Active MMP-8 (aMMP-8) as a Grading and Staging Biomarker in the Periodontitis Classification

Association between metabolic syndrome and salivary MMP-8, myeloperoxidase in periodontitis

OBJECTIVE

This study investigated the effect of metabolic syndrome (MetS) on periodontal clinical parameters and salivary biomarkers' matrix metalloproteinase-8 (MMP-8) and myeloperoxidase (MPO) in patients with periodontitis.

METHODS

A total of 120 participants aged 25-55 were categorized into three groups: MetS with periodontitis (n = 40); systemically healthy with periodontitis (n = 40); and systemically and periodontally healthy controls (n = 40). Data collected included systemic parameters like waist circumference (WC), blood pressure (BP), high- and low-density lipoproteins, triglycerides (TG), fasting blood sugar (FBS), and glycated hemoglobin (HbA1c). Periodontal parameters estimated included bleeding on probing score (BoP), full-mouth plaque score (FMPS), periodontal probing depth (PPD), clinical attachment loss (CAL), and the number of missing teeth. Unstimulated whole saliva was analyzed via ELISA for active MMP-8 (aMMP-8), total MMP-8 (tMMP-8), and MPO.

RESULTS

Participants with MetS and periodontitis exhibited significantly higher periodontal parameters, salivary aMMP-8, and MPO (26.26 vs. 24.1 ng/mL and 13.53 vs. 11.55 ng/mL compared to systemically healthy periodontitis patients) (all p < 0.01). Positive correlations occurred between aMMP-8 and WC, TG, and FBS (p < 0.01), and between MPO and WC, BP, and TG (p < 0.01).

CONCLUSIONS

The positive associations between these biomarkers and metabolic parameters indicate their potential utility for monitoring cardiovascular and glycemic risk in patients with periodontal disease.

Conventional diagnostic criteria for periodontal diseases (plaque-induced gingivitis and periodontitis)

This narrative review addresses conventional diagnostic criteria used in clinical practice to discriminate between periodontal health, gingivitis, and periodontitis. Visual examination of the color and texture of the periodontal tissues, assessment of plaque deposits, periodontal probing assessments, and diagnostic imaging enable the collation of information to make a periodontal diagnosis, followed by an appropriate treatment plan. The periodontal probe is an essential diagnostic tool to assess probing pocket depth, clinical attachment level, bleeding on probing, and the degree of furcation involvement at multirooted teeth. When clinical signs and symptoms of periodontitis are identified, diagnostic imaging enables evaluation of the level and extent of bone destruction and bone defect morphology. The diagnostic process requires clinicians who are trained to evaluate, record, and interpret these measures. This narrative review focuses on conventional clinical diagnostic parameters which, despite their limitations, are considered the current standard of care.

Diagnostic accuracy of salivary active matrix metalloproteinase (aMMP)-8 point-of-care test for detecting periodontitis in adults: A systematic review and meta-analysis

OBJECTIVE

To determine the accuracy of salivary active matrix metalloproteinase (aMMP)-8 point-of-care test (POCT) for detecting periodontitis in adults, through meta-analysis.

MATERIALS AND METHODS

Diagnostic studies evaluating the accuracy of salivary/oral rinse aMMP-8 POCT for detecting periodontitis in adults, when compared with clinical examination, were considered eligible. A comprehensive search was performed up to 31 August 2023 through five databases. Quality Assessment of Diagnostic Accuracy Studies 2 was utilized to evaluate the methodological quality of the included articles. Meta-analysis was performed using Bayesian bivariate hierarchical model and subgroup analysis.

RESULTS

From 368 screened studies, 6 studies (4 cross-sectional and 2 longitudinal studies) were included in the meta-analysis. Overall, the pooled sensitivity and specificity of salivary aMMP-8-POCT for detecting periodontitis were 0.63 (95% CI: 0.41-0.82) and 0.84 (95% CI: 0.65-0.95), respectively. Subgroup analyses revealed that the 95% CI for oral fluid types, predefined diagnostic thresholds and the POCT systems largely overlapped, indicating that the differences between them may not be significant.

CONCLUSION

Salivary aMMP-8 POCT shows fair accuracy for detecting periodontitis. The diagnostic accuracy cannot be significantly influenced by the types of oral fluids, predefined diagnostic thresholds or the specific POCT systems used. More research is needed to confirm the clinical utility and implementation of aMMP-8 POCT in the diagnosis of periodontitis.

In Vivo Regulation of Active Matrix Metalloproteinase-8 (aMMP-8) in Periodontitis: From Transcriptomics to Real-Time Online Diagnostics and Treatment Monitoring

BACKGROUND

This study investigated in vivo regulation and levels of active matrix metalloproteinase-8 (aMMP-8), a major collagenolytic protease, in periodontitis.

METHODS

Twenty-seven adults with chronic periodontitis (CP) and 30 periodontally healthy controls (HC) were enrolled in immunohistochemistry and transcriptomics analytics in order to assess Treponema denticola (Td) dentilisin and MMP-8 immunoexpression, mRNA expression of MMP-8 and its regulators (IL-1β, MMP-2, MMP-7, TIMP-1). Furthermore, the periodontal anti-infective treatment effect was monitored by four different MMP-8 assays (aMMP-8-IFMA, aMMP-8-Oralyzer, MMP-8-activity [RFU/minute], and total MMP-8 by ELISA) among 12 CP (compared to 25 HC).

RESULTS

Immunohistochemistry revealed significantly more Td-dentilisin and MMP-8 immunoreactivities in CP vs. HC. Transcriptomics revealed significantly elevated IL-1β and MMP-7 RNA expressions, and MMP-2 RNA was slightly reduced. No significant differences were recorded in the relatively low or barely detectable levels of MMP-8 mRNAs. Periodontal treatment significantly decreased all MMP-8 assay levels accompanied by the assessed clinical indices (periodontal probing depths, bleeding-on-probing, and visual plaque levels). However, active but not total MMP-8 levels persisted higher in CP than in periodontally healthy controls.

CONCLUSION

In periodontal health, there are low aMMP-8 levels. The presence of Td-dentilisin in CP gingivae is associated with elevated aMMP-8 levels, potentially contributing to a higher risk of active periodontal tissue collagenolysis and progression of periodontitis. This can be detected by aMMP-8-specific assays and online/real-time aMMP-8 chair-side testing.

Clinical and radiographic periodontal status in hypertensive patients with or without obstructive sleep apnea 10 years after diagnosis and CPAP initiation

OBJECTIVES

Through inflammation and hyposalivation, obstructive sleep apnea (OSA) is suggested to affect periodontal status over time. Our aim was to compare the clinical and radiographic periodontal status of hypertensive patients with or without long-term presence of OSA, treated or untreated with continuous positive airway pressure treatment (CPAP).

MATERIALS AND METHODS

In 2007-2009, a screening for OSA was conducted among 394 hypertensive primary care patients. Polygraphy was used to create three groups: no OSA, non-CPAP, or adherent CPAP based on the apnea hypopnea index (AHI). After 10 years, a cross-sectional sleep and periodontal examination including a clinical and radiographic examination, a questionnaire, and a matrix metalloproteinase-8 (MMP-8) chair-side test was conducted. Based on levels of alveolar bone, bleeding on probing (BoP), and probing pocket depth (PPD), patients were categorized into four periodontal stages: periodontal health/gingivitis and three periodontal disease stages. Periodontal status and periodontal stages were compared between the OSA (n = 49), non-CPAP (n = 38), or adherent CPAP (n = 34) groups.

RESULTS

The 121 patients (53% women) had a median age of 71 years. No differences were seen between the OSA groups regarding median number of teeth (p = .061), teeth/implants, (p = .107), plaque index (p = .245), BoP (p = .848), PPD ≥ 4 mm (p = .561), PPD ≥ 6 mm (p = .630), presence of MMP-8 (p = .693) except for bone loss (p = .011). Among patients with stage periodontal health/gingivitis a significant difference was seen, as 70% of those were categorized as no OSA, 20% as non-CPAP, and 10% as adherent CPAP (p = .029). Differences were not seen in periodontal disease stages.

CONCLUSIONS

Hypertensive patients with obstructive sleep apnea (OSA) did not have an adverse clinical periodontal status compared to patients without OSA. However, when combining radiographic and clinical status into periodontal stages, patients without OSA more frequently exhibited periodontal health or gingivitis compared to patients without OSA, regardless of CPAP treatment.

Serum asprosin levels are increased in patients with periodontitis and ST-segment elevation myocardial infarction and correlated with periodontal parameters: A case-control study

OBJECTIVE

The study aims to investigate whether patients with ST-elevation myocardial infarction (STEMI)-related periodontitis will experience any changes in asprosin levels.

BACKGROUND

Periodontitis is a common, chronic infection of the periodontium that is epidemiologically associated with cardiovascular disease. Although asprosin, a hormone released from adipose tissue, is a protective role in cardiovascular diseases, its effectiveness in periodontitis is unknown.

METHODS

The study was conducted on a total of 120 patients, divided into four groups; the group of healthy control (n = 35), the group of periodontitis (n = 35), the group of periodontitis+STEMI (n = 25), and the group of STEMI (n = 25). In each patient, age, serum asprosin, CRP, troponin-I, and clinical periodontal parameters [plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL)] were evaluated. The results were analyzed statistically.

RESULTS

Serum asprosin, CRP, and troponin-I levels were statistically higher in the STEMI+periodontitis group compared to the other groups. In addition, as a result of the study, it was observed that there was a correlation between serum asprosin levels, clinical periodontal parameters, and CRP levels.

CONCLUSIONS

The results of this study show that STEMI and periodontitis are associated with high asprosin levels. Since the risk of periodontitis is high in STEMI patients, periodontitis should also be considered when evaluating asprosin levels in STEMI patients.

A disposable immunosensor for the detection of salivary MMP-8 as biomarker of periodontitis

This work describes the development of a novel voltammetric immunosensor for the detection of salivary MMP-8 at the point-of-care. The electrochemical platform was based on a graphene (GPH) screen-printed electrode (SPE) functionalized by gold-nanospheres (AuNSs) and antibodies against MMP-8 protein (anti-MMP-8). The functionalization with anti-MMP-8 was realized by using 11-mercaptoundecanoic acid (11-MUA), thanks to its ability to give strong sulfur bonds with its -SH end, and to cross-link the -NH2 groups of the antibody molecule with the other -COOH end, using the traditional EDC-NHS method. The voltammetric sensor showed good performances with a linear range of 2.5-300 ng mL-1, a LOD value of 1.0 ± 0.1 ng mL-1 and a sensitivity of 0.05 µA mL cm-2 ng-1. Moreover, the proposed immunosensor was tested in real saliva samples, showing comparable results to those obtained with the conventional ELISA method. The biosensor was single-use and cost-effective and required a small quantity of test medium and a short preparation time, representing a very attractive biosensor for MMP-8 detection in human saliva.

Salivary and serum levels of neutrophil proteases in periodontitis and rheumatoid arthritis

OBJECTIVE

The aim was to profile serum and salivary levels of active-matrix metalloproteinase (aMMP)-8, tissue inhibitor MMP (TIMP)-1, aMMP-8/TIMP-1 ratio, total MMP (tMMP)-9, tMMP-9/TIMP-1 ratio, myeloperoxidase (MPO), and human neutrophil elastase (HNE) in periodontitis and rheumatoid arthritis (RA).

MATERIALS AND METHODS

Rheumatoid arthritis patients with periodontitis (RA + P, n = 26), periodontally healthy RA patients (RA, n = 23), systemically healthy periodontitis patients (P, n = 24), and controls (C, n = 24) were included. aMMP-8 levels were determined by a time-resolved immunofluorescence assay (IFMA), TIMP-1, tMMP-9, MPO, and HNE levels were measured by enzyme-linked immunosorbent (ELISA) assays.

RESULTS

Higher salivary aMMP-8 (p < 0.001), aMMP-8/TIMP-1 ratio (p = 0.043), tMMP-9 (p = 0.011), tMMP-9/TIMP-1 ratio (p = 0.022), MPO (p = 0.026) and HNE (p < 0.001) levels were detected in P relative to the controls. Salivary TIMP-1 was increased in RA patients regardless of periodontal status (RA + P vs. P: p = 0.038; RA vs. C: p = 0.020). Serum neutrophil proteases were increased in RA groups (RA + P, RA) compared to systemically healthy groups (P, C) (p < 0.05).

CONCLUSIONS

Serum levels of neutrophil proteases were increased in RA study groups; however rheumatologic status seemingly does not affect salivary levels of these proteins.

Clinical parameters and inflammatory biomarkers among patients with multibracket appliances: a prospective clinical trial

BACKGROUND

Aim of the presented study was to investigate changes in clinical parameters and active matrix metalloproteinase-8 (aMMP-8) levels in gingival crevicular fluid of patients before and during treatment with multibrackets appliances.

METHODS

Fifty-five adolescents scheduled for the treatment were included. Clinical parameters and subgingival samples were obtained at six time points: 1 week before appliance insertion (T0), 3 (T1), 6 (T2) weeks, 3 (T3), 6 (T4) months, and 1 year (T5) after that. Gingival index and plaque index were assessed to evaluated changes on the clinical status. Subgingival samples were collected to analyze changes in aMMP-8.

RESULTS

Scores for gingival and plaque index increased after bracket insertion. The gingival index increased from T2 (p < 0.05) until T5 (p < 0.0001). Plaque index also increased, reaching its maximum peak at T3 (p < 0.05). Moreover, an increase of aMMP-8 levels (p < 0.05) was noted. There was no significant between upper and lower jaws.

CONCLUSIONS

Treatment with multibracket appliances in adolescents favors dental plaque accumulation and may transitionally increase gingival and plaque index and aMMP-8 levels leading to gingival inflammation, even 1 year after therapy began.

TRIAL REGISTRATION

This study was approved by the Ethics Committee of the dental medical association Rheiland-Pfalz, Germany (process no. 837.340.12 (8441-F)), and followed the guidelines of Good Clinical Practices.

Oral active matrix metalloproteinase-8 immunotest may be less accurate in haemato-oncologic patients

OBJECTIVES

This study examines the associations of active matrix metalloproteinase-8 (aMMP-8) point-of-care immunotest (Periosafe) outcomes with oral health of patients with haemato-oncologic diseases.

METHODS

Adult patients diagnosed with haematological diseases aimed to be treated with haematopoietic stem cell transplantation (HSCT) between 2018 and 2019 were included in the study. Clinical and radiological dental examination were taken immediately prior to transplantation. The presence of oral foci of infections, caries or periodontitis was examined and compared with the outcomes of aMMP-8 immunotest.

RESULTS

Acute oral infection foci were present in 11.9%, chronic in 44.1% and periodontitis in 42.0% of the 143 subjects. aMMP-8 immunotest was positive in 13.3% of all the 143 subjects. Among subjects with periodontitis (n = 60), the aMMP-8 immunotest was also positive in 13.3% of these subjects. However, the subjects with positive aMMP-8 immunotest (n = 19) had more often acute or chronic infection foci and more than one of the examined dental treatment needs compared with subjects with negative immunotest (all p < 0.05). There were no differences in age, sex, hyposalivation, DMFT-index values nor with plasma levels of leukocytes, neutrophils or C-reactive protein between subjects with positive or negative aMMP-8 immunotest.

CONCLUSIONS

aMMP-8 immunotest accuracy might be reduced, in relation to periodontitis, in haemato-oncologic patients.

Association between Oral Active-Matrix Metalloproteinase-8 Levels and Subretinal Fibrosis among Wet Age-Related Macular Degeneration Patients

PURPOSE

Periodontitis causes low-grade systemic inflammation and has been associated with elevated active-matrix metalloproteinase (aMMP-8) levels, blood-ocular barrier breakdown and a risk of wet age-related macular degeneration. To assess the association between aMMP-8 levels and macular status among patients with wet age-related macular degeneration (AMD).

METHODS

Patients on anti-VEGF treatment for wet AMD were enrolled for oral aMMP-8 rinse test in Mehiläinen Private Hospital, Helsinki, Finland. Macular status was examined from spectral-domain optical coherence tomography (SD-OCT) scans by a medical retina specialist and aMMP-8 levels were analyzed with chairside point-of-care oral rinse (PerioSafe®) test and real-time quantitated by a dentist using the ORALyzer®- reader with a 10 ng/ml cut-off for aMMP-8 activity.

RESULTS

Elevated aMMP-8 levels were found in 10 out of 32 patients. Age, gender, anti-VEGF (bevacizumab or aflibercept) distribution, cumulative number of anti-VEGF injections and treatment interval were comparable between patients with aMMP-8 levels below and above the point-of-care level. Macular status differed in regard to aMMP-8 activity; among patients with aMMP-8 levels below the point-of-care subretinal fibrosis was found in 6 out of 22 eyes, whereas among patients with aMMP-8 levels above the point-of-care subretinal fibrosis was found in 8 out of 10 eyes (p = 0.005). Respectively, the mean thickness of subretinal fibrosis at fovea was 19.5 ± 44.1 and 92.3 ± 78.3 µm (p = 0.018). No differences were found in the presence and in the area of geographic atrophy, or fluid distribution, whereas thicknesses of serous pigment epithelial detachment (65.5 ± 99.5 and 12.9 ± 27.9 µm, p = 0.038) and neuroretina (204.2 ± 57.8 µm and 143.0 ± 43.7 µm, p = 0.006) were greater in the eyes of patients with physiological aMMP-8 levels compared to those with elevated aMMP-8 levels.

CONCLUSION

Elevated aMMP-8 levels may account for subretinal fibrosis formation in wet AMD.

Importance of Metalloproteinase 8 (MMP-8) in the Diagnosis of Periodontitis

Periodontitis is a complex condition. Left untreated, it leads to tooth loss and the need for prosthetic treatment. The incidence of periodontitis is steadily increasing, so new methods are being sought to aid in the diagnosis of the disease. Among the methods postulated is the determination of concentrations of bioactive compounds which include extracellular matrix metalloproteinases (MMPs). These enzymes are present in various structural elements of the stomatognathic system. The most promising enzyme of this group appears to be metalloproteinase 8 (MMP-8). MMP-8 assays are performed in gingival fluid or saliva, and MMP-8 levels have been shown to be higher in patients with periodontitis compared to healthy subjects and correlated with some clinical parameters of the condition and the severity of the disease. In addition, the preliminary usefulness of this enzyme in evaluating the effectiveness of periodontal treatment and doxycycline therapy has been demonstrated. Determination of the active form of MMP-8 (aMMP-8) in oral rinse fluid using off-the-shelf assays shows the highest potential. Despite reports about aMMP-8 and promising data on the role of MMP-8 in periodontal diagnosis, a clear determination of the usefulness of this enzyme requires further research.

Matrix Metalloproteinases in the Periodontium-Vital in Tissue Turnover and Unfortunate in Periodontitis

The extracellular matrix (ECM) is a complex non-cellular three-dimensional macromolecular network present within all tissues and organs, forming the foundation on which cells sit, and composed of proteins (such as collagen), glycosaminoglycans, proteoglycans, minerals, and water. The ECM provides a fundamental framework for the cellular constituents of tissue and biochemical support to surrounding cells. The ECM is a highly dynamic structure that is constantly being remodeled. Matrix metalloproteinases (MMPs) are among the most important proteolytic enzymes of the ECM and are capable of degrading all ECM molecules. MMPs play a relevant role in physiological as well as pathological processes; MMPs participate in embryogenesis, morphogenesis, wound healing, and tissue remodeling, and therefore, their impaired activity may result in several problems. MMP activity is also associated with chronic inflammation, tissue breakdown, fibrosis, and cancer invasion and metastasis. The periodontium is a unique anatomical site, composed of a variety of connective tissues, created by the ECM. During periodontitis, a chronic inflammation affecting the periodontium, increased presence and activity of MMPs is observed, resulting in irreversible losses of periodontal tissues. MMP expression and activity may be controlled in various ways, one of which is the inhibition of their activity by an endogenous group of tissue inhibitors of metalloproteinases (TIMPs), as well as reversion-inducing cysteine-rich protein with Kazal motifs (RECK).

The Impact of IL1B rs1143634 and DEFB1 rs11362 Variants on Periodontitis Risk in Phenylketonuria and Type 1 Diabetes Mellitus Patients in a Latvian Population

OBJECTIVES

Periodontitis is a multifactorial disease that affects approximately 11% of the global population. The objective of this study was to examine whether, among individuals with phenylketonuria and type 1 diabetes mellitus, those with the IL1B rs1143634 and/or DEFB1 rs11362 genetic variants exhibit a higher periodontitis risk compared to healthy controls.

MATERIALS AND METHODS

In all, 43 phenylketonuria patients (aged 12-53), 28 type 1 diabetes mellitus patients (aged 11-40), and 63 healthy controls (aged 12-53) were included. The evaluation of periodontitis risk was conducted using the Silness-Löe plaque index, the Greene-Vermillion index, and an assessment for the necessity of calculus removal. Genetic variants rs1143634 and rs11362 were genotyped from salivary samples using restriction length polymorphism analysis.

RESULTS

The DEFB1 rs11362 variant was associated with higher Silness-Löe and Greene-Vermillion index scores in phenylketonuria patients (p = 0.011 and p = 0.043, respectively). The IL1B rs1143634 variant was associated with lower calculus removal necessity in type 1 diabetes mellitus patients (p = 0.030). Clinical examination showed the worst oral hygiene index scores for PKU patients. PKU patients also reported the least consistent tooth brushing and flossing habits.

CONCLUSIONS

Genetic associations between DEFB1 rs11362 and IL1B rs1143634 variants and oral hygiene indices were observed in the PKU and T1DM groups, suggesting that genetic factors may contribute to periodontal health differences in these populations. Further research with a larger sample size is needed to confirm these findings and develop targeted oral health interventions.

Applicability of an active matrix metalloproteinase-8 point-of-care test in an oral and maxillofacial surgery clinic: a pilot study

OBJECTIVES

Matrix metalloproteinases are enzymes that participate in numerous inflammatory responses and have been targeted as biomarkers in numerous pathologic states. The detection of active matrix metalloproteinase-8 (aMMP-8) using a mouthrinse point-of-care test (POCT) has emerged as a diagnostic marker for periodontitis and other systemic inflammatory states. The objective of this pilot study was to assess the applicability of aMMP-8 POCT in an oral and maxillofacial surgery clinic and to evaluate the relationship between aMMP-8 levels and different patient groups.

MATERIALS AND METHODS

aMMP-8 POCT samples were collected from patients in an oral and maxillofacial surgery clinic during a one-month period. aMMP-8 levels were analyzed using a chairside lateral-flow immunotest and a digital reader. Clinically relevant patient variables were collected and descriptively evaluated. aMMP-8 levels over 20 ng/ml were considered to be elevated.

RESULTS

A total of 115 patients were interviewed of which 112 agreed to the test (97.4%). Elevated aMMP-8 levels were observed in 58 (51.8%) patients. Bone loss was noted in 75 (67.0%) patients. Of these patients, aMMP-8 levels were elevated in 47 (62.7%) patients. Patients at an increased risk of infection had 35.5% higher aMMP-8 values on average compared to patients with no prior illnesses.

CONCLUSION

aMMP-8 POCT provides a non-invasive and reliable method for measuring aMMP-8 levels. Future studies are warranted to assess the clinical relevance between elevated aMMP-8 levels and specific patient groups.

CLINICAL RELEVANCE

The rapid availability of the test score allows an immediate impact on treatment planning.

Correlations between different protein species of oral rinse MMP-8 and patient-related factors

OBJECTIVES

The aim of this study is to examine correlations between different oral rinse matrix metalloproteinase (MMP)-8 protein species in western blot (WB) analysis, quantitative MMP-8 measurements, and patient-related factors. Elevated activated MMP-8 (aMMP-8) associate with periodontitis and a diagnostic point-of-care technology has been developed based on aMMP-8. In WB, different MMP-8 protein species can be analyzed. Relative abundancy of fragmented 20-25 kDa forms in WB has been associated with and reflects MMP-8 activation and related fragmentation and elevated quantitative aMMP-8 measurements.

MATERIAL AND METHODS

A random sample of 192 participants from a periodontal disease screening study was used for this study. Oral rinse samples for biomarker analyses were collected before clinical periodontal examinations. aMMP-8 immunofluorometric (IFMA) and WB analysis (utilizing the same monoclonal antibody, 8708), polymorphonuclear leukocyte (PMN) elastase activity test and tissue inhibitor of metalloproteinases (TIMP)-1 ELISA levels were performed from the oral rinse samples. Distinct MMP-8 protein species were differentiated in the WB analysis. Principal component (PC) analysis was conducted to explore correlation patterns between the different species. Adjusted correlation analysis between the extracted PCs of WB and aMMP-8 IFMA levels and multilevel regression analysis were conducted to explore if the other periodontal disease-related biomarkers and clinical surrogate measures and patient-related factors are co-variating with the extracted components.

RESULTS

Distinct correlation patterns between the MMP-8 protein species were observed. The first four PCs explained 89% of the whole variance in PC analysis. Statistically significant correlation (p < 0.05) were observed as follows: PC1 positively with 21 kDa (r = .69) and 25 kDa fragments (r = .55) and negatively with 150 kDa complexes (r = -.46). PC2 correlated with 45 (r = .70) and 55 kDa (r = .65) activated forms, PC3 with 70-80 kDa latent proforms (r = .63) and 90-100 kDa complexes (r = .67), and PC4 with 35 kDa fragments (r = .81). There were significant correlations between quantitative (IFMA) aMMP-8 measurements and PC1 (p < 0.001), PC2 (<0.05) and PC3 (<0.05) but not with PC4. In multilevel regression models age, PMN elastase activity, TIMP-1 levels, and a number of 4-5 mm periodontal pockets were associated with PC1, nonsmoking with PC2, age and PMN elastase activity with PC3, and age and smoking with PC4.

CONCLUSIONS

Relative abundancy of fragmented 21-25 kDa protein species was correlated with the quantitative aMMP-8 (IFMA) measurements, which is in line with previous results. Different patient-related factors (smoking, age, proteolytic activity) may modify the formation of different MMP-8 protein species in oral rinse samples and may cause variability in quantitative aMMP-8 measurement.

Active Matrix Metalloproteinase-8 (aMMP-8) Versus Total MMP-8 in Periodontal and Peri-Implant Disease Point-of-Care Diagnostics

Active matrix metalloproteinase-8 (aMMP-8) is a promising biomarker candidate for the modern periodontal and peri-implant disease diagnostics utilizing the chairside/point-of-care oral fluid technologies. These rapid biomarker analysis technologies utilize gingival crevicular fluid (GCF), peri-implant sulcular fluid (PISF), or mouth rinse as the oral fluid matrices that can be collected patient-friendly and non-invasively without causing bacteremia. aMMP-8, but not total or latent proMMP-8, has been shown to be a relevant biomarker to be implemented to the latest 2017 classification system of periodontitis and peri-implantitis. Thus, aMMP-8 point-of-care-testing (POCT)-but not total or latent proMMP-8-can be conveniently used as an adjunctive and preventive diagnostic tool to identify and screen the developing and ongoing periodontal and peri-implant breakdown and disease as well as predict its episodic progression. Similarly, aMMP-8 POCT provides an important tool to monitor the treatment effect of these diseases, but also other diseases such as head and neck cancer, where it can identify and predict the rapid tissue destructive oral side-effects during and after the radiotherapy. Additionally, recent studies support aMMP-8 POCT benefitting the identification of periodontitis and diabetes as the escalating risk diseases for COVID-19 infection. Overall, aMMP-8 POCT has launched a new clinical field in oral medicine and dentistry, i.e., oral clinical chemistry.

Periradicular tissue fluid-derived biomarkers for apical periodontitis: An in vitro methodological and in vivo cross-sectional study

BACKGROUND

Periradicular tissue fluid (PTF) offers a source of diagnostic, prognostic and predictive biomarkers for endodontic disease.

AIMS

(1) To optimize basic parameters for PTF paper point sampling in vitro for subsequent in vivo application. (2) To compare proteomes of PTF from teeth with normal apical tissues (NAT) and asymptomatic apical periodontitis (AAP) using high-throughput panels.

METHODOLOGY

(1) To assess volume absorbance, paper points (n = 20) of multiple brands, sizes and sampling durations were inserted into PBS/1%BSA at several depths. Wetted lengths (mm) were measured against standard curves to determine volume absorbance (μL). To assess analyte recovery, paper points (n = 6) loaded with 2 μL recombinant IL-1β (15.6 ng/mL) were eluted into 250 μL: (i) PBS; (ii) PBS/1% BSA; (iii) PBS/0.1% Tween20; (iv) PBS/0.25 M NaCl. These then underwent: (i) vortexing; (ii) vortexing/centrifugation; (iii) centrifugation; (iv) incubation/vortexing/centrifugation. Sandwich-ELISAs determined analyte recovery (%) against positive controls. (2) Using optimized protocols, PTF was retrieved from permanent teeth with NAT or AAP after accessing root canals. Samples, normalized to total fluid volume (TFV), were analysed to determine proteomic profiles (pg/TFV) of NAT and AAP via O-link Target-48 panel. Correlations between AAP and diagnostic accuracy were explored using principal-component analysis (PCA) and area under receive-operating-characteristic curves (AUC [95% CI]), respectively. Statistical comparisons were made using Mann-Whitney U, anova and post hoc Bonferonni tests (α < .01).

RESULTS

(1) UnoDent's 'Classic' points facilitated maximum volume absorbance (p < .05), with no significant differences after 60 s (1.6 μL [1.30-1.73]), 1 mm depth and up to 40/0.02 (2.2 μL [1.98-2.20]). For elution, vortexing (89.3%) and PBS/1% BSA (86.9%) yielded the largest IL-1β recovery (p < .05). (2) 41 (NAT: 13; AAP: 31) PTF samples proceeded to analysis. The panel detected 18 analytes (CCL-2, -3, -4; CSF-1; CXCL-8, -9; HGF; IL-1β, -6, -17A, -18; MMP-1, -12; OLR-1; OSM; TNFSF-10, -12; VEGF-A) in ≥75% of AAP samples at statistically higher concentrations (p < .01). CXCL-8, IL-1β, OLR-1, OSM and TNFSF-12 were strongly correlated to AAP. 'Excellent' diagnostic performance was observed for TNFSF-12 (AUC: 0.94 [95% CI: 0.86-1.00]) and the PCA-derived cluster (AUC: 0.96 [95% CI: 0.89-1.00]).

CONCLUSIONS

Optimized PTF sampling parameters were identified in this study. When applied clinically, high-throughput proteomic analyses revealed complex interconnected networks of potential biomarkers. TNFSF-12 discriminated periradicular disease from health the greatest; however, clustering analytes further improved diagnostic accuracy. Additional independent investigations are required to validate these findings.

Antimicrobial and Anti-Inflammatory Oral Effects of Fermented Lingonberry Juice-A One-Year Prospective Human Intervention Study

OBJECTIVES

 A 1-year prospective human intervention study was performed to examine the anticaries, anti-inflammatory, antiproteolytic, and antimicrobial effects of fermented lingonberry juice (FLJ), used as a mouthwash for a period of 6 months, followed by a 6-month washout period.

MATERIALS AND METHODS

 Twenty-five adults were recruited from private dental clinics in Helsinki and Joensuu (Finland). Standard oral examinations and sample gatherings were performed at base level, 6 months, and 1 year for oral Streptococcus mutans (S. mutans), Candida, and Lactobacilli levels, and active matrix metalloprotease-8 (aMMP-8) levels, and for decayed, missing, filled teeth (DMFT), decayed, missing filled surfaces (DMFS) and decayed surfaces (DS) indexes, and probing pocket depths (PPDs), bleeding on probing (BOP), and visible plaque index (VPI). FLJ was used by the participants once daily for 30 seconds for 6 months. FLJ contains 0.212% (w/v) polyphenols, 3% (w/ v) sugars, and contains no excipients. Ten milliliters of FLJ were equal to 1 dL of lingonberry juice.

STATISTICAL ANALYSIS

 Statistical analyses were performed with nonparametric Friedman's test and pairwise post-hoc analysis with Dunn-Bonferroni test, SPSS (version 27; IBM) and p < 0.05 was considered as statistically significant.

RESULTS

 The levels of S. mutans and Candida counts, DS, BOP, and VPI decreased significantly (p < 0.05) during the FLJ period. Lactobacilli counts increased significantly, while there was also significant difference in aMMP-8 levels, DMFT, and DMFS between the three measurement points. PPDs were not affected.

CONCLUSIONS

 The specially formulated FLJ may have a positive decreasing effect on S. mutans, and Candida counts as well as decrease low-grade inflammation and proteolytic burden in the oral mucosa and periodontal tissues. The beneficial effects to the oral cavity of FLJ mouthwash may be useful among patients with oral diseases, such as dental caries, periodontitis and candidosis.

Association of chronic periodontitis with multiple sclerosis: A systematic review and meta-analysis

BACKGROUND

Chronic periodontitis (CP) is a multifactorial, chronic inflammatory disease of microbial etiology that manifests as a result of the dysfunction of the immune mechanism, culminating in the destruction of the alveolar bone of the jaws. Multiple sclerosis (MS) is an autoimmune disorder that affects the central nervous system (CNS), leads to demyelination and degeneration of nerve axons and often causes severe physical and/or cognitive impairment. As CP and MS involve inflammatory mechanisms and immune dysfunction, researchers have attempted to study the association between them.

AIM

To systematically review the literature on the epidemiological association between CP and MS in adults.

METHODS

PRISMA 2020 statement was used in the study protocol. The design was done according to the Cochrane methodology. A comprehensive literature search was performed in PubMed, Scopus and Cochrane databases; a manual search and evaluation of the gray literature was also performed. The meta-analysis was performed by Review Manager (RevMan) 5.4. Odds ratio (OR) with 95% confidence interval (CI) was defined as the effect size of the outcome. Heterogeneity was assessed by Chi-square and I2. The articles evaluated were written in English, without a time limit, concern observational studies (patient-controls) and report the diagnostic criteria of the diseases. Duplicate entries were excluded. To evaluate the reliability of the results of each study, Newcastle-Ottawa Scale (NOS) and GRADE tools were used. Two independent reviewers did all evaluations with a resolution of discrepancies by a third.

RESULTS

Meta-analysis included three observation studies examined 3376 people. MS patients are significantly more likely to be diagnosed with CP than healthy controls (OR 1.93, 95% CI 1.54-2.42, p<0.0001).

CONCLUSION

A high prevalence of CP was found among MS patients compared with healthy controls. Healthcare professionals should be aware of the association between these pathological entities to provide patients with high-quality care through an effective and holistic diagnostic and therapeutic approach.

Review Insights on Salivary Proteomics Biomarkers in Oral Cancer Detection and Diagnosis

Early detection is crucial for the treatment and prognosis of oral cancer, a potentially lethal condition. Tumor markers are abnormal biological byproducts produced by malignant cells that may be found and analyzed in a variety of bodily fluids, including saliva. Early detection and appropriate treatment can increase cure rates to 80-90% and considerably improve quality of life by reducing the need for costly, incapacitating medicines. Salivary diagnostics has drawn the interest of many researchers and has been proven to be an effective tool for both medication monitoring and the diagnosis of several systemic diseases. Since researchers are now searching for biomarkers in saliva, an accessible bodily fluid, for noninvasive diagnosis of oral cancer, measuring tumor markers in saliva is an interesting alternative to blood testing for early identification, post-treatment monitoring, and monitoring high-risk lesions. New molecular markers for oral cancer detection, treatment, and prognosis have been found as a result of developments in the fields of molecular biology and salivary proteomics. The numerous salivary tumor biomarkers and how they relate to oral cancer and pre-cancer are covered in this article. We are optimistic that salivary protein biomarkers may one day be discovered for the clinical detection of oral cancer because of the rapid advancement of proteomic technology.

aMMP-8 point-of-care - diagnostic methods and treatment modalities in periodontitis and peri-implantitis

INTRODUCTION

When collected in a standardized fashion, oral fluid analysis can refine the diagnosis of periodontal and peri-implant disease. In practice, dental professionals can perform active matrix metalloproteinase (aMMP-8) analysis chairside.

AREAS COVERED

Periodontal tissues are mainly made up of type I collagen, and collagen breakdown is one of the main events in periodontal and peri-implantitis destructive lesions. In addition to traditional measurements, their diagnosis can be refined with tests utilizing oral fluids. The active matrix metalloproteinase-8 (aMMP-8) is possible to be determined from the gingival crevicular fluid (GCF), peri-implant sulcus fluid (PISF), and other oral fluids such as mouth rinse and saliva. We also investigated the applicability of aMMP-8 chair-side test kits in the evaluation of oral health benefits of different adjunctive host-modulating periodontal therapies including fermented lingonberry mouthwash (FLJ) and antibacterial photodynamic therapy (aPDT).

EXPERT OPINION

The aMMP-8 levels can more reliably detect early activation of periodontal and peri-implant disease as compared to traditional diagnostic methods that assess the experienced health status or past disease, rather than the present or future pathology. Novel therapies like, fermented lingonberry juice as a mouthrinse or aPDT, are potential host-modulating adjunctive treatments to reduce the signs of oral inflammation and infection.

Periodontal Disease and Other Adverse Health Outcomes Share Risk Factors, including Dietary Factors and Vitamin D Status

For nearly a century, researchers have associated periodontal disease (PD) with risks of other adverse health outcomes such as cardiovascular disease, diabetes mellitus, and respiratory diseases, as well as adverse pregnancy outcomes. Those findings have led to the hypothesis that PD causes those adverse health outcomes either by increasing systemic inflammation or by the action of periodontopathic bacteria. However, experiments largely failed to support that hypothesis. Instead, the association is casual, not causal, and is due to shared underlying modifiable risk factors, including smoking, diet, obesity, low levels of physical activity, and low vitamin D status. Diabetes mellitus is also considered a risk factor for PD, whereas red and processed meat are the most important dietary risk factors for diabetes. Because PD generally develops before other adverse health outcomes, a diagnosis of PD can alert patients that they could reduce the risk of adverse health outcomes with lifestyle changes. In addition, type 2 diabetes mellitus can often be reversed rapidly by adopting an anti-inflammatory, nonhyperinsulinemic diet that emphasizes healthful, whole plant-based foods. This review describes the evidence that proinflammatory and prohyperinsulinemia diets and low vitamin D status are important risk factors for PD and other adverse health outcomes. We also make recommendations regarding dietary patterns, food groups, and serum 25-hydroxyvitamin D concentrations. Oral health professionals should routinely inform patients with PD that they could reduce their risk of severe PD as well as the risks of many other adverse health outcomes by making appropriate lifestyle changes.

An optical fiber-based point-of-care test for periodontal MMP-8 detection: a proof of concept

OBJECTIVES

The evaluation of salivary biomarkers has been proposed as a simple and non-invasive aid to the conventional periodontal diagnosis based on clinical-radiographic parameters. Matrix metalloproteinase-8 (MMP-8), especially in its active form, is considered one of the most reliable biomarkers of periodontitis, and point-of-care tests (POCTs) have been proposed for its clinical monitoring. In this proof-of-concept study, a novel highly sensitive POCT based on a plastic optical fiber (POF) biosensor exploiting surface plasmon resonance (SPR) to detect salivary MMP-8 is described.

METHODS

A SPR-POF biosensor was functionalized with a specific antibody to develop a surface-assembled monolayer (SAM) for the detection of total MMP-8. A white light source and a spectrometer connected to the biosensor were used to quantify MMP-8 level in both buffer and real matrix (saliva) by analysing the shift of the resonance wavelength determined by the specific antigen-antibody binding upon the SAM.

RESULTS

Dose-response curves by serial dilutions of human recombinant MMP-8 were realized, obtaining a limit of detection (LOD) of 40 pM (1.76 ng/ml) in buffer and 225 pM (9.9 ng/ml) in saliva and high selectivity compared to interferent analytes (MMP-2 and IL-6).

CONCLUSIONS

The proposed optical fiber-based POCT was able to detect and measure total MMP-8 with high selectivity and very low LOD in both buffer and saliva.

CLINICAL SIGNIFICANCE

The SPR-POF technology may be employed to create highly sensitive biosensors to monitor salivary MMP-8 levels. The possibility of specifically detecting its active, rather than total, form need to be further investigated. If confirmed and clinically validated, such a device may represent a promising tool to make an immediate, highly sensitive and reliable diagnosis of periodontitis, and to carry out a timely and targeted therapy, possibly helping to prevent the onset of local and systemic periodontitis-related complications.

Salivary E-cadherin as a biomarker for diagnosis and predicting grade of periodontitis

OBJECTIVES

To determine the abilities of salivary E-cadherin to differentiate between periodontal health and periodontitis and to discriminate grades of periodontitis.

BACKGROUND

E-cadherin is the main protein responsible for maintaining the integrity of epithelial-barrier function. Disintegration of this protein is one of the events associated with the destructive forms of periodontal disease leading to increase concentration of E-cadherin in the oral biofluids.

MATERIALS AND METHODS

A total of 63 patients with periodontitis (case) and 35 periodontally healthy subjects (control) were included. For each patient, periodontal parameters including bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded. Concentration of salivary E-cadherin was determined by ELISA. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to determine the diagnostic potentials of E-cadherin.

RESULTS

Level of salivary E-cadherin was significantly higher in periodontitis cases than controls. The ROC analysis showed that salivary E-cadherin exhibits excellent sensitivity and specificity (AUC 1.000) to differentiate periodontal health from periodontitis with a cutoff concentration equal to 1.325 ng/mL. The AUCs of E-cadherin to differentiate grade A from grade B and C periodontitis were 0.731 (cutoff point = 1.754 ng/mL) and 0.746 (cutoff point = 1.722 ng/mL), respectively. However, the AUC of salivary E-cadherin to differentiate grade B from grade C periodontitis was lower (0.541). Additionally, BOP and PPD were significantly and positively correlated with the concentration of salivary E-cadherin.

CONCLUSION

Salivary E-cadherin exhibited excellent sensitivity and specificity to differentiate periodontitis from a healthy periodontium. The level of accuracy of E-cadherin was also sufficient to recognize grade A periodontitis from grade B and C periodontitis.

Accuracy of aMMP-8 point-of-care test in indicating periodontal treatment outcomes in stage III/IV periodontitis: A 24-week follow-up study

OBJECTIVE

To analyse the correspondence between aMMP-8 PoC test results and the clinical endpoints of non-surgical periodontal treatment in stage III/IV periodontitis.

BACKGROUND

The diagnostic success of the active-matrix metalloproteinase-8 (aMMP-8) point-of-care (PoC) test has been demonstrated in various studies, but the evidence of its accuracy following periodontal treatment is limited.

MATERIALS AND METHODS

Altogether 42 stage III/IV grade C periodontitis patients were included in this prospective diagnostic study. Clinical periodontal indices were recorded, aMMP-8 PoC test was applied and mouthrinse was collected before and at 6, 12 and 24 weeks after non-surgical periodontal treatment. Quantitative aMMP-8 levels were determined with immunofluorometric assay (IFMA) for the verification of the PoC test results. The accuracy of the aMMP-8 PoC test was assessed using previously established clinical endpoints as references.

RESULTS

Sensitivity and specificity of aMMP-8 PoC test to indicate clinical endpoints were ranged as follows: Sensitivity 71.4% at baseline, 39.3%-42.4% at week 6, 28.6%-32.4% at week 12 and 35.3%-42.9% at week 24; specificity 64.3%-80% at week 6, 40%-57.1% at week 12 and 56%-64.3% at week 24.

CONCLUSIONS

The accuracy of aMMP-8 PoC test in identifying clinical endpoints after non-surgical periodontal treatment is reduced in relation to baseline. Individual healing patterns of each diseased pocket eventually limit the accuracy of the dichotomous aMMP-8 oral rinse test during the post-treatment period.

Peri-implant diseases diagnosis, prognosis and dental implant monitoring: a narrative review of novel strategies and clinical impact

BACKGROUND

The diagnosis of peri-implantar and periodontal relies mainly on a set of clinical measures and the evaluation of radiographic images. However, these clinical settings alone are not sufficient to determine, much less predict, periimplant bone loss or future implant failure. Early diagnosis of periimplant diseases and its rate of progress may be possible through biomarkers assessment. Once identified, biomarkers of peri-implant and periodontal tissue destruction may alert the clinicians before clinical signs show up. Therefore, it is important to consider developing chair-side diagnostic tests with specificity for a particular biomarker, indicating the current activity of the disease.

METHODS

A search strategy was created at Pubmed and Web of Science to answer the question: "How the molecular point-of-care tests currently available can help in the early detection of peri-implant diseases and throws light on improvements in point of care diagnostics devices?"

RESULTS

The PerioSafe® PRO DRS (dentognostics GmbH, Jena) and ImplantSafe® DR (dentognostics GmbH, Jena ORALyzer® test kits, already used clinically, can be a helpful adjunct tool in enhancing the diagnosis and prognosis of periodontal/peri-implantar diseases. With the advances of sensor technology, the biosensors can perform daily monitoring of dental implants or periodontal diseases, making contributions to personal healthcare and improve the current status quo of health management and human health.

CONCLUSIONS

Based on the findings, more emphasis is given to the role of biomarkers in diagnosing and monitoring periodontal and peri-implant diseases. By combining these strategies with traditional protocols, professionals could increase the accuracy of early detection of peri-implant and periodontal diseases, predicting disease progression, and monitoring of treatment outcomes.

Neutrophils in the periodontium: Interactions with pathogens and roles in tissue homeostasis and inflammation

Neutrophils are of key importance in periodontal health and disease. In their absence or when they are functionally defective, as occurs in certain congenital disorders, affected individuals develop severe forms of periodontitis in early age. These observations imply that the presence of immune-competent neutrophils is essential to homeostasis. However, the presence of supernumerary or hyper-responsive neutrophils, either because of systemic priming or innate immune training, leads to imbalanced host-microbe interactions in the periodontium that culminate in dysbiosis and inflammatory tissue breakdown. These disease-provoking imbalanced interactions are further exacerbated by periodontal pathogens capable of subverting neutrophil responses to their microbial community's benefit and the host's detriment. This review attempts a synthesis of these findings for an integrated view of the neutrophils' ambivalent role in periodontal disease and, moreover, discusses how some of these concepts underpin the development of novel therapeutic approaches to treat periodontal disease.

A Comparative Analysis of Treatment-Related Changes in the Diagnostic Biomarker Active Metalloproteinase-8 Levels in Patients with Periodontitis

BACKGROUND

Previous studies have revealed the potential diagnostic utility of aMMP-8, an active form of MMP-8, in periodontal and peri-implant diseases. While non-invasive point-of-care (PoC) chairside aMMP-8 tests have shown promise in this regard, there is a dearth of literature on the evaluation of treatment response using these tests. The present study aimed to investigate treatment-related changes in aMMP-8 levels in individuals with Stage III/IV-Grade C periodontitis compared to a healthy control group, using a quantitative chairside PoC aMMP-8 test, and to determine its correlation with clinical parameters.

METHODS

The study included 27 adult patients (13 smoker, 14 non-smoker) with stage III/IV-grade C periodontitis and 25 healthy adult subjects. Clinical periodontal measurements, real-time PoC aMMP-8, IFMA aMMP-8, and Western immunoblot analyses were performed before and 1 month after anti-infective scaling and root planing periodontal treatment. Time 0 measurements were taken from the healthy control group to test the consistency of the diagnostic test.

RESULTS

Both PoC aMMP-8 and IFMA aMMP-8 tests showed a statistically significant decrease in aMMP-8 levels and improvement in periodontal clinical parameters following treatment (p < 0.05). The PoC aMMP-8 test had high diagnostic sensitivity (85.2%) and specificity (100.0%) for periodontitis and was not affected by smoking (p > 0.05). Treatment also reduced MMP-8 immunoreactivity and activation as demonstrated by Western immunoblot analysis.

CONCLUSION

The PoC aMMP-8 test shows promise as a useful tool for the real-time diagnosis and monitoring of periodontal therapy.

Efficacy of a Novel Pleiotropic MMP-Inhibitor, CMC2.24, in a Long-Term Diabetes Rat Model with Severe Hyperglycemia-Induced Oral Bone Loss

Purpose

CMC2.24, a novel 4-(phenylaminocarbonyl)-chemically-modified-curcumin, is a pleiotropic MMP-Inhibitor of various inflammatory/collagenolytic diseases including periodontitis. This compound has demonstrated efficacy in host modulation therapy along with improved resolution of inflammation in various study models. The objective of current study is to determine the efficacy of CMC2.24 in reducing the severity of diabetes, and its long-term role as an MMP-inhibitor, in a rat model.

Methods

Twenty-one adult male Sprague-Dawley rats were randomly distributed into three groups: Normal (N), Diabetic (D) and Diabetic+CMC2.24 (D+2.24). All three groups were orally administered vehicle: carboxymethylcellulose alone (N, D), or CMC2.24 (D+2.24; 30mg/kg/day). Blood was collected at 2-months and 4-months' time-point. At completion, gingival tissue and peritoneal washes were collected/analyzed, and jaws examined for alveolar bone loss by micro-CT. Additionally, sodium hypochlorite(NaClO)-activation of human-recombinant (rh) MMP-9 and its inhibition by treatment with 10μM CMC2.24, Doxycycline, and Curcumin were evaluated.

Results

CMC2.24 significantly reduced the levels of lower-molecular-weight active-MMP-9 in plasma. Similar trend of reduced active-MMP-9 was also observed in cell-free peritoneal and pooled gingival extracts. Thus, treatment substantially decreased conversion of pro- to actively destructive proteinase. Normalization of the pro-inflammatory cytokine (IL-1ß, resolvin-RvD1), and diabetes-induced osteoporosis was observed in presence of CMCM2.24. CMC2.24 also exhibited significant anti-oxidant activity by inhibiting the activation of MMP-9 to a lower-molecular-weight (82kDa) pathologically active form. All these systemic and local effects were observed in the absence of reduction in severity of hyperglycemia.

Conclusion

CMC2.24 reduced activation of pathologic active-MMP-9, normalized diabetic osteoporosis, and promoted resolution of inflammation but had no effect on the hyperglycemia in diabetic rats. This study also highlights the role of MMP-9 as an early/sensitive biomarker in the absence of change in any other biochemical parameter. CMC2.24 also inhibited significant activation of pro-MMP-9 by NaOCl (oxidant) adding to known mechanisms by which this compound treats collagenolytic/inflammatory diseases including periodontitis.

Next-Generation Examination, Diagnosis, and Personalized Medicine in Periodontal Disease

Periodontal disease, a major cause of tooth loss, is an infectious disease caused by bacteria with the additional aspect of being a noncommunicable disease closely related to lifestyle. Tissue destruction based on chronic inflammation is influenced by host and environmental factors. The treatment of periodontal disease varies according to the condition of each individual patient. Although guidelines provide standardized treatment, optimization is difficult because of the wide range of treatment options and variations in the ideas and skills of the treating practitioner. The new medical concepts of “precision medicine” and “personalized medicine” can provide more predictive treatment than conventional methods by stratifying patients in detail and prescribing treatment methods accordingly. This requires a new diagnostic system that integrates information on individual patient backgrounds (biomarkers, genetics, environment, and lifestyle) with conventional medical examination information. Currently, various biomarkers and other new examination indices are being investigated, and studies on periodontal disease-related genes and the complexity of oral bacteria are underway. This review discusses the possibilities and future challenges of precision periodontics and describes the new generation of laboratory methods and advanced periodontal disease treatment approaches as the basis for this new field.

Determination of the Accuracy of Salivary Biomarkers for Periodontal Diagnosis

Background: We aimed to investigate the accuracy of salivary matrix metalloproteinases (MMP)-8 and -9, and tissue inhibitor of metalloproteinase (TIMP)-1 in diagnosing periodontitis and in distinguishing periodontitis stages (S)1 to S3. Methods: This study was a case–control study that included patients with periodontitis S1 to S3 and subjects with healthy periodontia (controls). Saliva was collected, and then, clinical parameters were recorded, including plaque index, bleeding on probing, probing pocket depth, and clinical attachment level. Diagnosis was confirmed by assessing the alveolar bone level using radiography. Salivary biomarkers were assayed using an enzyme-linked immunosorbent assay. Results: A total of 45 patients (15 for each stage) and 18 healthy subjects as controls were included. The levels of all salivary biomarkers and clinical parameters were significantly higher in periodontitis subjects than in the controls. The ROC curve showed that MMP-8, MMP-9, TIMP-1, MMP-8/TIMP-1, and MMP-9/TIMP-1 had statistically significant diagnostic accuracy, with areas under the curve (AUCs) of 0.892, 0.844, 0.920, 0.986, and 1.000, respectively, when distinguishing periodontitis from the controls. Similarly, these biomarkers showed significant diagnostic accuracy in the differentiation of S1 periodontitis from the controls (AUC range from 0.902 to 1.000). Conclusions: This study suggested that salivary biomarkers exhibited high diagnostic accuracy in distinguishing periodontal health from periodontitis in general as well as S1 periodontitis. Furthermore, TIMP-1 could differentiate S1 from S3.

Repeated Daily Use of Dual-Light Antibacterial Photodynamic Therapy in Periodontal Disease—A Case Report

Good oral hygiene at home is the foundation for optimal treatment response and long-term periodontal disease control. Antibacterial photodynamic therapy (aPDT) provides a very potent adjunctive treatment for plaque control. However, the literature regarding repeated aPDT use is sparse. aPDT has been a modality applied mainly in the dental office environment, and when applied once a year or every few months, the results have been usually disappointing. Recently, LED development has brought aPDT for repeated and practical use at home. We present the very positive results and clinical outcome of daily applied dual-light aPDT-technology treatment in conjunction with mechanical cleaning of a 78-year-old male patient with severe periodontal disease (Stage IV and Grade B).

Validation of a noninvasive aMMP‐8 point‐of‐care diagnostic methodology in COVID‐19 patients with periodontal disease

Objectives

The aim of this study was to validate an active matrix metalloproteinase (MMP‐8) point‐of‐care diagnostic tool in COVID‐19 patients with periodontal disease.

Subjects, Materials, and Methods

Seventy‐two COVID‐19‐positive and 30 COVID‐19‐negative subjects were enrolled in the study. Demographic data were recorded, periodontal examination carried out, and chairside tests run for evaluating the expression of active MMP‐8 (aMMP‐8) in the site with maximum periodontal breakdown via gingival crevicular fluid sampling as well as via a mouth rinse‐based kit for general disease activity. In COVID‐19‐positive patients, the kits were run again once the patients turned COVID‐19 negative.

Results

The overall (n = 102) sensitivity/specificity of the mouthrinse‐based kits to detect periodontal disease was 79.41%/36.76% and that of site‐specific kits was 64.71%/55.88% while adjusting for age, gender, and smoking status increased the sensitivity and specificity (82.35%/76.47% and 73.53%/88.24, respectively). Receiver operating characteristic (ROC) analysis for the adjusted model revealed very good area under the ROC curve 0.746–0.869 (p < .001) and 0.740–0.872 (p < .001) (the aMMP‐8 mouth rinse and site‐specific kits, respectively). No statistically significant difference was observed in the distribution of results of aMMP‐8 mouth rinse test (p = .302) and aMMP‐8 site‐specific test (p = .189) once the subjects recovered from COVID‐19.

Conclusions

The findings of the present study support the aMMP‐8 point‐of‐care testing (PoCT) kits as screening tools for periodontitis in COVID‐19 patients. The overall screening accuracy can be further increased by utilizing adjunctively risk factors of periodontitis. The reported noninvasive, user‐friendly, and objective PoCT diagnostic methodology may provide a way of stratifying risk groups, deciding upon referrals, and in the institution of diligent oral hygiene regimens.

Fermented lingonberry juice's effects on active MMP-8 (aMMP-8), bleeding on probing (BOP), and visible plaque index (VPI) in dental implants-A clinical pilot mouthwash study

OBJECTIVES

We aimed to study the effects of fermented lingonberry juice (FLJ) as a mouthwash on the levels of active matrix metalloproteinase-8 (aMMP-8) in peri-implant sulcular fluid (PISF), bleeding on probing (BOP), and visible plaque index (VPI). We hypothesized that FLJ rinsing could reduce inflammation (aMMP-8 and BOP) and microbial load (VPI) in the oral cavity, especially around dental implants.

MATERIALS AND METHODS

A clinical pilot study was performed using FLJ as a mouthwash. The inclusion criteria were at least one dental implant in the anterior or posterior areas with a screw-retained crown. Ten participants used 10 ml of mouthwash twice a day for 15 days, and 10 participants served as the control group. Point-of-care tests (POCTs) were used to measure aMMP-8 levels in the PISF, and BOP and VPI were recorded at the beginning of the trial and after 15 and 30 days.

RESULTS

The FLJ mouthwash had a reductive effect on aMMP-8, VPI, and BOP in the mouthwash group; however, there was no significant difference compared to the control group. The difference in VPI and BOP levels between the groups diminished after the lingonberry regimen ended. The decrease in aMMP-8 levels appeared to continue even after discontinuation of the mouthwash regimen.

CONCLUSION

The reduction in the amount of plaque, aMMP-8, and BOP by FLJ was promising and continuous considering the relatively short study period and sample size. FLJ is a natural and safe supplement for oral and dental implant home care. Further studies are required to verify these promising results.

Clinical Significance of Inflammatory Factors, Osteocalcin, and Matrix Metalloproteinase-8 in Gingival Crevicular Fluid in Drug Treatment of Severe Periodontitis

Whether gingival crevicular fluid (GCF) indexes in patients with severe periodontitis affect the efficacy of drug treatment was a new direction of recent research. At present, there were few studies on the effects of inflammatory indicators, BGP, and MMP-8 levels in GCF on the efficacy of drug treatment in such patients. So the purpose of this study was to observe the changes in osteocalcin (BGP), matrix metalloproteinase-8 (MMP-8), and inflammatory indexes levels in GCF of patients with severe periodontitis. The correlation between the above indexes and the effect of drug treatment in the patients was analyzed, in order to provide guidance for improving the clinical curative effect of severe periodontitis. A retrospective analysis was conducted to collect the baseline data of patients with severe periodontitis who were treated with Minocycline Hydrochloride Ointment in our hospital. The inflammatory indicators, BGP, and MMP-8 levels in GCF were analyzed before drug treatment, and the treatment effect on the patients was counted. Logistic regression was used to analyze the correlation between BGP, MMP-8, and inflammatory indicators levels in GCF and the drug treatment effect on the patients. After statistical analysis, we found that the response rate was 69% and the inefficiency was 31%. There were no significant differences in C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) levels between the inefficacy group and efficacy group (P > 0.05). Compared with the efficacy group, the levels of interleukin-6 (IL-6), interleukin-1β (IL-1β), interleukin-8 (IL-8), BGP, and MMP-8 were increased in the inefficacy group. High levels of IL-6, IL-1β, IL-8, BGP, and MMP-8 were associated with ineffective drug treatment in patients with severe periodontitis (all OR >1 and P < 0.05). Levels of IL-6, IL-1β, IL-8, BGP, and MMP-8 predicted that the AUCs of drug treatment failure in patients with severe periodontitis were all greater than 0.7, which were 1.398, 1.458, 1.244, 1.012, and 1.012, respectively. From this, we can conclude that increased levels of BGP, MMP-8, and inflammatory indicators such as IL-6, IL-1β, and IL-8 in GCF would increase the risk of ineffective drug treatment in patients with severe periodontitis. The clinical treatment plan could be adjusted according to the levels of the above indicators in GCF to improve the effectiveness of drug treatment in patients.

Assessing salivary matrix metalloproteinase‐8 in prostate cancer patients undergoing androgen deprivation therapy

Introduction

Matrix metalloproteinase‐8 (MMP‐8) is considered as one of the most promising diagnostic markers for periodontal disease. Androgen deprivation therapy (ADT) has been correlated with impaired collagen synthesis and an increase in periodontal tissue susceptibility to pathogenic microorganisms.

Objective

This study aims to investigate the impact of ADT on salivary MMP‐8 level and periodontal parameters, which might be useful in monitoring periodontal disease in prostate cancer patients undergoing ADT.

Materials and Methods

A total of 88 subjects were selected and were divided into two groups: Group I included n = 78 PC patients who have been undergoing ADT); Group II included n = 10 healthy individuals. Periodontal parameters such as plaque index (PI), gingival index (GI), periodontal probing depth (PPD), and clinical attachment level (CAL) were examined. The salivary MMP‐8 level was estimated by using the sandwich enzyme‐linked immunosorbent assay method.

Results

Significant differences in mean salivary MMP‐8 level were found between PC patients undergoing ADT and healthy individuals. Salivary MMP‐8 levels of all individuals were positively correlated with GI, PI, PPD, and CAL. Salivary MMP‐8 can distinguish between periodontitis and healthy individuals with an accuracy of about 80%.

Conclusion

Salivary MMP‐8 levels were found to be higher in prostate cancer patients undergoing ADT compared to healthy individuals.

aMMP-8 Oral Fluid PoC Test in Relation to Oral and Systemic Diseases

The manuscript uses the previously published literature and highlights the benefits of active-matrix metalloproteinase (aMMP)-8 chairside/point-of-care (PoC) diagnostic tools as adjunctive measures in oral and systemic diseases. Previous studies suggest that as a biomarker, aMMP-8 is more precise than total MMP-8, MMP-9, MMP-2, MMP-3, MMP-13, MMP-7, MMP-1, calprotectin, myeloperoxidase (MPO), human neutrophil elastase (HNE), tissue inhibitor of matrix metalloproteinase (TIMP)-1, and bleeding of probing (BOP). Therefore, aMMP-8 could be implemented as the needed key biomarker for the new disease classification for both periodontitis and peri-implantitis. With a sensitivity to the tune of 75–85% and specificity in the range of 80–90%, lateral flow aMMP-8 PoC testing is comparable to catalytic protease activity assays for aMMP-8. The test can be further applied to estimate the glycemic status of an individual, to ascertain whether a person is at risk for COVID-19, in managing the oral side effects of radiotherapy carried in head and neck cancers, and in selected cases pertaining to reproductive health. In the future, aMMP-8 could find application as a potential systemic biomarker in diseases affecting the cardiovascular system, cancers, bacteremia, sepsis, diabetes, obesity, meningitis, as well as pancreatitis. The aMMP-8 PoCT is the first practical test in the emerging new dental clinical field, that is, oral clinical chemistry representing oral medicine, clinical chemistry, peri-implantology, and periodontology.

Implementing of aMMP‐8 point‐of‐care test with a modified new disease classification in Finnish adolescent cohorts

Objectives

Material and Methods

Results

Conclusions

Diagnostic accuracy of active matrix metalloproteinase-8 point-of-care test for the discrimination of periodontal health status: Comparison of saliva and oral rinse samples

BACKGROUND AND OBJECTIVES

Assessment of biomarkers, specifically active matrix metalloproteinase-8 (aMMP-8), in saliva/oral rinses is a promising diagnostic approach for periodontal health and disease. Different oral fluids have specific advantages and limitations. This study investigates the effect of sampling different fluids on the accuracy of an aMMP-8 point of care test (POCT).

METHODS

Unstimulated whole saliva, a first, and a second oral rinse were sequentially taken from 95 consecutive adults. aMMP-8 was quantitatively determined with a lateral flow immunoassay (index test). A full-mouth periodontal examination was used to establish a diagnosis according to the 2017 World Workshop classification of periodontal diseases (reference standard). Diagnostic measures of the area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity were assessed and compared.

RESULTS

In all oral fluid samples, periodontitis patients (N = 61) had significantly elevated aMMP-8 levels and increased test positivity rates compared with subjects with periodontal health or gingivitis (N = 34). The intra-individual comparison showed that aMMP-8 levels were significantly higher in 1st oral rinse compared with other samples (1^st oral rinse > saliva = 2^nd oral rinse, p = .007). The aMMP-8 test using 1st oral rinse exhibited the best accuracy for detecting periodontitis with a sensitivity of 80.3%, a specificity of 67.8% and an AUROC of 0.740.

CONCLUSIONS

A 30-second oral rinse with water omitting the prerinse provided the best accuracy to discriminate periodontal health and disease with an aMMP-8 POCT. This regimen seems promising for further studies in large representative populations to verify the current findings.

The Role of Epigenetic and Biological Biomarkers in the Diagnosis of Periodontal Disease: A Systematic Review Approach

The aim of this systemic review was to collate and analyze existing data from published literature sources to identify the current understanding of the role of epigenetic and biological biomarkers in periodontal disease and diagnostics. A comprehensive searching strategy was undertaken in Embase, Medline, The Dentistry and Oral Sciences and CINAHL databases. Grey literature searching strategies were also employed. Articles published in the English language between 2017−2020 were included. A total of 1014 studies were returned of which 15 studies were included. All included articles were cross-sectional, case−control studies. Relevant data were extracted according to various demographic and methodological factors including cohort size, oral biofluid sampled, number of examiners, smoking status and reported outcomes. A measure of the biomarker levels and corresponding significance were documented where possible. This review identified that exRNA has the greatest diagnostic potential, with four biomarkers (SPRR1A, lnc-TET3-2:1, FAM25A, CRCT1) displaying sensitivity of >71% and specificity of 100% in the assessed samples (p < 0.001) for gingivitis. This work also identifies the need for a unified approach to future research to draw meaningful comparison. Further investigations are warranted to definitively validate exRNA data and for the development of an exRNA-specific point-of-care diagnostic test.

Salivary Biomarkers in Periodontitis Patients: A Pilot Study

Background and Objective. Periodontal disease is a chronic inflammatory condition, involving the destruction of both soft and hard tissues in the periodontal region. Advances in diagnostic research are moving toward methods whereby the periodontal risk can be identified and quantified by objective measures using specific inflammatory markers that can be correlated to the severity of the disease. The purpose of this study was to evaluate salivary concentrations of IL-1β, IL-6, MMP-8, and IL-10 in healthy and periodontitis patients and to assess the association between these biomarkers levels and clinical parameters in a Moroccan population. Materials and Methods. Forty subjects were included: 10 periodontally healthy subjects and 30 periodontitis patients. Periodontal examination and saliva sampling were performed in all patients. Levels of salivary cytokines including IL-1β, IL-6, MMP-8, and IL-10 were evaluated by a sandwich ELISA test kit. Data were analyzed by SPSS for Windows. Results. Regarding individual biomarkers, IL-1β, IL-6, and MMP-8 levels were significantly higher in periodontitis patients ( $p\le 0.001$ , $p<\text{0.}05$ , respectively). The concentration of these proteins in saliva showed a significant association with gingival index and pocket depth measurements and may reflect the clinical status of healthy and diseased periodontium. However, no significant differences were observed for the IL-10 component. Conclusion. IL-1β and IL-6 concentrations were statistically higher in periodontitis patients and may be used as potential tools in periodontitis diagnosis.

Ability of matrix metalloproteinase-8 biosensor, IFMA, and ELISA immunoassays to differentiate between periodontal health, gingivitis, and periodontitis

Objective

The aim of this study was to determine the diagnostic utility of an MMP‐8 biosensor assay in differentiating periodontal health from gingivitis and periodontitis and compare it with an established time‐resolved immunofluorescence assay (IFMA) and enzyme‐linked immunosorbent assay (ELISA).

Background

Currently available antibody‐based assays display a wide variability in their ability to accurately measure matrix metalloproteinase‐8 (MMP‐8) levels in saliva.

Methods

Salivary MMP‐8 levels were analyzed in 189 systemically healthy participants using an antibody‐based biosensor prototype that operates using a surface acoustic wave technology and compared with IFMA and ELISA antibody assays. Participants were categorized into 3 groups: periodontal health (59), gingivitis (63), and periodontitis (67). A sub‐population of participants (n = 20) with periodontitis received periodontal treatment and were monitored for 6 months.

Results

All the assays demonstrated significantly higher salivary MMP‐8 concentrations in participants with periodontitis versus gingivitis, periodontitis versus health, and gingivitis versus health (all p < .05). The biosensor data demonstrated significant correlations with IFMA (r = .354, p < .001) and ELISA (r = .681, p < .001). Significant reductions in salivary MMP‐8 concentrations were detected by the biosensor (p = .030) and IFMA (p = .002) in participants with periodontitis 6 months after non‐surgical periodontal treatment. IFMA had the best sensitivity (89.2%) for detecting periodontitis and gingivitis versus health and 96.6% for detecting periodontitis versus health and gingivitis. The biosensor had an AUC value of 0.81 and diagnostic accuracy of 74.2% for differentiating periodontitis and gingivitis from health; an AUC value of 0.86 and diagnostic accuracy of 82.8% for periodontitis versus health and gingivitis.

Conclusions

The biosensor, IFMA, and ELISA assays differentiated between periodontal health, gingivitis, and periodontitis based on salivary MMP‐8 levels. Only the biosensor and, particularly, IFMA identified an effect of periodontal treatment in the participants with periodontitis. Our findings support the potential utility of salivary oral fluid aMMP‐8‐based point‐of‐care technology in the future of periodontal diagnostics.

Repeated Home-Applied Dual-Light Antibacterial Photodynamic Therapy Can Reduce Plaque Burden, Inflammation, and aMMP-8 in Peri-Implant Disease—A Pilot Study

Until now, in clinical dentistry, antibacterial photodynamic therapy (aPDT) has been restricted to in-office treatments, which hampers repeated applications. This pilot study tested the benefit of a commercially available Lumoral^® device designed for regular periodontal dual-light aPDT treatment at home. Seven patients with peri-implant disease applied dual-light aPDT daily in addition to their normal dental hygiene for four weeks. A single Lumoral^® treatment includes an indocyanine green mouth rinse followed by 40 J/cm² radiant exposure to a combination of 810 nm and 405 nm light. A point-of-care analysis of active-matrix metalloproteinase (aMMP-8), visible plaque index (VPI), bleeding on probing (BOP), and peri-implant pocket depth (PPD) measurements was performed on day 0, day 15, and day 30. Reductions in aMMP-8 (p = 0.047), VPI (p = 0.03), and BOP (p = 0.03) were observed, and PPD was measured as being 1 mm lower in the implant (p = ns). These results suggest a benefit of regular application of dual-light aPDT in peri-implantitis. Frequently repeated application can be a promising approach to diminishing the microbial burden and to lowering the tissue destructive proteolytic and inflammatory load around dental implants. Further studies in larger populations are warranted to show the long-term benefits.

Efficacy of MMP-8 Level in Gingival Crevicular Fluid to Predict the Outcome of Nonsurgical Periodontal Treatment: A Systematic Review

Purpose: To explore whether baseline matrix metalloproteinase (MMP)-8 level in gingival crevicular fluid (GCF) (exposure) can predict the outcome (reduction in probing pocket depth (PPD) (outcome)) of nonsurgical periodontal therapy (NSPT) (manual or ultrasonic or both) in patients with periodontitis (population/problem) after 3 months. Methods: Six databases (PubMed, Cochrane library, ProQuest, Ovid, Scopus, EBSCO) were searched for relevant articles published until 30 July 2021. Retrieved articles were passed through a three-phase filtration process on the basis of the eligibility criteria. The primary outcome was the change in PPD after 3 months. Quality of the selected articles was assessed using Cochrane Risk of Bias tool (RoB2) and Risk of Bias In Non-Randomized Studies of Interventions (ROBINS-I) tools. Results: From 1306 articles, five were selected for analysis. The results showed high variations in the level of GCF MMP-8 level at baseline. The average amount of reduction in PPD was 1.20 and 2.30 mm for pockets with initial depth of 4−6 mm and >6 mm, respectively. Conclusion: On the basis of available evidence, it was not possible to reach a consensus on the ability of baseline GCF MMP-8 to forecast the outcome of NSPT. This could have been due to variation in clinical and laboratory techniques used. However, consistency in mean PPD reduction after 3 months was shown.

The Clinical, Microbiological, and Immunological Effects of Probiotic Supplementation on Prevention and Treatment of Periodontal Diseases: A Systematic Review and Meta-Analysis

(1) Background: Periodontal diseases are a global health concern. They are multi-stage, progressive inflammatory diseases triggered by the inflammation of the gums in response to periodontopathogens and may lead to the destruction of tooth-supporting structures, tooth loss, and systemic health problems. This systematic review and meta-analysis evaluated the effects of probiotic supplementation on the prevention and treatment of periodontal disease based on the assessment of clinical, microbiological, and immunological outcomes. (2) Methods: This study was registered under PROSPERO (CRD42021249120). Six databases were searched: PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, and Dentistry and Oral Science Source. The meta-analysis assessed the effects of probiotic supplementation on the prevention and treatment of periodontal diseases and reported them using Hedge’s g standardized mean difference (SMD). (3) Results: Of the 1883 articles initially identified, 64 randomized clinical trials were included in this study. The results of this meta-analysis indicated statistically significant improvements after probiotic supplementation in the majority of the clinical outcomes in periodontal disease patients, including the plaque index (SMD = 0.557, 95% CI: 0.228, 0.885), gingival index, SMD = 0.920, 95% CI: 0.426, 1.414), probing pocket depth (SMD = 0.578, 95% CI: 0.365, 0.790), clinical attachment level (SMD = 0.413, 95% CI: 0.262, 0.563), bleeding on probing (SMD = 0.841, 95% CI: 0.479, 1.20), gingival crevicular fluid volume (SMD = 0.568, 95% CI: 0.235, 0.902), reduction in the subgingival periodontopathogen count of P. gingivalis (SMD = 0.402, 95% CI: 0.120, 0.685), F. nucleatum (SMD = 0.392, 95% CI: 0.127, 0.658), and T. forsythia (SMD = 0.341, 95% CI: 0.050, 0.633), and immunological markers MMP-8 (SMD = 0.819, 95% CI: 0.417, 1.221) and IL-6 (SMD = 0.361, 95% CI: 0.079, 0.644). (4) Conclusions: The results of this study suggest that probiotic supplementation improves clinical parameters, and reduces the periodontopathogen load and pro-inflammatory markers in periodontal disease patients. However, we were unable to assess the preventive role of probiotic supplementation due to the paucity of studies. Further clinical studies are needed to determine the efficacy of probiotic supplementation in the prevention of periodontal diseases.

The Effect of Periodontal Therapy on the Level of MMP-8 in Patients with Chronic Periodontitis

OBJECTIVE

 The complete removal of bacterial plaque and their endotoxins in deeper areas of periodontal pockets is often difficult to achieve with conventional methods such as periodontal pocket curettage. An alternative to these methods that recently gained popularity in periodontology is the diode laser, with its antibacterial effect, angiogenesis promotion as advantages.

MATERIALS AND METHODS

 This study included 100 patients diagnosed with chronic periodontitis, with periodontal pockets up to 6 mm, and who were divided into two groups: patients treated with basic therapy and diode laser application, and patients treated with basic therapy and with flap surgery. The clinical periodontal evaluation was done before the treatment and 6 months after the treatment. Evaluation of matrix metalloproteinase (MMP)-8 as an inflammatory indicator in gingival exudate was done with dipstick immunoassay test before the treatment and 6 months later.

RESULTS

 This study showed a more pronounced improvement of periodontal clinical parameters, as well as a decrease in MMP-8 values in gingival exudate in the laser-treated group compared with the surgically treated group.

CONCLUSION

 The results of this study are encouraging for the use of the diode laser as a noninvasive method in the treatment of periodontal pathologies.