Evaluating the Long-Term Outcomes of Periodontal Surgery vs. Non-Surgical Treatment in Aggressive Periodontitis.

Background: Aggressive periodontitis is a severe form of periodontal disease characterized by rapid tissue destruction and tooth loss. The optimal treatment approach for managing this condition remains a topic of debate. Materials and Methods: A retrospective cohort study was conducted, involving patients diagnosed with aggressive periodontitis who received either surgical or non-surgical treatment between 2010 and 2020. Clinical and radiographic data were collected at baseline and regular intervals over a 5-year follow-up period. Surgical interventions included flap surgery, guided tissue regeneration, and bone grafting, while non-surgical treatments comprised scaling and root planning with or without adjunctive antibiotics. The primary outcomes assessed included changes in probing depth, clinical attachment level, tooth loss, and patient-reported quality of life measures. Results: A total of 120 patients were included in the study, with 60 patients in each treatment group. The surgical group demonstrated significantly greater reductions in probing depth and gains in clinical attachment level compared to the non-surgical group (P < 0.05). Tooth loss was significantly lower in the surgical group over the 5 years (P < 0.01). Patient-reported outcomes also favored the surgical group, with improved oral health-related quality of life. However, the surgical group had a higher incidence of postoperative complications. Conclusion: This study suggests that periodontal surgery yields superior long-term outcomes in the management of aggressive periodontitis compared to non-surgical treatment.

Evaluation of microbiome in primary and permanent dentition in grade C periodontitis in young individuals.

BACKGROUND: The aim of the present study was to evaluate the subgingival microbiome in patients with grade C molar-incisor pattern periodontitis (C-MIP) affecting the primary or permanent dentitions. METHODS: DNA was isolated from subgingival biofilm samples from diseased and healthy sites from 45 C-MIP patients and subjected to phylogenetic microarray analysis. C-MIP sites were compared between children affected in the primary to those affected in the permanent dentitions. Within-subject differences between C-MIP-affected sites and dentition-matched healthy sites were also evaluated. RESULTS: C-MIP sites of subjects affected in the primary dentition showed partially overlapping but distinct microbial communities from C-MIP permanent dentition sites (p < 0.05). Differences were due to increased levels in primary C-MIP sites of certain species of the genera Capnocytophaga and Leptotrichia, while C-MIP permanent dentition sites showed higher prevalence of Filifactor alocis. Aggregatibacter actinomycetemcomitans (Aa) was among species seen in high prevalence and levels in both primary and permanent C-MIP sites. Moreover, both permanent and primary C-MIP sites showed distinct microbial communities when compared to dentition-matched healthy sites in the same subject (p < 0.01). CONCLUSIONS: Primary and permanent teeth with C-MIP showed a dysbiotic microbiome, with children affected in the primary dentition showing a distinct profile from those affected in the permanent dentition. However, Aa was enriched in both primary and permanent diseased sites, confirming that this microorganism is implicated in C-MIP in both dentitions.

Case Report of a 4-Year-Old Girl with Stage IV Grade C Localized Periodontitis (Pre-Puberal Localized Aggressive Periodontitis) Affected by Misrecognition and Late Diagnosis.

BACKGROUND AND OBJECTIVES: Stage IV grade C localized periodontitis (pre-puberal localized aggressive periodontitis/LPP) is a rare form of inflammatory periodontal disease occurring in clinically healthy individuals (no/small calculus/dental plaque traces), due a hyper-aggressive auto-immune response to high amounts of bacteria present in the oral cavity. CASE PRESENTATION: This case report describes a 4-year-old Caucasian girl with localized gingival inflammation and advanced bone loss around the temporary lower left canine. The first diagnostic assumption was hypophosphatasia, and the patient was sent for further genetic and metabolic investigations (which turned out to be negative). The LPP diagnosis was made during the family's summer holidays due to her parents' concerns about persistent gingival inflammation and tooth mobility. RESULTS: The diagnosis of LPP was supported by clinical oral examination results, earlier X-rays, earlier blood tests, and a periodontal bacterial test. The treatment was limited to avoid spreading inflammation to other teeth (via topical antibiotic treatment) due to our limited time frame, while the main problem of excessive amounts of periodontal bacteria in the oral cavity was not addressed. The tooth was eventually lost. CONCLUSIONS: The ability to early recognize radiological and clinical LPP signs correlated with understanding of its pathological auto-immune mechanism is extremely important for expanding treatment options, since bone preservation and reducing amounts of bacteria are strictly correlated with therapeutic speed.

A genome-wide association study meta-analysis in a European sample of stage III/IV grade C periodontitis patients ≤35 years of age identifies new risk loci.

AIM: Few genome-wide association studies (GWAS) have been conducted for severe forms of periodontitis (stage III/IV grade C), and the number of known risk genes is scarce. To identify further genetic risk variants to improve the understanding of the disease aetiology, a GWAS meta-analysis in cases with a diagnosis at ≤35 years of age was performed. MATERIALS AND METHODS: Genotypes from German, Dutch and Spanish GWAS studies of III/IV-C periodontitis diagnosed at age ≤35 years were imputed using TopMed. After quality control, a meta-analysis was conducted on 8,666,460 variants in 1306 cases and 7817 controls with METAL. Variants were prioritized using FUMA for gene-based tests, functional annotation and a transcriptome-wide association study integrating eQTL data. RESULTS: The study identified a novel genome-wide significant association in the FCER1G gene (p = 1.0 × 10-9 ), which was previously suggestively associated with III/IV-C periodontitis. Six additional genes showed suggestive association with p < 10-5 , including the known risk gene SIGLEC5. HMCN2 showed the second strongest association in this study (p = 6.1 × 10-8 ). CONCLUSIONS: This study expands the set of known genetic loci for severe periodontitis with an age of onset ≤35 years. The putative functions ascribed to the associated genes highlight the significance of oral barrier tissue stability, wound healing and tissue regeneration in the aetiology of these periodontitis forms and suggest the importance of tissue regeneration in maintaining oral health.

Differentially expressed miRNAs associated with generalized aggressive periodontitis.

OBJECTIVE: This study aimed to investigate miRNA expression profiles in individuals with periodontitis which is a chronic inflammatory condition affecting the integrity of the periodontal attachment. miRNAs play a crucial role in gene regulation through various mechanisms, making them potential diagnostic markers and therapeutic targets for various diseases. MATERIALS AND METHODS: A total of 25 individuals with aggressive periodontitis and 25 controls were included in the study. Gingival tissues were collected for miRNA isolation and cDNA synthesis. miRNAs associated with periodontitis, including hsa-miR-185-5p, hsa-miR-17, hs-miR-146a, hs-miR-146b, hs-miR-155, hs-miR-203, hs-miR-205, hs-miR-223, and hsa-miR-21-3p, were analyzed using a combination of miRTarBase database analysis and literature mining was performed. Real-time PCR was used to assess the expression patterns of the target miRNAs, and the data were analyzed using the REST program. RESULTS: The study revealed upregulated expression levels of hsa-miR-223-3p, hsa-miR-203b-5p, hsa-miR-146a-5p, hsa-miR-146b-5p, and hsa-miR-155-5p in individuals with periodontitis. Conversely, downregulated expression was observed for hsa-miR-185-5p, hsa-miR-21-3p, and hsa-miR-17-3p. CONCLUSION: The findings suggest significant differences in the expression of specific miRNAs associated with inflammation in periodontitis. MZB1 acts as a hormone-regulated adipokine/pro-inflammatory cytokine, driving chronic inflammation and influencing cellular expansion. Predominantly expressed in marginal zone and B1 B cells, specialized subsets that respond rapidly to infections, MZB1 impacts immune protein synthesis and immune cell maturation, notably targeting microRNA-185 to potentially impede T cell development. Further research is needed to elucidate the functional significance and potential implications of these miRNAs. CLINICAL RELEVANCE: miRNAs regulate the expression of target genes by finely tuning protein expression levels. The current findings provide compelling evidence of notable variations in the expression levels of specific miRNAs associated with inflammation in individuals affected by periodontitis; hence, miRNAs hold promise as potential therapeutic targets for periodontitis.

Aggressive periodontitis in southwestern American Indian adolescents.

BACKGROUND: This study determined the prevalence of aggressive (molar-incisor pattern) (Ag/MI) periodontitis and assessed the associated subgingival bacterial-herpesvirus microbiota in Pueblo Indian adolescents in the southwestern United States. METHODS: The study included 240 Pueblo Indian adolescents, aged 13-20 years old, residing in three Rio Grande River villages in New Mexico and the Hopi Pueblo reservation in Arizona. Adolescents with Ag/MI periodontitis or periodontal health provided subgingival samples for culture of bacterial pathogens and for polymerase chain reaction detection of periodontal herpesviruses. RESULTS: Ag/MI periodontitis was detected in 22 (9.2%) Pueblo Indian adolescents, with 21 exhibiting a localized molar-incisor breakdown pattern. Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and other red/orange complex bacterial pathogens predominated in Ag/MI periodontitis, whereas periodontal health yielded mainly viridans streptococci and Actinomyces species. Periodontal herpesviruses demonstrated a 3.5 odds ratio relationship with Ag/MI periodontitis. The only adolescent with generalized Ag/MI periodontitis harbored viral co-infection by cytomegalovirus plus Epstein-Barr virus Type 1, in addition to A. actinomycetemcomitans, P. gingivalis, and several other periodontopathic bacteria. CONCLUSIONS: Pueblo Indian adolescents showed an unusually high prevalence of early-age Ag/MI periodontitis predominated by periodontopathic bacteria and herpesviruses suspected to be major etiologic agents of the disease.

Corrigendum: Aggregatibacter actinomycetemcomitans cytolethal distending toxin modulates host phagocytic function.

[This corrects the article DOI: 10.3389/fcimb.2023.1220089.].

Additively custom-made 3D-printed subperiosteal implants for the rehabilitation of the severely atrophic maxilla (a case report).

Key Clinical Message: Subperiosteal implants might be the future first-line treatment in patients with compromised alveolar ridges, although the use of proper techniques and pre-surgical imaging is required to ensure treatment success. Abstract: Severe bone loss puts the success of endosseous implants at risk. This technical report aims to introduce the subperiosteal implants (SPIs) created through additive manufacturing. A case study is presented, outlining the process and strategies employed to fully restore a maxillary structure using a customized subperiosteal implant. The patient, who had previously faced disappointment with traditional endosseous implants, received a customized SPI. A detailed 3-year follow-up is also provided. The design of the subperiosteal framework and abutments is based on digital records of the patient's jaw structure and a radiographic stent during occlusion. This ensures optimal placement within the dental arch. The implant and abutments are then three-dimensional (3D) printed using a titanium alloy, while a provisional denture is 3D-printed using polymer materials. SPIs offer a viable alternative for individuals with severe jaw bone degeneration, as demonstrated in this report detailing their application in complete maxillary restoration. This patient-specific, prosthesis-driven approach avoids the need for bone grafting and enables immediate functional recovery through a single surgical procedure.

Identification of disease-associate variants of aggressive periodontitis using genome-wide association studies.

Aggressive periodontitis (AgP), Stage III or IV and Grade C according to the new periodontitis classification, is characterized by the rapid destruction of periodontal tissues in the systemically healthy population and often causes premature tooth loss. The presence of familial aggregation suggests the involvement of genetic factors in the pathogenesis. However, the genes associated with the onset and progression of the disease and details of its pathogenesis have not yet been fully identified. In recent years, the genome-wide approach (GWAS), a comprehensive genome analysis method using bioinformatics, has been used to search for disease-related genes, and the results have been applied in genomic medicine for various diseases, such as cancer. In this review, we discuss GWAS in the context of AgP. First, we introduce the relationship between single-nucleotide polymorphisms (SNPs) and susceptibility to diseases and how GWAS is useful for searching disease-related SNPs. Furthermore, we summarize the recent findings of disease-related genes using GWAS on AgP inside and outside Japan and a possible mechanism of the pathogenesis of AgP based on available literature and our research findings. These findings will lead to advancements in the prevention, prognosis, and treatment of AgP.

Aggregatibacter actinomycetemcomitans cytolethal distending toxin modulates host phagocytic function.

Cytolethal distending toxins (Cdt) are a family of toxins produced by several human pathogens which infect mucocutaneous tissue and induce inflammatory disease. Human macrophages exposed to Aggregatibacter actinomycetemcomitans (Aa) Cdt respond through canonical and non-canonical inflammasome activation to stimulate cytokine release. The inflammatory response is dependent on PI3K signaling blockade via the toxin's phosphatidylinositol-3,4,5-triphosphate (PIP3) phosphatase activity; converting PIP3 to phosphatidylinsoitol-3,4-diphosphate (PI3,4P2) thereby depleting PIP3 pools. Phosphoinositides, also play a critical role in phagosome trafficking, serving as binding domains for effector proteins during phagosome maturation and subsequent fusion with lysosomes. We now demonstrate that AaCdt manipulates the phosphoinositide (PI) pools of phagosome membranes and alters Rab5 association. Exposure of macrophages to AaCdt slowed phagosome maturation and decreased phago-lysosome formation, thereby compromising macrophage phagocytic function. Moreover, macrophages exposed to Cdt showed decreased bactericidal capacity leading to increase in Aggregatibacter actinomycetemcomitans survival. Thus, Cdt may contribute to increased susceptibility to bacterial infection. These studies uncover an underexplored aspect of Cdt function and provide new insight into the virulence potential of Cdt in mediating the pathogenesis of disease caused by Cdt-producing organisms such as Aa.

A Modern Approach to Treat Molar/Incisor Pattern Periodontitis-Review.

Molar-incisor pattern periodontitis (MIPP) is a severe form of periodontal disease characterized by rapid attachment loss and bone destruction affecting the molars and incisors. Formerly referred to as aggressive periodontitis, the terminology for this condition was revised after the 2017 workshop on the classification of periodontal and peri-implant diseases and conditions. Despite the modification in nomenclature, the treatment strategies for MIPP remain a critical area of investigation. The core principles of MIPP treatment involve controlling local and systemic risk factors, managing inflammation, and arresting disease progression. Traditional non-surgical periodontal therapy, including scaling and root planing, is commonly employed as an initial step together with the prescription of antibiotics. Surgical intervention may be necessary to address the severe attachment loss. Surgical techniques like resective and regenerative procedures can aid in achieving periodontal health and improving esthetic outcomes. This review article aims to provide an overview of the current understanding and advancements in the treatment modalities of MIPP. Through an extensive analysis of the existing literature, we discuss various modern therapeutic approaches that have been explored for managing this challenging periodontal condition.

Correlation between crestal bone loss and PPD at teeth and implants: a 5- to 20-year long-term cohort study in patients with treated periodontal disease.

OBJECTIVE: The correlation between crestal bone loss at teeth and probing pocket depth (PPD) has been established. Whether these findings can also be applied to implants is not known. The objective of this study was to determine the correlation between crestal bone loss and PPD at teeth and implants. METHOD AND MATERIALS: Thirty-one periodontitis-susceptible patients were rehabilitated with fixed implant-supported single crowns and fixed partial dentures. Each patient was examined over a 5- to 20-year period in a 3- to 6-month strict recall program. At each session, periodontal clinical parameters were recorded at teeth and implants. In addition, standardized periapical radiographs were taken after superstructure insertion (baseline) and then at 1, 3, 5, 10, 15, and 20 years. RESULTS: The survival rate of implants (94.0%) and teeth (97.3%) did not significantly differ in all patients after 20 years (P = .68). Almost all patients had a PPD ≥ 5 mm at implants and teeth throughout the observation period. The crestal bone loss at implants and teeth increased continuously, especially in patients with advanced periodontitis, without a correlation with PPD. A few patients (n = 5) had a PPD ≥ 5 mm and annual bone loss ≥ 0.2 mm at one implant, with a correlation between bone loss and PPD. CONCLUSION: In healthy implants and teeth, moderate crestal bone loss is present without correlation with PPD. A few patients showed progressive crestal bone loss at only one implant, with a correlation with PPD.

Treatment of Periodontitis Affecting Human Primary Teeth-A Systematic Review.

The aim of this systematic review is to report the treatment options (Intervention) and outcomes (O) for primary teeth affected by periodontitis (Population) and if the treatment of primary teeth can prevent the spread of periodontitis to permanent teeth (Outcomes). The following databases were searched for papers published before December 2022: PubMed, Embase, Web of Science, and Ebscohost. Studies on children affected by periodontitis involving the primary teeth were included and those on children who presented with periodontitis as a manifestation of systemic disease were excluded. Narrative synthesis and methodological quality assessments were performed for the included studies. Three interventional studies (without a control group) that evaluated treatments involving scaling and root planing (SRP with antibiotics) and extraction were included (total n = 60 patients). Additionally, twelve case reports/case series articles (n = 19 patients) were identified. The diagnoses ranged from aggressive periodontitis to juvenile periodontitis and pre-pubertal periodontitis. Based on a limited number of published studies, it was found that the early treatment of periodontitis affecting the primary teeth using SRP and systemic antibiotics resulted in favorable improvements in PD and CAL. Limited evidence suggests that SRP and the extraction of the primary teeth involved have the potential to prevent periodontitis affecting permanent teeth. Future trials are required to standardize the treatment protocols and to confirm these findings.

Effects of Antimicrobial photosensitizers of Photodynamic Therapy (PDT) to Treat Periodontitis.

Along with antimicrobial photosensitizers or antimicrobial photodynamic therapy (aPDT), Photodynamic therapy (PDT) is a therapeutic approach in which lasers and different photosensitizers (PSs) are used to eradicate periodontopathic bacteria in aggressive and chronic periodontitis. Periodontitis is a localized infectious disease caused by periodontopathic bacteria and can destroy bones and tissues surrounding and supporting the teeth. The aPDT system has been shown by in vitro studies to have high bactericidal efficacy. It was demonstrated that aPDT has low local toxicity, can speed up dental therapy, and is cost-effective. Several photosensitizers (PSs) are available for each type of light source which did not induce any damage to the patient and are safe. In recent years, significant advances have been made in aPDT as a non-invasive treatment method, especially in treating infections and cancers. Besides, aPDT can be perfectly combined with other treatments. Hence, this survey focused on the effectiveness and mechanism of aPDT of periodontitis by using lasers and the most frequently used antimicrobial PSs such as methylene blue (MB), toluidine blue ortho (TBO), indocyanine green (ICG), Malachite green (MG) (Triarylmethanes), Erythrosine Dyes (ERY) (Xanthenes dyes), Rose bengal (RB) (Xanthenes dyes), Eosin-Y (Xanthenes dyes), Radachlorin group and Curcumin. The aPDT with these PSs can reduce pathogenic bacterial loads in periodontitis. Therefore, it is clear that there is a bright future for using aPDT to fight microorganisms causing periodontitis.

Clinical and microbiological assessment in a subpopulation of young Argentine patients with severe periodontitis.

Aggressive periodontitis (AP) is the most serious entity of periodontal disease (stage III/IV, grade C periodontitis according to the latest classification, 2017). Aim: to enhance knowledge of periodontal microbiota in AP in native Argentine patients and describe the effect of a combined pharmacologicalmechanical periodontal treatment on clinical and microbiological parameters. Materials and Method: The study analyzed 42 periodontal sites in 11 patients diagnosed with AP. Clinical periodontal parameters were recorded at baseline, 45, 90 and 180 days. Microbiological samples were taken before treatment and at 180 days. PCR was used to determine presence of the periodontopathic bacteria Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), Treponema denticola (Td), Prevotella intermedia (Pi) and Fusobacterium nucleatum (Fn). Patients underwent periodontal therapy including antibiotics (Amoxicillin 500mg + Metronidazole 250mg; 8hs/7 days), and were reevaluated at 45, 90 and 180 days. Results: Mean age was 28.4 ± 7.9 years. The initial PCR detected the following frequencies: Aa 14.3%, Pi 61.9%, Pg 71.4%, Tf 81.0%, Fn 95.2% and Td 97.6%. Baseline microbiological samples revealed significantly higher prevalence of Pg over Aa (p=0.012). Clinical parameters improved significantly after treatment (73.8% PS<5 mm; PS, NIC, SS p<0.001). At 180 days, a significant decrease in microbiological detection rates was observed (Fn, Td, Tf, Pi, Aa p<0.05). Aa was no longer detectable while Pg did not decrease significantly (p=0.052). Fn was the only study species detected in 100% (n=11:42) of residual pockets (PS≥5 mm) (p=0.053). Conclusion: In the initial samples, there was significant prevalence of Pg over Aa. Significant clinical improvement was achieved after the mechanical-pharmacological treatment, with undetectable levels of Aa, while Fn persisted in residual pockets, and Pg was present at most of the treated sites.

La periodontitis agresiva (PA) es la entidad más grave de la enfermedad periodontal (clasificación 2017: periodontitis estadio III/IV, grado C). Objetivo: mejorar el conocimiento sobre la microbiota periodontal de la PA en sujetos nativos argentinos y describir el efecto de un tratamiento mecánicofarmacológico periodontal sobre los parámetros clínicos y microbiológicos. Materiales y Método: se estudiaron 42 sitios periodontales correspondientes a 11 pacientes con PA. Los parámetros clínicos se registraron a 0, 45, 90 y 180 días. Las tomas microbiológicas se realizaron antes de iniciar el tratamiento y a los 180 días. La determinación de especies periodontopáticas (Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), Treponema denticola (Td), Prevotella intermedia (Pi) y Fusobacterium nucleatum (Fn)) se realizó por PCR. Los pacientes iniciaron terapia básica periodontal junto con antibioticoterapia (Amoxicilina 500 mg + Metronidazol 250 mg; 8 hs/7 días) y fueron evaluados a los 45, 90 y 180 días. Resultados: la edad media fue 28,4 ± 7,9 años. Las detecciones iniciales fueron: Aa 14,3%, Pi 61,9%, Pg 71,4%, Tf 81,0%, Fn 95,2% y Td 97,6%. En las muestras iniciales la prevalencia de Pg sobre Aa fue significativamente superior (p=0,012). Los pacientes tuvieron una respuesta clínica favorable al tratamiento (73,8% PS<5 mm; PS, NIC, SS p<0,001). A 180 días, se observó una disminución estadísticamente significativa en la detección microbiana (Fn, Td, Tf, Pi, Aa p<0,05). En igual plazo, Aa no fue detectado, mientras que Pg mostró una disminución no significativa (p=0,052). Fn fue el único detectado en el 100% (n=11:42) de las bolsas periodontales residuales (PS≥5 mm) (p=0,053). Conclusión: Las muestras iniciales evidenciaron prevalencia significativa de Pg sobre Aa. El tratamiento logró una significativa mejora clínica con niveles indetectables de Aa. La persistencia de Fn en las bolsas residuales y de Pg en la mayoría de los sitios tratados, caracterizaron la muestra poblacional estudiada

Serum nitric oxide concentration in generalized chronic and aggressive periodontitis in the Mexican population is not related to the severity of the disease / La concentración de óxido nítrico en suero de pacientes con periodontitis agresiva y crónica generalizada no está relacionada con la gravedad de la enfermedad

Introduction: Periodontitis is an inflammatory disease that affects the supporting tissues of teeth, the effects of excess of nitric oxide, may contribute to the symptoms of periodontitis. Objective: To determine the serum nitric oxide concentration in generalized chronic and aggressive periodontitis patients and to compare it with a healthy subject group from the Mexican population. Materials and methods: A case and control study was performed. Sixty-nine individuals were recruited from the Clínica de Posgrado de Periodoncia of the Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, México. Patients with clinical features of generalized chronic periodontitis (GCP group, n=19), generalized aggressive periodontitis (GAP group, n=11), and a group of healthy subjects (HS group, n=39) were included in the study. Informed consent was obtained from each subject, and serum nitric oxide concentration was measured by an enzyme-linked immunosorbent assay. Results: Nitric oxide concentration in the study groups was greater in the GCP group (462.57 ± 16.57 µmol/L) than in the GAP group (433.84 ± 18.61 µmol/L) and the HS group (422.46 ± 12.07 µmol/L). A comparison using Student's t-test (one-tailed) between healthy subjects and generalized chronic periodontitis showed borderline significance (p<0.04), whereas no significant differences were observed in HS and GAP groups, with a p-value of 0.64, and the GAP vs. GCP p-value was 0.33. Conclusion: The serum nitric oxide concentration observed in the present study suggests that nitric oxide plays a major role in the inflammatory process, which cannot necessarily be linked to the severity of the disease and periodontal tissue destruction.

Introducción. La periodontitis es una enfermedad inflamatoria que afecta los tejidos de soporte dental; los efectos del exceso de óxido nítrico pueden contribuir a los síntomas de la periodontitis. Objetivo. Determinar la concentración de óxido nítrico en el suero de los pacientes con periodontitis agresiva y crónica generalizada, y compararla con la de individuos sanos de población mexicana. Materiales y métodos. Se trata de un estudio de casos y controles. Se incluyeron 69 individuos de la Clínica de Posgrado de Periodoncia del Centro Universitario de Ciencias de la Salud de la Universidad de Guadalajara. Se dividieron en tres grupos: pacientes con periodontitis crónica generalizada (GCP, n=19), pacientes con periodontitis agresiva generalizada (GAP, n=11) e individuos sanos periodontalmente (HS, n=39). Se obtuvo el consentimiento informado de todos los participantes. Se utililizó la prueba ELISA para medir la concentración de óxido nítrico en suero. Resultados. Las concentraciones de óxido nítrico observadas fueron mayores en el grupo GCP (462,57 ± 16,57 µmol/L) que en los grupos GAP (433,84 ± 18,61 µmol/L) y HS (422,46 ± 12,07 µmol/L). La comparación entre HS y GCP mediante la prueba estadística t de Student (una cola), mostró diferencias significativas (p<0,04), y no se observaron diferencias entre los grupos HS y GAP (p=0,64), ni entre GAP y GCP (p=0,33). Conclusiones. La concentración de óxido nítrico en suero, observada en el presente estudio, sugiere que el óxido nítrico desempeña un importante papel en el proceso inflamatorio, lo que no necesariamente está ligado a la gravedad de la enfermedad ni a la destrucción del tejido periodontal.

Estimation and Co-Relation of the Neutrophil Count and Neutrophil Chemotaxis in Patients With Gingivitis, Chronic Periodontitis, and Localized Aggressive Periodontitis Compared With Healthy Controls.

INTRODUCTION: Neutrophils are the most plentiful WBCs found in human blood. They are the first cells to respond to wounds and foreign invaders in the human body. They help the body fight infections. The neutrophil count may be used to check for infections, inflammation, or any other underlying conditions. The lower the neutrophil count, the higher the infection risk. Chemotaxis is the ability of the body cells to move in a specific direction as a response to a chemical stimulus. Neutrophil chemotaxis, a feature of the innate immune response, is the directed migration of neutrophils from one site in the body to another to provide effector functions. The present study was aimed at estimating and co-relating the neutrophil count and neutrophil chemotaxis in patients who had gingivitis, chronic periodontitis, and localized aggressive periodontitis, and in healthy participants. METHODS: Eighty participants (40 males and 40 females), aged 20-50 years, were included in the study and divided into four groups: Group I: control group with healthy periodontium; Group II: participants with gingivitis; Group III: participants with periodontitis; and Group IV: participants with localized aggressive periodontitis. Blood samples were collected for hematological analysis to evaluate the neutrophil counts and neutrophil chemotaxis. RESULTS: The mean value of neutrophil count (%) was highest in Group IV (72.535) followed by Group III (71.29), Group II (62.13), and least in Group I (58.15). This difference is statistically significant (p < 0.001). On intergroup comparison, a statistically significant difference was noted between all the groups except between Group I and Group II, and between Group III and Group IV. The mean value of neutrophil count and neutrophil chemotaxis assay were found to be statistically significant in all four groups. CONCLUSION: This study shows a positive correlation between neutrophils and periodontal diseases which could be beneficial for further studies.

Clinical and microbiological assessment in a subpopulation of young Argentine patients with severe periodontitis / Periodontitis severa en jóvenes argentinos. Evaluación clínica y microbiológica en jóvenes argentinos con periodontitis severa

ABSTRACT Aggressive periodontitis (AP) is the most serious entity of periodontal disease (stage III/IV, grade C periodontitis according to the latest classification, 2017). Aim: to enhance knowledge of periodontal microbiota in AP in native Argentine patients and describe the effect of a combined pharmacological-mechanicalperiodontal treatment on clinical and microbiological parameters. Materials andMethod: The study analyzed 42 periodontal sites in 11 patients diagnosed with AP. Clinical periodontal parameters were recorded at baseline, 45, 90 and 180 days. Microbiological samples were taken before treatment and at 180 days. PCR was used to determine presence of the periodontopathic bacteria Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), Treponema denticola (Td), Prevotella intermedia (Pi) and Fusobacterium nucleatum (Fn). Patients underwent periodontal therapy including antibiotics (Amoxicillin 500mg + Metronidazole 250mg; 8hs/7 days), and were reevaluated at 45, 90 and 180 days. Results: Mean age was 28.4 ± 7.9 years. The initial PCR detected the following frequencies: Aa 14.3%, Pi 61.9%, Pg 71.4%, Tf 81.0%, Fn 95.2% and Td 97.6%. Baseline microbiological samples revealed significantly higher prevalence of Pg over Aa (p=0.012). Clinical parameters improved significantly after treatment (73.8% PS<5 mm; PS, NIC, SS p<0.001). At 180 days, a significant decrease in microbiological detection rates was observed (Fn, Td, Tf, Pi, Aa p<0.05). Aa was no longer detectable while Pg did not decrease significantly (p=0.052). Fn was the only study species detected in 100% (n=11:42) of residual pockets (PS>5 mm) (p=0.053). Conclusion: In the initial samples, there was significant prevalence of Pg over Aa. Significant clinical improvement was achieved after the mechanical-pharmacological treatment, with undetectable levels ofAa, while Fn persisted in residual pockets, and Pg was present at most of the treated sites.

RESUMEN La periodontitis agresiva (PA) es la entidad más grave de la enfermedad periodontal (clasificación 2017: periodontitis estadio III/IV, grado C). Objetivo: mejorar el conocimiento sobre la microbiota periodontal de la PA en sujetos nativos argentinos y describir el efecto de un tratamiento mecánico-farmacológico periodontal sobre los parámetros clínicos y microbiológicos. Materiales y Método: se estudiaron 42 sitios periodontales correspondientes a 11 pacientes con PA. Los parámetros clínicos se registraron a 0, 45, 90 y 180 días. Las tomas microbiológicas se realizaron antes de iniciar el tratamiento y a los 180 días. La determinación de especies periodontopáticas (Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf, Treponema denticola (Td), Prevotella intermedia (Pi) y Fusobacterium nucleatum (Fn)) se realizó por PCR. Los pacientes iniciaron terapia básica periodontal junto con antibioticoterapia (Amoxicilina 500 mg + Metronidazol 250 mg; 8 hs/7 días) y fueron evaluados a los 45, 90 y 180 días. Resultados: la edad media fue 28,4 ± 7,9 años. Las detecciones iniciales fueron: Aa 14,3%, Pi 61,9%, Pg 71,4%, Tf 81,0%, Fn 95,2% y Td 97,6%. En las muestras iniciales la prevalencia de Pg sobre Aa fue significativamente superior (p=0,012). Los pacientes tuvieron una respuesta clínica favorable al tratamiento (73,8% PS<5 mm; PS, NIC, SS p<0,001). A 180 días, se observó una disminución estadísticamente significativa en la detección microbiana (Fn, Td, Tf, Pi, Aa p<0,05). En igual plazo, Aa no fue detectado, mientras que Pg mostró una disminución no significativa (p=0,052). Fn fue el único detectado en el 100% (n=11:42) de las bolsas periodontales residuales (PS>5 mm) (p=0,053). Conclusión: Las muestras iniciales evidenciaron prevalencia significativa de Pg sobre Aa. El tratamiento logró una significativa mejora clínica con niveles indetectables de Aa. La persistencia de Fn en las bolsas residuales y de Pg en la mayoría de los sitios tratados, caracterizaron la muestra poblacional estudiada.

Photodynamic therapy as an adjunctive treatment for Grade C periodontitis in molar teeth: a preliminary trial.

OBJECTIVE: The present study aimed to evaluate the local effect of antimicrobial photodynamic therapy (aPDT) as adjunctive treatment for Grade C periodontitis in molars teeth. METHOD AND MATERIALS: Thirty-eight molar teeth from 11 patients were included in this split-mouth randomized clinical trial. The teeth were randomly divided into two groups (n = 19 each) that were submitted to conventional scaling and root planing in addition to aPDT (test group) and to scaling and root planing in addition to aPDT simulation (control group). The following periodontal parameters were obtained prior to treatment (baseline) and at 3 months after the intervention: bleeding on probing, probing depth, gingival recession, clinical attachment level, and furcation level. A 5% significance level was adopted in the statistical analysis. RESULTS: Both groups exhibited improvement in the clinical parameters (P < .001). However, the reductions in bleeding on probing and probing depth were greater in the test group (P < .001). There were no significant differences in the other clinical parameters between groups (P ≥ .130). CONCLUSIONS: Molar teeth treated with aPDT and scaling and root planing showed superior clinical improvement compared to those submitted only to scaling and root planing. aPDT may be used as adjunctive treatment for Grade C periodontitis affecting molar teeth since it seems to improve the clinical response to conventional debridement.

Clinical Aspects and Therapeutic Management of an Aggressive Manifestation of Stage III Grade C Periodontitis in a Female Teenager.

The main objective of this study was to evaluate the improvement of periodontal health in patients with periodontitis treated with non-surgical periodontal therapy and subgingival-administrated local and systemic antimicrobial agents. A female teenager with periodontitis-associated health issues and a history of dental trauma was selected for this study. Clinical indices were obtained, and radiographic examination was performed at the beginning of the study. The patient was treated with periodontal therapy and administration of antibiotics. After this therapy, visits were scheduled at regular intervals to observe the clinical changes. Non-surgical periodontal therapy and administration of local and systemic antibiotics resulted in a reduction in the patient pocket depth probing, plaque index, and bleeding on probing. Gingival and periodontal health improved in terms of gingival overgrowth, plaque, tartar index, and tooth mobility. Suppuration was eliminated, and no gingival inflammation signs were observed.