Membrana de fibrina versus injerto conectivo como tratamiento de recesión gingival / Fibrin membrane versus connective tissue graft as gingival recession treatment

RESUMEN: Este caso clínico de boca dividida a 6 meses tiene como objetivo comparar los resultados obtenidos con una membrana de fibrina rica en plaquetas y leucocitos (L-PRF) y un injerto de tejido conectivo (ITC) en el tratamiento de recesiones gingivales clase1 de Miller en un paciente con biotipo gingival grueso. El resultado muestra que el uso de una membrana de L-PRF provee un parcial cubrimiento de la recesión y un menor malestar subjetivo del paciente cuando se compara con el ITC. Sin embargo, el ITC proporciona un mayor porcentaje de cubrimiento radicular y un mejor resultado estético que la membrana de L-PRF al cabo de 6 meses.

ABSTRACT: The aim of this split-mouth clinical study, covering a 6 month period, is to compare the results obtained from Leucocyte and Platelet Rich Fibrin Membrane (L-PRF) and Connective Tissue Grafting (CTG) in the treatment of class 1 Miller gingival recessions in a patient with thick gingival biotype. The results show that the use of L-PRF membrane provides partial coverage of the recession, as well as lower subjective patient discomfort when compared with CTG. However, CTG provides a higher percentage of root coverage and better aesthetic results than the L-PRF membrane after a period of 6 months.

Effects of periodontal therapy on systemic markers of inflammation in patients with metabolic syndrome: a controlled clinical trial.

BACKGROUND: The systemic inflammation in both metabolic syndrome (MetS) and periodontitis is a common denominator of the association of these conditions with higher risk of atherosclerosis. The current study investigates whether periodontal therapy may reduce systemic inflammation in patients with MetS and reduce cardiovascular risk. METHODS: A parallel-arm, double-blind, randomized clinical trial of 1-year duration in patients with MetS and periodontitis was conducted. Participants were randomized to an experimental treatment group (ETG) (n = 82) that received plaque control and root planing plus amoxicillin and metronidazole or to a control treatment group (CTG) (n = 83) that received plaque control instructions, supragingival scaling, and two placebos. Risk factors for cardiovascular disease were recorded; serum lipoprotein cholesterol, glucose, body mass index (BMI), C-reactive protein (CRP) and fibrinogen concentrations, and clinical periodontal parameters were assessed at baseline and every 3 months until 12 months after therapy. The primary and secondary outcomes were changes in CRP and fibrinogen levels, respectively. RESULTS: The baseline patients' characteristics of both groups were similar. No significant changes in lifestyle factors, frequency of hypertension, BMI, serum lipoprotein cholesterol, and glucose levels were observed during the study period. The periodontal parameters significantly improved in both groups 3 months after therapy (P = 0.0001) and remained lower than baseline up to 12 months. The improvement of periodontal status was significantly greater in the ETG (P = 0.0001). A multiple linear regression analysis, controlled for sex, smoking, hypertension, and extent of periodontitis, demonstrated that CRP levels decreased with time and that this reduction was significant at 9 (P = 0.024) and 12 (P = 0.001) months in both groups, without difference between the groups. Fibrinogen levels significantly decreased in the ETG at 6 and 12 months but not in the CTG. CONCLUSION: Reduction of periodontal inflammation either with root planing and systemic antibiotics or with plaque control and subgingival scaling significantly reduces CRP levels after 9 months in patients with MetS.