Multilocus Sequence Typing of Non-JP2 Serotype b Aggregatibacter actinomycetemcomitans Strains of Ghanaian and Swedish Origin

Objective and MethodsThe Gram-negative bacterium, Aggregatibacter actinomycetemcomitans is associated with periodontitis affecting young individuals. The geographic dissemination of the highly leukotoxic JP2 genotype of serotype b of this species was previously studied by multilocus sequence typing (MLST). Here, we have used MLST to genetically characterize non-JP2 genotype strains of serotype b, isolated from individuals living in Ghana (n=41), and in Sweden (n=13), respectively.ResultsThe MLST analysis revealed a total of nine sequence types (ST). Both Ghanaian and Swedish isolates were distributed in ST 1-3. ST 5 and 6 were only identified among the Ghanaian strains, whereas ST 4, 7, 8 and 9 were uniquely represented among the Swedish strains. Previously, we characterized these non-JP2 genotype strains of A. actinomycetemcomitans serotype b by arbitrarily-primed (AP)-PCR, which distributed them into three groups, AP-PCR type 1, 2, and 3, respectively. AP-PCR type 1 strains are generally highly leukotoxic, and are associated with progression of periodontal attachment loss. As AP-PCR type 1 includes both JP2 genotype strains and a proportion of non-JP2 genotype strains of serotype b, a straightforward diagnostic procedure has been sought. This has revealed a gene, cagE, which appears to be conserved only in this AP-PCR type. According to our results, MLST was not a highly discriminatory method to identify AP-PCR type 1, as strains of this AP-PCR type could be found within three different ST: ST 2, ST 3 and ST 8.ConclusionAccording to MLST, a geographic dissemination of non-JP2 genotype A. actinomycetemcomitans serotype b appears to exist. However, aiming to identify carriers of AP-PCR type 1, non-JP2 genotype serotype b, PCR with cagE-specific primers is likely the most efficient diagnostic procedure known today.

Impact of Periodontal Attachment Loss on the Outcome of Endodontic Microsurgery: A Systematic Review and Meta-Analysis

Background and Objectives: Endodontic microsurgery (EMS) aims to eradicate the sources of infection once the apical root resection removes most of the infected anatomical structures and repairs potential procedural errors in the apical region. An endodontic-periodontal lesion yields a pathological communication between the pulp and the periodontium. The purpose of this systematic review and meta-analysis is to evaluate the impact of periodontal attachment loss on the outcome of teeth submitted to EMS. Materials and Methods: PRISMA guidelines were followed. An electronic search was performed in EBSCOhost, Embase and PubMed databases with the following search key: (“endodontic microsurgery” AND “outcome”). No filters were used concerning the year of publication or language. Only randomized clinical trials, prospective and retrospective clinical studies in humans, with a minimum one-year follow-up, defined clinical and radiographic outcome criteria and estimable success rate for endodontic-periodontal lesion were included. Statistical analysis was performed using OpenMeta[Analyst] software. Results: Of a total of 113 articles, 34 were selected for full-text reading after duplicates deletion and title and abstract analysis. Thirteen and six studies were included in the systematic review and meta-analysis, respectively. A total of 2775 pooled teeth were submitted to EMS, of which 492 teeth and 4 roots had periodontal involvement. According to the qualitative analysis, success rates of the endodontic-periodontal group ranged from 67.6% to 88.2%. Meta-analysis revealed that the absence of periodontal attachment loss was predictive of a higher likelihood of success with an odds ratio of 3.14. Conclusions: Periodontal attachment loss presents a risk factor for EMS outcome. Although endodontic-periodontal lesions were associated with lower success rates considering a 1 to 10 years follow-up period, long-term successful prognosis following EMS has been reported, therefore presenting a fully valid and viable therapeutic option for the management of this type of lesions.

Intentıonal reımplantatıon of hopeless teeth: Cases serıes

Intentional replantation is an alternative for the treatment of advanced periodontal destruction of the anterior teeth. Systemically healthy three female patient was referred to our clinic with functional complaints. Diagnosis were chronic periodontitis and class III mobility was noted at the mandibular incisors with complete periodontal attachment loss. After phase I periodontal treatment periodontally involved teeth were extracted, endodontic treatment accomplished, the teeth were replanted and fixed to its place with fiber reinforced composite splint. At the end of 2 years tooth was in function with alveolar bone gain. Intentional replantation provided long-term maintenance of patient’s own teeth.

Effect of Periodontal Serial Therapy Combined with Orthodontics on Periodontal Parameters in Patients with Periodontitis

Objective: To investigate the clinical efficacy of periodontal sequence in combination with orthodontic treatment of patients with periodontitis. Methods: Retrospective analysis of periodontitis patients (54 cases) treated at our hospital between February 2018 and June 2019. The clinical data of all the enrolled participants were subjected to periodontal serial combined orthodontic treatment, and all the registered participants were observed at the initial consultation, periodontal serial treatment1 Periodontal parameters at the end of months and at the end of orthodontic treatment, serial periodontal treatment and orthodontic treatment for all enrolled individuals, x-rays and Oral examinations were performed, and the results were analyzed. Results: Compared to the initial visit, all enrolled individuals had a higher plaque index (PLI) after 1 month of periodontal treatment and at the end of orthodontic treatment. Bleeding index (BI), periodontal probe depth (PD), and periodontal attachment loss (CAL) levels were all lower than those detected at the initial visit. The difference was statistically significant (P < 0.05); after serial periodontal treatment and orthodontic treatment, the x-ray results showed that the patients' Alveolar bone resorption or regeneration ceased; The results of the oral examination showed that the patient's occlusal relationship improved significantly and basically returned to normal. Status, a masticatory function was significantly improved, and individual tooth loosening due to occlusal trauma was improved considerably. Conclusion: The combination of periodontal sequence and orthodontic treatment of patients with periodontitis is beneficial to enhance periodontal parameters, improve occlusal relationships, and improve masticatory function.

Diagnostic informativeness of laboratory control of the severity of inflammatory and osteodestructive processes in periodontium

Aim. To offer a set of laboratory tests and to assess its informativeness in characterizing the severity of inflammatory and osteodestructive processes in periodontium. Methods. At the first stage of the study, two groups were formed: the study group (clinical, n=95) and the control group (relatively healthy individuals, n=31). Further, depending on the clinical situation, the clinical group was divided into subgroups. Subgroup 1 (n=40) included patients with catarrhal and ulcerative gingivitis, subgroup 2 (n=32) with mild chronic generalized periodontitis and subgroup 3 (n=33) with moderate chronic generalized periodontitis. In patients gingival fluid or in the contents of periodontal pockets, the concentration of tumor necrosis factor-, osteotropic mediators (soluble receptor activator of nuclear factor-B ligand and osteoprotegerin) were determined by the immunoassay method. Results. In patients with chronic generalized periodontitis, as well as with increase of severity of periodontal lesions, in the gingival fluid the concentration of tumor necrosis factor- and soluble receptor activator of nuclear factor-B ligand increases and the content of osteoprotegerin decreases. The change in the concentration of osteotropic mediators in the fluid from periodontal pockets occurred prior to osteolysis in the periodontium. The widest range of statistically significant correlations with periodontal indices was established for the concentration of tumor necrosis factor- in the contents of the gingival sulcus with the depth of periodontal pockets (R=0.79; р 0.0001) and periodontal attachment loss (R=0.83; р 0.0001), as well as for soluble receptor activator of nuclear factor-B ligand with the depth of periodontal pockets (R=0.75; р 0.0001) and periodontal attachment loss (R=0.87; р 0.0001). Conclusion. In patients with mild chronic generalized periodontitis, a decrease in the concentration of osteoprotegerin (p 0.05) and increase in the content of soluble receptor activator of nuclear factor-B ligand (р 0.05) in the gingival fluid relative to the norm requires active radiological monitoring of bone resorption.

Genetic Profiling of Aggregatibacter actinomycetemcomitans Serotype B Isolated from Periodontitis Patients Living in Sweden

The bacterium Aggregatibacter actinomycetemcomitans is associated with aggressive forms of periodontitis and with systemic diseases, such as endocarditis. By assessing a Ghanaian longitudinal adolescent cohort, we earlier recognized the cagE gene as a possible diagnostic marker for a subgroup of JP2 and non-JP2 genotype serotype b A. actinomycetemcomitans strains, associated with high leukotoxicity as determined in a semi-quantitative cell assay. This group of A. actinomycetemcomitans is associated with the progression of attachment loss. In the present work, we used conventional polymerase chain reaction (PCR) and quantitative PCR to perform the cagE genotyping of our collection of 116 selected serotype b A. actinomycetemcomitans strains, collected over a period of 15 years from periodontitis patients living in Sweden. The A. actinomycetemcomitans strains carrying cagE (referred to as cagE+; n = 49) were compared to the cagE-negative strains (n = 67), present at larger proportions in the subgingival plaque samples, and were also much more prevalent in the young (≤35 years) compared to in the old (>35 years) group of patients. Our present results underline the potential use of cagE genotyping in the risk assessment of the development of periodontal attachment loss in Swedish adolescents.

Assessment of Alcohol Consumption as A Potential Risk Factor on Periodontal Attachment Loss: A Longitudinal Study

In this modern society of ours alcohol has become a tradition and this relationship is deeply rooted. Apart from other health risk issues, its use has also emerged as a possible risk factor for periodontitis in reported recent reviews. Numerous prospective studies are already reported in literature but lack of such longitudinal studies to review the association of alcohol consumption on periodontal health status of the patients are rare. The aim of this study was to assess the relationship of alcohol consumption as a potential risk factor on periodontal attachment loss. It is a population-based cohort study conducted for a period of 4 years. A total of 1385 individuals were included in the study and only 730 individuals were left for the follow up after 4 years. Alcohol consumption and clinical examination for clinical attachment loss was recorded for each patient. Majority of subjects belonging to age group 35-44yrs, 45-54 yrs and 55-64 yrs showed high frequency intake of alcohol. Overall when measured, alcohol consumption and CAL progression was found to be significantly higher in males as compared to females. The subjects who were high and chronic drinkers, had 40% higher risk for CAL progression than non-drinkers. We concluded a positive linear relationship of alcohol consumption and periodontal attachment loss with more pronounced effect on males as compared to females. Thus alcohol proves to be a potential risk factor in progression of periodontitis in both high and chronic alcohol dosage.