Inflammatory profile of patients with different weight diagnoses and similar periodontal condition: A systematic review.

Background: This study aimed to systematically review the literature regarding the inflammatory profiles, measured by cytokines and chemokines, of individuals with different diagnoses of weight, but with the similar periodontal condition. Materials and Methods: Searches were performed in five databases (Scopus, EMBASE, PubMed, Web of Science, and Cochrane-Central). Studies that compared the inflammatory profile of normal-weight individuals to those with obesity and evaluated the same cytokine, collection method, and periodontal diagnosis (periodontal health, gingivitis, or periodontitis) were included. Cross-sectional studies underwent evaluation by independent researchers using the Joanna Briggs Institute Critical Appraisal Checklist. The GRADE (Grades of Recommendation, Assessment, Development and Evaluation) system assessed evidence certainty. Results: Twelve studies were included. The diagnosis of obesity was done on the basis of body mass index, waist circumference, and waist-hip ratio. Pro-inflammatory cytokines (interleukin-6 [IL-6], tumor necrosis factor-α [TNF]-α, IL-1ß, IL-31, and IL-34) were analyzed in serum, saliva, gingival crevicular fluid (GCF), and plasma. Periodontal diagnoses varied across studies. TNF-α expression was significantly higher in individuals with obesity and periodontal health or periodontitis. Serum IL-1ß levels showed mixed results, but salivary IL-1ß levels were elevated in obese individuals. IL-6 levels were higher in obese individuals, regardless of periodontal status. IL-34 and IL-10 showed no significant differences across groups. Monocyte chemoattractant protein-4 (MCP-4) levels were higher in obese individuals with periodontitis or periodontal health. IL-31 and IL-34 in GCF showed no significant differences between obese and nonobese individuals, without periodontitis. Conclusions: Heterogeneous results were noted for IL-6, IL-1ß, IL-31, IL-34, TNF-α, and MCP-4, hindering conclusions on weight's impact on inflammatory profiles in periodontal patients.

Association between salivary flow and dental caries in institutionalized adolescents: Cross-sectional study.

Background: Brazil has a larger number of adolescent offenders, but studies evaluating their oral health are still limited. Objective: Assess the association between salivary flow and caries experience in youngsters deprived of liberty. Methodology: Sixty-eight male adolescents in conflict with the law, aged between 15 and 19 years, from a Socio-Educational Assistance Center in Brazil participated in the present study. They answered a structured questionnaire, and oral examination was performed by the Decayed, Missing, and Filled Teeth (DMFT) index. The salivary flow rate was obtained using the mechanically stimulated total saliva method. Adjusted Poisson regression was used for the association with total DMFT and its decayed component, using the salivary flow (continuous fashion) or the hyposalivation (≤1 ml/min) as independent variables. Results: Participants were divided into two groups, those who did not have any decayed teeth at the moment of the examination (n = 39) and those who had at least one decayed tooth (n = 29). Moreover, two groups were formed based on the DMFT: those who had DMFT = 0 (n = 20) and those who had DMFT≥1 (n = 48). In the multivariate analysis, hyposalivation was associated with DMFT≥1 (p = 0.048), but when the salivary flow was included, no significant association with DMFT index was identified (p = 0.178). Conversely, the presence of at least one decayed tooth was significantly associated with the salivary flow (p = 0.004), but not with hyposalivation (p = 0.091). Conclusions: Institutionalized adolescents who present hyposalivation or low salivary flow are associated with DMFT≥1 index or presence of at least one decayed tooth, respectively.

Tratamento de periodontite estágio III localizado grau C em um indivíduo fumante: um relato de caso / Treatment of periodontitis stage III localized grade C in smoker individual: a case report

Objetivo: A periodontite é uma doença infecto-inflamatória que acomete os tecidos de inserção periodontal, e ser fumante representa um risco modificável significativo para todos os graus da doença. Ainda, indivíduos fumantes apresentam uma resposta inflamatória alterada quando comparados a não fumantes. Nesse contexto, o objetivo deste estudo foi reportar um relato de caso de tratamento periodontal de paciente fumante pesado. Relato de caso: O paciente DRS, sexo masculino, 22 anos, foi encaminhado à Faculdade de Odontologia da Universidade Federal de Pelotas (UFPel) com a queixa principal de necessidade de "realização de uma limpeza dentária". Na anamnese, relatou fumar 20 cigarros ao dia, há 7 anos (7 maços-ano). Na consulta inicial, foi encontrado índice de placa visível (IPV) de 100% e índice de sangramento gengival (ISG) de 66,67%. Foi encontrado cálculo supragengival como fator retentivo de placa (FRP) em 46,30% dos sítios. Estabeleceu-se o diagnóstico de periodontite estágio III localizado grau C. Os exames periodontais foram realizados por um único pesquisador calibrado e optou-se pelo tratamento periodontal não cirúrgico. Ao exame de 12 meses, o paciente apresentou IPV de 23,45% e ISG de 22,83%. Houve ausência de FRP. De uma forma geral, foi possível constatar a diminuição significativa das bolsas periodontais, bem como o ganho significativo de inserção clínica periodontal. Considerações finais: Dessa forma, é possível concluir a efetividade da terapia periodontal não cirúrgica, aliada à manutenção periodontal e instruções de higiene para o tratamento de periodontite estágio III, grau C, em paciente fumante.(AU)

Objective: Periodontitis is an infect-inflammatory diseases that affects the periodontal attachment tissues, and being smoker represents a significant modifiable risk for all degrees of the disease. Moreover, smokers have an altered inflammatory response when compared to non-smokers. Therefore, the aim of this study was to report a case report of periodontal treatment of a heavy smoker. Case report: A patient DRS, male, 22 years old, was referred to the School of Dentistry of the Federal University of Pelotas (UFPel) with the main complaint of the need to "perform a dental cleaning". During the anamnesis, he reported smoking 20 cigarettes a day for 7 years (7 pack-years). In the initial appointment, a visible plaque index (VPI) of 100% and a gingival bleeding index (GBI) of 66.67% were found. Supragingival calculus was found as a plaque retentive factor (PRF) in 46.30% of the sites. The diagnosis of periodontitis stage III localized grade C was established. Periodontal examinations were performed by a single calibrated researcher and non-surgical periodontal treatment was chosen. At the 12-month appointment, the patient had an VPI of 23.45% and an GBI of 22.83%. There was absence of PRF. In general, it was possible to observe a significant decrease in periodontal pockets, as well as a significant gain in periodontal clinical attachment. Final considerations: Thus, it is possible to conclude the effectiveness of non-surgical periodontal therapy, combined with periodontal maintenance and hygiene instructions for the treatment of periodontitis stage III localized grade C in a smoker.(AU)

Systemic Profile and Periodontal Condition of Hospitalized Women with High-Risk Pregnancy: A Cross-Sectional Study.

INTRODUCTION: The physiological changes in mother-infant pairs during pregnancy increase the susceptibility to a series of infections, including those of the oral cavity. Therefore, the oral and systemic health of pregnant women is related to adverse pregnancy outcomes. OBJECTIVE: This cross-sectional study aimed to evaluate the systemic profile and periodontal status of women with a high-risk pregnancy. METHODS: Eighty-nine pregnant women at risk of preterm labor admitted to a hospital in southern Brazil were interviewed and received a periodontal examination. Data related to obstetric complications during pregnancy (pre-eclampsia, infections, medication use, and gestational diabetes) and systemic diseases were collected from medical records. The periodontal parameters of probing pocket depth, bleeding on probing, and clinical attachment level were evaluated. The data were tabulated, and statistical analysis was performed (p < 0.05). RESULTS: The mean age of participants was 24 years (SD = 5.62). Gingival bleeding was recorded in 91% of the participants. The prevalence of gingivitis was 31.46%, and periodontitis was 29.21%. No association between systemic conditions and periodontal disease was observed. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Periodontal inflammation was not associated with the systemic profile during pregnancy. However, women with high-risk pregnancies showed higher levels of gingival inflammation, emphasizing the importance of dental care during pregnancy.

Association between different dietary patterns and eating disorders and periodontal diseases.

Periodontal diseases is a highly prevalent chronic condition regulated by the host immune response to pathogenic bacterial colonization on the teeth surfaces. Nutrition is a critical component in the modulation of the immune system, hence the importance of a balanced diet. With the understanding of how dietary intake composition affects various health outcomes, nutrient diversity has been reported as a modifiable risk factor for periodontal disease. Eating disorders and different dietary patterns can be associated with periodontal diseases. In this sense, balanced and healthy nutrition plays a major role in maintaining the symbiosis between oral microbiota and periodontal health. Therefore, this review seeks to report the associations found in the literature between high- or low-fat/sodium/sugar, eating disorders and periodontal diseases. It was found that some dietary patterns such as high carbohydrate/sugar, high fat, and low fiber intake may be associated with periodontal disease. In addition, the presence of eating disorders can negatively impact patients' oral health and it is related to the development of several complications, including periodontal diseases. In both situations, nutritional and vitamin deficiencies can aggravate the periodontal condition. However, the relationship between periodontal disease, dietary patterns, and eating disorders still needs more scientific support to be well established, mainly in the sense of pointing out a protective relationship between both.

Factors associated with poor academic performance among undergraduate dental students: A cross-sectional study.

OBJECTIVE: To evaluate the factors associated with poor academic performance among undergraduate dental students enrolled at a public university in Brazil. METHODS: A semi-structured questionnaire addressing the exploratory variables of interest (sociodemographic and economic characteristics, use of medications and drugs, dentistry as the first choice of undergraduate course, and the Pittsburgh Sleep Quality Index) was hosted on Google Forms and shared with all dental students at the Federal University of Pelotas. Academic performance was evaluated based on institutional records, access to which the participants had previously authorized; students with good (average ≥7.0 points) or poor academic performance (average <7.0 points) were considered. Adjusted logistic regressions were performed to verify the association between academic performance and the exploratory variables (p < 0.05). RESULTS: In total, 244 students were included, of whom 18.8% had poor academic performance. Increased age (OR: 1.34; 95%CI: 1.18-1.52), non-white skin color (OR: 1.34; 95%CI: 1.18-1.52), the use of medications for anxiety and depression (OR: 1.34; 95%CI: 1.18-1.52), and poor sleep quality (OR: 1.34; 95%CI: 1.18-1.52) were factors associated with poor academic performance. CONCLUSION: A low prevalence of poor academic performance was observed. Non-white skin color, increased age, use of anxiolytics or antidepressants, and poor or disturbed sleep may reduce dental students' academic performance.

Higher frequency of specific periodontopathogens in hypertensive patients. A pilot study.

Periodontitis and arterial hypertension are two of the pathologies with the highest global prevalence; evidence reported so far has been favorable to an association between them. This cross-sectional study aimed to evaluate and compare the microbiological counts of hypertensive and normotensive patients with periodontitis. Sociodemographic, behavioral, systemic health data and periodontal clinical parameters were assessed. Counts of A. actinomycetemcomitans, P. intermedia, P. gingivalis and F. nucleatum were performed by real-time polymerase chain reaction using subgingival biofilm samples. Thirty-eight patients were included in this preliminary analysis, divided into two groups: Normotensive Group (NG) (n = 14) and Hypertensive Group (HG) (n = 24). Patients diagnosed with periodontitis composed both groups. Data analysis was performed with significance level of 5%. There was no significant difference between groups for clinical periodontitis diagnosis. In addition, hypertensive individuals had higher P. intermedia, P. gingivalis, and F. nucleatum counts when compared to normotensive individuals. The parameters probing pocket depth, bleeding on probing, and A. actinomycetemcomitans count did not presented statistical differences between groups. With these preliminary results, it can be concluded that the presence of arterial hypertension may be associated with a greater quantity of periodontopathogenic bacterial of some species in individuals with periodontitis.

Higher frequency of specific periodontopathogens in hypertensive patients. A pilot study

Abstract Periodontitis and arterial hypertension are two of the pathologies with the highest global prevalence; evidence reported so far has been favorable to an association between them. This cross-sectional study aimed to evaluate and compare the microbiological counts of hypertensive and normotensive patients with periodontitis. Sociodemographic, behavioral, systemic health data and periodontal clinical parameters were assessed. Counts of A. actinomycetemcomitans, P. intermedia, P. gingivalis and F. nucleatum were performed by real-time polymerase chain reaction using subgingival biofilm samples. Thirty-eight patients were included in this preliminary analysis, divided into two groups: Normotensive Group (NG) (n = 14) and Hypertensive Group (HG) (n = 24). Patients diagnosed with periodontitis composed both groups. Data analysis was performed with significance level of 5%. There was no significant difference between groups for clinical periodontitis diagnosis. In addition, hypertensive individuals had higher P. intermedia, P. gingivalis, and F. nucleatum counts when compared to normotensive individuals. The parameters probing pocket depth, bleeding on probing, and A. actinomycetemcomitans count did not presented statistical differences between groups. With these preliminary results, it can be concluded that the presence of arterial hypertension may be associated with a greater quantity of periodontopathogenic bacterial of some species in individuals with periodontitis.

Resumo A periodontite e a hipertensão arterial são duas das patologias com maior prevalência global, as evidências relatadas até o momento têm sido favoráveis ​​a uma associação entre elas. Este estudo transversal teve como objetivo avaliar e comparar contagem microbiológicas de pacientes hipertensos e normotensos com periodontite. Dados sociodemográficos, comportamentais, de saúde sistêmica e parâmetros clínicos periodontais foram avaliados. Contagens de A. actinomycetemcomitans, P. intermedia, P. gingivalis e F. nucleatum foram realizadas por reação em cadeia da polimerase em tempo real utilizando amostras de biofilme subgengival. Trinta e oito pacientes foram incluídos nesta análise preliminar, divididos em dois grupos: Grupo Normotenso (GN) (n = 14) e Grupo Hipertenso (GH) (n = 24). Pacientes diagnosticados com periodontite compuseram os dois grupos. A análise dos dados foi realizada com nível de significância de 5%. Não houve diferença significativa entre os grupos para o diagnóstico clínico de periodontite. Além disso, os hipertensos apresentaram maior contagem de P. intermedia, P. gingivalis e F. nucleatum quando comparados aos normotensos. Os parâmetros profundidade de sondagem, sangramento à sondagem e contagem de A. actinomycetemcomitans não apresentaram diferenças estatísticas entre os grupos. Com esses resultados preliminares, pode-se concluir que a presença de hipertensão arterial pode estar associada a uma maior quantidade de bactérias periodontopatogênicas de algumas espécies em indivíduos com periodontite.

Association between clinical measures of gingival inflammation and obesity in adults: systematic review and meta-analyses.

OBJECTIVE: This study aimed to systematically review the literature about the association between clinical measures of gingival inflammation and obesity in adults. MATERIAL AND METHODS: Searches for studies were performed in five databases (Medline-PubMed, Scopus, Web of Science, Cochrane Library, and Embase) to compile studies of any design that evaluated the association between clinical measures of gingival inflammation and obesity in adults. Selection of studies, data extraction and risk of bias analysis were performed independently by two reviewers, and a third researcher was involved to resolve disagreements. Meta-analyses were performed for measures of gingival inflammation as compared to body mass index (BMI). Independent analyses were performed for studies involving periodontitis, gingivitis, and population-based/studies that did not provide a periodontal diagnosis. Standard mean deviation (SMD) and its 95% confidence interval (95%CI) were estimated. RESULTS: Ninety studies were included (cross-sectional/clinical trials [n=82], case-control [n=3], cohorts [n=5]). Most of the studies demonstrated no significant difference in the measures of gingival inflammation regardless of the comparison performed. However, meta-analysis showed that among individuals with periodontitis, significantly higher levels of gingival inflammation are observed in those with obesity (n of individuals=240) when compared to those who were not obese (n of individuals=574) (SMD:0.26; 95%CI:0.07-0.44). When considering population-based/those studies that did not provide periodontal diagnosis, significantly higher measures of gingival inflammation were observed in the groups with higher BMI. CONCLUSIONS: Within the limitations of the present study, it was concluded that higher measures of gingival inflammation may be expected for those with higher BMI. CLINICAL RELEVANCE: Clinicians must be aware that higher measures of gingival inflammation may be expected for individuals with higher BMI. However, there is a necessity for further longitudinal studies regarding the association between obesity and gingival inflammation.

Histomorphometric analysis of implant osseointegration using hydrophilic implants in diabetic rats.

OBJECTIVES: To evaluate peri-implant bone formation of titanium implants using an in vivo rat model with and without uncontrolled diabetes mellitus (DM) to evaluate osseointegration of hydrophobic (Neoporos®) and hydrophilic (Acqua®) surfaces. MATERIALS AND METHODS: 54 rats were divided into two groups: DM group (DMG) (streptozotocin-induced diabetes) and a control group (CG). Implants with hydrophobic (Neoporos®) and hydrophilic surfaces (Acqua®) were placed in the left or right tibia of animals. Animals were further divided into three groups (n = 9) euthanized after 7, 14, or 28 days. Bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO) were assessed in total, cortical, and medullary areas. RESULTS: The DMG group, after a 7-day healing period, yielded with the Acqua implants presented significantly higher total BIC (+37.9%; p=0.03) and trabecular BIC (%) (+46.3%; p=0.02) values in comparison to the Neoporos implants. After 28 days of healing, the CG yielded that the cortical BAFO of Acqua implants to be significantly, 14%, higher (p=0.04) than Neoporos implants. CONCLUSION: The positive effects of the Acqua surface were able to counteract the adverse impact of uncontrolled DM at early osseointegration periods. After 28 days in vivo, the metabolic systemic impairment caused by DM overcame the surface treatment effect, leading to impaired osseointegration in both hydrophilic and hydrophobic implants. CLINICAL RELEVANCE: The adverse effects of diabetes mellitus with respect to bone healing may be minimized by deploying implants with strategically modified surfaces. This study evaluated the effects of implants with Acqua® and Neoporos® surfaces in both diabetic and healthy animals. During the initial healing period in diabetic animals, the hydrophilic surface was demonstrated to have beneficial effect on osseointegration in comparison to the hydrophobic surface. The results provide an insight into early healing, but the authors suggest that a future short-term and long-term clinical study is needed to assess the possible benefit of the Acqua® implant as well as in increasing the predictability of implant osseointegration.

Condição bucal de mulheres com diabetes mellitus gestacional internadas em um hospital escola no sul do Brasil / Oral condition of women with gestational diabetes mellitus admitted in a school hospital in southern Brazil

Objetivo: avaliar a condição bucal de mulheres com diabetes mellitus gestacional (DMG) internadas no Hospital Escola (HE) da Universidade Federal de Pelotas (UFPel). Métodos: trata-se de um estudo transversal retrospectivo de base hospitalar, em que dois residentes treinados realizaram a coleta dos dados por meio da avaliação dos prontuários médicos e odontológicos, no período de setembro de 2019 a março de 2020. Os dados socioeconômicos e demográficos e o diagnóstico de DMG foram coletados dos prontuários médicos, enquanto hábitos e condição bucal, dos prontuários odontológicos. A análise dos dados foi realizada no programa Stata 11.0, usando os testes Exato de Fisher e Regressão de Poisson. Resultados: foram avaliados os prontuários de 83 gestantes, destas, 37 (44,6%) apresentavam DMG. A presença de DMG esteve asso-ciada com as gestantes de maior faixa etária (62,2%) e no terceiro trimestre de gestação. Em sua maioria, tinham renda de até dois salários mínimos, eram solteiras, tinham filhos e realizaram pré-natal. Em relação à avaliação bucal, apenas a presença de cálculo dental e inflamação gengival foi estatisticamente associada à presença de DMG (p= 0,030 e 0,014 respectivamente). A autopercepção do sorriso foi considerada ruim por 40,5%, e a maioria teve dentes perdidos por cárie (64,9%). Conclusões: a prevalência de DMG foi alta entre as gestantes internadas, sendo maior em mulheres de mais idade. Presença de cálculo dental e inflamação gengival foram fortemente associadas à presença de DMG, enquanto hábitos bucais e presença de cárie não apresentaram associação. Novas pesquisas, com exames periodontais completos, são necessárias para verifi-car as condições periodontais dessas mulheres.(AU)

Aim: to assess the oral condition of women with Gestacional Diabetes Mellitus (GDM) admitted in a School Hospital (HE)/UFPel. Methods: medical and dental records, from September 2019 to March 2020, were evaluated in this hospital-based retrospective cross-sectional study. Socioeconomic and demographic data were collected from medical records, while oral condition and habits were obtained from the dental records. Statistical analysis was performed with Stata 11.0 software using Fisher's exact test and Poisson regression. Results: the medical records of 83 pregnant women were evaluated, of which 37 (44.6%) had GDM. The presence of GDM was associated with pregnant women of older age (62.2%) and most in the third trimester of pregnancy. Most of them had an income of up to two minimum wages, were single, had children and underwent prenatal care. Regarding the oral evaluation, only the presence of dental calculus and gingival inflammation was statistically associated with the presence of GDM (p = 0.030 and 0.014 respectively). The self-perception of the smile was considered bad to 40.5% and many of them had lost teeth due to caries (64.9%). Conclusions: the prevalence of GDM was high in hospitalized pregnant women, being higher in older women. Presence of dental calculus and gingival inflammation were strongly associated with the presence of GDM, while oral habits and the presence of caries were not associated. Further research, with complete periodontal examinations is necessary to verify the periodontal conditions of these women.(AU)

Treatment of experimental periodontitis with chlorhexidine as adjuvant to scaling and root planing.

OBJECTIVES: To assess whether subgingival irrigation with 0.12 % or 0.2 % chlorhexidine (CHX) immediately after scaling and root planing (SRP) enhances periodontal tissue repair compared to irrigation with saline solution (control). MATERIALS AND METHODS: Periodontitis was ligature-induced in rat molars for 7 days. Animals were distributed into three groups: 1) SRP group, SRP and irrigation with 0.9 % saline (n = 30); 2) SRP + 0.12 % CHX group, SRP and irrigation with 0.12 % CHX (n = 30); 3) SRP + 0.2 % CHX group, SRP and irrigation with 0.2 % CHX (n = 30). Animals were killed at 7, 15, and 30 days after treatment. Furcation region was histometrically analyzed to determine the bone area. Immunohistochemical reactions were performed for receptor activator of nuclear factor-kB ligand (RANKL), osteoprotegerin (OPG) and tartrate-resistant acid phosphatase (TRAP). RESULTS: Both chlorhexidine groups presented less inflammation and improved tissue repair along the entire experiment when compared with the SRP group. In the histometric analysis at 7, 15 and 30 days, SRP group (4.58 ±â€¯2.51 mm2, 4.21 ±â€¯1.25 mm2, 3.49 ±â€¯1.48 mm2), showed statistically less bone area than groups SRP + 0.12 % CHX (1.86 ±â€¯1.11 mm2; 0.79 ±â€¯0.27 mm2; 0.34 ±â€¯0.14 mm2) and SRP + 0.2 % CHX (1.14 ±â€¯0.51 mm2; 0.98 ±â€¯0.40 mm2; 0.41 ±â€¯0.21 mm2). Both chlorhexidine concentrations modulated the expression of TRAP, RANKL and OPG. CONCLUSIONS: Subgingival irrigation with chlorhexidine contributed for a quicker shift from a proinflammatory destructive profile to healing of periodontal tissues.

Enxerto de tecido conjuntivo subepitelial e retalho coronal em recessões gengivais múltiplas / Subepithelial connective tissue graft and coronal fl ap in multiple gingival recessions

Algumas das principais indicações para o recobrimento de superfícies radiculares expostas por recessão gengival compreendem a hipersensibilidade dentinária cervical e o tratamento de defeitos estéticos. Este trabalho descreveu o tratamento de recessão gengival múltipla classe III de Miller em um periodonto delgado, após 36 meses de uma intervenção cirúrgica com enxerto gengival livre. O tratamento cirúrgico periodontal proposto foi o recobrimento radicular por meio de enxerto de tecido conjuntivo subepitelial associado a retalho reposicionado coronalmente na região vestibular dos elementos 31, 41 e 42. Após 90 dias, foi possível observar o recobrimento parcial da recessão, aumento da espessura tecidual e o controle do biofi lme pelo paciente, promovendo maior proteção da região e redução do risco de recidiva das recessões. Diante da resolução do caso clínico apresentado, pôde-se concluir que a técnica do enxerto de tecido conjuntivo subepitelial associado ao retalho reposicionado coronalmente, quando bem indicada e realizada, pode ser empregada com sucesso em áreas de recessões múltiplas e periodonto com espessura reduzida.

Some of the main indications for the root coverage of gingival recessions include cervical dentin hypersensitivity and treatment of aesthetic defects. This manuscript describes the treatment of a Miller's Class III multiple gingival recession 36 months after a free gingival graft surgical procedure. The periodontal surgical treatment proposed was the subepithelial connective tissue graft associated with a coronally repositioned fl ap at vestibular region of elements 31, 41 and 42. After 90 postoperative days, it was possible to observe an increase on tissue thickness and biofi lm control by the patient, promoting a greater protection of the region and reducing the risk of recession recurrence. It can be concluded that the subepithelial connective tissue graft technique associated with the coronal repositioned fl ap, when well indicated and performed, can be successfully used in multiple recessions and periodontal regions with reduced thickness.

O cálculo dental e a doença periodontal / Dental calculus and periodontal disease ­ a literature review

A doença periodontal (DP) é uma infecção crônica em resposta à presença de bactérias nos tecidos ao redor do dente, sendo definida como uma doença sujeito e sítio-específica, que evolui continuamente com períodos de exacerbação e de remissão. É uma patologia fortemente associada à presença de cálculo dentário em superfícies radiculares, porém, a superfície áspera do cálculo dental por si só não é suficiente para induzir à inflamação nos tecidos periodontais adjacentes. O cálculo dental atua como um substrato ideal para a colonização microbiana subgengival, e seu papel no desenvolvimento da doença periodontal tem sido investigado em vários estudos. Esta revisão buscou encontrar na literatura disponível estudos recentes sobre a relação existente entre o cálculo dental e a doença periodontal. Diante dos artigos encontrados, concluiu-se que a superfície porosa do cálculo dental abriga um biofilme viável, que propicia o crescimento e o desenvolvimento de periodontopatógenos. Ainda, pôde-se concluir que o papel do cálculo dental na etiologia da DP é secundário e que sua remoção da superfície dentária é essencial na fase inicial da terapia periodontal. Entretanto, nenhum método utilizado para o debridamento da superfície dental é eficaz na eliminação total do cálculo.

Periodontal disease (PD) is a site-specific, chronic infection in response to bacteria surrounding teeth, with periods of exacerbation and remission. It has been strongly associated to dental calculus (DC) at root surfaces; however, the rough nature of radicular tissues is not enough to trigger soft tissue adjacent infl ammation. The dental calculus act as an ideal substrate for subgingival colonization and its role on the development of periodontal disease has been investigated in several articles. The review aimed to identify recent studies on the relationship between PD and dental calculus. Based on the available data, it can be stated that the porous nature of dental calculus harbors an active biofi lm allowing for growth and development of periodontopathogenic microorganisms. Also, it can be said that DC has a secondary role on the PD etiology, and that its removal remains essential in the early phase of periodontal therapy. Nevertheless, no actual debridement method is effective for complete elimination of DC.

Root coverage of adjacent gingival recessions with a combination of two surgical techniques

Introduction: The dentin hypersensitivity associated with gingival recession is an occurrence of high prevalence in the clinical routine of dentists. Coverage of exposed root surfaces represents a challenge for periodontal treatment. Objective: The purpose of the present study is to describe an approach for adjacent gingival recession treatment using a combination of two surgical techniques: the subepithelial connective tissue graft (SCTG) with a laterally positioned double flap. Case report: This surgical treatment was conducted in a 45-yearold female patient who complained of sensitivity when brushing the lower right teeth. Clinical and radiographic examinations showed gingival recessions (Miller Class III) with traumatic origin promoted for tooth brushing and the presence of thin periodontium in the region. In addition, interproximal bone loss was noted on vestibular face of the right mandibular second premolar and mesial root of the right mandibular first molar. At 12 postoperative months, it was observed that the association of the two surgical techniques promoted an almost complete coverage of the gingival recessions, an increased keratinized gingival band and the elimination of initial dentin hypersensitivity. Conclusion: The appropriate choice of techniques and patient compliance to the periodontal support therapy led to treatment success and periodontal health maintenance in the region during the whole follow-up period.

Avaliação do reparo ósseo de defeitos de tamanho crítico tratados com plasma rico em plaquetas ou com fibrina rica em plaquetas: estudo histomorfométrico e imunoistoquímico em calvárias de ratos / Bone healing in critical-size defects treated with either platelet-rich plasma (PRP) or platelet-rich fibrin (PRF): a histomorphometric and immunohistochemical study in rats

Este estudo avaliou a influência do Plasma Rico em Plaquetas (PRP) e da Fibrina Rica em Plaquetas (FRP) no reparo ósseo de defeitos de tamanho crítico (DTC) criados cirurgicamente em calvárias de ratos. 90 ratos foram aleatoriamente divididos em 3 grupos: C (controle), PRP e FRP. Um DTC de 5 mm de diâmetro foi criado na calvária de cada animal. No Grupo C, o defeito foi preenchido com coágulo sanguíneo somente. Nos grupos PRP e FRP, os defeitos foram preenchidos com PRP e FRP, respectivamente. Os animais foram eutanasiados aos 7, 15 ou 30 dias pós-operatórios. Análises histomorfométrica e imunoistoquímica foram realizadas. A Área de Osso Neoformado (AON) foi calculada como uma porcentagem da área total do defeito original. Imunomarcações do antígeno nuclear de proliferação celular (PCNA), fator de transcrição relacionado à Runt 2 (Runx2), proteína morfogenética óssea - 2 (BMP-2) e fosfatase alcalina específica do osso (BALP) foram realizadas. Células positivas para PCNA e Runx2 foram quantificadas e as imunomarcações para BMP-2 e BALP foram semi-quantificadas. Os dados foram estatisticamente analisados. Aos 7 dias, o Grupo PRP (10,74 ± 4,80%) apresentou AON significativamente maior do que os grupos C (0,86 ± 0,98%) e FRP (2,95 ± 2,37%). Aos 15 dias, os grupos C, PRP e FRP apresentaram AON similares (13,07 ± 4,48%; 14,19 ± 2,85%; 18,83 ± 6,71%, respectivamente). Aos 30 dias, os grupos PRP (32,75 ± 7,39%) e FRP (28,73 ± 10,67%) apresentaram AON significativamente maior do que o Grupo C(13,55 ± 4,62%). Não houve diferenças estatisticamente significativas entre os grupos PRP e FRP aos 30 dias. Aos 7 dias, os grupos PRP e FRP apresentaram número de células PCNA-positivas significativamente maior do que o Grupo C. Aos 15 dias, o Grupo FRP apresentou número de células PCNA-positivas significativamente maior do que os grupos C e PRP e o Grupo PRP apresentou número de células PCNA-positivas significativamente maior e o Grupo PRP apresentou número de células PCNA...

This study evaluated the influence of Platelet-Rich Plasma (PRP) and Platelet-Rich Fibrin (PRF) on bone healing in surgically created critical-size defects (CSD) in rat calvaria. 90 rats were randomly divided into 3 groups: C (control), PRP and PRF. A 5 mm diameter CSD was created in the calvarium of each animal. In Group C, the defect was filled by blood clot only. In groups PRP and PRF, the defects were filled with PRP and PRF, respectively. Animals were euthanized 7, 15 or 30 days postoperatively. Histomorphometric and immunohistochemical analyses were performed. Newly formed bone area (NFBA) was calculated as percentage of the total area of the original defect. Proliferating cell nuclear antigen (PCNA), Runt-related transcription factor 2 (Runx2) Bone morphogenetic protein 2 (BMP-2) and Bone Alkaline phosphatase (BALP) immunohistochemical staining were performed. PCNA-positive and Runx2-positive cells were quantified and BMP-2 and BALP immunostaining were semi-quantified. Data were statistically analyzed. At 7 days, Group PRP (10.74 ± 4.80) had significantly greater NFBA than groups C (0.86 ± 0.98) and PRF (2.95 ± 2.37). At 15 days, groups C, PRP and PRF presented similar amount of NFBA (13.07 ± 4.48; 14.19 ± 2.85; 18.83 ± 6.71, respectively). At 30 days, groups PRP (32.75 ± 7.39) and PRF (28.73 ± 10.67) presented significantly greater NFBA than Group C (13.55 ± 4.62) and no significant differences were observed between groups PRP and PRF. At 7 days, Groups PRP and PRF showed a significantly higher number of PCNA-positive cells than Group C. At 15 days, Group PRF had a significantly higher number of PCNA-positive cells than groups C and PRP; Group PRP had a significantly higher number of these cells than Group C. At 30 days, Group PRF presented a significantly higher number of PCNA-positive cells than Group C. At 7 days, Group PRP had a significantly higher number of Runx2-positive cells than groups C and PRF. At 15 days, Group PRF presented a…

Avaliação do reparo ósseo de defeitos de tamanho crítico tratados com plasma rico em plaquetas ou com fibrina rica em plaquetas: estudo histomorfométrico e imunoistoquímico em calvárias de ratos / Bone healing in critical-size defects treated with either platelet-rich plasma (PRP) or platelet-rich fibrin (PRF): a histomorphometric and immunohistochemical study in rats

Este estudo avaliou a influência do Plasma Rico em Plaquetas (PRP) e da Fibrina Rica em Plaquetas (FRP) no reparo ósseo de defeitos de tamanho crítico (DTC) criados cirurgicamente em calvárias de ratos. 90 ratos foram aleatoriamente divididos em 3 grupos: C (controle), PRP e FRP. Um DTC de 5 mm de diâmetro foi criado na calvária de cada animal. No Grupo C, o defeito foi preenchido com coágulo sanguíneo somente. Nos grupos PRP e FRP, os defeitos foram preenchidos com PRP e FRP, respectivamente. Os animais foram eutanasiados aos 7, 15 ou 30 dias pós-operatórios. Análises histomorfométrica e imunoistoquímica foram realizadas. A Área de Osso Neoformado (AON) foi calculada como uma porcentagem da área total do defeito original. Imunomarcações do antígeno nuclear de proliferação celular (PCNA), fator de transcrição relacionado à Runt 2 (Runx2), proteína morfogenética óssea - 2 (BMP-2) e fosfatase alcalina específica do osso (BALP) foram realizadas. Células positivas para PCNA e Runx2 foram quantificadas e as imunomarcações para BMP-2 e BALP foram semi-quantificadas. Os dados foram estatisticamente analisados. Aos 7 dias, o Grupo PRP (10,74 ± 4,80%) apresentou AON significativamente maior do que os grupos C (0,86 ± 0,98%) e FRP (2,95 ± 2,37%). Aos 15 dias, os grupos C, PRP e FRP apresentaram AON similares (13,07 ± 4,48%; 14,19 ± 2,85%; 18,83 ± 6,71%, respectivamente). Aos 30 dias, os grupos PRP (32,75 ± 7,39%) e FRP (28,73 ± 10,67%) apresentaram AON significativamente maior do que o Grupo C(13,55 ± 4,62%). Não houve diferenças estatisticamente significativas entre os grupos PRP e FRP aos 30 dias. Aos 7 dias, os grupos PRP e FRP apresentaram número de células PCNA-positivas significativamente maior do que o Grupo C. Aos 15 dias, o Grupo FRP apresentou número de células PCNA-positivas significativamente maior do que os grupos C e PRP e o Grupo PRP apresentou número de células PCNA-positivas significativamente maior e o Grupo PRP apresentou número de células PCNA...

This study evaluated the influence of Platelet-Rich Plasma (PRP) and Platelet-Rich Fibrin (PRF) on bone healing in surgically created critical-size defects (CSD) in rat calvaria. 90 rats were randomly divided into 3 groups: C (control), PRP and PRF. A 5 mm diameter CSD was created in the calvarium of each animal. In Group C, the defect was filled by blood clot only. In groups PRP and PRF, the defects were filled with PRP and PRF, respectively. Animals were euthanized 7, 15 or 30 days postoperatively. Histomorphometric and immunohistochemical analyses were performed. Newly formed bone area (NFBA) was calculated as percentage of the total area of the original defect. Proliferating cell nuclear antigen (PCNA), Runt-related transcription factor 2 (Runx2) Bone morphogenetic protein 2 (BMP-2) and Bone Alkaline phosphatase (BALP) immunohistochemical staining were performed. PCNA-positive and Runx2-positive cells were quantified and BMP-2 and BALP immunostaining were semi-quantified. Data were statistically analyzed. At 7 days, Group PRP (10.74 ± 4.80) had significantly greater NFBA than groups C (0.86 ± 0.98) and PRF (2.95 ± 2.37). At 15 days, groups C, PRP and PRF presented similar amount of NFBA (13.07 ± 4.48; 14.19 ± 2.85; 18.83 ± 6.71, respectively). At 30 days, groups PRP (32.75 ± 7.39) and PRF (28.73 ± 10.67) presented significantly greater NFBA than Group C (13.55 ± 4.62) and no significant differences were observed between groups PRP and PRF. At 7 days, Groups PRP and PRF showed a significantly higher number of PCNA-positive cells than Group C. At 15 days, Group PRF had a significantly higher number of PCNA-positive cells than groups C and PRP; Group PRP had a significantly higher number of these cells than Group C. At 30 days, Group PRF presented a significantly higher number of PCNA-positive cells than Group C. At 7 days, Group PRP had a significantly higher number of Runx2-positive cells than groups C and PRF. At 15 days, Group PRF presented a…

A proporção plasma rico em plaquetas/enxerto ósseo autógeno pode influenciar o reparo ósseo de defeitos de tamanho crítico: um estudo radiográfico em calvária de ratos / The proportion platelet-rich plasma/particulate autogenous bone graft may influencebone healing in criticalsize defects: a radiographic study in rat calvaria

Introdução: Tem sido sugerido que enxertos ósseos associados ao Plasma Rico em Plaquetas (PRP) cicatrizam com maior densidade que os enxertos sem PRP. Contudo, esse resultado parece depender da proporção PRP/enxerto ósseo utilizada. Objetivo: O propósito deste estudo foi avaliar, radiograficamente, a influência da proporção PRP/enxerto de Osso Autógeno (OA) no reparo ósseo de defeitos de tamanho crítico (DTCs) criados cirurgicamente em calvárias de ratos. Material e método: Cinquenta ratos foram divididos em cinco grupos: C, OA, OA/PRP-50, OA/PRP-100 e OA/PRP-150. Um DTC de 5 mm de diâmetro foi criado na calvária de cada animal. No Grupo C, o defeito cirúrgico foi preenchido somente com coágulo sanguíneo. No Grupo OA, o defeito foi preenchido com enxerto de OA particulado. Nos grupos OA/PRP-50, OA/PRP-100 e OA/PRP-150, o defeito foi preenchido com enxerto de OA particulado associado a 50, 100 ou 150 µL de PRP, respectivamente. Os animais foram eutanasiados aos 30 dias pós-operatórios. Imagens radiográficas padronizadas das calvárias foram obtidas com o sistema Digora (Soredex, Finlândia). As imagens foram avaliadas por três examinadores por meio de escores, que indicaram o percentual de radiopacidade dos defeitos. Os escores obtidos foram submetidos ao Teste de Kruskal-Wallis (p < 0,05). Resultado: O Grupo C apresentou radiopacidade significativamente menor que os grupos OA, OA/PRP-50, OA/PRP-100 e OA/PRP-150 (p < 0,05). O Grupo OA/PRP-50 apresentou radiopacidade significativamente maior que os grupos OA/PRP-100 e OA (p < 0,05). Conclusão: Dentro dos limites deste estudo, pode-se concluir que a proporção PRP/enxerto de OA influencia a cicatrização de DTCs criados em calvárias de ratos.

Introduction: It has been suggested that bone grafts combined with platelet rich plasma (PRP) present greater density than bone grafts without PRP after healing process. However, this result may depend on proportion PRP/autogenous bone (AB) graft used. Objective: The purpose of this study was to analyze radiographically the influence of the proportion PRP/particulate autogenous bone (AB) graft on bone healing in surgically created criticalsize defects (CSD) in rat calvaria. Material and method: 50 rats were divided into 5 groups: C, AB, AB/PRP-50, AB/PRP-100 and AB/PRP-150. A 5 mm diameter CSD was created in the calvarium of each animal. In Group C the defect was filled by blood clot only. In Group AB the defect was filled with 0.01 mL of AB graft. In groups AB/ RP-50, AB/PRP-100 and AB/PRP-150 the defects were filled with 0.01 mL of AB graft combined with 50, 100 and 150 µL of PRP, respectively. All animals were euthanized at 30 days post-operative. Standardized radiographic images of the rat calvaria were obtained using Digora System (Soredex, Finland). The images were evaluated by three examiners using scores that indicated the percentage of radiopacity of the defect. The obtained data were subjected to statistical analysis (Kruskal-Wallis test, p <0.05). Result: Group C presented radiopacity significantly lower than groups AB, AB/PRP-50, AB/PRP-100 and AB/PRP-150. Group AB/PRP-50 showed radiopacity significantly greater than groups AB/PRP-100 and AB. Conclusion: It can be concluded that the proportion PRP/AB graft influences bone healing in CSD in rat calvaria.

Reparo ósseo de defeitos de tamanho crítico tratados com plasma rico em plaquetas derivado do sangue periférico ou do aspirado de medula óssea associado ou não ao enxerto de osso autógeno: estudo histológico e histométrico em calvárias de ratos / Bone healing in critical-size-defects treated with platelet-rich plasma derived from either peripheral blood or bone marrow aspirate combined or not with autogenous bone graft: a histologic and histometric study in rat calvaria

Este estudo avaliou, histomorfometricamente, o reparo ósseo de defeitos de tamanho crítico (DTC) criados cirurgicamente em calvárias de ratos e tratados com Plasma Rico em Plaquetas (PRP) derivado do sangue periférico (SP) ou do aspirado de medula óssea (AMO) associado ou não ao enxerto de osso autógeno (OA). 60 ratos foram divididos em 6 Grupos: Grupo C (controle), Grupo OA, Grupo PRP-sp, Grupo PRP-amo, Grupo OA/PRP-sp e Grupo OA/PRP-amo. Um DTC de 5 mm de diâmetro foi criado na calvária de cada animal. No Grupo C, o defeito foi preenchido somente com coágulo sangüíneo. No Grupo OA, o defeito foi preenchido com enxerto de OA particulado. Nos grupos PRP-sp e PRP-amo, os defeitos cirúrgicos foram preenchidos com PRP-sp e PRP-amo, respectivamente. Nos grupos OA/PRP-sp e OA/PRP-amo, os defeitos foram preenchidos com enxerto de OA particulado associado ao PRP-sp e ao PRP-amo, respectivamente. Todos os animais foram submetidos à eutanásia aos 30 dias pós-operatórios. A quantidade de osso neoformado foi calculada como uma porcentagem da área total do defeito original. Esses valores foram transformados em arcoseno para a análise estatística (ANOVA, Tukey, p<0,05). O Grupo C apresentou formação óssea significativamente menor (12,34 ± 2,51%) que os grupos OA (48,94 ± 3,91%), PRP-sp (31,48 ± 14,05%), PRP-amo (35,38 ± 17,19%), OA/PRP-sp (60,27 ± 9,12%) e OA/PRP-amo (44,19 ± 16,49%). A quantidade de formação óssea do Grupo OA/PRP-sp foi significativamente maior que a do Grupo PRP-sp. Dentro dos limites deste estudo, pode-se concluir que todos os tratamentos realizados potencializaram o reparo ósseo em DTC em calvárias de ratos. A associação enxerto de OA/PRP-sp demonstrou uma tendência de apresentar a maior AO

This study histomorphometrically evaluated the bone healing of critical-size defects (CSD) surgically created in rat calvaria and treated with Platelet-Rich Plasma (PRP) derived from either the peripheral blood (PB) or bone marrow aspirate (BMA) combined or not with autogenous bone (AB) grafts. 60 rats were divided into 6 groups: Group C (control), Group AB, Group PRP-pb, Group PRP-bma, Group AB/PRP-pb and Group AB/PRP-bma. A 5-mm diameter CSD was created in the calvarium of each animal. In Group C, the defect was filled with blood clot only. In Group AB, the defect was filled with AB graft. In groups PRP-pb and PRP-bma, the defects were filled with PRP derived from PB and BMA, respectively. In groups AB/PRP-pb and AB/PRP-bma, the defects were filled with AB grafts combined with PRP-pb and PRP-bma, respectively. All animals were euthanized at 30 days post-operatively. Bone Area (BA) was calculated as a percentage of the total area of the original defect. Percentage data were transformed into arccosine for statistical analysis (ANOVA, Tukey, p<0.05). Group C presented significantly less bone formation (12.34 ± 2.51%) than groups AB (48.94 ± 3.91%), PRP-pb (31.48 ± 14.05%), PRP-bma (35.38 ± 17.19%), AB/PRP-pb (60.27 ± 9.12%) and AB/PRP-bma (44.19 ± 16.49%). Bone formation in Group AB/PRP-pb was significantly greater than in Group PRP-pb. Within the limits of this study, it can be concluded that all treatments promoted bone formation in CSD in rat calvaria. The combination AB/PRP-pb demonstrated a trend to present the largest BA