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Journal of Periodontal Research Jan 2021The complement system is engaged in inflammatory reactions both in the periodontal pockets and in the periodontium itself, where it can mediate tissue destruction. The...
BACKGROUND AND OBJECTIVE
The complement system is engaged in inflammatory reactions both in the periodontal pockets and in the periodontium itself, where it can mediate tissue destruction. The aim of this study was, first, to compare salivary levels of the total complement system protein C3 and its split product, fluid-phase C3c in patients with periodontitis and periodontally healthy controls. Next, to determine if C3 and C3c levels had biomarker potential in diagnosing and monitoring periodontitis and its treatment. We hypothesized that salivary levels of total C3 and the split product C3c associated with the severity of periodontitis and reflected decreased inflammatory activity after periodontal treatment.
METHODS
At baseline, stimulated saliva samples were collected from patients with periodontitis (n = 18) and periodontally healthy controls (n = 15). Subsequently, non-surgical periodontal treatment was performed in the patients, and saliva sampling from patients was repeated two-, six-, and twelve weeks post-treatment (NCT02913248 at clinicaltrials.gov). The patients were grouped as good and poor responders to treatment according to the achieved reduction in bleeding on probing (BOP). Salivary levels of C3 and C3c were quantified using sandwich ELISA.
RESULTS
Patients with periodontitis had higher baseline levels of both total C3 and the split product C3c in saliva than did periodontally healthy controls (P < .0001). Receiver operating curve (ROC) analyses discriminated patients with periodontitis from controls based on both C3 (AUC (area under curve) = 0.91, P < .001) and C3c levels (AUC = 0.84, P < .001) in saliva. Periodontal treatment improved all clinical parameters (P < .01). Good responders (n = 10) had lower baseline levels of C3c than poor responders (n = 8), (P < .05), and baseline levels of C3c discriminated between good and poor responders (AUC = 0.80, P < .05).
CONCLUSION
In conclusion, patients with periodontitis had higher salivary levels of C3c, and the C3c levels were predictive of reductions in BOP, that is, the poor responders. This suggests that salivary C3c levels possess potential to serve as a biomarker predicting the clinical response to non-surgical periodontal treatment.
Topics: Biomarkers; Chronic Periodontitis; Humans; Periodontal Index; Periodontal Pocket; Periodontitis; Saliva
PubMed: 32681659
DOI: 10.1111/jre.12788 -
Journal of Periodontology Feb 2022Fetuin-A has garnered recognition in the etiopathogenesis of several systemic disorders. It has been recently acknowledged as an anti-inflammatory marker for periodontal...
BACKGROUND
Fetuin-A has garnered recognition in the etiopathogenesis of several systemic disorders. It has been recently acknowledged as an anti-inflammatory marker for periodontal disease. This study aimed to compare and correlate salivary and serum fetuin-A levels in health and patients with stages II-III periodontitis along with evaluating the effect of non-surgical periodontal therapy (NSPT) on the same.
METHODS
Group 1 comprised of 30 healthy subjects. Group 2 embodied 30 patients with stages II-III periodontitis. Clinical periodontal parameters were recorded. Saliva and serum samples were assembled. Periodontitis patients received non-surgical periodontal treatment. They were recalled after 6 months, and collection of samples and recording of clinical parameters were reiterated. Fetuin-A levels were analyzed using ELISA.
RESULTS
Salivary and serum fetuin-A levels were significantly lower in periodontitis patients when compared with the healthy subjects (P < 0.001) at baseline. Their concentrations significantly upregulated 6 months after active periodontal therapy (P < 0.001). Salivary fetuin-A levels revealed a significant positive correlation with their serum levels in Group 1 at baseline (P < 0.001). They also displayed a positive correlation in Group 2 at baseline and 6 months post periodontal therapy, nevertheless failed to establish a statistically significant association.
CONCLUSION(S)
Our study concluded that salivary and serum fetuin-A levels diminished with increasing severity of periodontal inflammation, and NSPT remarkably improved their levels. They also displayed a significant positive correlation in health, and a non-significant, yet positive correlation in patients with periodontitis.
Topics: Chronic Periodontitis; Dental Scaling; Humans; Periodontal Diseases; Periodontitis; Root Planing; Saliva; alpha-2-HS-Glycoprotein
PubMed: 33997977
DOI: 10.1002/JPER.21-0179 -
BMC Oral Health Jul 2021To date, there is still no consensus about the clinical efficacy of non-surgical periodontal therapy in rheumatoid arthritis (RA) patients with periodontitis. Therefore,... (Meta-Analysis)
Meta-Analysis
BACKGROUNDS
To date, there is still no consensus about the clinical efficacy of non-surgical periodontal therapy in rheumatoid arthritis (RA) patients with periodontitis. Therefore, the aim of this study was to summarize clinical data regarding the efficacy of scaling and root planing (SRP) in patients with RA and periodontitis compared to non-RA periodontitis patients.
METHODS
We selected randomized controlled trials (RCTs) that compared periodontal clinical data in RA as compared to non-RA periodontitis patients by searching Embase, PubMed and Cochrane Central Register of Controlled Trials and by manually retrieving from the earliest records to March 8, 2021. The overall effect size of plaque index (PI), gingival index (GI), attachment loss (AL), probing depth (PD) and bleeding on probing (BOP) were calculated by either a fixed or random-effect model, and subgroup analyses were conducted according to the different time points of follow-up. Two investigators extracted the data and assess the accuracy of the obtained results with 95% of Confidence Intervals (CI). Cochrane Collaboration's tool was responsible for the evaluation of the literature quality and the inter-study heterogeneity was evaluated by Q test and I statistic. Sensitivity analyses were applied for results with heterogeneity. Publication bias was determined by Begg's test, Egger's test and the trim-and-fill method.
RESULTS
Seven RCTs including 212 patients eventually met the inclusion criteria for the study. As the primary results, the change of PD was not statistically significant and in the secondary results changes of PI, GI, AL and BOP were also not statistically significant in RA patients with periodontitis compared to non-RA periodontitis patients. In subgroup analysis, a larger BOP reduction at 3 months, PI and AL reduction at 6 months were observed in patients with RA and periodontitis group. The results of sensitivity analyses had no significant effect. No evidence of potential publication bias was tested. There were some limitations due to the small number of eligible RCTs.
CONCLUSIONS
SRP is equally effective in RA as compared to non-RA periodontitis patients. It suggests RA does not affect the clinical efficacy of non-surgical periodontal therapy. These results could serve evidence-based practice.
Topics: Arthritis, Rheumatoid; Chronic Periodontitis; Dental Scaling; Humans; Periodontal Attachment Loss; Periodontal Index; Periodontitis; Root Planing
PubMed: 34246253
DOI: 10.1186/s12903-021-01695-w -
BMC Oral Health May 2021The purpose of periodontal treatments is to reduce inflammation, restore gingival health and clinical attachment level gain by controlling microbial plaque formation and... (Clinical Trial)
Clinical Trial
BACKGROUND
The purpose of periodontal treatments is to reduce inflammation, restore gingival health and clinical attachment level gain by controlling microbial plaque formation and other etiological factors. One of the drugs that has been tested in many areas and shown good anti-inflammatory properties is erythropoietin (EPO). We evaluated the effect of this drug on the improvement of periodontitis after the phase I treatment.
METHODS
This study was conducted on 30 patients with stage III periodontitis who had at least two bilateral teeth with CAL of ≥ 5 mm and PPD ≥ 6 mm at ≥ 2 non-adjacent teeth and bleeding on probing. After oral hygiene instruction and scaling and root planning (SRP), EPO gel containing a solution of 4000 units was applied deeply in the test group and placebo gel was deeply administered in the control pockets (5 times, every other day). The clinical parameters of the plaque index (PI), gingival index (GI), clinical attachment level (CAL), probing depth (PD) and bleeding index (BI) were measured at baseline and after three months of follow up. The P-value was set at 0.05.
RESULTS
All clinical variables improved after treatment in both groups. The BI and GI scores (which reflects the degree of gingival inflammation) showed statistically more reduction in test group. The CAL decreased from 5.1 ± 4.1 to 3.40 ± 2.71 mm; and 5.67 ± 4.32 to 4.33 ± 3.19 mm in test and control group, respectively (P < 0.00). After the treatment, there was a significant greater reduction in CAL and also PD values in test group (P < 0.01).
CONCLUSION
Local application of EPO gel in adjunct to SRP can improve clinical inflammation and CAL gain in periodontitis.
TRIAL REGISTRATION
This study was registered at 2017-11-06 in IRCT. All procedures performed in this study were approved with ID number of IR.TUMS.DENTISTRY.REC.1396.3139 in Tehran University of medical science.
Topics: Chronic Periodontitis; Dental Scaling; Erythropoietin; Follow-Up Studies; Humans; Iran; Periodontal Attachment Loss; Periodontitis; Root Planing; Treatment Outcome
PubMed: 33957902
DOI: 10.1186/s12903-021-01607-y -
European Journal of Oral Sciences Feb 2020We aimed to identify response patterns to non-surgical periodontal therapy and to investigate whether the new classification system for periodontitis reflects response...
We aimed to identify response patterns to non-surgical periodontal therapy and to investigate whether the new classification system for periodontitis reflects response to treatment after 1 yr. At baseline, data on sociodemographic status, smoking, and diabetes were obtained from participants with periodontal disease. Clinical periodontal data and subgingival plaque were also collected. Participants underwent non-surgical periodontal therapy, and after 3 and 12 months, clinical data were reassessed. Factor analyses, group-based-trajectory modeling, and mixed-effects regression models were used for data analysis. Factor analysis of the baseline periodontal parameters revealed two different periodontitis dimensions: 'moderate' and 'severe'. Two response patterns for each of these periodontitis dimensions were identified. Periodontal therapy had a beneficial effect on both 'moderate' and 'severe' periodontitis; however, individuals with higher levels of disease at baseline experienced greater treatment effect. Regarding the new classification system, while the staging component distinguished different levels of 'moderate' and 'severe' periodontitis before and after treatment, the grading component did not. This study shows the beneficial effect of non-surgical periodontal therapy on both 'moderate' and 'severe' periodontitis. However, the benefit was limited among individuals with low levels of disease. The new classification system did not adequately reflect the periodontal response to therapy in this patient group.
Topics: Dental Scaling; Humans; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Periodontitis; Phenotype; Root Planing
PubMed: 31995259
DOI: 10.1111/eos.12670 -
Quintessence International (Berlin,... Jun 2023The aim of the present study was to evaluate the effect on systemic inflammation of subgingival instrumentation (SI) with or without antibiotics. Moreover, systemic... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
The aim of the present study was to evaluate the effect on systemic inflammation of subgingival instrumentation (SI) with or without antibiotics. Moreover, systemic parameters were compared between periodontally healthy (PH) individuals and periodontitis patients.
METHOD AND MATERIALS
Patients with generalized periodontitis: stage III and PH individuals were recruited. Forty eight periodontitis patients were randomly allocated to each treatment group; systemic antibiotics for seven days after completion of SI (AB group), or SI alone (SI group). Periodontal parameters, serum high-sensitivity C-reactive protein (hsCRP), and hematological parameters were assessed at baseline and at week 8. Multivariate analysis was applied to analyze predictive effect of treatment allocated and improvement in periodontal parameters on change in systemic parameters.
RESULTS
At baseline, hsCRP, total leukocyte count (TLC), neutrophil, and monocyte count were significantly higher in periodontitis patients. There was comparable reduction in neutrophil count in both treatment groups. At week 8, change in periodontal parameters was similar in treatment groups, except for probing pocket depth (PPD). Improvement in both PPD and clinical attachment level (CAL) and CAL alone was predictive of change in TLC and lymphocyte count, respectively.
CONCLUSION
This study failed to demonstrate the significant benefit of systemic antibiotics as an adjuvant to SI on improvement in periodontal inflammation and systemic inflammatory parameters, despite significantly higher reduction in PPDs.
Topics: Humans; Anti-Bacterial Agents; C-Reactive Protein; Periodontitis; Inflammation; Dental Scaling; Chronic Periodontitis; Root Planing
PubMed: 36876718
DOI: 10.3290/j.qi.b3942249 -
Journal of the American Dental... Jul 2019
Topics: Chronic Periodontitis; Dental Scaling; Humans; Ozone; Periodontal Pocket; Root Planing
PubMed: 31053236
DOI: 10.1016/j.adaj.2019.02.034 -
Journal of Cellular and Molecular... Feb 2023Platelet-rich fibrin (PRF) has been widely used in regenerative dentistry due to many growth factors produced. Periostin, a matricellular protein, is a reliable marker...
Platelet-rich fibrin (PRF) has been widely used in regenerative dentistry due to many growth factors produced. Periostin, a matricellular protein, is a reliable marker for tissue regeneration. Periostin is part of the cellular matrix and regulates bone homeostasis. This study aims to explore the efficacy of PRF in improvement of the clinical periodontal parameters as an adjunct to the scaling and root planing and to evaluate periostin level in gingival crevicular fluid (GCF) at baseline, 1- and 3-month recall visits. Fourteen periodontitis patients who met the inclusion criteria were recruited in this study. Two contralateral periodontal pockets with 4-6 mm in depth in each patient were selected. The sites in every participant were randomly allocated into control sites or test sites. In control sites, only conventional scaling and root planing was carried out. In test sites, however, scaling and root planing method and PRF were applied. Periostin level in GCF and clinical periodontal parameters were measured. The test sites revealed greater relative attachment gain (2.614 ± 0.606 mm and 3.321 ± 0.668 mm) than control sites (1.285 ± 0.671 mm and 1.839 ± 0.632 mm) and a significant pocket reduction (2.535 ± 0.664 mm and 3.321 ± 0.668 mm) than the control sites (1.21 ± 0.508 mm and 1.892 ± 0.655 mm) at 1- and 3-month recall visits respectively. In the test sites, level of periostin (48.83 ± 9.3 ng/μl and 98.90 ± 24.94 ng/μl) were greater than periostin levels in the control sites (42.65 ± 7.03 ng/μl and 49.29 ± 15.14 ng/μl) at 1- and 3-month recall visits respectively. In conclusion, the non-surgical application of PRF as an adjunct to scaling and root planing significantly improved the clinical periodontal parameters through raising periostin level in GCF.
Topics: Humans; Platelet-Rich Fibrin; Periodontitis; Periodontal Pocket; Root Planing; Wound Healing; Follow-Up Studies
PubMed: 36691719
DOI: 10.1111/jcmm.17675 -
Clinical Oral Investigations Jun 2023The aim of this study was to evaluate the clinical efficacy of the adjunctive use of Nd:YAG laser (1064 nm) to full-mouth scaling and root planning (FMS), in stage... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
The aim of this study was to evaluate the clinical efficacy of the adjunctive use of Nd:YAG laser (1064 nm) to full-mouth scaling and root planning (FMS), in stage III/IV periodontitis patients.
MATERIALS AND METHODS
Sixty stage III/IV periodontitis patients were randomly assigned to three groups. The control group received FMS, laser 1 group received combined FMS/single Nd:YAG laser irradiation (3 W, 150 mJ, 20 Hz,100 μs), and laser 2 group received combined FMS/double Nd:YAG laser irradiation with 1-week interval (2.0 W, 200 mJ, 10 Hz, 100 μs). PD, CAL, FMPS, GI, FMBS, and GR were evaluated at baseline, 6 weeks, 3, 6, and 12 months after treatment. Patient-reported outcomes were evaluated 1 week after treatment.
RESULTS
A significant improvement (p < 0.001) for all clinical parameters was observed during the entire study period, with the exception of mean CAL gain for the laser 2 group at 12 months. The percentage of pockets ≤ 4 mm was significantly higher compared to baseline for all groups throughout the study, with no inter-group differences at any time point. Patient-reported analgesic consumption was higher for laser 1 group.
CONCLUSIONS
The adjunctive use of Nd:YAG laser irradiation was similarly effective to FMS alone, during the entire study period. A slightly higher, though not statistically significant improvement was reported for PD at 6 and 12 months after a single post-FMS application of Nd:YAG laser for pocket epithelium removal and coagulation.
CLINICAL RELEVANCE
Additional Nd:YAG laser application for sulcular epithelium removal and coagulation may provide minor long-term improvements compared to FMS or laser irradiation for pocket disinfection and detoxification.
TRIAL REGISTRATION
ISRCTN26692900. Registration date: 09/06/2022.
Topics: Humans; Lasers, Solid-State; Root Planing; Dental Scaling; Periodontal Pocket; Periodontitis; Treatment Outcome
PubMed: 36795248
DOI: 10.1007/s00784-023-04908-4 -
Periodontology 2000 Oct 2018In this paper, we consider personalized periodontics from a public health perspective. Periodontitis is an under-acknowledged and important public health problem, and... (Review)
Review
In this paper, we consider personalized periodontics from a public health perspective. Periodontitis is an under-acknowledged and important public health problem, and there has long been interest in identifying and treating those who are at high risk of developing this disease. Although susceptibility/risk-assessment tools in periodontology are currently in their early stages of development, personalized periodontics is increasingly becoming a realistic approach. At the population level, however, personalized periodontics is not an effective way of improving periodontal health because it would target only those who seek help or are able to access care. The occurrence of periodontitis in populations is socially patterned, with those of lower socio-economic position having poorer periodontal health and being far less likely to seek care. There is the potential for social inequalities actually to worsen as a result of personalized periodontics. In most health systems, personalized periodontics is likely to be accessible only to the social strata for whom it is affordable, and those with the greatest need for such an intervention will remain the least likely to be able to get it. Thus, personalized periodontics is likely to be a niche service for a small proportion of the adult population. This is at odds with the public health approach.
Topics: Dental Care; Disease Progression; Forecasting; Health Systems Plans; Humans; Periodontics; Periodontitis; Public Health; Risk Assessment; Socioeconomic Factors
PubMed: 30198135
DOI: 10.1111/prd.12228