Sirtuin6 and Lipoxin A4 levels are decreased in severe periodontitis.

OBJECTIVE: Sirtuin6 plays an important role in the regulation of inflammation, homeostasis, and apoptosis, and it has anti-inflammatory effects on several diseases. Lipoxin A4 is a pro-resolving lipid mediator of inflammation and inhibits hypoxia-induced apoptosis and oxidative stress. Considering that Lipoxin A4 and Sirtuin6 have protective effects on inflammatory diseases, the aim of this study is to determine the possible roles of these molecules on periodontitis inflammation in saliva and serum and to reveal the relationship of these data with clinical periodontal parameters. MATERIAL AND METHODS: A total of 20 stage III/grade B periodontitis and 20 periodontally healthy subjects were included in this cross-sectional study (all never smokers and systemically healthy). Clinical periodontal parameters (plaque index, probing pocket depth, bleeding on probing, clinical attachment loss) were recorded. Saliva and serum levels of Sirtuin6 and Lipoxin A4 were analyzed by enzyme-linked immunosorbent assay. RESULTS: Serum Sirtuin6 and saliva Lipoxin A4 levels were significantly lower in the periodontitis group than the control group (respectively, p = 0.0098, p = 0.0008). There were negative correlations between all periodontal clinical parameters and saliva Lipoxin A4 level (p < 0.05) and between probing pocket depth, clinical attachment loss, and serum and saliva Sirtuin6 levels (respectively, r = - 0.465 and r = - 0.473, p < 0.05). CONCLUSIONS: Decreased levels of serum Sirtuin6 and saliva Lipoxin A4 in periodontitis patients and their correlation with clinical periodontal parameters suggest that serum Sirtuin6 and saliva Lipoxin A4 may be related with periodontal inflammation. CLINICAL RELEVANCE: Scientific rationale for the study: Sirtuin6 is one of seven members of the family of NAD + dependent protein that played an important role in the regulation of inflammation, energy metabolism, homeostasis, and apoptosis. Sirtuin6 is associated with the pathogenesis of several diseases. Lipoxin A4 is a lipid mediator that inhibits hypoxia-induced apoptosis and oxidative stress, and it has an active role in the resolution of periodontal inflammation. No studies that investigated the potential role Sirtuin6 and its relationship with inflammation resolution and apoptosis mechanisms in severe periodontitis patients. PRINCIPAL FINDINGS: the serum Sirtuin6 and saliva Lipoxin A4 levels were significantly lower and negatively correlated with clinical periodontal parameters in the patients with periodontitis than the healthy controls. PRACTICAL IMPLICATIONS: this study shows that serum Sirtuin6 and saliva Lipoxin A4 may be candidate biomarkers related with periodontal inflammation and estimating to periodontal status. CLINICAL TRIAL REGISTRATION: NCT05417061.

Potential biomarkers reflecting inflammation in patients with severe periodontitis: Fractalkine (CX3CL1) and its receptor (CX3CR1).

OBJECTIVE: The aim of this study was to determine differences in GCF and serum levels of fractalkine/CX3CL1 and its receptor/ CX3CR1 between the patients with stage III/grade B periodontitis and periodontally healthy subjects. BACKGROUND: Fractalkine (CX3CL1), the only member of CX3C chemokine family, is involved in the pathogenesis of several systemic inflammatory diseases' disorders including rheumatoid arthritis, cardiovascular diseases, tonsillitis, and diabetes mellitus. It has critical functions in inflammatory cell migration, adhesion, and proliferation. METHODS: 20 stage III/grade B periodontitis (P) and 20 healthy individuals (control; C) were included in this clinical study (all never smokers and systemically healthy). Clinical periodontal parameters were measured. Serum and GCF levels of CX3CL1, CX3CR1, and IL-1ß were quantified by enzyme-linked immunosorbent assay and reported as total amounts and concentration. RESULTS: The GCF concentrations and also total amount of CX3CL1, CX3CR1, and IL-1ß were statistically significantly higher in the patients with periodontitis compared with control group (P < 0.05). CX3CL1, CX3CR1, and IL-1ß levels in the GCF were significantly and positively correlated with all the clinical periodontal parameters (PI, PPD, BOP, and CAL; P < 0.01, P < 0.05). There was a significant correlation between IL-1ß, CX3CL1, and CX3CR1 concentrations in the GCF (respectively; r = 0.838 and r = 0.874, P < 0.01). CONCLUSION: Fractalkine and its receptor may play role in mechanisms through the regulation of inflammation or on the pathogenesis of periodontal disease.

Free amino acid composition of saliva in patients with healthy periodontium and periodontitis.

OBJECTIVES: To identify and compare the free amino acids in the saliva of periodontitis patients and healthy individuals and to assess their levels in different periodontal disease types. MATERIALS AND METHODS: There were three groups: healthy individuals (control (C); n = 20), Stage III Grade B generalized periodontitis (GP-B; n = 20), and Stage III Grade C generalized periodontitis (GP-C; n = 20). Clinical periodontal parameters were measured. Amino acid analysis of the saliva was accomplished by liquid chromatography-mass spectrometry (LC MS/MS), taking the mean concentration. RESULTS: Citrulline and carnosine concentrations were significantly higher in patients with periodontitis than in the control group (p < 0.017). Methionine, glutamic acid, and arginine showed significantly higher concentrations in GP-C, whereas proline and tryptophan showed higher concentrations in the GP-B group (p < 0.017). There was a significant correlation between methionine, citrulline, arginine, and carnosine and clinical periodontal parameters. CONCLUSIONS: Our results demonstrate that periodontal status and disease type can result in variations in salivary amino acid (AA) content in correlation with clinical inflammatory signs. The significant correlation of methionine, citrulline, carnosine, and arginine with clinical parameters, regardless of systemic status, suggests that the levels of different salivary free AAs play roles in periodontitis. CLINICAL RELEVANCE: Salivary free AAs may be suggested as a potential diagnostic compound in patients with periodontitis. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT04642716.

Effects of vacuum-formed retainers on periodontal status and their retention efficiency.

INTRODUCTION: The stability of treatment results is a major concern in orthodontics. Numerous retention regimens to maintain stability have been introduced. The objectives of this study were to evaluate the effects of vacuum-formed retainers (VFRs) on periodontal tissues and the retention efficiency of VFRs. METHODS: Forty patients were included in this study. Clinical effectiveness of VFRs for nighttime use only over a 12-month period was assessed by using the American Board of Orthodontics' Objective Grading System. Periodontal measurements and indexes were recorded and evaluated immediately after removal of the braces and after 1, 6, and 12 months of VFR use. RESULTS: There was no significant change in the total Objective Grading System score between the end of the active treatment period and the end of the 12-month retention period. However, regarding periodontal measurements, the plaque and gingival indexes decreased, whereas the bleeding on probing, probing depth, calculus index, and clinical attachment loss increased between the evaluated periods. CONCLUSIONS: In terms of periodontal health, the use of VFRs resulted in a slight periodontal attachment loss that seemed to be clinically insignificant, without gingival inflammation or recession. In terms of stability, VFRs were found to be effective in orthodontic retention.

Inflammatory and immune pathways in the pathogenesis of periodontal disease.

The pathogenesis of periodontitis involves a complex immune/inflammatory cascade that is initiated by the bacteria of the oral biofilm that forms naturally on the teeth. The susceptibility to periodontitis appears to be determined by the host response; specifically, the magnitude of the inflammatory response and the differential activation of immune pathways. The purpose of this review was to delineate our current knowledge of the host response in periodontitis. The role of innate immunity, the failure of acute inflammation to resolve (thus becoming chronic), the cytokine pathways that regulate the activation of acquired immunity and the cells and products of the immune system are considered. New information relating to regulation of both inflammation and the immune response will be reviewed in the context of susceptibility to, and perhaps control of, periodontitis.

Evaluation of blood cell attachment on Er: YAG laser applied root surface using scanning electron microscopy.

BACKGROUND: Periodontal regeneration is dependent on the uninterrupted adhesion, maturation and absorption of fibrin clots to a periodontally compromised root surface. The modification of the root surface with different agents has been used for better fibrin clot formation and blood cell attachment. It is known that Er:YAG laser application on dentin removes the smear layer succesfully. AIM: The aim of this study is to observe blood cell attachment and fibrin network formation following ER:YAG laser irradiation on periodontally compromised root surfaces in comparison to chemical root conditioning techniques in vitro. MATERIALS AND METHODS: 40 dentin blocks prepared from freshly extracted periodontally compromised hopeless teeth. Specimens were divided in 5 groups; those applied with PBS, EDTA, Citric acid and Er:YAG. They were further divided into two groups: those which had received these applications, and the control group. The specimens were evaluated with scanning electron microscope and micrographs were taken. Smear layer and blood cell attachment scoring was performed. RESULTS: In the Er:YAG laser applied group, smear layer were totally removed. In the blood applied specimens, better fibrin clot formation and blood cell attachment were observed in the Er:YAG group. In the group that had been applied with citric acid, the smear layer was also removed. The smear layer could not be fully removed in the EDTA group. CONCLUSION: Er:YAG laser application on the root dentin seems to form a suitable surface for fibrin clot formation and blood cell attachment. Further clinical studies to support these results are necessitated.

Analysis of Biomarkers and Marginal Bone Loss in Platform-Switched and Nonplatform-Switched Implants: A Randomized Clinical Trial.

Objectives: To compare the peri-implant crevicular fluid (PICF) biomarker levels, peri-implant status, and marginal bone level (MBL) differences of implants restored with randomly assigned nonplatform-switched (NPS) or platform-switched (PS) abutments. Methods: Ninety-four implants in 27 subjects were included in this study. Receptor activator of nuclear factor kappa-B ligand (RANKL), osteoprotegerin (OPG), interleukin-1ß (IL-1ß), monocyte chemotactic protein-1 (MCP-1) levels in PICF, peri-implant health, and the change in the MBL were evaluated at the time of restoration (T 1) and after 12 months (T 2). Results: The IL-1ß levels decreased and the RANKL, OPG, and MCP-1 levels increased from T 1 to T 2 (P < 0.05) in both groups. RANKL/OPG ratio at T 1, MCP-1 levels at T 2, and the MCP-1 change from T 1 to T 2 were lower in the PS group than in the NPS group (P < 0.05). MBL change was lower (0.51 ± 0.31 mm) in the PS group than that (0.75 ± 0.29 mm) in the NPS group at T 2 (P < 0.001). Peri-implant health status between the study groups was negligible. Conclusion: PS was superior to NPS regarding the preservation of MBL. Higher MCP-1 levels, altered RANKL/OPG ratio, and lower OPG levels in the NPS group could be associated with subclinical peri-implant bone remodeling.

Marginal bone loss around implants supporting fixed restorations.

A key criterion of success following dental implants is the marginal bone level. Long-term clinical and radiographic evaluation is necessary to test the results of in vitro studies investigating how cantilevering of restorations or implant size affect bone level changes around implants. There is no consensus on the effect of several variables such as age, gender, implant size, and cantilever prostheses on marginal bone levels around fixed dentures supported by dental implants. Patients who received cemented, fixed restorations supported by implants and who were examined in routine recall sessions 6, 12, 24, and 36 months after loading were included in the study group. Comparative bone level measurements were obtained from images of radiographs at ×20 magnification using the CorelDraw 11.0 software program. Statistical analysis was performed using the Student t test and 1-way analysis of variance. In the 36-month observation period, there were no incidences of implant failure, excessive bone loss around implants, or peri-implant inflammation. One hundred twenty-six implants in 36 patients were evaluated, and the effect of several factors on marginal bone loss (MBL) during the 36 months after loading was analyzed statistically. There was no significant relationship between MBL and implant length or diameter, whereas age, gender, and cantilevers affected bone loss rates. MBL was elevated in older and female patients as well as in patients who received cantilevers. In cases of limiting anatomic conditions, short and/or narrow implants should be preferred over cantilever extensions.

Astra Tech, Brånemark, and ITI implants in the rehabilitation of partial edentulism: two-year results.

PURPOSE: To explore the soft tissue, marginal bone, and prosthetic complications (if any) of Astra Tech, Brånemark, and ITI implants supporting fixed prostheses during an observation period of 2 years. MATERIALS: The study comprised 26 patients, who received 42 Astra Tech, 36 Brånemark, and 29 ITI implants. After 3 months of healing, abutment connections were performed for Astra Tech and Brånemark implants, and fixed prostheses were delivered to the patients at 4 months. At 6-month, 1-year, and 2-year recall appointments, plaque index, periimplant inflammation index, and bleeding index scores, were recorded. The marginal bone levels were also measured at 2-year recall by means of radiographic evaluation, and prosthetic complications were recorded throughout the study. RESULTS: All implants survived during the 2-year observation period. The plaque index and periimplant inflammation index scores around Brånemark implants were higher than ITI and Astra Tech implants in the first year of function (P > 0.05). Marginal bone loss around ITI and Astra Tech implants was similar at 2 years (P > 0.05). The marginal bone loss around Brånemark implants was higher than Astra Tech implants (P < 0.05) but similar to ITI implants at 2-year recall appointment (P > 0.05). Fixed prostheses supported by ITI and Astra Tech implants did not experience prosthetic complications, and only 1 patient of the Brånemark group had porcelain veneer fracture. CONCLUSIONS: Astra Tech, Brånemark, and ITI implants supporting fixed prostheses had same survival rates (100%) in this study. ITI and Astra Tech implants had similar changes in marginal bone levels, whereas Brånemark implants had higher marginal bone loss, particularly in the first year of function.

Oral status and Candida colonization in patients with Sjögren's Syndrome.

OBJECTIVE: To determine the oral status, salivary flow rate, Candida carriage in saliva, and prevalence of Candida albicans colonization in several areas of the mouth in patients with primary and secondary Sjögren's syndrome as opposed to those of healthy subjects. STUDY DESIGN: Thirty-seven patients with Sjögren's syndrome (SS), [14 patients with primary SS (SS-1) and 23 patients with secondary SS (SS-2)], along with 37 healthy controls were examined in regard to number of teeth, pro-bing pocket depth (PPD), approximal plaque index (API), bleeding on probing (BOP), presence of prosthetic appliances and smoking habits. Salivary flow rate (SFR), Candida carriage in saliva, presence of Candida albicans colonization on buccal, angular, palatal and sulcular areas, on dentures and on the tongue's dorsal surface were determined. Statistical analyses were performed using the 2-tailed Fisher exact and Kruskal-Wallis test. RESULTS: No statistically significant difference was found between SS-1 and SS-2 groups based on the parameters analysed. Statistically significant differences were observed between patients with SS and healthy subjects in terms of SFR, oral signs and symptoms, API, BOP, C. albicans colonization on tongue and buccal area, and Candida carriage in saliva. In the gingival crevicular fluid positive C. albicans colonization was found in only one subject of SS subgroup. CONCLUSIONS: SS patients carry a higher risk of having periodontitis and are more predisposed to develop candidiasis. C. albicans is scarcely detected in gingival crevicular fluid despite high scores on C. albicans colonization in different areas of the oral cavity in SS patients.

Periodontal treatment outcomes in post menopausal women receiving hormone replacement therapy.

PURPOSE: To evaluate the effect of hormone replacement therapy(HRT) on periodontal treatment outcomes in a group of postmenopausal women with periodontitis. MATERIALS AND METHODS: 23 post-menopausal chronic periodontitis patients were included in this study. The test group(n=11) consisted of women who started HRT with this study and received conjugated estrogen and medroxyprogesteron. The control group(n=12) was women not taking any HRT or supplement therapy. Study groups received the same periodontal treatment. All subjects examiend by recording the following: plaque index (PI), sulcus bleeding index (SBI), periodontal pocket depth (PD) and relative attachment level (RAL) from 6 sites in each tooth. Measurements were recorded at the baseline, 1 month, 3 months, and 6 months following periodontal treatment. Serum estrogene level and bone mineral density was recorded at baseline and 6 months following periodontal treatment. RESULTS: The GI change was greater in the control group. There wasn't significant difference by means of PD, the attachment gain was significantly greater in the HRT receiving group. CONCLUSION: HRT seems to have a positive effect on periodontal treatment outcomes.

Performance of multiplex cytokine assays in serum and saliva among community-dwelling postmenopausal women.

Multiplexing arrays increase the throughput and decrease sample requirements for studies employing multiple biomarkers. The goal of this project was to examine the performance of Multiplex arrays for measuring multiple protein biomarkers in saliva and serum. Specimens from the OsteoPerio ancillary study of the Women's Health Initiative Observational Study were used. Participants required the presence of at least 6 teeth and were excluded based on active cancer and certain bone issues but were not selected on any specific condition. Quality control (QC) samples were created from pooled serum and saliva. Twenty protein markers were measured on five multiplexing array panels. Sample pretreatment conditions were optimized for each panel. Recovery, lower limit of quantification (LLOQ) and imprecision were determined for each analyte. Statistical adjustment at the plate level was used to reduce imprecision estimates and increase the number of usable observations. Sample pre-treatment improved recovery estimates for many analytes. The LLOQ for each analyte agreed with manufacturer specifications except for MMP-1 and MMP-2 which were significantly higher than reported. Following batch adjustment, 17 of 20 biomarkers in serum and 9 of 20 biomarkers in saliva demonstrated acceptable precision, defined as <20% coefficient of variation (<25% at LLOQ). The percentage of cohort samples having levels within the reportable range for each analyte varied from 10% to 100%. The ratio of levels in saliva to serum varied from 1∶100 to 28∶1. Correlations between saliva and serum were of moderate positive magnitude and significant for CRP, MMP-2, insulin, adiponectin, GM-CSF and IL-5. Multiplex arrays exhibit high levels of analytical imprecision, particularly at the batch level. Careful sample pre-treatment can enhance recovery and reduce imprecision. Following statistical adjustments to reduce batch effects, we identified biomarkers that are of acceptable quality in serum and to a lesser degree in saliva using Multiplex arrays.

Gingival inflammation and interleukin-1 beta and tumor necrosis factor-alpha levels in gingival crevicular fluid during the menstrual cycle.

BACKGROUND: Hormonal changes during puberty, pregnancy, and menopause may impact periodontal tissues by altering the host response. There are only a few studies that examined gingival changes during the menstrual cycle. This longitudinal and prospective study aims to investigate clinical and laboratory markers of gingival inflammation in women at different phases during their menstrual cycles. METHODS: Twenty-seven females were included in this study. Subjects were given oral hygiene instructions before the study, and their plaque index scores were recorded once a week for 2 months. The duration and regularity of the menstrual cycle were also checked at the same time. The gingival index and bleeding on probing (BOP) were recorded. Probing depths were measured to assess the periodontal condition of the subjects. Gingival crevicular fluid (GCF) was collected to analyze the levels of interleukin (IL)-1beta and tumor necrosis factor-alpha on the first menstruation day (MD), estimated ovulation day (OD), and estimated predominant progesterone secretion day (PgD). These exact menstrual cycle days were determined according to serum progesterone and estradiol levels. RESULTS: BOP and IL-1beta levels in GCF showed significant increases from the MD to PgD under optimal plaque control. Among the 12 subjects that had premenstrual symptoms, six subjects reported oral complaints during the premenstrual period, whereas apthous lesions were more frequent during the menstruation period. CONCLUSION: These results demonstrate that the fluctuation of sex steroid hormones impact gingival inflammation during menstruation.