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.

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.

Association of rs142548867 (EEFSEC) and periodontitis Grade C in a young Brazilian population

Abstract Periodontitis Stage III-IV, Grade C (PerioC) is a severe form of Periodontitis. The individual genetic background has been shown to be an important etiopathogenic factor for the development of this disease in young, systemically healthy, and non-smokers patients. Recently, after exome sequencing of families with a history of the disease, PerioC was associated with three single nucleotide variations (SNVs) - rs142548867 (EEFSEC), rs574301770 (ZNF136), and rs72821893 (KRT25) - which were classified as deleterious or possibly harmful by prediction algorithms. Objective Seeking to validate these findings in a cohort evaluation, this study aims to characterize the allele and genotypic frequency of the SNVs rs142548867, rs574301770, and rs72821893 in the Brazilian population with PerioC and who were periodontally healthy (PH). Methodology Thus, epithelial oral cells from 200 PerioC and 196 PH patients were harvested at three distinct centers at the Brazilian Southern region, their DNA were extracted, and the SNVs rs142548867, rs574301770, rs72821893 were genotyped using 5′-nuclease allelic discrimination assay. Differences in allele and genotype frequencies were analyzed using Fisher's Exact Test. Only the SNV rs142548867 (C > T) was associated with PerioC. Results The CT genotype was detected more frequently in patients with PerioC when compared with PH subjects (6% and 0.5% respectively), being significantly associated with PerioC (odds ratio 11.76, p=0.02). Conclusion rs142548867 represents a potential risk for the occurrence of this disease in the Brazilian population.

Routine screening of Vitamin D status in patients with Aggressive Periodontitis - A cross sectional clinical study

Background: Periodontal diseases are characterized by the presence of bleeding, inflammation, sensitivity, discomfort, mobility and tooth loss. Plenty of studies supported the assumption that vitamin D deficiency might be a risk factor for periodontal diseases. Our study aimed to investigate the true association between serum vitamin D level and the presence of periodontal disease. Materials and methods: The study evaluated 40 patients (age group 19-35 years) attending the outpatient department, Department of Periodontics and Implantology, Govt. Dental College and Hospital, Srinagar, equally divided into two groups (Group I and Group II) according to the inclusion criteria. Group I included generalized aggressive periodontitis patients while Group II included non periodontitis patients. Clinical parameters and serum 25-hydroxyvitamin D level were assessed. Results: Serum vitamin D levels of periodontitis patients compared to non-periodontitis patients presented non statistically significant differences (p-value = 0.878). Conclusion: Although the serum vitamin D level in aggressive periodontitis patients was lower than the healthy controls but the difference seemed to be statistically insignificant and hence it can be concluded that the serum vitamin D deficiency is not a risk factor for periodontitis.

Gene polymorphisms of cytochrome B-245 alpha chain (CYBA) and cholesteryl ester transfer protein (CETP) and susceptibility to generalized aggressive periodontitis / 北京大学学报(医学版)

OBJECTIVE@#To explore the correlation of cytochrome B-245 alpha chain (CYBA) rs4673 and cholesteryl ester transfer protein (CETP) rs12720922 polymorphisms with the susceptibility of gene-ralized aggressive periodontitis (GAgP).@*METHODS@#The study was a case-control trial. A total of 372 GAgP patients and 133 periodontally healthy controls were recruited. The CYBA rs4673 and CETP rs12720922 polymorphisms were detected by matrix assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF-MS). Logistic regression models were used to analyze the correlation of CYBA rs4673 and CETP rs12720922 variants with the susceptibility of GAgP. The interaction between the two gene polymorphisms to the susceptibility of GAgP was analyzed by the likelihood ratio test. The interaction model adopted was the multiplication model.@*RESULTS@#The mean age of GAgP group and control group was (27.5±5.2) years and (28.8±7.1) years respectively. There was significant difference in age between the two groups (P < 0.05). The gender distribution (male/female) was 152/220 and 53/80 respectively, and there was no significant difference between GAgP group and controls (P>0.05). For CYBA rs4673, the frequency of CT/TT genotype in the GAgP group was significantly higher than that in the controls [18.0% (66/366) vs. 10.6% (14/132), P < 0.05]. After adjusting age and gender, the individuals with CT/TT genotype had a higher risk of GAgP (OR=1.86, 95%CI: 1.01-3.45, P < 0.05), compared with CC genotype. There was no statistically significant difference in distributions of the CETP rs12720922 genotypes (GG, AA/AG) between GAgP patients and healthy controls (P>0.05). A significant interaction between CYBA rs4673 and CETP rs12720922 in the susceptibility to GAgP was observed. The GAgP risk of the individuals with CYBA rs4673 CT/TT and CETP rs12720922 GG genotypes was significantly increased (OR=3.25, 95%CI: 1.36-7.75, P < 0.01), compared with those carrying CC and AA/AG genotypes.@*CONCLUSION@#CYBA rs4673 CT/TT genotype is associated with GAgP susceptibility. There is a significant interaction between CYBA rs4673 CT/TT genotype and CETP rs12720922 GG genotype in the susceptibility of GAgP.

Relación entre obesidad y enfermedades crónicas no transmisibles e infecciosas / Relationship between obesity and chronic non-communicable and infectious diseases

Introducción: la obesidad aumenta el riesgo a padecer de enfermedades crónicas no transmisibles (ECNT) y afecta el curso de enfermedades de origen infeccioso. Objetivo: examinar la literatura sobre cómo influye la obesidad en la gravedad del cuadro clínico de algunas de las enfermedades no transmisibles y transmisibles de mayor impacto en el Perú. Métodos: investigación documental. Se hace un análisis de contenidos de artículos y documentos de estudios desarrollados en diversos contextos asociados a la presencia de obesidad junto con infecciones o ECNT y en base de datos. Resultados: la condición de obesidad alcanzada por malos hábitos de consumo y baja actividad física, es la principal responsable del elevado índice de las ECNT y por consecuente de las tasas de mortalidad. Conclusiones: el exceso de peso afecta al sistema inmunológico, contribuyendo específicamente en los fenómenos exacerbados de respuesta inflamatoria sistémica, determinada por el aumento de secreción de adipocitoquinas, que predispone al organismo a desarrollar y contraer ECNT y enfermedades infecciosas. (AU)

Introduction: Obesity increases the risk of chronic non-communicable diseases (NCDs) and affects the course of diseases of infectious origin. Objective: Reviewing the literature on how obesity influences the severity of the clinical picture of some of the non-communicable and communicable diseases of greatest impact in Peru. Methods:Documentary research, from studies developed in various contexts associated with the presence of obesity along with infections or NCDs. Results: The condition of obesity reached by bad consumption habits and low physical activity is the main responsible for the high rate of NCDs, consequently, mortality. Conclusions: Excess weight affects the immune system, contributing specifically to exacerbated phenomena of a systemic inflammatory response, determined by increased secretion of adipocytokines, which predisposes the body to develop and contract NCDs and infectious diseases. (AU)

Influence of rs6667202 SNP on Interleukin-10 levels in the gingival fluid of patients with periodontitis grade C

Grade C periodontitis in youngers is characterized by a severe form of periodontitis, and IL10 rs6667202 single nucleotide polymorphism (SNP) has been described as an important feature in this disease etiology. Aim: This study aimed to evaluate, in vivo, the functionality of IL10 rs6667202 SNP on IL-10 gingival fluid levels. Methods: Thirty patients with Perio4C were selected, 15 with the IL10 AA genotype (rs6667202) and 15 with AC/CC genotypes. The gingival fluid was collected from two sites with probing depth ≥ 7 mm and bleeding on probing, and two healthy sites. The IL-10 concentration was determined by Luminex/MAGpix platform. Results: In deep pockets, the IL10 AA genotype presented a lower concentration of IL-10 when compared with AC or CC genotypes (p<0.05). In shallow pockets, no difference between groups was seen (p>0.05). Conclusion: IL10 rs6667202 SNP decreases the production of IL-10 in crevicular fluid, potentially affecting this disease progression

Regeneración tisular guiada potencializada con fibrina rica en plaquetas en paciente con periodontitis agresiva generalizada. Reporte de un caso / Regeneração tecidual guiada potencializada com fibrina rica em plaquetas em paciente com periodontite agressiva generalizada: relato de caso clínico / Guided tissue regeneration with fibrin rich platelet in aggressive periodontitis patient: case report

Resumen Los concentrados de plaquetas son sustancias bioactivas autólogas, que tienen utilidad clínica en la regeneración tisular guiada. Este articulo muestra el caso de un paciente diagnosticado con periodontitis agresiva generalizada, quien fue medicado con doxiciclina e intervenido quirúrgicamente en dos tiempos, en la primera intervención se eliminó el tejido de granulación y agentes infecciosos locales a través de un raspaje y alisado radicular a campo abierto, en la segunda intervención, se realizó regeneración tisular guiada con aloinjerto y fibrina rica en plaquetas. En la reevaluación posquirúrgica, se valoró los cambios clínicos y radiográficos, observándose una disminución de la profundidad al sondaje, una mejoría en el nivel de inserción clínico y relleno óseo radiográfico cuando se compararon los datos basales y de seguimiento hasta por cuatro meses.

Abstract Platelet concentrates are autologous bioactive substances that have which has an important role clinical in the periodontal tissue regeneration. This article shows the case of a patient the patient had been diagnosed with aggressive periodontitis. The patient was treated by pharmacotherapy (docycline) and he underwent double surgeries. In the first surgical intervention was scaling and root planing with additional soft- tissue curettage. And the second surgical, tissue guided regeneration was performed using allograft and platelet rich plasma. Treatment generated satisfactory clinical outcomes in terms of probing depth reduction, clinical attachment level gain and radiographic bone fill. The data were recorded at base line, reevaluation, and 4 months post-surgery.

Resumo Os concentrados de plaquetas são substâncias bioativas autólogas que têm utilidade clínica na regeneração do tecido periodontal. Este artigo mostra o caso de um paciente diagnosticado com periodontite agressiva generalizada, medicado com doxiciclina e submetido a duas cirurgias. Na primeira intervenção, o tecido de granulação e os agentes infecciosos locais foram eliminados por raspagem em campo aberto e, na segunda intervenção, foi realizada regeneração tecidual guiada com aloenxerto e fibrina rica em plaquetas. Na reavaliação pós-cirúrgica, as alterações clínicas e radiográficas foram avaliadas, observando-se redução da profundidade da bolsa, melhor nível de inserção e preenchimento ósseo radiográfico quando comparados os dados basais e de acompanhamento por até quatro meses.

Comprehensive periodontal treatment in generalized stage IV, grade C periodontitis: a clinical case report / Tratamento periodontal abrangente em periodontite generalizada estágio IV, grau C: relato de caso clínico

Generalized stage IV, grade C periodontitis results in rapid bone destruction in the periodontium and can lead to early tooth loss. Scaling and root planing (SRP) complemented by systemic antibiotics, access surgery, regenerative techniques and implant placement are among the treatments used for patients with this condition. The aim of this article is to report a comprehensive periodontal treatment in a 23-year-old male who was referred to the periodontology department due to complaints of tooth mobility and gum infections diagnosed with generalized stage IV, grade C periodontitis according to the clinical, systemic, and family history features observed. Thorough non-surgical periodontal treatment consisting of scaling and root planing was provided, followed by a series of regenerative periodontal surgeries including guided tissue regeneration (GTR) and guided bone regeneration(GBR) to manage advanced bone defects. Six months after periodontal therapy, all implants were inserted using a one-stage approach and Six months later, they were restored with porcelain fused to metal crowns. During the one and two-year follow-ups, the teeth and implants did not show any signs of instability, attachment loss or bone loss. This case report shows that within the limitations of this study a successful outcome can be achieved with an early diagnosis and treatment involving elimination of infectious microorganisms and meticulous long-term maintenance combined with regenerative techniques and implant placement to restore the masticatory function and improve the quality of life for the patient. However further investigation and clinical studies are required to confirm these results (AU)

A periodontite generalizada estágio IV, grau C resulta em rápida destruição óssea do periodonto, podendo levar à perda dentária precoce. Raspagem e aplainamento radicular (SRP) complementada com antibióticos sistêmicos, acessos cirúrgicos, técnicas regenerativas e colocação de implantes estão entre os tratamentos usados para essa condição. O objetivo deste artigo é relatar o tratamento periodontal abrangente de um paciente de 23 anos, que foi encaminhado ao departamento de periodontia com queixas de mobilidade dentária e infecções gengivais, diagnosticado com periodontite generalizada estágio IV, grau C de acordo com as características clínicas, sistêmicas e de histórico familiar observadas. O tratamento periodontal não cirúrgico completo de raspagem e aplainamento radicular foi realizado, seguido por cirurgias periodontais regenerativas, incluindo regeneração tecidual guiada (GTR) e regeneração óssea guiada (GBR) para tratar defeitos ósseos avançados. Seis meses após a terapia periodontal, todos os implantes foram inseridos através de abordagem de estágio único e, seis meses depois, foram restaurados com porcelana fundida às coroas de metal. Durante os acompanhamentos de um e dois anos, os dentes e implantes não mostraram quaisquer sinais de instabilidade, perda de inserção ou perda óssea. Este relato mostra que, dentro das limitações deste estudo, um resultado bem-sucedido pode ser alcançado a partir de diagnóstico precoce e tratamento envolvendo a eliminação de microrganismos e manutenção meticulosa à longo prazo, combinada com técnicas regenerativas e colocação de implantes para restaurar a função mastigatória e melhorar a qualidade de vida do paciente. No entanto, mais investigações e estudos clínicos são necessários para confirmar esses resultados (AU)

High-throughput sequencing analysis of the microbiota of subgingival plaque in patients with periodontitis / 口腔疾病防治

Objective @# To detect the composition of the subgingival microbiota in generalized aggressive periodontitis (GAgP) and severe chronic periodontitis (SCP) patients tested by high-throughput sequencing (HTS) technologies, analyze its diversity and function by using bioinformatics, and observe changes in the subgingival microbiota before and after periodontal initial therapy.@* Methods@#Eleven patients with GAgP and 14 patients with SCP who visited the Department of Periodontics in Stomatological Hospital of Kunming Medical University from September 2018 to May 2019 were recruited, and subgingival plaque samples were collected at baseline and 6 weeks after initial therapy. Then, the genomic DNA was distracted and sequenced by the Illumina MiSeq high-throughput sequencing platform. QIIME (quantitative insights in microbial ecology), Mothur, SPSS and other software were used to analyze community information. LEfSe difference analysis (linear discriminant analysis effect size), network analysis, and the KEGG PATHWAY database (https://www.kegg.jp/kegg/pathway.html) were used to predict community function. @* Results @# At baseline, the dominant microbiota of GAgP and SCP patients were similar, including Bacteroidetes, Porphyromonas and Porphyromonas endodontalis. Six weeks after initial therapy, as the periodontal pocket became shallower, the variation trend of the microbiota of GAgP and SCP patients was similar. The relative abundance of gram-negative bacteria, such as Bacteroidetes, Porphyromonas and Porphyromonas endodontalis, decreased, while the relative abundance of gram-positive bacteria, such as Proteobacteria, Actinomyces and Rothia aeria, increased. Actinobacteria were significantly increased biomarkers of the subgingival microbiota in GAgP after treatment. Streptococcus is an important genus that connects the microbiota related to periodontitis and the microbiota related to periodontal health. Community function prediction result showed that initial treatment can reduce the functions of amino acid metabolism, methane metabolism, and peptidase in GAgP and SCP patients.@*Conclusion@#The subgingival microbiota of GAgP and SCP patients are similar. Streptococcus, as an early colonizer, may play an important role in promoting plaque biofilm formation and maturation in the process of subgingival flora from health to imbalance. Initial therapy can change the composition and structure of the subgingival microbiota, reduce community diversity, and reduce the functions of amino acid metabolism, methane metabolism, and peptidase in GAgP and SCP patients.

Association between root abnormalities and related pathogenic genes in patients with generalized aggressive periodontitis / 北京大学学报(医学版)

OBJECTIVE@#To explore the association between the abnormal root morphology and bone metabolism or root development related gene polymorphism in patients with generalized aggressive periodontitis.@*METHODS@#In the study, 179 patients with generalized aggressive periodontitis were enrolled, with an average age of (27.23±5.19) years, male / female = 67/112. The average number of teeth remaining in the mouth was (26.80±1.84). Thirteen single nucleotide polymorphisms (SNPs) of nine genes which related to bone metabolism and root development were detected by matrix assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF-MS). Root abnormalities were identified using periapical radiographs. The abnormal root morphology included cone-rooted teeth, slender-root teeth, short-rooted teeth, curved-rooted teeth, syncretic-rooted molars, and molar root abnormalities. The number of teeth and incidence of abnormal root morphology in different genotypes of 13 SNPs were analyzed.@*RESULTS@#The constituent ratio of root with root abnormality in GAgP patients was 14.49%(695/4 798). The average number of teeth with abnormal root morphology in GAgP was (3.88±3.84). The average number of teeth with abnormal root morphology in CC, CT and TT genotypes in vitamin D receptor (VDR) rs2228570 was (4.66±4.10), (3.71±3.93) and (2.68±2.68). There was significant difference between TT genotype and CC genotype (t = 2.62, P =0.01). The average number of root morphological abnormalities in CC, CT and TT genotypes of Calcitotin Receptor (CTR) gene rs2283002 was (5.02±3.70), (3.43±3.95), and (3.05±3.12). The incidence of root morphological abnormalities in CC genotype was higher than that in the patients with CT and TT, and the difference was statistically significant(87.86% vs. 65.26% & 63.64%, P=0.006, adjusted OR =3.71, 95%CI: 1.45-9.50). There was no significant difference in the incidence of abnormal root morphology between CT and TT genotypes.@*CONCLUSION@#VDR rs2228570 and CTR rs2283002 may be associated with the occurrence of abnormal root morphology in patients with generalized aggressive periodontitis, which is worthy of further research.

Impact of history of periodontitis on gene expression of bone-related factors in young patients

Abstract Although dental implants and bone regenerative procedures are important approaches for the reestablishment of esthetics and function in young patients with a history of generalized aggressive periodontitis (GAP), no predictable outcomes have been reported, and the host osteo-immunoinflammatory response may play a relevant role in this context. In view of the lack of molecular investigations into the bone tissue condition of young patients with periodontitis, the aim of this study was to evaluate the gene expression of bone-related factors in this population. Bone biopsies were obtained from the posterior mandible in 16 individuals previously diagnosed with GAP and on periodontal support therapy and from 17 periodontally healthy (PH) patients. The gene expression of tumor necrosis factor (TNF)-α, transforming growth factor (TGF)-β, receptor activator of the NF-κB ligand (RANKL), osteoprotegerin (OPG), osteocalcin (OC), bone sialoprotein (BSP), and type I collagen (COL-I), important biomarkers of bone turnover, was evaluated by qRT-PCR. Lower TGF-β and OPG mRNA levels were observed in GAP patients compared to PH individuals (p ≤ 0.05). There were no between-group differences in levels of TNF-α, BSP, RANKL, OC, or COL-I mRNA (p>0.05). In young adults, a history of periodontal disease can negatively modulate the gene expression of important bone-related factors in alveolar bone tissue. These molecular outcomes may contribute to the future development of therapeutic approaches to benefit bone healing in young patients with history of periodontitis via modulation of osteo-immuno-inflammatory biomarkers.

A study of susceptibility genes in rare monozygotic twins with generalized aggressive periodontitis / 口腔疾病防治

Objective@#Exploring the effects of susceptibility genes on aggressive periodontitis during its occurrence and development lays a foundation for further research on its genetic pathogenesis.@*Methods@#Medical history and clini⁃ cal indicators were collected from monozygotic twins with generalized aggressive periodontitis. Susceptibility genes were detected by polymerase chain reaction⁃restriction fragment length polymorphisms, and the exon gene components were analyzed by whole⁃exome sequencing. @*Results @#The severity of generalized aggressive periodontitis in the twins was dif⁃ ferent (P < 0.05). Florida diagnosis results showed that the younger sister’ s explored clinical depth (probing depth, PD) and clinical attachment loss (CAL) were higher than those for the elder sister, but her clinical bleeding index (bleeding on probing, BOP) was lower than that of the elder sister. In addition, their responses to periodontal basic treatment were different (P < 0.05). After treatment, the improvement of CAL and decline in BOP were more obvious in the elder sister,and the proportion of different periodontal pocket depths in the elder sister decreased after treatment, while the de⁃ crease was slighter in the younger sister. Genetic tests revealed that the twins had the same genotypes at target suscepti⁃ bility genes (IL⁃1β⁃511, IL⁃1β+3953, TNF⁃α⁃308, FcγR⁃IIIb, VDR, and ER) and differential exon gene components, and that the suspected differential genes, e.g. ZFPM1, PTH2, ZFYVE16, and LY6G6C, might be related to their pheno⁃ typic differences.@* Conclusion@#These monozygotic twins had different phenotypes of generalized aggressive periodonti⁃ tis. Their shared susceptibility genes increased the risk of disease, and their different genetic mutations affected the phe⁃ notype of the disease

Influential factors related to the long-term effect of periodontal-orthodontic treatment in patients with aggressive periodontitis and malocclusion / 中华口腔医学杂志

Objective@#To investigate the influential factors related to the long-term effect of periodontal-orthodontic treatment in patients with aggressive periodontitis (AgP).@*Methods@#A retrospective analysis was conducted in 25 AgP patients, who have received periodontal-orthodontic treatment in Peking University School and Hospital of Stomatology. Changes in the ratio of the residual alveolar bone height (RBH) was measured at three time points: baseline (T0), post orthodontic treatment (T1), and the last re-visit 3 years after orthodontic treatment (T2). Root abnormity was evaluated by observing periapical radiographs, and its relationship with alveolar bone loss after orthodontic treatment was analyzed. A multi-level analysis on factors related to the clinical outcome (alveolar bone height change) was performed.@*Results@#Totally 693 teeth of 25 patients at T0 and T1 and 368 teeth of 14 patients at T2 were investigated. During the periodontal-orthodontic treatment, the RBH was mainly influenced by root abnormity (estimation value −2.392), tooth position (estimation value for upper teeth vs. lower teeth 3.139, and anterior teeth vs. posterior teeth −3.469) and the baseline RBH at T0 (estimation value −0.391) (P<0.05). Teeth with root abnormity, teeth in mandibular and anterior area, and teeth with higher RBH showed less change in T1-T0 RBH values. In the long-term follow-up, RBH was mainly influenced by tooth position (estimation value for upper teeth vs. lower teeth 3.735, and anterior teeth vs. posterior teeth −5.318), the baseline RBH and probing depth (PD) at T0. Teeth in mandibular and anterior area, teeth with higher RBH (estimation value -0.498) and PD (estimation value -1.594) (P<0.05) showed less change in T0-T2 RBH values.@*Conclusions@#During orthodontic treatment, teeth with abnormal root, lower teeth, anterior teeth, and teeth with high RBH were unfavorable factors for bone gain. In the long-term observation, lower teeth, anterior teeth, teeth with high RBH and PD at first visit were unfavorable factors for bone gain.

Clinical and microbiological evaluation of surgical and nonsurgical treatment of aggressive periodontitis

Abstract The present study aimed to evaluate clinical and microbiological effects of surgical and nonsurgical periodontal therapy in generalized aggressive periodontitis (GAgP) treatment. Sixteen GAgP patients were included in this randomized split-mouth design clinical trial. Maxillary quadrants were allocated into two groups: Nonsurgical Therapy (NST) and Surgical Therapy (ST). The following clinical parameters were assessed: plaque index (PI), bleeding on probing index (BoP), probing depth (PD), clinical attachment level (CAL) and gingival margin position (GMP). Concentrations of Porphyromonas gingivalis (Pg) and Aggregatibacter actinomycetemcomitans (Aa) in the subgingival biofilm were also determined. Clinical and microbiological parameters were assessed at baseline (n=16), 3 (n=15), 6 (n=15) and 12 months (n=8) after treatment. ST was able to promote higher PD reduction compared to NST in deep pockets at 12 months (p<0.05) and in posterior teeth at 6 months (p<0.05). In addition, higher gingival recession was observed in posterior teeth of the ST group at the 6th month (p<0.05). However, ST failed to promoted additional CAL gain in any timepoint (p>0.05). Moreover, microbiological evaluation showed no statistical difference in levels of Aa and Pg for both groups at all follow-up periods. Surgical therapy promoted similar clinical benefits to GAgP therapy. Moreover, both therapies failed to reduce Aa and Pg levels at different follow-up times.

Resumo O presente estudo teve como objetivo avaliar os efeitos clínicos e microbiológicos de terapia periodontal cirúrgica e não cirúrgica no tratamento da periodontite agressiva generalizada (PAgG). Dezesseis pacientes portadores de PAgG foram incluídos neste estudo clínico, prospectivo, randomizado, de boca dividida. Os quadrantes superiores de cada paciente foram alocados em dois grupos: um grupo de terapia não-cirúrgica (NST) e um grupo de terapia cirúrgica (ST). Os parâmetros clínicos avaliados foram: índice de placa (PI), sangramento à sondagem índice (BoP), profundidade de sondagem (PD), nível clínico de inserção (CAL) e posição da margem gengival (GMP). Também foram determinadas as concentrações de Porphyromonas gingivalis (Pg) e Aggregatibacter actinomycetemcomitans (Aa) no biofilme subgengival. Os parâmetros clínicos e microbiológicos foram avaliados no início, 3, 6 e 12 meses após o tratamento. A terapia cirúrgica foi capaz de promover maior redução de PD em comparação com NST em bolsas profundas aos 12 meses (p<0,05) e em dentes posteriores aos 6 meses (p<0,05). Além disso, houve maior recessão gengival nos dentes posteriores do grupo ST no 6° mês (p<0,05). Entretanto, ST não promoveu ganho adicionais de inserção (CAL) em nenhum período do avaliação. A avaliação microbiológica não mostrou diferença estatística nos níveis de Aa e Pg, para ambos os grupos, em todos os períodos de acompanhamento. O tratamento cirúrgico promoveu benefícios clínicos similares ao tratamento não cirúrgico em pacientes com PAgG. Além disso, ambas as terapias não conseguiram reduzir os níveis Aa e Pg após terapia.

Effect of non-surgical periodontal therapy on stress and salivary Chromogranin-A levels: A clinico-biochemical study

Aim: The aim of the study was to compare chromogranin A (CgA) and stress levels before and after non-surgical periodontal therapy (NSPT). Materials and Methods: A sample of 40 patients in the age range 25–60 years were included in the study and were divided into gingivitis (10 subjects), chronic periodontitis (CP) (15 patients) and aggressive periodontitis (AgP) (15 patients). The patients were asked to complete two sets of stress questionnaires, plaque index, gingival index, probing depth and clinical attachment levels (CAL) were recorded. Salivary samples were taken at baseline and were repeated three months post NSPT. Results: CgA was detected in saliva samples of all the groups. A statistically significant correlation was established between levels of CgA and stress parameters, which was shown to be the highest in AgP (P < 0.001), followed by CP group (P < 0.005) at baseline. Following NSPT, an overall reduction was observed in the levels of CgA, which was correlated with the overall reduction in stress levels for AgP group (P < 0.005) followed by CP group (P < 0.037). Amongst the clinical parameters, CAL showed the strongest correlation with CgA both at baseline and after NSPT (P < 0.001). Conclusion: Stress was directly correlated to the levels of salivary CgA levels, which was the highest for aggressive periodontitis at baseline. NSPT showed a marked improvement in all the parameters. Levels of CgA and CAL showed a significant correlation in both the CP and AgP groups.

Terapia periodontal de suporte em paciente com periodontite agressiva generalizada: acompanhamento clínico e radiográfico de 13 anos / Periodontal maintenance therapy in patient with generalized aggessive periodontitis: clinical and radiographic following by 13 years

A terapia periodontal de suporte (TPS) tem como objetivo principal a manutenção dos resultados obtidos durante o tratamento periodontal ativo, sendo a forma mais previsível de controlar a doença periodontal. Essa extensão do tratamento periodontal, pode ocorrer em intervalos de tempo que variam de acordo com a severidade da doença, condição sistêmica do indivíduo, idade, fatores de risco, entre outros. A TPS contribui para a redução da perda dentária e recorrência da doença periodontal, além de possibilitar o diagnóstico de outras doenças bucais. Durante essa etapa, é possível traçar o perfil do paciente, identificar suas dificuldades e estabelecer condutas educativas, preventivas e terapêuticas necessárias para o controle do biofilme e da doença periodontal. Assim, o periodontista deve conscientizar o paciente sobre a importância da TPS, sendo que, a adesão ao tratamento é fundamental para a manutenção da saúde dos tecidos periodontais a longo prazo. O presente relato de caso clínico, demonstra o sucesso da TPS em paciente jovem acometida por periodontite agressiva generalizada. Após a realização da terapia periodontal não cirúrgica, a paciente foi inserida em um programa de manutenção periodontal, há 13 anos atrás, no qual participa ativamente até o presente momento. (AU)

The main objective of the periodontal maintenance therapy (PMT) is to maintain the results achieved during the active periodontal therapy, being the most predictable way of controlling the periodontal disease. This extension of the periodontal treatment may occur at different times, varying according to the aggressiveness of the disease, general health condition of the subject, age and risk factors, among others. The PMT contributes to the reduction of dental loss and prevents the reoccurrence of the periodontal disease, while also allowing the diagnose of other diseases of the mouth. During this phase it is possible to trace the patient's profile, identifying the difficulties and stablishing educational, preventive and therapeutic practices to control oral biofilm and periodontal disease. Thus, the periodontist must raise the patient's awareness to the importance of the PMT, as the patient compliance to the treatment is essential for the long term preservation of the periodontal tissue health. The clinical case here described demonstrates the success of the PMT performed on a young female patient afflicted with generalized aggressive periodontitis. After having performed the non-surgical periodontal therapy, the patient entered a periodontal maintenance program 13 years ago, in which she has been actively participating until the present time.(AU)

Tratamento ortodôntico em pacientes com periodontite agressiva: considerações clínicas / Orthodontic treatment in patients with aggressive periodontitis: clinical considerations

O objetivo desse trabalho foi confrontar as abordagens dos tratamentos envolvendo periodontite agressiva e ortodontia através de uma revisão de literatura baseada em artigos de condutas clínicas. Foi realizada uma busca na base de dados PubMed, retroativa a 10 anos e utilizando palavras-chave Mesh. Ao final da seleção, resultaram 13 artigos de casos clínicos e um artigo com uma série de casos. A maioria envolveu pacientes jovens e mulheres, e todos realizaram tratamento periodontal e ortodôntico para controle da periodontite agressiva. A perda óssea severa não contraindica o uso de aparelho ortodôntico, e a movimentação dentária associada com um intenso controle periodontal apresenta-se como uma forma de sucesso no tratamento da doença.

The aim of this study was to elucidate treatment approaches involving aggressive periodontitis and orthodontics through a literature review based on articles of clinical procedures. A search was conducted in PubMed database using MeSH key words and limited to the past 10 years. The appropriate studies were selected and resulted in 13 papers of single case reports and one paper including four case reports. The majority of the cases involved young patients and women, and all underwent orthodontic and periodontal treatment to control aggressive periodontitis. Severe bone loss does not contraindicate the use of braces and tooth movement together with an appropriate periodontal control presents a way to successfully treat the disease.

Impact of aggressive periodontitis and chronic periodontitis on oral health-related quality of life

Abstract The purpose of this cross-sectional study was to investigate the effect of different forms of periodontal diseases on Oral Health-Related Quality of Life (OHRQoL). Fifty-two patients with Aggressive Periodontitis (AP) or Chronic Periodontitis (CP) were included: nine patients with Localized Aggressive Periodontitis (LAP), thirty-three patients with Generalized Aggressive Periodontitis (GAP) and ten patients with Generalized Chronic Periodontitis (GCP). Oral Health Impact Profile questionnaires (OHIP-14) were distributed after a clinical examination that measured the following periodontal parameters: tooth loss, bleeding on probing (BoP), probing depth (PD), gingival recession (REC) and clinical attachment level (CAL). The global OHIP-14 score means were 10.6 for LAP, 16.5 for GAP, and 17.5 for GCP. A statistically significant difference (p < 0.01) was observed between the LAP group and the other two groups. There was significantly less bleeding and recession in the LAP group than in the patients with the generalized forms of periodontitis. LAP, GAP and GCP have an impact on patient quality of life when measured using the OHIP-14. Patients with GAP and GCP had poorer OHRQoL than LAP patients.

Expression profile of long non-coding RNA in gingival tissues from the patients with aggressive periodontitis / 中华口腔医学杂志

Objective@#To detect and analyze the differential expression profile of long non-coding RNA (lncRNA) in aggressive periodontitis (AgP) and healthy gingival tissues, in order to explore the role of lncRNA in AgP.@*Methods@#After the informed consents were obtained, gingival tissues from AgP patients (n=40) and healthy volunteers (n=40) were collected in Department of Periodontology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine (from Mar. 2012 to Aug. 2012) and Department of Periodontology, Hospital of Stomatology, Tianjin Medical University (from Oct. 2016 to Apr. 2017). The differential expression of lncRNA of tissues from AgP patients (n=20) and healthy volunteers (n=20) were examined via microarray assay. Bioinformatics was applied to analyze the expression data of lncRNA and correlative mRNA. Two lncRNAs (lncRNA-TNFRSF13C and lncRNA-API5) were chosen to verify the microarray results by using real time quantitative polymerase chain reaction (PCR) in the other gingival tissues.@*Results@#Compared with the result of healthy gingival tissues, totally 8 632 lncRNAs were differentially expressed in tissues from AgP patients. From these data, 1 986 lncRNAs were significantly upregulated while 6 646 lncRNAs were downregulated, amongst which 48 lncRNAs were upregulated (>10 times) (P<0.05), 14 lncRNAs were downregulated (>10 times) (P<0.05). Furthermore, totally 5 519 correlative mRNAs were differentially expressed, amongst which 1 676 mRNAs were upregulated (≥2 times, P<0.05) and 3 843 mRNAs were downregulated≤0.5 (P<0.05). The selected lncRNA-TNFRSF13C and lncRNA-API5 were up-regulated in AgP (P<0.05), which confirmed the results of microarray. From bioinformatics, differential expression lncRNAs were in association with many signal pathways including toll-like receptor signaling pathway, cell cycle and apoptosis pathway, and tumor necrosis factor receptor superfamily pathway.@*Conclusions@#LncRNA may be involved in the pathogenesis of AgP through various pathways, which need to be further explored.