• International Journal of Oral Biology
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• v.44 no.1
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• pp.14-19
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• 2019

The present study aimed at evaluating serum immunoglobulin G (IgG) avidity to Porphyromonas gingivalis in elderly patients with mild and severe chronic periodontitis. The avidity of antibodies against P. gingivalis present in the sera of 18 patients with mild chronic periodontitis and 18 patients with severe chronic periodontitis was evaluated using an ammonium thiocyanate-dissociated enzyme-linked immunosorbent assay (ELISA). The results showed that the mean absorbance value in serum IgG antibody titers was significantly higher in the severe chronic periodontitis group than in the mild chronic periodontitis group ($198{\pm}35ELISA$ unit [EU] vs. $142{\pm}32EU$, p < 0.01). However, there was no significant difference between the two groups in antibody avidity ($65{\pm}57EU$ vs. $54{\pm}27EU$). These findings suggest that humoral immune responses to P. gingivalis between mild and severe chronic periodontitis in elderly patients are characterized by the differences in the quantity rather than the quality of the antibodies.

• Journal of Periodontal and Implant Science
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• v.50 no.5
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• pp.303-312
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• 2020

Purpose: The purpose of this study was to evaluate severe periodontitis with tooth loss as a modifiable risk factor for Alzheimer dementia (AD), vascular dementia (VaD), and mixed dementia (MD) using the National Health Insurance Service-National Health Screening Retrospective Cohort database with long-term follow-up over 14 years. Methods: Multivariate Cox hazards regression analysis was applied to a longitudinal retrospective database, which was updated in 2018, to evaluate the association between severe periodontitis with few remaining teeth and dementia after adjusting for potential risk factors, including sociodemographic factors and comorbid diseases. Results: Among 514,866 individuals in South Korea, 237,940 (46.2%) participants satisfying the inclusion criteria were selected. A total of 10,115 age- and sex-matched participants with severe periodontitis and 10,115 periodontally healthy participants were randomly selected and evenly assigned. The results showed that the risks of AD (hazard ratio [HR], 1.08), VaD (HR, 1.24), and MD (HR, 1.16) were significantly higher in patients with severe periodontitis with 1-9 remaining teeth after adjustment for sociodemographic factors, anthropomorphic measurements, lifestyle factors, and comorbidities. Conclusions: Severe periodontitis with few remaining teeth (1-9) may be considered a modifiable risk factor for the development of AD, VaD, and MD in Korean adults.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.6
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• pp.445-453
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• 2021

Objectives: Periodontitis is the most common chronic disease that causes tooth loss and is related to systemic diseases such as cardiovascular disease and diabetes. An objective indicator of the current activity of periodontitis is necessary. Soluble forms of the receptor for advanced glycation end products (sRAGE) are markers that reflect the status of inflammatory diseases. In this study, the relationship between sRAGE and periodontitis was analyzed to determine whether it can be used to diagnose the current state of periodontitis. Patients and Methods: Eighty-four patients without any systemic diseases were diagnosed with periodontitis using three classifications of periodontitis. Demographics and oral examination data such as plaque index (PI), bleeding on probing (BOP) index, and probing pocket depth (PPD) were analyzed according to each classification. In addition, correlation and partial correlation between sRAGE and the values indicating periodontitis were analyzed. Results: In each classification, the level of sRAGE tended to decrease if periodontitis was present or severe, but this change was not statistically significant. sRAGE and periodontitis-related variables exhibited a weak correlation, among which the BOP index showed a relatively strong negative correlation (ρ=-0.20). Based on this, on analyzing the correlation between the BOP index and sRAGE in the group with more severe periodontitis (PPD≥5 mm group, severe group of AAP/CDC [American Academy of Periodontology/Centers for Disease Control and Prevention], periodontitis group of López), the correlation further increased (ρ=-0.23, -0.40, -0.50). Partial correlation analysis of the sRAGE and BOP index showed a stronger negative correlation (ρ=-0.36, -0.55, -0.45). Conclusion: sRAGE demonstrated a tendency to decrease upon increased severity of periodontitis according to the classifications used. Above all, the correlation with the BOP index, which reflects the current state of periodontitis, was higher in the group with severe periodontitis. This indicates that the current status of periodontitis can be diagnosed through sRAGE.

• Journal of Periodontal and Implant Science
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• v.44 no.4
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• pp.201-206
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• 2014

Purpose: Aggressive periodontitis, especially in its severe form, was traditionally considered to have an unfavourable prognosis. It required a complex treatment and its stabilization was often achieved by surgical therapy. The aim of this study was to investigate the results of nonsurgical periodontal treatment in severe generalized forms of aggressive periodontitis. Methods: Patients with advanced generalized aggressive periodontitis were included in the study. Probing depth (PD) of pockets ${\geq}7mm$ and clinical attachment level (CAL) of sites with attachment loss ${\geq}5mm$ were measured at baseline before nonsurgical periodontal treatment, at re-evaluation, and after treatment. The following other parameters were recorded: resolution of inflammation and bone fill. We compared the baseline values with re-evaluation and posttreatment values using the Friedman test. The Wilcoxon test with the Bonferroni correction was used for both re-evaluation and posttreatment values. Results: Seven patients with 266 periodontal sites were examined. A significant difference was found between values, reported as medians with interquartile ranges, for PD at baseline (7.94 [7.33-8.19] mm) and both re-evaluation (4.33 [3.63-5.08] mm) and posttreatment (3.54 [3.33-4.11] mm) values (P=0.002). A significant difference was also found between values for CAL at baseline (9.02 [7.5-9.2] mm) and both re-evaluation (6.55 [6.30-6.87] mm) and posttreatment (6.45 [5.70-6.61] mm) (P=0.002). Inflammation was resolved and angular bone defects were repaired in all cases. Conclusions: These therapeutic results suggest that this form of periodontitis could have positive outcomes after nonsurgical periodontal treatment. The reparative potential of tissue affected by severe aggressive periodontitis should encourage clinicians to save apparently hopeless teeth in cases of this form of periodontitis.

• Journal of Periodontal and Implant Science
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• v.41 no.6
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• pp.279-284
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• 2011

Purpose: To describe the profile of chronic and aggressive periodontitis among Senegalese (West Africans) attending the Institute of Dentistry of Dakar. Methods: A retrospective study was conducted with an inclusion period running from 2001 to 2008. The sample included 413 chronic periodontitis and 151 aggressive periodontitis cases, among them 299 males and 265 females selected from 2,274 records. A Student's independent t-test or Pearson chi-squared test was used for data analysis. Results: The proportion of females with aggressive periodontitis was significantly higher than those with chronic periodontitis (64.9% vs. 40.4%, P<0.001). The aggressive periodontitis patients had an average age of $28.1{\pm}8.9$ years, and had lost less than 3 teeth. Less than a third of them reported using a toothbrush. Attachment loss was as high as 8 mm and severe lesions had spread to an average of 12 teeth with maximum alveolar bone loss up to 80%. The chronic periodontitis patients had an average age of $44.9{\pm}14.0$ and had lost on average less than 3 teeth. Nearly 75% used a toothbrush. Attachment loss was significantly higher and lesions were more extensive in the aggressive periodontitis. Chronic periodontitis is associated with risk factors such as smoking or diabetes mellitus in 12.8% versus 0.7% in aggressive periodontitis (P<0.001). Differences between the two groups for most clinical and radiographic parameters were statistically significant. Conclusions: The profile of aggressive periodontist is characterized by more severe lesions than chronic periodontitis, whereas tooth loss experience is similar in both forms.

• Journal of Periodontal and Implant Science
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• v.50 no.6
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• pp.368-378
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• 2020

Purpose: Vitamin D deficiency may cause bone loss and increased inflammation, which are well-known symptoms of periodontal disease. This study investigated whether serum 25-hydroxyvitamin D (25(OH)D) levels are associated with periodontal disease status and tooth loss. Methods: Cross-sectional data from 5,405 individuals aged ≥50 years (2,253 males and 3,152 females) were obtained from the 2008-2010 Dong-gu study, a prospective cohort study of risk factors for chronic diseases. Periodontal examinations were conducted to evaluate the number of remaining teeth, the periodontal probing depth (PPD), the clinical attachment level (CAL), and bleeding on probing. The percentages of sites with PPD ≥4 mm and CAL ≥4 mm were recorded for each participant. The severity of periodontitis was classified using the Centers for Disease Control and Prevention and the American Academy of Periodontology case definitions. Serum 25(OH)D levels were classified as reflecting severe deficiency, deficiency, insufficiency, or sufficiency. Multivariate linear regression analysis was performed to assess the associations of serum 25(OH)D levels with periodontal parameters and the number of remaining teeth after adjusting for confounders including age, smoking status, alcohol consumption status, month of blood collection, and physical activity. Multivariate logistic regression was used to evaluate the association between serum vitamin D levels and severe periodontitis. An overall statistical analysis and a stratified analysis by sex were performed. Results: Overall, the rates of severe deficiency, deficiency, insufficiency, and sufficiency were 6.5%, 67.9%, 22.4%, and 3.2%, respectively. After adjustment for confounders, vitamin D levels were directly associated with the number of remaining teeth, an association that was significant in males, but not in females. Sufficient serum 25(OH)D was associated with a low frequency of severe periodontitis. Conclusions: This population-based cross-sectional study indicates that low serum 25(OH) D is significantly associated with tooth loss and severe periodontitis in Koreans aged 50 years and older.

• Journal of Periodontal and Implant Science
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• v.48 no.1
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• pp.47-59
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• 2018

Purpose: To evaluate the clinical and microbiological effects of the local use of egg yolk immunoglobulin against Porphyromonas gingivalis (anti-P.g. IgY) as an adjunct to scaling and root planing (SRP) in the treatment of moderate to severe chronic periodontitis. Methods: This was a randomized, placebo-controlled, double-blind trial involving 60 systematically healthy patients with moderate to severe chronic periodontitis. Subjects (n=20/group) were randomly assigned to receive SRP combined with subgingival irrigation of anti-P.g. IgY and anti-P.g. IgY mouthwash, subgingival irrigation of 0.2% chlorhexidine and 0.2% chlorhexidine mouthwash, or subgingival irrigation of placebo and placebo mouthwash for 4 weeks. Probing pocket depth, clinical attachment level, bleeding on probing, and the plaque index were evaluated at baseline and at 4 weeks. Subgingival plaque, gingival crevicular fluid, and saliva were simultaneously collected for microbiological analysis. Results: Our results showed that anti-P.g. IgY mouthwash was as effective as chlorhexidine at improving clinical parameters over a 4-week period. All the groups showed a significant reduction in levels of P.g. at 4 weeks. No significant difference was observed in the test group when compared to placebo regarding the reduction in the levels of P.g. Anti-P.g. IgY significantly suppressed the numbers of red complex bacteria (RCB) in subgingival plaque and saliva in comparison with placebo. No adverse effects were reported in any of the subjects. Conclusions: Within the limitations of the study, the present investigation showed that passive immunization with anti-P.g. IgY may prove to be effective in the treatment of chronic periodontitis due to its ability to improve clinical parameters and to reduce RCB. No significant differences were found between the anti-P.g. IgY and placebo groups in the reduction of P.g.

• Biomedical Science Letters
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• v.23 no.2
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• pp.133-137
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• 2017

Periodontitis is the major causation of tooth loss in the elderly population. Multiple risk factors include oral microorganisms, smoking, metabolic syndrome, and genetic factors influence periodontitis development. In this study, we conducted a replication study of using previous Korean GWAS results by examining an independent population. The study population was recruited from Mir Dental Clinic, Daegu, Korea. In total, 93 samples were evaluated from July 2016 to January 2017. The sample groups include relatively older patients (>60 years) with no periodontitis (n = 31) and relatively younger patients (range 40~60 years) with severe periodontitis (n = 62). A total of seven markers which were previously reported to be associated with periodontitis were genotyped. Among the seven SNPs, rs16846206 and rs2392510 showed a significant association by logistic regression analysis and Chi square test, respectively. The former SNP showed significant association with severe periodontitis, whereas this study also showed same tendency in which individuals with the minor allele are significantly more frequent in cases than those in controls. The SNP is located on a coding gene (SLC9C2), where the alanine residue 505 is replaced by glycine (Ala505Gly). The later SNP was significant when differed between case and control groups, but there was no significance by logistic regression analysis when controlled for age and sex as covariant. Although the study population size examined in the current study was relatively smaller compared to previous studies, our results implicated that at least the two SNPs (rs16846206 and rs2392510) might be important candidates for the further genetic study.

• Journal of Dental Rehabilitation and Applied Science
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• v.34 no.1
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• pp.46-55
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• 2018

Oral rehabilitation of a patient having severe periodontitis with alveolar bone resorption and periodontal inflammation presents a challenge to clinicians. However, if appropriate implant placement according to the bone shape is selected, unnecessary bone grafting or soft tissue surgery can be minimized. In recent years, using cone beam CT and software, it has become possible to operate the planned position with the surgical guide made with 3D printing technology. This case was a 70 years old female patient who required total extraction of teeth due to severe periodontitis and performed a full-mouth rehabilitation with an implant - supported fixed prosthesis. During the surgery, the implant was placed in a flapless manner through a surgical guide. Immediate loading of the temporary prosthesis made by CAD/CAM method before surgery was done. Since then, we have produced customized abutments and zirconia prostheses, and have reported satisfactory aesthetic and functional recovery.

• Journal of Microbiology and Biotechnology
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• v.28 no.10
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• pp.1614-1625
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• 2018

Periodontitis, which is a severe inflammatory disease caused by endotoxins secreted from oral pathogens, destructs gingival tissue and alveolar bone. Curcuma xanthorrhiza, commonly called Java turmeric, has been shown to possess anti-bacterial and anti-inflammatory activities. The present study evaluated the inhibitory effect of C. xanthorrhiza supercritical extract (CXS) standardized with xanthorrhizol on lipopolysaccharide (LPS)-induced periodontitis in an animal model. LPS was topically injected into the periodontium of Sprague-Dawley rats to induce periodontitis and CXS (30 and $100mg{\cdot}kg^{-1}{\cdot}day^{-1}$) was orally administered after day 12. Histologically, CXS inhibited the collapse of gingival tissue by preventing cell infiltration. CXS significantly downregulated the expression of matrix metalloproteases (MMPs) and inflammation-related biomarkers, such as nuclear factor-kappa B ($NF-{\kappa}B$) and interleukin-1 beta ($IL-1{\beta}$) in gingival tissue. CXS also improved bone remodeling by downregulating osteoclastic transcription factors, such as nuclear factor of activated T-cells c1 (NFATc1), tartrate-resistant acid phosphatase (TRAP), and cathepsin K. In addition, CXS upregulated osteoblast differentiation-related markers, alkaline phosphate (ALP) and collagen type I alpha (COLA1). Thus, CXS can ameliorate periodontitis by inhibiting inflammation and improving bone remodeling.