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Chronic periodontitis Diego Halabí Robles Programa de Doctorado en Ciencias Médicas Unversidad Austral de Chile

Chronic Periodontitis

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Page 1: Chronic Periodontitis

Chronic periodontitis

Diego Halabí RoblesPrograma de Doctorado en Ciencias Médicas

Unversidad Austral de Chile

Page 2: Chronic Periodontitis

Periodontitis

Highfield, 2009

Page 3: Chronic Periodontitis

Chronic periodontitis

Page 4: Chronic Periodontitis

Clinical

Highfield, 2009 Corbet, 2009

Page 5: Chronic Periodontitis

Epidemiology

93.4%35 to 44 years old

97.5%65 to 74 years old

38.6%35 to 44 years old

69.3%65 to 74 years old

>6 mm

>3 mm

Gamonal et al., 2010

Page 6: Chronic Periodontitis

Microbiology

Red complex: P. gingivalis, T. denticola and T. forsythia

Silva et al., 2008

Page 7: Chronic Periodontitis

Immunology

Periodontitis

IL-1β

TNF-α

Biofilm

(Mörmann et al., 2008)

(Zappa et al., 1991)

Page 8: Chronic Periodontitis

Zappa, U. et al., 1991

Page 9: Chronic Periodontitis

Kaushik, R., Yeltiwar, R.K. & Pushpanshu, K., 2011. Salivary interleukin-1β levels in patients with chronic periodontitis before and after periodontal phase I therapy and healthy controls: a case-control study . Journal of periodontology, 82(9), pp.1353-9.

Page 10: Chronic Periodontitis

CD4+/CD8+ ratios

Page 11: Chronic Periodontitis

Th17

Periodontitis

IL-1β

TNF-α

Biofilm

IL-17

RANKL

TFG-β

IL-6

IL-23

Th17

↑RORC2

Page 12: Chronic Periodontitis
Page 13: Chronic Periodontitis

Th1/Th17

Periodontitis

IL-1β

TNF-α

Biofilm

IL-17

RANKL

TFG-β

IL-6

IL-23

Th17

↑RORC2

IL-12

Th1

↑ T-bet

IL-1β

IFN-γ

Page 14: Chronic Periodontitis

Th17, Th1 and Treg

Periodontitis

IL-1β

TNF-αBiofilm

IL-17

RANKL

TFG-β

IL-6

IL-23

Th17

↑RORC2

IL-12Th1

↑ T-bet

IL-1β

IFN-γTFG-β

TregCTLA-4

TGF-β1

IL-10

[email protected]

↑Foxp3

Page 15: Chronic Periodontitis
Page 16: Chronic Periodontitis

TherapyPatient

Chronic periodontitis Health

Oral health instruction Plaque control Supragingival debridement Subgingival debridement Reevaluation

Chronic periodontitis

Chronic periodontitis

Antibiotics (amoxicillin + Metronidazole)

Chlorhexidine 0.05% per 3 months

Reevaluation

Oral health instruction

Page 17: Chronic Periodontitis

References• Corbet, E., 2009. Radiographs in periodontal disease diagnosis and management. Australian

dental journal, 54 Suppl 1, pp.S27–43.• Dutzan N, Gamonal J, Silva A, Sanz M, Vernal R (2009). Over-expression of forkhead box P3 and

its association with receptor activator of nuclear factor-kappa B ligand, interleukin (IL) -17, IL-10 and transforming growth factor-beta during the progression of chronic periodontitis. J Clin Periodontol 36:396-403.

• Gamonal, J. et al., 2010. Clinical attachment loss in Chilean adult population: First Chilean National Dental Examination Survey. Journal of periodontology, 81(10), pp.1403–10.

• Hernández, M. et al., 2011. Host-pathogen interactions in progressive chronic periodontitis. Journal of dental research, 90(10), pp.1164–70.

• Highfield, J., 2009. Diagnosis and classification of periodontal disease. Australian dental journal, 54 Suppl 1, pp.S11–26.

• Silva, N. et al., 2008. Characterization of progressive periodontal lesions in chronic periodontitis patients: levels of chemokines, cytokines, matrix metalloproteinase-13, periodontal pathogens and inflammatory cells. Journal of clinical periodontology, 35(3), pp.206–14.

• Zappa, U. et al., 1991. Cell populations and episodic periodontal attachment loss in humans. Journal of clinical periodontology, 18(7), pp.508–15.