The effect of nonsurgical periodontal therapy on hepcidin and on inflammatory and iron marker levels

Abstract Serum hepcidin levels may increase in response to infection and inflammation. The present study investigated the effect of nonsurgical periodontal therapy (NSPT) on levels of serum hepcidin, inflammatory markers, and iron markers. An interventional study was conducted on 67 patients (age 30-65 years) without other diseases, except for chronic periodontitis (CP). Patients were allocated to either CP or control groups. The CP group received supragingival and subgingival scaling and root planing procedures, whereas the control group received supragingival scaling. Probing depth (PD), bleeding on probing, clinical attachment level (CAL), visible plaque index (VPI), serum hepcidin and interleukin-6 (IL-6) levels, high-sensitivity C-reactive protein (hs-CRP), hematological markers, and iron markers were measured at baseline and at 90 days after NSPT. The CP group had statistically significant lower mean values for mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) (p ≤ 0.05). The control group had statistically significant reductions in hemoglobin, hematocrit, MCV, and MCH (p ≤ 0.05). Serum hepcidin, IL-6, and erythrocyte sedimentation rate (ESR) levels were significantly decreased in both groups after NSPT. Periodontal markers were more markedly reduced in the CP group compared with the control group (p ≤ 0.05). These findings suggest that NSPT may reduce the serum levels of IL-6, hepcidin, and periodontal parameters.

Clinical attachment loss and molecular profile of inflamed sites before treatment

Abstract Objective: To monitor early periodontal disease progression and to investigate clinical and molecular profile of inflamed sites by means of crevicular fluid and gingival biopsy analysis. Methodology: Eighty-one samples of twenty-seven periodontitis subjects and periodontally healthy individuals were collected for the study. Measurements of clinical parameters were recorded at day −15, baseline and 2 months after basic periodontal treatment aiming at monitoring early variations ofthe clinical attachment level. Saliva, crevicular fluid and gingival biopsies were harvested from clinically inflamed and non-inflamed sites from periodontal patients and from control sites of healthy patients for the assessment of IL-10, MMP-8, VEGF, RANKL, OPG and TGF-β1 protein and gene expression levels. Results: Baseline IL-10 protein levels from inflamed sites were higher in comparison to both non-inflamed and control sites (p<0.05). Higher expression of mRNA for IL-10, RANK-L, OPG, e TGF-β1 were also observed in inflamed sites at day −15 prior treatment (p<0.05). After the periodontal treatment and the resolution of inflammation, seventeen percent of evaluated sites still showed clinically detectable attachment loss without significant differences in the molecular profile. Conclusions: Clinical attachment loss is a negative event that may occur even after successful basic periodontal therapy, but it is small and limited to a small percentage of sites. Elevated inflammation markers of inflamed sites from disease patients reduced to the mean levels of those observed in healthy subjects after successful basic periodontal therapy. Significantly elevated both gene and protein levels of IL-10 in inflamed sites prior treatment confirms its modulatory role in the disease status.

Evaluation of the relative efficacy of an alloplast used alone and in conjunction with an osteoclast inhibitor in the treatment of human periodontal infrabony defects: A clinical and radiological study.

Background: Mucoperiosteal flap surgery stimulates varying amounts of alveolar bone loss due to accelerated osteoclastic activity [Regional Accelerated Phenomenon (RAP)]. Alendronate sodium inhibits osteoclastic activity and is thought to result in a net increase in osteoblastic activity. We undertook a preliminary study evaluating the effect of adjunctive use of topically delivered bisphosphonate alendronate (ALN) along with regenerative bone graft material in the treatment of periodontal infrabony defects. Materials and Methods: Fifteen patients with two-walled or three-walled infrabony defects were selected. In each patient, the infrabony defect of one side of arch was designated as group A (control site) and received hydroxyapatite (HA) bone graft material, while the infrabony defect on the contralateral side of same arch was designated as group B (test site) and received HA + 200 μg drug solution of ALN. Results: Both the groups exhibited a highly significant reduction in probing depth and gain in clinical attachment level and linear bone fill at the end of 24 weeks. Comparative evaluation between the study groups revealed a statistically nonsignificant reduction in probing depth (P=0.128 NS ) and mean gain in attachment level (P=0.218 NS ). However, there was a statistically significant gain in linear bone fill (P=0.040*) in group B as compared to group A. Conclusions: The results suggest that use of ALN along with graft material led to enhanced linear bone fill at the surgical site. This research provides a clue that bone-targeting properties of bisphosphonates can be harnessed along with regenerative materials to potentiate osseous regeneration.

E-cadherin and CD1a expression in gingival epithelium in periodontal health, disease and post-treatment.

Background: Epithelial integrity is important for maintenance of periodontal health. It is not fully known if non-surgical periodontal therapy is capable of recreating the epithelial barrier in its functional state. Patients and Methods: Sixty-five patients (31 males and 34 females) were included in the study. They were divided into group A (healthy gingiva 16 patients), group B (gingivitis 17 patients), group C (periodontitis 17 patients), and group D (post-treatment 15 patients). Gingival samples were collected and immunohistochemical study was done using E-cadherin and CD1a antibody. Statistical analysis was done using analysis of variance (ANOVA), followed by Tukey-Kramer multiple comparison test for CD1a and Tukey's highly significant difference (HSD) test for E-cadherin. Result: There was a statistically significant difference (P<0.001) in the expression of E-cadherin between healthy (1.846±0.555), gingivitis (1.100±0.994), and periodontitis group (0.700±0.483). Similarly, there was a statistically significant difference (P<0.001) in the expression of CD1a between healthy (75.70±3.09), gingivitis (42.53±3.09), and periodontitis group (29.07±3.08). However, the expression of E-cadherin (1.242±0.653) and CD1a in post-treatment samples (52.18±2.90) was lower with no statistically significant difference when compared to health. Discussion: The significant reduction in E-cadherin and CD1a levels in periodontal disease when compared to health could possibly be a result of invasion by the periodontopathogens and its subsequent sequel. Although, the post-treatment samples showed significant improvement when compared to disease, the reduction in E-cadherin and CD1a levels when compared to gingival health suggests that the epithelial barrier was not yet fully established in its functional state.

Influencia del nivel de inserción ósea del diente soporte en el desplazamiento de PPR de extremidad libre mandibular asociada al implante oseointegrado / Influence bone attachment level tooth displacement support free end PPR associated mandibular implant osseointegrated

La rehabilitación con prótesis parcial removible de extremidad libre (PPREL) inferior es compleja y el uso de implantes han mejorado el funcionamiento de este tipo de aparato. El nivel de inserción ósea alrededor del último diente soporte es factor agravante, ya que puede comprometer la longevidad del tratamiento. Así, el objetivo de este estudio fue evaluar la tendencia al desplazamiento de una PPREL asociada al implante oseointegrado, con diferentes niveles de inserción ósea y diferentes conexiones entre la PPR y el diente soporte, a través del método del elementos finitos. Fueron confeccionados 8 modelos: MA - PPREL, apoyo incisal, inserción integra; MB - PPREL, placa distal, inserción integra; MC - PPREL, apoyo incisal, inserción integra, con implante y sistema ERA; MD - PPREL, placa distal, inserción integra, con implante y sistema ERA; ME - PPREL, apoyo incisal, pérdida ósea; MF - PPREL, placa distal, pérdida ósea; MG - PPREL, apoyo incisal, pérdida ósea, con implante y sistema ERA; MH - PPREL, placa distal, pérdida ósea, con implante y sistema ERA. Fueron aplicadas fuerzas verticales de 50 N en cada cúspide. Fueron obtenidos mapas de desplazamiento que mostraron que el implante favorece esta asociación y la pérdida ósea perjudica el pronóstico de la prótesis. Se concluyó que: la introducción del implante con sistema ERA disminuyó la tendencia al desplazamiento del diente y estructuras subyacentes; la introducción de la placa distal disminuyó la tendencia a desplazamiento del diente soporte; la disminución del periodonto de sustentación no influenció significativamente la tendencia al desplazamiento en los modelos con placa distal, pero influenció en los modelos con apoyo distal

The rehabilitation with mandibular distal extension removable partial dentures (DERPD) is complex and the use of implants has been improving the functioning of this approach. The insertion bony level around of the last support tooth is an aggravating factor, since it can harm the longevity of the treatment. Thus, the aim of this research was to evaluate the displacement tendency of a mandibular DERPD associated to an implant, with different insertion bony levels and different connections between the RPD and the support tooth, by finite element analysis. Eight models were made: MA - DERPD, incisal rest, no bony loss; MB - DERPD, distal plate, no bony loss; MC - DERPD, incisal rest, no bony loss, with implant and ERA system; MD - DERPD, distal plate, no bony loss, with implant and ERA system; ME - DERPD, incisal rest, bony loss; MF - DERPD, distal plate, bony loss; MG - DERPD, incisal rest, bony loss, with implant and ERA system; MH - DERPD, distal plate, bony loss, with implant and ERA system. Loads of 50 N in each peak were applied. Displacement maps were obtained and showed that implant favors this association and the bony loss harms the prognostic of the prosthesis. It is concluded that: the introduction of the implant with ERA system reduced the displacement tendency of the tooth and supporting structures; introduction of distal plate reduced the movement tendency of the support tooth; the decrease of the periodontal support didn't influence significantly the displacement tendency of the models with distal plate distal, but it influenced the models with distal incisal rest

Influence of alcohol consumption on alveolar bone level associated with ligature-induced periodontitis in rats

Alcohol consumption is a risk indicator for periodontal disease. The purpose of this study was to morphometrically evaluate the influence of alcohol consumption on alveolar bone level associated with ligature-induced periodontitis in rats. Thirty-six female rats (Wistar, 120 days-old) were randomly divided into three groups that received a daily administration of a water diet (control, n = 12), a 10 percent alcohol diet (10 percent ethanol, n = 12) or a 20 percent alcohol diet (20 percent ethanol, n = 12). Four weeks after the onset of the experiment, cotton ligatures were placed around the cervix of the upper right second molar in six rats. The other 6 rats in each group remained unligated. The rats were sacrificed four weeks after ligature placement. The maxillary bones were removed and alveolar bone loss was analyzed by measuring the distance between the cementoenamel junction and the alveolar bone crest at 2 buccal and 2 palatal sites on the upper right second molar. Analyses between the ligated and unligated groups showed that the presence of ligature induced alveolar bone loss (p < 0.05). Unligated groups showed no significant differences between each other (p > 0.05). In the ligated groups, rats receiving 20 percent ethanol showed significantly greater bone loss compared to control rats or rats receiving 10 percent ethanol. These results demonstrate that alcohol consumption may increase alveolar bone loss in female rats in a dose-dependent manner.

Comparación del nivel de inserción periodontal entre individuos fumadores y no fumadores / Comparison of the level of insertion periodontal between smokers individuals and non smokers

El siguiente estudio comparativo de casos y controles tiene como objetivo comparar el nivel de inserción periodontal entre individuos fumadores y no fumadores para determinar la influencia que tiene el hábito tabáquico sobre el periodonto. Se utilizó una muestra de 1738 sitios periodontales específicos obtenidos de 50 sujetos de 19 a 59 años de edad, pertenecientes al Liceo Aníbal Pinto de Temuco, Chile, quienes presentaron un Examen de Salud Preventivo del Adulto Normal. Cada sitio periodontal fue sometido a un sondaje periodontal a través del cual se determinó el nivel de inserción. Además se determino el carácter fumador o no fumador de cada individuo y la frecuencia de este hábito en el primer grupo. Los datos fueron analizados mediante la prueba Chi – cuadrado con p< 0,05. Los resultados obtenidos indican que los individuos fumadores presentan una mayor pérdida de inserción periodontal que los no fumadores y en directa asociación con la frecuencia del hábito de fumar.

The following cases and controls study has as aim compare the level of periodontal insertion between smoking and not smoking individuals to determine the influence of the smoke on the periodontum. There was used a sample of 1738 specifics periodontal sites obtained of 50 subjects between 19 to 59 years old, from the Aníbal Pinto Lyceum of Temuco, Chile, who had received a normal Preventive Examination of Health of the Adult. Every periodontal site was submitted to a periodontal sounding to determinate insertion level. In addition it was determinate the smoking or not smoking character of every individual and the frequency of this habit in the first group. The information were analyzed by Chi - square test with p < 0,05.The results indicate that the smoking individuals present a major loss of periodontal insertion that not smokers and in direct association with the frequency of the smoking habit.

Histometric analysis of ligature-induced periodontitis in rats: a comparison of histological section planes

The purpose of this study was to analyze the histometry of ligature-induced periodontitis in rats at different histological section depths. Sixteen male adult Wistar rats were randomly assigned to two groups: ligature and control. In the ligature group, rats received a sterile 4/0 silk ligature around the maxillary right 2nd molar. Thirty serial sections containing the 1st and 2nd molars, in which the coronal and root pulp, cementoenamel junction (CEJ) in the mesial side of the 2nd molar, interproximal alveolar bone and connective fiber attachment were clearly visible, were selected for histometric analysis. The histological sections were clustered in groups of 10 sections corresponding the buccal (B), central (C) and lingual (L) regions of the of periodontal tissue samples. The distance between the CEJ in the mesial side of the 2nd molar and the attached periodontal ligament fibers (CEJ-PL) as well as the distance between the CEJ and the alveolar bone crest (CEJ-BC) were determined. From CEJ-PL and CEJ-BC distances measured for each specimen, the measurements obtained in the B, L and C regions were recorded individually and together. Data were submitted to statistical analysis. Significant differences (p<0.001) were observed between the control and ligature groups regarding CEJ-PL (0.05 mm and 0.26 mm, respectively) and CEJ-BC (0.47 mm and 0.77 mm, respectively) measurements. Regarding the depth of the buccal, central and lingual planes, the means of CEJ-PL and CEJ-BC of both groups showed no statistically significant differences (p>0.05). In conclusion, the selection of 10 serial sections of the central region of periodontal tissue samples at any depth can be considered as representative for the evaluation of periodontal ligament fiber attachment and bone loss in ligature-induced periodontitis in rats.

Free gingival graft in the treatment of class III gingival recession.

AIM: The purpose of this study was to assess the success and predictability of root coverage and esthetics obtained with free gingival grafts (FGGs) in the treatment of early class III gingival recessions for a period of 12 months. MATERIALS AND METHODS: Ten patients contributed to 12 sites, each with early class III recession with interdental bone loss < or = 4 mm from cemento enamel junction(CEJ). Clinical parameters recorded at baseline and at 1, 6, and 12 months were probing depth (PD), recession depth (RD), recession width (RW), and clinical attachment level (CAL). RESULTS: Reduction of recession resulted in a significant gain in CAL and PD at the end of 12 months. A statistically significant mean root coverage of 41.25 +/- 21.07% was obtained at the end of 12 months. A statistically significant improvement in Visual Analog Scale score was seen after a 12-month follow-up period. CONCLUSION: In a south Indian population, early class III gingival recessions treated with FGG procedures resulted in 40-50% root coverage with fairly acceptable esthetics.

Computer assisted image analysis methods for evaluation of periodontal wound healing / Imagem digitalizada para avaliação de cicatrização periodontal

O objetivo deste estudo foi determinar a precisão de um método de imagem digitalizada e avaliar sua aplicação na cicatrização periodontal. Material histológico de um estudo realizado em cães foi analisado em microscópio óptico conectado a uma câmera que adquire as imagens e transmite os sinais luminosos para um computador na forma de pixels e dessa forma, permite a realização de medidas. Vinte campos foram medidos para acessar a reprodutividade intra e inter examinador para os parâmetros: área preenchida por tecido, área de epitélio, área de osso e medidas lineares de cemento. Os números foram analisados pelo test-t para testar a hipótese de não diferença entre as medidas executadas pelo mesmo examinador e entre examinadores diferentes. Nenhuma diferença estatística significativa num intervalo de confiança de 95 por cento foi encontrada quando as medidas intra-examinadores foram analisadas (p>0,05). Resultados similares foram analisadas medidas de área. Entretanto, houve diferença estatística significativa quando as medidas lineares de cemento foram analisadas (p<0,05). Os resultados foram consistentes e uniformes e o método demonstrou ser bastante preciso quando medidas intra-examinadores foram avaliadas

Avaliaçäo do desempenho das redes neurais artificiais na identificaçäo de sítios sem e com perda de inserçäo, mediante parâmetros clínicos / Evaluation performance of artificial neural network in the identification of periodontal sites without and with attachment loss, based on clinical parameters

A avaliaçäo do desempenho das Redes Neurais (RN) na identificaçäo de sítios periodontais sem (SPI) e com perda de inserçäo (CPI) baseou-se nas observaçöes clínicas de uma amostra de 2701 sítios de 19 indivíduos monitorados por um período de 18 meses. Os dados referentes às medidas sequenciais do nível de inserçäo relativo foram analisados pelos métodos estatísticos de tolerância e regressäo para a determinaçäo de sítios SPI e CPI. Os seis parâmetros clínicos (sítio, dente, nível de inserçäo inicial, idade, sexo e fumo) considerados variáveis input, e os resultados estatísticos, representando a variável output, foram aplicados à RN nos Modelo Tolerância (MT) e Modelo Regressäo (MR). As variáveis input e output de 2188 sítios foram utilizadas na fase de treinamento da RN. Em seguida, somente as variáveis input dos 513 sítios restantes foram apresentadas à rede na fase teste, para verificar o seu treinamento. Os resultados evidenciaram a possibilidade de aplicaçäo das RN em Periodontia para identificar sítios SPI (alta especificidade), a partir de uma amostra representativa