Use and effectiveness of propolis on chronic periodontitis: a systematic review / Uso y efectividad del propóleo en periodontitis crónica: una revisión sistemática

Abstract The aim of this study was to determine the effect of propolis on non- surgical periodontal therapy in patients with chronic periodontitis (CP) as it appears in the recent literature. Propolis is a natural and biocompatible resinous substance that has shown, by means of several scientific studies, to possess medicinal properties such as antimicrobial, healing, anesthetic, anti-inflammatory, and analgesic, among others. There are several studies that have reported the use of propolis as a non- surgical treatment of CP, its comparison with other antimicrobials, and the improvement of clinical and microbiological parameters with scaling and root planing (SRP). A bibliographic search was conducted in the PubMed, Google Scholar, Web of Science, and Science Direct databases up to 2021. The results showed that there are very few reports focused on clinical studies; however, according to the analyzed data, propolis could be a good adjuvant for the treatment of patients with chronic periodontitis compared to the conventional treatment (SRP).

Resumen El objetivo de este estudio fue determinar el efecto del propóleo sobre la terapia periodontal no quirúrgica en pacientes con periodontitis crónica (PC) en la literatura reciente. El propóleo es una sustancia resinosa natural y biocompatible que ha sido demostrado a través de varios estudios científicos que posee propiedades medicinales como antimicrobianas, cicatrizantes, anestésicas, antiinflamatorias, analgésicas, entre otras. Existen varios estudios que han reportado el uso del propóleo como tratamiento no quirúrgico de la PC y su comparación con otros antimicrobianos y la mejora de los parámetros clínicos y microbiológicos con el raspado y alisado radicular (SRP). Se realizó una búsqueda bibliográfica en las bases de datos directas de PubMed, Google Scholar, Web of Science y Science hasta el 2021. Los resultados muestran que existen muy pocos reportes enfocados a estudios clínicos, sin embargo, según los datos analizados, el propóleo podría ser un buen adyuvante para el tratamiento de pacientes con periodontitis crónica en comparación con el tratamiento convencional (SRP).

Ozonoterapia como adyuvante en el tratamiento periodontal no quirúrgico y quirúrgico / Ozonoterapia as adjuvant in the non-surgical and surgical periodontal treatment

Introducción: El ozono (O3) presenta múltiples acciones biológicas, entre ellas su efecto antimicrobiano, lo que ha sido beneficioso en odontología, siendo la presentación acuosa la más utilizada (20 µg/ mL), la cual presenta efectos similares a la clorhexidina. Reporte de caso: Paciente masculino de 76 años de edad, diagnosticado con periodontitis crónica moderada localizada, el cual fue tratado mediante ozonoterapia acuosa durante la fase inicial periodontal y la fase quirúrgica en colgajo por debridación. 12 semanas posteriores al acto quirúrgico se obtuvo la eliminación de las bolsas periodontales, encontrándose un surco de 3 y 2 mm y un buen control de placa dentobacteriana. Conclusión: No existen reportes acerca del uso de ozonoterapia acuosa durante un colgajo por debridación. El éxito del tratamiento periodontal consiste en la eliminación del factor causal así como en establecer y mantener un control de placa dentobacteriana adecuado (AU)

Introduction: Ozone (O3) has multiple biological actions, including its antimicrobial effect, which has been beneficial in dentistry, the aqueous presentation being the most used (20 µg/mL), which has similar effects to chlorhexidine. Case report: Male patient of 76 years of age, diagnosed with localized moderate chronic periodontitis, which was treated by aqueous ozone therapy during the initial periodontal phase and surgical phase in debridement flap. Twelve weeks after surgery, the periodontal pockets were eliminated, finding a 3 and 2 mm groove and good control of dentobacterial plaque. Conclusion: There are no reports about the use of aqueous ozone therapy during a debridement flap. The success of the periodontal treatment consists in the elimination of the causal factor, as well as establishing and maintaining an adequate control of plaque (AU)

Facial antibioma formation: a case report

Odontogenic infections are associated with a variety of microorganisms. antibiotics are commonly used for the management of various dental infections and have a proven role in decreasing morbidity and mortality caused by infectious diseases. the frequent and over usage of antibiotics has been associated with a number of consequences such as the selection of drug resistant strains, and the formation of antibiomas. antibiomas are characterized by the formation of a localized pathology surrounded by thick fibrous tissues in response to long term antibiotics use. an established antibioma is characterized by a tough fibrous swelling accompanied by painful or painless swelling, intermittent fever and constitutional symptoms. in this article, we are reporting the case of a facial antibioma formed due to prolonged use of antibiotics prescribed for a residual periapical infection following endodontic treatment. in addition, the association of using antibiotics in this context is discussed.

Microbiological and clinical effects of probiotics and antibiotics on nonsurgical treatment of chronic periodontitis: a randomized placebo- controlled trial with 9-month follow-up

ABSTRACT Objective: The aim of this double-blind, placebo-controlled and parallel- arm randomized clinical trial was to evaluate the effects of Lactobacillus rhamnosus SP1-containing probiotic sachet and azithromycin tablets as an adjunct to nonsurgical therapy in clinical parameters and in presence and levels of Tannerella forsythia, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. Material and Methods: Forty-seven systemically healthy volunteers with chronic periodontitis were recruited and monitored clinically and microbiologically at baseline for 3, 6 and 9 months after therapy. Subgingival plaque samples were collected from four periodontal sites with clinical attachment level ≥1 mm, probing pocket depth ≥4 mm and bleeding on probing, one site in each quadrant. Samples were cultivated and processed using the PCR technique. Patients received nonsurgical therapy including scaling and root planing (SRP) and were randomly assigned to a probiotic (n=16), antibiotic (n = 16) or placebo (n = 15) group. L. rhamnosus SP1 was taken once a day for 3 months. Azithromycin 500mg was taken once a day for 5 days. Results: All groups showed improvements in clinical and microbiological parameters at all time points evaluated. Probiotic and antibiotic groups showed greater reductions in cultivable microbiota compared with baseline. The placebo group showed greater reduction in number of subjects with P. gingivalis compared with baseline. However, there were no significant differences between groups. Conclusions: The adjunctive use of L. rhamnosus SP1 sachets and azithromycin during initial therapy resulted in similar clinical and microbiological improvements compared with the placebo group.

Effect of 1% sodium alendronate in the non-surgical treatment of periodontal intraosseous defects: a 6-month clinical trial

Abstract Background and objectives Few studies have evaluated the effect of the topical application of sodium alendronate (ALN) on the treatment of intrabuccal bone defects, especially those caused by periodontitis. This 6-month randomized placebo controlled clinical trial aimed at evaluating the effect of non-surgical periodontal treatment associated with the use of 1% ALN, through clinical evaluations and cone-beam computed tomography (CBCT). Material and Methods Twenty individuals with chronic periodontitis underwent periodontal examination at the baseline as well as 3 and 6 months after periodontal treatment, registering clinical attachment level (CAL), periodontal probing depth (PPD), and bleeding on probing (BOP) as the clinical outcomes. After manual scaling and root planing, 40 bilateral sites with interproximal vertical bone defects were randomly treated with either 1% ALN gel or a placebo. Bone defects were evaluated through CBCT at the baseline and 6 months post-treatment. The clinical and CBCT parameters were compared using the Wilcoxon and Friedman tests (p<0.05). Results Although ALN produced a greater CAL gain when compared to the placebo at 6 months post-treatment (p=0.021), both treatments produced similar effects on the PPD, BOP, and bone height. Significant differences in bone fill were observed only in patients of the ALN group (4.5 to 3.8 mm; p=0.003) at 6 months post-treatment. Conclusions Topical application of 1% ALN might be a beneficial adjuvant to non-surgical periodontal therapy.

Gel de doxiciclina encapsulada em ß-ciclodextrina como agente tópico adjuvante para o tratamento não cirúrgico da periodontite crônica: um ensaio clínico randomizado / Efeito de gel de doxiciclina encapsulada em ß-ciclodextrina como agente tópico adjuvante para periodontite crônica: um ensaio clínico / Doxycycline gel encapsulated in ß-cyclodextrin as adjunctive topical agent for the treatment non surgical of chronic periodontitis: a randomized clinical trial

Objetivo: comparar a eficácia clínica de um gel de doxiciclina 10% encapsulada em ß-ciclodextrina (DOX) / ßCD), com o gel de 10% DOX - pura, como adjuvantes da Raspagem e Alisamento Radicular (RAR) em um ensaio clínico. Materiais e Métodos: trinta e três indivíduos com diagnóstico de periodontite crônica (PC) foram randomizados para: grupo I (GI) (10% de gel DOX + RAR), grupo II (GII) (10% de gel de DOX / ß-CD + RAR) que receberam aplicação dos géis em T0 e T1 e grupo III (GIII), apenas RAR. Os parâmetros clínicos de Profundidade à Sondagem Periodontal (PSP), Nível de Inserção Clínica (NIC), Sangramento à sondagem (SS) e Índice de Placa Visível (IPV) foram avaliados em: tempo inicial (T0), 30 dias (T1) e 60 dias (T2). Resultados: Dentro dos grupos, GII apresentou a redução mais significativa nas médias de PSP e SS e o maior ganho médio em NIC (p <0,05). Ao comparar os três grupos, GII apresentou maior redução em PSP (2,62 mm) (p <0,003) e atingiu o maior número de indivíduos com ganho de inserção clínica (2,54 mm) em T2 (p <0,003). O SS e IPV apresentaram uma forte redução em todos os grupos, comparando T2 com T0 (p <0,05). IPV e SS diminuiram ≥ 5 vezes e duas vezes, respectivamente em T0 até T1, mas diminuíram de forma semelhante em todos os grupos, sem diferença significativa. Na avaliação comparativa das densidades ósseas obtidas nos exames radiográficos de GI e GII realizados nos momentos T0 (RX inicial), T2 (RX 60 dias após T0) e T Final (RX 18 meses após T0), observou-se aumento da densidade óssea ao longo do tempo em todos os grupos. Houve um aumento maior na densidade óssea até 60 dias (TI). No entanto, o GII mostrou maior aumento na densidade óssea, mas não teve diferença significativa em relação ao tipo de gel aplicado. Conclusão: O presente estudo mostrou que a aplicação do gel de DOX a 10% incluída em ß-CD associada à RAR apresentou melhora significativa nos parâmetros clínicos periodontais (PSP, NIC e SS) e do IPV, em todos os protocolos analisados, proporcionando benefícios adicionais à RAR sozinha. Nos indivíduos tratados, as bolsas periodontais ficaram mais rasas ao final da investigação. Houve aumento da densidade óssea ao longo do tempo em todos os grupos. No entanto, GII mostrou um aumento estatisticamente significativo na densidade óssea entre os tempos T0 e T2, sem diferença significativa em relação à GI. O gel contendo somente DOX a 10% também apresentou benefícios significativos à RAR, porém menores se comparado ao gel com o composto de inclusão (DOX/ ß-CD). Estes resultados traduzem-se em um ganho real na saúde periodontal. Portanto, a inclusão da doxiciclina em ß-CD, liberada localmente, pode ser um adjuvante quimioterapêutico importante no tratamento da periodontite crônica.(AU)

Aim: to compare the clinical efficacy of 10% doxycycline encapsulated in ß- cyclodextrin (DOX)/ßCD) in gel with 10% DOX- pure gel along adjuvants with scaling and root planning (SRP) in a clinical trial. Materials and Methods: Thirty-three subjects with diagnosis of chronic periodontitis (CP) were randomized into: group I (GI) (10% DOX gel + SRP), group II (GII) (10% DOX / ß-CD gel + SRP) that received application of the gels at T0 and T1, and group III (GIII), only SRP. The clinical parameters of Periodontal Probing Depth (PPD), Clinical Attachment Level (CAL), Bleeding on Probing (BOP) and Visible Plaque Index (VPI) were evaluated at baseline (T0), 30 days (T1) and 60 days (T2). Results: Within the groups, GII presented the most significant reduction in the mean of PPD and BOP and the highest mean gain in CAL (p <0.05). When comparing the three groups, the GII presented a greater reduction in PPD (2.62 mm) (p <0.003) and reached the greatest number of individuals with a gain of clinical attachment (2.54 mm) at T2 (p <0.003). The BOP and VPI had a strong reduction in all groups, comparing T2 with T0 (p <0.05). The VPI and BOP decreased ≥ 5 times and twice, respectively at T0 up to T1 in a similar way for all groups, without significant difference. In the comparative evaluation of the bone density obtained in the radiographic examinations of GI and GII performed at moments T0 (initial RX), T2 (RX 60 days after T0) and T Final (RX 18 months after T0), it was observed increase in bone density over time in all groups. There was a greater increase in bone density up to 60 days (TI). However, GII showed greater increase in bone density, but didn't have a significant difference in relation to the type of gel applied. Conclusion: the present study showed that the application of the 10% DOX gel included in ß-CD associated with SRP showed a significant improvement in periodontal clinical parameters (PPD, CAL and BOP) and VPI, in all analyzed protocols, providing additional benefits to the SRP alone. In the treated individuals, the periodontal pockets were shallower at the end of the investigation. There was an increase in bone density over time in all groups. However, GII showed a statistically significant increase in bone density between T0 and T2 times, without significant difference in relation to GI. The gel containing only 10% DOX also presented significant benefits to RAR, but smaller when compared to gel with inclusion compound (DOX / ß-CD). These results translate to a real gain in periodontal health. Therefore, the inclusion of locally released doxycycline into ß-CD may be an important chemotherapeutic adjuvant in the treatment of chronic periodontitis.(AU)

Eficacia de terapia fotodinámica como complemento de terapia convencional periodontal versus terapia convencional en el tratamiento de pacientes adultos con periodontitis crónica: una revisión sistemática con metaanálisis / Effectiveness photodynamic therapy complementing conventional periodontal therapy versus conventional therapy in the treatment of adult patients with chronic periodontitis: a systematic review with meta-analyses

Se evaluó la eficacia de la terapia fotodinámica como complemento de terapia periodontal convencional comparándola con la terapia convencional en el tratamiento de sacos periodontales en pacientes adultos con periodontitis crónica basándose en ensayos clínicos comprendidos entre los años 2010 y 2015, para determinar si su uso otorga mejores resultados para el tratamiento de esta enfermedad. Se seleccionaron ensayos clínicos aleatorios prospectivos, aleatorizados o no aleatorizados, controlados y no controlados que permitieron la comparación entre el tratamiento convencional y la terapia fotodinámica, con un grupo en el cual se utilizó sólo la terapia convencional. Los datos de los ensayos clínicos fueron ingresados al software Review Manager®. Se realizaron tres metaanálisis para las variables: Nivel de inserción clínica (NIC) y profundidad de sondaje (PS), el test de I2 fue utilizado para medir la heterogeneidad del estudio y posteriormente un análisis de sensibilidad para determinar los estudios heterogéneos. Se pudieron analizar 7 estudios, con un total de 186 pacientes, quienes fueron controlados 3 meses post tratamiento. Se utilizó la diferencia de medias, un intervalo de confianza de 95 % para medir el NIC y PS. A los 3 meses, no se encontró diferencias significativas en NIC (p= 0,93) y PS (p= 0,71). Conclusión: La terapia fotodinámica en complementación a la terapia convencional no otorga mejor resultado clínico ni estadístico comparado con la terapia convencional al evaluar el nivel de inserción clínica. Al evaluar la profundidad de sondaje es recomendable la utilización de terapia convencional sola.

The efficacy of photodynamic therapy as an adjunct to conventional periodontal therapy evaluated by comparing with conventional therapy alone in the treatment of periodontal pockets in adult patients with chronic periodontitis based on clinical trials between 2010 and 2015, to determine if its use can provide better results for treating this disease. Prospective randomized clinical trials and randomized clinical trials or non-randomized, controlled and uncontrolled that allowed comparison between a group which was applied to conventional therapy and photodynamic therapy, a similar group was selected to which you He applied only conventional therapy. Data from clinical trials entered into Review Manager®. Three meta-analyzes for the variables analyzed were performed: Level clinical attachment (NIC) and probing depth (PS), the test of I2 was used to measure the heterogeneity of the study and then a sensitivity analysis to determine which studies awardedheterogeneity. As results, seven studies analyzed in 186 patients who underwent treatment at least controlled within 3 months post treatment. The mean difference was used, a confidence interval of 95 % to measure the NIC and PS. At 3 months, no significant differences in NIC (p= 0.93) and PS (p= 0.71). In conclusion, the photodynamic therapy complementary to conventional therapy does not provide better clinical or statistical results compared with conventional therapy to evaluate the clinical attachment level. In assessing probing depth, is advisable to use conventional therapy alone.

Função endotelial e tratamento periodontal não cirúrgico de pacientes diabéticos com periodontite / Endothelial function and non-surgical periodontal treatment in diabetic patients with periodontitis

O objetivo desse estudo foi investigar alterações na função endotelial, além de realizar meta-análises sobre o uso de antibióticos adjuvantes ao tratamento periodontal não cirúrgico em relação aos possíveis benefícios em termos de parâmetros clínicos periodontais e controle glicêmico nos pacientes diabéticos com periodontite. Quarenta e oito pacientes foram avaliados quanto aos parâmetros periodontais e função endotelial. Desses 48, 11 não tinham doença periodontal e não eram diabéticos (grupo A), 17 tinham periodontite crônica e não eram diabéticos (grupo B), e 20 tinham periodontite crônica e diabetes mellitus tipo 2 (grupo C). Dois revisores independentes examinaram ensaios clínicos controlados em 6 bases de dados eletrônicas, registros de ensaios clínicos, resumos de reuniões e 4 principais revistas odontológicas. A vasodilatação dependente do endotélio (fluxo de hiperemia) foi significantemente menor no grupo C quando comparado com os grupos A e B, assim como foi significantemente menor no grupo B quando comparado com o grupo A (p<0,05). As meta-análises mostraram um efeito significativo favorecendo tratamento periodontal associado a antibióticos para reduções na média de profundiade de sondagem (-0,22 mm [-0,34, -0,11]) e na média de porcentagem de sangramento a sondagem (4% [-7, -1]). Não houve efeito significativo no ganho de nível de inserção clínica e redução do índice de placa. Além disso, a associação de antibióticos e tratamento periodontal não reduziu os valores de hemoglobina glicada média (-0,11% [-0,35, 0,13]), e um intervalo de previsão estimado variando de -0,45 a 0,23. Também não houve efeito significativo favorecendo o uso adjuvante de doxiciclina sub-antimicrobiana na redução média da hemoglobina glicada (-0,19% [-1,07, 0,68]). Sendo assim, pode-se concluir que a periodontite crônica está associada a diminuição da vasodilatação dependente do endotélio do indivíduo, assim como diminui ainda mais quando associada ao diabetes mellitus. O antibiótico sistêmico adjuvante ao tratamento periodontal proporciona benefícios estatisticamente significantes em termos de reduções de média de profundidade de bolsa a sondagem e o percentual de sangramento a sondagem, porém não proporciona um benefício significativo em termos de melhoria de nível de inserção clínico, índice de placa e hemoglobina glicada.

The aim of this study was to investigate alterations in endothelial function, besides performing meta-analyzes on the use of adjuvant antibiotics to non-surgical periodontal treatment in relation to the possible benefits in terms of periodontal clinical parameters and glycemic control in diabetic patients with periodontitis. Forty-eight patients were evaluated for periodontal parameters and endothelial function. Of these, 11 h ad no periodontal disease and were not diabetic (group A), 17 had chronic periodontitis and were not diabetic (group B), and 20 had chronic periodontitis and type 2 diabetes mellitus (group C). Two independent reviewers examined controlled clinical trials in 6 electronic databases, clinical trial records, meeting summaries, and 4 major dental journals. Endothelium-dependent vasodilation (hyperemia flow) was significantly lower in group C when compared to groups A and B, as well as significantly lower in group B when compared to group A (p <0.05). The meta-analyzes showed a significant effect favoring antibiotic-associated periodontal treatment for reductions in the mean probing pocket depth (-0,22 mm [-0,34; -0,11]) and the mean percentage of bleeding probing ( 4% [-7, -1]). There was no significant effect on gain of clinical attachment level and reduction of plaque index. In addition, the association of antibiotics and periodontal treatment did not reduce mean glycated hemoglobin values (-0,11% [-0,35, 0,13]), and an estimated prediction interval ranging from -0,45 to 0,23. There was also no significant effect favoring the adjuvant use of sub-antimicrobial doxycycline in the mean reduction of glycated hemoglobin (-0,19% [-1,07, 0,68]). Thus, it may be concluded that chronic periodontitis is associated with decreased vasodilatation dependent on the endothelium of the individual, as well as decreases even more when associated with diabetes mellitus. The systemic antibiotic adjuvant to periodontal treatment provides statistically significant benefits in terms of reductions of mean probing pocket depth and % of bleeding on probing, but does not provide a significant benefit in terms of improvement of clinical attachment level, plaque index and glycated hemoglobin.

Asociación de la atorvastatina sistémica en las características clínicas inflamatorias de la periodontitis crónica / Association of atorvastatin in systemic inflammatory characteristics of chronic periodontitis

Determinar el efecto de la atorvastatina sistémica en el índice gingival y el índice de carga inflamatoria periodontal (PIBI), en pacientes con periodontitis crónica en una población adulta del sector norte de la ciudad de Antofagasta. Este estudio se realizó en pacientes derivados a la clínica de periodoncia del Centro Asistencial Norte Antofagasta, departamento dependiente del Servicio de Salud Antofagasta. Se seleccionó un grupo de 60 pacientes, mayores 40 años de edad, diagnosticados con periodontitis crónica, con al menos 14 dientes en la cavidad oral y sin tratamiento antibiótico en los últimos 6 meses. Se dividieron estos pacientes en dos grupos; 30 de ellos en tratamiento con atorvastatina por al menos 1 año (Grupo I) y 30 que no estaban en tratamiento con este medicamento (Grupo II). Las variables analizadas fueron el índice de placa bacteriana simplificado, el índice gingival y el PIBI, de la abreviación del inglés Periodontal inflammatory burden index. La atorvastatina sistémica se asocia a una disminución en el índice gingival y el PIBI, en pacientes adultos con periodontitis crónica.

To determine the effect of systemic atorvastatin on gingival index and periodontal inflammatory burden index (PIBI) in patients with chronic periodontitis in an adult population of the northern sector of the city of Antofagasta. This study was conducted in patients referred from the clinic of periodontology of Centro Asistencial Norte under the Department of Health Service of Antofagasta. A group of 60 patients over 40 years old was selected, diagnosed with chronic periodontitis, with at least 14 teeth in the mouth without antibiotic treatment in the last 6 months. These patients were divided into two groups; 30 of them were treated with atorvastatin for at least 1 year (Group I) and 30 who were not treated with this drug (Group II). The variables analyzed were simplified plaque index, gingival index and PIBI. The atorvastatin systemic is associated with adecrease in gingival index and PIBI in adult patients with chronic periodontitis.

Antifungal activity of propolis against Candidaspecies isolated from cases of chronic periodontitis

This research evaluated the fungistatic and fungicidal activities of red propolis alcoholic extract (RPAE) against different Candida species isolated from chronic periodontitis cases, and compared with chlorhexidine (CHX). Nineteen samples of Candida species (C. albicans [n = 12], C. tropicalis [n = 5] andC. glabrata[n = 2]) isolated from chronic periodontitis cases were analyzed. The fungistatic and fungicidal activity of both RPAE and CHX were evaluated using fluconazole and C. parapsilosis (ATCC 6258) as a control. Fungistatic activity was analyzed based on the Clinical and Laboratory Standards Institute (CLSI) reference procedure to determine the minimum inhibitory concentrations. Fungicidal activity was established according to the absence of fungal growth on Sabouraud Dextrose Agar medium. The fungistatic and fungicidal activities of RPAE were observed, respectively, at 32-64 μg/mL and 64-512 μg/mL for C.albicans, 64 μg/mL and 64-256 μg/mL for C. glabrata, and 32-64 μg/mL and 64 µg/mL for C. tropicalis. CHX fungistatic activity was observed at concentrations of 0.003-1.92 µg/mL for C. albicans, 1.92 µg/mL for C. glabrata, and 0.03-1.92 µg/mL for C. tropicalis. Fluconazole fungistatic activity ranged between 1-64 μg/mL, and fungicidal activity occurred at 8-64 μg/mL, for the threeCandida species analyzed. All the Candidaspecies were susceptible to RPAE antifungal activity, but five samples ofC.albicans, one ofC.tropicalis and one ofC.glabrata were resistant to fluconazole antifungal activity. CHX showed fungistatic activity against all the Candida species analyzed. The antifungal potential of these substances suggests that they can be applied as an alternative treatment for diseases affected by these species.

Subgingivally applied minocycline microgranules in subjects with chronic periodontitis: a randomized clinical and microbiological trial / Microgránulos de minociclina subgingival en sujetos con periodontitis crónica. Estudio clínico y microbiológico aleatorizado

El objetivo de este estudio fue evaluar el efecto clínico y microbiológico de microgránulos de Minociclina, colocados subgingivalmente como coadyuvante del raspaje y alisado radicular en pacientes con Periodontitis crónica severa. Participaron 26 sujetos voluntarios con Periodontitis crónica, no fumadores. Se seleccionaron 4 sitios contralaterales con Sangrado al Sondaje (SS) y Profundidad al Sondaje (PS) > 6 mm. Condición Basal (CB): se registró, PS y Nivel de Inserción (NI). Se determinó mdiante PCR la presencia de Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), Treponema denticola (Td) y Aggregatibacter actinomycetemcomitans (Aa). Un lado de la boca fue aleatoriamente asignado al tratamiento experimental: grupo T, el otro al tratamiento control: grupo C. Al día 30 y 90 se repitieron los exámenes clínicos y microbiológicos. Día 30: el SS se redujo al 81 por ciento en el grupo C y al 12 por ciento en el grupo T (p<0,05). Estas diferencias se mantuvieron al día 90 (C: 58 por ciento, T: 8 por ciento) (p<0.05). Día 30 y 90: hubo disminución de la PS en ambos grupos, siendo significativamente mayor en el grupo T (p<0,05). En ambos grupos hubo disminución significativa del NI (p<0,05), no hubo diferencias entre los grupos al día 30 y sí al día 90. A los 30 y 90 días en ambos grupos se redujo la prevalencia para Pg, Tf ,Td y Aa. A los 30 y 90 días la reducción de sitios con Pg fue mayor en el grupo T (p=0,002). A los 90 días Td disminuyó en el grupo T y aumentó en el grupo C (p=0,023). No se observaron efectos adversos. Los resultados mostraron que la aplicación subgingival de microgránulos de minociclina adjunta al raspaje y alisado radicular produjo una reducción mayor del SS, la PS y el NI que el raspaje y alisado solo, aumentó la probabilidad de suprimir Pg y retardó la recolonización con Td.

The aim of this study was to evaluate clinical and microbiological effects of subgingival minocycline microgranules when used as an adjunct to scaling and root planing in subjects with Chronic periodontitis. Twenty-six non-smoker volunteers participated in the study. Four opposite sites, clinically standardized, with bleeding on probing (BOP) and pocket depth (PD) ≥ 6 mm were selected. Baseline BOP, PD and Clinical attachment level (CAL) were measured and microbiological samples were collected from the study sites and analyzed using PCR. Porphyromonas gingivalis (Pg) Tannerella forsythia (Tf), Treponema denticola (Td) and Aggregatibacter actinomycetemcomitans (Aa) were detected. One side of the mouth was randomly allocated to the experimental treatment: scaling and root planing plus minocycline microgranules (Test group=T) and the other side of the mouth toscaling and root planing alone (Control group=C). At days 30 and 90, clinical and microbiological examination was repeated. After 30 days BOP was reduced to 81% in C and to 12% in T and at day 90 to 58% in C and to 8% in T (p<0.05). PD wassignificantly reduced in both groups (C: 4.8mm, T: 4.2mm) favoring T at days 30 and 90 (p<0.05). CAL reduction at day 30 showed no difference between groups. At day 90, CAL reduction was higher in T (p<0.05). At days 30 and 90 Pg, Tf, Td and Aa was reduced in both groups. Pg reduction wassignificantly greater in group T. At day 90 frequency of sites with Td decreased in T and increased in C (p<0.05). No adverse effect was observed. This study showed that minocycline microgranules adjunct to scaling and root planing resulted in grater reduction of BOP and PD, higher CAL gain, increased probability of Pg suppression and retarded recolonization of Td than root instrumentation alone.

Terapia fotodinâmica no tratamento periodontal: comparação microbiológica entre dois métodos / Photodynamic therapy adjunct in the treatment periodontal: microbiological comparison between two methods

a terapia fotodinâmica (PDT) tem a finalidade de reduzir os periodontopatógenos no biofilme dental através da associação de um laser a um corante fotossensibilizador, que culmina na produção de oxigênio singleto, levando à morte celular. Este estudo-piloto compara dois diferentes métodos de irradiação do laser de baixa potência na PDT, através da análise dos patógenos periodontais Porphyromonas gingivalis (P.g.), Tannerella forsythia (T.f.), Treponema denticola (T.d.) e Aggregatibacter actinomycetencomitans (A.a.). Material e métodos: este estudo-piloto é parte de um estudo clínico longitudinal, prospectivo, randomizado e duplo-cego. Foram selecionados cinco pacientes portadores de periodontite crônica, com dois dentes unirradiculares contralaterais com profundidade de sondagem maior ou igual a 5 mm, sem comprometimento sistêmico. Os pacientes foram submetidos à raspagem e alisamento radicular, e subsequentemente à PDT nos dentes experimentais. Estes foram alocados em dois grupos, de acordo com a maneira de entrega do laser: grupo A (transgengival) e grupo B (intrasulcular). A quantificação dos periodontopatógenos foi avaliada pela PCR em tempo real, sete e 30 dias após a intervenção, sendo adotado o nível de significância p ≤ 0,05. Resultados: não houve diferença entre os grupos A (irradiação transgengival) e B (irradiação intrasulcular), em relação aos níveis de A.a., T.f. e T.d. em qualquer momento do estudo. Em relação aos níveis de Pg, houve diferença significativa entre os grupos após 30 dias (p=0,032). Conclusão: os dois métodos foram semelhantes na redução de A.a., T.d. e T.f.. O método B (intrasulcular) mostrou uma redução significativa do patógeno P.g. no sétimo e 30º dia de avaliação.

Introduction: photodynamic therapy (PDT) has the purpose of reducing the periodontal biofilm by combining a laser with a photosensitizing dye that culminates in the production of singlet oxygen, leading to cell death. This pilot study compares two different methods of irradiation of low power laser in PDT, by analyzing the periodontal pathogen Porphyromonas gingivalis (P.g.), Tannerella forsythia (T.f.), Treponema denticola (T.d.) and actinomycetencomitans Aggregatibacter (A.a.). Material and methods: this pilot is part of a longitudinal, prospective, randomized, double-blind study. Were selected five patients with chronic periodontitis with two contralateral single-rooted teeth with depth greater than or equal to 5 mm, without systemic involvement. Patients underwent scaling and root planing and subsequent to PDT in experimental teeth, which were divided into two groups according to the manner of delivery of the laser: group A (transgingival) and group B (intrasulcular). The reduction of periodontal pathogens was evaluated by PCR real-time, 7 and 30 days after the intervention, with significance level p ≤ 0.05. Results: there was no difference between groups A (transgingival irradiation) and B (intrasulcular irradiation) with respect to A.a., T.f. and T.d. at any time during the study. With respect to levels of P.g., a significant difference between groups at 30 days (p=0.032). Conclusions: the two methods were similar in reducing A.a., T.d., T.f.. The method B (intrasulcular) showed a significant reduction in pathogen P.g. 7 and 30 days of evaluation.

Avaliação clínica e microbiológica das técnicas de full mouth disinfection e raspagem e alisamento radicular associadas à azitromicina ou clorexidina no tratamento da periodontite crônica: ensaio clínico controlado randomizado / Clinical and microbiological analysis of full mouth disinfection and scaling and root planing per quadrant techniques associated with chlorhexidine or azithromycin in the treatment of chronic periodontitis: randomized controlled trial

O tratamento não cirúrgico da doença periodontal inclui a realização de procedimentos de instrução de higiene oral e a raspagem e alisamento radicular por quadrantes (RAR). Com a finalidade de prevenir a rápida recolonização das bolsas periodontais por bactérias presentes em outros sítios intraorais, foi proposta a técnica de one stage full-mouth disinfection (FMD). De acordo com essa técnica as raspagens de todos os hemi-arcos são realizadas em 24 horas associadas à realização da descontaminação de tonsilas, mucosas, bolsas e língua com diferentes concentrações e formas de apresentação da clorexidina. Estudos revelaram dados controversos sobre a efetividade da técnica FMD, questionaram a necessidade de uso da clorexidina e, em adição propuseram o uso adjuvante de antibióticos. Neste sentido, a justificativa deste é a necessidade de estudos controlados que comparem a técnica FMD com a RAR, com as diferentes variações que podem ser aplicadas a ambos, analisando o seu impacto nos parâmetros periodontais clínicos e microbiológicos. Assim, o objetivo deste estudo foi avaliar, por meio de ensaio clínico controlado randomizado, a efetividade da técnica FMD e sua associação com clorexidina ou azitromicina em relação à RAR associada à clorexidina e azitromicina sob uma perspectiva clínica (avaliação da profundidade de sondagem, nível clínico de inserção, índice gengival e índice de placa) e microbiana (quantificação da carga bacteriana total e das seguintes bactérias: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola e Streptococcus oralis, por meio de PCR em tempo real, nos períodos de 90 e 180 dias após o tratamento). No presente ensaio clínico controlado randomizado foram avaliados 77 indivíduos divididos em 6 grupos: FMD-CX (raspagem e alisamento radicular de todos os dentes em 24 h associada à clorexidina para desinfecção de bolsas, tonsilas e mucosa ­ n= 15), FMD (raspagem e alisamento radicular de todos os dentes em 24 h ­ n=10), FMD-AZ (raspagem e alisamento radicular de todos os dentes em 24 h + azitromicina ­ n=15), RAR-AZ (raspagem e alisamento radicular por quadrante em intervalos semanais + azitromicina ­ n=11), RAR-CX (raspagem e alisamento radicular por quadrante, em intervalos semanais + clorexidina ­ n=13), RAR (raspagem e alisamento radicular, por quadrantes, em intervalos semanais ­ n=13). Os parâmetros clínicos foram analisados estatisticamente pelo teste de análise de variância (ANOVA) baseado em um planejamento para medidas repetidas e teste de comparações múltiplas de médias. A carga bacteriana total e das bactérias foi avaliada intragrupo (Teste de Friedman) e intergrupos (Teste de Kruskal Wallis). O grupo FMD-CX mostrou maior redução da profundidade de sondagem e ganho do nível clínico de inserção que os demais. Além disso, esse grupo mostrou redução de carga para quatro das cinco bactérias avaliadas: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Streptococcus oralis, Treponema denticola, Tannerella forsythia. Os grupos que utilizaram azitromicina não mostraram melhores resultados clínicos e microbiológicos. Pode-se concluir que a utilização da clorexidina nos grupos FMD-CX e RAR-CX mostrou melhores resultados clínicos e microbiológicos. Por outro lado, a utilização da azitromicina não apresentou melhorias nesses parâmetros

The non-surgical treatment of periodontal disease involves performing procedures of oral hygiene instruction and scaling and root planing per quadrant (SRP). This therapeutic approach aims to prevent rapid recolonization of bacteria in periodontal pockets in other intraoral sites, the technique of one stage full -mouth disinfection (FMD) is proposed. According to this technique the scalings of all hemi - arches are made within 24 hours associated with performing the decontamination of tonsils, mucosa, periodontal pockets and tongue with different concentrations and forms of presentation of chlorhexidine. Studies over the years have revealed controversial data on the effectiveness of the technique FMD, questioned the need to use chlorhexidine, and proposed adding the adjuvant use of antibiotics. In this sense, the justification of this research is the need for further controlled studies comparing the FMD technique with conventional quadrant scaling with differnt variations that can be applied to both, analyzing their impact on clinical and microbiological periodontal parameters. The objective of this study was to evaluate through a randomized controlled trial the effectiveness of the technique one stage full -mouth disinfection and its association with chlorhexidine or azithromycin compared to scaling and root planing per quadrant associated with chlorhexidine and azithromycin under a clinical perspective (evaluation of probing depth, clinical attachment level , gingival index and plaque index ) and microbial (assessment of the total bacterial load and the following bacteria : Aggregatibacter actinomycetemcomitans , Porphyromonas gingivalis , Tannerella forsythia , Treponema denticola and Streptococcus oralis) through of real-time PCR , in periods of 90 and 180 days after treatment. In the present randomized controlled trial evaluated 77 individuals were divided into 6 groups : FMD-CX (scaling and root planing of all teeth in 24 associated with chlorhexidine for disinfection pockets, tonsils and mucosa - n = 15 ) , FMD ( scaling and root planing of all teeth in 24 hours- n = 10 ) , FMD- AZ (scaling and root planing of all teeth in 24 hours + azithromycin - n = 15 ) , RAR - AZ ( scaling and root planing per quadrant at weekly intervals + azithromycinn = 11 ) , RAR - CX ( scaling and root planing per quadrant at weekly intervals + chlorhexidine - n = 13 ) , RAR ( scaling and root planing per quadrants at weekly intervals - n = 13 ) . The clinical parameters were statistically analyzed by analysis of variance (ANOVA) based on a planning for repeated measures and multiple comparisons of means test. The total bacterial load and bacteria was evaluated intragroup (Friedman test) and between groups (Kruskal Wallis). The FMD- CX group showed greater reduction in probing depth and gain in clinical attachment level than the others. Moreover, this group showed reduced load for four of five surveyed bacterias: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Streptococcus oralis, Treponema denticola, Tannerella forsythia. Groups using azithromycin did not show improved clinical and microbiological outcomes. It can be concluded that the use of chlorhexidine groups FMD-CX and RAR-CX showed the best clinical and microbiological results. On the other hand, the use of azithromycin did not show improvements in these parameters

Antimicrobial photodynamic therapy as an adjunctive modality in the treatment of chronic periodontitis

Due to penetration of pathogenic bacteria into the periodontal tissues in moderate to severe periodontitis, the mechanical methods are not sufficient in these cases. Therefore, administration of local/systemic antibiotic is recommended following mechanical root debridement. However, side effects of antibiotics such as microbial resistance and patient allergy led to development of alternative methods. One of the suggested methods is the antimicrobial photodynamic therapy [aPDT]. aPDT is a local non invasive treatment modality without the side effects caused by antibiotics. The aim of this study was to collect the clinical articles related to the application of aPDT in the treatment of chronic periodontitis. In order to find related clinical articles, a search of PubMed, Google Scholar and Science Direct until 2012 was performed. A total of 11 articles were found. In 7 of the 11 articles, the assessment of aPDT led to a significant improvement in the clinical attachment and probing depth. In 4 studies, there was no difference between the scaling and root planing [SRP] and adjunctive application of aPDT. aPDT in most cases resulted in less gingival bleeding compare to SRP alone. Furthermore, its application in multiple doses was more effective in comparison to a single dose treatment. It appears that aPDT is effective as an adjunctive therapy compared to conventional non_surgical treatment alone, and is recommended in multiple doses in order to achieve more appropriate results

Clinical efficacy of subgingivally delivered 0.5% controlled release azithromycin gel in the management of chronic periodontitis.

Background: Recent developments suggest that the local delivery of antimicrobials into periodontal pockets can improve periodontal health. Azithromycin (AZM) has a wide antimicrobial spectrum of action toward anaerobic bacteria as well as Gram-negative bacilli. It is effective against periodontal pathogens such as Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis. Therefore, this study was undertaken to investigate the clinical effectiveness of AZM at 0.5% concentration in an indigenously prepared bioabsorbable controlled release gel as an adjunct to non-surgical mechanical therapy in the treatment of chronic periodontitis. Materials and Methods: Thirty sites in patients with chronic periodontitis and probing depth (PD) 4-6 mm were categorized randomly into two treatment groups: Scaling and root planing (SRP) plus 0.5% AZM gel (group 1) and SRP only (group 2). Clinical evaluation was undertaken using the Gingival Index (GI) of Loe and Silness and plaque was assessed using the Turesky et al. modification of Quigley Hein Index at baseline and 21 days. Pocket PD and clinical attachment level (CAL) were also measured. Statistical Analysis: Results were expressed as mean ± standard deviation and percentages and the data were analyzed using Statistical Package for Social Sciences (SPSS version 16.0, SPSS, Chicago, IL) software. Result: Both therapies resulted in significant improvements. Mean reduction in GI from baseline to 21 days was 1.20 ± 0.41 and 0.73 ± 0.45 in group 1 and group 2, respectively. Plaque Index also improved through the study period in both groups, i.e., 0.86 ± 0.51 in group 1 and 1.6 ± 0.97 in group 2. Mean PD reduced significantly with SRP plus AZM gel application in group 1, i.e., 2.1 ± 0.91 mm as compared to 1.0 ± 1.06 mm achieved with SRP alone. A significant gain in mean CAL gain was observed in the test group (1.8 ± 0.63 mm) as compared to control group (1.0 ± 1.06 mm). Conclusion: Although both treatment strategies seem to benefit patients, the adjunctive use of 0.5% of AZM showed significant results.

Amoxicillin/metronidazole or scaling and root planing in the treatment of chronic periodontitis

The aim of the present study was to evaluate the treatment with amoxicillin or metronidazole in comparison to scaling and root planing in the treatment of chronic periodontitis. Randomised clinical trials were searched in the databases MEDLINE, EMBASE, SciELO, Cochrane and Scopus from 1989 to 2010. The search started with 2895 articles.. From this initial number of articles, 10 publications were selected and included in the study according to fixed criteria. Studies included adult patients of both sexes aged between 21 and 80, diagnosed with chronic periodontitis and treated with amoxicillin and/or metronidazole or scaling and root planning. From each article, details were abstracted relating to sample size, design, sex, age, oral hygiene habits, the exposure to drug (doses, schedule), and results such as clinical effect, analysis methods, stratification variables. Conclusion: this meta-analysis showed absence of statistically significant difference between the effects studied.

El objetivo del presente estudio fue evaluar el tratamiento con amoxicilina o metronidazol en comparacion con el raspado y alisado radicular en el tratamiento de la periodontitis cronica. Ensayos clinicos aleatorios se seleccionaron de las bases de datos MEDLINE, EMBASE, Scielo, Cochrane, y Scopus desde el ano 1989 a 2010. La busqueda comenzo con 2895 articulos. A partir de este numero inicial de articulos, 10 publicaciones fueron seleccionadas e incluidas en el estudio de acuerdo a los criterios fijados. Los estudios incluyeron pacientes adultos de ambos sexos, con edades entre 21 y 80 anos, diagnosticados con enfermedad periodontal cronica y tratados con amoxicilina y/o metronidazol o raspaje y alisado radicular. De cada articulo se extrajo el tamano muestral, diseno, genero y edad, habitos de higiene oral, medicacion (dosis y esquema), resultado clinico, metodo de analisis y variables de estratificacion. Conclusion: este meta-analisis mostro ausencia de significacion estadistica entre los efectos estudiados.

The use of ozonated water and 0.2% chlorhexidine in the treatment of periodontitis patients: A clinical and microbiologic study.

Background: The development of periodontal disease has been thought to be associated with several restricted members of the oral anaerobic species, such as black-pigmented Porphyromonas species and Actinobacillus actinomycetemcomitans (Aa), in the subgingival environment. Apart from bacteria, certain viruses and fungi that are associated with periodontal disease are also present in the subgingival plaque . Materials and Methods: A randomized, double-blind, crossover split-mouth design was performed. A total of 16 patients suffering from generalized chronic periodontitis were selected for the study. The study period of 18 days was divided into two time-intervals, i.e. baseline (0 days) to 7 th day, with a washout period of 4 days followed by a second time interval of 7 days. The use of ozone and chlorhexidine gluconate (CHX) irrigation was randomized. Both the patient and the clinician evaluating the clinical parameters were blinded regarding the type of irrigation used. Results: The interpretation of clinical and microbial data is from baseline to 7 th day. A higher percentage of plaque index (12%), gingival index (29%) and bleeding index (26%) reduction was observed using ozone irrigation as compared to chlorhexidine. The percentile reduction of Aa (25%) using ozone was appreciable as compared to no change in Aa occurrence using chlorhexidine. By using O 3 and chlorhexidine, there was no antibacterial effect on Porphyromonas gingivalis (Pg) and Tannerella forsythensis. The antifungal effect of ozone from baseline (37%) to 7 th day (12.5%) was pronounced during the study period, unlike CHX, which did not demonstrate any antifungal effect. Conclusion: Ozone may be considered as an alternative management strategy due to its powerful ability to inactivate microorganisms. Also, there is growing evidence that ozone can be employed as a useful therapeutic agent in both dentistry and medicine.

Chlorhexidine chip and tetracycline fibers as adjunct to scaling and root planing: a clinical study

Aim: Prevention of periodontal disease progression is the primary goal of periodontal therapy. When conventional therapy is found inadequate to attain periodontal health in chronic periodontitis, local antimicrobial agents have been used as adjunct to scaling and root planing, producing encouragingresults. Hence, a study was undertaken to evaluate clinically, the newly released sustained drugs, PerioColTMCG(Chlorhexidine - CHX- chip) with Periodontal Plus ABTM (Tetracycline fibers). Methods: Patients wereallocated in 3 experimental treatment groups, Group A- SRP + CHX Chip, Group B- SRP + Tetracycline fibers, and Group C- SRP alone (control group). Forty-five sites in 14 patients (9 females and 5 males) with chronic periodontitis (5-8mm probing depth), were evaluated clinically for probing depth (PD) and relative attachment level (RAL). Results: All the treatment groups were found to be efficacious in the treatment of periodontal disease as demonstrated by improvement in PD and RAL. Conclusion: Combination of SRP + CHX chip (Group A) resulted in added benefits compared to the other two treatment groups.

Recombinant human platelet-derived growth factor-BB: a promising role for fibroblast cell attachment in chronic periodontitis. A concentration-dependent effect on human cell adhesion: SEM study / Fator recombinante de crescimento-BB derivado de plaquetas humanas: um papel promissor para inserção de fibroblastos na periodontite crônica. Efeito dependente da concentração na adesão de células humanas: estudo com microscopia eletrônica

OBJECTIVE: The present study is aimed to test minimum threshold rhPDGF-BB concentration required to obtain greater root surface biocompatibility and most suitable condition for fibroblast cell attachment and growth in chronic periodontitis. MATERIAL AND METHOD: Proximal surfaces of twenty selected periodontitis teeth were prepared and divided into four groups (ten specimens/each): - I: untreated diseased (control); II: scaling & root planning (SRP); III: SRP then rhPDGF-BB application (50ng/ml); IV: SRP then rhPDGF-BB application (25ng/ml). Fibroblasts were pooled on root specimens, then specimens were incubated. Results of both cell count and shape were assessed by SEM and evaluated repeatedly within a representative standard area. RESULTS: Group II: showed a comparable negative effect, since no significant differences found.Group III: showed a significant positive effect, higher than both groups I & II but lower than group IV. Group IV: demonstrated the best results for cell quantity & quality, where it had favorable significant differences when compared to all others. CONCLUSION: rhPDGF-BB with 25ng/ml concentration showed a more positive effect in getting higher fibroblast cell count & more healthy cell shape than rhPDGF-BB (50ng/ml). A promising role of rhPDGF-BB (25ng/ml) as good modulating agent for fibroblast cell attachment in chronic periodontitis may be suggested.

OBJETIVO: O presente estudo objetivou testar o limite de concentração rhPDGF-BB requerido para obter maior biocompatibilidade com a superfície da raiz e a condição mais adequada para a inserção das células fibroblásticas e crescimento na periodontite crônica . MATERIAL E MÉTODO: Superfícies proximais de 20 dentes com periodontite selecionados foram preparados e divididos em quatro grupos (dez espécimes em cada grupo). I: dentes não tratados (controle): II: curetagem e alisamento radicular; III. aplicação de SRP seguido de rhPDGF (40ng/ml); aplicação de IV: SRP seguido de rh PDGF-BB. Os fibroblastos foram semeados em espécimes radiculares, seguindo-se incubação dos espécimes. Os resultados da contagem celular e forma foram observados pela SEM e avaliados repetidamente dentre de área padrão representativa. RESULTADOS: O Grupo II demonstrou um efeito negativo comparativamente, uma vez que não ocorreram diferenças significativas. O Grupo III mostrou um efeito positivo significativo, maior do que ambos grupos I e II, porém menor do que o Grupo IV. O Grupo IV mostrou o melhor resultado para a quantidade e qualidade celular, onde apresentou diferenças favoráveis quando comparados com todos os outros. CONCLUSÃO: rhPDGF-BB com 25 ng/ml de concentração demonstrou efeito mais positivo na contagem de fibroblastos e as células apresentaram forma mais sadia do que no rhPDGFBB com 50ng/ml. Sugere-se que o rhPDGF-BB apresenta boas possibilidades como um bom agente modulador para inserção de fibroblastos na periodontite crônica.

Efectos del tratamiento periodontal sobre los marcadores de inflamación sistémica en pacientes con riesgo de enfermedad cardiaca coronaria: Estudio piloto / Effects of periodontal therapy on markers of systemic inflammation in patients with coronary heart disease risk

Background- Studies investigating effects of periodontal treatment (PT) on markers of inflammation in healthy subjects show conflicting results. Few studies have investigated the effects ofPT among subjects with coronary heart disease (CHD) risk factors. Aim: To report the results of a pilot prospective study on the effects of periodontal treatment on markers of inflammation among subjects with CHD risk factors. Material and methods: Seventy three patients aged 53±6 years (25 percent males) with chronic periodontitis, dyslipidemia and other CHD risk factors were subjected to PT consisting on root planning and oral metronidazol and amoxicillin for 7 days. Periodontal clinical parameters, serum C-reactive protein (CRP), fibrinogen levels and erythrocyte sedimentation rate (ESR) were assessed before and at 6 weeks añerPT. Polymorphisms at the ILlA-889 andIL1B+3954genes were also genotyped. Results: After the treatment period, CRP levels significantly increased from 3.6±3.7 mg/ L to 5.4±5.7 mg/L (p =0.001). No significant changes were observed in fibrinogen levels and ESR. Higher post-treatment CRP levels were significantly associated with the composite polymorphic genotype at the ILlA-889 and IL1B+3954 genes (p =0.0001), and extensive periodontitis (p =0.005). Moderate alcohol consumption appeared as a protective factor for CRP elevation (p =0.029). Conclusions: The increase of the CRP levels after PT in patients with CVD risk factors appeared associated with IL-1 gene polymorphisms and extensive periodontitis.