Background: High levels of hepatocyte growth factor (HGF), a healing factor with regenerative and cytoprotective effects, are associated with inflammatory diseases, including periodontitis. HGF biologic activity requires binding to its receptors, the proto-oncogene c-Met and heparan sulfate proteoglycan (HSPG). This study investigates HGF expression and its relationship to subgingival microbiota in medically healthy individuals with and without periodontitis.

Methods: Saliva, gingival crevicular fluid (GCF), and blood samples from 30 patients with severe periodontitis and 30 healthy controls were analyzed for HGF concentration using enzyme-linked immunosorbent assay and binding affinity for HSPG and c-Met using surface plasmon resonance. The regenerative effects of saliva from three patients and controls were analyzed in an in vitro model of cell injury. Subgingival plaques were analyzed for the presence of 18 bacterial species.

Results: Patients with periodontitis showed higher HGF concentrations in saliva, GCF, and serum (P <0.001); however, the binding affinities for HSPG and c-Met were reduced in GCF and saliva (P <0.002). In contrast to the controls, saliva from patients showed no significant regenerative effect over time on gingival epithelial cells. Compared with controls, patients had a higher prevalence of periodontally related bacteria.

Conclusions: Higher circulatory HGF levels indicate a systemic effect of periodontitis. However, the HGF biologic activity at local inflammation sites was reduced, and this effect was associated with the amount of periodontal bacteria. Loss of function of healing factors may be an important mechanism in degenerative processes in periodontally susceptible individuals.

Background: This study examines whether preceding assessment of periodontal status in patients with established coronary artery disease (CAD) can predict future CAD endpoints (myocardial infarction, new revascularization procedure, or CAD-related death) during 8-year follow-up and whether the changes in periodontal status over time differ in patients with CAD compared with healthy controls. Methods: In 2003, periodontal status was examined in 161 patients with CAD who underwent percutaneous coronary intervention or coronary artery bypass graft due to significant stenosis in the coronary arteries and 162 controls without CAD. Eight years later, 126 patients with CAD (102 males and 24 females, mean age: 68 -8.9 years) and 121 controls (101 males and 20 females, mean age: 69 -9.0 years) were reexamined periodontally. A standard classification of periodontal disease in three groups (mild, moderate, and severe) was used. CAD endpoints during follow-up were obtained by review of medical records. CAD as cause of death was confirmed from the Swedish Cause of Death Register. Results: No significant differences were found among patients with CAD, with or without CAD-related endpoints at 8-year follow-up, and severity of periodontitis at baseline (P = 0.7). CAD did not influence the incidence or severity of periodontitis. Significant differences were found at the final examination in periodontitis prevalence and severity (P = 0.001), number of teeth (P = 0.006), probing depth 4 to 6 mm (P = 0.016), bleeding on probing (P = 0.001), and radiographic bone level (P = 0.042) between CAD patients and controls, all in favor of controls. Conclusions: The study results did not show a significant association during 8 years among CAD endpoints and periodontal status at baseline. The progression of periodontitis was low in both groups, although the higher proportion of individuals with severe periodontitis among patients with CAD compared with controls remained unchanged over the 8-year follow-up. Further long-term prospective studies are needed to show whether periodontitis can be considered a risk or prognostic factor for CAD, in terms of endpoints including myocardial infarction, new revascularization procedure, and CAD-related death.

Aim To study the long-term outcome of implant survival rate, soft and hard tissue conditions and prosthetic status in a group of individuals treated with either Astra Tech TiOblast or Branemark turned implants supporting a full-arch bridge. less thanbrgreater than less thanbrgreater thanMaterial and methods Edentulous patients treated with either Astra Tech TiOblast surface or Branemark turned implants were recalled for examination after 12-15years. Out of initially 66 patients 46 were available for examination. Intra-oral radiographs were taken for bone level assessments. Clinical prosthetic conditions, number of surviving implants, implant stability, plaque scores, probing pocket depths, bleeding and pus after probing were recorded. Analyses of bone level changes during the total observation period were performed. less thanbrgreater than less thanbrgreater thanResults Three patients in the Astra Tech group lost totally eight implants and five patients in the Branemark group lost 10 implants during the total observation period. No statistically significant difference in implant loss or bone level change was found. Sixteen per cent of Astra Tech and 29% of Branemark patients showed at least one implant with 2mm bone loss after the first year in function. The corresponding prevalence on implant level was 6% and 5% respectively. No significant differences were found between the other examined variables. Two patients showed prosthetic complications of the supra construction in need of repair. Seven bridges had minor ceramic chippings. less thanbrgreater than less thanbrgreater thanConclusion Treatment with Astra Tech TiOblast implants and Branemark turned implants supporting full-arch bridges showed generally good clinical results with low numbers of implants with marginal bone loss indicative of peri-implantitis. No significant differences were found between the implant systems after 12-15years in function.

The aim of this study was to evaluate the long term outcome of furcation involved molars in a population treated for periodontal disease. Initially, the study sample was 147 referred periodontal patients. Periodontal treatment consisted of oral hygiene instructions, supra- and subgingival scaling and periodontal surgery. After treatment 99 patients participated in a two year study on root caries. The patients got maintenance treatment every third to fourth month during 2 years. At the end of that study the patients were periodontally healthy and were referred back for supportive treatment to the referring dentist. Thirteen to 16 years after periodontal treatment 81 patients were still alive and 64 accepted a re-examination. At the start of the observation period the remaining 64 patients had in total 1537 teeth. During the 13 to 16 year follow up 217 teeth were lost. The number of molars at baseline was 361. The number of furcation involvement with different degrees were; 267 (0), 67 (I), 25 (II) and 2 (III) respectively. Totally 69 molars were lost during follow up. The proportion of molar loss according to the degree of furcation involvements 0 to III at baseline were 15%, 29%, 40% and 100% respectively. It was a significant greater risk of loosing an initially furcation involved molar than a single rooted tooth (pandlt;0.0001). The risk of loosing an initially furcated molar increased with the degree of furcation involvement (degree I; pandlt;0.05, degree II; pandlt;0.01). I N CONCLUSION: During a long term observation period molars with furcation involvements are more frequently lost than not furcation involved molars. However, two thirds are still in function 13 to 16 years after treatment which indicate that molars with furcation involvements might survive long after periodontal treatment.

Hepatocyte growth factor (HGF) is an angiogenic, cardioprotective factor important for tissue and vascular repair. High levels of HGF are associated with chronic inflammatory diseases, such as coronary artery disease (CAD) and periodontitis, and are suggested as a marker of the ongoing atherosclerotic event in patients with CAD. Periodontal disease is more prevalent among patients with CAD than among healthy people. Recent studies indicate a reduced biological activity of HGF in different chronic inflammatory conditions. Biologically active HGF has high affinity to heparan sulfate proteoglycan (HSPG) on cell-membrane and extracellular matrix. The aim of the study was to investigate the serum concentration and the biological activity of HGF with ELISA and surface plasmon resonance (SPR), respectively, before and at various time points after percutaneous coronary intervention (PCI) in patients with CAD, and to examine the relationship with periodontal condition. The periodontal status of the CAD patients was examined, and the presence of P. gingivalis in periodontal pockets was analyzed with PCR. The HGF concentration was significantly higher, at all time-points, in patients with CAD compared to the age-matched controls (P< 0.001), but was independent of periodontal status. The HGF concentration and the affinity to HSPG adversely fluctuated over time, and the biological activity increased one month after intervention in patients without periodontitis. We conclude that elevated concentration of HGF but with reduced biological activity might indicate a chronic inflammatory profile in patients with CAD and periodontitis.

Aim: To study if CAD-related morbidity and mortality (endpoints; myocardial infarction, coronary artery revascularization or CAD-related death) during 8-years follow was related to baseline periodontal status.

Material and methods: In 2003, periodontal status was examined in 161 CAD patients who underwent percutaneous coronary intervention or coronary artery by-pass graft due to significant stenosis in the coronary arteries, and in 162 control subjects without CAD history. Eight years later, 126 CAD patients and 121 controls were periodontally re-examined. The groups were classified into five categories as per periodontal disease experience (Hugoson & Jordan 1982). Cause of death due to CAD was obtained from Sweden’s death register. Myocardial infarction and coronary artery revascularization procedures were confirmed by review of medical records.

Results: No significant differences were found among CAD patients with / without CAD related endpoints and periodontal disease experience group (p=0.7). Significant differences were found at the final examination in periodontitis prevalence and severity (p=0.001), number of teeth (p=0.006), pockets 4-6 mm (p=0.016), bleeding on probing (p=0.001) and radiographic bone level between (p=0.042) between CAD-patients and controls.

Conclusion: The study results did not show a significant association between CAD outcomes after 8 years and periodontal status at baseline. Further long-term prospective studies are needed to show whether periodontitis can be considered a risk or prognostic factor for CAD.

Aim: To study periodontal conditions, root caries, number of lost teeth and causes for tooth loss during 11-14 years after active periodontal treatment. less thanbrgreater than less thanbrgreater thanMaterial and Methods: Sixty-four patients participated in the follow-up study. Reasons for tooth loss were identified through previous case books, radiographs and clinical photos. To identify factors contributing to tooth loss, a logistic multi-level regression analysis was used. less thanbrgreater than less thanbrgreater thanResults: The number of lost teeth was 211. The main reason was periodontal disease (n = 153). Due to root caries and endodontic complications, 28 and 17 teeth, respectively, were lost. Thirteen teeth were lost for other reasons. The number of teeth (p = 0.05) and prevalence of probing pocket depths, 4-6 mm (p = 0.01) at baseline, smoking (p = 0.01) and the number of visits at dental hygienists (p = 0.03) during maintenance, significantly contributed to explain the variation in tooth loss. less thanbrgreater than less thanbrgreater thanConclusion: Previously treated patients at a specialist clinic for periodontology continued to lose teeth in spite of maintenance treatments at general practitioners and dental hygienists. The main reason for tooth loss was periodontal disease. Tooth loss was significantly more prevalent among smokers than non-smokers. Tooth-related risk factors were smoking, low numbers of teeth and prevalence of periodontal pockets, 4-6 mm.

Background. Enhanced platelet reactivity and elevated inflammatory response together with neglected dental care promote coronary heart disease. For that reason we report associations between these risk factors in stable angina pectoris.

Methods. We enrolled patients (n¼59) with at least one significant stenotic lesion in at least one affected major coronary artery. Platelet reactivity, C-reactive protein (CRP) together with neutrophil and eosinophil counts were measured before elective coronary angiography. We analysed platelet reactivity i.e. platelet in vitro reactions after challenge with ADP(8.5 and 1.7 mmol/L) and a thrombin-related peptide(TRAP-6) (74 and 54 mmol/L). Dental health was assessed within one year after angiography. To estimate the degree of deeper gingivitis bleeding on probing (BOP) expressed as bleeding sites on the total number of sites in the dentition was determined.

Results. Patients (n ¼ 39) with ‘‘less severe’’ gingivitis(i.e. a BOP 5¼30%) were grouped together. The ‘‘more severe’’ gingivitis group consisted of 20individuals with a BOP 5¼ 30%. Subjects with ‘‘more severe’’ gingival inflammation had ‘‘less reactive’’ platelets. The p-values were p50.01 for both ADP dilutions. TRAP-6 challenge yielded similar results (p50.01 for both concentrations).CRP and neutrophils did not differ between the study groups. Augmented eosinophil counts(p50.01) proved to be related with ‘‘more severe’ ’dental inflammation. 

Conclusion. In stable angina pectoris, platelet reactivity is inversely related to the seriousness of the oral infection. Severe disease is associated with higher eosinophil counts but disease severity is unrelated to the acute phase response.

Background: High levels of hepatocyte growth factor (HGF), a healing factor with regenerative and cytoprotective effects, has been associated to inflammatory diseases including periodontitis. To induce cellular responses, biologic active HGF requires binding to its receptor c-Met and the co-receptor heparan sulphate proteoglycan (HSPG) on cell membranes and extracellular matrix. The aim of this study was to investigate the concentration and the biological activity of HGF and the relationship with subgingival microbiota in medically healthy subject with / without periodontitis.

Methods: Saliva, gingival crevicular fluid (GCF) and blood samples from thirty patients with severe periodontitis and thirty periodontally healthy controls were analysed for the concentration of HGF and the binding affinity to HSPG and c-Met, using ELISA and surface plasmon resonance (SPR). Subgingival plaque were analysed for the presence of 18 bacterial species.

Results: Compared to controls, patients with periodontitis showed higher concentrations of HGF in all three locations (P<0.001), however the binding affinity to HSPG and c-Met were markedly reduced in GCF and in saliva (P<0.002). The patients had higher prevalence of periodontal related bacterial species.

Conclusion: The increased concentration of HGF in GCF and saliva in patients with severe periodontitis was also reflected in the circulation indicating a systemic effect by periodontitis. However, the biological activity of HGF at local sites of inflammation was reduced. A loss of function of healing factors such as HGF may be one important mechanism in the dominant degenerative processes in periodontally susceptible subjects.