Biomarkers in Periodontal Health and Disease: Rationale, Benefits, and Future Directions

99 Pages·2020·3.289 MB·English

by  Nurcan Buduneli

Matthew P. Lungren
Michael R.B. Evans
Editors
Biomarkers in
Clinical Medicine
Periodontal Health
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and Disease
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Biomarkers in Periodontal
Health and Disease
Nurcan Buduneli
Biomarkers in
Periodontal Health
and Disease
Rationale, Benefits,
and Future Directions
Nurcan Buduneli
Department of Periodontology
Faculty of Dentistry
Ege University
Izmir, Turkey
ISBN 978-3-030-37315-3 ISBN 978-3-030-37317-7 (eBook)
https://doi.org/10.1007/978-3-030-37317-7
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The supreme guide in life is science.
Do not be afraid of telling the truth.
Mustafa Kemal ATATÜRK
Dedicated to mom, who has always been the major
encouraging power behind me; to dad, who had always
believed in me
And to my dear daughter and son, who are my hope
for the future
Preface
Periodontal diseases continue to be one of the most common chronic infec-
tious and inflammatory diseases in the world. Pathogenic mechanisms acting
in periodontal diseases contain two major arms: the microbial component and
the host response. Knowledge on both aspects has been increasing tremen-
dously during the last two decades. Indeed, the progress in knowledge and the
available evidence have led European Federation of Periodontology and
American Academy of Periodontology to combine power and build up a new
classification system for periodontal diseases in 2017 after 18 years passed
since the 1999 Classification.
Periodontology is one of the most glamorous fields of dentistry with doz-
ens of exciting papers, which open up completely novel pathways of research.
“The more we understand the scenario the more complex it becomes.” This is
quite true for periodontology. However, this complexity not only attracts even
more scientists to work in this field but also stimulates building new bridges
between various disciplines of dentistry and medicine to make the story clear.
Development of chair-side diagnostic tests for determining the presence or
absence of periodontal disease and activity is still a challenge in periodontol-
ogy. The use of biofluid samples such as gingival crevicular fluid, whole
saliva, and serum as a means of evaluating host-derived products, as well as
exogenous components has a great potential for diagnosis and monitorisation
of periodontal diseases. Having more precise and early diagnostic tools may
enable early intervention and help to develop individually tailored treatment
modalities. We are not there, yet, but shall expect to arrive soon. The techno-
logical developments in laboratory methods and the closer collaboration with
different branches of medicine bring great hope for the future. The spirit of
positivity with “can do” and “will do” is definitely encouraging; however, it
is clear that reliable biomarkers should base on strong evidence. I hope this
monograph will help to fire more researchers working in the field of peri-
odontology to get involved.
Moonlight floods the whole sky from horizon to horizon
How much it can fill your room depends on its windows.
Mawlana Jalal-al-Din Rumi
İzmir, Anatolia Nurcan Buduneli
September 2019
ix
Acknowledgements
I am grateful to Dr. Burcu Kanmaz for kindly preparing all the illustrations
and providing the photographs for this book.
xi
Contents
1 Anatomy of Periodontal Tissues . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Healthy Periodontal Tissues . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1.1 Gingiva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1.2 Dentogingival Junction . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.1.3 Cementum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.1.4 Periodontal Ligament . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.1.5 Alveolar Bone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.2 Blood Supply of the Periodontium . . . . . . . . . . . . . . . . . . . . . . 6
1.3 Lymphatic System of the Periodontium . . . . . . . . . . . . . . . . . . . 6
1.4 Nerves of the Periodontium . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.5 Stem Cells of the Periodontium . . . . . . . . . . . . . . . . . . . . . . . . . 6
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2 Nature of Periodontal Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.1 Inflammation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.2 Pathogen Microorganisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2.3 Immune Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2.4 Osteoclastic Bone Resorption . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2.5 Network of Cytokines and Chemokines . . . . . . . . . . . . . . . . . . 15
2.6 Lipid Mediators of Inflammation . . . . . . . . . . . . . . . . . . . . . . . . 16
2.7 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3 Conventional Diagnosis of Periodontal Diseases
and the 2017 Classification System . . . . . . . . . . . . . . . . . . . . . . . . . 21
3.1 1989 Classification of Periodontal Diseases . . . . . . . . . . . . . . . 21
3.2 1999 Classification of Periodontal Disease . . . . . . . . . . . . . . . . 22
3.3 2017 Classification of Periodontal Diseases . . . . . . . . . . . . . . . 22
3.4 Medical and Dental History . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
3.5 Clinical Periodontal Parameters . . . . . . . . . . . . . . . . . . . . . . . . . 26
3.5.1 Bleeding on Probing . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
3.5.2 Suppuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
3.5.3 Clinical Attachment Level . . . . . . . . . . . . . . . . . . . . . . . 30
3.5.4 Relative Attachment Level . . . . . . . . . . . . . . . . . . . . . . . 30
3.5.5 Probing Depth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
3.5.6 Gingival Recession . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
3.5.7 Furcation Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
3.5.8 Pathologic Tooth Migration . . . . . . . . . . . . . . . . . . . . . . 31
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xiv Contents
3.5.9 Increased Tooth Mobility . . . . . . . . . . . . . . . . . . . . . . . . 31
3.5.10 Bone Sounding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
3.5.11 Oral Hygiene Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
3.6 Radiographical Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
3.7 Limitations of the Conventional Diagnostic Methods . . . . . . . . 33
3.8 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
4 Novel Diagnostic Approaches in Periodontics . . . . . . . . . . . . . . . . 35
4.1 Controlled-Force, Standardised Probes . . . . . . . . . . . . . . . . . . . 36
4.2 Voice-Activated Charting System . . . . . . . . . . . . . . . . . . . . . . . 36
4.3 Advanced Techniques with 3-Dimensional Imaging . . . . . . . . . 36
4.4 Computer-Assisted Digital Radiography . . . . . . . . . . . . . . . . . . 37
4.5 Computer-Assisted Densitometric Image Analysis (CADIA) . . 37
4.6 Cone-Beam Computerised Tomography . . . . . . . . . . . . . . . . . . 37
4.7 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
5 Biomarkers for Periodontal Diseases . . . . . . . . . . . . . . . . . . . . . . . 41
5.1 Main Text . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
5.1.1 How to Find a Needle in the Haystack? . . . . . . . . . . . . . 41
5.2 Microbial Factors for the Diagnosis of Periodontal Diseases . . 42
5.3 Biomarkers for Detection of Periodontal Disease . . . . . . . . . . . 43
5.4 Biomarkers for Prognosis of Non-surgical
Periodontal Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
5.5 Biomarkers for Monitoring of Disease Progress . . . . . . . . . . . . 50
5.5.1 Response to Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . 50
5.6 Point-of-Care Diagnostics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
5.7 Limitations of Available Studies . . . . . . . . . . . . . . . . . . . . . . . . 53
5.8 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
6 Biological Samples for Biomarkers: Strengths
and Weaknesses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
6.1 Saliva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
6.1.1 Collection of Saliva Samples . . . . . . . . . . . . . . . . . . . . . 60
6.1.2 Content of Saliva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
6.1.3 Functions of Saliva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
6.2 Gingival Crevicular Fluid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
6.2.1 Methods of Collection . . . . . . . . . . . . . . . . . . . . . . . . . . 63
6.2.2 Reporting GCF Sample Volume and Biomarker Data . . . 65
6.3 Serum or Plasma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
6.4 Gingival Tissue Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
6.5 Calcified Tissue Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
6.6 Plaque . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
6.7 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
7 Technologies for Biomarkers in Periodontics . . . . . . . . . . . . . . . . . 69
7.1 Biochemical Analyses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69