Local levels of biomarkers after surgical and nonsurgical debridement of residual pockets and nonresidual sites in diabetic patients: a 12-month follow-up.

There is scarce evidence on suitable approaches for the treatment of unresponsive or residual periodontal sites in diabetic patients. This study assessed the effects of surgical debridement (SD) and nonsurgical debridement (NSD), associated with amoxicillin and metronidazole, on clinical and immunological outcomes of residual pockets and adjacent healthy sites in patients with type 2 diabetes. A split-mouth, randomized controlled trial was conducted in 21 patients presenting at least 2 residual pockets in contralateral quadrants 12 months after basic nonsurgical periodontal therapy. Patients received systemic antibiotics, and contralateral quadrants were assigned to receive SD or NSD. The changes in clinical parameters were evaluated from baseline to 12 months. Local levels of 14 cytokines and chemokines were measured with multiplex bead immunoassays at baseline and 3 and 12 months after therapy. There were no statistically significant differences between SD and NSD for changes in clinical parameters from baseline to 12 months (P > 0.05). There was a significantly greater increase in the levels of granulocyte-macrophage colony-stimulating factor and interleukin 6 from baseline to 3 months in the healthy sites adjacent to residual pockets receiving SD (P < 0.05). A significant decrease in the levels of monocyte chemoattractant protein-1 and macrophage inflammatory protein 1α occurred from baseline to 12 months in the residual pockets treated by SD (P < 0.05). In conclusion, SD and NSD resulted in similar clinical benefits at 12 months. The short-term increase in the levels of proinflammatory biomarkers in SD sites probably can be attributed to tissue trauma and healing, and the long-term decrease in the levels of chemotactic factors in residual pockets treated by surgery may reflect remission of infection and stable wound healing in these sites at 12 months.

Cytokines and bone-related factors in systemically healthy patients with chronic periodontitis and patients with type 2 diabetes and chronic periodontitis.

BACKGROUND: This study compares the levels of cytokines and bone-related factors in the gingival crevicular fluid (GCF) of systemically healthy patients with chronic periodontitis (CP); and better-controlled, and poorly controlled patients with type 2 diabetes and CP. METHODS: Thirty-seven patients with type 2 diabetes and CP and 20 systemically healthy patients with CP were enrolled in this study. The patients with diabetes mellitus were categorized as better-controlled (n = 17; HbA(1c) levels ≤8%) or poorly controlled (n = 20; glycated hemoglobin values >8%). Levels of tumor necrosis factor-α, interleukin (IL)-4, interferon (IFN)-γ, IL-23, IL-17, soluble receptor activator of nuclear factor-kappa B ligand (sRANKL), and osteoprotegerin (OPG) in GCF of diseased sites were analyzed by enzyme-linked immunosorbent assay. RESULTS: Type 2 diabetes mellitus, as a whole, upregulates the levels of OPG, sRANKL, IFN-γ, IL-17, and IL-23 and downregulates the production of IL-4 in sites with CP (P <0.05). Better-controlled individuals exhibited the highest levels of IFN-γ, whereas poorly controlled patients presented the highest levels of IL-17 (P <0.05). There were no differences in the levels of tumor necrosis factor-α, OPG, and IL-23 among systemically healthy, better-controlled, and poorly controlled patients with diabetes (P >0.05). CONCLUSIONS: Increased levels of proinflammatory cytokines and RANKL were observed in the GCF of patients with type 2 diabetes with CP, compared to patients without diabetes. In addition, poor or good glycemic status seems to modulate osteo-immunoinflammatory mediators in a different manner.

Effectiveness of full-mouth and partial-mouth scaling and root planing in treating chronic periodontitis in subjects with type 2 diabetes.

BACKGROUND: This study evaluated the clinical and metabolic effects of full-mouth scaling and root planing (FMSRP) compared to partial-mouth scaling and root planing (PMSRP) in patients with type 2 diabetes and chronic periodontitis, and it assessed the impact of the glycemic status on the clinical and metabolic response to periodontal therapy. METHODS: In this clinical trial, 18 subjects with diabetes received FMSRP in a maximum of 24 hours, and 18 subjects received PMSRP in a maximum of 21 days. Visible plaque accumulation, bleeding on probing, suppuration, probing depth, clinical attachment level (CAL), and glycosylated hemoglobin (HbA1c) levels were obtained at baseline and at 3 and 6 months post-therapy. Baseline HbA1c values > or =9% and <9% defined subjects with poorly and better-controlled diabetes, respectively. RESULTS: All clinical parameters improved after therapy (P <0.05). No significant differences were observed between treatment groups for clinical and metabolic parameters at any time (P >0.05). There were no changes in the HbA1c levels after therapy (P >0.05). No subject reported any adverse effects during the study. Individuals with better-controlled diabetes achieved a lower mean CAL at 6 months post-therapy, when FMSRP and PMSRP were evaluated together (P <0.05). CONCLUSIONS: FMSRP and PMSRP were equally effective in treating chronic periodontitis in subjects with type 2 diabetes, without significant improvements in the glycemic control at 3 and 6 months. Considering the periodontal therapy as a whole (FMSRP plus PMSRP), subjects with better-controlled diabetes exhibited a benefit in CAL at 6 months compared to subjects with poorly controlled disease.

Tumor necrosis factor-alpha levels after surgical anti-infective mechanical therapy for peri-implantitis: a 12-month follow-up.

BACKGROUND: The aim of the present case series was to evaluate the effects of a surgical anti-infective mechanical therapy for peri-implantitis on clinical parameters and tumor necrosis factor-alpha (TNF-alpha) levels at 12 months post-therapy. METHODS: Ten patients with peri-implantitis were treated with open surgical debridement, abrasive sodium carbonate air-powder, and resin curets. Clinical parameters were recorded before and 3 and 12 months after therapy. At these time points, the total amounts of TNF-alpha in the peri-implant crevicular fluid were measured by enzyme-linked immunosorbent assay. RESULTS: At 3 and 12 months, the anti-infective therapy resulted in significant improvements in all clinical parameters (P <0.05). Moreover, the total amount of TNF-alpha was significantly reduced at 3 and 12 months after therapy compared to baseline (P <0.05), paralleling the changes in mean probing depth and bleeding on probing. CONCLUSION: The anti-infective mechanical therapy reduced the crevicular levels of TNF-alpha in sites affected by peri-implantitis over a period of 12 months, and this phenomenon was associated with improvements in clinical parameters.

Differential cytokine expressions affect the severity of peri-implant disease.

OBJECTIVE: This study assessed gene expression by quantitative polymerase chain reaction of inflammatory- [interleukin (IL)-12, tumor necrosis factor-alpha (TNF-alpha), IL-4, and IL-10] and osteoclastogenesis-related factors [receptor activator of NF-kappaB ligand (RANKL) and osteoprotegerin (OPG)] in sites exhibiting different severities of peri-implant disease. MATERIAL AND METHODS: Peri-implant soft tissue biopsies (n=48) were harvested from healthy implant (HI), mucositis (MC), initial peri-implantitis (IP) and severe peri-implantitis (SP) sites. RESULTS: IL-12 and TNF-alpha mRNA levels were higher in SP, followed by IP and MC (P <0.05). IL-4 was higher in HI, followed by MC, SP and IP (P <0.05). IL-10 was the lowest in HI, while no differences were detected among the diseased groups (P>0.05). OPG mRNA levels were higher in HI, followed by IP, SP and MC, whereas RANKL was increased as the peri-implantitis severity increased (P<0.05). The highest OPG/RANKL ratio was observed in HI and the lowest in SP (P<0.01). CONCLUSION: These findings suggest that expressions of inflammatory- and osteoclastogenesis-related factors may play an important role in the onset and severity of the peri-implant diseases.

Effect of anti-infective mechanical therapy on clinical parameters and cytokine levels in human peri-implant diseases.

BACKGROUND: The objectives of this study were to clinically and immunologically assess the effects of mechanical anti-infective therapies for mucositis and peri-implantitis and to compare the levels of cytokines in untreated and treated peri-implant diseased sites to healthy ones. METHODS: Titanium dental implants were assigned to one of the following groups: healthy (n = 10) = control; mucositis (n = 10) = mechanical debridement using abrasive sodium carbonate air-powder and resin curets; and peri-implantitis (n = 20) = open surgical debridement using abrasive sodium carbonate air-powder and resin curets. Visible plaque accumulation, marginal bleeding, bleeding on probing, suppuration, and probing depth were assessed at baseline for all groups and at 3 months after therapies for diseased groups. At these times, the total amounts of interleukin (IL)-4, -10, and -12, tumor necrosis factor-alpha (TNF-alpha), receptor activator of nuclear factor-kappa B ligand (RANKL), and osteoprotegerin (OPG) in the peri-implant crevicular fluid (PICF) were measured by enzyme-linked immunosorbent assay. RESULTS: At 3 months, the anti-infective treatments resulted in a significant improvement in all clinical parameters for mucositis and peri-implantitis (P <0.05). Moreover, the total amounts of TNF-alpha in PICF were significantly higher in untreated diseased implants compared to healthy ones, and the OPG/RANKL ratio was higher for healthy implants than for untreated peri-implantitis (P <0.05). TNF-alpha levels were significantly reduced for both diseased groups (P <0.05), achieving the same level as the healthy group at 3 months after therapies (P >0.05). CONCLUSION: The proposed anti-infective therapies may locally modulate the levels of TNF-alpha and the OPG/RANKL ratio and improve clinical parameters around peri-implant tissues.

Short-term clinical and microbiological evaluations of peri-implant diseases before and after mechanical anti-infective therapies.

OBJECTIVES: The aim of this study was to evaluate the clinical and microbiological effects of mechanical anti-infective therapies for mucositis and peri-implantitis. MATERIAL AND METHODS: Subjects with at least one dental implant were assigned to healthy (n=10), mucositis (n=12) or peri-implantitis (n=13) groups. Implants with mucositis or peri-implantitis were decontaminated by means of teflon curettes and abrasive sodium carbonate air-powder, performed by an open flap for peri-implantitis and without surgery for mucositis. Visible plaque (PI), marginal bleeding (MB), bleeding on probing (BOP), suppuration (SUP), probing depth (PD) and relative clinical attachment level (rCAL) were assessed at baseline and at 3 months after therapies. At the same time points, submucosal plaque samples were collected from each implant and analyzed by Checkerboard DNA-DNA hybridization for 40 bacterial species. RESULTS: All clinical parameters improved at 3 months post-therapy in mucositis and peri-implantitis groups (P<0.05). The mean reduction in rCAL (+/-SD) was 1.4+/-1.2 mm and 2.3+/-1.6 mm, and it was 1.3+/-1.2 mm and 3.1+/-1.7 mm in PD (+/-SD) for mucositis and peri-implantitis, respectively. Levels of Treponema denticola, Tanerella forsythia and Parvimonas micra, and of Fusobacterium nucleatum ss nucleatum, were significantly reduced after peri-implantitis therapy and after mucositis therapy, respectively (P<0.05). In addition, counts of Porphyromons gingivalis, Treponema socranskii and the proportions of red complex were reduced in both groups at 3 months after treatments (P<0.05). CONCLUSION: Mechanical therapies alone were effective in treating mucositis and peri-implantitis over a period of 3 months. The open debridement procedure showed clinical and microbiological benefits on the treatment of peri-implantitis and could be safely used as a standard control group for future studies.

Peri-implant diseases may be associated with increased time loading and generalized periodontal bone loss: preliminary results.

The aim of this study was to evaluate the prevalence of peri-implant diseases around Branemark system implants in Brazilians and the possible relationship with periodontal bone loss, systemic condition, and demographic profile. A total of 113 individuals were enrolled in this study, and they received 347 implants. The implants were clinically and radiographically examined and diagnosed as healthy implants, mucositis, or peri-implantitis. The demographic and systemic profiles of the individuals were assessed via questionnaires, and the time of loading was obtained from files. The presence of periodontal bone loss in partially edentulous patients was determined by standardized radiographic evaluation. With regard to implants, the prevalence was 60.5% (n = 210), 32% (n = 111), and 7.5% (n = 26) for healthy tissues, mucositis, and peri-implantitis, respectively. No correlation was found between peri-implant tissue conditions and socioeconomic status, body mass index, smoking status, gender, age, diabetes mellitus, osteopenia, and osteoporosis. Statistically significant positive correlations were found in implants with mucositis and peri-implantitis in relation to time of loading and with peri-implantitis in relation to periodontal bone loss in the 4 quadrants (P < .05). Presence of peri-implant diseases may be associated with the increasing time of loading and generalized periodontal bone loss.