Periodontal Classification Revisited: The Classification System in the Test of Time.

At the EuroPerio conference held in Amsterdam in 2018, an update to the previous classification of periodontal diseases was presented. The update was a joint effort of the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP). On the face of it, the new classification system for diagnosing periodontal diseases and conditions is merely an update of previous definitions from 1999. However, upon close examination, it is much more than another semantic change of old definitions. The new classification rocks the ground upon which generations of pre- and post-graduate students and specialists in the field have stood. It is a perceptual change in the way clinicians describe, diagnose, and ultimately treat periodontal patients.

Tratamento reabilitador cirúrgico restaurador: relato de caso / Surgical-restoring rehabilitator treatment: a case report

Tendo em vista a abundância de procedimentos realizados envolvendo a inter-relação entre a Dentística Restauradora e Periodontia na Odontologia contemporânea, é preciso salientar a importância da realização de técnicas cirúrgica e restauradora corretas por parte dos cirurgiões-dentistas, assim como na conceitualização de que os tecidos periodontais podem reagir de forma positiva à presença de materiais restauradores adesivos posicionados apicalmente à gengiva, sem a necessidade da recuperação do espaço biológico. O presente estudo teve como objetivo demonstrar a técnica da realização de uma restauração transcirúrgica através de um relato de um caso clínico realizado no Complexo Odontológico do Centro Universitário da Serra Gaúcha (FSG). A paciente foi diagnosticada com uma cavidade subgengival no elemento 16 e submetida à procedimento restaurador transcirúrgico, sendo o ionômero de vidro fotopolimerizável o material restaurador de eleição. Este trabalho evidenciou como os tecidos periodontais podem reagir de maneira positiva à presença de materiais biocompatíveis resultando, inclusive, em um remodelamento ósseo favorável. (AU)

Considering the abundance of procedures performed involving the Restorative Dentistry and Periodontics relationship in contemporary dentistry, it is necessary to emphasize the importance of performing a correct surgical and restorative technique by dental surgeons, as well as in the conceptualization that periodontal tissues can react positively in the presence of adhesive restorative materials positioned apically to the gingiva, without the need of the recovery of the biological width. The present study aims to demonstrate the technique of performing a trans-surgical restoration through a clinical case report performed at the Odontological Complex of Centro Universitário da Serra Gaúcha (FSG). The patient was diagnosed with a subgingival cavity in element 16, underwent a trans-surgical procedure, the light-curing glass ionomer being the restorative material of choice. This work evidenced how the periodontal tissues can react in a positive way in the presence of biocompatible materials, resulting also in a favorable bone remodeling.(AU)

Retalho reposicionado coronalmente com a finalidade de recobrimento radicular / Coronally advanced flap with the purpose of root coverage

Introdução: a recessão gengival é caracterizada pelo desnudamento parcial da superfície radicular decorrente da migração apical da gengiva marginal e pela degradação do mecanismo de inserção gengival sobre o elemento dentário. Objetivo: descrever um caso clínico de retalho reposicionado coronalmente com a finalidade de recobrimento radicular em paciente que apresentava recessão gengival Classe I de Miller nos elementos dentários 23 e 24. Materiais e Métodos: O presente estudo contou com a participação de um paciente que queixava-se de hipersensibilidade dentinária, quando aplicado o estímulo térmico, e de insatisfação estética devido à exposição radicular visível ao sorrir e durante o ato de conversação. Foi traçado um plano de tratamento para o recobrimento radicular através de cirurgia de retalho reposicionado de forma coronal, seguido de encaminhamento para a realização de tratamento ortodôntico, já que o paciente possuía oclusão traumática na região acometida pela recessão gengival, decorrente da presença de contato prematuro. Resultados e Discussão: com a técnica empregada, foi possível restabelecer a normalidade estética, prevenir o acúmulo de biofilme dental, devido à maior facilidade de higienização da região cervical, permitindo também a redução da hipersensibilidade dentinária, anteriormente relatada pelo paciente. Conclusão: a técnica cirúrgica de retalho coronal, utilizada para a resolução deste caso, mostrou-se uma eficiente forma de tratamento, pois apresentou resultados satisfatórios levando-se em consideração a previsibilidade de recobrimento da superfície radicular para esta técnica, que é de 70 a 99% da área exposta, devolvendo assim, função ao elemento tratado. (AU)

Introduction: the gingival recession is characterized by the partial denudation of the root surface resulting from the apical migration of the marginal gingiva and by the degradation of the gingival insertion mechanism on the dental element. Objective: we present a clinical report of a coronally advanced flap with the purpose of root coverage in a patient who presented gingival recession Miller Class I in the elements 23 and 24. Material and Method: the patient complained of dental hipersensibility when a thermal stimulus was applied and also a aesthetics dissatisfaction due to a visible root exposure to smile and during the act of conservation. A treatment plan was traced for the root coverage by a coronally repositioned flat, followed by a orthodontic treatment due to premature contact. Results: with the technique employed, it was possible to restore aesthetic normality, to prevent the accumulation of dental biofilm due to an ease of cleaning the cervical region, also allowing the reduction of dental hipersensibility, previously reported by the patient. Conclusion: it's possible to claim that the surgical technique of coronal flap used to the resolution of this case is an efficient form of treatment taking into account the root surface coverage for this technique, which is of 70 to 99% of the exposure area, returning to the treated element its function. (AU)

Resultados da aplicação tópica do extrato de própolis na redução da progressão da doença periodontal / Results of topical application of propolis extracts in reducing progression of periodontal disease

RESUMO Agentes químicos têm sido usados para auxiliar na inibição da formação do biofilme e impedir desenvolvimento da doença periodontal (DP). O objetivo deste estudo foi avaliar radiograficamente a ação do extrato de própolis na progressão da DP induzida em ratos. Foram utilizados 48 ratos Wistar, divididos em 4 grupos (n=12): Controle, Pincel, Própolis e Clorexidina. Os grupos foram subdivididos para análise aos 7 e 21 dias. A progressão da DP foi avaliada radiograficamente pela distância entre a junção cemento-esmalte e a crista óssea alveolar na face mesial do 1º molar inferior. A perda óssea foi significativamente menor nos animais do grupo própolis em ambos os períodos (p ≤ 0,01). Concluiu-se por análise radiográfica que a aplicação tópica do extrato de própolis interfere reduzindo a progressão da doença periodontal induzida por ligadura em ratos, demonstrando a importância desse composto como substância auxiliar no tratamento periodontal.

ABSTRACT Chemical agents have been used to assist on inhibiting biofilm formation and on preventing the development of periodontal disease (PD). The aim of this study was to radiographically evaluate the action of propolis extract on the progression of PD induced in rats. 48 Wistar rats were divided into 4 groups (n = 12): Control, Brush, Propolis and Chlorhexidine. The groups were subdivided for analysis at 7 and 21 days. The progression of the periodontal disease was radiographically assessed by the distance between the cement-enamel junction and the alveolar bone crest mesial of the 1st molar. Bone loss was significantly lower in the Propolis group in both periods (p ≤ 0.01). By radiographic analysis, it is concluded that the topical application of propolis extract interferes by reducing the progression of ligature-induced periodontal disease in rats, demonstrating the importance of this compound as an auxiliary substance in periodontal treatment.

Development of mouthwash with Rosmarinus officinalis extract

Rosmarinus officinalis, which belongs to the Lamiaceae family, is a species of medicinal flora with therapeutic properties. In order to exploit the benefits of these properties, a mouthwash formulation was developed, with careful selection of raw materials to meet pharmacotechnical requirements. Extracts of the plant were incorporated into a mouthwash, which was shown to have inhibitory action in vitro against the micro-organisms commonly found in periodontics. Controls for assessing the quality of the drugs were carried out, quantifying phenols and flavonoids as chemical markers. Mouthwash solutions were formulated containing 0.1, 5 and 10% ethanol extract of R. officinalis; and 0.05, 5 and 10% of the hexane fraction of R. officinalis. In order to evaluate synergism, ethanol extract and hexane fraction were also added to formulations containing 0.05% sodium fluoride and 0.12% chlorhexidine digluconate. These formulations were assessed for inhibitory effect against the specific microorganisms involved in the process of bacterial plaque formation, S. mutans (ATCC25175) and C. albicans(ATCC 10231), frequently found in cases of oral infections. The agar diffusion method was used to evaluate the inhibitory activity of extracts and formulations. All mouthwash solutions displayed inhibitory activity having higher sensitivity to S. mutans for the 5% ethanol extract+0.05% sodium fluoride, and greater sensitivity to C. albicans for the 10% hexane fraction. Results were characterized by the appearance of a growth inhibition halo, justifying the utilization and association of extracts of R. officinalis.

Rosmarinus officinalis, pertencente à família Lamiaceae, é um exemplar da flora medicinal que possui propriedades terapêuticas. No intuito de usufruir destes benefícios, desenvolveu-se uma formulação de enxaguatório bucal com seleção criteriosa de matérias-primas que atendessem os requisitos farmacotécnicos. Incorporaram-se extratos dessa planta e verificou-se a capacidade inibitória in vitro frente a micro-organismos frequentemente encontrados em periodontias. Controles foram efetuados para a avaliação da qualidade dos fármacos, quantificando-se como marcadores químicos, os fenóis e os flavonóides. Formulações de enxaguatórios contendo 0,1, 5 e 10% de extrato etanólico de R. officinalis; e 0,05, 5 e 10% da fração hexânica de R. officinalis foram preparadas. Para avaliar o sinergismo, o extrato e a fração hexânica também foram adicionados às formulações que continham fluoreto de sódio 0,05% e diguclonato de clorexidina 0,12%. Nessas formulações avaliou-se a capacidade inibitória frente a micro-organismos específicos do processo de formação de placa bacteriana, S. mutans (ATCC 25175) e C. albicans (ATCC 10231), frequentemente encontrada em quadros de infecções orais. Foi empregado o método de difusão em ágar para a avaliação da atividade inibitória dos extratos e das formulações. Todos os enxaguatórios demonstraram atividade inibitória, verificando-se maior sensibilidade a S. mutans, quando se utilizou extrato etanólico 5% + fluoreto de sódio 0,05% e sensibilidade maior a C. albicans, quando se utilizou fração hexânica a 10%. Os resultados foram caracterizados pelo aparecimento de halo de inibição de crescimento, justificando a utilização e associação dos extratos de R. officinalis.

Associação entre doença periodontal e aterosclerose subclínica: uma revisão sistemática / Association betwenn periodontal disease and subclinic atherosclerosis: a sistematic review

A associação entre doença periodontal e o desenvolvimento de aterosclerose tem sido pesquisada. Esta revisão sistemática da literatura se propõe a verificar a associação entre a doença periodontal e a aterosclerose subclínica. A pesquisa utilizou as bases de dados: PubMed, Scopus, LILACS, BBO, Biblioteca Cochrane e Scielo com os termos: "doença periodontal", "periodontite", "carótida" e "aterosclerose". Foram excluídos artigos: que apresentaram resumos escritos em idiomas diferentes do português, inglês e espanhol; com abordagem laboratorial em modelos experimentais; sem descrição ou referência a estimadores de associação entre doença periodontal e aterosclerose subclínica; pesquisas que realizaram a medida da doença periodontal por parâmetros diferentes de exames clínicos; pesquisas que não analisaram a espessura da íntima média da artéria carótida através de exame de ultrassom; e que abordassem grupos específicos. Foram comparados os desenhos de estudo, protocolos de medida e os dados relatados. De um total de 63 referências, apenas 10 artigos contemplavam todos os critérios de inclusão, distribuídos em: 1 estudo longitudinal, 6 transversais e 3 casos controles. Observou-se uma heterogeneidade entre os estudos em relação ao método de mensuração da doença periodontal e os desfechos da aterosclerose. Concluiu-se que infecções periodontais são fortemente associadas ao desenvolvimento da aterosclerose subclínica, entretanto os mecanismos envolvidos no processo patogênico ainda permanecem desconhecidos.

The association between periodontal disease and the development of atherosclerosis has been studied. The systematic review of literature aims to evaluate the association between periodontal disease and subclinical atherosclerosis. A literature search of the PubMed, Scopus, LILACS, BBO, Cochrane Library and Scielo bibliographic databases was conducted using the following descriptors: "periodontal disease", "periodontitis", "carotid", and "therosclerosis". Articles were excluded if they: presented abstracts written in languages other than Portuguese, English and Spanish; experimental studies; did not contain data testing the degree of association between periodontal disease and subclinical atherosclerosis; did measure the extent of periodontal disease by parameters other than the clinical examination; did not measure the carotid artery intima-media wall thickness by ultrasonography; and covered specific population groups. The studies design, measurement protocols and reported data were compared. A total of 63 papers identified only 10 studies that met the inclusion criteria: 1 longitudinal study, 6 cross-sectional, and 3 case control studies. There was a wide heterogeneity between the studies regarding the methods of measuring periodontal disease and atherosclerosis outcomes. The conclusion is that periodontal infections are strongly associated with the development of subclinical atherosclerosis, however the mechanisms involved on the pathogenic process remain unknown.

Periodontitis crónica severa localizada, posiblemente asociada a una reactivación por infección por herpes virus: presentación de un caso / Localized severe chronic periodontitis possibly associated with reactivation of Herpes Virus infection: A case report

La periodontitis es una enfermedad infec-ciosa caracterizada por un conjunto de alte-raciones que afectan los tejidos soporte de las piezas dentales. Su etiología por muchos años ha sido considerada básicamente bac-teriana. Estudios recientes han analizado la presencia de algunos miembros de la fami-lia de los virus de la familia herpesviridae en el periodonto y el posible efecto que su infección podría ocasionar en él. Esta presentación de un caso clínico contribuye a la evidencia que vincula a algunos de los herpes virus en la etiopatogénesis de la enfermedad periodontal...(AU)

Periodontitis is an infectious disease cha-racterized by a variety of alterations, affec-ting tooth supporting tissues. For many years, its aetiology has been considered basically of bacterial origin. Recent studies have analyzed the occurrence of herpes vi-ruses in the periodontum and their possible effects to cause periodontitis. This case report provides evidence that link herpes viruses to the development of certain types of periodontitis...(AU)

Efecto bactericida del láser de diodo en periodoncia / Bactericidal effects of diode laser in periodontology

El láser en odontología, gracias a su capacidad antibacteriana, hemostática y de menor sintomatología operatoria, encuentra un amplio campo de aplicación en el ámbito de la terapiaperiodontal. En este estudio ha sido probada la eficacia de un protocolo que prevé la utilización asociada de irradiación láser y de agua oxigenada con el fin de reducir a carga bacteriana de cepas comúnmente presentes en las bolsas periodontales activas y resistentes a la acción bactericida de solamente la irradiación láser como la Prevotella intermedia, Fusobacterium nucleatum y Peptostreptococcus micron. La metodología de laboratorio preveía el siguiente protocolo: cada una de las suspensiones bacterianas ha sido expuesta al agua oxigenada a una concentración del 3% y ha sido irradiada con láser por 10, 15 o 20 segundos utilizando tubos estériles Eppendorf de 1,5 ml. Los resultados confirman la mayor eficacia bactericida de la acción combinada de agua oxigenada y láser. Los cultivos microbiológicos efectuados revelan cómo, no obstante el efecto bactericida, el láser tiene una escasa acción sobre las cepas bacterianas testadas si no es asociado al agua oxigenada. En particular, en el caso de la Prevotela intermedia y del Fusobacterium nucleatum, la utilización de agua oxigenada al 3% solamente ha dado resultado mejores respecto a solamente el láser, mientras que la asociación de los dos tratamientos hadado siempre óptimos resultados. En el caso del Peptostreptococcus micron, la utilización de agua oxigenada y el láser separadamente han dado una escasa disminución de la cuenta bacteriana mientras que la asociación de los tratamientos ha potenciado la acción bactericida (AU)

Laser in odontology, thanks to its antibacterial capabilities, haemostatic and of minor operating symptomatology, finds a vast field of application within the framework of periodontal therapy. In this study has been tested the effectiveness of a protocol that foresees the associated use of laser irradiation and hydrogen peroxide with the goal of reducing the bacterial charge of stocks commonly present in the active periodontal pockets and resistant to the bactericide action of laser irradiation alone such as Prevotella intermedia, Fusobacterium nucleatum, Peptostreptococcus micron. The laboratory method used foresees the following protocol: each bacterial suspension has been exposed to hydrogen peroxide at 3% concentrations and it has been irradiated with laser for 10, 15 or 20 seconds, using sterile 1.5 ml Eppendorf tubes. The results confirm the higher bactericide effectiveness of the combined action of hydrogen peroxide and laser. The microbiological cultivations carried out reveal how, in spite of the bactericide effect, the laser has an insufficient action on bacterial stocks tested if it isn’t associated with hydrogen peroxide. Particularly in the case of the Prevotella intermedia or the Fusobacterium nucleatum the use of just hydrogen peroxide at 3% has offered better results than the laser irradiation alone while the association of both treatments has always offered optimal results. In the case of the Peptostreptococcusmicron the use of hydrogen peroxide and laser separately has offered an insufficient reduction of the bacterial count while the association of treatments has increased their bactericide action (AU)

Perceived risk of deteriorating periodontal conditions.

BACKGROUND: Interpretation of risk for periodontitis is critical for treatment planning. How periodontists assess risk for periodontitis is unclear. PURPOSE: To study (1) what factors periodontists use when assessing the risks for worsening periodontal conditions anticipating that no treatment would be provided, and (2) if risk assessment is consistent and independent of specialty background training. MATERIAL AND METHODS: Medical history, clinical dental data, full-mouth intra-oral radiographs, and slide pictures were obtained from each of 51 subjects, and the information was provided to 23 examiners. RESULTS: The mean age of the study subjects was 51.5 years (SD +/- 17.7, range 23-81), with 28 women included. In 10 of the subjects, only gingivitis was identified, while 22 subjects had advanced chronic periodontitis. Risk scores assigned for 2 and 4 years differed significantly between European- and US-trained periodontists (p < 0.001) and between graduate students in training and periodontists from either the US or Europe (p < 0.01) (Wilcoxon n-pair test), with European periodontists scoring the lowest risks. Risk scores were correlated between groups (p < 0.01 with rho range 0.82-0.89) (Spearman's rank correlation). The best-fit model (r2 = 0.86) to assess perceived risk for worsening periodontal conditions based on data from all examiners combined included the following variables: (1) overall horizontal alveolar bone loss (p < 0.000), (2) age-adjusted proportional radiographic bone height score for the worst site (p < 0.000), and (3) proportion of pocket probing depths > or = 6.0 mm. CONCLUSIONS: Differences exist on the scale of risk values based on specialty training. Consistency in scoring patterns exists. The examiners based their assigned risk scores almost exclusively on measures of existing disease severity, including radiographic bone loss and numbers of periodontal pockets > or = 6.0 mm, and excluding most known risk factors such as smoking, diabetes, and poor oral hygiene.

Use of dental services: an analysis of visits, procedures and providers, 1996.

BACKGROUND: While many studies have provided data on Americans' access to dental care, few have provided a detailed understanding of what specific treatments patients receive. This article provides detailed information about the types of dental services that Americans receive and the types of providers who render them. METHODS: The authors provide national estimates for the U.S. civilian noninstitutionalized population in several socioeconomic and demographic categories regarding dental visits, procedures performed and the types of providers who performed them, using household data from the 1996 Medical Expenditure Panel Survey, or MEPS. RESULTS: Data show that while the combination of diagnostic and preventive services adds up to 65 percent of all dental procedures, the combination of periodontal and endodontic procedures represents only 3 percent. Additionally, while 81 percent of all dental visits were reported as visits to general dentists, approximately 7 percent and 5 percent of respondents who had had a dental visit reported having visited orthodontists or oral surgeons, respectively. CONCLUSION: MEPS data show the magnitude and nature of dental visits in aggregate and for each of several demographic and socioeconomic categories. This information establishes a nationally representative baseline for the U.S. population in terms of rates of utilization, number and types of procedures and variations in types of providers performing the procedures. These nationally representative estimates include data elements that describe specific dental visits, dental procedures and type of provider, and they offer details that are useful, important and not found elsewhere. PRACTICE IMPLICATIONS: By understanding these analyses, U.S. dentists will be better positioned to provide care and better meet the dental care needs of all Americans.

TRATAMIEMTO DE LA MOVILIDAD DENTARIA PATOLOGICA CON ACANA

El número y las técnicas usadas en el tratamiento de las enfermedades preiodontales en nuestro país, pareciera ser muy reducido si relacionamos con la literatura consultada que no es variada; pero, la incidencia y frecuencia es muy alta, cuando examinamos a las peresonas adultas y acuden a las diferentes clínicas o consultorios con evidentes signos de movilidad dentaria, como consecuencia de enfermedades periodontales. El presente trabajo es el resultado escrito de un estudio que corresponde a la odontología investigativa, debemos agradecer fundamentalmente a las técnicas y a los fármacos que se van perfeccionando y descubriendo cada día, el mejor conocimiento de la periodontología, que en estos últimos tiempos está avanzando vertiginosamente