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.

Características clínicas y microbiológicas de pacientes con periodontitis agresiva generalizada / Clinical and microbiological characteristics of a patients with generalized aggressive periodontitis

RESUMEN: Objetivo: el objetivo de este estudio es describir las características clínicas y microbiológicas de una muestra de pacientes diagnosticados con periodontitis agresiva generalizada (PAgG). Materiales y métodos: En este estudio de corte transversal, 20 sujetos menores de 30 años con PAgG atendidos en las clínicas odontológicas de la Universidad de Antioquia en Medellín Colombia, fueron invitados a participar entre diciembre del 2015 y marzo del 2017, las muestras microbiológicas fueron analizadas usando técnicas de cultivo y tomadas en los seis sitios más profundos de cada paciente (≥ 5mm). Resultados: Prevotella ssp y F. nucleatum fueron detectados en altos porcentajes, Porphyromonas gingivalis (P.g) fue positivo para la mitad de los sujetos estudiados; además de los microorganismos comúnmente estudiados, el 10% de los pacientes fueron positivos para bacilos entéricos gram-negativos. Conclusiones: se observaron grandes proporciones de microorganismos que incluyeron Prevotella spss y F. nucleatum; el 10% de los pacientes fueron positivos para bacilos entéricos gram-negativos.

ABSTRACT: Aim: The aim of this study is to describe the clinical and microbiological characteristics of a sample of patients diagnosed with generalized aggressive periodontitis (PAgG). Materials and methods: In this cross-sectional study, 20 subjects under 30 years of age with PAgG treated at the dental clinics of the University of Antioquia in Medellín, Colombia were invited to participate between December 2015 and March 2017, the microbiological samples analyzed using culture techniques were taken at the six deepest sites of each patient (≥ 5mm). Results: Prevotella ssp and F. nucleatum were detected in high percentages, Porphyromonas gingivalis (P.g) was positive for half of the studied subjects; In addition to the microorganisms commonly studied, 10% of the patients were positive for gram-negative enteric bacilli. Conclusions: large proportions of microorganisms were observed, including Prevotella spss and F. nucleatum; 10% of the patients were positive for gram-negative enteric bacilli.

Generalized aggressive periodontitis: microbiological composition and clinical parameters in non-surgical therapy / Periodontitis agresiva generalizada: composición microbiológica y parámetros clínicos en la terapia no quirúrgica

The aim of this study was to determine the variations in periodontal parameters and microbiological composition in periodontal pockets at the baseline and 3 and 6 months posttreatment in patients with Generalized Aggressive Periodontitis (GAP) undergoing nonsurgical periodontal treatment combined with chlorhexidine and systemic antibiotics. Medical and dental history was taken from 10 subjects, average age 30.62.7 years, diagnosed with GAP. A nonsurgical periodontal treatment combined with 0.12% chlorhexidine, 875 mg amoxicillin and 500 mg metronidazole every 12 hours for ten days was conducted. At each visit, the following measurements were recorded: bacterial plaque (BP), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), hypermobility, and furcation lesions, and a sample of subgingival plaque was taken from the site of the deepest probing depth of each sextant to identify Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, Prevotella intermedia and Aggregatibacter actinomycetemcomitans using molecular biology techniques. After 6 months, the Wilcoxon test showed an increase of 0.97 mm in CAL (p=0.0047) and 2.54 mm in PD (p=0.009). A healthy site was defined as having a PD <5 mm, negative BOP and no pathogenic bacteria detected at 6 months, indicating significant improvement (p=0.008), with OR (95% CI) =4.7 (1.102220.11). With the treatment protocol used in this study, 6 months after treatment, patients had an approximately 4fold higher possibility of presenting PD <5 mm and periodontal pockets without periodontal pathogenic bacteria.

En este trabajo, nos propusimos determinar las variaciones de los parámetros periodontales y la composición microbiológica de las bolsas periodontales al inicio, a los 3 y 6 meses después del tratamiento en pacientes con periodontitis agresiva generalizada (GAP), sometidos a tratamiento periodontal no quirúrgico combinado con clorhexidina y antibióticos sistémicos. Se elaboró historia médica y dental en 10 sujetos, con una edad media de 30,6 2,7 años, con diagnóstico de GAP. Se les practicó tratamiento periodontal no quirúrgico combinado con clorhexidina al 0,12%, 875 mg de amoxicilina y 500 mg de metronidazol. Los antibióticos se prescribieron cada 12 horas durante diez días. Se registraron: la placa bacteriana (BP), sangrado al sondaje (BOP), la profundidad de sondaje (PD), el nivel de inserción clínica (NIC), hipermovilidad y lesiones de furcación. En cada visita, se tomaron las mediciones, y se tomó una muestra de la placa subgingival en sitio de la mayor profundidad al sondaje en cada sextante para identificar mediante técnica de biología molecular: Porphyromonas gingivalis, Treponema denticola, forsythia Tannerella, Prevotella intermedia, y Aggregatibacter actinomycetemcomitans. Después de 6 meses, el análisis de la prueba de Wilcoxon mostró un aumento de 0,97 mm de CAL (p = 0,0047) y 2,54 mm en la PB (p = 0,009). Se definió sitio sano, cuando se determinó un PD <5 mm, BOP negativo, y no se detectaron bacterias patógenas a los 6 meses, lo que indicó una mejora significativa (p = 0,008), con (IC 95%) = 4,7 (1,1022 a 20,11). Con el protocolo de tratamiento presentado, es posible especular que a los 6 meses después del tratamiento, un paciente puede tener aproximadamente 4 veces más posibilidades de presentar una PD<5 mm y bolsillos periodontales sin bacterias patógenas.

Periodontite agressiva: conceito e considerações clínicas / Aggressive periodontitis: concept and clinical considerations

A periodontite agressiva (PAg) é uma das formas mais severas da doença periodontal (DP), tendo como característica o início precoce, a rápida instalação, a perda de inserção e a destruição óssea por agentes etiológicos diversificados, como presença de periodontopatógenos altamente virulentos, em contrapartida à quantidade inconsistente de biofilme bacteriano e à susceptibilidade genética do hospedeiro. O sucesso da intervenção terapêutica é dependente de um diagnóstico precoce, seu tratamento não possui protocolos específicos, mas há uma busca por respostas e tratamentos mais eficientes no controle da doença. Diante disso, esse estudo teve por objetivo realizar uma revisão de literatura sobre a PAg, abordando protocolos de tratamento, sua etiologia microbiana, susceptibilidade do indivíduo e envolvimento imunológico e genético associado à doença.

Long-term evaluation of the antimicrobial susceptibility and microbial profile of subgingival biofilms in individuals with aggressive periodontitis

This study evaluates the antimicrobial susceptibility and composition of subgingival biofilms in generalized aggressive periodontitis (GAP) patients treated using mechanical/antimicrobial therapies, including chlorhexidine (CHX), amoxicillin (AMX) and metronidazole (MET). GAP patients allocated to the placebo (C, n = 15) or test group (T, n = 16) received full-mouth disinfection with CHX, scaling and root planning, and systemic AMX (500 mg)/MET (250 mg) or placebos. Subgingival plaque samples were obtained at baseline, 3, 6, 9 and 12 months post-therapy from 3–4 periodontal pockets, and the samples were pooled and cultivated under anaerobic conditions. The minimum inhibitory concentrations (MICs) of AMX, MET and CHX were assessed using the microdilution method. Bacterial species present in the cultivated biofilm were identified by checkerboard DNA-DNA hybridization. At baseline, no differences in the MICs between groups were observed for the 3 antimicrobials. In the T group, significant increases in the MICs of CHX (p < 0.05) and AMX (p < 0.01) were detected during the first 3 months; however, the MIC of MET decreased at 12 months (p < 0.05). For several species, the MICs significantly changed over time in both groups, i.e., Streptococci MICs tended to increase, while for several periodontal pathogens, the MICs diminished. A transitory increase in the MIC of the subgingival biofilm to AMX and CHX was observed in GAP patients treated using enhanced mechanical therapy with topical CHX and systemic AMX/MET. Both protocols presented limited effects on the cultivable subgingival microbiota.

Periodontite agressiva localizada: considerações sobre etiopatogenia e tratamento / Localized aggressive periodontitis: aspects of etiopathogenesis and treatment

A periodontite agressiva localizada (PAL) é uma doença caracterizada pela destruição periodontal agressiva em dentes específicos, de agregação familiar, geralmente afetando a população jovem, principalmente os afrodescendentes. Apesar da baixa prevalência, o diagnóstico precoce desta doença é difícil, especialmente na dentição decídua, o que geralmente resulta em sua rápida progressão e eventual perda precoce de importantes dentes da cavidade oral. Até o presente momento, a maior parte dos estudos realizados tem envolvido populações pequenas, devido à dificuldade em se obter grandes populações com esta doença. Entretanto, há evidências científicas de espécies bacterianas e vírus associados à PAL, bem como de respostas imunológicas específicas associadas com indivíduos ou famílias de indivíduos afetados pela doença. Há evidências, ainda, da efetividade de antibióticos associados ao debridamento mecânico, quando se compara com a terapia mecânica isolada em PAL. No entanto, mais estudos são necessários para esclarecer mecanismos específicos relacionados à PAL, a participação de outros fatores na patogênese da doença e a estabilidade, a longo prazo, dos dentes com destruição periodontal inicialmente severa.

Revisión sistemática sobre polimorfismos genéticos de interleucina 1-ß en pacientes con periodontitis agresiva

La forma agresiva es la expresión clínica menos frecuente de laperiodontitis (0,1-1%). La inflamación, respuesta inmune del hospedador a la agresión delas bacterias periodontopatógenas del biofilm subgingival, conduce a la destrucción tisularmediante reclutamiento leucocitario y liberación de citocinas siendo Interleuquina-1 (IL-1)la principal citocina proinflamatoria y tiene 2 genotipos: IL-1α e IL-1β.OBJETIVO: Elaborar una síntesis del conocimiento científico disponible sobre el grado deasociación entre polimorfismos genéticos de IL-1β y periodontitis agresiva (PA) medianterevisión sistemática de estudios observacionales de casos y controles.MÉTODOS: Se realizó una revisión sistemática en base a búsqueda bibliográfica electrónicaen Bireme, MEDLINE, The Cochrane, SciELO, LILACS, BBO-Odontología (Brasil), CENTRALregistrode ensayos clínicos controlados, IBECS (España), Med Carib, DARE-RevisionesSistemáticas Avaladas y DeCS- Descriptores en Ciencias de la Salud, de estudios publicadosentre enero de los años 2003 y 2013 que estudiaron polimorfismos genéticos de IL- 1 β ysu asociación con PA.RESULTADOS: Se seleccionó cada artículo según criterios de inclusión. La búsqueda arrojó1.656 trabajos que incluían Meta-análisis (MA) y Artículos Originales (AO), de los cuales, 22estudios cumplieron los criterios de inclusión de esta revisión sistemática de la evidenciacientífica (RSEC). Ningún estudio corroboró asociación entre IL-1β C[+3953/4]T y PA. Un MAque incluyó 16 de estos estudios en poblaciones caucásicas y asiáticas resultó en OR=0,95;IC 95%=0,75/1,19. Los datos se organizaron en tablas para facilitar la interpretación,análisis y síntesis cualitativa del conocimiento aportado por la selección de artículos...

Aggressive periodontitis (AP) is the least common clinical expression ofthis disease (0.1-1%). The inflammation, which is the immune response of the host to theaggression of the periodontal pathogenic bacteria of the subgingival bio film, leads totissular destruction through leukocyte recruitment and cytokine liberation.Interleukine-1(IL-1) is the main proinflammatory cytokine, having 2 genotypes: IL-1α and IL-1β.AIM: To synthesize the available scientific knowledge as regards the degree of associationbetween IL-1β genetic polymorphysm and aggresive periodontitis (AP), by making asystematic revision of cases- control observational studies.METHODS: A systematic bibliographic search and revision was carried out from studiespublished in Bireme, MEDLINE, The Cochrane, SciELO, LILACS, BBO-Odontología (Brazil),CENTRAL- controlled clinical trials register , IBECS ( Spain), Med Carib, DARE-EndorsedSystematic Revisions and DeCS- Health Science Descritors, from studies published betweenJanuary 2003 and January 2014 such works examine IL-1β genetic polymorphysm and theirassociation with AP.RESULTS: Each article was selected according to inclusion criteria. The search yielded 1,656studies that included Meta-analysis (MA) and Original Articles (OA), 22 of which fulfilledthe inclusion criteria of this RSEC. No study was found to confirm the association betweenIL-1β C[+3953/4]T and AP. A MA that included 16 of these studies in Caucasian and Asianpopulations turned out to be in OR=0.95; CI 95%=0.75/1.19. The collected data weredistributed in tables to facilitate their interpretation, their analysis and the qualitativesynthesis of the knowledge gathered from the selected articles...

Periodontitis agresiva infantil en un niño de 4 años / Aggressive infantile periodontitis in a 4-year-old boy

Se define a la periodontitis agresiva como una forma agresiva y rápidamente destructiva de enfermedad, caracterizada por la pérdida severa del ligamento periodontal y hueso alveolar. Si bien la mayor prevalencia se ubica en la población adulta, se han registrado casos en niños y adolescentes. Se reporta el caso clínico de un niño de 4 años de edad que concurre a la consulta en el año 2010 por pérdida prematura de piezas dentarias. La evaluación de los exámenes de rutina y las radiografías con las que acudió permitieron descartar una periodontitis como manifestación de una enfermedad sistémica. Se confirma el diagnóstico de periodontitis infantil agresiva, por medio de examen microbiológico y ténica PCR. El tratamiento indicado fue terapia básica, antibioticoterapia y controles periódicos. Luego de tre años no hay signos clínicos de la enfermedad. El diagnóstico preciso, sumado a la motivación constante y los controles periódicos, hacen posible la detención del avance de la enfermedad...

Leukotoxicity of Aggregatibacter actinomycetemcomitans in generalized aggressive periodontitis in Brazilians and their family members

OBJECTIVE: The purpose of this study was to examine the leukotoxin promoter types of Aggregatibacter actinomycetemcomitans clones in subjects with generalized aggressive periodontitis (GAgP) and in their family members (FM). MATERIAL AND METHODS: Thirty-five patients with GAgP (33.9±7.1 years), 33 of their FM (22.8±11.4 years), and 41 patients with chronic periodontitis (CP) (44.1±9.4 years) were clinically analyzed using the plaque index, gingival index, probing depth (PD), and clinical attachment level (CAL). Subgingival biofilm samples were collected from four interproximal periodontal sites (>PD and >CAL) of each patient. The presence of A. actinomycetemcomitans and its leukotoxic clone was confirmed by polymerase chain reaction (PCR). RESULTS: A. actinomycetemcomitans was observed in 23 (51.1%) GAgP patients and 16 (30.1%) CP patients. Thirty-seven (94.8%) patients showed minimally leukotoxic strains and 2 (5.1%) showed highly leukotoxic strains. In the FM group, 10 (30.3%) had aggressive periodontitis (AgP), 12 (36.3%) had CP, 11 (33.3%) were periodontally healthy or had gingivitis, and 12.2% were A. actinomycetemcomitans positive. Greater full mouth PD and CAL were observed in GAgP patients positive for the bacteria than those negative for it (p<;0.05), and the presence of A. actinomycetemcomitans positively correlated with GAgP (Odds ratio, 3.1; confidence interval, 1.4-7.0; p=0.009). CONCLUSIONS: The presence of A. actinomycetemcomitans was associated with the clinical condition of GAgP, with most patients exhibiting a generalized form of the disease and minimally leukotoxic clones. Most of the relatives of GAgP patients presented either CP or AgP. .

Comparative analysis of presence of Cytomegalovirus (CMV) and Epsteinbarr virus -1 (EBV-1) in cases of chronic periodontitis and aggressive periodontitis with controls.

Aim : The aim of the present study was to evaluate the presence of Cytomegalovirus (CMV) and Epsteinbarr virus -1 (EBV-1)viruses in sub gingival plaque of chronic periodontitis (groupA), aggressive periodontitis patients (group B), periodontally healthy controls (group C) and to compare the clinical parameters between virus negative and positive sites in each of these groups. Materials and Methods : Sixty subjects were included in the study and equally divided into the 3 groups (group A - 20, group B - 20, group C - 20). Sub gingival plaque samples were obtained from the 3 deepest periodontal pocket sites in case of subjects suffering from periodontitis, and from one random bleeding site per quadrant in healthy groups. Clinical parameters like plaque index (PI), gingival index (GI), pocket depth (PD) and clinical loss of attachment (CAL) were recorded. Viral Deoxyribonucleic acid (DNA) was extracted using Proteinase-K DNA Extraction method, and the presence of CMV and EBV-1 was detected by polymerase chain reaction and 2% agarose gel. Results: Results of our study showed a 45% prevalence of CMV and EBV-1 in Aggressive periodontitis cases. Prevalence of CMV in chronic periodontitis and healthy subjects was 20% and 10%, respectively; while for EBV-1 it was 25% and 0%, respectively. In terms of comparison of the clinical parameters with virus presence, both CMV and EBV-1 positive sites showed a significantly higher mean pocket depth compared to virus negative sites. Conclusion: Our studyshowed that the prevalence of EBV1 was higher in chronic and aggressive periodontitis subjects compared to controls and the prevalence of CMV was higher in aggressive periodontitis patients. The virus positive sites showed higher pocket depth compared to virus negative sites.

Prevalence and antimicrobial susceptibility pattern of pathogens isolated from patients with juvenile periodontitis in Jamaica: a prospective multi-centre study of 15 cases over a 15-year period / Prevalencia y patrón de susceptibilidad antimicrobiana de patógenos aislados de pacientes con periodontitis juvenil en Jamaica: estudio prospectivo multicentro de 15 casos por un período de más de 15 años

Prevalence and antimicrobial susceptibility pattern of most frequent pathogens isolated from patients treated with juvenile periodontitis at three separate dental centres in Jamaica from 1989 to 2003 were studied. Swabs were taken from these patients periodontal pathologic pocket or root of most of their teeth with active disease processes. These swabs were processed at the microbiology department of the University Hospital of the West Indies Kingston, Jamaica and the Microbiology laboratory, School of Veterinary Medicine, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago. The identification of the microorganisms from positive cultures and their antimicrobial susceptibility profile were performed using standard microbiological procedures and dick diffusion (KirbyBauer) methods. Over 80% of the patients were females. The most frequent microorganisms isolated were Enterobacter (40.5%), followed by Klebsiella species (19%) and Acinetobacter species (10.8%).Actinobacillus actinomycetemcomitans, a widely known key pathogen in juvenile periodontal diseases was encountered only in 5.4% (2/37) of the cases in this study. The most frequent organism isolated were still highly susceptibility to the commonly used and available antimicrobials such as amoxycillin/clavulanate,trimethoprim/sulphamethoxazole, chloramphenicol and aminoglycosides. The most frequent pathogens encountered in this study were totally different from what obtains in other places. There is the need to be aware of microbes in other countries during the microbiology investigations of juvenile periodontitis and that the antimicrobial chemotherapy should always be based on susceptibility test results. Surgical treatment for mechanical debridement of the site and bone grafting with guided tissue regeneration should be mandatory in conjunction with specific antimicrobial chemotherapy.

Se estudió la prevalencia y el patrón de susceptibilidad antimicrobiana de los patógenos más frecuentemente aislados de los pacientes tratados por periodontitis juvenil en tres diferentes centros odontológicos en Jamaica de 1989 a 2003. Se tomaron muestras de las bolsas patológicas periodontales de estos pacientes, o de la raíz de la mayor parte de sus dientes, en medio del proceso activo de la enfermedad. Las muestras fueron procesadas en el departamento de Microbiología del Hospital de la Universidad de West Indies, Kingston, Jamaica, y en el laboratorio de Microbiología, Escuela de Medicina Veterinaria, Facultad de Ciencias médicas, Universidad de West Indies, San Agustín, Trinidad y Tobago. La identificación de los microorganismos a partir de cultivos positivos y su perfil de susceptibilidad antimicrobiana, se realizaron mediante procedimientos microbiológicos estándares y métodos de difusión por disco (KirbyBauer). Más del 80% de los pacientes eran mujeres. Los microorganismos más frecuentemente aislados fueron Enterobacter (40,5%), seguido por especies de Klebsiella (19%) y Acinetobacter (10,8%). Actinobacillus actinomycetemcomitans - un patógeno clave ampliamente conocido en enfermedades periodontales juveniles - se encontró sólo en 5,4% (2/37) de los casos en este estudio. Los organismos más frecuentemente aislados mostraban todavía una alta susceptibilidad frente a los antimicrobianos comúnmente usados y disponibles, tales como amoxicilina/clavulanato, trimetoprima/sulfametoxazol, cloranfenicol y los aminoglicósidos. Los patógenos más frecuentemente encontrados en este estudio fueron totalmente diferentes de lo que se obtiene en otros lugares. Es necesario tomar conciencia de los microbios en otros países durante las investigaciones de microbiológicas de la periodontitis juvenil, y no perder vista que la quimioterapia antimicrobiana debe basarse siempre en las pruebas de susceptibilidad. El tratamiento quirúrgico para el desbridamiento mecánico del sitio, así como el injerto óseo con regeneración tisular guiada debería, deben ser obligatorios en conjunción con la quimioterapia antimicrobiana específica.

Achados clínicos, genéticos e microbiológicos de uma família com Periodontite Agressiva em Maceió / Clinical, microbiological and genetics findings of a family with Aggressive Periodontitis from Maceio

O presente estudo relata achados clínicos, genéticos e microbiológicos de indivíduos de uma família com periodontite agressiva (PA) residente em Maceió - AL, Brasil. Quatorze membros da família foram submetidos a exames clínicos periodontais, coleta de células da mucosa oral para extração de DNA e coleta de fluido subgengival para detecção de cinco espécies de periodontopatógenos por meio da PCR (Reação em Cadeia da Polimerase). Polimorfismos nos genes Interleucina 4 e 10 (IL4 e IL10) foram investigados em cada indivíduo por meio da PCR-RFLP (Polimorfismo por Comprimento de Fragmento de Restrição). Seis membros da família apresentaram PA generalizada e oito foram considerados não afetados pela PA. Não houve associação de alelos, genótipos e haplótipos nos genes IL10 e IL4 com a presença de PA na família estudada. Treponema denticola (T.d.) foi o patógeno prevalente, seguido por Tannerella forsythia (T.f.). Houve correlação dos parâmetros clínicos investigados (perda de inserção clínica, sangramento à sondagem e profundidade de sondagem) com a presença de T.d., enquanto que para T.f. houve associação deste com o sangramento à sondagem. Conclui-se que, apesar de os polimorfismos investigados não terem relação com a suscetibilidade à PA, a presença de periodontopatógenos está associada a piores índices clínicos periodontais.

The present study reports clinical, microbiological and genetic findings in members of a family with Aggressive Periodontitis (AgP) from Maceió - AL, Brazil. After periodontal exams in fourteen members of the family, DNA was obtained from epithelial buccal cells and microbiological samples were collected from subgingival plaque to detect five species of periodontopathogens by Polymerase Chain Reaction (PCR). PCR-RFLP (Restriction Fragment Length Polymorphism) was used to investigate human polymorphisms in interleukin genes (IL4, IL10). Six members of the family showed Generalized AgP and eight were considered unaffected by the AgP. There was no association of alleles, genotypes and haplotypes in the IL10 and IL4 genes with the AgP in the studied family. Treponema denticola (T.d.) was the prevalent pathogen, followed by the Tannerella forsythia (T.f.). There was correlation between clinical findings (clinical attachment loss, bleeding on probing and probing depth) with the presence of T.d., while T.f. was correlated with bleeding on probing. In conclusion, although the investigated polimorphisms were not associated with the susceptibility to AgP, the presence of periodontopathogens is related to worse periodontal clinical parameters.

Efeito do tratamento periodontal não cirúrgico em pacientes com periodontite crônica e agressiva: achados microbiológicos e imunológicos / Effect of non surgical periodontal treatment in chronic and aggressive subjects: microbiological and immunological findings

O objetivo do presente estudo foi comparar a expressão de IL-1β, IL-4, IL-8, interferon-γ, atividade de elastase e a composição do perfil microbiano subgengival antes e depois do tratamento periodontal não cirúrgico em pacientes com doença peridontal crônica generalizada (PC) e agressiva generalizada (PA). Vinte pacientes com PC e quatorze com PA foram avaliados. Dados clínicos, fluido gengival e biofilme subgengival foram analisados na visita inicial (VI) e 3 meses (3M) após o tratamento periodontal não cirúrgico. Amostras de fluido gengival (FG) foram coletadas com tiras de papel e os níveis de: IL-1β, IL-4, IL-8 e INF-γ foram medidos, utilizando um tipo de imunoensaio multiplexado (Luminex). Atividade da elastase foi avaliada por um ensaio enzimático. Amostras de placa subgengival foram analisadas através do checkerboard DNA-DNA hybridization. Na avaliação de 3 meses após terapia periodontal foi encontrado melhora significativa para todos os parâmetros clínicos em ambos os grupos. Foram encontradas reduções significativas na atividade de elastase nos sítios rasos e profundos dos pacientes do grupo PA e nos sítios profundos do grupo PC, também foi achado um aumento significativo de INF-γ nos sítios rasos do grupo PA. Os dados microbiológicos, mostraram reduções significativas para os níveis dos membros do complexo vermelho (P. gingivalis, T. forsythia, T.denticola), e para as espécies E.nodatum e P.micra no grupo PC. No grupo PA, ocorreram reduções significativas no níveis de P. gingivalis, T. forsythia, Fusobacterium nucleatum ss polymorphum e Fusobacterium periodonticum. Quando as respostas clínica e imunológica 3M após terapia foram comparadas entre os grupos, apenas diferenças sutis foram observadas. Nenhuma diferença microbiológica foi encontrada entre os grupos após a terapia. Em conclusão, os achados suportam nossa hipótese de que as periodontites cronica e agressiva respondem de forma semelhante ao tratamento periodontal nao cirúrgico.

Our aim was to compare the expression of IL1β, IL-4, IL-8, INF-γ, elastase activity and the composition of the subgingival microbiota profile before and after non-surgical periodontal treatment in patients with untreated generalized chronic (GCP) and aggressive periodontitis (GAgP). Twenty patients with GCP and 14 with GAgP were evaluated. Clinical data, GCF and plaque were analyzed at baseline and 3 months after non-surgical periodontal treatment. IL-1β, IL-4, IL-8 and INFγ were analyzed in a luminex assay. Elastase activity was assessed by an enzymatic assay. Subgingival plaque samples were analyzed using checkerboard DNA-DNA hybridization. Three months after periodontal therapy significant improvement for all clinical parameters in both groups were found. We have found significant reductions in the elastase activity in shallow and deep sites from GAgP and in deep sites from GCP group. A significant increase in INF-γ in the shallow sites from GAgP group were also found. Microbiological data showed significant reductions in the levels of members of the red complex (P. gingivalis, T. forsythia, T. denticola), and for the species E.nodatum and P.micra on GCP group. In the GAgP group, there were significant reductions in levels of P. gingivalis, T. forsythia, Fusobacterium nucleatum and Fusobacterium polymorphum ss periodonticum. When the clinical and immunological responses after therapy were compared between groups, only slight differences were found. No microbiological difference was found between groups after therapy. In conclusion, the findings support our hypothesis that the chronic and aggressive periodontitis respond equally well to non-surgical periodontal treatment.

Avaliação dos fatores genéticos e microbiológicos da periodontite agressiva: revisão da literatura / Evaluation of genetic and microbiologic features of aggressive periodontitis: literature review

A Periodontite Agressiva acomete normalmente pacientes jovens, mas também adultos, tendo uma forte característica genética e microbiológica. O objetivo do presente estudo foi esclarecer a influência destes fatores na susceptibilidade do indivíduo a esta doença e se as características da doença propostas pela Academia Americana de Periodontologia em 1999 podem ser aplicáveis às diversas populações. Concluiu-se que o fator microbiológico é indiscutível na etiologia da Periodontite Agressiva, mas a susceptibilidade do hospedeiro e as respostas do organismo a esta doença variam nas diferentes populações.

Aggressive Periodontitis is more common in young patients and bears strong genetic and microbiologic features. The purpose of the present study was to search the existing data for what has been identified as factors for increased disease susceptibility, and whether the diagnostic criteria proposed by the American Academy of Periodontology in 1999 can be accepted throughout the world. The conclusions were that the microbiologic factors for Aggressive Periodontitis are certain, but the reasons for differences in populations’ susceptibility or immune response to the disease are still unclear.

The detection of eight putative periodontal pathogens in adult and rapidly progressive periodontitis patients: an institutional study.

PURPOSE: Periodontal disease is a commonly prevalent problem faced alike by both the developed and third world countries but showing wide variations in prevalence and severity across different geographical areas. The purpose was to identify Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Ekinella corrodens (Ec), Campylobacter rectus (Cr), Bacteroides forsythus (Bf), Treponema denticola (Td) and Fusobacterium nucleatum (Fn) in Indian adult periodontitis and rapidly progressive periodontitis patients. MATERIALS AND METHODS: Paper points were used to collect the sample from 28 sites in both adult periodontitis and rapidly progressive periodontitis (8 healthy/20 diseased sites) patients and DNA analysis done. The categorical data was analysed by Fishers exact test and difference in the clinical parameters was tested by Mann-Whitney test. RESULTS: In healthy sites of adult and rapidly progressive periodontitis patients, Aa, Ec, Bf and Aa, Pg, Pi, Td, Fn were detected respectively. However, when diseased and healthy sites were compared in both adult periodontitis and rapidly progressive periodontitis patients respectively, only Pg( P =0.004), Cr( P =0.04), Fn( P =0.014) and Pg( P =0.002), Cr( P =0.02), Fn( P =0.008) were statistically significant. CONCLUSION: The prevalence of the microorganisms correlate with the clinical parameters like probing depth and bleeding on probing as seen in the Japanese and Western periodontitis patients' population.

Un patógeno periodontal virulento: Actinobacillus actinomycetemcomitans / A virulent periodontal pathogen: Actinobacillus actinomycetemcomitans

Actinobacillus.actinomycetemcomitans es un bacilo Gram negativo, un patógeno virulento capaz de invadir las células epitelialesgingivales.Es agente etiológico de enfermedades periodontales destructivas y responsable de la Periodontitis Juvenil Localizada, aunque nola única causa de esta enfermedad. Es importante conocer el diagnóstico microbiológico para su estudio así como el tratamientoy terapia más eficiente para su destrucción.

Actinobacillus actinomycetemcomitans, is a Gram negative rod, a virulent pathogen able to invade the gingival epithelial cells.It is the cause of destructives periodontal diseases and responsible of Localized Juvenile Periodontitis, although it is not the onlycause of this disease.It is important to know its microbiological diagnostic ,and also the most efficient treatment and therapy to destroy it.

Anticorpos antileucotoxina contra Actinobacillus actinomycetemcomitans em amostras de soro e saliva de pacientes com periodontite juvenil localizada / Anti-leukotoxin antibodies against Actinobacillus actinomycetemcomitans in serum and saliva samples from patients with localized juvenile periodontitis

A leucotoxina de Actinobacillus actinomycetemcomitans é considerada seu principal fator de virulência com potencial de causar agressäo às defesas do hospedeiro. No presente trabalho, foram analisados os níveis séricos e salivares de anticorpos antileucotoxina de A. actinomycetemcomitans em soros e salivares de pacientes com periodontite juvenil localizada (PJL) e controles saudáveis. Adicionalmente, foi realizada a análise de complexo imune (CI) nas amostras de saliva. Foram utilizados os métodos ELISA clássico com leucotoxina obtida por gel filtraçäo em Sephadex G-200 e ELISA de captura utilizando IgG de coelho anti-A. actinomycetemcomitans FDC Y4 leucotóxico adsorvido com uma cepa da mesma espécie, porém, näo leucotóxica. Os resultados obtidos demonstraram níveis séricos de IgG significativamente mais elevados em pacientes com PJL em relaçäo aos controles sadios, tanto por ELISA clássico como por ELISA de captura (p<0,05). No entanto, näo foram observadas diferenças entre os níveis de IgG, IgA-S e CI nas salivas dos indivíduos examinados. Estes resultados sugerem que, embora A. actinomycetemcomitans apresente vários fatoras de virulência que afetam a resposta imune do hospedeiro, ocorre resposta imune à leucotoxina nos pacientes com PJL. Esse aumento de IgG na circulaçäo sangüínea pode contribuir na defesa do hospedeiro, limitando a lesäo nas regiöes periodontais amplamente colonizadas por A. actinomycetemcomitans

Periodontite pré-puberal: revisäo conceitual / Prepubertal periodontitis: literature review

As autoras apresentaram uma visäo de literatura referente à periodontite pré-puberal, condiçäo descrita na década de 80, embora pouco seja conhecido sobre a etiologia e patogênese da doença. Aspectos referentes a etiologia, microbiologia e tratamento säo apresentados

Prevalencia de la periodontitis juvenil en un grupo de jóvenes en la ciudad de Canelones / Prevalence of juvenile periodontitis in a gropu of young people in Canelones city

Se investigó la prevalencia de la periodontitis juvenil en 100 jóvenes de 11 a 18 años en la ciudad de Canelones, usando el C.P.I.T.N. Sólo uno de ellos (1 por ciento) presentaba características clínicas, radiográficas y microbiológicas similares a la periodontitis juvenil

Periodontitis prepuberal: un caso clínico / Prepuberal periodontitis: a clinical case

La periodontitis prepuberal ha sido una de las enfermedades periodontales menos estudiadas debido quizás al escaso número de pacientes que la padecen. En este trabajo se presenta un caso clínicamente detectado, además del estudio microbiológico de sitios sanos y enfermos. El estado periodontal de la paciente con dentición mixta y siete años, evaluado clínicamente, permiten concluir que se trata de una periodontitis prepuberal localizada. El examen clínico del grupo familiar resulta en buen estado periodontal. Actinobacillus actinomycetemcomitans es el principal agente etiológico de esta enfermedad