Condición Periodontal de los Dientes Temporales Adyacentes a la Hendidura Alveolar en Pacientes con Labio y Paladar Hendido Unilateral No Sindrómico, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense de Seguro Social

RESUMEN: Los dientes adyacentes a la hendidura alveolar, en pacientes con labio y paladar hendido, presentan mayor incidencia de problemas periodontales, según la literatura. El objetivo de este trabajo fue evaluar si los dientes temporales adyacentes a la hendidura alveolar presentan mayor incidencia de problemas periodontales en niños con labio y paladar hendido unilateral completo no sindrómico, nacidos en 2010 y 2011, atendidos en el Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense de Seguro Social. Este estudio prospectivo, transversal, descriptivo, e intervencional evaluó variables epidemiológicas, clínicas y radiográficas (placa bacteriana, profundidad de bolsa, nivel de inserción, recesión gingival, sangrado, encía queratinizada e insertada, cálculo y movilidad dental, tipo de hendidura alveolar). Se utilizó técnicas de análisis estadísticos descriptivas (distribución de frecuencias, cruce de variables y construcción de intervalos de confianza). El análisis de datos y procesamiento estadístico se realizó en SPSS versión 17.0 y en Excel. El grupo constó de 17 pacientes, con edad promedio de 5 años. Se encontró 47 % de placa dental y 0 % de cálculo dental. La profundidad de bolsa y el sangrado fueron estadísticamente mayores para los dientes dentro de la hendidura alveolar. Los dientes adyacentes a la hendidura presentaron menor cantidad de encía queratinizada e insertada. Referente a la movilidad dental no existe diferencia estadísticamente significativa. Solo un diente presentó recesión gingival. La hendidura alveolar completa predominó radiográficamente. Los dientes cercanos a la hendidura alveolar tienen mayor predisposición a problemas periodontales, por lo que es relevante el seguimiento regular de la salud periodontal.

ABSTRACT: The teeth adjacent to the alveolar cleft, in patients with cleft lip and palate, present a higher incidence of periodontal problems, according to the literature. The purpose of this study was to evaluate whether the temporary teeth adjacent to the alveolar cleft present a higher incidence of periodontal problems in children with non-syndromic complete unilateral cleft lip and palate, born in 2010 and 2011, treated at the Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense de Seguro Social. This prospective, cross-sectional, descriptive, and interventional study evaluated epidemiological, clinical and radiographic variables (bacterial plaque, pocket depth, insertion level, gingival recession, bleeding, keratinized and inserted gingiva, dental calculus and mobility, type of alveolar cleft). It used descriptive statistical analysis techniques frequency distribution, crossing of variables and construction of confidence intervals. Data analysis and statistical processing was performed in SPSS version 17.0 and in Excel. The group consisted of 17 patients, with an average age of 5 years. 47 % dental plaque and 0 % dental calculus were found. Pocket depth and bleeding were statistically higher for teeth in the alveolar cleft. The teeth adjacent to the cleft had less keratinized and inserted gingiva. Regarding dental mobility, there is no statistically significant difference. Only one tooth had gingival recession. The complete alveolar cleft predominated radiographically. Teeth close to the alveolar cleft have a greater predisposition to periodontal problems, so regular monitoring of periodontal health is relevant.

Evaluation of Dental CBCT in Assessing the Furcation Involvement in Mandibular Molars

Furcation involvement (FI) refers to the invasion of the bifurcation and trifurcation areas of multi-rooted teeth by periodontal disease. Diagnosis of FI by 2D radiographs can be overcome by the use of cone-beam computed tomography (CBCT) imaging technique. Objective: To compare the measurements of furcation depth by clinical method and CBCT in assessing the FI. Methods: The present study comprised of 60 furcation involved mandibular molars from 45 patients suffering from Chronic Generalized Severe Periodontitis. Teeth having probing pocket depth of ≥6mm were considered for the study. Clinical measurements of furcation depth were made on buccal or lingual sides of mandibular molars by using endodontic file with stopper which was done by two clinicians. The CBCT measurements were performed by measuring the deepest vertical and horizontal furcation defects at each furcation entrance. These measurements were then recorded, compiled and statistically analysed. Results: The comparison of furcation involvement clinically by clinician 1 and CBCT measurements in buccal side was statistically significant (p=0.0255*), while it was statistically not significant (p=0.3696 NS) on lingual side. Similarly, the comparison of furcation involvement clinically by clinician 2 and CBCT measurements in buccal side was statistically significant (p=0.0278*), while it was statistically not significant (p=0.4951 NS) on lingual side. Conclusion: CBCT technique can be considered a reliable tool for detecting FI as CBCT imaging showed high accuracy and moderate reproducibility in the assessment of furcation depth.

Relationship of clinical index between rheumatoid arthritis and chronic periodontitis / 口腔疾病防治

Objective@#To explore the relationship betweenrheumatoid arthritis (RA) and chronic periodontitis (CP). @*Methods@# A total of 48 RA patients were recruited from the Rhematology Department of The First Affiliated Hospital of Shantou University Medical College (SUMC). RA patients were matched on age and gender with healthy controls, who were recruited from the Stomatology Department. Dental parameters including unstimulated salivary flow rate(UWS), stimulated salivary flow rate (SWS), bleeding on probe (BOP), periodontal probing pocket (PD), clinical attachment level (CAL) and decayed, missing and filling (DMF) were recorded in all cases. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and Anticyclic citrullinated peptide antibody (Anti-CCP) were also recorded in RA patients. @*Results @#There were significant difference between RA group and health control group on salivary flow rate, BOP, PD, CAL and DMF (P< 0.001). Higher percentage of RA patients were diagnosed as periodontal disease than those in control group (P< 0.001). There was relationship between CAL and Anti-CCP antibody (P< 0.001). @*Conclusion @# RA patients have higher risk of CP, and there might be relationship between RA and CP.

Eficacia de terapia fotodinámica como complemento de terapia convencional periodontal versus terapia convencional en el tratamiento de pacientes adultos con periodontitis crónica: una revisión sistemática con metaanálisis / Effectiveness photodynamic therapy complementing conventional periodontal therapy versus conventional therapy in the treatment of adult patients with chronic periodontitis: a systematic review with meta-analyses

Se evaluó la eficacia de la terapia fotodinámica como complemento de terapia periodontal convencional comparándola con la terapia convencional en el tratamiento de sacos periodontales en pacientes adultos con periodontitis crónica basándose en ensayos clínicos comprendidos entre los años 2010 y 2015, para determinar si su uso otorga mejores resultados para el tratamiento de esta enfermedad. Se seleccionaron ensayos clínicos aleatorios prospectivos, aleatorizados o no aleatorizados, controlados y no controlados que permitieron la comparación entre el tratamiento convencional y la terapia fotodinámica, con un grupo en el cual se utilizó sólo la terapia convencional. Los datos de los ensayos clínicos fueron ingresados al software Review Manager®. Se realizaron tres metaanálisis para las variables: Nivel de inserción clínica (NIC) y profundidad de sondaje (PS), el test de I2 fue utilizado para medir la heterogeneidad del estudio y posteriormente un análisis de sensibilidad para determinar los estudios heterogéneos. Se pudieron analizar 7 estudios, con un total de 186 pacientes, quienes fueron controlados 3 meses post tratamiento. Se utilizó la diferencia de medias, un intervalo de confianza de 95 % para medir el NIC y PS. A los 3 meses, no se encontró diferencias significativas en NIC (p= 0,93) y PS (p= 0,71). Conclusión: La terapia fotodinámica en complementación a la terapia convencional no otorga mejor resultado clínico ni estadístico comparado con la terapia convencional al evaluar el nivel de inserción clínica. Al evaluar la profundidad de sondaje es recomendable la utilización de terapia convencional sola.

The efficacy of photodynamic therapy as an adjunct to conventional periodontal therapy evaluated by comparing with conventional therapy alone in the treatment of periodontal pockets in adult patients with chronic periodontitis based on clinical trials between 2010 and 2015, to determine if its use can provide better results for treating this disease. Prospective randomized clinical trials and randomized clinical trials or non-randomized, controlled and uncontrolled that allowed comparison between a group which was applied to conventional therapy and photodynamic therapy, a similar group was selected to which you He applied only conventional therapy. Data from clinical trials entered into Review Manager®. Three meta-analyzes for the variables analyzed were performed: Level clinical attachment (NIC) and probing depth (PS), the test of I2 was used to measure the heterogeneity of the study and then a sensitivity analysis to determine which studies awardedheterogeneity. As results, seven studies analyzed in 186 patients who underwent treatment at least controlled within 3 months post treatment. The mean difference was used, a confidence interval of 95 % to measure the NIC and PS. At 3 months, no significant differences in NIC (p= 0.93) and PS (p= 0.71). In conclusion, the photodynamic therapy complementary to conventional therapy does not provide better clinical or statistical results compared with conventional therapy to evaluate the clinical attachment level. In assessing probing depth, is advisable to use conventional therapy alone.

Surgical And Non-surgical Treatment Of Chronic Periodontal Disease

The aim of this paper is to compare nonsurgical and surgical treatment for periodontitis by longitudinal trials. Treatment of periodontits can be broadly classified into either surgical or non-surgical approaches. Non-surgical therapy includes plaque control, supra- and subgingival scaling, root planing (SRP), and the adjunctive use of chemotherapeutic agents. Surgical therapy can be divided into either resective or regenerative procedures. The majority of articles reviewed agree that when adequate access for root debridement is achieved, non-surgical treatment of chronic periodontal diseases seems to be as effective as surgical treatment in the long-term maintenance of clinical attachment levels (CAL). SRP is limited by the presence of furcation involvements, deep pocket depths, and root anatomy. Conclusion: Decision-making in periodontal therapy requires a thorough understanding of the long-term outcomes of all available treatment modalities. Studies have consistently shown that SRP can provide similar improvements of clinical attachment levels when compared to surgical treatment. However, several factors need to be considered when deciding on which treatment approach to select for the treatment of chronic periodontal disease

Determinantes del diagnóstico periodontal / Determinants of periodontal diagnosis

Un correcto diagnóstico periodontal es necesario para la realización de una terapia periodontal exitosa en nuestro paciente. Entendiendo que la enfermedad periodontal es un proceso infeccioso-inflamatorio, diferentes variables se deben analizar clínicamente para determinar el diagnóstico. El diagnóstico entonces es un análisis concienzudo de la expresión clínica de la enfermedad, desde gingivitis hasta periodontitis. Este artículo analiza los determinantes más importantes del diagnóstico periodontal utilizados en la práctica clínica diaria.

The correct diagnosis of periodontal disease is a pre-requisite for an appropriate periodontal treatment. Periodontal disease is an infectious-inflammatory process that affects different clinical variables that must be analyzed before reaching the diagnosis. The diagnosis should be a carefully performed analysis of the clinical expression of the disease, from gingivitis to periodontitis. This article reviews the most important determinants of periodontal diagnosis.

Prevalence of TT Virus in patients with chronic periodontitis, patients with aggressive periodontitis and healthy controls: a pilot study

Torque teno virus (TTV), a novel DNA virus resides in peripheral blood mononuclear cells and replicates when these cells get activated. The TTV replication shifts the immunobalance. Aim: To determine the presence of TTV in the gingiva of patients with aggressive periodontitis, patients withchronic periodontitis, and healthy controls, and to correlate the presence of TTV with probing pocket depth and clinical attachment level. Methods: Forty-two subjects (22 males and 20 females)aged 21 to 55 years were recruited for this study. Subjects were stratified into aggressive periodontitis (Group I), chronic periodontitis (Group II) and healthy controls (Group III). Gingival tissue biopsy was taken from all the subjects and the presence of TTV was analyzed using PCR and 2% agarose gel electrophoresis. Results: TTV was identified in half of the subjects and more number of subjects with periodontitis have TT virus compared to controls. There was significant association between presence of TT virus and pocket depth, clinical attachment level. Conclusions: The findings from the present study shows that there was no significant association between TT virus and periodontitis, even though it was isolated from more number of subjects with aggressive periodontitis, and TTV was associated with pocket depth and clinical attachment level. These findings need to be investigated in further studies.

Avaliação dos parâmetros clínicos periodontais de pacientes não fumantes em manutenção: estudo longitudinal prospectivo / Evaluation of the periodontal clinical parameters of non-smoking patients under maintenance: prospective longitudinal study

Neste estudo observacional longitudinal prospectivo, foram avaliados os parâmetros clínicos de 2257 sítios de 16 pacientes não fumantes em manutenção periodontal, através de sondagem computadorizada. Estes pacientes, tratados de periodontite crônica de moderada a severa, receberam manutenção periodontal trimestralmente durante dois anos. Na consulta inicial e aos 3, 6, 9, 12, 18 e 24 meses foram registrados, em seis sítios por dente, os parâmetros clínicos profundidade clínica de sondagem (PCS), retração gengival, nível clínico de inserção (NCI), sangramento e supuração à sondagem e presença de placa, além da mobilidade dentária. A mensuração e registro automatizado destas medidas foram realizados com precisão de 0,2 mm, sob pressão constante de 20 g. Todos os exames foram realizados pelo mesmo examinador, treinado e calibrado. Os sítios monitorados apresentaram, no período avaliado, redução de bolsa e ganho clínico de inserção significativos (p<0,00001). Considerando diferenças maiores do que 1 mm entre o NCI aos 24 meses e no exame inicial, 4,52% dos sítios apresentaram perda de inserção. O modelo multinível de regressão logística mostrou que, quanto menores o NCI e a PCS inicial do sítio, maiores seriam suas chances de perder inserção. Sítios com maiores frequências de presença de placa ou de sangramento à sondagem, bem como sítios proximais e em dentes com mobilidade, também tiveram maiores chances de perda de inserção. Sítios de alguns grupos dentários também apresentaram maiores chances deste desfecho. O reduzido número de sítios com perda de inserção e a melhora nos parâmetros clínicos detectados neste estudo demonstraram a importância de um programa de manutenção periodontal bem realizado e supervisionado, com intervalos regulares de três meses, na manutenção da saúde periodontal obtida com o tratamento.

In this prospective longitudinal observational study, the periodontal clinical parameters of 2257 sites of 16 non-smoking patients under maintenance were evaluated by computerized periodontal probing. These patients, who had been treated of moderate to severe chronic periodontitis, received periodontal maintenance every third month over two years. At baseline and at 3, 6, 9, 12, 18 and 24 months, the clinical parameters Probing Depth (PD), gingival recession, Clinical Attachment Level (CAL), bleeding and suppuration on probing and plaque presence, besides tooth mobility, were record at six sites per tooth. The measurement and automated recording of these measures was performed with resolution of 0.2 mm, under constant force of 20g. All examinations and measures were performed by the same trained and calibrated examiner. The monitored sites showed, in the evaluated period, significant (p<0.00001) pocket reduction and clinical attachment gain. When differences between the CAL at 24 months and at baseline greater than 1 mm were considered, 4.52% of the sites showed attachment loss. The multilevel logistic model showed that, the smaller the site NCI and PCS baseline values, the bigger its odds of loss attachment. Sites with higher frequencies of plaque presence or bleeding on probing, as well as proximal sites and sites in mobility teeth, showed bigger odds of attachment loss too. Sites in some tooth groups showed bigger odds of this outcome too. The reduced number of sites with attachment loss and the detected attachment gain in this trial demonstrated the importance of a well performed and supervised periodontal maintenance program, with regular intervals of three months, in the maintenance of the periodontal health obtained after treatment.

Periodontal Repair on Intrabony Defects treated with Anorganic Bovine-derived Xeonograft / 대한치주과학회지

The ultimate goal of periodontal treatment is to regenerate the lost periodontal apparatus. Many studies were performed in developing an ideal bone substitute. Anorganic bovine-derived xenograft is one of the bone substitues, which were studied and have been shown successful for decades. The aim of this study is to evaluate the effect anorganic bovine-derived xenograft. Total of 20 patients, with 10 patients receiving only modified widman flap, and the other 10 receiving anorganic bovine-derived xenograft and flap surgery, were included in the study. Clinical parameters were recorded before surgery and after 6 months. The results are as follows: 1. The test group treated with anorganic bovine-derived xenograft showed reduction in periodontal pocket depth and clinical attachment level with statistically significance(p<0.001) after 6 months. The control group treated with only modified Widman flap showed reduction only in periodontal pocket depth with statistically significance(p<0.001) after 6 months. 2. Although periodontal probing depth change during 6 months did not show any significant differences between the test group and the control group, clinical attachment level gain and recession change showed significant differences between the two groups(p<0.05). On the basis of these results, anorganic bovine-derived xenograft improves probing depth and clinical attachment level in periodontal intrabony defects. Anorganic bovine-derived xenograft could be a predictable bone substitute in clinical use.

Clinical evaluation of full mouth disinfection therapy / 대한치주과학회지

The aim of this study is to determine whether full-mouth disinfection therapy(FMT) in our clinical setting would show better improvement of clinical parameters than partial mouth disinfection therapy(PMT) in chronic periodontitis and aggressive periodontitis patients. Among 12 patients, 6 were treated FMT and other 6 were treated PMT. Clinical parameters were calculated 3 months and 6 months after initial therapy. 1. There were no statistically significant differences between FMT and PMT in the reduction rate of bleeding on probing after 3 months, 6 months 2. Initial probing depth was 4-6mm, the mean probing depth after 3 months was 2.2mm vs 2.5mm(FMT vs PMT), after 6 months was 2.4mm vs 2.8mm. This was significantly lower in the FMT groups. 3. Initial probing depth was > or = 7mm, the reduction rate of mean probing depth during first 3 months was 4.8mm vs 4.1mm(FMT vs PMT), and 3 to 6 months was 0.5mm vs 0.3mm. This was significantly larger in the FMT groups. 4. Initial probing depth was 4-6mm, the mean clinical attachment level after 3 months was 2.3mm vs 2.7mm(FMT vs PMT), after 6 months was 2.7mm vs 3.0mm. This was significantly lower in the FMT groups. 5. Initial probing depth was > or = 7mm, the reduction rate of mean probing depth during first 3 months was 4.0mm vs 3.0mm(FMT vs PMT), and 3 to 6 months was 0mm vs -0.1mm. This was significantly larger in the FMT groups. Although the results provided us with succeccful clinical improvement in aggressive periodontitis, further research is needed to prove its additional benefit in the treatment of chronic periodontitis

Clinical evaluation of full mouth disinfection therapy / 대한치주과학회지

The aim of this study is to determine whether full-mouth disinfection therapy(FMT) in our clinical setting would show better improvement of clinical parameters than partial mouth disinfection therapy(PMT) in chronic periodontitis and aggressive periodontitis patients. Among 12 patients, 6 were treated FMT and other 6 were treated PMT. Clinical parameters were calculated 3 months and 6 months after initial therapy. 1. There were no statistically significant differences between FMT and PMT in the reduction rate of bleeding on probing after 3 months, 6 months 2. Initial probing depth was 4-6mm, the mean probing depth after 3 months was 2.2mm vs 2.5mm(FMT vs PMT), after 6 months was 2.4mm vs 2.8mm. This was significantly lower in the FMT groups. 3. Initial probing depth was > or = 7mm, the reduction rate of mean probing depth during first 3 months was 4.8mm vs 4.1mm(FMT vs PMT), and 3 to 6 months was 0.5mm vs 0.3mm. This was significantly larger in the FMT groups. 4. Initial probing depth was 4-6mm, the mean clinical attachment level after 3 months was 2.3mm vs 2.7mm(FMT vs PMT), after 6 months was 2.7mm vs 3.0mm. This was significantly lower in the FMT groups. 5. Initial probing depth was > or = 7mm, the reduction rate of mean probing depth during first 3 months was 4.0mm vs 3.0mm(FMT vs PMT), and 3 to 6 months was 0mm vs -0.1mm. This was significantly larger in the FMT groups. Although the results provided us with succeccful clinical improvement in aggressive periodontitis, further research is needed to prove its additional benefit in the treatment of chronic periodontitis

Clinical effect of enamel matrix derivative(EMD) in the treatment of periodontal intrabony defects / 대한치주과학회지

tachment level was changed from 8.67+/-1.72mm to 7.00+/-1.60mm (control); from 8.93+/-2.23mm to 6.00+/-1.92mm (test); and bone probing depth was decreased from 10.20+/-1.90mm to 9.07+/-1.95mm (control); from 10.14+/-2.14mm to 7.43+/-2.06mm (test). This study indicates that treatment of periodontal intrabony defects with EMD is clinically superior to treatment without EMD (OFD alone) in every parameter evaluated. Within the limits of this study, the application of EMD in intrabony defects resulted in clinically significant gain of clinical attachment level and decrease of bone probing depth. And further controlled clinical studies are required to confirm the effectiveness of the EMD in the treatment of various osseous defects.

Clinical comparison of resorbable and nonresorbable Barrier in guided tissue regeneration of human intrabony defects / 대한치주과학회지

The purpose of this study was to compare the clinical results of guided tissue regeneration(GTR) using a resorbable barrier manufactured from an copolymer of polylactic acid (PLA) and polylactic-glycolic acid(PLGA) with those of nonresorbable ePTFE bdmer. Thirty two patients(25 to 59 years old) with one radiographically evident intrabony lesion of probing depth > or =6mm participated in a Gmonth controlled clinical trial. The subjects were randomly divided into three independent groups. The fist group(n=8) received a ePTFE barrier. The second group (n=12) received a resorbable PLA/PLGA barrier. The third group (n=12) received a resorbable PLA/PLGA barrier combined with an alloplastic bone graft. Plaque index (PI), gingival index(GI), probing depth(PD) , gingival recession, clinical attachment level(CAL), and tooth mobility were recorded prior to surgery and at 3,6 months postsurgery. Statistical tests used to analyze these data included independent t-test, paired t-test, one-way ANOVA. The results were as follows : 1. Probing depth was significantly reduced in all groups at 3,6 months postsurgery and there were not significant differences between groups. 2. Clinical attachment level was significantly increased in all groups at 3, 6 months postsurgery and there were not significant differences between groups. 3. There were not signifiicant differences in probing depth, clinical attachment level, gingival recession, tooth mobility between second group (PLA/PLGA barrier) and third group (PLA/RLGA barrier combined with alloplastic bone graft) 4. Tooth mobility was not significantly increased in all groups at 3,6 months postsurgery and there were not significant differences between groups. In conclusion, PLA/PLGA resorbable barrier has similar clinical potential to ePTFE barrier in GTR procedure of intrabony pockets under the present protocol.

Periodontal status in patients with osteoporosis / 대한치주과학회지

The purpose of this study was to evaluate the relationship between osteoporosis and periodontal condition in postmenopausal women. Twenty-eight patients who have been treated at Chonnam national university hospital with osteoporosis(osteoporotic group, mean age62.2+/-6.6) and 21 normal postmenopausal women with periodontitis(control group, mean age60.4+/-3.7) were examined. Bone mineral density(BMD) of lumbar spine(L2-L4) was measured by dual energy X-ray absorptiomemtry(DEXA). Percentage to peaked bone mass in osteoporotic group was 70.9% which had lower BMD than in control group(p<0.05). The number of present teeth were 23.6 in osteoporotic group and 23.1 in control group, Percentage of bleeding on probing was 41% in osteoporotic group and 37% in control group, probing depth and attachment level were shown 3.18 mm, 3.63 mm in osteoporotic group and 2.85mm, 3. 11 mm in control group, respectively. Probing depth and attachment level were significantly greater in osteoporotic group than in control group(p<0.05). The significant negative correlation was found between BMD level and periodontal attachment level(p<0,001, ?=-0. 56). These results suggest that osteoporosis may be associated with periodontal breakdown.