Background and objective The field of salivary diagnostics lacks an accepted and validated biomarker of alveolar bone remodeling. To address this we examined levels of salivary biomolecules specifically associated with biological aspects of bone remodeling in subjects with chronic periodontitis in a case-control study. Methods Levels of macrophage inflammatory protein (MIP)-1α, osteoprotegerin (OPG), C-telopeptide pyridinoline cross-links of type I collagen (ICTP), and β-C-terminal type I collagen telopeptide (β-CTX) in unstimulated whole saliva of 80 subjects (40 subjects with moderate to severe chronic periodontitis and 40 gender- and age-matched healthy control subjects) were measured using enzyme immunosorbent assays. Saliva was collected before clinical examination that included probing depth (PD), clinical attachment loss (CAL), and bleeding on probing (BOP). Results The mean level of MIP-1α in periodontitis subjects was 18-fold higher than in healthy subjects (p < 0.0001). Clinical periodontal indices significantly correlated with MIP-1α levels (p < 0.0001). MIP-1α, of the biomolecules examined, demonstrated the highest ability to discriminate between periodontal disease and health as determined by area under the curve (AUC = 0.94) and classification and regression tree analysis (sensitivity 94%, specificity 92.7%). OPG levels were elevated 1.6-fold (P = 0.055), whereas ICTP and β-CTX levels were below the level of detection in the majority of subjects. Conclusion These findings suggest that the chemokine MIP-1α may aid in identifying periodontitis. Future longitudinal studies are warranted to determine whether this biomarker can help to ascertain progression of bone loss in subjects with periodontal disease.

Objective This study determined the efficacy of a novel point-of-care immunoflow device (POCID) for detecting matrix metalloproteinase (MMP)-8 concentrations in oral fluids in comparison with a gold-standard laboratory-based immunoassay. Methods Oral rinse fluid and whole expectorated saliva samples were collected from 41 participants clinically classified as periodontally healthy or diseased. Samples were analyzed for MMP-8 by Luminex immunoassay and POCID. Photographed POCID results were assessed by optical scan and visually by two examiners. Data were analyzed by Pearson correlation and receiver operator characteristics. Results MMP-8 was readily detected by the POCID, and concentrations correlated well with Luminex for both saliva and rinse fluids (r=0.57–0.93). Thresholds that distinguished periodontitis from health were delineated from both the optical scans and visual reads of the POCID (sensitivity 0.7–0.9, specificity 0.5–0.7; p < 0.05). Conclusions Performance of this POCID for detecting MMP-8 in oral rinse fluid or saliva was excellent. These findings help demonstrate the utility of salivary biomarkers for distinguishing periodontal disease from health using a rapid point-of-care approach.

Background Salivary biomarkers are potentially important for determining the presence, risk, and progression of periodontal disease. However, clinical translation of biomarker technology from lab to chairside requires studies that identify biomarkers associated with the transitional phase between health and periodontal disease (i.e., gingivitis). Methods Eighty participants (40 with gingivitis, 40 healthy) provided saliva at baseline and 7 to 30 days later. An additional sample was collected from gingivitis participants 10 to 30 days after dental prophylaxis. Clinical parameters of gingival disease were recorded at baseline and the final visit. Salivary concentrations of interleukin (IL)-1β, IL-6, matrix metalloproteinase (MMP)-8, macrophage inflammatory protein (MIP)-1α, and prostaglandin E2 (PGE2) were measured. Results Clinical features of health and gingivitis were stable at both baseline visits. Participants with gingivitis demonstrated significantly higher bleeding on probing (BOP), plaque index (PI), and gingival index (GI) (P ≤ 0.002) and a significant drop in BOP, PI, and GI post-treatment (P ≤ 0.001). Concentrations of MIP-1α and PGE2 were significantly higher (2.8 times) in the gingivitis group than the healthy group (P ≤ 0.02). After dental prophylaxis, mean biomarker concentrations did not decrease significantly from baseline in the gingivitis group, although concentrations of IL-1β, IL-6, and MMP-8 approached healthy levels, whereas MIP-1α and PGE2 concentrations remained significantly higher than in the healthy group (P ≤ 0.04). Odds ratio analyses showed that PGE2 concentrations, alone and in combination with MIP-1α, readily discriminated gingivitis from health. Conclusions Salivary PGE2 and MIP-1α discriminate gingivitis from health, and patients with gingivitis who return to clinical health continue to produce inflammatory mediators for weeks after dental prophylaxis.

Calcium sulfate has a long history of use in medicine and dentistry. It exists in two forms (alpha and beta), which differ greatly in physical properties. It has been used in bone regeneration as a graft material and graft binder/extender and as a barrier in guided tissue regeneration. It is an unusually biocompatible material and is completely resorbed following implantation. It does not evoke a significant host response and creates a calcium-rich milieu in the area of implantation. These calcium ions may provide some stimulation to osteoblasts, which may account for some of the positive results reported with the material. Calcium sulfate can be used as a delivery vehicle for growth factors and antibiotics, although this application has not been thoroughly exploited in the clinical setting. It has been shown that tissue will often migrate over calcium sulfate if primary closure cannot be obtained, which provides further evidence of its biocompatibility. The raw material from which calcium sulfate is made is relatively inexpensive and abundant. Despite these advantages, calcium sulfate has never attracted the same degree of research interest as have other biomaterials. Recently, however, it has enjoyed a resurgence of sorts in the areas of periodontology, sinus augmentation, and orthopedic surgery. Future research must be directed toward improving handling characteristics and strength, while preserving the biocompatibility of the material.

Keratinized gingiva (KG) comprises free gingiva and attached gingiva (AG). 1 It extends from the gingival margin to the mucogingival junction. The free gingiva is the coronal portion of KG and is not attached to tooth surfaces, whereas AG is firm and tightly bound to the underlying periosteum or periodontium. 2 The width of the AG is the distance between the deepest point of the gingival sulcus and the mucogingival junction.AG has historically been regarded as having clinical relevance. 3 Extremes in the width of the AG at the facial site of teeth range from 1 to 9 mm 3 . Maxillae have a broader zone of AG than the mandible. 3 The width of the AG varies among persons and on different teeth in the same person. 4 The minimum width of AG as a standard necessary for maintaining periodontal health and preventing gingival recession has not yet been established. 4 Earlier studies found a correlation between the width of the AG and periodontal health. [1][2][3]5 It has been reported that a minimum of 2 mm of KG with a minimum of 1 mm of AG is necessary for maintaining gingival health. 6 Other controlled clinical studies, however, have found that with excellent oral hygiene practice, the absence of AG tissue is compatible with the maintenance of periodontal health. [7][8][9][10][11] With the advent of dental implants, the structure and function of the mucosa that surrounds them have been extensively examined. 12 As is true for teeth, the necessity of adequate keratinized or

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