Academic literature on the topic 'Periodontal parameter'

Objective. To determine the association between oxidative stress parameters with periodontal disease, bleeding, and the presence of different periodontal bacteria.Methods. A cross-sectional study in a sample of eighty-six patients, divided into three groups depending on their periodontal status. Thirty-three with chronic periodontitis, sixteen with gingivitis, and thirty-seven with periodontal healthy as control. Oxidative stress biomarkers (8-OHdG and MDA), total antioxidant capacity (TAOC), and the activity of two antioxidant enzymes (GPx and SOD) were determined in saliva. Subgingival plaque samples were obtained from the deepest periodontal pocket and PCR was used to determine the presence of the 6 fimA genotypes ofPorphyromonas gingivalis,Aggregatibacter actinomycetemcomitans,Tannerella forsythia, andTreponema denticola.Results. Periodontal disease was found to be associated with increased oxidative stress parameter levels. These levels rose according to the number and type of different periodontal bacteria found in the periodontal pockets. The presence of different types of periodontal bacteria is predictive independent variables in linear regresion models of oxidative stress parameters as dependent variable, above all 8-OHdG.Conclusions. Oxidative stress parameter levels are correlated with the presence of different types of bacteria. Determination of these levels and periodontal bacteria could be a potent tool for controlling periodontal disease development.

Background. The article shows the relevance of gerontostomatology, which associate with numerous features of epidemiology, clinical currents and treatment of oral diseases and the need for other approaches to diagnostic events. For the first time, the question of the consistency of the parameter of the depth of the periodontal pocket in assessing the degree of severity of generalized parodontitis in the elderly is raised and also provides a justification for choosing an «attachment loss-AL» indicator, as an alternative to the above criterion. The generalization of the literature data on histoarchitectonics of the periodontal complex, and its effect on the objectivity of instrumental examination, and confonderers in the gerontoparodontological practice. The authors give recommendations on the methodology of sounding packets, as well as correct interpretation of the data with the aim of correctly diagnosing and selecting a valid treatment tactic, including in group examinations. objectives. To optimize the periodontal probing and examination of elderly patients with chronic generalized periodontitis. Methods. 113 elderly patients with chronic generalized periodontitis were examined, using such parameters (determining the damage level of periodontal apparatus) as «depth of the periodontal pockets», «the attachment loss (AL)», «the average depth of the periodontal pockets», «the average AL», «the average max depth of the periodontal pockets», «the average max AL». results. The least measure was «the average depth of the periodontal pockets» (3,52±0,13 mm); «the average max depth of the periodontal pockets» was 4,78±0,17 mm; «the average AL» was more than «the average depth of the periodontal pockets», but it was less than «the average max depth of the periodontal pockets» and «the average max AL» (p<0,05). The most measure was «the average max AL» (5,6±0,19 mm). Conclusions. The most accurate measure was the average AL, which determining the true damage level of periodontal apparatus, taking into account such factors as gingival recession, or gingival hypertrophy.

For many years, the use of probiotics in periodontitis treatment was reflected in their abilities to control the immune response of the host to the presence of pathogenic microorganisms and to upset periodontopathogens. Accordingly, the aim of the present study was to assess the use of probiotics as adjuvant therapy on clinical periodontal parameters throughout a systematic review and meta-analysis. The literature was screened, up to 4 June 2021, by two independent reviewers (L.H. and R.B.) in four electronic databases: PubMed (MedLine), ISI Web of Science, Scielo, and Scopus. Only clinical trials that report the effect of the use of probiotics as adjuvants in the treatment of periodontal disease were included. Comparisons were carried out using Review Manager Software version 5.3.5 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). A total of 21 studies were considered for the meta-analysis. For the index plaque, the use of probiotics did not improve this clinical parameter (p = 0.16). On the other hand, for the periodontal pocket depth, the clinical attachment loss, the bleeding on probing, and the use of probiotics as adjuvant therapy resulted in an improvement of these parameters, since the control group achieved statistically higher values of this parameter (p < 0.001; p < 0.001; and p = 0.005, respectively). This study suggests that the use of probiotics led to an improvement in periodontal pocket depth, clinical attachment loss, and bleeding on probing parameters. On the other hand, this protocol seems to not be beneficial for the index plaque parameter.

The recurrence risk evaluation has been emphasized in periodontal stabilization during supportive periodontal therapy (SPT). However, nutritional factors, e.g., dietary habits such as the frequency of eating vegetables, are rarely included in the evaluation. In this study, the effect of nutritional factors on clinical periodontal parameters was examined in a lifestyle-related investigation and a periodontal examination in patients with periodontitis undergoing SPT. A total of 106 patients were recruited. Tendencies toward a negative correlation were found between rate of a probing depth (PD) of 4–5 mm, rate of PD ≥ 6 mm, the bleeding on probing (BOP) rate, periodontal inflamed surface area (PISA), and various nutritional factors. The number of teeth was a clinical parameter with a significantly high R2 (≥0.10) influenced by environmental factors, whereas PD, PD of 4–5 mm, the BOP rate, and PISA were influenced by nutritional factors. These results suggested that environmental factors reflected clinical parameters showing long-term pathophysiology, such as the PD rate. Nutritional factors tended to affect the current inflammatory pathophysiology, such as the BOP rate, PISA, and PISA/periodontal epithelial surface area. Therefore, environmental and nutritional factors appear to be useful for evaluating the risk of periodontitis during SPT.

Many popular mouthwashes containing herbal products have helped to control dental plaque and gingivitis; however, they are used for a short time and only as an adjunct to other oral hygiene measures such as brushing and flossing. Recently, herbs such as Zingiber ginger and Alpinia officinarum, with antioxidant, antifungal, anti-inflammatory, and antibacterial properties apart from being cheap and safe, have been used as plant extracts in mouthwashes. The aim of this study was to assess the effect of both herbal mouthwashes and periodontal therapy on oxidative stress, total antioxidant capacity, and antioxidant enzyme activities in the saliva of patients with periodontitis as well as to investigate the association between oxidative stress, antioxidant enzymes, total antioxidant capacity, and periodontal parameters. 72 patients were selected using random sampling and divided into three categories. Each category consisted of 24 patients: the first group received non-surgical periodontal treatment and Zingiber ginger mouthwash, the second group received Alpine officinarum and non-surgical periodontal therapy, while the third control group received non-surgical periodontal therapy only. Periodontal parameters (Clinical Attachment Loss and Plaque Index) were recorded by a calibrated periodontal probe (William probe). Salivary oxidative stress (eight hydroxy deoxyguanosine) was measured by ELISA, and catalase and total antioxidant capacity were measured using a spectrophotometer. The concentration of salivary antioxidants significantly increased, and the periodontal parameter and eight hydroxy deoxyguanosine significantly decreased after two weeks. The p-value in the ginger group was (P < 0.0001). For the alpine officinarum group, the clinical parameters showed a significant decrease, and the p-value was (P < 0.0001). While catalase displayed a significant increase (P < 0.0001), the eight hydroxy deoxyguanosine markers showed a significant decrease (P < 0.02). Zingiber ginger and Alpine officinarum mouthwashes, in addition to periodontal therapy, can be effective in controlling inflammation, reducing oxidative stress, and improving dental health in patients with chronic periodontitis. Mostly positive associations were detected among clinical and biochemical parameters.

Evaluating periodontal tissue condition is an important diagnostic parameter in periodontal disease. Noncontact electromagnetic vibration device (NEVD) was previously developed to monitor this condition using mechanical parameters. However, this system requires accelerometer on the target tooth. This study assessed application of laser displacement sensor (LDS) to NEVD without accelerometer using experimental tooth models. Tooth models consisted of cylindrical rod, a tissue conditioner, and polyurethane or polyurethane foam to simulate tooth, periodontal ligament, and alveolar bone, respectively. Tissue conditioner was prepared by mixing various volumes of liquid with powder. Mechanical parameters (resonant frequency, elastic modulus, and coefficient of viscosity) were assessed using NEVD with the following methods: Group A, measurement with accelerometer; Group B, measurement with LDS in the presence of accelerometer; and Group C, measurement with LDS in the absence of accelerometer. Mechanical parameters significantly decreased with increasing liquid volume. Significant differences were also observed between the polyurethane and polyurethane foam models. Meanwhile, no statistically significant differences were observed between Groups A and B; however, most mechanical parameters in Group C were significantly larger and more distinguishable than those of Groups A and B. LDS could measure mechanical parameters more accurately and clearly distinguished the different periodontal ligament and alveolar bone conditions.

While periodontitis deteriorates patients’ quality of life, non-surgical periodontal treatment seems to offer an improvement. The purpose of the present study was to evaluate the impact of non-surgical and surgical periodontal treatment on the oral health-related quality of life (OHRQoL) utilizing patient-centered assessments and surrogate clinical measurements in Greek adults. Eighty-three individuals with chronic periodontitis were enrolled in the study. Assessment of OHRQoL with the use of the Oral Health Impact Profile (OHIP-14) questionnaire in conjunction with clinical measurements of pocket probing depth (PPD), plaque index (PI) and bleeding on probing (BOP) were performed at baseline (t0), after non-surgical therapy (t1) and after periodontal surgery (t2). A statistically significant reduction of OHIP-14 score was recorded at t1 and t2 examination compared to baseline (p < 0.001) and a statistically significant improvement in all clinical parameter at all time points was recorded (p < 0.05). No correlation between the clinical parameters and the total score of OHIP-14 was recorded at any time point. Non-surgical periodontal treatment seemed to improve OHRQoL in terms of OHIP-14 scores, whilst supplementary surgical periodontal therapy did not offer any additional benefit. No correlation was found between patients’ perception of quality of life expressed by OHIP-14 score and the surrogate clinical parameters.

Epidemiological studies have shown strong evidence that periodontal disease does not affect all subjects in the same manner. There are subjects and sites with higher risk for disease progression. This study tested parameters to select "a priori" sites and subjects potentially at risk. The data from periodontal clinical examinations of 2273 subjects was used. The clinical loss of attachment was measured in 6 sites per tooth. Using computer software, the patients were distributed into 14 age groups, with intervals of 5 years, from 11 years to greater than 75 years of age. The measure of each site was compared with the average and the median values of the subject age group, with the results indicating site comparative severity (SCS). Three global parameters were calculated: parameter 1 (P1) - percentage of sites with clinical attachment loss > 4 mm; parameter 2 (P2) - percentage of sites with clinical attachment loss > 7 mm; parameter 3 (P3) - percentage of sites with clinical attachment loss surpassing the median value for the age group by 100% or more. There were 1466 (65%) females and 807 (35%) males. Most subjects had P1, P2 and P3 values less than 30%. Parameter 3 allowed a division of the sample similar to that of Parameters 1 and 2, with the advantage of analyzing the subject in relation to his/her age group. It was suggested that the methodology of SCS is useful for selecting a population with a high disease prevalence, and that cut-off lines between 10% and 20% would be appropriate for using Parameter 3.

Background: This study investigated gender dependent differences by the comparison of periodontal status and oral hygiene between diabetic patients and non-diabetic subjects. Methods: 517 mostly obese subjects (171 non-diabetic, 205 type 2 diabetic with oral and 141 with insulin therapy; mean: 59 years) completed an oral hygiene questionnaire and had a clinical examination, including periodontal screening and recording (PSR), percentage of bleeding teeth (PBT), probing pocket depth (PD), gingivitis index (GI), and number of teeth (Tn). Main parameters were “periodontitis” and “oral hygiene behaviour”, each defined by 5 sub-parameters. For a comparison of all results, each sub-parameter was set 0.2. The “low performance index“ (LoP) was the sum of significantly worse sub-parameters in the compared groups (maximum of low performing = 1.0). Results: Gender comparison: In non-diabetic and diabetic patients with oral medication, males performed worse (LoP: periodontitis 0.6 - 0.8; oral hygiene 0.4 - 0.6). The male insulin group performed worse oral hygiene (LoP: 0.4) than females with insulin therapy, whereas the periodontal status showed no difference. Diabetic and non-diabetic groups: Females: Diabetic groups performed worse than non-diabetics (LoP: periodontitis 0.2 - 1.0; oral hygiene 0.4). Insulin patients had worse periodontal status and showed no difference in oral hygiene when compared to diabetic patients with oral medication (LoP: 0.2). Males: Diabetic group with oral medication had worse periodontal status than non-diabetics (LoP: 0.6). Conclusions: The periodontal status was mainly due to oral hygiene behaviour, which was worse in men. Apparently behaviour and not diabetes is the major determinant of periodontitis. Men apparently need much more advise than women.

The aim: To estimate the neutrophil activities in adolescents with type 1 diabetes mellitus (T1DM) depending on periodontal state. Materials and methods: A total of 93 individuals aged 12-16 years, including 62 T1DM patients and 31 healthy (H) controls, were included. Both groups were categorized into subgroups depending on their periodontal state. Phagocytic activity of neutrophils (PAN) the index of neutrophil activation (INA), and the percent of formazan-active neutrophils were evaluated using the spontaneous and the induced nitroblue tetrazolium (sNBT and iNBT) tests into oral rinses. Results: PAN was significantly higher in the healthy (H) controls with gingivitis compared with the individuals with gingival health (p < 0.0001). This parameter decreased significantly in the T1DM subjects, especially with periodontitis, compared with the H controls (p < 0.0001). The percent of formazan-active neutrophils and INA in the sNBT test increased in the T1DM patients with gingival health and continued to raise as periodontal state of adolescents with T1DM worsened (p<0.0001). The parameters of the iNBT test in the T1DM adolescents decreased with the periodontal disease development (p < 0.0001) that may demonstrate that superoxide production exhausts in diabetes, especially associated with periodontal disease. Conclusions: The sNBT test in studied adolescents showed that both periodontal disease and T1DM increase the rate of activated neutrophils (p<0,05).

Prosthodontic and periodontal correlation on teeth In the daily dental practice 3 fundamental/empiric/clinical parameters have a role to establish the clinical success of prosthodontic treatment: function, aesthetic and longevity of the restorations. But, from a scientific point of view, how do we rate the success of the restorations? When analyzing the existing literature, it can be noted that many authors focus their attention on the precision of the margin, to pursuit a small gap between the abutment and the crown, and to achieve the clinical success. Christensen et al.1 and Mc Lean & Von Fraunhofer2 investigated the margins’ clinical acceptability by dentists and asked to measure the gap between the abutment and the crown to a number of practitioners: it was shown that a clinician can clinically appreciate a gap not lower than 120 microns using a sharp explorer. This result may end in a not sure and sufficient seal between the crown and abutment, and consequently leakage at the margins. This finding is not in agreement with the existing data coming from an in vitro study in which the acceptable marginal gap is lower than 50 microns3 Sorensen3 reported that small defects less or equal then 0,050 mm were associated with significantly less fluid flow and bone loss than defects exceeding this value. Martignoni4-5 reported that there are variable definitions regarding what constitutes a margin that cab ne clinically acceptable, and there is no definite threshold for the maximum marginal discrepancy that is clinically acceptable. Many authors accept the criteria established by McLean and Von Fraunhofer2, they completed a 5-year examination of 1000 restorations and concluded that 120 microns should be considered the maximum marginal gap. The adaptation, the precision and the quality of the restoration margin can be of greater significance in terms of gingival health, than the position of the margin6. According to Lang et al. 7 following the placement of restorations with overhanging margins, a subgingival flora was detected which closely resembled that of chronic periodontitis. Following the placement of the restorations with clinically perfect margins, a microflora characteristic for gingival health or initial gingivitis was observed. In patients with suitable oral hygiene, tooth-supported and implant-supported crowns with intra-sulcular margins were not predisposed to unfavorable gingival and microbial responses8. Even among patients receiving regular preventive dental care, subgingival margins are associated with unfavorable periodontal reactions9. Ercoli and Caton10, in a systematic review, describe how placement of restoration margins within the junctional epithelium and supracrestal connective tissue attachment can be associated with gingival inflammation and, potentially, recession or periodontal pocket. The presence of fixed prostheses finish line within the gingival sulcus or wearing of partial, removable dental prostheses does not cause gingivitis if the patients are complaint with self-performed plaque control and periodic maintenance. Procedures adopted for the fabrication of dental restorations and fixed prostheses have the potential to cause traumatic loss of the periodontal supporting tissue. They concluded that restoration margins located within the gingival sulcus do not cause gingivitis if the patients are complaint with self-performed plaque control and periodic maintenance. Tooth-supported and/or tooth-retained restorations and their design, fabrication, delivery, and materials, have often been associated with plaque retention and loss of attachment. Restoration margins placed within the junctional epithelium and supracrestal connective tissue attachment can be associated with inflammation and, potentially, recession. Factors related to the presence, design, fabrication, delivery and materials of tooth-supported prostheses seem to influence the periodontium, generally related to localized increase in plaque accumulation and, less often, to traumatic and allergic reactions to dental materials10. Jansson showd that the influence of a marginal overhang on pocket depth and radiographic attachment decrease with increasing loss of periodontal attachment in periodontitis-prone patients, and the effect on pocket depth of a marginal overhang may act synergistically, potentiating the effect of poor oral hygiene11. Subgingival restorations with their apical borders still located subgingivally after periodontal treatment should be regarded as a risk factor in the progression of periodontitis12. Consequently, placement of the restoration margin supragingivally is recommended, especially in periodontitis-prone patients with an insufficient plaque control12. Dental restorations may be suggested as a risk indicator for periodontal disease and tooth loss. Routine SPT (Supportive Periodontal Therapy) was found to be associated with decrease in the prevalence of deep PPD over time, and it is of the utmost importance in maintaining periodontal health, especially adjacent to teeth with restorations. Finally, these findings may support the treatment of caries lesions and faulty restorations as part of a comprehensive cause-related therapy and should be followed by a regular maintenance program13. The relationship between dental restorations and periodontal status has been examined for some time. Research has shown that overhanging dental restorations and subgingival margin placement play an important role providing an ecologic niche for periodontal pathogens14. An overhanging dental restoration is primarily found in the class II restoration, since access for interdental finishing and polishing of the restoration, and cleansing is often difficult in these areas, even for patients with good oral hygiene. Many studies have shown that there is more periodontal attachment loss and inflammation associated with teeth with overhangs than those without. Presences of overhangs may cause an increase in plaque formation15-21 and a shift in the microbial composition from healthy flora to one characteristic of periodontal disease14. The location of the gingival margin of a restoration is directly related to the health status of the adjacent periodontium8. Numerous studies8-12-25 have shown that subgingival margins are associated with more plaque, more severe gingival inflammation and deeper periodontal pockets than supragingival ones. In a 26-year prospective cohort study, Schatzle et al. 25 followed middle class Scandinavian men for a period of 26 years. Gingival index, and attachment level were compared between those who did and those who did not have restorative margins greater than 1mm from the gingival margin. After 10 years, the cumulative mean loss of attachment was 0.5 mm more for the group with subgingival margins. This was statistically significant. At each examination during 26 years of the study, the degree of inflammation in the gingival tissue adjacent to subgingival restorations was much greater than in the gingiva adjacent to supragingival margins. This is the first study to document a time sequence between the placement of subgingival margins and periodontal attachment loss, confirming that the subgingival placement of margins is detrimental to gingival and periodontal health. Plaque at apical margin of a subgingival restoration will cause periodontal inflammation that may in turn destroy connective tissue and bone approximately, 1-2 mm away from inflamed area14. Determination of the distance between the restorative margin and the alveolar crest is often done with bitewing radiographs; however, it is important to remember that a radiograph is a 2-dimensional representation of 3-dimensional anatomy and structure. Thus, clinical assessment and judgment are important adjuncts in determining if, and how much, bone should be removed to maintain adequate room for the dento-gingival supra crestal connective tissue height attachment14. Although surface textures of restorative materials differ in their capacity to retain plaque26, all of them can be adequately maintained if they are correctly polished and accessible to patient care27. This includes underside of pontics. Composite resins are difficult to finish interproximally and may be more likely to show marginal defects than other materials28. As a result, they are more likely to harbor bacterial plaque29. Intra-subject comparisons of unilateral direct compositive “veneers” showed a statistically significant increase in plaque and gingival indices adjacent to the composites, 5-6 years after placement28. In addition, when a diastema is closed with composite, the restorations are often overcontoured in the cervical-interproximal area, leading to increased plaque retention28. As more plaque is retained, this could pose a significant problem for a patient with moderate to poor oral hygiene14. For that, in absence of more specific prosthodontic parameters to evaluate the integration of crowns in to the periodontal environment, another way to determine the success and health of the restoration is to use the periodontal parameters such as: PPD (Periodontal Probing Depth) that is the measurement of the periodontal sulcus/pocket between the gingival margin and the bottom of the sulcus/pocket; REC (Recession) is the apical migration of the gingival margin measured with the distance between the gingival margin and the CEJ (Cement-Enamel Junction); PI (Plaque Index) the index records the presence of supragingival plaque; BOP (Bleeding On Probing) the presence or not of bleeding on surfaces of the teeth during the probing. The aim of this study/thesis was to propose a clinical procedure to evaluate single unit restorations and their relations with periodontal tissues by a new clinical score: the FIT ( Functional Index for Teeth). FIT, that is a novel index for the assessment of the prosthetic results of lithium disilicate crowns, based on seven restorative-periodontal parameters, that evaluate crowns placed on natural abutments, and want to be a reliable and objective instrument in assessing single partial crown success and periodontal outcome as perceived by patients and dentists.

The present cross-sectional study aimed to validate different biological factors relate to periodontal and diabetes diseases. Objective: Our study compared microbiological and salivary parameters of diabetics and non diabetics subjects matched by periodontal profile. Method: A total of 29 diabetic and 32 non diabetic subjects were included in this survey. The study population, allocated in Porto Velho-RO, Brazil, was submitted to clinical periodontal examinations, such as: Periodontal pocket depth (PPD), Clinical attachment loss (CAL), Plaque index (PI) and Gingival index (GI) as well as salivary, fasting blood glucose and glycated hemoglobin tests. Additionally, the presence of Agregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forshythia and Campylobacter rectus was performed by Polimerase Chain Reaction. Results: We observed the following clinical results: at the TG, mean values of PPD, CAL, PI and GI were respectively (2.410.64); (2.761.66); (0.460.24; (0.280.15) while at the CG were (2.550.71); (2.381.72); (0.400.24); (0.340.20). According to microbiological data we observed that the most prevalent pathogens in both groups were P. gingivalis (TG: 86.2%; CG:90,6%) and T. forsythia (TG: 93,1%; CG: 96,8%). Took in consideration parameters such as: Weight, body mass index and saliva we also verified no statistically significant differences between groups, on the other hand, the mean rates of glucose in diabetic patients were higher (p<0.05) than non diabetic subjects. Conclusion: The results of this study showed that salivary and microbial factors did not differ between groups, so these factors were not represent an important tool to characterize differences between diabetic and non diabetic patients. Then, we also recommend a different approaches, such as, longitudinal studies to validate these biological factors in the relationship of periodontal disease and diabetes.
A fundamentação do presente estudo foi o de validar alguns fatores biológicos importantes na associação doença periodontal e diabetes em estudo do tipo transversal. Objetivo: Foi comparar o perfil microbiano e salivar de indivíduos diabéticos (GT) em relação a não diabéticos (GC) equilibrados sob características clínicas periodontais Método: Foram incluídos 29 indivíduos diabéticos e 32 não-diabéticos, de ambos os gêneros, alocados em Porto Velho/RO e submetidos a exames laboratoriais como glicemia de jejum e hemoglobina glicada. Foi realizada ainda avaliação clínica bucal incluindo mensurações de profundidade de bolsa (PS), perda de inserção clínica (PIC), índice de placa (IP) e gengival (IG) para estabelecimento do diagnóstico periodontal. Exames microbianos foram realizados para avaliar a presença de Agregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevoltella intermedia, Tannerella forshythia, e Campylobacter rectus por Reação em cadeia da polimerase (PCR). Os exames salivares avaliaram pH, fluxo salivar, capacidade tampão e concentração de glicose na saliva. Resultados: Os valores médios e desvio-padrão dos parâmetros clínicos de PS, PIC, IP e IG foram respectivamente: GT (2,410,64); (2,761,66); (0,460,24; (0,280,15) e GC (2,550,71); (2,381,72); (0,400,24); (0,340,20). Na análise microbiológica, os patógenos mais prevalentes em ambos os grupos foram P. gingivalis e T. forsythia (GT: 86,2%; GC: 90,6%) e (GT: 93,1%; GC: 96,8%). Peso, Indice de massa corporal (IMC) e análise salivar, apresentaram-se iguais em ambos os grupos. As taxas glicêmicas dos indivíduos diabéticos foram superiores (p<0,05) as dos indivíduos não diabéticos. Conclusão: Após avaliação dos resultados concluímos que os fatores microbianos e salivares não diferiram entre os grupos examinados, logo estes fatores não foram importantes na caracterização de diabéticos e não diabéticos neste modelo de estudo. A condução de estudos longitudinais poderá elucidar a validade destes fatores biológicos na relação doença periodontal e diabetes.

碩士
國立成功大學
資訊工程學系
104
Periodontal diseases are very common and can affect up to 90% of the worldwide population. Some acute diseases have also been associated with periodontal diseases. Dental radiography and the periodontal probe are the most popular ways nowadays to diagnose periodontal disease, but the irradiation of radiography and the pain with examination of periodontal probe are annoying issues. It is necessary to develop a new diagnosis method with properties of non-ionization and painless examination to assess the periodontal disease. This study proposed a 70 MHz high-frequency ultrasound imaging system for measuring the depth of gingival sulcus and the tissue properties of gingiva. A plastic dental model was embedded in a tissue-mimicking phantom to be used to verify the ultrasound imaging system. Subsequently, the rat model for periodontal disease was achieved by ligature-induced. The phantom and gingival tissue were scanned by the ultrasonic transducer to acquire ultrasonic signals. By detecting every continuous B-mode image, the depth of gingival sulcus can be calculated. The degrees of periodontal disease were related to ultrasonic parameters. Integrated backscatter and Nakagami parameter were calculated from ultrasound image inside region of interest (ROI), respectively. The results of depth which were calculating by algorithm of automatically detecting gingival sulcus and periodontal probe show that calculating the depth of gingival sulcus by B-mode image is an feasible way to measurement. After ligature-induced gingivitis in rats, the results show that the thickness of gingival, Nakagami parameter and integrated backscatter were different from the control group. The difference between normal thickness of gingival and swelling thickness of gingival can also be seen on B-mode image. This study demonstrated that the 70 MHz high-frequency ultrasound imaging system which could be used to analyze the periodontal disease by measuring the depth of gingival sulcus and ultrasonic quantitative parameters.

Trabalho Final do Mestrado Integrado em Medicina Dentária apresentado à Faculdade de Medicina
Introdução: Quando existem condições que favorecem o crescimento de microrganismos patogénicos na cavidade oral, o desequilíbrio microbiano pode levar à incidência da doença periodontal. Vários métodos que têm como base a modulação do microbioma estão a ser utilizados para o tratamento e prevenção da doença periodontal de forma a manter a homeostasia. Os prebióticos surgem como uma nova abordagem para repor o equilíbrio na cavidade oral. Estes substratos modulam seletivamente o microbioma, e podem também melhorar a imunidade do hospedeiro, conferindo benefícios para a saúde. Objectivos: Estudar o potencial dos prebióticos de forma a entender o racional a nível biológico e avaliar a aplicabilidade clínica em doentes com doença periodontal através de uma pesquisa com uma metodologia de Revisão Sistemática. Metodologia: Foi estabelecida uma questão PICO: “Em pacientes com doença periodontal qual a ação dos substratos prebióticos, aplicados nas diversas formulações, comparado com a sua abstenção de utilização, através de uma avaliação quantitativa/qualitativa do microbioma, dos efeitos bioquímicos/imuno-inflamatórios e dos parâmetros clínicos?” A pesquisa eletrónica foi realizada nas bases de dados MEDLINE/PubMed, Embase e Cochrane com termos MeSH previamente definidos. Foram incluídas revisões sistemáticas, ensaios clínicos randomizados, estudos em animais e estudos in vitro publicados entre 1 de Janeiro de 2004 e 5 de Junho de 2019. Resultados: A pesquisa eletrónica gerou um total de 577 artigos, 30 satisfaziam os critérios de seleção: 1 revisão sistemática, 1 revisão sistemátia de estudos in vivo, ex vivo e in vitro, 5 ensaios clínicos randomizados, 9 estudos em animais, 14 estudos in vitro. Discussão: Os prebióticos mais estudados a nível da doença periodontal são os ácidos gordos polinsaturados e os polifenóis. O ómega 3 foi estudado em forma de suplementação mas não foram estudados os seus efeitos a nível direto na cavidade oral em indivíduos com doença periodontal. O resveratrol apresenta efeitos inibidores ao nível da contagem de certas bactérias porém ainda não foi estudado a nível clínico. Os taninos e os flavonoides apresentam estudos a nível do racional biológico e a nível clínico. A arginina é dos prebióticos menos estudados a nível da doença periodontal, apresentando efeitos benéficos na inibição de bactérias patogénicas. Conclusão: Os polifenóis e os ácidos gordos polinsaturados são os mais estudados a nível da doença periodontal. Dos ácidos gordos polinsaturados o ómega 3 é o que apresenta possíveis efeitos benéficos a nível do processo inflamatório, e possivelmente a nível dos parâmetros clínicos.Dos polifenóis os taninos e os flavonoides parecem ser os mais promissores, apresentando efeitos benéficos a nível do racional biológico e de alguns parâmetros clínicos.
In some conditions there may be an increase of pathogenic microorganims in the oral cavity that can disrupt the homeostasis, shifting the microbiome balance to periodontal disease. Several methods based on microbiome modulation are being used for the treatment and prevention of periodontal disease in order to maintain homeostasis The prebiotics arise as new approach to restore balance in the oral cavity. These substrates that are used selectively, modulate the microbiome, and may also enhancing host imunity, conferring health benefits to the host. Objectives: Know the potencial of prebiotics in order to understand the rational of the biologic level and evaluate the clinical applicability in pacientes with periodontal disease through a research with a systematic review methodology. Methodology: A PICO question was established: "In patients with periodontal disease what is the action of the prebiotic substrates, applied in the various formulations, compared to their abstention of use, through a quantitative / qualitative evaluation of the microbioma, biochemical / immunoinflammatory effects and clinical parameters?". The electronic search was performed on the MEDLINE / PubMed, Embase and Cochrane databases with previously defined MeSH terms. We included systematic reviews, randomized clinical trials, animal studies and in vitro studies published between 1 January 2004 and 5 June 2019. Results: The electronic research generated a total of 577 articles, 30 satisfying the selection criteria: 1 systematic review, 1 systematic review of in vivo, ex vivo and in vitro studies, 5 randomized clinical trials, 9 animal studies, 14 in vitro. Discussion: The prebiotics most studied in periodontal disease are polyunsaturated fatty acids and polyphenols. Omega 3 has been studied in the form of supplementation but its effects have not been studied directly in the oral cavity in individuals with periodontal disease. Resveratrol has inhibitory effects on the counts of certain bacteria but has not yet been studied clinically. Tannins and flavonoids present biological rationale studies and clinical studies. Arginine is one of the least studied prebiotics in periodontal disease, with beneficial effects on the inhibition of pathogenic bacteria. Conclusion: Polyunsaturated fatty acids and polyunsaturated fatty acids are the most studied in periodontal disease. In polyunsaturated fatty acids, omega-3 fatty acids have the potential to have beneficial effects on the inflammatory process, and possibly on clinical parameters. Of the polyphenols, the tannins and the flavonoids seem to be the most promising, presenting beneficial effects in the biological rationale and some clinical parameters.

碩士
臺北醫學大學
牙醫學系碩博士班
102
Objective: The aim of this study was to systematically review the literature and to determine the clinical outcome of osseous resective surgery (OS) versus non-osseous resective flap surgery (NOS) on clinical attachment level (CAL) gain, probing periodontal depth (PPD) reduction, gingival recession (REC) gain and other periodontal parameters. Additionally, factors affecting clinical outcomes of OS were also identified. Materials and Methods: An electronic search of the literature was conducted in the databases of MEDLINE OvidSP, PubMed, Cochrane, Scopus and Sciencedirect from January 1960 up to and including December 2013. Eligible studies were included in the systematic review if they met the following criteria: (1) randomized controlled clinical trial (RCT) (2) Human study (3) Patients with chronic periodontitis-related defects were performed with OS and NOS (4) studies showed at least 4-months of follow-up and included at least 7 subjects whose age ≥ 18. (5) Clinical parameters change [e.g., CAL gain, PPD reduction, REC increase, bony defect fill and bone crest reduction] were available to retrieve. (6) No language limitation. The exclusion criteria were: (1) Patients who use drugs or have systemic disease which involved in bone metabolism or periodontal inflammation (2) subjects diagnosed as aggressive periodontitis. Two investigators assessed the eligible publications independently. Results: The search provided 725 articles of which eleven RCTs were included. Nine studies were respectively included for meta-analysis. Less CAL gain (WMD -0.30mm; 95% CI: -0.68, 0.07) and more PPD reduction (WMD 0.11mm; 95% CI: -0.22, 0.44) were noted in OS group than NOS group after 0.5-1 year follow-up. More REC gain (WMD 0.81mm; 95% CI: 0.20, 1.43) was also noted in OS group than in MWF alone group1 year after surgery. After 5-year follow-up, results still showed less CAL gain (WMD -0.22mm; 95% CI: -0.71, 0.27) and more PPD reduction (WMD 0.13mm; 95% CI: -1.37, 1.63) in OS group. There has not enough data for meta-analysis of hard tissue alteration after OS and NOS. However, a tendency of less periodontal defect fill and more crestal bone reduction was noted in OS group. Conclusion: Treatment of periodontal defects with osseous resective surgery appears to be associated with improvement of periodontal clinical parameters and provides periodontal-related teeth with stable and promising prognosis.

Parodontitis und rheumatoide Arthritis (RA) haben eine Vielzahl gemeinsamer pathologischer Merkmale. Bedingt durch die hohe Prävalenz der Parodontitis, ist davon auszugehen, dass beide Erkrankungen häufig gemeinsam auftreten. Zahlreiche Studien, darunter umfangreiche Übersichtsarbeiten, konnten bei RA-Patienten im Vergleich zu gesunden Patienten eine erhöhte Prävalenz parodontaler Erkrankungen nachweisen. Darüber hinaus konnte festgestellt werden, dass RA-Patienten vermehrt unter schweren Formen der Parodontitis leiden und eine höhere Anzahl an fehlenden Zähnen aufweisen. Während bei der Parodontitis die Pathogenese inzwischen gut verstanden wird, sind die Ursachen der RA bis heute weiterhin unklar. Nach heutigen Erkenntnissen gelten Zusammenhänge zwischen Parodontitis und RA als nachgewiesen und sehr wahrscheinlich. Dabei scheint eine Wechselbeziehung vorzuliegen: Zum einen leiden RA-Patienten häufiger unter (schweren Formen der) Parodontitis. Zum anderen nimmt das parodontalpathogene Bakterium Porphyromonas gingivalis scheinbar eine wesentliche Rolle in der Pathogenese der RA ein. Allerdings ist noch unklar, welche pathobiologischen Mechanismen dieser Wechselbeziehung zu Grunde liegen. Mögliche Zusammenhänge beider Erkrankungen werden zunehmend unter der Berücksichtigung mikrobiologischer Aspekte betrachtet. Besonders vielversprechend ist die Betrachtung des parodontalpathogenen Keims Porphyromonas gingivalis. Dieser besitzt die einzigartige Fähigkeit, eine bakterielle Peptidylarginin-Desaminase zu exprimieren, die es ihm erlaubt, Proteine des Wirts zu citrullinieren. Da Antikörper gegen solche citrullinierten Proteine als hoch spezifische Biomarker für das Vorliegen einer RA identifiziert werden konnten, wird angenommen, dass Porphyromonas gingivalis eine Schlüsselrolle bei der Assoziation beider Erkrankungen spielen könnte. Folglich sollte im Rahmen der vorliegenden Arbeit die Mundgesundheitssituation, insbesondere der parodontale Zustand, von Patienten mit RA erfasst und einer gesunden Kontrollgruppe gegenübergestellt werden. Darüber hinaus sollten rheumatologische Krankheitsparameter erfasst werden, um qualitative Zusammenhänge mit parodontalen und mikrobiologischen Befunden zu detektieren. Insbesondere standen das subgingivale Keimspektrum (u.a. Porphyromonas gingivalis) sowie der citrullin-spezifische Blutparameter aCCP im Fokus der Betrachtung. Zu diesem Zwecke wurden Patienten mit RA und gesunde Probanden zahnärztlich untersucht. Hierbei wurden der zahnärztliche Befund (DMF-T), der Parodontalstatus mit Erfassung der Sondierungstiefe und Blutung auf Sondierung, dem Attachmentverlust sowie die gingivale Entzündung (PBI) erfasst. Zusätzlich erfolgte die Entnahme und mikrobiologische Untersuchung von Proben des subgingivalen Biofilms hinsichtlich elf ausgewählter (potenzieller) parodontalpathogener Bakterien. Aus den Krankenakten der RA-Patienten wurden spezifische Krankheitsparameter dokumentiert, z.B. Krankheitsdauer, Krankheitsaktivität und Rheumamedikation, sowie die Blutparameter Rheumafaktoren (RF) und Antikörper gegen citrullinierte Proteine (aCCP). Im Vergleich zur Kontrollgruppe wiesen die Patienten mit RA eine signifikant schlechtere Mundgesundheitssituation hinsichtlich der Anzahl fehlender Zähne und der parodontalen Situation auf: Es wurden erhöhte Sondierungstiefen, erhöhter klinischer Attachmentverlust und vermehrt schwere Formen der Parodontitis nachgewiesen. Die erste Arbeitshypothese (RA-Patienten leiden häufiger und unter schwereren Formen der Parodontitis, als die Teilnehmer der Kontrollgruppe) konnte somit bestätigt werden. Die Untersuchung des subgingivalen Biofilms hingegen zeigte bei beiden Gruppen ähnliche Prävalenzen der elf untersuchten parodontalpathogenen Bakterien. Innerhalb der RA-Gruppe konnte gezeigt werden, dass der Nachweis von aCCP im Serum tendenziell mit höheren subgingivalen Konzentrationen von Porphyromonas gingivalis und Fusobacterium nucleatum einherging. Eine statistische Signifikanz hierfür war jedoch nicht festzustellen. Darüber hinaus konnten die Faktoren Alter, PBI und Anwesenheit von Treponema denticola als unabhängige Einflussgrößen des parodontalen Zustandes identifiziert werden. Die zweite Arbeitshypothese (Innerhalb der RA-Gruppe ist ein Zusammenhang der Konzentration von Porphyromonas gingivalis im subgingivalen Biofilm mit dem Nachweis von Antikörpern gegen zyklische citrullinierte Proteine (aCCP) im Serum festzustellen) konnte nicht abschließend bestätigt werden. Die vorliegende Studie lässt folgende Schlussfolgerungen zu: • Die in der Literatur beschriebenen Zusammenhänge zwischen Parodontitis und RA konnten durch die vorliegende Studie bestätigt werden: Die RA-Patienten wiesen im Vergleich zur Kontrolle eine schlechtere Mundgesundheit auf (höhere Anzahl fehlender und zerstörter Zähne, häufiger (schwere Formen der) Parodontitis). • Die Vermutung, dass Porphyromonas gingivalis eine pathobiologische Verbindung zwischen beiden Erkrankungen darstellt, erscheint auf Grund der vorliegenden Ergebnisse weiterhin plausibel, konnte jedoch nicht abschließend nachgewiesen werden. • Zur Klärung der kausalen Zusammenhänge zwischen Parodontitis und RA bedarf es weiterer Studien. • Eine Verbesserung des Mundgesundheitszustandes von Patienten mit RA ist zwingend erforderlich. Mit einer meist unkomplizierten Parodontitistherapie kann die Entzündungslast, sowie die bakterielle Belastung u.a. mit Porphyromonas gingivalis deutlich reduziert werden, sodass verbesserte Voraussetzungen für eine medikamentöse Rheumatherapie geschaffen werden können. Patienten mit RA sollten daher routinemäßig einem parodontologisch tätigen Zahnarzt vorgestellt werden.:1 Einführung 1 1.1 Parodontitis - Ätiologie und Pathogenese 1 1.2 Parodontitis und Allgemeinerkrankungen - Zusammenhänge 3 1.3 Rheumatoide Arthritis (RA) 6 1.4 Assoziation von Parodontitis und rheumatoider Arthritis 9 1.5 Zielsetzung und Fragestellung der vorliegenden Studie 13 2 Publikationsmanuskript 14 3 Zusammenfassung der Arbeit 27 4 Ausblick 30 5 Literatur 34 6 Wissenschaftliche Präsentationen 42 7 Darstellung des eigenen Beitrags 43 8 Erklärung über die eigenständige Abfassung der Arbeit 45 9 Lebenslauf 46 10 Danksagung 47

Periodontal disease is an infectious and inflammatory disease with a high incidence in the global population and an extremely complex etiopathogenesis. Osteoporosis is one of the systemic diseases that can affect the integrity of periodontal tissues. Osteoporosis, as a skeletal disease, causes a reduction in bone mass and microarchitectural changes in the bone. Discussions about the connection between the two diseases affecting the bone began in 1960, but, contrary to the high number of studies, discoveries are still being made regarding the pathophysiological mechanisms that link the two diseases. The chapter proposes a systematized description of data on the influence of osteoporotic disease on the periodontal structures, therapeutic methods to address the patient with periodontal disease and osteoporosis and data on the potential influence of conventional and adjunctive periodontal treatment on systemic parameters in patients with osteoporosis.

Microbial agents including periodontal pathogens have recently appeared as important actors in Alzheimer’s disease (AD) pathology. We examined associations of clinical periodontal and bacterial parameters with incident all-cause and AD dementia as well as AD mortality among US middle-aged and older adults. Clinical [Attachment Loss (AL); probing pocket depth (PPD)] and bacterial [pathogen immunoglobulin G (IgG)] periodontal markers were investigated in relation to AD and all-cause dementia incidence and to AD mortality, using data from the third National Health and Nutrition Examination Surveys (NHANES III, 1988–1994) linked longitudinally with National Death Index and Medicare data through January 1, 2014, with up to 26 years of follow-up. Sex- and age-specific multivariable-adjusted Cox proportional hazards models were conducted. Among those ≥65 years, AD incidence and mortality were consistently associated with PPD, two factors and one cluster comprised of IgG titers against Porphyromonas gingivalis (P. gingivalis), Prevotella melaninogenica (P. melaninogenica) and Campylobacter rectus (C. rectus) among others. Specifically, AD incidence was linked to a composite of C. rectus and P. gingivalis titers (per SD, aHR = 1.22; 95% CI, 1.04–1.43, p = 0.012), while AD mortality risk was increased with another composite (per SD, aHR = 1.46; 95% CI, 1.09–1.96, p = 0.017) loading highly on IgG for P. gingivalis, Prevotella intermedia, Prevotella nigrescens, Fusobacterium nucleatum, C. rectus, Streptococcus intermedius, Capnocylophaga Ochracea, and P. melaninogenica. This study provides evidence for an association between periodontal pathogens and AD, which was stronger for older adults. Effectiveness of periodontal pathogen treatment on reducing sequelae of neurodegeneration should be tested in randomized controlled trials.

The periodontal ligament may be treated as a transversely-isotropic viscohyperelastic fibre-reinforced compressible material which is subject to large deformations and has an essentially nonlinear behavior. Within these assumptions, a continuum constitutive model of the PDL was proposed recently [48], which involves a number of material parameters that have to be identified from experimental data. An optical motion analysis system was developed [26] to collect data on the deformation of the PDL. In the present paper, an advanced version of the model is suggested, which is based on the assumption of the existence of an additive strain-energy function dependent on a number of principal invariants. The sensitivity analysis of the material parameters is performed and a parameter identification technique is suggested.

A periotome is a hand-held manual instrument that dentists use during tooth extraction. Using the sharp blade at the tool tip, dentists cut the periodontal ligaments that bonds the alveolar bone and the cementum surrounding the roots of teeth. Since this procedure usually requires dentists to repeatedly apply a certain level of force on the hand-held tool during the long-time procedure, it leads to dentists’ fatigue on their hands, inaccurate hand motion, and patients’ discomfort. Motorized periotomes can significantly improve the tooth extraction procedure by decreasing the force required from a dentist and reducing the procedure time. In this paper, we consider simple designs for motor-powered periotomes focusing on dynamic behaviors. Since the motor inside the tool creates motion and the hand-held tool moves as a result of dynamic response, the analysis requires detailed consideration of many factors such as tool mass, hand stiffness and damping. The motion of the tool tip should be monitored in this analysis to maximize the cutting performance. The analysis results will be used for choosing design options and parameters. This approach will be demonstrated using dynamic modeling and computer simulations.

Review question / Objective: The objective of our study is to evaluate whether periodontal treatment influences clinical outcomes and immunological conditions in HIV+ patients. (P) Participants: VIH+ patients. (I) Interventions: Surgical treatment, photodynamic therapy, antimicrobials, others. (C) Comparison: Non-surgical treatment. (O) Outcome measures: - Periodontal outcomes: plaque scores, bleeding on probing, periodontal pocket Depth, clinical attachment levels; - VIH outcomes: -Count CD4+; -Microbiological analysis. Condition being studied: Our study will analyze the effect of periodontal treatment in HIV+ patients and will evaluate changes in periodontal, immunological and microbiological parameters.