Periodontitis en niños sanos de 3 años: dos casos con seguimiento a 5 años / Periodontitis in healthy 3-year-old children: two cases with 5-year follow-up

Objetivo: La periodontitis en dentición primaria es ex- cepcional en niños sin enfermedades sistémicas. El objetivo de este informe es describir las características clínicas y ra- diográficas de dos casos de niños de 3 años sistémicamente sanos con periodontitis, y su tratamiento con seguimiento a 5 años. Casos clínicos: En ambos casos, a los 3 años de edad los niños fueron derivados al especialista en periodoncia por su odontopediatra debido a la pérdida muy temprana de inci- sivos inferiores. El examen clínico y radiográfico mostró pér- dida de inserción clínica, pérdida ósea y movilidad dental en otros incisivos superiores e inferiores. Se realizó la intercon- sulta médica y se descartó que los niños padecieran enferme- dades relacionadas con el diagnóstico de periodontitis como manifestación de una enfermedad sistémica. El tratamiento consistió en la instrucción de medidas de higiene bucal que debían ser ejecutadas por los padres, ins- trumentación subgingival, antisépticos locales, medicación antibiótica sistémica y mantenimiento periodontal. No se rea- lizaron extracciones como parte del tratamiento. En ambos casos uno de los incisivos presentes al momento de la con- sulta se perdió prematuramente, antes de los 4 años. El resto de los incisivos primarios cumplieron su ciclo normal. Luego de 5 años de seguimiento, a la edad de 8 años, ambos niños presentaban los incisivos y los primeros molares permanentes periodontalmente sanos y el resto de los dientes primarios sin signos de periodontitis (AU)

Aim: Periodontitis in primary dentition is exceptional in children without systemic diseases. The objective of this article is to describe the clinical and radiographic charac- teristics of two cases of systemically healthy 3-year-old chil- dren with periodontitis, and their treatment, with a 5-year follow-up. Clinical cases: In both cases, at 3 years of age, the chil- dren were referred to a periodontic specialist by their pediat- ric dentist, due to the very early loss of lower incisors. Clin- ical and radiographic examination showed loss of clinical attachment, bone loss and dental mobility in other upper and lower incisors. A medical consultation was carried out and diseases related to the diagnosis of periodontitis as a mani- festation of a systemic disease were ruled out. The treatment consisted of instruction on oral hygiene measures that had to be carried out by the parents, subgingival instrumentation, local antiseptics, systemic antibiotic medication, and perio- dontal maintenance. No extractions were performed as part of the treatment. In both cases, one of the incisors present at the time of consultation was lost prematurely, before the age of 4 years. The rest of the primary incisors completed their normal cycle. After 5 years of follow-up, at the age of 8 years, both children showed periodontally healthy incisors and first permanent molars, and the rest of the primary teeth without signs of periodontitis (AU)

Efectividad clínica y radiográfica de las estatinas en el tratamiento de la periodontitis / Clinical and radiographic effectiveness of statins in the treatment of periodontitis

Introducción: La enfermedad periodontal es un padecimiento inflamatorio, infeccioso y multifactorial crónico, caracterizado por la inflamación de los tejidos blandos periodontales. En estadios avanzados (periodontitis), produce la destrucción progresiva de los tejidos duros periodontales, lo que conduce a la posterior pérdida de dientes, si esta no es tratada. Objetivo: Determinar la efectividad clínica y radiográfica de las estatinas en el tratamiento de la periodontitis. Métodos: Se realizó una búsqueda de la literatura hasta abril del 2019, en las bases de datos biomé dicas: PubMed, Embase, SciELO, Science Direct, Scopus, Sistema de información sobre literatura gris en Europa, Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Google Académico y el Registro Central de Ensayos Clínicos Cochrane. Se definieron como criterios de selección de los estudios que fueran ensayos clínicos aleatorizados, con una antigüedad máxima de cinco años y que reportaran los efectos clínicos y radiográficos (profundidad al sondaje, nivel de inserción clínica, índice de placa, índice de sangrado, índice gingival, defecto intraóseo y profundidad del defecto) de las estatinas en el tratamiento de la periodontitis. Se analizó el riesgo de sesgo de los estudios por el Manual Cochrane de revisiones sistemáticas de intervenciones. Resultados: La estrategia de búsqueda arrojó 19 artículos, de los cuales el 100 por ciento reportó que había diferencia en la profundidad al sondaje, nivel de inserción clínica, índice de placa, índice de sangrado, índice gingival, defecto intraóseo y profundidad del defecto de las estatinas en el tratamiento de la periodontitis. Conclusiones: La literatura revisada sugiere que el uso de estatinas es efectivo, clínica y radiográficamente, en el tratamiento de la periodontitis(AU)

Introduction: Periodontal disease is a chronic multifactorial infectious inflammatory condition characterized by inflammation of soft periodontal tissue. In advanced stages (periodontitis) it causes progressive destruction of hard periodontal tissue, leading to eventual tooth loss if not treated. Objective: Determine the clinical and radiographic effectiveness of statins in the treatment of periodontitis. Methods: A search was carried out in the literature published until April 2019 in the biomedical databases PubMed, Embase, SciELO, Science Direct, Scopus, System for Information on Gray Literature in Europe, Latin American and Caribbean Health Sciences Literature, Google Scholar, and Cochrane Central Register of Clinical Trials. The following selection criteria were defined for the studies: randomized clinical trials published in the last five years and reporting on clinical and radiographic effects (probing depth, clinical insertion level, plaque index, bleeding index, gingival index, intraosseous defect and defect depth) of statins in the treatment of periodontitis. Bias risk analysis was based on the Cochrane manual of systematic reviews of interventions. Results: A total 19 papers were retrieved, of which 100 percent reported differences in the probing depth, clinical insertion level, plaque index, bleeding index, gingival index, intraosseous defect and defect depth of statins in the treatment of periodontitis. Conclusions: The literature review conducted suggests that the use of statins is clinically and radiographically effective in the treatment of periodontitis(AU)

Low level laser therapy as adjunctive support in implant dentistry: a reliable option? / Terapia láser de baja potencia como apoyo complementario en la implantología: ¿una opción fiable?

Use of low level laser therapy (LLLT) in bone healing has been studied for years, and its application in implant dentistry is still a controversial topic due to the difficult assessment of its clinical efficacy. We report the application of LLLT as aid in the osseointegration in two patients undergone to implant surgery in the upper jaw. In one hemi-arch the LLLT was applied and the other one was used as control. The assessment of the bone area surrounding the fixtures was performed by means of cone beam compute tomography and the area of bone-implants contact was measured by means of InVesalius® software. The radiological findings support the idea of considering the laser biostimulation as an adjunctive aid in implant surgery.

El uso de la terapia con láser de baja potencia (LLLT) en la reparación ósea se ha estudiado durante años y su aplicación en la implantología sigue siendo un tema controvertido, debido a la difícil evaluación de su eficacia clínica. Reportamos la aplicación de LLLT como ayuda en la osteointegración en dos pacientes sometidos a cirugía de implantes en el maxilar superior. En un hemi-arco se aplicó la LLLT y en el otro se utilizó como control. La evaluación del área ósea que rodea a las fijaciones se realizó mediante tomografía computarizada Cone Beam y el área de contacto hueso-implantes se midió mediante el software InVesalius®. Los hallazgos radiológicos apoyan la idea de considerar la bioestimulación con láser como un coadyuvante en la cirugía de implantes.

The accuracy of linear measurements in cone beam computed tomography for assessing intrabony and furcation defects: a systematic review and meta-analysis / La precisión de las mediciones lineales en la tomografía computarizada de haz cónico para evaluar defectos intraóseos y de furcación: una revisión sistemática y un metanálisis

Objective: This study aims to assess the accuracy of the linear measurements of intrabony and/or furcation defect quantified by cone beam computed tomography (CBCT). Material and Methods: A systematic search of the literature was conducted by two authors independently from the PubMed, Scopus, and EBSCO for full articles published in journals between January 2003 and March 2017. Eligible studies were assessed for quality and heterogeneity using the QUADAS-2 tool. A meta-analysis was performed to identify the accuracy of CBCT in the measurement of intrabony defects. The effect size was estimated and reported as the standardised mean difference (SMD). Results: A total of 105 titles and abstracts were screened. Of those, 11 articles met the inclusion criteria for the systematic review while only four were selected for meta-analysis. The overall effects of standardized mean difference and 95% CI was -0.03 [95% CI -0.67 to 0.60] with a x2 statistic of 0.49 with 3 degrees of freedom (p>0.05), I2= 0.01%. Conclusion: CBCT is highly accurate and reproducible regarding linear measurements for assessing intrabony defects with a weighted standardized mean difference of 0.03 mm. More randomised controlled trials are required to assess the accuracy of CBCT in assessing patients with periodontal defects.

Objetivo: Este estudio tiene como objetivo evaluar la precisión de las mediciones lineales de defectos intraóseos y/o de furcación cuantificados por tomografía computarizada de haz cónico (CBCT). Material y Métodos: Dos autores, independientemente realizaron una búsqueda sistemática de la literatura en PubMed, Scopus y EBSCO, para obtener artículos completos publicados en revistas entre Enero de 2003 y Marzo de 2017. Los estudios elegibles se evaluaron para determinar la calidad y la heterogeneidad utilizando la herramienta QUADAS-2. Se realizó un metanálisis para identificar la precisión de CBCT en la medición de defectos intraóseos. El tamaño del efecto se estimó y se informó como la diferencia de medias estandarizada (DME). Resultados: Se seleccionaron un total de 105 títulos y resúmenes. De ellos, 11 artículos cumplieron con los criterios de inclusión para la revisión sistemática, mientras que solo cuatro fueron seleccionados para el metanálisis. Los efectos generales de la diferencia de medias estandarizada y el IC del 95% fueron -0.03 [IC del 95%: -0.67 a 0.60] con una estadística X2 de 0.49 con 3 grados de libertad (p>0.05), I2= 0.01%. Conclusión: CBCT es altamente preciso y reproducible con respecto a mediciones lineales para evaluar defectos intraóseos con una diferencia de medias estandarizada ponderada de 0.03 mm. Se requieren más ensayos controlados aleatorios para evaluar la precisión de CBCT en la evaluación de pacientes con defectos periodontales.

The role of visfatin levels in gingival crevicular fluid as a potential biomarker in the relationship between obesity and periodontal disease

Abstract Objectives Visfatin is an adipokine that plays an important role in immune functions as a growth factor, enzyme, and pro-inflammatory mediator. We aimed to determine the levels of visfatin, interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in gingival crevicular fluid (GCF) in both obese/non-obese patients, with/without generalized chronic periodontitis (GCP). Methodology Patients were categorized as obese (O) (n=31) or non-obese (nO) (n=19). Groups were divided into four subgroups according to periodontal conditions: (1) periodontally healthy without obesity (nO-Ctrl); (2) GCP without obesity (nO-CP); (3) periodontally healthy with obesity (O-Ctrl); and (4) GCP with obesity (O-CP). Demographic variables, anthropometric and laboratory data were recorded. Periodontal parameters were measured at baseline and 3rd months after either non-surgical periodontal treatment or calorie -restricted diet therapy. At the same time, GCF samples were taken from patients to analyze TNF-alpha, IL-6,and visfatin levels. Results Periodontal parameters were significantly higher in the O group than in the nO group (P<0.05). IL-6 levels were higher in the O group than in the nO group (P<0.001). The visfatin levels of the obese patients were reduceddecreased following the treatments (P<0.05). Cholesterol levels were higher in the O group than in the nO groups (P<0.05). IL-6 levels were higher in O-CP and O-Ctrl groups than in the nO-Ctrl group (P<0.05). Compared to the other groups, visfatin levels were significantly higher in the O-CP group but decreased following treatment (P<0.05). Conclusions Our findings suggest that visfatin and IL-6 levels in GCF are associated with the pathogenesis of obesity and periodontitis. Within the limits of this study, we considered that there might be an association between the lipid profile and periodontitis on systemically healthy individuals.

Agreement, correlation, and kinetics of the alveolar bone-loss measurement methodologies in a ligature-induced periodontitis animal model

Abstract Periodontal research involves the use of animal models to better understand the biological processes of periodontal diseases and the potential of new or existing therapies. Currently, ligature-induced periodontitis in rats is the main model used in periodontal research, in this model, alveolar bone loss (ABL) is the main parameter evaluated by radiographic, morphometric, and histological techniques. Interestingly, although these methodologies are widely used, it is not totally clarified neither the kinetics of ABL over the induction time nor the agreement degree (repeatability and reproducibility) of these techniques. Objective: To characterize ABL kinetics at 0, 3, 7, 15, 30, and 60 days after ABL induction by ligature and to evaluate the intra- (repeatability) and inter-examiner (reproducibility) agreement and the correlation among the radiographic, morphometric, and histological methodologies. Material and Methods: 60 male Wistar rats with induced ABL were randomly divided into 6 experimental groups (n = 10 animals/group). After 0, 3, 7, 15, 30, and 60 days, the animals were euthanized and their hemimandibles were removed for ABL determination using radiographic, morphometric and histological techniques. Results: Radiographic and morphometric/linear techniques allowed the detection of statistically significant ABL on the third day, while histological and morphometric/area techniques could only detect ABL after the seventh day (ANOVA/Tukey, p<0.05). After the fifteenth day, except for histological analysis, the ABL was stabilized. Concerning the agreement of the methodologies, Bland Altman's test (intra and inter-examiner evaluations) showed no difference among the measurements (p>0.05). In addition, high correlations (Pearson's test, r2>0.9, p<0.05) were observed. Conclusion: The results indicated that the minimum time for ABL induction could vary from 3 to 7 days, according to the chosen analysis methodology. Agreement and correlation data support the comparison of results between studies with same induction time.

Treatment of experimental periodontal disease by laser therapy in simvastatin-modified rats

Abstract Low intensity laser can be used as a promising alternative in the treatment of periodontal disease. Objective The aim of this study was to evaluate low-level laser therapy (LLLT) as an adjuvant treatment for scaling and root planing (SRP) for the treatment of induced periodontitis in simvastatin-modified rats. Material and Methods A total of 180 rats were evenly divided into two groups: Veh - receiving oral administration of polyethylene glycol (vehicle); S - receiving oral administration of Simvastatin. Periodontal disease was induced in both groups at the first mandibular molar. After seven days, the ligature was removed and the animals were divided into subgroups according to the following local treatments: NT - no treatment; SRP - scaling and root planing and irrigation with saline solution; and LLLT ¬- SRP and laser irradiation (660 nm; 0.03 W; 4 J). Ten animals in each subgroup/local treatment were euthanized at 7, 15 and 30 days. Samples of gingival tissue were processed to analyze the tissue oxidative damage and radiographic analysis. Levels of oxidative stress were analyzed by the expressions of Tripeptideglutathione (TG), Malondialdehyde (MDA) and Carbonylated Proteins (CP). Results The animals in S group had higher levels of TG and lower levels of MDA and CP compared with Veh group (p<0.05). Radiographically, in the intragroup analysis Veh and S, LLLT showed lower bone loss (BL) compared with NT and SRP, in all experimental periods (p<0.01). In addition, a lower BL was observed for the animals of Veh group treated with LLLT compared with treatment SRP in the S group, in all experimental periods. Conclusion Within the limits of this study, we can conclude that LLLT was effective as adjuvant treatment for SRP protecting against the occurrence of oxidative tissue damages as well as for reducing alveolar bone loss in experimentally induced periodontitis simvastatin-modified rats.

Chemotaxis of neutrophils in patients with localized juvenile and rapidly progressive periodontitis

Neutrophil chemotaxis has been established as significant element in host's response to periodontal disease. In this study evaluation of chemotaxis of 3 groups of subjects [group I [normal controls], group II [LJP patients] and group III [rapidly progressive periodontitis patients]], was done. Chemotaxis assay for each group was done using agarose method, and statistical analysis showed that, there was a statistical significant difference between control group [group I] and each of LJP patients [group II] and rapidly progressive periodontitis patients [group III]. In conclusion, neutrophil chemotaxis can be used as a disease marker in the study of LJP and rapidly progressive periodontitis