Clinical and Microbiological Evaluation of Surgical and Nonsurgical Treatment of Aggressive Periodontitis.

The present study aimed to evaluate clinical and microbiological effects of surgical and nonsurgical periodontal therapy in generalized aggressive periodontitis (GAgP) treatment. Sixteen GAgP patients were included in this randomized split-mouth design clinical trial. Maxillary quadrants were allocated into two groups: Nonsurgical Therapy (NST) and Surgical Therapy (ST). The following clinical parameters were assessed: plaque index (PI), bleeding on probing index (BoP), probing depth (PD), clinical attachment level (CAL) and gingival margin position (GMP). Concentrations of Porphyromonas gingivalis (Pg) and Aggregatibacter actinomycetemcomitans (Aa) in the subgingival biofilm were also determined. Clinical and microbiological parameters were assessed at baseline (n=16), 3 (n=15), 6 (n=15) and 12 months (n=8) after treatment. ST was able to promote higher PD reduction compared to NST in deep pockets at 12 months (p<0.05) and in posterior teeth at 6 months (p<0.05). In addition, higher gingival recession was observed in posterior teeth of the ST group at the 6th month (p<0.05). However, ST failed to promoted additional CAL gain in any timepoint (p>0.05). Moreover, microbiological evaluation showed no statistical difference in levels of Aa and Pg for both groups at all follow-up periods. Surgical therapy promoted similar clinical benefits to GAgP therapy. Moreover, both therapies failed to reduce Aa and Pg levels at different follow-up times.

Evaluation of the effectiveness of diode laser on pain and edema in individuals with cleft lip and palate submitted to secondary bone graft.

OBJECTIVE : To clinically evaluate the effects of diode laser, Gallium-Aluminum-Arsenide laser (GaAlAs), on the pain and edema after secondary alveolar bone graft. DESIGN : Case-control, double-blind study. Setting : Institutional tertiary referral hospital. Participants : The sample was composed of 60 individuals with complete unilateral cleft lip and palate, of both genders, aged 9 to 15 years, submitted to secondary alveolar bone graft. MAIN OUTCOME MEASURES : The individuals were divided into an experimental group (patients irradiated with diode laser GaAlAs, energy density of 4 J/cm(2), power of 100 mW, and wavelength in the infrared spectrum, for 10 seconds per point on 10 points, adding up to a dose of 40 J/cm(2)) and a placebo group (simulated laser application for 60 seconds per point, also on 10 points). Applications were made on the receptor site immediately postoperatively and after 24 and 48 hours. The pain and edema were assessed preoperatively and at each application. RESULTS : The two groups presented increase in pain and edema in 24 and 48 hours. No statistically significant difference was found between groups. CONCLUSIONS : According to the present methodology, the use of low-level laser to control the pain and edema in the postoperative period of secondary alveolar bone graft was not effective.

Diagnóstico e tratamento de periodontite agressiva / Diagnosis and treatment in aggressive periodontitis

A periodontite agressiva é uma doença que ainda se apresenta como desafio para o diagnóstico e para o tratamento. Frequentemente, acomete pessoas saudáveis, tem forte correlação familiar e produz rápida perda de inserção. Entretanto, as características clínicas não são suficientes para fechar o diagnóstico. A presença de uma microbiota patogênica é fundamental para o início e a progressão da doença. A biodiversidade da microflora subgengival é bastante grande, e uma grande parte ainda permanece desconhecida. O perfil genético também pode estar diretamente relacionado à destruição periodontal, pela alteração de funções celulares relativas ao sistema imune-inflamatório, causadas por mutações ou polimorfismos. Embora a PA seja uma doença multifatorial de difícil compreensão dos fatores etiológicos, o tratamento de escolha para a PA é a terapia mecânica, que demonstrou melhora significativa dos parâmetros clínicos. O uso de antimicrobianos como auxiliar no tratamento tem tentado potencializar os resultados clínicos da terapia mecânica. O objetivo deste artigo foi pontuar as características clínicas, microbiológicas e imunológicas que possam auxiliar o diagnóstico da periodontite agressiva, bem como uma revisão dos protocolos de tratamento periodontal mais recentemente avaliados, permitindo um tratamento focado em características específicas dessa condição patológica.