Efeito do tratamento periodontal não-cirúrgico sobre o controle glicêmico, mediadores inflamatórios e adipocinas em pacientes com diabetes mellitus tipo 2 e periodontite crônica severa / Effect of non-surgical periodontal treatment on glycemic control, inflammatory mediators and adipokines in patients with type 2 diabetes and severe chronic periodontitis

O objetivo do presente estudo foi avaliar o efeito do tratamento periodontal não cirúrgico sobre o controle glicêmico e os níveis séricos de adipocinas e mediadores inflamatórios em pacientes com periodontite crônica e diabetes mellitus tipo 2 (DM2). Foram selecionados 41 pacientes com periodontite crônica severa e com DM2, que foram aleatoriamente alocados em dois grupos: o grupo teste (21 pacientes, idade média de 58,1 ± 8,4 anos, 11 homens e 10 mulheres), que foram submetidos ao tratamento periodontal não cirúrgico; e o grupo controle (20 pacientes, idade média de 54,1 ± 9,9 anos, 14 homens e 6 mulheres), que permaneceram sem tratamento periodontal. Os parâmetros clínicos (profundidade de sondagem ­ PS, nível de inserção clínica ­ NIC, SS - sangramento à sondagem e índice de placa ­ IP), os laboratoriais (hemoglobina glicada ­ HbA1c, colesterol total ­ CT, HDL, LDL e triglicerídeos) e os marcadores inflamatórios (interleucinas - 1ß e -6, fator de necrose tumoral-α, resistina, leptina e adiponectina) foram avaliados inicialmente (dia 0) e 90 dias após a terapia periodontal. Os resultados obtidos indicaram uma redução na % dos sítios com SS, IP e nos sítios com PS ≥ 6mm no grupo teste (P <0.05). Os níveis de HbA1c, glicose estimada, IL-1ß, TNF-α e resistina também diminuíram significativamente neste grupo. Os demais marcadores não tiveram alterações significantes em ambos os grupos. Concluindo, o tratamento periodontal não cirúrgico da periodontite crônica severa foi associado à melhora do controle glicêmico e à diminuição nos níveis de IL-1ß, TNF-α e resistina após 3 meses, em pacientes com diabetes mellitus tipo 2.

The aim of this study was to evaluate the effects of non-surgical periodontal treatment on glycemic control, adipokines and systemic inflammatory mediators levels in patients with severe chronic periodontitis and diabetes mellitus type 2 (DM2). Fourty-one patients with severe chronic periodontitis and DM2 were randomly allocated in the test group (21 patients, mean age 58.1 ± 8.4 years, 11 men and 10 women) underwent nonsurgical periodontal treatment; and the control group (20 patients, mean age 54.1 ± 9.9 years, 14 men and 6 women) who remained untreated. The clinical parameters (probing depth - PD, clinical attachment level - CAL, BOP- bleeding on probing and plaque index - PI), laboratory (glycated hemoglobin - HbA1c, total cholesterol - TC, HDL, LDL and triglycerides) and inflammatory mediators (interleukin - 1ß and -6, tumor necrosis factor-α, resistin, leptin and adiponectin) were evaluated at baseline and 90 days after periodontal therapy. After 90 days, there was a reduction in the% of sites with BOP, PI and sites with PD ≥ 6 mm in the test group. HbA1c levels, estimated glucose, IL-1ß, TNF-α and resistin also significantly decreased in this group. There were no significant changes in the other markers in both groups. In conclusion, non-surgical periodontal treatment improved glycemic control in patients with severe chronic periodontitis and DM2. IL-1ß, TNF-α and resistin levels decreased significantly after 3 months of the treatment.

Aterosclerose e periodontite: revisão de literatura / Atherosclerosis and periodontitis: literature review

A doença periodontal é um processo inflamatório dos tecidos de suporte dos dentes que, quando resulta em uma destruição progressiva do ligamento periodontal e osso alveolar, com formação de bolsa, retração ou ambas, recebe o nome de periodontite. Esta ocorre a partir de uma complexa interação entre infecção crônica por bactérias anaeróbias e resposta inflamatória do hospedeiro. A aterosclerose é uma doença sistêmica de natureza inflamatória muito comum, de início precoce, progressão lenta e sintomas clínicos raros antes dos 40 anos de idade. Uma parcela da população acometida pela aterosclerose não apresenta os fatores de risco tradicionais como a hipertensão, altos níveis de colesterol, tabagismo, diabetes e obesidade, o que levou ao surgimento da hipótese, baseada nos efeitos diretos de agentes infecciosos nos componentes celulares das paredes dos vasos, de que infecções bacterianas como a periodontite podem contribuir para o desenvolvimento da aterosclerose e de eventos tromboembólicos. Para isto, marcadores inflamatórios, como a proteína C-reativa (PCR), interleucina-6 e fibrinogênio que estão associados com alterações imunológicas, vêm sendo amplamente pesquisados. Apesar de inúmeros estudos corroborarem cada vez mais para a existência dessa relação entre a periodontite e as doenças cardiovasculares, ainda são necessários mais estudos multicêntricos, randomizados, que apresentem amostras significativas e menos fatores de confusão

Periodontal disease is an inflammatory process of supporting tissues of the teeth, that, when results in a graduald estruction of periodontal ligament and alveolar bone, with periodontal pocket, gingival retraction or both, is called periodontitis. This occurs because of a complex interaction between chronic infection by anaerobic bacteria and host inflammatory response. Atherosclerosis is a systemic disease very of common inflammatory nature, early onset, slow progression and rare clinical symptoms before the age of 40 years old. A portion of the population with atherosclerosis does not present the traditional risk factors such as hypertension, high cholesterol, smoking, diabetes and obesity, which led to the emergence of hypothesis, based on the direct effects of infectious agents in cellular components of vessel walls, that bacterial infections like periodontitis may contribute to the development of atherosclerosis and of thromboembolic events. For this, inflammatory markers, as C-reactive protein (CRP), interleukin-6 and fibrinogen, that are associated with immunological changes, have been widely researched. Despite numerous studies the existence of the relation shipbetween periodontitis and cardiovascular diseases, it is still required further multi-center and randomized studies, with significant samples and less confusion factors

Potential of bioactive glass particles of different size ranges to affect bone formation in interproximal periodontal defects in dogs.

BACKGROUND: The aim of this study was to compare the potential of bioactive glass particles of different size ranges to affect bone formation in periodontal defects, using the guided tissue regeneration model in dogs. METHODS: In six dogs, 2-wall intrabony periodontal defects were surgically created and chronified on the mesial surfaces of mandibular third premolars and first molars bilaterally. After 1 month, each defect was randomly assigned to treatment with bioabsorbable membrane in association with bioactive glass with particle sizes between 300 and 355 microm (group 1) or between 90 and 710 microm (group 2), membrane alone (group 3), or negative control (group 4). The dogs were sacrificed 12 weeks after surgeries, and histomorphometric measurements were made of the areas of newly formed bone, new mineralized bone, and bioactive glass particle remnants. RESULTS: With regard to the area of bioactive glass particle remnants, there was a statistically significant difference between groups 1 and 2, favoring group 1. There were greater areas of mineralized bone in groups 1 and 2 compared to groups 3 and 4 (P <0.05). CONCLUSION: The bioactive glass particles of small size range underwent faster resorption and substitution by new bone than the larger particles, and the use of bioactive glass particles favored the formation of mineralized bone.

Comparison between two surgical techniques for root coverage with an acellular dermal matrix graft.

AIM: The aim of this randomized, controlled, clinical study was to compare two surgical techniques with the acellular dermal matrix graft (ADMG) to evaluate which technique could provide better root coverage. MATERIAL AND METHODS: Fifteen patients with bilateral Miller Class I gingival recession areas were selected. In each patient, one recession area was randomly assigned to the control group, while the contra-lateral recession area was assigned to the test group. The ADMG was used in both groups. The control group was treated with a broader flap and vertical-releasing incisions, and the test group was treated with the proposed surgical technique, without releasing incisions. The clinical parameters evaluated before the surgeries and after 12 months were: gingival recession height, probing depth, relative clinical attachment level and the width and thickness of keratinized tissue. RESULTS: There were no statistically significant differences between the groups for all parameters at baseline. After 12 months, there was a statistically significant reduction in recession height in both groups, and there was no statistically significant difference between the techniques with regard to root coverage. CONCLUSIONS: Both surgical techniques provided significant reduction in gingival recession height after 12 months, and similar results in relation to root coverage.

Regeneração tecidual guiada no tratamento de defeito intra-ósseo. Relato de caso clínico / Guided tissue regeneration for the treatment of periodontal intrabony defect. Case report

Fatores relacionados ao paciente, ao defeito periodontal, ao procedimento cirúrgico e aos cuidados pós-operatórios determinam a previsibilidade dos resultados da terapia de regeneração tecidual guiada (RTG). Este trabalho relata um caso clinico de um paciente tratado na clínica de pós-graduação da Forp-USP, com diagnóstico de periodontite crônica generalizada e severa. Após o devido tratamento periodontal dos demais sítios da cavidade bucal, foi realizada a técnica de RTG associada ao enxerto de vidro bioativo para tratamento de um defeito intra-ósseo de duas paredes ósseas localizado na região mesial do dente 13, o qual apresentava 9 mm de profundidade de sondagem e 10 mm de perda de inserção clínica e que estava associado a uma deiscência óssea vestibular. No pós-operatório de seis meses, o exame radiográfico evidenciou a formação óssea com presença de lâmina dura bem definida na região do defeito e o exame clínico constatou uma redução de 6 mm da profundidade de sondagem e um ganho clínico de inserção de 7 mm. Os exames clínico e radiográfico, após 30 meses da realização da RTG, demonstraram a estabilidade destes resultados. Dessa forma, concluimos que os excelentes resultados clínicos podem ser alcançados no tratamento de defeitos intraósseos através da terapia de RTG associada ao enxerto de vidro bioativo, desde que os inúmeros fatores capazes de afetar a previsibilidade sejam observados e controlados.

Factors related to the patient, periodontal defect, surgical treatment, and postoperative period determine the predictability of guided tissue regeneration (GTR). The aim of this paper is to report a clinical case of a patient diagnosed with severe generalized chronic periodontitis, and treated with GTR in combination with the graft of bioactive glass. Following the elevation of a mucoperiosteal flap, a 2-wall intrabony defect localized on the mesial of the maxillary right canine with probing depth of 9 mm, and clinical attachment level of 10 mm, and associated to buccal bone dehiscence, was debrided, the exposed root surface was scaled and planned, and the regenerative therapy was performed. At the 6-month postoperative visit, the radiographic exam demonstrated the formation of a new bone with the presence of a well-defined lamina dura, and in the clinical exam, it was observed a reduction in probing depth of 6 mm, and a clinical attachment gain of 7 mm. These results have been maintained for 30 months. Conclusion: excellent clinical results can be achieved in the GTR treatment of periodontal intrabony defects, since many factors, which may affect the predictability of the results, have been observed, and controlled.

Comparison of two surgical procedures for use of the acellular dermal matrix graft in the treatment of gingival recessions: a randomized controlled clinical study.

BACKGROUND: The aim of this randomized, controlled, clinical investigation was to compare two surgical techniques for root coverage with the acellular dermal matrix graft to evaluate which technique provided better root coverage, a better esthetic result, and less postoperative discomfort. METHODS: Fifteen patients with bilateral Miller Class I or II gingival recessions were selected. Fifteen pairs of recessions were treated and assigned randomly to the test group, and the contralateral recessions were assigned to the control group. The control group was treated with a broader flap and vertical releasing incisions; the test group was treated with the proposed surgical technique, without vertical releasing incisions. The clinical parameters evaluated were probing depth, relative clinical attachment level, gingival recession (GR), width of keratinized tissue, thickness of keratinized tissue, esthetic result, and pain evaluation. The measurements were taken before the surgeries and after 6 months. RESULTS: At baseline, all parameters were similar for both groups. At 6 months, a statistically significant greater reduction in GR favored the control group. The percentage of root coverage was 68.98% and 84.81% for the test and control groups, respectively. The esthetic result was equivalent between the groups, and all patients tolerated both procedures well. CONCLUSIONS: Both techniques provided significant root coverage, good esthetic results, and similar levels of postoperative discomfort. However, the control technique had statistically significantly better results for root coverage of localized gingival recessions.