Diapositiva 1

Università degli Studi di Milano-Bicocca
Facoltà di Medicina e Chirurgia
Dipartimento di Neuroscienze e Tecnologie Biomediche
Corso di Laurea Specialistico in Odontoiatria e Protesi Dentaria
Corso di Laurea in Igiene Dentale
SCUOLA DI DOTTORATO IN SCIENZE MEDICHE SPERIMENTALI E CLINICHE
PHD in EXPERIMENTAL PERIODONTOLOGY
Coord: Prof. M. Baldoni
DOTT. ALBERTO BALDINI
Scholarship HEART FRIENDS AROUND THE WORLD
SAN PELLEGRINO TERME BERGAMO ITALY CLINICA QUARENGHI
17-23 MAY 2010
Università degli Studi di Milano-Bicocca
Facoltà di Medicina e Chirurgia
Dipartimento di Neuroscienze e Tecnologie Biomediche
Cattedra di Clinica Odontoiatrica
U. O. di Odontostomatologia
Corso di Laurea Specialistica in Odontoiatria e Protesi Dentaria
Corso di Laurea in Igiene Dentale
Scuola di Specializzazione in Chirurgia Orale
Dottorato di Ricerca in Parodontologia Sperimentale
Direttore: Prof. Marco Baldoni
_______________________________________________________________
CLINICA ODONTOIATRICA
PHD IN EXPERIMENTAL PERIODONTOLOGY
Stem cells
Strategies of regenerative medicine
Directed Differentiation
Biomimetic Scaffold to
make Bioartificial
Tissues
Biomimetic Scaffold to
induce regeneration
from resident cells
Vats A, Tolley NS, Polak JM,
Buttery LDK. Stem cells:
sources and applications.
Clin Otolaryngol 27:227232;2002
Stocum DL. Stem cells in
regenerative biology and
medicine. Wound Rep Reg
9:429-442; 2001
Past 2002-2006
Tissue Engineering: Development of New Strategies for Periodontal
and Alveolar Bone Regeneration by Using Haematopoietic-Derived
Mesenchymal Cells in Animal and Human. Evaluation of Systemic
Effects
Presentato a valere sul FIRB e ammesso al contributo MIUR con
Decreto Direttoriale n. 2 del 24/07/2002
STUDY PROTOCOL
DOSSIER PTC – MSC ODONTO
Alveolar bone regeneration in human by using hard tissue
engineering with bone marrow mesenchymal stem cells – Clinical
study.
Present 2007
Formulazione del brevetto
Autorizzazione all’utilizzo sull’uomo
Future 2008……
TISSUE ENGINEERING AND MESENCHIMAL
STEM CELLS:
SPERIMENTAL PROTOCOL OF PERIODONTAL
TISSUE REGENERATION
Regeneration of cranium facial tissues: bone
tissue and dental tissue.
• Application in bone tissue
regeneration
•
Application in dental pulp regeneration
•
Application in radicular cementum
regeneration.
•
Application in enamel regeneration.

Periodontology
Oral Surgery
PERIODONTAL DISEASE
The Periodontal Disease
The Periodontal disease is a chronic inflammation that provokes the
distruction of the periodontal tissues of support of the tooth, caused by
particularly bacterias pathogen in the dental plaque that organize on the
dental and periodontal surfaces .
(Sanz & Quirynen 2005)
Italian Society of Periodontology
2007
The Periodontal Disease
Caso clinico
Donna di 2 2 anni
PPD=2,6 CAL=2.1, BOP: presente in
maniera generalizzata.
Malattia Parodontale da lieve a grave
Paziente cardiopatico
sec Lindhe.
Trattamento parodontale non
chirurgico laser-assistito
Pre-Op
After 3 months
After 6 months
The Periodontal Disease
 SEVERE PERIODONTITIS IN 5 ,15 % OF
POPULATION
 WHO 2000

Pre-Op
Pre-Op
After 6 m.th
After 6 m.th
Before Laser
Pre-Op
Pre-Op
After 6 m.th
6 m.th
After 6 m.th
““
PERIODONTAL DISEASE
Parodontite aggressiva in un paziente uomo di 56 anni.
BIBLIOGRAFIA: RANNEY R.R. Diagnosis of Periodontal Diseases, Adv. Dent. Res. 1991. SOCRANSKY S, ANNE S & HAFFAJEE D. Periodontal microbial ecology, Periodontol 2000.
“ INNOVATIVO APPROCCIO GENETICO E MICROBIOLOGICO ALLA DIAGNOSI E ALLA TERAPIA
DELLA MALATTIA PARODONTALE: RUOLO DELL’IGIENISTA TRA CLINICA E RICERCA “
BACTERIAS AND PERIODONTAL DISEASES
BIBLIOGRAFIA: [Loesche et al., 1982]; [Haffajee et al., 1988].. CUTRESS HUNTER PB, HOSKINS DI. Comparision . f the eriodontal Index (PI) and Community Index of Treatment Needs
(CPITN) . LYONS SR, GRIFFEN AL, LEYS EJ. Quantitative real-time PCR for Porphyromonas gingivalis and total bacteria..
“ INNOVATIVO APPROCCIO GENETICO E MICROBIOLOGICO ALLA DIAGNOSI E ALLA TERAPIA
DELLA MALATTIA PARODONTALE: RUOLO DELL’IGIENISTA TRA CLINICA E RICERCA “
GENETIC
Genoma umano
Alleli
Polimorfisimi genetici
Diploide
= 23 coppie di cromosomi
Periodontal
Disease
22 cromosomi
autosomici
1 cromosomi sessuali
XX nelle femmine
XY nei maschi
conseguenze biologiche
IL-1α, IL-1β,IL-1RN, IL-10, TNF-α e COX2
INTERLEUKINA-1
citochina secreta da cellule del sistema immunitario
BIBLIOGRAFIA: KINANE DF, SHIBA H, HART TC. The genetic base of periodontits. KORNMAN K.S, CRANE A. The interleukin-1 genotype as a severity factor in adult periodontal diseas.
KREBS D, HILTON D. SOCS: physiological suppressors of cytokine signaling.
The Periodontal Disease
In Italy about the 60% of the population is affected
by Periodontal disease (moderate and mild ) and
about 10-14% shows (severe forms of periodontal
diseases ). These last forms grow-up in the age
from 5 0 and 70 years .
Italian Society of Periodontology
2007
PERIOMEDICINE
PERIO-MEDICINE
 Reports from clinical studies randomized informationed an




improvement of systemic inflammation after non surgical
periodontal therapy.
The Periodontal disease can increase the systemic inflammatory load
contribute to the inflammatory cronic disease like all the chronic
pathologies (Atherosclerosis)
Two Hypothesis :
1) The bacterias that cause the periodontal disease penetrate in the
gingival tissues and then in systemic blood.
2) The periodontal bacterias can produce an intense inflammatory
local answer with sistemic effects.
PERIODONTAL
DISEASE
PERIOMEDICINE
Adverse
Pregnancy
Diabetes
Mellitus
Cardiovascolar
Disesase
PERIODONTAL DISEASE
PERIOMEDICINE
Adverse
Pregnancy
Diabetes
Mellitus
Cardiovascolar
Disesase
ADVERSE PREGNANCY
ADVERSE PREGNANCY
 La Malattia Parodontale puo’ aumentare il rischio di parto prematuro e
di nascita di neonati sottopeso.
 Due ipotesi:
 1) Le donne con malattia parodontale hanno frequentemente episodi di
batteriemia e i batteri attivano una cascata di conseguenze
infiammatorie a livello della placenta e del feto con rischio di parto
prematuro e nascita bambini sottopeso.
 2) La malattia parodontale determina la produzione generalizzata di
citochine che avendo attivita’ proinfiammatoria provocano contrazioni
uterine.
PERIODONTAL DISEASE
PERIOMEDICINE
Adverse
Pegnancy
Diabetes
Mellitus
Cardiovascolar
Disesase
DIABETES MELLITUS
 The subjects with diabetes have frequently associated
gengivitis and diabetes.
 The association is transitive: the control of oral biofilm
and inflammatory factors can improve the level of
glicemic control, some inflammatory cytokines as
 IL- 6,TN alfa seem cause envelope of insulino-resistance.
PERIODONTAL DISEASE
PERIOMEDICINE
Adverse
Pegnancy
Diabetes
Mellitus
Cardiovascolar
Disesase
CARDIOVASCOLAR DISEASES
INCIDENCE CDV DISEASE
 The Cardiovascolar Diseases represent also
today the most important cause of death in the
world, cause the 44% of all the deaths.
In particular Coronary heart disease is in Italy
the most important cause of death 28%.
Bahekar A. Singh S.
The prevalence and incidence of coronary heart disease is significantly increased in
periodontitis. American Heart Journal 2007
FACTORS OF RISK OF PERIODONTAL DISEASE
 Smoke
 Genetic Predisposition
 Scarce Oral Hygiene
 Feeding (Obesity)
 Bacterial Infection
 Diabetes( risk increased of 3 times)
Tonetti 2008 SIDP
FACTORS OF RISK OF CARDIOVASCOLAR DISEASE









Smoke
Metabolic Factors
Hypertension
Stress
Bacterial Infection
Genetic Factors
Marker inflammation of blood
Feeding (Obesity)
Cholesterolemy
World Health Statistics 2006
FACTORS OF RISK OF PERIODONTAL DISEASE
 Smoke
 Genetic Predisposition
 Scarce Oral Hygiene
 Feeding (Obesity)
 Bacterial Infection
 Diabetes( risk increased of 3 times)
Tonetti 2008 SIDP
SMOKE
The Smoke is one of the most
important risk of factors for the
Periodontal disease.
G.R.Persson; 2008 , Cardiovascular disease and periodontitis: an update on the
associations and risk; J. of Clinical Periodontology
GENETIC PREDISPOSITION
The Periodontal disease envelopes in a severe way in
genetic subjects with predisposition .
The genetic suscectibility is caused from:
 low efficacy of the immune system
 imperfect regolation of the inflammatory answer
Michalowicz 1991 et Shapira 2005
SCARCE ORAL HYGENE
A great importance in cause the periodontal disease is given
from style of life particularly to the habits of oral hygene .
Palmer 2005
THE FEEDING(OBESITY)
The risk of periodontal disease increase three times in
subjects with index of body between 25 and 29,9 . In
obese subjects ,the adipocites produce inflammatory
cytokines .
(Saito 2007)
BATTERIC INFECTION
 Either in CVD disease and Periodontal
disease have been found some bacterial
species like A. Actinomicetemcomitans,
P.Gingivalis, P.Intermedia e T. Denticola.
Sharp A. , Klein E. Periodontal Infection and
coronary heart disease:
role of periodontal bacteria and importance of total pathogen burden in the
coronary event and periodontal disease. Intern Med 2006
DIABETES
Studies have showed how in patients with the diabetes
disease is easier to have gingivitis and periodontal
disease. The risk for a diabetic subject to fall ill of
periodontal disease is three times easier in confront to
a non diabetic subject.
Emrich 1991 et Yalda 1994
The Periodontal disease is a Risk
factor for CVD ?
• In the last 15 -20 years the concept of risk is changed in
the clinical practice.
• The traditional factors of CVD risk even if are very
important in primary prevention they don’t find in
percentage of 10-15% of subjects with cardiovascolar
events.
F. D’Aiuto SIDP 2008
RELATIONSHIP WITH
PERIODONTAL DISEASE AND SYSTEMIC DISEASES
CARDIOVASCULAR DISEASE
Gingival Inflammation
Periodontal
Patogens
Inflammatories Mediators
IL-1, IL-6, TNF
Batteremy
Inflammation
Immune
response
Liver (C- reactive protein,
fibrinogen)
I batteri
inducono
l’aggregazione
piastrinica,
invadono
l’endotelio.
Dottorato di Ricerca in
Parodontologia
Sperimntale
Coordinatore:
prof. M. Baldoni
(heart ,brain etc)
Anticorpi contro
batteri , gli antigeni
cross-reattivi
sensibilizzano i
linfociti T
REVIEW
 Cardiovascular disease and periodontitis (Persson 2008)
 Periodontal disease and C-reactive protein associated cardiovascular
risk (F. D'Aiuto, D.Ready, S. Tonetti 2004)
 Periodontal pathogens in atheromatous plaques. (F. Cairo, C. Gaeta, W.
Dorigo, M. R. Oggioni, C. Pratesi, G. P. Pini Prato, G. Pozzi 2004)
 Severe periodontitis in young adults is associated with subclinical
atherosclerosis (F. Cairo, S. Castellani, A. M. Gori, M. Nieri, G.
Baldelli, R. Abbate and G. P. Pini-Prato 2007)
 Systemic markers of inflammation in periodontitis (Loos BG 2005)
PERIO-CVD
Periodontal disease and Health : consensus
report of the Sixth European workshop on
Periodontology
“Evidence suggests that having periodontitis contributes to the total infectious
and inflammation burden and may contribute to cardiovascolar events and
stroke in suscheptible subjiects.The impact of Periodontal therapy must be
further investigated”.
Kinane D.,Bouchard P.2008
J.Clin Periodontology 2008;35 (suppl 8);333-337.
New technologies in Periodontal disease
• Non surgical therapy in Periodontal therapy
-Microbiological Test
-Laser-therapy
Linea Guida Sezione Parodontologia
Clinica Odontoiatrica
Università Milano Bicocca 2001
New technologies in Periodontal disease
• Non surgical therapy in Periodontal therapy
-Microbiological Test(PCR Real Time)
-Laser-therapy
Linea Guida Sezione Parodontologia
Clinica Odontoiatrica
Università Milano Bicocca 2001
Patogens bacterias present in periodontal
disease.
• Actinobacillus actinomycetemcomitans
• Porphyromonas gingivalis
• Prevotella intermedia
• Bacteroides forsythus
• Fusobacterium nucleatum
• Peptostreptococcus micros
• Spirochete (Treponema Denticola)
• Altri
MICROBIOLOGICAL DIAGNOSIS
Pasteur BJ et al. Journal of Bacteriology 2001; 183:3770-3783
Molecolar Exam
Cotti M., Corvino E. ,Gaeta C., Orrù G., La parodontite giovanile da Actinobacillus
Actinomicetemcomitans.Diagnosi molecolare con identificazione dei genotipi virulenti
.Atti del Simposio SIOCMF “Diagnostica e terapia nel cavo orale del paziente
pediatrico”,Cagliari 26-27 Aprile 2002,suppl. Doctor Os,Anno XIV n.1 Gennaio 2003,
pp.12-13
PCR Quantitative Real-time
Fluorescent probe
DNA of pathogen bacteria
Bond probe -DNA = fluorescent
The PCR amplifies the
number of molecules of
bacterial DNA increase of
the fluorecent
Morrison TB et al. Biotechniques 1998; 24:954-958
INTEGRATED PERIODONTAL TEST
Test analitico microbiologico e genetico
integra i dati dell’esame obiettivo
test microbiologico
BIBLIOGRAFIA: CORVINO E, GAETA C, POZZI G,. Virulence factor of periodontal pahogens: act. actinomycetemcomitans, porp. gengivalis, prev.intermedia
LASER
The word LASER is the meaning of
“Light Amplification by
Stimulated Emission of
Radiation”
New technologies in Periodontal disease
• Non surgical therapy in Periodontal therapy
-Microbiological Test
-Laser-therapy
Linea Guida Sezione Parodontologia
Clinica Odontoiatrica
Università Milano Bicocca 2001
Baldini A.,Monguzzi R., Tredici
G.,M.Baldoni
IADR Honolulu
12 Marzo 2004
Pre-trattamento Laser
Cardiopatic Patient 63 aa
*
batterio
individuato
Specie batterica
Actinobacillus
actinomycetemcomitans
Conta
batterica
**
conta batterica
elevata
*** conta batterica
molto elevata
Neg.
Enterococcus faecalis
Neg.
Tannerella forsythensis
2x107
Porphyromonas
gingivalis
1.5x10
Prevotella intermedia
Conta batterica
***
***
6
1.6x10
7
***
Treponema denticola
8x108
***
Fusobacterium
nucleatum
5.5x10
Micromonas micros
Carica totale
***
7
8.5x10
*
2
Non
2
3
4
5
6
7
8
9
10
Rilevat1 10 10 10 10 10 10 10 10 10 10
a
Terapia Parodontale non chirurgica laserassitita
-Test microbiologico
Protocollo Terapeutico laser-assistito
Protocolli di igiene domiciliare
Controlli periodici (TPS)
PCR a 12 mesi
Actinobacillus
actinomycetemcomitans
Neg.
Enterococcus faecalis
Neg.
Tannerella forsythensis
2,75
Porphyromonas
gingivalis
1,47
Prevotella intermedia
3,98
Treponema denticola
1,77
Fusobacterium
nucleatum
Neg
Micromonas micros
3,71
Periodontal
Diagnosis
Microbiological
evaluation and
control
CVD
Patient
Laser
Therapy
Periodontal
Treatment
Thank you for
attention