Synthetic Parathyroid Hormone May Augment Bone Volume in Autogenous Grafts: A Study in Rats.

BACKGROUND: Synthetic parathyroid hormone [PTH(1-34)] has been investigated for its benefits on bone healing and osteoporosis treatment; however, there is little information regarding bone grafts. This study therefore investigates the effect of PTH(1-34) on autogenous bone graft healing. METHODS: Bone grafts were harvested from the calvarium of rats with a trephine bur (3-mm internal diameter) and placed on the cortex near the mandible angle with a titanium screw. Animals were randomly assigned to group 1 (control): subcutaneous injections of saline solution, three times a week (n = 15); group 2: 2 µg/kg PTH(1-34), three times a week (n = 15); and group 3: 40 µg/kg PTH(1-34), three times a week (n = 15). Thirty days postoperatively, the animals were killed, and specimens (implant + bed + graft) were removed and used for undecalcified sections. The following histometric parameters were evaluated: total bone thickness (TT) (bed + gap + graft), graft thickness (GT) (adjacent to the implant), bone-to-implant contact (BIC), and bone area (BA) (within the limits of the threads). Five additional animals were sacrificed immediately after surgery (zero hour) to register bed and graft sizes before healing. RESULTS: Group 3 showed significantly greater bone gain compared with groups 1 and 2 (TT and GT, P <0.05). In relation to initial thickness (zero hour), groups 1 and 2 showed a total decrease in volume of 15.91% and 20.83%, respectively, whereas group 3 showed a slight bone gain (1.21%). Data analysis revealed a significant difference for group 3 compared with groups 1 and 2 (P <0.01). No differences were observed for BIC and BA (P >0.05). CONCLUSION: Systemic administration of PTH(1-34) augmented bone volume in autogenous grafts.

Role of rhBMP-2 and rhBMP-7 in the metabolism and differentiation of osteoblast-like cells cultured on chemically modified titanium surfaces.

This study analyzed the role of recombinant human bone morphogenetic protein 2 (rhBMP-2) and recombinant human bone morphogenetic protein 7 (rhBMP-7) in the adhesion and differentiation of rat osteoblast-like (osteo-1) cells cultured on chemically modified titanium surfaces. Osteo-1 cells were cultured on chemically modified (modified sandblasted and acid-etched) titanium surfaces in 3 different types of medium: control, medium supplemented with 20 ng/mL rhBMP-2, and medium supplemented with 20 ng/mL rhBMP-7. The following parameters were evaluated: cell adhesion after 24 hours; total protein content; collagen content and alkaline phosphatase (AP) activity after 7, 14, and 21 days; and calcified nodule formation after 21 days. The addition of rhBMP-2 or rhBMP-7 did not influence cell adhesion (P = .1175). Cell differentiation was influenced by rhBMP-2, as demonstrated by a significant increase in collagen content after 7 days of culture (P < .0001) and a significant decrease in AP activity after 21 days (P < .0001). The addition of rhBMP-7 only influenced AP activity, and a significant increase was observed after 21 days (P < .0001). Within the limitations of the study, we conclude that the presence of rhBMP-2 or rhBMP-7 did not influence cell adhesion to chemically modified titanium surfaces but provided an additional stimulus during the differentiation of rat osteo-1 cells cultured on this type of surface.

Two-year randomized clinical trial of enamel matrix derivative treated infrabony defects: radiographic analysis.

BACKGROUND: This split-mouth, double-blind randomized controlled trial evaluated radiographic changes in infrabony defects treated with open flap debridement (OFD) or OFD associated with enamel matrix derivative (EMD) after a 24-month follow-up. The radiographic distance from the CEJ to the bottom of the defect (BD) was considered the primary outcome. CEJ-BC and defect angle were secondary outcomes. METHODS: Ten patients presenting 2 or more defects were selected. An individualized film holder was used to take standardized radiographs of the 43 defects, at baseline and after 24 months. Images were digitized and used to measure the distances from the cemento-enamel junction (CEJ) to the alveolar crest (AC), CEJ to the bottom of the defect (BD) and infrabony defect angle. Statistical analysis was performed in SPSS for Windows (version 5.2). Paired samples t test was used to compare test and control groups and to evaluate changes within each group. The level of significance was set at α = 0.05%. RESULTS: After 24 months, a significant crestal bone loss was observed for EMD (1.01 mm; p = 0.049) but not for OFD (0.14 mm; p = 0.622). However, no differences were detected between groups (p = 0.37). Reduction of the bone defect depth was significant for OFD (0.70 mm; p = 0.005) but not for EMD (0.04 mm; p = 0.86), while no differences were detected between them (p = 0.87). Both EMD (0.69°; p = 0.82) and OFD (5.71°; p = 0.24) showed an improvement in defect angle measurements but no significant differences were observed after 24 months or between the groups (p = 0.35). CONCLUSION: Linear radiographic analysis was not able to demonstrate superiority of EMD treated infrabony defects when compared to ODF after 24 months. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02195765. Registered 17 July 2014.

Immunolocalization of bone morphogenetic protein 2 during the early healing events after guided bone regeneration.

OBJECTIVE: The objective of this study was to evaluate the immunolocalization of bone morphogenetic protein 2 (BMP-2) after autogenous block grafting covered or not with an e-PTFE membrane. STUDY DESIGN: Forty-eight rats were divided into 2 groups, autogenous block graft (B) and autogenous block graft + e-PTFE membrane (MB), and were evaluated by immunohistochemistry at baseline and 3, 7, 14, 21, and 45 days. RESULTS: The largest number of positive cells in the recipient bed was observed after 3 days in both groups. At the graft border, the largest number of positive cells was seen after 7 days in group B and after 14 days in group MB. The highest proportion of staining in the graft was observed after 3 days in group B and after 21 days in group MB. CONCLUSIONS: High proportions of stain were related to intense revascularization and osteogenesis. Except for the interface, BMP-2 staining occurred later in group MB than in group B in all structures analyzed.

Fontes de financiamento em ensaios clínicos: análise crítica / Sources of funding in clinical trials: critical analysis

Os ensaios clínicos são de grande valor para a descoberta e confirmação de terapias contra diferentes patologias. A declaração CONSORT tem o objetivo de evitar erros metodológicos e de interpretação de resultados em ensaios clínicos. Este artigo faz uma análise crítica acerca do item 25 da declaração CONSORT 2010, sobre Fontes de Financiamento em ensaios clínicos randomizados, pois pode haver tendenciosidade na publicação de resultados de pesquisas patrocinadas por indústrias. Assim, verifica-se a necessidade de adequação das pesquisas clínicas, principalmente quanto ao registro e à transparência no financiamento, a fim de promover uma real melhoria destas pesquisas, promovendo o surgimento de novas terapias.

Clinical trials in the medical are of great value for the discovery and confirmation of therapies against different diseases. However, one senses a possible bias in scientific articles published from clinical trials sponsored by industry. The CONSORT statement aims to avoid methodological errors and interpretation of results in clinical trials. Thus, this article makes a critical analysis of item 25 of the 2010 update of the CONSORT statement on Sources of Funding in randomized clinical trials. Thus, there is a need for adequacy of clinical research, especially regarding the registration and ethics in finance in order to promote a real improvement of this research, fostering the emergence of new therapies.

Recobrimento radicular associado a restaurações cervicais: posicionamento atual da literatura / Root coverage associated with cervical restorations: up date

As recessões gengivais constituem a migração apical da gengiva marginal em relação à junção cemento-esmalte (JCE). Devido à exposição radicular ao meio bucal, o elemento dental pode ficar susceptível à sensibilidade, cárie, reabsorção ou ainda lesão cervical não cariosa (LCNC). A presença destas alterações pode ser resolvida com restaurações estéticas de resina composta (RC) e/ou de ionômero de vidro modificado por resina (IVMR). Alguns estudos recentes têm associado técnicas de cirurgias plásticas periodontais à terapêutica restauradora, mostrando resultados promissores. Assim, o objetivo da presente revisão da literatura foi reportar o posicionamento atual sobre a utilização de cirurgias periodontais de recobrimento radicular em áreas de LCNC restauradas com diferentes materiais. Os resultados encontrados mostraram taxas médias de recobrimento da ordem de 80,20% quando o retalho deslocado coronariamente (RDC) foi associado à restaurações de IVMR e RC. O ganho de nível clínico de inserção (NCI) variou de 1,2 mm a 2,4 mm e a diminuição na profundidade de sondagem (PS) variou de 1,3 mm a 2,1 mm. Para todos os parâmetros, houve apenas diferença estatística para o parâmetro sensibilidade dentinária (SD), quando a técnica combinada foi utilizada. Concluiu-se que o procedimento associado entre a cirurgia periodontal e a Odontologia restauradora apresenta boa aplicabilidade clínica, sendo tão eficaz quanto a técnica cirúrgica sozinha, sem causar danos aos tecidos periodontais e não interferindo no resultado da cobertura da raiz com LCNC.

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.

Delineamentos de ensaios clínicos em pesquisas odontológicas / Clinical trial designs in dental researches

Ensaios clínicos randomizados, quando bem conduzidos, fornecem uma alta evidência para a avaliação da eficácia de intervenções, importante para decisões da prática clínica. A escolha certa do delineamento de ensaios clínicos, que é a forma como o estudo será conduzido, é fundamental para a redução de vieses nos resultados. O pesquisador precisa, portanto, conhecer os tipos de delineamento mais comuns e suas vantagens e implicações para que possa escolher o ideal para sua pesquisa. O objetivo desse trabalho é apresentar e analisar os principais tipos de delineamento no ensaio clínico odontológico, fornecendo informações básicas sobre cada um deles. Uma busca na literatura pela base de dados PubMed via Medline foi realizada a fim de localizar trabalhos que esclarecessem as normas dos delineamentos de estudos usados em ensaios clínicos. Os trabalhos selecionados tiveram suas informações extraídas e apresentadas nos resultados a fim de facilitar o entendimento de cada tipo de delineamento. Foram analisados os tipos de delineamento: paralelo, cruzado (“cross-over”), por agrupamento(“cluster”), boca- dividida e fatorial. A conclusão deste trabalho mostra que nem sempre o ensaio clínico do tipo paralelo, cujo uso é mais rotineiro, é o mais adequado para uma pesquisa. É necessário conhecer e escolher o delineamento que irá fornecer melhor custo-benefício e resultados significativos à pesquisa.

Randomized clinical trials, when appropriately conducted, provide a high quality of evidence for evaluating therapeutic effectiveness, important on practical decisions. Choosing the right design for a clinical trial, which is how the study will be conducted, is crucial to the final power of the study. Researcher needs to get familiarized with the most common design methods and its implications, to be able to choose the one that fits ideally better on his study. The aim of this present study is to elucidate and analyze the most common design methods, informing the basics of each one. A literature search was conducted on PubMed via Medline to locate studies that clarify the rules of the study designs used in clinical trials. Selected studies had their information extracted and presented at the results in order to facilitate the understanding of each type of design. The following trial designs were analyzed: parallel, cross-over, cluster, split-mouth and factorial. Our conclusion is that not always the parallel design, which is the most common design in clinical trials, is ideally better to a research. It is important to know and chose the trial design that will provide the best cost-benefit and significant results to a research.

Retalho deslocado lateralmente na correção de recessão gengival causada pela excisão cirúrgica de um fibroma ossificante periférico: relato de caso / Use of laterally positioned flap to correct gingival recession caused by excisional biopsy of peripheral ossifying fibroma: case report

o presente relato de caso refere-se a um paciente do sexo masculino (JP) de 45 anos que compareceu à clínica do Centro de Extensão, Treinamento e Aperfeiçoamento em Odontologia (CETAOl, com a seguinte queixa principal: "Sanqramento na gengiva" (sic). Na anamnese não foi relatada nenhuma alteração sistêmica. No exame extraoral nada digno de nota foi observado, No exame intraoral, notou-se um nódulo, levemente consistente, na região da gengiva marginal vestibular dos incisivos inferiores (entre os dentes 41 e 32), de coloração semelhante à mucosa, liso e com dimensões de 1,6 cm x 1,0 em, associado à retração gengival no dente 31. Após a realização de procedimentos básicos, e devido aos possíveis diagnósticos diferenciais, optou-se pela biopsia excisional da lesão e correção cirúrgica da retração no mesmo tempo operatório, através da técnica de retalho deslocado lateralmente. A lesão foi levada ao exame histopato- lógico, revelando como diagnóstico fibroma ossificante periférico. O paciente não apresentou nenhuma complicação pós-cirúrgica e após 10 meses de acompanhamento observou-se um recobrimento radicular significativo, sem a presença de recidiva da lesão.

This paper describes the treatment of a male patient, 45 years old, who showed up at the office complaining about gingival bleeding. No relevant information was detected in the inter- view and the extra-oral examination. The intra-oral examination revealed a firm nodule (t.scrn x 1,Ocm) at the marginal gingiva of the buccal aspect of the lower incisors (between 41 and 32). The color of the lesion was similar to the oral mucosa and a gingival recession was asso- ciated with the buccal aspect of tooth 31. After root scaling and dental hygiene orientation, the diagnostic hypotheses were evaluated and indicated a good prognosis with low chance of recurrence. Thus, the adopted surgical approach included the nodule removal and the root co- verage of tooth 31 recession, by the laterally positioned flap technique, at the same procedure. The histopathological diagnosis of the lesion was peripheral ossifying fibroma. Ten months after surgery, no complications were reported and significant root coverage oftooth 31 recession was obtained without recurrence of the lesion.

Avaliação da capacidade de descontaminação da terapia fotodinâmica no pós-operatório imediato de implantes: estudo piloto / Efficiency of photodynamic therapy in the immediate postoperative of dental implants: pilot study

Em todo ato cirúrgico para instalação de implanttes dentários ocorre uma contaminação inerente ao procedimento que pode prejudicar a cicatrização. Este projeto foi proposto para encontrar uma forma de reduzir a microbiota da área peri-implantar com a terapia fotodinâmica (PDT, do inglês photodynamic therapy). Após triagem (critérios de inclusão: normorreativos, com espaço intercalar superior, sem histórico de doença periodontal grave), cinco pacientes foram selecionados e reabilitados com implantes Standard Plus da Straumann®. Ao término da cirurgia, uma primeira coleta microbiológica peri-implantar foi efetuada (controle). Aplicou-se o corante azul de metileno a 0,005% por 5 minutos. Em seguida, a área peri-implantar foi irradiada com laser diodo de baixa potência (AsGaAl, 660 nm, 40mW), por 2 minutos, totalizando 120 J/cm(2) de densidade de energia, dividida em 4 pontos (2 na vestibular e 2 na palatina). Ao término da PDT, outra coleta microbiológica foi realizada (teste). Todo o material coletado passou pelo seguinte processo: diluições seriadas; semeadura em meios de cultura; incubação em meio anaeróbio por sete dias e contagem do número de unidades de colônias totais (UFC). O teste estatístico de Wilcoxon mostrou haver diferença significante (p < 0,001) na redução bacteriana para as UFC, tendo como mediana dessa redução 93,67%. Os resultados permitem afirmar que a PDT é um método eficaz de descontaminação da área cirúrgica no pós-operatório imediato de implantes dentários.

Abordagem cirúrgica para o restabelecimento estético/funcional dos pacientes com fibromatose gengival hereditária / Surgical approach for functional and aesthetic reestablishment of the patients with hereditary gingival fibromatosis

A fibromatose gengival hereditária (FGH) é uma condição bucal rara, caracterizada clinicamente pelo crescimento contínuo e progressivo do tecido gengival. O crescimento gengival severo causa comprometimento estético/funcional, tendo como sinais clínicos comuns diastemas, mau posicionamento dentário e proeminência labial. Este relato de caso descreve o tratamento cirúrgico em duas etapas de um paciente que se apresentou à Universidade de São Paulo (FOUSP) queixando-se do aspecto antiestético ao sorrir, devido ao aumento gengival. A primeira etapa consistiu em um retalho parcial com excisão de margem gengival (remoção de altura/espessura do tecido conjuntivo). Na segunda etapa, foi realizado um retalho total associado à excisão de margem, para obter acesso ao tecido ósseo e melhorar o contorno da margem gengival. O pós-operatório mostrou uma reparação satisfatória, com um padrão da margem gengival e da crista-óssea compatível com a saúde periodontal e de acordo com as expectativas estéticas do paciente. A avaliação histológica das biópsias gengivais confirmou o diagnóstico clínico de FGH. Considerando as limitações de um relato de caso, coloca-se uma alternativa viável para demonstrar que a associação dessas técnicas, desde que bem indicadas, é uma possível abordagem cirúrgica para o restabelecimento estético/funcional dos pacientes com FGH.

Hereditary gingival fibromatosis (HGF) is a rare buccal condition, characterized by a continuous and progressive enlargement of the maxilary and mandibular gingiva. The severe gingival overgrowth causes functional and aesthetic problems with common clinical aspects as diastemas, irregular dental positioning and labial prominence. This article describes the surgical treatment in 2 stages of a man who presented himself at the University of São Paulo (FOUSP) complaining of unfavorable smile sapect due to the gingival overgrowth. First stage consisted of a partial flap with internal bevel incision to remove height/thickness of the connective tissue. In the second stage mucoperiostal flaps with internal bevel incision were made to access the bone and to improve the contour of the gingival tissue. The postoperative course showed a satisfatory healing with a compatible relation between gingival tissue/bone crest, periodontal health and the aesthetic expectations of the patient. Histological examination of gingival specimens supported the clinical diagnosis of HGF. Considering the limitations of a case report, na alternative is presented to demonstrate the association of surgical techniques if well indicated and a possible surgical approach for functional and aesthetic reestablishment of the patients with HGF.

Influence of osteopenia in autogenous bone graft healing with or without expanded polytetrafluoroethylene membranes: histologic and histomorphometric study in rats.

PURPOSE: The aim of this study was to quantitatively evaluate and qualitatively describe autogenous bone graft healing with or without an expanded polytetrafluoroethylene (e-PTFE) membrane in ovariectomized rats. MATERIALS AND METHODS: Eighty Wistar rats, weighing approximately 300 g each, were used. A graft was obtained from the parietal bone and fixed to the sidewall of each animal's left mandibular ramus. The animals were randomly divided into four experimental groups (n = 20 in each group): group 1, sham operated and autogenous bone graft only; group 2, sham operated and autogenous bone graft covered by e-PTFE membrane; group 3, ovariectomized (OVX) and autogenous bone graft only; group 4, OVX and autogenous bone graft covered by e-PTFE membrane. The animals were sacrificed at five different time points: immediately after grafting or at 7, 21, 45, or 60 days after grafting. Histologic examination and morphometric measurement of the sections were performed, and values were submitted to statistical analyses. RESULTS: Both groups (sham and OVX) experienced loss of the original graft volume when it was not covered by the membrane, whereas use of the membrane resulted in additional bone formation beyond the edges of the graft and under the membrane. Histologic analysis showed integration of the grafts in all animals, although a larger number of marrow spaces was found in OVX groups. CONCLUSIONS: Association of bone graft with an e-PTFE membrane resulted in maintenance of its original volume as well as formation of new bone that filled the space under the membrane. Osteopenia did not influence bone graft repair, regardless of whether or not it was associated with e-PTFE membrane, but descriptive histologic analysis showed larger numbers of marrow spaces in the bone graft and receptor bed and formation of new bone in the OVX animals.

Efeitos do plasma rico em plaquetas no processo de reparação de feridas dérmicas padronizadas em ratos / Effect of platelet-rich plasma on the standardizd dermal wound healing in rats

O uso do plasma rico em plaquetas (PRP) pode apresentar resultados favoráveis na reparação de feridas. Analisou- se os efeitos do plasma rico em plaquetas no processo de reparação tecidual em feridas dérmicas padronizadas, com a utilização de “punch”, para excisão do fragmento de pele, com 5mm de diâmetro e 2mm de profundidade, no dorso de 40 ratos. Destes, 40 foram utilizados para análise microscópica e 8 para macroscópica. Os animais foram divididos em dois grupos: grupo teste as feridas foram tratadas com plasma rico em plaquetas e grupo controle foi utilizado soro fisiológico. Além disso, foram utilizados 5 ratos para a determinação do número de plaquetas presentes no PRP. Os resultados morfométricos obtidos através do teste de Mann-Whitney mostraram que não existiram diferenças estatisticamente significantes com relação à área e perímetro, entre os grupos teste e controle. No entanto houve diferença estatisticamente significante, em ambos os grupos, entre os períodos de avaliação, sendo maior no período “baseline” seguido em ordem decrescente pelos períodos 24 horas 3, 7 e 14 dias. Através da análise histomorfológica, utilizando o teste de Mann-Whitney, não foram verificadas diferenças estatisticamente significantes entre os grupos teste e controle em relação às variáveis estudadas, edema, exsudato inflamatório, neovascularização, necrose, colagenização, presença de fibroblastos jovens, reepitelização, presença de crosta, nos quatro períodos de observação (24 horas, 3 dias, 7 dias e 14 dias). A análise histomorfométrica também realizada através do teste de Mann-Whitney não mostrou diferenças estatisticamente significantes entre os grupos teste e controle em relação à celularidade, espaço em branco e matriz extracelular (matriz colagênica) nos quatro períodos de observação mencionados acima.

The employment of platelet-rich plasma (PRP) can present favorable outcomes in tissue healing since it represents anatural source of growth factors. The purpose of this research was to analyze the effects of platelet-rich plasma on tissue healing. Standard dermical wounds were made with the useof a punch, to excise a skin fragment with 5 millimeters of diameter and 2 milliner’s in depth in the back of 48 rats.Forty rats were used for microscopical analysis and 8 for macroscopic analysis. The animals were divided into twogroups according to the treatment they were submitted: in one group called Test, the wounds were treated with plateletrich plasma and in another one called Control, saline was used. Also, 5 rats were used to determine the number of platelets present in the platelet-rich plasma. The specimens were processed for macroscopic and microscopic analysis...

Características clínicas da mucosa periimplantar e gengiva inserida: revisão da literatura / Clinical characteristics of peri-implant mucosa and gingiva: literature review

Com a evolução da Implantodontia, começaram a ser produzidos estudos comparando as estruturas que suportavam dentes e depois passariam a suportar implantes. Estes estudos foram, e ainda são, importantes, por esclarecerem semelhanças e diferenças entre os tecidos que podem determinar o sucesso ou o fracasso no manejo dos tecidos periimplantares. O objetivo desta revisão é estabelecer diferenças e semelhanças entre os tecidos moles periimplantares e periodontais, em estudos feitos em cães.

With the evolution of the lmplantology studies comparing tissues that supported teeth and later would support fixtures started to be produced. These studies had been important to clarify similarities and differences between tissues, that can determine the success or failure in the handling of peri-implant tissues. The aim of this revision is to establish differences and similarities between soft tissues around implants and teeth, in studies in dogs.

Prática laboratorial de cirurgiaperiodontal: otimizando oensino-aprendizagem / Laboratorial practice of periodontal surgery: improvement of the teaching and learning process

O objetivo deste trabalho foi apresentar uma atividadede laboratório com mandíbula de porco utilizadana Disciplina de Periodontia da Faculdade de Odontologiada Universidade de São Paulo (FOUSP) queotimiza o ensino-aprendizado das técnicas cirúrgicasperiodontais. A mandíbula de porco tem característicasanatômicas semelhantes às das estruturas gengivaise periodontais humanas. É importante ressaltar queessa prática pré-clínica parece ter resultado num aprimoramentodo aprendizado por parte dos alunos.

Fibromatose gengival hereditária: relato de caso clínico / Hereditary gingival fibromatosis: a case report

A fibromatose gengival hereditária (FGH) é uma desordem genética rara, caracterizada pelo crescimento fibroso acentuado do tecido gengival maxilar e mandibular. Geralmente, desenvolve-se como uma desordem isolada, mas pode estar presente em outras síndromes. O presente artigo relata o caso clínico de paciente, gênero masculino, 34 anos, apresentando crescimento gengival generalizado, envolvendo maxila e mandíbula, com recobrimento parcial das coroas dentárias. Por apresentar alteração cardíaca, os procedimentos cirúrgicos deste paciente foram realizados em várias etapas. Devido ao comprometimento estético e a pedido do paciente, o tratamento cirúrgico iniciou-se pela região anterior da maxila. Foram realizados procedimentos a retalho com excisão da margem gengival para remover o excesso de tecido gengival. A avaliação histológica das biópsias gengivais confirmou o diagnóstico clínico de FGH. O pós-operatório cirúrgico foi satisfatório com melhora considerável da aparência do paciente.

Hereditary gingival fibromatosis (HGF) is a rare genetic oral disorder, characterized by a gradually progressive enlargement of the maxillary and mandibular gingiva. It usually develops as an isolated disorder but can be present in other syndromes. A case of a 34-year-old man is reported who presented a generalized gingival overgrowth, involving the maxillary and mandibular arches and covering part ofthe teeth. Due to cardiac condition, surgical procedures in this patient were carried out per sextants. Due to thea esthetic involvement and patient’s request, the surgical treatment was initiated in the anterior region of maxilla. Surgical procedures included mucoperiostal flaps with internalbevel incision to remove the excess tissue. Histological examination of gingival specimens supported the clinical diagnosis of HGF. The post operative course was uneventful and patient’s appearance improved considerably.

Ensaios clínicos multicêntricos: uma revisão de literatura / Multi-center clinical trials: a literature review

Ensaios clínicos multicêntricos são considerados o padrão ouro em pesquisa clínica. São extremamente úteis em pesquisa de doenças raras, na avaliação de novos fármacos e de novas terapias. Por atender comunidades distintas ao mesmo tempo coletando dados de diversas regiões geográficas, seus resultados podem ser interpretados como válidos para a população em geral. Apresentam como vantagem principal a redução no tempo de experimento porém são de alto custo e alta complexidade. Exigem a monitorização constante do desenvolvimento no protocolo, da coleta de dados e calibração constante dos pesquisadores participantes.

Uso da BMP-2 e 7 na promoção da osseointegração às superfícies dos implantes de titânio / The usage of BMP-2 and 7 for the promotion of the osseointegration to titanium implants surfaces

Para que seja possível a instalação dos implantes, há necessidade de que exista tecido ósseo de boa qualidade. Sem isto, as possibilidades de osseointegração e, portanto, de sucesso são muito reduzidas. As proteínas morfogenéticas ósseas (BMPs) são substâncias osteoindutoras e têm sido utilizadas na regeneração periodontal e na osseointegração. Em função disto, foi realizada uma revisão de literatura para analisar a influência da BMP-2 e 7 na osseointegração da superfície dos implantes com o osso neoformado. As BMP-2 e 7 promovem uma neoformação óssea, produzindo uma área propícia para a instalação dos implantes. Além disso, estas proteínas permitem uma melhor osseointegração com a superfície de titânio, acelerando-a e possibilitando uma adaptação precoce às cargas funcionais. A aplicação da BMP-2 ou 7 pode ter utilidade clínica, no caso os implantes, além de ser uma alternativa para os enxertos ósseos autógenos. Novos estudos são necessários para analisar a viabilidade e o sucesso da aplicação destas proteínas no caso de implantes intra-orais em humanos.

For the implants installation to be possible there is a need for a good quality osseous tissue to exist. Without this, the possibilities of osseointegration and, therefore, the success, are much reduced. The bone morphogenetic proteins (BMPs) are osseous inducers substances and have been used in the periodontal regeneration and in the osseointegration. In function of that, a literature revision was carried out to analyze the influence of BMP-2 and 7 in the osseointegrationof implants surface, with the neoformed bone. The BMP-2 and 7 promote a bone neoformation, thus producing an adequate area for the implants installation. Besides that, these proteins allow a better osseointegration with the titanium surface, expediting it and enabling a precocious adaptation to the functional loads. The application of BMP-2 or 7 can have clinical utility, in this case the implants, besides being an alternative for the autogenous osseous grafts. New studies are necessary to analyze the viability and the success of these proteins application, in case of intraoral implants in humans.

Characterization of bone cells obtained from the calvaria of neonatal rats (osteo-1) after serial subculture

The objective of the present study was to characterize bone cells grown in two culture media, and to determine the effective concentration of OP-1 on the growth of osteo-1 cells. Subcultured rat bone cells (osteo-1) were grown in alpha-modified Eagle's minimal essential medium (alpha-MEM) and Dulbecco's modified Eagle's medium (DMEM) and total protein content, alkaline phosphatase activity and the formation of mineralized nodules were evaluated after 7, 14 and 21 days. Cells were exposed to different concentrations of rhOP-1 for 1, 3, 5 and 7 days and compared with an untreated control. Osteo-1 cells presented a significant increase in alkaline phosphatase activity and calcium deposits were observed at 21 days. Cells treated with 10 and 20 ng/mL rhOP-1 for 24 h showed a significant increase in cell viability when compared to control. Osteo-1 cells cultured on DMEM demonstrated an osteoblastic phenotype as indicated by high alkaline phosphatase activity and the presence of calcified nodules. The results suggest that low concentrations of OP-1 may promote an osteogenic effect on osteo-1 cells.

Effect of enamel matrix proteins on the treatment of intrabony defects: a split-mouth randomized controlled trial study.

The objective of this split-mouth, double-blind, randomized controlled trial was to compare the clinical effect of treatment of 2- or 3-wall intrabony defects with open flap debridement (OFD) combined or not with enamel matrix proteins (EMP). Thirteen volunteers were selected with one pair of or more intrabony defects and probing pocket depth (PPD) > or = 5 mm. All individuals received instructions regarding oral hygiene and were submitted to scaling and root planing. Each participant received the two treatment modalities: test sites were treated with OFD and EMP, and control sites received only OFD. After 6 months, a significant reduction was observed in PPD for the EMP group (from 6.42 +/- 1.08 mm to 2.67 +/- 1.15 mm) and for the OFD group (from 6.08 +/- 1.00 mm to 2.00 +/- 0.95 mm) (p < 0.0001), but with no significant difference between groups (p = 0.13). A significant gain in relative attachment level (RAL) was observed in both groups (EMP: from 13.42 +/- 1.88 mm to 10.75 +/- 2.26 mm, p < 0.001; OFD: from 12.42 +/- 1.98 mm to 10.58 +/- 2.23 mm, p = 0.013), but with no significant difference between groups (p = 0.85). Gingival recession (GR) was higher in the EMP group (from 1.08 +/- 1.50 mm to 2.33 +/- 1.43 mm; p = 0.0009) than in the OFD group (from 0.66 +/- 1.15 mm to 1.16 +/- 1.33 mm; p = 0.16), but this difference was not significant (p = 0.06). In conclusion, the results showed that OFD combined with EMP was not able to improve treatment of intrabony defects compared to OFD alone.