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)

Procedimiento de descontaminación del biofilm para el tratamiento del absceso periodontal agudo y la periimplantitis / The biofilm decontamination approach for the treatment of periodontal abscess and peri-implantitis

Objetivo: mostrar el efecto de un nuevo procedimiento de descontaminación del biofilm sobre los abscesos periodontales agudos y la periimplantitis. Casos clínicos: un absceso periodontal agudo y una periimplantitis fueron tratados mediante un material de descontaminación de los tejidos bucales. Este consiste en un concentrado acuoso con una mezcla de ácidos hidroxibencensulfónicos e hidroxymetho-xybencénicos y ácido sulfúrico, que se coloca en las bolsas periodontales y alrededor de los implantes. En ninguno de los casos se utilizaron antibióticos locales ni sistémicos. Todos los casos tratados cicatrizaron rápidamente, sin complicaciones. Los pacientes sintieron una leve molestia durante la aplicación del material, que desapareció completamente en pocos segundos. Conclusión: el procedimiento de desecación del biofilm parecería ser una técnica promisoria para el tratamiento de los abscesos periodontales agudos ylas periimplantitis, con la ventaja adicional de que se evita el uso de antibióticos locales y sistémicos.

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.

Non-surgical instrumentation associated with povidone-iodine in the treatment of interproximal furcation involvements

OBJECTIVE: The aim of this controlled clinical trial was to evaluate the effect of topically applied povidone-iodine (PVP-I) used as an adjunct to non-surgical treatment of interproximal class II furcation involvements. MATERIAL AND METHODS: Thirty-two patients presenting at least one interproximal class II furcation involvement that bled on probing with probing pocket depth (PPD) >5 mm were recruited. Patients were randomly chosen to receive either subgingival instrumentation with an ultrasonic device using PVP-I (10 percent) as the cooling liquid (test group) or identical treatment using distilled water as the cooling liquid (control group). The following clinical outcomes were evaluated: visible plaque index, bleeding on probing (BOP), position of the gingival margin, relative attachment level (RAL), PPD and relative horizontal attachment level (RHAL). BAPNA (N-benzoyl-L-arginine-p-nitroanilide) testing was used to analyze trypsin-like activity in dental biofilm. All parameters were evaluated at baseline and 1, 3 and 6 months after non-surgical subgingival instrumentation. RESULTS: Six months after treatment, both groups had similar means of PPD reduction, RAL and RHAL gain (p>0.05). These variables were, respectively, 2.20±1.10 mm, 1.27±1.02 mm and 1.33±0.85 mm in the control group and 2.67±1.21 mm, 1.50±1.09 mm and 1.56±0.93 mm in the test group. No difference was observed between groups at none of the posttreatment periods, regarding the number of sites showing clinical attachment gain >2 mm. However, at 6 months posttreatment, the test group presented fewer sites with PPD >5 mm than the control group. Also at 6 months the test group had lower BAPNA values than control group. CONCLUSION: The use of PVP-I as an adjunct in the non-surgical treatment of interproximal class II furcation involvements provided limited additional clinical benefits.

Studies on development of controlled delivery of combination drug(s) to periodontal pocket.

Aim: The aim of this study to develop the controlled delivery of combination drug(s) to periodontal pocket. Materials and Methods: In the present investigation mucoadhesive gel formulations were prepared using carboxy methylcellulose (CMC), methylcellulose (MC), hydroxyethylcellulose (HEC), polyvinylpirrolidone (PVP), polycarbophil (PC), and poloxamer. Each formulation was characterized in terms of polarizing light microscopy, gelation, gel melting, hardness, compressibility, adhesiveness, cohesiveness, syringeability, adhesion to a mucin disk, rheological studies, drug release, and antibacterial activities. Addition of CMC and PVP to the gel favored hexagonal phase formation. The gelation temperature was decreased linearly with an increasing concentration of drug(s), whereas, the melting temperature increased with the concentration of drug(s). Increasing the concentrations of each polymeric component significantly increased formulation hardness, compressibility, adhesiveness, mucoadhesion, and syringeability, yet a decreased cohesiveness. Increased time of contact between the formulation and mucin significantly increased the required force of detachment. Drug release from all formulations was non-diffusion controlled and significantly decreased as the concentration of the polymer was increased, due to the concomitant increased viscosity of the formulations and the swelling kinetics of PC, following contact with the dissolution fluid. Result: Antibacterial studies revealed that a gel with 30% HEC had a growth inhibition zone on agar with all three strains. Conclusion: Formulations containing HEC exhibited superior physical characteristics for improved drug delivery to the periodontal pocket and are now the subject of long-term clinical investigations.

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.

Effect of absorbent tetracycline-loaded membrane used in the reduction of periodontal pockets: an in vivo study

This clinical study evaluated the influence of scaling and root planning (SRP), with and without the use of tetracycline-loaded bovine absorbent membrane, in the reduction of periodontal pockets according to 3 parameters: probing pocket depth (PPD), bleeding on probing (BOP) and plaque index (PI). Twenty-four patients were selected totalizing 144 random teeth divided in 2 groups (n=72 teeth) - control (SRP) and experimental (SRP with tetracycline-loaded absorbent membrane). PPD, BOP and PI were determined before and 28 days after the treatment. In all patients, the PPD values at the end of the treatment were always lower than the baseline values. There was a reduction of the PI for both treatments, but it was more evident on the experimental group. In conclusion, the use of tetracycline-loaded absorbent membrane could result in a better prognosis compared to scaling and root planning after only 28 days of evaluation.

Este estudo clínico avaliou a influência da raspagem e alisamento radicular, com e sem a utilização de membrana absorvível de liberação de tetraciclina na redução de bolsa periodontal utilizando 3 parâmetros: sondagem da profundidade de bolsa, sangramento à sondagem e índice de placa. Vinte e quatro pacientes foram selecionados totalizando 144 dentes aleatoriamente divididos em 2 grupos (n=72 dentes) - controle (raspagem e alisamento radicular) e experimental (raspagem e alisamento radicular e utilização de membrana absorvível de liberação de tetraciclina). Antes da execução do tratamento foram determimados profundidade de bolsa, sangramento à sondagem e índice de placa. Os pacientes foram avaliados usando os mesmos parâmetros após 28 dias. Os valores da sondagem da profundidade de bolsa foram sempre menores no final do tratamento quando comparado ao início. Houve redução no índice de placa para as 2 formas de tratamento, apesar de ter sido mais evidente no grupo experimental. Concluiu-se que o uso da membrana absorvível de liberação de tetraciclina pode resultar em melhor prognóstico quando comparado apenas com a raspagem e alisamento radicular, após 28 dias de análise.

Metronidazole-containing gel for the treatment of periodontitis: an in vivo evaluation

The aim of this investigation was to monitor metronidazole concentrations in the gingival crevicular fluid (GCF) collected from periodontal pockets of dogs after treatment with an experimental 15 percent metronidazole gel. Five dogs had periodontitis induced by cotton ligatures placed subgingivally and maintained for a 30-day period. After the induction period, only pockets with 4 mm or deeper received the gel. Each pocket was filled up to the gingival margin by means of a syringe with a blunt-end needle. GCF was collected in paper strips and quantified in an electronic device before and after 15 minutes, 1 h, 6 h, 24 h and 48 h of gel administration. The GCF samples were assayed for metronidazole content by means of a high performance liquid chromatography method. Concentrations of metronidazole in the GCF of the 5 dogs (mean ± SD, in µg/mL) were 0 ± 0 before gel application and 47,185.75 ± 24,874.35 after 15 minutes, 26,457.34 ± 25,516.91 after 1 h, 24.18 ± 23.11 after 6 h, 3.78 ± 3.45 after 24 h and 3.34 ± 5.54 after 48 h. A single administration of the 15 percent metronidazole gel released the drug in the GCF of dogs in levels several-fold higher than the minimum inhibitory concentration for some periodontopathogens grown in subgingival biofilms for up to one hour, but metronidazole could be detected in the GCF at least 48 hours after the gel application.

Clinical and microbial evaluation of dental scaling associated with subgingival minocycline in chronic periodontitis subjects

O objetivo deste estudo randomizado duplo-cego foi avaliar a presença de periodontopatógenos e o comportamento clínico de bolsas periodontais tratadas com raspagem e aplainamento radicular (RAR) associado à minociclina subgengival (MS). Foram incluídos no presente estudo 36 indivíduos de 26 a 60 anos de idade (40,7 ± 9,1), previamente diagnosticados com periodontite crônica. Dezoito indivíduos foram selecionados para o grupo teste (GT), tratado com RAR e MS (novo tratamento), e 18 indivíduos, para o grupo controle (GC), que recebeu RAR e veículo (tratamento convencional). Foram selecionados dois sítios homólogos em cada indivíduo com profundidade de sondagem (PS) > 6 mm para testar a hipótese proposta. Para avaliar o comportamento clínico após o tratamento, a mensuração da PS foi realizada inicialmente e após 90 dias. A avaliação microbiana foi realizada para detecção de 7 periodontopatógenos através de reação em cadeia da polimerase, inicialmente e após 30 e 120 dias. Observou-se redução média de 2,8 e 2,1 mm na PS nos grupos teste e controle, respectivamente. Inicialmente, P. gingivalis foi o microrganismo mais prevalente tanto no GT (65,8%) quanto no GC (48,6%). Após 120 dias, houve redução para 30,8% no GT e 23,1% no GC. Não houve diferenças estatisticamente significativas entre os grupos em relação à PS (teste Wilcoxon - p > 0,05) e presença dos periodontopatógenos (teste Wilcoxon e qui-quadrado - p > 0,05 e teste do sinal - p > 0,01). Os resultados observados demonstraram que o novo tratamento foi tão efetivo quanto o tratamento convencional na redução de periodontopatógenos e de PS em indivíduos com periodontite crônica.

clinical effects of topical metronidazole as adjunct therapy to subgingival debridement in adult periodontitis

The purpose of this investigation was to evaluate effect of local antibiotic therapy with metronidazole adjunctively to Scaling and Root Planning [SRP] mechanical or antibiotical treatment alone. This randomised double blind study was carried out in split-mouth design. Ten patients with moderate to severe adult periodontitis were selected. Each patient had to have at least 3 multi-root and 3 single-root nonadjacent teeth with a probing depth >/= 5[mm]. Randomly selected teeth were treated with application of 25% gel metronidazole [SRP+Elyzol]. A total of 141 site [

Local antimicrobial delivery in periodontal therapy.

Treatment strategies towards periodontal diseases have evolved to eliminate specific pathogens or suppress destructive host response. The inherent activity of the antibiotic against the target microorganism and various Pharmacokinetic parameters such as potency, permeability, intrinsic efficacy, and substantivity of the drug dictate the success of the therapeutic outcome. However selection of an appropriate delivery system is an important factor. Rapid advances in molecular biology have helped to overcome the disadvantages of systemic and topical applications, by direct placement of antimicrobial agent (s) into subgingival sites, thus minimizing antimicrobial impact on non-oral body sites. As periodontitis is a 'localized' disease condition it is amenable to localized drug treatments. By means of controlled local delivery from within the periodontal pocket, a single administration of a few milligram of an antibacterial agent can maintain therapeutic concentrations within the crevicular fluid for a longer period of time than any other mode of delivery. This paper shall review the different local delivery systems along with the commonly employed drugs through these delivery systems.

Antibacterial activity of ciprofloxacin-beta-cyclodextrin complex and its efficacy in dental implants.

Ciprofloxacin forms an inclusion complex with beta-cyclodextrin. The in vitro antibacterial activity of ciprofloxacin on E. coli and Staphylococcus aureus was found better on complexation. The complex was found very effective as a local antibacterial agent when used in dental implants. Significant reduction in the gingival index, probing pocket depth and microbial growth coupled with gain in attachment at the test site compared to control on the 14th day was observed when the implants containing 2.0 mg of the complex equivalent to 0.4 mg of ciprofloxacin was used in clinical trials.

Avaliaçäo da composiçäo morfotípica da microbiota subgengival após a irrigaçäo de bolsas periodontais com diferentes substâncias / Evaluation of the subgingival microbiota morphotypes composition after a periodontal pockets irrigation with different substances

Avaliou-se as alteraçöes morfotípicas percentuais e absolutas da microbiota subgengival após a utilizaçäo da irrigaçäo manual com as seguintes substâncias: soluçäo de tetraciclina a 50mg/ml, peróxido de hidrogênio a 3 por cento, soluçäo de clorexidina a 0,2 por cento, soluçäo de iodo a 1 por cento e soluçäo de cloreto de sódio a 0,85 por cento como controle negativo. Após o acompanhamento realizado em intervalos de tempo padronizados, realizou-se a contagem morfotípica através da microscopia de contraste de fase. As substâncias utilizadas foram avaliadas quanto a capacidade de alterar a contagem morfotípica (absoluta e percentual), bem como quanto ao seu suposto efeito residual. Todas as substâncias analisadas demonstraram a capacidade de alterar a composiçäo morfotípica da placa subgengival, contudo, as alteraçöes mais significativas foram observadas quando da utilizaçäo do iodo a 1 por cento (não alcoólico) e da clorexidina a 0,2 por cento

Liberaçäo local controlada de medicamentos nas bolsas periodontais / Local controlled delivery of medicaments in periodontal pockets

Neste artigo, os autores revisam os estudos sobre o uso de sistemas de liberaçäo local e controlada de medicaçäo nas lesöes periodontais através de dispositivos colocados no interior das bolsas. Informam sobre o estágio atual de desenvolvimento desses dispositivos, bem como as possíveis indicaçöes, contra-indicaçöes, vantagens, desvantagens e aplicabilidade desses sistemas como coadjuvantes no tratamento das periodontites

Tratamento de bolsas periodontais supra-ósseas: análise comparativa entre o tratamento ácido da superfície radicular isoladamente e em associaçäo com a técnica de cicatrizaçäo dirigida / Treatment of suprabone periodontal pockets: comparative analysis between radicular acid treatment alone and combined with guided cicatrization techniques in humans

Este trabalho analisou as diferenças entre os resultados de tratamento regenerativo em bolsas supra-ósseas, em humanos. Os tratamentos testados foram: colocaçäo de barreira mecânica (membrana Millipore, mantida por 30 dias no local) com aplicaçäo prévia de ácido cítrico pH 1,0 por 3 minutos (Grupo FA) e somente a aplicaçäo de ácido (Grupo A). As biópsias (7 espécimes em cada grupo) foram processadas histologicamente em cortes seriados e os parâmetros analisados foram: - Extensäo da área de inserçäo conjuntiva; - Contagem de fibroblastos por unidade de área na regiäo da inserçäo conjuntiva; - Contagem de fibroblastos por unidade de área na regiäo do ligamento periodontal; - Extensäo do cemento radicular neoformado na regiäo da inserçäo conjuntiva; Planimetria de pontos das áreas de reabsorçäo radicular; - Comprimento do epitélio gengival; Subsidiariamente, foram analisados os seguintes aspectos: - Comparaçäo entre dois métodos de medidas do comprimento do epitélio dentogengival, em cada grupo testado; - O número de fibroblastos por unidade de área entre as regiöes do ligamento periodontal e de inserçäo conjuntiva, nas duas situaçöes experimentais; - Os pares de correlaçäo que sugerem o limite de 75 por cento da correlaçäo perfeita, positiva ou negativa, obtendo-se os modelos de regressäo melhor ajustados para cada par de correlaçäo aceita como significativa; - Näo há diferença estatisticamente significante entre as medidas de inserçäo conjuntiva nos Grupos FA (média de 1,7376 mm) e A (1,5521 mm); - Näo há diferença estatisticamente significante entre as contagens de fibroblastos por unidade de área na regiäo da inserçäo conjuntiva nos Grupos FA (média de 17,4439 fibroblastos por área-padräo) e A (média de 19,5597 fibroblastos por área-padräo)...

Aplicación de una pasta compuesta por bicarbonato de sodio, cloruro de sodio y agua oxigenada en el tratamiento de bolsas parodontales activas / Application of a paste composed by sodium bicarbonate, sodium chloride and hydrogen peroxide in the treatment of active periodontal pockets

Es conocido mundialmente la relación íntima que existe entre la placa dentobacteriana y la enfermedad parodontal inflamatoria crónica, asícomo la efectividad de los tratamientos conservadores utilizados para eliminar la gingivitis crónica. Sin embargo, hace varios años, la enfermedad parodontal destructiva crónica solo era resuelta por el empleo de técnicas quirúrgicas, en sumayoría cruentas y de dudosa solución para algunos de los problemas paradontales; por estas razones, efectuamos un estudio para conocer el papel que desempeñabaun medicamento formado por bicarbonato de sodio, cloruro de sodio y agua oxigenada aplicado profundamente en forma de pasta dentro de las bolsas parodontales activas, luego de un alisado radicular exquisito a cielo abierto. Los resultados señalan como efectivo, en la terapéutica de la enfermedad parodontal inflamatoriacrónica, el uso de este procedimiento