published_or_final_version / abstract / Dentistry / Master / Master of Philosophy

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PURPOSE: The purpose of this study is to describe the subgingival bacterial biodiversity in untreated chronic periodontitis patients through the use of next generation 16S rRNA molecular analysis, and to determine similarities or differences between deep and shallow pockets within the same patients. METHODS: The analysis involved paired subgingival plaque samples from 24 subjects diagnosed with Generalized Moderate to Severe Chronic Periodontitis. One sample was selected from a single site having a probing depth >5 mm (i.e. Deep Site), and the other from a site with a probing depth <3mm (i.e. Shallow Site) within each subject. Bacterial DNA amplification of the V4-V6 region of the 16S rRNA was performed. The amplicons were sequenced via 454 Roche Genome Sequencer FLX System. The identified sequences were evaluated, and then compared to calculated false discovery rates. RESULTS: A total of 119 independent microbial genera were identified within the samples analyzed. Seven genera were identified to be statistically significant (p<0.05) in their association to deep or shallow sites following t-test and boot strap randomization: Actinomyces (p=0.004), Methylobacterium (p=0.028), Veillonella (p=0.028), and Rothia (p=0.038), and Streptococcus (p=0.033) in Shallow sites; while Mycoplasma (p=0.007) and Fusobacterium (p=0.016) were associated with deep sites. However, taking into account the calculated false discovery rates, it is suggested that none of the 119 microbial genera identified in this study were significantly associated with either deep nor shallow sites. CONCLUSION: The microbial genera identified within this study to be associated with deep and shallow sites follows the traditional pattern anticipated from the literature. However, the calculated false discovery rates suggest that these results may have occurred by chance and not due to a true difference.

Periodontitis is a polymicrobially-induced, chronic inflammatory disease of the tissues that support and surround the tooth. While greater than 500 organisms are found in dental plaque, Treponema denticola is one of only a few species associated with disease. It has been hypothesized that oral bacteria disrupt host homeostasis through manipulation of the innate immune system. In this study, we examine the impact of binding and subsequent cleavage of factor H, a complement regulator, by T. denticola in the evasion and subversion of complement. The molecular interaction between the sole FH-binding protein, FhbB, and FH was detailed by x-ray crystallography, site-directed mutagenesis, and inhibition analyses. Negatively-charged amino acids of FhbB formed salt-bridges with positively-charged residues of FH within the complement control protein domains (CCP) 6 and 7. In support of its critical role in disease, FhbB was universal among T. denticola isolates, although, different strains produce highly divergent FhbB proteins. Despite extensive sequence variation, predominantly within the FH-binding determinant, all FhbB proteins have similar structure and interact with FH using nearly identical molecular mechanisms. In addition to differences in FhbB, many isolates of T. denticola displayed significant variation in the activity of the chymotrypsin-like protease, dentilisin. Neither FhbB type produced nor dentilisin activity influenced serum resistance, as all strains tested were highly serum resistant. While sequence diversity of FhbB did not influence the interaction with FH or serum resistance, FhbB proteins elicited type-specific antibodies that blocked FH binding. Collectively, these analyses indicate that FH binding is an essential complement evasion mechanism of T. denticola and characterizes the uniquely complex interaction between T. denticola and complement. The data presented here provide novel insight into the pathogenesis of disease and begins to explore a hypothetical molecular mechanism by which this key periopathogen disrupts the host innate immune system, leading to periodontitis.

Periodontal diseases are bacterially induced, inflammatory diseases which are responsible for loss of alveolar bone and connective tissue supporting the teeth which results in loss of teeth. Gram negative anaerobic bacteria are highly associated with these diseases. One of them is Porphyromonas gingivalis belonging to the phylum Bacteroidetes. Infection by P. gingivalis is recurrent after physical removal of the bacteria from the oral cavity and even after antibiotic treatment as development of resistance is not rare. Hence complete understanding the biology of this bacterium is of significance. This gram negative obligate anaerobe, being aerotolerant, manages to survive inside the oral cavity, where oxidative stress is ubiquitous. Genome sequence of P. gingivalis shows the presence of a transcriptional regulator OxyR which is a homologue of OxyR present in E. coli. P. gingivalis OxyR induces the expression of antioxidant defense genes like sod, ahpC-F, dps to protect the bacteria from oxidative stress. Expression of P. gingivalis OxyR regulon is not very well understood. Microarray studies carried out in our lab using P. gingivalis W83 to study gene regulation by OxyR, indicated that several genes in P. gingivalis are co-regulated by iron-and OxyR. Literature also supports that in iron deplete conditions genes involved in oxidative stress are down-regulated. These studies formed the basis of our hypothesis that OxyR might regulate the genes in P. gingivalis in an iron dependent manner. To study the mechanism of regulation by P. gingivalis OxyR and to determine whether OxyR regulation is iron dependent, two approaches were applied - in vitro characterization of binding and in vivo characterization. First step of in vitro characterization was to perform CHIP-chip assay to determine OxyR-binding sites present on the genomic DNA of P. gingivalis. As this assay was performed under completely anaerobic conditions, the target fragments to which OxyR was found to bind during this assay were not same as reported in literature. These and the fragments reported in literature were used for EMSA. EMSAs carried out using crude cell lysates and in vitro OxyR protein preparations showed expected results but the results were not reproducible. In vivo expressed and purified P. gingivalis OxyR never bound to the target fragments used. Preparation of a stable protein preparation and improvement in the parameters of EMSA is very important to further investigate the binding in vitro. The second approach is based on in vivo characterization of binding. This requires tagging the P. gingivalis OxyR at its C-terminus with fluorescent protein to observe its binding to the target DNA sequences. Fluorescently tagged OxyR, is expected to emit fluorescence from a highly localized area to produce sharp fluorescent spots when it is bound to its target sequences. Unbound OxyR is expected to emit a fluorescent signal which is spread over the entire area of the cell. This technique will help to determine the conditions under which OxyR binds to its target DNA sequences. This provides a means to confirm the results obtained from in vitro characterization instead of just extrapolating them.

A Periodontite é uma doença de etiologia multifatorial que acomete os tecidos de suporte dentário resultando em perda progressiva de inserção e perda óssea. Este estudo clínico controlado, aleatorizado e duplo-cego avaliou a eficácia da Terapia Fotodinâmica antimicrobiana (TFDa), em aplicações múltiplas, como terapia adjuvante ao tratamento periodontal cirúrgico em pacientes com Periodontite Crônica Avançada (PCA). Dezesseis voluntários foram submetidos ao modelo de estudo do tipo boca dividida, recebendo tratamento de acesso cirúrgico associado a raspagem e alisamento radicular (RAR) adjunto à TFDa em protocolo de aplicação nos períodos de 0, 2, 7 e 14 dias pós-operatórios (Grupo Teste - GT), ou apenas tratamento de acesso cirúrgico associado a RAR (Grupo Controle - GC). Todos os pacientes receberam orientação de higiene oral e acompanhamento por 90 dias pós-cirúrgicos. Os seguintes parâmetros clínicos e microbiológicos foram avaliados: Nível clínico de inserção (NCI), Profundidade de sondagem (PS), Recessão gengival (RG), Sangramento à sondagem (SS), Índice de placa (IP) e contagem de 40 espécies microbianas subgengivais (checkerboard DNA-DNA hybridization). Os dados foram coletados nos períodos baseline (pré-terapia básica), 60 dias (30 dias após terapia não cirúrgica) e 150 dias (90 dias pós-cirurgia). Uma redução significativa na PS foi observada aos 150 dias para o GT, quando comparado ao GC no mesmo período (p &lt; 0,05). O ganho do NCI foi significativamente maior no GT entre os tempos de 60 e 150 dias (p &lt; 0,05). As mudanças da microbiota subgengival foram similares entre os grupos (p &gt; 0,05), mas o Grupo Teste apresentou quantidades mais elevadas de bactérias compatíveis com saúde periodontal no período final do experimento em relação ao GC (p &lt; 0,05). Concluiu-se que a utilização da TFDa em aplicações múltiplas, como terapia adjuvante ao tratamento cirúrgico periodontal, produziu melhoras significativas nos parâmetros clínicos no período de 90 dias de avaliação / Chronic Periodontitis is a multifactorial disease which results in tooth supporting tissues loss. This double-blind randomized controlled clinical trial assessed the efficacy of multiple sessions of antimicrobial photodynamic therapy (aPDT) as an adjunct to surgical periodontal treatment in patients with severe chronic periodontitis (SCP). Sixteen volunteers were selected into this Split-mouth study. They were subjected to scaling and root planning in open flaps (SRP) combined with aPDT at 0, 2, 7, and 14 postoperative days (Test Group - TG), or only SRP (Control Group CG). All patients were instructed about oral hygiene and were followed up for 90 days after surgery. The following clinical and microbiological parameters were assessed: clinical assessment level (CAL), probing depth (PD), gingival recession (GR), bleeding on probing (BOP), plaque index (PI). Levels of 40 subgingival species were measured by checkerboard DNA-DNA hybridization at baseline, 60 (30 days after non-surgical therapy) and 150 days (90 days post-surgery). Data were collected at baseline (pre-intervention), at 60 days (30 days after the end of nonsurgical therapy), and at 150 days (90 days after surgery). A significant reduction in PD was observed at 150 days for the TG, when compared to the CG (p &lt; 0.05). CAL gain was significantly higher in the TG at 60 and 150 days (p &lt; 0.05). Changes in the subgingival microbiota were similar between the groups (p &gt; 0.05), but the TG revealed a larger number of bacteria associated with periodontal disease at the end of the experiment compared to the CG (p &lt; 0.05). In conclusion, multiple sessions of aPDT as an adjunct to surgical periodontal treatment significantly improved clinical parameters at 90 postoperative days

O propósito deste estudo foi avaliar o efeito adjuvante da terapia probiótica (TProb) no tratamento periodontal não cirúrgico em pacientes com Periodontite Crônica generalizada (PCg). Em um estudo clínico aleatorizado, duplo-cego e placebo-controle, 41 pacientes com PCg foram tratados com TProb associada à raspagem e alisamento radicular (RAR Grupo Teste) ou apenas RAR (Grupo Controle). Os pacientes do Grupo Teste consumiram pastilhas contendo Bifidobacterium animalis subsp. lactis (B. lactis) HN019 durante 4 semanas. Os pacientes do Grupo Controle receberam pastilhas placebo (sem probiótico). Parâmetros clínicos periodontais foram avaliados no baseline (período pré-intervenção) e em 30 e 90 dias após a RAR. Nestes mesmos períodos foram coletadas amostras de placa subgengival para contagem de 40 espécies bacterianas (checkerboard DNA-DNA hybridization) e detecção do genoma de B. lactis HN019 (Reação em cadeia da polimerase em tempo real - q-PRC), amostras do fluido crevicular gengival para avaliação dos níveis de Interleucina (IL)-1beta, IL-8 e IL-10 (Imunoensaios multiplex) e amostras de saliva para avaliação dos níveis de Imunoglobulina A (IgA) (Nefelometria). Foram realizadas, também, biópsias de tecido gengival para determinação da expressão de beta-defensina (BD)-3 e receptores do tipo Toll (TLR)-4 (reações imunohistoquímicas - estreptavidina-biotina-peroxidase). Os dados obtidos foram estatisticamente analisados (p<0,05). O Grupo Teste apresentou, aos 90 dias, redução de profundidade de sondagem (PS) e ganho de inserção clínica significativamente maiores que aqueles do Grupo Controle. O Grupo Teste também apresentou menor quantidade de bolsas periodontais moderadas (aos 30 e 90 dias) e profundas (aos 90 dias) que o Grupo Controle (p<0,05), bem como menor quantidade de pacientes (p<0,05) apresentando 3 ou mais sítios com PS &ge; 6 mm ou PS = 5mm e sangramento à sondagem (SS) positivo. O Grupo Teste apresentou menor SS (aos 30 e 90 dias) e menor IP (aos 30 dias) quando comparado ao Grupo Controle (p<0,05). Na análise microbiológica, o Grupo Teste apresentou proporções significativamente menores de espécies microbianas dos complexos vermelho (ao 30 e 90 dias) e do complexo laranja (aos 30 dias), bem como maiores proporções de espécies do complexo azul (aos 90 dias) quando comparado ao Grupo Controle. A análise por meio de q-PCR mostrou que o Grupo Teste apresentou um aumento no número de cópias/&mu;L do genoma da cepa probiótica B. lactis HN019 no biofilme subgengival aos 30 e 90 dias (p<0,05). Na análise imunológica, o Grupo Teste apresentou menor razão (valores ajustados ao baseline) de IL-1&beta; (aos 30 e 90 dias) e de IL-8 (aos 30 dias) do que o Grupo Controle (p<0,05). Apenas o Grupo Teste apresentou valores de IL-10 significativamente maiores que aqueles do baseline aos 30 dias. Não foram observadas diferenças entres os grupos nas razões de IgA aos 30 e 90 dias. Na análise imunohistoquímica, o Grupo Teste apresentou expressões significativamente maiores de BD-3 e TLR-4 em sítios doentes quando comparado ao Grupo Controle aos 30 dias. Pode-se concluir que a utilização do probiótico B. lactis HN019 como recurso adjuvante à RAR promove benefícios clínicos, microbiológicos e imunológicos adicionais no tratamento de pacientes com PCg / The purpose of this study was to evaluate the adjuvant effect of probiotic therapy (ProbT) in non-surgical periodontal treatment in patients with generalized chronic periodontitis (GCP). In this randomized, double-blind, placebo-control, 41 patients with GCP were treated with ProbT associated with scaling and root planing (SRP - Test Group) or SRP only (Control Group). The patients in the Test Group consumed lozenges containing Bifidobacterium animalis subsp. lactis (B. lactis) HN019 during 4 weeks. The patients in the Control Group received placebo (lozenges without probiotic). Periodontal clinical parameters were evaluated at baseline (pre-intervention) and at 30 and 90 days after SRP. Samples of subgingival plaque were collected to count 40 bacterial species (checkerboard DNA-DNA hybridization) and detection of genome of B. lactis HN019 (polymerase chain reaction in real time - q-PCR). Gingival crevicular fluid samples were collected for assessing levels of interleukin (IL)-1beta, IL-8 and IL-10 (multiplex immunoassays). Saliva samples were collected to measure levels of immunoglobulin A (IgA) (nephelometry). Also, biopsies of gingival tissues were performed to determine the expression of beta-defensina (BD)-3 and Toll-Like receptors (TLR)-4 (immunohistochemical reactions - streptavidin-biotin-peroxidase). The data obtained were statistically analyzed (p < 0.05). The Test Group presented, at 90 days, reduction of probing pocket depth (PPD) and clinical attachment gain significantly higher when compared to the Control Group. The Test Group also presented a lower number of moderate (at 30 and 90 days) and deep (90 days) periodontal pockets than the Control Group (p < 0.05), as well as a lower number of subjects (p < 0.05) with 3 or more sites with PPD &ge;6 mm or PPD = 5mm and bleeding on probing (BOP) positive. The Test Group presented lower BOP (at 30 and 90 days) and lower PI (at 30 days) when compared to the Control Group (p<0.05). In the microbiological analysis, the Test Group showed significantly lower proportions of microbial species of red (at 30 and 90 days) and the orange (at 30 days) complexes, as well as higher proportions of species of blue complex (at 90 days) when compared to the Control Group. q-PCR analysis showed that the Test Group presented an increase in the number of copies/&mu;L of the genome of the probiotic strain B. lactis HN019 in subgingival biofilm at 30 and 90 days (p < 0.05). In the immunological analysis, the Test Group presented a lower ratio of IL-&beta;1 (at 30 and 90 days) and IL-8 (30 days) than the Control Group (p < 0.05). Only the Test Group presented values of IL-10 significantly higher than those of the baseline at 30 days. No differences were observed between the groups on the ratios of IgA at 30 and 90 days. In the immunohistochemical analysis, the Test Group showed significantly higher expression of BD-3 and TLR-4 in sites with periodontitis when compared to the Control Group at 30 days. It can be concluded that the use of probiotic B. lactis HN019 as an adjuvant to SRP promotes clinical, microbiological and immunological additional benefits in the treatment of patients with GCP

O objetivo deste estudo foi avaliar os efeitos da administração tópica de bactérias probióticas do gênero Bifidobacterium na doença periodontal experimental em ratos. Foram utilizados 32 ratos divididos nos seguintes grupos: CT (controle), DPT (doença periodontal), CT-HN019 (controle + probiótico) e DPT-HN019 (doença periodontal + probiótico). No dia 0 do experimento, a doença periodontal foi induzida nos animais dos grupos DPT e DPT-HN019 por meio da colocação de ligaduras ao redor dos primeiros molares inferiores. Nos Grupos CT-HN019 e DPT-HN019, 2 mL de uma suspensão contendo 109 unidades formadoras de colônia/mL de Bifidobacterium animalis subsp lactis (B. lactis) HN019 foram administrados topicamente na região subgengival dos primeiros molares inferiores nos dias 0, 3 e 7 do experimento. Nos grupos CT e DPT, as administrações tópicas foram realizadas com uma suspensão sham (sem probiótico). Todos os animais foram submetidos à eutanásia 14 dias após o início do experimento. Foram coletados tecido gengival, hemi-mandíbulas e biofilme bucal para avaliação dos seguintes parâmetros: i) microbiota bacteriana (checkerboard DNA-DNA hybridization; ii) expressão de citocinas pró e anti-inflamatórias (análise Multiplex); iii) imunorreatividade de peptídeos antimicrobianos (reações imunohistoquímicas - estreptavidina-biotina-peroxidase); iv) níveis inserção conjuntiva (análise histomorfométrica) e v) microarquitetura e volume ósseos (microtomografia computadorizada por transmissão de raios X). Os dados obtidos foram submetidos à análise estatística (p < 0,05). O grupo DPT apresentou maiores valores de porosidade óssea, espaçamento de trabéculas ósseas e nível de inserção conjuntiva, bem como menor número de trabéculas e volume ósseos quando comparado a todos os outros grupos (p < 0,05). No Grupo DPT-HN019, foram observados maiores percentuais de bactérias dos complexos amarelo e azul, bem como maiores expressões de Osteoprotegerina (OPG), Beta-defensina (BD)-1, BD-2 e BD-3 quando comparados àqueles do Grupo DPT (p < 0,05). O Grupo DPT apresentou níveis de Interleucina (IL)-1&beta; Receptor Ativador do Fator Nuclear Kappa-beta (RANKL) maiores que aqueles do Grupo DPT-HN019 (p < 0,05). As razões RANKL/OPG e IL-1&beta;/IL-10 foram mais elevadas no grupo DPT do que no Grupo DPT-HN019 (p < 0,05). Dentro dos limites deste estudo pode-se concluir que o uso tópico de B. lactis HN019 promove um efeito protetor contra a perda óssea e de inserção conjuntiva decorrentes da periodontite experimental em ratos. / The purpose of this study was to evaluate the effects of topical administration of probiotic bacteria of the genus Bifidobacterium on experimental periodontal disease in rats. 32 rats were divided into groups C (control), EP (experimental periodontitis), C-HN019 (control + probiotic) and EP-HN019 (EP+ probiotic). On day 0 of the experiment, periodontitis was induced in the animals of groups EP and EP-HN019 through the placement of ligatures around mandibular first molars. In groups C-HN019 and EP-HN019, 2 mL of suspensions containing 109 colony-forming units/mL of Bifidobacterium animalis subsp lactis (B. lactis) HN019 were topically administered in the subgingival region of mandibular first molars on days 0, 3 and 7 of the experiment. In groups C and EP, topical administrations were performed using a sham suspension (without probiotic). All animals were euthanized 14 days after the beginning of the experiment. Gingival tissue, hemi-mandibles and oral biofilm were collected for evaluation of the following parameters: i) bacterial microbiota (checkerboard DNA-DNA hybridization), ii) expression of pro- and anti-inflammatory cytokines (Multiplex analysis), iii) immunoreactivityof antimicrobial peptides (immunohistochemical reactions - streptavidin-biotin-peroxydase); iV) connective tissue attachment levels (histomorphometric analysis) and v) bone microarchitecture and volume (microtomographic analysis). Data were statistically analyzed (p < 0.05). Group EP presented greater values of bone porosity, trabecular separation and connective tissue attachment loss as well as reduced trabecular number and bone volume when compared with all the other groups (p < 0.05). In group EP-HN019, there were greater percentages of bacteria of the yellow and blue complexes and greater expressions of Osteoprotegerin (OPG) and beta-defensins (BD)-1, BD-2 and BD-3 when compared with group EP (p < 0.05). Group EP presented greater levels of Interleukin (IL)-1&beta; and Receptor Activator of Nuclear Factor-Kappa B ligand (RANKL) than group EP-HN019 (p < 0.05). The increase in the ratios RANKL/OPG and IL-1&beta;/IL-10 was greater in group EP than in group EP-HN019 (p < 0.05). Within the limits of the present study, it can be concluded that the topical use of B. lactis HN019 promotes a protective effect against alveolar bone and connective tissue attachment losses attributable to experimental periodontitis in rats.

A síndrome de Sjögren primária (SSp) é uma doença crônica autoimune sistêmica que pode levar à hipossalivação e afetar negativamente o ambiente oral. Os objetivos deste estudo foram detectar a influência da SSp nos níveis de biomarcadores inflamatórios na saliva e no fluido gengival nas amostras de pacientes com periodontite crônica, avaliar o efeito do tratamento periodontal não cirúrgico sobre os valores do índice clínico de avaliação da atividade sistêmica de pacientes com SSp e do índice reportado pelo paciente com SSp. Amostras de fluido gengival, saliva e os parâmetros clínicos periodontais que consistiram de medida da profundidade de sondagem (PS), nível clínico de inserção (NCI), sangramento à sondagem (SS) e índice de placa (IP) foram coletadas no início do estudo e 45 dias após a terapia periodontal não-cirúrgica de pacientes sistemicamente saudáveis com periodontite crônica (PC, n = 7) e pacientes com SSp e periodontite crônica (SP, n = 7). Pacientes periodontalmente saudáveis com SSp (SC, n = 7) e sistemicamente saudáveis (C, n = 7) também foram avaliados no início do estudo. Os grupos C, PC e SC foram pareados em gênero, idade e critério socioeconômico com o grupo SP. Os níveis de interleucina-8 (IL-8), IL-10 e IL-1ß foram avaliados por ensaio multiplex. Os níveis de atividade da doença foram medidos usando o Gold Standard da literatura chamado Índice Eular de atividade da síndrome de Sjögren (ESSDAI). Já para avaliação dos sintomas reportados pelo paciente com SSp foi utilizado o Índice Eular reportado pelo paciente com Sjögren (ESSPRI). Os parâmetros clínicos melhoraram após a terapia periodontal (p <0,05). No entanto, o NCI em pacientes com SSp não melhorou significativamente após a terapia (p> 0,05). Houve um aumento nos níveis de IL-1ß, IL-8 e diminuição dos níveis de IL-10 nas amostras de saliva de pacientes do grupo SC em comparação ao grupo C (p <0,05). Já em relação ao fluido gengival, pacientes do grupo SC tiveram maiores níveis de IL-1ß em comparação com o grupo C (p<0,05). Além disso, o tratamento periodontal não cirúrgico resultou num aumento dos níveis de IL-10 no fluido gengival no grupo SP e grupo PC em relação ao valor basal (p <0,05). O fluxo salivar foi significativamente aumentado após o tratamento periodontal apenas em pacientes do grupo SP (p = 0,039). Além disso, o tratamento periodontal não influenciou o índice ESSDAI (p = 0,35) e levou a uma diminuição significativa no índice ESSPRI (p = 0,03). Os presentes dados demonstraram que a SSp influencia os níveis salivares e de fluido gengival de biomarcadores inflamatórios em favor de um perfil próinflamatório, no entanto, este perfil parece não aumentar susceptibilidade dos indivíduos SSp à destruição periodontal. Além disso, os presentes dados demonstraram que o tratamento periodontal não-cirúrgico tem um impacto positivo sobre o fluxo salivar e sobre o índice ESSPRI de pacientes com SSp. Sugere-se assim que o tratamento periodontal pode melhorar a qualidade de vida de indivíduos com SSp. / Primary Sjögren\'s syndrome (pSS) is a chronic systemic autoimmune disease that might lead to hyposalivation and negatively affect the oral environment. The aims of this study were to detect the influence of pSS on the levels of inflammatory biomarkers in salivary and gingival crevicular fluid (GCF) samples of patients with chronic periodontitis and to evaluate the effect of non-surgical periodontal treatment on the disease activity index of patients with pSS, and on the reported index of patients with pSS. GCF and salivary samples and clinical parameters consisting of measuring probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP) and plaque index (PI) were collected at baseline and 45 days after non-surgical periodontal therapy from systemically healthy patients with chronic periodontitis (PC, n=7) and patients with pSS with chronic periodontitis (SP, n=7). Periodontally healthy patients with pSS (SC, n=7) and systemically healthy (C, n=7) were also evaluated at baseline. The groups C, PC and SC were pared on gender, years and socioeconomic status with the SP group. The levels of interleukin-8 (IL-8), IL-10, and IL-1ß were measured by using multiplex immunoassays. Disease activity levels were measured by using the Gold Standard called Eular Sjögren\'s syndrome disease activity index (ESSDAI). Also to evaluate the symptoms reported by the pacients with pSS we used the Eular Sjögren\'s syndrome patient reported index (ESSPRI). The clinical parameters improved significantly after periodontal therapy (p<0.05). However, CAL in pSS patients was not statistically improved after therapy (p>0.05). There was an increased expression of IL-1ß, IL-8 and decreased levels of IL-10 in the salivary samples of patients in the group SC compared to the group C (p<0.05). The GCF, patients in the group SC had bigger levels of IL-1ß in comparation with the C group (p<0.05). Moreover, nonsurgical periodontal treatment resulted in increased levels of IL-10 on GCF in the groups SP and PC in relation to the baseline (p<0.05). Salivary flow was significantly increased post-treatment only in the SP\'s group patients (p=0.039). In addition, periodontal treatment did not influence ESSDAI index (p=0.35) and led to a statistically significant decrease on the ESSPRI index (p=0.03). The present data demonstrated that pSS influences the salivary and GCF levels of inflammatory biomarkers in favour of a proinflammatory profile, however, this profile might doesn\'t increase the susceptibility of pSS subjects to periodontal breakdown. In addition, the present data demonstrated that non-surgical periodontal treatment has a positive impact on the salivary flow and ESSPRI index of pSS patients. Thus suggesting that periodontal treatment may improve the quality of life of pSS subjects.

O objetivo deste estudo foi avaliar os parâmetros clínicos periodontais: profundidade clínica de sondagem, nível clínico de inserção e sangramento a sondagem e os níveis de IL-17, M-CSF, GM-CSF, MCP-1, ICAM-1 IL-8, IL-10, IL-1?, TNF-?, IL-4 no fluido gengival de pacientes portadores de periodontite agressiva, comparando esses valores aos dados obtidos de sujeitos periodontalmente saudáveis, além de comparar os dados clínicos e imunológicos iniciais aos obtidos após um ano de tratamento nos pacientes com periodontite agressiva. Foram selecionados 37 pacientes portadores de periodontite agressiva e oito pacientes periodontalmente saudáveis, utilizados como grupo controle. Após a realização do exame clínico periodontal em todos os dentes, foi escolhido um sítio profundo de cada paciente com paeriodontite e um sítio raso dos pacientes saudáveis para coleta do fluido gengival. Todos os pacientes receberam tratamento periodontal que consistiu de orientação de higiene bucal, raspagens, remoção de fatores de retenção do biofilme bacteriano, polimento e uso de antibióticos. As amostras obtidas foram processadas e analisadas com um painel de 10 citocinas através de um ensaio multiplex. As análises estatísticas mostraram que não houve diferença estatisticamente significante entre os doentes e os saudáveis em relação a GM-CSF, IL-4, IL-8 e MCP-1. Quando foi feita a comparação longitudinal dos pacientes com periodontite agressiva, houve aumento após o tratamento para GM-CSF, ICAM-1, IL-4, IL-10, IL-17, MCP-1 e TNF-?. Com isso, pode-se concluir que mesmo após o tratamento periodontal com consultas trimestrais de manutenção e melhora dos parâmetros clínicos nos pacientes com PA que tinham um baseline mais inflamado, foi observado que alguns biomarcadores continuaram elevados, o que pode significar que esses pacientes continuam a apresentar atividade de doença ou que alguns desses biomarcadores não têm significância clínica para esses pacientes. / The aim of this study was to evaluate the periodontal clinical parameters: clinical probing depth, clinical attachment level and bleeding on probing and the IL-17, M-CSF, GM-CSF, MCP-1, ICAM-1, IL-8, IL-10, IL-1?, TNF-? and IL-4 levels in gingival crevicular fluid of aggressive periodontitis subjects, comparing these values with some data obtained from periodontal healthy patients, and also comparing clinic and immunologic initial data with the obtained after one year of treatment of aggressive periodontitis. The sample had 37 patients with aggressive periodontitis and 8 subjects clinically healthy, as control group. After the full periodontal examination, each patient with periodontitis had a deep site chosen, and a shallow site of the healthy ones, for collecting gingival fluid. All patients received periodontal treatment with oral hygiene, scaling, removal of retention factors, polishing and antibiotics. The obtained samples were processed and analyzed with a panel of 10 cytokines through a multiplex test. The statistical analyzes showed that there was no significant statistical difference between subjects with PA and healthy subjects with regard to GM-CSF, IL-4, IL-8 and MCP-1 levels.When longitudinal comparison of the subjects was made, it was noted some increase for GM-CSF, ICAM-1, IL-4, IL-10, IL-17, MCP-1 and TNF-?. Then, it can be concluded that, even after the periodontal treatment with trimestral maintenance and improvement on the clinical parameters, some biomarkers are still elevated, what can mean one of those possibilities: or the patients are still presenting some activity of the disease, or that some of these biomarkers don\'t have any clinical significance for this patients.