Cigarette smoking negatively affects healing response following flap debridement surgery.

BACKGROUND: The purpose of the present parallel design, controlled clinical trial was to evaluate the treatment outcome following flap debridement surgery (FDS) in cigarette smokers compared to non-smokers. METHODS: After initial therapy, 57 systemically healthy subjects with moderate to advanced periodontitis who presented with one area (at least 3 teeth) where surgery was required were selected. Twenty-eight patients (mean age: 39.6 years, 20 males) were smokers (> or = 10 cigarettes/day); 29 patients (mean age: 43.9 years, 7 males) were non-smokers. Full-mouth plaque (FMP) and bleeding on probing (BOP) scores, probing depth (PD), clinical attachment level (CAL), and recession depth (RD) were assessed immediately before and 6 months following surgery. Only sites with presurgery PD > or = 4 mm were used for statistical analysis. RESULTS: Presurgery FMP and BOP were similar in smokers and non-smokers and significantly decreased postsurgery in both groups. Overall, PD reduction and CAL gain were greater, although not significantly, in non-smokers (2.4 +/- 0.9 mm and 1.6 +/- 0.7 mm, respectively) than in smokers (1.9 +/- 0.7 mm and 1.2 +/- 0.7 mm, respectively). For moderate sites (PD 4 to 6 mm), no significant differences in PD and CAL changes were found between groups. For deep sites (PD > or = 7 mm), PD reduction was 3.0 +/- 1.0 mm in smokers and 4.0 +/- 0.8 mm in non-smokers, and CAL gain amounted to 1.8 +/- 1.1 mm in smokers and 2.8 +/- 1.0 mm in non-smokers (P = 0.0477). In smokers, 16% of deep sites healed to postsurgery PD values < or = 3 mm as compared to 47% in non-smokers (P = 0.0000); 58% of deep sites in smokers showed a CAL gain > or = 2 mm, as compared to 82% in non-smokers (P = 0.0000). CONCLUSIONS: Results of the study indicated that: 1) FDS determined a statistically significant PD reduction and CAL gain in patients with moderate to advanced periodontitis; 2) smokers exhibited a trend towards less favorable healing response following FDS compared to non-smokers, both in terms of PD reduction and CAL gain; and 3) this trend reached clinical and statistical significance at sites with initial deep PD.

Subpedicle connective tissue graft versus guided tissue regeneration with bioabsorbable membrane in the treatment of human gingival recession defects.

The purpose of the present clinical study was to evaluate the effect of guided tissue regeneration (GTR) in comparison to subpedicle connective tissue graft (SCTG) in the treatment of gingival recession defects. A total of 12 patients, each contributing a pair of Miller's Class I or II buccal gingival recessions, was treated. According to a randomization list, one defect in each patient received a polyglycolide/lactide bioabsorbable membrane, while the paired defect received a SCTG. Treatment effect was evaluated 6 months postsurgery. Clinical recordings included full-mouth and defect-specific oral hygiene standards and gingival health, recession depth (RD), recession width (RW), probing depth (PD), clinical attachment level (CAL), and keratinized tissue width (KT). Mean RD significantly decreased from 3.1 mm presurgery to 1.5 mm at 6 months postsurgery for the GTR group (48% root coverage), and from 3.0 mm to 0.5 mm for the SCTG group (81% root coverage). RD reduction and root coverage were significantly greater in SCTG group compared to GTR group. Mean CAL gain amounted to 1.7 mm for the GTR group, and 2.3 mm in the SCTG group. No significant differences in PD changes were observed within and between groups. KT increased significantly from presurgery for both treatment groups, however gingival augmentation was significantly greater in the SCTG group compared to GTR group. Results indicate that: 1) treatment of human gingival recession defects by means of both GTR and SCTG procedures results in clinically and statistically significant improvement of the soft tissue conditions of the defect; and 2) treatment outcome was significantly better following SCTG compared to GTR in terms of recession depth reduction, root coverage, and keratinized tissue increase.

Long-term stability of the mucogingival complex following guided tissue regeneration in gingival recession defects.

The purpose of the present study was to evaluate the stability of soft tissue conditions in gingival recession defects treated with guided tissue regeneration (GTR). The study population was selected among those patients who had been treated with GTR procedures for Miller's class I or II, deep (> or =3 mm), buccal gingival recession defects. Defects were included only when they had revealed recession depth reduction > or =2 mm and root coverage > or =60% at 6 months following GTR treatment. These defects were regarded as successfully treated and scheduled for further monitoring. 20 patients, 11 male and 9 female, aged 23 to 57 years (mean age: 33.2 years), each contributing 1 defect, were selected. 9 patients were smokers (> or =10 cigarette per day). Recession depth (RD), probing depth (PD), clinical attachment level (CAL), and width of keratinized gingiva (KG) were assessed immediately before surgery, at 6 months post-surgery (baseline examination), and at 4 years post-surgery (4-year examination). At baseline examination, RD reduction was 3.6+/-0.9 mm (mean root coverage: 80%). CAL gain amounted to 4.2+/-1.3 mm, 60% of the defects showing CAL gain > or =4 mm. KG increased from 1.9+/-1.2 mm at presurgery examination to 3.1+/-0.9 mm at baseline examination. At 4-year examination, no significant changes from baseline RD, CAL and KG recordings were observed. Differences in baseline-4 year changes between smokers and non-smokers were not statistically significant. The results of the present study demonstrate that clinical outcome achieved following GTR procedure in gingival recession defects can be maintained over periods up to 4 years.

Resorbable barrier and envelope flap surgery in the treatment of human gingival recession defects. Case reports.

The present case report evaluates the treatment outcome following mucogingival surgery combined with a bioresorbable barrier in gingival recession defects in humans. A total of 11 buccal, Miller Class I or II, gingival recession defects in 6 patients were consecutively treated. The exposed root surface was ultrasonically scaled and conditioned with a tetracycline HCl solution (10 mg/ml) for 4 min. A buccal full/split thickness envelope flap was then elevated, and a bioresorbable matrix barrier was positioned to completely cover the exposed root surface and surrounding bone margins. A flap was then positioned at or slightly coronal to its original position. In all cases, a variable amount of membrane was intentionally left uncovered on the exposed root surface. Clinical recordings, assessed presurgery and at 6 months postsurgery, included defects-specific plaque and gingival scores, recession depth (RD), probing depth (PD), clinical attachment level (CAL) and keratinized tissue width (KT). Immediately postsurgery, and at weeks 1, 2, 4, 6 and 8 postsurgery, the location of gingival margin or granulation tissue covering the previously exposed root surface was recorded, as well as the extent of barrier exposure. Statistical analysis showed that RD decreased from 2.3+/-0.2 mm presurgery to 0.8+/-0.5 mm at 6 months postsurgery (p=0.001), representing a mean root coverage of 65% (range: 40-100%). CAL gain paralleled RD reduction (1.5+/-0.5 mm; p=0.0009), while KT showed a slight increase (0.3+/-0.6 mm) at 6 months postsurgery. Results indicate that clinical improvement of gingival recession defects may be achieved by means of a barrier-supported envelope technique. The bioresorbable matrix barrier represented an effective scaffold to support the reconstruction of the mucogingival unit.

Healing response of gingival recession defects following guided tissue regeneration procedures in smokers and non-smokers.

This retrospective study evaluated healing response in gingival recession defects following guided tissue regeneration (GTR) in smokers. 22 systemically healthy patients who had been treated for deep (> or = 4 mm), buccal, Miller's class I or II gingival recession defects with ePTFE membranes were included. Patients were regarded as smokers if they smoked more than 10 cigarettes/day at the time of surgical procedure. Occasional and former smokers were excluded. 9 patients (6 male, mean age 29 years) were smokers, while 13 patients (4 male, mean age 35 years) were non-smokers. Clinical parameters, recorded presurgery and at 6 months postsurgery, included defect-specific plaque (DP1) and bleeding on probing (BoP) scores, recession depth (RD), probing depth (PD), clinical attachment level (CAL), and keratinized tissue width (KG). Extent of membrane exposure (ME) and newly formed tissue (NFT) gain were assessed at membrane removal. Statistical analysis revealed no significant differences between smokers and non-smokers in demographic and presurgery defect characteristics. DP1 and BoP scores were similar presurgery and remained almost unchanged throughout the observation interval in both groups. ME was significantly greater in smokers (2.6 +/- 1.4 mm) than in non-smokers (1.3 +/- 0.6 mm). NFT gain was 2.8 +/- 1.0 mm in smokers and 3.6 +/- 1.4 mm in non-smokers, the difference being not statistically significant. Smokers showed significantly less RD reduction and root coverage (2.5 +/- 1.2 mm and 57%, respectively) compared to non-smokers (3.6 +/- 1.1 mm and 78%, respectively). In conclusion, the results indicate that treatment outcome following GTR in gingival recession defects is impaired in cigarette smokers.

Comparison of mucogingival changes following treatment with coronally positioned flap and guided tissue regeneration procedures.

This study compared the variation in anatomic width of the mucogingival unit following coronally positioned flap or guided tissue regeneration procedures in deep (greater than or equal to 4 mm) buccal maxillary gingival recession defects 12 months postsurgery. Eighteen patients, 10 treated with guided tissue regeneration procedures and eight treated with coronally positioned flap procedures, were retrospectively analyzed. The results demonstrated that both treatments led to consistent recession depth reduction and coronal shift of the mucogingival junction. A significant increase in the amount of keratinized gingiva was observed for the guided tissue regeneration procedure, but a decrease that was not statistically significant was observed for the coronally positioned flap procedure.

Fibrin glue application in conjunction with tetracycline root conditioning and coronally positioned flap procedure in the treatment of human gingival recession defects.

A split-mouth clinical study was designed to determine the effect of fibrin glue (FG) in addition to tetracycline HCI (TTC) root conditioning and the coronally positioned flap (CPF) procedure in the treatment of maxillary buccal recession defects. 11 patients presenting with a pair of Class I or II recession defects were selected. After initial therapy, defect-specific and full-mouth oral hygiene standards and gingival condition, recession depth, recession width, probing depth, attachment level, and width of keratinized gingiva were recorded. The surgical procedure included elevation of a full split thickness flap, root debridement and root conditioning with a 10 mg/ml TTC solution for 4 minutes. According to a randomization list, in each patient, 1 defect was treated with topical FG application, while the paired defect did not receive FG. The flap was adapted and sutured coronally to the cemento-enamel junction without tension. Healing was evaluated 6 months postsurgery. Significant recession depth reduction and attachment gain were observed for both treatments. Average root coverage amounted to 65% in FG treated defects and 55% in defects treated with TTC conditioning only. There were no clinical and statistical significant differences between the treatments for any parameter considered. This study suggests that FG may not meaningfully enhance the outcome of the CPF procedure with TTC root conditioning.

Clinical effect of tetracycline demineralization and fibrin-fibronectin sealing system application on healing response following flap debridement surgery.

The aim of this controlled clinical trial was to assess the effect on healing following tetracycline (TTC) conditioning and fibrin-fibronectin sealing system (FFSS) application in association with flap debridement surgery (FDS) in 11 patients under treatment for moderate to severe periodontitis. Selection criteria included the presence of two bilateral, homologous, non-molar, interproximal sites with probing depth > or = 5 mm. The areas bilateral to the trial sites were matched for number and type of the teeth, and similar periodontal involvement. After initial therapy, a split-mouth design was used in which one area was treated by flap debridement surgery alone (control), and the contralateral area was treated following surgery with a 4-minute burnishing application of 100 mg/ml TTC solution and FFSS (test). Fibrin glue was applied with a syringe on the demineralized root surfaces and surrounding bone margins. Healing by primary intention was encouraged by flap repositioning with interrupted sutures left in place for 14 days. A monthly maintenance recall program was followed. Patients were clinically evaluated at baseline and 6 months and the following measurements were taken: gingival index, plaque control record, clinical attachment level, probing depth, recession, bleeding on probing. Statistical evaluation indicated that both approaches resulted in significant probing depth reduction and clinical attachment gain. However, the differences in healing between the test and control groups were not clinically nor statistically significant. These results suggest there is no additional benefit with TTC demineralization and topical FFSS application in conjunction with flap debridement surgery.

Clinical effect of subgingival tetracycline irrigation and tetracycline-loaded fiber application in the treatment of adult periodontitis.

A controlled clinical trial was carried out to compare the clinical effect of combined antimicrobial-mechanical treatment modalities on moderate-to-deep periodontal pockets in patients with adult periodontitis. Twelve patients having at least three nonadjacent sites of periodontitis were included in the split-mouth study. Gingival Index, Plaque Record, bleeding on probing, probing depth, attachment level, and recession depth were recorded immediately before treatment. In the control site, supragingival and subgingival scaling was performed with an ultrasonic scaler. One experimental site received supplemental irrigation with 15 mL of a 100-mg/mL tetracycline solution, while the other received a tetracycline-loaded fiber after mechanical instrumentation. Fibers were left in place for 10 days. Reevaluation 30 and 60 days after treatment showed that all three treatment modalities were effective in improving clinical parameters. No adjunctive effect on the healing response was obtained by augmenting mechanical debridement with tetracycline.

Effect of tetracycline HCl on periodontally-affected human root surfaces.

Scanning electron microscopy was used to evaluate surface characteristics of periodontitis-exposed instrumented human cementum and dentin surfaces following topical application of tetracycline HCl (TTC). Specimens were randomly assigned to application of sterile saline for 1 minute (control); TTC (10 mg/ml) for 1 minute and 4 minutes, respectively; and TTC (100 mg/ml) for 1 minute and 4 minutes, respectively. Solutions were applied with a cotton pellet using a burnishing technique. Control specimens exhibited an amorphous irregular surface smear layer. TTC treatment of cementum for 1 minute resulted in a relatively debris-free, nonhomogeneous surface. The 4-minute application resulted in a surface exhibiting a densely fibrillar, mat-like texture. Dentin specimens conditioned for 1 minute showed a smooth surface with many tubule openings partially occluded by debris. The 4-minute treatment exposed a 3-dimensional network of intertubular and peritubular collagen fibrils. No consistent morphologic differences were observed between cementum or dentin specimens treated with TTC at concentrations of 10 and 100 mg/ml, respectively. The results suggest that topical application of TTC produces morphologic alterations of periodontitis-exposed cementum and dentin that appear related to application interval rather than concentration of the drug.

Effects of tetracycline HCl conditioning and fibrin-fibronectin system application in the treatment of buccal gingival recession with guided tissue regeneration.

A split-mouth clinical trial was designed to evaluate the effect of treating deep wide buccal gingival recession with guided tissue regeneration using expanded polytetrafluoroethylene membrane combined with tetracycline HCl (TTC) root conditioning and fibrin-fibronectin sealing system (FFSS) application. Eight patients, aged 25 to 57 years, each presenting two similar mucogingival defects, were selected. The two bilateral recessions were randomly assigned in each patient to either test or control treatment procedure. After initial therapy, each patient was examined for assessment of plaque, gingivitis, recession depth (RD), probing depth (PD), probing attachment level (PAL), and keratinized tissue width (KT). The test procedure included the elevation of mucoperiosteal flap at the buccal aspect of the alveolar process. The root was debrided and demineralized with 100 mg/ml TTC solution for 4 minutes using a burnishing technique with cotton pellets. A teflon membrane was secured and a film of FFSS was applied between the membrane and the root surface. The buccal flap was sutured to completely submerge the membrane. Control treatment included gingival flap surgery with barrier membrane alone. After 6 weeks, the membrane was removed. Healing was evaluated 6 months after surgery. Both test and control procedures resulted in highly significant recession reduction (3.0 mm +/- 1.1 and 2.6 mm +/- 1.2, respectively) and attachment gain (3.6 mm +/- 1.7 and 2.6 mm +/- 1.1, respectively). Mean root coverage was of 67% in the TTC + FFSS treated sites and 60% in membrane-only treated sites. However, only treatment with TTC + FFSS significantly reduced PD and increased KT (P < 0.05). When treatments were compared, changes in PD and PAL were significantly greater in TTC + FFSS treated sites (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical evaluation of plaque removal by counterrotational electric toothbrush in orthodontic patients.

In the present crossover clinical trial, the plaque-removing efficacy of a counterrotational toothbrush was compared to that of a normal toothbrush in orthodontic patients. Twenty subjects, aged 11 to 26 years, who had orthodontic brackets on all fully erupted teeth of at least one arch were selected. At the first appointment, a prophylaxis was given to bring the plaque score to 0. Ten subjects received counterrotational brushes, and 10 subjects received manual brushes according to a randomized list. At 14 days, plaque scores were recorded and another prophylaxis was given. The subjects who were using the electric brush were assigned to the manual brush and vice versa. At 28 days, plaque scores were reassessed. Results showed that the counterrotational brush was significantly more effective in removing supragingival plaque from bracketed teeth than was the manual brush. The differences in plaque-removing effectiveness were particularly consistent on the proximal surfaces of the teeth.

Nondiseased cementum and dentin root surface following tetracycline hydrochloride conditioning: SEM study of the effects of solution concentration and application time.

Tetracycline hydrochloride treatment of cementum and dentin surfaces derived from human teeth not affected by periodontitis resulted in the removal of the smear layer and uncovered a fibrillar collagen substrate. In cementum specimens, the amount of exposure of the organic matrix appeared to be more related to morphologic structure of the cementum and mechanical instrumentation of the root surface rather than to concentration and time of application of tetracycline solution. Time-dependent changes were observed in dentin surfaces, the intertubular "matted" collagen matrix being evident only in the 4-minute specimens.

[Gingival overgrowth in patients under cyclosporin-A treatment. A clinical study]. / Aumento di volume gengivale nei pazienti in trattamento con cyclosporina-A. Studio clinico.

The aim of the present study was to investigate possible background factors causing gingival overgrowth (GO) among transplant patients treated with cyclosporine-A (Cy-A). Nineteen subjects were evaluated with regard to Cy-A therapy including: whole blood concentration, oral dosage, duration of therapy, cumulative exposure factor. Periodontal condition was assessed using Plaque Index, probing depth and probing attachment level. GO was assessed on plaster study models by a semiquantitative method. The occurrence of GO was 88%, with a total 35.9% of gingival sites presenting overgrowth. Statistical analysis showed no correlation between GO score on one hand, oral dosage, exposure factor and plaque score on the other. ANOVA revealed a significant relationship between GO score and percentage of affected sites.

Antiácido de alta potência versus cimetidina no tratamento da úlcera duodenal: comodidade posológica / High potency antacid versus cometidine in the treatment of duodenal ulcer: commodus psosology

Foram estudados 98 pacientes com úlcera péptica duodenal distribuídos de forma randômica em dois grupos. Um grupo recebeu antiácido liquido de alta potência (282,4mEq/dia) dividido em 4 tomadas durante 4 semanas e outro recebeu cimetidina (800 mg/dia) dividida em 2 tomadas por igual período. A potência antiácida da associaçäo líquida utilizada é de 7,06 mEq/ml. Todos os pacientes foram avaliados clinicamente no pré-tratamento e duas e quatro semanas após, com exames endoscópicos realizados na admissäo e após quatro semanas. A eficácia, considerada como cicatrizaçäo da úlcera duodenal associada a melhora da sintomatologia foi equivalente para ambos os tratamentos, näo havendo diferença estatisticamente significante. A tolerabilidade de ambas as drogas foi considerada boa

Incidência de carcinoma na esofagite cáustica / Incidence of carcinoma in caustic esophagitis

Na literatura médica säo descritos poucos casos de carcinoma do esôfago incidindo em pacientes com ingestäo prévia de substâncias cáusticas. Foram estudados quatro pacientes com esofagite cáustica que desenvolveram tardiamente carcinoma sobre a área afetada. O tempo médio entre a época da ingestäo do cáustico e o diagnóstico do carcinoma foi de 30 anos. A localizaçäo do processo neoplásico em todos os casos era do 1/3 médio do esôfago. Dois pacientes foram submetidos à esofagectomia com reconstituiçäo esofagogástrica cervical, um foi encaminhado à radioterapia e para o outro foi indicada a colocaçäo de prótese transtumoral via endoscópica. Em vista do elevado número destes pacientes e o potencial desta afecçäo sofrer degeneraçäo maligna na fase tardia, eles säo considerados grupo de alto risco e se enquadram no nosso programa de exame endoscópico, complementado com biópsia e citologia