Orthodontic treatment in patients with aggressive periodontitis.

INTRODUCTION: Aggressive periodontitis (AP) is a condition that promotes breakdown of the periodontal tissues in a short time. In severe cases, pathologic migration of teeth and tooth loss can occur, producing esthetic and functional problems for the patient. Orthodontic treatment may be recommended to restore esthetics and masticatory function. We assessed the effects of orthodontic movement in the periodontal tissues of treated patients with AP. METHODS: Ten subjects (ages 25.0 ± 5.22 years) with AP received periodontal treatment followed by orthodontic treatment. Maintenance sessions were performed monthly under a strict dental biofilm control. They were compared with 10 periodontally healthy subjects (ages 22.9 ± 5.23 years) who received orthodontic treatment. Probing pocket depth, clinical attachment level, bleeding on probing, and dental plaque index were measured at baseline, after orthodontic treatment, and after 4 months. RESULTS: Statistical analysis showed improvement in all clinical parameters between baseline and 4 months after orthodontic treatment: probing pocket depth (0.29 mm), clinical attachment level (0.38 mm), bleeding on probing (4.0%), and dental plaque index (11%). CONCLUSIONS: The periodontal parameters of the AP patients remained stable during orthodontic treatment under strict biofilm control.

Subgingival ultrasonic instrumentation of residual pockets irrigated with essential oils: a randomized controlled trial.

AIM: To evaluate the clinical efficacy of subgingival ultrasonic instrumentation irrigated with essential oils (EOs) of residual periodontal pockets. MATERIAL AND METHODS: Sixty-four individuals with chronic periodontitis were invited to participate in this randomized, double-blind, parallel, and placebo-controlled clinical trial. All subjects received non-surgical periodontal therapy. After re-evaluation (baseline), residual pockets (pocket depth ≥5 mm) received test (ultrasonic instrumentation irrigated with EOs) or control therapy (ultrasonic instrumentation irrigated with negative control). Probing pocket depth (PPD), gingival recession (R), clinical attachment level (CAL), bleeding on probing (BOP), and plaque were assessed at baseline and after 4, 12, and 24 weeks. Differences between groups and changes over the course of time were analysed according to a generalized linear model. RESULTS: There was a significant reduction in PPD and BOP, as well as a significant CAL gain in the two groups (p<0.001). Nevertheless, there were no differences between the groups at any time of the study. When only initially deep pockets (PPD ≥7 mm) were analysed, a significantly greater CAL gain (p=0.03) and PPD reduction (p=0.01) was observed in the test group. CONCLUSION: The adjunctive use of EOs may promote significant CAL gain and PPD reduction in deep residual pockets.

Compliance improvement in periodontal maintenance.

OBJECTIVES: The aim of this study was to assess the influence of efforts applied to modify the patients' behavior towards periodontal maintenance. MATERIAL AND METHODS: Patients were classified into three groups: Complete Compliance (participation in all visits), Irregular Compliance (irregular participation, one or more missing appointments), and Noncompliance (abandoned or never returned to the program). Complete compliers received usual procedures of the maintenance visit. The irregular compliers and non-compliers received usual procedures and strategies such as reminding next visit, informing patients on both periodontal disease and importance of maintenance, motivating the patient who showed an improvement in compliance. Thus, 137 patients were observed for 12 months. RESULTS: The degree of compliance has increased significantly during this period (p=0.001). No association was detected between age or gender and compliance degree. CONCLUSIONS: The results have shown that the intervention applied had a favorable influence on the patients' compliance.

Compliance improvement in periodontal maintenance

OBJECTIVES: The aim of this study was to assess the infuence of efforts applied to modify the patients' behavior towards periodontal maintenance. MATERIAL AND METHODS: Patients were classifed into three groups: Complete Compliance (participation in all visits), Irregular Compliance (irregular participation, one or more missing appointments), and Noncompliance (abandoned or never returned to the program). Complete compliers received usual procedures of the maintenance visit. The irregular compliers and non-compliers received usual procedures and strategies such as reminding next visit, informing patients on both periodontal disease and importance of maintenance, motivating the patient who showed an improvement in compliance. Thus, 137 patients were observed for 12 months. RESULTS: The degree of compliance has increased signifcantly during this period (p=0.001). No association was detected between age or gender and compliance degree. CONCLUSIONS: The results have shown that the intervention applied had a favorable infuence on the patients' compliance.

Avaliação dos parâmetros clínicos periodontais de pacientes não fumantes em manutenção: estudo longitudinal prospectivo / Evaluation of the periodontal clinical parameters of non-smoking patients under maintenance: prospective longitudinal study

Neste estudo observacional longitudinal prospectivo, foram avaliados os parâmetros clínicos de 2257 sítios de 16 pacientes não fumantes em manutenção periodontal, através de sondagem computadorizada. Estes pacientes, tratados de periodontite crônica de moderada a severa, receberam manutenção periodontal trimestralmente durante dois anos. Na consulta inicial e aos 3, 6, 9, 12, 18 e 24 meses foram registrados, em seis sítios por dente, os parâmetros clínicos profundidade clínica de sondagem (PCS), retração gengival, nível clínico de inserção (NCI), sangramento e supuração à sondagem e presença de placa, além da mobilidade dentária. A mensuração e registro automatizado destas medidas foram realizados com precisão de 0,2 mm, sob pressão constante de 20 g. Todos os exames foram realizados pelo mesmo examinador, treinado e calibrado. Os sítios monitorados apresentaram, no período avaliado, redução de bolsa e ganho clínico de inserção significativos (p<0,00001). Considerando diferenças maiores do que 1 mm entre o NCI aos 24 meses e no exame inicial, 4,52% dos sítios apresentaram perda de inserção. O modelo multinível de regressão logística mostrou que, quanto menores o NCI e a PCS inicial do sítio, maiores seriam suas chances de perder inserção. Sítios com maiores frequências de presença de placa ou de sangramento à sondagem, bem como sítios proximais e em dentes com mobilidade, também tiveram maiores chances de perda de inserção. Sítios de alguns grupos dentários também apresentaram maiores chances deste desfecho. O reduzido número de sítios com perda de inserção e a melhora nos parâmetros clínicos detectados neste estudo demonstraram a importância de um programa de manutenção periodontal bem realizado e supervisionado, com intervalos regulares de três meses, na manutenção da saúde periodontal obtida com o tratamento.

In this prospective longitudinal observational study, the periodontal clinical parameters of 2257 sites of 16 non-smoking patients under maintenance were evaluated by computerized periodontal probing. These patients, who had been treated of moderate to severe chronic periodontitis, received periodontal maintenance every third month over two years. At baseline and at 3, 6, 9, 12, 18 and 24 months, the clinical parameters Probing Depth (PD), gingival recession, Clinical Attachment Level (CAL), bleeding and suppuration on probing and plaque presence, besides tooth mobility, were record at six sites per tooth. The measurement and automated recording of these measures was performed with resolution of 0.2 mm, under constant force of 20g. All examinations and measures were performed by the same trained and calibrated examiner. The monitored sites showed, in the evaluated period, significant (p<0.00001) pocket reduction and clinical attachment gain. When differences between the CAL at 24 months and at baseline greater than 1 mm were considered, 4.52% of the sites showed attachment loss. The multilevel logistic model showed that, the smaller the site NCI and PCS baseline values, the bigger its odds of loss attachment. Sites with higher frequencies of plaque presence or bleeding on probing, as well as proximal sites and sites in mobility teeth, showed bigger odds of attachment loss too. Sites in some tooth groups showed bigger odds of this outcome too. The reduced number of sites with attachment loss and the detected attachment gain in this trial demonstrated the importance of a well performed and supervised periodontal maintenance program, with regular intervals of three months, in the maintenance of the periodontal health obtained after treatment.

Avaliação do nível clínico de inserção de pacientes em manutenção periodontal / Evaluation of the probing attachment level of patients under periodontal maintenance

Neste ensaio clínico prospectivo de curta duração, foi avaliado o Nível Clínico de Inserção (NCI) de 2500 sítios de 18 pacientes em Manutenção Periodontal (MP), pela sondagem computadorizada. Estes pacientes foram tratados em razão de periodontite crônica, de moderada a severa, e monitorados trimestralmente durante nove meses. Em cada consulta, previamente aos cuidados de MP, foram registrados, em seis sítios por dente, os parâmetros clínicos: Profundidade Clínica de Sondagem, retração gengival e NCI. A mensuração e registro automatizado destas medidas foram realizados com precisão de 0,2 mm, sob pressão constante de 20g. Todos os exames foram realizados pelo mesmo examinador, treinado e calibrado. Os 2500 sítios monitorados apresentaram, em média, no período avaliado, um ganho clínico de inserção de 0,18 mm. Esta tendência de ganho de inserção ocorreu também em todos os grupos de dentes, em todos os tipos de sítios e em cada tipo de sítio em cada grupo de dentes. O ganho clínico de inserção detectado neste estudo demonstrou a eficiência de um programa de MP bem realizado e supervisionado, com intervalos regulares de três meses, na manutenção da saúde periodontal obtida com o tratamento.

Avaliação da cooperação aos retornos dos pacientes em manutenção periodontal / Compiance evaluation of patients recalls in peridontal maintenance

Este estudo retrospectivo teve como objetivo determinar o grau de cooperação aos retornos dos pacientes em manutenção periodontal. Foram avaliados 420 pacientes cadastrados no Programa de Controle e Manutenção da Clínica de Pós Graduação da Disciplina de Periodontia da Faculdade de Odontologia da Universidade de São Paulo, de marçode 1998 a dezembrode 2003. Estes pacientes foram divididos em três grupos: 1) Cooperação completa; 2) Cooperação irregular; 3) Nenhuma cooperação. A análise mostrou que apenas 20,23% dos pacientes retornaram regularmente ao Programa (Grupo 1), 9,04% retornaram irregularmente (Grupo 2), e 70,71% abandonaram o programa ou nunca retornaram (Grupo 3). Houve diferença significante entre os grupos em relação à idade e tempo de manutenção ( p=0,004 e p<0,001), ao passo que, não houve associação significativa entre sexo e grau de cooperação (p=0,45).Os resultados demonstraram que o índice de cooperação aos retornos é muito baixo e deve ser melhorado.