twenty-seven free nucleosides were detected and an overlapping set of 12 nucleotides were detected in digested RNA. Among the free nucleosides, cytidine and three other modified nucleosides (inosine, queuosine and m6Am) were significantly altered in periodontitis patients. In digested RNA, only uridine was significantly higher in periodontitis patients. Importantly there was no correlation between free salivary nucleoside levels and the levels of those same nucleotides in digested salivary RNA, except for cytidine, m5C and uridine. This statement implies that the two detection methods are complementary. The high specificity and sensitivity of MS allowed the detection and quantification of multiple nucleosides from RNA and free nucleosides in saliva. Some ribonucleosides appear to be promising biomarkers of periodontitis. Our analytic pipeline opens new perspectives for diagnostic periodontitis biomarkers.

Clinical and Radiological Benefits of Hyaluronic Acid in Periodontal Infrabony Defects: A Systematic Review and Meta-analysis

Purpose:There is no consensus on the clinical and radiological benefits of hyaluronic acid (HA) in patients with periodontitis having infrabony defects. Hence, this study examined the effects of HA in periodontitis patients with infrabony defects through a comprehensive systematic review process.Methodology:A systematic literature search was performed using PubMed/Medline, Scopus, Embase and Cochrane Library from inception to March 2022. Randomized or non-randomized clinical trials and single-arm clinical trials that assessed the clinical and radiological benefits of HA in periodontitis patients with infrabony defects with a minimum of 6 months follow-up were included in this study. Surgical regenerative therapy was considered as the comparator. The Cochrane risk of bias assessment tool and Downs and Black checklist was used for the quality assessment of randomized and non-randomized interventional studies, respectively. A subgroup and sensitivity analyses were performed to explore the heterogeneity and robustness of the findings, respectively.Results:A total of 13 out of 725 studies were included in this systematic review, of which 9 were considered for meta-analysis. The meta-analysis indicated significant benefits of HA in terms of reduction in probing pocket depth (SMD: 1.12 mm; 95% CI: 0.60-1.65; 9 studies), bone defect depth (SMD: 1.04mm; 95%CI: 0.62-1.47; 3 studies) and gain in clinical attachment level (1.04 mm; 95% CI: 0.33-2.47; 8 studies). Overall, the quality of included studies was good.Conclusion:The current evidence indicates that the administration of HA in the periodontal regenerative treatment of infrabony defects was significantly effective in increasing clinical attachment levels and reducing probing pocket and bone defect depth.

Alpha-Defensin 1: An Emerging Periodontitis Biomarker

Background: Research on the development of reliable diagnostic targets is being conducted to overcome the high prevalence and difficulty in managing periodontitis. However, despite the development of various periodontitis target markers, their practical application has been limited due to poor diagnostic accuracy. In this study, we present an improved periodontitis diagnostic target and explore its role in periodontitis. Methods: Gingival crevicular fluid (GCF) was collected from healthy individuals and periodontitis patients, and proteomic analysis was performed. The target marker levels for periodontitis were quantified in GCF samples by enzyme-linked immunosorbent assay (ELISA). Mouse bone marrow-derived macrophages (BMMs) were used for the osteoclast formation assay. Results: LC-MS/MS analysis of whole GCF showed that the level of alpha-defensin 1 (DEFA-1) was higher in periodontitis GCF than in healthy GCF. The comparison of periodontitis target proteins galactin-10, ODAM, and azurocidin proposed in other studies found that the difference in DEFA-1 levels was the largest between healthy and periodontitis GCF, and periodontitis was more effectively distinguished. The differentiation of RANKL-induced BMMs into osteoclasts was significantly reduced by recombinant DEFA-1 (rDEFA-1). Conclusions: These results suggest the regulatory role of DEFA-1 in the periodontitis process and the relevance of DEFA-1 as a diagnostic target for periodontitis.

A population-based study of the salivary prevalence of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans in Saudi Arabian adults with chronic periodontitis

AimsThis study was designed to investigate the incidence of subgingival Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans infections and their relationship with genetic variability in Saudi Arabian adults with chronic periodontitis and to evaluate the correlation between infection frequency and other variables. MethodsMultiplex polymerase chain reaction (PCR) assays were developed to detect P. gingivalis 16 ​S rDNA, fimbria (fimA), and collagenase (prtC) genes, as well as the A. actinomycetemcomitans 16 ​S rDNA, leukotoxin (lktA), and fimbria-associated protein (fap) genes in saliva samples from 50 patients with periodontitis and 51 healthy subjects. ResultsThe incidence of both P. gingivalis and A. actinomycetemcomitans infections was higher (72% and 14%) in the “Periodontal disease” group than in the healthy subjects (P ​< ​0.001). The P. gingivalis 16 ​S rDNA, fimA, and prtC genes were detected in 43.56%, 61.36%, and 84.09% of saliva samples, respectively, while A. actinomycetemcomitans 16 ​S rDNA, lktA, and fap genes were detected in 6.93%, 71.43%, and 0%, respectively. P. gingivalis strains with the fimA+/prtC ​+ ​genotype were found in 61.11% and 25% of chronic periodontitis patients and healthy subjects, respectively. By comparison, A. actinomycetemcomitans strains with the lktA+ ​genotype were found in 71.43% of chronic periodontitis patients. ConclusionInfection with fimA+ and prtC+ ​P. gingivalis or lktA+ ​A. actinomycetemcomitans was correlated with periodontal disease occurrence in Saudi adults. Nevertheless, A. actinomycetemcomitans lktA and P. gingivalis fimA and prtC are closely linked to periodontal destruction, whereas A. actinomycetemcomitans fap is not.

Evaluation of salivary Thy-1 in health, periodontitis, and obesity.

Thy-1 (CD90) is a glycosylphosphatidyl-anchored protein belonging to the immunoglobulin family and is known to control mesenchymal stromal cells differentiation into osteoblasts or adipocytes. The study aimed to investigate the salivary levels of Thy-1 in health, periodontitis, obesity, and any potential association. Seventy-one participants were divided into four groups: healthy (H), subjects with periodontitis (P), obese individuals (O), and obese individuals having periodontitis (PO). Unstimulated whole saliva was collected from participants who were evaluated for periodontal parameters. The levels of Thy-1 were measured with a commercially available ELISA kit. The data were statistically analyzed. A significant difference in salivary Thy-1 levels among different groups was observed. Periodontitis patients had the maximum, and obese individuals had the minimum Thy-1 levels. Significant differences between H and P, H and PO, P and O, and O and PO were observed. Overall correlations between Thy-1 and periodontal parameters and a positive correlation with pocket depth in group PO were noted. Thy-1 could be detected in the saliva of all study participants. It is implied that a local inflammatory condition like periodontitis elevates the salivary levels of Thy-1 with, and without obesity.

The Evaluation of Medical Records of Gingival Recession in Chronic Periodontitis Patient

Background: Periodontitis is inflammation of the gingiva accompanied by alveolar bone loss, which causes loss of attachment. Local factors that can exacerbate periodontitis are gingival recession, a condition where the gingival margin is pulled away from the cemento-enamel junction (CEJ), resulting in the opening of the root surface that was initially closed. Objective: This study aimed to determine the distribution of gingival recession features in chronic periodontitis patients at the Universitas Trisakti Dental Hospital, Indonesia. Material and Methods: This type of research is an observational descriptive with a cross-sectional research design with periodic medical record samples from January 2013 to December 2017. Data obtained from medical records were recorded and grouped in tables and then analyzed manually. Results: Of the 583 periodontal patients, there were 311 patients with gingival recession consisting of 11 maxillary gingival recession patients, 21 mandibular gingival recession patients with the majority of mild classification of gingival recession (3.0 mm from the exposed root surface) and 279 patients suffering from in both jaws with the majority classification of severe gingival recession ( 4.0 mm exposed root surface). Conclusion: Gingival recession in patients with chronic periodontitis is more common in the mandible than the maxilla. Patients with chronic periodontitis mostly experience gingival recession of more than 1 tooth in the upper and lower jaw with severe classification ( 4 mm).

Critical roles of PU.1/cathepsin S activation in regulating inflammatory responses of macrophages in periodontitis.

To determine the critical roles of PU.1/cathepsin S activation in regulating inflammatory responses of macrophages during periodontitis. Cathepsin S (CatS) is a cysteine protease and exerts important roles in the immune response. Elevated CatS has been found in the gingival tissues of periodontitis patients and is involved in alveolar bone destruction. However, the underlying mechanism of CatS-driven IL-6 production in periodontitis remains unclear. Western blot was applied to measure mature cathepsin S(mCatS) and IL-6 expression in gingival tissues from periodontitis patients and RAW264.7 cells exposed to lipopolysaccharide from Porphyromonas gingivalis (P.g. LPS). Immunofluorescence was applied to confirm the localization of PU.1, and CatS in the gingival tissues of periodontitis patients. ELISA was performed to determine IL-6 production by the P.g. LPS-exposed RAW264.7 cells. Knockdown by shRNA was used to determine the effects of PU.1 on p38/ nuclear factor (NF)-κB activation, mCatS expression and IL-6 production in RAW264.7 cells. The expressions mCatS and IL-6 were significantly upregulated in gingival macrophages. In cultured RAW264.7 cells, increased mCatS and IL-6 protein paralleled the activation of p38 and NF-κB after exposure to P.g. LPS. CatS knockdown by shRNA significantly decreased P.g. LPS-induced IL-6 expression and p38/NF-κB activation. PU.1 was significantly increased in P.g. LPS-exposed RAW264.7 cells, and PU.1 knockdown dramatically abolished the P.g. LPS-induced upregulation of mCatS and IL-6 and the activation of p38 and NF-κB. Furthermore, PU.1 and CatS colocalized in macrophages within the gingival tissues of periodontitis patients. PU.1-dependent CatS drives IL-6 production in macrophages by activating p38 and NF-κB in periodontitis.

The Effect of titanium dioxide nanoparticles on the activity of salivary peroxidase in periodontitis patients

Background:The technology of nanoparticles has been expanded to many aspects of modern life. Titanium dioxide nanoparticles were of many nanomaterials utilized in biomedical applications. The interactions between nanoparticles and proteins are believed to be the base for the biological effect of the nanoparticles. The oxidation reaction of many substances is catalyzed by oxidizing enzymes called peroxidases. The activity of salivary peroxidase is elevated with periodontal diseases. the aim ofthis study is to examine the action of titanium dioxide nanoparticles on salivary peroxidase activity.Material and method75 participants were enrolled in this study—Periodontitis group with 44 participants and the non-periodontitis group with 31 participants. The participants' age range was 35 to 50 years for both groups. The clinical parameters of plaque index, gingival index, probing pocket depth and clinical attachment level were used in this study to determine the presence or absence of the periodontal disease. Unstimulated saliva was collected from all participants and analyzed for the activity of peroxidase enzyme under the effect of titanium dioxide nanoparticles. ResultsThe Periodontitis group showed higher peroxidase enzyme activity than the non-periodontitis group and the activity of salivary peroxidase showed no correlation with the clinical parameters. Titanium dioxide nanoparticles increased salivary peroxidase activity. ConclusionThis study demonstrated that the solid surface of nanoparticles could induce changes in the attached protein molecule which in turn causes changes in the effect of the nanoparticles on living tissue or organism. The titanium dioxide nanoparticles Play a role in increasing the activity of salivary peroxidase within the saliva of chronic periodontitis patients.

Human Neutrophil Peptide 1- 3 and Vitamin D levels in periodontitis

Human neutrophil peptides 1-3 (HNP1-3) contribute to oral health by playing a role in innate response against oral diseases, owing to their antimicrobial, antiplaque and immunomodulatory activity. Vitamin D may reduce the risk of infection through multiple mechanisms and boosts innate immunity by modulating the production of antimicrobial peptides and cytokine response. This study was performed to evaluate the level of human HNP1-3 in periodontitis patients and controls and to study the effect of vitamin D on the levels of peptides in periodontitis. Eighty-five subjects were enrolled in this observational case-control study aged 20-59 years. The subjects were divided into fifty patients with periodontitis and 35 healthy controls. Periodontal parameters used in this study were plaque index, gingival index bleeding on probing, probing pocket depth and clinical attachment loss. Blood samples were collected from all subjects, and then ELISA was done to estimate the levels of HNP1-3 and vitamin D in patients and controls. The finding revealed a significant increase (P˂0.01) in the mean level of HNP1-3 among the patient's group compared to the control group. Moreover, there is no significant correlation with all parameters except the gingival index, which has a considerable result (r=0.367, p=0.009). On the other hand, this study showed a significant decrease (P&lt;0.01) in the mean level of vitamin D in patients compared to controls, and also that there was no significant decrease in the serum level of HNP1-3 among vitamin D insufficient group in comparison to vitamin D sufficient group. These results indicated that the increased levels of HNP1-3 and its correlation with GI provide evidence for the critical role of neutrophils in the inflammatory process in periodontitis and vitamin D, which plays a role in antimicrobial peptide production. Keywords: periodontitis, antimicrobial peptides, human neutrophils peptides

Evaluation of leukocytes cells types counts in blood from patients with different severities of periodontal diseases

Background: Periodontal diseases are inflammatory disorders caused by the accumulation of oral biofilm and the host response to this accumulation which characterized by exaggerated leukocytes and neutrophils attraction to the sites of inflammation by chemoattractants which are a very important part of the pathogenesis of periodontal diseases. This study aimed to determine and compare the clinical periodontal parameters and the leukocyte cell types in the peripheral blood between patients with gingivitis and periodontitis with different severities compared to healthy controls. Materials and methods: This study included 150 male subjects aged between 35-50 years. They were divided into three groups: gingivitis group (n=30), periodontitis patients (n=90) which subdivided into Mild =30 patients, Moderate =30 patients, Severe =30 patients and a control group (n=30) with clinically healthy periodontium. Clinical periodontal parameters were recorded ((plaque index (PLI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD) and clinical attachment level (CAL)). Blood samples were collected then an automated blood analyzer evaluated leukocyte cell types. Results: Significant differences in The counts of neutrophils and lymphocytes exhibited significant differences among the study groups and subgroups. On contrary, differences in monocytes, eosinophils, and basophils counts were not significant. Additionally, severity of periosontitis was significantly correlated with the mean counts of the various leukocyte cell types; however, clinical periodontal characteristics did not show such correlation with these inflammatory cells. Conclusion: This study demonstrated that periodontal disease with different severities is associated with possible episodes of bacteremia that originate from periodontal lesions which mediate inflammatory conditions that in turn causing changes in the systemic markers especially leukocytes cells types.

Correlation of Salivary Melatonin Levels and Many Periodontal Parameters in Cigarette Smokers with Periodontitis

Background: Adults who have periodontitis are more likely to lose teeth, which affects their quality of life and causes masticatory dysfunction. Most people agree that smoking tobacco makes them more likely to get oral mucosal and periodontal diseases and makes the oral microbiome less balanced. Melatonin is a naturally occurring hormone that is released in a variety of organs. Objectives: To examine the relationship between smoking and salivary melatonin levels in periodontitis patients vs healthy people, and to establish a relationship between melatonin levels and periodontal parameters. Materials and Methods: The study was conducted at the College of Dentistry, University of Baghdad, Baghdad, Iraq. The study period was from February to May 2022. There were a total of 74 male subjects aged 35-55 years, and they were divided into four different groups; Group 1: a control group of non-smokers (n = 12), Group 2: a control group of smokers (n = 12), Group 3: a group of individuals with periodontitis (n = 25), Group 4: a group of individuals with both periodontitis and a record of smoking (n = 25). A whole, unstimulated sample of the participant's saliva (5 ml) was taken, and this was followed by an evaluation of clinical periodontal variables (probing pocket depth and clinical attachment level). To measure melatonin concentrations, saliva samples were biochemically analyzed using the Enzyme-Linked Immunosorbent Assay (ELISA).Results: Melatonin concentrations were shown to be lower in groups with periodontitis than in control groups, as well as lower in groups with smoking than in groups without smoking. It was found that there was a strong negative link between periodontal variables and the amount of melatonin in the saliva. Conclusion: According to this study, a reduced melatonin level was noticed in the salivary fluid of the smoker (healthy and periodontitis) groups in comparison with the non-smoker (healthy and periodontitis) groups. This suggests that active cigarette smoking had a retarding effect on the salivary levels of melatonin.

Influences of race/ethnicity in periodontal treatment response and bacterial distribution, a cohort pilot study.

Periodontitis disproportionately affects different racial and ethnic populations. We have previously reported the higher levels of Porphyromonas gingivalis and lower ratios of Streptococcus cristatus to P. gingivalis may contribute to periodontal health disparities. This prospective cohort study was designed to investigate if ethnic/racial groups responded differently to non-surgical periodontal treatment and if the treatment outcomes correlated to the bacterial distribution in patients with periodontitis before treatment. This prospective cohort pilot study was carried out in an academic setting, at the School of Dentistry, University of Texas Health Science Center at Houston. Dental plaque was collected from a total of 75 African Americans, Caucasians and Hispanics periodontitis patients in a 3-year period. Quantitation of P. gingivalis and S. cristatus was carried out using qPCR. Clinical parameters including probing depths and clinical attachment levels were determined before and after nonsurgical treatment. Data were analyzed using one-way ANOVA, the Kruskal-Wallis test, the paired samples t-test and the chi-square test. The gains in clinical attachment levels after treatment significantly differed amongst the 3 groups-Caucasians responded most favorably, followed by African-Americans, lastly Hispanics, while numbers of P. gingivalis were highest in Hispanics, followed by African-Americans, and lowest in Caucasians (p = 0.015). However, no statistical differences were found in the numbers of S. cristatus amongst the 3 groups. Differential response to nonsurgical periodontal treatment and distribution of P. gingivalis are present in different ethnic/racial groups with periodontitis.

Comparative prevalence of oral bacteria and protozoa in patients with periodontitis in Taiwan.

Periodontitis is an inflammatory disease caused by bacteria present in the dental biofilm. However, the presence of two oral protozoans, Entamoeba gingivalis and Trichomonas tenax, in patients with the periodontal disease remains largely unknown in Taiwan. Therefore, we investigated the prevalence of oral microbial infections between the sites with mild gingivitis and chronic periodontitis in patients. We collected 60 dental biofilm samples from sites with mild gingivitis (probing depth <5 mm) and chronic periodontitis (probing depth ≥5 mm) from 30 patients at the National Cheng Kung University Hospital. The samples were analyzed via polymerase chain reaction and gel electrophoresis. Among oral protozoans, E. gingivalis and T. tenax were detected in 44 (74.07%) and 14 (23.33%) of all samples, respectively. Among oral bacteria, Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia were detected in 50 (83.33%), 47 (78.33%), and 48 (80.0%) samples, respectively. This study, which is the first to analyze E. gingivalis and T. tenax presence among patients with periodontitis in Taiwan, revealed an association between periodontitis and oral microbes.

Glipizide Alleviates Periodontitis Pathogenicity via Inhibition of Angiogenesis, Osteoclastogenesis and M1/M2 Macrophage Ratio in Periodontal Tissue.

New consensus indicates type 2 diabetes mellitus (T2DM) and periodontitis as comorbidity and may share common pathways of disease progression. Sulfonylureas have been reported to improve the periodontal status in periodontitis patients. Glipizide, a sulfonylurea widely used in the treatment of T2DM, has also been reported to inhibit inflammation and angiogenesis. The effect of glipizide on the pathogenicity of periodontitis, however, has not been studied. We developed ligature-induced periodontitis in mice and treated them with different concentrations of glipizide and then analyzed the level of periodontal tissue inflammation, alveolar bone resorption, and osteoclast differentiation. Inflammatory cell infiltration and angiogenesis were analyzed using immunohistochemistry, RT-qPCR, and ELISA. Transwell assay and Western bolt analyzed macrophage migration and polarization. 16S rRNA sequencing analyzed the effect of glipizide on the oral microbial flora. mRNA sequencing of bone marrow-derived macrophages (BMMs) stimulated by P. gingivalis lipopolysaccharide (Pg-LPS) after treatment with glipizide was analyzed. Glipizide decreases alveolar bone resorption, periodontal tissue degradation, and the number of osteoclasts in periodontal tissue affected by periodontitis (PAPT). Glipizide-treated periodontitis mice showed reduced micro-vessel density and leukocyte/macrophage infiltration in PAPT. Glipizide significantly inhibited osteoclast differentiation in vitro experiments. Glipizide treatment did not affect the oral microbiome of periodontitis mice. mRNA sequencing and KEGG analysis showed that glipizide activated PI3K/AKT signaling in LPS-stimulated BMMs. Glipizide inhibited the LPS-induced migration of BMMs but promoted M2/M1 macrophage ratio in LPS-induced BMMs via activation of PI3K/AKT signaling. In conclusion, glipizide inhibits angiogenesis, macrophage inflammatory phenotype, and osteoclastogenesis to alleviate periodontitis pathogenicity suggesting its' possible application in the treatment of periodontitis and diabetes comorbidity.

Synergy of Regenerative Periodontal Surgery and Orthodontics Improves Quality of Life of Patients with Stage IV Periodontitis: 24-Month Outcomes of a Multicenter RCT.

In stage IV periodontitis patients with pathologic tooth migration (PTM), interdisciplinary treatment includes regenerative periodontal surgery (RPS) with an application of biomaterials and orthodontic therapy (OT) to restore function, esthetics and thereby quality of life (QoL). In a 24-month randomized trial we explored the synergy between regenerative medicine and biomechanical force application. The following methods were used: Forty-three patients had been randomized to a combined treatment comprising RPS and subsequent OT starting either 4 weeks (early OT) or 6 months (late OT) post-operatively. Clinical periodontal parameters and oral health-related QoL (GOHAI) were recorded up to 24 months. We obtained the following results: Mean clinical attachment gain (∆CAL ± SD) was significantly higher with early OT (5.96 ± 2.1 mm) versus late OT (4.65 ± 1.76 mm) (p = 0.034). Pocket closure (PPD ≤ 4 mm) was obtained in 91% of defects with early OT compared to 90% with late OT. GOHAI-scores decreased significantly from 26.1 ± 7.5 to 9.6 ± 4.7 (early OT) and 25.1 ± 7.1 to 12.7 ± 5.6 (late OT). Inconclusion, teeth severely compromised by intrabony defects and PTM can be treated successfully by RPS followed by early OT with the advantage of an overall reduced treatment time. As a result of the combined periodontal-orthodontic therapy, the oral health-related QoL of patients was significantly improved. Early stimulation of wound healing with orthodontic forces had a favorable impact on the outcomes of regenerative periodontal surgery.

Oxidative stress-related biomarkers in chronic periodontitis patients with or without type 2 diabetes: A systematic review and meta-analysis.

The purpose of this meta-analysis was to look at the differences in oxidative stress (OS) biomarkers between type 2 diabetes mellitus with chronic periodontitis (DMCP) and chronic periodontitis (CP) patients. Oxidative stress has been shown to be a key pathogenic component in DMCP. However, it is unclear whether oxidative stress levels differ in periodontitis patients with or without diabetes. A systematic search was conducted on PubMed, Cochrane, and Embase databases. Studies of DMCP participants were used as the experimental group and CP participants were used as the control group. Results are expressed as mean effects. Of a total of 1989 articles, 19 met the inclusion criteria. We found the levels of catalase (CAT) levels were reduced in the DMCP group compared with the CP group. However, there was no significant difference in the levels of superoxide dismutase (SOD), total antioxidant capacity (TAOC) malondialdehyde (MDA), and glutathione (GSH) between the two groups. And high heterogeneity was observed in some of the studies evaluated. Despite the limitations of this study, our results support the theory that there is an association between T2DM and the levels of OS-related biomarkers, especially CAT, in CP subjects, suggesting that OS plays an important role in the pathogenesis and development of DMCP.

Association of elevated IL-6 with poor glycemic control in periodontitis patients

Background: Interleukin-6 (IL-6) is a proinflammatory cytokine expressed in numerous chronic inflammatory diseases whose ability to alter the pathophysiology and progression of periodontitis is well documented. Further its role in diabetes mellitus by creating an insulin resistance responsible for poor glycemic control is also being evaluated. The aim was to compare the levels of IL-6 in gingival crevicular fluid in periodontitis patients with and without diabetes and to analyze these levels in patients with poor glycemic control (HBA1c), in order to assess its role in the progression of periodontal destruction. Methods: 60 chronic periodontitis patients confirmed with CPITN index of age group 30-70 years were enrolled for the study. GCF samples from 30 patients with diabetes confirmed using HBA1c reports and 30 without diabetes using Cimasoni method were collected and stored at -70degreescelsiusand subjected to ELISA for IL-6 using krishgen human IL-6 ELISA kit as per manufacturer's instruction. Descriptive and inferential statistics were used using SPSS software. Results: While the diabetic group readings ranged from 4.4 Pg/µl to 7.0 Pg/µl with a mean of 5.8pg/µl, the non- diabetic group ranged from 1.5 Pg/µl to 4.8 Pg/µl with a mean value of3.24 pg/µl. There was a prominent increase in the IL-6 levels in diabetic when compared to non- diabetic which was statistically significant with p value &lt; 0.001. Further, among the diabetic groups, patients with poor HBA1c with reading more than 7.7% showed a significant increase in IL-6 levels when compared to below 6.8%. Conclusions: The IL-6 levels in GCF were increased in chronic periodontitis patients with diabetes and more so in patients with poor glycemic control when compared to non-diabetic group. Therefore, periodontitis along with diabetes can play a major role in the inflammatory response within the periodontium.

Messenger RNA Expression and Quantification of L-plastin in Subgingival Tissue Samples of Generalized Severe Chronic Periodontitis Patients with and without Type 2 Diabetes Mellitus

Messenger RNA Expression and Quantification of L-plastin in Subgingival Tissue Samples of Generalized Severe Chronic Periodontitis Patients with and without Type 2 Diabetes Mellitus