Relevance of single-nucleotide polymorphism to the expression of resistin gene affecting serum and gingival crevicular fluid resistin levels in chronic periodontitis and type 2 diabetes mellitus: A randomized control clinical trial

The influence of chronic periodontitis and type 2 diabetes mellitus on resistin levels of gingival crevicular fluid- a systematic review and meta-analysis

Aim

Chronic periodontitis (CP), a prevalent inflammatory dental disease, has been linked to systemic conditions like Type 2 Diabetes Mellitus (T2DM). This systematic review and meta-analysis aimed to evaluate resistin levels in the Gingival Crevicular Fluid (GCF) of CP individuals with T2DM. The objective was to determine if resistin could be a potential biomarker for periodontal disease in T2DM individuals.

Methods

The review included data from seventeen clinical studies that investigated resistin levels in GCF of individuals diagnosed with CP and T2DM. Data were sourced from PubMed, Scopus, and EBSCOhost, selected for their extensive coverage of medical and dental research, ensuring thorough retrieval of relevant studies. From the initial seventeen studies, five complied with the strict inclusion criteria for meta-analysis.

Results

Using a comprehensive meta-analysis, the significance of GCF Resistin levels in individuals with CP and T2DM relative to the healthy groups was examined. In addition, a meta-analysis was carried out to look into the relationship between periodontal probing depth (PPD) and CP and T2DM. The results indicated that individuals with T2DM and CP had significantly higher GCF resistin levels than the other groups. Furthermore, the PPD in T2DM with CP was significantly greater than in the other groups.

Conclusion

The present review highlights the potential role of resistin as a biomarker to diagnose individuals with chronic periodontitis and T2DM.

Clinical significance

The significantly elevated levels of resistin suggest that resistin could serve as a potential biomarker for T2DM in individuals with CP. This could lead to improved methods of early diagnosis and treatment, which could enhance individual outcomes and quality of life.

Prospero registration

The registration number CRD42023467186.

Endogenous and microbial biomarkers for periodontitis and type 2 diabetes mellitus

It has been well documented that there is a two-way relationship between diabetes mellitus and periodontitis. Diabetes mellitus represents an established risk factor for chronic periodontitis. Conversely, chronic periodontitis adversely modulates serum glucose levels in diabetic patients. Activated immune and inflammatory responses are noted during diabetes and periodontitis, under the modulation of similar biological mediators. These activated responses result in increased activity of certain immune-inflammatory mediators including adipokines and microRNAs in diabetic patients with periodontal disease. Notably, certain microbes in the oral cavity were identified to be involved in the occurrence of diabetes and periodontitis. In other words, these immune-inflammatory mediators and microbes may potentially serve as biomarkers for risk assessment and therapy selection in diabetes and periodontitis. In this review, we briefly provide an updated overview on different potential biomarkers, providing novel diagnostic and therapeutic insights on periodontal complications and diabetes mellitus.

The Influence of Fixed Dental Prostheses on the Expression of Inflammatory Markers and Periodontal Status-Narrative Review

A dental prosthesis will only be successful if the restoration lasts for a long period and does not cause any illness. The presence of permanent prosthetic restorations has been linked to an increased risk of periodontal infections, according to a large body of research that has been gathered. When chronic inflammation is brought on by fixed prosthetic constructions, both cellular and noncellular immunity are activated as adaptive immune mechanisms. It has previously been stated that both clinically adequate and inadequate restorations might cause gingival inflammation. Areas surrounding the abutment teeth presented periodontal pockets, attachment loss, congestion, bleeding on probing, and gingival hyperplasia after fixed restorations were removed. The depth of pockets, bleeding on probing, and bone loss are all closely correlated with disease's severity and IL-1β concentration in gingival crevicular fluid; IL-1β shows higher values in disease sites than in healthy ones. hs-CRP and TNF-α blood levels showed a considerable reduction one day after fixed restorations were applied, in comparison with the pre-treatment values. Collaboration between prosthodontists and periodontists is essential for a good treatment outcome since it will increase the restoration's lifespan, enhance periodontal health, and improve the quality of life for dental patients.

Comparison of Short-Term Restorative Effects and Periodontal Health Status of Restorations Made of Different Materials in Full-Crown Restoration of Mandibular Premolar Tooth Defects

Purpose

To compare the short-term restorative effect and periodontal health status of restorations with different materials in full-crown restoration of mandibular premolar tooth defects.

Methods

A total of 105 cases (123 affected teeth) of mandibular premolar tooth defects who visited the Department of Stomatology between January 2019 and January 2020 were selected, of which 58 cases (68 affected teeth) restored with cobalt-chromium alloy porcelain crowns were included in the metal-ceramic crown (MCC) group and 47 cases (55 affected teeth) repaired by zirconium dioxide all-ceramic crowns were assigned to the zirconia crown (ZC) group. The restorative effect, inflammatory factors (high-sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor-α (TNF-α)) and periodontal health indicators (human cartilage glycoprotein-39 (YKL-40), resistin, aspartate aminotransferase (AST), and alkaline phosphatase (ALP)) after treatment, and the occurrence of adverse reactions were compared between the two groups.

Results

The ZC group outperformed the MCC group in terms of margin fitness, restoration fracture, gingival condition, and color matching. After restoration, hs-CRP and TNF-α were statistically decreased in both groups, while YKL-40, resistin, AST, and ALP were significantly increased; and compared with the MCC group, hs-CRP, TNF-α, YKL-40, resistin, AST, and ALP were lower in the ZC group. The ZC group also scored statistically higher in retention effect, aesthetic effect, masticatory function, voice function, and comfort. Moreover, the ZC group had a higher total effective rate and a lower incidence of adverse reactions than the MCC group, with statistical significance.

Conclusions

Zirconia dioxide all-ceramic crowns contribute to a better short-term restorative effect in the full-crown restoration of mandibular premolar tooth defects, with little impact on periodontal health and high patient satisfaction, which deserves popularization and application.

Periodontitis and diabetes mellitus co-morbidity: A molecular dialogue

BACKGROUND

Type 2 diabetes mellitus (T2DM) and periodontitis are two biologically linked diseases that often coexist in complex interaction. While periodontitis may lead to insulin receptor desensitization, diabetes may increase the expression of inflammatory cytokines, such as Tumor Necrosis Factor-α (TNF-α) and Interleukin 6 (IL-6), in the gingival crevicular fluid and activate osteoclasts via Receptor activator of nuclear factor kappa-Β ligand (RANK-L) production, leading to bone resorption. However, the association between the two diseases processes, where one may exacerbate the progression of the other, is unclear. In addition, both diseases have similar mechanistic themes, such as chronic inflammation and oxidative stress. This review aimed to investigate the pathophysiological and molecular mechanisms underlying T2DM and periodontitis.

HIGHLIGHT

Uncontrolled diabetes is often associated with severe periodontitis, measured by clinical attachment loss. Alteration in the oral microbiome composition, which may activate the host inflammatory response and lead to irreversible oxidative stress, is a common finding in both diseases. An understanding of the molecular crosstalk between the two disease processes is crucial for developing therapeutic targets that inhibit bone resorption and halt the progression of periodontitis in patients with diabetes.

CONCLUSION

The Oral microbiome composition in T2DM and periodontitis shifts toward dysbiosis, favoring bacterial pathogens, such as Fusobacteria and Porphyromonas species. Both conditions are marked by pro-inflammatory immune activity via the activation of Interleukin 17 (IL-17), Interleukin 1 (IL-1), TNF-α, and Nuclear Factor Kappa Beta (NF-κB). Common molecular crosstalk signaling appears to involve advanced glycation end products (AGEs) and oxidative stress. Thus, future drug targets are multifactorial, ranging from modulatory of host inflammatory response to preventing the accumulation of AGEs and oxidative free radicals.

Evaluation and association of periodontal status with levels of Porphyromonas gingivalis in chronic periodontitis with and without Type 2 diabetes mellitus following nonsurgical periodontal therapy using quantitative polymerase chain reaction: An interventional study

Background:

The aim of the present study was to detect and correlate the levels of Porphyromonas gingivalis with clinical parameters after nonsurgical periodontal therapy (NSPT) in chronic periodontitis patients with or without Type 2 diabetes mellitus (T2DM), using quantitative polymerase chain reaction (Q-PCR) method.

Materials and Methods:

Sixty patients equally divided into three groups, i.e., periodontally healthy (Group I), chronic periodontitis (CP) (Group II), and CP with T2DM patients (Group III) were assessed through clinical parameters of probing pocket depth (PPD) and clinical attachment level (CAL) and were correlated for the presence of P. gingivalis in the respective groups. PPD, CAL, and saliva samples for microbiological evaluation were assessed at baseline, 1-, and 3-month post-NSPT.

Results:

Significant reduction of PPD was found 1.26 ± 0.22 versus 0.43 ± 0.33 mm in Group I, 4.62 ± 0.78 versus 2.58 ± 0.60 mm in Group II, and 6.28 ± 1.52 versus 4.01 ± 1.38 mm in Group III post-NSPT at 3 months. Similarly, a notable reduction of CAL was exhibited in both Group II (5.28 ± 0.80 vs. 3.12 ± 0.77 mm) and Group III (7.14 ± 1.59 vs. 4.51 ± 1.38 mm) patients after NSPT at 3 months. A greater reduction of P. gingivalis concentrations was observed in both Group II and Group III at 3-month post-NSPT.

Conclusion:

The substantial improvement of clinical parameters was found to be in correlation with the load of P. gingivalis, which was reduced more in Group II than in Group III, emphasizing the applicability and sensitivity of Q-PCR method for its assessment.

Effect of non-surgical periodontal treatment on gingival crevicular fluid and serum leptin levels in periodontally healthy chronic periodontitis and chronic periodontitis patients with type 2 diabetes mellitus

AIM

The aim of the present study was to evaluate the effect of non-surgical periodontal therapy (NSPT) on gingival crevicular fluid (GCF) and serum leptin levels and glycemic status in periodontally healthy patients with chronic periodontitis (CP) with and without type 2 diabetes mellitus (T2DM).

METHODS

Ninety patients were divided into three groups: periodontally healthy (group 1), CP (group 2) and CP with T2DM (group 3). The groups were evaluated for clinical parameters of probing pocket depth (PPD), clinical attachment level (CAL), plaque index, gingival index, biochemical parameters of GCF, serum leptin levels, and glycemic status pre- and post-NSPT.

RESULTS

The baseline PPD and CAL for group 2 was 4.98 ± 0.49 mm and 5.35 ± 0.55 mm, respectively; for group 3 it was 5.60 ± 0.38 mm and 6.01 ± 0.38 mm, respectively. There was a considerable reduction in these parameters post-NSPT, with group 2 showing better resolution. Pretreatment serum leptin levels revealed increasing values from group 1 to group 3 and decreasing GCF values from group 3 to group 1, exhibiting an inverse relationship. Group 3 also showed an improvement in glycemic status post-NSPT.

CONCLUSION

NSPT was effective in improving clinical parameters, increasing GCF, reducing serum leptin levels, and also improving glycemic status in patients with CP and CP with T2DM.