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Selected Abstracts

Fibre retention osseous resective surgery: a novel conservative approach for pocket elimination

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 2 2007
Gianfranco Carnevale
Abstract Aim and Background: The position of the most apical inter-dental portion of the alveolar crest is classically used in osseous resective surgery (ORS) to establish the amount of the inter-proximal and buccal/lingual bone resection. Supracrestal fibres connected to the root cementum are always present coronal to the alveolar crest both in healthy and diseased sites. The aim of this paper is to report a novel surgical approach that combines the classical method of osseous resection with the gingival fibre retention technique. Material and Methods: A description of the surgical procedure in four steps is provided (flap design, marginal soft tissue removal and fibre retention, ORS, suture of the flap). Results and Conclusion: The proposed technique shifts the bottom of the defect in a more coronal position at the level of the connective tissue fibre attachment, establishing a more conservative supporting bone resection. [source]

Bone resorbing activity and cytokine levels in gingival crevicular fluid before and after treatment of periodontal disease

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 6 2004
Anders Holmlund
Abstract Background: The aim of the present study was to investigate bone resorption activity (BRA), interleukin-1, (IL-1,), IL-1, and interleukin-1 receptor antagonist (IL-1ra) in gingival crevicular fluid (GCF) in sites with no signs of periodontol disease and in sites with horizontal or angular loss of periodontal bone. These assessments were performed before and after periodontal treatment. Methods: GCFs were collected from 10 individuals with filter strips from two healthy sites and four sites with deep pathological periodontal pockets, two of which showed horizontal bone loss and two with angular bone loss. All diseased pockets were treated with flap surgery and systemic Doxyferm®. Twelve months later GCF was collected again and treatment outcome evaluated. BRA in GCFs was assessed in a bone organ culture system by following the release of 45Ca from neonatal mouse calvariae. The amounts of IL-1,, IL-1, and IL-1ra in GCFs were quantified by enzyme-linked immunosorbent assay (ELISA). Results: Treatment resulted in reduction of pocket depths with 3.5±0.5 mm in sites with angular bone loss and 2.8±0.3 mm in sites with horizontal bone loss. Initially, BRA, IL-1,, IL-1, and IL-1ra were significantly higher in GCFs from diseased sites compared with healthy sites. No differences in BRA and cytokine levels were seen between GCFs from pockets with horizontal and angular bone losses. The levels of IL-1,, IL-1, and IL-1ra were significantly reduced after treatment of diseased pockets. Pocket depths were significantly correlated to BRA only in pre-treatment sites with angular bone loss. BRA was correlated to Il-1,, IL-1,, but not to IL-1ra, in diseased sites with angular bone loss, before and after treatment. The reductions of BRA in the individual sites, seen after treatment, were not correlated to the reductions of Il-1,, IL-1, or IL-1ra. Conclusions: These data show that BRA and cytokine levels are increased in GCFs from sites with periodontal disease and that periodontal treatment results in reduction of the cytokines. Our findings further indicate that IL-1, and IL-1, play important roles for the BRA present in GCFs, but that other factors also contribute to this activity. [source]

Systemic disorders in patients with periodontal disease

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 4 2003
Maria Lagervall
Abstract Background, aims: Over the past 10 years several studies have been published pointing towards a relationship between periodontal disease and various systemic disorders or diseases. The purpose of this retrospective study was to investigate the occurrence of self-reported systemic disorders in patients referred to a specialist clinic for periodontal treatment and to explore possible relationships between general health and periodontal disease severity in this population. Material and Methods: Data were collected from the dental records and the health questionnaires of 1006 subjects. Stepwise multiple linear regression analyses were adopted to calculate correlations between systemic disorders as independent variables and number of remaining teeth and the relative frequency of periodontal pockets of 5 mm or more, respectively, as the dependent variable. Results: The number of remaining teeth was significantly and positively correlated to the presence of cardiovascular disease, diabetes and rheumatoid disease after adjustment for age, sex and smoking. The relative frequency of diseased sites, however, was not significantly correlated to any one of the investigated systemic health disorders. Conclusion: No significant associations between investigated systemic disorders and periodontal disease severity were found if the relative frequency of deep periodontal pockets was used as the clinical parameter for periodontal disease severity. However, cardiovascular disease, diabetes and rheumatoid disease were found to be significantly correlated to number of lost teeth, which may represent one aspect of periodontal health. This result held true in nonsmokers only. Zusammenfassung Hintergrund: Während der letzten 10 Jahre wurden zahlreiche Studien publiziert, die auf einen Zusammenhang zwischen Parodontitis und verschiedenen systemischen Störungen und Erkrankungen hinweisen. Zielsetzung: Feststellung der Häufigkeit von selbst angegebenen systemischen Erkrankungen bei Patienten, die an eine parodontologische Spezialklinik zur Parodontitistherapie überwiesen worden waren, in einer retrospektiven Studie und Untersuchung möglicher Zusammenhänge zwischen allgemeiner Gesundheit und dem Schweregrad parodontaler Erkrankungen in dieser Bevölkerungsgruppe. Material und Methoden: Die Daten wurden aus den Behandlungsakten und Gesundheitsfragebögen von 1006 Personen gewonnen. Eine schrittweise multiple lineare Regressionsanalyse wurde verwendet, um Korrelationen zwischen systemischen Erkrankungen als unabhängigen Variablen und der Zahl verbliebener Zähne bzw. der relativen Häufigkeit parodontaler Taschen 5 mm als abhängigen Variablen zu berechnen. Ergebnisse: Nach Korrektur für Alter, Geschlecht und Rauchen war die Zahl verbliebener Zähne signifikant positiv mit Herz-Kreislauf-Erkrankungen, Diabetes und rheumatischen Erkrankungen korreliert. Die relative Häufigkeit erkrankter Stellen war allerdings mit keiner der untersuchten systemischen Erkrankungen korreliert. Schlussfolgerung: Wenn die relative Häufigkeit tiefer parodontaler Taschen als Maß für den Schweregrad parodontaler Erkrankung gewählt wurde, ließ sich keine Assoziation zwischen den untersuchten systemischen Erkrankungen und dem Parodontitisschweregrad zeigen. Allerdings waren Herz-Kreislauf-Erkrankungen, Diabetes und rheumatischen Erkrankungen signifikant mit der Zahl verlorener Zähne korreliert, die einen Aspekt parodontaler Gesundheit repräsentieren. Dieses Ergebnis ergab sich aber nur für Nichtraucher. Résumé Références et buts: Au cours des 10 dernières années, plusieurs études ont été publiées pour souligner une relation entre la maladie parodontale et diverses désordres ou maladies systémiques. Cette étude rétrospective se propose de rechercher l'apparition de désordres systémiques racontés par des patients adressés à une clinique spécialisée pour traitement parodontal et d'explorer de possibles relations entre la santé générale et la sévérité de la maladie parodontale dans cette population. Matériel et Méthodes: Les données furent récoltées des dossiers dentaires et des interrogatoires médicaux de 1006 sujets. Une analyse de régression multiple linéaire échelonnée a été utilisée pour calculer les corrélations entre les désordres systémiques en tant que variables indépendantes et le nombre de dents restantes et la fréquence relative de poches parodontales d'au moins 5mm, respectivement, comme variable dépendante. Résultats: le nombre de dents restantes était significativement et positivement corréléà la présence de maladies cardiovasculaires, de diabète et de maladie rhumatoïde après ajustement pour l'âge, le sexe, et le tabagisme. La relative fréquence de sites malades, cependant, n'était corrélée à aucun des désordres systémiques étudiés. Conclusion: Aucune association significative entre les désordres systémiques étudiés et la sévérité de la maladie parodontale ne fut trouvée lorsque la fréquence relative de poches parodontales profondes était utilisée comme paramètre clinique pour définir la sévérité de la maladie parodontale. Cependant, une maladie cardio-vasculaire, le diabète, une maladie rhumatoïde sont corrélées significativement au nombre de dents perdues qui peut être représentatif d'un aspect de santé parodontale. Ces résultats n'étaient valables que chez les non fumeurs. [source]

Accumulation of methylglyoxal in the gingival crevicular fluid of chronic periodontitis patients

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 4 2003
S. Kashket
Abstract Background, aims: Methylglyoxal (MG), a toxic product of cellular metabolism, is elevated in tissues and fluids in a number of human diseases. A cross-sectional study was undertaken to determine whether MG accumulates in the gingival crevicular fluid (GCF) of chronic periodontitis patients. Methods: GCF samples were collected for 30 s each from three teeth with pocket depths greater than 3 mm (DD sites), from 14 chronic periodontitis patients. Control samples were taken from three healthy sites (DH sites) in the same patients, as well as from seven subjects who were periodontally healthy (HH sites). Fluid volumes were determined and the strips were placed in 0.5 N perchloric acid. Subsequently, samples were derivatized with o -phenylenediamine and the resulting methylquinoxaline was assayed by high-performance liquid chromatography on Lichrospher® -100 RP-18, with UV detection. Results: Mean pocket depths were 5.7±0.7, 2.7±0.6 and 2.7±0.5 mm (mean±SD) for the DD, DH and HH sites, respectively. Mean MG levels were found to be 208.7±241.7 and 142.9±235.7 pmol/site in the GCF from DD and DH sites, respectively (p=0.0023), but only 11.5±4.4 pmol/site for the HH sites. Bacteroides forsythus has been found to accumulate high levels of MG in culture (unpublished data) and, consistent with this, the sampled diseased sites contained higher levels of B. forsythus than the corresponding healthy sites (2.7±4.2×105 versus 0.7±1.1×105, respectively; p=0.022). Total "red complex" microorganisms were significantly elevated in the DD sites. Conclusions: In view of the known protein- and DNA-modifying effects of MG, the finding of elevated levels of MG in the GCF from chronic periodontitis patients supports the hypothesis that MG may contribute to destructive tissue damage in this disease. Zusammenfassung Hintergrund: Methylglyoxal (MG), ein toxisches Produkt des Zellstoffwechsels, ist bei einer Reihe menschlicher Erkrankungen in Geweben und Körperflüssigkeiten erhöht. Zielsetzung: Querschnittsstudie zur Klärung der Frage, ob sich MG in der Sulkusflüssigkeit (SF) bei Patienten mit chronischer Parodontitis ansammelt. Methoden: Bei 14 Patienten mit chronischer Parodontitis wurde SF für 30 s an 3 Zähnen mit Sondierungstiefen >3 mm (DD-Stellen) gewonnen. Kontrollproben wurden von jeweils 3 gesunden Stellen (DH-Stellen) bei den gleichen Patienten und bei 7 parodontal gesunden Personen gewonnen (HH-Stellen). Die Flüssigkeitsvolumina wurden bestimmt und die Probenstreifen in 0,5 N Perchlorsäure gegeben. Anschließend wurden die Proben mit o-Phenyldiamin versetzt und das resultierende Methylquinoxalin wurde mittels High-Performance-Liquid-Chromatographie in einem Lichrospher®-100 RP-18 bei UV-Detektion nachgewiesen. Ergebnisse: Die mittleren Sondierungstiefen lagen bei 5,7±0,7, an den DD-Stellen, bei 2,7±0,6 (DH) und 2,7±0,5 mm (Mittelwert + Standardabweichung) (HH). Die mittleren MG-Spiegel lagen bei 208,7±241,7 an den DD-Stellen und bei 142,9±235,7 pmol/Stelle an den DH-Stellen (p=0,0023), aber nur bei 11,5±4,4 pmol/Stelle an den HH-Stellen. Es war gezeigt worden, dass Bacteroides forsythus in Kultur hohe Konzentrationen von MG ansammelt (unveröffentlichte Daten) und übereinstimmend damit wurden an den untersuchten DD-Stellen höhere Zahlen von B. forsythus gefunden als an den entsprechenden gesunden Stellen (2,7±4,2×105 versus 0,7±1,1×105; p=0,022). Die Zahl aller Keime des "Roten Komplexes" waren an DD-Stellen signifikant erhöht. Schlussfolgerungen: In Anbetracht der bekannten Proteine und DNS verändernden Effekte von MG unterstützt dieser Nachweis erhöhter MG-Spiegel in der SF bei Patienten mit chronischer Parodontitis die Hypothese, dass MG zur Gewebezerstörung bei Parodontitis beiträgt. Résumé Références et buts: Le méthylglyoxal (MG), un produit toxique du métabolisme cellulaire est retrouvé en quantitéélevée dans les tissus et les fluides lors de nombreuses maladies humaines. Une étude croisée fut réalisée pour déterminer si MG s'accumulait dans le fluide gingival (GCF) des patients atteints de parodontite chronique. Méthodes: Des échantillons de GCF furent prélevés pendant 30 secondes chacun de 3 dents avec des profondeurs de poches de plus de 3 mm (sites DD), chez 14 patients atteints de parodontites chroniques. Des échantillons contrôles furent prélevés sur des sites sains (sites DH) chez les mêmes patients, et aussi chez 7 sujets au parodonte sain (sites HH). Les volumes de fluide furent déterminés et les bandelettes ont été mises dans 0.5 N d'acide perchlorique. Puis, les échantillons furent transformés à l'aide de o-phenylenediamine et la méthylquinoxaline ainsi créée fut analysé par chromatographie liquide à haute performance sur une Lichrospher®-100 RP-18, avec détection aux UV. Résultats: Les profondeurs de poche moyenne étaient de 5.7 ± 0.7, 2.7 ± 0.6 et 2.7±0.5 mm (moyenne ± SD) pour les sites DD, DH et HH, respectivement. Les niveaux moyen de MG étaient de 208.7±241.7 et 142.9±235.7 pmol/site dans le fluide des sites in DD et DH, respectivement (p=0.0023), mais seulement de 11.5±4.4 pmol/site pour les sites HH. On a trouvé que Bacteroides forsythus accumulait de hauts niveaux de MG en culture (données non publiées) et les sites malades échantillonnés contenait effectivement de plus hauts niveaux de B. forsythus que les sites sains correspondants (2.7±4.2×105 contre 0.7±1.1×105, respectivement; p=0.022). Les microorganismes du complexe rouge étaient significativement en nombre élevé dans les sites DD. Conclusions: Au vu des effets connus de MG pour modifier les protéines et l'AND, la découverte de niveaux élevés de MG dans le fluide gingival de patients atteints de maladie parodontale chronique supporte l'hypothèse selon laquelle MG pourrait contribuer aux dommages tissulaires destructifs rencontrés au cours de cette maladie. [source]

A multiplex immunoassay demonstrates reductions in gingival crevicular fluid cytokines following initial periodontal therapy

JOURNAL OF PERIODONTAL RESEARCH, Issue 1 2010
D. 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]

Viruses in periodontal disease , a review

ORAL DISEASES, Issue 4 2005
I Cappuyns
The purpose of this review was to evaluate the evidence supporting the hypothesis that viral infection plays a role in the development of periodontitis. An involvement in periodontal diseases has been suspected specifically for human immunodeficiency virus (HIV) and herpes viruses. An association has been demonstrated between HIV infection and some distinct forms of periodontal infection, i.e. necrotizing lesions. Furthermore, reports of increased prevalence and severity of chronic periodontitis in HIV-positive subjects suggests that HIV infection predispose to chronic periodontitis. Several studies, most of them from the same research group, have demonstrated an association of herpesviruses with periodontal disease. Viral DNA have been detected in gingival tissue, gingival cervicular fluid (GCF) and subgingival plaque from periodontaly diseased sites. In addition markers of herpesviral activation have been demonstrated in the GCF from periodontal lesions. Active human cytomegalovirus (HCMV) replication in periodontal sites may suggest that HCMV re-activation triggers periodontal disease activity. Concerns regarding sampling, methods and interpretation cast doubts on the role of viruses as causes of periodontal disease. [source]