Preventive effects of systemic Pistacia eurycarpa Yalt. administration on alveolar bone loss and oxidative stress in rats with experimental periodontitis

Abstract Objective: This study aimed to investigate the effects of systemic administration of P. eurycarpa Yalt. plant extract on alveolar bone loss and oxidative stress biomarkers in gingival tissue in a rat model of experimental periodontitis. Methodology: 32 male Wistar albino rats, weighing 200-250 g, were divided into four groups (n=8): Healthy control (HC), Experimental periodontitis control (EPC), Experimental periodontitis 400 mg/kg (EP400), Experimental periodontitis 800 mg/kg (EP800). Experimental periodontitis was induced using the ligating method. Distilled water was administered to the HC and EPC groups and the plant extract was administered to the EP400 and EP800 groups by oral gavage at doses of 400 mg/kg and 800 mg/kg, respectively. The rats were sacrificed on the 15th day. The values of glutathione peroxidase GSH-Px, malondialdehyde (MDA), superoxide dismustase (SOD), interleukin-1β (IL-1β), interleukin-10 (IL-10), total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI) in the gingival tissues were analyzed by ELISA tests. Alveolar bone loss was assessed using micro-CT images of the maxilla. Results: Although the IL-1β, TOS, OSI results of the healthy control group were lower than those of the other groups, the TAS values were higher (p<0.05). No significant difference was found in the biochemical parameters among the EPC, EP400, and EP800 groups (p>0.05). Alveolar bone loss was significantly reduced in the extract groups compared to the EPC group (p<0.001). Conclusion: Within the limitations of this study, it was observed that the systemic P. eurycarpa extract application reduced alveolar bone loss in a rat model of experimental periodontitis. Further studies are needed to elucidate the beneficial effects of P. eurycarpa.

Demineralized freeze-dried bone allograft with/without i-Platelet-rich fibrin in 3 wall intrabony defects

Demineralized freeze-dried bone allograft (DFDBA) contains bone morphogenetic proteins (BMPs), hence is osteoinductive. Autologous platelet concentrates exhibit a higher quantity of growth factors. Both these biomaterials aid in bone regeneration when placed in three-wall intrabony defects. However, their efficacy when used alone and in conjugation is not clear. Aim: To assess clinical and radiographic efficacy of injectable platelet-rich fibrin (i-PRF) with microsurgical access flap in the treatment of three-wall intrabony defects in chronic periodontitis patients. Methods: Thirty sites with three-wall intrabony defects were randomly assigned to control and test group by computer generated method. The test group obtained i-PRF mixed with DFDBA while the control group received only DFDBA. Clinical parameters such as site-specific Plaque index (PI), Radiographic intrabony defect depth (IBDD), modified- Sulcular bleeding index (mSBI), Clinical attachment level (CAL), and Probing pocket depth (PPD) were measured at baseline, three and six months. Results: Intragroup comparison within the control group and test group exhibited statistically highly significant variation of mean PI, mSBI, PPD, CAL, and IBDD score from baseline to 3 months and from 3-6 months (p<0.001). However, intergroup comparison demonstrated no statistically significant variation of mean IBDD at all 3 intervals (p>0.05). Conclusion: i-PRF combined with DFDBA enhanced the radiographic and clinical parameters as opposed to DFDBA alone. The role of i-PRF is promising in its capacity for easy obtainability and increased potential to aid in regeneration

The intra- and inter-rater reproducibility of bone level measurements at strategic mini-implants using dental panoramic radiography

Abstract Objectives: This experimental study focused on the intra- and inter-rater reproducibility of vertical bone level (VBL) measurements at strategic mini-implants (MI) using digital panoramic radiographs (PR). Study design: VBLs of 152 MIs for removable partial denture stabilization at 50 randomly chosen PRs from a clinical trial were digitally evaluated by three ratters. Rater deviations exceeding 0.5 mm were re-examined. The intra-class correlation coefficient (ICC) was applied to estimate reliability. The smallest detectable change (SDC) was interrelated to the minimal clinically important change of 0.2 mm. Results: The first measurement round revealed intra- and inter-rater ICCs of > 0.8. However, 28 sites (9 %) were unreadable, and 97 sites (32 %) revealed differences between observers of ≥ 0.5 mm. Following a consensus session and re-training, an additional 8 sites were excluded and all remaining VBL differences were ≤ 0.5 mm. Thus, the SDCs with 95 % credibility were improved from 0.73 to 0.31 mm in the intra-rater and from 1.52 to 0.34 mm in the interrater statistics. Given a 50 % credibility for this special setting, both the intra- and inter-rater SDCs were 0.11 mm. Conclusions: Digital PR can be reliably utilized to determine VBLs around MIs under conditions of at least two trained observers, mutual calibration sessions, and exclusion of unquantifiable radiographs. German Clinical Trials Register ID:DRKS00007589, www.germanctr.de

Partial extraction therapies (PET): a review of the literature / Terapias de extração parcial (TEP): uma revisão da literatura

ABSTRACT One of the most common dental procedures is tooth extraction; however, the bone defect resulting from the process is only partially restored, leading to considerable bone loss. To rehabilitate a fully or partially edentulous patient, we must handle these sites with delicate surgical procedures. There is a large literature presenting attempts to overcome the negative effects of a dental extraction, with the aim of reducing tissue volume loss or restoring the alveolar architecture. In this context, Partial Extraction Therapy (PET) represents a subgroup of interventions to prevent bone loss after extraction using the tooth itself to prevent alveolar bone loss. This literature review aims to make a survey of the published articles on PET, with an emphasis on socket shield technique, and to explain the other techniques such as root burial, pontic-shield and proximal socket-shield, their indications and counter indications in order to deepen the knowledge of these techniques. To identify the included or considered studies, we adopted a detailed search strategy for MEDLINE and Cochrane Library focused in the last 31 years, whose language was English, Spanish or Portuguese. This text presents an analysis of current data regarding the alternatives for alveolar preservation and the installation of immediate implants in these areas, presenting the possibility of a different surgical technique. However, due to the immaturity and lack of conclusive scientific evidence regarding the predictability of the procedures, it is considered that the use of the socket shield technique must be done in an extremely cautious way.

RESUMO Um dos procedimentos odontológicos mais comuns é a extração dentária, contudo, , o defeito ósseo decorrente do processo é apenas parcialmente restaurado, levando a uma perda ossea volumétrica consideravel. Para reabilitar um paciente totalmente ou parcialmente desdentado, devemos manusear estes sitios com intervenções cirúrgicas delicadas. Há uma vasta literatura apresentando tentativas de transpor os efeitos negativos de uma extração dentária, com o objetivo de diminuir a perda volumétrica tecidual ou restaurar a arquitetura alveolar. Neste contexto, a Terapia de Extração Parcial (TEP) representa um subgrupo de intervenções para prevenir a perda óssea após exodontia, usando o próprio dente para prevenir a perda óssea alveolar. Essa revisão de literatura tem por objetivo fazer um levantamento dos artigos publicados sobre as TEP, com ênfase na técnica de socket shield, e explanar a cerca das demais técnicas como sepultamento radicular, pontic-shield e proximal socket-shield, suas indicações e contra-indicações, a fim de aprofundar o conhecimento dessas técnicas. Para a identificação dos estudos inclui?dos ou considerados, adotamos a estrate?gia de busca detalhada para os bancos MEDLINE e Biblioteca Cochrane nos u?ltimos 31 anos, cujo idioma fosse o ingle?s, espanhol ou o portugue?s. Este texto, apresenta uma análise de dados atuais a respeito das alternativas para a preservação alveolar e instalação de implantes imediatos nestas áreas, apresentando a possibilidade de uma técnica cirúrgica diferenciada. No entanto, devido a imaturidade e falta de comprovação cientifica contundente a respeito da previsibilidade dos procedimentos, considera-se que o emprego da técnica de socket shield deve ser feito de forma cautelosa.

Efecto del tratamiento con ácido zoledrónico e hidroxocobalamina sobre la microarquitectura ósea en ratones con periodontitis y osteoporosis inducida: Estudio preclínico / Effect of zoledronic acid and hydroxocobalamin treatment on bone microarchitecture in mice with induced periodontitis and osteoporosis: preclinical study

Objetivo. Evaluar el efecto del tratamiento con ácido zoledrónico e hidroxocobalamina sobre la microarquitectura ósea alveolar en ratones con periodontitis y osteoporosis inducidas. Métodos. Diseño experimental en fase preclínica. Se incluyeron 16 ratones hembras a quienes se les indujo osteoporosis mediante la ovariectomía total y también se indujo la periodontitis por inflamación por ligadura de seda negra 5/0 en el segundo molar maxilar, todos los protocolos fueron sometidos durante anestesia general. Los ratones se distribuyeron en 4 grupos: control, tratamiento con ácido zoledrónico, tratamiento con hidroxocobalamina y tratamiento combinado. A las 16 semanas, se realizó la autanasia, se realizó la disección para la evaluación mediante microtomografía; determinando la densidad mineral ósea (BMD), el volumen de hueso (BV/TV), espesor trabecular (Tb. Th), número de trabéculas (Tb.N), separación trabecular (Tb.Sp); se realizó el análisis descriptivo y bivariado mediante ANOVA de 1 vía considerando un 95% de nivel de confianza. Resultados. El grupo que recibió tratamiento combinado de ácido zoledrónico e hidroxocobalamina presentó mayor densidad mineral ósea (DMO), mayor volumen óseo (BV/TV) y menor separación trabecular (Tb.Sp) en comparación con el grupo de control (p<0,05). Conclusiones. El tratamiento combinado de ácido zoledrónico e hidroxocobalamina mejora las características microarquitectónicas óseas en ratones con osteoporosis y periodontitis inducidas.

Objective. Evaluate the effect of zoledronic acid and hydroxocobalamin treatment on alveolar bone microarchitecture in mice with induced periodontitis and osteoporosis. Methods. Experimental design in preclinical phase. Sixteen female mice were included in which osteoporosis was induced by total ovariectomy and periodontitis was also induced by inflammation by 5/0 black silk ligation of the maxillary second molar, all protocols were performed under general anesthesia. The mice were distributed into 4 groups: control, treatment with zoledronic acid, treatment with hydroxocobalamin and combined treatment. At 16 weeks, euthanasia was performed, dissection was performed for evaluation by microtomography; determining bone mineral density (BMD), bone volume (BV/TV), trabecular thickness (Tb.Th), number of trabeculae (Tb.N), trabecular separation (Tb.Sp); descriptive and bivariate analysis was performed using 1-way ANOVA with a 95% confidence level. Results. The group that received combined treatment of zoledronic acid and hydroxocobalamin presented higher bone mineral density (BMD), higher bone volume (BV/TV) and lower trabecular separation (Tb.Sp) compared to the control group (p<0.05). Conclusions. Combined treatment with zoledronic acid and hydroxocobalamin improves bone microarchitectural features in mice with induced osteoporosis and periodontitis.

Use of enamel matrix- derived proteins combined with bone graft for the treatment of intrabony defects: overview of reviews (FRISBEE review) / Uso de proteínas derivadas de la matriz del esmalte combinado con injerto óseo para el tratamiento de defectos intraóseos: resumen estructurado de revisiones sistemáticas (revisión FRISBEE)

Introduction: The use of enamel matrix-derived proteins (EMD) has increased in recent years due to their tissue-inducing properties that support periodontal regeneration. This study is an overview of systematic reviews with FRISBEE methodology on the use of EMD alone or combined with autologous bone graft materials (BGM) in the treatment of intrabony defects. Materials and Methods: A systematic search in the Epistemonikos database was performed. RevMan 5.3 and GRADEpro were used for data analysis and presentation Results: Four systematic reviews and two clinical trials were identified. All studies analysed change in probing depth, clinical attachment level, gingival margin level and bone defect depth (all changes in favour of EMD+BGM groups: mean difference (MD): 0.37 mm more, MD: 0.7 mm more, MD: 0.3 mm less, MD: 0.75 more, respectively). Conclusions: Adding autologous bone graft to EMD to treat intrabony defects showed better results, but not a relevant clinical difference compared to the use of EMD alone.

Introducción: El uso de proteínas derivadas de la matriz del esmalte (EMD) ha aumentado en los últimos años debido a sus propiedades inductoras de tejidos que apoyan la regeneración periodontal. Este estudio es una revisión sistemática de revisiones sistemáticas utilizando metodología FRISBEE sobre el uso de EMD solo o combinado con materiales injerto óseo autólogo (BGM) en el tratamiento de defectos intraóseos. Materiales y Métodos: Se realizó una búsqueda sistemática en la base de datos Epistemonikos. Se utilizaron RevMan 5.3 y GRADEpro para el análisis y la presentación de los datos. Resultados: Se identificaron cuatro revisiones sistemáticas y dos ensayos clínicos. Todos los estudios analizaron el cambio en la profundidad de sondaje, el nivel de inserción clínica, el nivel del margen gingival y la profundidad del defecto óseo (todos los cambios a favor de los grupos EMD+BGM: MD: 0,37 mm más, media de diferencia (MD): 0,7 mm más, MD: 0,3 mm menos, MD: 0,75 más, respectivamente). Conclusión: La adición de injerto óseo autólogo a la EMD para tratar defectos intraóseos mostró mejores resultados, pero no una diferencia clínica relevante en comparación con el uso de la EMD sola.

Serum nitric oxide concentration in generalized chronic and aggressive periodontitis in the Mexican population is not related to the severity of the disease / La concentración de óxido nítrico en suero de pacientes con periodontitis agresiva y crónica generalizada no está relacionada con la gravedad de la enfermedad

Introduction: Periodontitis is an inflammatory disease that affects the supporting tissues of teeth, the effects of excess of nitric oxide, may contribute to the symptoms of periodontitis. Objective: To determine the serum nitric oxide concentration in generalized chronic and aggressive periodontitis patients and to compare it with a healthy subject group from the Mexican population. Materials and methods: A case and control study was performed. Sixty-nine individuals were recruited from the Clínica de Posgrado de Periodoncia of the Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, México. Patients with clinical features of generalized chronic periodontitis (GCP group, n=19), generalized aggressive periodontitis (GAP group, n=11), and a group of healthy subjects (HS group, n=39) were included in the study. Informed consent was obtained from each subject, and serum nitric oxide concentration was measured by an enzyme-linked immunosorbent assay. Results: Nitric oxide concentration in the study groups was greater in the GCP group (462.57 ± 16.57 µmol/L) than in the GAP group (433.84 ± 18.61 µmol/L) and the HS group (422.46 ± 12.07 µmol/L). A comparison using Student's t-test (one-tailed) between healthy subjects and generalized chronic periodontitis showed borderline significance (p<0.04), whereas no significant differences were observed in HS and GAP groups, with a p-value of 0.64, and the GAP vs. GCP p-value was 0.33. Conclusion: The serum nitric oxide concentration observed in the present study suggests that nitric oxide plays a major role in the inflammatory process, which cannot necessarily be linked to the severity of the disease and periodontal tissue destruction.

Introducción. La periodontitis es una enfermedad inflamatoria que afecta los tejidos de soporte dental; los efectos del exceso de óxido nítrico pueden contribuir a los síntomas de la periodontitis. Objetivo. Determinar la concentración de óxido nítrico en el suero de los pacientes con periodontitis agresiva y crónica generalizada, y compararla con la de individuos sanos de población mexicana. Materiales y métodos. Se trata de un estudio de casos y controles. Se incluyeron 69 individuos de la Clínica de Posgrado de Periodoncia del Centro Universitario de Ciencias de la Salud de la Universidad de Guadalajara. Se dividieron en tres grupos: pacientes con periodontitis crónica generalizada (GCP, n=19), pacientes con periodontitis agresiva generalizada (GAP, n=11) e individuos sanos periodontalmente (HS, n=39). Se obtuvo el consentimiento informado de todos los participantes. Se utililizó la prueba ELISA para medir la concentración de óxido nítrico en suero. Resultados. Las concentraciones de óxido nítrico observadas fueron mayores en el grupo GCP (462,57 ± 16,57 µmol/L) que en los grupos GAP (433,84 ± 18,61 µmol/L) y HS (422,46 ± 12,07 µmol/L). La comparación entre HS y GCP mediante la prueba estadística t de Student (una cola), mostró diferencias significativas (p<0,04), y no se observaron diferencias entre los grupos HS y GAP (p=0,64), ni entre GAP y GCP (p=0,33). Conclusiones. La concentración de óxido nítrico en suero, observada en el presente estudio, sugiere que el óxido nítrico desempeña un importante papel en el proceso inflamatorio, lo que no necesariamente está ligado a la gravedad de la enfermedad ni a la destrucción del tejido periodontal.

Alveolar and mandibular cortex bone status in individuals with type 1 diabetes mellitus: a cross-sectional paired study / Condição óssea alveolar e da cortical mandibular em indivíduos com diabetes mellitus tipo 1: um estudo transversal pareado

Aim: This study compared alveolar bone loss, teeth with furcation, and mandibular cortical modification between individuals with type 1 diabetes mellitus (T1DM) and nondiabetic individuals. Methods: Radiographs of 50 T1DM individuals and 100 nondiabetic individuals were examined to evaluate the presence of teeth with furcation, alveolar bone loss, and mandibular cortical modifications. The Mann-Whitney, Chi-square, and Student's t tests were used to analyze personal characteristics and bone status. Linear and logistic regression was performed to explore associations. Results: A significant difference was observed in the average number of teeth with furcation and in the median of alveolar bone loss between T1DM and the nondiabetic participants. T1DM individuals are more likely to have alveolar bone loss (OR = 3 2.250), teeth with furcation (OR = 8.903), and mandibular cortical modification (OR = 15.667) than are nondiabetic individuals. Among T1DM individuals, the glycemic control has a high influence in mandibular cortical modifications (p < 0.05). Conclusions: A high association between uncontrolled blood glucose and mandibular cortical modifications was observed among T1DM individuals. Alveolar bone loss of T1DM individuals was associated with age, time of diagnosis, glycemic control, and the existence of chronic complications.

Objetivo:Comparar a perda óssea alveolar, a presença de dentes com lesão de furca e a alteração da cortical óssea entre indivíduos com DMT1 e indivíduos não-diabéticos. Métodos: Foram examinadas radiografias de 50 indivíduos diabéticos e de 100 não-diabéticos para avaliar a presença de dentes com lesão de furca, perda óssea alveolar e alteração cortical mandibular. Para analisar as características individuais e as condições ósseas foram usados os testes de Mann-Whitney,Qui-quadrado e t de Student. Regressões linear e logística foram realizadas para identificar associações. Resultados: Foi encontrada diferença significativa na média de dentes com lesão de furca e na mediana da perda óssea alveolar entre diabéticos e não-diabéticos. Indivíduos com DMT1 possuem mais chance de apresentar perda óssea alveolar (OR = 32,250), lesão de furca (OR=8,903) e alteração da cortical mandibular (OR = 15,667) em comparação aos indivíduos não-diabéticos. Entre os diabéticos, o controle da glicemia possui grande influência nas alterações da cortical mandibular (p < 0,05). Conclusões: Existe uma alta associação entre os níveis de glicemia descontrolada e alterações na cortical mandibular entre os indivíduos com DMT1. A perda óssea alveolar de indivíduos com DMT1 foi associada aos fatores idade, tempo de diagnóstico, controle da glicemia e a presença de complicações crônicas.

Exercise improves alveolar bone loss and the inflammatory profile of periodontal disease / El ejercicio mejora la pérdida de hueso alveolar y el perfil inflamatorio de la enfermedad periodontal / O exercício melhora a perda de osso alveolar e o perfil inflamatório da doença periodontal

ABSTRACT Periodontal disease (PD) is an inflammatory oral disease and alveolar bone loss is the most important sign of PD. However, the effects of exercise on inflammatory factors and alveolar bone loss in individuals with PD have been little studied. This meta-analysis assesses the effect of physical exercise on alveolar bone loss (ABL) and the inflammatory profile of PD in animal models. Relevant studies published through July 2020 in PubMed, Medline, Embase and Web of Science were searched after developing a PICOS statement. Quality assessment and risk of bias were analyzed according to the SYRCLE protocol. A total of 52 references were retrieved, 4 of which were considered eligible for inclusion. A total of thirty-four male Wistar rats from the included studies were evaluated for alveolar bone loss and assessed for inflammatory profile. The results indicated that physical exercise could reduce alveolar bone loss (95% CI -2.85 to -0.82, p = 0.002) and the pro-inflammatory tumor necrosis factor-α (TNF-α) in serum or gingival tissue (95% CI -0.45 to -0.24, p < 0.00001). Inversely, exercise increased anti-inflammatory interleukin-10 (IL-10) in serum or gingival tissue (95% CI 0.28 to 0.69, p < 0.00001). However, one study reported a negative result in the expression of TNF-α and IL-10. Current evidence indicates that physical exercise contributes to ameliorate PD by reducing alveolar bone loss and inflammation in animal PD models, which suggests that moderate exercise can be implemented in clinical practice to maintain periodontal health. Level of Evidence I; Systematic Review and Meta-analysis

RESUMEN La enfermedad periodontal (EP) es una enfermedad inflamatoria oral y la pérdida de hueso alveolar es su signo más importante. Sin embargo, los efectos del ejercicio sobre los factores inflamatorios y la pérdida ósea alveolar en individuos con EP han sido poco estudiados. Este meta-análisis evalúa el efecto del ejercicio sobre la pérdida ósea alveolar (POA) y el perfil inflamatorio de la EP en modelos animales. Se llevaron a cabo estudios relevantes publicados hasta julio de 2020 en PubMed, Medline, Embase y Web of Science tras desarrollar la investigación con el método PICO. La evaluación de la calidad y el riesgo de sesgo se analizaron según el protocolo SYRCLE. Se recuperó un total de 52 referencias, cuatro de las cuales se consideraron elegibles para su inclusión. En un total de 34 ratas Wistar macho de los estudios incluidos se evaluó la pérdida de hueso alveolar y el perfil inflamatorio. Los resultados indicaron que el ejercicio puede reducir la pérdida de hueso alveolar (IC del 95%: -2,85 a -0,82; p = 0,002) y el factor de necrosis tumoral proinflamatorio-α (TNFα) en suero o tejido gingival (IC del 95%: -0,45 a -0,24; p < 0,00001). Por el contrario, el ejercicio aumentó la interleucina-10 (IL-10) antiinflamatoria en el suero o en el tejido gingival (IC del 95%: 0,28 a 0,69; p < 0,00001). Sin embargo, un estudio informó de un resultado negativo en la expresión de TNFα e IL-10. Las pruebas actuales indican que el ejercicio contribuye a mejorar la EP al reducir la pérdida de hueso alveolar y la inflamación en modelos animales de EP, lo que sugiere que se puede implementar el ejercicio moderado en la práctica clínica para mantener la salud periodontal. Nivel de Evidencia I; Revisión Sistemática y Meta-análisis.

RESUMO A doença periodontal (DP) é uma doença inflamatória oral e a perda óssea alveolar é seu sinal mais importante. No entanto, os efeitos do exercício sobre os fatores inflamatórios e a perda óssea alveolar em indivíduos com DP têm sido pouco estudados. Esta metanálise avalia o efeito do exercício físico sobre a perda óssea alveolar (POA) e o perfil inflamatório da DP em modelos animais. Estudos relevantes publicados até julho de 2020 em PubMed, Medline, Embase e Web of Science foram pesquisados depois de desenvolver a pesquisa com o método PICO. A avaliação da qualidade e o risco de viés foram analisados de acordo com o protocolo SYRCLE. Um total de 52 referências foram recuperadas, quatro das quais foram consideradas elegíveis para inclusão. Um total de 34 ratos Wistar machos dos estudos incluídos foram avaliados quanto à perda de osso alveolar e avaliados quanto ao perfil inflamatório. Os resultados indicaram que o exercício físico pode reduzir a perda de osso alveolar (IC 95% -2,85 a -0,82, p = 0,002) e o fator de necrose tumoral pró-inflamatório-α (TNFα) no soro ou tecido gengival (IC 95% -0,45 a -0,24, p < 0,00001). Inversamente, o exercício aumentou a interleucina-10 anti-inflamatória (IL-10) no soro ou no tecido gengival (IC 95% 0,28 a 0,69, p < 0,00001). Contudo, um estudo relatou resultado negativo na expressão de TNFα e IL-10. As evidências atuais indicam que o exercício físico contribui para melhorar a DP, reduzindo a perda de osso alveolar e a inflamação em modelos animais de DP, o que sugere que o exercício moderado pode ser implementado na prática clínica para manter a saúde periodontal. Nível de Evidência I; Revisão Sistemática e Metanálise.

Peri-implant clinicoradiographic status among betel-quid chewers and controls

Abstract The aim of the present case-control observational study was to evaluate the peri-implant clinicoradiographic status among betel-quid chewers and controls. Self-reported betel-quid chewers and controls were included. Participants were categorized into 3 groups: Group-1: Individuals chewing betel-quid with tobacco; Group-2: Individuals chewing betel-quid without tobacco; and Group-3: Controls (individuals not using tobacco in any form). Demographic data was collected using a questionnaire. Periodontal and peri-implant clinicoradiologic parameters (plaque and gingival indices [PI and GI], probing depth [PD] and crestal bone loss/marginal bone loss [CBL/MBL]) were assessed. Clinical attachment loss (AL) around teeth was also assessed. Group comparisons were done using the one-way analysis of variance and Bonferroni Post-hoc adjustment tests. Correlation of periodontal and peri-implant inflammatory parameters with the duration of betel-quid chewing habit and duration of placement in the mouth were assessed using logistic regression analysis. P<0.05 was considered statistically significant. Thirty, 30 and 30 patients were included in groups 1, 2 and 3, respectively. Full-mouth PI (P<0.01), GI (P<0.01), clinical AL (P<0.01), PD (P<0.01) and mesial and distal MBL (P<0.01) were higher in groups 1 and 2 than Group-3. Peri-implant mPI (P<0.01), mGI (P<0.01), PD (P<0.01) and MBL/CBL (P<0.01) were significantly higher in groups 1 and 2 than Group-3 with no significant difference in groups 1 and 2. Betel-quid chewing habit either with or without tobacco is a risk-factor of peri-implant soft-tissue inflammation and CBL.

Resumo O objetivo do presente estudo observacional de casos-controles foi avaliar o estado clínico-radiográfico periimplantar dos usuários de bétele. Foram incluídos usuários que relataram utlizar a substância bétele como tabaco de mascar. Os participantes foram categorizados em 3 grupos: Grupo-1: Indivíduos que mascam bétele com tabaco; Grupo-2: Indivíduos que mascam bétele sem tabaco; e Grupo-3: Controle (indivíduos que não usam tabaco sob qualquer forma). Os dados demográficos foram recolhidos utilizando um questionário. Foram avaliados parâmetros clínico-radiográfico e periimplantares (índices placa e gengivais [IP e IG], profundidade de sondagem [PS] e perda de crista óssea/ perda óssea marginal [PCO/POM]). Também foi avaliada a perda inserção clínica (IC) em torno dos dentes. As comparações de grupo foram feitas utilizando a análise de variância unidireccional e os testes de ajustamento post-hoc de Bonferroni. A correlação dos parâmetros inflamatórios periodontais e periimplantares com a duração do hábito de mastigação da bétele e duração da colocação na boca foi avaliada utilizando a análise de regressão logística. P<0,05 foi considerado estatisticamente significativo. Foram utilizados 30 pacientes em cada grupo. O IP de boca inteira (P<0,01), IG (P<0,01), IC clínica (P<0,01), PS (P<0,01) e POM mesial e distal (P<0,01) foram mais elevados nos grupos 1 e 2 do que no grupo 3. O mPI peri-implantar (P<0,01), '(P<0,01), PD (P<0,01) e POM/PCO (P<0,01) foram significativamente mais elevados nos grupos 1 e 2 do que no grupo 3, sem diferença significativa nos grupos 1 e 2. O hábito de mastigar a substância bétele com ou sem tabaco é um fator de risco de inflamação dos tecidos moles periimplantares e PCO.

Vertical bone augmentation with guided bone regeneration: a scoping review / Aumento óseo vertical con regeneración ósea guiada: scoping review

Introduction: There are multiple techniques for vertical bone augmentation. Guided bone regeneration is one of them; however, the literature is diverse and includes different study designs, which makes it difficult to synthesize results. Objective: To analyze the general technical characteristics, clinical results, and complications of vertical bone augmentation performed with guided bone regeneration in humans. Material and Methods: This scoping review was based on the PRISMA-ScR guidelines. A search was performed in the Pubmed, Scielo, and Worldcat databases. Papers published from 1990 to April 2020 were included in the study. Research articles not conducted in humans or published in languages other than English and Spanish were excluded. Title and abstract were screened by two reviewers, then full studies were extracted, and data tabulated. Results: 89 studies were included. The highest percentage reported having obtained a vertical bone increase of less than 5 mm and having used non-resorbable membranes. The most frequent type of graft is autogenous and combinations of grafts, the most common being autogenous with xenograft. All studies that reported bone stability of implants in regenerated bone were favorable, as was implant survival, reporting values between 83.8% and 100%. Membrane exposure is the most frequently reported complication, followed by infection or abscesses, and tissue dehiscence. Conclusion: Vertical bone regeneration is a reliable technique, with high predictability and low incidence of complications compared to other vertical bone augmentation techniques.

Introducción: Existen múltiples técnicas para el aumento óseo vertical siendo una opción la regeneración ósea guiada, sin embargo, la literatura es diversa y con distintos diseños que dificultan la síntesis de resultados. Objetivo: Analizar las características generales técnicas, resultados clínicos y complicaciones del aumento óseo vertical realizado con regeneración ósea guiada en humanos. Material y Métodos: Esta revisión de alcance se basó en la guía PRISMA-ScR. Se realizó una búsqueda en las bases de datos Pubmed, Scielo y Worldcat. Fueron incluidos aquellos publicados desde el año 1990 hasta abril de 2020. Se excluyeron los estudios no realizados en humanos o publicados en idiomas distintos al inglés y español. Dos revisores examinaron título y resumen, luego los estudios completos se extrajeron y se ordenaron los datos en tablas. Resultados: 89 estudios fueron incluidos. El mayor porcentaje reportó haber obtenido un aumento óseo vertical menor a 5 mm y haber utilizado membranas no reabsorbibles. El tipo de injerto que más frecuente es el autógeno y las combinaciones de injertos, siendo el más común autógeno con xenoinjerto. Todos los estudios que reportaron estabilidad ósea de implantes en hueso regenerado fueron favorables, al igual que la supervivencia de implantes, reportando valores entre 83,8% y 100%. La exposición de membrana es la complicación que más se repite en los estudios, seguido por infección o abscesos y dehiscencia de tejidos. Conclusión: La regeneración ósea vertical es una técnica confiable, con alta predictibilidad y baja incidencia de complicaciones en comparación a otras técnicas de aumento óseo vertical.

Orthodontic Treatment in Adult Patients with Periodontal Commitment: Case Report / Tratamento Ortodôntico em Pacientes Adultos com Comprometimento Periodontal: Relato de Caso

Abstract There is an increasing demand for orthodontic treatment by adult patients in dental offices. Orthodontic treatment in adults has particular characteristics, because, in addition to not showing active growth, there are situations that demand interrelation with other areas of dentistry, such as, Periodontics, Dental Prosthesis, Restorative Dentistry and Implantology. The objective of this work was to describe a clinical case of an adult patient with periodontal involvement, establishing the main considerations to be taken in the orthodontic treatment of adult patients with periodontal involvement. The results obtained in the clinical case showed that it is possible to treat patients with periodontal involvement as long as some precautions are taken, such as strict hygiene control, in association with the specialty of periodontics, a reduced sequence of wires, in order to shorten treatment time, using low intensity forces, to minimize damage to periodontal tissues. The orthodontic treatment performed, gave the patient the desired smile functionality and aesthetics, prioritizing a strict hygiene control, the use of light forces, simplification in orthodontic movement, as well as the use of fixed and permanent restraints in areas of reduced periodontium. (AU)

Resumo É crescente a procura de tratamento ortodôntico por pacientes adultos nos consultórios odontológicos. O tratamento ortodôntico em adultos, apresenta características particulares, pois, além de não apresentar crescimento ativo, ocorrem situações que demandam a inter-relação com outras áreas da odontologia como a, Periodontia, Prótese dentária, Dentística Restauradora e Implantodontia. O objetivo desse trabalho foi descrever um caso clínico de paciente adulta comprometida periodontalmente, estabelecendo as principais considerações a serem tomadas no tratamento ortodôntico de pacientes adultos com comprometimento periodontal. Os resultados obtidos no caso clínico, demonstraram, que é possível tratar os pacientes com comprometimento periodontal desde que sejam tomados alguns cuidados, como controle restrito de higienização, em associação com a especialidade da periodontia, uma sequência reduzida de fios, com o intuito de abreviar o tempo de tratamento, utilizando forças de baixa intensidade, para minimizar danos aos tecidos periodontais. O tratamento ortodôntico realizado, devolveu a paciente a funcionalidade e a estética do sorriso almejada, priorizando um controle rígido de higienização, o uso de forças leves, a simplificação na movimentação ortodôntica, bem como o uso de contenções fixas e permanentes em áreas de periodonto reduzido. (AU)

Dysbiotic oral microbiota contributes to alveolar bone loss associated with obesity in mice

Abstract Periodontal diseases (PD) are inflammatory conditions that affect the teeth supporting tissues. Increased body fat tissues may contribute to activation of the systemic inflammatory response, leading to comorbidities. Some studies have shown that individuals with obesity present higher incidence of PD than eutrophics. Objective: To investigate the impact of obesity on periodontal tissues and oral microbiota in mice. Methodology: Two obesity mice models were performed, one using 12 weeks of the dietary protocol with a high-fat (HF) diet in C57BL/6 mice and the other using leptin receptor-deficient mice (db/db-/-), which became spontaneously obese. After euthanasia, a DNA-DNA hybridization technique was employed to evaluate the microbiota composition and topical application of chlorhexidine (CHX), an antiseptic, was used to investigate the impact of the oral microbiota on the alveolar bone regarding obesity. Results: Increased adipose tissue may induce alveolar bone loss, neutrophil recruitment, and changes in the oral biofilm, similar to that observed in an experimental model of PD. Topical application of CHX impaired bone changes. Conclusion: Obesity may induce changes in the oral microbiota and neutrophil recruitment, which are associated with alveolar bone loss.

Transcrestal sinus lift with simultaneous implant placement using osseodensification in posterior maxilla with residual bone height of 4-6 mm / Elevação de seio maxilar via crista do rebordo com instalação simultânea de implante utilizando osseodensificador em região posterior de maxila com altura do remanescente ósseo de 4 a 6 mm

Objective: The aim of this study was to evaluate the transcrestal sinus lift using Osseodensification technique with simultaneous implant placement. Material and Methods: In this case series 7 patients who needed implant placement in the atrophic posterior maxilla were enrolled. In all the cases the residual bone height between the sinus floor and the alveolar crest was 4-6 mm. Transcrestal sinus lift was performed using Osseodensification with simultaneous implant placement. Cone-beam computed tomography (CBCT) were obtained immediately postoperative and 6 months after operation. Implant stability using Osstell® were assessed at the time of implant placement and implant exposure (6 months). Results: The results showed that the mean bone height gain was 5.33±0.83mm at 6 months postoperatively. Mean bone density value was 818.43±109.63 HU. Mean ISQ value was 80.00±3.11 at 6 months postoperatively. The duration of surgical procedure (minutes) ranged between 25-38 minutes with an average of 30.86±4.10 minutes. Conclusion: The crestal maxillary sinus floor elevation using Osseodensification technique with simultaneous implant placement provide superior results regarding bone density and implant stability and less duration of surgical procedure. (AU)

Objetivo: O objetivo deste estudo foi avaliar a elevação de seio maxilar via crista do rebordo com a técnica de Osseodensificação com instalação simultânea de implante. Material e Métodos: Nesta série de casos, participaram 7 pacientes que necessitavam de implantes em região posterior de maxila atrófica. Em todos os casos a altura de remanescente ósseo entre o soalho do seio e a crista alveolar estava entre 4 a 6 mm. A elevação de seio maxilar via crista do rebordo foi realizada com osseodensificação com instalação simultânea de implante. As Tomografias Computadorizadas Cone Beam (TCCB) foram obtidas imediatamente após a cirurgia e 6 meses depois. A estabilidade dos implantes utilizando Osstell® foi avaliada no momento da instalação do implante e no momento da reabertura (6 meses). Resultados: Os resultados mostraram que a média de ganho de altura óssea foi de 5.33±0.83mm após 6 meses da cirurgia. A média da densidade óssea foi de 818.43±109.63 HU. A média de ISQ foi de 80.00±3.11 após 6 meses da cirurgia. A duração do procedimento cirúrgico (minutos) foi entre 25 a 38 minutos com uma média de 30.86±4.10 minutos. Conclusão: A elevação do soalho de seio maxilar via crista do rebordo com instalação simultânea de implante utilizando osseodensificador promove resultados superiores em relação à densidade óssea, estabilidade do implante e menor duração do tempo cirúrgico (AU)

Cone-beam computed tomographic evaluation of dimensional hard tissue changes following alveolar ridge preservation with leucocyte and platelet-rich fibrin techniques: a pilot study / Avaliação tomográfica computadorizada de feixe cônico das alterações dimensionais de tecido duro após preservação de crista alveolar com técnicas de fibrina rica em leucócitos e plaquetas: um estudo piloto

Objective: This study evaluated the effect of leucocyte and platelet-rich fibrin (L-PRF) techniques used in alveolar ridge preservation on dimensional hard tissue changes of the alveolar ridge assessed using cone-beam computed tomography (CBCT) scans. Material and Methods: Elective alveolar ridge preservation surgeries were performed on seven systemically healthy patients who underwent single posterior tooth extraction. Patients were randomly treated with PRF mixed with a commercial bone xenograft (n = 3) or PRF plug (n = 4). CBCT scans were taken immediately after tooth extraction and then four months later, just before implant surgery. Dimensional alterations in socket height (SH), socket area (SA) and socket volume (SV) were evaluated on CBCT scans by percentage differences before and after treatments. Results: Sockets treated with PRF plus bone xenograft had a tendency to maintain alveolar bone dimensions over time (SH= 11.22% to 82.74%, SA= 1.84% to 48.91% and SV= 9.11% to 203.62%), while sockets treated only with PRF plug technique presented only a modest increase in height (SH= 1.47% to 11.11%) but greater alveolar ridge resorption confirmed by a decrease in socket area and volume dimensions (SA= 0.21% to -24.09% SV= 8.53% to -54.12%). Conclusion: Within the limitations of this study, the maintenance of alveolar socket dimensions was observed when PRF was associated with a xenograft. However, the loss of alveolar ridge dimensions was not entirely prevented by PRF treatment alone.(AU)

Objetivo: Este estudo avaliou o efeito das técnicas de fibrina rica em leucócitos e plaquetas (L-PRF) usadas na preservação da crista alveolar em alterações dimensionais de tecido duro da crista alveolar avaliadas por tomografia computadorizada de feixe cônico (CBCT). Material e Métodos: Foram realizadas cirurgias eletivas de preservação da crista alveolar em sete pacientes sistemicamente saudáveis que foram submetidos a uma única extração dentária posterior. Os doentes foram tratados aleatoriamente com PRF misturado com um xenoenxerto ósseo comercial (n = 3) ou com PRF plug (n = 4). CBCT foi realizada imediatamente após a extração dentária e quatro meses depois, imediatamente antes da cirurgia de implante. Alterações dimensionais na altura do alvéolo (SH), área do alvéolo (SA) e volume do alvéolo (SV) foram avaliadas em exames CBCT por diferenças percentuais antes e depois dos tratamentos. Resultados: Os alvéolos tratados com PRF mais xenoenxerto ósseo apresentaram tendência a manter as dimensões ósseas alveolares ao longo do tempo (SH= 11.22% a 82.74%, SA= 1.84% a 48.91% e SV= 9.11% a 203.62%), enquanto alvéolos tratados apenas com a técnica de PRF plug apresentaram apenas um aumento modesto na altura (SH= 1.47% a 11.11%), mas uma maior reabsorção alveolar confirmada pela redução das dimensões de área e volume do alvéolo (SA= 0.21% a -24.09% SV= 8.53% a -54.12%). Conclusão: Dentro das limitações deste estudo, a manutenção das dimensões alveolares foi observada quando o PRF foi associado ao xenoenxerto. No entanto, a perda das dimensões alveolares não foi totalmente evitada pelo tratamento apenas com PRF. (AU)

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.

Bone evaluation of single edentulous areas of maxilla: short communication / Avaliação óssea de regiões maxilares candidatas à reabilitação unitária implantossuportada: uma comunicação curta

Objective: Evaluate the height and bone thickness in healed sites of single implant areas. Materials and Methods:In this cross-sectional study, cone-beam computed tomography (CBCT) images of single edentulous areas of maxilla of patients who needed aesthetic single implant rehabilitations were evaluated for measure the height and thickness using an implant planning software. Data were statistically analyzed using the Mann-Whitney and Pearson correlation test, considering the time, reason and region of tooth loss. For all tests, a p-value <0.05 was considered significant. Results: 48 patients with single tooth loss were included. The statistical analysis demonstrated that reason for the loss was not related to height or bone thickness. Bone thickness was statis-tical significant higher in the posterior region. For the anterior region, the bone thickness was significantly higher when the tooth was lost within 5 years. Pearson correlation test showed a moderate negative signifi-cant correlation between time of tooth loss and bone thickness in anterior region. Conclusion: Reason for tooth loss had no influence on the bone measurements of the residual ridge. In contrast, bone thickness may vary according to the region of tooth loss. The time of tooth loss and bone thickness in the anterior region were inversely proportional. Registration number at https://ensaiosclinicos.gov.br/rg/RBR-5cnyjj.

Objetivo: Avaliar a altura e espessura óssea em sítios unitários cicatrizados. Materiais e Métodos: Neste estudo transversal, imagens de tomografia computa-dorizada de feixe cônico (TCFC) de regiões edêntulas unitárias maxilares de pacientes candidatos a reabilitação unitária implantossuportada foram mensuradas em relação à altura e espessura óssea usando um software de planejamento de implante. Os dados foram analisados estatisticamente por meio do teste Mann-Whitney e de correlação de Pearson, considerando o tempo, o motivo e região da perda dentária. Para todos os testes, um valor de p <0,05 foi considerado significativo. Resultados: Foram incluídos 48 pacientes com perda dentária unitária. A análise estatística demonstrou que o motivo da perda dentária não influenciou na altura ou na espessura óssea. A espessura óssea foi estatisticamente maior na região posterior. Para a região anterior, a espessura óssea foi significativamente maior quando o dente foi perdido em até 5 anos. O teste de correlação de Pearson demonstrou uma correlação significativa negativa moderada entre o tempo de perda do dente e a espessura óssea na região anterior. Conclusão: O motivo da perda dentária não influenciou nas medidas ósseas do rebordo residual. Em contraste, a espessura do osso pode variar de acordo com a região da perda dentária. O tempo de perda dentária e a espessura óssea da região anterior foram inversamente proporcionais. Número de registro em https://ensaiosclinicos.gov.br/rg/RBR-5cnyjj

Alveolar bone loss with microarchitecture changes in aged rat / Pérdida ósea alveolar con alteraciones en la microarquitectura en ratas envejecidas

SUMMARY: The aim of the present study was to evaluate the changes of alveolar bone in aged rats. The mandibles of the 4- month and 22-month aged rats were scanned by micro-CT. After the reconstruction of the alveolar bone,the distance between the cemento enamel junction (CEJ) and the alveolar bone crest (ABC) was measured. The micro architectures of the inter-radicular alveolar bone were analyzed. The 22-month rats experienced the reduction in alveolar crest height in the buccal side and the lingual side, and significant increase in alveolar bone loss compared with the 4-month rats. The 22-month rats had a porous microarchitecture, the trabecular arrangement was obviously dissociated with the expanded inter-bone spaces of marrow, and the bone histomorphometry analysis showed the decreased bone volume/tissue volume and trabecular thickness in the 22-month rats. These results suggest that alveolar bone loss and alveolar trabecular bone deterioration might contribute to the weakening of molar support in the elderly.

RESUMEN: El objetivo del presente estudio fue evaluar los cambios del hueso alveolar en ratas envejecidas. Las mandíbulas de las ratas de 4 y 22 meses se escanearon mediante micro-TC. Después de la reconstrucción del hueso alveolar, se midió la distancia entre la unión cementoesmalte (CEJ) y la cresta ósea alveolar (ABC). Se analizaron las microarquitecturas del hueso alveolar interradicular. Las ratas de 22 meses experimentaron la reducción de la altura de la cresta alveolar. en el lado bucal y lingual, y un aumento significativo en la pérdida de hueso alveolar en comparación con las ratas de 4 meses. Las ratas de 22 meses tenían una microarquitectura porosa, la disposición trabecular estaba obviamente disociada con los espacios interóseos expandidos de la médula y el análisis de histomorfometría ósea mostró una disminución del volumen óseo / volumen tisular y del grosor trabecular en las ratas de 22 meses. Estos resultados sugieren que la pérdida ósea alveolar y el deterioro del hueso trabecular alveolar podrían contribuir al debilitamiento del soporte molar en los ancianos.

Cambios Dimensionales en Técnicas de Preservación Alveolar Bartee y Bio-Col con Xenoinjerto Inteross®

RESUMEN: La preservación de las dimensiones y contorno del reborde alveolar posterior a una extracción es de suma importancia para evitar problemas subsecuentes para la colocación de un implante dental. El objetivo de este estudio fue comparar los cambios dimensionales mediante el análisis en tomografía computarizada de haz cónico (CBCT) en sitios pre y post preservados con técnica Bartee y Bio-Col con xenoinjerto a los 6 meses de cicatrización. En un paciente de 62 años, se realizaron 6 preservaciones alveolares en órganos dentarios uniradiculares, con diagnóstico periodontal sin esperanza, grupo A la técnica de preservación alveolar Bartee (n= 3) y grupo B la técnica de preservación alveolar Bio-Col (n= 3). Se utilizó xenoinjerto (InterOss ® Anorganic Cancellous Bone Graft Granules 0,25- 1mm Sigma graft) en ambos grupos. En el grupo A se colocó injerto óseo en la totalidad del alveolo asistido por una membrana no reabsorbible de politetrafluoroetile no denso (Cytoplast ™ Regentex TXT-200 singles, Osteogenics Biomedical Inc, Lubbock, Texas). En el grupo B se colocó el injerto óseo en 3⁄4 del alveolo y el último 1⁄4 del alveolo fue ocupado por apósito de colágeno reabsorbible (CollaPlug ® Zimmer biomet). Se registraron mediciones obtenidas mediante CBCT inicial previa a la realización de preservaciones alveolares y se tomó una segunda CBCT a los 6 meses de cicatrización obteniendo la medición en sentido vertical y horizontal, coincidiendo en el plano de corte. Se observó mediante el análisis dimensional en grupo A y Grupo B obteniendo en sentido vertical un 13,58 % y 20,76 % de reabsorción y en sentido horizontal 13,45 % y 15,72 % respectivamente a los 6 meses de cicatrización, utilizando xenoinjerto por lo que no existe diferencia estadísticamente significativa en cuanto a los cambios dimensionales entre ambas técnicas p>0,05. La preservación alveolar proporciona una estabilidad dimensional contrarrestando el proceso de reabsorción fisiológica, siendo una opción predecible.

ABSTRACT: Preserving the dimensions and contour of the alveolar ridge after the dental extraction, it´s of utmost importance to avoidsubsequent problems for the placement of a dental implant. The objective of this study was compare the dimensional changes through the analysis in Cone-beam computed tomography (CBCT), in pre and post sites preserved with the Bartee and Bio-Col technique with xenograft at 6 months of healing. In a 62-year-old patient, 6 alveolar preservations were performed in uniradicular dental organs, with a hopeless periodontal diagnosis, group A the Bartee alveolar ridge preservation technique (n = 3) and group B the Bio-Col alveolar ridge preservation technique (n = 3). Xenograft (InterOss ® Anorganic Cancellous Bone Graft Granules 0.25-1mm Sigma graft) was used in both groups. In the group A a bone graft was placed in the entire socket, assisted by a dense non-absorbable polytetrafluoroethylene membrane (Cytoplast ™ Regentex TXT-200 singles, Osteogenics Biomedical Inc, Lubbock, Texas). In the group B the bone graft was placed in 3⁄4 of the socket and the last 1⁄4 of the socket was occupied by an absorbable collagen dressing (CollaPlug ® Zimmer biomet). Measurements obtained by initial CBCT before recording alveolar ridge preservations were recorded, and the second CBCT was taken 6 months after healing obtaining the measurement vertically and horizontally, coinciding in the section plane. It was observed through dimensional analysis in group A and Group B, obtaining 13.58% and 20.76% of reabsorption vertically and 13.45% and 15.72% respectively at 6 months of healing, using xenograft, so there is no statistical difference significant in terms of dimensional changes between both techniques p> 0.05. Alveolar ridge preservation provides dimensional stability by counteracting the physiological resorption process, being a predictable option.

Tratamiento quirúrgico de la periodontitis en un paciente con obesidad. Reporte de caso / Surgical treatment of periodontitis in an obese patient. A case report

Se presenta el caso clínico de una paciente mujer de 39 años con diagnóstico de obesidad clase 1 y periodontitis generalizada que acudió al posgrado de Periodoncia para reducir el "sangrado de sus encías". Al examen clínico se evidenció inflamación generalizada del margen gingival y papilas interdentales, profundidad de sondaje promedio de 3,8 mm, pérdida de inserción clínica promedio de 3,9 mm y lesiones de furcación clase 1. Se planificó un tratamiento periodontal mecánico evidenciándose mejora en los parámetros clínicos al cabo de seis meses, sin embargo, persistieron las bolsas periodontales por lo que se indicó terapia periodontal quirúrgica resectiva a través de colgajos de Widman modificado. Con un seguimiento de dos años se evidenció mantenimiento de la salud periodontal con una profundidad al sondaje media de 2 mm sangrado al sondaje de 6% e índice de higiene oral de 11%, así también presentar zonas con profundidad de sondaje >3 mm pero sin sangrado al sondaje en dichas zonas. Se concluye que luego de una terapia periodontal quirúrgica resectiva, los parámetros periodontales de inflamación gingival, profundidad al sondajes y sangrado al sondaje fueron reducidos y controlados en una paciente diagnosticada con obesidad clase 1 y periodontitis generalizada.

Clinical case: 39-year-old female patient with class 1 obesity and generalized periodontitis diagnosis, attended the Postgraduate Periodontology program to reduce "bleeding from her gums". The clinical examination revealed generalized inflammation of the gingival margin and interdental papillae, an average probing depth of 3.8 mm, an average clinical attachment loss of 3.9 mm and class 1 furcation lesions. A mechanical periodontal treatment was planned, showing improvement in the clinical parameters after six months, however, the periodontal pockets persisted, for which resective surgical periodontal therapy was indicated through modified Widman flaps. With a two-year follow-up, periodontal health was maintained with a mean probing depth of 2 mm, bleed-ing on probing of 6% and oral hygiene index of 11%, as well as presenting areas with probing depth> 3 mm but without bleeding on probing in these areas. It is concluded that after resective surgical periodontal therapy, the periodontal parameters of gingival inflammation, depth to probing and bleeding on probing were reduced and controlled in a patient diagnosed with class 1 obesity and generalized periodontitis.