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.

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)

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.

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.

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.

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.

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.

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.

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.

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)

Tratamento de recessões gengivais múltiplas pela técnica de bruno modificada / Tratamento de recessões gengivais múltiplas pela técnica de bruno modificada

Recessão gengival corresponde à migração apical da margem gengival em relação à junção cemento/esmalte (JCE). A exposição da superfície radicular ­ uma consequência das recessões gengivais ­ pode causar hipersensibilidade dentinária, cárie radicular, discrepâncias de altura da margem gengival e consequentes defeitos estéticos ao paciente. Dentre as diversas opções de tratamento, os procedimentos cirúrgicos são as estratégias mais indicadas para correção desses defeitos gengivais. Para realizar este tipo de correção, é necessário classifi car esses defeitos, principalmente, quanto à perda de tecido interproximal e presença de mucosa ceratinizada apicalmente à margem gengival. Desta forma, o objetivo desse trabalho foi relatar um caso clínico de recobrimento radicular de múltiplas recessões classe I de Miller, utilizando a técnica de Bruno modifi cada, avaliando a redução das recessões gengivais, a reversão do quadro de hipersensibilidade dentinária e a satisfação estética relatada pelo paciente.

Gingival recession is the gingival margin migration related to the cemetum enamel junction. The root surface exposure, an outcome of gingival recession, may cause dentin hipersensibility, root caries, height variance of gingival margins causing aisthetic problems to the patient. Among the various treatment options, surgical procedures are the most suitable strategies for correction of these gingival defects. In order to perform this type of correction, it is necessary to classify these defects specially concerning about interdental tissue loss and presence of keratinized mucosa apically to the gingival margin. Therefore, the aim of this work was to report a clinical case of root coverage Miller Class I multiple recessions, using the modifi ed Bruno technique, evaluating the gingival recession, reversion of dentin hypersensitivity, and the aesthetic satisfaction reported by the patient.

Ortodontia x periodontia em paciente adulto ­ relato de caso / Orthodontics x periodontics in adult patient ­ case report

Este trabalho descreve o tratamento de um indivíduo de 53 anos, xantoderma, Classe I de Angle bilateral, mordida cruzada anterior e doença periodontal avançada com perda óssea significante generalizada. O indivíduo passou por tratamento periodontal e após 6 meses foi possível iniciar a ortodontia. A mecânica foi realizada com fios leves e lançando mão de recursos que permitissem que ocorresse da forma mais atraumática possível. O tratamento foi finalizado e bem sucedido, devolvendo estética e função em dentes que haviam sido condenados por outros profissionais. O tratamento de casos semelhantes deve obrigatoriamente ser interdisciplinar e, sempre que possível, conservador. Este estudo tem o objetivo de relatar um caso clínico bastante comum em pacientes com comprometimento periodontal e discutir aspectos atuais envolvidos no êxito do tratamento desses pacientes. (AU)

This paper describes the treatment of a male, 53 year old, xantonoderma, bilateral Angle Class I, anterior crossbite and advanced periodontal disease with generalized significant bone loss. The patient underwent periodontal treatment and after 6 months, it was possible to start the orthodontics. The mechanics was performed with light wires and using resources that allowed it to occur in the most atraumatic way as possible. The treatment was completed and successful, restoring aesthetics and function in teeth that had been condemned by other professionals. The treatment of similar cases must be interdisciplinary and, whenever possible, conservative. This study aims to report a very common clinical case in patients with periodontal impairment and to discuss current aspects involved in a favorable outcome in these patients treatment. (AU)

Prevalencia de pérdida de inserción periodontal en una muestra de adolescentes de 15-19 años en Medellín, Colombia / Prevalence of periodontal attachment loss in a sample of adolescents aged 15-19 in Medellin, Colombia

Resumen Introducción y objetivo: La información epidemiológica acerca de la prevalencia de las enfermedades periodontales en adolescentes en Suramérica es escaza. Un estudio en Chile reportó que el 69,2% de los estudiantes adolescentes entre 12 y 21 años, tenían pérdida del nivel de inserción clínico > 1mm, el 16% > 2mm y el 4,5% >3mm. El objetivo de este estudio fue determinar las características epidemiológicas de la pérdida de inserción clínica de una muestra de adolescentes del Municipio de Medellín. Materiales y métodos: Se realizó un estudio transversal como parte de un estudio multicéntrico sobre prevalencia de pérdida de inserción en Suramérica. Se seleccionaron aleatoriamente estudiantes entre 15 y 19 años de escuelas públicas y privadas del municipio de Medellín. Se evaluaron el nivel clínico de inserción (NIC), el sangrado al sondaje (BoP) y la profundidad clínica de sondaje. Resultados: Se evaluaron 73 estudiantes con un predominio del género masculino del 52,1%. El sangrado al sondaje y el índice de placa en mujeres fue de 11,1±10,8 y 54,2±26,1 respectivamente, mientras que en los hombres fue de 15,1±15 y 44,2±21,1. Se encontró que el 65% de los hombres y el 60 % de las mujeres tenían pérdida de inserción > 1mm. La prevalencia de pérdida de inserción >3 mm fue de 14 % en mujeres. Conclusión: La prevalencia de pérdida de inserción leve en estudiantes de 15-19 años de colegios públicos y privados de la ciudad de Medellín es alta.

Abstract Introduction and objetive: The epidemiological information on the prevalence of periodontal disease in adolescents in South America is scarce. A study in Chile reported that 69.2% of teenage students between 12 and 21 years, had loss of clinical attachment level > 1 mm, 16% had > 2 mm loss and 4.5% >3mm. The aim of this study was to determine the epidemiological characteristics of the loss of a clinical sample of adolescents from Medellin insertion. Materials and method: A cross-sectional study was conducted as part of a multicenter study in South America. Students between 15 and 19 years were randomized to public and private in the city of Medellin. Clinical attachment level (NIC), bleeding on probing (BOP) and clinical probing depth were evaluated. Results: 73 students were evaluated with a prevalence of 52.1% male. Bleeding on probing and plaque index in women was 11.1 ± 10.8 and 54.2 ± 26.1respectively, while in men was 15.1 ± 15 and 44.2 ± 21, 1, respectively. It was found that 65% of men and 60% of women had insertion loss > 1mm. The prevalence of attachment loss >3 mm was 14% in women. Conclusion: The prevalence of incipient clinical attachment loss is high in this sample of students aged 15-19.

Correlación entre biotipo gingival, ancho y grosor de encía adherida en zona estética del maxilar superior / Correlation between gingival biotype, width and thickness of attached gingiva in an aesthetic of the upper jaw

Actualmente, para realizar distintos procedimientos odontológicos se hace necesaria una correcta evaluación del biotipo periodontal utilizando las herramientas adecuadas que nos permitan medir de manera certera su grosor. El objetivo de esta investigación fue evaluar distintos métodos diagnósticos, correlacionándolos con la medición directa de ancho y grosor de encía adherida en la zona anterosuperior del maxilar. Se reclutaron 30 pacientes periodontalmente sanos, y en los dientes 1.1, 1.2 y 1.3 se realizó: identificación del biotipo según parámetros visuales, medición directa del ancho, grosor de encía adherida y transparencia de la sonda periodontal como método indirecto. Mediante la transparencia de la sonda, el biotipo grueso fue el más prevalente (53,3 por ciento), observándose más en hombres (62,5 por ciento) versus mujeres (37,50 por ciento). Según parámetros visuales, el biotipo fino fue más prevalente (56,7 por ciento) que el grueso (43,3 por ciento), y al comparar ambos métodos no existieron diferencias significativas. Se observó un ancho promedio de la encía adherida de 2,79 mm y un grosor de 1,06 mm, presentándose valores más elevados en el biotipo grueso (ancho 2,94 mm y grosor 1,10 mm) versus el fino (ancho 2,67 mm y grosor 1,01 mm). Según los resultados obtenidos podemos concluir que tanto el diagnóstico visual como la transparencia de la sonda son válidos para identificar el biotipo gingival. Sin embargo, la inspección visual mostró menor reproducibilidad y mayor porcentaje de error al definir biotipo fino.

To perform different dental procedures it is currently necessary to make a correct assessment of periodontal biotype, using the right tools that allow its thickness to be accurately measured. The objective of this study was to evaluate different diagnostic methods and correlating them with direct measurement of width and thickness of attached gingiva in the front upper jaw area. The study included 30 periodontally healthy patients, in whom biotype identification was performed on teeth 1.1, 1.2 and 1.3, using visual parameters, direct measurement of the width and attached gingiva thickness, and transparency of the periodontal probe as an indirect method. According to the transparency of the probe, the thick biotype was the most frequent (53.3 percent) was observed more in men (62.5 percent) than women (37.50 percent). According to the visual parameters, thin biotype was more prevalent (56.7 percent) than the thick biotype (43.3 percent). There were no significant differences on comparing the 2 methods. The mean width of attached gingiva was 2.79 mm and a thickness of 1.06 mm, being greater in the thick biotype (width 2.94 mm and thickness 1.10) than in the thin biotype (width 2.67 mm and thickness 1.01 mm). According to the results, it can be concluded that both the visual diagnosis and transparency of the probe are valid to identify the gingival biotype. However, a lower reproducibility by visual inspection was observed, and the thin biotype showed a higher error rate.

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

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

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

The smear layer created by scaling and root planing is physiologically eliminated in a biphasic process

Mechanical instrumentation of the root surface causes the formation of a smear layer, which is a physical barrier that can affect periodontal regeneration. Although different procedures have been proposed to remove the smear layer, there is no information concerning how long the smear layer persists on root surfaces after instrumentation in vivo. This study assessed the presence of the smear layer on root surfaces over a 28-day period after subgingival instrumentation with hand instruments. Fifty human teeth that were referred for extraction because of advanced periodontal disease were scaled and root planed (SRP) by a single experienced operator. Ten teeth were randomly assigned to be extracted 7, 14, 21, and 28 days after SRP. Another 10 teeth were extracted immediately after instrumentation (Day 0, control group). The subgingival area of the instrumented roots was evaluated with scanning electron microscopy. Representative photomicrographs were assessed by a blinded and calibrated examiner according to a scoring system. A rapid and significant (p < 0.05, Z test) initial reduction in the amount of smear layer was observed at 7 days, and a further significant (p < 0.05) decrease was observed 28 days after SRP. Interestingly, even 28 days after SRP, the smear layer was still present on root surfaces. This study showed that the physiological elimination of the smear layer occurred in a biphasic manner: a rapid initial reduction was observed 7 days after instrumentation, which was followed by a slow process leading to a significant decrease 28 days after instrumentation.

Comparación de las características sociodemográficas, clínicas y microbiológicas de pacientes con periodontitis agresiva y crónica / Comparison of sociodemographic, clinical and microbiological characteristics of patients with aggressive and chronic periodontitis

Fundamento: algunos autores documentan diferencias en las características clínicas y en la prevalencia de los periodontopatógenos asociados con periodontitis agresiva y crónica en las poblaciones estudiadas. Objetivo: comparar las características sociodemográficas, clínicas y microbiológicas de pacientes con diagnóstico de periodontitis agresiva y periodontitis crónica en una población Colombiana. Métodos: en el presente estudio de corte transversal, el universo estuvo constituido por 94 pacientes: 40 con periodontitis crónica, 40 con periodontitis agresiva, y 14 controles sin periodontitis. Se realizó un examen periodontal completo que evaluó los parámetros periodontales más importantes. Se tomaron muestras microbiológicas de los pacientes en sitios con una profundidad de sondaje ≥ 5 mm. Resultados: se encontró una mayor proporción de Porphyromonas gingivalis y Tanerella forsythia en el grupo de periodontitis crónica (p<0.05). De la misma manera, se observó mayor proporción de Aggregatibacter actynomicetemcomitans en el grupo de periodontitis agresiva, con diferencias estadísticamente significativas (p<0.05). Se halló un mayor número de fumadores en el grupo de periodontitis crónica (p<0.05). La asociación entre A. actinomycetemcomitans y periodontitis agresiva arrojada por el análisis de regresión logística multinomial se conservó después de ajustar por variables de confusión. Se observaron peores parámetros periodontales en los pacientes con periodontitis crónica comparado con los otros dos grupos y las diferencias fueron estadísticamente significativas (p<0.05). Igualmente los pacientes con periodontitis agresiva presentaron mayor profundidad al sondaje y pérdida de inserción comparado con el grupo sin periodontitis (p<0.05). Conclusiones: los resultados del presente estudio muestran algunas particularidades microbiológicas y clínicas de la periodontitis agresiva y la periodontitis crónica en la población estudiada. En términos de estrategias de prevención y tratamiento de las enfermedades periodontales, los clínicos deben tener presente las potenciales diferencias en la microbiota subgingival y su asociación con el estado periodontal en una población particular.

Background: some authors documented difference in the clinical characteristics and in the prevalence of periodontopathogens associated with aggressive and chronic periodontitis among the populations studied. Objective: to compare the demographic, clinical and microbiological characteristics between patients diagnosed with aggressive periodontitis and chronic periodontitis in a Colombian population. Methods: in this cross-sectional study, the universe consisted of 94 patients: 40 with chronic periodontitis, 40 with aggressive periodontitis and 14 controls without periodontitis. A complete periodontal examination that evaluated the most important periodontal parameters was performed. Microbiological samples were taken from patients at sites with a probing depht ≥ 5 mm. Periodontopathogens were identified performing a polymerase chain reaction. The sociodemographic characteristics were assessed using a structured questionnaire. Results: a higher proportion of Porphyromonas gingivalis and Tanerella forsythia in chronic periodontitis group was found (p <0.05). Similarly, a higher proportion of Aggregatibacter actynomicetemcomitans was observed in the group of aggressive periodontitis, with statistically significant differences (p <0.05). A higher number of smokers in the chronic periodontitis group were found (p <0.05). The association between periodontitis and Aggregatibacter actinomycetemcomitans performed by the multinomial logistic regression analysis was retained after adjusting for confounding variables. Periodontal worst parameters were observed in patients with chronic periodontitis compared with the other two groups, and the differences were statistically significant (p <0.05). Similarly, patients with aggressive periodontitis had higher probing depth and attachment loss compared with those without periodontitis (p <0.05). Younger people and lower socioeconomic status were observed in the aggressive periodontitis group (p <0.05). Conclusions: the results of this study show some special microbiological and clinical characteristics of aggressive and chronic periodontitis in the population studied. In terms of strategies for prevention and treatment of periodontal disease, clinicians should be aware of potential differences in the subgingival microbiota and their association with periodontal status in a particular population.

Minocycline hydrochloride slow-release antibacterial ointment in the treatment of combined periodontal-endodontic lesions / 中国组织工程研究

BACKGROUND:The role of minocycline hydrochloride in adjuvant therapy of chronic periodontitis and periodontal abscess has been widely reported, but detailed study of minocycline hydrochloride for combined periodontal-endodontic lesions is rare at present. OBJECTIVE:To investigate the effect of minocycline hydrochloride in the treatment of combined periodontal-endodontic lesions. METHODS:A total of 68 teeth with combined periodontal-endodontic lesions were treated with periodontal mechanical treatment and root canal therapy. According to the patient’s wiling, 68 patients were divided into experimental group (n=24; local injection of minocycline hydrochloride after periodontal mechanical treatment), positive control group (n=24; local injection of iodine glycerol after periodontal mechanical treatment), and negative control group (n=20; no injection after periodontal mechanical treatment). These three groups were reviewed 1 month after periodontal mechanical treatment, and the differences before and after treatment were compared, including periodontal probing depth, attachment loss and gingival bleeding index. RESULTS AND CONCLUSION: Probing depth, attachment loss and gingival bleeding index in three groups were significantly improved after 1 month of periodontal mechanical treatment (P sulcus bleeding index in experimental group and positive control group were better than that of the negative control group (P of positive control group (P periodontal-endodontic lesions, in addition to periodontal mechanical treatment and root canal therapy, local application of minocycline hydrochloride can effectively reduce the depth of periodontal pocket, improve gingival inflammatory conditions and consolidate curative effect.

Periodontal findings in patients with Hansen's disease

OBJECTIVE@#To find out whether there are any relationship between leprosy and periodontitis as evidenced by clinical parameters.@*METHODS@#Fifteen diagnosed patients with Hansen's disease were selected and compared against 50 healthy individuals. Clinical parameters like probing pocket depth and clinical attachment level were evaluated for both the groups and the results were subjected to statistical analysis.@*RESULTS@#Mean probing depth and attachment loss is seen more in patients with Hansen's disease than the healthy controls which are statistically significant.@*CONCLUSIONS@#Patients with Hansen's disease tend to have more periodontal destruction than the healthy controls.