Prevalence and risk indicators of peri-implantitis after 8 to 10 years of function / Prevalência e indicadores de risco de peri-implantite após 8 a 10 anos em função

Abstract Introduction The investigation of peri-implant diseases risk indicators helps to prevent and target treatment techniques. Objective The aim of this cross-sectional study was to determine the occurrence of peri-implantitis and its potential risk indicator factors, besides to assess the long-term success and survival rates of dental implants after 8 to 10 years of function. Material and method For this, fifty individuals who had received their implant-supported rehabilitation between 2003 and 2005 were included. Data regarding demographics, medical and dental history were collected and a complete clinical examination was performed. Multivariate analysis was used to identify potential risk indicator factors related to the occurrence of peri-implantitis. Overall, 211 implants had been placed; 197 were in function, 9 were still submerged, and 5 had been lost. Result Success and survival rates were 81.5% and 97.6%, respectively. Peri-implant mucositis affected 77.1% of subjects and 52.3% of implants. Peri-implantitis was diagnosed in 14 individuals (29.2%) and 25 implants (12.7%). Subjects with osteoporosis (OR = 2.84) and generalized bleeding on probing (OR = 8.03) were significantly associated with higher odds of peri-implantitis. At the implant level, visible plaque (OR = 4.45) and deep probing depths (OR = 4.47) were significantly associated with peri-implantitis. Conclusion Through these results, our study suggests that osteoporosis and generalized periodontal/peri-implant mucosa inflammation increase the likelihood of peri-implantitis.

Resumo Introdução A investigação dos fatores indicadores de risco para as doenças peri-implantares auxilia na prevenção e direcionamento das técnicas de tratamento Objetivo O objetivo deste estudo transversal foi determinar a ocorrência de peri-implantite e seus potenciais fatores indicadores de risco, além de avaliar as taxas de sucesso e sobrevida em longo prazo dos implantes dentários após 8 a 10 anos de função Material e método Foram incluídos cinquenta indivíduos que receberam sua reabilitação implanto-suportada entre 2003 e 2005. Dados demográficos, história médica e odontológica foram coletados e um exame clínico completo foi realizado. A análise multivariada foi utilizada para identificar potenciais fatores indicadores de risco relacionados à ocorrência de peri-implantite. Ao todo, 211 implantes foram colocados; 197 estavam em função, 9 ainda estavam submersos e 5 haviam sido perdidos. Resultado As taxas de sucesso e sobrevivência foram de 81,5% e 97,6%, respectivamente. A mucosite peri-implantar afetou 77,1% dos indivíduos e 52,3% dos implantes. A peri-implantite foi diagnosticada em 14 indivíduos (29,2%) e 25 implantes (12,7%). Indivíduos com osteoporose (OR = 2,84) e sangramento generalizado à sondagem (OR = 8,03) foram significativamente associados a uma maior chance de peri-implantite. Ao nível do implante, a placa visível (OR = 4,45) e as maiores profundidades de sondagem (OR = 4,47) foram significativamente associadas à peri-implantite. Conclusão Por meio desses resultados, nosso estudo sugere que a osteoporose e a inflamação generalizada da mucosa periodontal / peri-implantar aumentam a probabilidade de peri-implantite.

Randomized clinical trials in periodontology: focus on outcomes selection

Abstract Randomized clinical trials (RCTs) are human studies carried out to compare different treatments or interventions, and their results are used to support clinical decision-making and improve patient care. Herein, the aim of this study was to review the selection process of study outcomes in periodontology. Primary outcomes should draw the main conclusions of the study, whereas secondary outcomes should only be used to help explain the main findings and generate future research hypothesis. Outcomes are classified as clinically relevant (CROs) or surrogate outcomes. CROs - the first option for primary outcome variables - should convey not only substantial health benefits, but also be deemed important by patients. In periodontology, tooth loss/retention and oral health-related quality of life (OHRQoL) are examples of CROs. While tooth loss has main limitations as a primary outcome, emerging evidence suggest that patient-reported outcome measures (PROMs) can accurately detect OHRQoL following periodontal therapy. When CROs cannot be assessed, validated surrogate outcomes can be used as proxies. Primary outcome variables should reflect a treatment endpoint at the patient level that can be easily used to inform decision-making in daily practice. These outcomes should allow the implementation of a treat-to-target concept in which the intervention can be clearly judged against a prespecified treatment target. Recently, the presence of at most 4 sites with periodontal probing depth ≥5 mm post-treatment was suggested as an effective endpoint for periodontal trials. In perspective, a combination of validated clinical parameters and PROMs will provide a more comprehensive assessment of periodontal treatments.

The impact of maintenance on peri-implant health

Abstract Most of the literature evaluating dental implants focuses on implant survival, which is a limited proxy for the successful rehabilitation of patients with missing teeth. Success should include not only survival but also lack of mechanical, biological, and esthetics problems. A comprehensive review of local and systemic risk factors prior to implant placement will allow the tailoring of treatment planning and maintenance protocols to the patient's profile in order to achieve longitudinal success of the therapy. This review discusses the role of controlling different risk factors and prevention/treatment of peri-implant mucositis in order to avoid peri-implantitis. Although the literature addressing the topic is still scarce, the existing evidence shows that performing optimal plaque control and regular visits to the dentist seem to be adequate to prevent peri-implant lesions. Due to impossibility of defining a probing depth associate with peri-implant health, radiographic evaluations may be considered in the daily practice. So far, there is a strong evidence linking a past history of periodontal disease to peri-implant lesions, but this is not so evident for other factors including smoking and diabetes. The prevention of biological complications starts even before implant placement and include a broader analysis of the patient risk profile and tailoring the rehabilitation and maintenance protocols accordingly. It should be highlighted that the installation of implants does not modify the patient profile, since it does not modify genetics, microbiology or behavioral habits of any individual.

Obesity and dental caries among South Brazilian schoolchildren: a 2. 5-year longitudinal study

Abstract The aim of this study was to assess the association between weight status and ΔDMFS among 12-year-old schoolchildren from South Brazil. A total of 801 12-year-old schoolchildren were followed-up for 2.5 ± 0.3 years. Data collection included questionnaire, recording of anthropometric measures (height and weight), and caries examination. The outcome was the difference between DMFS (number of decayed, missing or filled surfaces) at follow-up and baseline (ΔDMFS). Weight status, based on body mass index-for-age Z-scores, was considered the main predictor variable. Negative binomial regression models were used to model the association, and rate ratios and their 95% confidence intervals were estimated. A multivariable fractional polynomial model was used to further explore the relationship between obesity and dental caries. DMFS increased by 0.86 (95%CI = 0.65-1.07), 0.91 (95%CI = 0.59-1.23), and 0.42 (95%CI = 0.03-0.80) for normal weight, overweight, and obese schoolchildren, respectively. Obese adolescents had significantly lower ΔDMFS than normal weight ones (p < 0.05). No significant association between categories of weight status and ΔDMFS was found (overweight, IRR=0.92, 95%CI = 0.69-1.21, p = 0.54; obese IRR = 0.75, 95%CI = 0.51-1.12, p = 0.16). However, the multivariable fractional polynomial model showed an inverted U shaped relationship with a decreasing ΔDMFS with increasing BMI (p < 0.05). This population-based longitudinal study showed an inverse association between obesity and ΔDMFS over a 2.5-year period among South Brazilian adolescents.

Oral health related quality of life among pregnant women: a randomized controlled trial

Abstract: The aim of the present study was to compare negative impacts of oral conditions in Oral Heath Related Quality of Life (OHRQoL) assessed by the Oral Health Impact Profile-14 (OHIP-14) scores in pregnant women receiving or not comprehensive periodontal treatment. This randomized controlled clinical trial included pregnant women aged between 18 and 35 years old. Participants were randomized in a test group with 96 and a control group with 114 women. Patients in the test group received comprehensive periodontal treatment, supra and subgingival scaling and root-planning and periodontal maintenance appointments. The OHIP-14 was applied before and after treatment. The primary outcome was changes in OHIP-14 scores after follow-up period. The impact of having received or not comprehensive periodontal treatment on the change of the OHIP-14 scores was also investigated. Both groups showed significant reduction in OHIP-14 scores and effect size for the test group was 0.60 and 0.36 for the control group. Multinomial logistic regression analysis showed that participants of the control group had 5.9-fold odds (CI 95% 1.88-18.52) of worsening in OHIP-14 scores and their perception of oral conditions in relation to test group. Comprehensive periodontal treatment during pregnancy can reduce the negative impacts in OHRQoL.

Predictors of clinical outcomes after periodontal treatment of aggressive periodontitis: 12-month randomized trial

Abstract Little is known about the factors that may be used in clinical practice to predict the therapeutic response of aggressive periodontitis patients. The aim of this study was to determine predictors of clinical outcomes after non-surgical treatment of aggressive periodontitis. A total of 24 patients (aged 13-26 years) received oral hygiene instructions, as well as subgingival scaling and root planing. Twelve subjects received systemic azithromycin at random. Clinical variables were assessed at baseline, 3, 6, 9, and 12 months. Baseline microbiological assessment was performed by checkerboard DNA-DNA hybridization. Multivariable models used generalized estimating equations. There were significant improvements in the entire sample in regard to pocket depth, clinical attachment level and bleeding on probing. Significant predictors of a reduction in mean pocket depth were: use of azithromycin, non-molar teeth, generalized disease and baseline pocket depth. Absence of plaque predicted a 0.22 mm higher attachment gain, whereas a baseline pocket depth ≥7 mm predicted a 1.36 mm higher attachment loss. Azithromycin, plaque, and baseline pocket depth were significant predictors of bleeding on probing. The concomitant presence of all three red complex species predicted a 0.78 mm higher attachment loss. It may be concluded that dental plaque, tooth type, disease extent, baseline pocket depth, and use of azithromycin were significant predictors of the clinical response to treatment for aggressive periodontitis in young individuals. Moreover, the presence of multiple periodontal pathogens may predict challenges in achieving a favorable outcome for aggressive periodontitis.

A population-based cohort study of oral health in South Brazil: The Porto Alegre Study / Um estudo de coorte de base populacional de saúde bucal no sul do Brasil: Estudo de Porto Alegre

Few population-based cohort studies have been established in Dentistry and this is especially true for Latin America. We conducted a population-based prospective study focusing on oral health in Porto Alegre, south Brazil, and herein we describe its methodology and discuss directions for further research. The cohort was established in 2001 using a multistage probability sample of 1,465 toothed and 121 edentulous subjects. A 5-year follow-up was performed in 2006 that included 755 individuals. The main aim of this study was to determine the pattern and risk factors for periodontal disease progression and tooth loss incidence. A full-mouth protocol was used including periodontal assessments at six sites per tooth. Primary outcomes were periodontal attachment loss and tooth loss. Oral mucosal lesions, dental plaque, gingivitis, supragingival calculus, probing depths, gingival recession, and dental caries were also assessed. This is the first population-based cohort study to focus on periodontal disease in Latin America. Findings will contribute to our understanding of the epidemiology of periodontal disease and provide valuable data for the planning and implementation of preventive and therapeutic strategies.

Poucos estudos de coorte de base populacional têm sido estabelecidos em Odontologia e isso é especialmente verdade para a América Latina. Nós conduzimos um estudo prospectivo de base populacional focando em saúde bucal em Porto Alegre, sul do Brasil, e aqui descrevemos a metodologia do estudo e discutimos direções futuras da pesquisa. A coorte foi estabelecida em 2001 utilizando uma amostra probabilística múltiplo-estágio de 1.465 dentados e 121 desdentados. Um acompanhamento de 5 anos foi realizado em 2006 e incluiu 755 indivíduos. Os objetivos principais do estudo foram determinar o padrão e os fatores de risco para progressão de doença periodontal e incidência de perda dentária. Um protocolo de exame de boca completa foi utilizado, incluindo registros periodontais em 6 sítios por dente. Os desfechos primários foram perda de inserção periodontal e perda dentária. Lesões de mucosa bucal, placa visível, gengivite, cálculo supragengival, profundidade de sondagem, recessão gengival e cárie dentária também foram acessados. Este é o primeiro estudo de coorte de base populacional a focar em doença periodontal na América Latina. Os achados deste estudo contribuirão para o entendimento da epidemiologia da doença periodontal e fornecerão dados valiosos para planejamento e implementação de estratégias preventivas e terapêuticas.

Comparação da resposta clínica do uso coadjuvante de azitromicina em dentes molares e não-molares no tratamento não-cirúrgico da periodontite agressiva / Comparison of the clinical response of adjunctive azithromycin in molars and non-molars on nonsurgical treatment of aggressive periodontitis

Objetivo: comparar a resposta clínica do uso coadjuvante de azitromicina em molares e não molares no tratamento da periodontite agressiva. Material e métodos: 28 pacientes com periodontite agressiva (13 a 26 anos) receberam tratamento periodontal supra e subgengival. Os pacientes foram alocados aleatoriamente em dois grupos. O grupo teste usou 500 mg de azitromicina uma vez ao dia durante três dias, enquanto o grupo controle recebeu placebo. As variáveis clínicas foram obtidas no início, 3, 6, 9 e 12 meses. As médias de profundidade de sondagem (PS), perda de inserção (PI) e sangramento à sondagem (SS) foram comparadas entre os grupos teste e controle, separadamente em molares e não-molares. Resultados: houve redução significativamente maior da PS no grupo azitromicina (molares 2,61±0,34mm; não molares 3,02±0,22mm), comparado ao placebo (molares 1,50±0,40mm; não molares 2,00±0,39mm), após 12 meses em ambos os grupos dentários. O ganho de inserção no grupo azitromicina foi significativamente maior (1,69±0,26mm) comparado ao placebo (0,80±0,33mm) somente em molares. Considerando somente as bolsas inicialmente profundas (7+mm), o efeito clínico da azitromicina foi significativamente maior do que o placebo somente em molares tanto para PS quanto para PI. Não houve diferença significativa na redução de SS entre os grupos nos dois grupos dentários. Conclusão: o efeito benéfico adicional da azitromicina em comparação a placebo é mais evidente em dentes molares de pacientes com periodontite agressiva

Aim: to compare the clinical response of adjunctive azithromycin in molars and non-molars on the treatment of aggressive periodontitis. Material and methods: 28 subjects with aggressive periodontitis (13 to 26 years-old) received both supra and subgingival periodontal treatment. Individuals were randomly assigned in two groups. The test group used 500 mg azithromycin once a day for 3 days, whereas the control group used a placebo. Clinical variables were assessed at baseline, 3, 6, 9, and 12 months. Means of probing depth (PD), clinical attachment lost (CAL) and bleeding on probing (BOP) were compared between test and control groups separately for molars and non-molars. Results: there was a significantly higher PD reduction in azithromycin group (molars 2.61±0.34mm; non-molars 3.02±0.22mm) compared to placebo (molars 1.50±0.40mm; non-molars 2.00±0.39mm) after 12 months in both tooth types. The gain of clinical attachment in the azithromycin group was significantly higher (1.69±0.26mm) compared to placebo (0.80±0.33mm) only in molars. Considering only initially deep pockets (7+mm), the clinical effect of azithromycin was significantly higher than placebo only in molars, for PD and CAL. There were no significant differences in BOP changes between azithromycin and placebo in any of the tooth types. Conclusion: the additional benefits of azithromycin compared to placebo are more evident in molar teeth of aggressive periodontitis patients.

Pesquisa clínica em periodontia: princípios metodológicos e aspectos éticos / Clinical research in periodontics: methodological principles and ethical issues

O número de publicações em periodontia aumentou consideravelmente nas últimas décadas. Entretanto, uma importante proporção dos estudos clínicos recentemente publicados nacional e internacionalmente ainda apresenta erros metodológicos que afetam a sua validade. O objetivo desse artigo é apresentar princípios metodológicos que devem ser observados durante o planejamento e execução de estudos clínicos em Periodontia. Adicionalmente, aspectos éticos e de normatização serão discutidos visando garantir a integridade das evidências clínicas geradas.

The effect of smoking on gingival crevicular fluid volume during the treatment of gingivitis / Efeito do tabagismo sobre o volume de fluido crevicular gingival durante o tratamento da gengivite

Smoking is detrimental to periodontal tissues, and periodontal destruction is greater among smokers. Paradoxically, smokers seem to have less gingival bleeding than never-smokers with comparable supragingival plaque. There is scarce information about the impactof smoking on gingival crevicular fluid (GCF) volume. This singlearm study clinical trial assessed the effect of smoking on GCF volume during the treatment of gingivitis. The sample included 24 never-smokers (47.3 ± 6.7 years old, 41.7% males) and 21 smokers (45.8 ± 5.1 years old; 55% males; 19.6 ± 11.8 cigarettes/day; 24.1 ± 8.7 years of smoking) with gingivitis and chronic periodontitis. After baselinesupragingival scaling, patients received oral hygiene instructions weekly for 180 days. Participants were examined at baseline, 30, 90 and 180 days, and gingival bleeding index (GBI), bleeding on probing (BOP), periodontal probing depth (PPD) and GCF volume wererecorded. Statistical analysis was performed using linear models (Wald test, p<0.05%). Smokers had significantly smaller GCF volumes than never-smokers. This finding was not attributed to GBI, BOP or PPD. Higher volumes of GCF were significantly associated with deeper pockets. GCF was significantly reduced throughout thestudy for both smokers and never-smokers, and the largest reductionswere seen at 30 days. Smoking affected the GCF crevicular fluid volumeindependently of the presence of gingival bleeding, BOP and PPD. Smoking status and PPD should be taken into account when GCG volume and components are under investigation.

O tabagismo é capaz de alterar a resposta periodontal determinando maior expressão de destruição periodontal em pacientes fumantes. Paradoxalmente, estes pacientes apresentam menos sangramento gengival frente a uma quantidade semelhante de biofilme dental, quando comparados a pacientes que nuncafumaram. Por outro lado, existe pouca informação sobre o impacto do tabagismo sobre o volume de fluido crevicular gengival (FCG). O presente ensaio clínico de braço único teve comoobjetivo avaliar o efeito do tabagismo sobre o volume de FCG durante o tratamento da gengivite. A amostra foi composta por 24 pacientes que nunca fumaram (47.3 ± 6.7 anos, 41.7% homens) e 21 fumantes (45.8 ± 5.1 anos; 55% homens; 19.6 ± 11.8cigarros por dia; 24.1 ± 8.7 anos de exposição ao tabaco), com diagnóstico de gengivite e periodontite crônica. Os exames periodontais: Índice de Placa Visível (IPV), Índice de SangramentoGengival (ISG), Sangramento à Sondagem (SS) e Profundidade de Sondagem (PS) e a coleta de FCG foram realizados nos dias 0, 30, 90 e 180. Após a raspagem supragengival realizada no dia zero (dia 0), os pacientes receberam instrução de higienebucal semanalmente, até o dia 180. A análise estatística utilizou modelos lineares (Teste de Wald, p<0.05%). Os fumantes apresentaram um volume significativamente menor de FCG. Esteresultado não esteve associado ao ISG, SS ou PS. Sítios com maiores valores de PS apresentaram maior volume de FCG.Durante o tratamento, uma redução significante do volume de FCG foi observada em fumantes e pacientes que nunca fumaram. Conclui-se que o tabagismo influenciou o volume de FCG independente da presença de sinais inflamatórios clínicos e que o hábito de tabagismo e a PS devem ser observados quando o volume de FCG e seus componentes estiverem sob investigação.

Correlação entre a radiografia panorâmica e tomografia computadorizada na avaliação das alturas ósseas no planejamento em implantodontia / Correlation between panoramic radiograph and computed tomography measurements for the evalution of vertical bone height in oral implantology

O objetivo deste trabalho é avaliar a correlação entre a altura óssea medida em radiografias panorâmicas e tomografias computadorizadas para a avaliação pré-operatória de implantes osseointegrados. Cinqüenta sítios na região do forame mentual de pacientes que previamente realizaram tomografia computadorizada e radiografia panorâmica para planejamentode implantes osseointegrados nas regiões posteriores da mandíbula foram analisados. A comparação entre a TC e a radiografia panorâmica apresentou uma concordância moderada, sendo que a TC sistematicamente apresentou valores menores que as medições realizadas na radiografia panorâmica, sendo essa diferença (1,6 a 1,7mm) estatisticamente significante (p<0,0001). Os autores sugerem a utilização de uma margem de segurança de 2mm na região de forame mentual, após a compensação da magnificação da imagem, quando for utilizada a radiografia panorâmica

Associação entre obesidade e periodontite: um possível indicador de risco? / Association between obesity and peridontitis: a possible risk indicator?

Apesar da doença periodontal ter origem infecciosa, sabe-se que o biofilme bacteriano é uma causa necessária, mas não suficiente para o desenvolvimento da periodontite, pois a suscetibilidade individual é determinante para ocorrência da mesma. Assim devido a esse aspecto, alguns indivíduos têm maior probabilidade de desenvolver a doença do que outros. Os fatores de risco à periodontite podem modular esse processo. Fumo e diabete têm maior comprovação científica sobre sua relação com a doença periodontal destrutiva. Entretanto, outros fatores têm sido estudados quanto a sua associação com periodontite, entre eles, a obesidade. O objetivo deste trabalho é fazer uma revisão de literatura sobre as possíveis explicações biológicas para associação entre obesidade e periodontite e avalias os estudos epidemiológicos existentes que investigaram essa associação, na medida em que há relatos de que a obesidade pode ser positivamente associada com perda de inserção por mecanismo patogênicos comuns.

A importância do treinamento, reprodutibilidade e calibragem para a qualidade dos estudos / The importance of training, reproducibility and calibration to the quality of the studies

A odontologia está passando por uma profunda modificaçäo na sua forma de produzir, utilizar e interpretar o conhecimento científico, sendo que a necessidade de utilizar a melhor evidência possível tanto para o entendimento dos processos físicos e biológicos, quanto para a tomada de decisäo clínica, tem despertado interesse no estudo de áreas até entäo relegadas a segundo plano. Nesse panorama, a capacidade de avaliar a qualidade dos diferentes estudos e de produzí-los com padräo internacional tem ensejado um aumento na procura de conheciemntos sobre metodologia de pesquisa. A forma pela qual os dados säo obtidos numa pesquisa e os procedimentos säo realizados podem ter influência definitiva na sua capacidade de gerar evidência. Assim, treinamento, reprodutibilidade e calibragem säo palavras que devem fazer parte do dia-a-dia de todos envolvidos no processo de criaçäo e utilizaçäo do conhecimento