Levels of Pro-Inflammatory and Bone-Resorptive Mediators in Periodontally Compromised Patients under Orthodontic Treatment Involving Intermittent Forces of Low Intensities.

During orthodontic treatment, diverse cytokines, enzymes, and osteolytic mediators produced within the teeth surrounding periodontal tissues determine the rate of alveolar bone remodeling and consequent teeth movement. In patients with teeth presenting reduced periodontal support, periodontal stability should be ensured during orthodontic treatment. Thus, therapies based on the application of low-intensity intermittent orthodontic forces are recommended. To determine if this kind of treatment is periodontally well tolerated, this study aimed to analyze the production of receptor activator of nuclear factor kappa-B ligand (RANKL), osteoprotegerin (OPG), interleukin (IL)-6, IL-17A, and matrix metalloproteinase (MMP)-8 in periodontal tissues of protruded anterior teeth with reduced periodontal support and undergoing orthodontic treatment. Patients with periodontitis-associated anterior teeth migration received non-surgical periodontal therapy and a specific orthodontic treatment involving controlled low-intensity intermittent orthodontic forces. Samples were collected before periodontitis treatment, after periodontitis treatment, and at 1 week to 24 months of the orthodontic treatment. During the 2 years of orthodontic treatment, no significant differences were detected in the probing depth, clinical attachment level, supragingival bacterial plaque, and bleeding on probing. In line with this, the gingival crevicular levels of RANKL, OPG, IL-6, IL-17A, and MMP-8 did not vary between the different evaluation time-points of the orthodontic treatment. When compared with the levels detected during the periodontitis, the RANKL/OPG ratio was significantly lower at all the analyzed time-points of the orthodontic treatment. In conclusion, the patient-specific orthodontic treatment based on intermittent orthodontic forces of low intensities was well tolerated by periodontally compromised teeth with pathological migration.

Péptidos antimicrobianos y mediadores lipídicos: rol en las enfermedades periodontales / Antimicrobial peptides and lipid mediators: their role in periodontal diseases

En la actualidad existe consenso en que el daño de los tejidos de soporte dentario que se produce durante la periodontitis es un proceso complejo en el cual la presencia de los patógenos periodontales es necesaria, pero no suficiente, para explicar en su totalidad la extensión y severidad de dicho daño. Asimismo, la destrucción del tejido de soporte periodontal es en gran medida producida por el desbalance de la respuesta inmune generada por el paciente frente a antígenos y factores de virulencia derivados de los patógenos periodontales. Esta respuesta inmune, desencadenada por las bacterias periodontopatógenas, incluye tanto mecanismos asociados a inmunidad innata como adaptativa, siendo el rol de los péptidos antimicrobianos y mediadores lipídicos aspectos relacionados con ambas ramas de la inmunidad y que no han sido completamente dilucidados en relación con sus mecanismos de acción contra los patógenos periodontales. En esta revisión se describe el rol de los péptidos antimicrobianos y de los mediadores lipídicos en la enfermedad periodontal, enfocándonos en su contribución tanto a la protección como a la destrucción del tejido de soporte dentario durante la infección periodontal. Se destaca además la importancia de considerarlos dentro del complejo escenario de la respuesta inmune durante las enfermedades periodontales, ya que forman parte fundamental de la respuesta inmune del hospedero. Analizar la enfermedad periodontal ampliando la perspectiva de estudio a este tipo de moléculas que participan de la respuesta inmune permitiría en el futuro lograr un nuevo enfoque terapéutico de las enfermedades periodontales.

Currently, there is consensus that the damage of the tooth support tissues that occurs during periodontitis is a complex mechanism, in which the presence of specific periodontal pathogens is necessary, but not sufficient, to fully explain the extent and severity of the observed periodontal destruction. Moreover, the destruction of periodontal support tissue is largely the effect of the imbalance in the patient immune response, triggered by periodontal pathogen-derived antigens and virulence factors. The immune response elicited by periodontal pathogenic bacteria includes mechanisms associated with both innate and adaptive responses, where the role of antimicrobial peptides and lipid mediators are related to these two arms of immunity, and have not been fully elucidated in relation to their mechanisms of action against periodontal pathogens. In this review, a discussion is presented on the characteristics of these molecules and their role in periodontal disease in relation to both protection and destruction of tooth supporting tissue during periodontal infection. The relevance of considering these mediators within the complex scenario of the immune response during periodontal diseases is also highlighted, since they are a fundamental part of the host immune response. Periodontal diseases should be analysed in a broader perspective, where the study of these types of molecules involved in the immune response of periodontal tissues, may help to develop new therapeutic approaches to periodontal diseases in the future.