MMP-13 and TIMP-1 determinations in progressive chronic periodontitis

Matrix metalloproteinase (MMP)-13 is a collagenase involved in extracellular matrix degradation either by its direct degradative effects or by processing bioactive substrates. The aim of this study was to determine the levels of MMP-13 and tissue inhibitor of metalloproteinase (TIMP)-1 in gingival crevicular fluid (GCF) and gingival biopsies obtained from active and inactive sites during chronic periodontitis progression. MATERIALS AND METHODS: This was a longitudinal study in which chronic periodontitis patients with moderate to severe disease were included and followed until they developed progression determined by the tolerance method. GCF samples were obtained from periodontitis, active, inactive and healthy sites and additional gingival biopsies were taken from active and inactive sites. MMP-13 and TIMP-1 determinations were carried out by immunodot blots and immunowestern blots. RESULTS: In progressive periodontitis, MMP-13 and TIMP-1 remained unchanged between active and inactive sites, but as the TIMP-1 relative levels increased together with MMP-13 elevation in inactive samples, an inverse correlation was observed in active sites. Besides, MMP-13 was undetectable in healthy controls. CONCLUSION: Chronic periodontitis is characterized by increased MMP-13 expression. During disease progression, active sites tended to decrease TIMP-1 levels in association with MMP-13 elevation.     

Juvenile and rapidly progressive periodontitis

Juvenile and rapidly progressive periodontitis are grouped under the heading of early-onset periodontitis. In recent years, much attention has been devoted to studying immunologic factors in early-onset periodontitis. This study was designed to investigate peripheral blood lymphocyte subpopulations, natural killer cells and interleukin-2 receptor positive (IL-2R +) cells in patients with juvenile and rapidly progressive periodontitis. 38 patients with juvenile and 30 patients with rapidly progressive periodontitis, plus 30 normal healthy control subjects were included in the study. Peripheral blood T-lymphocytes, helper T-cells, suppressor T-cells, HLA-DR+ cells, and IL-2R + cells were determined using appropriate monoclonal antibodies and the indirect immunofluorescence method. B-lymphocytes were identified using the direct immunofluorescence technique. Both groups of patients had normal number of total CD3+ T-cells, CD4+ helper T-cells, CD8+ suppressor T-cells, HLA-DR+ cells and IL-2R+ cells. Natural killer cells were found to be significantly elevated in both groups. These findings could contribute to the immunopathogenesis of early-onset periodontitis.     

Herpesviral-bacterial interactions in aggressive periodontitis

BACKGROUND: Human cytomegalovirus, Epstein-Barr virus and herpesvirus co-infections occur with significantly higher frequency in actively progressing than in stable periodontitis sites of adolescents and young adults. Also, periodontal presence of cytomegalovirus and Epstein-Barr virus is associated with increased occurrence of subgingival Porphyromonas gingivalis, Bacteroides forsythus, Dialister pneumosintes, Prevotella intermedia, Prevotella nigrescens, Treponema denticola and Actinobacillus actinomycetemcomitans. AIM: This article reviews the evidence linking herpesviruses to the development of aggressive periodontitis and suggests a potential mechanism for herpesviral acceleration of the periodontal disease process. CONCLUSIONS: It seems to be a reasonable supposition that the etiopathogenesis of various types of aggressive periodontitis includes the combined action of herpesviruses and specific bacterial species. New vaccines and vaccination technologies that are being developed against herpesviruses warrant testing for their ability to induce a protective immune response against destructive periodontal disease. Clearly, the importance of combined herpesviral-bacterial infections and associated host responses in the development of periodontitis needs to be studied further.     

Peripheral T lymphocyte subsets in rapidly progressive periodontitis

The peripheral blood lymphocyte subsets of 10 patients with rapidly progressive periodontitis were investigated with monoclonal antibody. In 4 patients, the T helper/T suppressor ratio was increased. 5 others had a slightly reduced T helper/T suppressor ratio as compared to control group. These findings may indicate a possible cellular immune response in the pathogenesis of rapidly progressive periodontitis.     

Porphyromonas gingivalis-epithelial cell interactions in periodontitis

Emerging data on the consequences of the interactions between invasive oral bacteria and host cells have provided new insights into the pathogenesis of periodontal disease. Indeed, modulation of the mucosal epithelial barrier by pathogenic bacteria appears to be a critical step in the initiation and progression of periodontal disease. Periodontopathogens such as Porphyromonas gingivalis have developed different strategies to perturb the structural and functional integrity of the gingival epithelium. P. gingivalis adheres to, invades, and replicates within human epithelial cells. Adhesion of P. gingivalis to host cells is multimodal and involves the interaction of bacterial cell-surface adhesins with receptors expressed on the surfaces of epithelial cells. Internalization of P. gingivalis within host cells is rapid and requires both bacterial contact-dependent components and host-induced signaling pathways. P. gingivalis also subverts host responses to bacterial challenges by inactivating immune cells and molecules and by activating host processes leading to tissue destruction. The adaptive ability of these pathogens that allows them to survive within host cells and degrade periodontal tissue constituents may contribute to the initiation and progression of periodontitis. In this paper, we review current knowledge on the molecular cross-talk between P. gingivalis and gingival epithelial cells in the development of periodontitis.     

Radiographic alveolar bone morphology and progressive periodontitis

1 Background

This study evaluated the relationship between radiographic crestal alveolar bone morphology and progressive periodontitis.

2 Methods

A total of 1,356 posterior interproximal sites in 56 adults treated for chronic periodontitis and receiving systematic 3‐month maintenance care were scored for angular or horizontal marginal bone morphology, as well as for alveolar crestal lamina dura, on radiographs obtained at baseline of a 30‐month post‐treatment period. Semi‐annually, the study patients were clinically evaluated for progressive periodontitis. Logistic regression analysis assessed baseline parameters to progressive periodontitis over the 30‐month post‐treatment period.

3 Results

Progressive periodontitis was detected at 33 (2.4%) posterior interproximal sites in 20 (35.7%) patients. Sites with post‐treatment angular bony defects developed progressive periodontitis more frequently (14.7%) than sites with a horizontal bone topography (1.8%). Angular bony defects (odds ratio = 10.6) and periodontal probing depths ≥5 mm (odds ratio = 4.2) were identified as statistically significant independent predictors of progressive periodontitis at posterior interproximal sites. Angular bony and horizontal lesions with intact radiographic lamina dura revealed an absence of progressive periodontitis through 24 months.

4 Conclusions

Post‐treatment presence of angular bone morphology and periodontal probing depths ≥5 mm significantly increased risk of progressive periodontitis at posterior interproximal sites. Sites of all morphology and probing depth that displayed radiographic crestal lamina dura at post‐treatment baseline exhibited clinical stability for ≥24 months.     

Immunohistological and morphometric analysis of inflammatory cells in rapidly progressive periodontitis and adult periodontitis

The purpose of this study was to localize, characterize, and quantify in situ the inflammatory cells in the gingival connective tissue prior and subsequent to the initial therapy of ten patients with rapidly progressive periodontitis (RPP) and five patients with adult periodontitis (AP). Using immunohistological techniques, the amount of T lymphocytes, alphabeta-T lymphocytes, gammadelta-T lymphocytes, B lymphocytes, and plasma cells was determined at the beginning of the periodontal therapy (baseline) and at the time of periodontal surgery. Furthermore, the distribution of collagen types I, III, V, and VI was investigated using transmission electron microscopy. At baseline, patients with RPP revealed much higher numbers of inflammatory cells than patients with AP. During initial therapy of patients with RPP, the amount of T cells, alphabeta-T cells, and gammadelta-T cells was reduced significantly (P<0.05). Biopsies of patients with AP revealed a statistically significant reduction of all cell types, except alphabeta-T cells and gammadelta-T cells in the deep connective tissue. The transmission electron microscopy of biopsies from patients with RPP and AP with severe inflammation taken at baseline revealed that collagen types I and III were destroyed nearly completely in areas with leukocyte infiltration, whereas collagen types V and VI revealed a more pronounced labeling reaction. The results revealed that, during initial therapy, the amount of inflammatory cells was reduced significantly more in biopsies of patients with AP than in patients with RPP. At baseline, the inflamed gingival tissue consists mainly of collagen types V and VI in areas with infiltrates of inflammatory cells.     

Vascular expansion in chronic periodontitis

Animal studies have demonstrated expansion and remodelling of gingival blood vessels in inflamed gingival tissues. However, there is a paucity of information, regarding the vascular response in human gingivitis and periodontitis. In this study, gingival biopsies were obtained from 51 separate patients. Fifteen minimally inflamed, 16 gingivitis and 20 periodontitis specimens were studied. Gingival biopsies were divided into five fields, and a quantitative survey of vascular changes was performed. In fields adjacent to the bacterial plaque irritant, vessel profiles were increased in number with the development of the advanced periodontal lesion. The diameter of blood vessels throughout the entire thickness of gingival biopsies was found to increase with advancing periodontal disease. It is concluded that considerable remodelling of the gingival vasculature occurs in chronic periodontitis, and that this may contribute to the tissue destruction seen in this disease.     

Psychosocial factors and adult onset rapidly progressive periodontitis

Abstract On the basis of clinical observations, some periodontologists have suggested an association between psychosocial factors such as depression, stress and anxiety, and adult onset rapidly progressive periodontitis (RPP). This study investigated more formally possible associations between a number of relevant psychosocial factors and RPP The significance of the psychosocial variables was assessed by comparing 3 groups: 50 patients with RPP, 50 patients with routine chronic adult periodontitis (RCAP). and 50 patients without significant periodontal destruction (controls). It was anticipated that the RPP group would show higher levels of psychosocial maladjustment than the RCAP and control groups. A between-subjects multivariate analysis of covariance indicated that the combined psychosocial variables were significantly related to the periodontal diagnosis. 2 psychosocial factors, depression and loneliness, were significant in distinguishing between groups. The RPP group presented significantly increased depression and loneliness compared to the RCAP and control groups. Future research is indicated to further clarify the significance of these psychosocial differences in relation to the onset and progression of RPP.     

Rapidly progressive periodontitis. Report of a case

A nineteen year old white female was referred for an evaluation of severe, rapidly progressive periodontitis. Although the patient was physically healthy and did not demonstrate any remarkable abnormalities in routine laboratory tests or upon physical examination, a detailed immune profile elucidated abnormal findings. Additionally, the patient demonstrated a poor healing response after tooth removal and a continued loss of bone following insertion of dentures.     

快速进展性牙周炎患者外周血单核细胞趋化功能的研究

目的 研究快速进展性牙周炎患者的外周血单核细胞趋化功能是否异常。方法 采用微孔波膜法对10例快速进展性牙周炎患者的外周血单核细胞趋化功能进行测定。结果 发现快速进展性牙周炎患者的外周血单核细胞趋化功能与正常对照者无差异。结论 部分快速进展性牙周炎可能与单核细胞趋化功能缺陷无关。     

Treatment considerations in rapidly progressive periodontitis: a case report

This article presents a concept for the control of periodontal pathogens in early-onset periodontitis and demonstrates the reparative potential of periodontal tissue when the infection is under control. The patient discussed here was diagnosed with rapidly progressive periodontitis. We were able to reduce the bacterial mass with scaling and root planing and, in conjunction with systemic antibiotics, return the microbial profile to the normal range. Microbiological testing was used to monitor the microbiota and to adjust antimicrobial treatment. Improvements in probing depths and attachment levels were monitored for more than 1 year. Tissue response to this treatment made surgical intervention unnecessary. Although not essential, orthodontic treatment enhanced cleansability and improved esthetics.