Multidisciplinary Treatment of a Fenestration-type Defect.

The case report aimed at treating a fenestration-type defect with multidisciplinary conventional and advanced surgical techniques. Fenestrations are isolated areas in which the exposed root surface is covered only by the periosteum and gingiva, but the remaining cortical bone remains intact. Root coverage is indicated in cases of root hypersensitivity, treatment of shallow caries lesions, cervical abrasions, and esthetic and cosmetic needs. In this case report, after proper hygiene instruction and dental biofilm control, a fenestration-type defect was treated using guided tissue regeneration (anorganic bovine matrix and resorbable membrane) and a connective tissue grafts, associated to an endodontic apicoectomy. After reevaluation, the remaining gingival recession was treated with a second gingival connective tissue graft covered with q double papillae type in order to reconstruct the periodontal tissues of the involved tooth. In this clinical case, the interaction between the different areas of dentistry has made it possible to correct a fenestration-type defect, following procedures based on scientific evidence, restoring periodontal health, esthetics, self-esteem, and meeting the patient's expectations regarding her initial complaint. This case report shows the important role of interdisciplinary approach to treating a patient with a complex periodontal defect that required different types of knowledge and abilities to achieve the best results based on the current status of dentistry possibilities.

Longitudinal assessment of immunological and oral clinical conditions in patients undergoing anticancer treatment for leukemia.

OBJECTIVE: The aim of this study was to evaluate the evolution of the immunological and oral clinical conditions of children and adolescents undergoing anticancer treatment for leukemia (ATL). METHODS: Twenty patients aged 3-15 years undergoing chemotherapy seen at a referral center for cancer treatment in the State of Maranhão, Brazil, from 2008 to 2009, were evaluated at baseline (1st). Twenty-two controls were selected in public schools. Oral lesions, caries experience (deft and DMFT), plaque index (PI), gingival index (GI) and salivary IgA were analyzed. Patients and controls were evaluated after 6 months (2nd). The Shapiro Wilk, Mann-Whitney, Wilkoxon and Spearman correlation tests were carried out (alpha=5%). RESULTS: Gingivitis and mucositis were the most frequent manifestations in oral mucosae during the two phases. The mean DMFT index increased from 3.9 ± 4.2 (1st) to 4.4 ± 4.3 (2nd) (p = 0.04). The mean deft index was the same in the 1st (1.9 ± 2.7) and 2nd (1.9 ± 2.7) evaluation (p = 0.86). The GI also did not vary between assessments: 1st (1.3 ± 0.4) and 2nd (1.3 ± 0.3) - (p = 0.12), except on the lingual and distal surfaces, where increased from the 1st to 2nd evaluation (p < 0.01). The PI varied from 0.9 to 1.1, but this difference was not significant (p = 0.48), except for the lingual surface, where increased from 0.6 to 1.0 (p = 0.04). There was a reduction in salivary IgA levels from 2.9 to 1.9 µg/mL (p = 0.04), and mean IgA was significantly higher in the control group (5.4 µg/mL) if compared to cases (p < 0.01). CONCLUSION: The clinical and immunological oral conditions of children and adolescents undergoing ATL presented an unfavorable evolution. This study highlights the need for monitoring oral conditions during the ATL and draws attention to the additional responsibility of the otolaryngologist in referring ATL patients to the dentist, especially in the presence of clinical evidence of oral problems. We suggest that the planning of ATL take into account the oral health, in a multidisciplinary oncology team.