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    Evaluation of Clinical Periodontal Indices and Serum Interleukin-27 by One-stage Full-mouth Disinfection and Quadrant Scaling and Root Planing in Periodontitis. Babaloo Amirreza,Rahbar Mahdi,Babaloo Zohre,Ghasemi Shima,Amini Amjad The journal of contemporary dental practice INTRODUCTION:One-stage oral disinfection technique has been developed to prevent cross-contamination between the treated and untreated areas between treatment sessions. Considering the role of inflammatory mediators in periodontitis, this study has been designed to compare the effects of one-stage oral disinfection with quadrant scaling and root planing (Q-SRP) on serum interleukin-27 (IL-27) levels in patients with moderate-to-advanced periodontitis. MATERIALS AND METHODS:In this study, two groups were considered. One group was treated with one-stage full-mouth oral disinfection (FMD), while the other group was treated with Q-SRP. In each group, 20 patients with chronic periodontitis were randomly selected based on the inclusion criteria. To evaluate the periodontal status, the clinical parameters of bleeding on probing (BOP), clinical attachment level (CAL), and probing depth (PD) were measured before treatment as well as at 2- and 4-month intervals after treatment. At the same intervals, the immunological index of the study (serum IL-27) was measured by special laboratory kits. The data were analyzed using the Statistical Package for the Social Sciences, version 16 (SPSS 16) software. In this study, p-value < 0.05 was considered statistically significant. RESULTS:The results of this study indicate that there has been an elevation in the mean of serum IL-27 after treatment in both treatment groups. There is no significant difference between the levels of IL-27 in the FMD group during the study period (p = 0.20). All periodontal indices (BOP, CAL, and PD) show clinical improvement in each group (p < 0.001). However, no significant difference was observed in the improvement of periodontal indices of CAL and PD (p < 0.05). CONCLUSION:According to the findings of this study, it can be said that both FMD and Q-SRP improve the periodontal indices and increase the serum level of the inflammatory mediator IL-27 in patients with periodontitis. CLINICAL SIGNIFICANCE:Considering the benefits of the FMD method, such as patient and dentist comfort, systemic effects, and its cost-effectiveness, use of this method is suggested in patients suffering from periodontitis.
    Severe periodontitis enhances macrophage activation via increased serum lipopolysaccharide. Pussinen Pirkko J,Vilkuna-Rautiainen Tiina,Alfthan Georg,Palosuo Timo,Jauhiainen Matti,Sundvall Jouko,Vesanen Marja,Mattila Kimmo,Asikainen Sirkka Arteriosclerosis, thrombosis, and vascular biology OBJECTIVE:In periodontitis, overgrowth of Gram-negative bacteria and access of lipopolysaccharide (LPS) to circulation may activate macrophages leading to foam cell formation. We investigated whether periodontal treatment affects proatherogenic properties of low-density lipoprotein (LDL) and, thus, macrophage activation. METHODS AND RESULTS:LDL was isolated and characterized before and after treatment from 30 systemically healthy patients with periodontitis. Production of cytokines and LDL cholesteryl ester (LDL-CE) uptake by macrophages (RAW 264.7) was determined. Baseline periodontal variables correlated positively with serum LPS and C-reactive protein concentrations, as well as macrophage cytokine production and LDL-CE uptake. LPS concentration correlated positively with serum concentration of oxidized LDL and cytokine production. Higher cytokine production and LDL-CE uptake were induced by LDL isolated from patients with elevated number of affected teeth before treatment. Patients with serum LPS concentrations above the median (0.87 ng/mL) at baseline had higher serum high-density lipoprotein (HDL) cholesterol (baseline versus after treatment, 1.30+/-0.19 versus 1.48+/-0.28 mmol/L; P=0.002) and HDL/LDL ratio (0.31+/-0.01 versus 0.34+/-0.10; P=0.048), but lower serum LPS concentration (1.70+/-0.49 versus 0.98+/-0.50 ng/mL; P=0.004) and autoantibodies to beta2-glycoprotein I (0.11+/-0.06 versus 0.09+/-0.04 ELISA units; P=0.022) after treatment. CONCLUSIONS:Our results suggest that in systemically healthy patients, the infected/inflamed area in periodontitis is associated with macrophage activation via increased serum LPS concentration. 10.1161/01.ATV.0000145979.82184.9f
    Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. Tonetti Maurizio S,Greenwell Henry,Kornman Kenneth S Journal of periodontology BACKGROUND:Authors were assigned the task to develop case definitions for periodontitis in the context of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. The aim of this manuscript is to review evidence and rationale for a revision of the current classification, to provide a framework for case definition that fully implicates state-of-the-art knowledge and can be adapted as new evidence emerges, and to suggest a case definition system that can be implemented in clinical practice, research and epidemiologic surveillance. METHODS:Evidence gathered in four commissioned reviews was analyzed and interpreted with special emphasis to changes with regards to the understanding available prior to the 1999 classification. Authors analyzed case definition systems employed for a variety of chronic diseases and identified key criteria for a classification/case definition of periodontitis. RESULTS:The manuscript discusses the merits of a periodontitis case definition system based on Staging and Grading and proposes a case definition framework. Stage I to IV of periodontitis is defined based on severity (primarily periodontal breakdown with reference to root length and periodontitis-associated tooth loss), complexity of management (pocket depth, infrabony defects, furcation involvement, tooth hypermobility, masticatory dysfunction) and additionally described as extent (localized or generalized). Grade of periodontitis is estimated with direct or indirect evidence of progression rate in three categories: slow, moderate and rapid progression (Grade A-C). Risk factor analysis is used as grade modifier. CONCLUSIONS:The paper describes a simple matrix based on stage and grade to appropriately define periodontitis in an individual patient. The proposed case definition extends beyond description based on severity to include characterization of biological features of the disease and represents a first step towards adoption of precision medicine concepts to the management of periodontitis. It also provides the necessary framework for introduction of biomarkers in diagnosis and prognosis. 10.1002/JPER.18-0006