Calprotectin levels in gingival crevicular fluid predict disease activity in patients treated for generalized aggressive periodontitis.

BACKGROUND AND OBJECTIVE: Clinical parameters such as probing depth and bleeding on probing are commonly used for monitoring after periodontal treatment. However, these parameters have poor prognostic utility. The biomarker calprotectin is used to monitor conditions such as inflammatory bowel disease because of its ability to predict disease activity. Levels of calprotectin in gingival crevicular fluid correlate with periodontal disease severity and treatment outcome. The validity of calprotectin as predictor for future periodontal disease activity has not yet been investigated. MATERIAL AND METHODS: Thirty-six subjects with generalized aggressive periodontitis were treated with scaling and root planing (SRP), and with adjunctive antimicrobial medications. Probing depth, clinical attachment level and bleeding on probing were assessed at baseline, and 3 and 6mo after SRP. A gingival crevicular fluid sample was collected from the initially deepest site in each patient 3mo after SRP and analysed for calprotectin levels. Activity was defined as a probing depth increase of >0.5mm between 3 and 6mo at the sample site. The ability of individual parameters to predict activity was analysed by construction of receiver operating characteristic curves. RESULTS: Nine active sites were identified. Clinical attachment level, probing depth, bleeding on probing and gingival crevicular fluid volume showed no predictive utility [area under the curve (AUC) <0.6, p>0.05]. However, calprotectin concentration (AUC=0.793, p=0.01) and the total amount/sample of calprotectin (AUC=0.776, p=0.02) significantly predicted activity. Patients with calprotectin levels above calculated cut-off values had significantly more active sites than patients with negative results. CONCLUSION: Calprotectin levels were predictors of disease activity at both site and subject levels. The calculated cut-off values provide a dichotomous basis for prospective evaluation of calprotectin as a diagnostic marker for monitoring periodontal treatment.

Periodontal disease in patients with ankylosing spondylitis.

OBJECTIVE: Ankylosing spondylitis (AS) and periodontal disease (PD) are characterised by dysregulation of the host inflammatory response, resulting in soft and hard connective tissue destruction. AS has been related to other inflammatory diseases, however, there is a paucity of data on whether AS is associated with inflammatory PD. METHODS: The association between AS and PD was examined in 48 patients with AS and 48 healthy controls, matched for age and gender. AS was diagnosed according to the modified New York criteria. Periodontal examination included probing pocket depth (PPD), clinical attachment loss (CAL), plaque index (PI) and bleeding on probing (BOP). Potential risk factors of PD such as smoking, low education, alcohol consumption, body mass index (BMI), as well as chronic diseases associated with PD and AS were assessed through questionnaires. RESULTS: In stepwise logistic regression, including AS status, age, gender, education, smoking, alcohol consumption and BMI, only AS status, age and education remained significant predictors of PD. Patients with AS had significant 6.81-fold increased odds (95% CI 1.96 to 23.67) of PD (defined as mean attachment loss >3 mm) compared to controls. The strength of the association was attenuated but remained statistically significant after further adjustment for plaque accumulation (odds ratio (OR) 5.48, 95% CI 1.37 to 22.00). CONCLUSIONS: The present study shows that patients with AS have a significantly higher risk of PD, strongly suggesting the need for close collaboration between rheumatologists, periodontists and dental hygienists when treating patients with AS.

Lysyl oxidase (lox) gene deficiency affects osteoblastic phenotype.

Lysyl oxidase (LOX) catalyzes cross-linking of elastin and collagen, which is essential for the structural integrity and function of bone tissue. The present study examined the role of Lox gene deficiency for the osteoblast phenotype in primary calvarial osteoblasts from E18.5 Lox knockout (Lox ( -/- )) and wild type (wt) (C57BL/6) mice. Next to Lox gene depletion, mRNA expression of Lox isoforms, LOXL1-4, was significantly downregulated in Lox ( -/- ) bone tissue. A significant decrease of DNA synthesis of Lox ( -/- ) osteoblasts compared to wt was found. Early stages of osteoblastic apoptosis studied by annexin-V binding as well as later stages of DNA fragmentation were not affected. However, mineral nodule formation and osteoblastic differentiation were markedly decreased, as revealed by significant downregulation of osteoblastic markers, type I collagen, bone sialoprotein, and Runx2/Cbfa1.

Effects of Porphyromonas gingivalis on cell cycle progression and apoptosis of primary human chondrocytes.

BACKGROUND: It has been suggested that bacterial infections have a role in the pathogenesis of rheumatoid arthritis (RA). P gingivalis, a Gram-negative, anaerobic rod, is one of the major pathogens associated with periodontal disease. OBJECTIVE: To examine P gingivalis infection and its effects on cell cycle progression and apoptosis of human articular chondrocytes. METHODS: Primary human chondrocytes cultured in monolayers were challenged with P gingivalis. Infection and invasion of P gingivalis into chondrocytes was analysed by scanning electron microscopy, double immunofluorescence and by antibiotic protection and invasion assay. Cell cycle progression of infected chondrocytes was evaluated by flow cytometry. Also, cell apoptosis was visualised by terminal deoxynucleotidyl transferase-mediated dUTP nick end labelling (TUNEL) of DNA strand breaks and by western blot analysis. RESULTS: Data showed that P gingivalis could adhere and infect primary human chondrocytes. After chondrocyte infection, intracellular localisation of P gingivalis was noted. Flow cytometry analyses demonstrated affected cell cycle progression, with an increase of the G(1) phase and a significant decrease of the G(2) phase after infection. In addition, increased apoptosis of P gingivalis-infected chondrocytes was visualised by TUNEL assay and by upregulation of caspase-3 protein expression. CONCLUSION: These data demonstrate that P gingivalis infects primary human chondrocytes and affects cellular responses, which might contribute to the tissue damage seen in the pathogenesis of rheumatoid arthritis.

Association among rheumatoid arthritis, oral hygiene, and periodontitis.

BACKGROUND: A limited number of studies suggest a higher prevalence of periodontal disease among individuals with rheumatoid arthritis (RA); however, results have been inconsistent. Further, it is unclear to what extent poor oral hygiene among patients with RA may account for this association. METHODS: The association between RA and periodontitis was examined in 57 subjects with RA and 52 healthy controls, matched by age and gender. Oral examination included plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment loss (CAL). Potential risk factors for periodontal disease, such as smoking, education, alcohol consumption, and body mass index (BMI), as well as chronic diseases associated with RA and periodontal disease were assessed through questionnaires. RESULTS: In a stepwise logistic regression, including RA status, age, gender, education, smoking, alcohol consumption, and BMI, only RA status and age remained significant predictors of periodontal disease. Subjects with RA had a significant 8.05-fold increased odds (95% confidence interval: 2.93 to 22.09) of periodontitis compared to controls. The strength of the association was attenuated but remained statistically significant after further adjustment for PI, GI, or both. PI alone accounted for 12.4%, GI alone accounted for 11.1%, and PI and GI combined accounted for 13.4% of the association between RA and periodontitis. CONCLUSIONS: Subjects with RA have significantly increased periodontal attachment loss compared to controls. Oral hygiene may only partially account for this association.

Obesity, inflammation, and periodontal disease.

The prevalence of obesity has increased substantially over the past decades in most industrialized countries. Obesity is a systemic disease that predisposes to a variety of co-morbidities and complications that affect overall health. Cross-sectional studies suggest that obesity is also associated with oral diseases, particularly periodontal disease, and prospective studies suggest that periodontitis may be related to cardiovascular disease. The possible causal relationship between obesity and periodontitis and potential underlying biological mechanisms remain to be established; however, the adipose tissue actively secretes a variety of cytokines and hormones that are involved in inflammatory processes, pointing toward similar pathways involved in the pathophysiology of obesity, periodontitis, and related inflammatory diseases. We provide an overview of the definition and assessment of obesity and of related chronic diseases and complications that may be important in the periodontist's office. Studies that have examined the association between obesity and periodontitis are reviewed, and adipose-tissue-derived hormones and cytokines that are involved in inflammatory processes and their relationship to periodontitis are discussed. Our aim is to raise the periodontist's awareness when treating obese individuals.

CrossLaps and beta-glucuronidase in peri-implant and gingival crevicular fluid.

Collagen degradation products of the carboxyterminal region possibly reflect bone and attachment loss. In the present study, the Serum CrossLaps One-Step enzyme-linked immunosorbent assay was used to determine a specific part of the carboxyterminal region of type I collagen, the CrossLaps. Samples of peri-implant and gingival crevicular fluid of 111 implants and 53 teeth from 47 partially or completely edentulous patients were examined in reference to levels of CrossLaps and beta-glucuronidase (beta G), an established marker of periodontal disease. Clinical probing pocket depth (PPD), bleeding on probing (BOP), plaque accumulation, mobility, radiographic bone loss, and the occurrence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia were assessed. The mean values were: for PPD at implants 3.76 +/- 1.41 mm, at teeth 3.44 +/- 0.88 mm; for beta G at implants 0.364 +/- 0.392 pU/min, at teeth 0.314 +/- 0.209 pU/min; for CrossLaps at implants 0.069 +/- 0.059 pmol/min, at teeth 0.082 +/- 0.053 pmol/min. Bleeding on probing was significantly higher on implants than on teeth (McNemar test, P = .004). No significant difference of beta G levels was found between teeth and implants (Wilcoxon test). A negative correlation was found between beta G levels and CrossLaps levels at teeth (Pearson-rank correlation, P = .002). On implants, no significant correlation of these 2 parameters was seen, but significant correlations were found between sulcus fluid flow rate and PPD (P = .012), beta G levels and bone loss (P < 0.0005), and CrossLaps levels and PPD (P = .011). CrossLaps can be detected in both gingival and peri-implant crevicular fluid. While rising levels of beta G may indicate acute peri-implantitis, CrossLaps may not, but could play a role as a marker of ongoing attachment loss.

[Localized periodontal recession--only caused by the chronic brushing trauma?]. / Die lokalisierte parodontale Rezession--nur eine Folge des chronischen Putztraumas?

Localized periodontal recession (LPR) is not rarely found in adults: 10.4% in subjects age 16-19 years, 24.8% in 20-24-year-old persons, and 46.8% in the age group of 35-44 years (N = 11,401 subjects). There is an accumulation of LPR-patients, who referred to the Department of Periodontology, in young adults. Patients suffering from LPR show, in comparison to healthy people, a smaller diameter of the canine's apical basis both in the maxillary and mandibular arches, a smaller circumference of the alveolar crest as well as an upper canine-crown which is turned out from the teeth arcus in a more labial direction. The vestibular sites of teeth 44, 23, 34, 13, 14, 24, and 43 are mainly affected by LPR. Right-handers generally show more and stronger LPR in both arches as well as a smaller value of oral hygiene index. The chronic trauma of teeth brushing is very important in the pathogenesis of the LPR. Prevention of LPR involves individual oral health education to protect the vestibular gingiva from chronic brushing trauma.

[The modification of the mechanically loaded periodontium during orthodontically induced tooth movement with nonsteroidal anti-inflammatory agents in an animal experiment]. / Zur Beeinflussung des mechanisch belasteten Parodonts während orthodontisch induzierter Zahnbewegung mit nichtsteroidalen Antiphlogistika im Tierexperiment.

In a total of 123 female adult Wistar rats the first upper molar was moved by orthodontics for more than 28 days. This orthodontically stimulated tooth movement was influenced by local application of Cu-salicylate, Cu-indomethacin or epsilon-Aminocapronacid. The application of Cu-salicylate and Cu-indomethacin caused reduced tooth movement, a decrease in osteoclasts in the pressure region of the periodontium, and an increase of hydroxyproline in the desmodont. Generally, the local application of Cu-nonsteroidal antiphlogistics seems to stabilize the experimentally induced tooth movement.

[The influence of initial therapy on the symptoms of adult periodontitis]. / Der Einfluss der Initialtherapie auf Symptome der Erwachsenen-Parodontitis.

Pocket depth, attachment level (AL), bleeding on probing (BOP), amount of dental plaque and calculus, concentrations of immunoglobulin G and C-reactive protein in GCF were determined at 54 periodontal sites in 9 patients suffering from adult periodontitis before and 1 week after periodontal initial therapy (IT). At the same time the subgingival plaque was assessed by dark-field microscopy (DFM). 17% of the sites treated showed further loss of attachment. Attachment gain was observed at 39% of the examined sites. IT had no influence on the IgG- and CRP-concentrations of GCF. Measuring of AL, BOP and the assessment of subgingival plaque by DFM seem to be recommendable measures for monitoring adult periodontitis.

[First results with a microbiological quick diagnostic procedure in periodontitis]. / Erste Erfahrungen mit einer mikrobiologischen Schnelltestung in der Parodontologie.

We tested a new diagnostic procedure for the characterization of subgingival plaque in 119 subjects suffering from adult periodontitis. The method can be characterized as a hydrolysis of BANA (N-benzoyl-DL-arginine-beta-naphthylamide) by peptidases of Porphyromonas gingivalis, Bacteroides forsythus and Treponema denticola. The result of a positive will be a more or less blue coloured test paper representing the amount of these three peridontal pathogens into the subgingival plaque. After the periodontal initial therapy the frequency of the positive colour reaction was significantly reduced. A correlation between the colour reaction and the clinical signs of periodontitis as well as the morphological characterization of subgingival plaque by darkfield microscopy could not been found. The new method for the characterization subgingival plaque seems to be useful for the judgement of a successful periodontal therapy at single sites.

[Influence of marginal and submarginal restoration margins on periodontal tissues]. / Der Einfluss marginaler und submarginaler Restaurationsränder auf das periodontale Gewebe.

Subgingival and irregular restoration margins have an unfavourable influence on the marginal periodont. The margins close to the gingiva of 206 restorations (age of restorations mean = 49.4 months) showed incorrectnesses in most cases with marginal inflammation as a result. That's why the demand of high precision, supragingival positioning of margin restoration and removal of all potential plaque-retentive or mechanic irritated surface is raised.

[Marginal periodontium and osseointegrated implants--literature review and own investigations. 1. Literature review]. / Das marginale Periodont und enossale Implantate. Literaturübersicht und eigene Untersuchungen. 1. Mitteilung: Literaturübersicht.

A review from literature is given to problems of osseointegration of implants, to the biologic host defensive mechanism against plaque accumulation in the marginal region of osseointegrated implants as well as to problems of functional occlusal stress of such implants. Results of an investigation at IMZ-implants are integrated in the discussion: size of plaque accumulation, quality of subgingival plaque (dark field microscopy), bleeding on probing, pocket depth, correlation between these clinical signs.

[The marginal periodontium on osseointegrated implants--literature review and own investigations. 2. Own investigations]. / Das marginale Periodont und enossale Implantate. Literaturübersicht und eigene Untersuchungen. 2. Mitteilung: Eigene Untersuchungen.

19 IMZ-implants with a medium age of incorporation of 10.5 months were examined at four sites concerning their periimplantary situation. Gingival index, bleeding on probing, pocket depth and composition of subgingival plaque corresponded in 67% of the examined sites with periodontal health. Favourable correlations were stated between the values of plaque index and of the bleeding on probing as well as between the wide of fixed gingiva and the dimension of gingival recession. Compared to bridge constructions more unfavourable results concerning the amount of plaque and clinical criteria of the gingival margin were observed in case of mucosal fixed prostheses.

[The pattern of prevalence of localized periodontal recessions]. / Zum Prävalenzmuster der lokalisierten periodontalen Rezessionen.

It is reported the kind of prevalence of localized periodontal recessions (lpr) in cases of 121 subjects aged from 20 up to 34 years. Most frequently the facial sites of the teeth 44, 23, 34, 13, 14, 24 and 43 are involved. We could not detected an increase of frequency of lpR with the increase of age. Right-handed persons generally show more and deeper lpr in both jaw-sites compared with left-hander. Also right-hander show a smaller plaque accumulation. This result gives us support for our recommendation for a special gentle method of tooth cleaning for subjects suffering from lpr.

[The clinical periodontal condition in patients with pain dysfunction syndrome]. / Der klinische Periodontstatus bei Patienten mit Schmerz-Dysfunktionssyndrom.

50 patients suffering from tempero-mandibular dysfunction syndrome (TMS), 25 patients suffering from localized periodontal recessions, and 25 clinical healthy subjects were used for a clinical investigation. The oral hygiene index (Greene/Vermillion), the pocket depth, the size of periodontal recessions, the frequency of McCall-garlands, the frequency of Stillman-clefts, the frequency of wedge-shaped defects, the amount of occlusal wearing, and the clinical and anamnestic dysfunctions-index (Helkimo) were compared between the three different groups. No connection between the frequency and the size of any periodontal symptoms and the signs of TMS-dysfunctions could be found.

[The relevance of the loss of first permanent molar for the periodontium of neighbouring teeth]. / Die Bedeutung des Verlustes des Sechsjahrmolaren für das Periodont der Nachbarzähne.

There is a controversial discussion according to treatment of the early loss of first permanent molar. The aim of this investigation was to study the change of periodontal conditions of the teeth neighbouring the gap. We investigated 33 patients with 55 gaps. The average time of first molar loss was 10.5 years. The position of neighbouring teeth was influenced by the early loss of the first molar. Oral hygiene and self cleaning of the periodontal tissues was of good quality in this region. The bleeding on probing was smaller in this region compared with control teeth. The pocket depth of the second molar was higher than that of the second premolar. The loss of alveolar bone detected by radiography was greater in the second molar compared with the second premolar and also in the distal periodontal site of the second molar and the mesial site of the second premolar controlled with sites neighbouring the gap.

[Clinical aspects of gingival hyperplasia]. / Die Klinik der Gingivahyperplasie.

This paper demonstrates the clinical variety of gingival enlargement. An increase of the number of individuals who suffer from local or general enlargement caused by microbial gingival inflammation or different drugs can be demonstrated. All imbalances of leukopoesis or homeostasis require particular diagnostic attention by dentists, because early diagnosis is decisive for patient prognosis.

[Construction and managing of maintenance care in periodontology]. / Aufbau und Gestaltung einer Dispensairebetreuung in der Periodontologie.

The maintenance care of periodontal treated patients is the necessary prerequisite for the individual long-life tooth preservation. The recall interval derives from the recidivity, the compliance of the patient, and from the individual disposition. The use of a self-developed data-bank-system relieve evaluation and processing of the extensive data which will be raised site-specific in the recall session. It will be given some directions to the content of the periodontal maintenance care.