Clinical and computed tomographic evaluations of periodontal phenotypes in a Chinese population: a cross-sectional study.

OBJECTIVES: To investigate the diagnostic value of probe transparency related to gingival thickness (GT) and keratinized gingival width (KGW) at individual and site levels and explore the relationship of buccal bone plate thickness (BT) with GT and KGW. MATERIALS AND METHODS: A total of 1,606 teeth from 167 patients with periodontally healthy maxillary anterior region were included. GT was measured with probe transparency and transgingival probing. KGW was measured directly. BTs were assessed at the level 1 mm apical to the alveolar crest (BT1) and midpoint of the root (BT2) and evaluated at individual and tooth levels along with their mutual associations. RESULTS: The prevalence of thick gingiva was 53% with probe transparency measurement and 51% with transgingival probing. The cutoff gingival thickness was 0.8 mm, which correlated moderately with a Cohen's kappa of 0.386. The mean GT, KGW, and BTs (BT1 and BT2) in the maxillary anterior region were 0.97 ± 0.46, 5.51 ± 1.62, 0.85 ± 0.31, and 0.79 ± 0.32 mm, respectively. GT and KGW correlated mildly (r = 0.261), and GT and BTs correlated moderately (BT1: r = 0.298; BT2: r = 0.338). GT and BTs differed significantly between men and women and among different tooth sites. CONCLUSIONS: GT and BTs correlated positively in the maxillary anterior region and varied within and among individuals. Sex was a factor influencing the gingival phenotype and bone morphotype. CLINICAL RELEVANCE: GT measured with transgingival probing, with a cutoff of 0.8 mm, could serve as an objective measure to distinguish different gingival phenotypes.

Digitally measured exposed root surface area for predicting the effectiveness of modified coronally advanced tunnel combined de-epithelialized gingival grafting in the treatment of multiple adjacent gingival recessions.

OBJECTIVES: To assess the predictive value of baseline digitally measured exposure root surface area (ERSA) on the effectiveness of modified coronally advanced tunnel and de-epithelialized gingival grafting (MCAT + DGG) technique for the treatment of multiple adjacent gingival recessions (MAGRs). MATERIALS AND METHODS: A total of 96 gingival recessions (48 RT1 and 48 RT2) from 30 subjects were included. ERSA was measured on the digital model obtained by intraoral scanner. Generalized linear model was used to analyze the possible correlation of ERSA, Cairo recession type (RT), gingival biotype, keratinized gingival width (KTW), tooth type, and cervical step-like morphology on the mean root coverage (MRC) and complete root coverage (CRC) at 1-year after MCAT + DGG. The predictive accuracy of CRC is tested using receiver-operator characteristic curves. RESULTS: At 1-year postoperatively, the MRC for RT1 was 95.14 ± 10.25%, which was significantly higher than 78.42 ± 22.57% for RT2 (p < 0.001). ERSA (OR:1.342, p < 0.001), KTW (OR:1.902, p = 0.028) and lower incisors (OR:15.716, p = 0.008) were independent risk factors for predicting MRC. ERSA and MRC showed significant negative correlation in RT2(r = -0.558, p < 0.001), but not in RT1(r = 0.220, p = 0.882). Meanwhile, ERSA (OR:1.232, p = 0.005) and Cairo RT (OR:3.740, p = 0.040) were independent risk factors for predicting CRC. For RT2, the area under curve was 0.848 and 0.898 for ERSA without or with other correction factors, respectively. CONCLUSIONS: Digitally measured ERSA may provide strong predictive values for RT1 and RT2 defects treated with MCAT + DGG. CLINICAL RELEVANCE: This study demonstrates that digitally measured ERSA is a valid outcome predictor for root coverage surgery, especially applicable for predicting RT2 MAGRs.

Evaluation of salivary biomarkers for the diagnosis of periodontitis.

BACKGROUND: Salivary interleukin (IL)-1ß, matrix metalloproteinase (MMP)-8, pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP) and Porphyromonas gingivalis (Pg) are related to periodontitis. This study aimed to investigate the diagnostic potential of these biomarkers and to build a prediction panel for diagnosing periodontal disease. METHODS: A total of 80 participants were enrolled in a cross-sectional study and divided into healthy (n = 25), gingivitis (n = 24), and periodontitis (n = 31) groups based on their periodontal exam results. A full mouth periodontal examination was performed and unstimulated saliva was collected. Salivary IL-1ß, MMP-8, ICTP, and Pg were assessed using enzyme-linked immunosorbent assay (ELISA) and quantitative real time PCR (qPCR). Their potentials for diagnosing periodontal disease were analyzed and combined prediction panels of periodontal disease were evaluated. RESULTS: As a single marker, IL-1ß showed the best diagnostic value of the four markers evaluated and exhibited an area under the curve (AUC) value of 0.88 with 90% sensitivity and 76% specificity for discriminating periodontitis subjects from healthy subjects, an AUC value of 0.80 with 83% sensitivity and 76% specificity for discriminating gingivitis subjects from healthy subjects and an AUC value of 0.66 with 68% sensitivity and 64% specificity for differentiating periodontitis subjects from gingivitis subjects. The combination of IL-1ß, ICTP, and Pg exhibited the highest efficacy for discriminating periodontitis subjects from healthy subjects (AUC = 0.94) and gingivitis subjects (AUC = 0.77). The combination of IL-1ß and MMP-8 exhibited the best ability to discriminate gingivitis from healthy subjects (AUC = 0.84). CONCLUSIONS: Salivary IL-1ß, MMP-8, ICTP, and Pg showed significant effectiveness for diagnosing periodontal disease. The combination of IL-1ß, ICTP, and Pg can be used to discriminate periodontitis subjects from healthy subjects and gingivitis subjects, and the combination of IL-1ß and MMP-8 can be used to discriminate gingivitis subjects from healthy subjects.

Magnetically Separable Nanocatalyst with the Fe3O4 Core and Polydopamine-Sandwiched Au Nanocrystal Shell.

This work reports a novel Fe3O4@polydopamine/Au/polydopamine core/shell nanocomposite toward a magnetically separable nanocatalyst. Because the polydopamine (PDA) layer-sandwiched Au nanocrystals were prepared by a layer-by-layer method, the content of Au could be controlled by varying the Au shell number (such as burger-like Fe3O4@PDA/Au/PDA/Au/PDA). Fe3O4@PDA/Au/PDA exhibited excellent catalytic activity in reducing p-nitrophenol because the substrate could penetrate the PDA shell. Owing to the protection of the PDA shell, Fe3O4@PDA/Au/PDA presented higher cyclability than Fe3O4@PDA/Au. The activity of Fe3O4@PDA/Au/PDA maintained 95% after 7 cycles, while that of Fe3O4@PDA/Au was only 61%. The detailed cycling catalytic mechanism was investigated, and it was found that the catalytic rate of Fe3O4@PDA/Au/PDA/Au/PDA was faster than that of Fe3O4@PDA/Au/PDA because of the higher Au content. Interestingly, this method could be extended for other magnetic nanocomposites with two different kinds of noble metal nanocrystals integrated within one particle, such as Fe3O4@PDA/Au/PDA/Ag/PDA and Fe3O4@PDA/Au/PDA/Pd/PDA.

The accuracy of cone-beam computed tomography in assessing maxillary molar furcation involvement.

AIM: The aim of this study was to investigate the accuracy of cone-beam computed tomography (CBCT) in assessing maxillary molar furcation involvement (FI). MATERIALS AND METHODS: Fifteen patients with generalized chronic periodontitis after initial therapy were recruited. CBCT was performed in maxillary molars with probing pocket depths of ≥6 mm and advanced FI, and CBCT images were analysed. Furcation surgery was performed in 20 maxillary molars. Lastly, intra-surgical FI assessments were compared with CBCT-based data. RESULTS: Intra-surgical findings confirmed 82.4% of the CBCT data, with a weighted kappa of 0.917. The agreement between both assessments was the highest in buccal furcation entrances, followed by distopalatal and mesiopalatal furcation entrances. Of the four parameters tested of detailed root anatomy and furcation morphology, the mean length of the root trunk and the width of the furcation entrance revealed by CBCT were consistent with their respective intra-surgical values (p > 0.05). Horizontal bone loss and vertical bone loss were underestimated by CBCT relative to their respective intra-surgical classifications (p ≤ 0.05). CONCLUSIONS: Cone-beam computed tomography images demonstrate a high accuracy in assessing the loss of periodontal tissue of the FI and root morphologies in maxillary molars.

[Effect of regenerative therapy for the furcation involvements of mandibular molars evaluated by cone-beam computed tomography].

OBJECTIVE: To evaluate the effect of regenerative therapy for the treatment of furcation involvements of mandibular molars with cone-beam computed tomography (CBCT). METHODS: In the study, 38 furcation involvements of mandibular molars were included and randomly divided into two groups. The experimental group accepted guided tissue regeneration and bone graft therapy, and the control group only flap surgery. The clinical examination and CBCT examination were performed at baseline and 1 year post-surgery. RESULTS: The clinical and CBCT data of both groups were not statistically different at baseline (P>0.05). At the end of 1 year post-surgery, except gingival recession, the clinical parameters of both groups were significantly improved (P<0.001). The vertical and horizontal attachment gains of the experimental group were (3.20 ± 1.82) mm and (2.05 ± 1.27) mm, respectively, and significantly higher than the changes of the control group (P<0.001). And at the end of 1 year post-surgery, the experimental group showed significantly higher bone gain at the vertical and horizontal directions compared with those of the control group: (2.82 ± 0.97) mm and (2.24 ± 0.92) mm, respectively (P<0.001). CONCLUSION: With the limitation of this study, the effect of guided tissue regeneration surgery and bone graft therapy for the treatment of furcation involvements of mandibular molars is significantly better than that of the flap surgery. CBCT can reflect the horizontal and vertical bone changes of furcation area, which is more comprehensive than traditional periapicals.

Survival of nonsurgically splinted mandibular anterior teeth during supportive maintenance care in periodontitis patients.

Background/purpose: Splinting mobile teeth is a choice to improve the patient's oral comfort. The purpose of this study was to assess the survival and stability of mobile anterior mandibular teeth after splinting in patients with periodontitis undergoing supportive periodontal therapy (SPT). Materials and methods: Patients with splinted mobile anterior mandibular teeth were assessed retrospectively. Periodontal statuses were recorded at baseline and follow-up visits. Tooth and splint survival as well as splint repairs were recorded. Multilevel Cox regression analyses were performed to evaluate patient- and tooth-related factors that might have influenced the survival rates of splints. Results: Sixty-one patients, collectively having 161 splints, were followed for an average of 5.44 years. On average, probing depth (PD) of splinted teeth decreased from 4.31 mm to 2.93 mm and clinical attachment loss (CAL) decreased from 5.02 mm to 4.58 mm. Alveolar bone was stable in the follow-up period. None of the splinted teeth were extracted, The overall survival rate of the splints was 65.2%. Splints made of composite resin alone were associated with a higher risk of breakage when compared to splints composed of composite resin with mesh grid strips. Conclusion: Splinting showed long-term survival and splinting combined with periodontal supportive treatment is a feasible option to maintain mobile mandibular anterior teeth.

Periodontitis induced by Porphyromonas gingivalis drives impaired glucose metabolism in mice.

Periodontitis has been demonstrated to be bidirectionally associated with diabetes and has been recognized as a complication of diabetes. As a periodontal pathogen, Porphyromonas gingivalis is a possible pathogen linking periodontal disease and systemic diseases. It has also been found to be involved in the occurrence and development of diabetes. In this study, 6-week-old male C57BL/6 mice were orally administered the P. gingivalis strain ATCC381 for 22 weeks. Histological analysis of the gingival tissue and quantified analysis of alveolar bone loss were performed to evaluate periodontal destruction. Body weight, fasting glucose, glucose tolerance test (GTT), and insulin tolerance test (ITT) were used to evaluate glucose metabolism disorder. We then analyzed the expression profiles of inflammatory cytokines and chemokines in gingival tissue, the liver, and adipose tissue, as well as in serum. The results showed that mice in the P. gingivalis-administered group developed apparent gingival inflammation and more alveolar bone loss compared to the control group. After 22 weeks of P. gingivalis infection, significant differences were observed at 30 and 60 min for the GTT and at 15 min for the ITT. P. gingivalis-administered mice showed an increase in the mRNA expression levels of the pro-inflammatory cytokines (TNF-α, IL-6, IL-17, and IL-23) and chemokines (CCL2, CCL8, and CXCL10) in the gingiva and serum. The expression levels of the glucose metabolism-related genes were also changed in the liver and adipose tissue. Our results indicate that oral administration of P. gingivalis can induce changes in the inflammatory cytokines and chemokines in the gingiva and blood, can lead to alveolar bone loss and to inflammatory changes in the liver and adipose tissues, and can promote glucose metabolism disorder in mice.

[Effect of periodontal initial therapy on the serum level of lipid in the patients with both periodontitis and hyperlipidemia].

OBJECTIVE: To observe the effect of periodontal initial therapy on the serum level of lipid in the patients with both periodontitis and hyperlipidemia. METHODS: Twenty patients with both hyperlipidemia and moderate to severe chronic periodontitis were enrolled in this study. Periodontal parameters [plaque index (PLI), bleeding on probing (BOP), bleeding index (BI), probing depth (PD) and attachment level (AL)] were evaluated prior to and 3 months after periodontal initial therapy. Simultaneously, the patients' serum levels of total cholesterol, triglyceride, high-lipoprotein cholesterol, low-lipoprotein cholesterol were also measured. RESULTS: (1) Three months after periodontal therapy, the periodontal infection and inflammation in patients reduced comparing with baseline. The PD, PLI, BI, and BOP decreased significantly (the PD, PLI, BI, and BOP reduced from 3.98+/-0.12 to 2.39+/-0.13, 1.23+/-0.10 to 0.84+/-0.08, 2.63+/-0.14 to 1.48+/-0.08 and 94.26+/-1.84 to 33.57+/-2.06, respectively; P<0.05), and the attachment level increased significantly after periodontal treatment (AL decreased from 5.17+/-0.21 to 3.92+/-0.16, P<0.05). (2) The total cholesterol and triglyceride levels in these patients also reduced significantly (reducing 0.25 mmol/L and 0.20 mmol/L respectively, P<0.05) at 3 month after periodontal therapy comparing with baseline. At the same time, high-lipoprotein cholesterol levels in these patients increased significantly (increasing 0.18 mmol/L, P<0.05). Eight out of 20 patients showed their serum levels of lipid down to the normal levels. CONCLUSION: Our observation indicated that periodontal initial therapy could reduce the serum lipid levels of patients with both periodontitis and hyperlipidemia, which might be helpful for decreasing risk of cardiovascular disease such as coronary heart disease.

Intracellular adhesion molecule-1 is regulated by porphyromonas gingivalis through nucleotide binding oligomerization domain-containing proteins 1 and 2 molecules in periodontal fibroblasts.

BACKGROUND: The mechanism by which Porphyromonas gingivalis regulates intracellular adhesion molecule 1 (ICAM-1) expression in human periodontal ligament cells (hPDLCs) and human gingival fibroblasts (hGFs) is unknown. The aim of this study is to investigate whether nucleotide binding oligomerization domain-containing protein (NOD) 1 and NOD2 are involved in this process and the clinical significance of ICAM-1 in periodontitis. METHODS: hPDLCs and hGFs were treated with P. gingivalis, l-Ala-γ-d-glutamyl-mesodiaminopimelic acid (an agonist for NOD1), and muramyl dipeptide (an agonist for NOD2). Alternatively, cells transfected with small interfering RNA targeting NOD1and NOD2 were treated with P. gingivalis. ICAM-1, NOD1, and NOD2 were detected at mRNA and protein levels. In addition, clinical examinations were performed in 30 healthy controls and 40 patients with chronic periodontitis (CP) before and after treatment, and serum-soluble ICAM-1 (sICAM-1) levels in these individuals were detected by enzyme-linked immunosorbent assay. RESULTS: This study shows that P. gingivalis caused an increase in ICAM-1, NOD1, and NOD2 expression in periodontal fibroblasts. There was a linear correlation between ICAM-1 and NOD1 and NOD2 levels. Activation of NOD1 and NOD2 by the specific agonist led to the upregulation of ICAM-1, whereas knocking down NOD1 and NOD2 caused a reduction in P. gingivalis-induced ICAM-1 production. Furthermore, sICAM-1 levels were higher in patients with CP than in healthy controls and were positively related to the clinical periodontal parameters. After periodontal treatment, sICAM-1 levels decreased significantly. CONCLUSIONS: The present results indicate that sICAM-1 levels are correlated to the severity of periodontitis. NOD1 and NOD2 mediate P. gingivalis-induced ICAM-1 production in periodontal fibroblasts. NOD1 and NOD2 could be considered potential targets for periodontal therapy.