Early Detection of Tissue

Breakdown

Dentognostics test systems are based on the detection of matrix metalloproteinase-8 (MMP-8), which is the most important biomarker for periodontal tissue breakdown processes.

Detecting and Measuring Sub-Clinical Collagen Breakdown

aMMP-8 for Early Detection of Tissue Breakdown

aMMP-8 is an early risk marker for the hidden breakdown of gingival, periodontal, and/or peri-implant soft and hard tissue – often before signs of inflammation or of attachment loss become clinically visible. The PerioSafe immunological prevention diagnostic is based on aMMP-8 detection, and can therefore indicate a risk of progressive destructive disease of the teeth’s supporting tissue – which would otherwise only be detected weeks or months later using probing or x-ray examination.

What exactly is aMMP-8 and what does it do?
aMMP-8 is short for activate matrix metalloproteinase-8. It is an enzyme produced naturally in the body as a collagenase. In other words, its function is to degrade collagen. Collagenases like aMMP-8 are found almost everywhere in the human body and 23 different human MMPs have already been identified. This enzyme is required for physiological structuring and restructuring processes, e.g. in embryonic development, wound healing, nerve growth, and angiogenesis. MMPs are also involved in most pathological processes, including arthritis, tumors, cardiovascular diseases, wound healing, and periodontitis.

What role does aMMP-8 play in the development of periodontitis/peri-implantitis?
Bacteria in the dental biofilm release waste products that may irritate the gums. As soon as an inflammatory response starts in the periodontal tissue, endothelial cells, fibroblasts and, in particular, neutrophil granulocytes, activate and secrete the enzyme MMP-8. It “cuts” through the dense network of collagen fibers so that defense cells can move faster to the center of infection. Rather like a machete cutting through a jungle of collagen, aMMP-8 clears the way for granulocytes, macrophages and osteoclasts.
Depending on various factors (e.g. genetics, general health, smoking, hormonal changes, stress, diabetes etc.), the patient may have a chronic overreaction to the bacterial attack. As periodontitis develops, the balance shifts in favor of the aMMPs, and so these then come to have an elevated, active concentration.
aMMP-8 is the only metalloproteinase enzyme capable of splitting both type I and type III collagen. In recent years, the correlation between elevated concentrations of aMMP-8 in the saliva and GCF/PISF of periodontitis patients has led to aMMP-8 becoming an established biomarker (Sorsa et al. 2006, Sapna et al. 2014).

How does aMMP-8 get into the saliva?
aMMP-8 is one of the most important interstitial collagenases in the context of periodontal tissue destruction. In patients with periodontal disease, aMMP-8 is present in elevated concentrations not only in the gingival tissue but also in the sulcular fluid. This constantly seeps out as a filtrate of the serum at the neck of the tooth between the tooth and gum and passes gradually into the saliva. As a result, aMMP-8 can be detected diagnostically in the GCF/PISF (gingival crevicular fluid/peri-implant sulcular fluid) using the PerioSafe test systems.

Why is aMMP-8 measured?
aMMP-8 is the main enzyme involved in tissue destruction in periodontitis. In its active form, it breaks down fibrillary collagen structures, and is also associated with destruction of the alveolar bone. Currently, the release of aMMP-8 offers the only indication of whether collagen is being broken down in the tissue or whether it is stable at the time of measurement. That makes aMMP-8 and objective diagnostic marker for the detecting the point in time when the breakdown of periodontal tissue begins, as well as a marker for peri-implant tissue destruction.

PerioSafe can help uncover previously undetected periodontal inflammation, in particular in patients in certain risk groups. As a result, prophylactic measures can be taken at an early stage, ideally before symptoms occur.

What information can the PerioSafe/ImplantSafe aMMP-8 test provide?
aMMP-8 is a marker for tissue destruction rather than for inflammation, i.e. it is a biomarker for acute and acutely progressive tissue destruction, which could only be detected weeks or months later by probing or taking an x-ray. In this way, the aMMP-8 test closes the gap that previously existed between conventional diagnostic methods such as probing, blood on probing (BoP), x-ray, or bacterial testing.

With the PerioSafe aMMP-8 test, the dynamic process of active periodontal degeneration can be analyzed in the saliva, around an individual tooth, or as a pool sample, depending on the requirements of each individual situation, and its future development can be predicted. In juvenile patients, the aMMP-8 saliva test also indicates a possible genetic predisposition to active periodontal degeneration.

An elevated level of active MMP-8 (> 20 ng/ml in the saliva, gingival crevicular fluid (GCF) or peri-implant sulcular fluid (PISF)) results in the progression of active periodontal degeneration. The likelihood of this gingivitis or peri-implant mucositis becoming or being correlated with periodontitis or peri-implantitis is 80 to 90%.

A negative test result, in conjunction teeth that present as clinically normal, indicates that no risk or only a slight risk of periodontal inflammation with tissue breakdown is present. Therefore, a negative test result following periodontal treatment means that the therapeutic measures taken were successful.

Evidence-Based Science

How Do Professional Associations Rate the aMMP-8 Test?

The German Society of Periodontology (DG PARO) and the German Society of Dentistry and Oral Medicine (DGZMK) rated the aMMP-8 test in a joint “scientific statement” (Meisel & Eickholz 2015). They stated that the test for MMP-8 stands out as the frontrunner for diagnosing periodontitis, ahead of all other possible tests for the inflammation-related expression of matrix metalloproteinases.

The authors of the statement, Eickholz and Meisel, cite progression monitoring as a possible are of application for the aMMP-8 test. They point out that the success of treatments such as tartar removal and scaling and root planing (SRP) can be monitored by measuring MMP-8 to distinguish treatment responders from non-responders. In addition, the two societies emphasize that the ease with which this test can be conducted is particularly impressive. The authors propose that one beneficial application of the test would be to use it in situations where a dentist is not available. As examples, they mention medical clinics specializing in systemic diseases that demonstrate clear associations with periodontitis, such as diabetes or obesity.

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