Clinical efficacy of endodontic protocols on reducing cultivable bacteria and endotoxin in infected root canal in patients submitted to head and neck radiotherapy: a randomised clinical trial.

OBJECTIVES: Assess the efficacy of biomechanical preparation using a reciprocating system followed by final irrigation protocols, then intracanal medication, on reducing endotoxins and cultivable bacteria of infected teeth in irradiated patients. MATERIALS AND METHODS: Twenty-two infected single-rooted canals in patients submitted to head and neck radiotherapy were prepared by reciprocating motion and 2.5% NaOCl. Patients were randomly divided into two groups of 11 patients before the final irrigation protocol: apical positive pressure (APP) or passive ultrasonic activation (PUA). Both groups were treated in two sessions, using Ca(OH)2 as intracanal medication for 14 days. Root canal content sampling was performed after canal access (S1), after biomechanical preparation plus the irrigation protocol (S2), and after intracanal medication (S3). Chromogenic limulus amoebocyte lysate assay measured endotoxin levels (EU/mL), and bacterial load was determined by culture techniques (CFU/mL). RESULTS: Treatment protocols reduced bacterial counts after S2 in both groups (p = 0.01). S3 differed from S1 (p = 0.01), but not from S2 (p = 0.4). Endotoxin levels were reduced in both groups after S2 (P = 0.03) and were lower in S3 than in S2, with significant differences in the APP group (p = 0.03). CONCLUSIONS: Biomechanical preparation using a reciprocating system and 2.5% NaOCl in irradiated teeth, followed by the irrigation protocol (APP or PUA), demonstrated efficacy in reducing endodontic contaminants. Ca(OH)2 as intracanal medication should be performed in irradiated patients with infected root canals. CLINICAL RELEVANCE: This clinical study demonstrated that endodontic treatment in irradiated patients is efficacious at reducing bacterial load and endotoxin levels.

New Volume-Stable Collagen Matrix and Modified Coronally Advanced Flap to Treat Multiple Gingival Recessions Associated With Partially Restored Non-Carious Cervical Lesions: A Case Report.

INTRODUCTION: Gingival recession (GR) is a prevalent problem that is related to esthetic demands and dentin hypersensitivity. Frequently, GR is associated with non-carious cervical lesion (NCCLs) forming a combined defect (CD), which requires restorative and surgical treatment. Connective tissue graft procedures allow predictable root coverage but can result in patient discomfort. CASE PRESENTATION: This first case report describes multiple GRs associated with B+ NCCL at teeth #4 and #6 of a 27-year-old patient with a thin periodontal phenotype. The aim of this report was to evaluate the 6-month outcome of a new volume-stable collagen matrix (VCMX) combined with modified coronally advanced flap (MCAF) and partial restoration to treat CDs. After 6 months, significant improvement was observed regarding CD coverage (69.05%), recession reduction (2.25 mm), gingival thickness gain (0.74 mm), and keratinized tissue width gain (0.75 mm). In addition, excellent esthetic evaluation and patient comfort were achieved by using the biomaterial. CONCLUSION: VCMX associated with MCAF and partial restoration may be an option to treat multiple recession defects plus B+ NCCLs.

Comparison of Three Anxiety Management Protocols for Extraction of Third Molars With the Use of Midazolam, Diazepam, and Nitrous Oxide: A Randomized Clinical Trial.

PURPOSE: The objective of the present study was to compare 3 sedation protocols using diazepam, midazolam, and nitrous oxide. PATIENTS AND METHODS: A total of 120 patients with an indication for extraction of third molars were selected. All 120 patients had had moderate to severe levels of anxiety according to the Corah Dental Anxiety Scale. The patients were randomly divided into 3 groups. The patients' vital signs were measured, and the results analyzed by descriptive statistical analysis and statistical tests of comparison. RESULTS: No statistically significant differences were found in the patients' heart rate. However, the differences in the systolic and diastolic blood pressure were statistically significant after 15 minutes of nitrous oxide sedation. The oximetry data showed no differences among the 3 sedation protocols. We also found no statistically significant differences in the retrograde amnesia test. The differences in anxiety from preoperatively to postoperatively were statistically significant for all techniques, demonstrating their effectiveness in anxiety control. CONCLUSIONS: All 3 preoperative sedation techniques for anxious patients undergoing extraction of third molars used in the present study were effective in controlling the anxiety, with little effect on the patients' vital signs and retrograde amnesia.

Photobiomodulation for the treatment of periodontal pockets in patients with type 2 diabetes: 1-year results of a randomized clinical trial.

This study investigated the local effect of photobiomodulation (PBM) for the treatment of periodontal pockets in patients with periodontitis and type 2 diabetes. Thirty-eight periodontal pockets presenting probing depth (PD) and clinical attachment level (CAL) ≥ 5 mm were selected from 19 patients (two pockets/patient). The selected periodontal pockets were randomly assigned to receive mechanical debridement only (control group) or mechanical debridement with PBM (PBM group). Clinical measures, such as PD, CAL, bleeding on probing (BoP), and presence of supragingival biofilm (PI), were collected and compared at baseline, 3, 6, and 12 months. After 12 months, no statistically difference was observed for mean PD and mean CAL when control and PBM groups were compared. The frequency of pockets with PD 5-6 mm was significantly lower for the PBM group at 6 months when compared to the control group. Pockets with PD ≥ 7 mm changed significantly between baseline and 3, 6, and 12 months for the PBM group, while for the control group, statistical significance was only observed between baseline and 6 months. The PBM protocol used in this study did not provide significant changes for PD and CAL in periodontal pockets when compared to mechanical therapy only. However, PBM was more effective in reducing the percentage of moderate periodontal pockets at 6 months in patients with type 2 DM.

Treatment of single maxillary gingival recession associated with non-carious cervical lesion: Randomized clinical trial comparing connective tissue graft alone to graft plus partial restoration.

BACKGROUND: Gingival recession (GR) is frequently associated with non-carious cervical lesion (NCCL) forming a combined defect (CD). The aim of this study was to evaluate a new multidisciplinary protocol for CDs. METHODS: Forty patients presenting 40 Miller's Class I or II GR defects associated with B+ tooth cervical defect were randomly allocated to one of the following treatments: test group (n = 20), partial restoration (PR) of the NCCL, in which the apical border of the restoration was placed 1 mm beyond the cement-enamel junction estimation, and connective tissue graft (CTG + PR) and Control Group (n = 20), odontoplasty of the NCCL and connective tissue graft (CTG). Clinical, aesthetic and patient-centred outcomes were evaluated. RESULTS: After 12 months, CD coverage rates were 75.3% (2.5 ± 1.0 mm) for CTG + PR and 74.6% (2.4 ± 1.1 mm) for CTG (p > 0.05). The estimated complete root coverage was 60% (n = 12) for CTG + PR and 70% (n = 14) for CTG. CTG + PR resulted in significantly better dentin hypersensitivity (DH) reduction (p = 0.034). Both groups resulted in aesthetic improvements; however, the CTG + PR group showed better gingival contour results. CONCLUSIONS: CTG and CTG + PR were effective to treat CD. Use of PR resulted in better gingival margin contour and DH reduction, without effect on CD coverage by CTG. (NCT02817763).

Local adjunct effect of antimicrobial photodynamic therapy for the treatment of chronic periodontitis in type 2 diabetics: split-mouth double-blind randomized controlled clinical trial.

Diabetes has become a global epidemic. Its complications can have a significant impact on quality of life, longevity, and public health costs. The presence of diabetes might impair the prognosis of periodontal treatments due to its negative influence on wound healing. Antimicrobial photodynamic therapy (aPDT) is a local approach that can promote bacterial decontamination in periodontal pockets. The aim of this study was to investigate the local effect of adjunct aPDT to ultrasonic periodontal debridement (UPD) and compare it to UD only for the treatment of chronic periodontitis in type 2 diabetic patients. Twenty type 2 diabetic patients with moderate to severe generalized chronic periodontitis were selected. Two periodontal pockets with probing depth (PD) and clinical attachment level (CAL) ≥5 mm received UPD only (UPD group) or UPD plus adjunct aPDT (UPD + aPDT group). Periodontal clinical measures were collected and compared at baseline and 30, 90, and 180 days. After 180 days of follow-up, there were statistically significant reductions in PD from 5.75 ± 0.91 to 3.47 ± 0.97 mm in the UPD group and from 6.15 ± 1.27 to 3.71 ± 1.63 mm in the UPD + aPDT group. However, intergroup analysis did not reveal statistically significant differences in any of the evaluated clinical parameters (p > 0.05). The adjunct application of aPDT to UPD did not present additional benefits for the treatment of chronic periodontitis in type 2 diabetic patients. The ClinicalTrials.gov identifier of the present study is NCT02627534.