Placental TLR recognition of salivary and subgingival microbiota is associated with pregnancy complications.

BACKGROUND: Pre-term birth, the leading cause of neonatal mortality, has been associated with maternal periodontal disease and the presence of oral pathogens in the placenta. However, the mechanisms that underpin this link are not known. This investigation aimed to identify the origins of placental microbiota and to interrogate the association between parturition complications and immune recognition of placental microbial motifs. Video Abstract METHODS: Saliva, plaque, serum, and placenta were collected during 130 full-term (FT), pre-term (PT), or pre-term complicated by pre-eclampsia (PTPE) deliveries and subjected to whole-genome shotgun sequencing. Real-time quantitative PCR was used to measure toll-like receptors (TLR) 1-10 expression in placental samples. Source tracking was employed to trace the origins of the placental microbiota. RESULTS: We discovered 10,007 functionally annotated genes representing 420 taxa in the placenta that could not be attributed to contamination. Placental microbial composition was the biggest discriminator of pregnancy complications, outweighing hypertension, BMI, smoking, and maternal age. A machine-learning algorithm trained on this microbial dataset predicted PTPE and PT with error rates of 4.05% and 8.6% (taxonomy) and 6.21% and 7.38% (function). Logistic regression revealed 32% higher odds of parturition complication (95% CI 2.8%, 81%) for every IQR increase in the Shannon diversity index after adjusting for maternal smoking status, maternal age, and gravida. We also discovered distinct expression patterns of TLRs that detect RNA- and DNA-containing antigens in the three groups, with significant upregulation of TLR9, and concomitant downregulation of TLR7 in PTPE and PT groups, and dense correlation networks between microbial genes and these TLRs. 70-82% of placental microbiota were traced to serum and thence to the salivary and subgingival microbiomes. The oral and serum microbiomes of PTPE and PT groups displayed significant enrichment of genes encoding iron transport, exosome, adhesion, quorum sensing, lipopolysaccharide, biofilm, and steroid degradation. CONCLUSIONS: Within the limits of cross-sectional analysis, we find evidence to suggest that oral bacteria might translocate to the placenta via serum and trigger immune signaling pathways capable of inducing placental vascular pathology. This might explain, in part, the higher incidence of obstetric syndromes in women with periodontal disease.

The Effect of Flowable Composite Resins on Periodontal Health, Cytokine Levels, and Immunoglobulins.

Objective: This study investigated the effects of flowable resin composites (FCR) on the restoration of noncarious cervical lesions (NCCL) and their impact on periodontal tissues. Materials and Methods: 30 periodontally healthy patients were assigned into three groups randomly; group VF: self-adhering FCR, group NF: fluoride-releasing FCR, and group SF: microhybrid FCR. Gingival crevicular fluid (GCF) volume levels of osteoprotegerin (OPG), immunoglobulins (IgA, IgM), and interleukins (IL-1, IL-1ß, and IL-10) in GCF were analyzed with ELISA tests. Clinical success rates were evaluated using USPHS criteria during the 12-month follow-up. Results: The GCF volume was increased mostly in group SF (1.34 ± 0.09 µl). While the titer of interleukin was increased in all groups, higher increases were observed in IL-1 and IL-1ß in group NF (170.78 pg/ml and 39.35 pg/ml). Increased IL-10 was observed in group VF (14.33 ± 0.85 pg/ml). IgA levels varied partially among all groups (p > 0.05), and even IgM levels were elevated immediately after the restoration process but returned to normal on the 28th day (p < 0.05). Group NF failed in most of the USPHS criteria, while the material group VF and group SF presented acceptable results except in the marginal adaptation criterion (p < 0.05). Conclusions: Clinical efficacy of self-adhering FCR was found the best for restoration of NCCL while fluoride-releasing FCR stimulated the periodontal response and had negative effects on GCF volume, cytokine, and immunoglobulin levels.

Extra-Short Implants with Osteotome Sinus Floor Elevation: A Prospective Clinical Study.

PURPOSE: The aim of this study was to assess the radiographic and clinical outcomes of extra-short implants either alone or in conjunction with osteotome sinus floor elevation and to compare these with regular-sized implants in the posterior atrophic maxilla. MATERIALS AND METHODS: Systemically healthy, nonsmoker individuals having at least one tooth gap in the posterior maxilla were included in the study. When the residual bone height was < 4 mm, an extra-short implant (4 to 6 mm) in conjunction with osteotome sinus floor elevation was placed; when the residual bone height was between 4 and 7 mm, an extra-short implant alone was placed; and when it was ≥ 8 mm, a regular implant (8 to 10 mm) was placed. The implants were uncovered at 4 months, and porcelain-fused-to-metal crowns were fabricated. Crestal bone level, change in the crestal bone level, crown-to-implant ratio, and residual bone height were measured at baseline and 6 and 18 months postloading. RESULTS: Thirty patients (15 men, 15 women, age range: 30 to 73 years) received 80 implants. One implant in the extra-short implant (n = 27 implants) and regular implant (n = 24 implants) groups and two implants in the extra-short implant with osteotome sinus floor elevation group (n = 29 implants) failed before loading. Crestal bone level was significantly higher in the regular implant group compared with the extra-short implant with osteotome sinus floor elevation group at 18 months (P < .028). Crestal bone level change between 6 and 18 months was significantly lower in the extra-short implant + osteotome sinus floor elevation group compared with the regular implant group (P = .003). There was no correlation between the crestal bone level, crestal bone level change, and prosthetic and implant characteristics (P > .05). CONCLUSION: Extra-short implants placed either in native bone or in conjunction with osteotome sinus floor elevation may provide similar clinical and radiographic outcomes that are comparable to those obtained with regular implants. Both extra-short implant placement methods can be promising noninvasive treatment options for the posterior maxilla, and implant dimension, crown length, crown-to-implant ratio, and residual bone height may not affect the crestal bone level change, at least in the short term.

Coronally advanced flap with connective tissue graft or xenogeneic acellular dermal matrix in the treatment of multiple gingival recessions: A split-mouth randomized clinical trial.

OBJECTIVE: To evaluate the clinical efficacy of xenogeneic acellular dermal matrix (XADM) or connective tissue graft (CTG) combined with modified-coronally advanced flap (M-CAF) in the treatment of multiple gingival recessions. MATERIALS AND METHODS: Twelve participants with bilateral MGRs (multiple gingival recession) (82 gingival recessions) randomly received XADM (test group, 41 teeth) on one side and subepithelial CTG (control group, 41 teeth) on the other side in conjunction with M-CAF in the same session and completed the 18-months study period. Recession depth (RD), recession width (RW), keratinized tissue width (KTW), probing depth (PD), and clinical attachment level (CAL) were recorded at baseline, and 6-, 18-months postoperatively. RESULTS: PD was significantly higher in the test group at 18-months (P < .05). PD in the test group was also significantly higher at 6- and 18-months compared to baseline (P < .05). RD and RW were significantly lower at 6- and 18-months compared to baseline in both groups (P < .05) and both parameters were significantly higher in the test group at 18-months (P < .05). Percentage of teeth with complete root coverage in the test and control groups were similar at 6-months (78% and 70.7%, respectively) and at 18-months (both 87.8%) (P > .05). CONCLUSION: Within the limits of the study, M-CAF combined with XADM or CTG seems to be similarly effective in RD reduction of class I and II MGRs at least in the short term. Soft tissue shrinkage and increase in PD may be observed with XADM, while; CTG seems to provide stable clinical outcomes for 18-months follow-up. CLINICAL SIGNIFICANCE: Even though the CTG and XADM in conjunction with M-CAF may provide similar RD reduction in class I and II multiple gingival recessions in the short term. CTGs may be superior in terms of soft tissue shrinkage and PD values.

Do Adhesive Flash-free Brackets Affect Bacterial Plaque in Patients with Adequate Oral Hygiene? A Randomised Controlled Clinical and Microbiological Assessment.

PURPOSE: To compare adhesive flash-free (FF) and adhesive pre-coated (APC) brackets in terms of plaque retention and constituents, gingival biomarkers and enamel demineralisation. MATERIALS AND METHODS: Fifty adolescents (mean age ± SD; 14.23 ± 0.15 years, age range: 13-18 years) were randomly distributed to receive FF or APC ceramic brackets in the maxillary right or left quadrant. Plaque and gingival indices, quantitative light-induced fluorescence (QLF) imaging, gingival crevicular fluid (GCF) and plaque sampling were performed at baseline and at 1, 2 and 3 months (T0, T1, T2, T3) after bracket placement. QLF was repeated following debonding. GCF samples were analysed for biomarkers by immunoassay and plaque by real-time PCR for bacterial content. Data were analysed using the Wilcoxon test on dependent samples and 2-tailed ANOVA. RESULTS: Plaque index, gingival index and fluorescence changes were similar for the two adhesive-bracket systems. GCF volumes and interleukin (IL)-1ß levels increased compared to baseline (p < 0.05). IL-17A levels and RANKL:OPG ratios were similar in both groups. In dental plaque, Aggregatibacter actinomycetemcomitans numbers were higher in the APC group at T3. Fusobacterium nucleatum (Fn) counts statistically significantly decreased at T1 and T3 as compared to T0 in the FF group (p < 0.05 and p < 0.01, respectively), whereas Fn counts increased in the APC group at T3 (p < 0.01). Porphyromonas gingivalis, Streptococcus oralis and total bacterial counts were significantly higher in the APC group than in the FF group at T3 (p < 0.01). CONCLUSION: In orthodontic patients with good oral hygiene, the quantity of plaque on adhesive flash-free brackets and conventional brackets did not differ, but the constituents of plaque differed, with less pathogenic bacteria detected around adhesive flash-free brackets. Further studies also including a group of individuals with poor oral hygiene and longer follow-up periods may better clarify the issue.

Cholinergic signalling mechanisms and early implant healing phases in healthy versus generalized aggressive periodontitis patients: A prospective, case-control study.

AIMS: Periodontal diseases negatively affect implant osseointegration. Perturbations in non-neuronal cholinergic signalling mechanisms are associated with periodontitis; however, their role in generalized aggressive periodontitis (GAgP) is unknown. The aim of this prospective case-control study was to determine the relationship between non-neuronal cholinergic signalling mechanisms, secreted Ly-6/uPAR-related protein-1 (SLURP-1), interleukin-17 (IL-17) family cytokines and healing of dental implants in health and GAgP. MATERIAL AND METHODS: Thirteen GAgP patients and seven periodontally healthy individuals (PH) were recruited. Peri-implant crevicular fluid (PICF) was obtained at baseline and 1 month post-placement. Acetylcholine (ACh) levels and cholinesterase activity were determined biochemically. SLURP-1, IL-17A and IL-17E levels were determined by ELISA. Marginal bone loss (MBL) at 1 and 6 months post-placement was determined radiographically. RESULTS: The concentration of ACh, cholinesterase activity and IL-17A levels was elevated in PICF of patients with GAgP compared to PH individuals at baseline and 1 month post-placement. The concentration of ACh and cholinesterase activity levels in PICF correlated with levels of IL-17A and MBL around implants 1 month post-placement in patients with GAgP. CONCLUSIONS: Non-neuronal cholinergic mechanisms may play a role in the aetiopathogenesis of GAgP and may directly or indirectly, through modulation of IL-17A, influence early implant osseointegration and potential long-term implant survival.

A novel soft tissue thickness measuring method using cone beam computed tomography.

OBJECTIVE: The aim of this study was to introduce a novel soft tissue thickness measurement method using cone beam computed tomography (CBCT) and to compare the new method with ultrasonic device applications and transgingival probing measurements. METHODS: Twenty-five participants (12 female, 13 male, age range, 25-51 years) were included the study. Soft tissue thickness in lateral incisor, canine, premolar, and molar regions were measured using transgingival probing (group T), ultrasonic device (group U), and CBCT scan measurements (group C). Differences and correlations between groups and agreement between measurement methods were evaluated. RESULTS: Soft tissue thickness was significantly lower in group U in premolar region, but was significantly higher in molar region compared with group C and group T (P < .05). There were significant positive correlations in lateral incisor and canine region, between group U and group C, in premolar region between group T and group C, and in molar region between group U and group C, and between group C and group T (P < .05). The highest agreement between measurement methods was evident between group T and group C. CONCLUSION: Soft tissue thickness values in maxilla may differ depending on the measurement method and location of the measurement. Ultrasonic device, transgingival probing, and CBCT measures may not necessarily correlate in all locations. The high agreement between CBCT measurements and transgingival probing may suggest the newly introduced method as a promising technique for soft tissue thickness evaluation. CLINICAL SIGNIFICANCE: This study evaluated the relation between different soft tissue thickness measurement methods and demonstrated a novel method which can be used in any part of the mouth. The outcome also suggested that the measurement method and the location might affect the soft tissue thickness value obtained, and therefore might be important in clinical decision making.

Biomarkers and Bacteria Around Implants and Natural Teeth in the Same Individuals.

BACKGROUND: This cross-sectional study assesses cytokine levels in peri-implant crevicular fluid (PICF)/gingival crevicular fluid (GCF) and a selection of subgingival/submucosal plaque bacteria from clinically healthy or diseased sites in the same individuals. METHODS: Samples from 97 implants/teeth (58 implants [19 healthy, 20 mucositis, 19 peri-implantitis] and 39 natural teeth [19 healthy, 12 gingivitis, eight periodontitis] in 15 systemically healthy patients were investigated by immunoassay and real-time polymerase chain reaction. Samples were obtained first, with probing depth, clinical attachment level, bleeding on probing, plaque index scores, and keratinized tissue width then recorded. Data were analyzed by Wilcoxon, Mann-Whitney U, and permutation tests on dependent, independent, and mixed dependent and independent samples and Spearman correlation. RESULTS: Interleukin (IL)-1ß levels were significantly higher in PICF samples of healthy implants than in GCF samples of healthy teeth (P = 0.003), and soluble receptor activator of nuclear factor-κB ligand (sRANKL) concentrations were significantly higher in the gingivitis than the mucositis group (P = 0.004). Biomarker levels were similar in peri-implantitis and periodontitis groups (P >0.05). Actinomyces naeslundi and Streptococcus oralis levels were significantly higher in the healthy implant group than in healthy teeth (P <0.05). Prevotella intermedia and Treponema denticola (Td) levels were lower in the mucositis group than the gingivitis group (P <0.05). Prevotella oralis and S. oralis levels were significantly higher in the periodontitis group (P <0.05), and Td levels were significantly higher in the peri-implantitis group (P <0.05). CONCLUSION: There were many similarities but, crucially, some differences in biomarker levels (IL-1ß and sRANKL) and bacterial species between peri-implant and periodontal sites in the same individuals, suggesting similar pathogenic mechanisms.

Effects of smoking on salivary C-telopeptide pyridinoline cross-links of type I collagen and osteocalcin levels.

AIM: This study was planned to investigate whether smoker patients with inflammatory periodontal disease exhibit different salivary concentrations of C-telopeptide pyridinoline cross-links of type I collagen (ICTP) and osteocalcin (OC) compared to the non-smoker and/or ex-smoker counterparts. METHODS: Whole saliva samples, full-mouth clinical periodontal recordings were obtained from 67 otherwise healthy patients with inflammatory periodontal disease. According to self-reports there were 34 smokers, 22 non-smokers and 11 ex-smokers. Salivary cotinine, ICTP and OC levels were determined by enzyme-linked immunoassays. RESULTS: Salivary cotinine measurements confirmed self-reports about smoking. Smoker patients revealed significantly higher plaque index values than non-smokers (p<0.05). Bleeding on probing values were significantly lower in smoker group than ex-smoker group (p<0.05). There was no significant difference between the study groups in salivary ICTP levels (p>0.05). OC levels in smoker group was significantly lower than the other groups (p<0.001). Salivary ICTP levels correlated negatively with number of teeth present (p<0.05), positively with bleeding on probing (p<0.01). Salivary OC levels correlated negatively with years smoked (p<0.01). CONCLUSIONS: Within the limits of this study, smoking seems to suppress salivary osteocalcin level but ICTP levels seem not to be affected by smoking status. This suppression in OC levels may be one mechanism of deteriorating effects of smoking on periodontal health.