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.

Local delivery natural products to treat periodontitis: a systematic review and meta-analysis.

OBJECTIVES: This study aimed to answer the PICO question: in adults with periodontitis, does subgingival delivery of natural products (NP) after scaling and root planing (SRP) results in a better reduction of probing pocket depth (PPD) when compared with SRP alone or SRP plus placebo? MATERIAL AND METHODS: A search for trials was carried out in eight databases. Two independent investigators performed all steps of this review. PPD reduction, clinical attachment level (CAL) gain, gingival inflammation, and biofilm accumulation reduction were investigated. We conducted meta-analyses where data could be pooled. RESULTS: Searches yielded 4771 records, in which 27 trials fulfilled the eligibility. There was a large heterogeneity among trials (I2 > 0.69, χ2 < 0.000). Only four studies were at low risk of bias. The evidence quality was very low. The effectiveness of NP was demonstrated in a follow-up of 3-6 months considering PPD reduction (8 trials: 0.72 mm [95%CI: 0.23, 1.22]) and CAL gain (5 trials: 1.07 mm [95%CI: 0.36, 1.78]). A significant reduction in periodontal inflammation favors the use of NP. The biofilm accumulation reduction effect of NP was very weak or non-significant. CONCLUSION: Although the high risk of bias and large heterogeneity of trials impose some restrictions on the validity of effect estimate, this review indicates that adjunctive NP better reduced the PPD when compared to SRP alone or SRP plus placebo in a follow-up of 3-6 months. CLINICAL RELEVANCE: The evidence of non-responsive patients to conventional periodontal therapy highlights the need for therapeutic alternatives to treat periodontitis.

Erosive effect of industrialized fruit juices exposure in enamel and dentine substrates: An in vitro study.

BACKGROUND: Erosive tooth wear has been a highly prevalent and emerging phenomenon related to eating habits of the population. Aim: This study sought to investigate industrialized fruit juices exposure in enamel and dentine substrates in terms of erosive effect. MATERIAL AND METHODS: Human enamel and dentine specimens were randomized into 8 groups (n=8): Grape juice - Ades®, Grape juice - Del Valle Kapo®, Grape juice - Aurora®, Orange juice - Del Valle Kapo®, Orange juice - Ades®, Strawberry juice - Mais Vita®, Strawberry juice - Ades®, Citrus fruit juice - Tampico®. Specimens were submitted to an in vitro erosive challenge and to a microhardness test to evaluate the percentage of surface microhardness loss. The pH, titratable acidity, buffering capacity, degree of saturation and critical pH concerning hydroxyapatite and fluorapatite of the juices were measured as well as their composition of calcium, phosphate, fluoride, and total protein. Data were submitted to the analysis of variance and multivariate linear regression (α=0.05). RESULTS: All test agents were undersaturated concerning hydroxyapatite and fluorapatite. A significant interaction between the type of juice and substrate was found (α=0.000, ß=0.99). However, Orange juice - Del Valle Kapo®, Orange juice - Ades®, and Strawberry juice - Mais Vitta® demonstrated no difference between substrates. Grape juice - Ades® promoted less mineral than other juices in enamel and dentine. The calcium concentration in juices was a protective variable for microhardness loss in both substrates. CONCLUSIONS: The erosive effect of industrialized fruit juices affects enamel differently from dentine, and this effect differed between some, but not all, tested juices. Key words:Tooth erosion, dental enamel, dentine. beverages, food habits.

The influence of varying maxillary central incisor vertical dimension on perceived smile aesthetics.

OBJECTIVE: To evaluate patient perception of the smile focused on analysis of the upper incisors. DESIGN: Cross-sectional study. SETTING: Department of Clinical and Social Dentistry at Federal University of Paraíba, João Pessoa, Brazil. PARTICIPANTS: The sample consisted of 135 individuals (73 women and 62 men). METHODS: Images with different characteristics associated with the incisal edges were shown at random and analysed using a Likert scale. Data were analysed using the Chi-square test or Fisher's exact test with a statistically significant difference ( P < 0.05). RESULTS: Smile I (difference of 1.5 mm in relation to the central incisor and lateral) was considered the most aesthetic, while Smile III (no difference in height between the central and lateral incisors) was the least aesthetic. A significant difference was found between perception of smile II (difference of 1 mm in relation to the central incisor and lateral) and age groups ( P < 0.005), with 31% (n = 13) of individuals aged 45-64 years considering smile II as not pleasant, 4.4% (n = 2) aged 15-24 years and 8.3% (n=4) aged 25-44 years and 4.4% (n = 2) aged 15-24 years considering the same. A significant difference was also found in relation to educational background of the assessor and smile perception, with smile III ( P = 0.0441) and smile IV ( P = 0.0053) considered the most aesthetic ( P = 0.0116). CONCLUSION: The smile considered most attractive among the sample was that with 1.5 mm steepness between the central and lateral incisors, while a flat smile arc was considered least attractive.

A novel combination of biallelic ALPL mutations associated with adult hypophosphatasia: A phenotype-genotype association and computational analysis study.

Hypophosphatasia (HPP) is an inherited metabolic disorder that causes defective skeletal and dental mineralization. HPP exhibits a markedly heterogeneous range of clinical manifestations caused by dysfunction of the tissue-nonspecific isozyme of alkaline phosphatase (TNSALP), resulting from loss-of-function mutations in the ALPL gene. HPP has been associated with predominantly missense mutations in ALPL, and a number of compound heterozygous genotypes have been identified. Here, we describe a case of a subject with adult-onset HPP caused by a novel combination of missense mutations p.Gly473Ser and p.Ala487Val, resulting in chronic musculoskeletal pain, myopathy, persistent fatigue, vomiting, and an uncommon dental phenotype of short-rooted permanent teeth. Pedigree and biochemical analysis indicated that severity of symptoms was correlated with levels of residual ALP activity, and co-segregated with the p.Gly473Ser missense mutation. Bioinformatic analysis to predict the structural and functional impact of each of the point mutations in the TNSALP molecule, and its potential contribution to the clinical symptoms, revealed that the affected Gly473 residue is localized in the homodimer interface and predicted to have a dominant negative effect. The affected Ala487 residue was predicted to bind to Tyr479, which is closely located the N-terminal α-helix of TNSALP monomer 2, suggesting that both changes may impair dimer stability and catalytic functions. In conclusion, these findings assist in defining genotype-phenotype associations for HPP, and further define specific sites within the TNSALP molecule potentially related to neuromuscular manifestations in adult HPP, allowing for a better understanding of HPP pathophysiology.