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

Abstract

Severe periodontitis is ranked as the sixth most prevalent disease affecting humankind, with an estimated 740 million people affected worldwide. The diagnosis of periodontal diseases mainly relies upon assessment of conventional clinical parameters. However, these parameters reflect past, rather than current, clinical status or future disease progression and, likely, outcome of periodontal treatment. Specific and sensitive biomarkers for periodontal diseases have been examined widely to address these issues and some biomarkers have been translated as point-of-care (PoC) tests. The aim of this review was to provide an update on PoC tests for use in the diagnosis and management of periodontal diseases. Among the PoC tests developed so far, active matrix metalloproteinase-8 has shown promising results in terms of diagnostic and prognostic values. However, further studies are required to increase the sensitivity and specificity via combining more than one biomarker and merging these test kits with periodontal risk assessment tools. Furthermore, the validity of these test kits needs to be investigated by applying the results in further independent studies and the impact on these test kits’, together with the results of risk factors for periodontal diseases, such as diabetes and smoking, also needs to be examined.

Oral Diagnostic Methods for the Detection of Periodontal Disease

“…Both qualitative and quantitative point-of-care immunotest technologies have been developed for the fast detection of pathologically elevated levels of active matrix metalloproteinase-8 in the saliva and may in fact assist in diagnosis and predict the prognosis of periodontitis [ 23 ]. Many reports have examined various different biomarkers in oral fluids in order to achieve diagnostic tools for periodontal disease, which have been designed into the latest classification system [ 23 , 52 ]. The majority of studies have focused on active MMP8 due to its importance.…”

The Chairside Periodontal Diagnostic Toolkit: Past, Present, and Future

“…For this reason, the symptom-based diagnosis techniques, e.g., use of periodontal probes or dental imaging, can only provide the status about previous damages caused by periodontal disease, but they are limited to obtain detailed information about disease activity that is required for personalized treatment planning. However, with a recent understanding of pathophysiology in periodontal diseases, various biomarkers (e.g., biochemical-, microbial-, or genetic-based) have been suggested as having potential for improving diagnosis or outcomes for better understanding of disease activity [ 8 , 11 , 12 , 13 , 32 ]. As inflammation further processes due to periodontal disease, several types of mediators are released into GCF and saliva as well as other oral rinses, thus they can be utilized as indicators through biomarker assays.…”

“…In addition, these methods are expected to allow the clinicians to evaluate the prognosis after treatment for any future treatments [ 11 , 12 , 150 , 151 ]. Although an ideal biomarker for periodontal disease has yet to be identified, biomarkers that measure disease pathogenesis or bio-components linked to tissue destruction, host defense mechanisms, and bacterial metabolism during disease progression are actively being studied [ 8 , 152 ].…”

“…So far, the specific biomarkers and their thresholds have not been established yet, but we expect they will be incorporated and used in periodontal disease grade assessment as evidence will become available soon. Efforts to accelerate the development of chairside periodontal assay kits or automated biosensors by combining clinically relevant biomarkers with lab-on-a-chip or point-of-care technologies are still active [ 8 , 11 , 158 ]. Compared to conventional labor-intensive and time-consuming laboratory procedures, the automated chairside periodontal assay methods are believed to provide immediate analysis results related to the disease.…”

“…Although the clinical diagnostic analyses inform both periodontal disease diagnosis and treatment, they are also inherently limited in that they can only assess disease history but not disease activity [ 8 ]. This is because once periodontal disease initiates, it does not follow a linear progression and can be characterized by periods of activity and remission [ 9 , 10 ].…”