Treatment of peri-implantitis using nonsurgical debridement combined with bioresorbable doxycycline nanospheres: a case report with 3-year follow-up.

Treatment of peri-implant diseases focuses on reducing the bacterial load and consequent infection control. The use of local antimicrobials as an adjunct to mechanical therapy may result in a better outcome. Among antimicrobials, doxycycline stands out because of its local modulation of cytokines, microbial reduction, and clinical parameters in the treatment of periodontal diseases. The objective of this case report was to describe the combined application of mechanical debridement and bioresorbable doxycycline-loaded nanospheres for the treatment of peri-implantitis in a 71-year-old man. At the 3-year evaluation, the peri-implant tissues had improved, showing decreased probing depths, an absence of bleeding on probing, and no suppuration. This case report highlights the importance of supportive therapy, which is essential for the long-term success of peri-implantitis treatment.

Smoking negatively impacts the clinical, microbiological, and immunological treatment response of young adults with Grade C periodontitis.

OBJECTIVE: This study aimed to investigate the influence of smoking on clinical, microbiological and immunological parameters in young adult with stage III-IV Grade C periodontitis after full-mouth ultrasonic debridement (FMUD) associated with Amoxicillin and Metronidazole (AMX + MTZ), comparing smokers (PerioC-Y-Smk) with non-smokers (PerioC-Y-NSmk). MATERIALS AND METHODS: Fifteen PerioC-Y-NSmk and 14 PerioC-Y-Smk patients underwent FMUD associated with AMX + MTZ for 10 days. All parameters were collected at baseline and 3 and 6 months after treatment. Plaque index (PI), bleeding on probing (BoP), probing depth (PD), clinical attachment level (CAL)- the primary variable-, and gingival recession (GR) were clinically assessed. The impact of PI on CAL change at 6-month was verified by a regression analysis. Samples of the subgingival biofilm was collected for detection of levels of Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), Porphyromonas gingivalis (P.gingivalis), Tannerella forsythia (T. forsythia), and Fusobacterium nucleatum ssp (F. nucleatum), and were analyzed by real-time qPCR; gingival crevicular fluid was collected for detection of levels of interleukin (IL)-1ß, IL-4, IL-6, IL-10, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ, which were analyzed using an enzyme immunoassay. RESULTS: PerioC-Y-Smk had significantly higher PI, BOP, and GR at baseline compared to non-smokers (p < .05). PerioC-Y-Smk presented higher PD, CAL, and GR at 3 and 6 months (p < .05) compared with PerioC-Y-NSmk in the same periods; PI negatively affected CAL gain in PerioC-Y-NSmk at 6-month follow-up (p = .052) and did not impact on clinical response in PerioC-Y-Smk (p = .882). Lower levels of IFN-γ, IL1-ß, and IL-4 were observed at 3 months in the PerioC-Y-NSmk (p < .05) compared with PerioC-Y-Smk. Lower proportions of P. gingivalis were observed in PerioC-Y-NSmk at baseline and at 3 months (p < .05) and lower proportions of F. nucleatum were observed at 6 months, in the PerioC-Y-NSmk (p < .05). CONCLUSIONS: PerioC-Y-Smk presents an unfavorable clinical, microbiological, and immunological response after 3 and 6 months after FMUD associated with AMX + MTZ. CLINICAL RELEVANCE: Smoking worsens periodontal condition of young treated adults presenting stage III/IV Grade C periodontitis.

Novel 20% doxycycline-loaded PLGA nanospheres as adjunctive therapy in chronic periodontitis in type-2 diabetics: randomized clinical, immune and microbiological trial.

OBJECTIVE: This study evaluated the clinical, microbiological, and immunological results of poly lactic-co-glycolic acid (PLGA) nanospheres containing 20% doxycycline (DOXY) in the treatment of type-2 diabetic patients (DM-2) with chronic periodontitis (CP). MATERIAL AND METHODS: A parallel, double-blind, randomized, placebo-controlled clinical trial was conducted in DM-2 presenting severe and generalized CP. All patients received one-stage full-mouth ultrasonic debridement (FMUD) and they were randomly divided into two groups: PLAC (n = 20)-local application of placebo PLGA nanospheres, and DOXY (n = 20)-local application of doxycycline-loaded nanospheres; both in six non-contiguous sites. Clinical, metabolic (fasting plasma glucose level-FPG and glycated hemoglobin-HbA1c), cytokine pattern (multiplexed bead immunoassay) and microbiological assessments were performed at baseline, and 1, 3, and 6 months after treatment. RESULTS: Both groups showed clinical improvement in all parameters after treatment (p < 0.05). Deep pockets showed improvements in bleeding on probing-BoP (3 and 6 months), PD (at 3 months), and CAL gain (at 1 and 3 months) favoring DOXY (p < 0.05). The percentage of sites presenting PD reduction and CAL gain ≥ 2 mm was higher in DOXY at 3 months (p < 0.05). DOXY group exhibited a significant increase in the levels of anti-inflammatory interleukin (IL)-10 and a reduction in IL-8, IFN-y, IL-6, and IL-17 (p < 0.05), significant reduction in periodontal pathogens (p < 0.05), and a lower mean percentage of HbA1C at 3 months (p < 0.05). CONCLUSION: DOXY nanospheres may be considered a potential adjunct to mechanical debridement in the therapy of periodontitis in DM-2, offering additional benefits in deep pockets, improving the cytokine profile, and reducing periodontal pathogen levels. CLINICAL RELEVANCE: The use of locally applied doxycycline nanospheres may represent an adjunctive therapeutic approach in the treatment of periodontal disease in type-2 diabetic patients, achieving additional benefits in the local modulation of cytokines, microbial reduction, and clinical parameters, especially in deep pockets.

Doença peri-implantar: Abordagens contemporâneas / Peri-implant disease: contemporary approaches

O uso de implantes dentários é considerado uma revolução na Odontologia moderna. Entretanto, um dos grandes desafios encontrados na Implantodontia é o processo de reabsorção óssea ao redor dos implantes, após sua colocação ou durante o uso. Esta revisão teve por objetivo discutir alguns avanços nas pesquisas científicas que utilizam parâmetros clínicos para classificação da doença peri-implantar. Diversos estudos na literatura demonstram que essas ferramentas podem promover uma melhor compreensão, tanto do cirurgião-dentista quanto dos pacientes que necessitam da utilização desses.

The use of dental implants is considered a revolution in modern dentistry. However, the great challenges found at implantodontology is the process of bone resorption around implants after placement or during use. This review aims to discuss some advances in scientific research that use clinical parameters to classify peri-implant disease. Several studies in the literature demonstrate these tools can promote a better understanding for both dental surgeons and patients in need of this.

Periodontia e Ortodontia: o paciente ortodôntico e o controle do biofilme / Periodontics and Orthodontics: the orthodontic patient and biofilm control

Está bem estabelecido que a presença de uma microflora patogênica no biofilme é o fator etiológico primário no desenvolvimento das doenças periodontais. Assim, o principal objetivo durante a terapia periodontal é o rompimento e remoção do biofilme, juntamente com a restauração do relacionamento homeostase entre a resposta imune do hospedeiro e a comunidade polimicrobiana do biofilme. Fatores como as características de uma superfície podem influenciar a quantidade e a qualidade do biofilme a ser removido da superfície dental, como é possível observar em pacientes ortodônticos. O tratamento ortodôntico com componentes fixos é utilizado amplamente na resolução de diversas más-oclusões. Durante a terapia ortodôntica, os ortodontistas são frequentemente confrontados com gengivite generalizada em seus pacientes, entre outras alterações periodontais. Não há um consenso na literatura sobre a transitoriedade dessas reações no periodonto. Assim, o objetivo desta revisão da literatura foi discutir diferentes perspectivas relacionadas às áreas de Periodontia e Ortodontia no controle do biofilme em pacientes ortodônticos.

It is well established that the presence of a pathogenic microflora in biofilm is the primary etiological factor in the development of periodontal diseases. Thus, the main objective in periodontal therapy is the disruption and removal of biofilm along with the restoration of homeostasis relationship between the host immune response and polymicrobial biofilm community. Factors such as the characteristics of a surface can influence the quantity and quality of the biofilm to be removed from the tooth surface, as can be seen in orthodontic patients. Orthodontic treatment with fixed components is widely used in solving various malocclusions. During orthodontic treatment, orthodontists are often faced with generalized gingivitis in their patients, among other periodontal changes. There is no consensus in the literature about the transience of these reactions in periodontal tissues. The objective of this literature review was to discuss differents perspectives related areas of Periodontics and Orthodontics about the biofilm control in orthodontics patients.

Diagnóstico, etiologia e tratamento das doenças peri-implantares / Diagnosis, etiology, and treatment of peri-implant diseases

Sendo a mucosite e a peri-implantite as lesões mais recorrentes ao redor de implantes, e cada vez mais frequentes no consultório odontológico, faz-se necessária uma compreensão abrangente sobre seus principais fatores etiológicos, métodos de prevenção e modalidades de tratamento para uma correta conduta clínica. A presente revisão da literatura visa, de forma clara e sintetizada, identificar e ressaltar as principais causas de mucosite e peri-implantite descritas na literatura, orientar o cirurgião-dentista na obtenção do diagnóstico, informar o leitor sobre as principais modalidades de tratamento e destacar a importância da terapia de suporte para a manutenção da saúde peri-implantar. A busca eletrônica nas bases de dados Scopus, PubMed e Web of Science foi orientada pelos seguintes tópicos: definição de mucosite e peri-implantite, prevalência, obtenção do diagnóstico, fatores de risco, modalidades de tratamento e terapia de suporte. Os resultados da busca indicaram: 1) a mucosite peri-implantar pode ocorrer em 80% dos indivíduos, e a peri-implantite em até 56%; 2) não há uma única ferramenta para o diagnóstico das doenças peri-implantares, mas sim uma associação destas; 3) a etiologia da peri-implantite parece ser multifatorial, e alguns indivíduos parecem ser mais propensos ao seu desenvolvimento do que outros; 4) a mucosite pode se resolver apenas com a remoção e desinfecção não cirúrgica dos fatores locais, enquanto que na peri-implantite a terapia cirúrgica é adotada quando os sítios afetados não respondem à terapia básica; e 5) a terapia de suporte é imprescindível na determinação do sucesso a longo prazo no tratamento das doenças peri-implantares.

As the mucositis and peri-implantitis are the most recurrent lesions around implants and these increasingly frequent in the dental office, a comprehensive understanding of its main etiological factors, prevention methods and treatment modalities is necessary for proper clinic conduct. This literature review aims, in a clearly and synthesized form, identify and highlight the main causes of mucositis and peri-implantitis described in the literature, guide the dentist in getting the diagnosis, inform the reader about the main types of treatment and highlight the importance of supportive therapy for maintenance of the peri-implant health. The electronic search in Scopus databases, PubMed and Web of Science was guided by the following topics: definition of mucositis and peri-implantitis, prevalence, diagnosis, risk factors, treatment modalities and supportive therapy. The search results indicated that: 1) peri-implant mucositis can occur in 80% of individuals, peri-implantitis up to 56%; 2) there isn't a unique tool for the diagnosis of peri-implant disease, but a association of tools; 3) etiology of peri-implantitis appears to be multifactorial, and some individuals appear to be more prone to their development than others; 4) mucositis can be solved only with the non-surgical removal and disinfection of factors, while in peri-implantitis surgical therapy is used where the affected sites do not respond to primary therapy; and 5) supportive therapy is essential in determining the long-term success in the treatment of peri-implant diseases.

Conhecimento sobre saúde periodontal dos pacientes submetidos à triagem nos postos de saúde de Barretos / Patient’s knowledge about periodontal health in the screening service of health units from Barreto

O objetivo deste estudo é avaliar o nível de conhecimento sobre saúde periodontal de indivíduos submetidos à triagem nos postos de saúde da cidade de Barretos, interior de São Paulo. Na primeira fase do estudo, todos os pacientes que compareceram à triagem foram convidados e aceitaram responder a um questionário enquanto aguardavam a consulta. O questionário, com oito perguntas abordava conhecimento sobre placa bacteriana e doença periodontal com respostas em aberto. Na segunda fase, as respostas obtidas foram transcritas, e aquelas mais frequentes foram agrupadas para construir as opções de múltiplas-escolhas do novo questionário. Na terceira fase, este novo instrumento foi aplicado aos indivíduos que comparecerem à triagem de março a agosto de 2013. Sessenta e seis pacientes participaram desta fase. Destes, 36,4% caracterizaram a placa bacteriana como um “acúmulo de resíduos que pode provocar doenças na gengiva e cárie”. Para a maioria dos pacientes (72,7%) a placa bacteriana deve ser removida pelo dentista. Adicionalmente, 62,1% dos pacientes assinalou que a placa bacteriana causa cárie; e 72,7%, que causa gengivite. Responderam ainda que a correta higienização é importante para evitar o mau-hálito (48,5%) e para ter uma boca saudável (65,2%). Com base nos resultados obtidos pode-se concluir que os pacientes têm conhecimento do que seja a placa bacteriana e que esta pode causar gengivite. Além disto, acreditam que a higienização é importante para manter a saúde, porém consideram que a responsabilidade de remover a placa bacteriana é do cirurgião-dentista.

The aim of this study is to assess the level of knowledge about periodontal health of subjects submitted to screening at public health clinics of Barretos. In the first phase of the study, all patients who attended the screening were invited and agreed to answer a questionnaire while waiting for appointments. The questionnaire with eight questions addressed knowledge about plaque and periodontal disease with open answers. In the second phase, the responses were transcribed, and those most frequently were grouped to construct the multiple choice options for the new questionnaire. In the third phase, this new tool has been applied to individuals who attend the screening from March to August 2013. Sixty-six patients participated in this phase. Of these, 36.4 % characterized the plaque as a “waste buildup that can cause gum disease and tooth decay”. For the majority of patients (72.7%) plaque must be removed by the dentist. Additionally, 62.1% of patients indicated that the plaque causes tooth decay, and 72.7%, causing gingivitis. Yet responded to the correct hygiene is important to prevent bad breath (48.5%) and to have a healthy mouth (65.2 %). Based on the results obtained it can be concluded that the patients to be aware of and plaque that can cause gingivitis. Moreover, they believe that hygiene is important for maintaining health, but consider that the responsibility to remove plaque is the dentist.