Gingivitis en el embarazo

Introducción: El embarazo es una época de cambios para las mujeres. Se producen cambios en todo el organismo debido al aumento de los niveles de la hormona progesterona. La encía es un tejido clave para la acción de las hormonas esteroideas, por tal motivo los cambios clínicos en los tejidos periodontales se identifican durante los periodos de fluctuación hormonal. Objetivo: Sistematizar aspectos sobre qué es la gingivitis en el embarazo, cuáles son sus causas y consecuencias, y cómo tratarla de forma segura para la madre y el bebé. Método: Se realizaron revisiones bibliográficas donde se pudo abordar e interpretar las manifestaciones de la enfermedad periodontal durante el embarazo. Fueron examinados 20 artículos científicos de revistas nacionales e internacionales tanto en español y portugués de los últimos 5 años (2018-2022); de los 20 artículos se excluyeron 5, ya que no coincidían con el tema investigado. Resultados: Los efectos de los estrógenos y la progesterona en el periodonto han sido objeto de atención por los investigadores a lo largo de los años. Por esta razón los tejidos periodontales de la mujer son más susceptibles a esta patología durante el embarazo debido al aumento gradual en el nivel plasmático de progesterona y estrógenos, lo cual conlleva a un acúmulo anormal de bacterias, lo que genera esta enfermedad conocida como gingivitis. Dicha entidad presenta una prevalencia que oscila entre el 35 al 100 %. Consideraciones finales: Si la gingivitis no es tratada durante los dos primeros trimestres las bacterias pueden migrar al torrente sanguíneo y fijarse en la placenta. El cuerpo, como mecanismo de defensa para salvar al bebé entra en trabajo de parto, lo que provoca un parto prematuro. Por este hecho es indispensable asistir a los controles odontológicos.

Introduction: Pregnancy is a time of change for women. Changes occur throughout the body due to increased levels of the hormone progesterone. The gingiva is a key tissue for the action of steroid hormones, for this reason clinical changes in periodontal tissues are identified during periods of hormonal fluctuation. Objective: To systematize aspects of what gingivitis in pregnancy is, what its causes and consequences are, and how to treat it safely for the mother and baby. Method: Bibliographic reviews were carried out where the manifestations of periodontal disease during pregnancy could be addressed and interpreted. 20 scientific articles from national and international journals in both Spanish and Portuguese from the last 5 years (2018-2022) were examined; Of the 20 articles, 5 were excluded, since they did not coincide with the topic investigated. Results: The effects of estrogen and progesterone on the periodontium have been the subject of attention by researchers over the years. For this reason, women's periodontal tissues are more susceptible to this pathology during pregnancy due to the gradual increase in the plasma level of progesterone and estrogen, which leads to an abnormal accumulation of bacteria, which generates this disease known as gingivitis. This entity has a prevalence that ranges between 35 to 100%. Final considerations: If gingivitis is not treated during the first two trimesters, bacteria can migrate into the bloodstream and settle in the placenta. The body, as a defense mechanism to save the baby, goes into labor, which causes premature birth. For this reason, it is essential to attend dental check-ups.

Introdução: A gravidez é um momento de mudanças para a mulher. Mudanças ocorrem em todo o corpo devido ao aumento dos níveis do hormônio progesterona. A gengiva é um tecido fundamental para a ação dos hormônios esteróides, por esta razão são identificadas alterações clínicas nos tecidos periodontais durante períodos de flutuação hormonal. Objetivo: Sistematizar aspectos do que é gengivite na gravidez, quais são suas causas e consequências e como tratá-la com segurança para a mãe e o bebê. Método: Foram realizadas revisões bibliográficas onde puderam ser abordadas e interpretadas as manifestações da doença periodontal durante a gravidez. Foram examinados 20 artigos científicos de revistas nacionais e internacionais em espanhol e português dos últimos 5 anos (2018-2022); Dos 20 artigos, 5 foram excluídos, por não coincidirem com o tema investigado. Resultados: Os efeitos do estrogênio e da progesterona sobre o periodonto têm sido objeto de atenção de pesquisadores ao longo dos anos. Por este motivo, os tecidos periodontais das mulheres são mais suscetíveis a esta patologia durante a gravidez devido ao aumento gradual do nível plasmático de progesterona e estrogênio, o que leva a um acúmulo anormal de bactérias, o que gera esta doença conhecida como gengivite. Esta entidade tem uma prevalência que varia entre 35 a 100%. Considerações finais: Se a gengivite não for tratada nos dois primeiros trimestres, as bactérias podem migrar para a corrente sanguínea e se instalar na placenta. O corpo, como mecanismo de defesa para salvar o bebê, entra em trabalho de parto, o que provoca o nascimento prematuro. Por esse motivo, é imprescindível a realização de exames odontológicos.

Avaliação do comportamento das fibras colágenas periodontais durante a progressão da periodontite experimental em ratos / Evaluation of the behaviour of periodontal collagen fibers during the progression of experimental periodontitis in rats

Introdução: A periodontite é uma doença infecto-inflamatória, resultante da disbiose microbiana e da resposta do hospedeiro, que leva à destruição dos tecidos de suporte dentário, inclusive das fibras colágenas periodontais, podendo culminar na perda do elemento dental. Objetivo: Avaliar o comportamento das fibras colágenas periodontais durante a progressão da periodontite experimental induzida em ratos. Material e método: Doze ratos Wistar foram distribuídos nos grupos: Controle (C), Periodontite Experimental 14-dias (PE-14d), Periodontite Experimental 21-dias (PE-21d) e Periodontite Experimental 42-dias (PE-42d). No dia 0, os animais do grupo C foram eutanasiados. Neste mesmo dia, os animais remanescentes foram submetidos à instalação de uma ligadura de algodão ao redor do primeiro molar inferior esquerdo para indução da periodontite experimental. Tais animais foram eutanasiados aos 14 (PE-14d), 21 (PE-21d) e 42 (PE-42d) dias após a instalação da ligadura. Executou-se o processamento histológico das hemimandíbulas e as secções foram submetidas à reação histoquímica pelo vermelho picro-sirius. A análise qualitativa descritiva foi realizada sob microscopia de luz polarizada, na região de furca dental, evidenciando as fibras do ligamento periodontal. Resultado: O grupo C exibiu feixes espessos e orientados de fibras colágenas maduras, condizentes com aspecto de normalidade. Os grupos com periodontite experimental exibiram desestruturação tecidual severa, com fibras colágenas imaturas e de menor espessura, sendo tais condições mais exacerbadas nos grupos PE-14d e PE-21d. Conclusão: As fases iniciais da periodontite apresentam caráter agudo e, portanto, resultam na rápida destruição dos tecidos periodontais de suporte, prejudicando potencialmente a fibrilogênese e a reestruturação do colágeno no ligamento periodontal.

Introduction: Periodontitis is an infectious-inflammatory disease resulting from microbial dysbiosis and host response that leads to the destruction of tooth support tissues, including periodontal collagen fibers, which may culminate in tooth loss. Objective: To evaluate the behavior of periodontal collagen fibers during the progression of induced experimental periodontitis in rats. Material and method: Twelve Wistar rats were distributed into groups: Control (C), 14-days Experimental Periodontitis (PE-14d), 21-days Experimental Periodontitis (PE-21d) and 42-days Experimental Periodontitis (PE-42d). At day 0, the animals of group C were euthanized. At the same day, the remaining animals were submitted to the installation of a cotton ligature around the lower left first molar for the induction of experimental periodontitis. The animals were euthanized at 14 (PE-14d), 21 (PE-21d) and 42 (PE-42d) days after the installation of ligature. Histological processing of the hemi-mandibles was performed and the sections underwent histochemical reaction using picro-sirius red. The descriptive qualitative analysis was performed under polarized light microscopy, in the dental furcation region, evidencing the fibers of the periodontal ligament. Result: Group C exhibited thick and oriented bundles of mature collagen fibers, consistent with a normal appearance. The groups with experimental periodontitis exhibited severe tissue disruption, with immature and thinner collagen fibers, with such conditions being more exacerbated in the PE-14d and PE-21d groups. Conclusion: The early stages of periodontitis present acute response, and therefore result in rapid destruction of periodontal support tissues and potentially impair fibrillogenesis and collagen restructuring in the periodontal ligament.

Effect of Stress on Periodontium and Oral Health in Covid-19 Positive Patients: An Online Questionnaire-Based Survey

Background: Emergence of Covid-19 pandemic resulted in stressful living conditions throughout the world leading to an alteration of habits and detrimental effects on overall health particularly oral health and hygiene of people throughout the world. The aim was to access perceived stress and its impact on periodontium and oral health in Covid-19 positive patients.Material & Methods:An online health questionnaire was submitted by Covid-19 positive patients over a period of six months with answers regarding their systemic health, perceived stress, existing habits and their alteration, oral hygiene maintenance and symptoms of oral and periodontal diseases during covid positivity.Results:Results showed that there was increase in stress levels of Covid-19 positive patients with alteration of habits and increased incidence of negative effects on oral and periodontal health.Conclusions:Although Covid-19 positive patients experienced more stress and higher incidence of oral and periodontal diseases but no direct relation could be established.

Routine screening of Vitamin D status in patients with Aggressive Periodontitis - A cross sectional clinical study

Background: Periodontal diseases are characterized by the presence of bleeding, inflammation, sensitivity, discomfort, mobility and tooth loss. Plenty of studies supported the assumption that vitamin D deficiency might be a risk factor for periodontal diseases. Our study aimed to investigate the true association between serum vitamin D level and the presence of periodontal disease. Materials and methods: The study evaluated 40 patients (age group 19-35 years) attending the outpatient department, Department of Periodontics and Implantology, Govt. Dental College and Hospital, Srinagar, equally divided into two groups (Group I and Group II) according to the inclusion criteria. Group I included generalized aggressive periodontitis patients while Group II included non periodontitis patients. Clinical parameters and serum 25-hydroxyvitamin D level were assessed. Results: Serum vitamin D levels of periodontitis patients compared to non-periodontitis patients presented non statistically significant differences (p-value = 0.878). Conclusion: Although the serum vitamin D level in aggressive periodontitis patients was lower than the healthy controls but the difference seemed to be statistically insignificant and hence it can be concluded that the serum vitamin D deficiency is not a risk factor for periodontitis.

Research Progress on Mechanical Loading Model of Periodontium / 医用生物力学

Periodontium is mechanoresponsive to multiple types of mechanical stimuli like occlusal and orthodontic force and reacts quickly. It is widely used as the loading subject in researches regarding dental mechanical force models both in vivo and in vitro. This review summarized various animal models and cell culture loading methods (including static gravity approach, centrifugation approach, vibration approach, cyclical tension approach, fluid flow approach),as well as parameters for periodontium in recent years, so as to provide references for the study of periodontal mechanoresponsive mechanism and the development of new clinical therapies.

The Role of Exosomes in Force-Related Periodontal Inflammatory Response / 医用生物力学

Exosomes are extracellular vesicles secreted by cells with a variety of molecular components, which can play the role of substance transport and signal communication between cells through autocrine and paracrine. Exosomes exist widely in vivo and participate in many physiological and pathological processes, including force-related periodontal inflammation. There are stress receptor cells in the periodontium, which can sense force loading on the tooth. An appropriate amount of mechanical loading can maintain health of the periodontium, while excessive mechanical loading may cause destruction and absorption of the periodontium, leading to periodontal inflammation. This article reviews the role of exosomes in force-related inflammation response, especially in periodontal inflammation response.

Influência da técnica de preparo sobre o contorno cervical dos laminados cerâmicos: relato de caso / Influence of the preparation technique on the cervical contour of ceramic laminates: a case report / Influencia de la técnica de preparación en el contorno cervical de los laminados cerámicos: reporte del caso

Introdução: Devido à crescente demanda estética, a odontologia restauradora se renova na intenção de alcançar melhores resultados na harmonia do sorriso. Entretanto, a atenção deve voltar-se também aos tecidos periodontais, visto que há uma integração entre material restaurador e os tecidos. Objetivo:Descrever e discutir as etapas clínicas para a confecção de laminados cerâmicos, atentando-se a preparos minimamente invasivos, contorno cervical e fatores que podem intervir na longevidade do procedimento.Relato de caso:Paciente do sexo masculino, 28 anos de idade, compareceu a Associação Brasileira de Odontologia, seção de Alagoas, relatando insatisfação em relação ao tamanho dos seus dentes. Os arcos superior e inferior foram moldados para a obtenção dos modelos de estudo e enceramento diagnóstico. Ao início do tratamento foi orientado ao paciente clareamento dental pela técnica combinada. O preparo dos dentes foi guiado por uma matriz de silicone, sendo estes uniformes e conservadores, seguido de moldagem, fase laboratorial e cimentação final. Finalizado o caso foi realizado o ajuste oclusal solicitando ao paciente que realizasse movimentos de lateralidade e protrusão. Conclusões:A técnica do preparo influência na longevidade dos laminados cerâmicos, por relacioanar-se à adesão e a saúde periodontal. O preparo deve ser mínino e limitado ao esmalte dental sempre que possível, determinando assim um maior e melhor prognóstico (AU).

Introduction:Due to the growing aesthetic demand, restorative dentistry is renewed to achieve better results in smile harmony. However, attention should also be turned to periodontal tissues since there is an integration between restorative material and tissues. Objective:To describe and discuss the clinical steps for the manufacture of laminate veneers, paying attention to minimally invasive preparations, cervical contour, and factors that can intervene in the procedure's longevity. Case report:A 28-year-old male patient attended the Brazilian Dental Association, the Alagoas section, reporting dissatisfaction with his teeth' size. The upper and lower arches were molded to obtain the study and diagnostic waxing models. At the beginning of treatment, the patient was instructed by the combined technique. After the case, the occlusal adjustment was performed, asking the patient to perform laterality and protrusion movements. Conclusions:The preparation technique influences the longevity of laminate veneers due to adherence and periodontal health. The preparation should be minimal and limited to dental enamel whenever possible, thus determining a higher and better prognosis (AU).

Introducción: Debido a la creciente demanda estética, la odontología restauradora se renueva para lograr mejores resultados en la armonía de la sonrisa. Sin embargo, también se debe prestar atención a los tejidos periodontales ya que existe una integraciónentre el material restaurador y los tejidos.Objetivo: Describir y discutir los pasos clínicos para la confección de carillas laminares, prestando atención a las preparaciones mínimamente invasivas, al contorno cervical y a los factores que pueden intervenir en la longevidad del procedimiento.Reporte del caso: Un paciente masculino de 28 años asistió a la Asociación Dental Brasileña, sección de Alagoas, reportando insatisfacción con el tamaño de sus dientes. Los arcos superior e inferior fueron moldeados para obtener los modelos de depilación de estudio y diagnóstico. Al comienzo del tratamiento, el paciente fue instruido por la técnica combinada. La preparación de los dientes fue guiada por una matriz de silicona, siendo estas uniformes y conservadoras, seguidas de moldeo, fase de laboratorio y cementación final. Después del caso, se realizó el ajuste oclusal, pidiendo al paciente que realizara movimientos de lateralidad y protuberancia. Conclusiones: La técnica de preparación influye en la longevidad de los laminados cerámicos, debido a la adherencia y la salud periodontal. La preparación debe ser mínima y limitada al esmalte dental siempre que sea posible, determinando así un pronóstico más alto y mejor (AU).

Epithelial rests of Malassez in experimental animals at different ages / Restos epiteliales de Malassez en animales experimentales a diferentes edades

ABSTRACT Epithelial rests of Malassez (ERMs) are fragments of Hertwig's sheath in the periodontal ligament. There is extensive knowledge of their role in the etiology ofpathological processes and current evidence links them to maintenance of periodontal homeostasis. The aim of this study was to assess the behavior of ERMs with relation to the changes in periodontal tissues during growth in an experimental model with Wistar rats. Mesiodistal sections were made of the first lower molars from Wistar rats aged 1 month (n=7), 3 months (n=7) and 5 months (n=6). Sections were stained with H&E to evaluate number of ERMs/ mm, size/area of ERMs (μm2), height of periodontal ligament (PL.h) (pm), area of cement in the furcation zone (C.Ar) (μm2) and bone area related to the ERM zone (BAr/TAr)(%). Posthoc Bonferroni and ANOVA were applied for statistical analysis of results. Number of ERMs/mm declined significantly with age (1m: 4.34±1.51, 3m: 1.48±0.89, 5m: 0.27± 0.50, p<0.05), and there was great variability in size. There was significant increase in C.Ar (1m: 3418.96 ± 905.88, 3m: 19365.76 ± 5500.52, 5m: 32182.76 ± 7114.51, p< 0.05) and interradicular (BAr/TAr) (1m: 25.26 ± 2.37, 3m: 44.70 ± 3.95, 5m: 46.81 ± 7.80, p< 0.05: 1 vs 3, 1 vs 5). There was significant decline in PLh at 5 months (1m: 141.42 ± 29.25, 3m: 162.06 ± 28.21, 5m: 124.72 ± 18.67, p< 0.05: 1 vs. 3, 3 vs. 5). The decline in number of ERMs as animal age increases may be related to the significant increase in C.Ar and reduction in PL.h. It remains to ascertain its relationship with the increase observed in BAr/ TAr. Further studies are needed to learn more about the role of ERMs and their relationship with periodontal tissues when confronted with different normal and pathological stimuli.

RESUMEN Los restos epiteliales de Malassez (ERMs) son fragmentos de la vaina de Hertwig, en el ligamento periodontal. Se conoce extensamente su rol en la etiología de procesos patológicos y actualmente las evidencias los vinculan al mantenimiento de la homeostasis periodontal. El objetivo del presente trabajo fue evaluar el comportamiento de los ERMs en relación a los cambios de los tejidos periodontales durante el crecimiento en un modelo experimental de ratas Wistar. Se obtuvieron cortes mesio-distales del 1er molar inferior de ratas Wistar de 1 mes (n=7), 3 meses (n=7) y 5 meses (n=6) de edad. En cortes coloreados con H&E, se evalúo: N° de ERMs/mm, tamaño/ área de ERMs (μm2), altura del ligamento periodontal (PL.h) (μm), área de cemento en la zona de furcación (C.Ar) (μm2) y área del hueso relacionado con la zona de los ERMs (BAr/TAr) (%). Los resultados se analizaron estadísticamente mediante ANOVA y Bonferroni post-hoc. El N° de ERMs/mm disminuyó significativamente con la edad (1m: 4.34±1.51, 3m: 1.48±0.89, 5m: 0.27± 0.50, p<0.05), observándose una gran variabilidad de tamaño. Se observó un aumento significativo del CAr (1m: 3418.96 ± 905.88, 3m: 19365.76 ± 5500.52, 5m: 32182.76 ± 7114.51, p< 0.05) y del (BAr/TAr). interradicular (1m: 25.26 ± 2.37, 3m: 44.70 ± 3.95, 5m: 46.81 ± 7.80, p< 0.05: 1 vs 3, 1 vs 5). Además, se halló una disminución significativa en PLh a los 5 meses (1m: 141.42 ± 29.25, 3m: 162.06 ± 28.21, 5m: 124.72 ± 18.67, p< 0.05: 1 vs 3, 3 vs 5). La disminución hallada del número de ERMs conforme aumenta la edad del animal podría vincularse con el aumento significativo del C.Ar y la reducción del PL.h. Resta por dilucidar su relación con el aumento de BAr/TAr. observado. Se requieren más estudios para profundizar sobre el rol de los ERMs y su relación con los tejidos periodontales ante distintos estímulos normales y patológicos.

The Role of MicroRNA in Force-Related Periodontal Inflammatory Response and Tissue Remodeling / 医用生物力学

Micro-ribonucleic acid(miRNA) is a kind of non-coding single-stranded RNA, which can regulate the expression of genetic information by inhibiting mRNA translation of the target gene and participate in the occurrence and development of a variety of biological processes in vivo. miRNAs also take part in inflammatory diseases and tissue remodeling induced by mechanical forces. Mechanosensitive cells in periodontal tissue can lead to pathological/physiological changes such as periodontal inflammatory response and periodontal remodeling. miRNAs might have played important roles in the occurrence and development of force-related periodontal inflammatory diseases and tissue remodeling, by inhibiting the translation of specific genes in these cells. This article reviews the roles of miRNAs in force-related inflammatory response and tissue remodeling, especially in periodontal inflammatory response and tissue remodeling.

Finite element analysis of the effects of periodontal tissue temperature by continuous wave technique / 华西口腔医学杂志

OBJECTIVES@#The safety of root canal filling with 200 °C hot gutta-percha was investigated to study the effect of continuous wave technique combined with high-temperature injectable gutta-percha condensation technique on the surface temperature of periodontal tissue.@*METHODS@#CT technique and Mimics, Geomagic, and Solidworks software were utilized to build the entity models of alveolar bone, dentin and root canal, periodontal ligament, and blood flow, respectively, which were then assembled in Solidworks into a finite element model of tooth with blood flow. By utilizing ABAQUS collaborative simulation platform, fluid-structure coupling was analyzed on the whole process of root canal filling. Consequently, the surface temperature of the periodontal tissue was obtained.@*RESULTS@#In the absence of blood flow, the temperature of the periodontal ligament surface reached 50.048 ℃ during root canal filling with 200 ℃ gutta-percha. Considering blood flow, the temperature of periodontal ligament surface was 39.570 ℃.@*CONCLUSIONS@#The temperature of the periodontal ligament surface increased when the continuous wave root canal was filled with 200 ℃ gutta-percha, and the periodontal tissue was not damaged.

Focus on periodontal engineering by 3D printing technology ­ a systematic review / Enfoque en la ingeniería periodontal mediante la tecnología de impresión 3D: una revisión sistemática

Three-dimensional (3D) bioprinting of cells is an emerging area of research but has not been explored yet in the context of periodontal tissue engineering. Objetive: This study reports on the optimization of the 3D bioprinting scaffolds and tissues used that could be applied clinically to seniors for the regenerative purpose to meet individual patient treatment needs. Material and Methods: We methodically explored the printability of various tissues (dentin pulp stem/progenitor cells, periodontal ligament stem/progenitor cells, alveolar bone stem/progenitor cells, advanced platelet-rich fibrin and injected platelet-rich fibrin) and scaffolds using 3D printers pertaining only to periodontal defects. The influence of different printing parameters with the help of scaffold to promote periodontal regeneration and to replace the lost structure has been evaluated. Results: This systematic evaluation enabled the selection of the most suited printing conditions for achieving high printing resolution, dimensional stability, and cell viability for 3D bioprinting of periodontal ligament cells. Conclusion: The optimized bioprinting system is the first step towards the reproducible manufacturing of cell laden, space maintaining scaffolds for the treatment of periodontal lesions.

La bioimpresión tridimensional (3D) de células es un área emergente de investigación, pero aún no se ha explorado en el contexto de la ingeniería de tejidos periodontales. Objetivo: Este estudio informa sobre la optimización de los tejidos y andamios de bioimpresión 3D utilizados que podrían aplicarse a personas mayores en el entorno clínico con fines regenerativos para satisfacer las necesidades de tratamiento de cada paciente. Material y Métodos: Exploramos metódicamente la capacidad de impresión de varios tejidos (células madre / progenitoras de la pulpa de dentina, células madre / progenitoras del ligamento periodontal, células madre / progenitoras de hueso alveolar, fibrina rica en plaquetas avanzada y fibrina rica en plaquetas inyectada) y andamios utilizando impresoras 3D que pertenecen solo a defectos periodontales. Se ha evaluado la influencia de diferentes parámetros de impresión con la ayuda de andamios para promover la regeneración periodontal y reemplazar la estructura perdida. Resultados: Esta evaluación sistemática permitió la selección de las condiciones de impresión más adecuadas para lograr una alta resolución de impresión, estabilidad dimensional y viabilidad celular para la bioimpresión 3D de células del ligamento periodontal. Conclusión: El sistema de bioimpresión optimizado es el primer paso hacia la fabricación reproducible de andamios de mantenimiento de espacio cargados de células para el tratamiento de lesiones periodontales

Expansion treatment using Invisalign®: Periodontal health status and maxillary buccal bone changes. A clinical and tomographic evaluation / Tratamiento de expansión con Invisalign®: estado de salud periodontal y cambios óseos maxilares. Evaluación clínica y tomográfica

ABSTRACT The aim of this study was to evaluate changes in periodontal status and maxillary buccal bone by considering clinical and tomographic parameters during the first year of orthodontic expansion with Invisalign® aligners. Upper first (1PM) and upper second (2PM) premolars of 19 patients with orthodontic expansion requirement treated with Invisalign® aligners were evaluated. Plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL) and cone beam tomographic (CBCT) records were collected at 76 sites before starting treatment (T0) and at 12 months (T1). Bone height was measured from cementoenamel junction (CEJ) to the crest cortical bone (CC). Bone thickness was measured at two levels: 4 mm (CEJ+4) and 6 mm (CEJ+6) apical to the CEJ. A descriptive analysis was made of the variations of bone thickness and height in a series of cases. The average expansion was 1.93 mm for 1PM and 167 mm for 2PM. Arithmetic mean of distance CEJ-CC in 1PM was 3.05 mm at T0, and remained at 3.05 mm at T1. Arithmetic mean of distance CEJ-CC in 2PM was 2.06 mm at T0 and 2.31 at T1. Post-expansion, most of the analyzed sites (86%) exhibited a bone thickness of ≥0.5 mm. The greatest variations between T0 and T1 were observed at the level of 1PM CEJ+ 4 and 2PM CEJ+ 6. The minimal changes in the clinical records (GI, PI, PPD and CAL) between T0 and T1 were compatible with the maintenance of gingivalperiodontal health. Invisalign® for expansion movements did not produce substantial changes in the evaluated periodontal clinical parameters or in the bone measurements. Removable appliances reduce plaque retentive factors and favor adequate oral hygiene.

RESUMEN El objetivo de este estudio fue evaluar los cambios en el estado periodontal y hueso facial maxilar a través de parámetros clínicos y tomográficos durante la expansión ortodóncica con alineadores Invisalign® en el primer año de tratamiento. Se evaluaron los primeros (1PM) y segundos (2PM) premolares superiores pertenecientes a 19 pacientes con requerimiento de expansión ortodóncica tratados con alineadores Invisalign®. Se registraron los índices de placa (IP), índice gingival (IG), profundidad al sondaje (PS) y nivel de inserción (NI) y registros tomográficos de haz cónico (CBCT) en 76 sitios antes de comenzar el tratamiento (T0) y a los 12 meses (T1). Se midió la altura ósea desde el límite amelocementario (LAC) hasta la cortical de la cresta (CC) y el espesor en dos niveles; a 4 mm (LAC+4) y a 6 mm (LAC+6) hacia apical del LAC. Se realizó un análisis descriptivo de las variaciones de la altura y espesor óseo en una serie de casos. La expansión promedio para 1PM fue de 1,93 mm y para 2PM fue de 1,67 mm. La media aritmética de LAC-CC en primeros premolares fue de 3,05 mm en T0 y se mantuvo el valor de 3,05 mm en T1. La media aritmética de LAC-CC en segundos premolares fue de 2,06 mm en T0 y 2,31 en T1. Post expansión, la mayoría de los sitios (86%) analizados exhibieron un espesor óseo ≥0,5 mm. Las mayores variaciones entre T0 y T1 se observaron a nivel de 1PM CEJ+4 y 2PM CEJ+6. Los registros clínicos (PI, GI, PPD y CAL) evidenciaron mínimos cambios entre T0 y T1, compatibles con el mantenimiento de la salud gíngivo-periodontal. El uso de Invisalign ® para movimientos de expansión no produjo cambios sustanciales en los parámetros clínicos periodontales evaluados ni en las mediciones óseas. La aparatología removible reduce los factores retentivos de placa bacteriana y facilita una adecuada higiene oral.

Experimental acute sepsis reduced number of osteocalcin immunolabeled cells in periodontal ligament

Abstract The aim of this study was to evaluate the effect of acute sepsis in the periodontal ligament, alveolar and furcation bone in absence of periodontitis induction through histological and immunohistochemical analyses. A septic rat model was established by cecal ligation and puncture (CLP). Twelve rats were randomly divided into CLP (n=6) and Sham (n=6) groups. The animals were euthanized at 24 h and hemimandibles were submitted to histomorfometric (bone matrix, collagenous fibers, fibroblasts, osteocytes, inflammatory cells, and blood vessels) and immunohistochemical (BMP-2/4, RANKL and osteocalcin) evaluation in alveolar bone, furcation bone and periodontal ligament. Our results demonstrated that histomorphometric parameters were similar in alveolar bone, furcation bone and periodontal ligament of Sham and CLP rats. Regarding to immunohistochemical analyses, the number of BMP-2/4 and RANKL immunolabeled cells was also similar in both groups. Furthermore, it was detected a reduction in the osteocalcin immunolabeled cells in periodontal ligaments of CLP compared to Sham rats (p=0.0014). In conclusion, the acute sepsis induction resulted in reduced number of osteocalcin labelled cells in periodontal ligament region. Moreover, no significant histological differences were observed in the periodontium of rats under acute sepsis. Considering the role of osteocalcin in bone remodeling, the study contributes to revealing the importance of careful periodontal evaluation in the presence of sepsis.

Resumo O objetivo deste estudo foi avaliar o efeito da sepse aguda no ligamento periodontal, osso alveolar e osso da furca por meio de análise histológica e imunohistoquímica. O modelo de sepse em ratos foi estabelecido pelo procedimento de ligação e perfuração do ceco (CLP). Doze ratos foram divididos de forma randomizada em ratos sépticos (n=6) e controle - grupo Sham (n=6). Os animais foram eutanasiados após 24 horas e suas hemimandíbulas foram submetidas aos procedimentos histotécnicos para análise histomorfométricos (matriz óssea, fibras colágenas, fibroblastos, osteócitos, células inflamatórias e vasos sanguíneos) e imunohistoquímicos (BMP-2/4, RANKL e osteocalcina) no osso alveolar, osso de furca e ligamento periodontal. Nossos resultados demonstraram que os parâmetros histomorfométricos foram similares no osso alveolar, osso de furca e ligamento periodontal dos animais do grupo sepse e do grupo Sham. Em relação à análise por imunohistoquímica, o número de células imunomarcadas para BMP-2/4 e RANKL também foi similar em ambos os grupos. Entretanto, houve redução (p=0.0014) no número de células imunomarcadas para osteocalcina no ligamento periodontal de ratos sépticos em relação ao grupo Sham. Como conclusão, o estabelecimento de sepse aguda resultou em um número reduzido de células imunomarcadas para osteocalcina na região do ligamento periodontal (p=0,0014). Além disso, não foram observadas diferenças histológicas significativas no periodonto de ratos na presença de sepse aguda. Considerando o papel da osteocalcina na remodelação óssea, este estudo contribui para revelar a importância da avaliação periodontal cuidadosa na presença de sepse.

Association between the use of statins and periodontal status: a review

ABSTRACT: Background: Statins are drugs used for the treatment of dyslipidemia. However, statins have multiple actions, including anti-inflammatory and immunomodulatory effects, as well as the ability to stimulate new bone formation. Such features could be beneficial for periodontal pathology therapy. Methods: A literature review was conducted using filtered electronic databases (Cochrane and Trip) and unfiltered databases (Medline/PubMed, Scielo and Google Scholar). The articles chosen were controlled and randomized clinical trials that performed local delivery of statins to humans and assessed the effects of immunomodulation and bone regeneration on periodontal disease between 2010 and 2017. All of the studies were blind or double-blind and were written in English. Results: The inclusion criteria were applied to a total of 79 identified articles, and 10 studies were ultimately chosen. The results show that an injected dose of statins or the local delivery of atorvastatin (ATV) leads to a significant improvement in clinical and radiographic periodontal parameters. Moreover, rosuvastatin (RSV) induced stronger beneficial effects when administered systemically, whereas ATV and simvastatin (SMV) had better results following topical delivery. Conclusions: Statins can affect periodontal status, increasing the gain in clinical attachment and decreasing gingival bleeding, probing depth and the magnitude of bone defects. For this reason, statins represent an excellent support measure for conventional periodontal therapy. Specifically, positive effects are seen for local delivery of statins as an adjunct treatment to scaling and root planing (SRP) at doses of 1.2 to 2%. Statins could be administered through topical delivery via direct injection in the periodontal pocket or by brushing with medicated dentifrices. More studies with appropriate designs should evaluate the short and long term clinical benefit of statins inpatients with periodontal pathology. These studies should determine the appropriate dose, timing side effects and ideal vehicles for delivery.

Leucocyte Platelet Rich Fibrin with Autologous Gingival Fibroblasts in the Treatment of Adjacent Recession Defects / Fibrina Rica en Plaquetas Leucocitarias con Fibroblastos Gingivales Autólogos en el Tratamiento de Defectos de Recesión Adyacentes

ABSTRACT: Periodontium can submit changes that lead to loss of integrity, such as periodontal disease, immune disorders or traumatic brushing. One of the most common consequences resulting from these events is the apical migration of gingival marginal tissue. Among biomaterials used for periodontal tissue regeneration, fibrin matrices have received significant attention to correct gingival recessions. Five oral mucosa biopsies were extracted, fibroblasts were in vitro cultured and frozen in liquid nitrogen. Three 10 mL glass sterile tubes were filled with patient blood and centrifuged immediately; clots were extracted and compressed to obtain L-PRF membranes. Autologous oral mucosa fibroblasts were added to the membranes and surgical procedures were performed in five patients. L-PRF fibrin network pore size was too small to allow human fibroblasts penetration but they were firmly attached to membrane surface. Gingival fibroblasts from fresh cell culture and recently thawed were used to attach on the L-PRF membranes. It was possible to establish a protocol for blood collection, centrifugation, fibrin clot compression, fibroblast adhesion to the membrane surface and patient application in a relatively short time (1 hour-1 hour and 30 minutes). Two patients expressed pain symptoms and the other ones presented light swelling without pain. In the first week, adjacent tissue showed few inflammation signs. Research efforts are being conducted to develop more conservative surgical techniques and new biomaterials that can promote cellular proliferation. Because of its properties, L-PRF membranes represent a tempting alternative. A combined technique to treat adjacent recession defects with L-PRF membranes and autologous oral mucosa fibroblasts in a coronal displaced flap did not show initial advantage compared with a gold standard surgery that includes an autologous soft tissue graft. Nevertheless, it could be an alternative for clinical application as a new functional cell biomaterial. More clinical evidence is needed.

RESUMEN: El periodonto puede presentar cambios que conducen a la pérdida de integridad, como la enfermedad periodontal, los trastornos inmunes o el cepillado traumático. Una de las consecuencias más comunes que resultan de estos eventos es la migración apical del tejido marginal gingival. Entre los biomateriales utilizados para la regeneración del tejido periodontal, las matrices de fibrina han recibido una atención significativa para corregir las recesiones gingivales. Se extrajeron cinco biopsias de mucosa oral, los fibroblastos se cultivaron in vitro y se congelaron en nitrógeno líquido. Tres tubos de vidrio estériles de 10 ml se llenaron con sangre del paciente y se centrifugaron inmediatamente. Los coágulos fueron extraídos y comprimidos para obtener membranas de L-PRF. Se agregaron fibroblastos autólogos de mucosa oral a las membranas y se realizaron procedimientos quirúrgicos en cinco pacientes. El tamaño de poro de la red de fibrina L-PRF era demasiado pequeño para permitir la penetración de los fibroblastos humanos, pero estaban firmemente unidos a la superficie de la membrana. Se usaron fibroblastos gingivales de cultivos de células frescas y recientemente descongelados para unirlos a las membranas L-PRF. Fue posible establecer un protocolo para la extracción de sangre, centrifugación, compresión de coágulos de fibrina, adhesión de fibroblastos a la superficie de la membrana y aplicación al paciente en un tiempo relativamente corto (1 hora, 1 hora y 30 minutos). Dos pacientes expresaron síntomas de dolor y los otros presentaron hinchazón leve sin dolor. En la primera semana, el tejido adyacente mostró pocos signos de inflamación. Se están realizando esfuerzos de investigación para desarrollar técnicas quirúrgicas más conservadoras y nuevos biomateriales que puedan promover la proliferación celular. Debido a sus propiedades, las membranas L-PRF representan una alternativa tentadora. Una técnica combinada para tratar los defectos de recesión adyacentes con membranas de L-PRF y fibroblastos de mucosa oral autóloga en un colgajo coronal desplazado no mostró una ventaja inicial en comparación con una cirugía estándar que incluye un injerto de tejido blando autólogo. Sin embargo, podría ser una alternativa para la aplicación clínica como un nuevo biomaterial de células funcionales. Se necesita más evidencia clínica.

Creeping attachment após enxerto gengival livre: relato de caso / Creeping attachment after autogenous free gingival grafting: case report

Introdução: As técnicas de enxerto gengival livre têm como principal objetivo a criação/aumento da faixa de mucosa ceratinizada. Quando se utiliza o tratamento químico da raiz e o correto posicionamento do enxerto no leito receptor podem acarretar em um fenômeno incomumdenominado de Creeping Attachment. Objetivo: descreverum caso de recobrimento radicular apósum enxerto gengival livre e Creeping Attachment. Relato do caso: Paciente sexo masculino, 28 anos de idade, não fumante e sem alterações sistêmicas apresentouse a faculdade de odontologia Universidade Federal de Santa Catarinacom a queixa principal de comprometimento estético e hipersensibilidade dentinária na região anterior-inferior. No exame clínico verificou-se uma recessão gengival unitária no dente 41, classificada como classe I de Miller. Logo indicou-se a cirurgia de enxerto gengival livre, obtido da região de palato duro, visandouma melhora estética efuncional, bem como a remissão da hipersensibilidade. Conclusão: Diante dos resultados clínicos podemos concluir que o enxerto gengival livre é uma técnica previsível e de fácil realização para o aumentoda faixa de mucosa queratinizada para posterior recobrimento radicular, contudo apesar de incomum o fenômeno Creeping Attachment deve ser esperado como alternativa a etapade recobrimento radicular. (AU)

Introduction: Free gingival graft techniques have as main objective the creation / increase of the keratinized mucosa band. When using the chemical treatment of the root surfaceand the correct positioning of the graft in the recipiente bed can lead to anuncommon phenomenon calledCreeping Attachment. Objective: This scientific paper describes a clinical case of root coverage after a free gingival graft and Creeping Attachment. Case Report: A 28-year-old male patient, non-smoker, was assisted in the Federal University of Santa Catarina by students and teachers of dentistry presented the main complaint the aesthetic impairment and dentin hypersensitivity in the anterior region of the jaw. In the clinical examination was observed an unitary gingival recession in tooth 41, classified as Miller class I. The gingival graft surgery, obtained from the hard palate region, was then indicated to improve the esthetic and functional condition, as well as to promove the end of symptoms of hypersensitivity. Conclusion: Inview of the clinical results we can conclude that the free gingival graft is a predictable and easy to perform technique to increase the line of keratinized mucosa for the subsequent root coverage. However, although the Creeping Attachment phenomenon is uncommon, it should be expected as an alternative to the root coverage (AU)

Trauma oclusal: fundamentação teórica e correlações clínicas / Occlusion trauma: theoretical foundation and clinical correlations

Introdução: Na odontologia, a oclusão é a relação dos dentes superiores situados na maxila com os dentes inferiores situados na mandíbula quando se encontram em atividade normal e fisiológica, sem ocasionar desconfortos e dores para o paciente durante a mastigação. De forma contrária, temos uma alteração patológica ou adaptativa que pode lesionar o periodonto devido a forças excessivas, estas podem resultar no trauma oclusal. Objetivos: Sintetizar informações de bases científicas que abordem o trauma oclusal em busca de evidenciar a importância do conhecimento sobre a sua etiologia, diagnóstico e possíveis tratamentos para essa patologia. Métodos: Foi realizada uma revisão de literatura sistematizada nas bases de dados eletrônicas, Pubmed e Medline, limitando-se a busca ao período de 2011 a 2018. Conclusão: Diante das informações apresentadas, o cirurgião-dentista precisa estar apto para obter o diagnóstico correto do trauma dentário. Dessa forma, uma análise criteriosa feita a partir de exames complementares é indispensável para obter êxito no diagnóstico final.

Introduction: In dentistry, occlusion is the relationship of the upper teeth located in the maxilla with the lower teeth located in the mandible when they are in normal and physiological activity, without causing discomforts and pain to the patient during chewing. Conversely, we have a pathological or adaptive alteration that damages the periodontium due to excessive forces resulting in occlusal trauma. Objectives: This paper aims to synthesize scientifically based information that addresses occlusal trauma in order to highlight the importance of knowledge about its etiology, diagnosis and possible treatments for this pathology. Methods: A literature review systematized in the electronic databases, Pubmed and Medline, was limited to the search for the period from 2011 to 2018. Conclusion: Given the information presented, the dental surgeon must be able to obtain the correct diagnosis of dental trauma. Thus, a careful analysis made from complementary tests is indispensable to be successful in the final diagnosis.

Oral and periodontal features of autosomal recessive syndromes: a tabular review / Características oral e periodontal de síndromes autossômicas recessivas: uma revisão tabular

Objective: To systematically review the data and results of case reports of autosomal recessive syndromes associated with periodontitis. Material and Methods: An internet search using Google and PubMed search engine and keywords- autosomal recessive, periodontitis, syndromes, periodontium and gingiva was carried out. Full-text articles in the English language of all the case reports and reviews that were published in journals from the year 1966 to 2016 were obtained and evaluated and presented in tabular form. Abstracts and articles published in other languages were not included in the review. Results: The data available from the clinical trials were analyzed and presented under broad headings of, systemic features, dental features, periodontal features and laboratory findings presented in tabular form. Conclusion: Many autosomal recessive syndromes with dental component also present with changes or alteration in the periodontium thus stressing the fact that thorough periodontal examination is important during the medical evaluation of patients with syndromes (AU)

Objetivo: Analisar sistematicamente os dados e resultados de relatos de caso de síndromes autossômicas recessivas associadas à periodontite. Material e Métodos: realizou-se uma pesquisa na internet usando os sites Google e PubMed com as palavras-chave: autossômica recessiva, periodontite, síndromes, periodonto e gengiva. Os critérios de inclusão foram restritos aos artigos em texto completo em língua inglesa, relatos de casos e revisões publicados em periódicos de 1966 a 2016. Resumos e artigos publicados em outras línguas não foram incluídos na revisão. Resultados: Os dados extraídos de cada estudo foram agrupados da seguinte forma: as síndromes associadas a características sistêmicas, aos achados dentários e aos achados periodontais, apresentados no formato de tabelas. Conclusões: Diversas síndromes autossômicas recessivas que apresentam alterações dentárias também podem apresentar alterações no periodonto, ressaltando assim, o fato de que o exame periodontal completo é importante durante a avaliação médica de pacientes com síndromes (AU)

Finite element analysis of torque control efficiency of a homemade four-curved auxiliary arch for anterior teeth / 口腔疾病防治

Objective @#To analyze the initial displacement of the upper central incisor and stress distribution of periodontal ligament under different torque values of upper incisors under the action of a four-curved auxiliary arch to provide a reliable basis for the safety of clinical application of four-curved auxiliary arches.@*Methods @# A three-dimensional finite element model for torque control of upper anterior teeth with a homemade quadrilateral auxiliary arch was established. Four different states were analyzed: molar ligation without extraction space (group A), microimplant ligation without extraction space (group B), molar recovery with extraction space closure (group C) (the adductive traction force was set at 115 g) and microimplant recovery with extraction space closure (group D) (the adductive traction force was set at 115 g). When four types of torque (0.5 N, 1.0 N, 1.5 N, and 2.0 N) were applied. The initial displacement of upper central incisors and the stress distribution of periodontal ligament in 16 groups (A1-A4, B1-B4, C1-C4, D1-D4) were observed.@*Results @#Under different conditions, as the strength of the four-curve auxiliary arch increases, the maxillary anterior teeth has crown labial inclination and a root lingual inclination. The displacement of the incisor tip increases with the increase in the loading force of the torque auxiliary arch, and the displacement of the incisor root apex increases as the force increases. The difference in incisor-apex displacement distance in A1-A4, B1-B4, C1-C4, D2 and D4 groups increased as the torque force increases, while the difference between the D3 group and D1 and D2 groups decreased slightly. The stress of the cervical periodontal ligament of the upper central incisor did not exceed the stress of the periodontal ligament in the following groups: A1, A2, B1, B2, B3, C1, C2, D1, and D2. The stress of the lip side of the upper central incisor did exceed the stress of the periodontal ligament in the following groups: A3, A4, B4, C3, C4, D3, and D4. In other words, when using the four-curved auxiliary arch as an implant anchorage, the force applied in the absence of extraction space should not exceed 1.5 N, and the force applied in the adduction of extraction space should not exceed 1.0 N. When using the nonimplant anchorage, the force applied in the absence of extraction space and the adduction of extraction space should not exceed 1.0 N. In addition, the range of force should not exceed the maximum stress of the periodontal ligament in the cervical region such that the effective and safe torque movement can be achieved. Under other stress conditions, the stress of the labial and cervical periodontal ligament of the upper central incisor exceeded the stress value (2.6 × 10-2MPa). The stress value of periodontal ligament was 2.6 × 10-2MPa in all groups.@*Conclusion@#A four-curved auxiliary arch has a significant effect on the upper anterior teeth, and the use of microimplants can better control root movement such that the crown of upper central incisors cannot be excessively lip inclined.

Cambios morfofuncionales en el periodoncio asociados al movimiento dentario por tratamiento ortodóncico / Morfofunctional changes in the periodontium associated to the teeth movement due to orthodontic treatment

Los cambios morfofuncionales que se producen en las estructuras de soporte dentario durante el movimiento ortodóncico involucran procesos bioquímicos, histológicos y fisiológicos. Desde hace más de un siglo, existen disímiles teorías que tratan de explicarlos; sin embargo, todavía se siguen realizando estudios a fin de comprenderlos más a fondo. En la presente comunicación se ofrece una actualización secuencial y resumida de dichos episodios, con el propósito de incrementar el nivel de conocimientos sobre el tema y mejorar la calidad en la atención ortodóncica.

Morfofunctional changes which take place in the supporting structures during the orthodontic movement involve biochemical, histological and physiologic processes. For more than one century, dissimilar theories exist that try to explain to them; however, studies are still being carried out in order to understand them thoroughly. In the present communication a sequential and summarized updating of these episodes, with the purpose of increasing the knowledge on the topic and improving the quality in the orthodontic care.