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Severe Chronic Periodontitis (severe + chronic_periodontitis)
Selected AbstractsInterleukin-6 (G-174C) and tumour necrosis factor-alpha (G-308A) gene polymorphisms in geriatric patients with chronic periodontitisGERODONTOLOGY, Issue 1 2010A. M. Costa doi:10.1111/j.1741-2358.2009.00291.x Interleukin-6 (G-174C) and tumour necrosis factor-alpha (G-308A) gene polymorphisms in geriatric patients with chronic periodontitis Background and objective:, Periodontitis is a chronic inflammatory disease, and genetic factors may have an important role in its severity. Polymorphisms in the promoter regions of the interleukin-6 (IL-6) and tumour necrosis factor-, (TNF-,) genes have been reported to cause changes in the production of these cytokines. The aim of this study was to evaluate the possible role of IL-6 (G,174C) and tumour necrosis factor (G,308A) polymorphisms, in the severity of chronic periodontitis in an elderly population. Materials and methods:, In this study, a group of 65 elderly women, comprising 17 patients with moderate chronic periodontitis, 21 with severe chronic periodontitis and 27 healthy patients were selected. DNA was isolated from all subjects, and polymerase chain reaction was used to study the IL-6 and TNF-, gene polymorphisms. Results:, The results of this study showed a significant difference in the allele and genotype frequencies of IL-6 gene polymorphism between patients with periodontal disease and controls. Subjects carrying the G/G genotype of IL-6 were most severely affected by periodontitis. The TNF-, gene polymorphism showed no association with chronic periodontitis between patients and controls. Conclusion:, The results suggest that the IL-6 gene polymorphism may be associated with chronic periodontitis, and that TNF-, gene polymorphism may not be involved in the progression of chronic periodontitis in the population of elderly Brazilian women. [source] Post-treatment effects of subantimicrobial dose doxycycline on clinical parameters and gingival crevicular fluid transforming growth factor-,1 in severe, generalized chronic periodontitisINTERNATIONAL JOURNAL OF DENTAL HYGIENE, Issue 2 2008A Gürkan Abstract:, Objective:, Present study aimed to evaluate the effect of 3-month adjunctive subantimicrobial dose doxycycline (SDD) on clinical parameters and gingival crevicular fluid (GCF) transforming growth factor-beta1 (TGF-,1) levels in chronic periodontitis patients over 12 months. Methods:, Thirty-five patients with severe, generalized periodontitis participated in the present randomized, placebo-controlled study. Patients received scaling and root planing (SRP) plus 3 months adjunctive SDD or placebo. Clinical measurements and GCF sampling were performed at baseline, 3, 6, 9 and 12 months. Eleven periodontally healthy subjects served as controls for GCF TGF-,1 analysis. Results:, Clinical parameters of both SDD and placebo groups significantly improved during the study (P < 0.0125). SDD group exhibited significantly higher PD reduction at deep sites (baseline PD ,7 mm) compared with placebo group at 6 months (P < 0.05). In SDD group significantly higher percentage of deep pockets resolved (PD reduction ,3 mm from baseline) when compared with placebo group at 6 and 9 months (73.4% versus 49.7%; 79.9% versus 50.6%, respectively, P < 0.05). PD reduction ,4 mm for deep pockets from baseline was also greater in SDD group than placebo at 6 months (53.4% versus 36.3%, P < 0.05). GCF TGF-,1 levels of SDD group was significantly higher than baseline (P < 0.0125) and placebo group (P < 0.017) at 3 months. Conclusions:, These results ensure further data for beneficial effects of adjunctive SDD therapy in the management of severe chronic periodontitis. [source] Monozygotic twins are discordant for chronic periodontitis: clinical and bacteriological findingsJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 2 2010Gaudy L. Torres de Heens Torres de Heens GL, Loos BG, van der Velden U. Monozygotic twins are discordant for chronic periodontitis: clinical and bacteriological findings. J Clin Periodontol 2010; 37: 120,128. doi: 10.1111/j.1600-051X.2009.01511.x. Abstract Objectives: The aim of this study was to assess, in monozygotic (MZ) and dizygotic (DZ) twin pairs in whom the proband of the twin pair was suffering from moderate to severe chronic periodontitis, the contribution of genetics, periodontal pathogens and lifestyle factors towards the clinical phenotype. Material and Methods: For this study, 18 adult twin pairs were selected on the basis of interproximal attachment loss (AL) 5 mm in 2 non-adjacent teeth in one twin member. The study included 10 MZ and eight DZ twin pairs, in whom the periodontal condition, presence of periodontal pathogens, educational level, smoking behaviour and body mass index (BMI) were evaluated. Results: Both MZ and DZ twins were discordant regarding AL and alveolar bone loss. Discordance was greater in DZ compared with MZ twins. In MZ twins, the discordance could not be explained by education, smoking, BMI and periodontal pathogens. In DZ twins, 45.6% of the discordance could be explained by more pack-years of the probands. Conclusion: The results confirm a possible role of genetic factors in periodontitis. However, the magnitude of the genetic effects on disease severity may have been overestimated previously. [source] Common single nucleotide polymorphisms in cyclooxygenase-2 and risk of severe chronic periodontitis in a Chinese populationJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 3 2009Cheng-Jie Xie Abstract Aim: Several common single nucleotide polymorphisms (SNPs) of the cyclooxygenase-2 (COX-2) gene have been reported to be functional. The association between ,1195GA, ,765GC and 8473TC of COX-2, and severe chronic periodontitis (CP) in a Chinese population was investigated. Material and Methods: 148 cases of healthy controls (control group) and 146 cases of severe CP were recruited in this study. Genotypes of ,1195GA, ,765GC and 8473TC were determined by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP). The distributions of genotypes and haplotypes were compared by ,2 test and the odds ratios (ORs) were calculated by logistic regression analysis. Results: The prevalence of the ,1195A was more prevalent in CP group (60.62%) than control group (51.35%), and the distributions of the ,765C and 8473C were higher in control group (6.76% and 21.96%) compared with CP group (3.08% and 15.07%). Only genotype distribution of ,1195GA was significant when p -value was corrected for multiple testing (pc=0.033). The adjusted ORs for the ,1195AA/GA, ,765GC and 8473CC/TC were 2.49 (95% CI=1.33,4.69, p=0.005), 0.45 (95% CI=0.20,1.04, p=0.061) and 0.67 (95% CI=0.41,1.11, p=0.118). Subjects with the haplotype AGT had a significantly higher risk of periodontitis than those with the most common haplotype GGT (OR=1.91, 95% CI=1.32,2.76, pc<0.001). Conclusions: It suggests the ,1195A variant is associated with an increased risk for severe CP. [source] Formation of osteoclast-like cells from peripheral blood of periodontitis patients occurs without supplementation of macrophage colony-stimulating factorJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 7 2008Stanley T. S. Tjoa Abstract Aim: To determine whether peripheral blood mononuclear cells (PBMCs) from chronic periodontitis patients differ from PBMCs from matched control patients in their capacity to form osteoclast-like cells. Material and Methods: PBMCs from 10 subjects with severe chronic periodontitis and their matched controls were cultured on plastic or on bone slices without or with macrophage colony-stimulating factor (M-CSF) and receptor activator of nuclear factor- ,B ligand (RANKL). The number of tartrate-resistant acid phosphatase-positive (TRACP+) multinucleated cells (MNCs) and bone resorption were assessed. Results: TRACP+ MNCs were formed under all culture conditions, in patient and control cultures. In periodontitis patients, the formation of TRACP+ MNC was similar for all three culture conditions; thus supplementation of the cytokines was not needed to induce MNC formation. In control cultures, however, M-CSF or M-CSF/RANKL resulted in higher numbers compared with cultures without cytokines. Upregulations of osteoclast marker mRNA cathepsin K and carbonic anhydrase II confirmed the osteoclastic character. Bone resorption was only observed when PBMCs were cultured in the presence of M-CSF and RANKL. Conclusion: Our data indicate that PBMCs from periodontitis patients do not need priming by M-CSF to become osteoclast-like cells, suggesting that PBMCs from periodontitis patients are present in the circulation in a different state of activity. [source] Evaluation of enamel matrix derivative as an adjunct to non-surgical periodontal therapyJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 8 2003Mauricio A. Gutierrez Abstract Objectives: The aim of this study was to evaluate the adjunctive use of enamel matrix derivative (EMD) on periodontal healing following nonsurgical periodontal therapy (scaling and root planing , SRP). Material and methods: The study was performed as an intraindividual, longitudinal trial of 3 months duration with a double-blinded, split-mouth, controlled, and randomized design. Twenty-two patients with moderate to severe chronic periodontitis were enrolled in the study. In each patient, two sites with pocket depths 5 mm and with radiographic angular bone defects >3 mm were selected. Baseline examination included measurement of probing pocket depth (PPD) and clinical attachment levels (CAL). The presence or absence of plaque and bleeding on probing at selected sites was also recorded. Following initial examination, full-mouth SRP was performed. Study sites were then treated with 24% EDTA for 2 min, followed by thorough irrigation with sterile saline. The sites were then randomized. The experimental site received subgingival application of enamel matrix derivative (Emdogain®, BIORA AB, Malmo, Sweden). The control site received no additional treatment. At 3 months, all sites were re-examined. The response to therapy in experimental and control sites was evaluated, using change in probing depth and CAL as the primary outcome variables. Statistical analysis (paired t -tests) was used to compare response to treatment in control versus experimental sites. Results: Statistically significant changes in PPD and CAL were seen in both treatment groups from baseline to 3 months. The mean PPD reduction was 2.3±0.5 mm for control sites and 2.0±0.3 mm for experimental sites. The mean CAL gain was 1.8±0.4 mm for control sites, and 1.4±0.3 mm for experimental sites. Statistical analysis, however, revealed no significant difference in PPD reduction or CAL gain between experimental and control groups (p>0.4). In addition, no difference was found between treatment groups in bleeding or plaque indices at 3 months. Conclusion: The findings from the present study do not support the use of EMD during routine, nonsurgical debridement of periodontal pockets as measured 3 months post SRP. Zusammenfassung Ziel: Das Ziel dieser Studie war die Evaluation eines adjunktiven Gebrauchs von Schmelzmatrixderivaten (EMD) auf die parodontale Heilung nach nicht chirurgischer parodontaler Therapie (Wurzelreinigung und ,glättung, scaling und root planing , SRP). Material und Methoden: Die Studie wurde als eine intraindividuelle, für 3 Monate longitudinale Studie mit einem doppelt blinden, split-mouth, kontrolliertem und randomisiertem Protokoll durchgeführt. 22 Patienten mit moderater bis schwerer chronischer Parodontitis wurden in die Studie einbezogen. Bei jedem Patient wurden zwei Flächen mit Sondierungstiefen5 mm und mit radiographisch feststellbaren angulären Knochendefekten>3 mm ausgesucht. Die Basisuntersuchung umfasste die Messung der Sondierungstiefen (PPD) und des klinischen Stützgewebeniveaus (CAL). Die An- oder Abwesenheit von Plaque und Provokationsblutung an den ausgesuchten Flächen wurden auch dokumentiert. Nach der anfänglichen Untersuchung wurde eine alle Zähne betreffende SRP durchgeführt. Die Studienflächen wurden dann mit 24% EDTA für zwei Minuten behandelt, gefolgt von einer sorgsamen Spülung mit steriler Kochsalzlösung. Die Flächen wurden dann randomisiert. Die experimentellen Flächen erhielten eine subgingivale Applikation von Schmelzmatrixderivaten (Emdogain®, BIORA AB, Malmö, Schweden). Die Kontrollflächen erhielten keine zusätzliche Behandlung. Zum dritten Monat wurden alle Flächen reexaminiert. Die Antwort auf die Therapie bei den experimentellen und Kontrollflächen wurden evaluiert in Hinsicht der Veränderung der Sondierungstiefe und CAL als die primären Ergebnisvariablen. Statistische Analysen (gepaarter t -Test) wurden für den Vergleich der Behandlung zwischen experimentellen und Kontrollflächen genutzt. Ergebnisse: Statistisch signifikante Veränderungen bei der PPD und dem CAL wurden in beiden Behandlungsgruppen zwischen Basis und 3 Monaten beobachtet. Die mittlere PPD Reduktion betrug 2.3±0.5 mm für die Kontrollflächen und 2.0±0.3 mm für die experimentellen Flächen. Der mittlere CAL Gewinn betrug 1.8±0.4 mm für die Kontrollflächen und 1.4±0.3 mm für die experimentellen Flächen. Die statistischen Analysen erbrachten jedoch keine signifikanten Differenzen für PPD Reduktion und CAL Gewinn zwischen den experimentellen und Kontrollgruppen (p>0.4). Es wurden auch keine Differenzen zwischen den Gruppen hinsichtlich Provokationsblutung und Plaqueindex zum dritten Monat beobachtet. Schlussfolgerung: Die Ergebnisse von der vorliegenden Studie unterstützen nicht die Anwendung von EMD während der routinemäßigen nicht chirurgischen Reinigung der parodontalen Taschen, wie die Messungen drei Monate nach SRP. Résumé Objectif: Le but de cette étude fut d'évaluer l'utilisation des dérivés de la matrice amellaire (EMD) sur la cicatrisation parodontale après un traitement parodontal non chirurgical (détartrage et surfaçage radiculaire). Matériel et méthodes: L'étude fut conçue en essai longitudinal intra-individuel d'une durée de 3 mois randomisée, contrôlée en double aveugle et en bouche croisée. 22 patients atteints de parodontites chroniques modérées ou sévères furent enrôlés. Pour chaque patient, 2 sites avec des profondeurs de poches5 mm et des lésions osseuses angulaires radiographiques>3 mm furent sélectionnés. L'examen initial comportait la mesure des profondeurs de poche au sondage (PPD) et les niveaux cliniques d'attache (CAL). La présence ou l'absence de plaque et de saignement au sondage sur les sites sélectionnés furent aussi enregistrées. Après l'examen initial, un détartrage et un surfaçage complet étaient réalisés. Les sites étudiés étaient alors traités par de l'EDTA à 24% pendant 2 minutes, puis fortement rinçés avec du serum physiologique. Les sites étaient alors répartis aléatoirement. Le site expérimental recevait une application sous gingivale d'EMD (Emdogain®, BIORA AB, Malmo, Sweden). Le site contrôle ne recevait pas de traitement supplémentaire. A 3 mois, les sites étaient réévalués. La réponse au traitement était évaluée par les modifications de profondeur de poches et de niveau d'attache comme variables primaires. L'analyse statistique (Test t apparié) permit de comparer la réponse au traitement. Résultats: Des modifications statistiquement significatives de PPD et de CAL ont été observées dans les deux groupes de traitement. La réduction de PPD moyenne était de 2.3±0.5 mm pour les sites contrôles et de 2.0±0.3 mm pour les sites expérimentaux. Le gain de CAL moyen était respectivement de 1.8±0.4 mm et de 1.4±0.3 mm.L'analyse statistique, cependant, ne révélait pas de différences significatives entre les deux groupes (p>0.4). De plus, aucune différence n'apparaissait entre les groupes pour le saignement et les indices de plaque au troisième mois. Conclusion: Les données de cette étude n'étayent pas l'utilisation routinière d' EMD lors du débridement non chirurgical des poches parodontales lorsqu'on en mesure les résultats 3 mois après détartrage et surfaçage radiculaire. [source] Systemic medications: clinical significance in periodonticsJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 2002Sebastian G. Ciancio Abstract Systemic medications are of value as adjuncts to periodontal therapy. These medications can be divided into two major categories: antibiotics and agents for host modulation. Antibiotics have been shown to be valuable adjuncts in specialized types of periodontal disease, such as localized and generalized aggressive periodontitis, and of possible value in severe chronic periodontitis. Antibiotics have been studied individually, in combination and in sequential therapy. Host modulators include Periostat, non-steroidal anti-inflammatory agents, alendronate (Fosamax), hormone replacement therapy and anti-arthritic medications. These agents produce their beneficial effects by a variety of mechanisms of action, including inhibition of matrix metalloproteinases, inhibition of prostaglandin production, stimulation of osteoblasts, inhibition of osteoclasts, and other anti-inflammatory mechanisms of action. [source] A multiplex immunoassay demonstrates reductions in gingival crevicular fluid cytokines following initial periodontal therapyJOURNAL OF PERIODONTAL RESEARCH, Issue 1 2010D. H. Thunell Thunell DH, Tymkiw KD, Johnson GK, Joly S, Burnell KK, Cavanaugh JE, Brogden KA, Guthmiller JM. A multiplex immunoassay demonstrates reductions in gingival crevicular fluid cytokines following initial periodontal therapy. J Periodont Res 2009; doi: 10.1111/j.1600-0765.2009.01204.x. © 2009 John Wiley & Sons A/S Background and Objective:, Cytokines and chemokines play an important role in the pathogenesis of periodontal diseases. The objective of this study was to quantitatively assess the effect of initial periodontal therapy on gingival crevicular fluid levels of a comprehensive panel of cytokines and chemokines, including several less extensively studied mediators. Material and Methods:, Clinical examinations were performed and gingival crevicular fluid samples obtained from six subjects with generalized severe chronic periodontitis prior to initial periodontal therapy and at re-evaluation (6,8 weeks). Four diseased and two healthy sites were sampled in each subject. Twenty-two gingival crevicular fluid mediators were examined using a multiplex antibody capture and detection platform. Statistical analyses were performed by fitting mixed effects linear models to log-transformed gingival crevicular fluid values. Results:, Gingival crevicular fluid interleukin (IL)-1, and IL-1, were the only cytokines to differ in initially diseased vs. initially healthy sites. Following initial therapy, 13 of the 16 detectable cytokines and chemokines decreased significantly in diseased sites, including IL-1,, IL-1,, IL-2, IL-3, IL-6, IL-7, IL-8, IL-12 (p40), CCL5/regulated on activation, normally T cell expressed and secreted (RANTES), eotaxin, macrophage chemotactic protein-1, macrophage inflammatory protein-1, and interferon-,. At healthy sites, only three of the 16 mediators were significantly altered following therapy. Conclusion:, This is the first study, to our knowledge, to evaluate such an extensive panel of gingival crevicular fluid mediators within the same sample prior to and following initial therapy. The results confirm that periodontal therapy effectively reduces pro-inflammatory cytokines and chemokines, including less well-described mediators that may be important in initiation and progression of periodontitis. The multiplex assay will prove useful for future gingival crevicular fluid studies. [source] Smoking modulates interleukin-6:interleukin-10 and RANKL:osteoprotegerin ratios in the periodontal tissuesJOURNAL OF PERIODONTAL RESEARCH, Issue 2 2007J. B. César-Neto Background and Objective:, This study evaluated the effect of smoking on the gene expression of interleukin-1,, -1ra, -6, -8 and -10, tumor necrosis factor-,, matrix metalloproteinase (MMP)-2 and -8, receptor activator of NF-,B ligand (RANKL) and osteoprotegerin, in sites with periodontitis. Material and Methods:, Gingival biopsies were divided into three groups: the healthy group (periodontally healthy subjects; n = 10); the periodontitis group [subjects with severe chronic periodontitis who never smoked (probing depth ,,7 mm) (n = 25)]; and the smoking group (subjects diagnosed with severe chronic periodontitis who smoked ,,1 pack per day for at least 10 years; n = 25). Gene and protein expressions were analyzed by quantitative polymerase chain reaction and enzyme-linked immunosorbent assay, respectively. Results:, Data analysis demonstrated that, except for MMP-8 and osteoprotegerin, the levels of all factors were increased by inflammation (p < 0.001). The levels of interleukin-1,, -1ra, -6 and -8, and RANKL, were higher in smokers with periodontitis compared with controls, whereas the levels of interleukin-10, MMP-8 and osteoprotegerin were lower (p < 0.001). Smoking lowered the levels of interleukin-1,, -8, -10, tumor necrosis factor-,, MMP-8 and osteoprotegerin, and increased the levels of interleukin-6 and -1ra in sites with a comparable type of periodontitis (p < 0.001). Conclusion:, In conclusion, smoking modulates gene expression in the periodontium, and the influence of smoking on periodontal disease may involve effects of interleukin-6:interleukin-10 and RANKL:osteoprotegerin ratios. [source] Periodontal therapy: a novel non-drug-induced experimental model to study human inflammationJOURNAL OF PERIODONTAL RESEARCH, Issue 5 2004F. D'Aiuto Background:, Chronic periodontitis causes a low-grade systemic inflammatory response; its standard treatment, however, induces an acute inflammatory response. The aim of this study was to describe the systemic inflammatory reactions to an intensive periodontal treatment regimen. Methods:, Fourteen otherwise healthy subjects suffering from severe chronic periodontitis were enrolled in a 1 month pilot single-blind trial. Intensive periodontal treatment, consisting of full-mouth subgingival root debridement delivered within a 6-h period, was performed. Periodontal parameters were recorded before and 1 month after completion of treatment. Blood samples were taken at baseline and 1, 3, 5, 7 and 30 days after treatment. Interleukin-1 receptor antagonist (IL-1Ra), Interleukin-6 (IL-6) and C-reactive protein (CRP) serum concentrations were determined by enzyme-linked immunosorbent assay (ELISA). Complete blood counts were also performed. Results:, One day after treatment, mild neutrophilia and monocytosis (p < 0.05) and lymphopenia (p < 0.01) were accompanied by a sharp increase in inflammatory markers (IL-1Ra, IL-6, p < 0.01). A 10-fold increase in CRP (p < 0.001) was detected on day 1 and its kinetics followed a pattern of a classical acute phase response (significantly raised concentrations up to 1 week, p < 0.01). At 3,7 days after treatment, subjects presented also with a mild tendency towards a normocytic anaemic state (p < 0.01) and a degree of lympho-thrombocytosis (p < 0.05). The observed changes were similar to those expected following the well-characterized endotoxin-challenge model of inflammation. Conclusions:, Intensive periodontal treatment produced an acute systemic inflammatory response of 1 week duration and might represent an alternative to classic endotoxin-challenge or drug-induced models to study acute inflammation in humans. [source] Periodontal healing and bone regeneration in response to azithromycinAUSTRALIAN DENTAL JOURNAL, Issue 2 2010R Hirsch Abstract Azithromycin, first synthesized in 1980, is a macrolide antibiotic related to erythromycin. It is widely used by the medical profession as a broad-spectrum antibiotic in the treatment of pneumonia, urinary tract infections and tonsillitis. In addition to its antibiotic properties, azithromycin has immune-modulating effects and is used for this reason in the management of cystic fibrosis and chronic obstructive pulmonary diseases. The drug is taken up by neutrophils, macrophages and fibroblasts, and is slowly released by these cells. Three diverse case reports are presented in which a single course of azithromycin (consisting of one 500 mg tablet being taken a day for three days) was prescribed before any periodontal intervention occurred. Azithromycin was the principal mode of treatment of severe chronic and aggressive periodontitis in Cases 1 and 2. Azithromycin, together with monthly subgingival debridement, was the treatment in Case 3 (severe chronic periodontitis in a poorly controlled diabetic complicated by gingival overgrowth related to medication with a calcium channel blocker). Favourable resolution of inflammation, reduction in pocket depths and evidence of bone regeneration were evident, even when no periodontal treatment had occurred. In Case 3, resolution of gingival overgrowth occurred over eight months. The potential implications for periodontal management, understanding of the pathogenesis of periodontal diseases and periodontal research are briefly discussed. [source] | ||||||||||