Clinical and microbiological assessment in a subpopulation of young Argentine patients with severe periodontitis / Periodontitis severa en jóvenes argentinos. Evaluación clínica y microbiológica en jóvenes argentinos con periodontitis severa

ABSTRACT Aggressive periodontitis (AP) is the most serious entity of periodontal disease (stage III/IV, grade C periodontitis according to the latest classification, 2017). Aim: to enhance knowledge of periodontal microbiota in AP in native Argentine patients and describe the effect of a combined pharmacological-mechanicalperiodontal treatment on clinical and microbiological parameters. Materials andMethod: The study analyzed 42 periodontal sites in 11 patients diagnosed with AP. Clinical periodontal parameters were recorded at baseline, 45, 90 and 180 days. Microbiological samples were taken before treatment and at 180 days. PCR was used to determine presence of the periodontopathic bacteria Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), Treponema denticola (Td), Prevotella intermedia (Pi) and Fusobacterium nucleatum (Fn). Patients underwent periodontal therapy including antibiotics (Amoxicillin 500mg + Metronidazole 250mg; 8hs/7 days), and were reevaluated at 45, 90 and 180 days. Results: Mean age was 28.4 ± 7.9 years. The initial PCR detected the following frequencies: Aa 14.3%, Pi 61.9%, Pg 71.4%, Tf 81.0%, Fn 95.2% and Td 97.6%. Baseline microbiological samples revealed significantly higher prevalence of Pg over Aa (p=0.012). Clinical parameters improved significantly after treatment (73.8% PS<5 mm; PS, NIC, SS p<0.001). At 180 days, a significant decrease in microbiological detection rates was observed (Fn, Td, Tf, Pi, Aa p<0.05). Aa was no longer detectable while Pg did not decrease significantly (p=0.052). Fn was the only study species detected in 100% (n=11:42) of residual pockets (PS>5 mm) (p=0.053). Conclusion: In the initial samples, there was significant prevalence of Pg over Aa. Significant clinical improvement was achieved after the mechanical-pharmacological treatment, with undetectable levels ofAa, while Fn persisted in residual pockets, and Pg was present at most of the treated sites.

RESUMEN La periodontitis agresiva (PA) es la entidad más grave de la enfermedad periodontal (clasificación 2017: periodontitis estadio III/IV, grado C). Objetivo: mejorar el conocimiento sobre la microbiota periodontal de la PA en sujetos nativos argentinos y describir el efecto de un tratamiento mecánico-farmacológico periodontal sobre los parámetros clínicos y microbiológicos. Materiales y Método: se estudiaron 42 sitios periodontales correspondientes a 11 pacientes con PA. Los parámetros clínicos se registraron a 0, 45, 90 y 180 días. Las tomas microbiológicas se realizaron antes de iniciar el tratamiento y a los 180 días. La determinación de especies periodontopáticas (Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf, Treponema denticola (Td), Prevotella intermedia (Pi) y Fusobacterium nucleatum (Fn)) se realizó por PCR. Los pacientes iniciaron terapia básica periodontal junto con antibioticoterapia (Amoxicilina 500 mg + Metronidazol 250 mg; 8 hs/7 días) y fueron evaluados a los 45, 90 y 180 días. Resultados: la edad media fue 28,4 ± 7,9 años. Las detecciones iniciales fueron: Aa 14,3%, Pi 61,9%, Pg 71,4%, Tf 81,0%, Fn 95,2% y Td 97,6%. En las muestras iniciales la prevalencia de Pg sobre Aa fue significativamente superior (p=0,012). Los pacientes tuvieron una respuesta clínica favorable al tratamiento (73,8% PS<5 mm; PS, NIC, SS p<0,001). A 180 días, se observó una disminución estadísticamente significativa en la detección microbiana (Fn, Td, Tf, Pi, Aa p<0,05). En igual plazo, Aa no fue detectado, mientras que Pg mostró una disminución no significativa (p=0,052). Fn fue el único detectado en el 100% (n=11:42) de las bolsas periodontales residuales (PS>5 mm) (p=0,053). Conclusión: Las muestras iniciales evidenciaron prevalencia significativa de Pg sobre Aa. El tratamiento logró una significativa mejora clínica con niveles indetectables de Aa. La persistencia de Fn en las bolsas residuales y de Pg en la mayoría de los sitios tratados, caracterizaron la muestra poblacional estudiada.

Terapia periodontal regenerativa con hemocomponentes en Santiago de Cuba desde lo social y formativo

RESUMEN Las periodontitis constituyen la primera causa de pérdida dentaria en la edad adulta y su tratamiento depende, casi por completo, del empleo de la implantación de sustitutos estructurales para lograr el potencial reparador necesario. El uso en los últimos años de la medicina celular regenerativa con células mononucleares, plaquetas y lisado plaquetario, han acelerado el proceso de cicatrización de los tejidos blandos y la regeneración ósea. Los resultados que se presentan derivan de una estrategia de superación profesional dirigida al periodoncista para el mejoramiento del desempeño en la aplicación de esta nueva terapéutica, como proyecto de investigación, en el Hospital Juan Bruno Zayas Alfonso de Santiago de Cuba, desde septiembre a diciembre del 2020. Su objetivo consiste en analizar la terapia periodontal regenerativa con hemocomponentes en Santiago de Cuba desde lo social y lo formativo.

ABSTRACT Periodontitis is the first cause of tooth loss in adulthood and its treatment depends, almost entirely, on the use of implantation of structural substitutes to achieve the necessary restorative potential. The use in recent years of regenerative cell medicine with mononuclear cells, platelets and platelet lysate, has accelerated the process of soft tissue healing and bone regeneration. The results presented are derived from a professional improvement strategy aimed at the periodontist to improve performance in the application of this new therapy, as a research project, at the Juan Bruno Zayas Alfonso Hospital in Santiago de Cuba, from September to December 2020. Its objective is to analyze regenerative periodontal therapy with blood components in Santiago de Cuba from a social and educational perspective.

Uso de probióticos como adición al tratamiento periodontal no quirúrgico en pacientes con periodontitis / Use of probiotics as an adjunctive therapy to non-surgical periodontal treatment in patients with periodontitis

RESUMEN Introducción: El tratamiento periodontal no quirúrgico corresponde a la terapia estándar para la periodontitis crónica. En este contexto, se ha propuesto que el uso de probióticos orales como complemento al tratamiento estándar podría mejorar los resultados obtenidos clínicamente, sin embargo no existe claridad respecto a su efectividad. Métodos: Se realizó una búsqueda en Epistemonikos: base de datos de revisiones sistemáticas en salud mantenida mediante el cribado de múltiples fuentes de información, la cuál incluye MEDLINE, EMBASE, Cochrane, entre otras. Se extrajeron los datos desde las revisiones identificadas y un análisis de los datos de los estudios primarios. Se realizó un metanálisis y se preparó una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Se Identificaron seis revisiones sistemáticas que en conjunto incluyeron 14 estudios primarios, todos correspondientes a ensayos aleatorizados. De los resultados analizados se concluye que el uso de probióticos orales como complemento al tratamiento no quirúrgico de periodontitis crónica probablemente resulta en nula o poca diferencia en la reducción de la profundidad de sondaje, el sangrado al sondaje y una ganancia de nivel de inserción clínico en los sitios afectados. Por otro lado, no se encontraron estudios que evaluaran el riesgo de presentar halitosis en pacientes sometidos a terapia periodontal no quirúrgica con adición de probióticos.

ABSTRACT: Introduction: Non-surgical periodontal treatment is the standard treatment to chronic periodontitis. It has been proposed that the use of oral probiotics as an adjunctive therapy may improve clinical outcomes, however there is no clarity regarding its effectiveness. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified six systematic reviews including 14 studies overall, of which all were randomized trials. We concluded that the addition of probiotics to non-surgical periodontal treatment probably results in little or no difference in probing depth reduction, clinical attachment level gain and reduction in bleeding on probing. No studies were found evaluating halitosis in patients undergoing non-surgical periodontal treatment with the addition of probiotics.

A influência da doença periodontal e a manipulação dos tecidos periodontais na bacteremia sistêmica: uma revisão de literatura / The influence of periodontal disease and the manipulation of periodontal tissues on systemic bacteremia: a review of the literature

Periodontal disease is the most prevalent oral infection in patients admitted to intensive care units. The periodontium is surrounded by a multitude of lymphatic vessels. Through this path, the lymphatic fluid mixes with the venous blood, resulting in an invasion of bacteria in the circulatory system, even for a short period of time. Periodontal bacteria, in addition to entering the circulatory system, produce inflammatory mediators that are generally not limited to periodontal tissues. Through these and other processes, it is possible to observe the relationship between periodontal diseases and systemic diseases. The objective of this review was to observe the pathways between periodontal disease and systemic events, emphasizing the bacteremia caused by the manipulation of periodontal tissues in patients with periodontitis. A search was performed on the Pubmed, Lilacs and Scielo databases, using the English descriptors "periodontal diseases", "periodontitis", "bacteremia", "bacteraemia" and "periodontal therapy". Studies show that periodontal disease and manipulation of periodontal tissues are capable of promoting bacteremia and of influencing systemic diseases. It was also concluded that the studies present a heterogeneous methodology, which suggests the need for greater standardization to better compare the data (AU)

A doença periodontal é a infecção bucal de maior prevalência em pacientes internados em unidades de terapia intensiva. O periodonto é cercado por uma infinidade de vasos linfáticos. Por este trajeto, o fluido linfático se mistura ao sangue venoso, resultando numa invasão de bactérias no sistema circulatório, ainda que por curto período de tempo. As bactérias periodontais, além de adentrarem no sistema circulatório, produzem mediadores inflamatórios que, geralmente, não se limitam aos tecidos periodontais. Por meio desses e outros processos, é possível observar a relação das doenças periodontais com as doenças sistêmicas. O objetivo desta revisão foi observar as vias de ligação entre a doença periodontal e os eventos sistêmicos, salientando a bacteremia originada da manipulação dos tecidos periodontais em pacientes com periodontite. Foi realizada uma busca nas bases de dados Pubmed, Lilacs e Scielo, utilizando os descritores em inglês "periodontal diseases", "periodontitis", "bacteremia", "bacteraemia", "periodontal therapy". Estudos mostram que a doença periodontal e a manipulação dos tecidos periodontais são capazes de promover a bacteremia e de influenciar doenças sistêmicas. Concluiu-se ainda, que os estudos apresentam uma metodologia heterogênea, o que sugere a necessidade de maior padronização para melhor comparação dos dados (AU)

Efeito do tratamento periodontal não cirúrgico em indivíduos com artrite reumatóide e periodontite: aspectos epidemiológicos, clínicos, microbiológicos e biomarcadores / Effect of non-surgical periodontal treatment in individuals with rheumatoid arthritis and periodontitis: epidemiological, clinical, microbiological and biomarkers aspects

Objetivos: Evidências atuais reconhece que a periodontite (PE) e a artrite reumatóide (AR) compartilham comuns fatores de risco e alguns caminhos fisiopatológicos semelhantes, como inflamação crônica induzida por citocinas pró-inflamatórias e destruição de tecidos conjuntivos e ósseos. Assim, esta tese apresenta quatro estudos da possível associação entre PE e AR com os seguintes objetivos: avaliar a condição periodontal, gravidade e extensão da periodontite e aspectos clínicos e epidemiológicos da sua associação com a AR. Investigar a influência do tratamento periodontal não cirúrgico (TPNS) sobre os parâmetros clínicos periodontais, níveis bacterianos de A. actinomycetemcomitans, P. gingivalis, T. forsythia, T dentícola e a atividade da AR (DAS28). Adicionalmente quantificar níveis sanguíneos e salivares dos biomarcadores RANKL, OPG, RANKL / OPG, Survivina, e anticorpos antipeptídeos citrulinados cíclicos (ACPAs) e anti-carbamiladas (Anti-CarP). Métodos: A amostra do estudo foi composta por um total de 471 indivíduos divididos aleatoriamente em grupos, de acordo com o objetivo de cada estudo. O ensaio clínico realizou as seguintes avaliações no início do estudo (T1) e 45 dias (T2) após TPNC: exames periodontais de boca completa, análise microbiológica por meio de qPCR em tempo real, avaliações do Disease Activity Score (DAS-28). Em adição, a quantificação de biomarcadores e anticorpos Anti-Carp e ACPAs realizada por meio de ELISA no soro/saliva. Resultados: O presente estudo reportou uma alta prevalência de PE em indivíduos com AR e uma importante associação entre ocorrência, gravidade e extensão da PE associadas à AR e ao tabagismo. O tratamento periodontal não cirúrgico foi eficaz em melhorar a condição cliníca periodontal, reduziu a presença dos patógenos periodontais avaliados e melhorou o quadro clínico da AR (redução dos escores de DAS-28). Adicionalmente, reduziu os níveis de survivina, RANKL e concentração de ACPAs e Anti-CarP. Conclusão: Nossos achados corroboram a robustez das evidências científicas da associação entre periodontite e AR. Assim, o controle da infecção periodontal em pacientes com AR e PE pode ser uma importante ferramenta terapêutica no controle da AR.

Objectives: Current evidence recognizes that periodontitis (PE) and rheumatoid arthritis (RA) share common risk factors and some similar pathophysiological pathways, such as chronic inflammation induced by pro-inflammatory cytokines and destruction of connective and bone tissues. Thus, this thesis presents four studies of the possible association between PE and RA with the following objectives: to assess the periodontal condition, severity and extent of periodontitis and the clinical and epidemiological aspects of its association with RA. To investigate the influence of non-surgical periodontal treatment (TPNS) on the periodontal clinical parameters, bacterial levels of A. actinomycetemcomitans, P. gingivalis, T. forsythia, T dentic and the activity of RA (DAS28). In addition to quantify blood and salivary levels of the biomarkers RANKL, OPG, RANKL / OPG, Survivina, and cyclic citrullinated anti-peptide antibodies (ACPAs) and anti-carbamylates (Anti-CarP). Methods: The study sample consisted of a total of 471 individuals randomly divided into groups, according to the objective of each study. The clinical trial performed the following assessments at baseline (T1) and 45 days (T2) after TPNC: periodontal examinations of full mouth, microbiological analysis using real-time qPCR, assessments of the Disease Activity Score (DAS-28). In addition, the quantification of biomarkers and Anti-Carp antibodies and ACPAs performed by ELISA in serum / saliva. Results: The present study reported a high prevalence of PE in individuals with RA and an important association between the occurrence, severity and extent of PE associated with RA and smoking. The non-surgical periodontal treatment was effective in improving the clinical periodontal condition, reduced the presence of the periodontal pathogens evaluated and improved the clinical picture of RA (reduced DAS-28 scores). Additionally, it reduced the levels of survivin, RANKL and concentration of ACPAs and Anti-CarP. Conclusion: Our findings corroborate the robustness of the scientific evidence on the association between periodontitis and RA. Thus, the control of periodontal infection in patients with RA and PE can be an important therapeutic tool in the control of RA.

Uso de la Fibrina Rica en Plaquetas Inyectable (i-PRF) en Defectos Infra Óseos en Terapia Periodontal no Quirúrgica. Reporte de Dos Casos / Use of Injectable Platelet-Rich Fibrin (i-PRF) in Infra Osseous Defects in Non-Surgical Periodontal Therapy. Report of Two Cases

RESUMEN: Entre los concentrados plaquetarios de segunda generación, ha suscitado creciente interés, el uso de fibrina rica en plaquetas y leucocitos inyectable (i-PRF); que se obtiene a partir de la centrifugación inmediata de sangre venosa del propio individuo, y que aporta concentraciones elevadas de factor de crecimiento vascular endotelial, factor de crecimiento transformante beta, y factor de crecimiento derivado de plaquetas, entre otras proteínas que inician y coordinan el proceso reparativo. Su nula citotoxicidad y consistencia líquida abren un nuevo campo de estudio y experimentación en el ámbito de la Cirugía Oral y de la Periodoncia, como sustancia para irrigar. El objetivo de este manuscrito fue reportar el uso del i-PRF como irrigador subgingival en el tratamiento periodontal convencional de defectos infra óseos con 6 meses de seguimiento. En ambos casos, se verificó un efecto positivo de irrigación, lo que abre el debate al uso de productos farmacéuticos tradicionales como la clorhexidina versus preparados autólogos sin efectos adversos reportados a la fecha.

ABSTRACT: Second generation platelet concentrates include the use of injectable platelet-rich fibrin (i-PRF), which has generated increasing interest because it is derived from immediate centrifugation of venous blood from the patients themselves. It provides high concentrations of vascular endothelial growth factor, transforming growth factor beta, and platelet-derived growth factor, among other proteins that initiate and coordinate the healing process. Its null cytotoxicity and liquid consistency has opened new research lines in the field of oral surgery and periodontics, as an irrigation substance. The aim of this manuscript was to report the use of i-PRF, as a subgingival irrigator in conventional periodontal treatment of infra osseous defects, with six months follow-up. In both cases, a positive effect of irrigation was confirmed. These findings, open the debate as regards the use of traditional pharmaceutical products (such as chlorhexidine), versus autonomous preparations without adverse effects reported to date.

Resolución del agrandamiento gingival mediante terapia periodontal no quirúrgica: reporte de caso / Gingival enlargement resolution by means of non-surgical periodontal therapy: case report

Resumen: El agrandamiento gingival es una lesión crónica inflamatoria, cuyo factor causal es la placa bacteriana. Se presenta como una tumefacción a nivel de la papila interdental y/o la encía marginal, puede estar de manera localizada o generalizada, siendo de progresión lenta e indolora, pudiendo ser exacerbado por efectos hormonales o por el uso de fármacos. Este artículo reporta el caso de una paciente con agrandamiento gingival y lesiones gingivales inducidas por placa bacteriana resuelto mediante terapia periodontal no quirúrgica. Se realizó la terapia manual y antibióticoterapia sistémica por siete días. Al mes de reevaluación se evidencio la resolución del agrandamiento; reducción de la inflamación, supuración, porcentaje de bolsas y grado de movilidad dental, se realiza mantenimiento periodontal. A los tres meses se observa reducción en el porcentaje de bolsas periodontales y grado de movilidad dental; se realizó terapia periodontal de mantenimiento.

Abstract: Gingival enlargement is a chronic inflammatory lesion caused by bacterial plaque. It appears as a tumefaction at the level of the inter-dental papilla and/or marginal gingival tissue; it can be localized or generalized. It exhibits slow and painless progression and can be exacerbated by hormonal causes or use of drugs. The present article studies the case of a patient afflicted with gingival enlargement and gingival lesions induced by bacterial plaque. The case was resolved with use of non surgical periodontal therapy. For seven days, antibiotic therapy and manual therapy were conducted. Re-evaluation one month later revealed resolution of the enlargement, decrease of inflammation, suppuration, periodontal pocket percentage and degree of dental mobility; periodontal maintenance was executed at that point. After three months, decrease of periodontal pockets percentage and degree of dental mobility were observed; at that point maintenance periodontal therapy was conducted.

Improvement of cervical dentin hypersensitivity after two different treatments / Redução da dor decorrente da hipersensibilidade dentinária cervical após dois tratamentos

ABSTRACT BACKGROUND AND OBJECTIVES: Cervical dentin hypersensitivity is a routine clinical condition caused by dentin exposure to the oral environment and sensitivity caused by the ingestion of cold, sweet or sour foods, which induces localized, acute and brief pain. This study aimed at clinically evaluating the efficacy of two treatments to improve cervical dentin hypersensitivity, as well as the duration of their effects. METHODS: The study was developed as a clinical, doubleblind and comparative study where 14 patients with cervical dentin hypersensitivity treated in the Clinic School of Dentistry of the University Center Cesmac were selected. Participants were divided in two groups of seven individuals. The first group was submitted to treatment with 5% potassium nitrate desensitizing (Nano P®-FGM) and the second group received fluoride varnish applications (Fluorniz®-SS White). Both treatments have followed manufacturers’ instructions. RESULTS: Clinical evaluations were performed 7, 14, 21 days and 1 month after treatment. After statistical analysis of results, it was possible to conclude that products have improved initial cervical dentin hypersensitivity in studied dental elements after their applications and that the desensitizing effect of potassium nitrate was longer lasting as compared to fluoride varnish. CONCLUSION: Potassium nitrate desensitizing effect was longer lasting as compared to fluoride varnish.

RESUMO JUSTIFICATIVA E OBJETIVOS: A hipersensibilidade dentinária cervical é uma condição clínica rotineira na atualidade que decorre da exposição da dentina ao meio bucal e sensibilidade causada após a ingestão de alimentos frios, doces ou ácidos, o que ocasiona dor localizada, aguda e de curta duração. O objetivo deste estudo foi analisar clinicamente a eficácia de dois tratamentos utilizados na redução da hipersensibilidade dentinária cervical, bem como a duração dos seus efeitos. MÉTODOS: O estudo foi desenvolvido como um ensaio clínico duplamente encoberto comparativo, onde foram selecionados 14 pacientes com hipersensibilidade dentinária cervical, atendidos na Clínica Escola de Odontologia do Centro Universitário Cesmac. Os participantes foram divididos em dois grupos com 7 integrantes cada. O primeiro grupo foi submetido ao tratamento com o dessensibilizante à base de nitrato de potássio a 5% (Nano P®-FGM) e no segundo grupo foi aplicado o verniz fluoretado (Fluorniz®-SS White). Em ambos os tratamentos foram seguidas as instruções dos fabricantes. RESULTADOS: As avaliações do quadro clínico ocorreram aos 7, 14, 21 dias e 1 mês. Após a análise estatística dos resultados pôde-se concluir que ambos os produtos apresentaram redução clínica inicial no quadro de hipersensibilidade dentinária cervical nos elementos dentais pesquisados após as suas aplicações e que o efeito do dessensibilizante à base de nitrato de potássio foi mais duradouro do que o do verniz fluoretado. CONCLUSÃO: O efeito de dessensibilização com base de nitrato de potássio foi mais durável do que o do verniz fluoretado.

Comparación en los niveles de ansiedad en pacientes previo a la realización de terapia endodóntica y periodontal / Comparison of anxiety levels in patients prior to performing endodontic and periodontal treatment

La ansiedad que generan los tratamientos odontológicos generalmente perturba el comportamiento de los pacientes constituyéndose en una problemática que dificulta, retarda y muchas veces impide la realización de los procedimientos dentales. Este estudio tiene por objetivo comparar los niveles de ansiedad rasgo (estado emocional de base) y de ansiedad estado (situación emocional transitoria) a 80 pacientes (40 hombres y 40 mujeres) que asistieron a las clínicas de pregrado de la Universidad Mayor. Antes de realizar el tratamiento propiamente dicho de patologías endodónticas y periodontales asintomáticas se aplicó la encuesta inventario STAI a toda la muestra, que fue dividida en 2 grupos. Grupo A: 40 pacientes (20 hombres y 20 mujeres) que iban a ser sometidos a terapias endodónticas. Grupo B: 40 pacientes (20 hombres y 20 mujeres) que iban a ser sometidos a terapias periodontales. Resultados Los pacientes manifestaron diferencias significativas en la ansiedad rasgo (p < 0,2473) y ansiedad estado (p < 0,0329) cuando enfrentaron tratamientos periodontales versus endodónticos. Al comparar en hombres y mujeres la ansiedad rasgo/estado, se encontraron diferencias significativas (p < 0,05). Conclusiones Los pacientes manifiestan mayor ansiedad cuando tienen que enfrentar tratamientos periodontales. Las mujeres enfrentan ambos tratamientos dentales con mayor ansiedad que los hombres.

Anxiety generated by dental treatment usually affects the behaviour of patients, and this is a problem that can impede patients from seeking treatment, or complicate or delay dental procedures. The objective of this study is to compare the state anxiety (normal state of anxiety on the day to day basis) and trait anxiety (arousal of anxiety due to a particular situation) levels in 80 patients (40 women and 40 men) who sought treatment at the undergraduate clinic at the Universidad Mayor. Before being treated for asymptomatic endodontic and periodontal diseases the State-Trait Anxiety Inventory questionnaire was completed in group A: 40 endodontic patients, and group B: 40 periodontal patients (men and women were evenly distributed between groups). Results Patients showed significant differences in trait anxiety (P = .2473) and state anxiety (P = .0329) before periodontal treatments versus endodontic treatments. Significant differences were found in the Trait/State Anxiety significant differences (P = .05) when comparing men and women. Conclusions (i) Patients feel more anxiety when faced with periodontal treatments than when faced with endodontic treatments, and (ii) women feel more anxiety than men when faced with either dental treatment.

Caracterización del paciente que solicita atención de especialidad en periodoncia en una población chilena / Characteristics of patients requesting treatment at a periodontics specialty facility in a Chilean population

Objetivo: Realizar la caracterización de los pacientes que solicitan atención de especialidad en periodoncia. Material y métodos: Estudio descriptivo que incluyó a todos los pacientes inscritos para recibir atención odontológica de una población de la Quinta Región de Chile. Los datos se agruparon de acuerdo con el sexo femenino, masculino y rango de edad. Se registró ausencia o presencia de hábito de tabaco, diabetes mellitus (DM) tipo 2, ingreso a tratamiento periodontal, abandono de tratamiento e ingreso a terapia periodontal de mantenimiento (TPM). Para el análisis estadístico las diferencias en la frecuencia se determinó con χ2, alpha de 0.05, nivel de confianza de 95%, potencia de 80% y t Student evaluando diferencias en la edad, sexo femenino y sexo masculino. Resultados: Solicitaron atención 110 pacientes, 75 sexo femenino y 35 sexo masculino, ingresaron a la especialidad el 94%. La edad promedio fue de 41 (DE 15) años. Durante el seguimiento por un año, el 68% se mantuvo en tratamiento y el 19% ingresó a TPM. La tasa de DM tipo 2 fue de 4% en mujeres y 31% en hombres (p < 0.001). El rango de edad entre 14 a 29 años abandonó más el tratamiento periodontal. En relación con la DM tipo 2 las diferencias fueron estadísticamente significativas en la edad promedio, 39.5 (DE 15.3) años (p= 0.002) y edad promedio de abandono, 33.2 (DE 17.7) años (p > 0.001). Conclusiones: Las mujeres asisten más a tratamiento periodontal que los hombres y las personas jóvenes abandonan más el tratamiento. Al estudiar ambos sexos, masculino y femenino, los hombres alcanzaron un mayor porcentaje de DM tipo 2. Además el paciente diabético demostró ser más joven en edad promedio y en edad promedio de abandono de tratamiento periodontal.

Objective: To undertake characterization of patients requesting periodontic specialty care. Material and methods: The present was a descriptive study which included all patients registered to receive dental care in a population of the Quinta Region in Chile. Data were grouped according to male and female gender, as well as age range. The following was recorded: presence or absence of tobacco use habit, type II diabetes mellitus (DM), admission to periodontal treatment, treatment desertion and admission to posttreatment periodontal therapy (PTPT). For statistical analysis of frequency differences χ2 test, alpha 0.05, confidence level 95% potency 80% and t student test were used, assessing differences according to age and gender. Results: 110 patients requested treatment: 75 female and 35 male. 94% were admitted in the specialty program. Average age was 41 years (SD 15). During the one-year follow-up, 68% of patients remained in treatment, and 19% was admitted in PTPT. Type II DM rate was 4% for females and 31% for males (p < 0.001). Patients in age range 14-29 years were more prone to abandon periodontal treatment. With respect to type II DM differences were statistically significant in average age, 39.5 (SD 15.3) years (p = 0.002) and average age for desertion 33.2 (SD 17.7) years (p > 0.001). Conclusions: Women were more inclined to attend periodontal treatment than men, young patients deserted treatment more frequently. Studies on both genders revealed that males exhibited greater rate of type II DM. Additionally, diabetic patients were younger in average age as well as in average age for desertion of periodontal treatment.

Uso terapéutico de los antibióticos en el tratamiento periodontal: revisión de la literatura / Therapeutic use of antibiotics in periodontal treatment: a review of the literature

Las enfermedades periodontales son consecuencia de la acumulación de la placa dental. Las bacterias presentes en ella inician un proceso inflamatorio en los tejidos periodontales por medio de la liberación de toxinas bacterianas. El tratamiento indicado implica terapias mecánicas no quirúrgicas y quirúrgicas y, en algunos casos, terapia farmacológica. En pacientes que no responden a la terapia mecánica, los estudios sugieren el uso de terapias complementarias con antibióticos locales o sistémicos. En esos casos, es necesario el desarreglo previo de la placa dental adherida a la superficie radicular. Los antibióticos, junto con el raspado y alisado radicular (RAR) y el colgajo periodontal, son una alternativa de agentes terapéuticos, pues garantizan resultados satisfactorios en el tratamiento periodontal. El objetivo de esta revisión es analizar las propiedades de los antibióticos como agentes coadyuvantes de la terapia periodontal...

Avaliação de marcadores inflamatórios séricos em indivíduos com diabetes mellitus tipo 2 após tratamento periodontal intensivo não-cirúrgico: estudo clínico randomizado / Evaluation of serum inflammatory markers in individuals with type 2 diabetes mellitus after intensive non-surgical periodontal therapy: a randomized clinical trial effects

O objetivo deste trabalho foi comparar os efeitos sorológicos e clínicos de dois protocolos de terapias periodontais em indivíduos com diabetes tipo 2 (DMT2) e periodontite crônica. Foram analisados 36 pacientes, randomizados em dois grupos: um grupo recebeu terapia intensiva de raspagem e alisamento radicular (INT; n=18) e outro recebeu apenas raspagem supragengival (SUP; n=18). Os grupos foram avaliados quanto aos parâmetros clínicos periodontais e marcadores inflamatórios séricos, antes e após 6 meses do tratamento periodontal. O exame clínico periodontal avaliou: placa visível (IP), índice gengival (IG), supuração (SUPUR), profundidade clínica de sondagem (PCS) e nível clínico de inserção (NCI). Amostras sanguíneas foram obtidas para análise de marcadores inflamatórios e hemoglobina glicada (HbA1c). Os marcadores de inflamação avaliados foram: interleucina (IL)-1, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, IL-13, IL-17, fator estimulador de colônias granulocitárias (G-CSF), fator estimulador de colônias de granulócitos-macrófagos (GM-CSF), interferon- (IFN-), proteína quimiotática de monócito-1 (MCP-1), proteína inflamatória de macrófago-1 (MIP-1) e fator de necrose tumoral (TNF-), através do imunoensaio multiplex (Bioplex). Ambas as terapias resultaram na melhora de quase todos os parâmetros clínicos periodontais (p<0,05), com exceção do NCI (p=0,09) no grupo SUP. Não houve diferença significativa para os níveis de IL-1, IL-4, IL-5, IL-10, IL-13, MIP-1 e TNF- (p>0,05), após tratamento, em ambas as terapias. Houve redução significativa de IL-6 (p=0,01), IL-12 (p=0,04) e MCP-1 (p=0,02) no grupo INT e de GCS-F nos grupos SUP (p=0,04) e INT (p=0,01). Os níveis de IL-2, IL-7, IL-8, IL-17, GM-CSF e IFN- não foram detectados. A terapia INT tem um efeito benéfico na redução dos níveis séricos de IL-6, IL-12 e MCP-1, na redução de PCS em sítios profundos e no ganho de inserção quando comparado à terapia supragengival em um período de 6 meses...

The objective of this study was to compare the serological and clinical effects of two periodontal therapies in individuals with type 2 diabetes (T2DM) and chronic periodontitis. 36 patients were analyzed, randomized into two groups: one group received intensive t of scaling and root planing (INT, n=18) and another received only supragingival scaling (SUP, n=18). The groups were evaluated for periodontal parameters and serum inflammatory markers before and after 6 months of periodontal treatment. The periodontal parameters assessed were: visible plaque (PI), gingival index (GI), suppuration (SUP), probing pocket depth (PPD) and clinical attachment level (CAL). Blood samples were obtained for analysis of inflammatory markers and glycated hemoglobin (HbA1c). The inflammatory markers evaluated were: interleukin (IL)- 1 , IL- 2, IL -4, IL -5, IL -6, IL -7 , IL-8 , IL-10 , IL-12 , IL-13 , IL -17, granulocyte colony-stimulated factor (G -CSF), colony stimulating factor granulocyte-macrophage (GM -CSF), interferon - (IFN - ), monocyte chemotactic protein-1 (MCP-1) , macrophage inflammatory protein-1 (MIP-1 ) and tumor necrosis factor (TNF- ) through a multiplex immunoassay (Bioplex). Both therapies resulted in improvement of almost all periodontal clinical parameters (p<0.05), with the exception of the NCI in SUP group. There was no significant difference for (IL )- 1 , IL- 4, IL -5, IL-10 , IL-13 , MIP- 1 and TNF- after treatment for both therapies (p>0.05). A significant reduction was observed in IL-6 (p=0.01), IL-12 (p=0.04) and MCP-1 (p=0.02) levels for INT group and in GCS- F levels for SUP (p=0.04) and INT (p=0.01) groups. The levels of IL-2, IL -7, IL-8 , IL-17, GM- CSF and IFN- were not detectable. The INT therapy has a beneficial effect in reducing serum levels of IL-6, IL-12 and MCP-1, in reducing PPD of deep sites and in attachment gain when compared to SUP therapy considering a period of 6 months...

Mecanismos moleculares implicados en la destrucción ósea en la periodontitis: revisión de la literatura / Molecular mechanisms involved in bone destruction in periodontitis: literature review

La periodontitis es una enfermedad inflamatoria crónica multifactorial, la cual se inicia a partir de la biopelícula que se forma alrededor de los dientes y se acumula en margen gingival, colonizando el surco gingival. La complejidad de la biopelícula madura genera estímulos para las células epiteliales e inflamatorias y sobre las demás células del tejido conectivo activando los mecanismos de la respuesta inmune innata y adaptativa. Se reconoce que la acumulación de placa dental genera de forma indefectible gingivitis, pero se desconocen las señales específicas que disparan la periodontitis. Se reconoce también que microorganismos periodontopáticos como Aggregatibacter actynomicetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Prevotella intermedia, Prevotella nigrescens, entre otros, poseen mediadores osteolíticos que actúan directa o indirectamente en las células del hueso y que son responsables del proceso de remodelación ósea, lo cual desequilibra el eje RANKL-RANK/OPG. Los productos microbianos y la respuesta inflamatoria inducen la secreción de citoquinas específicas como IL-1B, TNFalfa y otros mediadores pro-inflamatorios como PGE2, metalloproteinases, MMP-8, MMP-3, RANKL, además los linfocitos T y B activados inducen la pérdida de hueso alveolar al sintetizar y secretar directamente RANKL. Debido a que la pérdida de hueso alveolar es uno de los signos patognomónicos de la enfermedad periodontal, se hace importante revisar los mecanismos moleculares que explican la destrucción ósea, así como algunos avances en el tratamiento óseo.

Periodontitis is a multifactorial chronic inflammatory disease started by biofilm accumulation around the teeth and the gingival margin including the gingival sulcus. Mature biofilm is complex in microbial nature and it triggers signals to the boundary connective tissue and epithelial cells activating mechanisms of innate and acquired immune response. It is known that the dental plaque accumulation indefectibly results in gingivitis. However the specific signals that lead to periodontitis are unknown. The main periodontopathic organisms are Aggregatibacter actynomicetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Prevotella intermedia, Prevotella nigrescens among others. Those microorganisms produce osteolytic mediators that act directly and indirectly on bone cells affecting the bone turnover rate, regulated by the axis RANKL-RANK/OPG. Microbial products and periodontal inflammation induce the release of specific cytokines IL-1B, TNFalpha, PGE2, metalloproteinases, MMP-8, MMP-3, RANKL, T and B lymphocytes elicit bone resorption. Indeed, alveolar bone loss is one of the most pathognomonic features of periodontal disease. Therefore it is essential to review the molecular mechanisms explaining periodontal destruction, as well as the advances in bone therapy.

Control Glucémico de Diabetes Mellitus y Tratamiento de Enfermedades Periodontales: Reporte de Dos Casos Clínicos / Diabetes Mellitus Glycemic Control and Treatment of Periodontal Diseases: Report of Two Cases

Las Enfermedades Periodontales afectan de forma adversa el control metabólico de Diabetes Mellitus. Se postula que si un paciente diabético mantiene salud periodontal a través del tratamiento periodontal no quirúrgico puede mejorar el control glucémico. Por lo tanto el identificar pacientes con enfermedad periodontal avanzada puede ser un elemento clínico relevante para sospechar de diabetes no diagnosticada y su tratamiento puede tener un efecto positivo en el control metabólico de la diabetes, medido a través de los niveles de hemoglobina glucosilada (HbA1c). En el primer caso se da seguimiento a un paciente con Diabetes Mellitus tipo 1 y en el segundo reporte clínico a un paciente con Diabetes Mellitus tipo 2, con el objetivo de observar si el tratamiento periodontal mejora el control glucémico. Después del tratamiento periodontal no quirúrgico, en ambos casos clínicos existió disminución de hemoglobina glucosilada (HbA1c) teniendo un efecto positivo el tratamiento periodontal en el control metabólico medido a través de los niveles de hemoglobina glucosilada (HbA1c).

Periodontal Diseases affect Diabetes Mellitus metabolic control adversely. It is stated that if a diabetic patient keeps his/her periodontal health by means of a non-surgical periodontal treatment, his/her glycemic control can improve. Therefore, to identify patients with advanced periodontal diseases it can be a relevant clinical element to suspect a non-diagnosed diabetes and its treatment can have a positive effect on the diabetes metabolic control, measured through glycosylated hemoglobin levels (HbA1c). In the first case, a patient with Diabetes Mellitus type 1 is followed up, and in the second clinical report a patient with Diabetes Mellitus type 2 was followed up with the purpose of observing whether the periodontal treatment improves glycemic control. After the non-surgical periodontal treatment, there was a glycosylated hemoglobin decrease (HbA1c), with periodontal treatment having a positive effect on the metabolic control measured through glycosylated hemoglobin levels (HbA1c).

Tratamiento de la hipersensibilidad dentinaria post terapia periodontal, mediante el uso de dos dentífricos desensibilizantes / Dentin hypersensitivity treatment post periodontal therapy, using two desensitizing dentifrices

Objetivo: El objetivo de este estudio fue evaluar y comparar la eficacia en la reducción de la hipersensibilidad dentinaria posterior a la terapia periodontal utilizando dentífricos que contienen arginina al 8 por ciento - carbonato de calcio versus acetato de estroncio al 8 por ciento, tras una y tres semanas de uso de las pastas dentales. Materiales y Método: Estudio clínico, aleatorio, ciego y controlado con dos grupos paralelos, y tres semanas de seguimiento, en el cual el universo de trabajo fue de 20 pacientes con diagnóstico de periodontitis crónica generalizada leve o moderada y que hayan presentado hipersensibilidad dentinaria posterior a la terapia periodontal no quirúrgica en al menos un canino y/o premolar, y asociado a recesión gingival. Los pacientes fueron seleccionados aleatoriamente y se distribuyeron al azar en cada grupo de pastas dentales y fueron evaluados tras una y tres semanas de uso de los dentífricos. Se les aplicó aire proveniente de la jeringa triple del equipo dental en la zona cervical con hipersensibilidad, estandarizando la técnica. La cuantificación del dolor se realizó a través de la Escala Visual Análoga (EVA). Resultados: No hubo diferencia estadísticamente significativa entre el uso de los dentífricos que contienen arginina 8 por ciento - carbonato de calcio versus acetato de estroncio al 8 por ciento para la reducción de la hipersensibilidad dentinaria tras una y tres semanas de uso de las pastas dentales. Existió diferencia estadísticamente significativa en la reducción del dolor con el uso de ambos dentríficos a la primera y tercera semana de medición.

Aim: The aim of this clinical study was to evaluate and to compare the efficacy in reducing the dentin hypersensitivity after periodontal therapy using dentifrices which contain 8 percent arginine, calcium carbonate versus 8 percent strontium acetate, after one and three weeks of use of the dentifrices. Methods: A three-week clinical study with 20 subjects with diagnosis of slight to moderate chronic periodontitis with dental hypersensitivity after periodontal therapy, and presence of gingival recession in canines and/or premolars. Patients were randomly selected and assigned to each group and toothpastes were evaluated after one and three weeks of use. Air from a triple syringe was applied into the cervical area with hypersensitivity. The quantification of pain was performed using the Visual Analogue Scale (VAS). Results: There was not statistically significant difference between the use of the dentifrices which contain 8 percent arginine, calcium carbonate versus 8 percent strontium acetate in reducing dentin hypersensitivity after one and three weeks of use of the dentifrices. Nevertheless, there was a statistically significant difference in the reduction of pain using both dentifrices in the first and third week of measurement.

Activity of platelet activating factor acetylhydrolase following phase I periodontal therapy / Actividad de la acetilhidrolasa del factor activador de las plaquetas tras la fase I de la terapia periodontal

OBJECTIVE: Elevated levels of platelet activating factor (PAF), a potent inflammatory mediator, in perio-dontal disease and decreased PAF levels following periodontal surgical therapy have been previously detected in gingival tissues and gingival crevicular fluid (GCF). Platelet activating factor acetylhydrolase (PAF-AH) is a calcium-independent phospholipase A2 that catalyses the hydrolysis of PAF, thereby inactivating this mediator. The hypothesis, a relationship between activity of PAF-AH and healing following periodontal therapy, was tested by detecting activity of PAF-AH in GCF samples collected from sites that had undergone phase I periodontal therapy with generalized chronic periodontitis. METHODS: Twenty patients with generalized chronic periodontitis were divided into two groups (n = 10): group 1 with probing pocket depth (PPD) 4-5 mm and group 2 with PPD > 6-8 mm. Clinical parameters were recorded and GCF was sampled before phase I periodontal therapy and at the 2nd, 7th, 14th, 21st and 28th day follow-up evaluation visits. Activity of PAF-AH in GCF was analysed by enzyme-linked immunosorbent assay (ELISA). RESULTS: Probing pocket depth at the 21st and 28th day in group 1, and PPD at the 14th, 21st and 28th day in group 2 were significantly decreased when compared to the baseline values (p < 0.001). Activity of PAF-AH (µmol/ml) was significantly decreased at the 7th, 14th, 21st and 28th day following phase I periodontal therapy in both groups 1 and 2 compared to the baseline values (p < 0.05). CONCLUSION: Platelet activating factor acetylhydrolase is detectable in GCF by ELISA and showed a continuous decrease following phase I periodontal therapy. Changes in the PAF-AH activity would be a progressive marker of periodontal healing to evaluate the success of periodontal therapies.

OBJETIVO: Niveles elevados del factor activador de las plaquetas (PAF) - un potente mediador inflamatorio en la enfermedad periodontal - y niveles disminuidos de PAF tras la terapia quirúrgica periodontal, han sido detectados previamente en los tejidos gingivales y el fluido crevicular gingival (FCG). La acetilhidrolasa del factor activador de las plaquetas(PAF-AH) es una fosfolipasa A2 independiente del calcio, que cataliza la hidrólisis de PAF, inactivando así este mediador. La hipótesis - la existencia de una relación entre la actividad de PAF-AH y la curación tras la terapia periodontal - fue sometida a comprobación mediante la detección de la actividad de PAF-AH en muestras de FCG recogidas de sitios que pasaron por la fase I de la terapia periodontal por periodontitis crónica generalizada. MÉTODOS: Veinte pacientes con periodontitis crónica generalizada fueron divididos en dos grupos (n = 10): grupo 1 con una profundidad de bolsa al sondeo (PPD) de 4-5 mm, y grupo 2 con PPD = 6-8 mm. Se registraron los parámetros clínicos, y se obtuvieron muestras de FCG antes de la fase I de la terapia periodontal, y en las visitas de evaluación de seguimiento los días 2, 7, 14, 21 y 28. La actividad de PAF-AH en FCG se analizó mediante ensayo por inmunoabsorción ligada a enzimas (ELISA). RESULTADOS: La profundidad de bolsa al sondeo los días 21 y 28 en el grupo 1, y PPD los días 14, 21 y 28 en el grupo 2 se vieron disminuidas significativamente cuando se les comparó con los valores iniciales (p < 0.001). La actividad de PAF-AH (µmol/ml) disminuyó significativamente los días 7, 14, 21 y 28 tras la fase I de la terapia periodontal en ambos grupos 1 y 2 en comparación con los valores al inicio del estudio (p< 0.05). CONCLUSIÓN: La acetilhidrolasa del factor activador de las plaquetases detectable en FCG mediante ELISA, y mostró una disminución continua tras la fase I de la terapia periodontal. Los cambios en la actividad de la PAF-AH sería un marcador progresivo de la curación periodontal para evaluar el éxito de las terapias periodontales.

Bisfosfonato alendronato na terapêutica periodontal / Bisphosphonate alendronate in the periodontal therapy

O alendronato de sódio é um medicamento utilizado no tratamento de doenças ósseas do metabolismo humano e, nos últimos anos, pesquisas apontam para a possibilidade do seu uso na terapia periodontal, devido a sua capacidade de controlar a reabsorção óssea, inibindo a atividade de osteoclastos e apresentando-se como potencial agente carreador de moléculas bioativas. Todavia, seu uso sistêmico e prolongado está relacionado com a ocorrência de osteonecrose dos maxilares. Interessantemente, são encontrados níveis muito baixos de resíduos do alendronato em aloenxertos ósseos, originados de indivíduos que faziam uso contínuo desse medicamento. A literatura científica ainda não apresenta um consenso sobre o uso do alendronato na terapêutica periodontal, uma vez que os resultados dos estudos são controversos

Alendronate is a medicine for the treatment of bone diseases of the human metabolism and in recent years, studies indicate the possibility of its use in periodontal therapy due to their ability to control bone resorption, mediating osteoclasts, osteoblasts and showing potential as carrier agent of bioactive molecules. However, systemic and prolonged use is associated with the occurrence of osteonecrosis in the jaw. Interestingly, they are found very low levels of residues of alendronate in bone allografts, originating from individuals who took continuous use of this drug. The scientific literature has not yet showed a consensus on the use of alendronate on periodontal therapy, since the results of the studies are controversies.

Tratamiento clínico de un paciente con periodontitis crónica avanzada generalizada en la Facultad de Odontología de la Universidad de Antioquia, Medellín, Colombia: reporte de un caso / Clinical treatment of a patient with generalized advanced chronic periodontitis at the School of Dentistry of Universidad de Antioquia, Medellín, Colombia

La enfermedad periodontal afecta la salud del paciente comprometiendo la forma, función y estética del sistema estomatognático, llevando a un deterioro notable de la calidad de vida de las personas. En este caso clínico se presenta el tratamiento integral de unpaciente de sexo masculino de 43 años de edad con periodontitis crónica avanzada generalizada que incluyó: tratamiento periodontal no quirúrgico, quirúrgico y de rehabilitación oral, hecho durante dieciocho meses por un estudiante de último año del pregrado y un grupo de docentes especialistas en periodoncia y rehabilitación oral bajo la modalidad docencia-asistencial de la Facultad de Odontología de la Universidad de Antioquia (Medellín, Colombia.

Periodontal disease affects the patient’s health altering the form, function, and esthetics of the stomatognathic system andproducing huge deterioration in the person’s quality of life. This clinical case presents the comprehensive treatment of a 43-year-old male patient with generalized advanced chronic periodontitis including: non-surgical and surgical periodontal treatment and oral rehabilitation during a period of eighteen months by a senior undergraduate student and a group of professors specialized in periodontics and oral rehabilitation under the modality of teaching-social assistance at the School of Dentistry of Universidad de Antioquia (Medellín, Colombia

Diabetes y su impacto en el territorio periodontal / Diabetes and its impact in periodontal tissues

Diabetes y enfermedad periodontal corresponden probablemente al mejor ejemplo de cómo una enfermedad sistémica puede tener un efecto en el territorio periodontal. Si bien esta asociación ha sido extensamente estudiada, muchas de las asociaciones propuestas presentan contradicciones. En la presente revisión de la literatura se analizan los siguientes tópicos relevantes para la práctica clínica en periodoncia e implantología: i) Identificación de enfermedad periodontal severa y su capacidad para diagnosticar casos de diabetes; ii) Efectos de la diabetes sobre la enfermedad periodontal; iii) Efectos de la diabetes sobre la reparación periodontal y periimplantaria; iv) Efecto del tratamiento periodontal sobre el control metabólico de la diabetes.

Diabetes and periodontal disease correspond to conditions that probably exemplify how a systemic disease may have a strong impact in the periodontium. Although this association has been studied for several years, many of these studies still show contradictory results. The present review analyses the following questions relevant for the clinician in the fields of periodontology: i) Value of the diagnosis of severe periodontitis and its capacity to identify previously un-diagnosed cases of diabetes; ii) Effects of diabetes on periodontal disease; iii) Effects of diabetes on periodontal and peri-implant tissue repair and regeneration and; iv) Effect of periodontal therapy on the metabolic control of diabetes.

Terapia periodontal no quirúrgica / Nonsurgical periodontal therapy

Introducción: en el tratamiento de las enfermedades periodontales contamos con la terapia periodontal no quirúrgica, la cual ha sido avalada científicamente mostrando su efectividad. El principal objetivo de este artículo es demostrar la efectividad de la terapia periodontal no quirúrgica evidenciada en múltiples estudios con relación a las indicaciones, aspectos microbiológicos, efectos enlos tejidos y la importancia de la terapia de mantenimiento una vez finalizado el tratamiento. Métodos: se hizo una revisión con relación al tema en los últimos años teniendo como patrón los conceptos clave periodontales. Resultados: la terapia periodontal no quirúrgica (TPNQ) no es un procedimiento que pueda y deba realizarse en un corto tiempo y en pocas citas, el tiempo para su ejecución se amplía lo necesario en especial para lograr una limpieza y regularización de las raíces lo más completa posible. Conclusión: varios autores reportanque la reducción de la microbiota se mantuvo entre 14 y 180 días, luego de la terapia, esto justifica las citas periódicas de mantenimientoperiodontal y estos señalan que el aspecto crítico de la terapia no es la escogencia entre un procedimiento quirúrgico o no quirúrgico, sino la limpieza detallada y completa por el profesional y el buen nivel de higiene bucal por parte del paciente.

Introduction: In the treatment of periodontal diseases, we can rely on nonsurgical periodontal therapy, which has been scientifically proven as its effectiveness has been recognized. The main objective of this article is to demonstrate the usefulness of nonsurgical periodontal therapy, as evidenced in several studies that serve as guidelines, as well as microbiological aspects, effects on tissues and theimportance of maintenance therapy after treatment completion. Methods: a review was conducted in order to revise this topic considering key periodontal concepts as a guideline. Results: nonsurgical periodontal therapy (NSPT) is a procedure that cannot and should not be carried out in a few sessions; the time required for its completion is extended as necessary in order to achieve cleaning and adjustmentof the roots as completely as possible. Conclusions: Several authors have reported that reduction of microbiota remains between 14 and 180 days after therapy. This explains the regular periodontal maintenance appointments. They also indicate that the critical aspect of this therapy is not the choice between a surgical or a nonsurgical procedure, but a detailed and thorough cleaning by the dental professionaland the good level of oral hygiene achieved by the patient.