In vitro antimicrobial effect of cetylpyridinium chloride on complex multispecies subgingival biofilm

Abstract Periodontopathogenic subgingival biofilm is the main etiological agent of periodontitis. Thus, a search for antimicrobials as adjuvant for periodontal treatment in the literature is intense. Cetylpyridinium chloride (CPC) is a well-known antimicrobial agent commonly used in mouthrinses. However, CPC effects on a complex biofilm model were not found over the literature. Therefore, the aim of this manuscript is to evaluate 0.075% CPC antimicrobial properties in a multispecies subgingival biofilm model in vitro. The subgingival biofilm composed by 31 species related to periodontitis was formed for 7 days, using the calgary device. The treatments with CPC and chlorhexidine (CHX) 0.12% (as positive control) were performed 2x/day, for 1 min, from day 3 until the end of experimental period, totaling 8 treatments. After 7 days of biofilm formation, biofilm metabolic activity was evaluated by a colorimetric reaction and biofilms microbial composition by DNA-DNA hybridization. Statistical analysis was performed using ANOVA with data transformed via BOX-COX followed by Dunnett post-hoc. Both CPC and CHX reduced biofilm metabolic activity in 60% and presented antimicrobial activity against 13 different species. Specifically, only CHX reduced levels of F.n. vicentii and P. gingivalis while only CPC reduced A. odontolyticus and A. israelli. CPC was as effective as CHX as antimicrobial through in vitro complex multispecies subgingival biofilm. However, future studies using in vivo models of experimental periodontal disease should be performed to prove such effect.

Resumo O biofilme subgengival periodontopatogênico é o principal agente etiológico da periodontite. Assim, a pesquisa de antimicrobianos como adjuvantes para o tratamento periodontal na literatura é intensa. Cloreto de cetilpiridínio (CPC) é um agente antimicrobiano comumente usado em enxaguatórios bucais. No entanto não foram encontrados na literatura estudos avaliando os efeitos do CPC em um modelo complexo de biofilme. Portanto, o objetivo deste artigo é avaliar as propriedades antimicrobianas do cloreto de cetilpiridinio 0,075% em um modelo de biofilme subgengival multiespécie in vitro. O biofilme subgengival composto por 31 espécies relacionadas à periodontite foi formado por 7 dias, utilizando o dispositivo calgary. Os tratamentos com CPC e clorexidina (CHX) 0,12% (controle positivo) foram realizados 2x/dia, por 1 min, do dia 3 até o final do período experimental, totalizando 8 tratamentos. Após 7 dias de formação do biofilme, a atividade metabólica do biofilme foi avaliada por reação colorimétrica e a composição microbiana dos biofilmes por hibridização DNA-DNA. A análise estatística foi realizada usando ANOVA com dados transformados via BOX-COX seguido do teste de Dunnett. Tanto o CPC como a CHX reduziram a atividade metabólica do biofilme em aproximadamente 60% e apresentaram atividade antimicrobiana contra 13 espécies diferentes. Especificamente, apenas os níveis de F.n. Vicentii e P. gingivalis foram reduzidos somente pelo tratamento com a CHX enquanto apenas o CPC reduziu A. odontolyticus e A. israelli. O CPC foi tão eficaz quanto o CHX como antimicrobiano através de biofilme subgengival complexo multiespecífico in vitro. No entanto, futuros estudos usando modelos in vivo de doença periodontal experimental devem ser realizados para comprovar tal efeito.

Microbiological and clinical effects of adjunctive systemic metronidazole and amoxicillin in the non-surgical treatment of peri-implantitis: 1 year follow-up

Abstract The aim of this study was to evaluate the effects of adjunct systemic antibiotic treatment with metronidazole (MTZ) and amoxicillin (AMX) in patients receiving non-surgical subgingival debridement (NSD) for peri-implantitis. Forty subjects presenting with at least one implant with severe peri-implantitis were randomized into an experimental group [treated with NSD plus MTZ (400 mg) and AMX (500 mg) three times a day for 14 days] and a control group treated with NSD plus placebo. Clinical parameters and submucosal biofilm profiles were evaluated up to 1 year post-treatment. Overall, both treatments improved clinical parameters over time. At 1 year, mean probing depth (PD), mean clinical attachment (CA) level and proportions of red complex pathogens did not differ significantly between the two groups. In addition, mean PD and CA changes to 1-year posttreatment did not differ significantly between the two groups between baseline and 1-year post-treatment. These results suggest that the addition of MTZ and AMX to the treatment protocol of patients undergoing NSD for with severe peri-implantitis does not improve the clinical and microbiological outcomes of NSD. The fact that half of the implants in both groups did not achieve clinical success (PD < 5 mm, no BoP, no bone loss) suggest that neither of the tested protocols were effective for treating severe peri-implantitis.

Additive manufacturing of titanium alloy could modify the pathogenic microbial profile: an in vitro study

Abstract Additive manufacturing (AM) is an emerging process for biomaterials and medical devices. Direct Laser Metal Sintering (DLMS) is an AM technique used to fabricate Ti-6Al-4V implant materials with enhanced surface-related properties compared with wrought samples; thus, this technique could influence microbial adsorption and colonization. Therefore, this in vitro study was conducted to evaluate the impact of different implant production processes on microbial adhesion of periodontal pathogens. Titanium discs produced using two different processes—conventional and AM—were divided into three groups: conventional titanium discs with machined surface (G1), AM titanium discs with chemical treatment (G2) and AM titanium discs without chemical treatment (G3). Subgingival biofilm composed of 32 species was formed on the titanium discs, and positioned vertically in 96-well plates, for 7 days. The proportions of microbial complexes and the microbial profiles were analyzed using a DNA-DNA hybridization technique, and data were evaluated using Kruskal-Wallis and Dunnett tests (p < 0.05). Lower proportions of the red complex species were observed in the biofilm formed in G2 compared with that in G1 (p < 0.05). Moreover, the proportions of the microbial complexes were similar between G2 and G3 (p > 0.05). Compared with G1, G2 showed reduced levels of Porphyromonas gingvalis , Actinomyces gerencseriae, and Streptococcus intermedius , and increased levels of Parvimonas micra , Actinomyces odontolyticus, and Eikenella corrodens (p < 0.05). The microbial profile of G3 did not differ from G1 and G2 (p > 0.05). The results of this in vitro study showed that titanium discs produced via AM could alter the microbial profile of the biofilm formed around them. Further clinical studies should be conducted to confirm these findings.

An umbrella review on the effects of diabetes on implant failure and peri-implant diseases

Abstract The aim of this review is to summarize the evidence on associations between diabetes mellitus (DM) and complications around dental implants. Electronic database searches of MEDLINE, EMBASE, JBI Database of Systematic Reviews and Implementation Reports, Cochrane Database of Systematic Reviews and the PROSPERO register were performed from 1990 up to and including May 2018, using MeSH terms and other keywords. Systematic reviews and meta-analyses investigating the associations of DM and implant complications (failure, survival, bone loss, peri-implant diseases, and post-surgery infection) were eligible. The quality of the included reviews was determined using the Assessment of Multiple Systematic Reviews Tool 2 (AMSTAR 2). Twelve systematic reviews were included. Implant survival rates ranged from 83.5% to 100%, while implant failure rates varied from 0% to 14.3% for subjects with DM. The three meta-analyses performed for event "implant failure" reported no statistically significant differences between diabetic and non-diabetic subjects. An apparently increased risk of peri-implantitis is reported in patients with DM. According to the AMSTAR 2 classification, 50% of the reviews were classified as being of "critically low", 25% as of "low" and 25% as of "moderate" quality. Evidence indicates high levels of survival and low levels of failure of implants inserted in patients with DM. However, DM was assessed as a whole in the majority of studies and, the actual influence of hyperglycemia on implant survival/failure is still uncertain. DM/hyperglycemia seems to be associated with a high risk of peri-implantitis. However, this conclusion is based on a limited number of systematic reviews.

Successful and failed mini-implants: microbiological evaluation and quantification of bacterial endotoxin

Abstract Objectives Using two groups of mini-implants (successful and failed) the objectives of this in vivo study were: to evaluate the microbial contamination by the checkerboard DNA-DNA hybridization technique and to quantify the bacterial endotoxin by the limulus amebocyte lysate assay. Material and Methods The 15 successful and 10 failed mini-implants (1.6 mm diameter × 7.0 or 9.0 mm long), placed in the maxilla and/or mandible, were obtained from 15 patients undergoing orthodontic treatment. Data were analyzed statistically by the Wilcoxon rank-sum test using the SAS software (a=0.05). Results All 40 microbial species were detected in both groups of mini-implants, with different frequencies. No differences were observed between the groups with respect to microbial complexes (blue, purple, yellow, green, orange, red and other species) and endotoxin quantification (p>0.05). Conclusion Neither microbial contamination nor endotoxin quantification was determinant for the early loss of stability of the mini-implants.

Effectiveness of a pre-procedural mouthwash in reducing bacteria in dental aerosols: randomized clinical trial

Abstract The aim of this randomized, single blinded clinical trial was to evaluate the effect of a pre-procedural mouthwash containing cetylpyridinium chloride (CPC), zinc lactate (Zn) and sodium fluoride (F) in the reduction of viable bacteria in oral aerosol after a dental prophylaxis with ultrasonic scaler. Sixty systemically healthy volunteers receiving dental prophylaxis were randomly assigned to one of the following experimental groups (15 per group): (i) rinsing with 0.075% CPC, 0.28% Zn and 0.05% F (CPC+Zn+F), (ii) water or (iii) 0.12% chlorhexidine digluconate (CHX), and (iv) no rinsing. Viable bacteria were collected from different locations in the dental office on enriched TSA plates and anaerobically incubated for 72 hours. The colonies were counted and species were then identified by Checkerboard DNA–DNA Hybridization. The total number of colony-forming units (CFUs) detected in the aerosols from volunteers who rinsed with CPC+Zn+F or CHX was statistically significantly (p<0.05) lower than of those subjects who did not rinse or who rinsed with water. When all locations were considered together, the aerosols from the CPC+Zn+F and CHX groups showed, respectively, 70% and 77% fewer CFUs than those from the No Rinsing group and 61% and 70% than those from the Water group. The mean proportions of bacterial species from the orange complex were statistically significantly (p<0.05) lower in aerosols from the CPC+Zn+F and CHX groups compared with the others two groups. In conclusion, the mouthwash containing CPC+Zn+F, is effective in reducing viable bacteria in oral aerosol after a dental prophylaxis with ultrasonic scaler.

Association of three putative periodontal pathogens with chronic periodontitis in Brazilian subjects

ABSTRACT Objective The aim of this study was to evaluate the association of Porphyromonas endodontalis, Filifactor alocis and Dialister pneumosintes with the occurrence of periodontitis. Material and Methods Thirty subjects with chronic periodontitis (ChP) and 10 with periodontal health (PH) were included in the study. Nine subgingival biofilm samples were collected as follows: i) PH group - from the mesial/buccal aspect of each tooth in two randomly chosen contralateral quadrants; ii) ChP group - from three sites in each of the following probing depth (PD) categories: shallow (≤3 mm), moderate (4-6 mm) and deep (≥7 mm). Checkerboard DNA-DNA hybridization was used to analyze the samples. Results We found the three species evaluated in a higher percentage of sites and at higher levels in the group with ChP than in the PH group (p<0.05, Mann-Whitney test). We also observed these differences when the samples from sites with PD≤4 mm or ≥5 mm of subjects with ChP were compared with those from subjects with PH (p<0.05, Mann-Whitney test). In addition, the prevalence and levels of D. pneumosintes, and especially of F. alocis were very low in healthy subjects (0.12x105 and 0.01x105, respectively). Conclusion F. alocis and D. pneumosintes might be associated with the etiology of ChP, and their role in the onset and progression of this infection should be further investigated. The role of P. endodontalis was less evident, since this species was found in relatively high levels and prevalence in the PH group.

Comparison of independent and dependent culture methods for the detection of transient bacteremia in diabetic subjects with chronic periodontitis / Comparación entre métodos de cultivo independientes y dependientes para la detección de bacteriemia transitoria en individuos diabéticos con periodontitis crónica

Introduction: Oral-derived bacteremia may occur after several dental procedures and routine daily activities. Some conditions of the oral cavity may favor episodes of bacteremia. This would be the case of patients with diabetes mellitus and periodontitis, who exhibit exacerbated gingival inflammation and may be more prone to developing oral-derived bacteremia. Objective: To compare the effectiveness of an independent culture method (quantitative real-time PCR- qCR) and the most commonly used method (BacT-ALERT 3D ® ) for the diagnosis of bacteremia. Materials and methods: Blood samples were drawn from subjects with type 2 diabetes mellitus and chronic periodontitis before and after apple chewing. Samples were processed by an automated blood culture system (BacT-ALERT 3D ® ) monitored for 15 days with suitable subculture of positive cultures. In parallel, whole DNA from blood samples was purified using a commercial kit and screened by qPCR using a universal primer set of 16S rDNA for bacteria detection. Results: Blood cultures taken before apple chewing were shown to be negative by the two diagnostic methods. After chewing, two samples (11%) showed bacterial growth by BacT-ALERT 3D ® whereas qPCR did not detect the presence of bacteria in any sample. Conclusions: qPCR did not show greater effectiveness than the BacT-ALERT 3D ® in the detection of bacteremia of oral origin.

Introducción. Las bacteriemias de origen oral pueden ocurrir después de procedimientos odontológicos y de otros actos cotidianos. Algunas condiciones de la cavidad oral favorecen las bacteriemias como en el caso de pacientes con diabetes mellitus y periodontitis que presentan inflamación gingival exacerbada. Objetivo. Comparar la eficacia de un método independiente de cultivo (PCR cuantitativa) y otro dependiente (BacT-ALERT 3D ® ) en la detección de la bacteriemia. Materiales y métodos. Se tomaron muestras de sangre de individuos con diabetes mellitus de tipo II y periodontitis, antes y después de la masticación de manzana. Una alícuota se procesó por el sistema automatizado de hemocultivo (BacT-ALERT 3D ® ) y se monitorizó durante 15 días; la otra alícuota fue tratada para la extracción del ADN y procesada por RT-PCR usando un conjunto de cebadores de 16S rDNA exclusivos para bacterias. Resultados. En las muestras tomadas antes de masticar se confirmó la ausencia de bacterias mediante los dos métodos. En las muestras tomadas después de masticar la presencia de bacterias se evidenció únicamente en dos hemocultivos y en ninguna de las muestras se detectó la presencia de bacterias con el método de RT-PCR. Conclusiones. La PCR cuantitativa no mostró mayor eficacia que el BacT-ALERT 3D ® en la detección de la bacteriemia de origen oral.

The effect of systemic antibiotics administered during the active phase of non-surgical periodontal therapy or after the healing phase: a systematic review

Objective The aim of this systematic review was to compare the clinical effectiveness of systemic antibiotics administered in the active stage of periodontal treatment or after the healing phase. Material and Methods An electronic search was performed in the databases EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials (CENTRAL), in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. A manual search of the reference list of selected studies and of review articles was also performed up to November 2013. Randomized Clinical Trials (RCT) that evaluated the systemic administration of antibiotics as adjuvants to scaling and root planning (SRP) at different phases of periodontal treatment were included. Systematic reviews and studies that evaluated subjects with systemic diseases and those that used subantimicrobial doses of antibiotics were excluded. Results The initial search identified 1,039 articles, of which seven were selected, and only one met the inclusion criteria. This study showed that subjects taking metronidazole and amoxicillin at the initial phase of treatment exhibited statistically significantly greater reduction in pocket depth and gain in clinical attachment level in initially deep sites (PD≥7 mm) than subjects taking antibiotics after healing (p<0.05). This comparison was conducted 2 months after antibiotic intake, at the healing phase. Conclusion To date, only one short-term RCT has directly compared different moments of systemic antibiotics administration, as adjuncts to SRP, in the treatment of periodontitis. Although the results of this study suggested some benefits for antibiotics intake during the active phase of therapy, these findings need to be confirmed by larger placebo-controlled randomized clinical trials with longer follow-up periods. .

Microbial Reduction by Two Chemical-Mechanical Protocols in Primary Teeth with Pulp Necrosis and Periradicular Lesion - An In Vivo Study

The objective of this study was to determine the efficacy of chemical-mechanical procedures of two endodontic protocols for septic content reduction of root canals from primary teeth with pulp necrosis and periradicular lesion. Twenty-four primary root canals with pulp necrosis and periradicular lesion were divided into two treatment groups (n=12): multiple-visit and single-visit protocols. Samples were collected using sterile paper points before and after endodontic cleaning followed by microbiological identification through checkerboard DNA-DNA hybridization. Statistical analysis was performed using Proportion Test for score=0 comparing the findings before and after treatment for each group (Wilcoxon's test) as well as the differences in scores between protocols (Mann-Whitney's test) (p<0.05). Data were expressed as prevalence (presence or absence) and estimate of the average count (x105 cells) of each species. Differences in proportions of score=0 prior to treatment were non-significant (p=0.415), demonstrating equivalence between groups. A significant increase in score=0 was detected after treatment for both groups (p<0.0001). Single-visit protocol achieved a significantly greater reduction in mean scoring following endodontic treatment (p=0.024). Both protocols were capable of significantly reducing septic content in root canals of primary teeth with periradicular lesion. Moreover, single-visit protocol showed greater efficacy in reducing endodontic infection.

O objetivo deste estudo foi determinar a eficácia das manobras químico-mecânicas de dois protocolos endodônticos, na redução do conteúdo séptico de canais radiculares de dentes decíduos com polpa necrosada e lesão perirradicular. Vinte e quatro canais radiculares decíduos com necrose pulpar e lesão perirradicular foram divididos em dois grupos de tratamento (n=12): multisessões e sessão única. Amostras foram coletadas usando pontas de papel estéreis, antes e após a limpeza endodôntica, seguido de identificação microbiológica por hibridização DNA-DNA checkerboard. A análise estatística foi realizada usando teste de proporções para escore=0, comparando os achados antes e após tratamento para cada grupo (teste de Wilcoxon) e as diferenças dos escores entre os protocolos (teste de Mann-Whitney) (p<0,05). Os dados foram expressos em prevalência (presença ou ausência) e contagem média (x105 células) de cada espécie. As diferenças nas proporções de escore=0 antes do tratamento não foram significativas (p=0,415), mostrando equivalência entre os grupos. Um aumento significativo de escore=0 foi detectado após o tratamento para ambos os grupos (p<0,0001). O protocolo de sessão única mostrou uma redução significativamente maior dos escores médios após o tratamento endodôntico (p=0,024). Ambos os protocolos são capazes de reduzir significativamente o conteúdo séptico de canais radiculares de dentes decíduos com lesão perirradicular. Entretanto, o protocolo de sessão única mostrou uma maior eficácia na redução da infecção endodôntica.

Mechanisms of action of systemic antibiotics used in periodontal treatment and mechanisms of bacterial resistance to these drugs

Antibiotics are important adjuncts in the treatment of infectious diseases, including periodontitis. The most severe criticisms to the indiscriminate use of these drugs are their side effects and, especially, the development of bacterial resistance. The knowledge of the biological mechanisms involved with the antibiotic usage would help the medical and dental communities to overcome these two problems. Therefore, the aim of this manuscript was to review the mechanisms of action of the antibiotics most commonly used in the periodontal treatment (i.e. penicillin, tetracycline, macrolide and metronidazole) and the main mechanisms of bacterial resistance to these drugs. Antimicrobial resistance can be classified into three groups: intrinsic, mutational and acquired. Penicillin, tetracycline and erythromycin are broad-spectrum drugs, effective against gram-positive and gram-negative microorganisms. Bacterial resistance to penicillin may occur due to diminished permeability of the bacterial cell to the antibiotic; alteration of the penicillin-binding proteins, or production of β-lactamases. However, a very small proportion of the subgingival microbiota is resistant to penicillins. Bacteria become resistant to tetracyclines or macrolides by limiting their access to the cell, by altering the ribosome in order to prevent effective binding of the drug, or by producing tetracycline/macrolide-inactivating enzymes. Periodontal pathogens may become resistant to these drugs. Finally, metronidazole can be considered a prodrug in the sense that it requires metabolic activation by strict anaerobe microorganisms. Acquired resistance to this drug has rarely been reported. Due to these low rates of resistance and to its high activity against the gram-negative anaerobic bacterial species, metronidazole is a promising drug for treating periodontal infections.

Changes in the subgingival biofilm composition after coronally positioned flap

OBJECTIVES: This study evaluated the effects of coronally positioned flap (CPF) on the subgingival biofilm composition. MATERIAL AND METHODS: Twenty-two subjects with gingival recessions were treated with CPF. Clinical parameters were assessed before and at 6 months after surgery. Subgingival biofilms were analyzed by checkerboard DNA-DNA hybridization technique for 40 bacterial species. RESULTS: Recession height, clinical attachment level and bleeding on probing improved significantly (p<0.05) at 6 months post-CPF. The proportions of 10 periodontal pathogens and the proportions of red and orange complexes decreased at 6 months. CONCLUSION: In conclusion, CPF can induce beneficial effects on the composition of the subgingival microbiota after 6 months.

Prevalência de Archaea em indivíduos com doença periodontal e saúde periodontal / Prevalence of Archaea in subjets with periodontal disease and periodontally healthy

Apesar de micro-organismos do domínio Archaea já terem sido detectados em amostras de biofilme subgengival de indivíduos com periodontite, nenhum estudo comparou diretamente a associação de Archaea com as periodontites crônica e agressiva. Assim sendo, o objetivo desse estudo foi avaliar a prevalência do domínio Archaea em indivíduos com periodontite crônica generalizada (PCrG), periodontite agressiva generalizada (PAgG) e indivíduos com saúde periodontal (SP), e correlacionar os achados microbiológicos com o aumento da profundidade de sondagem (PS). Foram selecionados 15 indivíduos com PCrG, 15 com PAgG e 15 com SP. Inicialmente, os indivíduos foram submetidos ao exame clínico-periodontal. Em seguida, amostras de biofilme subgengival foram coletadas de 9 sítios nos indivíduos do grupo SP e de 9 sítios (PS <3mm, 3 PS 4-6mm e 3 PS >7mm) nos indivíduos dos grupos PCrG e PAgG. Após a extração do DNA, as amostras foram submetidas à reação de amplificação do gene 16S rRNA de Archaea. A presença de Archaeafoi detectada em 11/15 indivíduos do grupo PCrG, em 9/15 indivíduos com PAgG e 12/15 indivíduos com SP (p>0,05). Em relação ao número de amostras positivas, foram 21 no grupo SP, 39 no PAgG e 43 no PCrG observados. Não foram observadas diferenças estatísticas entre os diferentes grupos experimentais (p>0,05) e também não houve correlação entre a presença de Archaea e as diferentes categorias de profundidade de sondagem. Em conclusão, sugere-se ausência de associação entre a detecção de Archaea e a periodontite.

Archaea has been detected in subgingival biofilm samples from individuals with periodontitis, however, no studies were found to enable a direct comparison of the association of Archaea with chronic and aggressive periodontitis. Therefore, the aim of the present study was to evaluate the prevalence of the Archaea domine in individuals with generalized chronic periodontitis (GCrP), generalized aggressive periodontitis (GAgP) and periodontal healthy (PH) and correlation these finding with the increase of probing depth (PD). Fifteen individuals with GCrP, fifteen individuals with GAgP and fifteen individuals with PH were selected. The individuals were submitted a clinical periodontal examination. Subgingival biofilm samples were collected from 9 sites in the PH group and 9 sites (3 PD ¡Ü3mm, 3 PD 4-6mm and 3 PD ¡Ý7mm) in the 30 individuals in the GAgP and GCrP groups. After the DNA extraction, the presence of Archaea was analyzed by polymerase chair reaction (PCR). The occurrence of Archaea was detected in 11/15 individuals in the GCrP group, 9/15 individuals with GAgP and 12/15 individuals with SP (p>0.05). Among the individuals of with SP, PAgG and PCrG, 21, 39 and 43 samples were positive for Archaea, respectively. However, there were no statistical differences observed among experimental groups (p>0.05). There was no correlation between the presence of Archaea and the different probing depth categories. In conclusion, these results suggest the absence of association between the detection of Archaeaand periodontitis.

Qual o antibiótico para periodontite agressiva? / What antibiotic to aggressive periodontitis?

As doenças periodontais são um grupo de infecções que possuem como fator etiológico primário as bactérias presentes na cavidade bucal, especialmente as que colonizam as superfícies dos dentes, supra e subgengivalmente, organizadas num biofilme cuja presença acomete as estruturas de proteção e sustentação dos dentes, levando à perda de inserção, de tecido ósseo e, eventualmente, do elemento dentário1. Muitos avanços tecnológicos nas áreas da imunologia e biologia molecular, ocorridos principalmente nas duas últimas décadas, facilitaram sobremaneira o entendimento da etiopatogenia das periodontites, incluindo a microbiota patogênica relacionada a cada tipo de doença e o perfil do hospedeiro. Esses conhecimentos têm facilitado o direcionamento de terapias mais específicas para cada paciente, que, sendo fundamentadas nos fatores etiológicos da infecção, podem trazer melhores resultados clínicos e microbiológicos em longo prazo.

The ability of the BANA test to detect different levels of P. gingivalis, T. denticola and T. forsythia

The aim of this study was to evaluate the ability of the BANA Test to detect different levels of Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia or their combinations in subgingival samples at the initial diagnosis and after periodontal therapy. Periodontal sites with probing depths between 5-7 mm and clinical attachment level between 5-10 mm, from 53 subjects with chronic periodontitis, were sampled in four periods: initial diagnosis (T0), immediately (T1), 45 (T2) and 60 days (T3) after scaling and root planing. BANA Test and Checkerboard DNA-DNA hybridization identified red complex species in the subgingival biofilm. In all experimental periods, the highest frequencies of score 2 (Checkerboard DNA-DNA hybridization) for P. gingivalis, T. denticola and T. forsythia were observed when strong enzymatic activity (BANA) was present (p < 0.01). The best agreement was observed at initial diagnosis. The BANA Test sensitivity was 95.54 percent (T0), 65.18 percent (T1), 65.22 percent (T2) and 50.26 percent (T3). The specificity values were 12.24 percent (T0), 57.38 percent (T1), 46.27 percent (T2) and 53.48 percent (T3). The BANA Test is more effective for the detection of red complex pathogens when the bacterial levels are high, i.e. in the initial diagnosis of chronic periodontitis.

Efeitos da profilaxia profissional repetida como terapia adjunta à raspagem e alisamento radicular / The efect of professional supragengival plaque control as part of the active phase of periodontal therapy

O objetivo deste estudo foi avaliar os efeitos clínicos e microbiológicos da terapia de raspagem e alisamento radicular (RAR) isoladamente ou em combinação com o controle profissional da placa supragengival (CPP). Foram selecionados 30 indivíduos com periodontite crônica e, posteriormente, distribuídos aleatoriamente em dois grupos terapêuticos: controle (RAR) e teste (RAR + CPP). Os exames clínicos (índice de placa, índice gengival, profundidade de sondagem, nível clínico de inserção, sangramento à sondagem e supuração) e microbiológico (Teste BANA) foram realizados no momento inicial, 40 e 60 dias após a terapia de RAR. A terapia de RAR foi realizada em 21 dias e o CPP foi iniciado juntamente com a RAR, duas vezes semanais, e prosseguiu durante 40 dias após o término desta. Os parâmetros clínicos foram reduzidos significativamente aos 60 dias pós-terapia em ambos os grupos terapêuticos (p6 mm) no grupo CPP tiveram melhores resultados em relação à redução do acúmulo de placa e na profundidade de sondagem em comparação ao grupo controle. Ambas as terapias levaram a melhora microbiológica durante o período experimental (p0,05). Em conclusão, a combinação do CPP com a RAR promove benefícios clínicos em comparação com a RAR isolada.

The purpose of the present study was to evaluate the clinical and microbiological effects of scaling and root planing (RAR) alone or in combination with professional supragingival pla- que control (CPP). Thirty subjects with chronic periodontitis were assigned into two therapeutic groups: Control (RAR) and Test (RAR + CPP). Clinical (visible plaque, gingival bleeding, probing depth, clinical attachment levei, bleeding on probing and suppuration) and microbiological (BANA Test] examinations were performed at baseline, 40 and 60 days post-SRP. The CPP treatment was made twice a week and began with SRP and was continued for 40 days post-SRP. The clinical pa- rameters were significantly reduced at 60 days post-therapy in both treatment groups (p6mm) in the PPC group also had a better reduction in the percentage of sites with bleeding on probing and in probing depth and in the gain of clinical attachment compared to the control group. Both therapies led to a microbiological improvement overtime (p0.05). In conclusion, the combination of CPP and RAR leads to clinical benefits in comparison to RAR alone.

Microbiological composition associated with vitamin D receptor gene polymorphism in chronic periodontitis

The aim of this cross-sectional study was to examine the relationship between the composition of the subgingival microbiota and the vitamin D receptor (VDR) gene polymorphism in Brazilian adults with chronic periodontitis. The clinical parameters of probing depth, clinical attachment level, bleeding on probing, plaque accumulation and suppuration were measured in 60 Caucasian adults who were divided into two groups: 30 healthy individuals (control) and 30 with chronic periodontitis (ChP). Subgingival plaque samples were collected from 6 sites per subject and analyzed for 38 bacterial species using the Checkerboard DNA-DNA Hybridization. DNA was obtained from the subjects' epithelial cells by scraping the buccal mucosa and using a mouthwash containing 3 percent of glucose. Polymorphism in the VDR gene was analyzed by the polymerase chain reaction (PCR), followed by Taql digestion (RFLP). The healthy subjects presented significantly lower levels (0.3 × 10(7) ± 0.7 × 10(7)) of total microbial counts in comparison with subjects with chronic periodontitis (4.5 × 10(7) ± 2.9 × 10(7)). Regarding the occurrence of VDR polymorphism, it was observed that the Tt genotype was more prevalent in the Periodontitis group (60 percent) than in the Healthy group (30 percent), while the prevalences of the TT genotype were 23.3 percent and 53.3 percent, respectively (Chi-square test, p < 0.05). No difference was found in the composition of subgingival microbiota among the VDR genotypes evaluated for the Healthy and Periodontitis groups. In conclusion, the Tt genotype was associated with periodontal disease; however, no association with the subgingival microbiota was observed.

Da infecção focal à medicina periodontal / From focal infection to periodontal medicine

A participação de bactérias da cavidade oral na etiopatogenia de outras doenças no organismo pode ocorrer pela migração da própria bactéria para o foco de infecção extra-oral ou pelo estabelecimento de um quadro inflamatório sistêmico crônico a partir da infecção localizada na boca. Evidências científicas recentes sugerem que as doenças periodontais podem interferir na saúde sistêmica por meio desses dois mecanismos, principalmente pela liberação contínua de diversos mediadores químicos e subprodutos da inflamação. Concentrações plasmáticas elevadas dessas substâncias por períodos prolongados podem influenciar o início ou a progressão de outras enfermidades, como eventos adversos na gravidez e doenças cardiovasculares. Este artigo apresenta um breve histórico sobre a influência de bactérias orais na saúde sistêmica, desde a teoria da Infecção Focal até o atual conceito de Medicina Periodontal. Também são abordados os mecanismos de interação entre a microbiota periodonto patogência e a respostado hospedeiro.

Controle da placa bacteriana supragengival na terapia periodontal não-cirúrgica / Supragingival plaque control on non-surgery periodontal therapy

O tratamento periodontal está relacionado diretamente aos microrganismos envolvidos nos processos de saúde e doença, sendo assim, as terapias devem ser direcionadas para o controle desses microrganismos. A raspagem e o alisamento radicular (RAR) são uma terapia inespecífica que tem capacidade de alterar microbiologicamente o ambiente subgengival e proporcionar resultados clínicos positivos. Todavia, tais resultados não persistem a longo prazo devido à recolonização dos sítios tratados pelas bactérias remanescentes da região subgengival ou por agentes bacterianos provenientes da região supragengival. Nesse contexto, por meio de uma revisão de literatura, este estudo visa a esclarecer a importância da remoção mecânica da placa supragengival e a influência de tal procedimento nos resultados clínicos e microbiológicos da terapia periodontal. Diferentes metodologias clínicas e microbiológicas, tais como métodos de cultura, de microscopia de campo escuro e técnicas mais apuradas de biologia molecular foram utilizadas com o objetivo de avaliar o efeito do controle de placa supragengival associado ou não a RAR. Esses resultados têm demonstrado melhoras adicionais clínicas e microbiológicas quando é realizado um meticuloso controle da placa supragengival associado à RAR. O reconhecimento de novas metodologias microbiológicas faz do controle de placa supragengival um assunto em discussão e novos estudos precisam ser realizados na tentativa de aprimorar o conhecimento sobre a recolonização a longo prazo por periodontopatógenos nos sítios tratados

The periodontal treatment is relationship directly with the microorganism involved on the health and diseases status, and consequently, the therapies must focus the control of these microorganisms. The scaling and root planning (SRP) is an unspecific therapy that are able not only to change the microbial composition of the subgingival area but also to offer positive clinical results. Nevertheless, these positive results are not longer observed due to re-colonization of the treated periodontal sites by the pathogens remained either in the sub- or in the supragingival area. Therefore, by means of a review of literature this study aims to clarify the importance of both mechanic removal of the subgingival dental plaque and the influence of the SRP on the microbiological and clinical results. Different clinic and microbiologic methodologies such as cultivable techniques, dark-field electron microscopy, and molecular biology were used with the purpose to evaluate the effect of the supragingival plaque control associated or not with the SRP. These results have shown better clinical and microbiological additional results when there is and association between meticulous supragingival plaque control and SRP. The recognize of new microbiological methodologies demonstrate that the control of the supragingival plaque is a field in currently discussion and further investigations must be conducted to try arise the knowledge about the long term re-colonization of treated periodontal sites by periodontal pathogens