Radiographic imaging is a common resource for endodontic diagnosis, treatment, and prognosis. Two-dimensional (2D) periapical and digital panoramic radiographs often showed image distortion; this issue was resolved with the emergence of three-dimensional (3D) cone-beam computed tomography (CBCT). This review examines the accuracy of various radiographic techniques in the assessment of periapical lesion after endodontic treatment. Our goal was to determine whether a 2D radiograph (periapical and panoramic) is as accurate as a 3D radiograph (i.e., CBCT) in the assessment of periapical lesion after endodontic treatment. We searched the electronic databases Medline and Cochrane and trial registries for ongoing trials. We included both retrospective and prospective studies comparing the efficacy of periapical healing with various radiographic techniques after endodontic treatment. The outcome of interest was the percentage detection of periapical lesions and periapical healing assessment after endodontic treatment. All data were collected using a specially designed extraction form. We assessed the risk of bias in the studies using the Cochrane tool for diagnostic tests (QUADAS). We judged two studies to be at low risk and two to be at moderate risk of bias. Although there was a difference in the percentage detection of periapical healing efficacy by various radiographic techniques, all studies reported that CBCT had higher accuracy in the detection of periapical lesions compared to periapical and panoramic radiography. The next best choice is periapical radiographs, followed by panoramic radiographs as they provide better visualization and accuracy.

Objective: This study investigated the effect of metabolic syndrome (MetS) on periodontal clinical parameters and salivary biomarkers' matrix metalloproteinase‐8 (MMP‐8) and myeloperoxidase (MPO) in patients with periodontitis.Methods: A total of 120 participants aged 25–55 were categorized into three groups: MetS with periodontitis (n = 40); systemically healthy with periodontitis (n = 40); and systemically and periodontally healthy controls (n = 40). Data collected included systemic parameters like waist circumference (WC), blood pressure (BP), high‐ and low‐density lipoproteins, triglycerides (TG), fasting blood sugar (FBS), and glycated hemoglobin (HbA1c). Periodontal parameters estimated included bleeding on probing score (BoP), full‐mouth plaque score (FMPS), periodontal probing depth (PPD), clinical attachment loss (CAL), and the number of missing teeth. Unstimulated whole saliva was analyzed via ELISA for active MMP‐8 (aMMP‐8), total MMP‐8 (tMMP‐8), and MPO.Results: Participants with MetS and periodontitis exhibited significantly higher periodontal parameters, salivary aMMP‐8, and MPO (26.26 vs. 24.1 ng/mL and 13.53 vs. 11.55 ng/mL compared to systemically healthy periodontitis patients) (all p < 0.01). Positive correlations occurred between aMMP‐8 and WC, TG, and FBS (p < 0.01), and between MPO and WC, BP, and TG (p < 0.01).Conclusions: The positive associations between these biomarkers and metabolic parameters indicate their potential utility for monitoring cardiovascular and glycemic risk in patients with periodontal disease.

Background: Advanced glycation end products (AGE) and their receptors (RAGE) have been implicated in developing periodontal complications in diabetic patients. This study aimed to identify salivary AGE, RAGE, soluble RAGE (sRAGE), and active‐matrix metalloproteinase‐8 (aMMP‐8) levels at varying glycemic levels in periodontitis patients.Methods: Ninety‐eight participants were categorized into uncontrolled DM‐PD group (n = 27)—periodontitis patients with uncontrolled Type 2 diabetes mellitus (T2DM) (glycated hemoglobin [HbA1c] ≥7%); controlled DM‐PD group (n = 33)—periodontitis patients with controlled T2DM (HbA1c 5.7%–6.9%); SH‐PD group (n = 18)—systemically healthy periodontitis patients; and SH‐PH group (n = 20)—systemically and periodontally healthy individuals. HbA1c along with the periodontal parameters bleeding on probing (BoP), periodontal probing depth (PPD), clinical attachment loss (CAL), number of missing teeth, and periodontal inflamed surface area (PISA) were estimated. Enzyme‐linked immunosorbent assay (ELISA) was used for analyzing salivary AGE, RAGE, sRAGE, and aMMP‐8. Multiple linear regression analysis was conducted to develop predictive models for HbA1c based on relevant predictor variables.Results: Periodontitis participants with uncontrolled T2DM exhibited significantly higher BoP, PPD, CAL, number of missing teeth, and PISA, along with elevated AGE, RAGE, and aMMP‐8, compared to other groups (p < 0.01). A significant positive association was observed between RAGE and HbA1c levels (p < 0.01). Among the predictors, BoP (p = 0.046) and CAL (p < 0.001) demonstrated a significant positive effect on salivary AGE. PPD was positively associated with RAGE (p < 0.05), and BoP was negatively associated with salivary sRAGE levels (p = 0.038).Conclusions: Salivary biomarkers like RAGE and aMMP‐8 exert a potential role in monitoring periodontal health and glycemic control in T2DM patients.Plain Language Summary: Advanced glycation end products (AGE) and their receptors (RAGE) have been implicated in developing periodontal complications in diabetic patients. This study aimed to identify salivary AGE, RAGE, soluble RAGE (sRAGE), and aMMP‐8 levels at varying glycemic levels in periodontitis patients. Ninety‐eight participants were categorized into Group 1 (n = 27)—periodontitis patients with uncontrolled Type 2 diabetes mellitus (T2DM); Group 2 (n = 33)—periodontitis patients with controlled T2DM; Group 3 (n = 18)—systemically healthy periodontitis patients; and Group 4 (n = 20)—systemically and periodontally healthy individuals. Enzyme‐linked immunosorbent assay (ELISA) was used for analyzing salivary AGE, RAGE, sRAGE, and aMMP‐8. The study revealed that participants with uncontrolled T2DM and severe periodontitis exhibited significantly higher levels of salivary AGE, RAGE, and aMMP‐8, along with increased periodontal parameters, compared to controlled T2DM and systemically healthy groups. Conversely, salivary sRAGE levels were significantly lower in the uncontrolled T2DM group. The study also found significant associations between salivary RAGE levels and glycated hemoglobin (HbA1c), as well as between aMMP‐8, AGE, and clinical periodontal parameters. The findings of this study highlight the potential clinical utility of salivary biomarkers, particularly RAGE and aMMP‐8, as noninvasive diagnostic and monitoring tools to evaluate glycemic control and periodontal health in individuals with diabetes.

Background: In this study, we describe a method by which a patient can independently assess their own periodontitis risk, for example, at home, with a mobile application. The aim of the study is to use active matrix metalloproteinase aMMP-8 mouth rinse cut-off 20 ng/mL point-of-care testing (POCT) and a polynomial function to reveal patients’ statistical risk of periodontitis. Methods: The polynomial function presented in this study was modeled with multiple logistic regression and the function estimates the risk of periodontitis using a probability measure. To investigate variables associated with periodontitis, we used data from adult patients visiting dental clinics in Thessaloniki, Greece. Results: The research results revealed that with appropriate information it is possible to obtain sufficient accuracy about a patient’s potential risk of periodontitis. The function for estimating risk of periodontitis is PERIORISK = (1 + e^{−(3.392×X1+0.002×X2+1.858×X3−9.151)})⁻¹, where X1 = aMMP-8 test result and tobacco smoking status, X2 = age × waist circumference and X3 = patient’s individual and parental history of diabetes. Conclusions: The prediction of periodontitis risk using an aMMP-8 test and a polynomial function seems to be a useful, non-invasive, safe-to-use and cost-effective tool for all people. Overall, in the model created, mouth rinse cut-off 20 ng/mL aMMP-8 test result, age, waist circumference, tobacco smoking status and patient’s individual and parental history of diabetes were found to be good factors explaining the risk of periodontitis.

Objectives: The increasing prevalence of metabolic syndrome (MetS) and periodontitis, both marked by chronic inflammation that disrupts immune function, underscores the need for tailored healthcare approaches that account for their systemic inflammatory impact. The study aimed to estimate and compare the diagnostic accuracy of aMMP-8 expression in oral rinse, saliva, and GCF (gingival crevicular fluid) among patients with periodontitis and those with and without MetS. Materials and methods: A pilot sample of 77 participants was categorized into three groups based on the 2018 AAP/EFP periodontitis classification and the 2006 IDF metabolic syndrome criteria: MetS with periodontitis (MetS-PD; n = 34), systemically healthy with periodontitis (SH-PD; n = 21), and healthy controls (SH-PH; n = 22). Active metalloproteinase-8 (aMMP-8) levels in oral biofluids were quantified using an enzyme-linked immunosorbent assay. ANOVA and ROC curve analysis were done to assess diagnostic accuracy across groups. Results: aMMP-8 levels varied by group but remained consistent across biofluids, with lower levels in SH-PH and higher levels in SH-PD and MetS-PD ( p < 0.001). aMMP-8 levels were significantly elevated in MetS-PD (25.86 ± 4.48 ng/ml) and SH-PD (24.72 ± 2.13 ng/ml) compared to controls (11.99 ± 3.46 ng/ml) in oral rinse samples ( p < 0.001). Oral rinse demonstrated superior diagnostic accuracy (AUC = 0.89) compared to saliva (AUC = 0.85) and GCF (AUC = 0.82) in distinguishing MetS-PD from healthy controls, with an optimal cut-off value of 20 ng/ml. Conclusion: Oral rinse may be a preferable matrix for diagnosing periodontal disease, particularly in patients with systemic conditions, compared to saliva and GCF. Prospective longitudinal studies are required to evaluate its utility for monitoring over time. Clinical relevance: This study highlights the potential of aMMP-8 as a reliable biomarker for assessing periodontal disease severity in patients with MetS, utilizing non-invasive oral fluids. With oral rinses demonstrating high diagnostic accuracy, they may be an effective and accessible tool for screening and case-finding in medical and dental settings in patients with MetS, facilitating early detection and tailored management strategies. aMMP-8 immunoassay chair-side kit offers a practical alternative to traditional methods for screening patients in non-dental settings.