Preface

**Section 4 Immune Strategy 111**

**VI** Contents

D'Aiuto and Nidhi Sofat

**Section 5 Advances in Periodontal Therapy 169**

**Regeneration Membrane 171**

Chapter 6 **Periodontal Disease and Autoimmunity: What We Have**

Chapter 7 **Immunopathogenesis of Chronic Periodontitis 143**

Visentainer and Cleverson de Oliveira e Silva

Chapter 8 **Polycaprolactone-Based Biomaterials for Guided Tissue**

**Learned from Microbiome Studies in Rheumatology 113** Zoe Rutter-Locher, Nicholas Fuggle, Marco Orlandi, Francesco

Ana Maria Sell, Josiane Bazzo de Alencar, Jeane Eliete Laguila

Thanaphum Osathanon, Phunphimp Chanjavanakul, Pattanit Kongdecha, Panipuk Clayhan and Nam Cong-Nhat Huynh

In recent times, periodontitis has become a global health burden. An understanding of perio‐ dontal diseases and associated systemic diseases has exponentially increased, and the study of oral-systemic health connections has been rapidly advancing among scientists, clinicians, and the public as well. A robust knowledge in the pathophysiology of periodontal disease is mandatory to arrive at an unambiguous treatment planning and prevention of the disease.

This comprehensive book *Periodontitis - A Useful Reference* has been compiled by a team of experts with the main objective of providing an overview of the basic pathology of "perio‐ dontitis" and its implication on oral health and general systemic health. This book encom‐ passes seven individual chapters under four sections. The essential subjects that are emphasized through the chapters in this book include key components of immunopatholo‐ gy, autoimmunity, host-bacteria interaction, and tissue or cellular changes that occur during periodontitis and therapies. The traditional clinical management using basic and reconstruc‐ tive surgery and advancement in therapies is reviewed. Further, the overall impact of dental plaque in management of the disease itself and various considerations of the periodontal status of patients before and post-orthodontic treatment are highlighted in the subsequent chapters. The knowledge of remodeling process occurring in periodontal tissues during or‐ thodontic treatments is clinically vital for the appropriate choice of mechanical stress appli‐ cation, to regulate the duration of treatment therefore avoiding adverse consequences. These important concepts have been well interrogated and presented in the second section. Thus, this compilation is anticipated to be a useful reference for the dental clinicians, scientists, and patients as well.

In Brief: An introductory chapter inaugurates the topic with a gist of the subject.

Chapter 2 gives insight into the implication of dental plaque, the microbiota, and the patho‐ genesis of periodontal disease. The current approaches in the management of periodontitis are reviewed.

Chapter 3 recapitulates the link between human oral microbiome, various cells of the im‐ mune system, and the host-pathogen interaction. This book chapter illustrates how the dys‐ biotic keystone pathogen *Porphyromonas gingivalis* interacts with other bacterial community in the oral cavity and promotes chronic inflammation and tissue destruction of periodonti‐ tis. A fundamental knowledge in the cellular response provoked by *P. gingivalis* infection is highlighted.

The following chapter (4) provides information on the remodeling process taking place in the periodontal tissues during various orthodontic tooth movements. The biological sub‐ stances that are significant biomarkers of the changes during the orthodontic treatment are discussed in this chapter. The importance of each biomarker involved has been enlisted. It will be a beneficial reference for the clinicians to decide on proper choice of orthodontic treatment to prevent adverse effects on the tooth-supporting structures.

The next chapter (5) presents the best available knowledge on the association of periodontal status in adult orthodontic treatment. The main objective of this discussion is to make the clinicians aware of the parameters to consider prior, during, and after the orthodontic treat‐ ment in adult dental patients. The authors have illustrated the bidirectional relationship be‐ tween periodontal health and orthodontic treatment and the potential ways to standardize it. The authors have not only focused the pre-orthodontic parameters but also posttreatment aspects. Henceforth, this will be very useful information for both the clinicians to bring about effective orthodontic results and patients for a desirable treatment outcome.

This chapter (6) sheds light on the current literature concerning the role of microbiota in rheumatological conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and systemic lupus. Here, the suggestive underlying mechanisms that link these systemic conditions to periodontal inflammation are reviewed. This chapter describes the role played by the oral microorganisms on host immunology and physiology, the under‐ standing of which is very essential for the management of autoimmune disorders.

This chapter (7) summarizes the role of innate and specific immune response involved in the pathogenesis of periodontitis. The subdivisions demonstrate the role of cells and inflamma‐ tory mediators contributing to the inflammatory process of the ligamentous supporting structure and in bone resorption.

The concluding chapter (8) highlights the application and advancement in the usage of bio‐ active membranes in guided tissue regeneration (GTR) that aid in periodontal tissue regen‐ eration. Here, the authors focus on a new biomaterial, namely, polycaprolactone, specifically Jagged1-coated PCL membrane. The added merits of coated PCL as they prevent the epithe‐ lium downgrowth in the lesion and promote formation of alveolar bone for a successful guided tissue regeneration are described in this section.

We are grateful to everyone who has supported and encouraged us in completing this project.

**Dr. Pachiappan Arjunan** Assistant Professor, Department of Periodontics Dental College of Georgia Augusta University (formerly GRU) Augusta, USA

**Section 1**
