Effect of systemic antibiotic and probiotic therapies as adjuvant treatments of subgingival instrumentation for periodontitis: a randomized controlled clinical study

Abstract Objective: This study assessed the efficacy of two adjunct therapies (antibiotic and probiotic) for periodontal treatment based on clinical and immunological parameters in patients with Stage II and III Grade B periodontitis. Methodology: 45 patients were randomly allocated into three groups: control group (CG); antibiotic group (GAtb), in which 500 mg amoxicillin + 400 mg metronidazole were used; and probiotic group (GProb), for which Lactobacillus reuteri was used. Patients received medications after undergoing periodontal debridement. Clinical and immunological parameters were assessed at baseline, 30 days, and 90 days. Results: All therapies reduced bleeding on probing (BoP) in the evaluated periods, and the GAtb had a greater reduction at 90 days (p=0.03). The GProb group showed better results for plaque index (PI) and gingival recession (GR) compared to the GAtb at 90 days (p=0.0014; p=0.006). The area of inflammation (PISA Index) significantly decreased in all therapies in the evaluated periods. Therapies had no significant differences regarding moderate pockets. The GAtb had a greater reduction in probing depth (PD) for deep pockets (p=0.03) at 90 days and in the number of deep pocket sites at 30 days (p=0.04). The occurrence of adverse effects was commonly reported in the GAtb as a percentage per patient. The GAtb had a significant reduction in the concentration of interleukins IL-1β and IL-8 and an increase in IL-10 and TNF-α. The CG had a reduction in IL-6 and IL-1 β, whereas in the GProb there was no difference. Conclusion: After three months, none of the adjuvant therapies provided any additional benefit for subgingival instrumentation.

The influence of LLLT applied on applied on calvarial defect in rats under effect of cigarette smoke

Abstract Objective Considering the global public health problem of smoking, which can negatively influence bone tissue repair, the aim of this study is to analyze the influence of photobiomodulation therapy (PBM) on calvaria defects created surgically in specimens under the effect of cigarette smoke and analyzed with use of histomorphometric and immunohistochemistry techniques. Methodology Calvaria defects 4.1 mm in diameter were surgically created in the calvaria of 90-day-old rats (n=60) that were randomly divided into 4 experimental groups containing 15 animals each: control group (C), smoking group (S), laser group (L), and smoke associated with laser group (S+L). The animals were subjected to surgery for calvaria defects and underwent PBM, being evaluated at 21, 45, and 60 days post-surgery. The specimens were then processed for histomorphometric and immunohistochemistry analyses. The area of bone neoformation (ABN), percentage of bone neoformation (PBNF), and the remaining distance between the edges of the defects (D) were analyzed histometrically. Quantitative analysis of the TRAP immunolabeled cells was also performed. The data were subjected to analysis of variance (ANOVA) in conjunction with Tukey's test to verify the statistical differences between groups (p<0.05). Results The smoking group showed less ABN compared to the other experimental groups in all periods, and it also showed more D at 21 days compared to the remaining groups and at 45 days compared to the laser group. The smoking group showed a lower PNBF compared to the laser group in all experimental periods and compared to smoking combined with LLLT group at 21 days. Conclusions PBM acted on bone biomodulation, thus stimulating new bone formation and compensating for the negative factor of smoking, which can be used as a supportive therapy during bone repair processes.

Chronic kidney disease and periodontal disease. Case report. / Doença renal crônica e tratamento periodontal. Relato de caso

Chronic renal disease promotes a decrease on kidneys filterability and nitrogen products accumulation on blood, electrolyte and system endocrine functions imbalance. Among the many clinical manifestations of chronic renal failure (CRF) in the oral cavity, there are: dry mouth, uremic stomatitis, radiographic changes in maxillary and jaw bones and accumulation of calculus on the teeth that increases levels of periodonto pathogenic microorganisms able to lead a periodontal tissue destruction and also have the potential to act from a distance on other organs, e.g. the kidneys. Thus, it becomes evident that a periodontal treatment of patients suffering from chronic renal failure is crucial for maintaining their general health conditions and a subsequent successful organ transplant.Thus, the objectives of this case report were to highlight how important the periodontal treatment is for chronic renal failure patients and to demonstrate improvements in their clinical condition through the treatment plan proposed herein. A patient with 43 years old carrier generalized moderate chronic periodontitis and CRF was submitted to scaling and root planning sessions, and later surgical access for scaling where the basic treatment not resulted in a resolution of the inflammatory periodontal process. The results obtained from a well-developed periodontal treatment and an effective cooperation of patient showed satisfactory results with periodontal disease process resolution or stabilization.Thus, periodontal treatment and patient compliance were crucial for the improvement of periodontal clinical conditions enabling a future successful renal transplantation. (AU)

A doença renal crônica promove uma redução na filtrabilidade dos rins e produtos nitrogenados acumulam no sangue promovendo um desequilíbrio eletrolítico e funcional do sistema endócrino. Dentre as diversas manifestações clínicas da doença renal crônica (DRC) na cavidade bucal estão: xerostomia, estomatite urêmica, alterações radiográficas nos ossos maxilares e mandibulares e acúmulo de cálculo dental que eleva os níveis de microrganismos periodontopatogênicos capazes de promover a destruição periodontal e também a capacidade de agir à distância em outros órgãos, como por exemplo, os rins. Dessa forma, torna-se evidente que o tratamento periodontal de pacientes que sofrem com a doença renal crônica é crucial para a manutenção de sua saúde geral e para o subsequente sucesso no transplante de órgão. Então, os objetivos deste relato de caso foram evidenciar a importância do tratamento periodontal para pacientes renais crônicos e demonstrar a melhora na condição clínica através do plano de tratamento proposto. Um paciente de 43 anos de idade, portador de periodontite crônica moderada generalizada e de DRC foi submetido às sessões de raspagem e alisamento radicular, e posteriormente, acesso cirúrgico para raspagem onde o tratamento básico não resultou na resolução do processo inflamatório periodontal. Os resultados obtidos a partir de um tratamento periodontal bem conduzido e uma efetiva cooperação do paciente mostraram resultados satisfatórios com a resolução ou estabilização da doença periodontal. Desta forma, o tratamento periodontal e a cooperação do paciente foram cruciais para a melhora das condições clínicas periodontais possibilitando um sucesso no futuro transplante renal. (AU)

Probiotic therapy as a novel approach in the prevention and treatment of gingivitis. a review / Terapia probiótica como uma nova abordagem na prevenção e tratamento da gengivite. Uma revisão

Objective: Gingivitis is caused by a mixture of Gram-positive and Gram-negative species and is characterized by inflammatory exudate in the marginal region. Probiotics have been introduced in the prevention and treatment of periodontal diseases and represent an innovative approach to maintaining oral health using beneficial bacteria when administered in adequate amounts. The mechanism of action of probiotics in the oral cavity is not fully understood but is commonly explained by a combination of local and systemic immunomodulation. The results of the studies suggest that probiotics may be useful in the prevention and treatment of gingivitis, but their effectiveness is still very questionable. Thus, more in vivo research is needed through randomized controlled studies evaluating the main periodontal clinical parameters, levels of inflammatory mediators and microbiological analyzes, especially to elucidate some still unknown mechanisms of action and to ensure the use of probiotics as an effective therapy in the prevention and treatment of gingivitis. (AU)

Objetivo: A gengivite é causada por uma mistura de espécies Gram-positivas e Gram-negativas e é caracterizada pelo exsudado inflamatório na região marginal. Os probióticos tem sido introduzido na prevenção e tratamento das doenças periodontais e representam uma abordagem inovadora para manter a saúde bucal através da utilização de bactérias benéficas quando administradas em quantidades adequadas. O mecanismo de ação dos probióticos na cavidade bucal não é totalmente compreendido, mas é comumente explicado por uma combinação de imunomodulação local e sistêmica. Os resultados dos estudos sugerem que os probióticos podem ser úteis na prevenção e tratamento da gengivite, porém sua eficácia é muito questionável ainda. Desta forma, são necessárias mais pesquisas in vivo através de estudos randomizados controlados avaliando os principais parâmetros clínicos periodontais, níveis de mediadores inflamatórios e analises microbiológicas, especialmente para elucidar alguns mecanismos de ação ainda desconhecido e para assegurar a utilização dos probióticos como terapia eficaz na prevenção e tratamento da gengivite.(AU)