Use of Ionized Monocalcium phosphate and enameline derivatives to reduce dentin hypersensitivity after periondontal therapy / Uso de Fostato Monocálcio y derivados en Enamelina para reducir la hipersensibilidad dentaria después de terapia periodontal

Abstract This study aimed to evaluate the effectiveness of using an ionized monocalcium phosphate and enamelin derivatives (IMP+ED) based mouthwash for the treatment of dentin hypersensitivity (DH) after scaling and root planing (SRP). 47 patients who reported DH after SRP treatment were included in this prospective cohort study. The Schiff Cold Air Sensitivity Scale (SCASS) was applied to classify their degree of pain in mild, moderate or intense at two times: after SRP (T0), and after one month of using a IMP+ED-based mouthwash (T1). The McNemar-Bowker test was used to compare the correlated proportions between both times (p<0.05). After the SRP therapy (T0), all the sample members reported pain distributed in the following manner: 12.8% were mild, 27.6% moderate, and 59.6% intense. At one month since treatment and with the use of the IMP+ED-based mouthwash (T1), the distribution of pain levels changed to 83% mild, 12.8% moderate, and 4.3% intense, this change was statistically significant (p<0.001). IMP+ED-based mouthwash produces a positive effect in reducing painful responses caused by exposure of the dentin tubules to the oral environment after SRP therapy.

Resumen El objetivo de este estudio fue evaluar la efectividad de un enjuague bucal a base de fosfato monocálcico ionizado y derivados de enamelina (FCI+DE) para el tratamiento de hipersensibilidad dentinaria (HD) posterior al tratamiento de raspado y alisado radicular (RAR). 47 pacientes que reportaron tener HD posterior al tratamiento de RAR fueron incluidos en este estudio prospectivo de cohorte. Con el fin de clasificar la HD de los pacientes en leve, moderada o intensa se utilizó la Escala de Sensiblidad al Aire Frío de Schiff (ESAFS). Los pacientes fueron evaluados después del tratamiento de RAR (T0) y posterior al uso de un enjuague bucal basado en FCI+DE (T1). Para comparar las proporciones correlacionadas se utilizó la prueba de McNemar-Bowker (p<0.05). La distribución del dolor de los pacientes posterior al tratamiento de RAR (T0) fue la siguiente: 12.8% fueron leves, 27.6% moderado, and 59.6% intenso. Un mes después del uso del enjuague buccal basado en FCI+DE (T1) la distribución en los niveles de dolor cambio a 83% leve, 12.8% moderado, and 4.3% intenso, este cambio fue estadísticamente significativo (p<0.001). El uso del enjuague bucal basado en FCI+DE produce una reducción significativa a la respuesta de dolor causada por la exposición de la dentina al ambiente oral como consecuencia del tratamiento de RAR.

Avaliação dos efeitos da coenzima Q10 utilizada como coadjuvante local e/ou sistêmica ao tratamento mecânico da periodontite experimental em ratos tratados com nicotina / Evaluation of the effects of coenzyme Q10 as local and/or systemic adjuvant to mechanical treatment of experimental periodontitis in rats treated ith nicotine

O propósito do estudo foi avaliar a efetividade da raspagem e alisamento radicular (RAR) associado à coenzima Q10 (CQ10) administrada localmente e/ou sistemicamente no tratamento da periodontite experimental (PE) em ratos tratados sistemicamente com nicotina (NIC). 128 ratos (Wistar) foram divididos em oito grupos (n=16). Durante todo o período experimental, os animais receberam duas injeções subcutâneas diárias de 3mg/kg de hemissulfato de nicotina ou solução salina (SS) na região dorsal, com 12 horas de intervalo entre elas, começando nos 30 dias que antecederam à indução da PE. Após 15 dias da indução da PE, o protocolo de RAR foi realizado bem como o tratamento coadjuvante local e/ou sistêmico com CQ10, com e sem tratamento com a NIC, sendo: SS-PE-RAR e NIC-PE-RAR: irrigação subgengival com SS; SS-PE-RAR/Q10L e NIC-PE-RAR/Q10L: irrigação subgengival com 1ml solução de CQ10; SS-PE-RAR/Q10S e NIC-PE-RAR/Q10S: gavagem gástrica diária com 120 mg de CQ10; SS-PE-RAR/Q10LS e NIC-PE-RAR/Q10LS: irrigação subgengival com 1ml solução de CQ10 e gavagem gástrica diária com 120 mg de CQ10. As eutanásias foram realizadas 7 e 28 dias após tratamento. As peças coletadas foram processadas com desmineralização para as análises histopatológica, histométrica e imunoistoquímica para detecção de TRAP. Os dados foram submetidos ao teste paramétrico Anova two-way e pós-teste de Tukey. O nível de significância adotado foi de 5% (p≤0,05). Na análise histopatológica, pode-se observar que os grupos NIC-PE-RAR-Q10L E NIC-PE-RAR-Q10LS apresentaram tecidos periodontais com aspecto de normalidade, com preservação da inserção conjuntiva e de região de furca preservada aos 7 e 28 dias, de modo distinto do grupo NIC-PE-RAR e NIC-PE-RAR-Q10S em ambos os períodos. Na análise histométrica, pode-se observar maior porcentagem de osso na furca (POF) (p≤0,05) nos grupos NIC-PE-RAR-Q10L, NIC-PE-RAR-Q10S e NIC-PERAR-Q10LS em comparação com o grupo NIC-PE-RAR em ambos os períodos e também com o grupo SS-PE-RAR aos 28 dias. Pode-se observar menor número de células TRAP positivas (p≤0,05) no grupo NIC-PE-RAR-Q10L quando comparado aos grupos SS-PE-RAR E NIC-PE-RAR aos 7 dias e no grupo NIC-PE-RAR-Q10LS quando comparado aos mesmos grupos aos 28 dias. Conclui-se que RAR associado à CQ10 utilizada local e local/sistemicamente no tratamento da PE em ratos tratados sistemicamente com nicotina foram efetivas mostrando resultados favoráveis nas análises histopatológica, histométrica e imunoistoquímica(AU)

The aim of this study was to evaluate the effectiveness of scaling and root planing (SRP) combined with adjunctive local and/or systemic administration of coenzyme Q10 (CQ10) for the treatment of experimental periodontitis (EP) in rats systemically treated with nicotine (NIC). 128 Wistar rats were divided into 8 groups (n=16). Throughout the experiment, animals received two subcutaneous injections of either 3mg/kg nicotine hemissulfate or physiological saline solution (PSS) with 12 h interval between them. These injections were initiated 30 days prior EP induction. 15 days after EP induction, the protocol for SRP was performed together (or not) with local and/or systemic adjunctive CQ10 administration in animals treat with either NIC or PSS, as described: PSS-EP-SRP and NIC-EP-SRP: subgingival irrigation with PSS; PSS-EP-SRP/Q10L and NIC-EP-SRP/Q10L: subgingival irrigation with 1ml of CQ10 solution; PSS-EP-SRP/Q10S and NIC-EP-SRP/Q10S: daily gastric gavage with 120 mg of CQ10; PSS-EP-SRP/Q10LS and NIC-EP-SRP/Q10LS: subgingival irrigation with 1ml of CQ10 solution and daily gastric gavage with 120 mg of CQ10. The euthanasia was performed at 7 and 28 days after treatment. The specimens were collected and processed for histopathologic, histometric and immunochemical for of TRAP analyzes. The data were submitted to the two-way ANOVA and Tukey's post-test. The level of significance adopted was 5% (p≤0.05). In the histopathological analysis, it can be observed that the NIC-PE-RAR-Q10L and NIC-PE-RAR-Q10LS groups presented periodontal tissues with normal aspect, preserving the conjunctival insertion and furca region preserved at 7 and 28 days, differently from the NIC-PE-RAR and NIC-PE-RAR-Q10S groups in both periods. In histometric analysis, a higher percentage of bone in furca (PBF) (p≤0.05) can be observed in the NIC-PE-RAR-Q10L, NIC-PE-RAR-Q10S and NIC-PE-RAR-Q10LS groups compared to the NIC-PE-RAR group in both periods and also with the SS-PE-RAR group at 28 days. A lower number of TRAPpositive cells (p≤0.05) can be observed in the NIC-PE-RAR-Q10L group when compared to the SS-PE-RAR and NIC-PE-RAR groups at 7 days and in the NIC-PE-RAR-Q10LS group when compared to the same groups at 28 days. It was concluded that RAR associated with CQ10 used locally and locally/systemically in the treatment of EP in rats treated systemically with NIC were effective, showing favorable results in histopathological, histometric and immunohistochemical analyses(AU)

Guía clínica para el tratamiento de lesiones endoperiodontales sin compromiso radicular en pacientes periodontales / Clinical practice guide for the treatment of endoperiodontal lesions without root compromise in periodontal patients

La comunicación patológica entre la pulpa y el pe-riodonto se denomina lesión endoperiodontal. Puede presentarse de forma aguda o crónica, y su mani-festación más común es la presencia de un absceso acompañado de dolor. Es importante realizar una detenida evaluación clínica y radiográfica para esta-blecer un correcto diagnóstico y plan de tratamiento. Por este motivo, el objetivo de esta guía es presentar un protocolo consensuado entre las Cátedras de Pe-riodoncia y Endodoncia de la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA), para su tratamiento (AU)

The pathological communication between the pulp and the periodontium is called Endoperiodontal Lesion. It can be presented in an acutely or chronically form and its most common manifestation is the presence of an abscess accompanied by pain. It is important to carry out a careful clinical and radiographic evaluation to establish a correct diagnosis, prognosis, and treatment plan. For this reason, the objective of this guide is to present a consensus protocol between Periodontics and Endodontics Departments of the Faculty of Dentistry of the University of Buenos Aires (FOUBA) for their treatment (AU)

Comparação entre as técnicas de raspagem e alisamento radicular e desbridamento ultrassônico no protocolo de desinfecção de boca toda: relato de caso / Comparison between scaling and root planing and ultrasonic debridement techniques in the full mouth disinfection protocol: case report

O tratamento periodontal consiste na remoção do biofilme patogênico, através da raspagem e alisamento radicular. O desbridamento ultrassônico de boca toda promove uma instrumentação mais conservadora, porém eficiente da superfície radicular, em sessão única. Evitando a translocação bacteriana de uma região tratada para outra que já foi. O objetivo do presente trabalho foi realizar uma comparação entre a eficácia da raspagem manual e a ultrassônica dentro do protocolo da FMD, através de um relato de caso clínico. Houve uma melhora nos parâmetros clínicos periodontais em todos os quadrantes, porém resultados superiores foram observados com o desbridamento com ultrassom e irrigação com clorexidina. A instrumentação com ultrassom associada a clorexidina no tratamento da periodontite estágio III grau C generalizada, reduz com eficácia o tempo de tratamento, otimizando o tempo do paciente e profissional(AU)

Periodontal treatment consists of removing the pathogenic biofilm, by scaling and root planing. Ultrasonic debridement of the entire mouth promotes more conservative, yet efficient instrumentation of the root surface, in a single session. Avoiding bacterial translocation from one treated region to another that has already been. The objective of the present study was to make a comparison between the effectiveness of manual and ultrasonic scraping within the FMD protocol, through a clinical case report. There was an improvement in periodontal clinical parameters in all quadrants, but superior results were observed with debridement with ultrasound and irrigation with chlorhexidine. Instrumentation with ultrasound associated with chlorhexidine in the treatment of generalized stage III grade C periodontitis, effectively reduces treatment time, optimizing patient and professional time(AU)

Efeito do tratamento periodontal não cirúrgico em pacientes portadores de periodontite e hipertensão arterial refratária / Effect of non-surgical periodontal treatment in patients with periodontitis and refractory arterial hypertension

Objetivo: O objetivo do presente estudo clínico foi de avaliar o efeito do tratamento periodontal não cirúrgico, nos parâmetros clínicos periodontais, na pressão arterial sistêmica, nos níveis plasmáticos de marcadores de inflamação sistêmica em pacientes com hipertensão arterial refratária e periodontite. Métodos: Vinte e sete participantes com hipertensão arterial refratária e periodontite foram incluídos e receberam o tratamento periodontal não cirúrgico e orientação de higiene bucal. Os parâmetros clínicos analisados foram profundidade de sondagem (PS), nível de inserção clínica (NIC), sangramento à sondagem (SS), índice de placa (IP). Foram avaliados a pressão arterial sistêmica, hemograma completo, coagulograma, dosagem de creatinina, proteína C reativa (PCR), hemoglobina glicada, dosagem do colesterol, transaminase glutâmica oxalacética (TGO) e transaminase glutâmica pirúvica (TGP). Foram obtidas as médias de cintura/quadril e índice de massa corporal (IMC). Todas as análises foram obtidas antes do tratamento, 90 e 180 dias após. Os dados obtidos foram analisados estatisticamente (α=5%). Resultados: Vinte e dois participantes foram incluídos nas reavaliações. Os resultados clínicos mostraram que a melhora das porcentagens de IPV, SS, PS≤4mm, PS≥5mm e NIC≤3mm foram estatisticamente significantes aos 90 e 180 dias após o tratamento (p<0,05). O tratamento periodontal reduziu significativamente o nível sanguíneo de PCR (p< 0,02). Não houve redução significante nos parâmetros da pressão arterial, nos períodos avaliados. Conclusão: Os resultados do presente estudo demonstraram que o tratamento periodontal não cirúrgico promoveu melhoras nos parâmetros clínicos periodontais e redução do nível plasmático de PCR em pacientes hipertensos refratários com periodontite estágios III e IV, no entanto não foi capaz de promover redução dos valores da pressão arterial sistêmica(AU)

Objective: The aim of this clinical study was to evaluate the effect of non-surgical periodontal treatment in periodontal clinical parameters on systemic blood pressure and plasma levels of systemic inflammation markers in patients with refractory hypertension and periodontitis. Methods: Twenty-seven participants with refractory hypertension and periodontitis were included and received non-surgical periodontal treatment and oral hygiene guidance. The clinical parameters analyzed were probing depth (PD), clinical attachment level (CAL), probing bleeding (PB), plaque index (PI). Systemic blood pressure, complete blood count, coagulogram, creatinine dosage, C-reactive protein (CRP), glycated hemoglobin, cholesterol dosage, glutamic oxaloacetic transaminase (GOT) and glutamic pyruvic transaminase (GPT) were evaluated. Mean waist/hip and body mass index (BMI) were obtained. All analyzes were obtained before treatment, 90 and 180 days later. The data obtained were analyzed statistically (α5%). Results: Twenty-two participants were included in the revaluations. The clinical results showed that the improvement in the percentages of PI, BOP, PD≤4mm, PD≥5mm and CAL≤3mm were statistically significant at 90 and 180 days after treatment (p<0.05). Periodontal treatment significantly reduced the blood level of CRP (p<0.02). There was no significant reduction in blood pressure parameters in the evaluated periods. Conclusion: The results of the present study demonstrated that the non-surgical periodontal treatment promoted improvements in clinical periodontal parameters and a reduction in the plasma level of CRP in refractory hypertensive patients with stage III and IV periodontitis, however it was not able to promote a reduction in pressure values systemic arterial(AU)

Resin Nano-Ceramic Material Surface Roughness, Color Stability, and Bacterial Adhesion Evaluation After Different Scaling Methods / Rugosidade superficial, estabilidade de cor e adesão bacteriana de resina nano-cerâmica após diferentes métodos de raspagem

Objective: TThe study evaluated in vitro the changes in roughness, color stability, and bacterial count of a CAD/CAM Resin Nano-Ceramic material surface treated by various scaling procedures. Material and Methods: 70 disks (5mm diameter, 0.5 mm thickness) of Resin Nano-Ceramic (Lava ™Ultimate, 3M, ESPE) material were cemented in standardized cavities prepared in bovine teeth. A custom-made scaling apparatus of a double pan balance was used for different scaling methods, simulating standard clinical conditions. The specimens were assigned to three main groups: no scaling(C), ultrasonic scaling (U), and manual scaling (M). Each group was then divided into three subgroups according to scaling tip material; stainless steel tip (St), plastic tip (P), and titanium tip (Ti). The surface texture was analyzed quantitatively and qualitatively with a tactile profilometer and atomic force microscopy. A spectrophotometer was used for color measurement. Streptococcus mutans were counted in a colony counter. All the data were tabulated and statistically analyzed. Results: Two-way ANOVA was used to study the effect while One-way ANOVA was performed to compare between study groups. The significance level was set at p ≤ 0.05. The ultrasonic titanium tip(UTi) revealed the significant highest mean value of alterations (p < 0.001). The integrity of the material surface was altered in the form of deep scratches on the ultrasonically scaled surfaces and numerous smaller scratches on the hand-scaled surfaces. Conclusion: The plastic instrument would appear to be the instrument of choice during a routine maintenance procedure for Resin Nano-Ceramic materials (AU).

Objetivo: Este estudo avaliou in vitro as alterações na rugosidade, estabilidade de cor e quantidade de bactérias da superfície de uma resina nano-cerâmica produzida em CAD/CAM tratada por diferentes procedimentos de raspagem. Material e Métodos: 70 discos (5 mm diâmetro, 0,5 espessura) de resina nano-cerâmica (Lava ™Ultimate, 3M, ESPE) foram cimentadas em cavidades padronizadas preparadas em dentes bovinos. Um aparato customizado de raspagem com pratos duplos de balança foram usados para os diferentes métodos de raspagem, simulando uma condição clínica padronizada. Os espécimes foram distribuídos em três principais grupos: Sem raspagem (C), raspagem ultrassônica (U) e raspagem manual (M). Cada grupo foi dividido em três subgrupos de acordo com a ponta do material de raspagem; ponta de aço inoxidável (St), ponta plástica (P), ponta de titânio (Ti). A textura da superfície foi analisada qualitativamente e quantitativamente por um perfilômetro tátil e microscopia de força atômica. Um espectrofotometro foi usado para a mensuração da cor. Estreptococos mutans foram contados em um contador de colônias. Todos os dados foram tabulados e analisados estatisticamente. Resultados: Anova dois fatores foi utilizado para estudar os efeitos, enquanto ANOVA um fator foi utilizado para comparar os grupos experimentais. O nível de significância foi estabelecido em p≤ 0,05. A ponta de ultrassom de titânio (UTi) revelou o valor significante mais alto de alterações (p < 0,001). A integridade da superfície d matérias foi alterada na forma ranhuras profundas, nas superfícies raspada por ultrassom e numerosas ranhuras menores nas superfícies raspadas à mão. Conclusão: O instrumento plástico poderia apresentar-se como um instrumento de escolha durante o pocedimento de manutenção routineira para materiais de resina nano-ceramica. (AU)

An in vitro evaluation of surface roughness, color stability and bacterial accumulation of lithium disilicate ceramic after prophylactic periodontal treatment / Avaliação in vitro da rugosidade superficial, estabilidade de cor e acúmulo bacteriano em cerâmica de dissilicato de lítio após tratamento de profilaxia periodontal

Objective: To evaluate the effect of scaling procedures using different ultrasonic tips on the surface roughness, color stability and bacterial accumulation of lithium disilicate ceramic. Material and Methods: Scaling procedure was carried out using ultrasonic scaler (Satalec, Acteon, North America) with stainless-steel tip (US), titanium tip (UT) and plastic tip (UP), on disc shaped lithium disilicate samples cemented into a cavity prepared onto the labial surface of freshly extracted bovine teeth (10 samples per group). The samples were stored in coffee solution in an incubator at 37°C for 12 days, which is equivalent to 1 year of coffee consumption. The surface roughness was measured before and after the scaling procedure using a profilometer and atomic force microscopy. The color parameters were measured before and after scaling and staining procedures using VITA Easyshade Advance 4.0 according to the CIE L*a*b* color order system. The samples were then incubated with Streptococcus mutans (S. mutans) suspension. After incubation, the plates with 30 to 300 typical colonies of S. mutans were counted in a colony counter and mean values of colony forming units were obtained (CFU/mL). Results:The titanium scaling tip showed a statistically significant higher mean values of change in surface roughness ΔRa and bacterial count than the plastic scaling tip. Color changes (ΔE) were not a statistically significant among the groups. The results showed a statistically significant positive (direct) correlation between surface roughness and color change (p = 0.012) and also between surface roughness and bacterial count (p = 0.00). Conclusion: Within the limitations of this study, titanium scaling instruments cause irreversible surface alterations of lithium disilcate ceramics which was in direct correlation to the color changes and bacterial accumulation; therefore, dentists should proceed with caution when scaling lithium disilicate surfaces. The findings of the current study may indicate the need for instruments or equipment that can remove plaque and calculus without causing surface damage (AU)

Introdução: Avaliar o efeito de procedimentos de raspagem com diferentes pontas de ultrassom na rugosidade superficial, estabilidade de cor e acúmulo bacteriano em cerâmica de dissilicato de lítio. Material e Métodos: O procedimento de raspagem foi realizado usando um aparelho de ultrassom (Satalec, Acteon, América do Norte) com ponta de aço inoxidável (US), ponta de titânio (UT) e ponta de plástico (UP), em amostras de dissilicato de lítio em forma de disco cimentadas em uma cavidade preparada na superfície vestibular de dentes bovinos recém-extraídos (10 amostras por grupo). As amostras foram armazenadas em solução de café em incubadora a 37 ° C por 12 dias, o que equivale a 1 ano de consumo de café. A rugosidade da superfície foi medida antes e após o procedimento de raspagem usando um perfilômetro e um microscópio de força atômica. Os parâmetros de cor foram medidos antes e depois dos procedimentos de raspagem e armazenagem no café usando VITA Easyshade Advance 4.0 de acordo com o sistema de ordem de cores CIE L*a*b*. As amostras foram incubadas com suspensão de Streptococcus mutans (S. mutans). Após a incubação, as placas com 30 a 300 colônias típicas de S. mutans foram contadas em contador de colônias e obtidos os valores médios das unidades formadoras de colônias (UFC / mL). Resultados: A ponta de titânio mostrou valores estatisticamente maiores de mudança na rugosidade da superfície ΔRa e contagem de bactérias do que a ponta de raspagem de plástico. A mudança de cor (ΔE) não foi estatisticamente significativa entre os grupos. Os resultados mostraram uma correlação positiva (direta) estatisticamente significativa entre rugosidade superficial e alteração de cor (p = 0,012) e também entre rugosidade superficial e contagem bacteriana (p = 0,00). Conclusão: Dentro das limitações deste estudo, os instrumentos de raspagem de titânio causam alterações irreversíveis na superfície das cerâmicas de dissilicato de lítio que estão em correlação direta com as mudanças de cor e o acúmulo de bactérias. Portanto, os dentistas devem proceder com cautela ao realizar raspagem em superfícies de dissilicato de lítio. Os resultados deste estudo podem indicar a necessidade de instrumentos ou equipamentos que possam remover a placa e cálculo sem causar danos à superfície. (AU)

Clinical study of periodontal endoscope-assisted subgingival scaling in the treatment of residual pocket / 华西口腔医学杂志

OBJECTIVES@#To compare the treatment effects of periodontal endoscope-assisted and traditional subgingival scaling on residual pockets.@*METHODS@#A total of 13 patients with periodontitis from Dept. of Periodontics, West China Hospital of Stomatology, Sichuan University were recruited. After 4-6 weeks of initial treatment, the residual pockets with a probing depth (PD) of ≥4 mm and attachment loss (AL) of ≥4 mm and bleeding on probing were examined with traditional (control group) and periodontal endoscope-assisted subgingival scaling (endoscopy group) in a randomly controlled split-mouth design. At baseline and 6 weeks and 3 months after treatment, plaque index (PLI), PD, AL, and bleeding index (BI) were measured. Differences in these clinical parameters within and between groups and patient-reported outcomes were compared.@*RESULTS@#A total of the 694 sites of 251 teeth were included in this trial. Both groups showed significant improvement in each periodontal parameters 6 weeks and 3 months after treatment (@*CONCLUSIONS@#Periodontal endoscope-assisted subgingival scaling resulted in better effects than traditional subgingival scaling when the residual pockets were in a single-rooted tooth, with a PD of ≥5 mm but without vertical alveolar bone resorption and furcation involvement.

Efectividad de antimicrobianos en el tratamiento del raspado y alisado radicular en el adulto mayor / Effectiveness of antimicrobials in the treatment of scaling and root planing in the elderly

RESUMEN Introducción: La terapia antimicrobiana después del raspado y alisado radicular en el anciano no ha sido evaluada en la Clínica Estomatológica Provincial Docente "Mártires del Moncada", de Santiago de Cuba. Objetivo: Evaluar la efectividad de la tetraciclina y azitromicina en el tratamiento del raspado y alisado radicular en el adulto mayor. Método: Estudio cuasiexperimental de intervención terapéutica, realizado entre 2018-2019, en 30 pacientes con 60 y más años y con diagnóstico de periodontitis crónica. Se crearon tres grupos con 10 casos mediante el método aleatorio simple. El Grupo 1 tratado con la técnica convencional y los Grupos 2 y 3, después de la técnica, se aplicó una concentración subgingival de tetraciclina y azitromicina respectivamente y la colocación de cemento quirúrgico por siete días. Se emplearon variables como edad, sexo, cuadro clínico, evolución de signos y síntomas al séptimo día, 1 y 3 meses, y efectividad de curación. La validación estadística fue a través de la prueba Chi-cuadrado, con un 95 % de confiabilidad y la efectividad antimicrobiana, mediante el Análisis de Varianza ANOVA. Resultados: Predominio del grupo 65-69 años y sexo femenino, persistencia de inflamación gingival en el 30,0 % del Grupo 1 al tercer mes, disminuyó la profundidad al sondaje y hubo ganancia de inserción clínica, mejorando sus medias en el tiempo. Se logró un 100,0 % de efectividad de curación en los Grupos 2 y 3. Conclusiones: Elevada efectividad de la aplicación tópica subgingival de tetraciclina y azitromicina con cemento quirúrgico, sobre aquellos tratados con raspado y alisado radicular convencional.

ABSTRACT Introduction: Antimicrobial therapy after scaling and root planing treatment in the elderly has not been evaluated at the "Mártires del Moncada" Provincial Teaching Stomatology Clinic in Santiago de Cuba. Objective: To evaluate the effectiveness of tetracycline and azithromycin in the treatment of scaling and root planing in the elderly. Method: Quasi-experimental study of therapeutic intervention, carried out between 2018 and 2019, on 30 patients with the age of 60 and over and diagnosed with chronic periodontitis. Three groups with 10 cases were created using the simple randomized method. Group 1 treated with the conventional technique and groups 2 and 3, after using the same technique, a subgingival concentration of tetracycline and azithromycin was applied respectively and surgical cement placement for 7 days. Variables such as age, sex, clinical picture, evolution of signs and symptoms at the seventh day, 1 and 3 months, and healing effectiveness were used. The statistical validation was through the Chi-square test, with a 95% reliability and the antimicrobial effectiveness, through the Analysis of Variance ANOVA. Results: Predominance of the group age between 65 and 69 years and female sex, persistent gingival inflammation in 30,0 % of group 1 at the third month, decreased the depth of the catheterization and there was a clinical insertion gain, improving their averages in time. A 100.0% healing effectiveness was achieved in groups 2 and 3. Conclusions: High effectiveness of subgingival topical application of tetracycline and azithromycin with surgical cement, over patients treated with conventional scaling and root planing.

Liposomal anesthetic gel for pain control during periodontal therapy in adults: a placebo-controlled RCT

Abstract Periodontal therapy usually requires local anesthesia. If effective, a non-invasive, liposomal anesthetic gel could increase the levels of acceptance of patients in relation to periodontal therapy. Objective: This study investigated the efficacy of liposomal anesthetic gel for pain control during periodontal therapy. Methodology: Forty volunteers with moderate to severe chronic periodontitis were recruited, of which at least three sextants required periodontal therapy. At least one of the selected teeth had one site with a probing depth of ≥4 mm. The volunteers received the following three gels: a placebo, lidocaine/prilocaine (Oraqix®), or a liposomal lidocaine/prilocaine, which were applied to different sextants. Pain frequency was registered during treatment and the volunteers received a digital counter to register any painful or uncomfortable experiences. At the end of each session, the volunteers indicated their pain intensity using rating scales (NRS-101 and VRS-4). The volunteers had their hemodynamic parameters measured by a non-invasive digital monitor. Results: Pain frequency/intensity did not show statistical difference between intervention groups. The tested gels did not interfere with the hemodynamic indices. Dental anxiety, suppuration and probing depth could influence pain during periodontal therapy. Conclusion: Our results suggest limited indications for the use of non-invasive anesthesia when used for scaling and root planing. Intra-pocket anesthetic gel could be a good option for anxious patients, or those who have a fear of needles.

Effect of periodontal treatment in patients with periodontitis and diabetes: systematic review and meta-analysis

Abstract The evidence is inconclusive regarding the effect of periodontal treatment on glycemic control and systemic inflammation in patients with type 2 diabetes (T2D) and periodontitis Objective: To evaluate the effect of scaling and root planing (SRP) on the metabolic control and systemic inflammation of patients with type 2 diabetes (T2D). Methodology: A literature search was conducted using the MEDLINE database via PubMed and the Cochrane Central Register of Controlled Trials, from their oldest records up to July 2018. Only randomized clinical trials (RCT) were considered eligible for evaluating the effect of periodontal treatment on markers of metabolic control [glycated hemoglobin (HbA1C)] and systemic inflammation [C-reactive protein (CRP)] in patients with T2D. The quality of the studies was evaluated using the Cochrane Collaboration risk assessment tool. Meta-analyses were performed for HbA1c and CRP using random effects models. The size of the overall intervention effect was estimated by calculating the weighted average of the differences in means (DM) between the groups in each study. Heterogeneity was assessed using the Q-statistic method (x2 and I²). The level of significance was established at p<0.05. Results: Nine RCT were included. SRP was effective in reducing HbA1c [DM=0.56 (0.36-0.75); p<0.01] and CRP [DM=1.89 (1.70-2.08); p<0.01]. No heterogeneity was detected (I2=0%, p>0.05). Conclusions: SRP has an impact on metabolic control and reduction of systemic inflammation of patients with T2D.

Referral pattern of periodontal disease among general dental practitioners in Iraq / Padrão de referência da doença periodontal entre os clínicos odontológicos gerais no Iraque

Objectives: To evaluate the type of "periodontal treatment" performed by general dental practitioners and the referral patterns of periodontists in Iraq. Material and methods: A total of 201 general dentists were asked to complete a self-administered questionnaire consisting of nine questions regarding periodontal treatment and the referral patterns of periodontists. Results: The study showed that 91.1% of general dental practitioners (GDPs) performed "phase-I therapy", and most of them done "scaling". Regarding surgical periodontal therapy, only 12.9% of them performed surgical periodontal therapy, half of the GDPs did gingivectomy, and less than 30% performed crown lengthening. When evaluating maintenance therapy after periodontal treatment, it was found that 77.9% of the GDPs scheduled appointments for patients in the maintenance phase, 49.4% of them after one month, 24.7% after three months, and 15.6% after six months. Using TRUF analysis, most general dentists believed that the patient and periodontal factors were responsible for the recurrence of periodontal disease. Conclusions: There is still a lack of awareness of periodontal surgical procedures among the "general dental practitioners". Thus, it is essential to increase the comprehension of periodontal treatment among general dentists. (AU)

Objetivo: Avaliar o tipo de "tratamento periodontal" realizado por dentistas generalistas e os padrões de encaminhamento aos periodontistas, no Iraque. Material e métodos: Um total de 201 dentistas generalistas preencheram um questionário autoaplicável que consistiu em nove perguntas sobre o tratamento periodontal e os padrões de encaminhamento para periodontistas. Resultados: O estudo mostrou que 91,1% dos dentistas gerais (DG) realizavam "terapia fase I" e a maioria realizava "raspagem". Em relação à terapia periodontal cirúrgica, apenas 12,9% deles realizavam, sendo que metade dos DG realizavam gengivectomia e menos de 30% realizavam aumento de coroa clínica. Ao avaliar a terapia de manutenção após o tratamento periodontal, constatou-se que 77,9% dos DGs agendaram consultas para pacientes em fase de manutenção, sendo 49,4% após um mês, 24,7% após três meses e 15,6% após seis meses. Usando a análise TRUF, a maioria dos dentistas gerais acredita que o paciente e os fatores periodontais são responsáveis pela recorrência da doença periodontal. Conclusões: Ainda existe um desconhecimento dos procedimentos cirúrgicos periodontais entre os "dentistas generalistas". Assim, é essencial aumentar a compreensão do tratamento periodontal entre os cirurgiões-dentistas gerais (AU)

Plasma rich in growth factors (PRGF) in non-surgical periodontal therapy: a randomized clinical trial

Abstract The aim of this split mouth, double blinded, randomized clinical trial was to evaluate the clinical efficacy of use of Plasma rich in growth factors (PRGF) as an adjunct to scaling and root planing (SRP) in the treatment of periodontal pockets. Twenty six patients (15 males, 11 females) diagnosed with generalized periodontitis with Pocket Depth > 5mm and plaque index score < 1.5, were randomly allocated by using computer generated random sequence, into two groups, one treated with intra-pocket application of PRGF adjunct to SRP and other with SRP alone. The clinical outcomes like pocket depth (PD), relative attachment level (RAL) and sulcus bleeding index (SBI) were assessed at baseline, 3 months and 6 months. Twenty two patients (44 sites) were analyzed at the end of 6 month follow-up, using SPSS 20.0v software. There was a significant statistical difference observed between both the groups favouring SRP +PRGF group in terms of PD (p = 0.007) and RAL (p = 0.021) at the end of 6 month follow-up. Also there was a statistical significant difference (< 0.001) at all time points compared to baseline, for all parameters in intra-group comparison. Moreover, the sites with PD>4mm necessitating further treatment after 6-month follow-up were significantly lesser for SRP+PRGF group. The use of PRGF technology in non-surgical periodontal therapy, by single intra-pocket application in to periodontal pockets as an adjunct to SRP, in chronic periodontitis patients, was found to be effective in reduction of pocket depth and gain in clinical attachment level.

Efficacy of clarithromycin in the adjuvant treatment of chronic periodontitis: a Meta-analysis / 华西口腔医学杂志

OBJECTIVE@#To evaluate the clinical efficacy of clarithromycin (CLM) in the adjuvant treatment of chronic periodontitis systematically, obtain reasonable conclusions through evidence-based medicine, and provide guidance for clinical rational drug use.@*METHODS@#Literature about CLM in the adjuvant treatment of chronic periodontitis was searched in CNKI, VIP, Wanfang, Chinese Biomedical Literature Database, PubMed, ScienceDirect, and Embase databases from inception to February 2019 using a computer. Meta-analysis was performed on the homogeneous study using RevMan 5.3 software after two independent reviewers screened the literature, evaluated the quality of the study, extracted the data, and evaluated the risk of bias in the included studies.@*RESULTS@#Six randomized controlled trials were included in 316 subjects. The meta-analysis showed that compared with the scaling and root planning (SRP) group, the probing depth (PD) was reduced in patients with CLM and SRP [MD=-1.00, 95%CI (-1.55, -0.45), P=0.000 04]. Clinical attachment loss was obtained [MD=-0.03, 95%CI (0.43, 0.65), P<0.000 01], and the difference between the groups was statistically significant. The modified sulcus bleeding index (mSBI) was reduced [MD=-0.01, 95%CI (-0.14, 0.19), P=0.66]. No significant difference was observed between the groups, but the decrease in mSBI was more significant in CLM combined with SRP group.@*CONCLUSIONS@#CLM combined with subgingival SRP can achieve remarkable results in treating chronic periodontitist.

Effect of scaling and root planing on serum C-reactive protein levels in patients with moderate to severe chronic periodontitis: a systematic review and Meta-analysis / 华西口腔医学杂志

OBJECTIVE@#To evaluate the effect of scaling and root planing (SRP) on serum C-reactive protein (CRP) levels in patients with moderate to severe chronic periodontitis.@*METHODS@#We searched the PubMed, Web of Science, EMBASE, Cochrane, CNKI, Wanfang, and VIP databases from the inception to July 8th, 2019. Two reviewers independently screened literature, extracted data, and evaluated the bias risk of included studies. Then, a meta-analysis was performed using RevMan 5.3 software.@*RESULTS@#A total of 13 randomized controlled clinical trials and 12 prospective clinical trials were included. Meta-analysis showed that serum CRP levels decreased at 2 and 3 months after SRP (P<0.05), and no significant difference in serum CRP levels was found at 6 months (P=0.49).@*CONCLUSIONS@#SRP can reduce serum CRP levels in systematically healthy patients with moderate to severe chronic periodontitis at 2 and 3 months after SRP.

Efficacy of periodontal endoscope-assisted non-surgical treatment for severe and generalized periodontitis / 华西口腔医学杂志

OBJECTIVE@#To evaluate the effectiveness of periodontal endoscope as an adjuvant therapy for the non-surgical periodontal treatment of patients with severe and generalized periodontitis.@*METHODS@#Patients (n=13) were divided into three groups: patients treated with conventional subgingival scaling and root planing (SRP) (n=7, 408 sites) (group A), SRP using periodontal endoscope (n=4, 188 sites) (group B) or SRP with periodontal endoscope 3 months after initial SRP (n=2, 142 sites) (group C). Two subgroups were divided into 2 subgroups according to PD at the baseline: 46 mm as subgroup 2. Probing depth (PD), attachment loss (AL), gingival recession (GR) and bleeding on probing (BOP) were recorded.@*RESULTS@#The results of 3 months after treatment showed all PD, AL, and GR values in group A1 were less than those in group B1 (P6 mm, the application of periodontal endoscopy can increase the effect, reducing PD and GR, which may be an effective supplement to the current non-surgical periodontal treatment.

Ultrasound subgingival scaling combined with manual root planing for treatment of chronic periodontitis in elderly patients / 南方医科大学学报

OBJECTIVE@#To evaluate the clinical efficacy of ultrasound subgingival scaling combined with manual root planing for treatment of chronic periodontitis in elderly patients.@*METHODS@#Forty elderly patients with chronic periodontitis were randomly divided into test group for treatment with ultrasound and Gracey subgingival curette for subgingival scaling combined with manual root planing and control group treated with ultrasound subgingival curette scaling (=20). We compared plaque index (PLI), bleeding index (BI), probing depth (PD), and attachment loss (AL) between the two groups before and at 6 weeks and 12 weeks after the treatment.@*RESULTS@#After periodontal treatment, PLI, BI, PD and AL all decreased significantly in both groups compared with the levels before the treatment ( < 0.05). The patients in the test group showed significantly more obvious decrease of PD and AL than those in the control group ( < 0.05), but the reduction of PLI and BI was comparable between the two groups (>0.05).@*CONCLUSIONS@#Ultrasound subgingival scaling combined with manual root planing produces better therapeutic effect than ultrasonic subgingival scaling alone for treatment of chronic periodontitis in elderly patients.

Clinical outcomes of ultrasonic subgingival debridement combined with manual root planing in severe periodontitis / 北京大学学报(医学版)

OBJECTIVE@#To compare the clinical effects of ultrasonic subgingival debridement and ultrasonic subgingival debridement combined with manual root planing on severe periodontitis and then to investigate the necessity and significance of manual root planing.@*METHODS@#Twenty-three patients with severe periodontitis participated in this split-mouth randomized-controlled clinical trial. Baseline examination and randomization were performed after supragingival scaling: each of the upper and lower jaws had a quadrant as the test group treated with ultrasonic subgingival debridement combined with manual root planing, whereas the other two quadrants were the control group treated with ultrasonic subgingival debridement. Treatment of each patient was at intervals of one week and completed in two visits. Clinical indicators concerning probing depth (PD), clinical attachment loss (CAL) and bleeding index (BI) were recorded at baseline and 1 month, 3 months, 6 months after treatment.@*RESULTS@#There was no significant difference of periodontal indicators between the test group and the control group at baseline. Both the test group and control group resulted in significant improvement of PD, CAL and BI. One and three months after treatment, reduction of PD in the test group was higher than that in the control group [1 month: (2.13±1.31) mm vs. (1.79±1.33) mm, P<0.01; 3 months: (2.46±1.33) mm vs. (2.17±1.38) mm, P<0.01] and reduction of CAL in the test group was higher than that in the control group [1 month: (1.89±2.03) mm vs. (1.65±1.93) mm, P<0.01; 3 months: (2.03±2.05) mm vs. (1.83±1.97) mm, P<0.05]. Six months after treatment, PD in the test group and the control group decreased by (2.52±1.40) mm and (2.35±1.37) mm respectively, and the improvement in the test group was significantly better than that in the control group (P<0.01). CAL in the test group and the control group decreased by (1.89±2.14) mm and (1.77±2.00) mm respectively, and there was no statistical difference between the groups. There was no significant difference in the changes of BI between the two groups 1, 3 and 6 months after treatment.@*CONCLUSION@#Ultrasonic subgingival debridement combined with manual root planing has more reduction in PD and CAL compared with ultrasonic subgingival debridement. Therefore, it is still necessary to use manual instruments for root planing following ultrasonic subgingival debridement.

Clinical and microbiological evaluation of surgical and nonsurgical treatment of aggressive periodontitis

Abstract The present study aimed to evaluate clinical and microbiological effects of surgical and nonsurgical periodontal therapy in generalized aggressive periodontitis (GAgP) treatment. Sixteen GAgP patients were included in this randomized split-mouth design clinical trial. Maxillary quadrants were allocated into two groups: Nonsurgical Therapy (NST) and Surgical Therapy (ST). The following clinical parameters were assessed: plaque index (PI), bleeding on probing index (BoP), probing depth (PD), clinical attachment level (CAL) and gingival margin position (GMP). Concentrations of Porphyromonas gingivalis (Pg) and Aggregatibacter actinomycetemcomitans (Aa) in the subgingival biofilm were also determined. Clinical and microbiological parameters were assessed at baseline (n=16), 3 (n=15), 6 (n=15) and 12 months (n=8) after treatment. ST was able to promote higher PD reduction compared to NST in deep pockets at 12 months (p<0.05) and in posterior teeth at 6 months (p<0.05). In addition, higher gingival recession was observed in posterior teeth of the ST group at the 6th month (p<0.05). However, ST failed to promoted additional CAL gain in any timepoint (p>0.05). Moreover, microbiological evaluation showed no statistical difference in levels of Aa and Pg for both groups at all follow-up periods. Surgical therapy promoted similar clinical benefits to GAgP therapy. Moreover, both therapies failed to reduce Aa and Pg levels at different follow-up times.

Resumo O presente estudo teve como objetivo avaliar os efeitos clínicos e microbiológicos de terapia periodontal cirúrgica e não cirúrgica no tratamento da periodontite agressiva generalizada (PAgG). Dezesseis pacientes portadores de PAgG foram incluídos neste estudo clínico, prospectivo, randomizado, de boca dividida. Os quadrantes superiores de cada paciente foram alocados em dois grupos: um grupo de terapia não-cirúrgica (NST) e um grupo de terapia cirúrgica (ST). Os parâmetros clínicos avaliados foram: índice de placa (PI), sangramento à sondagem índice (BoP), profundidade de sondagem (PD), nível clínico de inserção (CAL) e posição da margem gengival (GMP). Também foram determinadas as concentrações de Porphyromonas gingivalis (Pg) e Aggregatibacter actinomycetemcomitans (Aa) no biofilme subgengival. Os parâmetros clínicos e microbiológicos foram avaliados no início, 3, 6 e 12 meses após o tratamento. A terapia cirúrgica foi capaz de promover maior redução de PD em comparação com NST em bolsas profundas aos 12 meses (p<0,05) e em dentes posteriores aos 6 meses (p<0,05). Além disso, houve maior recessão gengival nos dentes posteriores do grupo ST no 6° mês (p<0,05). Entretanto, ST não promoveu ganho adicionais de inserção (CAL) em nenhum período do avaliação. A avaliação microbiológica não mostrou diferença estatística nos níveis de Aa e Pg, para ambos os grupos, em todos os períodos de acompanhamento. O tratamento cirúrgico promoveu benefícios clínicos similares ao tratamento não cirúrgico em pacientes com PAgG. Além disso, ambas as terapias não conseguiram reduzir os níveis Aa e Pg após terapia.