Protease-activated receptor type 2 activation downregulates osteogenesis in periodontal ligament stem cells.

Protease-activated receptor-2 (PAR2) is associated with the pathogenesis of many chronic diseases with inflammatory characteristics, including periodontitis. This study aimed to evaluate how the activation of PAR2 can affect the osteogenic activity of human periodontal ligament stem cells (PDLSCs) in vitro. PDLSCs collected from three subjects were treated in osteogenic medium for 2, 7, 14, and 21 days with trypsin (0.1 U/mL), PAR2 specific agonist peptide (SLIGRL-NH2) (100 nM), and PAR2 antagonist peptide (FSLLRY-NH2) (100 nM). Gene (RT-qPCR) expression and protein expression (ELISA) of osteogenic factors, bone metabolism, and inflammatory cytokines, cell proliferation, alkaline phosphatase (ALP) activity, alizarin red S staining, and supernatant concentration were assessed. Statistical analysis of the results with a significance level of 5% was performed. Activation of PAR2 led to decreases in cell proliferation and calcium deposition (p < 0.05), calcium concentration (p < 0.05), and ALP activity (p < 0.05). Additionally, PAR2 activation increased gene and protein expression of receptor activator of nuclear factor kappa-Β ligand (RANKL) (p < 0.05) and significantly decreased the gene and protein expression of osteoprotegerin (p <0. 05). Considering the findings, the present study demonstrated PAR2 activation was able to decrease cell proliferation, decreased osteogenic activity of PDLSCs, and upregulated conditions for bone resorption. PAR2 may be considered a promising target in periodontal regenerative procedures.

Protease-activated receptor type 2 activation downregulates osteogenesis in periodontal ligament stem cells

Abstract Protease-activated receptor-2 (PAR2) is associated with the pathogenesis of many chronic diseases with inflammatory characteristics, including periodontitis. This study aimed to evaluate how the activation of PAR2 can affect the osteogenic activity of human periodontal ligament stem cells (PDLSCs) in vitro. PDLSCs collected from three subjects were treated in osteogenic medium for 2, 7, 14, and 21 days with trypsin (0.1 U/mL), PAR2 specific agonist peptide (SLIGRL-NH2) (100 nM), and PAR2 antagonist peptide (FSLLRY-NH2) (100 nM). Gene (RT-qPCR) expression and protein expression (ELISA) of osteogenic factors, bone metabolism, and inflammatory cytokines, cell proliferation, alkaline phosphatase (ALP) activity, alizarin red S staining, and supernatant concentration were assessed. Statistical analysis of the results with a significance level of 5% was performed. Activation of PAR2 led to decreases in cell proliferation and calcium deposition (p < 0.05), calcium concentration (p < 0.05), and ALP activity (p < 0.05). Additionally, PAR2 activation increased gene and protein expression of receptor activator of nuclear factor kappa-Β ligand (RANKL) (p < 0.05) and significantly decreased the gene and protein expression of osteoprotegerin (p <0. 05). Considering the findings, the present study demonstrated PAR2 activation was able to decrease cell proliferation, decreased osteogenic activity of PDLSCs, and upregulated conditions for bone resorption. PAR2 may be considered a promising target in periodontal regenerative procedures.

Root Coverage Procedures in Noncarious Cervical Lesions With and Without Restoration: A Systematic Review and Meta-Analysis.

The aim of this systematic review was to assess in patients with gingival recessions and noncarious cervical lesions (NCCLs) whether restoration of NCCLs may influence the percentage of root coverage following surgical root coverage procedures compared to surgical root coverage procedures without subsequent restoration. Four studies (randomized controlled trials) assessing the effects of NCCL restoration in combination with surgical root coverage procedures were included. Meta-analyses showed no significant differences in overall root coverage, CAL gain, and KTW change between test and control groups. In teeth with NCCLs and gingival recessions, restoration of NCCLs does not affect the clinical outcomes of surgical root coverage.

Protease-Activated Receptor Type 1 Activation Enhances Osteogenic Activity in Human Periodontal Ligament Stem Cells.

Protease-activated receptor 1 (PAR1) has been associated to tissue repair and bone healing. The aim of the present study was to evaluate the effect of PAR1 activation on the osteogenic activity of human periodontal ligament stem cells (PDLSCs). PDLSCs were cultured in the presence of PAR1-selective agonist peptide (100 nM), thrombin (0.1 U/mL), or PAR1 antagonist peptide (100 nM). Calcium deposits, calcium concentration (supernatant), alkaline phosphatase activity (ALP), cell proliferation, and gene (qPCR) and protein expression (ELISA assay) of osteogenic factors were assessed at 2, 7, and 14 days. PAR1 activation led to increased calcium deposits (p < 0.05), calcium concentration (p < 0.05), ALP activity (p < 0.05), and cell proliferation (p < 0.05). Further, PAR1 activation may increase gene and protein expression of Runx2 (p < 0.05) and OPG (p < 0.05). In conclusion, PAR1 activation increases osteogenic activity of PDLSCs, providing a possible new strategy for periodontal regenerative therapies.

PAR-2 expression in the gingival crevicular fluid reflects chronic periodontitis severity.

Recent studies investigating protease-activated receptor type 2 (PAR-2) suggest an association between the receptor and periodontal inflammation. It is known that gingipain, a bacterial protease secreted by the important periodontopathogen Porphyromonas gingivalis can activate PAR-2. Previous studies by our group found that PAR-2 is overexpressed in the gingival crevicular fluid (GCF) of patients with moderate chronic periodontitis (MP). The present study aimed at evaluating whether PAR-2 expression is associated with chronic periodontitis severity. GCF samples and clinical parameters, including plaque and bleeding on probing indices, probing pocket depth and clinical attachment level, were collected from the control group (n = 19) at baseline, and from MP patients (n = 19) and severe chronic periodontitis (SP) (n = 19) patients before and 6 weeks after periodontal non-surgical treatment. PAR-2 and gingipain messenger RNA (mRNA) in the GCF of 4 periodontal sites per patient were evaluated by Reverse Transcription Polymerase Chain Reaction (RT-qPCR). PAR-2 and gingipain expressions were greater in periodontitis patients than in control group patients. In addition, the SP group presented increased PAR-2 and gingipain mRNA levels, compared with the MP group. Furthermore, periodontal treatment significantly reduced (p <0.05) PAR-2 expression in patients with periodontitis. In conclusion, PAR-2 is associated with chronic periodontitis severity and with gingipain levels in the periodontal pocket, thus suggesting that PAR-2 expression in the GCF reflects the severity of destruction during periodontal infection.

Effects of periodontal treatment on primary sjȫgren's syndrome symptoms.

The aim of this longitudinal prospective study was to evaluate the effects of periodontal treatment on the clinical, microbiological and immunological periodontal parameters, and on the systemic activity (ESSDAI) and subjective (ESSPRI) indexes in patients with primary Sjögren's Syndrome (pSS). Twenty-eight female patients were divided into four groups: pSS patients with or without chronic periodontitis (SCP, SC, respectively), and systemically healthy patients with or without chronic periodontitis (CP, C, respectively). Periodontal clinical examination and immunological and microbiological sample collection were performed at baseline, 30 and 90 days after nonsurgical periodontal treatment (NSPT). Levels of interleukin IL-1ß, IL-8 and IL-10 in saliva and gingival crevicular fluid (GCF) were evaluated by ELISA, as well as the expression of Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans, (Aa) Tannerella forsythia (Tf), and Treponema denticola (Td), by qPCR. Systemic activity and pSS symptoms were evaluated by ESSDAI and ESSPRI. NSPT resulted in improved periodontal clinical parameters in both SCP and CP groups (p>0.05). Pg, Aa, and Tf levels decreased after NSPT only in CP patients (p<0.05). Significantly greater levels of IL-10 in GCF were verified in both SCP and CP groups (p<0.05). SCP patients showed increased salivary flow rates and decreased ESSPRI scores after NSPT. In conclusion, NSPT in pSS patients resulted in improved clinical and immunological parameters, with no significant effects on microbiological status. pSS patients also showed increased salivary flow and lower ESSPRI scores after therapy. Therefore, it can be suggested that NSPT may improve the quality of life of pSS patients.

PAR-2 expression in the gingival crevicular fluid reflects chronic periodontitis severity

Abstract Recent studies investigating protease-activated receptor type 2 (PAR-2) suggest an association between the receptor and periodontal inflammation. It is known that gingipain, a bacterial protease secreted by the important periodontopathogen Porphyromonas gingivalis can activate PAR-2. Previous studies by our group found that PAR-2 is overexpressed in the gingival crevicular fluid (GCF) of patients with moderate chronic periodontitis (MP). The present study aimed at evaluating whether PAR-2 expression is associated with chronic periodontitis severity. GCF samples and clinical parameters, including plaque and bleeding on probing indices, probing pocket depth and clinical attachment level, were collected from the control group (n = 19) at baseline, and from MP patients (n = 19) and severe chronic periodontitis (SP) (n = 19) patients before and 6 weeks after periodontal non-surgical treatment. PAR-2 and gingipain messenger RNA (mRNA) in the GCF of 4 periodontal sites per patient were evaluated by Reverse Transcription Polymerase Chain Reaction (RT-qPCR). PAR-2 and gingipain expressions were greater in periodontitis patients than in control group patients. In addition, the SP group presented increased PAR-2 and gingipain mRNA levels, compared with the MP group. Furthermore, periodontal treatment significantly reduced (p <0.05) PAR-2 expression in patients with periodontitis. In conclusion, PAR-2 is associated with chronic periodontitis severity and with gingipain levels in the periodontal pocket, thus suggesting that PAR-2 expression in the GCF reflects the severity of destruction during periodontal infection.

Effects of periodontal treatment on primary sjogren's syndrome symptoms

Abstract The aim of this longitudinal prospective study was to evaluate the effects of periodontal treatment on the clinical, microbiological and immunological periodontal parameters, and on the systemic activity (ESSDAI) and subjective (ESSPRI) indexes in patients with primary Sjögren’s Syndrome (pSS). Twenty-eight female patients were divided into four groups: pSS patients with or without chronic periodontitis (SCP, SC, respectively), and systemically healthy patients with or without chronic periodontitis (CP, C, respectively). Periodontal clinical examination and immunological and microbiological sample collection were performed at baseline, 30 and 90 days after nonsurgical periodontal treatment (NSPT). Levels of interleukin IL-1β, IL-8 and IL-10 in saliva and gingival crevicular fluid (GCF) were evaluated by ELISA, as well as the expression of Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans, (Aa) Tannerella forsythia (Tf), and Treponema denticola (Td), by qPCR. Systemic activity and pSS symptoms were evaluated by ESSDAI and ESSPRI. NSPT resulted in improved periodontal clinical parameters in both SCP and CP groups (p>0.05). Pg, Aa, and Tf levels decreased after NSPT only in CP patients (p<0.05). Significantly greater levels of IL-10 in GCF were verified in both SCP and CP groups (p<0.05). SCP patients showed increased salivary flow rates and decreased ESSPRI scores after NSPT. In conclusion, NSPT in pSS patients resulted in improved clinical and immunological parameters, with no significant effects on microbiological status. pSS patients also showed increased salivary flow and lower ESSPRI scores after therapy. Therefore, it can be suggested that NSPT may improve the quality of life of pSS patients.

Aspectos relevantes da síndrome de Sjõgren para o cirurgião-dentista / Sjogren’s syndrome’s relevant aspects for the dental surgeon

A síndrome de Sjõgren (SS), conhecida como síndrome sicca, é uma doença autoimune caracterizada pela hipofunção das glândulas salivares e lacrimais, cuja prevalência na população mundial é de aproximadamente 0,5% a 1%. Por ser uma doença autoimune complexa e de difícil diagnóstico, é sub-diagnosticada e sub-tratada segundo o consenso realizado em 2012 pelo Colégio Americano de Reumatologia (ACR). O Cirurgião-Dentista pode desempenhar papel importante na detecção de possíveis alterações compatíveis com a síndrome, além de auxiliar no tratamento de diversas patologias orais decorrentes da síndrome. Este trabalho tem como objetivo explanar aspectos importantes referentes ao diagnóstico e tratamento da síndrome aqui discutida. A SS apesar de ser considerada uma doença de evolução lenta, em estágios avançados pode ser fatal, principalmente por aumentar as chances dos pacientes virem a desenvolver linfoma não Hodking. O tratamento odontológico dos pacientes com SS deve principalmente ser profilático, com a recomendação do uso de repositores de saliva e controle rígido da higiene bucal.

Sjogren’s syndrome (SS), known as the sicca syndrome, is an autoimmune disease characterized by salivary and lacrimal glands hypofunction which prevalence in the world population is approximatel y around 0,5% to 1%. For being a complex autoimmune disease and with difficult diagnosis, it is sub diagnosed and miss treated according to the consensus occurred in 2012 by the American College of Rheumatology (ACR). The surgeon-dentist (SD) may play a important role on the detection of possible changes compatible to the syndrome, besides can help in the treatment of many oral pathologies caused by the syndrome. This work has the main purpose to explain the important aspects regards to the correct diagnosis and treatment of this syndrome.The SS besides been considered a slow evolution disease, in advanced stages it can be fatal,mainly for increasing the patient’s chances of developing non-Hodking lymphoma. The dental treatment of patients with SS must be prophylactic, with the recomedations of the use of salivary replenishing and careful control of the oral hyigiene.

Avaliação dos efeitos do tratamento periodontal não cirúrgico sobre os sinais e sintomas da síndrome de Sjõgren primária / Evaluation of periodontal non-surgical treatment effects on the signs and symptoms on primary Sjõgren's syndrome

A síndrome de Sjõgren primária (SSp) é uma doença crônica autoimune sistêmica que pode levar à hipossalivação e afetar negativamente o ambiente oral. Os objetivos deste estudo foram detectar a influência da SSp nos níveis de biomarcadores inflamatórios na saliva e no fluido gengival nas amostras de pacientes com periodontite crônica, avaliar o efeito do tratamento periodontal não cirúrgico sobre os valores do índice clínico de avaliação da atividade sistêmica de pacientes com SSp e do índice reportado pelo paciente com SSp. Amostras de fluido gengival, saliva e os parâmetros clínicos periodontais que consistiram de medida da profundidade de sondagem (PS), nível clínico de inserção (NCI), sangramento à sondagem (SS) e índice de placa (IP) foram coletadas no início do estudo e 45 dias após a terapia periodontal não-cirúrgica de pacientes sistemicamente saudáveis com periodontite crônica (PC, n = 7) e pacientes com SSp e periodontite crônica (SP, n = 7). Pacientes periodontalmente saudáveis com SSp (SC, n = 7) e sistemicamente saudáveis (C, n = 7) também foram avaliados no início do estudo. Os grupos C, PC e SC foram pareados em gênero, idade e critério socioeconômico com o grupo SP. Os níveis de interleucina-8 (IL-8), IL-10 e IL-1ß foram avaliados por ensaio multiplex. Os níveis de atividade da doença foram medidos usando o Gold Standard da literatura chamado Índice Eular de atividade da síndrome de Sjõgren (ESSDAI). Já para avaliação dos sintomas reportados pelo paciente com SSp foi utilizado o Índice Eular reportado pelo paciente com Sjõgren (ESSPRI).

Os parâmetros clínicos melhoraram após a terapia periodontal (p <0,05). No entanto, o NCI em pacientes com SSp não melhorou significativamente após a terapia (p> 0,05). Houve um aumento nos níveis de IL-1ß, IL-8 e diminuição dos níveis de IL-10 nas amostras de saliva de pacientes do grupo SC em comparação ao grupo C (p <0,05). Já em relação ao fluido gengival, pacientes do grupo SC tiveram maiores níveis de IL-1ß em comparação com o grupo C (p<0,05). Além disso, o tratamento periodontal não cirúrgico resultou num aumento dos níveis de IL-10 no fluido gengival no grupo SP e grupo PC em relação ao valor basal (p <0,05). O fluxo salivar foi significativamente aumentado após o tratamento periodontal apenas em pacientes do grupo SP (p = 0,039). Além disso, o tratamento periodontal não influenciou o índice ESSDAI (p = 0,35) e levou a uma diminuição significativa no índice ESSPRI (p = 0,03). Os presentes dados demonstraram que a SSp influencia os níveis salivares e de fluido gengival de biomarcadores inflamatórios em favor de um perfil próinflamatório, no entanto, este perfil parece não aumentar susceptibilidade dos indivíduos SSp à destruição periodontal. Além disso, os presentes dados demonstraram que o tratamento periodontal não-cirúrgico tem um impacto positivo sobre o fluxo salivar e sobre o índice ESSPRI de pacientes com SSp. Sugere-se assim que o tratamento periodontal pode melhorar a qualidade de vida de indivíduos com SSp.

Primary Sjõgren's syndrome (pSS) is a chronic systemic autoimmune disease that might lead to hyposalivation and negatively affect the oral environment. The aims of this study were to detect the influence of pSS on the levels of inflammatory biomarkers in salivary and gingival crevicular fluid (GCF) samples of patients with chronic periodontitis and to evaluate the effect of non-surgical periodontal treatment on the disease activity index of patients with pSS, and on the reported index of patients with pSS. GCF and salivary samples and clinical parameters consisting of measuring probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP) and plaque index (PI) were collected at baseline and 45 days after non-surgical periodontal therapy from systemically healthy patients with chronic periodontitis (PC, n=7) and patients with pSS with chronic periodontitis (SP, n=7). Periodontally healthy patients with pSS (SC, n=7) and systemically healthy (C, n=7) were also evaluated at baseline. The groups C, PC and SC were pared on gender, years and socioeconomic status with the SP group. The levels of interleukin-8 (IL-8), IL-10, and IL-1ß were measured by using multiplex immunoassays. Disease activity levels were measured by using the Gold Standard called Eular Sjõgren's syndrome disease activity index (ESSDAI). Also to evaluate the symptoms reported by the pacients with pSS we used the Eular Sjõgren's syndrome patient reported index (ESSPRI).

The clinical parameters improved significantly after periodontal therapy (p<0.05). However, CAL in pSS patients was not statistically improved after therapy (p>0.05). There was an increased expression of IL-1ß, IL-8 and decreased levels of IL-10 in the salivary samples of patients in the group SC compared to the group C (p<0.05). The GCF, patients in the group SC had bigger levels of IL-1ß in comparation with the C group (p<0.05). Moreover, nonsurgical periodontal treatment resulted in increased levels of IL-10 on GCF in the groups SP and PC in relation to the baseline (p<0.05). Salivary flow was significantly increased post-treatment only in the SP's group patients (p=0.039). In addition, periodontal treatment did not influence ESSDAI index (p=0.35) and led to a statistically significant decrease on the ESSPRI index (p=0.03). The present data demonstrated that pSS influences the salivary and GCF levels of inflammatory biomarkers in favour of a proinflammatory profile, however, this profile might doesn't increase the susceptibility of pSS subjects to periodontal breakdown. In addition, the present data demonstrated that non-surgical periodontal treatment has a positive impact on the salivary flow and ESSPRI index of pSS patients. Thus suggesting that periodontal treatment may improve the quality of life of pSS subjects.

Diabetes mellitus: o que os periodontistas devem saber / Diabetes Mellitus: what periodontists must know

A doença periodontal, uma doença infecto-inflamatória crônica que pode levar à perda dentária, é considerada a sexta principal complicação que ocorre no paciente diabético, podendo ter sua susceptibilidade aumentada em até três vezes para esse tipo de paciente. Assim como o diabetes aumenta o risco para periodontite, na via contrária, a periodontite dificulta o controle metabólico pelo paciente diabético. O Diabetes do tipo 2 tem se tornado uma epidemia com prevalência crescente em todo o mundo, afetando aproximadamente 382 milhões de pessoas e acredita-se que até 2035 esse número aumente para 592 milhões. O Diabetes Mellitus é uma das principais causas de mortalidade, insuficiência renal, amputação de membros inferiores, cegueira e doença cardiovascular, além de apresentar perda importante de qualidade de vida. Baseados nesses números e na relação bidirecional existente entre essas doenças, nós acreditamos na necessidade do entendimento do diabetes pelo periodontista...

Periodontal disease, a chronic infectious inflammatory disease that can lead to tooth loss, is considered the sixth major complication that occurs in diabetic patients, and may increase susceptibility up to three times for this type of patient. As diabetes increases the risk for periodontitis, periodontitis in the opposite direction complicates metabolic control by the diabetic patient. Type 2 diabetes has become an epidemic with increasing prevalence worldwide affecting approximately 382 million people, and it is believed that by 2035 this number will reach 592 million. Diabetes mellitus is a major cause of mortality, renal failure, lower limb amputation, blindness and cardiovascular disease, as well as significant loss of quality of life. Based on these numbers and the existing bidirectional relationship between these two diseases, we believe the need that periodontists have to understand diabetes mellitus...

Laser de baixa potência na periodontia: uma revisão do estado atual do conhecimento / Low power laser in periodontics: a review of knowledge of the current state of knowledge

O uso do laser de baixa potência como instrumento terapêutico vem sendo amplamente incorporado na Medicina e na Odontologia, pois este tem se mostrado um importante auxiliar em tratamento de processos inflamatórios devido à capacidade de imunomodulação dos tecidos. A irradiação com laser excita uma série de moléculas presentes nas mitocôndrias, principalmente os: citocromo c oxidase e superóxido dismutase (NADH), responsáveis pela absorção da luz vermelha e infravermelha. Essas moléculas absorvem a luz e aceleram a transferência de elétrons na cadeia respiratória mitocondrial, aumentando a produção de trifosfato de adenosina (ATP). Devido a essa propriedade, o laser de baixa potência na odontologia é muito bem indicado para as mais diversas especialidades, principalmente na periodontia. Diversos estudos clínicos comprovam que o uso do laser atua como coadjuvante na melhora da resposta inflamatória em diversas situações clínicas como na raspagem subgengival e na reparação de cirurgias periodontais...

The use of low power laser as a therapeutic tool has been widely incorporated in medicine and dentistry, because it has been an important aid in the treatment of inflammatory processes due to its ability of immuno - modulation of tissues . The laser irradiation excites a number of molecules present in the mitochondria especially : cytochrome c oxidase and superoxide dismutase (NADH) responsible for absorption of red and infrared light. These molecules absorb light and accelerate the transfer of electrons in the mitochondrial respiratory chain increasing the production of adenosine triphosphate (ATP). Due to this property, the low-power laser in dentistry is well suited to the most diverse specialties especially in periodontics . Several clinical studies have shown that the use of laser acts as an adjuvant to improve the inflammatory response in many clinical situations such as subgingival scaling and repair of periodontal surgery...