Severe Chronic Periodontitis Patients Research Articles

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

Study on the imbalance of M1/M2 macrophage polarization in severe chronic periodontitis.

Macrophages commonly exist in two distinct subsets in different microenvironments: classically activated macrophages (M1) and alternatively activated macrophages (M2). The imbalance of M1-M2 macrophage polarization is often related to various diseases or inflammatory states. The purpose of this study was to determine whether there is an imbalance in the expression of M1 and M2 macrophage-related cytokines in severe chronic periodontitis. A total of 30 clinical specimens, including severe chronic periodontitis tissues (n= 15) and healthy control tissues (n= 15), were used in this study. Reverse transcription polymerase chain reaction (RT-PCR) and Western blot methods were used to detect the mRNA and protein expression levels of M1 macrophage-related cytokines (inducible nitric oxide synthase (iNOS) and signal transducer and activator of transcription 1 (STAT1)) and M2 macrophage-related cytokines (arginase-1 (Arg-1) and STAT6), respectively. The mRNA and protein expression levels of M1 macrophage-related cytokines (iNOS and STAT1) and M2 macrophage-related cytokines (Arg-1 and STAT6) were significantly increased in severe chronic periodontitis patients. In addition, the ratios of iNOS/Arg-1 and STAT1/STAT6 in the severe chronic periodontitis group were also significantly increased (P< 0.01). The imbalance of M1/M2 macrophages exists in the pathogenesis of severe chronic periodontitis, and has a tendency towards M1 polarization. Therefore, maintaining the immune balance of M1/M2 macrophages may be a novel therapeutic alternative for the management of severe chronic periodontitis.

Non-surgical periodontal therapy in severe chronic periodontitis patients associated with Type II Diabetes mellitus: A case report

Diabetes mellitus is a condition that affects both adults and children and is caused by insulin insufficiency, insulin resistance, or both. Gingivitis, periodontitis, recurrent periodontal abscess, delayed healing after extraction, etc. are the most common oral symptoms. Early identification and management of diabetes mellitus with simultaneous periodontal therapy can improve the oral complications. Close coordination between the medical and dental teams can benefit the diabetic individuals. The goal of this article was to raise awareness regarding the oral signs and complications of diabetes mellitus.

Editorial

Editorial

Evaluation of Osteocalcin Levels in Saliva of Periodontitis Patients and Their Correlation with the Disease Severity: A Cross-Sectional Study.

Objectives The present study aimed to investigate osteocalcin levels in saliva of healthy and periodontitis patients and correlate these levels with periodontitis severity. Materials and Methods This cross-sectional study was conducted in a hospital setup. A total of 95 individuals participated in the study with 46 subjects in group I (healthy individuals) and 49 subjects in group II (mild, moderate, and severe chronic periodontitis patients). A detailed assessment of clinical periodontal parameters and alveolar bone loss was made. Unstimulated saliva samples were collected from all study subjects and osteocalcin levels were quantitatively analyzed by sandwich enzyme-linked immunosorbent essay technique. Statistical Analysis One-way analysis of variance, Spearman’s correlation test, and Pearson’s chi-squared test were applied at a significance level of 95%. p -Values less than 0.05 were considered statistically significant. Results The results showed a significant association of qualification with group II ( p < 0.02). Bone loss scores were also significantly associated with periodontitis severity ( p < 0.01). However, no statistically significant difference was observed between group I and group II in terms of mean salivary osteocalcin levels ( p = 0.68). Also, an insignificant correlation was also observed between osteocalcin levels and periodontitis severity ( p = 0.13). Conclusion The overall study results showed that there was no significant difference between saliva osteocalcin levels of healthy and periodontitis patients. Also, there was a nonsignificant correlation between osteocalcin levels and periodontitis severity. The findings of the present study support the hypothesis that low osteocalcin levels in saliva might be considered as a poor indicator of periodontal disease progression and severity.

A case report of a successful staged patient education approach for a generalized severe chronic periodontitis patient

A case report of a successful staged patient education approach for a generalized severe chronic periodontitis patient

8-year follow up of a generalized severe chronic periodontitis patient treated by root amputation and comprehensive dentistry

8-year follow up of a generalized severe chronic periodontitis patient treated by root amputation and comprehensive dentistry

Impact of One-Stage Full Mouth Disinfection and Periodontal Surgery on Oral Health-Related Quality of Life

Statement of the Problem: Information on patient-centered outcomes of periodontal disease and the impact of different periodontal treatment phases on the life quality of periodontal patients is limited. Purpose:This study sought to compare patients’ perception of their oral health-related quality of life (OHQoL) following one-stage full mouth disinfection (OSFMD) and surgical periodontal treatment. Materials and Method:A pre-and post-interventional study design was conducted in two phases on a single group of patients. Subjects were recruited from moderate to severe chronic periodontitis patients referred to a private clinic. At baseline and after each treatment phase, periodontal parameters were recorded by a blind examiner. Patients received OSFMD, followed by periodontal flap surgeries and completed the validated Iranian version of the OHIP-49 questionnaire (OHIP-35-IR) at three time points (baseline, two weeks post-initial therapy and after completion of surgical phase). Data were analyzed using repeated measure ANOVA, paired and independent t-tests, and multivariate regression analysis by SPSS software version 21. Results:38 patients (14 men, 24 women, mean age 40.30±11.93) completed the study. Periodontal parameters showed progressive improvement from baseline to the end of the study (p< 0.05). The total mean OHIP-35-IR score at baseline (89.25±19.26) was significantly improved (reduced) compared to each treatment phase (75.63±17.15 and 74.22±15.46, respectively; p< 0.001), with no significant difference between treatments. Improvements in subdomains of psychological discomfort, functional limitation, physical pain, and handicap accounted for the changes. The effect size was calculated to be 0.80 for the first and 0.66 for the second treatment phases. Conclusion: Within limits, OSFMD and periodontal surgical treatment have positive impacts on the OHQoL of patients. Intensive periodontal non-surgical treatment is as effective as surgical intervention for achieving desirable patient-centered outcomes.

A clinical case report of long-term follow up in severe chronic periodontitis patient with type II diabetes

2 型糖尿病を有する重度慢性歯周炎患者の12 年間の治療経過について報告する．患者は2 型糖尿病を有する63 歳男性で，主訴は7 の動揺と腫脹であった．初診時の血糖コントロール状態はヘモグロビンA1c（HbA1c）: 9.9, 空腹時血糖値（FBS）:140 と不良な状態であり，7 は動揺度は3 度であり，エックス線写真では骨吸収が根尖付近まで進行していた．診断：7 に咬合性外傷を伴う広汎型重度慢性歯周炎．治療方針として血糖コントロールの状態を考慮しながら歯周基本治療を行い，残存歯の保存に努めることとした．治療経過と結果：主訴であった7 は保存 不可能のため抜歯を行った．その後も血糖コントロールは不良であったため，インスリン療法を開始するも奏効せず入院し，しばらく歯科治療を中断．退院後は血糖コントロールが改善したが残存歯の歯周状態は徐々に悪化し，上顎は部分床義歯を装着することとなった．歯周病安定期治療期（SPT）に移行し，血糖コントロール状態は安定していたが上顎の残存歯の歯周組織破壊は少しずつ進行し，結果として上顎の残存歯数は初診時の11 歯から現在までに2 歯へと減少した．結論：過去の報告からは，歯周治療，糖尿病治療による歯周組織と血糖値の改善に相互関係が示唆されているが，本症例のように，治療開始時期にすでに血糖コントロール状態が極めて不良の場合には，血糖値が改善した後も歯周組織の破壊が進行していき，結果として歯の喪失が生じることが考えられた． 【顎咬合誌 39（3）:175-183，2019】

Comparison of periodontitis patients' classification in the 2018 versus 1999 classification.

We aimed to assess how the 2018 and 1999 classifications of periodontal diseases reflect (a) patients' characteristics, (b) disease severity/extent/progression and (c) tooth loss (TL) during observation period. A total of 251 patients were followed over 21.8±6.2years. For the 1999 classification, using clinical attachment level (CAL), patients were classified as localized/generalized, mild/moderate/severe and aggressive/chronic periodontitis. For the 2018 classification, patients were staged according to their CAL or bone loss (BL) and the number of lost teeth (stages I-IV). Further factors like probing pocket depths (PPD) or furcation involvement modified the stage. The extent was sub-classified as generalized/localized. Patients were graded according to the BL/age index, smoking and/or diabetes. According to the 1999 classification, most patients suffered from generalized severe chronic periodontitis (203/251) or generalizedaggressive periodontitis (45/251). Patients with aggressive periodontitis were younger and less often female or smokers. They showed similar TL (0.25±0.22 teeth/patient*year) as generalized severe chronic periodontitis patients (0.23±0.25teeth/patient*year). According to the 2018 classification, most patients were classified as generalized III-C (140/251), III-B (31/251) or IV-C (64/251). Patients' age, smoking status, CAL, PPD and BL were well reflected. TL differed between IV-C (0.36±0.47), generalized III-C (0.21±0.24) and localized forms (0.10-0.15). Patients' characteristics, disease severity/extent/progression and TL were well reflected by the 2018 classification.

Impact of One-Stage Full Mouth Disinfection and Periodontal Surgery on Oral Health-Related Quality of Life.

Statement of the Problem Information on patient-centered outcomes of periodontal disease and the impact of different periodontal treatment phases on the life quality of periodontal patients is limited. Purpose This study sought to compare patients' perception of their oral health-related quality of life (OHQoL) following one-stage full mouth disinfection (OSFMD) and surgical periodontal treatment. Materials and Method A pre-and post-interventional study design was conducted in two phases on a single group of patients. Subjects were recruited from moderate to severe chronic periodontitis patients referred to a private clinic. At baseline and after each treatment phase, periodontal parameters were recorded by a blind examiner. Patients received OSFMD, followed by periodontal flap surgeries and completed the validated Iranian version of the OHIP-49 questionnaire (OHIP-35-IR) at three time points (baseline, two weeks post-initial therapy and after completion of surgical phase). Data were analyzed using repeated measure ANOVA, paired and independent t-tests, and multivariate regression analysis by SPSS software version 21. Results 38 patients (14 men, 24 women, mean age 40.30±11.93) completed the study. Periodontal parameters showed progressive improvement from baseline to the end of the study (p< 0.05). The total mean OHIP-35-IR score at baseline (89.25±19.26) was significantly improved (reduced) compared to each treatment phase (75.63±17.15 and 74.22±15.46, respectively; p< 0.001), with no significant difference between treatments. Improvements in subdomains of psychological discomfort, functional limitation, physical pain, and handicap accounted for the changes. The effect size was calculated to be 0.80 for the first and 0.66 for the second treatment phases. Conclusion Within limits, OSFMD and periodontal surgical treatment have positive impacts on the OHQoL of patients. Intensive periodontal non-surgical treatment is as effective as surgical intervention for achieving desirable patient-centered outcomes.

Clinical and Radiographic Assessment of Periodontal Infrabony Defect Depth and Width and Their Correlation

Brief Background There is preliminary evidence of periodontal defect depth, number of walls and the width of infrabony defects exerting influence on the regenerative potential of particular therapeutic modality. Aim: To assess defect width and defect depth and their influence on pretreatment defect angle in patients affected with periodontal disease. Materials and Methods 60 untreated severe chronic or aggressive periodontitis patients were selected for the study. Digital intraoral periapical radiograph of defects in all patients were taken using RVG. First auxiliary line was drawn to represent tooth axis (AUX1). Perpendicular to this, a second auxiliary line (AUX2) was drawn that ran through most coronal margin of defect (M3). The depth of defect was measured as the distance between the base of bony defect and AUX2. The width of defect was the distance from coronal margin of bony defect to the root surface perpendicular to AUX1. Results In a total of 67 defects, the radiographic defect depth, defect width and defect angle for maxillary arch was 3.19 ± 1.19 mm , 2.82 ± 0.63 mm and 37.34 ± 9.47 ° respectively while these values for mandibular sites were 3.69 ± 0.92 mm, 2.87 ± 0.76 mm and 35.62 ± 7.08 ° respectively. Multilevel regression analysis revealed narrow defect angles to be related to deep infrabony defects, whereas the width of the interdental space to wide defects. Summary and Conclusion Defect dimensions are determined by the radius of action of microbial biofilm and the baseline defect angle of an infrabony defect would be a function of defect depth. Key Words: Periodontitis, periodontal therapy, vertical defects, radiography

Effect of non-surgical periodontal therapy on the fibrinogen levels in chronic periodontitis patients

ObjectiveThis study aimed to evaluate the effect of non-surgical periodontal therapy on the fibrinogen levels in chronic periodontitis patients when compared to the levels seen in healthy subjects. Materials and methodsA total of 30 subjects, with an average age of 38 ± 25 years, were enrolled in the present study. They were divided into two groups, namely Group 1 (15 periodontally healthy subjects) and Group 2 (15 moderate to severe chronic periodontitis patients). The periodontal condition of each periodontitis patient was assessed by recording the probing pocket depth (PD), clinical attachment level (CAL), plaque index (PI), and bleeding index (BI) both before and after periodontal therapy had been administered for one month. Additionally, blood samples were collected from the healthy subjects and the periodontitis patients before and after the periodontal treatment in order to assay the plasma fibrinogen levels. ResultsThe clinical parameters were found to be improved after one month of periodontal therapy, with the statistical difference in the mean values of the BI and PD being highly significant (P < 0.01), while the statistical differences concerning the PI and CAL were significant (P < 0.05). The fibrinogen levels (mg/dL) for the periodontitis patients before and after treatment were 342.26 ± 69.00 and 352.93 ± 64.3 mg/dL, respectively. The level was 269.85 ± 43.68 mg/dL for the healthy subjects. In terms of the between-group comparison, the fibrinogen levels of the healthy subjects were observed to be highly significantly lower than the levels of the periodontitis patients before and after the treatment (P < 0.01), in contrast the statistical analysis showed a non-significant difference in the fibrinogen levels (P > 0.05) before and after the periodontal treatment. In addition, the statistical analysis revealed non-significant correlation between the fibrinogen levels and all the periodontal parameters (P > 0.05). ConclusionThe non-surgical periodontal therapy proved to be effective in improving the clinical periodontal condition of the periodontitis patients, while the plasma fibrinogen levels were not found to be influenced by the periodontal therapy. Further studies are needed to evaluate the fibrinogen levels over a longer duration after periodontal treatment in patients following a periodontal maintenance program.

Evaluation of Association of Vitamin D Receptor Genetic Polymorphism with Severe Chronic Periodontitis in an Ethnic Tamilian Population.

Periodontitis is a multifactorial disease characterized by inflammatory responses to increased levels of subgingival pathogens, resulting in connective tissue destruction and alveolar bone loss. The susceptibility of an individual is determined by the complex interplay of the host, genetic, and environmental factors. Vitamin D, a secosteroid hormone, interacts with its nuclear receptor vitamin D receptor (VDR) to regulate crucial biological processes, such as bone metabolism and immune function modulation. Various studies have been conducted in different populations to analyze the association of VDR gene polymorphisms with chronic periodontitis, as these polymorphisms have been demonstrated to play vital roles in the pathogenesis of other diseases. The aim of the present study was to determine the prevalence and association of the VDR TaqI gene polymorphism with severe chronic periodontitis in an Ethnic Tamilian population. A total of 140 subjects were recruited for the study, of which 70 were diagnosed with severe chronic periodontitis and 70 had healthy gums. Each subject's medical and dental histories were taken, and periodontal examinations were performed. Genomic DNA was extracted and genotyping of the VDR gene at the TaqI site was carried out using polymerase chain reaction/restriction fragment length polymorphism. The frequencies of genotypes and alleles were analyzed between the study groups. The frequency of homozygous TT genotype was 40%, for both the severe chronic periodontitis and the healthy control groups. The distribution of heterozygous Tt genotype was 42.9% in the severe chronic periodontitis group and 47.1% in the healthy control group. The frequency of homozygous tt genotype was 17.1% in the severe chronic periodontitis group and 12.7% in the healthy control group. Although the prevalence of genotype tt and t allele was slightly increased in severe chronic periodontitis patients compared with healthy controls, the frequency of VDR genotype between the study groups was not statistically significant (p-value = 0.751). This present study performed in an Ethnic Tamilian population does not support an association between either of the TaqI alleles within the VDR gene and Severe Chronic Periodontitis.

Tolerance induced by Porphyromonas gingivalis may occur independently of TLR2 and TLR4.

ObjectivePeriodontitis is a microbe-induced chronic inflammatory disease. Previous exposure of the host to bacteria or their virulence factors leads to refractory responses to further stimuli, which is called tolerance. Porphyromonas gingivalis (P. gingivalis) is one of the most important pathogenic microorganisms associated with periodontitis, and is a potent inducer of pro- and anti-inflammatory cytokines. The aim of this study was to explore the roles and possible mechanisms of tolerance induced by P. gingivalis.MethodsTHP-1-derived macrophages were pretreated with 1x108 colony-forming units/ml P. gingivalis ATCC 33277 or 21 clinical isolates from moderate to severe chronic periodontitis patients (24 h), washed (2 h) and treated with P. gingivalis ATCC 33277 or the same clinical isolates again (24 h). Levels of pro-inflammatory cytokines TNF-α and IL-1β and anti-inflammatory cytokine IL-10 in supernatants were detected by ELISA. Moreover, to identify the possible mechanisms for the changes in cytokine secretion, Toll-like receptor 2 (TLR2) and TLR4 protein expressions were explored in these cells by flow cytometry.ResultsAfter repeated challenge with P. gingivalis ATCC 33277 or clinical isolates, production of TNF-α and IL-1β in macrophages was decreased significantly compared with that following a single stimulation (p<0.05), while only comparable levels of IL-10 were detected in P. gingivalis ATCC 33277 or clinical isolate-tolerized cells (p>0.05). In addition, there was interstrain variability in the ability to induce IL-1β and IL-10 production after repeated P. gingivalis stimulation. However, no significant changes in TLR2 or TLR4 were detected in macrophages that were repeatedly treated with P. gingivalis ATCC 33277 or clinical isolates compared with those stimulated with P. gingivalis only once (p>0.05).ConclusionsRepeated P. gingivalis stimulation triggered tolerance, which might contribute to limiting periodontal inflammation. However, tolerance induced by P. gingivalis might develop independently of TLR2 and TLR4 and be related to molecules in signaling pathways downstream of TLR2 and TLR4.

Clinical efficacy of semiconductor laser-assisted minocycline in moderate-to-severe chronic periodontitis patients with type 2 diabetes mellitus

Purpose: To study the clinical efficacy of semiconductor laser-assisted minocycline in the treatment of moderate-to-severe chronic periodontitis (CP) in type 2 diabetes mellitus (T2DM) patients.Methods: A total of 109 cases of CP combined with T2DM and obesity admitted to The First Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi’an, China, from November 2016 to November 2017 were included in the study. Among them, 54 patients in the study group were treated with semiconductor laser-assisted minocycline, while 55 patients in the control group were treated with minocyclin injection. Periodontitis, blood glucose and blood lipid levels were compared between the two groups before and after treatment.Results: Post-treatment (12 weeks), bleeding on probing, gingival index, periodontal probing depth (PD), plaque index (PLI), clinical attachment loss (CAL), and sulcus bleeding index (SBI) in the two groups of patients were significantly improved (p &lt; 0.05). The levels of PD, BOP, PLI, and CAL in the positive SBI group (4.06 ± 0.25, 20.37 %, 0.50 ± 0.28, 3.42 ± 0.27, and 1.43 ± 0.26, respectively) were significantly lower than the corresponding levels in the control group (p &lt; 0.05. Fasting plasma glucose (FPG) and HbA1c for the two groups were significantly improved, when compared with values prior to treatment (p &lt; 0.05), but there was no significant difference in FPG level between the two groups. Significantly lower HbA1c levels were found in the treatment group than in the control group (t = 4.2360, p = 0.0001). Post-treatment, triglyceride (TG), total cholesterol (TC) and body mass index (BMI) did not improve significantly in the two groups, nor were there significant differences in these parameters before and after treatment (p &gt; 0.05).Conclusion: Semiconductor laser-assisted minocycline is effective in treating moderate and severe chronic periodontitis patients with type 2 diabetes, and can improve blood glucose. However, its effect on body weight needs further studies.Keywords: Semiconductor laser, Minocycline, Chronic periodontitis, Type 2 diabetes, Obesity

Periodontal-orthodontic treatment in a generalized severe chronic periodontitis patient: A case report with 17-year follow-up

歯周治療に不用意に矯正治療を組み込むことにより，歯周組織破壊が進行する可能性があるが，炎症が十分にコントロールされていれば禁忌ではないと報告されている。今回，歯科恐怖症の広汎型重度慢性歯周炎患者に対し，歯周基本治療，歯周―矯正治療を行い，supportive periodontal therapy（SPT）を行っている17年経過症例を報告する。患者は歯科恐怖症であり，歯周外科治療を拒絶されたため，非外科的治療で対応した。通常の歯周組織検査に加え，細菌検査，血清抗体価検査を行い，診断の補助とモチベーションの維持に活用し，治療を行った。患者の適切なセルフケアと術者のスケーリング・ルートプレーニングにより歯肉の炎症は劇的に改善し，その後の歯周―矯正治療により，術前に認められた歯間離開，歯列不正は改善され，歯周組織と咬合の安定が得られた。現在初診より17年経過し，歯周―矯正治療後13年間SPTを継続しているが，良好な状態が保持されている。したがって病的な歯の位置異常が認められる患者に対して，炎症のコントロールに加え，歯周―矯正治療を行うことは，歯周組織破壊の進行した歯の保存やより良好な機能と審美性を得るために有効であると考えられる。

PC238: A case of comprehensive treatment for generalized severe chronic periodontitis patient with type‐2 diabetes

PC238: A case of comprehensive treatment for generalized severe chronic periodontitis patient with type‐2 diabetes

PC267: Interdisciplinary management of a localised severe chronic periodontitis patient

PC267: Interdisciplinary management of a localised severe chronic periodontitis patient

Correlation between Gingival Biotype, Marginal Bone Loss, Periapical Infection and Schneiderian Membrane Thickness in Chronic Periodontitis Patients (A Cross-Sectional

Background: Identification of factors affecting maxillary sinus membrane thickness would be of practical importance in surgical planning for both implant placement and otolaryngeal surgery. This study aimed to analyze a possible correlation be­tween Schneiderian membrane thickness (SMT) and gingival biotype (GB), marginal bone loss (MBL) and presence of periapical infection (PAI) of related teeth using Cone beam computed tomography (CBCT)Subjects and Methods: A total of fifty consecutive moderate to severe chronic periodontitis patients were included in this cross-sectional study. The patients’ sex and age were recorded. Clinical measurement of (GB) was performed in the premolar and first molar area, and then (CBCT) images of patients were examined for (SMT), (MBL) and presence of (PAI) in the same area. All measured parameters were analyzed and graded. Then correlation between these parameters and Schneiderian membrane thickness was evaluated.Results: Higher percentage of severe SMT was observed in patient with thick gingival biotype (37.3%) than those with thin biotype (33.3%) and a direct positive correlation between SMT and MBL (r= 0.595, p<0.001) was detected. Cases with PAI showed higher mean sinus membrane thickness (5.3±1.97) than normal cases (2.26±1.90) (p<0.001).Conclusion: The presence of periapical infection marginal bone loss or clinically detected thick gingival biotype in the maxilla could be associated with thicker Schneiderian membrane, so clinicians should be aware of these clinical and radiographic findings that could predict the sinus membrane thickness.