Periodontal Outcomes Research Articles

Stability and Side Effects of Orthodontic Retainers - A Systematic Review

Background: The role of orthodontic retainers in maintaining stability after orthodontic treatment, and side effects associated with orthodontic retainers have not been well established. Objective: To investigate whether fixed retainers improve stability after orthodontic treatment, or increase the risk of side effects on the teeth and periodontium in comparison with removable retainers, no retainer, or fiberotomy. Methods: A systematic literature search was conducted in PubMed, Embase, the Cochrane Library, HTAdatabases of NHS Centre for Reviews and Dissemination, Swedish Council on Health Technology Assessment (SBU), Norwegian Knowledge Centre for the Health Services (NOKC), Danish Health and Medicines Authority, and reference lists. Data extraction was verified by at least two authors. The quality of evidence was rated. Meta-analysis was not suitable. Results: Two systematic reviews (SR), two randomized controlled trials (RCT), four non-randomized controlled studies (CT), and five case series were included. The SRs were well reported, but addressed issues that differed from the addressed question, or did not add to the identified primary studies. Both RCTs and CTs had study limitations, and problems with directness and/or precision. None of the studies compared fixed retainers to fiberotomy. Conclusion: According to the literature there is only low quality of evidence, that treatment stability may be improved by a fixed retainer after orthodontic treatment in comparison with a removable retainer, or no retainer (GRADE ⊕⊕⃝⃝). Furthermore, there is very low quality of evidence, whether periodontal outcomes, dental caries prevalence, or presence of calculus differ between the various types of retainer regimens (GRADE ⊕⃝⃝⃝).

A Study to Evaluate the Relationship between Il-1β and Tnf-Α Levels In Gcf in Non- Smoker, Previous or Current Smoker Female Patients with Chronic Periodontitis

Background: It has been postulated that the association between periodontal disease and systemic conditions may be because of the confounding effects of smoking. Studies of this type rarely investigate the adverse pregnancy outcomes like preterm birth or low birth weight. This study evaluates relationship between periodontal disease and adverse pregnancy outcomes. Aim: The aim of this study was to compare and evaluate the relationship between IL-1β and TNF-α levels and adverse pregnancy outcomes in females with a history of smoking and non- smokers. Materials and methods: 40 pregnant women recruited in a hospital were examined. Data including history of smoking or passive smoking before pregnancy was collected. Patients with advanced gingivitis and periodontitis were selected. GCF samples was collected 2-4 days post operatively. Eliza kits were used for analysis of TNF- α and IL-1 β .The samples collected were immediately transferred to an eppendorf tube and stored at -80 C till the analysis was done. Results: The results of the study suggest that increased TNF-α and IL-1 β levels signify that adverse pregnancy outcomes in women who are non- smokers and those with a history of smoking are because of the confounding effects of smoking on periodontitis.

Periodontal Emotional Stress Syndrome: Review of Basic Concepts, Mechanism and Management

Stress is an unavoidable consequence of life. It is described as adverse emotions or reactions to unpleasant experiences. Thus, stress can be viewed as a process with both psychological and physiological components. The possible mechanisms by which psychosocial factors act on periodontal tissues are oral hygiene negligence, changes in dietary intake, smoking, bruxism, gingival circulation, alteration in salivary component and flow, hormonal changes and lowered host resistance. During stress hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system interact and release glucocorticoid which has myriad of effects that disrupt homeostasis and lead to increased susceptibility to periodontal diseases. The dental practioner, thus, may always decide to refer patients to appropriate professional for assistance and counselling. Therefore, reducing stress and improving coping strategies may improve the periodontal prognosis and treatment outcomes. The aim of this review is to provide an insight into the relationship between psychological stress and periodontal diseases.

Body Mass Index as a Predictive Factor of Periodontal Therapy Outcomes

Body mass index (BMI) and obesity are associated with the prevalence, extent, and severity of periodontitis. This study investigated the predictive role of overweight/obesity on clinical response following non-surgical periodontal therapy in patients with severe periodontitis. Two hundred sixty adults received an intensive course of non-surgical periodontal therapy. Periodontal status at baseline and 2 months was based upon probing pocket depths (PPD), clinical attachment levels (CAL), and whole-mouth gingival bleeding (FMBS) as assessed by two calibrated examiners. Generalized estimating equations (GEE) were used to estimate the impact of BMI and overweight/obesity on periodontal treatment response while controlling for baseline status, age, smoking status (smoker or non-smoker), and full-mouth dental plaque score. BMI (continuous variable) and obesity (vs. normal weight) were associated with worse mean PPD (p < .005), percentage of PPD > 4 mm (p = .01), but not with FMBS (p > .05) or CAL (p > .05) at 2 months, independent of age, smoking status, or dental plaque levels. The magnitude of this association was similar to that of smoking, which was also linked to a worse clinical periodontal outcome (p < .01). BMI and obesity appear to be independent predictors of poor response following non-surgical periodontal therapy.

Morphometric Assessment of Periodontal Tissues in Relation to Periodontal Disease in Dogs

Dimensions of periodontal tissues are thought to predispose to the development of periodontal disease in man and dogs. Several studies have suggested that thin gingiva correlates with an increased incidence of periodontal disease. In this study, we hypothesized that the dimensions of periodontal tissues will vary in different breeds of dogs and could possibly correlate with the incidence of periodontal disease. Forty-two jaws of dogs aged up to 5-years were examined post-mortem and gingival and alveolar bone thickness were measured using methods of transgingival probing and digital calipers, respectively. Dogs were divided into three groups based on their body weight. Group I (< 5.0 kg; n=21), group II (5 to 10 kg; n=11), and group III (10 to 15 kg; n=10). Thickness of gingiva ranged from 0.30-mm to 3.2-mm and was relatively thinner in group I than in group II and III based on the means of ratios comparison. Alveolar bone thickness ranged from 0.27-mm to 4.1-mm and was relatively thinner in group I compared with groups II and III. Our study showed significantly thinner gingiva and alveolar bone in toy breed dogs compared with small and medium-sized breed dogs. Both gingival and alveolar bone dimensions may be predictors for severity of periodontal disease and influence clinical outcome in certain periodontal surgical procedures.

Mechanical Debridement of Subgingival Biofilm in Subjects with Asymptomatic Third Molars Does Not Reduce Deeper Probing Depths in the Molar Regions of the Mouth

Assess the impact of mechanical debridement of sub-gingival biofilm on periodontal outcomes in young adults with asymptomatic third molars.

The Presence of Visible Third Molars Negatively Influences Periodontal Outcomes: The Population Study NHANES 2009-10

Purpose: Assess the impact of mechanical debridement of sub-gingival biofilm on periodontal outcomes in young adults with asymptomatic third molars. Subjects and Methods: Healthy subjects with four asymptomatic third molars were enrolled in an IRBapproved longitudinal study. Clinical data were collected at enrollment and at follow-up visits. Full mouth periodontal probing, six sites per tooth were assessed as measures of clinical periodontal status. At enrollment all subjects had a dental prophylaxis after data collection which included removal of sub-gingival biofilm; this was repeated annually. The primary outcome measures were the comparison from baseline to follow-up two years after enrollment of subjects’ periodontal probing depths for third molars and first and second molars. In addition, a comparison of extent scores baseline to follow-up two years after enrollment for periodontal probing sites at least 4mm (PD4+) were calculated for the same molar regions of the mouth. Changes over time in clinical periodontal status from enrollment to the follow-up at least two years later were analyzed with Mantel-Haenszel row mean score statistics. Level of significance set at P<0.05. Results:Median follow-up from entry to the study was 2.2 years (IQR 2.0-2.8 years) for 262 subjects who averaged 27.7 years of age (SD 1.2 years); 53% were female, and 81% Caucasian. Most subjects, 90%, were educated beyond high school. Based on periodontal probing depths, subjects’ clinical periodontal status did not differ from enrollment to follow-up. Conclusions: Dental prophylaxis at yearly intervals in subjects with asymptomatic third molars, which included mechanical removal of sub-gingival biofilm, had minimal or no impact on reducing deeper probing depths, clinical indicators of periodontal pathology in young adults.

The Presence of Visible Third Molars Negatively Influences Periodontal Outcomes in the Maternal Oral Therapy to Reduce Obstetric Risks Study

This study was conducted to assess the relationship between the presence or absence of visible 3rd molars and outcomes for periodontal inflammatory disease in an IRB approved, multi-site study of obstetric subjects, Maternal Oral Therapy to Reduce Obstetric Risks (MOTOR).

Periodontal health of palatally displaced canines treated with open or closed surgical technique: A multicenter, randomized controlled trial

The aim of this study was to investigate differences in the periodontal outcomes of palatally displaced canines (PDC) exposed with either an open or a closed surgical technique. A multicenter, randomized controlled trial was undertaken in 3 hospitals in the United Kingdom, involving 2 parallel groups. Patients with unilateral PDC were randomly allocated to receive either an open or a closed surgical exposure. Periodontal health was assessed 3 months after removal of fixed appliances. Parameters measured included clinical attachment levels, recession, alveolar bone levels, and clinical crown height. Data from 62 participants (closed, 29; open, 33) were analyzed. There was no difference between PDC exposed with an open vs a closed surgical technique (mean difference, 0.1 mm; 95% confidence interval [CI], -0.2-0.5). There was, however, a statistical difference in mean attachment loss between the operated and unoperated (contralateral) canines (mean difference, 0.5 mm; 96% CI, 0.4-0.7; P<0.001). Twenty of the 62 subjects had some recession on the palatal aspect of the operated canine, whereas only 4 subjects had some visible root surface on the palatal aspect on the unoperated side (P= 0.001). There is a periodontal impact when a unilateral PDC is exposed and aligned. This impact is small and unlikely to have clinical relevance in the short term; however, the long-term significance is unknown. When the open and closed techniques were compared, no difference in periodontal health was found.

Diabetes and periodontal diseases: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases

Diabetes and periodontitis are complex chronic diseases with an established bidirectional relationship. There is long-established evidence that hyperglycaemia in diabetes is associated with adverse periodontal outcomes. However, given the ubiquity of periodontal diseases and the emerging global diabetes epidemic, the complications of which contribute to significant morbidity and premature mortality, it is timely to review the role of periodontitis in diabetes. To report the epidemiological evidence from cross-sectional, prospective and intervention studies for the impact of periodontal disease on diabetes incidence, control and complications and to identify potential underpinning mechanisms. Over the last 20 years, consistent and robust evidence has emerged that severe periodontitis adversely affects glycaemic control in diabetes and glycaemia in non-diabetes subjects. In diabetes patients, there is a direct and dose-dependent relationship between periodontitis severity and diabetes complications. Emerging evidence supports an increased risk for diabetes onset in patients with severe periodontitis. Type 2 diabetes is preceded by systemic inflammation, leading to reduced pancreatic β-cell function, apoptosis and insulin resistance. Increasing evidence supports elevated systemic inflammation (acute-phase and oxidative stress biomarkers) resulting from the entry of periodontal organisms and their virulence factors into the circulation, providing biological plausibility for the effects of periodontitis on diabetes. AGE (Advanced Glycation Endproducts)-RAGE (Receptor for AGEs) interactions and oxidative-stress-mediated pathways provide plausible mechanistic links in the diabetes to periodontitis direction. Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal therapy associates with approximately a 0.4% reduction in HbA1C at 3 months, a clinical impact equivalent to adding a second drug to a pharmacological regime for diabetes. RCTs are needed with larger numbers of subjects and longer term follow-up, and if results are substantiated, adjunctive periodontal therapies subsequently need to be evaluated. There is no current evidence to support adjunctive use of antimicrobials for periodontal management of diabetes patients. Given the current evidence, it is timely to provide guidelines for periodontal care in diabetes patients for medical and dental professionals and recommendations for patients/the public.

Diabetes and periodontal diseases: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases

Diabetes and periodontitis are complex chronic diseases with an established bidirectional relationship. There is long-established evidence that hyperglycaemia in diabetes is associated with adverse periodontal outcomes. However, given the ubiquity of periodontal diseases and the emerging global diabetes epidemic, the complications of which contribute to significant morbidity and premature mortality, it is timely to review the role of periodontitis in diabetes. To report the epidemiological evidence from cross-sectional, prospective and intervention studies for the impact of periodontal disease on diabetes incidence, control and complications and to identify potential underpinning mechanisms. Over the last 20 years, consistent and robust evidence has emerged that severe periodontitis adversely affects glycaemic control in diabetes and glycaemia in non-diabetes subjects. In diabetes patients, there is a direct and dose-dependent relationship between periodontitis severity and diabetes complications. Emerging evidence supports an increased risk for diabetes onset in patients with severe periodontitis. Biological mechanisms: Type 2 diabetes is preceded by systemic inflammation, leading to reduced pancreatic b-cell function, apoptosis and insulin resistance.Increasing evidence supports elevated systemic inflammation (acute-phase and oxidative stress biomarkers) resulting from the entry of periodontal organisms and their virulence factors into the circulation, providing biological plausibility for the effects of periodontitis on diabetes. AGE (Advanced Glycation Endproducts)-RAGE (Receptor for AGEs) interactions and oxidative-stress-mediated pathways provide plausible mechanistic links in the diabetes to periodontitis direction. Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal therapy associates with approximately a 0.4% reduction in HbA1C at 3 months, a clinical impact equivalent to adding a second drug to a pharmacological regime for diabetes. RCTs are needed with larger numbers of subjects and longer term follow-up, and if results are substantiated, adjunctive periodontal therapies subsequently need to be evaluated. There is no current evidence to support adjunctive use of antimicrobials for periodontal management of diabetes patients. Given the current evidence, it is timely to provide guidelines for periodontal care in diabetes patients for medical and dental professionals and recommendations for patients/the public.

The Presence of Visible Third Molars Negatively Influences Periodontal Outcomes in the Maternal Oral Therapy to Reduce Obstetric Risk Study

To assess the relationship between the presence or absence of visible third molars and outcomes for periodontal inflammatory disease. Obstetric subjects, at enrollment in an institutional review board-approved, multisite study, Maternal Oral Therapy to Reduce Obstetric Risk (N= 1,798), were divided into 2 groups, those with no visible third molars (n= 692) and those with at least 1 visible third molar (n= 1,106), the predictor variables for this study. The principal outcome variables were the patient-level periodontal status of the first/secondmolars: mean periodontal probing depths, mean attachment levels, and mean extent scores. Periodontal disease severity also was assessed by criteria from the Oral Conditions and Pregnancy trial and the Centers for Disease Control and Prevention/American Academy of Periodontology. Outcomes according to the presence or absence of third molars were compared with χ(2) statistics and multivariable analyses. Significance was set at P < .05. Significantly more subjects had at least 1 third molar (62%) as compared with subjects with novisible third molar (38%) (P < .01). Ethnic characteristics of the 2 groups were similar. Overall, more subjects were white (61%), with most identifying their ethnicity as Latino. African-American subjects were well represented (37%). Subjects with a visible third molar were more likely to be significantly older, to be receiving medical assistance, and to have used tobacco before pregnancy. If subjects had at least 1visible third molar, the mean first/second molar probing depths, attachment levels, and scores for bleeding on probing were significantly greater even after adjustment for covariates. On the basis of either Oral Conditions and Pregnancy criteria or Centers for Disease Control and Prevention/American Academy of Periodontology criteria, subjects were significantly more likely to have moderate or severe periodontal disease if a third molar was detected. If at least 1 visible third molar was detected in subjects in the Maternal Oral Therapy to Reduce Obstetric Risk study at enrollment as compared with no detected third molars, periodontal outcomes were significantly worse.

Do patients with osteoporosis have an increased prevalence of periodontal disease? A cross-sectional study

The study examined if women with osteoporosis were at increased risk of periodontal disease. Three hundred eighty females aged 45-65 years with recent dual-energy X-ray absorptiometry (DXA) scans of the spine and proximal femur agreed to a dental examination. No association was established between the presence of severe periodontal disease and osteoporosis. The purpose of this study is to determine whether patients with osteoporosis have an increased severity and extent of periodontal disease, taking full account of confounding factors. Volunteer dentate women (45-65 years), who had undergone recent DXA of the femur and lumbar spine, received a clinical examination of their periodontal tissues by a single trained operator who was blind to the subject's osteoporosis status. Clinical examinations were performed within 6 months of the DXA. Basic Periodontal Examination score, gingival bleeding score, periodontal pocket depth, recession and calculus were the periodontal outcome measures. Potential confounding factors were recorded. Logistic regression was performed for the dichotomous outcome measure of severe periodontal disease (present or absent) with osteoporotic status, adjusting for confounding factors. There were 380 dentate participants for whom DXA data were available. Of these, 98 had osteoporosis. When compared with osteoporotic subjects, those with normal bone mineral density were significantly younger (p = 0.01), had a higher body mass index (p = 0.03) and had more teeth (p = 0.01). The prevalence of severe periodontal disease in the sample was 39 %. The unadjusted odds ratio for the association between osteoporosis and severe periodontal disease was 1.21 (0.76 to 1.93). The adjusted odds ratio analysis including other covariates (age, smoking, hormone replacement therapy, alcohol) was 0.99 (0.61 to 1.61). No association was established between the presence of severe periodontal disease and osteoporosis.

Mechanical Debridement of Subgingival Biofilm in Participants With Asymptomatic Third Molars Does Not Reduce Deeper Probing Depths in the Molar Regions of the Mouth

To assess the impact of mechanical debridement of subgingival biofilm on periodontal outcomes in adolescents and young adults with asymptomatic third molars. Healthy participants with 4 asymptomatic third molars were enrolled in an institutional review board-approved longitudinal study. Clinical data were collected at enrollment and at follow-up visits. Full-mouth periodontal probing, 6 sites per tooth, was assessed as a measure of clinical periodontal status. At enrollment, all participants had dental prophylaxis after data collection, which included removal of subgingival biofilm; this was repeated annually. The primary outcome measures were the comparison from baseline to follow-up 2 years after enrollment of participants' periodontal probing depths for third molars and first/second molars. In addition, a comparison of extent scores at baseline to follow-up 2 years after enrollment for periodontal probing sites of at least 4 mm was performed for the same molar regions of the mouth. Changes over time in clinical periodontal status from enrollment to the follow-up at least 2years later were analyzed with Mantel-Haenszel row mean score statistics. The level of significance was set at P<.05. The median follow-up from entry to the study was 2.2 years (interquartile range, 2.0-2.8 years) for 262 participants who averaged 27.7 years of age (SD, 1.2 years); 53% were female participants, and 81% were white. Most participants (90%) were educated beyond high school. On the basis of periodontal probing depths, participants' clinical periodontal status did not differ from enrollment to follow-up. Dental prophylaxis at yearly intervals in participants with asymptomatic third molars, which included mechanical removal of subgingival biofilm, had minimal or no impact on reducing deeper probing depths, clinical indicators of periodontal pathology in young adults.

Understanding the advances in biology of orthodontic tooth movement for improved ortho-perio interdisciplinary approach

This article provides an insight on detailed current advances in molecular understandings of periodontal ligament cells and the influence of orthodontic force on them in the light of recent advances in molecular and genetic sciences. It sequentially unfolds the cellular events beginning from the mechanical force initiated events of cellular responses to bone remodeling. It also highlights the risks and limitations of orthodontic treatment in certain periodontal conditions, the important areas of team work, orthodontic expectations from periodontal treatment and the possibility of much more future combined research to improve the best possible periodontal health and esthetic outcome of the patient.

Individualized Oral Health Education Improves Oral Hygiene Compliance and Clinical Outcomes in Pregnant Women with Gingivitis

Background: Pregnant women have been shown to demonstrate an increase in clinical signs and symptoms of gingivitis despite similar plaque levels to non-pregnant peers. Objective: The goal of this investigation was to utilize a comprehensive regimen of oral hygiene techniques and practices and to evaluate the methodology to teach that regimen by assessing periodontal health outcomes and health behaviors and knowledge in pregnant women. Methods: 120 pregnant participants with Gingival Index (GI) scores ≥ 2 at ≥ 50 % of tooth sites were recruited. At baseline, patients were examined and Plaque Index (PI), Gingival Index (GI), Probing Depth (PD) and Clinical Attachment Level (CAL) were recorded. Patients’ self-reported oral hygiene compliance and oral hygiene knowledge was examined using a pre- and post-test examination at baseline and after the study period. Intensive oral hygiene counseling was provided at baseline, 4 and 8 week visits. Clinical measures and tests of oral hygiene compliance and knowledge were repeated at follow up. Results: A statistically significant reduction in all clinical parameters was shown over the study period. On average whole mouth PI and GI scores were reduced by 54.7% and 48.4%, respectively, and the percentage of sites with PI and GI ≥ 2 decreased from 40% to 17% and 53% to 21.8%, respectively. Whole mouth PD also decreased an average of 0.45 mm and whole mouth CAL decreased an average of 0.24 mm. A statistically significant proportion of patients self-reported an increase in frequency of oral hygiene procedures and an increase in the use of all materials provided in the study oral care regimen. A greater proportion of patients also demonstrated increased knowledge regarding dental and maternal/fetal health after the intervention. Conclusion: Pregnancy may represent a unique opportunity for oral hygiene intervention.

Onychophagia and postorthodontic isolated gingival recession: Diagnosis and treatment

This clinical report describes the diagnosis and the management of isolated-type recession defects of complex etiology in 2 healthy postorthodontic patients. The lesions were confined to 1 mandibular incisor and were associated with an abnormal buccolingual inclination of the affected tooth despite a lingual retainer made with a round stainless steel twisted wire. After careful questioning, it was determined that the recession defects were indirect effects of habitual onychophagia. The concomitant fingernail-biting habit and the lingual bonded retainer led to the indirect development of bone dehiscence and, consequently, gingival recession.

Lack of association between maternal periodontal status and adverse pregnancy outcomes: a multicentric epidemiologic study

Objective(s): The aim of this study was to explore the relationship between periodontal health and pregnancy outcomes in a large cohort of Italian postpartum women. Methods: 750 postpartum women were enrolled in a case–control study within 5 days from delivery at three Italian obstetric clinics. Cases were defined as those mothers who delivered an infant weighing under 2500 g (LBW) and/or had premature delivery and/or delivered small for gestational age newborns (SGA) and/or experienced preeclampsia/pregnancy induced hypertension (PE/PIH) or preterm premature rupture of membranes (pPROM) during pregnancy. All women received comprehensive oral and dental examination. Associations between adverse pregnancy outcome and exposures of interest were evaluated by the use of multivariate logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: There was no significant difference between cases and controls with respect to country of birth, age, place of residence, educational achievement, smoking, and periodontal status. By definition, infant birth weight [2,750 g (IQR = 2,300–3,200 g) and 3,275, (IQR = 3,010–3,538 g) p < 0.001, respectively] and gestational age at delivery [259 days (IQR = 245–273) and 273 days (IQR = 266–280), p < 0.01, respectively] were significantly lower in cases than in controls. In multivariate analyses, a borderline association was found between poor obstetric outcomes and current smokers (OR: 1.5; 95% CI: 0.1–2.5). Finally, after adjusting for smoking status neither country of birth, nor age or place of residence or education or periodontitis were associated with a significantly increased risk of adverse pregnancy outcome. Conclusion(s): Our data failed to demonstrate the association between periodontitis and an adverse pregnancy outcome such as preterm birth, low birth weight, preeclampsia, intrauterine growth restriction, and premature rupture of membranes.

Maxillary rehabilitation of periodontally compromised patients with extensive one-piece fixed prostheses supported by natural teeth: a retrospective longitudinal study

This study aims to evaluate the long-term success and stability of periodontal tissue around extensive one-piece prostheses supported by natural teeth in periodontally compromised maxillae. A total of 28 fixed dental prostheses (FDPs) fabricated by different technologies were inserted in 28 patients with a history of chronic periodontitis after successful periodontal treatment. Subsequently, a program of supportive periodontal therapy (SPT) was instituted. Clinical parameters were evaluated in each patient after insertion of the FDP and during a follow-up examination. The reported follow-up examinations took place after a mean clinical service of 75.7 (9.9–232.7) months. Probing depths had remained essentially unchanged by that time (2.6 ± 0.8 mm at baseline versus 2.7 ± 0.6 mm at follow-up). Significant deteriorations were observed based on plaque index scores (from 24.8% to 33.2%) and bleeding on probing (from 8.5% to 26.2%). One case of framework fracture was noted. Restorative treatment with extensive one-piece FDPs resulted in long-term stability of the periodontal outcomes. Gingival conditions were shown to deteriorate mildly despite periodic recalls for SPT. An association between deterioration and compliance was observed, suggesting that periodic examinations are essential for maintaining oral hygiene and hence to the success of treatment. Given a favorable distribution of potential abutment teeth, treatment with tooth-supported extensive FDPs is desirable even in patients with a history of periodontitis. Removable dentures would involve a number of shortcomings, including functional problems and severe degradation of oral ecology. Tooth-supported FDPs are capable of restoring function, esthetics, phonation, and mastication.

Analysis of IL-1α(−889) and IL-1B(+3953) Gene Polymorphism in Syrian Patients with Aggressive Periodontitis: A Pilot Study

Polymorphisms in IL-1 gene have been suggested to influence transcription of IL-1α and IL-1B and thereby the pathophysiology of periodontitis. Using genotyping IL-1 test, a pilot study was conducted on 32 Syrian patients with aggressive periodontitis (AgP) and 35 healthy controls to investigate the association between the IL-1α(−889), IL-1B(+3953) gene polymorphisms and AgP among schoolchildren. The results revealed a similar distribution of genotypes between patients and controls, and did not support an association between IL-1 gene polymorphisms and AgP, however, the association was significant in male patients only. To determine and confirm any susceptible or resistant genes for AgP, future studies should use many target genes and well-defined related periodontal outcomes.