Active MMP-8 (aMMP-8) as a Grading and Staging Biomarker in the Periodontitis Classification

Abstract

The aim of this study was to investigate the utility of incorporating active matrix metalloproteinase-8 (aMMP-8) as a biomarker into the new periodontitis classification system (stage/grade) presented in 2018. This study included 150 Greek adults aged 25-78, of whom 74 were men and 76 women. Participants were tested with an aMMP-8 point-of-care mouthrinse test, after which a full-mouth clinical examination was performed to assess their periodontal and oral health. The aMMP-8 levels in mouthrinse were significantly lower among healthy patients compared with patients in more severe periodontitis stages and grades (Kruskal-Wallis test and Dunn-Bonferroni test for pairwise post-hoc comparisons; p < 0.01 and p < 0.05, respectively). Furthermore, aMMP-8 levels were less correlated with plaque levels than bleeding on probing (BOP) (Spearman's rho = 0.269, p < 0.001; Spearman's rho = 0.586, p < 0.001); respectively). Thus, aMMP-8 was more robust to the confounding effects of oral hygiene than traditional periodontal parameter bleeding on probing. The aMMP-8 point-of-care mouthrinse test can be utilized as an adjunctive and preventive diagnostic tool to identify periodontal disease, classified by stage and grade, and ongoing periodontal breakdown chairside in clinical practice in only 5 min. Overall, integrating aMMP-8 into the new periodontitis classification system seems beneficial.

Diagnostic Models for Screening of Periodontitis with Inflammatory Mediators and Microbial Profiles in Saliva

“…In this study, we included both pro- and active forms of MMP-8. Several studies found that the active forms of MMP could distinguish periodontitis [ 19 , 29 , 30 , 31 , 32 , 33 , 34 ]; however, in this study, two forms were significantly different among all stages of periodontitis. The increase was considered to reflect the increased leakage of all types of MMP-8 according to the severity of periodontitis.…”

Diagnostic Accuracy of Oral Fluids Biomarker Profile to Determine the Current and Future Status of Periodontal and Peri-Implant Diseases

“…In support for this notion, a recent study aimed to incorporate a point-of-care (PoC) mouth rinse test into the new classification system. The authors have suggested the usefulness of this test as a rapid and effective adjunct diagnostic tool in determining grading and staging of periodontitis [ 40 ].…”

“…Amongst the PoC test kits, PerioSafe ® and ImplantSafe ® have shown to be the most reliable and applicable [ 40 , 94 , 108 , 156 ]. Their reliability as diagnostic kits are demonstrated by their ability to differentiate gingivitis and periodontitis from healthy periodontium by the cut off value of 6.46 ng/mL.…”

“…This is of great value, as these results can be used as a screening tool for patients in the clinic and in research settings where time is limited. In dental clinics, this helps the clinician to exclude the patients that do not require periodontal examination because an MMP8 level <6.46 ng/mL shows that they have a healthy periodontium, or it might encourage the clinician to provide a thorough treatment plan for patients with periodontitis through integrating these test results into the 2017 classification system when the MMP8 level is in the active range from 20–60 ng/mL [ 40 , 94 , 108 , 156 ]. In periodontal studies and epidemiological surveys, the prevalence of the most serious form of the disease (periodontitis) could be determined more quickly and accurately by conducting the PerioSafe ® test instead of a very time-consuming full mouth periodontal examination of a large number of participants, using a partial mouth protocol or examining representative teeth (CPITN indexed teeth), which have been shown to produce inaccurate results [ 157 ].…”

An Oral Rinse Active Matrix Metalloproteinase-8 Point-of-Care Immunotest May Be Less Accurate in Patients with Crohn’s Disease

“…In periodontology, point-of-care (PoC) tests aim to detect periodontal diseases by analyzing the levels of biomarkers in oral fluids (saliva, oral rinse, and/or gingival crevicular fluid) without need of a laboratory [17,18]. Among the tested biomarkers, salivary and oral rinse levels of MMP-8 are shown to be effective in distinguishing periodontitis patients from periodontally healthy individuals [19][20][21]. For instance, PoC tests using active MMP (aMMP)-8 as a diagnostic marker with a threshold of 20 ng/mL can successfully identify periodontitis with 64-95% sensitivity and 60-100% specificity [22][23][24][25].…”