Full mouth periodontal debridement with or without adjunctive metronidazole gel in smoking patients with chronic periodontitis: A pilot study.

BACKGROUND AND OBJECTIVE: The evidence of effectiveness of metronidazole (Mtz) as an adjunct therapy to periodontal procedure in the treatment of patients with chronic periodontitis is not conclusive. The aim of this study was to compare the effect of Mtz (delivered locally as a gel or systemically as a tablet) as an adjunctive therapy with full mouth periodontal debridement (1 h of ultrasonic calculus/plaque removal) in smokers with chronic periodontitis. MATERIAL AND METHODS: This pilot study involved 30 smokers with at least six teeth with a clinical attachment loss of ≥ 5 mm and probing pocket depth (PPD) of ≥ 5 mm. They were randomly assigned into one of three groups (n = 10): (i) 3 g daily of placebo gel applied topically (using a dental tray with the gel overnight) + periodontal debridement; (ii) 3 g daily of a 15% Mtz benzoate gel applied topically (using a dental tray with the gel overnight) + periodontal debridement; and (iii) a daily single dose of 750 mg Mtz (Flagyl(®)) + periodontal debridement. Clinical parameters (visible plaque index, gingival bleeding index [GBI], relative attachment level and PPD) and quantitative analysis (by real-time polymerase chain reaction) of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia were assessed at baseline and at 1, 3 and 6 mo after periodontal debridement. RESULTS: There was no statistically significant difference in the average GBI and visible plaque index values at baseline between the groups (p ≥ 0.05). There was no significant difference between groups in all parameters evaluated (p ≥ 0.05). Significant reductions in GBI at 3 and 6 mo were observed in all groups (p < 0.05). Significant reductions in both PPD and relative attachment level at 1, 3 and 6 mo were observed in all groups (p < 0.05). Significant reductions in bacterial levels at 7 and 30 d were observed in all groups (p < 0.05). CONCLUSION: Adjunctive use of Mtz (gel or tablet) to periodontal debridement had similar clinical and microbiological improvement compared to treatment with placebo + periodontal debridement in smokers with chronic periodontitis up to 6 mo post-treatment. Further studies are necessary to confirm the clinical relevance of these findings.

[Need of periodontal treatment evaluated with CPITN and its relation to the quality of the cervical margin of restorations]. / Necessidade de tratamento periodontal avaliada pelo CPITN e sua relação com a qualidade de acabamento cervical das restaurações.

Irregularities of the cervical margin of restorations facilitate the retention of bacterial plaque, hindering plaque control through the habitual procedures of oral hygiene and favoring the development of periodontal disease. The aim of this study was to evaluate the periodontal condition and treatment needs (applying CPITN) in relation to the cervical margin of dental restorations. Three hundred and sixty-seven teeth with class II and V cavities restored with amalgam, class III cavities restored with composite resin, cast metal restorations and unitary prostheses were examined. With a WHO periodontal probe, the position of the cervical margins of restorations was verified (supragingival, subgingival or at the gingival margin level); the presence of defects (lack or excess of restoring material) and the presence of score 2 of CPITN were also assessed. After the analysis of the data, it was possible to conclude that: 1) supragingival margins offered the best marginal adaptation and the lowest frequency of score 2; 2) both the lack and the excess of restoring material favor the development of score 2, despite the utilized material and 3) in subgingival margins, incorrect marginal adaptation was the most frequent event, mainly due to excess of restoring material, and in these cases there was higher frequency of score 2 of CPITN.

The effect of an immunosuppressive therapy and its withdrawal on bone healing around titanium implants. A histometric study in rabbits.

BACKGROUND: Immunosuppressive agents have been recognized as a factor affecting bone metabolism. We investigated the consequences of the administration and withdrawal of cyclosporin A/nifedipine on bone around titanium implants to observe whether these changes occur and if they are reversible. METHODS: Twenty-eight New Zealand rabbits were included in the study. Following anesthesia, the tibiae surface was exposed, and 2 screw-shaped implants 7.0 mm in length and 3.75 mm in diameter were placed bilaterally. The animals were randomly assigned to 1 of 4 experimental groups and received daily subcutaneous injections for 14 days: groups A and C were injected with vehicle while groups B and D received cyclosporin A (10 mg/kg) plus nifedipine (0.5 mg/kg). Groups A and B were sacrificed 14 days and groups C and D 42 days postoperatively. The degree of bone contact with the implant surface and the bone area within the limits of the threads of the implant were measured. RESULTS: Intergroup analysis revealed no significant difference (P > 0.05) in the degree of bone contact with the implant surface between the control and test groups on days 14 and 42. In contrast, the treated animals demonstrated a significant (P < 0.05) decrease in the bone area within the limits of the threads of the implant in both periods. CONCLUSIONS: The data of the present study suggest that the use of cyclosporin A/nifedipine may influence bone healing around titanium implants. This observation may have important clinical implications.

Clinical study of guided bone regeneration and/or bone grafts in the treatment of ligature-induced peri-implantitis defects in dogs.

This study evaluated, by clinical analysis, the hard tissue response following treatment of ligature-induced peri-implantitis defects in 5 dogs. The mandibular premolars were removed from both sides of the jaw. After 3 months of healing, two titanium implants were placed on each side of the mandible. Following abutment connection, 3 months later, experimental peri-implantitis was induced by the placement of cotton ligatures in a submarginal position. Ligatures and abutments were removed after one month and the bony defects were randomly assigned to one of the following treatments: debridement (DE), debridement plus guided bone regeneration (GBR), debridement plus mineralized bone graft (BG) and debridement plus guided bone regeneration associated with mineralized bone graft (GBR + BG). The peri-implant bone defects were clinically measured before and 5 months post-treatment. Results showed a higher percentage of vertical bone fill for GBR + BG (27.77 +/- 14.07) followed by GBR (21.78 +/- 16.19), BG (21.26 +/- 6.87), DE (14.03 +/- 5.6). However, there were no statistically significant differences between any of the treatments proposed (one way repeated measures analysis of variance, P = 0.265).

Treatment of ligature-induced peri-implantitis defects by regenerative procedures. Part II: A histometric study in dogs.

The purpose of this study was to evaluate, by histometric analysis, re-osseointegration following treatment of ligature-induced peri-implantitis in dogs. Five dogs were used in this study. Their mandibular premolars (P2, P3 and P4) were first removed. After 3 additional months of healing, two titanium implants were placed on each side of the mandible. After 3 months, the abutment connection was performed and experimental peri-implantitis was induced by placing cotton ligatures in a submarginal position. Ligatures and abutments were removed after one month and the peri-implant bone defects were randomly assigned to one of the treatments: debridement, debridement plus guided-bone regeneration, debridement plus mineralized-bone graft, and debridement plus guided-bone regeneration associated with mineralized-bone graft. Five months post-treatment, the degree of bone contact with the implant surface and the bone area within the threads were measured in 12 threads, the 6 most coronal at each side of each implant. One-way analysis of variance did not reveal statistically significant differences between the treatment modalities (p > 0.05). Within the limits of the present study, it can be concluded that there is a limited possibility of re-osseointegration around implant surfaces previously exposed by ligature-induced peri-implantitis.

Histometric evaluation of bone regeneration around immediate implants partially in contact with bone: a pilot study in dogs.

Bone regeneration was evaluated around immediate implants partially in contact with bone, with or without the concurrent application of a combination of platelet-derived growth factor (PDGF) and insulin-like growth factor (IGF-1). Mandibular premolars were removed, and the implant osteotomies were prepared; a uniform circumferential gap was prepared 1.25 mm beyond the width of the implant bed in the coronal half. Twelve implants (8.5 x 3.75 mm) were inserted in six dogs. Before insertion, an implant received a single application of 5 micrograms/mL of PDGF and IGF-1 delivered in 0.10 mL of 4% methylcellulose gel or 0.10 mL of 4% methylcellulose gel only as a control. To label regenerated bone, a 2% calcein green solution was administered by intramuscular injection at 0, 7, 15, 30, and 45 days after implant insertion Three and 8 weeks after implant insertion undecalcified sections were obtained, and the degree of bone to implant contact, the bone area, and the intensity of bone labeling were measured into the limits of the eight most coronal threads of the implant (four threads on each side of each implant). The results showed a greater extension of bone-to-implant contact, a larger percentage of bone area, and greater intensity of bone labeling for test versus control implants (P < .01). Within the limits of the present study, it was concluded that the combination of PDGF/IGF-1 might be an alternative for enhancing bone healing around implants partially in contact with bone.

Treatment of ligature-induced peri-implantitis defects by regenerative procedures: a clinical study in dogs.

We carried out a clinical evaluation of the hard tissue fill following treatment of ligature-induced peri-implantitis in dogs. Four dogs were used and their mandibular premolars (P2, P3 and P4) were removed. After 3 months of healing, two titanium implants were placed on each side of the mandible. After 3 months, the abutment connection was performed, and experimental peri-implantitis was induced by placement of cotton ligatures in a submarginal position. The ligatures and abutments were removed after one month, and the peri-implant bone defects were assigned randomly to one of the treatments: debridement (control), debridement plus guided bone regeneration (GBR), debridement plus mineralized bone graft (BG), and debridement plus guided bone regeneration associated with a mineralized bone graft (GBR + BG). Clinical measurements of the peri-implant bone defects before and 5 months after treatment revealed no statistically significant differences between the defects treated by GBR, BG and GBR + BG. These 3 treatment methods provided more hard tissue fill than debridement alone (p < 0.05). Thus, it can be concluded that GBR, BG or a combination of the two techniques can enhance the hard tissue fill in defects caused by peri-implantitis in dogs.

Titanium implants in rabbit femur: a histologic evaluation.

The success achieved by Scandinavian researchers in the development of long-term implants has stimulated many dentists to apply them worldwide. However, most of the implants did not have sufficient scientific support. The purpose of this study was to evaluate host tissue response to the insertion of an endosseous dental implant. Twenty adult New Zealand rabbits were used. Histological evaluation was prepared from the femurs. Results showed a hemorrhagic aspect and inflammatory infiltration which was subsequently substituted by granulation tissue, and later, formation of bone tissue. In the cortical bone, the presence of a necrotic area was observed which was later remodelled, and also an intense proliferation of endosteum and periosteum in the regions next to the implant, resulting in a thickening of the cortical bone surface close to the implant. Therefore, it was observed that titanium implants (Carbontec-Special Materials Ltda.) did not interfere with the bone healing process.