Proteinase bone morphogenetic protein 1, but not tolloid‐like 1, plays a dominant role in maintaining periodontal homeostasis

Abstract

Background

Periodontitis is caused by multiple factors involving a bacterial challenge and a susceptible host, although there is no report on gene mutation directly linked to this common disease. Mutations in the proteinase bone morphogenetic protein 1 (BMP1) were identified in patients with osteogenesis imperfecta, who display some dentin defects and alveolar bone loss. We previously reported essential roles of BMP1 and tolloid‐like 1 (TLL1), two closely related extracellular proteinases with overlapping functions, in mouse periodontium growth by simultaneous knockout (KO) of both genes, although the separate roles of BMP1 and TLL1 have remained unclear. Here, we have investigated whether and how BMP1 and TLL1 separately maintain periodontal homeostasis by comparing single Bmp1 KO and Tll1 KO with double KO (dKO) phenotypes.

Methods

Floxed Bmp1 and/or Tll1 alleles were deleted in transgenic mice via ubiquitously expressed Cre^ERT2 induced by tamoxifen treatment starting at 4‐weeks of age (harvested at 18‐weeks of age). Multiple approaches, including X‐ray, micro‐CT, calcein and alizarin red double‐labeling, scanning electron microscopy, and histological and immunostaining assays, were used to analyze periodontal phenotypes and molecular mechanisms.

Results

Both Bmp1 KO and double KO mice exhibited severe periodontal defects, characterized by periodontal ligament (PDL) fiber loss and ectopic ossification in the expanded PDL area, and drastic reductions in alveolar bone and cementum volumes, whereas Tll1 KO mice displayed very mild phenotypes. Mechanistic studies revealed a sharp increase in the uncleaved precursor of type I collagen (procollagen I), leading to defective extracellular matrices.

Conclusions

BMP1, but not TLL1, is essential for maintaining periodontal homeostasis. This occurs at least partly via biosynthetic processing of procollagen I, thereby maintaining appropriate levels of procollagen I and its activated products such as mature collagen I.

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https://aap.onlinelibrary.wiley.com/doi/abs/10.1002/JPER.20-0354?af=R

On the value of the 2017 classification of phenotype and gingival recessions

Abstract

The 2017 World Workshop completely restructured knowledge in periodontology with a series of official consensus statements jointly agreed upon by the American Academy of Periodontology and the European Federation of Periodontology. Among them, the 2017 classification of phenotype and gingival recession successfully incorporated the most relevant previous classifications into a treatment‐oriented diagnostic matrix. Despite the significant advantages related with the implementation of this new classification of gingival recessions, recent articles still report data based on previous outdated systems. Therefore, the present commentary aimed to dive into the key advantages of the 2017 classification of phenotype and gingival recession, and to stress why it should be fully integrated into research and practice settings.

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https://onlinelibrary.wiley.com/doi/abs/10.1002/JPER.20-0487?af=R

Independent impact of periodontitis and cardiovascular disease on elevated soluble urokinase‐type plasminogen activator receptor (suPAR) levels

Abstract

Background

Previous studies have demonstrated that a soluble urokinase‐type plasminogen activator receptor (suPAR) plays an essential function in leukocytes and endothelial homeostasis and, therefore, in the development of coronary heart disease (CHD) and periodontitis. The aim of this study was to analyze the impact of gingival health, periodontitis, and CHD on suPAR levels in plasma and saliva and to evaluate suPAR as a biomarker of periodontitis and CHD.

Methods

Healthy controls (n = 33), patients with periodontitis (n = 31), CHD (n = 29), and a combination of periodontitis + CHD (n = 29) were enrolled in the present study. All patients were clinically and periodontally evaluated and regularly assessed for socioeconomic status, serum lipids, high‐sensitivity C‐reactive protein (hs‐CRP), and for plasma and salivary suPAR levels.

Results

Patients with periodontitis (P <.001) and with periodontitis + CHD (P <.001) presented higher median plasma and salivary suPAR levels compared with CHD and healthy controls. Moreover, univariate regression analysis demonstrated that hs‐CRP (P <.001) and periodontitis (P <.001) had a significant negative direct effect on both plasma and salivary suPAR levels. The multivariate regression analysis showed that periodontitis was the only significant predictor of plasma suPAR (P = .035) while hs‐CRP was the only significant predictor of salivary suPAR (P <.001).

Conclusions

The results of the present study demonstrated that patients with periodontitis and periodontitis + CHD presented higher suPAR levels in both plasma and saliva in comparison with healthy controls and CHD. Moreover, periodontitis and hs‐CRP were the only significant predictors of the augmented suPAR levels in plasma and saliva, respectively.

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https://onlinelibrary.wiley.com/doi/abs/10.1002/JPER.20-0242?af=R

Interproximal attachment gain: The challenge of periodontal regeneration

Abstract

The new classification of periodontal diseases recognizes the key role of the interdental clinical attachment for defining the periodontal status and the extent of disease severity. Regenerating interdental clinical attachment not only improves the prognosis of the tooth, but it also lessens the severity of the disease condition. This manuscript provides a state‐of‐the‐art review on surgical reconstructive approaches for treating papillary deficiency associated with soft and hard tissue interproximal defects. Combination therapy of papilla preservation, connective tissue grafting and coronally advanced flaps may result in regeneration of the intrabony defect coupled with root coverage. Future research highlighted in this review may have the potential especially in combination approaches to repair challenging interproximal soft and hard tissue deficiencies.

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https://onlinelibrary.wiley.com/doi/abs/10.1002/JPER.20-0587?af=R

Quantile regression to estimate the survivor average causal effect (SACE) of periodontal treatment effects on birthweight and gestational age

Abstract

Background

Survival average causal effect (SACE) can give valid estimates of the periodontal treatment effect on birth outcomes in randomized controlled trials when fetal losses are unequal across the treatment arms. A regression‐based method to estimate SACE using ordinary least squares (OLS) regression can be biased if the treatment effect varies across the outcome distribution. In this case quantile regression may be a suitable alternative.

Methods

We compared OLS and quantile regression models estimating SACE to calculate the effect of periodontal treatment on birthweight and gestational age in secondary analyses of publicly available Obstetrics and Periodontal Therapy (OPT) trial data.

Results

Periodontal treatment tended to increase birthweight and gestational age at the lowest quantiles, remained flat in the middle quantiles, and trended to decrease both birthweight and gestational age in the highest quantiles. In quantile regression models estimating SACE the β‐coefficients: 95% confidence intervals (CI) for the 5th, 50th, and 95th percentiles were 277.5:  −141.0 to 696.0 g, 1.4: −107 to 110.3 g, and −84: −344 to 175.3 g for birthweight, and 0.6: −1.0 to 2.2 weeks, −0.1: −0.5 to 0.2 weeks, and −0.6: −1.0 to −0.1 weeks for gestational age. Estimates from OLS models estimating SACE were close to the null, β: 95% CI −4.7: 132.3 to 123.0 g for birthweight, and 0.03: −0.72 to 0.78 weeks for gestational age.

Conclusions

OLS models to evaluate SACE for periodontal treatment effects on birthweight and gestational age may be biased towards the null. Quantile regression may be a preferable alternative.

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https://onlinelibrary.wiley.com/doi/abs/10.1002/JPER.20-0376?af=R

Evaluation of the need to prescribe opioid medication to control post‐surgical pain of different periodontal/oral surgeries

Abstract

Background

To determine the level of perceived pain after different types of periodontal/oral surgical procedures, and the differences in patients’ selection of pain management, over the counter (OTC) versus opioid, based on procedure type.

Methods

Patients undergoing surgical procedures were asked to complete a pain questionnaire at four time points: 1) before surgery 2) first dose of analgesic at home, 3) 24 hours postoperatively, and 4) 72 hours postoperatively. The questionnaire consisted of numerical and descriptive scales to describe the perceived pain.

Results

A total of 198 patients completed the questionnaire. All surgical procedures were grouped into five major categories: bone augmentation procedures (11% BAP), teeth extractions (26% EXT), surgical implant placement (25% IP), mucogingival surgeries (21% MGS), and pocket elimination procedures (17%). IP surgery was associated with significantly less pain compared with MGS and EXT (P <0.05). There was a statistically significant difference for taking any medication based on type of surgical procedure at 24 hours (P <0.05).

Conclusions

IP is associated with significantly lower perceived pain compared with EXT and MGS surgery. Analgesic consumption was generally parallel to pain perception. A considerable number of patients elected to control the post‐surgical pain using OTC medication up to 72 hours. Periodontal/oral surgery procedures vary in the amount of perceived postoperative pain. Tailoring postoperative medications to the type of periodontal/oral surgery performed will help prevent overprescribing of opioids.

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https://onlinelibrary.wiley.com/doi/abs/10.1002/JPER.20-0315?af=R

Clinical evaluation of impact of periodontal phenotype on the outcome of open flap debridement in patients with chronic periodontitis: A comparative interventional study

Abstract

Background

A number of studies have implicated the role of periodontal phenotype (PP) in the outcome of various periodontal interventions. However investigations have not been performed to estimate such impact on the outcome of open flap debridement (OFD) for the management of chronic periodontitis.

Methods

73 individuals with chronic periodontitis underwent scaling and root planing (SRP). 8 weeks following SRP, modified Widman flap (MWF) surgery was performed in 40 patients (20 of either PP) presenting with probing depth (PD) ≥4 mm and gingival index (GI) ≥1 at ≥4 sites distributed over ≥2 anterior teeth with radiographic evidence of horizontal bone loss. PD, clinical attachment level (CAL), gingival recession, plaque index, GI and bleeding on probing (BOP) were recorded at baseline, 3 and 6 months. PP was assessed using transparency of periodontal probe through the gingival margin at midfacial level.

Results

34 patients were re‐evaluated after intervention. All periodontal parameters improved in both groups after periodontal surgery. PD & PP were found to have positive correlation with CAL gain in ≥7 mm probing sites. Attachment gain of >2 mm was observed in more percentage of sites in thick PP than in thin PP.

Conclusion

PP can be an important factor influencing CAL gain in OFD.

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https://onlinelibrary.wiley.com/doi/abs/10.1002/JPER.19-0668?af=R