Interdisciplinary management of dental anomalies: fusion and supernumerary teeth.

A 16-year-old boy presented with a fused permanent maxillary left central incisor with a supplemental tooth and an additional supplemental tooth lingual to the permanent maxillary right central incisor. Following leveling, alignment, and endodontic therapy, the maxillary fused left central incisor was sectioned and the mesial portion extracted as planned. Fixed orthodontic treatment commenced after 10 days to align the maxillary anterior segment. After completion, the midline diastema was closed with veneers. This case highlights the treatment options of a fused tooth and the need for multidisciplinary planning and treatment.

Correlation of gingival crevicular fluid interleukin-18 and monocyte chemoattractant protein-1 levels in periodontal health and disease.

BACKGROUND: Interleukin (IL)-18 is a proinflammatory cytokine of the IL-1 superfamily and is unique, with the capacity to induce T-helper (Th)1 or Th2 differentiation depending on the immunologic context. Monocyte chemoattractant protein (MCP)-1 is a CC chemokine responsible for chemotaxis of monocytes. A previous study showed the induction of MCP-1 by IL-18 in mice macrophages. The present study was carried out to examine the gingival crevicular fluid (GCF) levels of IL-18 and MCP-1 in periodontal health and disease and to evaluate any correlation between IL-18 and MCP-1 GCF levels. METHODS: Sixty subjects (30 males and 30 females; age range: 26 to 49 years) participated in the study. The subjects were initially divided into three groups, consisting of 20 subjects in each group, based on the gingival index, probing depth (PD), clinical attachment loss (AL), and radiologic parameters (bone loss): healthy (group 1), gingivitis (group 2), and periodontitis (group 3), whereas patients in group 3 after treatment constituted group 4. GCF samples were collected from all of the groups to estimate the levels of IL-18 and MCP-1 using enzyme-linked immunosorbent assay. RESULTS: The mean IL-18 and MCP-1 concentrations in GCF were highest in group 3 (330.61 pg/microl and 73.3 pg/microl, respectively). The results suggest that IL-18 and MCP-1 levels increased in GCF from periodontal health to disease and decreased after periodontal therapy. Levels of IL-18 and MCP-1 positively correlated with PD and clinical AL in group 3. In addition, IL-18 and MCP-1 levels significantly correlated with each other in groups 2, 3, and 4. CONCLUSIONS: GCF IL-18 and MCP-1 concentrations increased in periodontal disease compared to health and correlated positively with the severity of disease. Further, based on the positive correlation of IL-18 and MCP-1 found in this study, it can be proposed that IL-18 may promote an inflammatory response by the induction of MCP-1 production and the subsequent recruitment and activation of circulating leukocytes at the inflammatory site.

Serum levels of monocyte chemoattractant protein-1 in periodontal health and disease.

OBJECTIVES: Initial research has reported high levels of monocyte chemoattractant protein-1 (MCP-1) in gingival crevicular fluid (GCF) of periodontitis patients. Present study has been carried out to assess its concentration in serum and to find its association with periodontal health and disease. DESIGN: 60 subjects were divided into three groups (n=20) based on gingival index (GI), probing pocket depth (PPD) and clinical attachment loss (CAL): healthy (group I), gingivitis (group II) and chronic periodontitis (group III). A fourth group (group IV) consisted of 20 subjects from group III, 6-8 weeks after treatment [i.e. scaling and root planing (SRP)]. Serum samples obtained from each patient were quantified for MCP-1 using enzyme-linked immunosorbent assay (ELISA). RESULTS: The mean MCP-1 concentration in serum was found to be the highest in group III i.e. 465.80 pg/ml and lowest in group I i.e. 155.20 pg/ml. For group II (251.60 pg/ml) and group IV (263.20 pg/ml) the mean MCP-1 concentrations were found to lie in between the concentrations obtained in group I and III. CONCLUSIONS: Serum MCP-1 concentration was found to be, approximately one and half folds higher in gingivitis patients (group II) and three folds higher in chronic periodontitis patients (group III) as compared to healthy subjects (group I). Further, the MCP-1 concentration increased proportionally with the severity of disease in group II and III showing positive correlation with clinical parameters. Thus, its role as an inflammatory biomarker in periodontal disease can be proposed.

Exploring the role of Th1 cytokines: interleukin-17 and interleukin-18 in periodontal health and disease.

There are conflicting data regarding the role of interleukin (IL)-17 in periodontal health and disease. However, IL-18 levels are known to increase with the severity of periodontal disease. The present study was performed to explore the role of these proinflammatory cytokines in periodontal disease progression, and also to clarify the effect of periodontal treatment on their concentration. Sixty age- and gender-matched subjects were divided into three groups each consisting of 20 subjects on the basis of gingival index (GI), probing pocket depth (PPD), clinical attachment loss (CAL) and radiological parameters (bone loss): healthy (group 1), gingivitis (group 2) and chronic periodontitis (group 3), while group 3 patients after treatment constituted group 4. GCF samples collected from all the groups were assayed by enzyme-linked immunosorbent assay to estimate the levels of IL-17 and IL-18. IL-18 levels in GCF increased proportionally with the severity of periodontal disease, and decreased after treatment. However, IL-17 levels in GCF were nearly zero. Since our data indicate an absence of IL-17 in GCF, it cannot be considered as a biomarker of periodontal disease progression, at least in Indian populations. However, IL-18 appears to be a good inflammatory biomarker.

Gingival crevicular fluid levels of monocyte chemoattractant protein-1 in periodontal health and disease.

OBJECTIVES: Monocyte chemoattractant protein-1 (MCP-1) stimulates the chemotaxis of monocytes and also several cellular events associated with chemotaxis thus causes recruitment of inflammatory cells. Its increased gingival crevicular fluid (GCF) levels in periodontal disease have been reported in previous studies. The present study has been carried out to assess the role of MCP-1 in periodontal disease progression and also to determine the effect of periodontal treatment on MCP-1 concentration in GCF. DESIGN: A total of 60 subjects were divided into three groups (n=20) based on gingival index (GI), probing pocket depth (PPD) and clinical attachment loss (CAL): healthy (group I), gingivitis (group II) and chronic periodontitis (group III). A fourth group (group IV) consisted of 20 subjects from group III, 6-8 weeks after treatment (i.e. scaling and root planing). GCF samples collected from each patient were quantified for MCP-1 using ELISA. RESULTS: The mean MCP-1 concentration in GCF was found to be the highest in group III, i.e. 72.60 pg/microl. The mean MCP-1 concentration in group I was 19.70 pg/microl and in group IV was 8.50 pg/microl. The mean MCP-1 concentration (37.00 pg/microl) in group II was found to lie in between the concentrations obtained in groups I and III. CONCLUSIONS: GCF MCP-1 levels increased progressively with the progression of disease and decreased after treatment. Levels of MCP-1 correlated positively with clinical parameters like GI, PPD and CAL thus it can be considered as an inflammatory biomarker in periodontal disease and also deserves further consideration as a therapeutic target.