Dyslipidemia rather than Type 2 Diabetes Mellitus or Chronic Periodontitis Affects the Systemic Expression of Pro- and Anti-Inflammatory Genes.

A high percentage of type 2 diabetes mellitus (T2D) patients are also affected by dyslipidemia and chronic periodontitis (CP), but no studies have determined the gene expression in patients that are simultaneously affected by all three diseases. We investigated the systemic expression of immune-related genes in T2D, dyslipidemia, and CP patients. One hundred and fifty patients were separated into five groups containing 30 individuals each: (G1) poorly controlled T2D with dyslipidemia and CP; (G2) well-controlled T2D with dyslipidemia and CP; (G3) normoglycemic individuals with dyslipidemia and CP; (G4) healthy individuals with CP; (G5) systemic and periodontally healthy individuals. Blood analyses of lipid and glycemic profiles were carried out. The expression of genes, including IL10, JAK1, STAT3, SOCS3, IP10, ICAM1, IFNA, IFNG, STAT1, and IRF1, was investigated by RT-qPCR. Patients with dyslipidemia demonstrated statistically higher expression of the IL10 and IFNA genes, while IFNG, IP10, IRF1, JAK1, and STAT3 were lower in comparison with nondyslipidemic patients. Anti-inflammatory genes, such as IL10, positively correlated with parameters of glucose, lipid, and periodontal profiles, while proinflammatory genes, such as IFNG, were negatively correlated with these parameters. We conclude that dyslipidemia appears to be the primary disease that is associated with gene expression of immune-related genes, while parameters of T2D and CP were correlated with the expression of these important immune genes.

Stomatognathic evaluation at five years of age in children born premature and at term.

BACKGROUND: The high frequency of alterations of the stomatognathic system associated with premature birth may suggest that prematurity is an important risk factor in the development of this system. Prematurity has an incidence between 6-11% of births and is associated with factors such as genetic, maternal conditions (obstetric problems, nutritional status, infections) and antenatal care. In addition, undesirable situations, such as changes in enamel and the development of the skeletal structure, also appears to be associated with prematurity. This study aimed to look for changes in the stomatognathic system at five years of age associated with premature birth. METHODS: We estimated the prevalence of developmental disorders of the stomatognathic system in the primary dentition of preschool children at five years of age. Changes in preterm infants (n = 32) compared with term born (n = 381) were evaluated . Clinical examinations and questionnaire with sociodemographic and health of mothers and children information. Gestational age, birth weight, head circumference, Apgar score and mechanical ventilation, were collected from the medical records to birth records. The explanatory variable was preterm (<37 weeks gestational age). RESULTS: Prevalence of 7.7% of preterm infants was found. Of these, 40.6% had atresic palate, 56.2% malocclusion and 21.8% enamel hypoplasia. Forty (9.6%) children were not breastfed at the breast, and 26 (65.0%) had some type of malocclusion, showing association between not breastfeeding with an abnormal development of the stomatognathic system. The group of preterm infants showed five times more changes in head circumference and three times more mechanical ventilation use at birth. Change in head circumference at birth and mechanical ventilation has a significant association between groups of preterm and term infants. CONCLUSIONS: Mechanical ventilation at birth directly contributed to an increased risk of developmental disorders of the stomatognathic system in preterm infants, especially dental hypoplasia. Non-breastfed children had a higher risk of developing malocclusion. Alterations in head circumference were related effective on dental malocclusion. The results suggest that changes in the stomatognathic system are influenced by premature birth and points to the imperative need of using methods of preventive.

Modulation of cell proliferation, survival and gene expression by RAGE and TLR signaling in cells of the innate and adaptive immune response: role of p38 MAPK and NF-KB.

OBJECTIVE: The aim of this study was to evaluate a possible synergism between AGE-RAGE and TLR4 signaling and the role of p38 MAPK and NF-kB signaling pathways on the modulation of the expression of inflammatory cytokines and proliferation of cells from the innate and adaptive immune response. MATERIAL AND METHODS: T lymphocyte (JM) and monocyte (U937) cell lines were stimulated with LPS and AGE-BSA independently and associated, both in the presence and absence of p38 MAPK and NF-kB inhibitors. Proliferation was assessed by direct counting and viability was assessed by a biochemical assay of mitochondrial function. Cytokine gene expression for RAGe, CCL3, CCR5, IL-6 and TNF-α was studied by RT-PCR and RT-qPCR. RESULTS: RAGE mRNA expression was detected in both cell lines. LPS and AGE-BSA did not influence cell proliferation and viability of either cell line up to 72 hours. LPS and LPS associated with AGE induced expression of IL-6 and TNF-α in monocytes and T cells, respectively. CONCLUSIONS: There is no synergistic effect between RAGE and TLR signaling on the expression of IL-6, TNF-α , RAGE, CCR5 and CCL3 by monocytes and lymphocytes. Activation of RAGE associated or not with TLR signaling also had no effect on cell proliferation and survival of these cell types.

Modulation of cell proliferation, survival and gene expression by RAGE and TLR signaling in cells of the innate and adaptive immune response: role of p38 MAPK and NF-KB

Objective: The aim of this study was to evaluate a possible synergism between AGE-RAGE and TLR4 signaling and the role of p38 MAPK and NF-kB signaling pathways on the modulation of the expression of inflammatory cytokines and proliferation of cells from the innate and adaptive immune response. Material and Methods: T lymphocyte (JM) and monocyte (U937) cell lines were stimulated with LPS and AGE-BSA independently and associated, both in the presence and absence of p38 MAPK and NF-kB inhibitors. Proliferation was assessed by direct counting and viability was assessed by a biochemical assay of mitochondrial function. Cytokine gene expression for RAGe, CCL3, CCR5, IL-6 and TNF-α was studied by RT-PCR and RT-qPCR. Results: RAGE mRNA expression was detected in both cell lines. LPS and AGE-BSA did not influence cell proliferation and viability of either cell line up to 72 hours. LPS and LPS associated with AGE induced expression of IL-6 and TNF-α in monocytes and T cells, respectively. Conclusions: There is no synergistic effect between RAGE and TLR signaling on the expression of IL-6, TNF-α , RAGE, CCR5 and CCL3 by monocytes and lymphocytes. Activation of RAGE associated or not with TLR signaling also had no effect on cell proliferation and survival of these cell types. .

[Anxiety regarding dental treatment: prevalence and predictors among Brazilians]. / Ansiedade frente ao tratamento odontológico: prevalência e fatores predictores em brasileiros.

Considering the negative impact anxiety can exert over dental treatment, the scope of this study was to determine the prevalence of predictors of anxiety regarding dental treatment among Brazilians. A cross-sectional study was carried out using the Corah dental anxiety scale to assess the degree of anxiety regarding dental treatment among 3000 patients. The results reveal that two out of every eight Brazilian patients manifest moderate to severe anxiety regarding dental treatment. In this sample, the degree of anxiety was higher among females (p=0.007), over 20 years of age (p=0.006), without access to the Internet and/or newspapers (p=0.016), with a low frequency of oral hygiene (p=0.001), for whom the reason for the dental appointment was curative treatment, pain or another problem rather than a check up (p=0.047) and those suffering from toothache (p<0.001). Fear and anxiety regarding dental treatment indeed exist in the Brazilian population and the findings of this study suggest that, besides the lack of economic resources, negligence with respect to oral health, gender and age may increase the degree of anxiety.

Long-term treatment with alendronate increases the surgical difficulty during simple exodontias - an in vivo observation in Holtzman rats.

BACKGROUND: Atraumatic teeth extractions protocols are highly encouraged in patients taking bisphosphonates (Bps) to reduce surgical trauma and, consequently, the risk of jaws osteonecrosis development. In this way, this paper aims to report the findings of increased surgical difficulty during simple exodontias in animals treated with bisphosphonates. METHODS: Sixty male Holtzman rats were randomly distributed into three groups of 20 animals and received daily subcutaneous administration of 1 mg/kg (AL1) or 3 mg/kg (AL3) of alendronate or saline solution (CTL). After 60 days of drug therapy all animals were submitted to first lower molars extractions under general anesthesia. Operatory surgical time and the frequency of teeth fractures were measured as principal outcomes and indicators of surgical difficulty degree. RESULTS: Animals treated with alendronate (AL1 and AL3) were associated to higher operatory times and increased frequency of teeth fractures compared to match controls. CONCLUSIONS: The bisphosphonate therapy may be associated with an increased surgical difficulty and trauma following simple exodontias protocols, which is considered a critical issue when it comes to osteonecrosis development.

Ansiedade frente ao tratamento odontológico: prevalência e fatores predictores em brasileiros / Anxiety regarding dental treatment: prevalence and predictors among Brazilians

Diante do impacto negativo que a ansiedade exerce sobre o atendimento odontológico, buscou-se conhecer sua prevalência e seus fatores predictores frente esse tratamento em brasileiros. Foi realizado um estudo de corte transversal, utilizando-se a escala de ansiedade de Corah para avaliar 3000 pacientes. Os resultados demonstram que 2 em cada 8 brasileiros avaliados apresentaram moderada ou severa ansiedade frente ao atendimento odontológico, verificando-se que a probabilidade de um paciente da população da qual a amostra foi extraída apresentar ansiedade é mais elevada se: for mulher (p = 0,007), da faixa etária superior a 20 anos (p = 0,006), se não possuir acesso a internet e/ou jornais (p = 0,016), se tiver baixa frequência de higiene oral (p = 0,001), se a visita dental for motivada por busca de tratamento curativo, por dor ou outro problema, ao invés de um check-up (p = 0,047), e experiência de odontalgia (p<0,001). O medo e a ansiedade a fatores odontológicos existem de fato na população brasileira e as conclusões do estudo sugerem que, além da falta de recursos econômicos, o descaso com a saúde bucal, o gênero e a idade podem aumentar o grau de ansiedade.

Considering the negative impact anxiety can exert over dental treatment, the scope of this study was to determine the prevalence of predictors of anxiety regarding dental treatment among Brazilians. A cross-sectional study was carried out using the Corah dental anxiety scale to assess the degree of anxiety regarding dental treatment among 3000 patients. The results reveal that two out of every eight Brazilian patients manifest moderate to severe anxiety regarding dental treatment. In this sample, the degree of anxiety was higher among females (p=0.007), over 20 years of age (p=0.006), without access to the Internet and/or newspapers (p=0.016), with a low frequency of oral hygiene (p=0.001), for whom the reason for the dental appointment was curative treatment, pain or another problem rather than a check up (p=0.047) and those suffering from toothache (p<0.001). Fear and anxiety regarding dental treatment indeed exist in the Brazilian population and the findings of this study suggest that, besides the lack of economic resources, negligence with respect to oral health, gender and age may increase the degree of anxiety.

Avaliação da correlação entre peroxidação lipídica e o perfil de marcadores inflamatórios em pacientes com Diabetes mellitus tipo 2, dislipidemia e periodontite crônica / Correlation between lipid peroxidation and inflammatory markers profile in Diabetes mellitus type 2 patients with dyslipidemia and chronic periodontal disease

O presente estudo teve por objetivo avaliar os níveis locais e sistêmicos de peroxidação lipídica (LPO) e sua correlação com o perfil de marcadores inflamatórios, locais e sistêmicos em com Diabetes mellitus (DM) tipo 2, dislipidemia e periodontite crônica, comparando-os a indivíduos sem diabetes. Além disso, buscou-se propor um método validado para avaliar o malondiadeído (MDA) no fluido sulcular gengival de sítios saudáveis e doentes. A amostra foi constituída de 120 pacientes com doença periodontal crônica divididos em 4 grupos: Grupo1 (DM descompensado); Grupo2 (DM compensado); Grupo3 (sem diabetes com dislipidemia); Grupo 4 (sistemicamente saudável). Toda a amostra foi submetida a exame periodontal completo, exame físico e avaliação laboratorial para verificação da glicemia de jejum, hemoglobina glicada (HbA1c), insulina, proteína C-reativa e perfil lipídico. O exame periodontal consistiu na avaliação do índice de placa visível, do índice de sangramento marginal, da posição da margem gengival, da profundidade de sondagem, do sangramento à sondagem e do nível clínico de inserção. Para todos os grupos foram coletadas amostras de fluido sulcular gengival (FSG) (4 sítios sem periodontite e 4 sítios com periodontite) e de sangue para obtenção do plasma sanguíneo. Os níveis de peroxidação lipídica representados pelo MDA, avaliado por HPLC, e pelo LDL oxidado (LDLox), avaliado por ELISA, foram quantificados no fluido sulcular gengival e no plasma. Foram avaliadas ainda as citocinas (IL)-1E, -2, - 4, -5, -6, -7, -8, -10, -12, -13 e fator de necrose tumoral α (TNF-α) no FSG e no plasma. Foi possível determinar e validar o método de avaliação no fluido sulcular gengival, com alta precisão, sendo que os coeficientes de variação intra- e inter-dias encontrados foram abaixo de 6.3% e 12.4%, respectivamente. O método foi considerado sensível e capaz de detectar o MDA em pequenas quantidades, sendo o limite de quantificação (S/N = 5) de 0.03 µM, permitindo avaliação deste marcador no fluido de sítios saudáveis. Foi observado que os sítios com doença periodontal apresentavam-se com valores maiores de MDA do que os sítios saudáveis. Os resultados mostraram que o grupo 1 apresentou maior severidade da doença periodontal quando comparado aos demais grupos, em especial quanto ao sangramento à sondagem, profundidade de sondagem≥6mm, nível de inserção clínica≥5mm e supuração. Em relação aos parâmetros de LPO local e sistêmico, os grupos com diabetes apresentaram maiores níveis de peroxidação quando comparados aos grupos sem diabetes, sendo que o grupo 1 apresentou diferença significativa também em relação ao grupo 2. Em relação às citocinas inflamatórias no FSG, foi observado que o TNF-α, IL-6 e IL-10 estavam significativamente aumentadas no fluido de pacientes com diabetes, sendo esta diferença maior no grupo 1. Foram verificadas correlações positivas e significantes entre os níveis de peroxidação lipídica e citocinas no FSG (IL6, IL-10, TNF-α) bem como com parâmetros de doença periodontal, dentre estes sangramento à sondagem, profundidade de sondagem ≥ 6mm, nível de inserção clínica ≥ 5mm e presença de supuração. Já no plasma, a expressão das citocinas seguiu um padrão decrescente do grupo 1 ao grupo 4 tanto para citocinas pró- quanto anti-inflamatórias, sendo esta diferença significante para (IL)-1E, -4, -6, -8 e TNF-α. Esta diferença ocorreu em maior magnitude no grupo 1, embora nos pacientes portadores de diabetes com adequado controle metabólico os níveis destas citocinas também estivessem mais elevados em relação aos pacientes saudáveis. Os níveis de LPO plasmática apresentaram correlação intermediária e positiva (p<0.0001) com níveis de IL1- ß(0.50), TNF-α.(0.40) e IL-6(0.40). Concluimos que a peroxidaçao lipídica pode ser um mecanismo importante na expressão aumentada de marcadores inflamatórios e maior severidade da doença periodontal no paciente com DM e dislipidemia

The aim of this study is to evaluate the levels of the lipid peroxidation and its correlation with systemic and local inflammatory markers profile in patients with type 2 diabetes mellitus (DM2) dyslipidemia and chronic periodontitis compared to systemically healthy patients. We also aimed to quantify a specific product of the lipid peroxidation process, malondialdehyde (MDA), in gingival crevicular fluid and to describe the validation of this method in this matrix using HPLC. The study sample comprised 120 patients divided into four groups with 30 patients in each group: group 1- diabetes with poor metabolic control with dyslipidemia, group 2- diabetes with good metabolic control, group 3- without diabetes with dyslipidemia and group 4- systemically healthy. All the subjects will go through a complete periodontal examination and physical and laboratory evaluation in order to verify fasting plasma glucose, glycated hemoglobin (HbA1c), lipid profile, insulin and high sensitivity C-reactive protein. Periodontal examination will consist of visible plaque index, gingival bleeding index, bleeding on probing, probing depth (PD) and clinical attachment levels (CAL). Plasma and samples of gingival crevicular fluid (GCF) will be collected in 4 sites without periodontal disease and 4 sites with periodontal disease. The lipid peroxidation levels, evaluated by oxidized LDL (ox LDL) and MDA were measured in GCF and in plasma. Inflammatory cytokines, (IL)-1E, -2, -4, -5, -6, -7, -8, -10, -12, -13 and tumor necrosis factor-alpha α (TNF-α) were also evaluated in plasma and GCF. It was possible to validate a HPLC-based method to identify and quantify the MDA in GCF with sensitivity, precision, and accuracy even in small concentrations as observed in healthy sites GCF. Samples' intra- and interday coefficients of variation were below 6.3% and 12.4%, respectively. The limit of quantitation (S/N = 5) was 0.03 µM. GCF in the periodontal diseased sites presented higher values of MDA than healthy sites for all groups. The results also showed that all the periodontal parameters were considered worse in group 1 (DM with inadequate metabolic control) when compared to the others groups, particularly BOP, PD ≥ 6mm, CAL ≥ 5mm and suppuration. Regarding lipid peroxidation evaluated by MDA in plasma and in gingival crevicular fluid (GCF), significant differences were observed between the groups with diabetes when compared to the groups without DM and G1 presented higher values of MDA when compared to G2 (p<0.05). The local inflammation assessed by cytokines in GCF(IL6, IL-10, TNF-α) increased in all diabetic patients, being significant in the group with poorly controlled diabetes and dyslipidemia. It was possible to verify significant and positive correlations between GCF lipid peroxidation markers, GCF cytokines (IL6, IL-10, TNF-α) and periodontal parameters such as bleeding on probing, PD ≥ 6mm, CAL ≥ 5mm and presence of suppuration. The cytokines panel in plasma showed a decreasing pattern from the poorly controlled diabetes to the healthy group being significant to (IL)-1E, -4, -6, -8 e TNF-α. This difference was more evident is group 1 but even in well-controlled DM with dyslipidemia the levels of MDA, OxLDL and inflammatory cytokines were significantly increased when compared to the non DM/dyslipidemic group. There was a wide range of, moderate positive, correlations observed between DM status, LPO markers and inflammatory cytokines expression, such as MDA and IL1-ß(0.50); MDA and TNF-α.(0.40); MDA and IL-6(0.40). These findings indicate an important role for LPO in the severity of the local inflammatory response to bacteria and the susceptibility to periodontal disease in DM patients and suggest that LPO may represent an additive effect in the aggravation of inflammation in DM and a role of increased oxidative metabolism in the inflammatory response

Is rheumatoid arthritis a risk factor for oral bisphosphonate-induced osteonecrosis of the jaws?

Bisphosphonate-related osteonecrosis of the jaws is a relevant side-effect of these drugs that has been generating a great concern through increasing reports, worldwide, of this bone necrosis. Among several BRONJ hypothetical co-factors that could play a role in BRONJ pathogenesis, rheumatoid arthritis (RA) has been included as a relevant risk factor for BRONJ; however, until now the relationship between these diseases has not been fully explained. Thus, the purpose of this paper is to establish hypothetical factors that could link these two diseases, considering mainly inflammatory components and the organism effects of medicines used to treat RA, particularly steroids and methotrexate (MTX).

Doença periodontal em pacientes com Diabetes Mellitus:influência de polimorfismos genéticos? / Periodontal disease in patients with Diabetes Mellitus:influence of genetic polymorphisms?

Nos últimos anos, evidenciou-se que, em muitas patologias, há fatores que não causam diretamente a doença, mas podem modificá-la, tornando o quadro clínico mais grave e a progressão mais rápida. Observa-se um número crescente de estudos investigando a relação entre Diabetes Mellitus (DM) e Doença Periodontal (DP), com alguns enfoques sobre a influência de fatores genéticos nesse processo. Existem polimorfismos genéticos cuja expressão está associada a fatores de risco. Portanto, para que as variantes genéticas afetem a severidade da doença ou aincidência de forma significativa, os polimorfismos genéticos devem agir cumulativamente ou pela interação com outros fatores, como a presença do diabetes. O objetivo deste estudo foi verificar, por meio de revisão sistemática da literatura, a influência de polimorfismos genéticos no perfil inflamatório da DP em pacientes com diabetes. Foram utilizadas as bases de dados BIREME e PubMed com os termos Periodontitis ou Periodontal disease, Polymorphism e Diabetes Mellitus. Realizando-se um refinamento na pesquisa bibliográfica, foram selecionados cinco referênciasque relacionavam DP crônica com DM e polimorfismos em genes de citocinas, especialmente Interleucina 1 (IL1) e IL6. Estudos associaram a presença de polimorfismos em pacientes portadores de diabetes à maior concentração de citocinas pró-inflamatórias no fluido gengival, quando comparados a pacientes sem diabetes. Conclui-se que, para confirmar essa associação, é necessária a realização de estudos longitudinais, investigando um maior número de genes para compreender melhor as relações causa-efeito entre polimorfismos genéticos, DM e DP.

Currently it is clear that there are several factors that can act as modifiers of diseases, without causing them directly, but having the potential to make these conditions to progress faster and more severe. There is a growing number of studies investigating the relationship between Diabetes Mellitus (DM) and Periodontal Disease (PD), includingsome studies focusing on the influence of genetic factors in this process. The aim of this study was to verify through a literature review, the influence of genetic polymorphisms in the development of PD in patients with DM. PubMed and BIREME were used as databases and the terms Periodontitis or Periodontal Disease, Polymorphism, Diabetes Mellitus were searched. After a refinement in the literature, five studies were selected and they were related to chronic PD with DM and polymorphisms in cytokine genes, especially interleukin 1 (IL1) e IL6. Polymorphismswere associated with a higher concentration of pro-inflammatory cytokines in the gingival crevicular fluid of diabetic patients when compared to non-diabetic. In conclusion, it is necessary to confirm this association with longitudinal studies that must investigate a larger number of cytokine genes in order to understand the cause-effectrelationship between genetic polymorphisms, DM and PD.

Diabetes mellitus and oral mucosa alterations: prevalence and risk factors.

AIMS: To investigate the prevalence of oral mucosa alterations in patients with type 2 diabetes and to identify possible risk factors related to oral mucosa alterations. METHODS: 146 patients with type 2 diabetes and 111 age- and gender-matched healthy controls subjects were consecutively recruited from Araraquara School of Dentistry to answer a structured questionnaire designed to collect demographic data as well as current and former history of diabetes. Clinical examination of the oral mucosa was carried out by a stomatologist. RESULTS: A higher prevalence of oral mucosa alterations was found in patients with diabetes than in patients without diabetes (p<0.001), with significant difference to development conditions (p<0.0001), potentially malignant disorders (p<0.0001) and fungal infections (p<0.05). In the multiple logistic regression, diabetes (odds ratio 9.9 IC 5.11-19.16) and smoking habit (odds ratio 3.17 IC 1.42-7.12) increased the odds of oral mucosa alterations significantly. CONCLUSIONS: Patients with diabetes mellitus not only showed an increased prevalence of oral mucosa alterations but also a significant percentage of potentially malignant disorders. These findings elucidate the necessity of regular clinical examination to ensure early diagnosis and prompt management of oral mucosa lesions in patients with diabetes.

Implantes dentais em pacientes com diabetes mellitus / Dental implants in patients with diabetes mellitus

Os implantes osseointegráveis representam um grande avanço da Odontologia, no que diz respeito à reabilitação de áreas edêntulas, uma vez que permite o restabelecimento estéticofuncional com previsibilidade e sucesso em longo prazo. No entanto, a efetividade deste tratamento depende do processo de osseointegração, sendo consequentemente dependente do estado de saúde geral do paciente. Sob esse aspecto, a aplicabilidade de implantes em indivíduos portadores de diabetes mellitus (DM) permanece controversa, uma vez que o estado hiperglicêmico pode representar um fator negativo para a osseointegração, conduzindo ao insucesso do tratamento. Além disso, existem fatores de risco inerentes ao diabetes que podem aumentar as taxas de insucesso na terapia com implantes dentários, permanecendo a dúvida se o diabetes seria uma contraindicação absoluta a este tipo de terapia. Dessa forma, o diabetes tem sido considerado uma contraindicação relativa para realização de implantes dentários, de modo que pacientes com controle metabólico adequado são considerados aptos a este tipo de tratamento. Em função desses questionamentos, foi realizada uma revisão da literatura sobre a aplicabilidade de implantes dentais em portadores de diabetes.

Dental implants represent a great improvement in Dentistry in respect to rehabilitation of edentulous ridges due to the functional and aesthetic reestablishment with long-term predictability and success. However, the effectiveness of this treatment relies on successful osseointegration during the healing period. In this way, the applicability of dental implants in patients with diabetes mellitus (DM) remains controversial, by the fact that the hyperglycemic status presents a negative effect on the osseointegration. It is not clear yet if the therapy with dental implants is an absolute contraindication to these patients. For this reason, the aim of the present study is to review the literature about the treatment with dental implants in patients with diabetes and to propose a protocol to perform dental implants in patients with diabetes. Diabetes has been considered a relative contraindication to dental implants, as the patients with adequate metabolic control can be treated with this kind of therapy, because inadequate metabolic control can lead to the failure of the treatment. Besides, there are risk factors for the diabetic implant patient that may decrease the success rates of dental implants therapy. In this way, the dentist should understand all the relevant implications before considering the indication of dental implants to patients with diabetes. It is important to have more controlled studies to evaluate the effects of diabetes on the implant-tissue interface and further investigations are necessary in order to elucidate the role of insulin and molecular mechanisms that might interfere on the osseointegration in patients with diabetes.

Enxerto ósseo homólogo como alternativa na enxertia do rebordo maxilar atrófico / Allogeneic boné graft as na alternative for atrophic maxillary anterior region augmentation: case report

O posicionamento tridimensional do implante em relação ao processo alveolar e aos tecidos moles orofaciais, consiste em um dos maiores desafios da Implantodontia moderna, visto que a inserção do implante deve ser realizada em áreas ósseas adequadas, que propiciem uma condição favorável na qual o implante permaneça envolto por tecido ósseo e em uma posição harmônica com a mucosa periimplantar. A tentativa de se reconstruir defeitos ósseos através de enxertos homólogos é secular. Atualmente, apesar de não ser conhecido por completo, o mecanismo de incorporação desse tipo de osso, o índice de sucesso nas cirurgias de enxerto homólogo tem crescido de forma considerável. O objetivo deste trabalho é relatar um caso clínico no qual foi utilizado osso homólogo, obtido de banco de tecidos, para reconstrução de um defeito ósseo, na região anterior da maxila, que impossibilitava a reabilitação com implantes. Neste artigo demonstra-se através de análises clínicas e histológicas que o uso do osso homólogo, previamente a colocação de implantes, pode ser uma alternativa promissora no aumento ósseo, uma vez que possui a vantagem de não sacrificar uma segunda área para remoção do enxerto e pela viabilidade e a praticidade dessa técnica cirúrgica.

Erupção dentária após remoção de odontoma / Tooth eruption after surgical removal of an odontoma

Os odontomas são anomalias de desenvolvimento relativamente comuns e se originam do crescimento diferenciado de células epiteliais e mesenquimais que potencializam funcionalmente odontoblastos e ameloblastos. Essas lesões são comumente encontradas como causa da não erupção de algumas unidades dentárias e devem ser submetidas à avaliação e tratamento criteriosos. A proposta deste artigo é ilustrar o potencial de erupção de um segundo molar inferior impactado após remoção cirúrgica de um odontoma complexo numa paciente de 13 anos de idade.

A influencia de variáveis clinicas na susceptibilidade à doença periodontal de puérperas com parto a termo / Influence of clinicai variables in the periodontal disease susceptibility in puerperium women of term birth

A presente pesquisa de campo tem como objetivo avaliar a condição periodontal de mulheres no puerpério imediato, até 24 horas após o parto, período em que as condições bucais ainda estão sob influências dos hormônios da gravidez, estudando a associação de variáveis clínicas como fatores de risco à doença periodontal. A amostra foi composta de 140 puérperas, sendo utilizados como instrumentos de avaliação dois roteiros de entrevistas e, em seguida, foi realizado o exame bucal para mapeamento periodontal em ficha clínica padronizada. Os resultados encontrados mostram que a doença periodontal esteve presente em 85% das pacientes e teve relação direta com variáveis clinicas como frequência de escovação, uso de fio dental e intervalo de tempo da última consulta ao dentista. A consulta ao pré-natal, apesar da elevada frequência (97,2%), não foi acompanhada da visita ao dentista (37,9%). Diante do exposto, aponta-se para a imperativa necessidade de unir conhecimentos médicos e odontológicos visando diminuir o risco da gestante de ser acometida pela doença periodontal que, assim como qualquer doença infecciosa pode colocar em risco não só a saúde da mãe, como também a do concepto.