How to diagnose and treat periodontalendodontic lesions?

Objective: This literature review aims to assess the causes and consequences of periodontal-endodontic lesions, as well as its clinical, radiographic and microbiological aspects. Literature review: Periodontal-endodontic lesions are often changes that affect all teeth due to the close relationship between pulp and periodontium. Many authors researched about this, but there are many disagreements on the subject, starting with the different types of classification, in which many are based on the origin of the disease, the other forms of treatment, degree of pulp involvement, among others, with the purpose of helping in the correct diagnosis. The knowledge of the etiology of the disease is extremely important, because the success of the treatment depends on the rapidity of its onset, the treatment protocol adopted and medication use. Conclusion: It is necessary that the dentists know the morphology and structure of the oral cavity, as well as the knowledge of all factors that can cause the same damage, so that they differentiate the types of periodontalendodontic lesions regarding to its origin, defining the best treatment to be followed.

Papillary regeneration: anatomical aspects and treatment approaches

Introduction and objective: This paper aims to report a literature review on the anatomy and morphology of the interproximal papilla and present the options of both surgical and nonsurgical treatment for the recovery of interdental papilla. Literature review: The loss of the interdental papilla because of the interproximal bone loss accounts for aesthetic, phonetic and functional problems of patients with periodontal disease. The interproximal tissue reconstruction has been reported in literature through both surgical procedures with the use of subepithelial connective tissue graft, restorative and orthodontic treatment. Conclusion: The etiology of gingival black space is multifactorial, therefore, it is important to diagnose properly the etiological factor to establish an appropriate treatment planing. However, the treatment approaches are not predictable and further studies are necessary to recommend the clinical practices available to date.

Comparação de duas técnicas radiográficas para avaliar o nível da crista óssea alveolar de pacientes com doença periodontal / Comparison of two radiographic techniques for assessing the level of alveolar bone crest in patients with periodontal disease

INTRODUÇÃO E OBJETIVO: Por meio de radiografias panorâmica e periapical teve-se o propósito de quantificar e comparar o nível da perda óssea alveolar de cinco pacientes que apresentavam periodontite. MATERIAL E MÉTODOS: Foram realizadas as medidas da junção esmalte-cemento (JEC) até a crista óssea alveolar (COA) nas superfícies mesial e distal dos incisivos superiores e inferiores, primeiros pré-molares inferiores e primeiros molares inferiores. Submeteram-se os dados à análise estatística Anova e ao teste de Tukey, com nível de significância de 5 por cento. RESULTADOS: Quando comparados os valores da média da perda óssea alveolar entre a radiografia panorâmica e a periapical, verificou-se que a panorâmica se apresentava 0,93 mm maior que a média dos valores da radiografia periapical, uma diferença estatisticamente significante (p < 0,01). A distorção ocorreu no grupo dos dentes molares. Os incisivos inferiores e superiores tiveram as menores distorções. Não houve diferença estatística expressiva entre as medidas efetuadas nas superfícies mesial e distal. CONCLUSÃO: O exame periapical pode ser considerado o melhor método radiográfico para avaliar o nível da perda óssea alveolar e, por conseguinte, ajudar no diagnóstico da doença periodontal. Contudo a radiografia panorâmica ainda é um método válido para analisar o nível de perda óssea causada pela doença periodontal, desde que o cirurgião-dentista esteja familiarizado com as limitações e características dessa técnica. Caso ele tenha dúvida, deve complementar o exame com radiografias periapicais.

INTRODUCTION AND OBJECTIVE: To quantify and compare the level of alveolar bone loss on panoramic and periapical radiographs of five (5) patients presenting periodontitis. MATERIAL AND METHODS: On the panoramic and periapical radiographs of five patients, the measurements from the cement-enamel junction (CEJ) to the alveolar bone crest (ABC), at the mesial and distal surfaces of the upper and lower incisors, lower first premolars and first molars, were performed. Data were submitted to statistic analysis by Anova and Tukey test, with level of significance set at 5 percent. RESULTS: When the mean values of the alveolar bone loss were compared between panoramic and periapical radiograph, it was verified that the panoramic radiograph measurements were 0.93 mm higher than periapical radiograph values. This difference was statistically significant (p < 0.01). The highest distortion occurred in the group of molar teeth. The upper and lower incisors presented lower distortions. It was not found significant statistically differences between the measurements at the mesial and distal surfaces. CONCLUSION: Periapical radiograph can be considered the best radiographic method to evaluate the alveolar bone loss level and, consequently, to help the diagnosis of the periodontal disease. However, the panoramic radiograph is still a valid method for evaluating the level of bone loss caused by the periodontal disease, although the dentist should be aware of the limitation and characteristics of this radiographic technique. When in doubt, radiographic examination should be completed by periapical radiographic.

Periodontal disease induced by porphyromonas gingivalis and fusobacterium nucleatum in Wistarrats / Periodontite induzida pela porphyromonas gingivalis e fusobacterium nucleatum em ratos Wistar

Prior studies have shown that it is necessary to place ligatures around molars to study periodontal destruction in rats. The present research aims to examine a periodontal disease model in which specific pathogen-free Wistar rats are orally exposed to Porphyromonas gingivalis associated with Fusobacterium nucleatum. Periodontitis was induced by specific infection with P. gingivalis and F. nucleatum. Twenty adult male Wistar rats were divided into two groups. The control animals were not infected. The experimental animals were repeatedly infected with Porphyromonas gingivalis and Fusobacterium nucleatum for one week. For the next three weeks, the animals were repeatedly infected with P. gingivalis alone. The distance from the cemento-enamel junction (CEJ) to the alveolar bone crest of the second molar was measured at different sites: buccal-distal (d), buccal-furcation region (f), buccal-mesial (h), and area region. The Mann-Whitney test was applied (p<0.001). The results showed that all values obtained were significantly greater in the infected group. Infected group values for the measures d, f, h, and area were 0.41 mm, 0.46 mm, 0.67mm, and 1.04 mm2, respectively, while in the control group, values for the measures d, f, h, and area were0.19 mm, 0.26 mm, 0.26 mm, 0.88 mm2, respectively. Our study showed that four weeks following infection with Porphyromonas gingivalis and Fusobacterium nucleatum bone loss in Wistar rats could be identified.

Morphometric study of length and grooves of lower central incisors roots / Estudo morfométrico das concavidades proximais e do comprimento radicular dos incisivos centrais inferiores em humanos

Introduction: Root grooves are considered a risk factor for periodontal disease. The purpose of this study was to measure the length of the root of lower central incisors (LCI), as well as the width and depth of the concavities of their proximal surfaces. Material and methods: The width and depth of root concavities, as well as root length, were evaluated in 90 LCI. All teeth were measured using a digital contour measuring instrument (Contracer®) for the root grooves and a digital calliper for evaluating root length. Results: After statistical analysis (t-Student and Kruskal-Wallis Anova tests, p<0.05) it was possible to confirm: the mean root length on its distal surface (13.88 ±1.47 mm) and on its mesial surface (13.76±1.50 mm). Concavities were present in 100% of the samples; concavities were found 2 mm, coronally from the CEJ, at the CEJ, and at all root surface. The concavities were wider than deeper; on the mesial surface, the greatest width was 1.877 mm and the greatest depth was 0.135 mm; on the distal surface the greatest width was 1.717 mm and the greatest depth was 0.118 mm. Conclusion: The distal surface of the lower central incisor is the longest. The root concavities on the proximal surfaces are present in 100%; the greatest width and depth was at 6 mm apically from the CEJ at both sides, which corresponds to the root middle third. One must get acquainted to the morphological variations of roots to enhance diagnosis, prognosis and treatment.

Introdução e objetivo: Concavidades radiculares são tidas como fator de risco de doenças periodontais. Esta investigação foi realizada com o objetivo de estudar as concavidades radiculares proximais (largura e profundidade) e o comprimento radicular do incisivo central inferior (ICI). Material e métodos: A largura e a profundidade das concavidades radiculares, assim como o comprimento radicular, foram avaliadas em 90 ICI. Todos os dentes foram medidos por aparelho Contracer® computadorizado para as concavidades radiculares, enquanto os comprimentos radiculares foram medidos por meio de um paquímetro digital. Resultados: Após análise estatística (testes t de Student e Kruskal-Wallis Anova), foi possível confirmar a média dos comprimentos radiculares em sua superfície distal (13,88±1,47 mm) e mesial (13,76±1,50 mm). As concavidades estavam presentes em 100% da amostragem; foram encontradas concavidades 2 mm coronariamente à JEC, na JEC e também em toda a superfície radicular. As concavidades tinham maior largura do que profundidade; na superfície mesial, as maiores medidas de largura e profundidade foram 1,877 mm e 0,135 mm, enquanto na superfície distal foram 1,717 mm e 0,188 mm. Conclusão: A superfície distal do ICI é a mais longa. As concavidades estão presentes em todos os ICIs; a maior largura e profundidade foi de 6 mm apicalmente à JEC em ambos os lados, correspondendo ao médio da raiz. É preciso, portanto, conhecer as variações morfológicas de raízes para melhores diagnósticos, prognósticos e tratamentos.

Avaliação dos fatores genéticos e microbiológicos da periodontite agressiva: revisão da literatura / Evaluation of genetic and microbiologic features of aggressive periodontitis: literature review

A Periodontite Agressiva acomete normalmente pacientes jovens, mas também adultos, tendo uma forte característica genética e microbiológica. O objetivo do presente estudo foi esclarecer a influência destes fatores na susceptibilidade do indivíduo a esta doença e se as características da doença propostas pela Academia Americana de Periodontologia em 1999 podem ser aplicáveis às diversas populações. Concluiu-se que o fator microbiológico é indiscutível na etiologia da Periodontite Agressiva, mas a susceptibilidade do hospedeiro e as respostas do organismo a esta doença variam nas diferentes populações.

Aggressive Periodontitis is more common in young patients and bears strong genetic and microbiologic features. The purpose of the present study was to search the existing data for what has been identified as factors for increased disease susceptibility, and whether the diagnostic criteria proposed by the American Academy of Periodontology in 1999 can be accepted throughout the world. The conclusions were that the microbiologic factors for Aggressive Periodontitis are certain, but the reasons for differences in populations’ susceptibility or immune response to the disease are still unclear.

Lesões endoperiodontias: considerações clínicas e microbiológicas / Endodontic-periodontal lesions: clinical and microbiological considerations

A polpa e o periodonto possuem uma estreita ligação entre si, e um pode interferir na saúde do outro. São vários os caminhos pelos quais essa interação ocorre; os principais são o forame apical, os canais acessórios, os canais laterais e os túbulos dentinários. Quando uma lesão acontece ao mesmo tempo na polpa e no periodonto de um dente, é denominada lesão endoperiodontal. Um correto diagnóstico é de suma importância para o estabelecimento do melhor plano de tratamento das lesões endoperiodontais. O tratamento delas consiste na terapia endodôntica, na terapia periodontal ou ambas. Similaridades são encontradas nas floras microbianas da polpa e do periodonto, mas os tipo microbianos existentes no canal são mais restritos do que os encontrados no periodonto. Neste artigo, uma revisão de literatura foi realizada com o objetivo de auxiliar no conhecimento clínico e microbiológico das lesões endoperiodontais. O presente trabalho fará uma breve revisão de literatura abordando os efeitos que os tecidos periodontal e pulpar podem exercer um sobre o outro, a fim de ajudar na escolha da melhor forma de tratamento

The pulp and the periodontium have a close link, and one can interfere with the health of the other. There are several ways by which this interaction occurs. The apical foramen, accessory canals, lateral canalsand dentinal tubules are the main path. When a lesion occurs in the same time in the pulp and periodontium, this lesion is called endoperiodontal lesion. A correct diagnosis is very important for establishing the best treatment of lesions. The treatment of these endoperiodontal lesions is in endodontic therapy, periodontal therapy or both. Similarities are found in bacterial flora of the pulp and the periodontium, but the bacterial types exist in the canal are more restricted than those of periodontium. In this article, a literature review was conducted. The goal was the knowledge of the clinical and microbiological diagnosis in endoperiodontal lesions. This work will make a brief review of literature addressing the effect that theperiodontal and pulpal tissues may have one on the other, in order to assist in choosing the best form of treatment