Impacto do uso sistêmico de estatinas e de bisfosfonatos nos tecidos periodontais: revisão narrativa / Impact of the systemic use of statins and bisphosphonates in the periodontal tissues: narrative review

Introdução: A literatura tem apontado uma possível relação entre diversas condições sistêmicas e as doenças periodontais. Dentro das doenças sistêmicas que podem gerar o uso crônico de medicamentos, com potencial associação com as doenças periodontais, destacam-se a hipercolesterolemia e o uso de estatinas; e as doenças do metabolismo ósseo e o uso de bisfosfonatos. Objetivo: Dessa maneira, o presente estudo objetivou revisar a literatura sobre o efeito das estatinas e dos bisfosfonatos nos parâmetros clínicos e radiográficos periodontais de indivíduos adultos. Resultados: Apenas estudos observacionais em humanos foram incluídos. Um estudo mostrou que, em pacientes que apresentam doença periodontal e usam estatina, houve 37% menos bolsas periodontais (profundidade de sondagem ≥4mm) quando comparadas aos que não utilizam a medicação, além de apresentarem menor índice de carga inflamatória e menor perda de inserção clínica. Em relação aos bisfosfonatos em indivíduos com doenças que envolvem o metabolismo ósseo, sugere-se que a utilização do fármaco tem obtido resultados positivos nos parâmetros periodontais, como menores sinais clínicos de inflamação gengival, menor profundidade de sondagem, menor perda de inserção clínica e maior nível de osso alveolar, quando comparados aos que nunca realizam essa terapia. Conclusão: Dessa forma, as estatinas e os bisfosfonatos apresentam efeitos promissores, em pacientes sob tratamento para suas respectivas condições sistêmicas, na melhoria dos parâmetros periodontais, porém é importante salientar que são necessários mais estudos sobre o assunto para melhor entender os reais efeitos a longo prazo do uso desses fármacos.(AU)

Introduction: The literature showed a possible relationship between several systemic conditions and periodontal diseases. Within the systemic diseases that can generate the chronic use of these drugs, potentially related with periodontal diseases, it may be cited the hypercholesterolemia and the use of statins; and bone metabolism diseases and the use of bisphosphonates. Objective: In this sense, the present study aimed to review the literature about the effect of statins and bisphosphonates in the periodontal parameters of adults individuals. Results: Only observational studies in humans were included. A study showed that, in patients with periodontal disease and users of statins, there 37% fewer periodontal pockets (probing depth ≥4mm) when compared to those who do not use the medication, as well as having a lower rate of inflammatory burden and less loss of clinical insertion. Regarding the bisphosphonates in individuals diagnosed with diseases involving bone metabolism, it was suggested that the use of the drug has obtained positive results in periodontal parameters, such as a greater absence of plaque, less clinical signs of gingival inflammation, less probing depth, lower level of clinical insertion and higher level of alveolar bone when compared to those who never undergo this therapy. Conclusion: Thus, statins and bisphosphonates have promising effects in patients under treatment for their respective systemic condition in improving periodontal parameters, but it is important to emphasize that further studies on the subject are needed to better understand the long-term effects of the use of these drugs.(AU)

The effect of hyaluronic acid on the periodontium in spontaneous periodontitis in rats / El efecto del ácido hialurónico sobre el periodonto en periodontitis espontánea en ratas

SUMMARY: The aim of the article was to study changes in periodontal tissues in rats with spontaneous periodontitis (SP) and to evaluate the effect of hyaluronic acid (HA) on the state of the periodontium. Wistar rats with signs of SP were divided into 6 groups: 1) intact group; 2) intact animals with HA "HD-1,0 MDa"; 3) SP group; 4) SP with HA "S-2,4 MDa"; 5) SP with HA "ST-2,4 MDa"; 6) SP with HA "HD-1,0 MDa". The study of the periodontium rats with SP noted the main structural changes (collagen reduction, resorption of alveolar bone, dilatation and stasis of the vessels of the periodontium, gingival papilla and tooth pulp), which were assessed as moderate. Morphological evidence of inflammation was infiltration of neutrophils into the connective tissue of the gums, without the formation of abscesses. Local administration of HA did not cause additional structural damage in periodontal tissues of rats with SP, but also did not affect changes in the microvascular system of periodontium and tooth pulp, periodontal ligaments, only a tendency to inhibit alveolar bone resorption in rats was noted. One can consider the tendency to improve the condition of periodontal tissues in the group of rats injected with high molecular HA and HA with mannitol (2.4 MDa).

RESUMEN: El objetivo del artículo fue estudiar los cambios en los tejidos periodontales en ratas con periodontitis espontánea (PE) y evaluar el efecto del ácido hialurónico (HA) sobre el estado del periodonto. Las ratas Wistar con signos de PE se dividieron en 6 grupos: 1) grupo intacto; 2) animales intactos con HA "HD-1,0 MDa"; 3) grupo PE; 4) PE con HA "S-2,4 MDa"; 5) PE con HA "ST-2,4 MDa"; 6) PE con HA "HD-1,0 MDa". En las ratas con PS se observaron los principales cambios estructurales (reducción de colágeno, reabsorción del hueso alveolar, dilatación y estasis de los vasos del periodonto, papila gingival y pulpa dentaria), que fueron evaluados como moderados. La evidencia morfológica de inflamación fue la infiltración de neutrófilos en el tejido conectivo de las encías, sin la formación de abscesos. La administración local de HA no causó daño estructural adicional en los tejidos periodontales de las ratas con PE, pero tampoco se produjo cambios en el sistema microvascular del periodonto y en la pulpa dental y ligamentos periodontales.Se observó una tendencia a inhibir la resorción del hueso alveolar. Se puede considerar la tendencia a mejorar el estado de los tejidos periodontales en el grupo de ratas inyectadas con HA de alto peso molecular y HA con manitol (2,4 MDa).

Atorvastatin-medicated dentifrice significantly inhibits CD4+ T cell proliferation: in vitro pilot study / Pasta dental medicada con atorvastatina inhibe de forma significativa la proliferación de células T CD4+: un estudio piloto in vitro

Reports indicate that statins (cholesterol-lowering drugs), in addition to lowering cholesterol, have an immunomodulatory effect. This effect may be beneficial for the treatment of several diseases, including periodontal disease. The aim of the present study was to evaluate the immunomodulatory effect of an atorvastatin-medicated dentifrice on CD4+ T cell proliferation. CD4+ T cell proliferation assays and peripheral blood mononuclear cell (PBMC) viability assays were conducted on PBMCs from healthy donors cultured under the following conditions: control, atorvastatin solution, atorvastatin-medicated dentifrice, and dentifrice without atorvastatin at concentrations of 1, 5, 10, 50 and 100 µM. A Generalized Equation Estimation (GEE) model was used to analyze concentration versus proliferation and concentration versus percentage of dead cells within each group evaluated. Atorvastatin-medicated dentifrice (p-value <0.0001) and atorvastatin solution (p-value <0.0001) significantly inhibited CD4+ T cell proliferation in a dose-dependent manner compared with the dentifrice without atorvastatin and control conditions. Only the relationship between atorvastatin solution and percentage of dead cells was significant compared to the other conditions (p-value 0.019). The results revealed that atorvastatin-medicated dentifrice at concentrations of 1 to 100 µM had immunomodulatory effects, inhibiting CD4+ T cell proliferation without affecting PBMC viability. The other components of the dentifrice did not affect CD4+ T cell proliferation or cell viability, indicating its utility as a vehicle to achieve the desired effects of atorvastatin in periodontal tissue. Controlled clinical trials are still needed to evaluate the clinical effects of an atorvastatin-medicated dentifrice on the periodontium.

La literatura indica que las estatinas (medicamentos para bajar el colesterol), además de reducir el colesterol, tienen un efecto inmunomodulador. Este efecto puede ser beneficioso para el tratamiento de varias enfermedades, incluyendo la enfermedad periodontal. El objetivo de este estudio es evaluar el efecto inmunomodulador de una pasta dental medicada con atorvastatina sobre la proliferación celular de linfocitos T CD4+. A partir de células mononucleares de sangre periférica de donantes sanos (PBMC), se realizaron ensayos de proliferación y viabilidad de linfocitos T CD4+ bajo las siguientes condiciones: control, solución de atorvastatina, dentífrico medicado con atorvastatina y dentífrico sin atorvastatina, en concentraciones 1, 5, 10, 50 and 100 µM. Se realizó el análisis estadístico utilizando el modelo Generalized Equation Estimation (GEE) a fin de analizar la concentración versus la proliferación y la concentración versus el porcentaje de muerte celular para cada uno de los grupos. El dentífrico medicado con atorvastatina (valor p <0,0001) y solución de atorvastatina (valor p <0,0001) inhibieron significativamente la proliferación de células T CD4 + de una manera dependiente de la dosis en comparación con el dentífrico sin atorvastatina y condiciones de control. Sólo la relación entre la atorvastatina solución y el porcentaje de células muertas fue significativa en comparación con las otras condiciones (vale-p 0,019). Los resultados revelaron que el dentífrico medicado con atorvastatina en concentraciones de 1 a 100 mM tenía efectos inmunomoduladores, inhibiendo la proliferación de células T CD4 + sin afectar la viabilidad de PBMC. Los otros componentes del dentífrico no afectaron la proliferación de células T CD4 + o la viabilidad celular, indicando su utilidad como vehículo para conseguir los efectos deseados de atorvastatina en el tejido periodontal. Todavía se necesitan ensayos clínicos controlados para evaluar los efectos clínicos de un dentífrico medicado con atorvastatina sobre el periodonto.

Novel biological activity of ameloblastin in enamel matrix derivative

Objective Enamel matrix derivative (EMD) is used clinically to promote periodontal tissue regeneration. However, the effects of EMD on gingival epithelial cells during regeneration of periodontal tissues are unclear. In this in vitro study, we purified ameloblastin from EMD and investigated its biological effects on epithelial cells. Material and Methods Bioactive fractions were purified from EMD by reversed-phase high-performance liquid chromatography using hydrophobic support with a C18 column. The mouse gingival epithelial cell line GE-1 and human oral squamous cell carcinoma line SCC-25 were treated with purified EMD fraction, and cell survival was assessed with a WST-1 assay. To identify the proteins in bioactive fractions of EMD, we used proteome analysis with two-dimensional gel electrophoresis followed by identification with liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis. Results Purified fractions from EMD suppressed proliferation of GE-1 and SCC-25. LC-MS/MS revealed that ameloblastin in EMD is the component responsible for inhibiting epithelial cell proliferation. The inhibitory effect of ameloblastin on the proliferation of GE-1 and SCC-25 was confirmed using recombinant protein. Conclusion The inhibitory effects of EMD on epithelial cell proliferation are caused by the biological activities of ameloblastin, which suggests that ameloblastin is involved in regulating epithelial downgrowth in periodontal tissues. .

Influence of combined oral contraceptives on the periodontal condition

Most studies investigating the impact of oral contraceptives have been performed some years ago, when the level of sexual hormones was greater than the actual formulations. Objective: The aim of this study was to evaluate the effects of current combined oral contraceptives (COC) on periodontal tissues, correlating the clinical parameters examined with the total duration of continuous oral contraceptive intake. Material and methods: Twenty-five women (19-35 years old) taking combined oral contraceptives for at least 1 year were included in the test group. The control group was composed by 25 patients at the same age range reporting no use of hormone-based contraceptive methods. Clinical parameters investigated included pocket probing depth (PD), clinical attachment level (CAL), sulcular bleeding index (SBI) and plaque index (Pl.I). Data were statistically evaluated by unpaired t test, Pearson’s correlation test and Spearman’s correlation test. Results: The test group showed increased PD (2.228±0.011 x 2.154±0.012; p<0.0001) and SBI (0.229±0.006 x 0.148±0.005, p<0.0001) than controls. No significant differences between groups were found in CAL (0.435±0.01 x 0.412±0.01; p=0.11). The control group showed greater Pl.I than the test group (0.206±0.007 x 0.303±0.008; p<0.0001). No correlation between the duration of oral contraceptive intake, age and periodontal parameters was observed. Conclusions: These findings suggest that the use of currently available combined oral contraceptives can influence the periodontal conditions of the patients, independently of the level of plaque accumulation or total duration of medication intake, resulting in increased gingival inflammation.

[ effect of qat chewing on periodontal tissues and buccal mucous membrane]

Qat leaves usually chewed during social and cultural gathering where the chewing practice may take up 5 hours. In the past, qat chewing habit was socially normalized among Yemeni adult male only, but, recently the habit spread to include a high percentage of females and even children. The purpose of this study is to assess the effects of qat chewing on periodontal tissues [gingival recession and pocket depth] in addition to buccal ulcerative lesions in the oral side of chewing. The sample was 200Yemeni men over 20 years of age, who have been chewing qat for more than one year. They have been studied for the effects of qat on the chewing side compared with the opposite side that is not used for chewing. The study shows that the longer qat chewing duration, the prevalence of both gingival recession and periodontal pocket increased. Reversely, individuals with a history of less than five-year duration of chewing show almost a lower frequency of both gingival recession and periodontal pocket. The prevalence of the gingival recession and periodontal pocket is significantly more in the side of chewing. The study reveals that 56 out of 76 [73.7%] smokers are suffering from gingival recession, with a highest rate of the recession is recorded among those who have a history of smoking for more than 16 years. Only 24 cases [12%] show clinical ulcerative lesions on the buccal mucosa and there are no findings suspicious for pre-malignant or malignant changes. This study demonstrates a relationship between qat chewing and periodontal diseases, [gingival recession, pocket depth] attributed to chronic local mechanical effect. However, the study recommends further studies including longitudinal clinical inspections, biopsies of the tissue changes of qat chewers and the effects of chemicals used to accelerate the growth of the qat

Microscopic qualitative evaluation of fixation time and decalcification media in rat maxillary periodontium

The rat model is widely used in periodontal research and the quality of histological sections is essential. The purpose of this study was to evaluate the histological characteristics of periodontal tissues in Wistar rat maxillae, with different times of fixation and decalcified by nitric acid or formic acid (Anna Morse Solution). Fifteen rats were used. Fixation was performed for 24, 48 and 72 hours. The maxillae were hemi-sectioned and each part was decalcified either in nitric acid for 7 days or in Anna Morse solution for 35 days. Two trained and blinded examiners performed the evaluation. Fourty eight hours of fixation and decalcification with Anna Morse solution showed more clear characteristics of the epithelium-connective tissue interface and of the periodontal structures. Mean measurements between the cementum-enamel junction and the bone crest varied in the different experimental times from 176.5 (± 60.45) to 210.94 (± 39.33) pixels on the buccal aspect, and from 199.69 (± 38.33) to 298.55 (± 70.81) pixels on the palatal aspect, with no statistically significant differences (ANOVA, p > 0.05). In the same fixation period, decalcification with nitric acid or Anna Morse solution did not display any statistically significant differences. It may be concluded that for a qualitative histological analysis, fixation should preferably be for 48 hours and the demineralization should be made by Anna Morse solution. For a histomorphometric analysis, the decalcification solution does not interfere in the results.

O modelo rato é extensamente usado na pesquisa periodontal, e a qualidade dos cortes histológicos é essencial. A proposta deste estudo foi avaliar as características histológicas dos tecidos periodontais nas maxilas de ratos Wistar, após diferentes períodos de fixação e descalcificação pelo ácido nítrico ou pelo ácido fórmico (Solução de Anna Morse). Quinze ratos foram usados. A fixação foi realizada nos períodos de 24, 48 e 72 horas. As maxilas foram divididas e parte foi descalcificada em ácido nítrico durante 7 dias e parte com solução de Anna Morse por 35 dias. Dois examinadores treinados e cegos executaram a avaliação. Quarenta e oito horas de fixação e descalcificação com solução de Anna Morse mostraram características mais evidentes da interface epitélio-conjuntivo, assim como das estruturas periodontais. As médias, por vestibular, entre a junção cemento-esmalte e a crista óssea nos diferentes tempos experimentais variaram entre 176,5 (± 60,45) e 210,94 (± 39,33) "pixels", e, na face palatina, entre 199,69 (± 38,33) e 298,55 (± 70,81) "pixels", sem nenhuma diferença estatisticamente significativa (ANOVA, p > 0,05). No mesmo período de fixação, a descalcificação com ácido nítrico ou solução de Anna Morse não mostrou diferenças estatisticamente significantes. Pode-se concluir que, para a análise histológica qualitativa, a fixação deve ser preferivelmente em 48 horas e a desmineralização por solução de Anna Morse. Para a análise histo-morfométrica, a solução descalcificadora não interferiu nos resultados.

Periodontal regeneration--fantasizing the future.

Periodontal Regenerative Surgical Procedures are, by definition, supposed to restore all three tooth-supporting tissues i.e. periodontal ligament fibres, alveolar bone and the cementum. In humans, we can now regenerate considerable amounts of alveolar bone, and periodontal ligament with the use of bone graft material and barrier membranes. The purpose of this article is to acquaint the reader with the current trends as well as some new areas along which periodontal regenerative therapy might shape up in the future. Since, some fields are still in their infancy, it can be only envisioned as to how these new fields of science might constantly evolve to redefine periodontal therapy in due time.

Influencia de los factores sistémicos en los tejidos periodontales de los adultos mayores / The influence of systemic factors on periodontal tissues of older adults

Se estudiaron diferentes patologías sistémicas y su grado de compromiso con el tejido periodontal, así como el uso de medicamentos sistémicos que afectan la encía produciendo alteraciones de la misma. Un buen control de higiene bucal es necesario para comenzar el tratamiento de cualquiera de las enfermedades mencionadas en el trabajo. Por lo dicho se deduce que el cuidado bucal y el control de placa son fundamentales en la disminución de la flora normal y la colonización potencial de gérmenes patógenos y lesiones oportunistas. Pero ante la aparición de estas últimas, el tratarlas adecuadamente en interrelación médica colaborará al bienestar del paciente y minimizará los riesgos de compromiso sistémico. Un adecuado diagnóstico odontológico del adulto mayor deberá ser precedido por una historia clínica completa que, aunque demande más de una sesión, permitirá orientar satisfactoriamente al tratamiento

Avaliaçäo "in vitro", após preparo de espaço para retentor intra-radicular, da impermeabilizaçäo da dentina diante da aplicaçäo de produtos diversos / In vitro evaluation of dentin impermeability after space preparation for intraradicular post, following the application of different products

A permeabilidade dentinária exerce importante papel na relaçäo canal-periodonto. Durante a terapia endodôntica procura-se aumentá-la com o intuito de sua sanificaçäo e ao final busca-se o seu vedamento para isolar o meio interno (periodonto) do externo, representado pela ligaçäo canal-câmara pulpar-cavidade oral, comunicados entre si. Porém, no preparo para retentores intra-radiculares, os túbulos dentinários voltam a ser expostos permitindo novamente que o periodonto seja afetado através do canal radicular. Para coibir tal fato testaram-se quatro produtos que aplicados na dentina exposta promoveriam sua impermeabilizaçäo. Os resultados mostraram diferentes eficiências de impermeabilizaçäo, em ordem decrescente para os seguintes produtos: verniz tipo copal, cianoacrilato de ácido butílico (Histoacryl), verniz biológico (Dentino-S), adesivo dentinário de terceira geraçäo (Tenure)

Clinical and bacteriological evaluation of the effect of estrogen supplementation on the periodontium of postmenopausal women

Sixty postmenopausal females with marginal periodontitis who were on maintenance periodontal therapy were selected for this study. Thirty of these cases were on estrogen replacement therapy for the management of their menopausal symptoms. The other 30 served as a control group and have not received any hormonal medication. Clinical and bacteriological assessment for both groups included gingival index, plaque index, probing depth, attachment level and counts of certain selected periopathogens, were recorded and subjected to statistical analysis using Student-t test. On comparing both groups, the results indicated that the mean of the gingival index was significantly lower in the estrogen group, and the difference was statistically significant. On the other hand, slightly lower values of the plaque index, probing depth and attachment levels were observed for the estrogen group, but the difference from the control did not have any statistical significance. Also, nonstatistically significant differences were observed on comparing the mean values of the bacteriological counts for the estrogen group with their controls. The results suggested that, estrogen supplementation in postmenopausal women results in less gingival inflammation when compared to an age matched control group

comparative study of the effect of interim tooth-attached denture and overdenture on the periodontium of abutment

A clinical study was carried out to compare between the effect of interim tooth-attached denture and overdenture on the two m and ibular canines concerning their periodontium. Twenty male patients having two m and ibular canines were selected for this study. For each patient interim denture and overdenture were constructed. All clinical measurements were performed at the time of denture insertion and six months after wearing the denture. The results showed that the tooth mobility, depth of pocket, gingival crevicular fluid and the resorption of alveolar bone crest mesial and distal to the abutments were significantly increased after six months of wearing interim denture and markedly decreased after wearing the overdenture for the same period of time