Underdiagnosis in Background of Emerging Public Health Challenges Related to Peri-Implant Diseases: An Interventional Split-Mouth Study.

Peri-implant diseases are an emerging public health problem, and it's considered that limitations of standard diagnostics play the role herein. The study objective was the estimation of pathological bone resorption at clinical and biological level in patients with peri-implant mucositis (PIM) and peri-implantitis (PI) before and 6 months after standard treatment and to compare them with healthy controls (HC). The split-mouth interventional study included 60 patients affected with PIM or PI. Patients that also presented at least one more HC were enrolled in the study and underwent standard non-surgical and surgical treatment, respectively. Standard clinical parameters and soluble levels of RANKL were measured in peri-implant crevicular fluid baseline and 6 months following treatment. Clinical parameters and RANKL significantly decreased following treatment in PIM and PI. However, bleeding on probing and probing depth remained significantly increased when compared to HC. RANKL answered requests for biomarker of peri-implant diseases, its baseline levels were significantly increased in PIM and PI, they decreased following treatment and reached HC in peri-implantitis, while in PIM RANKL remained significantly increased. Presence of pathological bone resorption in patients lacked its clinical signs, and respective persistence following treatment suggest the need for biomarker-supported diagnosis for timely diagnosis of peri-implantitis and appropriate orientation of respective management strategies.

A Roadmap towards Precision Periodontics.

Periodontitis is among the most common health conditions and represents a major public health issue related to increasing prevalence and seriously negative socioeconomic impacts. Periodontitis-associated low-grade systemic inflammation and its pathological interplay with systemic conditions additionally raises awareness on the necessity for highly performant strategies for the prevention and management of periodontitis. Periodontal diagnosis is the backbone of a successful periodontal strategy, since prevention and treatment plans depend on the accuracy and precision of the respective diagnostics. Periodontal diagnostics is still founded on clinical and radiological parameters that provide limited therapeutic guidance due to the multifactorial complexity of periodontal pathology, which is why biomarkers have been introduced for the first time in the new classification of periodontal and peri-implant conditions as a first step towards precision periodontics. Since the driving forces of precision medicine are represented by biomarkers and machine learning algorithms, with the lack of periodontal markers validated for diagnostic use, the implementation of a precision medicine approach in periodontology remains in the very initial stage. This narrative review elaborates the unmet diagnostic needs in periodontal diagnostics, the concept of precision periodontics, periodontal biomarkers, and a roadmap toward the implementation of a precision medicine approach in periodontal practice.

Assessment of risk factors and preventive measures and their relations to work-related musculoskeletal pain among dentists.

BACKGROUND: Dentists have a high prevalence of musculoskeletal (MS) pain, which is the most common symptom associated with work-related musculoskeletal disorders (WMSDs). To overcome this problem, identification of the risk factors and preventive measures for MS pain are of paramount importance to dentists in order to improve their quality of life and work. OBJECTIVES: The aims of this study were to recognize the risk factors for MS pain and their impact on dental work, as well as to identify preventive measures of MS pain among dentists. METHODS: Self-reporting questionnaire consisting of 78 questions was exclusively developed for the study and sent to 500 working active dentists in Serbia. RESULTS: Response rate was 71.2% (356 dentists). The prevalence of MS pain was 82.6% among dentists. The main risk factors for MS pain were advanced age, female dentists, presence of chronic diseases, long working hours, and high frequency of treated patients. The most effective preventive measures in preventing MS pain were massage treatments and physical activities. Followed by use of ergonomically designed equipment, correct and dynamic working positions, and an adequate workflow organization. CONCLUSION: The risk factors for MS pain and their impact on dental work should widely be disseminated among dentists. Importantly, proper implementation in everyday life of adequate preventive measures is essential for preventing MS pain and development of WMSDs.

Herpesviral-bacterial co-infection in mandibular third molar pericoronitis.

OBJECTIVE: The aim of this study was to assess the presence of herpesviruses and periodontopathic bacteria and to establish their potential association with pericoronitis. MATERIALS AND METHODS: Fifty samples obtained with paper points (30 from pericoronitis and 20 controls) were subjected to polymerase chain reaction (PCR) analysis. A single-stage and nested PCR assays were used to detect herpesviruses: human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) and six periodontopathic anaerobic bacteria: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Parvimonas micra, Treponema denticola, and Tannarella forsythia. RESULTS: Pericoronitis samples harbored HCMV and EBV at significantly higher rates than the control group (70 vs. 40 % and 46.7 vs. 15 %, P = 0.035, P = 0.021, respectively). P. micra and T. forsythia (66.7 vs. 0 %, and 40 vs. 10 %, P = 0.001, P = 0.021, respectively) were significantly more common in pericoronitis compared to the control group. Multivariate logistic regression analysis showed that the presence of T. forsythia was associated with pericoronitis development (OR 7.3, 95 % CI, 1.2-43.2, P = 0.028). CONCLUSION: The occurrence of HCVM and EBV extends our previous knowledge on microbiota in pericoronitis. These PCR-based findings demonstrated that bacterial and viral DNA occurred concomitantly in pericoronitis samples. T. forsythia appeared to be significantly associated with pericoronitis development in the examined sample. CLINICAL RELEVANCE: Herpesviral-bacterial co-infections might exacerbate the progression of pericoronitis.

The Association Between Periodontal Inflammation and Labor Triggers (Elevated Cytokine Levels) in Preterm Birth: A Cross-Sectional Study.

BACKGROUND: Periodontitis is considered to be a risk factor for preterm birth. Mechanisms have been proposed for this pathologic relation, but the exact pathologic pattern remains unclear. Therefore, the objective of the present study is to evaluate levels of four major labor triggers, prostaglandin E2 (PGE2), interleukin (IL)-1ß, IL-6, and tumor necrosis factor (TNF)-α, in gingival crevicular fluid (GCF) and serum samples between women with preterm birth (PTB) and full-term birth (FTB) and correlate them with periodontal parameters. METHODS: PGE2, IL-1ß, IL-6, and TNF-α levels were estimated using enzyme-linked immunosorbent assays in GCF and serum samples collected 24 to 48 hours after labor from 120 women (60 FTB, 60 PTB). RESULTS: Women with PTB exhibited significantly more periodontitis, worse periodontal parameters, and increased GCF levels of IL-6 and PGE2 compared with the FTB group; there were no significant differences in serum levels of measured markers. GCF levels of IL-1ß, IL-6, and PGE2 and serum levels of TNF-α and PGE2 were significantly higher in women with periodontitis compared with periodontally healthy women. Serum levels of PGE2 were positively correlated with probing depth (PD) and clinical attachment level (CAL) as well as with GCF levels of TNF-α in women with PTB. CONCLUSIONS: Women with PTB demonstrated worse periodontal parameters and significantly increased GCF levels of IL-6 and PGE2 compared with those with FTB. Based on significant correlations among serum PGE2 and PD, CAL, and GCF TNF-α in PTB, periodontitis may cause an overall increase of labor triggers and hence contribute to preterm labor onset.

MMP-9 -1562 C>T (rs3918242) promoter polymorphism as a susceptibility factor for multiple gingival recessions.

The objective of this pilot study was to investigate the potential role of -1562 C>T single nucleotide polymorphism (SNP) in the promoter region of the matrix metalloproteinase-9 (MMP-9) gene as a risk modulator in the development of multiple gingival recessions (MGRs) in young adults in the Serbian population. The study sample comprised 161 systemically healthy people: 60 with MGRs and 101 controls with healthy periodontal tissues. Genotyping was done using polymerase chain reaction/restriction fragment length polymorphism approach on DNA obtained from buccal swabs. Clinical measurements included vertical recession depth (VRD), clinical attachment level (CAL), keratinized gingival width (KGW), visible plaque index (PI), and bleeding on probing (BOP). Heterozygotes (CT) were significantly more frequent in the MGRs group than in the control group (P = .005) and carriers of the T allele had an approximately threefold increase of MGRs risk. Patients with the CT genotype exhibited significantly higher values of VRD and CAL and significantly lower values of KGW than patients with the wildtype genotype. Associations among different genotypes and periodontal biotypes in the MGRs group remained insignificant because all participants exhibited thin biotype. The -1562 C>T SNP in the promoter region of MMP-9 appears to be a risk factor for MGR development and a potential predictor of more severe clinical phenotype.

[Utilization of two different surgical techniques in gingival recession treatment: a comparative study].

INTRODUCTION: Gingival recession is a displacement of gingival margin apically to cement-enamel junction. OBJECTIVE: The aim of this study was to compare the results achieved with two different surgical procedures used in gingival recession treatment. METHODS: Ten patients with bilateral buccal recession on maxillary canines or premolars were included in the study. Professional teeth cleaning was performed before surgery. Recession on the experimental side was treated with connective tissue graft in combination with coronally advanced, split thickness flap (tunnel technique). Control side recession was treated with connective tissue graft in combination with trapezoidal coronally advanced, full thickness flap. Coin toss was used for side decision. The following parameters were evaluated before surgery and 6 months post-op: Vertical Recession Dimension, Clinical Attachment Level, Apico-coronal width of the keratinized tissue, Healing index (Laundry), RES index, and Patient evaluation of esthetic results. Student's t-test was used for statistical analysis. RESULTS: Six months after surgery, mean root coverage was 91.5 +/- 14.1% and 90.1 +/- 14.6% on the experimental and on the control side, respectively. RES index, Healing index (Laundry) and Patient Subjective evaluation of esthetic results showed significantly better results (p < 0.05). CONCLUSION: Both surgical procedures produce highly successful clinical results based on evaluated parameters, but this tunnel technique provides significantly better esthetic results.

Antioxidative status of saliva before and after non-surgical periodontal treatment.

INTRODUCTION: Oxidative stress and antioxidants play an important role in the pathogenesis of inflammatory disease, including chronic periodontitis (CP). Saliva contains enzymatic (glutathione peroxidase - GPx, superoxide dismutase - SOD, etc.) and non-enzymatic (albumin - ALB, uric acid - UA, glutathione, etc.) antioxidants. OBJECTIVE: The aims of this study were to investigate: a) level of SOD, GPx, UA, ALB and total antioxidative status (TAS) of saliva in CP patients before and after non-surgical treatment, and b) correlations between clinical periodontal parameters and levels of salivary antioxidants. METHODS: Saliva was collected from 21 CP patients before and after non-surgical treatment. The condition of periodontium was assessed by plaque index, gingival index, bleeding on probing, probing depth and clinical attachment loss. Level of investigated antioxidants (except GPx) and TAS was determined using colorimetric method and commercial kits. GPx activity was determined using UV method and commercial kits. RESULTS: After the treatment significant increase of UA, ALB, Gpx, TAS was detected (p<0.01) and decrease of SOD activity (p>0.05). A significant correlation was observed between GPx and PI (r=0.575, p=0.008), SOD and GI (r=0.525, p=0.017) before therapy, and SOD and bleeding on probing (BP) (r=0.59, p=0.006), TAS and BP (r=0.453, p=0.045) after therapy. CONCLUSION: These data suggest that levels of salivary antioxidants generally increase after non-surgical periodontal treatment. Correlation between some clinical periodontal parameters and level of salivary antioxidants was found.