Mabelle Freitas Monteiro

Objectives: The NLRP3 inflammasome amplifies inflammation and may contribute to the destruction of tooth-supporting tissues in periodontitis. This study evaluated the expression of inflammasome markers (NLRP3, AIM2, IL-1β, TNF-α, CASP1, IL-10, TLR2, and TLR4) and the epigenetic patterns of NLRP3 and IL-1β in primary gingival fibroblasts from healthy individuals and patients with Grade C periodontitis (PerioC). Materials and methods: Cells were exposed to Aggregatibacter actinomycetemcomitans Protein Extract ( Aa PE) (5 µg/ml) for 1.5 h. After the experimental period, total RNA and DNA were collected and extracted. Total RNA was isolated and gene expressions of TLR2, TLR4, NLRP3, CASP1, AIM2, IL-10, IL-1β and TNF-α were analyzed via qPCR. DNA methylation and hydroxymethylation patterns of the IL-1β and NLRP3 genes were evaluated. Statistical analyses were performed considering a significance level of 5%. Results: Fibroblasts from PerioC exhibited higher AIM2 levels before and after stimulation compared to healthy individuals ( p < 0.05). Conversely, IL-10 expression was lower in PerioC before Aa PE incubation ( p < 0.05). NLRP3 expression increased post-stimulation in healthy cells but remained unchanged in PerioC. IL-1β expression was consistently lower in PerioC in both conditions. The NLRP3 gene showed reduced methylation after Aa PE exposure only in healthy fibroblasts, resulting in lower methylation levels compared to PerioC ( p < 0.05). Conclusions: PerioC fibroblasts exhibited dysregulated inflammasome-related gene expression and a distinct epigenetic response to AaPE, suggesting altered local immune regulation at the transcriptional level. Clinical relevance: Patients with severe and rapidly progressing periodontitis exhibit an altered inflammasome-related gene expression and epigenetic response to bacterial stimulation. The reduced transcriptional responsiveness of inflammatory mediators and distinct DNA methylation profile observed in PerioC cells may contribute to ineffective host defense and persistent periodontal tissue destruction.

Background: A gummy smile can result from several factors, often leading to a disharmonious appearance and causing physical and psychological discomfort for the patient. This study aimed to evaluate changes in self‐esteem and quality of life for patients, as well as the recidivism rate, following aesthetic crown lengthening (ACL) surgery. Methods: Twenty‐two periodontally healthy patients who expressed interest in undergoing ACL and met the procedural indications were selected. Before surgery, at 30 days, and 2 years postoperatively, the Oral Health Impact Profile – 14 items (OHIP‐14) and the Rosenberg Self‐Esteem Scale were used to assess patients' perceptions of quality of life and self‐esteem. Crow dimensions, gingival phenotype, and the recidivism rate were assessed. Results: ACL significantly improved the psychosocial parameters of patients ( p < 0.05). Both self‐esteem and quality of life showed improvement 30 days post‐surgery ( p = 0.02 and 0.00024, respectively). After 2 years, further improvements were observed in the self‐esteem index compared to the 30‐day results (from 11 [interquartile range {IQR}: 8.0–14.0] to 14 [IQR:12–15, p < 0.05]) and in the OHIP score (from 19 [IQR:14–27] to 6 [IQR: 0.0–8.0]). The clinical crown length established 30 days after surgery remained stable after 2 years (0.82 ± 0.11). Conclusions: ACL can enhance patients' quality of life and self‐esteem, serving as a valuable procedure in aesthetic periodontics. Plain language summary: A “gummy smile,” where too much gum tissue shows when a person smiles, can affect both appearance and confidence. This study looked at whether aesthetic crown lengthening surgery (a procedure that reshapes the gums and exposes more of the teeth) could improve how people feel about themselves and their daily lives. We followed 22 patients who underwent this surgery and measured their self‐esteem and quality of life before the procedure, 1 month later, and again 2 years after the procedure. Results showed that patients felt noticeably better about their smiles and overall quality of life just 1 month after surgery. Even more encouraging, these benefits continued to grow over the course of 2 years, with patients reporting higher self‐esteem and fewer problems related to their oral health. Importantly, the changes achieved by the surgery—such as the new tooth and gum proportions—remained stable, with no return of the gummy smile. These findings suggest that crown lengthening is not only an effective and lasting solution for improving the appearance of a gummy smile but also has meaningful, long‐term benefits for patients’ confidence and well‐being.

Background: This study aimed to evaluate the radiographic bone level in primary molars in a Brazilian population, define the prevalence of bone loss, and identify the local factors associated with early bone alterations. Methods: Radiographs of children who attended Piracicaba Dental School (Brazil) between 2014 and 2020 were evaluated. Two calibrated examiners measured the distance between the cementoenamel junction and the bone crest (CEJ‐BC) in bitewing radiographs, and CEJ‐BC > 2 mm represented bone loss. Local factors in the measured sites were screened. Multiple linear and logistic regressions were used in the analysis. Results: 828 bitewing radiographs from 527 patients (8.27 ± 1.71 years) were evaluated. The mean CEJ‐BC distance was 1.12 ± 0.40 mm (0.0–3.4 mm). 85 sites were positive for bone loss, with a prevalence of 2.62% at site and 13.28% (70 individuals) at patient levels. Male patients, increasing age, maxilla, first primary molars, and local factors were related to a higher CEJ‐BC. Pulpectomies, fillings, and adjacent tooth eruption were positively associated with bone loss, and those statistically significant local factors were present in 42.4% of the sites with bone loss. Conclusion: The prevalence of radiographic bone alterations in primary molars was 13.28%. The CEJ‐BC distance and bone loss were positively associated with local factors (58.8% of the cases); however, 41.2% of the sites positive for bone loss did not present the local factors evaluated in this study. Clinical Relevance: Scientific rationale for this study : Bone loss can be present in children and adolescents, and radiographic evaluation could help to elucidate its prevalence and the factors associated with its occurrence. Principal findings : A prevalence of 13.28% bone loss was found at the patient level in primary molars in a Brazilian population, and local factors were positively associated with bone alterations. Despite some cases diagnosed with bone loss being related to local factors, 41.2% had no association with the local risk factors evaluated in the study. Practical implications : The findings regarding bone loss prevalence in primary dentition highlight the importance of careful radiographic examination in children and adolescents as an initial tool to diagnose periodontitis at early stages and to prevent severe damage. Plain Language Summary: This study analyzed x‐rays of Brazilian children to assess bone loss in primary molars. It aimed to determine how common bone loss is and to identify local factors linked to the associated bone loss. Researchers reviewed 828 x‐rays from 527 children (average age 8.27 years) who visited Piracicaba Dental School between 2014 and 2020. Bone loss was identified when the distance between the cementoenamel junction and bone crest (CEJ‐BC) was greater than 2 mm. The results showed an average CEJ‐BC distance of 1.12 mm, with 85 areas showing bone loss. The bone loss prevalence was 2.62% per site and 13.28% per patient. Factors linked to higher bone loss included being male, older age, having teeth in the maxilla, first primary molars, and specific local factors. Procedures such as pulpectomies, fillings, and nearby tooth eruptions were associated with bone loss; however, 41.2% of cases identified with bone loss did not present the local factors evaluated in the study. The study concluded that 13.28% of children showed bone changes in their primary molars, with bone loss linked to local factors and other conditions.

Background: Individuals with Down syndrome (DS) are particularly vulnerable to early‐onset and rapidly progressing periodontitis, yet the local immune‐inflammatory alterations that contribute to this susceptibility are not fully understood. This study aimed to characterize cytokine profiles in gingival crevicular fluid (GCF) from individuals with DS and periodontitis and to compare them with those of periodontitis patients without DS and periodontally healthy controls. Methods: Forty‐five participants were enrolled and divided equally into three groups ( n = 15 each): DS with periodontitis (DSP), periodontitis without DS (P), and systemically and periodontally healthy controls (C). GCF samples were collected from two interproximal sites per participant and analyzed for IL‐1β, IL‐4, IL‐6, IL‐10, TNF‐α, and IFN‐γ using multiplex immunoassays. Standard periodontal parameters, including probing depth, attachment level, bleeding on probing, and plaque index, were also recorded. Non‐parametric comparisons and multivariate approaches, including principal component analysis and hierarchical clustering, were employed to explore cytokine distribution patterns. Results: Individuals with DS and periodontitis exhibited a heterogeneous but predominantly pro‐inflammatory cytokine profile, characterized by elevated IL‐1β, IL‐6, TNF‐α, and higher Th1/Th2 and IL‐1β/IL‐10 ratios. In contrast, the P group demonstrated a Th2‐skewed response with higher levels of IL‐4, IL‐10, and IFN‐γ, suggestive of compensatory immune regulation. Healthy controls consistently displayed the lowest cytokine concentrations. Conclusion: This preliminary study identifies a distinct pro‐inflammatory cytokine profile in Down syndrome‐associated periodontitis, characterized by heightened IL‐1β responses and a Th1‐skewed immune pattern. While limited by sample size and the absence of a DS‐healthy control group, these findings provide initial mechanistic insights into the accelerated periodontal breakdown observed in DS and lay the groundwork for future, larger‐scale investigations. Plain language summary: People with Down syndrome (DS) often develop gum disease, called periodontitis, much earlier and more severely than others. This condition damages the tissues and bone that support the teeth and can lead to tooth loss. Researchers believe that an overactive immune system may play a role, but the exact reasons are not well understood. In this study, we examined the levels of several immune signaling molecules, called cytokines, in the fluid around the gums of people with DS and periodontitis, comparing them with individuals with periodontitis but without DS and with healthy participants. We found that people with DS and periodontitis had higher levels of inflammatory cytokines, showing an exaggerated immune reaction dominated by molecules that promote inflammation. In contrast, people with periodontitis but without DS showed signs of a more balanced immune response, including molecules that help to limit inflammation. These findings suggest that individuals with DS experience a stronger and less controlled inflammatory reaction in their gums, which may explain why their gum disease progresses so rapidly. Understanding these immune differences may help to develop better prevention and treatment strategies for people with Down syndrome.

Aim: Molar‐Incisor ( PerioC ‐ MIP ) and Generalized ( PerioC ‐G) Grade C Periodontitis could have distinctive etiopathogenesis behind their unique clinical patterns. Thus, this study aimed to distinguish these two phenotypes by analyzing the subgingival metagenomic profile and the inflammatory markers levels. Methods: In this cross‐sectional comparative study, Gingival Crevicular Fluid ( GCF ) and Subgingival Biofilm ( SB ) were collected from 18 PerioC ‐ MIP North Americans and 14 periodontally healthy controls ( HC ) from the same location ( HC ‐ MIP ) and 20 PerioC ‐G Brazilians and 20 controls ( HC ‐G). From GCF , immunoenzymatic analysis was performed. SB functional and taxonomic bacterial content was determined using shotgun metagenomics sequencing. Results: Taxonomic results showed significantly different alpha‐ and beta‐diversity profiles between disease groups ( p < 0.05). Aggregatibacter actinomycetemcomitans and Streptococcus sanguinis were associated with PerioC ‐ MIP ; levels of Tannerella forsythia , Filifactor alocis , Porphyromonas gingivalis , Fretibacterium fastidiosum , and Treponema denticola were significantly enriched at PerioC ‐G ( p < 0.05). PerioC ‐G had the function for flagellar assembly enriched, while PerioC ‐ MIP SB was associated with biofilm formation of Escherichia coli . Different GCF inflammatory marker levels for each pattern resulted in PerioC ‐G presenting higher levels of IL ‐1β, IL ‐6, and IL ‐10 than PerioC ‐ MIP ( p < 0.05). Conclusion: PerioC ‐G and PerioC ‐ MIP presented different taxonomical profiles and GCF cytokine levels, raising the hypothesis that they may represent two different stages/susceptibility patterns of Periodontitis Grade C.

This study evaluated the biomechanical behavior of narrow-diameter Morse taper implants (3.5 mm) placed in bone of different densities and at different depths, using finite element analysis. Sixteen three-dimensional virtual models, meshed with tetrahedral elements, were created. Each model comprised cortical bone, cancellous bone, a Morse taper implant, an abutment, and a single maxillary central incisor crown. An oblique force (30 degrees buccally) of 150 N was applied to evaluate peri-implant stress distribution across four bone densities (D1, D2, D3, and D4) and at four placement depths (0, 1, 2, and 3 mm). The interfaces were modeled as perfectly bonded, except at the implant-abutment interface (friction coefficient = 0.3). All materials were assumed to be linearly elastic and isotropic. After a nonlinear analysis, the maximum and minimum principal stresses, maximum principal strain, and Mohr-Coulomb ratio were recorded. The results revealed a stress distribution pattern with lower peak stress values at shallower placement depths and in D1 bone. All groups showed a similar trend: as the implant placement depth increased, the point of greatest stress concentration shifted apically. Implant placement in cortical bone provided a protective effect under oblique loads. In D3 and D4 bone types, crestal placement showed better biomechanical performance than subcrestal placement.

Objective: To analyze the availability of periodontal instruments, services, and specialized referrals in Primary Health Care and compare Brazilian geographical regions. Material and Methods: The historical time series analysis was carried out based on secondary data extracted from the 1st (2012), 2nd (2014), and 3rd (2018) cycles of the external evaluation of the Basic Care Access and Quality National Program. A comparison was carried out between the proportion (%) of Oral Health Teams (OHT) and dependent variables (Periodontal instruments, service offered, and specialized referral) and the independent variables of Brazilian geographical regions and years. Results: The number of OHT evaluated was 12,562 (2012), 18,333 (2014), and 21,817 (2018). Increase was observed in the availability of periodontal probe, periodontal curette, sharpening stones, and sodium bicarbonate jet for the Brazilian OHT, and in all regions of the country between 2014 and 2018 (p<0.001), and reduction in the availability of dental ultrasound in Brazil, mainly in the Southern (p<0.001), Southeastern (p<0.001), and Midwestern (p=0.008) regions. Supragingival Scaling and Root Planing were the most commonly performed periodontal procedures. At the same time, frenotomy/frenectomy was the least performed procedure by the OHT in Brazil and in all Brazilian regions, with a gradual increase according to the cycle (p<0.001). The offer of periodontal specialist referral increased from 54.6% (2012), 68.3% (2014), to 81.8% (2018) in Brazil and all Brazilian regions (p<0.001). Conclusion: Despite the increase in periodontal instruments, procedures, and specialist referrals in Brazil, regional differences were still observed.

Aim: To investigate whether periodontitis in parents is associated with differences in the faecal microbiome and systemic markers in both themselves and their children. Methods: Eighty participants were divided into four groups ( n = 20): parents with periodontitis (PP); healthy parents (PC); and their respective children (CP, CC). Clinical periodontal parameters were recorded. Saliva and faecal bacterial DNA were analysed via 16S rRNA sequencing. Salivary lactoferrin, faecal calprotectin, gingival crevicular fluid cytokines (IFN‐γ, IL‐10, IL‐17, IL‐1β, IL‐4, TNF‐α) and urinary intestinal permeability markers (claudin‐2, ‐3, ‐4, haptoglobin) were quantified. Results: Parents with periodontitis showed distinct faecal microbiota profiles, which were mirrored in their children and significantly differed from controls. Claudin‐2 levels were elevated in both PP and CP groups ( p < 0.05) and positively correlated with the oral dysbiosis index and the faecal Firmicutes/Bacteroidetes ratio. Conclusions: Parental periodontal health appears to influence the faecal microbiome and systemic markers in the offspring. These findings highlight a potential pathway for oral–gut microbial transmission and its relevance to systemic health, warranting further investigation.

Aim: To evaluate the subgingival proteome and microbiome of mothers with periodontitis and their offspring, thereby assessing signatures of periodontal diseases. Methods: Forty participants in four groups were included: mothers with periodontitis and their offspring, as well as periodontally healthy mothers and their offspring. Periodontal clinical parameters were assessed. Gingival crevicular fluid (GCF) and subgingival biofilm were collected from the same sites. Proteome from GCF was investigated by liquid chromatography‐tandem mass spectrometry with data‐independent acquisition (DIA‐PASEF). Bacterial DNA from subgingival biofilms was sequenced using the 16S rRNA gene for taxonomy assignment. Results: Overall, 6147 bacterial and human proteins (≥ 2 peptides) were quantified. Despite the absence of attachment loss, the offspring of mothers with periodontitis presented with similar proteotypes as their mothers, characterised by up‐regulation of inflammatory response cascades and down‐regulation of epithelial barrier proteins. They also displayed higher colonisation patterns by periodontopathogens while presenting with increased expression of bacterial virulence proteins compared with controls. Conclusion: The study showed that the maternal periodontal microbiome and proteome associate with those of the offspring and relate to maternal periodontal status. These early ecological events may potentially promote offspring's susceptibility to dysbiosis and may predispose them to periodontitis.

This study investigated the distinct microbiological and immunologic characteristics of peri-implantitis as compared with periodontitis. Both diseases are biofilm-driven inflammatory conditions affecting supportive tissues around teeth or implants, but their specific causes remain not fully understood. A cross-sectional study was carried out to compare the microbial profiles (i.e., composition and functional activity), the inflammatory mediators in crevicular fluid, and the potential impact of titanium particles in peri-implantitis. Twenty patients with moderate to severe periodontitis and 20 with peri-implantitis were included. Clinical assessments were performed, and biofilms were collected for 16S rRNA gene sequencing and metatranscriptomic analysis. Gingival crevicular fluid and peri-implant crevicular fluid were obtained to measure inflammatory markers and titanium levels (peri-implantitis group only). Results showed significant differences in microbial diversity between peri-implantitis and periodontitis. Specifically, peri-implantitis displayed enrichment of species such as Streptococcus parasanguinis , Streptococcus mutans , Cutibacterium acnes , and Aerococcus viridans . Additionally, the immune response in peri-implantitis appeared skewed toward a Th2/Th17 dominance. Analysis of the biofilm’s functional activity presented heightened expression of genes associated with flagella, bacterial chemotaxis, and various metabolic pathways in the peri-implantitis group. Interestingly, titanium levels modulate the overall microbial community structure, are associated with the abundance of certain peri-implantitis–associated species, and are positively correlated with Th17 levels in PICF. Peri-implantitis harbors distinct microbial communities and inflammatory patterns, potentially influenced by titanium particles. These findings suggest a unique environment driving tissue destruction in peri-implantitis as compared with periodontitis.