Focal Dermal Hypoplasia (Goltz Syndrome): A Case Report Showing a Wide Variety of Systemic and Oral Manifestations.

Focal dermal hypoplasia (FDH), also known as Goltz syndrome, consists of an unusual genodermatosis that affects tissues of ectodermal and mesodermal origin and various organs and systems, especially skin, bones, eyes, and oral cavity. While systemic manifestations of FDH have been well documented, the oral manifestations have not been extensively discussed. We present a 22-year-old female patient with history of FDH that showed a variety of systemic and oral manifestations. FDH was diagnosed at birth based on cutaneous alterations. Extra and intraoral examination showed facial asymmetry, lip and perioral atrophy, upper lip papilloma, malocclusion, enamel hypoplasia, and gingival hyperplasia. Mucosal lesions, periodontal diseases, and malocclusion were treated by oral surgery, periodontal therapy and orthodontic treatment, respectively. Although FDH is an uncommon syndrome, health professionals should be aware of its systemic and oral manifestations to establish an early diagnosis and adequate treatment.

Root coverage with tunneling technique or modified advanced flap associated with acellular dermal matrix: results from 6 months randomized clinical trial.

OBJECTIVES: This study compared two surgical techniques using acellular dermal matrix (ADM) for the treatment of multiple gingival recessions. MATERIAL AND METHODS: Twenty patients, with bilateral RT1 gingival recessions, were selected. One side received a modified extended coronally advanced flap (MECAF), and the contralateral side a supra-periosteal flap (TUN). The evaluated parameters were probing depth (PD), relative clinical attachment level, gingival index, gingival recession height (GR), width of keratinized tissue, keratinized tissue thickness, and gingival recession area at baseline and 6 months postoperative. Pain was evaluated weekly, using a visual analog scale (VAS) during first month postoperative. RESULTS: Both groups were effective in reducing GR (ΔGR: MECAF 2.28 mm; TUN 1.93 mm), without significant differences. The % of root coverage was numerically superior favoring MECAF (MECAF 61.24%; TUN 56.07%), without significant differences between groups. VAS scale failed to provide differences between groups. CONCLUSIONS: Both treatment were effective in root coverage and might be valuable for the treatment of multiple gingival recessions. The use of vertical releasing incisions and a flap design including the papillae did not hamper root coverage. CLINICAL RELEVANCE: This study compared two techniques for use of ADM in large multiple gingival recessions. Within its limitations, both treatments successfully achieved root coverage and were able to reduce gingival recession. It is expected a partial root coverage when using these techniques in large gingival recessions. The study failed to provide significant differences between groups. The use of modified extended coronally advanced flap may be advisable for the treatment of multiple gingival recessions, specially involving large defects when using ADM, to avoid early matrix exposure.

Clinical performance of short versus standard dental implants in vertically augmented bone: an overview of systematic reviews.

OBJECTIVE: To answer the question: What do we know so far about the clinical performance of short implants (≤ 7 mm) when compared to standard length implants in vertically augmented bone, as well as which is the overall confidence of the systematic reviews (SRs) about this topic? MATERIALS AND METHODS: An overview of SRs was conducted. The searches were performed in six electronic databases and grey literature. SRs about short (≤ 7 mm) versus standard dental implants performance in vertically augmented bone were included. The assessed outcomes were marginal bone loss (MBL), implant survival (IS), prosthetic (PC) and biological complications (BC), costs, surgical time, and patient satisfaction. AMSTAR 2 was used to evaluate the overall confidence of included SRs. RESULTS: Thirteen SRs were included. Nine of twelve SRs reported a lower MBL for the short implant group. All the included SRs showed no difference in the IS between groups. A higher rate of BC was reported for standard-length implants in four out of five SRs. No differences regarding PC were reported in four of five SRs. Information related to patient preference, cost, and surgery time were underreported. The confidence evaluation of the SRs was stratified as low for five SRs and critically low for eight SRs. CONCLUSIONS: In an overall low-to-very low confidence levels, short implants appear to perform better in the mid-term (up to 5 years) than standard dental implants associated with vertical bone augmentation regarding MBL and BC, but they have a similar performance regarding IS rates and PC. There is an imperative need to improve the methodological quality of SRs, and efforts should focus on conducting RCTs to broaden the knowledge on this topic. CLINICAL RELEVANCE: Short implants could represent a viable, simpler, and less invasive treatment when available bone height is limited.

Effects of non-surgical periodontal therapy on the cytokine profile in gingival crevicular fluid of breast cancer patients with periodontitis undergoing chemotherapy.

OBJECTIVE: This study evaluated the effect of non-surgical periodontal therapy (NSPT) on the cytokine profile in gingival crevicular fluid (GCF) in patients with breast cancer and periodontitis. METHODS: Forty patients were allocated into the periodontitis group (P) (n = 20) and breast cancer with periodontitis group (BC/P) (n = 20). Two days before the removal of infectious foci from the oral cavity and NSPT, as well as periodontal reevaluations, C-reactive protein, neutrophils (103µL), and platelets (103µL), were evaluated. The following cytokines in GCF, interleukin (IL)-4, IL-10, IL-2, IL-6, IL-1ß, tumor necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ), and transforming growth factor-ß (TGF-ß) were evaluated by the Luminex assay at baseline, and 45 and 180 days after therapy. Cytokine levels were analyzed for correlations with the clinical parameters: clinical attachment level (CAL), probing depth (PD), bleeding on probing (BOP), and plaque index (PI). RESULTS: After NSPT, IL-2, TNF-α, and TGF-ß were downregulated (p<0.05) in the BC/P. In the P group, INF-γ, IL-2, and TNF-α were downregulated (p<0.05), and TGF-ß was increased (p<0.05). At 180 days, IL-6 in GCF was significantly positively correlated with PD and CAL (r=0.45, r=0.56) in the BC/P (p<0.05). In the P group, IL-1ß in GCF was positively correlated with PD and CAL (r=0.56, r=0.59) at 45 days (p<0.05). CONCLUSION: NSPT, before the start of chemotherapy, helps to reduce the inflammatory markers associated with the activity of periodontal disease, favoring a less inflammatory pattern, to avoid the exacerbation of periodontitis.

Specific inhibition of IL-6 receptor attenuates inflammatory bone loss in experimental periodontitis.

BACKGROUND: Periodontal pathogenesis takes into consideration that disease results from a complex inflammatory immune response. Among the major cytokines related to periodontal damage, interleukin (IL)-6 enhances a cascade of tissue destruction. Tocilizumab (TCZ) is a humanized monoclonal anti-human IL-6 receptor that inhibits IL-6-mediated proinflammatory activity. This study aimed to elucidate whether TCZ inhibits the deleterious effect of ligature-induced periodontitis. METHODS: Experimental ligature-induced periodontitis was treated with systemic administration of TCZ intraperitoneally in three different concentration dosages (2 mg/kg, 4 mg/kg, and 8 mg/kg. Euthanasia occurred at 7 and 14 days after the initiation of the study. Local changes in the alveolar bone were measured by bone volume, the ratio of bone volume, and trabecular thickness using microcomputed tomography. Attachment loss and inflammatory infiltrate were evaluated by histology. Immune response was analyzed focusing on the Th17 pattern. RESULTS: TCZ inhibited alveolar bone resorption and attachment loss in 7 and 14 days for all dosage groups in comparison to controls (P  < 0.05). Besides, TCZ induced lower expression of inflammatory infiltrate (P <0.05) and less production of Th17-related cytokines (P <0.05) and RANKL (P <0.05). CONCLUSIONS: The inhibition of IL-6-mediated proinflammatory activity by IL-6R blocking reduced alveolar bone resorption and attachment loss supported by the modulation of the Th17 periodontal response. Considering the inflammatory status, modulatory therapy may be a promising approach to periodontal disease.

Influence of nano-hydroxyapatite coating implants on gene expression of osteogenic markers and micro-CT parameters. An in vivo study in diabetic rats.

This study evaluated the response of a nano-hydroxyapatite coating implant through gene expression analysis (runt-related transcription factor 2 (Runx2), alkaline phosphatase (Alp), osteopontin (Opn), osteocalcin (Oc), receptor activator of nuclear factor-kappa B (Rank), receptor activator of nuclear factor-kappa B ligand (Rank-L), and osteoprotegerin (Opg)). Three-dimensional evaluation (percent bone volume (BV/TV); percent intersection surface (BIC); bone surface/volume ratio (BS/BV); and total porosity (To.Po)) were also analyzed. Mini implants were surgically placed in tibias of both healthy and diabetic rats. The animals were euthanized at 7 and 30 days. Evaluating all factors the relative expression of Rank showed that NANO surface presented the best results at 7 days (diabetic rats). Furthermore the levels of Runx2, Alp, Oc, and Opn suggest an increase in osteoblasts proliferation, especially in early stages of osseointegration. %BIC in healthy and diabetic (7 days) depicted statistically significant differences for NANO group. BV/TV, BS/BV and To.Po demonstrated higher values for NANO group in all evaluated time point and irrespective of systemic condition, but BS/BV 30 days (healthy rat) and 7 and 30 days (diabetic rat). Microtomographic and gene expression analyses have shown the benefits of nano-hydroxyapatite coated implants in promoting new bone formation in diabetic rats.

Root coverage using coronally advanced flap with porcine-derived acellular dermal matrix or subepithelial connective tissue graft: a randomized controlled clinical trial.

OBJECTIVE: The aim of this study is to investigate the use of a porcine-derived acellular dermal matrix (MD) in root coverage procedures combined with extended coronally positioned flap (eCAF), in comparison to the subepithelial connective tissue graft (SCTG) associated with the eCAF. MATERIAL AND METHODS: Eighteen adult patients presenting bilateral type 1 gingival recession were randomly assigned to SCTG or MD groups. Clinical and patient-based outcomes were recorded at 3 and 6 months after the surgical procedure. RESULTS: Both groups showed a significant reduction in the mean recession height of 3.33 ± 0.89 mm to 1.24 ± 1.10 mm (MD) and 3.21 ± 0.8 mm to 0.83 ± 0.86 mm (SCTG) without difference between groups. Six patients in the test group and eight in the control group obtained complete root coverage. The keratinized tissue height and thickness (KTT) showed a significant increase after 3 and 6 months in both groups. The average KTT gains were 0.39 ± 0.4 mm (MD) and 0.51 ± 0.5 mm (SCTG) (p < 0.05). Performing multivariate analysis suggests that MD addition to coronally advanced flaps may be similar to SCTG. CONCLUSION: The MD had similar results in comparison to SCTG and in the context of reducing patient morbidity it can be used as an alternative for the treatment of gingival recessions. CLINICAL RELEVANCE: The SCTG is the gold standard therapy for root coverage. The MD has been widely used in mucogingival surgery as a substitute for SCTG and proposed similar results. A substitute is very important for clinicians and patients. It will give a better postoperative and possibilities to treat multiples recession. (Clinicaltrials.gov Identifier: NCT03675334).

Root coverage of gingival recessions with non-carious cervical lesions: a controlled clinical trial.

OBJECTIVE: The non-carious cervical lesion (NCCL) is commonly produced by improper toothbrushing techniques, occlusion trauma, anatomic mal-positioned teeth, and acid erosion, thus sharing the same etiology of gingival recession (GR). The association of a graft to the coronally advanced flap had demonstrated the best long-term outcome for root coverage (RC). However, substitutes for the autogenous graft must be studied. This split-mouth clinical trial investigates the RC and the increase in keratinized tissue (KT) when comparing RC of NCCLs associated with GR with intact roots using an extended coronally advanced flap (ECAF) associated with the acellular dermal matrix graft (ADMG), a connective tissue replacement graft. MATERIAL AND METHODS: Seventeen individuals with bilateral GR were included in the study. One side had a NCCL (TG) and the opposite root was intact (CG). All patients were treated with the ECDF associated with ADMG. All clinical parameters were assessed at baseline and 6 months postoperative. RESULTS: Root coverage means (CG, 69.5 ± 19 and TG. 72.2 ± 16.5; p value = 0.849570) were not significantly different between control and test groups. In addition, the KT had an increase in the follow-up period for both groups. CONCLUSION: GR associated with NCCLs can be successfully treated with the ECDF and ADMG. CLINICAL RELEVANCE: Patients frequently search for GR treatment due to cervical wear, root sensitivity, and compromising aesthetics. The NCCL participates with the same issues. The present study contributes to the literature that GR associated with NCCLs can be successfully treated with the ECAF and the ADMG.

Periodontal and Dental Considerations in Florid Cemento-Osseous Dysplasia: Clinical and Radiographic Analysis of 11 Cases.

PURPOSE: Florid cemento-osseous dysplasia (COD) is a well-described condition that occurs predominantly in black women. The lesion is usually asymptomatic, but in severe cases, symptoms can occur in association with focal expansion due to infection. The safety of dental procedures that involve areas with florid COD has been little discussed. Therefore, the present study aims to emphasise the importance of nonsurgical periodontal treatment in patients with periodontal diseases and COD. MATERIALS AND METHODS: Four thousand five hundred panoramic radiographs from the image bank of the School of Dentistry of Ribeirão Preto were clinically and radiographically evaluated. RESULTS: Eleven patients had images compatible with florid COD. Eight patients were asymptomatic and three symptomatic. All patients were diagnosed with chronic periodontitis (CP) and their panoramic radiographs showed mixed radiopaque and radiolucent images in the alveolar bone. In symptomatic patients, besides the clinical signs of CP, exposed bone with severe suppuration occurred in the posterior region of the mandible. CONCLUSIONS: The maintenance of systemic and oral health is mandatory to prevent secondary infections, and knowledge about the interface between different dental specialties and florid COD management may prevent erroneous decisions and ensure patient safety, taking into account the dental treatment that can be performed without further complications.

Clinical attachment loss and molecular profile of inflamed sites before treatment.

OBJECTIVE: To monitor early periodontal disease progression and to investigate clinical and molecular profile of inflamed sites by means of crevicular fluid and gingival biopsy analysis. METHODOLOGY: Eighty-one samples of twenty-seven periodontitis subjects and periodontally healthy individuals were collected for the study. Measurements of clinical parameters were recorded at day -15, baseline and 2 months after basic periodontal treatment aiming at monitoring early variations ofthe clinical attachment level. Saliva, crevicular fluid and gingival biopsies were harvested from clinically inflamed and non-inflamed sites from periodontal patients and from control sites of healthy patients for the assessment of IL-10, MMP-8, VEGF, RANKL, OPG and TGF-ß1 protein and gene expression levels. RESULTS: Baseline IL-10 protein levels from inflamed sites were higher in comparison to both non-inflamed and control sites (p<0.05). Higher expression of mRNA for IL-10, RANK-L, OPG, e TGF-ß1 were also observed in inflamed sites at day -15 prior treatment (p<0.05). After the periodontal treatment and the resolution of inflammation, seventeen percent of evaluated sites still showed clinically detectable attachment loss without significant differences in the molecular profile. CONCLUSIONS: Clinical attachment loss is a negative event that may occur even after successful basic periodontal therapy, but it is small and limited to a small percentage of sites. Elevated inflammation markers of inflamed sites from disease patients reduced to the mean levels of those observed in healthy subjects after successful basic periodontal therapy. Significantly elevated both gene and protein levels of IL-10 in inflamed sites prior treatment confirms its modulatory role in the disease status.

Effect of smoking on the DNA methylation pattern of the SOCS1 promoter in epithelial cells from the saliva of patients with chronic periodontitis.

BACKGROUND: The aim of the present study was to evaluate the methylation pattern in the suppressor of cytokine signaling 1 (SOCS1) gene in smokers and non-smokers with chronic periodontitis (CP). METHODS: Methylation-specific polymerase chain reaction (PCR) was performed to determine the methylation status of the SOCS1 promoter in 45 saliva samples from smokers and non-smokers with CP. RESULTS: Cells from the saliva of CP patients who smoked were 7.08 times more likely to have a methylated SOCS1 promoter than cells from the saliva of non-smoking patients. CONCLUSIONS: SOCS1 gene promoter methylation, with its potential effects on the expression of this gene, seems to be a consequence of exposure to tobacco and not to periodontal disease. Further studies are needed to elucidate the relationship between the epigenetic control of immune response gene expression, exposure to environmental factors, and the development, progression, and prognosis of CP.

Sub-antimicrobial doses of doxycycline decreased bone loss related to ligature-induced periodontitis in hypertensive rats.

BACKGROUND/OBJECTIVE: The beneficial effects of sub-antimicrobial dose doxycycline (SDD) associated with nonsurgical periodontal therapy are well documented. Recently, the effects of SDD on metalloproteinases have been investigated in the treatment of hypertension. The aim of this study was to evaluate the effects of SDD on ligature-induced periodontitis in spontaneously hypertensive rats (SHR). METHODS: Fifty-four adult male rats were divided into three groups: SHR-C, SHR-L and SHR-L-DOX (C - Control; L - Ligature). In group SHR-L-DOX, animals were treated with daily 5 mg/kg SDD administration. In L groups, a ligature remained around mandibular first molars for the first 10 days. Each group was divided for euthanasia at 10 or 21 days. Microtomographic and histometric analyses were performed. Osteoclastogenesis was evaluated by tartrate-resistant acid phosphatase (TRAP) assay and gene expression of 84 inflammatory mediators by polymerase chain reaction (PCR) array. RESULTS: Group SHR-L-DOX presented reduced systolic blood pressure when compared with group SHR-L at both 10 and 21 days (p < 0.05). Group SHR-L-DOX showed decreased bone and attachment loss in comparison with group SHR-L at both 10 and 21 days (p < 0.05). SDD treatment reduced the amount of TRAP-positive cells at 10 days (p < 0.05). Group SHR-L-DOX showed a downregulated inflammatory genes profile in comparison with SHR-L at 10 and 21 days. CONCLUSION: SDD therapy exerted systemic modulatory effect on inflammation with reduced periodontal tissue destruction in hypertensive rats.

Effects of non-surgical periodontal therapy on clinical and immunological profile and oral colonization of Candida spp in HIV-infected patients with chronic periodontitis.

BACKGROUND: After the introduction of antiretroviral therapy (ART), human immunodeficiency virus (HIV) infection has become a chronic controllable disease. For this reason, chronic conditions related to both HIV infection and senescence, such as chronic periodontitis (CP) need to be studied. This study investigated the impact of non-surgical periodontal therapy (NSPT) on clinical and immunological features of CP, and on oral colonization by Candida spp. in HIV-infected and non-HIV-infected individuals. METHODS: HIV-infected (test group) and non-HIV-infected (control group) adults patients with CP were selected. Gingival bleeding index (GI), probing depth (PD), clinical attachment level (CAL), number of teeth, CD4+ T lymphocytes and viral load (only for HIV-infected individuals), salivary cytokines (interleukin, [IL]-6, IL-8, and tumoral necrosis factor-alpha [TNF-α]), and oral Candida infection (colony forming units and species) were assessed at baseline, and 30 and 90 days after NSPT. RESULTS: Twenty-two HIV-infected patients and 20 non-HIV-infected patients were evaluated. Candida counts and salivary IL-6, IL-8, and TNF-a levels were higher in the test group than in the control group. Both groups showed a decrease in oral Candida counts, GI, PD, IL-6, and IL-8 as well as gain in CAL at 30 and 90 days after NSPT. In addition, patients in the test group showed an increase of CD4+ T lymphocytes and a decrease of viral load. CONCLUSION: NSPT had a beneficial impact on clinical and immunological parameters of CP, reduction of oral Candida counts, and improvement of HIV-infection status.

Antimicrobial photodynamic therapy as adjunct to non-surgical periodontal treatment in smokers: a randomized clinical trial.

OBJECTIVES: This study aims to investigate the additional influence of multiple applications of antimicrobial photodynamic therapy (aPDT) in smokers with chronic periodontitis. MATERIALS AND METHODS: Twenty smokers with chronic periodontitis were treated in a split-mouth design study with aPDT adjunct to Scaling and Root Planing (SRP) or SRP. aPDT was performed by using a laser light source with 660 nm wavelength associated with a photosensitizer. The applications were performed in four episodes (at days 0, 2, 7, and 14). All patients were monitored for 90 days. Plaque index, probing depth, clinical attachment level, and bleeding on probing were performed at baseline, 30, and 90 days after the SRP. Gingival crevicular fluid and subgingival plaque samples were collected for immunological and microbiological analysis, respectively. Data obtained were statistically analyzed. RESULTS: aPDT as an adjunct to SRP did not demonstrate statistically significant advantages on clinical parameters when compared with SRP alone. No statistic significant differences between groups were observed (p < 0.05). Levels of anti-inflammatory cytokines and bacterial species were comparable in both groups at day 90 after treatment. CONCLUSION: Periodontal treatment with SRP + aPDT in multiples episodes was not able to promote additional clinical, immunological, and microbiological benefits in smokers when compared SRP alone in patients with chronic periodontitis. CLINICAL RELEVANCE: Multiple episodes of aPDT adjunctive to non-surgical treatment did not improve significantly the clinical, immunological, and microbiological parameters when compared with SRP alone. More randomized clinical trials are needed to evaluate adjuvant therapies for scaling and root planning in smokers with chronic periodontitis. ClinicalTrials.gov Identifier: NCT03039244.

Multiple sessions of antimicrobial photodynamic therapy associated with surgical periodontal treatment in patients with chronic periodontitis.

BACKGROUND: This double-blind, randomized, controlled clinical trial assessed the efficacy of multiple sessions of antimicrobial photodynamic therapy (aPDT) as an adjunct to surgical periodontal treatment (ST) in patients with severe chronic periodontitis (SCP). METHODS: Sixteen patients with SCP were treated with aPDT+ST (test group, TG) or ST only (control group, CG), in a split-mouth design. aPDT was applied at 0, 2, 7, and 14 postoperative days only in TG. All patients were followed up for 90 days after surgery. The following clinical and microbiological parameters were assessed: clinical attachment level (CAL), probing depth (PD), gingival recession (GR), bleeding on probing (BOP), plaque index (PI), and count of 40 subgingival microbial species (checkerboard DNA-DNA hybridization). Data were collected at baseline (preintervention), at 60 days (30 days after the end of non-surgical therapy), and at 150 days (90 days after surgery). RESULTS: A significant reduction in PD was observed at 150 days for the TG, when compared with the CG (P Ë‚ 0.05). CAL gain was significantly higher in the TG at 60 and 150 days (P Ë‚ 0.05). Changes in the subgingival microbiota were similar between the groups (P Ëƒ 0.05), but the TG revealed a larger number of bacteria associated with periodontal disease at the end of the experiment compared with the CG (P < 0.05). CONCLUSION: Multiple sessions of aPDT as an adjunct to surgical periodontal treatment significantly improved clinical parameters at 90 postoperative days.

Effects of Bifidobacterium probiotic on the treatment of chronic periodontitis: A randomized clinical trial.

AIM: This randomized placebo-controlled clinical trial evaluated the effect of Bifidobacterium animalis subsp. lactis (B. lactis) HN019-containing probiotic lozenges as adjuvant to scaling and root planing (SRP) in patients with generalized chronic periodontitis. MATERIALS AND METHODS: Forty-one chronic periodontitis patients were recruited and monitored clinically, immunologically, and microbiologically at baseline (before SRP) and 30 and 90 days after SRP. All patients were randomly assigned to a Test (SRP + Probiotic, n = 20) or Control (SRP + Placebo, n = 21) group. The probiotic lozenges were used twice a day for 30 days. The data were statistically analysed. RESULTS: The Test group presented a decrease in probing pocket depth and a clinical attachment gain significantly higher than those of the Control group at 90 days. The Test group also demonstrated significantly fewer periodontal pathogens of red and orange complexes, as well as lower proinflammatory cytokine levels when compared to the Control group. Only the Test group showed an increase in the number of B. lactis HN019 DNA copies on subgingival biofilm at 30 and 90 days. CONCLUSION: The use of B. lactis HN019 as an adjunct to SRP promotes additional clinical, microbiological, and immunological benefits in the treatment of chronic periodontitis (NCT03408548).

Evaluation of a bone substitute covered with a collagen membrane for ridge preservation after tooth extraction. Clinical and tomographic randomized controlled study in humans.

OBJECTIVE: To evaluate the use of a synthetic bone substitute covered with a collagen membrane for ridge preservation after tooth extraction, by clinical and tomographic analysis. MATERIAL AND METHODS: Fifteen patients, presenting at least two maxillary anterior teeth indicated for extraction, were selected: in the test group (TG), post-extraction sockets were filled by a synthetic bone substitute; in the control group (CG), by blood clot. In both groups, the sockets were covered by a collagen membrane. Cone-beam computerized tomography (CBCT) scans were acquired immediately after and 6 months post-surgically, and horizontal and vertical dimensional bone changes were quantified. RESULTS: Transurgical clinical analysis presented no statistically significant differences between TG and CG (p > .05). CBCT intragroup evaluation presented statistically significant reduction for the buccal alveolar measurement (TG = 1.58 mm or 21.82%, and CG = 1.66 mm or 24.08%) and horizontal cervical measurement (TG = 0.55 mm or 8.30% and CG = 1.30 mm or 17.68%), and not significant for palatal alveolar measurement (TG = 0.44 mm or 3.42% and CG = 0.26 mm or 3.89%). For alveolar height and horizontal apical measurements, this decrease was significant only for the CG, with reductions of 1.03 mm and 0.50 mm, respectively, compared to a decrease of 0.57 mm and 0.19 mm for the TG. The intergroup analysis showed significant difference for cervical horizontal measurement after 6 months (p < .05). CONCLUSION: The results showed that the use of the bone substitute covered with a collagen membrane resulted in less changes in vertical and horizontal alveolar ridge dimensions than the collagen membrane alone.

Relationship between human immunodeficiency virus (HIV-1) infection and chronic periodontitis.

INTRODUCTION: Current studies show that, even in the era of antiretroviral therapies, HIV-1 infection is associated with more severe and frequent refractory chronic periodontitis. Areas covered: This review, based on a systematic analysis of the literature, intends to provide an update on factors that may be involved in the pathogenesis of periodontal disease in HIV-1-infected patients, including local immunosuppression, oral microbial factors, systemic inflammation, salivary markers, and the role of gingival tissue as a possible reservoir of HIV-1. Expert commentary: The therapeutic revolution of ART made HIV-1 infection a chronic controllable disease, reduced HIV-1 mortality rate, restored at least partially the immune response and dramatically increased life expectancy of HIV-1-infected patients. Despite all these positive aspects, chronic periodontitis assumes an important role in the HIV-1 infection status for activating systemic inflammation favoring viral replication and influencing HIV-1 status, and also acting as a possible reservoir of HIV-1. All these issues still need to be clarified and validated, but have important clinical implications that certainly will benefit the diagnosis and management of chronic periodontitis in HIV-1-infected patients, and also contributes to HIV-1 eradication.

Local administration of Tiludronic Acid downregulates important mediators involved in periodontal tissue destruction in experimental periodontitis in rats.

OBJECTIVE: The purpose of this study was to evaluate whether local administration of TIL could influence the expression of the inflammatory mediators IL-1ß, TNF-α, MMP-8 and COX-2 in rats with experimental periodontitis (EP). METHODS: Twenty-four adult male rats (Rattus norvegicus, albinus, Wistar) were assigned to groups C, EP, EP-TIL (CControl group, EP-Periodontitis groups). On EP groups, a ligature was placed around maxillary 2nd molars on day 1. On group EP-TIL, 20 µL of TIL solution (1 mg/kg body weight) was injected into the subperiosteal palatal area adjacent to the maxillary 2nd molar every other day until euthanasia (day 11). Alveolar bone loss was morphometrically analyzed. mRNA expressions of IL-1ß, TNF-α, MMP-8 and COX-2 were assessed by qPCR. IL-1ß, TNF-α, MMP-8 and COX-2 were immunohistochemically analyzed. Data were analyzed statistically. RESULTS: Group EP-TIL presented reduced alveolar bone loss when compared with group EP (p < 0.05). Group EP-TIL presented decreased mRNA expressions of IL-1ß, TNF-α, MMP-8 and COX-2 and reduced immunolabeling of IL-1ß, TNF-α and MMP-8 when compared with group EP (p < 0.05). No differences regarding the immunolabeling of COX-2 were found when group EP-TIL was compared with the other groups (p > 0.05). CONCLUSION: Within the limits of this study, it can be concluded that local administration of TIL downregulates important mediators involved in periodontal tissue destruction in ligature-induced periodontitis in rats.

Effect of surgical periodontal treatment associated to antimicrobial photodynamic therapy on chronic periodontitis: A randomized controlled clinical trial.

AIM: This randomized controlled clinical trial evaluated the effects of an adjunctive single application of antimicrobial photodynamic therapy (aPDT) in Surgical Periodontal Treatment (ST) in patients with severe chronic periodontitis (SCP). MATERIAL AND METHODS: In a split-mouth design, 20 patients with SCP were treated with aPDT+ST (Test Group, TG) or ST only (Control Group, CG). aPDT was applied in a single episode, using a diode laser and a phenothiazine photosensitizer. All patients were monitored until 90 days after surgical therapy. Levels of 40 subgingival species were measured by checkerboard DNA-DNA hybridization at baseline, 60 and 150 days. Clinical and microbiological parameters were evaluated. RESULTS: In deep periodontal pockets depth (PPD ≥5 mm), Test Group presented a significantly higher decrease in PPD than Control Group at 90 days after surgical therapy (p < .05). Test Group also demonstrated significantly less periodontal pathogens of red complex (Treponema denticola) (p < .05). CONCLUSION: A single episode of aPDT used in adjunct to open flap debridement of the root surface in the surgical treatment of SCP: i) significantly improved clinical periodontal parameters; ii) eliminates periodontal pathogens of the red complex more effectively (NCT02734784).