Expression of MMPs and TIMP-1 in smoker and nonsmoker chronic periodontitis patients before and after periodontal treatment.

BACKGROUND AND OBJECTIVE: Nonsurgical periodontal treatment controls periodontal inflammation. Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) are implicated both in the destruction and in the healing of periodontal tissues. The aim of the present study was to compare the mRNA expression of MMP-1, -3, -8, -9 and -13 and TIMP-1 in chronic periodontitis before and after initial periodontal treatment. MATERIAL AND METHODS: Ninety gingival samples were harvested from 30 patients with chronic periodontitis (15 nonsmokers and 15 smokers) before and after nonsurgical treatment and from 30 periodontally healthy control subjects (15 nonsmokers and 15 smokers). Clinical parameters were assessed before and after treatment. Total RNA was isolated, and mRNA expression of MMPs and TIMP-1 was assessed by RT-PCR. RESULTS: Periodontal treatment significantly increased TIMP-1 expression and decreased the ratios of MMPs/TIMP-1. Post-treatment, nonsmokers with periodontitis had significantly higher MMP-8 and TIMP-1 expression than healthy nonsmokers, and smokers with periodontitis had significantly higher MMP-13 and TIMP-1 expressions than healthy smokers. Post-treatment, smokers had significantly higher TIMP-1 expression and lower MMP-8/TIMP-1 ratio than nonsmokers. Post-treatment, there was no correlation among MMPs, and the expression of MMPs and TIMP-1 was not correlated with clinical measurements. CONCLUSION: Periodontal treatment increased TIMP-1 expression and decreased the ratios of MMPs/TIMP-1 in chronic periodontitis. The post-treatment increase in TIMP-1 expression was higher for smokers. The TIMP-1 expression was higher post-treatment than in health. Post-treatment, MMP-8 expression was higher in nonsmokers with periodontitis than in healthy nonsmokers, whereas MMP-13 expression was higher in smokers with periodontitis than in healthy smokers.

The relationship between osteoporosis and periodontitis in women aged 45-70 years.

OBJECTIVE: To explore the possible relationship between the osteoporotic condition and the severity of periodontitis in women aged 45-70 years. MATERIALS AND METHODS: Ninety women with generalized chronic periodontitis, aged 45-70 years, were studied. Areal bone mineral density (BMDa) was assessed using standardized dual energy X-ray absorptiometry (normal: T-score ≥ -1, osteopenic: -2.5 ≤ T-score <-1, osteoporotic: T-score < -2.5). Gingival index (GI), bleeding on probing, clinical attachment loss (CAL), probing pocket depth and gingival recession (GR) were recorded. Periodontitis severity was represented by CAL. Menopausal condition and smoking were documented. RESULTS: Mean GI, bleeding on probing, CAL and GR were significantly greater for osteoporotic women than women with normal BMDa (P = 0.002, P = 0.01, P = 0.04, respectively). Osteopenic women and women with normal BMDa significantly differed in mean GI (P = 0.02). The associations found between osteoporotic women and women with normal BMDa and the associations found between osteopenic women and women with normal BMDa existed even after adjusting for smoking and menopausal status. CONCLUSION: Subjects with osteoporosis (OPR) presented with greater CAL than the subjects with normal BMDa, which suggests a greater severity of periodontitis. Subjects with OPR had greater GR than the subjects with normal BMDa. Subjects with osteopenia and subjects with normal BMDa did not differ in CAL, which might suggest that the early diagnosis of reduced BMDa, prior to the establishment of a significant negative impact on the periodontal tissues, might be important. Smoking and menopausal status did not alter these associations.

The effect of smoking on the mRNA expression of MMPs and TIMP-1 in untreated chronic periodontitis patients: a cross-sectional study.

BACKGROUND AND OBJECTIVE: Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) are important for extracellular matrix. Expression of MMPs has been evaluated in gingiva without studying smoking. The aim of this study was to explore the effect of smoking on mRNA expression of MMP-1, -3, -8, -9 and -13 and TIMP-1 in untreated chronic periodontitis and in periodontal health. MATERIAL AND METHODS: Gingival samples were harvested from 30 subjects with untreated chronic periodontitis (15 nonsmokers and 15 smokers) and 30 periodontally healthy subjects (15 nonsmokers and 15 smokers). Full-mouth plaque score, gingival index, bleeding on probing, probing depth and clinical attachment level were recorded. Total RNA was isolated, and the mRNA expression of MMPs and TIMP-1 was assessed by RT-PCR. RESULTS: Periodontitis groups were comparable in clinical measurements. Nonsmoker subjects with periodontitis had statistically significantly higher MMP-1, lower MMP-9 and TIMP-1 expression and higher MMP-1/TIMP-1 ratio than smokers; and higher MMP-8 expression and MMP-8/TIMP-1 and MMP-1/TIMP-1 ratios than healthy nonsmokers. Healthy nonsmokers had statistically significantly higher MMP-13 expression than healthy smokers. Smoker periodontitis and healthy subjects had similar expression levels of MMPs and TIMP-1 and MMPs/TIMP-1 ratios. There was correlation among the MMPs only for smoker periodontitis subjects. Expression of MMP-13 was correlated with mean clinical attachment level. CONCLUSION: Within its limits, this study demonstrated that smoking affected mRNA expression of MMPs and TIMP-1, MMPs/TIMP-1 ratios and relationships among MMPs in untreated chronic periodontitis and expression of MMPs in health. In the absence of smoking, chronic periodontitis affected expression of MMPs and MMPs/TIMP-1 ratios.

The adjunctive use of platelet-rich plasma in the therapy of periodontal intraosseous defects: a systematic review.

BACKGROUND AND OBJECTIVE: The evidence for the efficacy of the adjunctive use of platelet-rich plasma (PRP) in periodontal intraosseous defects has not been systematically evaluated. The objective of this review was to address the focused question, 'What is the efficacy, with respect to clinical, radiographical and patient-centred outcomes, of combinations of PRP with other therapeutic bioactive agents/procedures, compared with the efficacy of the same agents/procedures without the adjunctive use of PRP in the therapy of periodontal intraosseous defects in patients with chronic periodontitis and without systemic diseases that could potentially influence the outcome of periodontal therapy?' by performing a systematic review of randomized controlled clinical trials (RCTs) published in the dental literature in any language, up to and including September 2008. MATERIAL AND METHODS: Data sources principally included electronic databases, manually searched journals and contact with experts. In the first phase of study selection, the titles and abstracts, and in the second phase, full papers were screened independently and in duplicate by two reviewers. RESULTS: In the first phase, 6124 potentially relevant titles and abstracts were examined. In the second phase, the full text of 20 publications was thoroughly evaluated. Eventually, 10 RCTs were selected. CONCLUSION: Diverse outcomes (positive and negative) have been reported for the efficacy of PRP combined with various therapeutic bioactive agents/procedures, reflecting the limited and heterogeneous data available and possibly suggesting that the specific selection of agents/procedures combined with PRP could be important. Additional research on the efficacy of each specific combination of PRP is necessary.

Effect of homologous PRP on proliferation of human periodontally affected osteoblasts. In vitro preliminary study. Report of a case.

OBJECTIVE: The purpose of this in vitro study was to evaluate the effect of two concentrations of homologous platelet-rich plasma (PRP) on the proliferative response of osteoblasts derived from a patient with aggressive periodontitis. METHODS: 8.5 ml of venous blood were taken from 1 healthy and non-smoker volunteer. PRP was prepared following the protocol of Curasan. Osteoblasts were derived from alveolar bone chips obtained from a patient with aggressive periodontitis during conventional periodontal surgery and a clinically healthy person during crown lengthening surgical procedure. Cells were grown in 24-well dishes and on day 2 of quiescence were treated with 1% and 5% (v/v) of PRP. The effect on cell proliferation was estimated by measuring [3H] thymidine incorporation. After 48h of incubation, cells were processed to subject to scintillation counting. Counts per minute were determined for each sample. RESULTS: The addition of 1% and 5% of PRP provoked a statistical significant (p<0.05) increase in cell growth. CONCLUSIONS: Data revealed significant enhancement of proliferative response of osteoblasts in the presence of PRP, which might serve as a source of growth factors promoting periodontal repair by modulating cell response and activities.

Smoking cessation and response to periodontal treatment.

Smoking has detrimental oral effects. The aim of this study was to review the literature related to the impact of smoking cessation on periodontal health, periodontal disease and periodontal treatment outcome as well as to review the smoking cessation strategies and the dentist's role in the smoking cessation effort. Smoking cessation seems to have a positive effect on the periodontium, to decrease the risk for incidence and progression of periodontitis and to lead to a non-significant trend for greater mean probing depth reductions after non-surgical treatment over a 12-month period. Smoking cessation effect on the periodontium should be further investigated. Dentists should inform their patients on the harmful effect of smoking and the beneficial effect of smoking cessation on oral health. They should advise, motivate and support their patients to quit smoking. Smoking-control strategies should be incorporated in dental practise. The dentist's role in the smoking cessation effort is important. Guidelines on smoking-control strategies applied in the dental office are required.

Doxycycline-tricalcium phosphate composite graft facilitates osseous healing in advanced periodontal furcation defects.

The purpose of this study was to compare the effectiveness of a tricalcium phosphate, plaster of paris, and doxycycline composite graft to surgical debridement alone in the treatment of Class II and Class III furcation defects. Fifteen patients with adult periodontitis and at least two mandibular molars with Class II or III furcation defects were selected. A total of 40 sites were treated: 26 were Class II defects and 14 were Class III. Following initial therapy one site was randomly selected to receive the composite graft while the remaining site served as the surgically debrided control. Osseous healing was evaluated by direct measurements from an acrylic stent at the time of graft surgery and at the 6-month reentry. Following surgery each patient was placed on doxycycline 100mg/day for 10 days. The absence of clinical inflammation and infection during the healing process provided additional substantiation of the biocompatibility of the grafting materials. Results after 6 months indicated that sites treated with the composite graft had improved defect fill, defect resolution, probing depths, and clinical attachment levels when compared to the surgically debrided controls. Defect fill was 3.7 times greater in grafted sites and these sites were 4.0 times more likely to have 50% or greater defect fill. The effect of grafting was more pronounced in Class III defects where horizontal defect fill and gain of clinical attachment was achieved only in grafted sites. The plaster of paris functioned well as a binder, preventing particle scatter and facilitating graft retention. Additionally the plaster served as a vehicle to carry and retain the doxycycline at the treated site. These short-term results point to the potential of a composite graft containing tricalcium phosphate, plaster of paris, and doxycycline in promoting healing of furcation lesions.

Dental and periodontal complications of lip and tongue piercing: prevalence and influencing factors.

BACKGROUND: The aim of this study was to compare the prevalence of lip and tongue piercing complications and explore the effect of ornament time wear period, habits, ornament morphology and periodontal biotype on the development of complications. METHODS: One hundred and ten subjects with 110 lip and 51 tongue piercings were assessed for abnormal toothwear and/or tooth chipping/cracking (dental defects), gingival recession, clinical attachment loss and probing depth of teeth adjacent to the pierced site. Piercing habits (biting, rolling, stroking, sucking) were recorded. RESULTS: Wear time and habits significantly affected the prevalence of dental defects and gingival recession. Pierced site significantly affected dental defects prevalence, with greater prevalence for tongue than lip piercing. Wear time significantly affected attachment loss and probing depth. Attachment loss and probing depth did not significantly differ between tongue and lip piercings. Gingival recession was significantly associated with ornament height closure and stem length of tongue ornaments. Periodontal biotype was not significantly associated with gingival recession, attachment loss and probing depth. CONCLUSIONS: Dental defects prevalence is greater for tongue than lip piercing. Gingival recession is similar for tongue and lip piercing. Longer wear time of tongue and lip piercing is associated with greater prevalence of dental defects and gingival recession, as well as greater attachment loss and probing depth of teeth adjacent to pierced sites. Ornament morphology affects gingival recession prevalence.

Gingival fibromatosis and significant tooth eruption delay in an 11-year-old male: a 30-month follow-up.

This case report describes the dental management of an unusual case of idiopathic gingival fibromatosis with multiple impacted primary teeth, and the absence of eruption of permanent teeth, in an 11-year-old boy and at the 30-month follow-up. The patient presented with severely enlarged gingival tissues affecting both arches and multiple retained and non-erupted primary teeth. He had already been subjected to localized gingivectomies at the ages of 7 and 9 years. He had no known syndrome and there was no family history of any similar disorder. The patient was treated under general anaesthesia to remove the excessive gingival tissues using apically positioned flaps. During the surgical procedure, over-retained and unerupted impacted primary teeth were extracted in order to facilitate the eruption of the permanent successors. Two years postoperatively, there was no recurrence of the gingival enlargement. Overdentures were then constructed because none of the permanent teeth had yet erupted. Furthermore, pre-eruptive coronal resorption was detected radiographically affecting the crown of the unerupted 36. Thirty months postoperatively, no recurrence of gingival enlargement was seen, but the permanent teeth had still not erupted.

Selection of the most accurate method of conventional radiography for the assessment of periodontal osseous destruction.

The purpose of the present study was to compare the radiographic measurements of periodontal osseous destruction with the surgical measurements, which represent the true value of osseous destruction, and to select the most successful method of conventional radiography in detecting and accurately assessing periodontal osseous destruction. A total of 5072 proximal surfaces in 2536 teeth of 100 patients with periodontitis were evaluated surgically during periodontal flap surgery and radiographically by using periapical and panoramic radiography. Comparative evaluation of the measurements obtained by these 3 different methods of osseous destruction assessment revealed the following. (1) The radiographic detection ability of small osseous destruction (1-4 mm) was very low for both methods of assessment and became even lower for the initial osseous destruction (1 or 2 mm). (2) Periapical radiography was more successful than panoramic in the detection of osseous destruction, especially of the small destruction (4.7x). (3) Panoramic radiography underestimated the osseous destruction, whereas periapical radiography was relatively accurate in the osseous destruction assessment. (4) Periapical radiography was more accurate in the osseous destruction assessment than panoramic, regardless of the location of the dental surfaces (jaw, tooth group, mesial or distal) and the degree of osseous destruction. (5) The deviation of the radiographic measurements of osseous destruction from the surgical measurements, as well as the difference between the two radiographic methods, depended on the jaw location, the tooth group and the degree of osseous destruction. (6) The radiographic assessment of osseous destruction underestimated the osseous destruction in initial periodontitis, it was relatively accurate in moderate periodontitis, but overestimated it in severe periodontitis. The radiographic measurements of osseous destruction deviated least from the surgical measurements in the group of moderate periodontitis and most in that of severe osseous destruction. (7) The 2 radiographic methods agreed most in the assessment of osseous destruction in the severe periodontitis group and least in the initial periodontitis group. (8) The indirect Schei method was less successful in detecting the small osseous destruction and less accurate in assessing the osseous destruction than the direct millimetric method of radiographic evaluation. (9) The osseous destruction as assessed from periapical radiographs by the Schei method was not significantly different from that assessed by the radiopaque Fixot-Everett grid. The results of the present study suggest that periapical radiography is more successful in detecting periodontal osseous destruction and more accurate in assessing it than panoramic radiography.

Radiographic detection and assessment of the periodontal endosseous defects.

AIMS: The aim of the present study was to investigate the potential of conventional radiography in detecting and accurately imaging periodontal endosseous (or osseous) defects when compared to surgical measurements. A further objective of the study was the selection of the most successful radiographic method for the assessment of endosseous defects. METHOD: Surgical measurements, during periodontal flap surgery, and radiographic measurements, from periapical and panoramic radiographs, were obtained from 5,072 proximal surfaces of 100 patients presenting with periodontitis. RESULTS: Statistical evaluation of the surgical and radiographic measurements revealed the following. (1) The ability of the radiographs to detect periodontal osseous defects was relatively low. (2) For periapical radiography, it depended, in descending order, on the depth and buccolingual width of the defect, the number of osseous walls and the jaw location. For panoramic radiography, it depended only on buccolingual width. (3) Osseous defects of small depth and/or small buccolingual width were the most difficult to detect radiographically. (4) Periapical radiography was more successful than panoramic in detecting osseous defects, and more accurate in assessing the defect dimensions (depth, mesiodistal width). (5) The difference in the defect detection ability between the 2 radiographic methods, the accuracy of the radiographic defect dimensions assessment as well as the degree of agreement between periapical and panoramic assessment depended on defect location and dimensions. CONCLUSIONS: Periapical radiography is superior to panoramic in detecting and accurately imaging periodontal osseous destruction.