Clinical study of polyetheretherketone resin-bonded bridge for restoring anterior missing teeth in patients with periodontitis / 口腔疾病防治

Objective@#To study the clinical effect of a polyetheretherketone (PEEK) bonding bridge on the loss of 3 internal incisors in patients with periodontitis.@*Methods@#This study was reviewed and approved by the ethics committee, and informed consent was obtained from the patients. Thirty-eight patients with periodontitis and 3 missing central or lateral teeth were selected to undergo restoration with a PEEK bonding bridge and then returned to the hospital 3, 6, 12, and 24 months after the restoration was completed. The survival rate of the restorations was assessed by the modified USPHS/Ryge criteria. The plaque index, gingival index, periodontal probing depth and attachment loss of the abutments were recorded, and the changes in periodontal tissues after restoration were observed and compared.@*Results@#Over 24 months of clinical follow-up observation of 38 patients, only 1 patient underwent secondary bonding after partial debonding (evaluated as grade B), while bonding was successful in the other 37 cases (evaluated as grade A). The plaque index, gingival index and periodontal probing depth were significantly lower after restoration than before (P<0.05). There was no significant change in attachment loss between before and after restoration (P>0.05).@*Conclusion@#For periodontitis patients missing 3 internal incisors, short-term PEEK bonding bridge repair has good clinical efficacy.

Unvaccinated periodontal patients with a history of COVID-19: clinical findings in a Dental School setting

Abstract This study analyzed the periodontal clinical data of individuals with a history of COVID-19 treated in a dental school during the pandemic in 2021 before vaccination. Methods: This analysis included individuals older than 18 years with no history of systemic disorders other than systemic arterial hypertension. Individuals who had COVID-19 were classified according to the World Health Organization as asymptomatic, with mild, moderate, severe, or critical symptoms. Results: A total of 95 individuals were evaluated, which included 24 with a history of COVID-19. Seventeen percent had been asymptomatic, 21% had mild, 25% moderate, 21% severe, and 17% critical symptoms, including intubation. Individuals with no history of COVID-19 presented significantly lower measurements of probing depth (p=0.003; Mann-Whitney test) and clinical attachment level (p=0.002) compared to individuals with a history of COVID-19. A significant negative association was found between bleeding on probing and the severity of characteristics of COVID-19 (rho= -0.233; p=0.023). Conversely, positive associations between the values of probing depth (rho= 0.292; p=0.004) and mean clinical attachment level (rho= 0.300; p=0.003) and the characteristics of COVID-19 were found. Conclusions: The periodontal data shows that patients who had COVID-19 before vaccination may present a worse periodontal status when compared to patients in the same clinical setting with no history of COVID-19. However, a more extensive study should confirm it with more participants.

Resumo Este estudo analisou os dados clínicos periodontais de indivíduos com histórico de COVID-19 tratados em uma escola de odontologia durante a pandemia em 2021, antes da vacinação. Métodos: Essa análise incluiu indivíduos maiores de 18 anos sem histórico de distúrbios sistêmicos, exceto hipertensão arterial sistêmica. Os indivíduos que tiveram COVID-19 foram classificados de acordo com a Organização Mundial da Saúde como assintomáticos, com sintomas leves, moderados, graves ou críticos. Resultados: 95 indivíduos foram avaliados, incluindo 24 com histórico de COVID-19. 17% eram assintomáticos, 21% tinham sintomas leves, 25% moderados, 21% graves e 17% críticos, incluindo intubação. Os indivíduos sem histórico de COVID-19 apresentaram medidas significativamente mais baixas de profundidade de sondagem (p=0,003; teste de Mann-Whitney) e nível de fixação clínica (p=0,002) em comparação com indivíduos com histórico de COVID-19. Foi encontrada uma associação negativa significativa entre o sangramento à sondagem e a gravidade das características da COVID-19 (rho= -0,233; p=0,023). Por outro lado, foram encontradas associações positivas entre os valores de profundidade de sondagem (rho = 0,292; p = 0,004) e o nível médio de apego clínico (rho = 0,300; p = 0,003) e as características da COVID-19. Conclusão: Os dados periodontais mostraram que os pacientes que tiveram COVID-19 antes da vacinação podem apresentar um pior estado periodontal quando comparados a pacientes no mesmo ambiente clínico sem histórico de COVID-19. No entanto, um estudo mais extenso deve ser realizado para confirmar tal achado com maior número de participantes.

Evaluation of Salivary IL?8 and Calcium Levels in Postmenopausal Females with and without Periodontitis—A Comparative Study

Background and Objective: Menopause is a normal developmental stage in a woman’s life marking the permanent cessation of menstruation. Calcium is predominant in intracellular signalling and its intracellular increase can affect the cell’s proliferation, phagocytosis and cytokine secretion. IL?8 expression in various cells such as neutrophils and osteoblasts was reported to involve a calcium signalling pathway. Well?known functions of IL?8 includes help in angiogenesis, role in tumour progression, tissue remodelling, etc., Hence, the aim of this study was to establish the relationship between calcium?dependent IL?8 and periodontal disease in postmenopausal females. Method: The study population included 52 postmenopausal women aged 45–57 years. The patients were divided into two groups in which group I included postmenopausal women without periodontitis and group II with periodontitis. Unstimulated salivary samples were collected from all the participants to evaluate IL?8 and calcium levels. Results: There was a statistically significant difference in salivary IL?8 levels between the two groups (P < 0.001), but there was no statistical difference in salivary calcium levels between the two groups (P = 0.730). A weak negative correlation between salivary IL?8 and calcium was found in group I, while a weak positive correlation was found between the same in group II. Conclusion: Analysis of salivary IL?8 from the present study was in accordance with several previous studies. It can be concluded that saliva can also be used as a reliable oral diagnostic fluid for IL?8 and calcium detection in periodontitis.

Systematic review of clinical effects of enamel matrix derivative as adjunctive therapy for gingival recession / 口腔疾病防治

Objective @#To evaluate the clinical effect of enamel matrix derivative(EMD) assisted with connective tissue graft(CTG) in the treatment of gingival recession.@*Methods @#Search The Cochrane Library, PubMed, EMbase, Web of Science, Wanfang Public Database,VIP database and CNKI to search for randomized controlled trials of EMD in the treatment of gingival recession. The search period is from the establishment of the databases to October 3, 2022. The test group was treated with EMD+CTG, while the control group was treated with CTG alone. Meta-analyses were performed using Review Manager 5.4.1 and Stat12.0.@*Results@# Meta analysis results showed that only 12 months after treatment, there was a statistically significant difference in the PD and CAL outcome indicators between the EMD assisted treatment group and the control group [MDPD=-0.10, 95% CI (-0.19, -0.01), P = 0.03], [MDCAL=-0.38, 95% CI(-0.71, -0.04), P = 0.03]. There was no significant difference between the test group and the control group in other indicators.@*Conclusion @#EMD assisted CTG in the treatment of gingival recession may be beneficial to the reduction of PD and CAL.

Sobredentadura parcial como alternativa de tratamiento en paciente con secuela periodontal. Reporte de caso

La rehabilitación de pacientes desdentados parciales periodontalmente comprometidos es un desafío a nivel protésico. Esto se debe a que la condición de los dientes pilares no siempre es la adecuada, viéndose afectada la proporción corono-radicular por las secuelas de una enfermedad periodontal. Es en estas situaciones límite donde el uso de implantes óseo-integrados acompañado de ataches resilientes mejora la retención de una prótesis parcial removible convencional, disminuyendo el riesgo de sobrecarga en los dientes remanentes. En este reporte de caso se presenta una rehabilitación integral, resuelto con una sobredentadura parcial maxilar sin cobertura palatina sobre pilares Locator®, minimizando la carga en los dientes remanentes del grupo II con secuelas periodontales; y una rehabilitación del arco mandibular con operatoria directa, indirecta y prótesis fija, recuperando funcionalidad, soporte oclusal y manteniendo los dientes remanentes en el sector anterior.

Rehabilitation of periodontally compromised partially edentulous patients has always been a challenge at the prosthetic level, because the condition of the remaining teeth is not always adequate and the crown-root ratio is often affected by the sequelae of periodontal disease. In these borderline situations, the use of osseointegrated implants accompanied by resilient attachments improves the retention of a conventional removable partial denture, reducing the risk of overloading the remaining teeth. This case report presents a comprehensive rehabilitation, resolved with a maxillary partial overdenture without palatal coverage on Locator® abutments, minimizing the load on the remaining pieces of group II with periodontal sequelae; and a rehabilitation of the mandibular arch with direct, indirect and fixed prosthesis. In this way, it was possible to recover functionality, occlusal support and keep the remaining teeth in the front part of the maxilla.

Effects of Photodynamic Therapy with Laser Photobiomodulation as an Adjunct to Scaling and Root Planing: Systematic Review / Efeitos da Terapia Fotodinâmica com Fotobiomodulação Laser Adjuvante a Raspagem e Alisamento Radicular: Revisão Sistemática

Scaling and root planing is the gold standard procedure in the periodontal disease treatment. Although this therapy has the ability to reduce or eliminate periodontopathogens mthrough periodontal instrumentation, sometimes the response to treatment may not promote the complete eradication of pathogens, affecting the healing process and leading to the presence of residual periodontal pockets. The aim of this study was to analyze the effectiveness of photodinamic therapy with laser photobiomodulation and as an adjunct to scaling and root planing (having as a conductive agent a fiber optic tip radiating inside the periodontal pocket), compared to scaling and root planing alone in patients with periodontitis on randomized trials. This systematic review was carried out complying with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta Analyses. The databases used were Pubmed, Lilacs, Biblioteca Virtual em Saúde - Odontologia and Medline. "Periodontal Disease" OR "Periodontal Treatment" AND m"Photodinamic Theraphy" were the descriptors used. A total of five articles were included. Two studies have shown superior results in relation to the referred association; a study indicated benefits in biochemical and/or microbiological aspects; it suggests, however, that clinical relevance needs to be better evaluated; two studies did not reveal benefits that categorize photodynamic therapy + scaling and root planning as superior to conventional treatment. The association in question, when well standardized and performed, can result in promising responses in the control of periodontal disease; however, the clinical benefits that demonstrate its superiority will certainly be subject to new researches. (AU)

A raspagem e alisamento radicular é o procedimento padrão-ouro no tratamento da doença periodontal. Embora essa terapia seja capaz de reduzir ou eliminar os periodontopatógenos por meio da instrumentação periodontal, algumas vezes a resposta ao tratamento pode não promover completa erradicação dos patógenos, afetando assim, o processo de cicatrização e levando à presença de bolsas periodontais residuais. O objetivo do presente estudo foi analisar a eficácia da terapia fotodinâmica com fotobiomodulação laser adjuvante a raspagem e alisamento radicular (tendo como agente condutor uma ponta de fibra óptica que irradia o interior da bolsa periodontal), em comparação com a raspagem e alisamento radicular isoladamente em pacientes com periodontite, avaliados em estudos clínicos randomizados. Esta revisão sistemática foi realizada de acordo com as recomendações Principais Itens para Relatar Revisões sistemáticas e Meta-análises. As bases de dados utilizadas foram Pubmed, Lilacs, Biblioteca Virtual em Saúde - Odontologia e Medline. "Doença periodontal" OR "Tratamento periodontal" AND "Terapia fotodinâmica" foram os descritores utilizados. Um total de cinco artigos foram incluídos. Dois estudos mostraram resultados superiores em relação à referida associação; um estudo indicou benefícios nos aspectos bioquímicos e/ou microbiológicos; sugere, no entanto, que a relevância clínica precisa ser melhor avaliada; dois estudos não revelaram benefícios que categorizassem a terapia fotodinâmica + raspagem e alisamento radicular como superiores ao tratamento convencional. A associação em questão, quando bem padronizada e realizada, pode resultar em respostas promissoras no controle da doença periodontal; entretanto, os benefícios clínicos que demonstram sua superioridade certamente serão alvo de novas pesquisas. (AU)

Coverage Of Multiple Maxillary Gingival Recessions Using Coronally Advanced Flap With Subepithelial Connective Tissue Graft: A Case Report

Background:This case report describes treatment of multiple gingival recession with subgingival connective tissue graft and coronally advanced flap technique in treatment of maxillary teeth. Material And Methods:Connective tissue grafting wasdone in relation to upper right second premolar, first premolar, canine, right central incisor, left central incisor and left lateral incisor (#15,#14,#13,#11,#21,#22). A split thickness flap was elevated without disturbing periosteum in this region. The area between canine and second premolar was selected to harvest the graft. The graft was placed on the recipient bed and suturing was done. Result:Predictable root surface coverage could be obtained with use of coronally advanced flap and subepithelial connective tissue graft. Conclusion:Subepithelial connective tissue graft along with coronally advanced flap still stand as a gold standard treatment for gingival recession coverage.

Suporte periodontal em diferentes idades em humanos: revisão sistemática e metanálise / Periodontal support at different ages in humans: systematic review and meta-analysis

A tomada de decisões na prática da clínica odontológica está baseada na utilização de parâmetros periodontais como o nível de osso alveolar e de inserção clínica, desconsiderando a idade do paciente, podendo resultar em extrações desnecessárias de dentes que ainda possuem suporte periodontal capaz de manter o elemento dentário inserido no alvéolo, chegando a 70 anos de vida com pelo menos 1/3 do comprimento da raiz radicular com suporte ósseo. O objetivo desta revisão sistemática com metanálise foi verificar qual é o nível de osso alveolar ou de inserção clínica periodontal em população adulta, ao longo da vida, identificando a prevalência de indivíduos ou de sítios periodontais que apresentam perda de inserção clínica (CAL) ≥ 1, 2, 3, 4, 5, 6, 7, 9 e a diferença de suporte periodontal entre dentes remanescentes e extraídos. O método empregado foi a busca estratégica nas bases PubMed, Embase, Lilacs, Google Scholar, catálogo CAPES, de estudos seccionais (inquéritos epidemiológicos) que utilizaram amostras de base populacional ou estudos de coorte, publicados de 1940 a 2020, em qualquer idioma. Os estudos foram exportados para o EndNote 20.3, com seleção e extração de dados realizada por duas revisoras independentes e avaliação de risco de viés pela ferramenta JBI. O tratamento estatístico foi realizado com software R Project 1.3 e RevMan 5. Os resultados foram a identificação de 9952 estudos, 740 excluídos na identificação, 8996 na triagem, restando 216 elegíveis, incluídos 21 na revisão. Obteve-se na metanálise medida de prevalência sumária de indivíduos com CAL ≥ 3 de 0.86% (IC 95%, 0.71-0.94); CAL ≥ 4 de (0.18-0.47), CAL ≥ 5 de 0.40 % (IC 95%, 0.19-0.67), CAL ≥ 7 de 0.06 (0.02-0.13) por idade 20-40, 41-60, 71+ anos. Houve associação significativa entre perda de inserção de CAL ≥ 1 mm e local de estudos (continente americano), sendo 91.41% da variância real dos estudos explicada pela idade. A variação de CAL em grupo < 50 anos foi de 0.62 (0.03) a 2.39 (1.27) mm, e > 50 anos, de 1.46 (0.05) a 4.90 (1.70) mm. A variação de perda óssea alveolar (ABL) foi de 20 a 79 anos, 0.2 (0.03) a 8.8 (0.5) mm; 31-65 anos, 1.32 (0.36) a 2.81 (0.93) mm. A medida sumária de diferença de média de CAL entre dentes extraídos e remanescentes foi de 1.84 (1.14-2.54) mm, sem diferença significativa dos subgrupos < 50 anos e 50 anos ou mais. A maioria dos estudos foi classificada como alto risco de viés e a avaliação GRADE do nível de certeza da evidência foi classificada como muito baixa.. A conclusão foi de que a taxa de perda óssea por década de vida, a partir dos 20 anos é fundamental para a avaliação da progressão de doença periodontal e deve ser mantida entre 0.38 a 1.5 mm para que se alcance 70 anos de vida com dente apresentando suporte periodontal. Recomenda-se a realização de mais estudos longitudinais que avaliem idade e determinantes sociais como confundidores da relação doença periodontal e desfechos de CAL ou ABL.

Decision-making in clinical dental practice is based on the use of periodontal parameters such as the level of alveolar bone and clinical attachment, disregarding the patient's age, which may result in unnecessary extractions of teeth that still have periodontal support capable of maintaining the element. tooth inserted into the socket, reaching 70 years of age with at least 1/3 of the root root length with bone support. The objective of this systematic review was to verify the level of alveolar bone or periodontal clinical attachment in an adult population, throughout life, identifying the prevalence of individuals or periodontal sites that present clinical attachment loss (CAL) ≥ 1, 2, 3, 4, 5, 6, 7, 9 mm and the difference in periodontal support between the remaining and extracted teeth. The method used was a strategic search in PubMed, Embase, Lilacs, Google Scholar, CAPES catalog, of cross-sectional epidemiological studies (epidemiological surveys) using the population-based sample or cohort studies, published from 1940 to 2020, in any language. The studies were exported to EndNote 20.3, with data selection and extraction performed by two masked reviewers and risk of bias assessment by the JBI tools. Statistical treatment was performed using the free software R Project 1.3 and RevMan 5. The results were the identification of 9952 studies, 740 excluded in the identification, 8996 in the screening, leaving 205 eligible, and 21 articles were included in the review. In the meta-analysis, a summary prevalence measure of individuals with CAL ≥ 3 of 0.86% (95% CI, 0.71-0.94) was obtained; CAL ≥ 4 of 0.18-0.47, CAL ≥ 5 of 0.40% (95% CI, 0.19-0.67), CAL ≥ 7 of 0.06 (0.02-0.13) by age 20-40, 41-60, 71+ years. There was a significant association between CAL insertion loss ≥ 1 mm and study location (american continent), with 91.41% of the real variance of the studies explained by age. The range of CAL in the < 50 years group was from 0.62 (0.03) to 2.39 (1.27) mm, and > 50 years, from 1.46 (0.05) to 4.90 (1.70) mm. The ABL (Alveolar Bone Loss) range was from 20 to 79 years from 0.2 (0.03) to 8.8 (0.5) mm and from 31 to 65 years from 1.32 (0.36) to 2.81 (0.93) mm. The summary measure of mean difference in CAL between extracted and remaining teeth was 1.84 (1.14-2.54) mm, with no a significant difference between the age subgroups < 50 years and 50 years and over. Most studies were rated as high risk of bias and the GRADE assessment of the confidence level of the evidence was rated as very low. The conclusion was that the rate of bone loss per decade of life, from the age of 20 onwards, is fundamental for the assessment of the progression of periodontal disease and should be maintained between 0.38 and 1.5 mm in order to reach 70 years of life with a tooth showing periodontal support. Further longitudinal studies are recommended to assess age and social determinants as confounders of the relationship between periodontal disease and CAL or ABL outcomes.

Morphological analysis of mandibular anterior alveolar bone in high-angle adult females assessed with cone-beam computed tomography / 口腔疾病防治

Objective@#To investigate the features of alveolar bone morphology of mandibular central incisors in high-angle adult females using cone-beam computed tomography (CBCT) and evaluate the influence of aging in these patients.@*Methods@# CBCT and lateral cephalometric images of 142 untreated adult female patients were selected and grouped by facial growth pattern. The number of high-angle cases was increased to 164 to further explore the difference within high-angle adult females who were divided into two groups according to age. The indexes of alveolar bone height and thickness in the lower incisor region and inclination of the lower incisors were measured by Dolphin software. The data was statistically analyzed.@*Results@#Compared with the average-angle group, the high-angle group had a lower alveolar bone attachment level (P < 0.05) and less bone thickness at the root apex level (P < 0.05). The thickness of lingual alveolar bone decreased with labial inclination of the lower incisors in both the high-angle and average-angle groups (r = -0.251, P = 0.025; r = -0.428, P = 0.001, respectively). In hyperdivergent female patients, the middle-aged group had a lower attachment level of alveolar bone than the young group (P < 0.05), but no significant difference in bone thickness at the root apex level (P > 0.05) was found between the two groups@*Conclusion @# High-angle adult females had thinner mandibular anterior alveolar bone with significantly lower attachment levels. Aging and inclination of lower incisors influenced bone morphology and should be taken into careful consideration.

Combined periodontal regeneration of molar severely compromised by furcation, intrabony defects and attachment loss to the apex: a case report / Regeneración periodontal combinada de molar gravemente comprometido por furcación, defectos intraóseos y pérdida de inserción en el ápice: reporte de un caso

Introduction: Clinicians tend to encounter unfavorable situations in the treatment of teeth with severe attachment loss. Periodontal regeneration has been a successful therapeutic approach in treatments that require a long-term prognosis improvement. This case shows the benefits of combined regenerative periodontal therapy in a patient with a molar severely compromised by furcation, intrabony defects and attachment loss to the apex. Case Report: The clinical case included an endo-periodontal, class III furcation and intrabony defects in a generalized periodontitis, Stage III Grade C patient. After non-surgical periodontal treatment and re-evaluation, a full-thickness flap and surgical debridement were performed. Dental root surface was treated with EDTA and enamel matrix derivatives and the defects were filled with allograft and platelet-rich fibrin, additionally a collagen membrane was applied over the graft. After a 12-month follow-up there was a resolution of the intrabony defects and periodontal regeneration. Clinical and radiographic evaluation also showed the partial resolution of the class III furcation defect. Conclusion: Combined periodontal regeneration can be a therapeutic approach to improve the prognosis and prevent the extraction of molars severely compromised by furcation, intrabony defects and attachment loss to the apex.

Introducción: Los clínicos tienden a encontrar situaciones desfavorables en el tratamiento de dientes por pérdida de inserción severa. La regeneración periodontal ha sido un enfoque terapéutico exitoso en tratamientos que requieren una mejora del pronóstico a largo plazo. Este caso demuestra los beneficios de la terapia periodontal regenerativa combinada en un paciente con un molar gravemente comprometido por furcación, defectos intraóseos y por pérdida de inserción hasta el ápice. Reporte de caso: El caso clínico incluyó un defecto endoperiodontal, furcación clase III y defectos intraóseos en una Periodontitis estadio III generalizada grado C. Tras el tratamiento periodontal no quirúrgico y la reevaluación, se realizó un colgajo de espesor total y un desbridamiento quirúrgico. La superficie de la raíz dental se trató con EDTA y derivados de la matriz de esmalte y los defectos se rellenaron con aloinjerto y fibrina rica en plaquetas, adicionalmente se aplicó una membrana de colágeno sobre el injerto. Después de un seguimiento de 12 meses hubo resolución de los defectos intraóseos y regeneración periodontal. La evaluación clínica y radiográfica también mostró la resolución parcial del defecto de furcación de clase III. Conclusión: La regeneración periodontal combinada puede ser un abordaje terapéutico para mejorar el pronóstico y prevenir la extracción de molares severamente comprometidos por furcación, por defectos y hasta el ápice.

Clinical efficacy evaluation of minimally invasive periodontal therapy assisted by endoscopy / 口腔疾病防治

Objective @# To investigate the clinical effect of periodontal endoscope-assisted scaling and root planing (SRP) in treating advanced periodontitis. @*Methods@# Nineteen cases of grade Ⅲ and Ⅳ periodontitis selected from June 2017 to January 2019 in the Nanjing Stomatological Hospital, Medical School of Nanjing University were divided into the periodontal endoscope and control groups. In the periodontal endoscope group, SRP was performed under a periodontal microscope in one treatment after initial supragingival scaling; in the control group, SRP was performed under regular conditions, and additional SRP was conducted in positive bleeding on probing sites twice every other week as needed. Periodontal status, including probing depth (PD), bleeding on probing (BOP) and attachment loss (AL), was recorded by a Florida probe.@*Results@# For sites of 4<PD ≤ 6 mm, there was no significant difference in PD- and BOP-positive rates or AL between the two groups at baseline. The PD- and BOP-positive rates and AL in the endoscope group and control group decreased significantly from baseline at 3 and 6 months. PD in the endoscope group was smaller than that in the control group at 3 months (P < 0.05). There was no significant difference between the two groups at 6 months (P >0.05). There was no significant difference in the BOP positive rate or AL change between the two groups at 3 months and 6 months (P > 0.05). For sites with PD > 6 mm, at baseline, the positive rates of PD, BOP and AL in the endoscope group were more serious than those in the control group, and the differences were statistically significant. The PD- and BOP-positive rates and AL in the endoscope group and control group decreased significantly from baseline at 3 and 6 months. However, PD in the endoscope group became shallower than that in the control group (P < 0.05) after 3 and 6 months. There was no significant difference in the BOP positive rate or AL between the two groups (P>0.05). @*Conclusion @#When compared to regular SRP, periodontal microscope-assisted SRP achieves better improvement in PD and is more beneficial for reducing the BOP and AL of deeper sites.

In-Vitro Quantitative Comparison of Platelet Rich Fibrin, and Plasma Rich in Growth Factor, with Age, Gender, Blood Parameters

Periodontal therapy and its recent advances has modernised leaps and bounds with newer regenerative modalities in an attempt to regenerate bone, gingiva, periodontal ligament and cementum. One of the newly accepted trends in regenerative therapy is the use of platelet concentrates such as platelet rich fibrin, plasma rich in growth factor which act as biological scaffold, fillers as well a vehicle along with bone grafts. Platelet concentrates have been found to be rich in growth factors and are used in the field of periodontology as an additive to bone grafting in sites of bony defects as a potential filler material. We wanted to evaluate the relation between the volume of blood extracted and weight of corresponding platelet rich fibrin and plasma rich in growth factor, and correlation of weight of platelet rich fibrin and plasma rich in growth factor with age, gender and blood parameters. MethodsA sample of 36 systemically healthy patients was randomly selected from the outpatient department of a dental college in Chennai. They were matched for age, gender and distributed into two broad groups: one for PRF and the other for PRGF comprising 9 females and 9 males in each group. A routine complete blood count including red blood cell count, white blood cell count and platelet count and haemoglobin were determined. ResultsThere was no relation between the weight of platelet rich fibrin and plasma rich in growth factor and the gender or age of the patient. There was also no apparent correlation between the platelet count and the platelet weight obtained. In some patients despite high platelet concentration, substantial PRF or PRGF weight was not obtained. ConclusionsWithin the limits of this study, it was found that the quantity of PRF and PRGF obtained is independent of age, and gender with no direct relation between the RBC count, WBC count, and haemoglobin.

Investigation of dental caries and periodontal conditions in maintenance hemodialysis patients / 口腔疾病防治

Objective@#To compare the prevalence of dental caries and periodontal disease in patients with end-stage renal disease treated with maintenance hemodialysis with that in healthy controls and to investigate the relationship between end-stage renal disease, dental caries and periodontal disease.@*Methods @#A total of 82 maintenance hemodialysis patients who met the inclusion criteria were selected as the case group, and 86 healthy persons who underwent oral examination in the physical examination center were selected as the control group. Dental caries and periodontal conditions were examined in the two groups. The dental caries examination was conducted by determining the number of decayed-missing-filled teeth, which was recorded as recommended by the World Health Organization. The periodontal condition parameters included the plaque index, calculus index, bleeding on probing, periodontal pocket depth and clinical attachment loss.@*Results@#The prevalence of dental caries in the case group and healthy control group was 87.8% and 81.4%, respectively, and there was no statistically significant difference between the two groups (P > 0.05). The periodontal indexes, including the plaque index, calculus index, probe bleeding index, periodontal pocket depth and clinical attachment level, in the case group were significantly higher than those in the control group (P < 0.05), and the prevalence of periodontitis in the case group was significantly higher than that in the control group (97.6% vs 88.4%, P < 0.05).@*Conclusion@#The dental caries conditions were comparable between the case group and the control group, but the prevalence and severity of periodontitis were significantly higher in the case group than in the control group.

Clinical attachment loss and molecular profile of inflamed sites before treatment

Abstract Objective: To monitor early periodontal disease progression and to investigate clinical and molecular profile of inflamed sites by means of crevicular fluid and gingival biopsy analysis. Methodology: Eighty-one samples of twenty-seven periodontitis subjects and periodontally healthy individuals were collected for the study. Measurements of clinical parameters were recorded at day −15, baseline and 2 months after basic periodontal treatment aiming at monitoring early variations ofthe clinical attachment level. Saliva, crevicular fluid and gingival biopsies were harvested from clinically inflamed and non-inflamed sites from periodontal patients and from control sites of healthy patients for the assessment of IL-10, MMP-8, VEGF, RANKL, OPG and TGF-β1 protein and gene expression levels. Results: Baseline IL-10 protein levels from inflamed sites were higher in comparison to both non-inflamed and control sites (p<0.05). Higher expression of mRNA for IL-10, RANK-L, OPG, e TGF-β1 were also observed in inflamed sites at day −15 prior treatment (p<0.05). After the periodontal treatment and the resolution of inflammation, seventeen percent of evaluated sites still showed clinically detectable attachment loss without significant differences in the molecular profile. Conclusions: Clinical attachment loss is a negative event that may occur even after successful basic periodontal therapy, but it is small and limited to a small percentage of sites. Elevated inflammation markers of inflamed sites from disease patients reduced to the mean levels of those observed in healthy subjects after successful basic periodontal therapy. Significantly elevated both gene and protein levels of IL-10 in inflamed sites prior treatment confirms its modulatory role in the disease status.

Perda de inserção periodontal e associações com indicadores de risco sociodemográficos e comportamentais / Periodontal attachment loss and associations with sociodemographic and behavioral risk indicators

Resumo Introdução A perda de inserção clínica periodontal (PIP) tem sido indicada como parâmetro determinante para o estudo de indicadores de risco de periodontite crônica. Objetivo Descrever a prevalência, severidade e extensão de PIP em um grupo populacional que se abstém de álcool e tabaco, além de avaliar associações com características sociodemográficas e comportamentais dos participantes. Método Uma amostra de 420 indivíduos adultos, participantes do Estudo Advento (São Paulo), foi submetida ao exame periodontal de seis sítios por dente e respondeu um questionário estruturado. As associações foram verificadas por meio de análise de regressão logística múltipla. Resultado A prevalência de periodontite foi de 20,7% e de gengivite, 38,8%; a PIP média foi de 1,38 mm (± 0,5) e a perda dental, 5,4 (± 9,0). A prevalência de PIP ≥ 3 mm, ≥ 4 mm e ≥ 6 mm foi de 69,7%, 31,7% e 9,6% dos indivíduos, e 11,4%, 4,4% e 1,2% dos dentes por indivíduo, respectivamente. Houve associação significativa de PIP ≥ 4 mm com sexo masculino, idade superior a 55 anos, baixa escolaridade, placa visível, autocuidado irregular, falta de orientação em higiene bucal e doença sistêmica referida. Para PIP ≥ 6 mm, foi observada maior razão de chances para as variáveis idade e doença sistêmica. Conclusão O grupo populacional estudado apresentou baixa extensão e severidade de PIP, possivelmente pelas características da amostra. As associações de risco encontradas confirmam a necessidade de atenção integral ao paciente, incluindo o incentivo à prevenção e ao controle de doenças crônicas, ao lado de orientações específicas para higiene bucal.

Abstract Introduction Clinical attachment loss (CAL) has been indicated as a determining parameter for the study of risk indicators of chronic periodontitis. Objective To describe the prevalence, severity and extent of CAL in a population group that abstains from alcohol and tobacco use and to evaluate associations with sociodemographic and behavioral characteristics of participants. Method A sample of 420 adult individuals, participants of the Advento Study (São Paulo) were submitted to a periodontal examination of six sites per tooth and answered a structured questionnaire. Associations were verified by multiple logistic regression analysis. Result Prevalence of periodontitis was 20.7% and gingivitis 38.8%; mean CAL was 1.38mm (±0.5) and dental loss 5.4 (±9.0). Prevalence of CAL ≥3 mm, ≥4 mm and ≥6 mm was 69.7%, 31.7% and 9.6% of the individuals, affecting 11.4%, 4.4% and 1.2% of the teeth per individual, respectively. After adjustments, there was a significant association of CAL ≥4 mm with males, over 55 years of age, low education, visible plaque, irregular self-care, lack of oral hygiene guidance and reported systemic disease. For CAL ≥6 mm, there was a higher odds ratio for the variables age group and systemic disease. Conclusion The population group studied presented low extension and severity of CAL, possibly due to the sample characteristics. The risk associations found confirm the need for comprehensive patient care, including encouraging prevention and control of chronic diseases, along with specific oral hygiene guidelines.

A subestimativa da reabsorção radicular apical irregular em radiografias periapicais é relevante? / Is relevant the underestimation of irregular apical root re-sorption by periapical radiographs?

Introdução: O controle periódico da reabsorção radicular durante o tratamento ortodôntico é frequentemente realizado através de exames radiográficos bidimensionais, nos quais as reabsorções irregulares não são detectadas no sentido vestibulolingual. Objetivo: Quantificar a área reabsorvida de raízes de incisivos com reabsorção radicular apical irregular subestimada por exames radiográficos bidimensionais. Material e Métodos: Foram avaliadas imagens de tomografia computadorizada de feixe cônico de 18 pacientes que apresentavam incisivos superiores com reabsorção radicular apical irregular substimada por exames radiográficos bidimensionais (grupo experimental) e os incisivos correspondentes contralaterais sem reabsorção radicular (grupo controle). No grupo controle foi simulada uma reabsorção radicular apical regular na mesma altura da encontrada nos incisivos com reabsorção irregular. As áreas apical e total das raízes dos incisivos com reabsorção radicular irregular e regular simulada foram avaliadas e comparadas. O teste t de Student para amostras pareadas foi utilizado, sendo considerado um nível de significância de 0,05. Resultados: A área apical nos incisvos com reabsorção radicular irregular foi significativamente menor do que nos incisivos com reabsorção radicular regular simulada (p<0,001). Não houve diferença significativa entre as áreas radiculares totais (p=0,435). Conclusão: A reabsorção radicular irregular foi significativamennte subestimada em imagens radiográficas bidimensionais quando a área apical radicular foi analisada. Entretanto, quando a área radicular total é considerada, a qual é responsável pela maior parte do suporte periodontal, esta subestimativa não foi significativa.

Introduction: Periodic control of root resorption during orthodontic treatment is frequently made by two-dimensional radiographic examinations, in which irregular resorptions are not detected buccolingually. Objective: Quantifying the resorbed root area of incisors with irregular apical root resorption underestimated by two-dimensional radiographic methods. Materials and Methods: Cone beam computed tomography images of 18 patients whose maxillary incisors presented irregular apical root resorption underestimated by two-dimensional radiographic methods (experimental group) and their contralateral correspondents without resorption (control group) were evaluated. In the control group, a regular apical root resorption was simulated at the same height as that of the irregularly resorbed incisors. The apical and total root surface areas of the incisors with irregular root resorption and simulated regular root resorption were measured and compared. The Student ́s t test for paired samples was used at a level of significance of 0.05. Results: The apical area of the incisors with irregular root resorption was significantly smaller than that of the incisors with simulated regular resorption (p<0.001). There was no significant difference in the comparison between total root surface areas (p=0.435). Conclusion: Underestimation of the irregular root resorption shown on two-dimensional images was significant when analyzing the apical area of the tooth. However, when considering the total root surface area of the tooth, which is responsible for the most part of the periodontal support, such underestimation was not significant.

Treatment of a tooth with severe periodontal involvement using intentional replantation: case report

Although intentional replantation is frequently used as a treatment modality for endodontic problems, severe periodontal involvement has usually been regarded as a contraindication. However, there are some studies suggesting that intentional replantation could be a successful treatment alternative for periodontally involved teeth. This paper reports the treatment of a tooth with severe periodontal involvement using intentional replantation. The tooth, which had had root canal therapy due to endodontic-periodontal combined lesion but showed extensive bone loss, was gently extracted and replanted after thorough debridement of the root surface. By intentional replantation, a tooth with severe periodontal involvement in this case could be preserved, without extraction, over the course of a 3-year follow-up period.

Long-term assessment of periodontal disease progression after surgical or non-surgical treatment: a systematic review

The primary aim of this systematic review was to assess the evidence on periodontal disease progression after treatment in patients receiving supportive periodontal therapy (SPT) and to identify predictors of clinical attachment level (CAL) loss. A protocol was developed to answer the following focused question: In adult patients treated for periodontitis, what is the disease progression in terms of CAL loss after surgical or non-surgical treatment? Randomized controlled clinical trials, prospective cohort studies, and longitudinal observational human studies with a minimum of 5 years of follow-up after surgical or non-surgical treatment that reported CAL and probing depth changes were selected. Seventeen publications reporting data from 14 investigations were included. Data from 964 patients with a follow-up range of 5–15 years was evaluated. When the CAL at the latest follow-up was compared to the CAL after active periodontal therapy, 10 of the included studies reported an overall mean CAL loss of ≤0.5 mm, 3 studies reported a mean CAL loss of 0.5–1 mm, and 4 studies reported a mean CAL loss of >1 mm. Based on 7 publications, the percentage of sites showing a CAL loss of ≥2 mm varied from 3% to 20%, and a high percentage of sites with CAL loss was associated with poor oral hygiene, smoking, and poor compliance with SPT. The outcomes after periodontal therapy remained stable over time. Disease progression occurred in a reduced number of sites and patients, mostly associated with poor oral hygiene, poor compliance with SPT, and smoking.

Avaliação do biotipo periodontal em áreas acometidas por recessão gengival em acadêmicos de odontologia / Evaluation of the periodontal biotype in gingival recession affected areas on academics of dentistry graduation

A determinação do biotipo periodontal é fundamental para estabelecer prognóstico em tratamentos restauradores, ortodônticos e periodontais. Também pode auxiliar na prevenção da ocorrência de recessão gengival. Objetivo: O objetivo deste trabalho foi determinar o biotipo periodontal em áreas acometidas por recessão gengival em acadêmicos de Odontologia. Material e Métodos: Foram avaliados os dentes superiores 11, 13, 14 e 16 de acadêmicos do curso de Odontologia. Foram observados os parâmetros: profundidade de sondagem; largura da faixa de gengiva queratinizada; formato das papilas; formato do dente 11 (triangular ou quadrado); espessura da gengiva marginal, dada pela translucidez da sonda periodontal através da gengiva marginal livre; e a espessura do periodonto de sustentação avaliada por palpação. As recessões gengivais encontradas foram mensuradas e classificadas de acordo com Miller. Os dados numéricos foram anotados em formulário próprio, analisados em porcentagem e estatisticamente. Resultados: Como resultado obteve-se uma prevalência do biotipo periodontal fino-festonado em 48,48% dos acadêmicos, biotipo periodontal espesso-festonado em 33,33% e biotipo periodontal plano-espesso em 18,18%. O biotipo periodontal fino-festonado apresentou estatisticamente significante mais recessões (60,60%) do que os biótipos espesso-festonado (33,33%) eplano-espesso (6,06%). Quando analisados os indivíduos que utilizaram aparelho ortodôntico, o tipo plano-espesso apresentou proporcionalmente menos recessão do que os outros grupos. Conclusão: A recessão gengival foi mais frequente em indivíduos com biotipo periodontal fino e o biotipo plano espesso exibiu menos recessões quando submetido a tratamento ortodôntico (AU)

The determination of the periodontal biotype is crucial to establish prognosis on restorative, orthodontic and periodontal treatments as well. It can also help to prevent the occurrence of retraction of the gingival tissue. Objective: the objective of this study was to determine the periodontal biotype on areas affected by gingival recession on academics of dentistry graduation. Material and Methods: We evaluated the upper teeth: 11, 13, 14 and 16, of academics of dentistry graduation. The following parameters were observed: probing depth; width of the keratinized gum strip; format of the papillae; 11 tooth shape (triangular or square); thickness of the marginal gingiva, given by the translucency of periodontal probe Willians through the free marginal gingiva on the buccal aspect of the mentioned teeth; the thickness of the supporting periodontal was evaluated by palpation and classified as thin or thick. Gingival recessions found were measured (by height and width) and classified according to Miller. Numerical data was noted on a specific form, analyzed in percentage and submitted to statistical analyses. Results: as result was obtained thin-scalloped periodontal biotype (48.48%) on of the students, thick-scalloped periodontal biotype (33.33%) and plan-thick periodontal biotype (18.18%) of them. The thin-scalloped periodontal biotype exhibited statistically significant more gingival recessions (60,60%) than the thick-scalloped biotype (33,33%) and plan-thick biotype (6,06%). Conclusion: Gingival recession was more frequent in patients with thick-scalloped biotype and the plan thick biotype exhibited less recessions when submitted to orthodontic treatment. (AU)

Association between metabolic syndrome and periodontitis: a systematic review and meta-analysis

Abstract The aim of the present study was to evaluate the association between metabolic syndrome (MS) and periodontitis (PD), through a systematic review and meta-analysis. Original observational studies assessing the association between MS and PD in adults, published before May 11th (2017), were identified through electronic searches of MEDLINE, EMBASE and Cochrane Library databases. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was used. For studies to be included, they had to mention the criteria used to diagnose MS and to have used at least one clinical measure to diagnose PD. There was no language restriction. Three reviewers independently identified eligible studies for possible inclusion in the systematic review and meta-analysis. The quality of the studies was evaluated by the Newcastle-Ottawa scale for observational studies. A random model meta-analysis was conducted. The strategies used to investigate heterogeneity were sequential analysis, subgroup analysis, univariate meta-regression and sensitivity analysis. Thirty-three studies met the inclusion criteria for the systematic review, and 26 had enough information to be included in the meta-analysis, totaling 52,504 patients. MS and PD were associated with an odds ratio of 1.38 (95%CI 1.26-1.51; I2 = 92.7%; p < 0.001). Subgroup analysis showed that complete periodontal examination (I2 = 70.6%; p < 0.001) partially explained the variability between studies. The present findings suggest an association between MS and PD. Individuals with MS are 38% more likely to present PD than individuals without this condition. Prospective studies should be conducted to establish cause and effect relations between MS and PD.