Etiologia e tratamento das periimplantites: revisão integrativa / Etiology and treatment of periimplantites: integrative review

Atualmente, o número de dentes perdidos por pessoa tem diminuído, e ainda, os meios para reparar essas perdas têm sido mais rápidos e confortáveis, como é o caso dos implantes dentários. No entanto, algumas complicações podem ocorrer associadas a esses procedimentos, podendo levar a perda dos implantes dentários. O objetivo deste trabalho foi realizar uma revisão integrativa da literatura acerca da etiologia e dos tratamentos utilizados para a periimplantite. Para isto, foi realizada uma busca nas bases de dados BVS, Cochrane Central e PUBMED, utilizando os descritores: "dental implants" e "periimplantitis". Foram encontrados inicialmente 1348 artigos. Após a leitura dos títulos e resumos, foi realizada a remoção das duplicatas e, posteriormente, foram analisados os critérios de elegibilidade, sendo excluídos artigos que tratavam de estudos em animais e aqueles com mais de dez anos de publicação, com base nesses critérios foram selecionados 34 artigos. Foi realizada a leitura completa dos artigos selecionados e as informações sobre etiologia e tratamento foram inseridas em uma tabela. Os principais fatores relacionados a etiologia da periimplantite foram a mucosite periimplantar, tabagismo, doenças sistêmicas, hiperglicemia, presença dos mesmos fatores biológicos e bacterianos da periodontite, falta de descontaminação da superfície do implante, origem infecciosa ocasionada pela negligência na higiene oral, implantes inseridos imediatamente após a extração, entre outras. Quanto ao tratamento, se pode listar uma grande quantidade, dentre eles: o tratamento de mucosite, a terapia periodontal básica, os grânulos de titânio poroso, o mineral ósseo bovino com membrana de colágeno, a terapia foto dinâmica, o tratamento cirúrgico, o uso de antibióticos, as nanopartículas, os lasers, entre outros. Com base nesses achados, é necessário o conhecimento dos fatores etiológicos das periimplantites para que haja sucesso no tratamento e evite a perda dos implantes dentários... (AU)

Currently, the number of teeth lost per person has decreased, and yet, the means to repair these losses have been faster and more comfortable, as is the case with dental implants. However, some complications can occur associated with these procedures, which can lead to the loss of dental implants. The objective of this work was to carry out a integrative review of the literature about the etiology and treatments used for periimplantitis. For this, a search was carried out in the VHL, Cochrane Central and PUBMED databases, using the descriptors: "dental implants" and "periimplantitis". 1348 articles were initially found. After reading the titles and abstracts, the duplicates were removed and, subsequently, the eligibility criteria were analyzed, articles that dealt with animal studies were excluded and those with more than ten years of publication were selected based on these criteria. 34 articles. A complete reading of the selected articles was carried out and the information on etiology and treatment was inserted in a table. The main factors related to the etiology of periimplantitis were periimplant mucositis, smoking, systemic diseases, hyperglycemia, presence of the same biological and bacterial factors as periodontitis, lack of decontamination of the implant surface, infectious origin caused by negligence in oral hygiene, implants inserted immediately after extraction, among others. As for treatment, a large number can be listed, among them: mucositis treatment, basic periodontal therapy, porous titanium granules, bovine bone mineral with collagen membrane, photodynamic therapy, surgical treatment, the use of antibiotics, nanoparticles, lasers, among others. Based on these findings, it is necessary to know the etiologicl factors of periimplantitis in order for treatment to be successful and prevent the loss of dental implants... (AU)

Control of pain in patients undergoing gingivectomy and gingivoplasty with low intensity laser / Controle da dor em pacientes submetidos a gengivectomia e gengivoplastia com laser de baixa intensidade

Objective: To evaluate the efficiency of Laser Low Intensity (LLI) in pain control and reduction of analgesic consumption after gingivectomy and gingivoplasty. Methods: Twenty patients with gingival hyperplasia were randomly divided into two groups with 10 subjects each. In the test group it was applied after gingivectomy / gingivaplasty, low intensity laser in the operative wound and prescription only in case of pain, while in the control group only analgesia was performed in case of pain. Results: The laser was applied at 3 points in the region of periodontal surgery. The irradiation was performed in a single session, using diode laser (808 nm, 100nW, 100J / cm², 30 s). Pain was assessed by Visual Analogue Scale, as well as the amount of analgesics ingested by the patient. In the test group, 80% of the individuals did not report postoperative pain, those who reported symptomatology, were identified only as mild discomfort. The analysis of the data showed a statistically significant difference when compared to the higher postoperative pain between the groups (p = 0.026). However, there was no difference in the evaluation of analgesic use. Conclusion: Based on our results, it is suggested that LLI therapy decreases the intensity of postoperative pain in periodontal surgeries (AU)

FoxP3+ regulatory T cells in oral tongue squamous cell carcinoma in young and older patients

Abstract Regulatory T (Treg) cells can suppress antitumor immune response, but little is known about possible age-related differences in the number of these cells in the microenvironment of oral tongue squamous cell carcinoma (OTSCC). The aim of this study was to determine the number of FoxP3+ Treg cells in the microenvironment of OTSCC in young (≤ 45 years) and older (≥ 60 years) patients, and to correlate the findings with clinicopathological parameters (sex, tumor size/extent, regional lymph node metastasis, clinical staging, and histopathological grade of malignancy). Forty-eight OTSCCs (24 diagnosed in young patients and 24 diagnosed in older patients) were selected. Lymphocytes exhibiting nuclear immunopositivity for FoxP3 were quantified at the tumor invasive front and the results were analyzed statistically using the non-parametric Mann-Whitney test. FoxP3+ lymphocytes were observed in all cases assessed. The number of FoxP3+ lymphocytes in OTSCC tended to be higher in older patients (p = 0.055). Analysis of OTSCC in males and in early clinical stages revealed a higher number of Treg cells in older patients than in young ones (p < 0.05). In older patients, the number of Treg cells tended to be higher in smaller tumors (p = 0.079). Tumors with intense inflammatory infiltrate exhibited a larger number of Treg cells, both in young (p = 0.099) and older patients (p = 0.005). The results suggest a greater participation of Treg cells in immunoinflammatory responses in the microenvironment of OTSCC in older patients, particularly in males and in early stages.

Immunoexpression of human leukocyte antigen-DR in actinic cheilitis and lower lip squamous cell carcinoma

Abstract The aim of this study was to evaluate the immunoexpression of human leukocyte antigen-DR (HLA-DR) in actinic cheilitis (AC) and lower lip squamous cell carcinoma (LLSCC), and to correlate the findings with clinical (tumor size/extent, regional lymph node metastasis, and clinical stage) and histopathological (grade of epithelial dysplasia and inflammatory infiltrate for AC and histopathological grade of malignancy for LLSCC) parameters. Twenty-four AC and 48 LLSCC cases (24 with regional nodal metastasis and 24 without regional nodal metastasis) were selected. The scores of immunopositive cells for HLA-DR in the epithelial component of the lesions were assessed and the results were analyzed statistically using the nonparametric Mann-Whitney test. Epithelial expression of HLA-DR was observed in only five (20.8%) cases of AC (two low-grade and three high-grade lesions), with a very low median score of immunopositivity. By contrast, expression of HLA-DR was found in most LLSCC (97.9%), with a relatively high median score of positive cells. The score of HLA-DR-positive cells tended to be higher in tumors with regional lymph node metastasis, tumors in advanced clinical stages, and low-grade tumors, but the difference was not statistically significant (p > 0.05). In addition, there was a tendency towards higher expression of HLA-DR in highly/moderately keratinized tumors, and tumors with little/moderate nuclear pleomorphism (p > 0.05). The results suggest a potential role of HLA-DR in lip carcinogenesis, particularly in the development and progression of LLSCC. The expression of this protein can be related to the degree of cell differentiation in these tumors.

Associação de técnicas cirúrgicas periodontais para recobrimento de recessões múltiplas e controle da dor pós operatória com laserterapia: relato de caso / Association of periodontal surgical techniques for covering multiple recessions and control of postoperative pain with lasertherapy: case report

Introdução: As cirurgias periodontais têm sido amplamente utilizadas para a correção de defeitos mucogengivais, como a recessão gengival. Objetivo: relatar por meio de um caso clínico o recobrimento radicular em recessões gengivais classe I de Miller nos dentes 11, 12 e 13 com enxerto de tecido conjuntivo subepitelial associado a retalho posicionado coronalmente. Relato do caso: Paciente do sexo masculino, 24 anos de idade, foi atendido na Clínica de Odontologia da Universidade Federal de Campina Grande, queixando-se de hipersensibilidade nos dentes 11, 12 e 13. Ao realizar a avaliação inicial, as medidas das recessões na face vestibular foram 5mm, 1mm e 2mm, respectivamente. Durante o planejamento periodontal optou-se pela realização dos procedimentos básicos: raspagem e alisamento coronorradicular e orientação de higiene bucal. Em seguida foi necessária a complementação cirúrgica para recobrimento radicular por meio da técnica de enxerto de tecido conjuntivo subepitelial associada ao tracionamento coronal do retalho, a fim de reduzir ou eliminar a recessão e ampliar a faixa de mucosa ceratinizada. Após a cirurgia foi aplicado laser de baixa intensidade a fim de diminuir a dor pós-operatória. O procedimento foi bem sucedido, com a cobertura radicular total. Conclusão: A técnica do enxerto subepitelial de tecido conjuntivo e tracionamento coronal do retalho merecem ser consideradas técnicas efetivas em obter resultados satisfatórios, tendo em vista a possibilidade de recobrimento radicular total em casos de recessões gengivais múltiplas. (AU)

Introduction: Periodontal surgery have been widely used for the correction of mucogengivais defects, such as gingival recession. Objective: To report through a case the root coverage in Miller's Class I recessions on teeth 11, 12 and 13 with graft of subepithelial connective tissue associated with coronally positioned flap. Case Report: A male patient, 24 years old, was treated at the Clinic of Dentistry, Federal University of Campina Grande, complaining of hypersensitivity in the teeth 11, 12 and 13. When performing the initial assessment, the measures of recessions the buccal surface were 5mm, 1mm and 2mm, respectively. During periodontal planning was chosen for carrying out the basic procedures: scaling and root planing and corono-orientation for oral hygiene. Then surgical root coverage for complementation by connective tissue graft technique subepithelial associated flap coronal traction was required in order to reduce or eliminate the recession and extend the range keratinized mucosa. After surgery low intensity laser was applied in to reduce postoperative pain. The procedure was successful, with complete root coverage. Conclusion: The subepithelial graft technique of connective tissue and coronally positioned flap deserve to be considered effective techniques to obtain satisfactory results, given the possibility of complete root coverage in cases of multiple gingival recessions. (AU)