The effect of a multicomponent oral care regimen on gingival inflammation: A randomized controlled clinical trial.

BACKGROUND: Oral care regimens can be explored to improve oral health in patients with gingivitis. This study aimed to evaluate the efficacy of a multicomponent oral care regimen with a dual zinc plus arginine (DZA) toothpaste and cetylpyridinium chloride with zinc lactate (CPC + Zn) mouthwash in reducing gingival bleeding in patients with gingivitis. METHODS: This randomized clinical trial included 94 participants with gingivitis who were randomized into two groups: the DZA/CPC + Zn group, which used a 1450-ppm fluoride toothpaste containing 0.96% zinc plus 1.5% arginine and a fluoride-containing mouthwash with 0.075% CPC and 0.28% zinc lactate, and the control group, which used a 1450-ppm fluoride toothpaste and a placebo mouthwash for 6 months. All participants were examined by a blinded examiner who measured the gingival index, plaque index, and gingival severity index. Data were analyzed using paired t test, independent t test, and analysis of covariance (ANCOVA). RESULTS: Both groups presented statistically significant reductions in all clinical parameters compared to baseline. The DZA/CPC + Zn group exhibited significantly greater reductions in gingival index, gingival severity index, proximal gingival index, plaque index and proximal plaque index compared to the control group at 1, 3, and 6 months. Furthermore, DZA/CPC + Zn significantly decreased the percentage of patients with generalized gingivitis over a 6-month follow-up period. However, differences between the DZA/CPC + Zn and the control groups were not maintained after both groups established similar regimens with fluoride toothpaste. CONCLUSION: The multicomponent oral care regimen consisting of DZA toothpaste and CPC + Zn mouthwash is effective in reducing gingival inflammation and supragingival biofilm in patients with gingivitis.

Parents with periodontitis drive the early acquisition of dysbiotic microbiomes in their offspring.

AIM: To evaluate the microbial colonization in different dentition phases on individuals from 0 to 18 years of age belonging to families with a history of periodontitis compared to descendants of periodontally healthy parents. MATERIALS AND METHODS: The offspring of subjects with periodontitis ('Perio' group) and the offspring of periodontally healthy subjects ('Healthy' group), matched for gender and age, were included in this cross-sectional study and divided according to the dentition phase: pre-dentate, primary, mixed and permanent. The patients were clinically assessed, and their saliva was collected. DNA was extracted, and V1-V3 and V4-V5 regions of the 16S rRNA gene were sequenced. RESULTS: Fifty children of parents with periodontitis and 50 from healthy parents were included in the study and divided according to the dentition phase: pre-dentate (n = 5/group), primary dentition (n = 15/group), mixed dentition (n = 15/group) and permanent dentition (n = 15/group) in each group. The microbiome composition was different between dentitions for both groups. Children of the Perio group presented a microbial diversity different from that of the Healthy group in mixed and permanent dentitions. The more intense shift in the community occurred between primary and mixed dentition in the Perio group, while the transition between mixed and permanent dentition was the period with greater changes in the microbiome for the Healthy group. Furthermore, a pathogen-rich environment-higher prevalence and abundance of periodontitis-associated species such as Prevotella spp., Selenomonas spp., Leptotrichia spp., Filifactor alocis, Prevotella intermedia, Treponema denticola and Tannerella forsythia- was observed in the Perio group. CONCLUSIONS: The parents' periodontal status significantly affects the microbiome composition of their offspring from an early age. The mixed dentition was the phase associated with establishing a dysbiotic and pathogen-rich microbiome in descendants of parents with periodontitis.

Adverse events of metronidazole and amoxicillin: Retrospective analysis of a large data set of five randomized clinical trials.

AIM: To evaluate the frequency of side effects associated with intake of metronidazole (MTZ) + amoxicillin (AMX) in periodontal treatment, and to explore associations between these events and patients' features. MATERIALS AND METHODS: Data of five randomized clinical trials testing MTZ + AMX adjunctive to mechanical therapy were evaluated. Volunteers answered an adverse event questionnaire. RESULTS: Information from 656 subjects was assessed. The frequency of side effects in the antibiotic- and placebo-treated groups ranged from 1.0% to 17.7% and 0.9% to 13.7%, respectively. The events more frequently observed in the antibiotic than in the placebo group were diarrhoea and metallic taste (p < .05). Diabetes significantly raised the odds of a patient reporting discomfort (odds ratio [OR] = 2.6), diarrhoea (OR = 4.0), weakness (OR = 6.0) and excessive sleepiness (OR = 2.9). In systemically healthy volunteers, using antibiotics 3 months post-mechanical treatment (healing phase) (OR = 3.0), being a woman (OR = 3.9) and aged ≤49 (OR = 4.5) significantly increased the chances of reporting adverse events. CONCLUSIONS: The occurrence of side effects during MTZ + AMX treatment ranged from uncommon (1%) to very common (17.7%). The main factors raising the chances of a patient reporting adverse events were diabetes and taking antibiotics in the healing phase, instead of in the active phase of treatment. Patients ≤ 49 years old and females also tend to report more side effects.

The effect of a toothpaste containing oleanolic acid in reducing plaque and gingivitis: a proof-of-concept randomized trial.

OBJECTIVES: To assess the safety and efficacy of an oleanolic acid (OA)-containing toothpaste in reducing gingival inflammation and plaque in patients with gingivitis. METHODS: This proof-of-concept parallel, double-blind, randomized controlled clinical trial included 99 patients. Following a 1-week washout, patients were randomized into three groups: OA group (fluoride toothpaste containing 0.1% OA and placebo mouthwash); negative control (fluoride toothpaste and placebo mouthwash); and CHX group (fluoride toothpaste and 0.12% chlorhexidine mouthwash). Patients were clinically assessed at inclusion, pre-washout visit, baseline and after 4 days, 1 week and 2 weeks of twice-daily use of the products. Patients received a diary for documentation of bleeding on brushing and provided unstimulated saliva samples. RESULTS: After two weeks, all groups showed significant reductions in all clinical parameters. The CHX group exhibited significantly greater reductions in gingival index and interproximal gingival index scores at week 2, as compared to patients in the negative control (p = 0.04). In contrast, reductions in gingival index scores did not differ between CHX and OA groups and between OA and negative control groups at week 2. The CHX group had significantly greater reductions in plaque index scores at day-4, 1-week and 2-week evaluations, as compared to the negative control and OA groups. The frequency of adverse events was similar among the groups. None of the groups reduced salivary transferrin levels. Finally, the OA group had the lowest percentage of self-reported bleeding events. CONCLUSION: OA toothpaste failed to provide antiplaque and antigingivitis effects superior to those of a fluoride toothpaste after 2 weeks of use.

Periodontopathogenic bacteria in subglottic samples from patients undergoing elective intubation for general anesthesia: A pilot study.

BACKGROUND: Translocation of periodontal pathogens into the respiratory tract could either cause pneumonia or disrupt local defense mechanisms, predisposing the host to infection by respiratory pathogens. The objective of this pilot study was to evaluate the levels of periodontopathogenic bacteria in subglottic samples of intubated and mechanically ventilated patients and the impact of oral decontamination with chlorhexidine (CHX) on subglottic levels of these microorganisms. METHODS: Patients scheduled to undergo elective surgical procedures requiring endotracheal intubation and mechanical ventilation for at least 3 hours were included. Following full-mouth periodontal examination, patients were randomly assigned to groups that rinsed preoperatively with 0.12% CHX or 0.9% saline (control). After 3 hours of orotracheal intubation, subglottic contents were collected. Quantification of Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), Porphyromonas gingivalis (P. gingivalis), and Tannerella forsythia (T. forsythia) in subglottic samples was determined using quantitative real-time polymerase chain reaction. Data were analyzed by Fisher Exact Probability, unpaired Student's t and Mann-Whitney tests. RESULTS: Of the 69 patients included, 43 completed study participation. There were no differences between control and CHX groups in subglottic detection rates and abundance levels of P. gingivalis (P = 0.59), T. forsythia (P = 0.83) and A. actinomycetemcomitans (P = 0.07). Moreover, our data indicate that periodontal health has no impact on subglottic levels of P. gingivalis, T. forsythia, and A. actinomycetemcomitans. CONCLUSIONS: Periodontal pathogens were detected in subglottic samples of intubated and mechanically ventilated patients. Moreover, a single CHX rinse prior to endotracheal intubation may have no effect on subglottic contamination by P. gingivalis, T. forsythia, and A. actinomycetemcomitans.

Oral Dysbiosis in Severe Forms of Periodontitis Is Associated With Gut Dysbiosis and Correlated With Salivary Inflammatory Mediators: A Preliminary Study.

Inflammation is a driven force in modulating microbial communities, but little is known about the interplay between colonizing microorganisms and the immune response in periodontitis. Since local and systemic inflammation may play a whole role in disease, we aimed to evaluate the oral and fecal microbiome of patients with periodontitis and to correlate the oral microbiome data with levels of inflammatory mediator in saliva. Methods: Nine patients with periodontitis (P) in Stage 3/Grade B and nine age-matched non-affected controls (H) were evaluated. Microbial communities of oral biofilms (the supra and subgingival from affected and non-affected sites) and feces were determined by sequencing analysis of the 16SrRNA V3-V4 region. Salivary levels of 40 chemokines and cytokines were correlated with oral microbiome data. Results: Supragingival microbial communities of P differed from H (Pielou's evenness index, and Beta diversity, and weighted UniFrac), since relative abundance (RA) of Defluviitaleaceae, Desulfobulbaceae, Mycoplasmataceae, Peptostreococcales-Tissierellales, and Campylobacteraceae was higher in P, whereas Muribaculaceae and Streptococcaceae were more abundant in H. Subgingival non-affected sites of P did not differ from H, except for a lower abundance of Gemellaceae. The microbiome of affected periodontitis sites (PD ≥ 4 mm) clustered apart from the subgingival sites of H. Oral pathobionts was more abundant in sub and supragingival biofilms of P than H. Fecal samples of P were enriched with Acidaminococcus, Clostridium, Lactobacillus, Bifidobacterium, Megasphaera, and Romboutsia when compared to H. The salivary levels of interleukin 6 (IL-6) and inflammatory chemokines were positively correlated with the RA of several recognized and putative pathobionts, whereas the RA of beneficial species, such as Rothia aeria and Haemophilus parainfluenzae was negatively correlated with the levels of Chemokine C-C motif Ligand 2 (CCL2), which is considered protective. Dysbiosis in patients with periodontitis was not restricted to periodontal pockets but was also seen in the supragingival and subgingival non-affected sites and feces. Subgingival dysbiosis revealed microbial signatures characteristic of different immune profiles, suggesting a role for candidate pathogens and beneficial organisms in the inflammatory process of periodontitis.

Oral and Fecal Microbiome in Molar-Incisor Pattern Periodontitis.

In order to improve our understanding on the microbial complexity associated with Grade C/molar-incisor pattern periodontitis (GC/MIP), we surveyed the oral and fecal microbiomes of GC/MIP and compared to non-affected individuals (Control). Seven Afro-descendants with GC/MIP and seven age/race/gender-matched controls were evaluated. Biofilms from supra/subgingival sites (OB) and feces were collected and submitted to 16S rRNA sequencing. Aggregatibacter actinomycetemcomitans (Aa) JP2 clone genotyping and salivary nitrite levels were determined. Supragingival biofilm of GC/MIP presented greater abundance of opportunistic bacteria. Selenomonas was increased in subgingival healthy sites of GC/MIP compared to Control. Synergistetes and Spirochaetae were more abundant whereas Actinobacteria was reduced in OB of GC/MIP compared to controls. Aa abundance was 50 times higher in periodontal sites with PD≥ 4 mm of GC/MIP than in controls. GC/MIP oral microbiome was characterized by a reduction in commensals such as Kingella, Granulicatella, Haemophilus, Bergeyella, and Streptococcus and enrichment in periodontopathogens, especially Aa and sulfate reducing Deltaproteobacteria. The oral microbiome of the Aa JP2-like+ patient was phylogenetically distant from other GC/MIP individuals. GC/MIP presented a higher abundance of sulfidogenic bacteria in the feces, such as Desulfovibrio fairfieldensis, Erysipelothrix tonsillarum, and Peptostreptococcus anaerobius than controls. These preliminary data show that the dysbiosis of the microbiome in Afro-descendants with GC/MIP was not restricted to affected sites, but was also observed in supragingival and subgingival healthy sites, as well as in the feces. The understanding on differences of the microbiome between healthy and GC/MIP patients will help in developing strategies to improve and monitor periodontal treatment.

Chemokines and cytokines profile in whole saliva of patients with periodontitis.

Clinical features suggest differences in immune response among periodontitis forms, albeit a large number of cytokines and chemokines remain to be evaluated. The saliva is an available source of mediators and its analysis would be valuable in order to understand pathophysiological differences. The objective of this study was analyze chemokines/cytokines profile in whole saliva of individuals with severe periodontitis (Stage III) presenting moderate [Grade B; GB] or rapid progression rate with a localized incisor-molar pattern [Grade C; GC/IMP]. A case-control study was designed for each periodontitis group. GB (n = 9) and GC/IMP (n = 7) patients and their healthy controls (C-GB, n = 9 and C-GC, n = 7) were evaluated. Non-stimulated saliva samples were assessed by a multiplex assay for a total of 40 cytokines, C-C and C-X-C motif chemokines. GC/IMP group presented higher levels of CCL17 and CCL27 (p = 0.04, FDR > 0.05), and lower levels of CCL2 (p = 0.04, FDR > 0.05) and CCL25 (p = 0.006, FDR < 0.05) when compared to its control. GB patients had higher levels of IL-6, IL-1ß (p = 0.04, FDR > 0.05), and elevated pro-inflammatory (TNF-α,IL-1ß,INF-γ,IL-6, IL-16): anti-inflammatory (IL-2, IL-4, IL-10) ratio (p = 0.01, FDR < 0.05) compared to its control [p-values by Mann-Whitney test, and False Discovery Rate (FDR) by Benjamini-Hochburg corrections]. CCL-chemokines and cytokines contributed to differences between GC/C-GC and GB/C-GB, respectively (p < 0.05, PERMANOVA test). These preliminary data revealed that each periodontitis phenotype presented distinct immune profiles differentially expressed in saliva compared to their related controls, suggesting differences in the etiopathogenesis of GB and GC/IMP.

Retalho de pedículo subcutâneo em formato de tubarão na região perialar / Subcutaneous pedicle flap shaped like a shark on perinasal region

A região nasal é frequentemente acometida por neoplasias cutâneas, especialmente em indivíduos de fototipos baixos, em quem a incidência de carcinoma basocelular é elevada. Defeitos cirúrgicos na asa nasal e região perinasal constituem desafio à sua reconstrução, uma vez que envolve várias unidades cosméticas e preservação do sulco nasal. A preservação dos limites entre essas unidades mostra-se fundamental, portanto, para o bom resultado funcional e estético. Este artigo tem como objetivo mostrar a aplicação do retalho de pedículo subcutâneo em formato de tubarão para correção de defeitos em asa nasal e região perinasal.

The nasal region is often affected by cutaneous neoplasm, especially in individuals of low phototypes, where the incidence of basal cell carcinoma is high. Surgical defects in the nasal wing and perinasal region constitute a challenge to its reconstruction since it involves several cosmetic units and preservation of the nasal groove. The preservation of the limits between these units is thus fundamental for good functional and aesthetic results. This article aims to show the application of the Shark Island Flap for the correction of defects in the nasal and perinasal regions.

Effect of periodontal treatment on Aggregatibacter actinomycetemcomitans colonization and serum IgG levels against A. actinomycetemcomitans serotypes and Omp29 of aggressive periodontitis patients.

OBJECTIVE: To evaluate the effect of the periodontal treatment on Aggregatibacter actinomycetemcomitans JP2 clone, and the IgG serum levels against its outer membrane protein (Omp29) and A. actinomycetemcomitans serotypes in aggressive periodontitis (AgP). SUBJECTS AND METHODS: Seventeen patients with generalized (GAgP), 10 with localized (LAgP), and 10 healthy controls were included. AgP participants were submitted to periodontal treatment-scaling and root planing plus antibiotics (SRP+A). Periodontal parameters, for example, probing depth (PD) and clinical attachment loss (CAL), were evaluated at baseline and at 1-year. Serum IgG against Omp29 and serotypes a, b, and c were determined by ELISA. The levels of A. actinomycetemcomitans JP2 clone were determined in subgingival biofilm samples by qPCR. RESULTS: Periodontal treatment resulted in significant reductions of PD, CAL, and IgG levels against Omp29, serotypes b, and c. After therapy, IgG levels against A. actinomycetemcomitans serotypes, as well as the levels of the JP2 clone in AgP, became similar to controls. The reduction in JP2 clone count was correlated with a reduction of PD and IgG response against Omp29. CONCLUSION: Scaling and root planing plus antibiotics decreased IgG levels response against Omp29 and A. actinomycetemcomitans serotypes involved in the disease (b and c), while the serum response increased against tne commensal serotype (a), similar to what occurs in periodontally healthy individuals.

Tratamento de cicatrizes hipertróficas com laser fracionado ablativo e drug delivery de triancinolona / Treatment of hypertrophic scars with factional ablative laser and triamcinolone drug delivery

Introdução: As cicatrizes são muito prevalentes na população mundial e podem ter impacto psicológico importante na vida do paciente. Já existem métodos clínicos e cirúrgicos convencionais para seu tratamento. Entretanto, a recidiva e os efeitos colaterais apresentados impulsionam a busca por novas modalidades terapêuticas. Objetivo: Avaliar a melhora clínica de pacientes com cicatrizes hipertróficas tratados com laser fracionado ablativo associado a drug delivery de triancinolona. Material e métodos: Foram selecionadas 18 pacientes com cicatrizes para serem tratadas, por oito semanas, com quatro sessões quinzenais de laser fracionado ablativo associado a drug delivery de triancinolona 20mg/ml. Antes e após o tratamento, o grupo foi avaliado por três examinadores por meio da evolução fotográfica, considerando-se os parâmetros aparência, discromia e grau de hipertrofia. Resultados: Completaram o estudo 15 pacientes. Destas, 35,53% apresentaram pouca ou nenhuma melhora; 37,80%, melhora moderada a intermediária; 8,89%, melhora importante e 17,80%, melhora próxima à resolução. Conclusões: A associação proposta é uma opção terapêutica promissora para o tratamento de cicatrizes hipertróficas por ser de rápida realização e cicatrização tecidual, com melhores resultados em relação às terapêuticas aplicadas isoladamente, com menores efeitos colaterais e com mais tolerabilidade pelo paciente, além de ser facilmente reproduzível em consultório.

Introduction: Scars are very prevalent in the world's population and can have a significant psychological impact in the patient's life. There are already conventional clinical and surgical methods for their treatment. However, recurrence and existing side effects drive the search for new therapeutic modalities. Objective: To evaluate the clinical improvement of patients with hypertrophic scarring treated with fractional ablative laser associated to triamcinolone drug delivery. Material and methods: Eighteen patients with scars to be treated were selected during eight weeks, with four fortnightly sessions of fractional ablative laser associated to 20mg/ml triamcinolone drug delivery. Before and after the treatment, the group was evaluated by three examiners, through the photographic evolution , considering the parameters appearance, dyschromia and degree of hypertrophy. Results: Fifteen patients completed the study. Of these, 35.53% had no or little improvement; 37.80%, moderate to intermediate improvement; 8.89%, expressive improvement and 17.80%, improvement near resolution. Conclusions: The proposed association is a promising therapeutic option for the treatment of hypertrophic scars because it is quick to perform and to heal, with less side effects and better tolerated by the patient when compared to the therapies used alone, besides being easily replicable in the office.

Tratamento de melasma facial com associação do microagulhamento robótico e drug delivery de ácido tranexâmico / Treatment of facial melasma with robotic microneedling associated to drug delivery of tranexamic acid

Introdução: A despeito de todo arsenal terapêutico existente, o melasma continua sendo um desafio dermatológico. A busca de novas modalidades de tratamento visa otimizar resultados e minimizar efeitos colateriais sistêmicos. Objetivo: Avaliar a melhora clínica de pacientes com melasma tratados com microagulhamento robótico associado a drug delivery de ácido tranexâmico. Material e Métodos: Foram selecionadas 17 mulheres com melasma para tratamento durante oito semanas com quatro sessões quinzenais de microagulhamento robótico associado ao drug delivery de 1ml de ácido tranexâmico 4mg/ml. Antes e após o tratamento, o grupo foi avaliado sob os seguintes parâmetros: evolução fotográfica avaliada por três examinadores, autoavaliação através do Melasma Quol e evolução do Masi. Resultados: 15 pacientes de fototipos de Fitzpatrick de II a VI completaram o estudo. Delas, 31,11% apresentaram pouca ou nenhuma melhora; 24,45% melhora moderada a intermediária; 33,33% melhora importante, e 11,11% melhora próxima à resolução. Em relação ao Masi, houve melhora significativa, com redução de 21,33% para 11,19%. Conclusões: A associação proposta apresentou resultados satisfatórios, configurando- -se em modalidade terapêutica inovadora, reproduzível e segura para o tratamento do melasma.

Introduction: Despite all the existing therapeutic tools, melasma continues to be a dermatological challenge. Therefore, the search for new treatment modalities aims to optimize results and reduce systemic side effects. Objective: Evaluate the clinical improvement of patients with melasma treated with robotic microneedling associated to drug delivery of tranexamic acid. Material and Methods: Seventeen women with melasma were selected to be treated during eight weeks with four fortnightly sessions of robotic microneedling associated to drug delivery of 1.0ml of 4mg/ml tranexamic acid. The group was evaluated before and after the treatment with the following parameters: photographic evolution evaluated by three examiners, self-evaluation with Melasma QoL and MASI improvement. Results: Fifteen Fitzpatrick phototype II to VI patients completed the study. Of those, 31.11% showed little or no improvement; 24.45% moderate to intermediate improvement; 33.33% significant improvement and 11.11% improved almost to resolution. In regards to MASI, there was a significant improvement, with a reduction from 21.33% to 11.19%. Conclusions: The proposed association showed satisfactory results, constituting an innovative, replicable and safe therapeutic modality for the treatment of melasma.

A systematic review and meta-analysis of the survival rate of implants placed in previously failed sites.

The aim of this study was to conduct a systematic review and meta-analysis to assess the clinical outcomes of dental implants placed in previously early and late implant failed sites. An electronic literature search was conducted in several databases for articles published up to February 2018. Human clinical trials that received at least one implant in a previously failed site were included. Hence, the PICO question that was aimed to be addressed was: Do patients undergoing implant replacement (second and third attempts) in previous failed sites have survival rates similar to implants placed at first attempts? A random effects model was used to calculate survival weighted means and corresponding 95% Confidence Intervals (CI) among studies. Eleven studies of low to moderate methodological quality were included in this review. Implants placed in sites with history of one and two implant failures had a weighted survival rate (SR) of 88.7% (95%CI 81.7-93.3) and 67.1% (95%CI 51.1-79.9), respectively. Implants placed in sites with a previous early failure revealed a weighted SR of 91.8% (95%CI 85.1-95.6). First implants presented higher SR than implants placed in sites with one or two previous implant failures. In contrast, implants placed in sites with one and two implant failures had similar SR. Within its limitations, this review suggests that replacement implants have moderate SR. Larger prospective studies with well-defined criteria for early and late implant failure are necessary to confirm and expand on these results.

Orthodontic treatment in patients with aggressive periodontitis.

INTRODUCTION: Aggressive periodontitis (AP) is a condition that promotes breakdown of the periodontal tissues in a short time. In severe cases, pathologic migration of teeth and tooth loss can occur, producing esthetic and functional problems for the patient. Orthodontic treatment may be recommended to restore esthetics and masticatory function. We assessed the effects of orthodontic movement in the periodontal tissues of treated patients with AP. METHODS: Ten subjects (ages 25.0 ± 5.22 years) with AP received periodontal treatment followed by orthodontic treatment. Maintenance sessions were performed monthly under a strict dental biofilm control. They were compared with 10 periodontally healthy subjects (ages 22.9 ± 5.23 years) who received orthodontic treatment. Probing pocket depth, clinical attachment level, bleeding on probing, and dental plaque index were measured at baseline, after orthodontic treatment, and after 4 months. RESULTS: Statistical analysis showed improvement in all clinical parameters between baseline and 4 months after orthodontic treatment: probing pocket depth (0.29 mm), clinical attachment level (0.38 mm), bleeding on probing (4.0%), and dental plaque index (11%). CONCLUSIONS: The periodontal parameters of the AP patients remained stable during orthodontic treatment under strict biofilm control.

The ideal time of systemic metronidazole and amoxicillin administration in the treatment of severe periodontitis: study protocol for a randomized controlled trial.

BACKGROUND: The combination of systemic metronidazole (MTZ) and amoxicillin (AMX) with scaling and root planing (SRP) has shown to be an effective periodontal treatment. However, some essential issues associated with the use of these antibiotics remain unanswered, such as the ideal time of administration during the course of periodontal treatment. Although these agents are often prescribed after the healing phase of the SRP procedure, there is biological plausibility to support its use in conjunction with the mechanical treatment. However, to date, no placebo controlled randomized clinical trial (RCT) has directly compared these two protocols. Therefore, the aim of this RCT is to compare the clinical, microbiological and immunological effects of the adjunctive systemic MTZ + AMX administered in different phases of the treatment of severe periodontitis. METHODS: Subjects with severe periodontitis (n = 180) are being randomly assigned into three groups (n = 60/group): (i) SRP-only (control group), SRP in combination with 400 mg MTZ + 500 mg AMX, starting (ii) at the first SRP session (active phase group), or (iii) after 3 months of its completion (healing phase group). All volunteers are receiving clinical and microbiological evaluation at baseline, 3, 6 and 12 months, and immunological assessment at baseline and 12 months post-therapy. Nine subgingival biofilm samples are being collected per subject and analyzed for counts and proportions of 40 bacterial species by checkerboard DNA-DNA hybridization, and six gingival crevicular fluid samples are being collected and analyzed for the levels of 20 chemokines by multiplex immunoassay. The primary outcome variable is the number of volunteers reaching the clinical endpoint for treatment (≤ 4 sites with probing depth ≥5 mm) at 1 year post-therapy. Differences in clinical, microbiological and immunological parameters among groups and over time will be evaluated using analysis of variance, analysis of covariance and the Chi-square and Tukey tests. Microbiological and immunological analyses will be performed using adjustments for multiple comparisons. Statistical significance will be set at 5%. TRIAL REGISTRATION: ClinicalTrials.gov , NCT02954393 . Registered on 3 November 2016.

Impact of aggressive periodontitis and chronic periodontitis on oral health-related quality of life.

The purpose of this cross-sectional study was to investigate the effect of different forms of periodontal diseases on Oral Health-Related Quality of Life (OHRQoL). Fifty-two patients with Aggressive Periodontitis (AP) or Chronic Periodontitis (CP) were included: nine patients with Localized Aggressive Periodontitis (LAP), thirty-three patients with Generalized Aggressive Periodontitis (GAP) and ten patients with Generalized Chronic Periodontitis (GCP). Oral Health Impact Profile questionnaires (OHIP-14) were distributed after a clinical examination that measured the following periodontal parameters: tooth loss, bleeding on probing (BoP), probing depth (PD), gingival recession (REC) and clinical attachment level (CAL). The global OHIP-14 score means were 10.6 for LAP, 16.5 for GAP, and 17.5 for GCP. A statistically significant difference (p < 0.01) was observed between the LAP group and the other two groups. There was significantly less bleeding and recession in the LAP group than in the patients with the generalized forms of periodontitis. LAP, GAP and GCP have an impact on patient quality of life when measured using the OHIP-14. Patients with GAP and GCP had poorer OHRQoL than LAP patients.

A systematic review and meta-analysis of the survival rate of implants placed in previously failed sites

Abstract The aim of this study was to conduct a systematic review and meta-analysis to assess the clinical outcomes of dental implants placed in previously early and late implant failed sites. An electronic literature search was conducted in several databases for articles published up to February 2018. Human clinical trials that received at least one implant in a previously failed site were included. Hence, the PICO question that was aimed to be addressed was: Do patients undergoing implant replacement (second and third attempts) in previous failed sites have survival rates similar to implants placed at first attempts? A random effects model was used to calculate survival weighted means and corresponding 95% Confidence Intervals (CI) among studies. Eleven studies of low to moderate methodological quality were included in this review. Implants placed in sites with history of one and two implant failures had a weighted survival rate (SR) of 88.7% (95%CI 81.7-93.3) and 67.1% (95%CI 51.1-79.9), respectively. Implants placed in sites with a previous early failure revealed a weighted SR of 91.8% (95%CI 85.1-95.6). First implants presented higher SR than implants placed in sites with one or two previous implant failures. In contrast, implants placed in sites with one and two implant failures had similar SR. Within its limitations, this review suggests that replacement implants have moderate SR. Larger prospective studies with well-defined criteria for early and late implant failure are necessary to confirm and expand on these results.

Impact of aggressive periodontitis and chronic periodontitis on oral health-related quality of life

Abstract The purpose of this cross-sectional study was to investigate the effect of different forms of periodontal diseases on Oral Health-Related Quality of Life (OHRQoL). Fifty-two patients with Aggressive Periodontitis (AP) or Chronic Periodontitis (CP) were included: nine patients with Localized Aggressive Periodontitis (LAP), thirty-three patients with Generalized Aggressive Periodontitis (GAP) and ten patients with Generalized Chronic Periodontitis (GCP). Oral Health Impact Profile questionnaires (OHIP-14) were distributed after a clinical examination that measured the following periodontal parameters: tooth loss, bleeding on probing (BoP), probing depth (PD), gingival recession (REC) and clinical attachment level (CAL). The global OHIP-14 score means were 10.6 for LAP, 16.5 for GAP, and 17.5 for GCP. A statistically significant difference (p < 0.01) was observed between the LAP group and the other two groups. There was significantly less bleeding and recession in the LAP group than in the patients with the generalized forms of periodontitis. LAP, GAP and GCP have an impact on patient quality of life when measured using the OHIP-14. Patients with GAP and GCP had poorer OHRQoL than LAP patients.

Avaliação Geriátrica Ampla e sua Utilização no Cuidado de Enfermagem a Pessoas Idosas / Wide Geriatric Assessment and its use in Nursing care for the Elderly

O envelhecimento humano é considerado um fenômeno populacional reconhecidamente heterogêneo e multidimensional. Objetivou-se, nesse estudo, investigar a utilização da Avaliação Geriátrica Ampla (AGA) como subsídio para o processo de cuidar em enfermagem a pessoas idosas, em uma Caixa de Autogestão em Saúde, na cidade de Fortaleza-CE. Trata-se de um estudo documental, transversal, de abordagem quantitativa. A amostra foi composta de 70 prontuários de acompanhamento de idosos acima de 80 anos. A coleta dos dados ocorreu, por meio de um formulário semiestruturado, realizada no período de maio a junho de 2015. Constatou-se que 50% dos participantes apresentaram mais de oito anos de estudo. Verificou-se, ainda, que 57,1% são independentes para as atividades de vida diária (AVDs) e que 78,6% dos domicílios estão adequados para redução de risco de quedas. Dentre as comorbidades clínicas existentes, a hipertensão arterial está presente em 22%, seguida de Diabetes Mellitus, com 14,3%. Considera-se, nesse estudo, que a perda funcional ainda se constitui como uma condição de atenção ao cuidado de enfermagem para a população idosa, porquanto pode causar fraturas, síndrome da imobilidade, aumento do grau de dependência, depressão, isolamento social, dentre outras questões referentes ao processo de senilidade, implicando, desse modo, a necessidade de atuação de forma contínua e dinâmica em estratégias de educação em saúde a essa parcela crescente da população. (AU)

Human aging is considered a population phenomenon that is admittedly heterogeneous and multidimensional. The purpose of this study was to investigate the use of the Ample Geriatric Assessment (AGA) as a subsidy for the nursing care process for elderly people in a Health Self- Management Box in the city of Fortaleza-CE. This is a documentary study, cross-sectional with a quantitative approach. The sample consisted of 70 follow-up charts for the elderly over 80 years. The data were collected through a semi-structured form, carried out from May to June 2015. It was verified that 50% of the participants presented more than 8 years of study. It was also verified that 57.1% are independent for activities of daily living (ADLs) and that 78.6% of the households are adequate to reduce the risk of falls. Among the existing clinical comorbidities, arterial hypertension is present in 22%, followed by Diabetes Mellitus, with 14.3%. It is considered in this study that functional loss is still a condition of attention to nursing care for the elderly population, as it can cause fractures, immobility syndrome, increased dependency, depression, social isolation, among other issues relating to the senility process, implying, therefore, the need to act in a continuous and dynamic form in health education strategies to this growing part of the population. (AU)

PAR-2 expression in the gingival crevicular fluid reflects chronic periodontitis severity.

Recent studies investigating protease-activated receptor type 2 (PAR-2) suggest an association between the receptor and periodontal inflammation. It is known that gingipain, a bacterial protease secreted by the important periodontopathogen Porphyromonas gingivalis can activate PAR-2. Previous studies by our group found that PAR-2 is overexpressed in the gingival crevicular fluid (GCF) of patients with moderate chronic periodontitis (MP). The present study aimed at evaluating whether PAR-2 expression is associated with chronic periodontitis severity. GCF samples and clinical parameters, including plaque and bleeding on probing indices, probing pocket depth and clinical attachment level, were collected from the control group (n = 19) at baseline, and from MP patients (n = 19) and severe chronic periodontitis (SP) (n = 19) patients before and 6 weeks after periodontal non-surgical treatment. PAR-2 and gingipain messenger RNA (mRNA) in the GCF of 4 periodontal sites per patient were evaluated by Reverse Transcription Polymerase Chain Reaction (RT-qPCR). PAR-2 and gingipain expressions were greater in periodontitis patients than in control group patients. In addition, the SP group presented increased PAR-2 and gingipain mRNA levels, compared with the MP group. Furthermore, periodontal treatment significantly reduced (p <0.05) PAR-2 expression in patients with periodontitis. In conclusion, PAR-2 is associated with chronic periodontitis severity and with gingipain levels in the periodontal pocket, thus suggesting that PAR-2 expression in the GCF reflects the severity of destruction during periodontal infection.