Leif Jansson

Relationship between apical and marginal healing in periradicular surgery.

OBJECTIVE The purpose of the present study was to evaluate the relationship between apical and marginal periodontal healing after periapical surgery. STUDY DESIGN The investigation was conducted on 59 patients referred for periradicular surgery. A radiographic examination as well as assessments of periodontal attachment and pocket depth of teeth undergoing surgery and control teeth were performed at the time of surgery and 1 year after surgery. The radiographic periapical healing pattern was evaluated. RESULTS After an observation time of 1 year, 85% of the healing patterns were classified as successful or uncertain. Teeth within the surgical area showed a significant loss of clinical attachment during the observation period. The mean clinical attachment loss in teeth with an unsuccessful healing was 0.85 mm and differed significantly from successfully healed cases (mean, 0.15 mm). CONCLUSIONS A persisting endodontic infection may be regarded as a contributing risk factor for a progressing marginal attachment loss.

Association between alcohol consumption and dental health

OBJECTIVES To study the association of alcohol consumption with dental health in a sample from the County of Stockholm. MATERIAL AND METHODS In a longitudinal investigation, 513 individuals were examined in 1970 and 1990. Clinical and radiographic examinations were performed as well as an interview including questions on alcohol consumption. The clinical investigation consisted of the registration of the number of remaining teeth, dental restorations, caries and periodontal conditions. The marginal bone level and longitudinal bone loss were determined by assessments on the proximal surfaces of all measurable teeth on the radiographs. Stepwise multiple regression analyses were adopted to calculate the partial correlations between alcohol consumption and the investigated odontological variables. RESULTS The group of subjects with the highest alcohol consumption (>5 cl pure alcohol per day) had more tooth surfaces with caries, more calculus and more teeth with apical lesions compared with those who reported an alcohol consumption </=5 cl of pure alcohol per day. Alcohol consumption was not associated with periodontal disease. CONCLUSION The observations do not support any association between alcohol consumption and periodontal disease. However, individuals with high alcohol consumption had significantly more teeth with decayed surfaces and apical lesions indicating that lifestyle-related factors may influence dental health.

Gene Expression Profiles in Paired Gingival Biopsies from Periodontitis-Affected and Healthy Tissues Revealed by Massively Parallel Sequencing

Periodontitis is a chronic inflammatory disease affecting the soft tissue and bone that surrounds the teeth. Despite extensive research, distinctive genes responsible for the disease have not been identified. The objective of this study was to elucidate transcriptome changes in periodontitis, by investigating gene expression profiles in gingival tissue obtained from periodontitis-affected and healthy gingiva from the same patient, using RNA-sequencing. Gingival biopsies were obtained from a disease-affected and a healthy site from each of 10 individuals diagnosed with periodontitis. Enrichment analysis performed among uniquely expressed genes for the periodontitis-affected and healthy tissues revealed several regulated pathways indicative of inflammation for the periodontitis-affected condition. Hierarchical clustering of the sequenced biopsies demonstrated clustering according to the degree of inflammation, as observed histologically in the biopsies, rather than clustering at the individual level. Among the top 50 upregulated genes in periodontitis-affected tissues, we investigated two genes which have not previously been demonstrated to be involved in periodontitis. These included interferon regulatory factor 4 and chemokine (C-C motif) ligand 18, which were also expressed at the protein level in gingival biopsies from patients with periodontitis. In conclusion, this study provides a first step towards a quantitative comprehensive insight into the transcriptome changes in periodontitis. We demonstrate for the first time site-specific local variation in gene expression profiles of periodontitis-affected and healthy tissues obtained from patients with periodontitis, using RNA-seq. Further, we have identified novel genes expressed in periodontitis tissues, which may constitute potential therapeutic targets for future treatment strategies of periodontitis.

Treatment Outcome in Patients With Peri-Implantitis in a Periodontal Clinic: A Retrospective Study

BACKGROUND The number of placed implants has grown during the past decade, and the prevalence of peri-implantitis has increased. The purpose of the present study is to investigate the treatment outcome of peri-implantitis and to identify factors influencing the treatment success rate. METHODS The study was conducted as a retrospective longitudinal study on a referral population. The material included 382 implants with peri-implantitis in 150 patients. Peri-implantitis was defined as presence of pocket depths ≥5 mm, bleeding at probing and/or suppuration, and the presence of implant radiographic bone loss ≥3 mm or bone loss comprising at least three threads of the implant. Variance analyses, χ(2) analyses, and logistic regression analysis were used for data analyses. RESULTS The mean age of the participants at baseline was found to be 64 years (range: 22 to 87 years). The mean ± SD follow-up time was 26 ± 20 months, and the mean time between implant installation and baseline was 6.4 years (range: 1 to 20 years). Periodontal flap surgery with osteoplasty was the most common type of therapy (47%), and regenerative surgery procedures with bone substitute materials were chosen in 20% of the cases. The mean success rate at patient level was 69%. The results of the logistic regression analyses showed that the success rate was significantly lower for individuals with the diagnosis of severe periodontitis, severe marginal bone loss around the implants, poor oral hygiene, and low compliance. CONCLUSION The effectiveness of the peri-implantitis therapy was impaired by severe periodontitis, severe marginal bone loss around the implants, poor oral hygiene, and low compliance.

Prevalence of Periodontitis in Patients with Established Rheumatoid Arthritis: A Swedish Population Based Case-Control Study

Introduction The possible hypothesis of a link between periodontitis and rheumatoid arthritis (RA), specifically anti-citrullinated protein antibody (ACPA) positive RA, prompted us to investigate the prevalence of periodontitis in the Swedish Epidemiological Investigation of RA (EIRA), a well-characterised population-based RA case-control cohort. Methods Periodontal status of 2,740 RA cases and 3,942 matched controls was retrieved through linking EIRA with the National Dental Health Registry (DHR), where dental diagnostic- and treatment codes on the adult Swedish population have been registered. Dental records from 100 cases and controls were reviewed to validate the periodontal diagnostic codes in DHR. Results The reviewed dental records confirmed 90% of the periodontitis diagnoses in DHR among RA cases, and 88% among controls. We found the positive predictive value of periodontitis diagnoses in the DHR to be 89% (95% CI 78 to 95%) with a sensitivity of 77% (95% CI: 65 to 86%). In total, 86% of EIRA participants were identified in DHR. The risk for periodontitis increased by age and current smoking status in both cases as well as controls. No significant differences in prevalence of periodontal disease in terms of gingivitis, periodontitis, peri-implantitis or increased risk for periodontitis or peri-implantitis were observed between RA cases and controls. In addition, there was no difference on the basis of seropositivity, ACPA or rheumatoid factor (RF), among patients with RA. Conclusions Our data verify that smoking and ageing are risk factors for periodontitis, both in RA and controls. We found no evidence of an increased prevalence of periodontitis in patients with established RA compared to healthy controls, and no differences based on ACPA or RF status among RA subjects.

Progression rate of approximal carious lesions in Swedish teenagers and the correlation between caries experience and radiographic behavior. An analysis of the survival rate of approximal caries lesions

The objectives were to study the progression rate of approximal caries in 14 to 19-year-old adolescents and to assess the influence of experience of previous caries as a predictor of caries progression during the following years. The study population comprised 100 adolescents, all 19 years old, randomly selected. In all, there were 93 adolescents included in the study, for whom all sets of bitewing radiographs from 14 up to and including the age of 19 were assessed with respect to approximal caries. It could be noted that 32% of the adolescents had had at least one bitewing examination every year from 14 to 19 years of age. At the age of 14, 38% of the males and 24% of the females were radiographically without any sign of caries lesions (caries-free). The median survival time of initial caries in the present study was >5 years, while for manifest caries it was 3.2 years. It was found that 37% of the surfaces with manifest caries in males and 18% of the corresponding surfaces in females were restored within a year. The results show that experience of previous caries does not seem to be a significant indicator and does not influence when the next radiographic examination should be performed. It is thus concluded that individualized bitewing examination is the exception rather than the rule.The objectives were to study the progression rate of approximal caries in 14 to 19-year-old adolescents and to assess the influence of experience of previous caries as a predictor of caries progression during the following years. The study population comprised 100 adolescents, all 19 years old, randomly selected. In all, there were 93 adolescents included in the study, for whom all sets of bitewing radiographs from 14 up to and including the age of 19 were assessed with respect to approximal caries. It could be noted that 32% of the adolescents had had at least one bitewing examination every year from 14 to 19 years of age. At the age of 14, 38% of the males and 24% of the females were radiographically without any sign of caries lesions (caries-free). The median survival time of initial caries in the present study was >5 years, while for manifest caries it was 3.2 years. It was found that 37% of the surfaces with manifest caries in males and 18% of the corresponding surfaces in females were restored within a year. The results show that experience of previous caries does not seem to be a significant indicator and does not influence when the next radiographic examination should be performed. It is thus concluded that individualized bitewing examination is the exception rather than the rule.

Inhibition of microsomal prostaglandin E synthase-1 by aminothiazoles decreases prostaglandin E2 synthesis in vitro and ameliorates experimental periodontitis in vivo

The potent inflammatory mediator prostaglandin E2 (PGE2) is implicated in the pathogenesis of several chronic inflammatory conditions, including periodontitis. The inducible enzyme microsomal prostaglandin E synthase‐1 (mPGES‐1), catalyzing the terminal step of PGE2 biosynthesis, is an attractive target for selective PGE2 inhibition. To identify mPGES‐1 inhibitors, we investigated the effect of aminothiazoles on inflammation‐induced PGE2 synthesis in vitro, using human gingival fibroblasts stimulated with the cytokine IL‐1β and a cell‐free mPGES‐1 activity assay, as well as on inflammation‐induced bone resorption in vivo, using ligature‐induced experimental periodontitis in Sprague‐Dawley rats. Aminothiazoles 4‐([4‐(2‐naphthyl)‐1,3‐thiazol‐2‐yl]amino)phenol (TH‐848) and 4‐(3‐fluoro‐4‐methoxyphenyl)‐N‐(4‐phenoxyphenyl)‐1,3‐thiazol‐2‐amine (TH‐644) reduced IL‐1β‐induced PGE2 production in fibroblasts (IC50 1.1 and 1.5 μM, respectively) as well as recombinant mPGES‐1 activity, without affecting activity or expression of the upstream enzyme cyclooxygenase‐2. In ligature‐induced experimental periodontitis, alveolar bone loss, assessed by X‐ray imaging, was reduced by 46% by local treatment with TH‐848, compared to vehicle, without any systemic effects on PGE2, 6‐keto PGF1α, LTB4 or cytokine levels. In summary, these results demonstrate that the aminothiazoles represent novel mPGES‐1 inhibitors for inhibition of PGE2 production and reduction of bone resorption in experimental periodontitis, and may be used as potential anti‐inflammatory drugs for treatment of chronic inflammatory diseases, including periodontitis.—Kats, A., Båge, T., Georgsson, P., Jönsson, J., Quezada, H. C., Gustafsson, A., Jansson, L., Lindberg, C., Näsström, K., Yucel‐Lindberg, T. Inhibition of microsomal prostaglandin E synthase‐1 by aminothiazoles decreases prostaglandin E2 synthesis in vitro and ameliorates experimental periodontitis in vivo. FASEB J. 27, 2328–2341 (2013). www.fasebj.org

Relationship between apical periodontitis and marginal bone loss at individual level from a general population

AIM To study the relationship between the presence of apical periodontitis in root-filled teeth and marginal bone loss (MBL) in individual subjects from a general population. MATERIALS AND METHODS The study was conducted on a sample of 1,152 dentate individuals (participants in an epdemiological investigation) who were subjected to clinical and radiographic investigations. The presence of root fillings and apical periodontitis were registered. MBL was measured mesially and distally at all roots. The MBL index of the subject was defined as the mean MBL value at all measurable points in the same individual. Multiple regression analysis was adopted to calculate the influence of the presence of apical periodontitis and potential confounders on the dependent variable, MBL index. RESULTS There was a significant correlation between MBL and the percentage of root-filled teeth and the percentage of root-filled teeth with apical periodontitis. The results of the multiple regression analysis showed that the relative frequency of root-filled teeth with apical periodontitis was significantly higher in subjects with more MBL, irrespective of age, number of remaining teeth, relative frequency of root-filled teeth and smoking habits. CONCLUSIONS A significant association between the presence of apical and marginal periodontitis in individual subjects was found. The mechanisms behind the associations between these diseases are unknown and this cross-sectional observational study did not permit distinction between cause and effect. It is hoped that future cohort studies may provide more knowledge about the biological actions behind the relationship between apical and marginal disease.

Patient satisfaction 8–14 years after dental implant therapy – a questionnaire study

Abstract Objective: The aim of this questionnaire study was to investigate patient satisfaction 8–14 years after dental implant therapy and complications influencing the degree of satisfaction. Materials and methods: A questionnaire was sent by post to 587 patients at a specialist clinic of periodontology. The questionnaire consisted of 19 statements or questions such as the degree of satisfaction with the implants and knowledge of complications. In nine of the questions, respondents were asked to grade the extent of their agreement with a statement by selecting from fixed answers. Three of the questions were designed to be answered using a visual analog scale. Results: In total, 400 individuals (81%) responded to the questionnaire. The mean time elapsed since implant installation was 10 years. A great majority (81%) experienced a high chewing comfort and was satisfied or sufficiently satisfied (94%) with the aesthetic aspects of their implant restorations, while 32% of the individuals had experienced problems with their implant reconstructions. The disadvantage that patients remarked on was the cost of the treatment. Those who had experienced problems with their implant reconstructions were also less satisfied with the treatment. Conclusion: A great majority of the patients expressed a high degree of satisfaction with their dental implants 8–14 years after the treatment. Patients were less satisfied if they had experience of problems with their implant reconstructions and in cases when the clinicians were unable to resolve their complications.

Mucin 4 and matrix metalloproteinase 7 as novel salivary biomarkers for periodontitis.

Abstract Aim Periodontitis is a chronic inflammatory disease, characterized by irreversible destruction of tooth‐supporting tissue including alveolar bone. We recently reported mucin 4 (MUC4) and matrix metalloproteinase 7 (MMP7) as highly associated with periodontitis in gingival tissue biopsies. The aim of this study was to further investigate the levels of MUC4 and MMP7 in saliva and gingival crevicular fluid (GCF) samples of patients with periodontitis. Materials and Methods Saliva and GCF samples were collected from periodontitis patients and healthy controls. The levels of MUC4, MMP7, and total protein concentrations were analysed using ELISA or Bradford assay. Results MUC4 levels were significantly lower in saliva and GCF from periodontitis patients relative to healthy controls. MMP7 levels were significantly higher in saliva and GCF from periodontitis patients. Multivariate analysis revealed that MUC4 was significantly associated with periodontitis after adjusting for age and smoking habits and, moreover, that the combination of MUC4 and MMP7 accurately discriminated periodontitis from healthy controls. Conclusions MUC4 and MMP7 may be utilized as possible novel biomarkers for periodontitis.