Effect of surgical periodontal treatment associated to antimicrobial photodynamic therapy on chronic periodontitis: A randomized controlled clinical trial.

AIM: This randomized controlled clinical trial evaluated the effects of an adjunctive single application of antimicrobial photodynamic therapy (aPDT) in Surgical Periodontal Treatment (ST) in patients with severe chronic periodontitis (SCP). MATERIAL AND METHODS: In a split-mouth design, 20 patients with SCP were treated with aPDT+ST (Test Group, TG) or ST only (Control Group, CG). aPDT was applied in a single episode, using a diode laser and a phenothiazine photosensitizer. All patients were monitored until 90 days after surgical therapy. Levels of 40 subgingival species were measured by checkerboard DNA-DNA hybridization at baseline, 60 and 150 days. Clinical and microbiological parameters were evaluated. RESULTS: In deep periodontal pockets depth (PPD ≥5 mm), Test Group presented a significantly higher decrease in PPD than Control Group at 90 days after surgical therapy (p < .05). Test Group also demonstrated significantly less periodontal pathogens of red complex (Treponema denticola) (p < .05). CONCLUSION: A single episode of aPDT used in adjunct to open flap debridement of the root surface in the surgical treatment of SCP: i) significantly improved clinical periodontal parameters; ii) eliminates periodontal pathogens of the red complex more effectively (NCT02734784).

Antimicrobial photodynamic therapy as an alternative to systemic antibiotics: results from a double-blind, randomized, placebo-controlled, clinical study on type 2 diabetics.

AIM: This double-blind, placebo-controlled clinical study compared multiple applications of the antimicrobial photodynamic therapy (aPDT) treatment protocol, to systemic doxycycline as adjuvant to scaling and root planing (SRP) on type 2 diabetic patients on clinical, systemic and immune-inflammatory outcomes. MATERIALS AND METHODS: Thirty patients with Hba1c >7% were allocated in two groups, SRP + Doxy (n = 15) using systemic doxycycline 100 mg/day (14 days) and SRP + aPDT (n = 15) with multiple applications (0, 3, 7 and 14 days). Primary outcome was glycated haemoglobin levels (HbA1c). Clinical parameters: plaque score (PS), bleeding on probe, probing depth, suppuration, gingival recession, and clinical attachment level, percentage of pockets with desired clinical endpoint were measured at baseline and 3 months after therapy. Cytokine profile was assessed at 0, 1 and 3 month to measure IL1-ß, TNF-α and TGF-ß on gingival crevicular fluid. RESULTS: No significant difference was detected on HbA1c, between treatments. The SRP + aPDT group showed advantage on reducing moderate pockets in single-rooted teeth at 3 months. SRP + aPDT presented better results at 3 months on IL1-ß levels. There were no significant differences between TNF-α and TGF-ß. CONCLUSIONS: Both treatments improved clinical and systemic outcomes (Hba1c). SRP + aPDT performed better in moderate probing pocket depth on single-rooted teeth, reduced favourably inflammation in short term, and may be an alternative to systemic antibiotics. (Clinicaltrials.org ID NCT01595594).

Comparative study of two surgical techniques for root coverage of large recessions in heavy smokers.

Reduced root coverage due to diminished periodontal vascularity can be expected in heavy smokers. The aim of this study was to evaluate the root coverage obtained for large gingival recessions in heavy smokers using two different surgical techniques. Twenty heavy smokers were selected. Each patient had large, bilateral Miller class I or II gingival recessions (Control Group (CG): 3.30 ± 1.29; Test Group (TG): 3.45 ± 0.80) on nonmolar teeth. Clinical measurements of probing pocket depth (PPD), clinical attachment level (CAL), recession height (RH), keratinized mucosa height (KMH), and keratinized mucosa thickness (KMT) were determined at baseline and after 12 months. One side received a coronally positioned flap (CPF), while the contralateral side received the extended flap technique (EFT), both procedures carried out in conjunction with a subepithelial connective tissue graft (SCTG). Saliva samples to measure cotinine levels were taken at baseline and after 12 months as an indicator of the level of exposure to nicotine. Intergroup and intragroup analysis showed no statistical differences for the evaluated clinical parameters. Patients maintained the same exposure to smoke during the evaluation period. Both techniques resulted in low root coverage (CPF: 48.60%; EFT: 54.28%), but both techniques were effective in decreasing the gingival recessions (P ≤ 0.01). The variables smoke exposure, root coverage, and the thickness and height of keratinized tissue were subjected to linear regression. Regardless of the surgical technique used, heavy smoking strongly limits root coverage, especially for large recessions.

Influence of periodontal tissue thickness on buccal plate remodelling on immediate implants with xenograft.

AIM: To evaluate the influence of gingival thickness and bone grafting on buccal bone plate remodelling after immediate implant placement in sockets with thin buccal bone, using a flapless approach. MATERIALS AND METHODS: The gingiva of eight dogs was thinned at one side of the mandible, mandibular premolars were extracted without flaps, and four implants were installed on each side at 1.5 mm from the buccal bone. The sites were randomly assigned into: TG (test group) = thin gingiva; TG + GM (TG with grafting material); CG (control group) = normal gingiva; and CG + GM (CG with grafting material). After 12 weeks the dogs were sacrificed and the samples were processed for histological analysis. RESULTS: All animals exhibited a thin buccal bone initially. In all the experimental groups the buccal gap was filled with newly formed bone and the buccal bone level was slightly apical to the implant shoulder. There were no statistically significant differences among the groups for the histomorphometric parameters. CONCLUSIONS: The thickness of the buccal bone was a fundamental factor in buccal bone plate resorption, even with flapless implantation. The gingival thickness or the addition of a biomaterial in the gap did not influence the results.

The influence of the periodontal biotype on peri-implant tissues around immediate implants with and without xenografts. Clinical and micro-computerized tomographic study in small Beagle dogs.

OBJECTIVE: Soft tissues and buccal bone plate remodeling after immediate implantation in sockets with thin buccal bone, using the flapless approach with or without bone graft into the buccal gap, was compared between sites with thin and normal gingiva. MATERIAL AND METHODS: Eight dogs had the gingiva of one side of the mandible thinned, the mandibular premolars were extracted without flaps, and 4 implants were installed in each side, positioned 1.5 mm from the buccal bone. The sites were randomly assigned into: TG (test group) = thin gingiva; TG + GM (TG with grafting material); CG (control group) = normal gingiva; and CG + GM (CG with grafting material). Buccal bone thickness (BBT), thickness of keratinized tissue (TKT), alveolar thickness (AT), gingival recession (GR), and probing depth (PD) were clinically evaluated. Within 12 weeks the dogs were sacrificed and the samples were analyzed by micro-computerized tomography. RESULTS: A thin BBT was observed in all the dogs. The presurgical procedures reduced TKT in the test group, with minimal changes of the AT. There were no statistically significant differences among the groups for the clinical parameters and the tomographic analysis showed similar linear and tri-dimensional bone reduction in all the groups. CONCLUSION: The thickness of the buccal bone was a fundamental factor in buccal bone plate resorption, even with flapless implantation. The decrease in gingival thickness or the addition of a biomaterial in the gap did not influence the results.

A modified surgical technique for root coverage with an allograft: a 12-month randomized clinical trial.

BACKGROUND: The aim of this randomized controlled clinical study is to investigate whether a modified surgical technique could provide better results for root coverage and greater amounts of keratinized tissue (KT) with the acellular dermal matrix graft (ADMG). METHODS: Fifteen bilateral Miller Class I or II gingival recessions (GRs) were selected. The recessions were treated and assigned randomly to the test group (TG), and the contralateral recessions were assigned to the control group (CG). The ADMG was used in both groups with differences in the graft positioning between them. The following clinical parameters were measured before the surgeries and after 12 months: 1) probing depth; 2) relative clinical attachment level; 3) GR; 4) thickness of KT (TKT); and 5) KT width. A new parameter, the GR area (GRA), was measured in standardized photographs using a special device and software. RESULTS: There was no significant difference between groups in KT width and TKT parameters at the 12-month postoperative period. However, there was a significant difference between the gains in GR (ΔGR) and GRA (ΔGRA), favoring the TG after 12 months. The TG presented ΔGR = 3.04 ± 0.29 mm and ΔGRA= 38,919 ± 9,238 pixel square values (pix(2)), and the CG presented ΔGR= 2.61 ± 0.41 mm and ΔGRA= 22,245 ± 9,334 pix(2) (P <0.05 and <0.001, respectively). CONCLUSIONS: Both techniques were successful. The TG treatment was more effective in reducing GR and GRA. The flap and graft position may be of importance in root coverage procedures outcome.

A Randomized comparative clinical study of two surgical procedures to improve root coverage with the acellular dermal matrix graft.

AIM: This randomized, controlled, clinical study compared two surgical techniques for root coverage with the acellular dermal matrix graft (ADMG) to evaluate which procedure could provide better root coverage and greater amounts of keratinized tissue. MATERIALS AND METHODS: Fifteen pairs of bilateral Miller Class I or II gingival recessions were treated and assigned randomly to the test group, and the contra-lateral recessions were assigned to the control group. The ADMG was used in both groups. In the control group, the graft and flap were positioned at the level of the cemento-enamel junction (CEJ), and in the test group, the graft was positioned 1 mm apical to the CEJ and the flap 1 mm coronal to the CEJ. The clinical parameters were taken before the surgeries and after 6 months. The gingival recession area, a new parameter, was measured in standardized photographs through a special device and software. RESULTS: There were statistically significant differences favouring the proposed technique for all parameters except for the amount of keratinized tissue at 6 months. CONCLUSIONS: The proposed test technique is more suitable for root coverage procedures with ADMG, and the new parameter evaluated appears valuable for root coverage analysis. (Clinicaltrials.gov Identifier: NCT01175720).

Treatment of gingival recessions in heavy smokers using two surgical techniques: a controlled clinical trial.

Smokers have small root coverage which is associated with bad vascularity of periodontal tissues. This study evaluated a technique that can increase the blood supply to the periodontal tissues compared with a traditional technique. Twenty heavy smokers (10 males and 10 females) with two bilateral Miller class I gingival recessions received coronally positioned flaps in one side (Control group)and extended flap technique in the other side (Test group). Clinical measurements (probing pocket depth, clinical attachment level, bleeding on probing, gingival recession height, gingival recession width, amount of keratinized tissue, and width and height of the papillae adjacent to the recession) were determined at baseline, 3 and 6 months postoperatively. Salivary cotinina samples were taken as an indicator of the nicotine exposure level. No statistically significant differences (p>0.05) were detected for the clinical measurements or smoke exposure. Both techniques promoted low root coverage (Control group: 43.18% and Test group: 44.52%). In conclusion, no difference was found in root coverage between the techniques. Root coverage is possible and uneventful even, if rather low, in heavy smoker patients with low plaque and bleeding indices.

Desenvolvimento de bases ósseas padronizadas para avaliação da estabilidade primária de implantes / Development of standardized bone specimens to evaluate primary stability of dental implants

A qualidade óssea do sítio receptor é considerada um dos fatores relevantes para o sucesso de implantes orais. O objetivo deste estudo piloto foi avaliar comparativamente cilindros ósseos de origem suína, de alta e baixa densidades, em modelo in vitro, por meio de análises bidimensional (radiografia digital) e tridimensional (tomografia computadorizada). Os cilindros ósseos foram preparados a partir de osso suíno, retirados do côndilo mandibular ou da cabeça do fêmur, e separados em dois grupos: grupo A: cilindros removidos da cabeça do fêmur (alta densidade óssea); grupo B: cilindros removidos do côndilo mandibular (baixa densidade óssea). Para a certificação dos cilindros (análise 2D) foram realizadas tomadas radiográficas digitais para determinar a densidade radiográfica. Foram realizadas ainda análises tridimensionais, por meio de tomografias computadorizadas, avaliando os seguintes parâmetros tomográficos: área óssea do cilindro, volume ósseo do cilindro, densidade óssea tridimensional, volume total do espaço de poros, porcentagem da porosidade total. O teste t Student foi utilizado para verificar a significância da diferença entre os grupos A e B; em todas as análises foi considerado nível de significância de 5%. Os resultados da análise 2D dos blocos ósseos mostraram que a diferença entre os grupos A e B foi estatisticamente significante (p < 0,0001). As diferenças entre os grupos A e B também foram estatisticamente significantes para todos os parâmetros tomográficos avaliados (p < 0,05). Concluiu-se que a metodologia apresentada gera cilindros ósseos padronizados de alta e baixa densidades, que poderão ser utilizados em estudos futuros para avaliar comparativamente a estabilidade inicial de implantes.

Bone quality is one of most important factors for the success of dental implants. The purpose of this study was to comparatively evaluate porcine bone cylinders, of high and low bone density, using 2D- (digital radiograph) and three-dimensional (computerized tomography) analysis. Bone cylinders were prepared from porcine bone, removed from mandibular condyle or from the femur head, and separated in two groups: Group A: cylinders removed from femur head (high bone density), and Group B: cylinders removed from mandibular condyle (low bone density). Digital radiographs were taken for the certification of bone cylinders (2D analysis), to determine the radiographic bone density. Using computerized tomograms, tri-dimensional analysis were made, evaluating the following tomographic parameters: cylinder bone area, cylinder bone volume, tridimensional bone density, total volume of porosity, total percentage of porosity. The Student´s t test was used to verify the significance of differences between groups A and B (at 5% level). The results showed that for 2D analysis of bone cylinders, the difference between groups A and B was statistically significant (p < 0.0001). The differences between groups were also statistically significant for all the evaluated tomographic parameters (p < 0.05). It was concluded that the methodology evaluated can produce standardized bone cylinders of high and low bone density that should be used in future studies to comparatively evaluate the initial stability of dental implants

Treatment of gingival recessions in heavy smokers using two surgical techniques: a controlled clinical trial

Smokers have small root coverage which is associated with bad vascularity of periodontal tissues. This study evaluated a technique that can increase the blood supply to the periodontal tissues compared with a traditional technique. Twenty heavy smokers (10 males and 10 females) with two bilateral Miller class I gingival recessions received coronally positioned flaps in one side (Control group)and extended flap technique in the other side (Test group). Clinical measurements (probing pocket depth, clinical attachment level, bleeding on probing, gingival recession height, gingival recession width, amount of keratinized tissue, and width and height of the papillae adjacent to the recession) were determined at baseline, 3 and 6 months postoperatively. Salivary cotinina samples were taken as an indicator of the nicotine exposure level. No statistically significant differences (p>0.05) were detected for the clinical measurements or smoke exposure. Both techniques promoted low root coverage (Control group: 43.18 percent and Test group: 44.52 percent). In conclusion, no difference was found in root coverage between the techniques. Root coverage is possible and uneventful even, if rather low, in heavy smoker patients with low plaque and bleeding indices.

Fumantes apresentam resultados ruins no recobrimento radicular, o que pode estar relacionado à má vascularização dos tecidos periodontais. O objetivo deste estudo foi avaliar uma técnica que pode aumentar a nutrição do tecido periodontal, comparando com uma técnica tradicional.Vinte fumantes pesados (10 homens e 10 mulheres) apresentando duas retrações bilaterais classe I de Miller receberam recobrimento radicular pela técnica de retalho posicionado coronalmente de um lado e pela técnica do retalho estendido no outro lado. Medidas clínicas (profundidade de sondagem, nível clínico de inserção, sangramento a sondagem, altura e largura da retração gengival, quantidade de tecido queratinizado, altura e largura das papilas dos dentes adjacentes a retração gengival)foram realizadas no início do estudo, 3 e 6 meses de pós-operatório. Amostras salivares foram feitas para detectar cotinina, um indicador do nível de exposição ao fumo. Não foram detectadas diferenças estatisticamente significantes (p>0,05) para os parâmetros clínicos ou exposição ao fumo. Ambas as técnicas tiveram baixo recobrimento radicular (controle: 43,18 por cento e teste: 44,52 por cento). Nenhuma diferença estatisticamente significante foi encontrada para o recobrimento radicular entre as técnicas. Em pacientes fumantes pesados com baixo índice de placa e de sangramento gengival o recobrimento radicular é possível e comum, no entanto, o recobrimento é parcial.

Comparison between micro- and macrosurgical techniques for the treatment of localized gingival recessions using coronally positioned flaps and enamel matrix derivative.

BACKGROUND: The aim of this study is to compare the macro- and microsurgery techniques for root coverage using a coronally positioned flap (CPF) associated with enamel matrix derivative (EMD). METHODS: Thirty patients were selected for the treatment of localized gingival recessions (GRs) using CPF associated to EMD. Fifteen patients were randomly assigned to the test group (TG), and 15 patients were randomly assigned to the control group (CG). The microsurgical approach was performed in the TG, and the conventional macrosurgical technique was performed in the CG. The clinical parameters evaluated before surgery and after 6 months were GR, probing depth, relative clinical attachment level, width of keratinized tissue (WKT), and thickness of keratinized tissue (TKT). The discomfort evaluation was performed 1 week postoperative. RESULTS: There were no statistically significant differences between groups for all parameters at baseline. At 6 months, there was no statistically significant difference between the techniques in achieving root coverage. The percentage of root coverage was 92% and 83% for TG and CG, respectively. After 6 months, there was a statistically significant increase of WKT and TKT in TG only. Both procedures were well tolerated by all patients. CONCLUSIONS: The macro- and microsurgery techniques provided a statistically significant reduction in GR height. After 6 months, there was no statistically significant difference between the techniques regarding root coverage, and the microsurgical technique demonstrated a statistically significant increase in WKT and TKT.