Journal of Clinical Periodontology最新文献

Aim

To evaluate treatment outcomes following implantoplasty or the use of rotating titanium brushes in the surgical therapy of peri-implantitis.

Materials and Methods

Thirty patients with peri-implantitis in need of surgical treatment were enrolled in a 12-month randomised clinical trial with a non-inferiority set-up. Surface decontamination was performed using either titanium brushes (test group) or implantoplasty (control group). Clinical and radiographic parameters as well as patient-reported outcomes (Oral Health Impact Profile-14; OHIP-14) were evaluated.

Results

At 12 months, the composite outcome was achieved in 6/15 implants in the test group and in 4/15 in the control group. Probing pocket depth (PPD) values decreased by 3.6 ± 1.5 mm (test) and 3.3 ± 1.2 mm (control), demonstrating non-inferiority of the test procedure. Additional bone loss was observed in the control group (0.7 ± 1.2 mm), while bone levels remained unchanged in the test group (0.0 ± 0.6 mm). Baseline PPD (p = 0.044) and the presence of an adjacent implant affected by peri-implantitis (p = 0.033) were relevant factors for pocket closure (PPD ≤ 5 mm at 12 months). Time for surface decontamination was significantly less in the test (3 min 1 s) when compared to the control group (5 min 27 s) (p = 0.006). OHIP-14 scores were statistically indifferent.

Conclusion

Both groups showed favourable outcomes, demonstrating non-inferiority of titanium brushes to implantoplasty.

Trial Registration: The trial was registered with the Clinical Research Information Service of the National Research Institute of Health (South Korea), no. KCT007900. (https://cris.nih.go.kr/cris/search/detailSearch.do?seq=23346&search_page=L)

Aim

To test the hypothesis that a volume-stable collagen matrix (VCMX) can serve as an effective rhBMP-2 carrier for bone regeneration while compensating for the volume instability of absorbable collagen sponge (ACS).

Materials and Methods

(i) rhBMP-2 release kinetics from VCMX and ACS were measured over 7 days by enzyme-linked immunosorbent assay. (ii) Bilateral sinus augmentations were performed in 15 rabbits using either VCMX or ACS, with or without rhBMP-2. After 4 weeks, radiographic and histological analyses were conducted.

Results

The overall release patterns between VCMX and ACS did not differ significantly, although VCMX showed a delayed peak release (at 3 h) compared to ACS (at 10 min). Three-dimensional radiographic analysis showed greater volumetric gains in VCMX groups than in ACS groups, regardless of rhBMP-2 loading. Histologically, VCMX/rhBMP-2 group exhibited the largest total augmented area (13.1 ± 2.9 mm²). The use of rhBMP-2 led to significant increases in new bone area for both VCMX (3.9 ± 1.1 vs. 1.6 ± 1.3 mm², p = 0.003) and ACS (1.8 ± 0.8 vs. 1.0 ± 0.6 mm², p = 0.035). Notably, the proportion of new bone in the total augmented region was comparable between the VCMX/rhBMP-2 and ACS/rhBMP-2 groups (p > 0.05).

Conclusion

rhBMP-2-loaded VCMX enhances bone regeneration in sinus augmentation, suggesting that its volume maintenance may contribute to the improved clinical and radiographic outcomes.

Aim

To investigate whether exhaled carbon monoxide (CO) is dose-dependently associated with subgingival polymicrobial clusters before and after non-surgical periodontal therapy.

Material and Methods

We followed 163 adults with periodontitis, measuring CO before and at 2, 14 and 26 months after therapy. Subgingival plaque samples were analysed using 16S rRNA gene sequencing. We applied topic models and regression analysis, adjusted for age, sex, treatment group, pocket probing depth and plaque levels.

Results

Smokers had generally higher mean CO levels at every visit and showed significant declines at 14 and 26 months after therapy (p < 0.01). Before therapy, CO was not associated with dysbiosis; after therapy, higher levels were positively associated. In sensitivity analyses, self-reported smoking status explained more variance in dysbiosis than CO alone, with only marginal gains when both were combined. Among smokers, a distinct polymicrobial cluster dominated by Fusobacterium and Prevotella increased with higher exhaled CO. Every 10 parts per million increase in CO was associated with an estimated 16% increase in cluster abundance (95% confidence interval: 8%–26%).

Conclusion

Exhaled CO may help monitor persistent dysbiosis and select an anaerobe-dominated subgingival community after periodontal therapy among smokers.

Aim

To determine (i) the parameters used by dental professionals to evaluate patients with periodontitis, (ii) the prevalence of periodontitis using different case definitions and (iii) associations between periodontitis and diabetes mellitus, cardiovascular disease and rheumatoid arthritis among adult patients in private practices in Denmark.

Materials and Methods

This nationwide descriptive study used data collected from private practices using the DentalSuite electronic dental record system between 2000 and 2022. Patients 18 years or older with a Danish social security number were included in the study. Prevalences of periodontitis were calculated using periodontal registrations and different case definitions for periodontitis. Registrations of selected comorbidities along with periodontitis, namely diabetes mellitus, cardiovascular diseases and rheumatoid arthritis, were also collected.

Results

A total of 1,473,428 individuals were included in the study, of whom 782,464 (53%) were females. About 302,604 (20.5%) patients complied with the periodontal probing depth ≥ 5 mm PD case definition. Furthermore, 130,688 (8.9%) patients had periodontal parameters that fulfilled the more specific 2018 AAP/EFP classification. Periodontal probing depth registrations were available for 24% of the patients. Patients identified with periodontitis had higher prevalences of the selected comorbidities compared to the population as a whole.

Conclusions

In private practices in Denmark, probing pocket depth was the most frequently registered periodontal parameter used for screening and monitoring periodontitis. The selected comorbidities appeared to be more prevalent in patients with periodontitis.

Aim

This secondary analysis of a cross-sectional study tested the hypothesis that a salivary biomarker panel (i.e., consisting of 2–6 features) could accurately identify periodontitis in persons with Type 2 diabetes (T2DM) compared with non-periodontitis in systemically healthy persons.

Materials and Methods

Salivary concentrations of 12 protein biomarkers and 14 oral microbiome species were evaluated by immunoassays and 16S rRNA sequencing, respectively, from 28 systemically healthy non-periodontitis adults and 28 T2DM patients with periodontitis. Data were analysed for the identification of periodontitis from non-periodontitis using 5-fold cross-validation logistic regression, receiver operating characteristics (ROC) and odds ratios.

Results

Bacteria showed better predictive value than individual salivary proteins. Two bacteria (Porphyromonas gingivalis and Mycoplasma faucium) yielded specificities > 90%, Prevotella species yielded high sensitivity (86%) and Treponema socranskii demonstrated the top area under the curve (AUC) (0.81). A salivary panel consisting of bacteria (Selenomonas sputigena, P. gingivalis, Prevotella nigrescens, Pr. dentalis) and protein ratios (prostaglandin E2/tissue inhibitor of metalloproteinase-1 or macrophage inflammatory protein-1α/tissue inhibitor of metalloproteinase-1) produced robust diagnostic accuracy (95%) and precision (96.6%) for the detection of periodontitis in T2DM.

Conclusions

A salivary panel using bacteria and ratios of host-response biomarkers accurately identified periodontitis in T2DM compared with systemically healthy persons without periodontitis.

Aim

To analyse gene expression profiles in human tissue samples obtained from dental implant sites with or without peri-implantitis.

Materials and Methods

Soft-tissue biopsy samples obtained from patients presenting with implants with severe peri-implantitis and adjacent reference implants with no signs of peri-implantitis were analysed by spatial transcriptomics (n = 4), RNA-sequencing (n = 20) and immunohistochemistry (n = 38).

Results

The analysis disclosed evident associations between distinct gene clusters and specific tissue compartments in both groups of specimens. Samples from peri-implantitis sites showed higher levels of gene activity than samples from reference implant sites. Gene-set enrichment analysis revealed that several important biological pathways, for example, ‘regulation of antimicrobial host response’, ‘collagen fibril organisation’ and ‘regulation of angiogenesis’, were severely dysregulated in peri-implantitis lesions when compared to reference implant sites. Similarly, immunohistochemical evaluation showed elevated levels of proteins corresponding to the most up-regulated, differentially expressed genes (DEGs), which were identified by spatial transcriptomics and RNA-sequencing.

Conclusions

Peri-implant lesions demonstrated associations between gene clusters and specific tissue compartments. Several biological pathways linked to the activation of host response towards bacterial insults were dysregulated in peri-implantitis specimens when compared to reference implant samples.

Aim

To investigate whether periodontitis in parents is associated with differences in the faecal microbiome and systemic markers in both themselves and their children.

Methods

Eighty participants were divided into four groups (n = 20): parents with periodontitis (PP); healthy parents (PC); and their respective children (CP, CC). Clinical periodontal parameters were recorded. Saliva and faecal bacterial DNA were analysed via 16S rRNA sequencing. Salivary lactoferrin, faecal calprotectin, gingival crevicular fluid cytokines (IFN-γ, IL-10, IL-17, IL-1β, IL-4, TNF-α) and urinary intestinal permeability markers (claudin-2, -3, -4, haptoglobin) were quantified.

Results

Parents with periodontitis showed distinct faecal microbiota profiles, which were mirrored in their children and significantly differed from controls. Claudin-2 levels were elevated in both PP and CP groups (p < 0.05) and positively correlated with the oral dysbiosis index and the faecal Firmicutes/Bacteroidetes ratio.

Conclusions

Parental periodontal health appears to influence the faecal microbiome and systemic markers in the offspring. These findings highlight a potential pathway for oral–gut microbial transmission and its relevance to systemic health, warranting further investigation.

Aim

To investigate the cellular composition and molecular mechanisms of periodontal granulation tissue formation using single-cell RNA sequencing (scRNA-seq), aiming to enhance the understanding of periodontal disease pathogenesis and identify potential targets for regenerative therapies.

Materials and Methods

Granulation tissue samples were collected from patients undergoing periodontal surgery (n = 3). Fresh tissues were processed into single-cell suspensions and subjected to scRNA-seq. The data were integrated and compared with existing datasets from healthy gingiva and periodontal ligament. Computational analyses were performed and validated through immunofluorescence staining.

Results

Ten distinct cell clusters were identified across the samples. Granulation tissue exhibited a higher abundance of immune cells compared to healthy tissues. A novel endothelial cell subpopulation, exclusive to granulation tissue, was discovered and characterised by NOTCH3 expression and involvement in ossification pathways. Additionally, granulation tissue fibroblast subpopulations demonstrated a progenitor-like state, characterised by extracellular matrix reorganisation and low differentiation, similar to cancer-associated fibroblasts.

Conclusion

This study identified a novel endothelial subpopulation offering new insights into the disease's pathogenesis and presenting potential targets for regenerative therapies. These findings will help advance the understanding of periodontal disease granulation tissue formation and provide information for the development of materials to modulate specific cellular pathways to improve periodontal disease management.

Aim

The objectives of this study were to gain a comprehensive understanding of patients' barriers to adherence to periodontal treatment and to derive intervention functions for a digital companion to support them through their therapy journey.

Materials and Methods

A qualitative study incorporating patient and expert interviews was designed. Data were analysed using thematic analysis. Barriers to therapy adherence and functions for a digital intervention were synthesised with the help of the Capability, Opportunity and Motivation behaviour change model.

Results

Barriers related to periodontal therapy are a lack of awareness of the patients' own responsibility and prioritisation of individual oral health, lack of time to both instruct as well as learn and perform better oral hygiene and lack of knowledge about disease characteristics and ideal habits. Participants expected that a digital intervention should incorporate personalised and comprehensive educational material, possibilities to visually document progress, simple descriptions of oral hygiene tasks, reminders and the inclusion of prompts for self-reflection.

Conclusion

While a digital health companion has the potential to address the aforementioned barriers, future research should also aim to develop strategies to focus on health systems barriers (e.g., financing and workforce arrangements) as these can influence patient engagement and adherence.

Aim

To evaluate the subgingival proteome and microbiome of mothers with periodontitis and their offspring, thereby assessing signatures of periodontal diseases.

Methods

Forty participants in four groups were included: mothers with periodontitis and their offspring, as well as periodontally healthy mothers and their offspring. Periodontal clinical parameters were assessed. Gingival crevicular fluid (GCF) and subgingival biofilm were collected from the same sites. Proteome from GCF was investigated by liquid chromatography-tandem mass spectrometry with data-independent acquisition (DIA-PASEF). Bacterial DNA from subgingival biofilms was sequenced using the 16S rRNA gene for taxonomy assignment.

Results

Overall, 6147 bacterial and human proteins (≥ 2 peptides) were quantified. Despite the absence of attachment loss, the offspring of mothers with periodontitis presented with similar proteotypes as their mothers, characterised by up-regulation of inflammatory response cascades and down-regulation of epithelial barrier proteins. They also displayed higher colonisation patterns by periodontopathogens while presenting with increased expression of bacterial virulence proteins compared with controls.

Conclusion

The study showed that the maternal periodontal microbiome and proteome associate with those of the offspring and relate to maternal periodontal status. These early ecological events may potentially promote offspring's susceptibility to dysbiosis and may predispose them to periodontitis.