Microbial Profiling in Experimentally Induced Biofilm Overgrowth Among Patients With Various Periodontal States
- Autores: Andre Paes Batista da Silva, Silvana Pereira Barros, Kevin L. Moss, John S. Preisser, Julie T. Marchesan, Marilyn Ward, Steven Offenbacher
- Localización: Journal of periodontology, ISSN 0022-3492, Vol. 87, Nº. 1, 2016, págs. 27-35
- Idioma: inglés
- Enlaces
-
Resumen
Background: This study measures microbial composition changes during biofilm overgrowth and subsequent removal among patients with various states of periodontal disease.
Methods: In this prospective cohort study, 175 participants with various periodontal states (five biofilm-gingival interface [BGI] groups) abstained from oral hygiene while using an acrylic stent. At day 21, participants reinstituted oral hygiene and were followed for 4 weeks. Clinical parameters were recorded, and subgingival plaque samples were analyzed at baseline, peak of induction (day 21), and resolution using 16S rRNA probes (human oral microbe identification microarray [HOMIM]). Using the change score (peak at induction minus baseline) for bleeding on probing and probing depth (PD), the patients were separated into high and low clinical responders.
Results: At baseline, synergistetes were more abundant in moderate and severe periodontitis (BGI-P2 and -P3) compared to mild periodontitis (BGI-P1), health (BGI-H), and gingivitis (BGI-G) (P = 0.005). Overall, at day 21 there was an increase in HOMIM scores of firmicutes (P ≤0.001), fusobacteria (P = 0.003), proteobacteria (P ≤0.001), synergistetes (P = 0.04), and bacteroidetes (P ≤0.001). At resolution, these phyla returned to baseline, except for synergistetes. Levels of synergistetes were significantly higher at day 21 (P ≤0.0001) and resolution (P = 0.0002) for high clinical responders compared to low responders.
Conclusion: The association of synergistetes as a baseline predictor of incident PD increase, as well as the higher levels at day 21, indicates a pathogenic role for these organisms in disease progression in addition to the previously characterized fusobacteria, proteobacteria, firmicutes, and bacteroidetes.
Advances in molecular techniques have led to greater understanding of the diversity and complexity of periodontal microbiota communities.1-3 To the authors’ knowledge, there are no studies that characterize the subgingival microbial composition using human oral microbe identification microarray (HOMIM) for the biofilm–gingival interface (BGI) classification of periodontal diseases (based on biologic phenotypes). This BGI classification4 identified new clinical categories representing distinct biologic phenotypes according to distinct patterns of biofilm composition, humoral antibody response, and local inflammatory mediator levels. Five BGI clinical conditions were defined using probing depths (PDs) and bleeding on probing (BOP) scores. The difference between this classification system and the standard system (developed by the Centers for Disease Control and Prevention and the American Academy of Periodontology)5 is related primarily to the identification of the BGI-P1 subgroup as a distinct, well-controlled minimal plaque/minimal inflammation group of patients who would otherwise be classified as having mild, moderate, or severe periodontitis according to PD and clinical attachment level (CAL). It is important to note, however, that the BGI classification data were based on the cultivable flora detected by DNA checkerboard, which identified only 18 organisms.4 Biofilm composition during stent-induced biofilm overgrowth (SIBO) in patients with various periodontal diseases has not been investigated using HOMIM. The experimental gingivitis model first described by Löe et al.6 and Theilade et al.7 has been extensively used to study the changes in gingival clinical signs and biofilm composition after biofilm overgrowth.8-11 Burrell and Walters12 and Offenbacher et al.13 adapted the experimental gingivitis model to include the use of intra-oral stents that cover only selected teeth, worn only during routine oral hygiene for 21 days, to permit the study of localized changes in biofilm overgrowth and inflammation. In the present study, to examine microbial composition changes during stent-induced biofilm overgrowth, this model is extended to include not only healthy individuals, but also patients with untreated gingivitis and periodontitis. In this model, the 21-day biofilm induction phase was followed by reinstitution of oral hygiene to permit clinical resolution. Although this is a descriptive study to characterize the complex changes in HOMIM profiles that are seen during induction and resolution, it may identify periodontal pathogens not previously associated with progression and severity of disease.
