Periodontitis and Tooth Loss Have Negative Systemic Impact on Circulating Progenitor Cell Levels: A Clinical Study

Crosstalk between periodontitis and cardiovascular risk

Recent demographic developments resulted in an aged society with a rising disease burden of systemic and non-communicable diseases (NCDs). In cardiovascular disease (CVD), a NCD with high morbidity and mortality, recent preventive strategies include the investigation of comorbidities to reduce its significant economic burden. Periodontal disease, an oral bacterial-induced inflammatory disease of tooth-supporting tissue, is regulated in its prevalence and severity by the individual host response to a dysbiotic oral microbiota. Clinically, both NCDs are highly associated; however, shared risk factors such as smoking, obesity, type II diabetes mellitus and chronic stress represent only an insufficient explanation for the multifaceted interactions of both disease entities. Specifically, the crosstalk between both diseases is not yet fully understood. This review summarizes current knowledge on the clinical association of periodontitis and CVD, and elaborates on how periodontitis-induced pathophysiological mechanisms in patients may contribute to increased cardiovascular risk with focus on atherosclerosis. Clinical implications as well as current and future therapy considerations are discussed. Overall, this review supports novel scientific endeavors aiming at improving the quality of life with a comprehensive and integrated approach to improve well-being of the aging populations worldwide.

Transcriptomic analysis identifies diagnostic genes in polycystic ovary syndrome and periodontitis

PURPOSE

To investigate underlying co-mechanisms of PCOS and periodontitis through transcriptomic approach.

METHODS

PCOS and periodontitis gene expression data were downloaded from the GEO database to identify differentially expressed genes. GO and KEGG pathway enrichment analysis and random forest algorithm were used to screen hub genes. GSEA analyzed the functions of hub genes. Correlations between hub genes and immune infiltration in two diseases were examined, constructing a TF-ceRNA regulatory network. Clinical samples were gathered from PCOS and periodontitis patients and RT-qPCR was performed to verify the connection.

RESULTS

There were 1661 DEGs in PCOS and 701 DEGs in periodontitis. 66 intersected genes were involved and were enriched in immune and inflammation-related biological pathways. 40 common genes were selected from the PPI network. RF algorithm demonstrated that ACSL5, NLRP12, CCRL2, and CEACAM3 were hub genes, and GSEA results revealed their close relationship with antigen processing and presentation, and chemokine signaling pathway. RT-qPCR results confirmed the upregulated gene expression in both PCOS and periodontitis.

CONCLUSION

The 4 hub genes ACSL5, NLRP12, CCRL2, and CEACAM3 may be diagnostic genes for PCOS and periodontitis. The created ceRNA network could provide a molecular basis for future studies on the association between PCOS and periodontitis.

Thermographic Changes During Soft Tissue Incisions with Diode Infrared Lasers

Objective: This study aimed to demonstrate temperature changes and heat transfer patterns in soft tissues when using infrared (IR) diode lasers, utilizing thermographic techniques. Methods: Bovine tongue slices (5 mm thick) were placed between two glass slides at 11 cm from a thermographic camera. Twenty-two centimeter-long incisions were made along the soft tissue parallel to the camera capture field. Incisions were performed using the 970 and 980 nm lasers (continuous wave, 2-watt, 320 μm-thick glass initiated, and noninitiated fiber tips, 30-sec irradiation). The maximum temperature changes in oC (ΔT) and the vertical and lateral heat transfer (in mm) were recorded for 30 sec, using the thermographic images captured using the IR camera. The ΔT and the amount of lateral and vertical heat distribution were measured in 10-sec intervals for a 30-sec irradiation period. A repeated analysis of variance (ANOVA) (p < 0.05) statistical test was used to analyze the statistical differences between the average ΔT and heat transfer patterns between the initiated and noninitiated lasers. Results: The maximum ΔT for the 970 nm diode laser with initiated tips at the 30-sec mark was 17.81 ± 11.48, while the maximum ΔT for the 980 nm diode laser with initiated tips was 13.24 ± 6.90 (p = 0.041). Statistically significant differences between the vertical and horizontal heat transfer patterns were noted between the initiated and noninitiated diode lasers. The 980 nm diode laser with initiated tips proved to have statistically significant greater vertical and lateral heat transfer when compared to the 970 nm diode laser. The 970 nm diode laser with noninitiated tips proved to have a statistically significant higher heat distribution when compared to the 980 nm laser with noninitiated tips. Conclusions: Different near-IR lasers present differences in lateral heat and tissue penetration, using initiated or noninitiated fibers, and due to these differences, power settings and irradiation period must be considered to avoid risks due to overheating.

Analysis of oral microbiome on temporary anchorage devices under different periodontal conditions

BACKGROUND

Temporary anchorage devices (TADs) are maximum anchorages that have been widely used in orthodontic treatment. The aim of the study was to uncover whether a history of periodontitis would influence microbiome colonization on the TAD surface.

RESULTS

Patients were grouped by periodontal evaluations before the orthodontic treatment. Patients with healthy periodontal conditions were classified as the healthy group, and patients diagnosed with periodontitis stage II or even worse were classified as the periodontitis group. Scanning electron microscopy (SEM) was used to analyze the existence of biofilm on the surface of 4 TADs from the healthy group and 4 TADs from the periodontitis group. Fifteen TADs from the healthy group and 12 TADs from the periodontitis group were collected. The microorganisms on the surface of TADs were harvested and analyzed by 16S rRNA gene sequencing. α-diversity indices and β-diversity indices were calculated. Wilcoxon's test was used to determine differences between genera, species as well as KEGG functions. SEM analysis revealed bacteria colonization on the surface of TADs from both groups. Principal coordinate analysis (PCoA) based on β diversity revealed differential sample clusters depending on periodontal conditions (P < 0.01). When comparing specific genera, Fusobacterium, Porphyromonas, Saccharibacteria_(TM7)_[G-1], Dialister, Parvimonas, Fretibacterium, Treponema were more enriched in TADs in the periodontitis group. In the KEGG analysis, TADs in the periodontitis group demonstrated enriched microbial activities involved with translation, genetic information processing, metabolism, and cell motility.

CONCLUSIONS

This analysis elucidated the difference in total composition and function of TADs oral microorganisms between patients periodontally healthy and with periodontitis.

Association between periodontitis and postoperative complications in hospital medical surgical procedures: a systematic review

Background

Periodontitis is potentially harmful in the perioperative period due to biofilm generating a environment for bacteria to spread and colonize other anatomical areas, which can generate a potential risk of infection, delayed healing, increased morbidity, and even induce avulsion in intubated patients, and subsequent aspiration or ingestion of teeth with increased mobility.

Objective

Associate the presence of periodontitis and postoperative complications in patients who underwent an in-hospital medical surgical procedure.

Methods

A systematic review based on studies extracted from PubMed and Scopus was carried out on June 10, 2020, based on the Population, Intervention, Comparison and Result search strategy. As inclusion criteria, the studies had to include all the disaggregated terms of the research question, have a publication date of less than 15 years, and the target population had to have undergone elective hospital medical-surgical interventions. The exclusion criteria corresponded to not presenting an analytical or experimental observational study design, not having made a periodontal clinical diagnosis of the study subjects, and not expressing in the results the presence of postoperative medical-hospital complications. Articles were assessed for quality by supplementing the STROBE guideline and Newcastle Ottawa, for risk of bias by supplementing the STROBE guideline and the Cochrane Collaboration handbook tool.

Results

A total of 131 articles were obtained, which were subjected to a selection process, resulting in 5 final analytical observational studies. A meta-analysis was performed and determined that periodontitis was a risk factor to postoperative complications after surgical procedures with an OR = 4,76; 95%CI [1,11-20,41].

Conclusions

Optimize the guidelines for assessing quality and risk of bias can make their comparison with other studies complex, however it was determined in a statistically significant way that patients with periodontitis have a higher risk of generating postoperative complications after a medical hospital surgery.

Thioredoxin-1 promotes the restoration of alveolar bone in periodontitis with diabetes

Treatment of periodontitis in people with diabetes remains challenging. The present study aimed to investigate the therapeutic potential of thioredoxin-1 (TRX1) in periodontitis with diabetes, as well as its role in modulating osteogenic differentiation. Our findings indicated that the production of reactive oxygen species (ROS) was elevated, while the expression of TRX1 was significantly reduced in the periodontal tissues of periodontitis mice with diabetes. Furthermore, knockdown of TRX1 in periodontal ligament stem cells (PDLSCs) resulted in the inhibition of osteogenic differentiation through disrupting Wnt/β-catenin signaling. However, this inhibition was restored upon administration of recombinant human TRX1 (rhTRX1). Importantly, rhTRX1 treatment decreased ROS generation, activated Wnt/β-catenin signal pathway and considerably promoted the alveolar bone repair of periodontitis mice with diabetes. These findings highlighted the crucial protective role of TRX1 in periodontitis with diabetes and suggested that it may serve as a potential therapeutic target for refractory periodontitis associated with oxidative stress.

Diagnostic potential of miR-200 family members in gingival crevicular fluid for chronic periodontitis: correlation with clinical parameters and therapeutic implications

OBJECTIVE

The purpose of this study was to evaluate the potential of miR-200 family members in gingival crevicular fluid (GCF) as diagnostic biomarkers for chronic periodontitis (CP), aiming to provide valuable insights for the early detection and management of the disease.

METHODS

GSE89081 dataset profiled miRNAs in GCF derived from 5 healthy and 5 periodontitis was analyzed by GEO2R. Quantitative real-time PCR was used to quantify the expression levels of miR-200 family members (miR-200a-3p, miR-200a-5p, miR-200b-3p, miR-200b-5p, miR-200c-3p, miR-200c-5p, miR-141-3p, miR-141-5p, and miR-429) in the GCF samples from 103 CP patients and 113 healthy controls. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic potential of miR-200 family members in differentiating CP patients from healthy controls.

RESULTS

By analyzing the GSE89081 dataset, miR-200a-5p, miR-200b-5p and miR-200c-5p were significantly upregulated in GCF of the CP patients compared to the healthy control. In this study, miR-200a-3p, miR-200a-5p, miR-200b-3p, miR-200b-5p, miR-200c-3p, miR-200c-5p were significantly increased in GCF of CP patients compared to the healthy control, while miR-141 and miR-429 did not show significant differences. MiR-200a, -200b and 200c had good diagnostic value, and when these miRNAs were combined, they demonstrated excellent diagnostic value for CP with an AUC of 0.997, sensitivity of 99.03%, and specificity of 98.23%. MiR-200a, -200b and 200c in GCF showed significant and positive correlation with plaque index (PI), gingival index (GI), bleeding on probing (BOP), clinical attachment level (CAL), and probing pocket depth (PPD).

CONCLUSION

MiR-200a, -200b and 200c in GCF may serve as potential biomarkers for the early diagnosis of CP, which was correlated with clinical parameters, being therapeutic targets for CP.

The underlying molecular mechanisms and biomarkers between periodontitis and COVID-19

OBJECTIVE

Emerging evidence shows the clinical consequences of patient with COVID-19 and periodontitis are not promising, and periodontitis is a risk factor. Periodontitis and COVID-19 probably have a relationship. Hence, this study aimed to identify the common molecular mechanism that may help to devise potential therapeutic strategies in the future.

MATERIAL AND METHODS

We analyzed two RNA-seq datasets for differential expressed genes, enrichment of biological processes, transcription factors (TFs) and deconvolution-based immune cell types in periodontitis, COVID-19 and healthy controls. Relationships between TFs and mRNA were established by Pearson correlation analysis, and the common TFs-mRNA regulatory network and nine co-upregulated TFs of the two diseases was obtained. The RT-PCR detected the TFs.

RESULTS

A total of 1616 and 10201 differentially expressed gene (DEGs) from periodontitis and COVID-19 are found. Moreover, nine shared TFs and common biological processes associated with lymphocyte activation involved in immune response were identified across periodontitis and COVID-19. The cell type enrichment revealed elevated plasma cells among two diseases. The RT-PCR further confirmed the nine TFs up-regulation in periodontitis.

CONCLUSION

The pathogenesis of periodontitis and COVID-19 is closely related to the expression of TFs and lymphocyte activation, which can provide potential targets for treatment.

Association and comparison of periodontal and oral hygiene status with serum HbA1c levels: a cross-sectional study

BACKGROUND

Diabetes Mellitus and periodontitis are chronic diseases with known reciprocal association. Studies have shown that uncontrolled diabetes increases the risk of development and progression of periodontal disease. This study aimed to explore the association and severity of periodontal clinical parameters and oral hygiene with HbA1c levels in non-diabetics and T2DM patients.

MATERIALS AND METHODS

In this cross-sectional study, the periodontal status of 144 participants, categorized into non-diabetics, controlled T2DM, and uncontrolled T2DM and were assessed via the Community Periodontal Index (CPI), Loss of Attachment Index (LOA index), and the number of missing teeth, while oral hygiene was measured by utilizing the Oral Hygiene Index Simplified (OHI-S). SPSS was used for data analysis. Chi-square test was used to find out the association of different independent variables with HbA1c groups, while ANOVA and post-hoc tests were run for inter-group and intra-group comparison respectively.

RESULTS

Out of 144 participants, the missing dentition was prevalent in uncontrolled T2DM with mean 2.64 ± 1.97 (95% CI 2.07-3.21; p = 0.01) followed by controlled T2DM 1.70 ± 1.79 (95% CI 1.18-2.23; p = 0.01) and non-diabetics 1.35 ± 1.63 (95% CI 0.88-1.82; p = 0.01) respectively. Furthermore, non-diabetics had a higher proportion of CPI score 0 (Healthy) [30 (20.8%); p = 0.001] as compared to uncontrolled T2DM [6 (4.2%); p = 0.001], while CPI score 3 was more prevalent in uncontrolled T2DM in comparison to non-diabetics. Loss of attachment (codes-2,3 and 4) was also frequently observed in uncontrolled T2DM compared to non-diabetics (p = 0.001). Similarly, based on Oral Hygiene Index- Simplified (OHI-S), the result showed that poor oral hygiene was most commonly observed in uncontrolled T2DM 29 (20.1%) followed by controlled T2DM patients 22 (15.3%) and non-diabetic [14 (9.7%); p = 0.03].

CONCLUSION

This study showed that periodontal status and oral hygiene status were deteriorated in uncontrolled T2DM patients compared to non-diabetic participants and controlled T2DM.

Association between Cardiovascular Diseases and Peri-Implantitis: A Systematic Review and Meta-Analysis

Background

A potential relationship between oral inflammation and cardiovascular disease has been proposed; however, the impact of cardiovascular disease on implant restoration remains unclear. This systematic review aims to assess the relationship between peri-implantitis and cardiovascular disease based on review of data obtained through observational studies.

Materials and Methods

An extensive systematic literature search was performed using the PubMed/MEDLINE, Scopus, Web of Science and Cochrane Library databases. Studies published in English language up to June 2022 were conducted in accordance with PRISMA guidelines. These efforts identified 230 unique publications and, after selection, five studies were included in this meta-analysis. The Newcastle-Ottawa Scale table was used for literature quality assessment. A fixed-effect model was selected and RevMan software version 5.3 was used to identify the origin of the outcomes of the meta-analysis. Finally, results were reported through the PRISMA statement.

Results

This meta-analysis found that in implant restoration the incidence of peri-implantitis in patients with cardiovascular disease was higher than those without cardiovascular disease (Risk ratio (RR) = 1.12; 95% CI: 1.02-1.23; z = 2.34; p < 0.05).

Conclusions

Based on current evidence, we conclude that the presence of cardiovascular disease increases the incidence of peri-implantitis.

Registration

PROSPERO database (CRD42022353693).

Association of vitamin D in individuals with periodontitis: an updated systematic review and meta-analysis

BACKGROUND

There are differences in vitamin D levels between periodontitis and healthy individuals, but the effect of vitamin D on periodontitis is controversial. The purpose of this Meta-analysis is twofold: (1) compare vitamin D levels in individuals with or without periodontitis; (2) assess the effects of vitamin D supplementation during scaling and root planing (SRP) on periodontal clinical parameters in individuals with periodontitis.

METHODS

A systematic search was conducted in five databases (PubMed, Web of Science, MEDLINE, EMBASE, and Cochrane library), published from the database inception to 12 September 2022. The Cochrane Collaboration Risk of bias (ROB) assessment tool, the risk of bias in non-randomized studies of intervention (ROBINS-I) tool, the Newcastle-Ottawa Quality Assessment Scale (NOS), and Agency for Healthcare Quality and Research (AHRQ) were used to evaluate randomized controlled trial (RCT), non-RCT, case-control study, and cross-sectional study, respectively. Statistical analysis was performed using RevMan 5.3 and Stata 14.0 software, with weighted mean difference (WMD), standardized mean difference (SMD) and 95% confidence intervals (CI) as the effect measures, and heterogeneity was tested by subgroup analysis, sensitivity analysis, Meta-regression.

RESULTS

A total of 16 articles were included. The results of Meta-analysis showed that periodontitis was associated with lower serum vitamin D levels compared to normal population (SMD = -0.88, 95%CI -1.75 ~ -0.01, P = 0.048), while there was no significant difference in serum or saliva 25(OH)D levels between periodontitis and normal population. Additionally, the Meta-analysis showed that SRP + vitamin D and SRP alone had a statistically significant effect on serum vitamin D levels in individuals with periodontitis (SMD = 23.67, 95%CI 8.05 ~ 32.29, P = 0.003; SMD = 1.57, 95%CI 1.08 ~ 2.06, P < 0.01). And SRP + vitamin D could significantly reduce clinical attachment level compared to SRP alone (WMD = -0.13, 95%CI -0.19 ~ -0.06, P < 0.01), but had no meaningful effect on probing depth, gingival index, bleeding index, respectively.

CONCLUSION

The evidence from this Meta-analysis suggests that the serum vitamin D concentration of individuals with periodontitis is lower than that of normal people, and SRP along with vitamin D supplementation has been shown to play a significant role in improving periodontal clinical parameters. Therefore, vitamin D supplementation as an adjuvant to nonsurgical periodontal therapy has a positive impact on the prevention and treatment of periodontal disease in clinical practice.

Periodontal inflammation is associated with increased circulating levels of endothelial progenitor cells: a retrospective cohort study in a high vascular risk population

Background

One of the main biological mechanisms behind the link between periodontitis and atherosclerotic vascular diseases is vascular endothelial dysfunction. Particularly, circulating endothelial progenitor cells (EPCs) have been considered a biomarker of altered vascular endothelial function.

Objectives

The aim of this study was to investigate relationship between periodontal inflammation and increased number of circulating EPCs.

Design

This is retrospective cohort study.

Methods

In this study, 85 elderly patients with a previous history of hypertension were followed up to 12 months. A baseline full-mouth periodontal assessment was carried out, and the amount of periodontal tissue inflamed per subject was calculated as a proxy of periodontal inflammation [periodontal inflamed surface area (PISA)]. The number of circulating EPCs (CD34+/CD133+/KDR+) was determined by flow cytometry from peripheral blood samples collected at baseline and 12 months.

Results

Mean concentrations of CD34+/CD133+/KDR+ progenitor cells were higher in periodontitis patients than in those without periodontitis at baseline [55.4, 95% confidence interval (CI) = 20.8 to 90.0 versus 27.2, 95% CI = 13.6 to 40.8, p = 0.008] and 12 months (114.6, 95% CI = 53.5 to 175.7 versus 19.1, 95% CI = 10.8 to 27.4, p = 0.003). A significant increase over the follow-up was noticed in the group of subjects with periodontitis (p = 0.049) but not in the nonperiodontitis group (p = 0.819). PISA was independently associated with CD34+/CD133+/KDR+ EPCs at baseline (B coefficient = 0.031, 95% CI = 0.005 to 0.058; p = 0.021). The relationship between PISA and CD34+/CD133+/KDR+ EPCs at 12 months was confounded by increased baseline body mass index (B coefficient = 0.064, 95% CI = -0.005 to 0.132; p = 0.066).

Conclusion

Periodontal inflammation is associated with high number of CD34+/CD133+/KDR+ EPCs, thus supporting a potential link between periodontitis and endothelial dysfunction.

Increased levels of PD1 and glycolysis in CD4+ T cells are positively associated with lymph node metastasis in OSCC

BACKGROUND

Cervical lymph node metastasis is one of the poorest prognostic factors in oral squamous cell carcinoma (OSCC). Activated immune cells generally have metabolic abnormalities in the tumour microenvironment. However, it is unknown whether abnormal glycolysis in T cells could facilitate metastatic lymph nodes in OSCC patients. The aim of this study was to investigate the effects of immune checkpoints in metastatic lymph nodes and determine the correlation between glycolysis and immune checkpoint expression in CD4⁺ T cells.

METHODS

Flow cytometry and immunofluorescence staining were used to analyse the differences in CD4⁺ PD1⁺ T cells between metastatic lymph nodes (LN⁺) and negative lymph nodes (LN^-). RT‒PCR was performed to detail the expression of immune checkpoints and glycolysis-related enzymes in LN⁺ and LN^-.

RESULTS

The frequency of CD4⁺ T cells decreased in LN⁺ patients (p = 0.0019). The PD1 expression of LN⁺ increased markedly compared to that of LN^- (p = 0.0205). Similarly, the PD1 of CD4⁺ T cells in LN⁺ increased significantly compared to that of LN^-. Additionally, glycolysis-related enzyme levels in CD4⁺ T cells from LN⁺ patients were dramatically higher than those in LN^- patients. PD1 and Hk2 expression in CD4⁺ T cells was also increased in LN⁺ OSCC patients with prior surgical treatment compared to those without.

CONCLUSIONS

These findings suggest that lymph node metastasis and recurrence in OSCC are associated with increases in PD1 and glycolysis in CD4⁺ T cells; this response may serve as a potential regulator of OSCC progression.

Relationship of preoperative oral hypofunction with prognostic nutritional index in gastric cancer: A case-control retrospective study

Preoperative nutritional status is an important prognostic factor in gastric cancer patients. This study will evaluate whether preoperative oral dysfunction is associated with prognostic nutrition index (PNI). This case-control study analyzed 95 patients who underwent oral function management. We assessed the following parameters: body mass index, stage of gastric cancer, C-reactive protein, total lymphocyte count, albumin, and prognostic nutritional index. The patients were divided into groups with prognostic nutritional indexes <45 and >45. Logistic regression analysis was used to assess the association between the measurements of oral function and the prognostic nutritional index. Univariate analysis of factors associated with decreased oral function and prognostic nutritional index showed significant differences between the two groups in C-reactive protein, neutrophils, and tongue pressure (p<0.01). However, oral hygiene, oral dryness, occlusal force, tongue-lip motor function, masticatory function, and swallowing function were not significantly different. Multivariate analysis showed that C-reactive protein (odds ratio: 0.12, 95% confidence interval: 0.30-0.45, p<0.01) and tongue pressure (odds ratio: 3.62, 95% confidence interval: 1.04-12.60, p<0.05) were independent risk factors for oral hypofunction. Oral function decreased in perioperative patients with gastric cancer, and decreased tongue pressure is associated with a decreased prognostic nutritional index.

Investigating the Influence of Periodontal Disease on the Association Between Complex Multimorbidity and Health: A Cross-Sectional Study

Aims and Objectives

The aim of this study was to evaluate whether periodontal disease (PD) moderates the association between complex multimorbidity (MM) and fair/poor general health in a US representative sample of older individuals.

Materials and Methods

This study identified 937 participants who were at least 60 years of age from the 2013-2014 National Health and Nutrition Examination Survey. A multivariable logistic regression model was used to estimate the association between complex MM (including chronic conditions, functional limitations, and geriatric syndromes) and self-reported fair/poor general health. Subsequently, we specified interactions between complex MM and PD to determine whether PD moderates the effect of complex MM on fair/poor general health.

Results

Nineteen percent of participants reported fair/poor general health. Complex MM was associated with 2.2 times greater odds of self-reported fair/poor health. However, PD was neither independently associated with fair/poor health nor an effect modifier for the association between complex MM and fair/poor general health. Age, white race, those with at least a high-school education level, a family income-to-poverty ratio of at least 2, former smoking status, and being married were significantly associated with fair/poor general health.

Conclusion

Complex MM, but not PD, was associated with greater odds to report fair/poor general health, and PD did not moderate the association between complex MM and fair/poor general health. People with complex MM are more likely to have worse general health; however, PD did not strengthen this association. Further studies are needed to evaluate whether treatment for PD for people vulnerable to the development of complex MM has a positive effect on their general health.

Impact exerted by scaffolds and biomaterials in periodontal bone and tissue regeneration engineering: new challenges and perspectives for disease treatment

The periodontium is an appropriate target for regeneration, as it cannot restore its function following disease. Significantly, the periodontium's limited regenerative capacity could be enhanced through the development of novel biomaterials and therapeutic approaches. Notably, the regenerative potential of the periodontium depends not only on its tissue-specific architecture and function but also on its ability to reconstruct distinct tissues and tissue interfaces, implying that the development of tissue engineering techniques can offer new perspectives for the organized reconstruction of soft and hard periodontal tissues. With their biocompatible structure and one-of-a-kind stimulus-responsive property, hydrogels have been utilized as an excellent drug delivery system for the treatment of several oral diseases. Furthermore, bioceramics and three-dimensional (3D) printed scaffolds are also appropriate scaffolding materials for the regeneration of periodontal tissue, bone, and cartilage. This work aims to examine and update material-based, biologically active cues and the deployment of breakthrough bio-fabrication technologies to regenerate the numerous tissues that comprise the periodontium for clinical and scientific applications.

Remnant Cholesterol as an Independent Predictor of Periodontitis: A Population-Based Study

Objective

Numerus studies present that remnant cholesterol (RC) as a risk factor participates in the progression of multiple diseases. The aim of this study was to assess the relationship between cholesterol and periodontitis in the US population to find a reliable lipid predictor for periodontitis.

Materials and Methods

Clinical data was retrieved from the National Health and Nutrition Examination Survey (NHANES) database between 2009 and 2014. The logistic regression was conducted to examine the corelationship between RC and various clinical features. Meanwhile, the dose-response relationship was measured through restricted cubic spline analysis. And the propensity score matching (PSM) was established to further investigate the potential relationship between RC and periodontitis.

Results

A number of 4,829 eligible participants were included in this study. It was found that the increased RC is associated with the higher risk of periodontitis after adjusting the potential confounding factors with the adjusted odds ratios (aOR) of 1.403 (95% confidence intervals (CI): 1.171-1.681, P < 0.001, univariate analysis) and 1.341 (95% CI: 1.105-1.629, P = 0.003, multivariate analysis) in the highest grade. There were significant differences in the relationship between RC and various clinical features including age, gender, body mass index (BMI), race, hypertension, and diabetes mellitus (all P < 0.001). Besides, the calculated thresholds for predicting periodontitis were 19.99 (before propensity score matching (PSM)) and 20.91 (after PSM) mg/dL.

Conclusions

In this study, RC was identified to be positively associated with the occurrence of periodontitis, which suggests that RC can be considered as a predictor for periodontitis.

Novel Herbal Therapeutic YH23537 Improves Clinical Parameters in Ligature-Induced Periodontal Disease Model in Beagle Dogs

Currently, available medicine does not satisfy the clinical unmet needs of periodontal disease. Therefore, novel drugs with improved efficacy profiles are needed. We previously demonstrated that YH14642, water extracts of Notoginseng Radix and Rehmanniae Radix Preparata, improved probing depths in double-blind phase II clinical trial. However, it still has hurdles for commercialization due to the low efficiency of active compound extraction. To resolve this issue, we developed YH23537 through process optimization to extract active compounds efficiently while still achieving the chemical profile of YH14642. In this study, we investigated the therapeutic effects of YH23537 compared with YH14642 using a canine model of ligature-induced periodontitis. Human gingival fibroblast (hGF) cells were treated with various concentrations of YH23537 or YH14642 with lipopolysaccharide (LPS) for 24 hr. IL-6 and IL-8 levels in the conditioned media were determined using Luminex. Sixteen 3-year-old male beagle dogs had their teeth scaled and polished using a piezo-type ultrasonic scaler under general anesthesia and brushed once daily for the following 2 weeks. Two weeks after the scaling procedure, the left upper second premolar (PM2), third premolar (PM3), and fourth premolar (PM4) as well as the left lower PM3, PM4, and first molar (M1) were ligated with silk-wire twisted ligatures. The dogs were fed with soft moistened food to induce periodontitis for 8 weeks, and the ligatures were then removed. YH23537 and YH14642 were administered for 4 weeks, and clinical periodontal parameters such as plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BoP) were determined before and 1, 2, 3, and 4 weeks after treatment. YH23537 inhibited IL-6 and IL-8 secretion in a dose-dependent manner in hGF cells stimulated with LPS. The IC₅₀ values for YH23537 were 43 and 54 μg/ml for IL-6 and IL-8, respectively, while the values for YH14642 were 104 and 117 μg/ml, respectively. In the animal study, clinical parameters including GI, PD, CAL, and BoP were significantly increased after 8 weeks of ligature-induced periodontitis. The YH23537 300 and YH23537 900 mg groups had significant improvements in CAL from 1 to 4 weeks after treatment in comparison to the placebo group. GR values in the YH23537 900 mg group were decreased throughout the treatment period. GI values were also reduced significantly after 4-week treatment with 300 and 900 mg of YH23537. YH23537 at 300 mg doses showed comparable efficacy for CAL and GR with 1,000 mg of YH14642. YH23537 showed therapeutic efficacy against periodontitis in dogs, mediated by anti-inflammatory effects. These findings indicate that YH23537 has the potential for further development as a new drug for patients suffering from periodontal disease.

Identification of abnormally methylated differentially expressed genes in chronic periodontitis by integrated bioinformatics analysis

BACKGROUND

DNA methylation plays a vital role as an epigenetic change that contributes to chronic periodontitis.

OBJECTIVE

This study aimed to integrate two methylation datasets (GSE173081 and GSE59962) and two gene expression datasets (GSE10334 and GES16134) to identify abnormally methylated differentially expressed genes related to chronic periodontitis.

METHODS

Differentially methylated genes were obtained. Functional enrichment analysis of DMGs was performed. The protein-protein interaction (PPI) network was constructed using STRING and Cytoscape software. Finally, the hub genes were selected from the PPI network by using CytoHubba.

RESULTS

In total, 122 hypomethylated and highly expressed genes were enriched in the biological mechanisms that are involved in the differentiation of extracellular matrix organization, extracellular structure organization, and cell chemotaxis. The three selected hub genes of the PPI network were IL1B, KDR, and MMP9. A total of 122 hypermethylated and lowly expressed genes were identified, and biological processes, such as cornification, epidermis development, skin development, and keratinocyte differentiation were enriched. CDSN DSG1, and KRT2 were identified as the top 3 hub genes of the PPI network.

CONCLUSION

Based on the comprehensive bioinformatics analysis, six hub genes (IL1B, KDR, MMP9, CDSN DSG1, and KRT2) were associated with chronic periodontitis. Our findings provide novel insights into the mechanisms underlying epigenetic changes in chronic periodontitis.

Porphyromonas gingivalis lipopolysaccharide affects the angiogenic function of endothelial progenitor cells via Akt/FoxO1 signaling

AIMS

Endothelial progenitor cells (EPCs) function as the angiogenic switch of many physiological and pathological conditions. We aimed to investigate the effects of Porphyromonas gingivalis lipopolysaccharide on the angiogenic capacity of EPCs and delineate the underlying mechanisms.

MATERIALS AND METHODS

EPCs were isolated from human umbilical blood. CCK-8 assay was undertaken to analyze the cell viability. The migration and tube formation capacity were assessed by wound healing and tube formation, respectively. The protein expression of Akt/p-Akt, endothelial nitric oxide synthase (eNOS)/p-eNOS, and Forkhead box O1 (FoxO1)/p-FoxO1 was determined by Western blot. The intracellular localization of FoxO1 was evaluated by immunofluorescent staining.

RESULTS

P. gingivalis LPS at 10 μg/ml significantly increased the viability (10.9 ± 2.9%), migration (16.3 ± 3.1%), and tube formation (38.6 ± 5.5%) of EPCs, along with increased phosphorylation of Akt, eNOS, and FoxO1. Mechanistically, Akt inhibition by specific inhibitor wortmannin and FoxO1 forced expression by adenovirus transfection in EPCs markedly attenuated the P. gingivalis LPS-induced eNOS activation, tube formation, and migration. Moreover, P. gingivalis LPS-induced phosphorylation and nuclear exclusion of FoxO1 were blunted by Akt inhibition.

CONCLUSIONS

The present study suggests that P. gingivalis LPS could affect the angiogenic function of EPCs through the Akt/FoxO1 signaling. The current findings may shed light on the clinical association of periodontitis with aberrant angiogenesis seen in atherosclerotic plaque rupture.

Unexpected Relationships: Periodontal Diseases: Atherosclerosis-Plaque Destabilization? From the Teeth to a Coronary Event

Atherosclerotic cardiovascular disease (ASCVD) and periodontal disease (PD) are global health problems. High frequency of ASCVD is associated with the spread of many risk factors, including poor diet, sedentary lifestyle, diabetes, hyperlipidemia, obesity, smoking, hypertension, chronic kidney disease, hypertension, hyperhomocysteinemia, hyperuricemia, excessive stress, virus infection, genetic predisposition, etc. The pathogenesis of ASCVD is complex, while inflammation plays an important role. PD is a chronic, multifactorial inflammatory disease caused by dysbiosis of the oral microbiota, causing the progressive destruction of the bone and periodontal tissues surrounding the teeth. The main etiological factor of PD is the bacteria, which are capable of activating the immune response of the host inducing an inflammatory response. PD is associated with a mixed microbiota, with the evident predominance of anaerobic bacteria and microaerophilic. The "red complex" is an aggregate of three oral bacteria: Tannerella forsythia Treponema denticola and Porphyromonas gingivalis responsible for severe clinical manifestation of PD. ASCVD and PD share a number of risk factors, and it is difficult to establish a causal relationship between these diseases. The influence of PD on ASCVD should be treated as a factor increasing the risk of atherosclerotic plaque destabilization and cardiovascular events. The results of observational studies indicate that PD significantly increases the risk of ASCVD. In interventional studies, PD treatment was found to have a beneficial effect in the prevention and control of ASCVD. This comprehensive review summarizes the current knowledge of the relationship between PD and ASCVD.

Clinical Outcomes of Free Gingival Graft Following Recipient Bed Preparation with Er,Cr:YSGG Laser Versus Scalpel: A Split-Mouth Randomized Clinical Trial

Objective: Free gingival graft (FGG) procedure is accompanied with a considerable rate of graft shrinkage. This study was aimed to assess the dimensional changes of FGG after recipient site preparation with Er,Cr:YSGG laser and surgical scalpel. Materials and methods: This split-mouth randomized clinical trial evaluated 11 patients with bilateral lack of keratinized gingiva in mandibular premolars. The test side in each patient was prepared with Er,Cr:YSGG laser (3 W power, 300 mJ energy, 10 Hz frequency, long-pulsed mode), whereas the control side was prepared by surgical scalpel. All FGGs were harvested from the palate with standard dimensions of 14 × 9 mm. The graft width, length, surface area, and shrinkage and color match were measured after 1, 3, and 6 months. Postoperative complications, including pain and bleeding were also evaluated using a questionnaire. Results: In both groups, the surface area and width of graft significantly decreased at all time points compared with baseline but the difference in this respect was not significant between the two groups (p > 0.05). In both groups, maximum shrinkage occurred within the first 3 months. In control group, the surface shrinkage in 3 months was significantly greater than the first month (p = 0.025) without significant difference between groups (p = 0.79). The two groups were not significantly different regarding pain score and bleeding score either. On the day of surgery, the test group had slightly lower pain score and higher bleeding score in comparison to the control group without significant difference. The pain and bleeding scores reduced in both groups with no significant difference (p > 0.05). Conclusions: Er,Cr:YSGG laser has promising results for preparation of FGG recipient site and yields results comparable to those of surgical scalpel.

Mandibular Advancement Devices (MAD) as a Treatment Alternative for Obstructive Sleep Apnea Syndrome (OSAS)

Background:

Continuous Positive Airways Pressure therapy (CPAP) is the gold standard treatment of the Obstructive Sleep Apnea Syndrome (OSAS), however, the scarce adherence to the therapy requires the evaluation of other therapeutic alternatives.

Objective:

The aim of the present study was to assess the effectiveness of Mandibular Advancement Devices (MAD) in subjects affected by OSAS who had interrupted the treatment with CPAP and to make comparative evaluations.

Methods:

Eighteen subjects (15 males and 3 females), aged between 27 and 60 years, with a diagnosis of moderate to severe OSAS were included. Inclusion criteria: polysomnographic examination before treatment (T0) and after 1 month from the beginning of the therapy with CPAP(T1), interruption of the treatment due to loss of compliance, Epworth Sleepiness Scale (ESS) questionnaire filled out at T0 and T1. Subjects started the treatment with MAD and polysonnographic examination was prospectively executed after 3 months (T2) and 1 year (T3). One-way analysis of the variance (ANOVA) was used to compare data of polysonnographic examination performed at T0, T1, T2 and T3 as well as the differences of ESS scores recorded at different timing.

Results:

Compared to baseline (T0), all functional parameters tested showed statistically significant differences at T1, T2 and T3 (p < 0.001), meanwhile no differences were found between data recorded after therapy with MAD (T2 and T3) and with CPAP (T1). Similar results were also found with the score of ESS among different timelines (p < 0.001).

Conclusion:

These findings suggest that MAD could be a valid alternative for the treatment of OSAS in those patients with scarce adherence to the CPAP therapy.

Root Resorption of Maxillary Posterior Teeth after Rapid Maxillary Expansion: A Comprehensive Review of the Current Evidence from in-vitro and in-vivo Studies

Background:

The application of heavy forces to the dentition, as those produced during a Rapid Maxillary Expansion (RME), has been associated in the literature with the development of root resorption of maxillary posterior teeth.

Objective:

The aim of the present manuscript was to report the available data from in-vitro and in-vivo studies that can elucidate the biological processes of resorption and repair of radicular cementum after RME.

Methods:

Studies evaluating the occurrence of root resorption after RME by means of histological and radiographic methodology were included. We detailed the changes of the radicular anatomy after RME and provided a synthesis of the most valuable scientific evidence showing the biological processes behind the potential modifications of radicular anatomy. Results. Loss of cementum material and reduction of radicular volumes were seen after rapid maxillary expansion. A small radicular volumetric recovery of anchored teeth occurred after the retention period; this reparative phenomenon was caused by cementum deposition without the reattachment of periodontal fibers, supporting the detrimental effects associated with RR.

Conclusion:

Retention period and the timing of radiographic examination could influence the extension of radicular resorption detected after RME since root resorption and cementum repair may occur at the same time at this stage.

Effectiveness of a nutraceutical agent in the non-surgical periodontal therapy: a randomized, controlled clinical trial

OBJECTIVE

Nutraceutical agents have been demonstrated as adjuncts for the treatment of several inflammatory diseases. The present study analyzed and compared new nutraceutical agent as an adjunct to Scaling and root planing (SRP) versus SRP alone for the treatment of periodontitis.

MATERIALS AND METHODS

Sixty-six patients with moderate periodontitis were enrolled. Through a randomized design, the patients were randomly assigned to SRP + nutraceutical agent (test group) or SRP alone (control group). Patients were regularly examined the clinical, inflammatory mediators and visual analogue scale (VAS) changes over a 6-month period. Clinical attachment level (CAL) was the primary outcome variable chosen. Gingival crevicular fluid (GCF) inflammatory mediator change and the impact of treatment on VAS were evaluated through a linear regression model.

RESULTS

Both treatments demonstrated an improvement in periodontal parameters compared with baseline. After 6 months of treatment, compared with the control group, the test group determined a significant probing depth (PD) (p = 0.003) and bleeding on probing (BOP) reduction (p < 0.001), while CAL gain was significantly obtained at 30 and 60 days after treatment (p < 0.05). In the test group, the level of inflammatory mediators was significantly reduced compared with the control group (p < 0.05). The linear regression analysis demonstrated that the nutraceutical agent exerted, in the test group, a significant influence on VAS at 6, 12, 24, and 48 h after treatment (p < 0.05).

CONCLUSIONS

Nutraceutical agent resulted in a more significant reduction in clinical, inflammatory mediators and short-term pain compared with SRP alone.

CLINICAL RELEVANCE

Nutraceutical agent, when combined with SRP, was demonstrated to be effective in reducing periodontal parameters and controlling the levels of inflammatory mediators and pain in patients with periodontitis.

Aesthetic Parameters and Patient-Perspective Assessment Tools for Maxillary Anterior Single Implants

Background

This review aimed to concisely describe the current aesthetic objective indices for a single-implant maxillary anterior crown. The secondary aim was to propose introducing a unified, standardized questionnaire for adequately collecting patient-reported outcome measures (PROMs) in implant dentistry.

Materials and Methods

A literature review was conducted using both EMBASE/Ovid and MEDLINE/PubMed databases by combining keywords and Emtree/Mesh terms related to “Esthetics,” “Self-Assessment or Surveys and Questionnaires,” and “Single-Tooth Dental Implants.”

Results

The most meaningful aesthetic objective indices for single implants in the literature are the Pink Esthetic Score (PES), the Papilla Presence Index (PPI), Peri‐Implant and Crown Index (PICI), PES/White Esthetic Score (PES/WES), the Implant Crown Aesthetic Index (ICAI), and a modified version of the ICAI (mod-ICAI) index. Clearly, PES/WES is still the most widely accepted tool. It is encouraging to observe that there is an increasing tendency in recent years to report PROMs more frequently in the implant dentistry literature. We proposed the implementation of a unified, standardized questionnaire using a self-administered visual analogue scale (VAS) scoring system, which evaluates overall satisfaction, comfort, tooth appearance, gingival appearance, function, and hygiene complexity. This tool should be validated in the oral implantology research context for its regular implementation or further development.

Conclusions

Conducting qualitative studies among dental implant patients who received few implants or single-tooth implant reconstructions in the aesthetic zone may help dental researchers understand better how to efficiently develop and validate a quantitative instrument. This standard tool would reduce heterogeneity bias by providing comparable data between studies.

A clinical evaluation of the alterations in the level of serum zinc, copper, iron, and manganese in the ischemic heart disease patients of Bangladesh - A case-control study

Background

Ischemic heart disease (IHD) is a major cause of death globally. Countries vary in their rates, and changes have occurred over time. Nowadays, developing countries pose new public health challenges.

Objectives

The objective of the present study was to appraise the alterations in the levels of serum Zn, Cu, Fe, and Mn that occur in patients with ischemic heart disease and to depict the correlations of the effects of these changes that lead to the pathogenesis of IHD.

Methods

Zn, Cu, Fe, and Mn in the IHD patients were determined by Atomic Absorption Spectroscopy (AAS).

Results

This study evaluated 52 patients with IHD, and 61 healthy volunteers served as controls. The primary outcomes of interest were explored regarding the correlations of the serum levels of these trace elements in patients with IHD. The secondary outcomes were explored in terms of inter-element relations to connect them with the pathogenesis of IHD. Our study found significantly reduced levels of Zn and Cu (2.50 ± 0.19 mg/L and 2.52 ± 0.17 mg/L, respectively) and an elevated level of Fe (148.97 ± 17.25 mg/L) in the patient group with IHD. The level of Mn (7.32 ± 1.23 mg/L) was elevated in the sera of the patients with ischemic heart disease (IHD) compared to healthy control subjects.

Conclusion

Our results indicate strong associations of the pathogenesis of IHD with depleted serum levels of Zn and Cu and elevated Fe and Mn levels, which may provide a prognostic tool for the treatment of this concerning the disease.

Association of vitamin D in patients with periodontitis: A cross-sectional study

BACKGROUND AND OBJECTIVE

Vitamin D has been considered to possess anti-inflammatory and antimicrobial activity, which may be a link for the known interaction of periodontitis (CP) and coronary heart disease (CHD). This study investigated the association between serum vitamin D levels and periodontitis in patients with CP and with CHD. Furthermore, the objective was to determine whether periodontitis and CHD had an impact on serum vitamin D levels.

MATERIAL AND METHODS

Using a cross-sectional design, a total of 46 patients with CP, 45 patients with CHD, 45 patients with both CP and CHD, and 43 healthy patients were enrolled in the present study.

RESULTS

Patients in the CP (17.4 ± 5.2 ng/mL) and in the CP + CHD (16.5 ± 5.6 ng/mL) group presented a significantly lower mean serum level of 25(OH)vitamin D compared to patients in the CHD (24.6 ± 3.7 ng/mL) and healthy control groups (29.9 ± 5.4 ng/mL) (P < .001). 25(OH)vitamin D levels were positively correlated with the number of teeth and negatively with C-reactive protein (CRP) and all periodontal parameters (P < .001). In all patients, there was a proportional increase of 25(OH)vitamin D levels with a progressive increase in number of teeth (P-trend <.001) while there were a proportional decrease in 25(OH)vitamin D levels with a progressive increase in clinical attachment level (CAL, P-trend = .001), probing depth (PD, P-trend = .006), and bleeding sites (BOP, P-trend <.001) levels.

CONCLUSION

Patients with CP and CP + CHD presented significantly lower serum levels of vitamin D compared to CHD and healthy controls. Moreover, the presence of CP negatively influenced serum vitamin D levels.

In Vitro Feasibility Analysis of a New Sutureless Wound-Closure System Based on a Temperature-Regulated Laser and a Transparent Collagen Membrane for Laser Tissue Soldering (LTS)

For the post-surgical treatment of oral wounds and mucosal defects beyond a certain size, the gold standard is still an autologous skin or mucosal graft in combination with complex suturing techniques. A variety of techniques and biomaterials has been developed for sutureless wound closure including different tissue glues or collagen patches. However, no wound covering that enables for sutureless fixation has yet been introduced. Thus, a new system was developed that allows for sutureless wound covering including a transparent collagen membrane, which can be attached to the mucosa using a specially modified 2λ laser beam with integrated temperature sensors and serum albumin as bio-adhesive. The sutureless wound closure system was tested for its applicability and its cytocompatibility by an established in vitro model in the present study. The feasibility of the laser system was tested ex vivo on a porcine palate. The in vitro cytocompatibility tests excluded the potential release of toxic substances from the laser-irradiated collagen membrane and the bio-adhesive. The results of the ex vivo feasibility study using a porcine palate revealed satisfactory mean tensile strength of 1.2–1.5 N for the bonding of the membrane to the tissue fixed with laser of 980 nm. The results suggest that our newly developed laser-assisted wound closure system is a feasible approach and could be a first step on the way towards a laser based sutureless clinical application in tissue repair and oral surgery.

The Oral Microbiome of Healthy Japanese People at the Age of 90

For a healthy oral cavity, maintaining a healthy microbiome is essential. However, data on healthy microbiomes are not sufficient. To determine the nature of the core microbiome, the oral-microbiome structure was analyzed using pyrosequencing data. Saliva samples were obtained from healthy 90-year-old participants who attended the 20-year follow-up Niigata cohort study. A total of 85 people participated in the health checkups. The study population consisted of 40 male and 45 female participants. Stimulated saliva samples were obtained by chewing paraffin wax for 5 min. The V3–V4 hypervariable regions of the 16S ribosomal RNA (rRNA) gene were amplified by PCR. Pyrosequencing was performed using MiSeq. Operational taxonomic units (OTUs) were assigned on the basis of a 97% identity search in the EzTaxon-e database. Using the threshold of 100% detection on the species level, 13 species were detected: Streptococcus sinensis, Streptococcus pneumoniae, Streptococcus salivarius, KV831974_s, Streptococcus parasanguinis, Veillonella dispar, Granulicatella adiacens, Streptococcus_uc, Streptococcus peroris, KE952139_s, Veillonella parvula, Atopobium parvulum, and AFQU_vs. These species represent potential candidates for the core make-up of the human microbiome.

A Preliminary Study on the Ability of the Trypsin-Like Peptidase Activity Assay Kit to Detect Periodontitis

This study aimed to explore whether the Trypsin-Like Peptidase Activity Assay Kit (TLP-AA-Kit), which measures the activity of N-benzoyl-dl-arginine peptidase (trypsin-like peptidase), can be used as a reliable tool for periodontitis detection in population-based surveillance. In total, 105 individuals underwent a full-mouth periodontal examination and provided tongue swabs as specimens for further analyses. The results of the TLP-AA-Kit were scored between 1 and 5; higher scores indicated higher trypsin concentrations. Receiver operating characteristic analyses were used to evaluate the predictive validity of the TLP-AA-Kit, where the periodontitis case definition provided by the Centers for Disease Control/American Academy of Periodontology served as the reference. Severe and moderate periodontitis were identified in 4.8% and 16.2% of the study population, respectively. The TLP-AA-Kit showed high diagnostic accuracy for severe periodontitis, with an area under the curve of 0.93 (95% confidence interval = 0.88-0.99). However, the diagnostic accuracy of the TLP-AA-Kit for moderate/severe periodontitis was not reliable. While further studies are necessary to validate our results, the results provided herein highlight the potential of the TLP-AA-Kit as a useful tool for the detection of periodontitis, particularly in severe cases, for population-based surveillance.

Evaluation of salivary and serum asymmetric dimethylarginine (ADMA) levels in patients with periodontal and cardiovascular disease as subclinical marker of cardiovascular risk

BACKGROUND

Asymmetric dimethylarginine (ADMA) plays a crucial role in endothelial function and maybe a link for the known interaction of periodontitis and coronary heart disease (CHD). In this pilot study, we compared the impact of gingival health, periodontitis (CP), CHD, or of both diseases (CP + CHD) on salivary and serum ADMA levels.

METHODS

The clinical and periodontal characteristics, serum, and saliva samples were collected from 35 patients with CP, 33 patients with CHD, 35 patients with both CP + CHD, and 35 healthy subjects. Levels of ADMA and C-reactive protein (CRP) were assessed with a commercially available kit.

RESULTS

The median (25% and 75% percentile) concentrations of salivary and serum ADMA were significantly higher in the CHD group [serum: 1.5 (1.2 to 1.8) μmol/L; salivary 1.3 (1 to 1.7) μmol/g protein, P < 0.01] and in the CP + CHD [serum: 1.8 (1.4 to 2.0) μmol/L; salivary 1.5 (1.2 to 1.7) μmol/g protein, P < 0.001] group compared to CP patients and controls. In univariate models, CP (P = 0.034), CHD (P < 0.001), and hs-CRP (P < 0.001) were significantly associated with serum ADMA, whereas in a multivariate model, hs-CRP remained a significant predictor of serum ADMA (P < 0.001). In a multivariate model, the significant predictors of salivary ADMA levels were hs-CRP (P < 0.001) and education socioeconomic status (P = 0.042).

CONCLUSIONS

Patients with CHD and CP + CHD presented higher levels of salivary and serum ADMA compared to healthy subjects and CP patients. hs-CRP was a significant predictor of increased salivary and serum ADMA levels.

Oral Microbiome in Four Female Centenarians

The oral microbiome of healthy older adults has valuable information about a healthy microbiome. In this study, we collected and analyzed the oral microbiome of denture plaque and tongue coating samples from four female centenarians. After DNA extraction and purification, pyrosequencing of the V3–V4 hypervariable regions of the 16S rRNA was carried out. The bacterial taxonomy for each lead was assigned based on a search of the EzBioCloud 16S database. We obtained a total of 199,723 valid, quality-controlled reads for denture plaque and 210,750 reads for tongue coating. The reads were assigned 407 operational taxonomic units with a 97% identity cutoff. Twenty-nine species were detected in both denture plaque and tongue coatings from all subjects. Firmicutes was the most abundant phylum; the Streptococcus salivarius group was the most abundant species in both the denture plaque and tongue coatings; and the Fusobacterium nucleatum group was detected in all subjects. In the bacterial profile, species formed clusters composed of bacteria with a wide range of prevalence and abundance, not dependent on phyla; each cluster may have specific species that could be candidates for a core microbiome. Firmicutes and Veillonella were abundant phyla on both plaque and tongue coatings of centenarians.

BactericidalActivity of Crevicular Polymorphonuclear Neutrophils in Chronic Periodontitis Patients and Healthy Subjects under the Influence of Areca Nut Extract: An In Vitro Study

Arecanutchewing is an established risk factor for oral submucous fibrosis (OSMF), but its role in periodontal disease has not yet been defined. Thisstudy aimed to assess the effect of areca nut extracts (ANE) on the bactericidal activity of crevicular polymorphonuclear neutrophils (cPMNs) in healthy subjects and chronic periodontitis (CP) patients. An in vitro study was designed with an equal number of (n = 30) gingival crevicular fluid (GCF) samples collected from CP patients and healthy subjects. Bactericidal activity and hydrogen peroxide (H2O2) assays were performed with the GCF samples pre-treated with extracts of two varieties of areca nut: ripe and tender. Simultaneously, controls were also carried out with Hank’s balanced salt solution (HBSS) and catechin. Independent t-test and one-way analysis of variance (ANOVA), along with post-hoc analysis, were employed for statistical analysis. In both study groups, a significant reduction (p < 0.01)in the bactericidal activity was noted when the samples treated with the ripe areca nut (rANE) were compared with the tender variant (tANE). Similarly, H2O2 levels were significantly reduced (p < 0.001) in the rANE in contrast to tANE for both study groups. The above results were significant within the group but were found to be non-significant between the study groups, except when it was treated with HBSS (p < 0.001). In the present study, it was found that there was a reduction in the bactericidal activity and H2O2 production of cPMNs in both healthy subjects and CP patients in the presence of areca nut extract. Moreover, the effect of rANE on cPMNs was more detrimental than tANE.

Oral Health and Related Factors Associated with General Health and Quality of Life

Oral well-being is an integral part of individual general health. The mouth and teeth are, in fact, part of our body, increasingly characterizing personal identity. Oral diseases are a public health problem that has a growing prevalence. Oral pathologies can occur in childhood, and as they have a chronic and progressive course, if not properly treated, they can affect the relational, psychological, and social skills of an individual. The population most affected are those with a low socio-economic level, so much so that the presence of diseases of the oral cavity is considered a marker of social disadvantage. In this regard, much effort is needed from scientists, and their applied sciences, in order to give the knowledge required for public health personal to take note of the seriousness of the situation and to start changing the way we deal with the problem.

Role for Lipids Secreted by Irradiated Peripheral Blood Mononuclear Cells in Inflammatory Resolution in Vitro

Periodontal inflammation is associated with dying cells that potentially release metabolites helping to promote inflammatory resolution. We had shown earlier that the secretome of irradiated, dying peripheral blood mononuclear cells support in vitro angiogenesis. However, the ability of the secretome to promote inflammatory resolution remains unknown. Here, we determined the expression changes of inflammatory cytokines in murine bone marrow macrophages, RAW264.7 cells, and gingival fibroblasts exposed to the secretome obtained from γ-irradiated peripheral blood mononuclear cells in vitro by RT-PCR and immunoassays. Nuclear translocation of p65 was detected by immunofluorescence staining. Phosphorylation of p65 and degradation of IκB was determined by Western blot. The secretome of irradiated peripheral blood mononuclear cells significantly decreased the expression of IL1 and IL6 in primary macrophages and RAW264.7 cells when exposed to LPS or saliva, and of IL1, IL6, and IL8 in gingival fibroblasts when exposed to IL-1β and TNFα. These changes were associated with decreased phosphorylation and nuclear translocation of p65 but not degradation of IκB in macrophages. We also show that the lipid fraction of the secretome lowered the inflammatory response of macrophages exposed to the inflammatory cues. These results demonstrate that the secretome of irradiated peripheral blood mononuclear cells can lower an in vitro simulated inflammatory response, supporting the overall concept that the secretome of dying cells promotes inflammatory resolution.

One Step before 3D Printing-Evaluation of Imaging Software Accuracy for 3-Dimensional Analysis of the Mandible: A Comparative Study Using a Surface-to-Surface Matching Technique

The accuracy of 3D reconstructions of the craniomaxillofacial region using cone beam computed tomography (CBCT) is important for the morphological evaluation of specific anatomical structures. Moreover, an accurate segmentation process is fundamental for the physical reconstruction of the anatomy (3D printing) when a preliminary simulation of the therapy is required. In this regard, the objective of this study is to evaluate the accuracy of four different types of software for the semiautomatic segmentation of the mandibular jaw compared to manual segmentation, used as a gold standard. Twenty cone beam computed tomography (CBCT) with a manual approach (Mimics) and a semi-automatic approach (Invesalius, ITK-Snap, Dolphin 3D, Slicer 3D) were selected for the segmentation of the mandible in the present study. The accuracy of semi-automatic segmentation was evaluated: (1) by comparing the mandibular volumes obtained with semi-automatic 3D rendering and manual segmentation and (2) by deviation analysis between the two mandibular models. An analysis of variance (ANOVA) was used to evaluate differences in mandibular volumetric recordings and for a deviation analysis among the different software types used. Linear regression was also performed between manual and semi-automatic methods. No significant differences were found in the total volumes among the obtained 3D mandibular models (Mimics = 40.85 cm3, ITK-Snap = 40.81 cm3, Invesalius = 40.04 cm3, Dolphin 3D = 42.03 cm3, Slicer 3D = 40.58 cm3). High correlations were found between the semi-automatic segmentation and manual segmentation approach, with R coefficients ranging from 0,960 to 0,992. According to the deviation analysis, the mandibular models obtained with ITK-Snap showed the highest matching percentage (Tolerance A = 88.44%, Tolerance B = 97.30%), while those obtained with Dolphin 3D showed the lowest matching percentage (Tolerance A = 60.01%, Tolerance B = 87.76%) (p < 0.05). Colour-coded maps showed that the area of greatest mismatch between semi-automatic and manual segmentation was the condylar region and the region proximate to the dental roots. Despite the fact that the semi-automatic segmentation of the mandible showed, in general, high reliability and high correlation with the manual segmentation, caution should be taken when evaluating the morphological and dimensional characteristics of the condyles either on CBCT-derived digital models or physical models (3D printing).

Craniomandibular Disorders in Pregnant Women: An Epidemiological Survey

Temporomandibular joint (TMJ) disorder has been reported to be 1.5 to two times more common in women than men. Such a gender-based difference could be attributed to behavioral, hormonal, anatomical, and psychological characteristics. Physiological hormonal differences between genders could be one of the possible explanations for the higher incidence of temporomandibular disorder (TMD) in women. As the plasma level of certain female hormones increases during gestation, it could be assumed that there is a higher prevalence of dysfunctional signs and symptoms in pregnant women. We performed an epidemiological survey based on screening for TMD in a group of 108 pregnant women and found that 72% of young women reported significant signs of TMJ disorders, 9% of the young women reported mild signs of TMJ disorders, and 19% of the included subjects reported no signs or symptoms of TMD. The presence of estrogen receptors in the temporomandibular joint of female baboons could be the basis of an explanation for the increased prevalence of dysfunction in young women reported in the literature and the high feedback we have seen of joint noises in pregnant women. On the basis of the present findings, it could be assumed that gestation period could represent a risk factor for craniomandibular dysfunctions.

Bruxism Throughout the Lifespan and Variants in MMP2, MMP9 and COMT

Bruxism is a masticatory muscle activity characterized by grinding of the teeth and clenching of the jaw that causes tooth wear and breakage, temporomandibular joint disorders, muscle pain, and headache. Bruxism occurs in both adults and children. Clinical characteristics and habits were evaluated in an adult sample. Moreover, we used DNA samples from 349 adults and 151 children to determine the presence of association with specific genes. Genomic DNA was obtained from saliva. The markers rs2241145 and rs243832 (metalloproteinase 2 (MMP2)), rs13925 and rs2236416 (metalloproteinase 9 (MMP9)), and rs6269 (cathecol-o-methyltransferase (COMT)) were genotyped. Data were submitted to statistical analysis with a significance level of 0.05. In adults, in univariate logistic regression, presence of caries, attrition, and use of alcohol were increased in bruxism individuals (p < 0.05). In addition, in adults, there was an association between bruxism and MMP9 (rs13925, p = 0.0001) and bruxism and COMT (rs6269, p = 0.003). In children, a borderline association was observed for MMP9 (rs2236416, p = 0.08). When we performed multivariate logistic regression analyses in adults, the same clinical characteristics remained associated with bruxism, and orthodontic treatment was also associated, besides rs13925, in the AG genotype (p = 0.015, OR_a: 3.40 (1.27-9.07)). For the first time, we provide statistical evidence that these genes are associate with bruxism.

Characterizing Peri-Implant and Sub-Gingival Microbiota through Culturomics. First Isolation of Some Species in the Oral Cavity. A Pilot Study

BACKGROUND

In recent years, culture-independent molecular techniques have been developed to investigate microbiota considered uncultivable. However, the data in the literature suggest that molecular techniques and cultural methods target different spectra of bacteria. The objective of this pilot study was to search for not yet identified oral species in the peri-implant and sub-gingival microbiota in patients without signs of oral pathologies, through the use of the culturomics approach, which has never been used before in dentistry.

METHODS

Four patients were enrolled; from each patient, samples of sub-gingival and peri-implant plaque were taken and analysed by culturomics.

RESULTS

Of 48 isolated species, only 30 had been previously identified by metagenomics in other studies; on the contrary, 12 species had never been associated with the oral cavity before, and 5 of them had never been isolated from clinical specimens.

CONCLUSIONS

By adopting culturomics in dentistry, it could be possible to identify a large amount of fastidious microorganisms that inhabit the oral cavity and to more accurately characterize the microorganisms that lead to periodontitis and peri-implantitis. This evidence could represent an important step forward for the diagnosis and treatment of peri-implantitis, as well as a very useful means for the characterization of new potential aetiologic agents.

Chronic Periodontitis and Immunity, Towards the Implementation of a Personalized Medicine: A Translational Research on Gene Single Nucleotide Polymorphisms (SNPs) Linked to Chronic Oral Dysbiosis in 96 Caucasian Patients

Chronic periodontitis (CP) is a complex pathology with a significant impact worldwide causing bone loss. Oral dysbiosis is a highly inflammatory condition associated to a long-term insulting infection and represents an underestimated CP key factor associated with an imbalance of pro-inflammatory and anti-inflammatory gene responses. The presence of a single nucleotide polymorphisms (SNPs) in the promoter region of interleukin 10 (IL-10) gene-1082, -819, and -592 was a possible determinant cause. This translational research aimed to provide outcomes on the role of IL-10 gene expression in bone loss diseases in patients affected by CP. Caucasian patients (n = 96) affected by CP were recruited from the Italian population. The subgingival samples were collected using the Bacterial Periodontal Assessment by Biomolecular Diagnostic^® and the characterization of a set of 15 bacterial DNA responsible of periodontitis was performed by real-time multiplex PCR. In addition, two viruses, Epstein-Barr Virus (EBV) and Herpes Simplex Virus 1 (HSV-1), and a pathogenic fungi (Candida albicans) were included as a part of our panel. Our results confirmed an existing association between IL-10 gene polymorphisms and polymorphism of tumor necrosis factor alpha (TNFα), interleukin 1α-β-RN (IL-1α-β-RN), collagen type-l alpha (COLIA1), and vitamin D receptor (VDRs) genes in CP. Further studies are needed to improve diagnosis and endorse more effective therapeutic procedures for periodontal disease.

A Full Diagnostic Process for the Orthodontic Treatment Strategy: A Documented Case Report

The need for extractions in orthodontic treatment has always been a controversial topic. However, to date there is not a specific clinical guideline that can help the clinicians deciding to plan an extractive or a non-extractive orthodontic treatment. In this respect, clinicians must deal with patients’ occlusal, functional, periodontal and aesthetics characteristics before planning an orthodontic treatment including extraction. Considering the absence of specific guidelines, the choice to extract teeth or not is complicated, particularly in borderline cases. In this case report, we present a borderline case of a patient with the skeletal Class III pattern and significant crowding in both arches that could be treated with or without extraction, illustrating the diagnostic and decision-making processes that were conducted for the orthodontic treatment strategy.

Personalized Dentistry: Approaching a New Way for Diagnosis and Treatment of Oral Diseases

For years, it has been thought that the field of dentistry was referring exclusively to some diseases that strictly affect the oral cavity. Dental caries, periodontal disease, and pathologies associated with their worsening were considered almost the only interest in scientific research in dentistry. Recent studies have begun to shed light on the effect of the oral microbiota on general health and on the crucial role of dentistry in its maintenance. In this way, we came to understand that the bacterial populations that make up the oral microbiota can vary profoundly between individuals and that contribute in a fundamental way to outlining the so-called “oral signature”. This characteristic is called into question to evaluate the susceptibility, or lack thereof, of the subject to the contraction of a wide range of pathologies, apparently not connected with oral health. From this evidence, it will also be possible to study therapeutic approaches aimed at the eradication of species considered at risk or colonization with species considered protective; thus, giving life to so-called “personalized dentistry”. Therefore, this Special Issue is aimed at spreading the scientific knowledge over the current limits in terms of new molecular and culturomic approaches towards the diagnosis of oral microbiota and the treatment techniques of eventually associated systemic diseases. In vivo studies and systematic literature reviews with quantitative analysis of results, when possible, will be given a high priority.

The Efficacy of Retention Appliances after Fixed Orthodontic Treatment: A Systematic Review and Meta-Analysis

The purpose of this article is to evaluate the amount of the relapse of anterior crowding and the efficacy of retention appliances by reviewing the best available scientific evidence. A survey of articles published up to November 2019 about the stability of dental alignment and retention after fixed orthodontic treatment was performed using seven electronic databases. Study Selection: Only randomized clinical trials investigating patients previously treated with multi-bracket appliances with a follow-up period longer than 6 months were included. Data Extraction: Two authors independently performed the study selection, data extraction, and risk of bias assessment. All pooled data analyses were performed using a random-effects model. Statistical heterogeneity was evaluated. In total, eight randomized clinical trials (RCTs) were included, grouping data from 987 patients. The ages of the patients varied across the studies, ranging between 13 and 17 years. The observation period ranged between 6 and 24 months. The data showed no significant intercanine width modifications during the retention period with both fixed and removable retainers. A significant modification of Little’s Index was found for the mandibular removable retainers with a mean difference of 0.72 mm (95% Cl, 0.47 to 0.98) and for the maxillary removable retainers with a mean difference of 0.48 mm (95% Cl, 0.27 to 0.68). No significant changes were found by evaluating Little’s Index modification for the mandibular fixed retainers. The results of this meta-analysis showed that all the considered retainers were effective in maintaining dental alignment after fixed orthodontic treatment. However, fixed retainers showed greater efficacy compared to removable retainers.

Oral Microbiota: Discovering and Facing the New Associations with Systemic Diseases

The economic crisis of the first decades of the 2000s had serious repercussions on the economy of individual countries, producing a gradual impoverishment of populations. The reduction in financial resources has significantly reduced citizens’ access to care, forcing them to abandon preventive medicine treatments and check-ups. The health of the oral cavity, which had long been considered of secondary importance when compared with systemic pathologies whose course can be potentially fatal for the patient, has therefore been strongly neglected. In recent years, however, new mechanisms of etiology of systemic diseases have been studied with the aim of evaluating some aspects still unknown. The microbiota, whose interest has grown considerably in the national scientific community, was immediately considered as a key factor in the pathogenesis of some disorders. These analyses have also benefited from numerous advances in the field of crop and molecular diagnostics in the microbiological field. Although pioneering studies have focused on the microbiota of the gastro-intestinal system, subsequent evidence has also been drawn from various studies conducted on the oral microbiota. What emerged is that oral microbiota dysbiosis has been associated with numerous systemic diseases. Therefore, the purpose of this Special Issue is to encourage scientific research on the topic of the relationship between the oral microbiota and systemic diseases, also inviting the use of new techniques for culture and molecular diagnosis. Particular attention will be given to original works in vivo and to literature reviews provided they are carried out with a systematic approach and, if possible, supported by additional quantitative analyses.

Description of a Digital Work-Flow for CBCT-Guided Construction of Micro-Implant Supported Maxillary Skeletal Expander

The introduction of miniscrew-assisted rapid palatal expansion (MARPE) has widened the boundaries of orthodontic skeletal correction of maxillary transversal deficiency to late adolescence and adult patients. In this respect, Maxillary Skeletal Expander (MSE) is a particular device characterized by the engagement of four miniscrews in the palatal and nasal cortical bone layers. Thus, the availability of sufficient supporting bone and the perforation of both cortical laminas (bi-corticalism) are two mandatory parameters for mini-screw stability, especially when orthopedic forces are used. Virtual planning and construction of MSE based on cone-beam computed tomography (CBCT)-derived stereolithography (.stl) files have been recently described in the literature. In this manuscript we described: (a) a user-friendly digital workflow which can provide a predictable placement of maxillary skeletal expander (MSE) appliance according to the patient's anatomical characteristics, (b) the construction of a positional template of the MSE that allows lab technician to construct the MSE appliance in a reliable and accurate position, according to the virtual project planned by the orthodontist on the patient CBCT scans. We also described a case report of an adult female patient affected by skeletal transversal maxillary deficiency treated with MSE appliance that was projected according to the described workflow.

Salivary Microbiota Shifts under Sustained Consumption of Oolong Tea in Healthy Adults

Tea is the most widely consumed beverages next to water, however little is known about the influence of sustained tea consumption on the oral bacteria of healthy adults. In this study, three oral healthy adults were recruited and instructed to consume 1.0 L of oolong tea infusions (total polyphenol content, 2.83 g/L) daily, for eight weeks. Salivary microbiota pre-, peri-, and post-treatment were fully compared by high-throughput 16S rRNA sequencing and multivariate statistical analysis. It was revealed that oolong tea consumption reduced salivary bacterial diversity and the population of some oral disease related bacteria, such as Streptococcus sp., Prevotella nanceiensis, Fusobacterium periodonticum, Alloprevotella rava, and Prevotella elaninogenica. Moreover, via correlation network and Venn diagram analyses, seven bacterial taxa, including Streptococcus sp. (OTU_1), Ruminococcaceae sp. (OTU_33), Haemophilus sp. (OTU_696), Veillonella spp. (OTU_133 and OTU_23), Actinomyces odontolyticus (OTU_42), and Gemella haemolysans (OTU_6), were significantly altered after oolong tea consumption, and presented robust strong connections (|r| > 0.9 and p < 0.05) with other oral microbiota. These results suggest sustained oolong tea consumption would modulate salivary microbiota and generate potential oral pathogen preventative benefits. Additionally, diverse responses to oolong tea consumption among subjects were also noticed.

A Comparative Assessment of Pain Caused by the Placement of Banded Orthodontic Appliances with and without Low-Level Laser Therapy: A Randomized Controlled Prospective Study

Patients still refuse or discontinue orthodontic treatment due to related pain and discomfort. In this study, we investigate if low-level laser therapy (LLLT) can reduce pain caused by orthodontic bands. Sixty subjects who needed bands placed on the upper permanent first molars were assigned randomly to the LLLT group, placebo, and control groups. Inclusion criteria were: age range 10–14 years, fully erupted upper first molars in healthy condition, presence of tight mesial proximal contact. Exclusion criteria were: systemic or metabolic diseases, chronic pain or neurological or psychiatric disorders, use of pharmacological agents interfering with pain perception, previous orthodontic treatment or the simultaneous presence of other devices in the patient’s mouth. The assessment of pain was performed by using a numeric rating scale (NRS) considering different time intervals, i.e., immediately after bands placement, 6 h, 24 h, and from day 2 to day 5. Differences in the maximum pain and in pain experienced at each time-point, among the three groups, was assessed by using the Kruskal–Wallis H. The final sample included 56 patients, 29 males, and 27 females, with a mean age of 12.03 ± 1.3 years. Patients were randomly allocated into three groups (tested, control, and placebo group) with each group consisting respectively of 19, 20, and 17 individuals. Subjects in the LLLT experienced less pain at each time interval as well as the maximum pain score being lower in the LLLT compared to control and placebo groups. These findings were all statistically significant (p < 0.05). LLLT can alleviate the intensity of pain after the placement of orthodontic bands.