A Roadmap towards Precision Periodontics

Periodontitis is among the most common health conditions and represents a major public health issue related to increasing prevalence and seriously negative socioeconomic impacts. Periodontitis-associated low-grade systemic inflammation and its pathological interplay with systemic conditions additionally raises awareness on the necessity for highly performant strategies for the prevention and management of periodontitis. Periodontal diagnosis is the backbone of a successful periodontal strategy, since prevention and treatment plans depend on the accuracy and precision of the respective diagnostics. Periodontal diagnostics is still founded on clinical and radiological parameters that provide limited therapeutic guidance due to the multifactorial complexity of periodontal pathology, which is why biomarkers have been introduced for the first time in the new classification of periodontal and peri-implant conditions as a first step towards precision periodontics. Since the driving forces of precision medicine are represented by biomarkers and machine learning algorithms, with the lack of periodontal markers validated for diagnostic use, the implementation of a precision medicine approach in periodontology remains in the very initial stage. This narrative review elaborates the unmet diagnostic needs in periodontal diagnostics, the concept of precision periodontics, periodontal biomarkers, and a roadmap toward the implementation of a precision medicine approach in periodontal practice

Underdiagnosis in Background of Emerging Public Health Challenges Related to Peri-Implant Diseases: An Interventional Split-Mouth Study

Peri-implant diseases are an emerging public health problem, and it’s considered that limitations of standard diagnostics play the role herein. The study objective was the estimation of pathological bone resorption at clinical and biological level in patients with peri-implant mucositis (PIM) and peri-implantitis (PI) before and 6 months after standard treatment and to compare them with healthy controls (HC). The split-mouth interventional study included 60 patients affected with PIM or PI. Patients that also presented at least one more HC were enrolled in the study and underwent standard non-surgical and surgical treatment, respectively. Standard clinical parameters and soluble levels of RANKL were measured in peri-implant crevicular fluid baseline and 6 months following treatment. Clinical parameters and RANKL significantly decreased following treatment in PIM and PI. However, bleeding on probing and probing depth remained significantly increased when compared to HC. RANKL answered requests for biomarker of peri-implant diseases, its baseline levels were significantly increased in PIM and PI, they decreased following treatment and reached HC in peri-implantitis, while in PIM RANKL remained significantly increased. Presence of pathological bone resorption in patients lacked its clinical signs, and respective persistence following treatment suggest the need for biomarker-supported diagnosis for timely diagnosis of peri-implantitis and appropriate orientation of respective management strategies

Antioxidative status of saliva before and after non-surgical periodontal treatment

Introduction. Oxidative stress and antioxidants play an important role in the pathogenesis of inflammatory disease, including chronic periodontitis (CP). Saliva contains enzymatic (glutathione peroxidase - GPx, superoxide dismutase - SOD, etc.) and non-enzymatic (albumin - ALB, uric acid - UA, glutathione, etc.) antioxidants. Objective. The aims of this study were to investigate: a) level of SOD, GPx, UA, ALB and total antioxidative status (TAS) of saliva in CP patients before and after non-surgical treatment, and b) correlations between clinical periodontal parameters and levels of salivary antioxidants. Methods. Saliva was collected from 21 CP patients before and after non-surgical treatment. The condition of periodontium was assessed by plaque index, gingival index, bleeding on probing, probing depth and clinical attachment loss. Level of investigated antioxidants (except GPx) and TAS was determined using colorimetric method and commercial kits. GPx activity was determined using UV method and commercial kits. Results. After the treatment significant increase of UA, ALB, Gpx, TAS was detected (p lt 0.01) and decrease of SOD activity (p>0.05). A significant correlation was observed between GPx and PI (r=0.575, p=0.008), SOD and GI (r=0.525, p=0.017) before therapy, and SOD and bleeding on probing (BP) (r=0.59, p=0.006), TAS and BP (r=0.453, p=0.045) after therapy. Conclusion. These data suggest that levels of salivary antioxidants generally increase after non-surgical periodontal treatment. Correlation between some clinical periodontal parameters and level of salivary antioxidants was found.Uvod. Oksidativni stres i antioksidansi igraju važnu ulogu u patogenezi zapaljenjskih oboljenja, uključujući i hroničnu parodontopatiju. Pljuvačka sadrži enzimske antioksidanse, kao što su glutation-peroksidaza (GPx) i superoksid-dismutaza (SOD), i neenzimske antioksidanse, poput albumina (ALB), mokraćne kiseline (UA), glutationa itd. Cilj rada. Cilj istraživanja bio je da se ispitaju nivoi SOD, GPx, UA i ALB i utvrdi ukupan antioksidantni status pljuvačke (TAS) kod osoba s hroničnom parodontopatijom pre i posle kauzalne terapije, te ustanove korelacije između kliničkih pokazatelja stanja parodoncijuma i nivoa antioksidansa u pljuvački. Metode rada. Pljuvačka je sakupljena od 21 pacijenta s hroničnom parodontopatijom pre i posle kauzalne terapije. Stanje parodoncijuma je procenjivano pomoću: plak-indeksa (PI), gingivalnog indeksa (GI), indeksa krvarenja gingive (BP), dubine parodontalnog džepa i nivoa pripojnog epitela. Nivo ispitivanih antioksidansa (osim GPx) i TAS određivan je pomoću kolorimetrijske metode i komercijalnih reagensa. GPx je određivan primenom UV metode i komercijalnih reagensa. Rezultati. Nakon terapije ustanovljeni su značajno povećanje koncentracije UA, GPx i TAS (p lt 0,01) i smanjenje aktivnosti SOD (p>0,05). Primećena je i značajna korelacija između GPx i PI (r=0,575; p=0,008), te SOD i GI (r=0,525; p=0,017) pre terapije, odnosno SOD i BP (r=0,59; p=0,006), kao i TAS i BP (r=0,453; p=0,045) posle nje. Zaključak. Dobijeni nalazi pokazuju da se nivoi antioksidansa u pljuvački povećavaju nakon kauzalne terapije parodontopatije. Uočene su pozitivne korelacije između kliničkih pokazatelja stanja parodoncijuma i ispitivanih koncentracija antioksidansa u pljuvački