Sex‐specific genetic factors affect the risk of early‐onset periodontitis in Europeans

Aims: Various studies have reported that young European women are more likely to develop early-onset periodontitis compared to men. A potential explanation for the observed variations in sex and age of disease onset is the natural genetic variation within the autosomal genomes. We hypothesized that genotype-by-sex (G × S) interactions contribute to the increased prevalence and severity. Materials and methods: Using the case-only design, we tested for differences in genetic effects between men and women in 896 North-West European early-onset cases, using imputed genotypes from the OmniExpress genotyping array. Population-representative 6823 controls were used to verify that the interacting variables G and S were uncorrelated in the general population. Results: In total, 20 loci indicated G × S associations (P < 0.0005), 3 of which were previously suggested as risk genes for periodontitis (ABLIM2, CDH13, and NELL1). We also found independent G × S interactions of the related gene paralogs MACROD1/FLRT1 (chr11) and MACROD2/FLRT3 (chr20). G × S-associated SNPs at CPEB4, CDH13, MACROD1, and MECOM were genome-wide-associated with heel bone mineral density (CPEB4, MECOM), waist-to-hip ratio (CPEB4, MACROD1), and blood pressure (CPEB4, CDH13). Conclusions: Our results indicate that natural genetic variation affects the different heritability of periodontitis among sexes and suggest genes that contribute to inter-sex phenotypic variation in early-onset periodontitis

Epigenetic adaptations of the masticatory mucosa to periodontal inflammation

Background: In mucosal barrier interfaces, flexible responses of gene expression to long-term environmental changes allow adaptation and fine-tuning for the balance of host defense and uncontrolled not-resolving inflammation. Epigenetic modifications of the chromatin confer plasticity to the genetic information and give insight into how tissues use the genetic information to adapt to environmental factors. The oral mucosa is particularly exposed to environmental stressors such as a variable microbiota. Likewise, persistent oral inflammation is the most important intrinsic risk factor for the oral inflammatory disease periodontitis and has strong potential to alter DNA-methylation patterns. The aim of the current study was to identify epigenetic changes of the oral masticatory mucosa in response to long-term inflammation that resulted in periodontitis. Methods and results: Genome-wide CpG methylation of both inflamed and clinically uninflamed solid gingival tissue biopsies of 60 periodontitis cases was analyzed using the Infinium MethylationEPIC BeadChip. We validated and performed cell-type deconvolution for infiltrated immune cells using the EpiDish algorithm. Effect sizes of DMPs in gingival epithelial and fibroblast cells were estimated and adjusted for confounding factors using our recently developed “intercept-method”. In the current EWAS, we identified various genes that showed significantly different methylation between periodontitis-inflamed and uninflamed oral mucosa in periodontitis patients. The strongest differences were observed for genes with roles in wound healing (ROBO2, PTP4A3), cell adhesion (LPXN) and innate immune response (CCL26, DNAJC1, BPI). Enrichment analyses implied a role of epigenetic changes for vesicle trafficking gene sets. Conclusions: Our results imply specific adaptations of the oral mucosa to a persistent inflammatory environment that involve wound repair, barrier integrity, and innate immune defense

Pneumocephalus as result of nonsurgical peri‐implantitis treatment with an air‐polishing device for submucosal debridement : a case report

Background: A subcutaneous emphysema is an infrequent but potentially life‐ threatening complication after dental treatment involving instruments functioning with pressurized air. Emphysemata after the use of high‐speed handpieces and air‐ syringes are well documented, however, more recently several reports on emphysemata produced by air‐polishing devices during management of peri‐ implant biological complications have appeared. To the best of our knowledge, direct development of pneumocephalus after a dental procedure has never been reported before. Introduction of air likely contaminated with oral bacteria to the intracranial space bares the risk of developing meningitis. Case Presentation: This case report describes the spreading of a subcutaneous emphysema into the intracranial space (i.e., development of a pneumocephalus) after treatment of a peri‐implantitis lesion with an air‐polishing device equipped with the nozzle for submucosal debridement. A subcutaneous emphysema was noticed during the use of an air‐polishing device and the subsequent computed tomogra- phy (CT) examination revealed a quite unexpected spreading of the emphysema into the intracranial space. The patient was admitted to the hospital for close surveillance, CT follow‐up, and intravenous antibiotics to prevent the development of meningitis due to the introduction of air—likely contaminated with oral bacteria— into the intracranial space. After 3 days, the patient was discharged in good condition without any further complications. Conclusion: In case of an extensive subcutaneous emphysema as result of a dental procedure, a more extended radiographic examination including the mediastinal and cranial space should be considered, to assess the risk for potentially life‐threatening complications

Can hyaluronan injections augment deficient papillae at implant-supported crowns in the anterior maxilla? A randomized controlled clinical trial with 6 months follow-up

OBJECTIVES: The present randomized controlled trial aimed to assess the effect of hyaluronan (HY) injections to augment deficient interproximal papillae at implant-supported crowns in the anterior maxilla. METHODS: Twenty-two patients with a deficient papilla in the anterior maxilla next to an implant-supported crown were randomly assigned to receive twice either HY (test) or saline solution (control) injection. The following parameters were recorded prior to injection (baseline) and 3 and 6 months after injection: distance between the papilla tip and contact point (PT-CP), modified papilla index score (MPIS), and standard clinical periodontal parameters. Pain level after injection was recorded on a visual analogue scale (VAS). The deficient area was evaluated on clinical photographs, and the esthetic appearance was recorded on a VAS. Differences in mucosal volume were assessed after 3 months by intraoral scans. The bone level was assessed on periapical radiographs. RESULTS: No differences were observed between groups, neither at baseline nor at 3 and 6 months post-treatment. Mean PT-CP ranged between 1.8 mm and 2.3 mm without significant differences between groups or over time within groups; MPIS was 2 for all patients at all time points. Similarly, insignificant differences between groups or time points were observed for deficient area, gingival volume changes, bone level, and esthetic appearance. There were no differences in pain level between groups during injection, but discomfort after injection lasted longer in the test group. CONCLUSIONS: Injection of HY adjacent to maxillary anterior implant-supported crowns did not result in any clinical conspicuous volume augmentation of deficient papillae

Adverse reaction after hyaluronan injection for minimally invasive papilla volume augmentation : A report on two cases

Objectives: To report two cases of adverse reaction after mucosal hyaluronan (HY) injection around implant-supported crowns, with the aim to augment the missing interdental papilla. Material and Methods: Two patients with single, non-neighbouring, implants in the anterior maxilla, who were treated within the frames of a randomized controlled clinical trial testing the effectiveness of HY gel injection to reconstruct missing papilla volume at single implants, presented an adverse reaction. Injection of HY was performed bilaterally using a 3-step technique: (i) creation of a reservoir in the mucosa directly above the mucogingival junction, (ii) injection into the attached gingiva/mucosa below the missing papilla, and (iii) injection 2–3 mm apically to the papilla tip. The whole-injection session was repeated once after approximately 4 weeks. Results: Both patients presented with swelling and extreme tenderness with a burning sensation on the lip next to the injection area, after the second injection session. In one of the cases, a net- like skin discoloration (livedo reticularis) was also noted. The symptoms lasted for up to 7 days, and in both cases, symptoms resolved without any signs of skin or mucosal necrosis or any permanent damage. Conclusion: Most likely, water attraction over time by the highly hygroscopic HY, exerted progressively an external vascular compression and at least partial occlusion of neighbouring blood vessels. An infection or an allergic reaction seems unlikely, since all symptoms gradually disappeared within a week irrespective use of antimicrobials, while an allergic reaction most likely would not have been restricted to one side

Hyaluronan vid parodontal behandling

Hyaluronan (HY) har på grund av sina egenskaper (bakteriostatiska, antiin ammatoriska et cetera) nyligen introducerats för användning i parodon- tal terapi. Denna litteraturgenomgång bygger del- vis på en nyligen publicerad systematisk översikt, och har kompletterats med gingivitstudier och de senast publicerade vetenskapliga arbetena med HY inom parodontitbehandling. Artikeln ger en sammanfattning av de terapeutiska möjligheterna med HY-applikation som monoterapi eller som ett tillägg till behandling av gingivit och parodontit. Vid sökning i tre litteraturdatabaser fann vi 18 kontrollerade studier. I majoriteten av dessa stu- dier beskrivs för HY-testgruppen jämfört med kontrollgruppen ● en statistiskt signi kant förbättring i gingivalin- dex för gingivitpatienter ● en statistiskt signi kant minskning i blödning vid sondering och fickdjup vid icke-kirurgisk parodontal behandling ( gur I), dock i måttligt kliniskt relevant utsträckning. Att erhålla någon ytterligare vinst i klinisk fästenivå av HY-applikation vid parodontal kirurgi verkar inte troligt. Till dags dato saknas rapporter av oönskade bi- verkningar av HY-applikation. På grund av den avsevärda heterogeniteten i studierna (avseende produkter, metoder för applicering, dos och applikationstid) går det inte att dra någon tydlig slutsats om administration och e ektstorlek av HY vid behandling av gingivit eller parodontit

Hyaluronan Injections Are Ineffective to Reconstruct Missing Papilla Volume at Single Implants in the Anterior Maxilla : an RCT with 6 M Follow-Up

Background: There is an increasing demand from patients for highly esthetic outcomes of implant restorations. Open gingival embrasures – also called ‘black triangles’ – may occur after tooth replacement with an implant due to loss of interproximal papilla volume. Black triangles are perceived as unaesthetic by most patients, especially when these are located in the maxillary anterior region. In a case series, Becker et al. (2010) described promising results with a simple, minimally invasive, non-surgical technique for augmenting the interproximal gingival papilla volume and thus reducing the black triangles; the technique involved hyaluronan (HY) injection in the deficient papilla. HY is an important component of the extracellular matrix and responsible for tissue resilience and volume. HY is used in dermatology as injectable dermal filler for wrinkle reduction. So far, no controlled clinical study on the potential of HY injection to augment the volume of the interproximal papilla is available. Aim/Hypothesis: The present randomized controlled clinical trial aimed to assess the effect of HY injection into the interproximal mucosal tissue to reconstruct missing papilla volume next to a single implant restoration in the anterior maxilla. Material and Methods: Patients with a deficient papilla next to an implant in the anterior maxilla were randomly assigned to receive twice an injection of HY (test group) or saline solution (control group). The following parameters were recorded prior to- (baseline) and 3, and 6 months after injection: modified papilla index score, distance between the papilla tip and contact point, and standard clinical periodontal parameters. The deficient area (i.e. black triangle) was evaluated on pictures and aesthetic appearance and pain level were recorded on a visual analogue scale. Mucosal volume changes were assessed after 3 months by intraoral scans and differences in the bone level before/after treatment were radiographically assessed after 6 months. A sample size calculation based on the data from Becker et al. with a significance level alpha of 0.05 and a power of 0.8 resulted in a sample size of 16 patients; due to a possible dropout rate (i.e. 20%), 20 patients per group were planned. Due to normal distribution the independent t-test was used for comparisons between control and test group and the dependent t-test for comparisons between baseline and 3 and 6 months data. Differences at baseline between the groups regarding gender, gingival phenotype, and tissue texture and color distribution were tested with Fisher's exact test. Results: Due to a preliminary analysis of 10 patients, which showed no difference between the groups and specifically no change of the modified papilla index score, the patient recruitment was stopped after 22 patients (11/group). Except for bleeding on probing, no significant differences between groups or over time within groups were observed for any of the clinical parameters; bleeding on probing was at baseline significantly lower in the test compared to the control group. Modified papilla index score was 2 for all patients at all time-points. Mean distance between the papilla tip and contact point ranged between 1.8 and 2.3 mm without significant differences between groups or over time within groups. Similarly, insignificant differences between groups were detected regarding the deficient area, gingival volume changes, bone level, aesthetic appearance and pain level during injection; only discomfort within the first week after injection lasted significantly longer in the test group (P = 0.03). Conclusions and clinical implications: The present randomized controlled clinical trial showed that HY injection into deficient interproximal papillae tissue between a tooth and an implant in the upper anterior did not have any relevant effect in terms of reconstructing the missing papilla volume

The impact of a “successfully treated stable periodontitis patient status” on patient‐related outcome parameters during long‐term supportive periodontal care

Aim: To assess the importance of achieving a successfully treated stable periodontitis patient status (PPS) during long-term supportive periodontal care (SPC). Methods: This retrospective cohort study included 100 periodontitis patients, who continued for ≥ 7.5 years after active periodontal treatment with SPC and were judged as overall adherent. The effect of various predictors on 3 patient-related outcome parameters was assessed: number of 1) diseased teeth at last SPC, 2) teeth lost due to periodontitis, and 3) teeth lost due to any reason. Results: One fifth of the patients were classified as stable after active periodontal treatment. After a mean follow-up of 10.77 years, 24 patients lost 38 teeth due to periodontitis. An unstable PPS and a higher number of diseased teeth per patient at first SPC, and inadequate oral hygiene levels over time significantly increased the risk for a higher number of diseased teeth per patient at last SPC and for more lost teeth due to periodontitis. However, high adherence to SPC appeared to mitigate the negative effect of an unstable PPS, especially regarding tooth loss due to periodontitis. Further, tooth loss due to any reason was about 3-times higher than tooth loss due to periodontitis and was affected by a larger number of predictors. Conclusions: Successfully treated patients with a stable PPS maintained a low number of diseased teeth and barely lost teeth during long-term SPC compared to patients not achieving a stable PPS after active periodontal therapy