Publication: Estudio de la influencia de los factores genéticos y microbiológicos en la progresión de la periodontitis
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2016-04-21
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Universidad Complutense de Madrid
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Abstract
La periodontitis es una enfermedad multifactorial de etiología bacteriana caracterizada por una respuesta inflamatoria desarrollada por el huésped frente a los microorganismos de la placa bacteriana, capaces de estimular la liberación de mediadores, como IL-1, responsables de la destrucción del tejido conectivo y hueso alveolar. A pesar del papel de las bacterias como factor etiológico primario de la periodontitis, la extensión y severidad de la enfermedad también se ve influenciada por distintos factores de riesgo relacionados con el huésped, no modificables como la susceptibilidad genética, o modificables como el tabaco. Esto significa que puede existir una variación considerable entre los individuos en el riesgo de progresión de la periodontitis. Los estudios longitudinales que han evaluado los resultados del tratamiento periodontal concluyeron que es posible detener la pérdida de tejidos de soporte y prevenir la progresión de la enfermedad, a través de una terapia exhaustiva y citas de mantenimiento periodontal regulares. No obstante, hasta en los grupos de pacientes bien controlados, se han descrito episodios de pérdida de inserción clínica o pérdida de dientes. En ese sentido, la identificación de localizaciones o pacientes con mayor riesgo, o susceptibilidad, de progresión de la periodontitis representa un desafío permanente y tiene, actualmente, particular relevancia por distintos aspectos: porque la periodontitis tiene impacto considerable en la calidad de vida de los pacientes, por las secuelas estéticas y funcionales de la enfermedad y/o de su tratamiento, por la relación entre la periodontitis y diferentes patologías sistémicas y, finalmente, por ser considerada un factor de riesgo para las complicaciones biológicas en el tratamiento con implantes. A fin de valorar el riesgo de pérdida de inserción futura se han evaluado, en los últimos años, distintas variables clínicas, microbiológicas, inmunológicas y genéticas...
Periodontitis is a multifactorial disease with microbial aetiology and characterized by an inflammatory response in the host in which different mediators are released, such as interleukin (IL)-1, that are responsible for the connective tissue and alveolar bone destruction. Although bacteria are the primary etiologic factor in this disease, several risk factors related to the host have key importance in the onset, severity and extension of tissue destruction. Some of these risk factors are genetic, impossible to modify, and others are environmental, manageable to eliminate. This means that there is a great variability between different individuals in the susceptibility to periodontal destruction. The main goal of periodontal treatment is to stop connective tissue and bone destruction, prevent future disease progression and avoid tooth loss. The longitudinal studies that have evaluated treatment results have shown that this goal can be accomplished by the means of comprehensive treatment followed by regular supportive therapy. But the literature has also shown that, even in well-controlled patients, there are episodes of loss of clinical attachment and even tooth loss, in approximately one fifth to one fourth of treated population. For this reason, the identification of patients or sites at a greater risk of periodontal destruction is presently a great challenge, for multiple reasons: because of the impact that periodontitis has on quality of life of the patients, because of the aesthetic and functional sequelae of the disease, because periodontitis as proved to be related to multiple other systemic diseases and, finally, because it is a risk factor for the biological complications of implant therapy...
Periodontitis is a multifactorial disease with microbial aetiology and characterized by an inflammatory response in the host in which different mediators are released, such as interleukin (IL)-1, that are responsible for the connective tissue and alveolar bone destruction. Although bacteria are the primary etiologic factor in this disease, several risk factors related to the host have key importance in the onset, severity and extension of tissue destruction. Some of these risk factors are genetic, impossible to modify, and others are environmental, manageable to eliminate. This means that there is a great variability between different individuals in the susceptibility to periodontal destruction. The main goal of periodontal treatment is to stop connective tissue and bone destruction, prevent future disease progression and avoid tooth loss. The longitudinal studies that have evaluated treatment results have shown that this goal can be accomplished by the means of comprehensive treatment followed by regular supportive therapy. But the literature has also shown that, even in well-controlled patients, there are episodes of loss of clinical attachment and even tooth loss, in approximately one fifth to one fourth of treated population. For this reason, the identification of patients or sites at a greater risk of periodontal destruction is presently a great challenge, for multiple reasons: because of the impact that periodontitis has on quality of life of the patients, because of the aesthetic and functional sequelae of the disease, because periodontitis as proved to be related to multiple other systemic diseases and, finally, because it is a risk factor for the biological complications of implant therapy...
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Tesis inédita de la Universidad Complutense de Madrid de la Facultad de Odontología del Departamento de Estomatología III, leída el 26-11-2015