Influence of obesity on experimental periodontitis in rats: histopathological, histometric and immunohistochemical study.

OBJECTIVES: This study assessed the influence of obesity on the progression of ligature-induced periodontitis in rats. MATERIALS AND METHODS: Forty-eight adult Wistar rats were randomly divided into two groups: the HL group (n = 24) was fed high-fat animal food to induce obesity, and the NL group (n = 24) was fed normolipidic animal food. Obesity was induced within a period of 120 days, and the induction of experimental periodontitis (EP) was subsequently performed for 30 days. The animals were euthanized after 7, 15, and 30 days, and the jaws were removed for histopathological, histometric, and immunohistochemical analyses. Tartrate-resistant acid phosphatase (TRAP), receptor activator of nuclear factor kappa beta ligand (RANKL), and osteoprotegerin (OPG) were analyzed via immunolabeling. RESULTS: Histological findings indicated that the inflammation was more extensive and lasted longer in the HL/EP; however, advanced destruction also occurred in the NL/EP. Greater bone loss was verified in the HL/EP group (2.28 ± 0.35) in the period of 7 days than in the NL/EP group (1.2 ± 0.29). High immunolabeling was identified in the HL/EP group in the initial periods for RANKL and TRAP, whereas the NL/EP group presented with moderate immunolabeling for both factors. The HL/EP and NL/EP groups showed low immunolabeling for OPG. CONCLUSIONS: Obesity induced by a high-fat diet influenced alveolar bone metabolism when associated with experimental periodontitis and caused a more severe local inflammatory response and alveolar bone loss. CLINICAL RELEVANCE: Obesity is related to greater alveolar bone loss and an accentuated local inflammatory response, which may be reflected in the clinical severity of periodontitis and dental loss.

Periodontal Disease and Body Weight Assessment in Children.

PURPOSE: The purpose of this study was to assess body weight and periodontal disease development in obese and normal weight children. METHODS: Eighty-eight 5- to 10-year-old children participated in this study. Periodontal measurements included the visible plaque index (VPI), community periodontal index (CPI), and bleeding on probing (BOP). Complete periodontal examinations were performed in some children with CPI codes three and four. Anthropometric examination consisted of body mass index (BMI, kg/m2), which was adjusted by age according to percentiles. The groups were divided into children of normal weight (N=43, BMI less than 85 per age) and obese children (N=45, BMI greater than 97 per age). RESULTS: The results showed that the obesity group showed significant proportions of CPI codes one (44.2%) and three (7.4%), when compared with normal weight subjects (P<0.05). VPI was similar between both groups (P>0.05). BOP was higher in obese patients than in children with normal weight (P<0.05). CPI zero was more prevalent in normal weight subjects (62.6%, P<0.05). CONCLUSION: Obese children seem to be more susceptible to periodontal disease.

Framingham cardiovascular risk in patients with obesity and periodontitis.

BACKGROUND: Obesity is a chronic inflammatory condition that has been associated to a risk factor for the development of periodontitis and cardiovascular disease; however, the relationship still needs to be clarified. The objective of this study was to evaluate the cardiovascular risk in obese patients with chronic periodontitis. MATERIALS AND METHODS: A total of 87 obese patients were evaluated for anthropometric data (body mass index [BMI], waist circumference, body fat), systolic blood pressure (SBP) and diastolic blood pressure (DBP), cholesterol, high-density lipoprotein (HDL) and low-density lipoprotein (LDL), triglycerides, glycemia and periodontal parameters (visible plaque index (VPI), gingival bleeding index (GBI), bleeding on probing (BOP), periodontal probing depth (PPD) and clinical attachment level (CAL)). RESULTS: PATIENTS WERE DIVIDED INTO TWO GROUPS ACCORDING TO THE PERIODONTAL CHARACTERISTICS FOUND: Group O-PD: Obese patients with chronic periodontitis (n = 45), 22 men and 23 women; and Group O-sPD: Obese patients without chronic periodontitis (n = 42), 17 men and 25 women. Patients had a BMI mean of 35.2 (±5.1) kg/m(2) . Group O-PD showed a similarity between the genders regarding age, SBP, DBP, cholesterol, HDL, GBI, VPI, PPD ≥4 mm and CAL ≥4 mm. O-PD women showed greater glycemia level and smoking occurrence, but O-PD men presented a 13% - risk over of developing coronary artery disease in 10 years than O-PD women, 9% - risk over than O-sPD men and 15% - risk over than O-sPD women, by the Framingham Score. CONCLUSIONS: It was concluded that obesity and periodontal disease are cardiovascular risk factors and that the two associated inflammatory conditions potentially increases the risk for heart diseases.

Prevalence of Periodontal Bone Loss in Brazilian Adolescents through Interproximal Radiography.

Purpose. The aim of this study was to verify the prevalence of alveolar bone loss in Brazilian adolescents through the interproximal X-rays analysis. Methods. Bilateral and standardized interproximal (bitewing) X-rays were performed in 15-year-old adolescents (n = 326), and the processing of films and measurements of alveolar bone levels were accomplished by a single examiner. A distance between the cementoenamel junction (CEJ) and the alveolar bone crest more than 2 mm was considered as periodontal bone loss. Results. The results showed percentage of bone loss of 10.4% with predominance of horizontal defects (8.9%) over the vertical types (1.5%). It was verified higher individual distribution of one lesion (67.6%) than two (26.5%) or three lesions (5.6%), and higher occurrence was detected in men (14.95) than in women (8.21). Conclusion. It can be concluded that the interproximal radiography was an efficient method for the detection of alveolar bone loss, revealing low prevalence in adolescents and predominance of horizontal bone defects.

Histopathological features of dental pulp in teeth with different levels of chronic periodontitis severity.

Purpose. To evaluate the histopathological condition of the pulp in teeth with different levels of chronic periodontitis in humans. Methods. Twenty-five single-root nondecayed teeth were divided into three groups as follows: group 1, clinical attachment level (CAL) 3 to 4 mm and alveolar bone loss (BL) from 4 to 6 mm without reaching the tooth apex; group 2, CAL ≥ 5 mm and BL > 6 mm without reaching the tooth apex; group 3, CAL ≥ 5 mm and BL > 6 mm up to the tooth apex. Histological analyses were accomplished after laboratorial processing. Results. The mean of CAL was 3.2 ± 0.7 mm in group 1, 7.6 ± 2.0 mm in group 2, and 12.1 ± 2.8 mm in group 3, while for BL it was 4.8 ± 0.9 mm, 7.6 ± 2.2 mm, and 11.9 ± 2.1 mm, respectively. Histopathological data in the pulpal chambers were similar among the three groups showing normal aspects, and, the radicular pulps showed variable levels of reactive dentin, fibrosis, dystrophic mineralizations, atrophy, and mononuclear inflammatory infiltrate. Conclusions. Gradual progression of the chronic periodontitis led to changes in the histopathological aspects of the radicular pulp with progressive involvement.

Clinical and microbiological effects of photodynamic therapy associated with nonsurgical periodontal treatment. A 6-month follow-up.

Experimental studies in animals and in vitro have shown the usefulness of photodynamic therapy (PDT) as an adjunct to periodontal treatment. The aim of this study was to evaluate the long-term clinical and microbiological effects of PDT associated with nonsurgical periodontal treatment. Three sites in each of 33 patients with chronic periodontitis were randomly allocated in a split-mouth design to a treatment group: (1) scaling and root planing (SRP group); (2) SRP and irrigation with toluidine blue O (TBO group); and (3) SRP, irrigation with TBO and low-level laser irradiation (PDT group). Clinical parameters including visible plaque index, bleeding gingival index, bleeding on probing, probing depth, gingival recession and clinical attachment level were measured at baseline, and after 60, 90 and 180 days. Additionally, subgingival plaque samples were collected for microbiological analysis by PCR. Intergroup and intragroup statistical analyses were performed. All treatment groups showed an improvement in all clinical parameters, and a significant reduction in the proportion of sites positive for periodontopathogens at 60, 90 and 180 days compared to baseline (p < 0.05). None of the periodontal parameters showed a significant difference among the groups (p > 0.05). At 180 days, PDT treatment led to a significant reduction in the percentage of sites positive for all bacteria compared to SRP alone (p < 0.05). Within the limits of this study it may be concluded that PDT as an adjunct to periodontal treatment produced statistically significant reductions in some of the key periodontal pathogens but produced no statistically significant benefit in terms of clinical outcome.

Summers' technique modification for sinus floor elevation using a connective tissue graft. A case report.

The sinus floor elevation technique with Summers' osteotome is simpler and less invasive than access through the lateral wall of the sinus; however, it is susceptible to a higher level of sinusal membrane rupture. The objective of the present study was to display a modification of the osteotomy technique by connective tissue interposition in order to weaken the impact of sinus cortical fracture, and therefore prevent perforations in the sinusal membrane. A case is reported in which a patient presented with an absent tooth #4 for osseointegrated implant rehabilitation. Maxillary sinus elevation was required to perform the procedure. Initially, the flap was raised and the receptor site was prepared with a sequence of burs, without disrupting cortical bone. In order to weaken the fracture impact with the osteotome, a connective tissue graft was interposed to allow access to the sinus. Clinically, a satisfactory primary locking was obtained with torque greater than 50 Ncm. Through radiographic evaluation, good bone filling was observed immediately after surgery, with maxillary sinus wall elevation without membrane rupture. Two years after the initial procedure, a 5.3 mm increase in bone extension formed in contact with implant distal surface was observed. Thus, the osteotomy technique modification with connective tissue interposition was successful, both clinically and radiographically, showing an image suggesting long-term osseous formation.

Effect of induced diabetes mellitus on alveolar bone loss after 30 days of ligature-induced periodontal disease.

Several studies have shown that diabetics are more susceptible to the development of severe periodontal disease. Currently, the use of animal models can be considered a feasible alternative in radiographic assessments of these two pathologies. The purpose of this radiographic study was to evaluate the effect of induced diabetes mellitus on alveolar bone loss after 30 days of ligature-induced periodontal disease. Sixty-four Wistar rats were randomly distributed into four experimental groups. Diabetes was induced in Groups II and IV, while periodontal disease was induced in Groups III and IV; Group I was used as control. In order to perform the radiographic assessment of the specimens, the rats were killed on the 3rd and 30th days of the study. Radiographic measurements were assessed with ANOVA and Tukey's test to determine statistically significant differences (p < 0.05). It was observed that Groups III and IV featured greater bone loss when compared to Groups I and II. Only the diabetic group with periodontal disease (Group IV) featured statistically significant greater bone loss when compared to the other groups. These results suggested that the alveolar bone loss resulting from the periodontal disease installation is greater when associated to the diabetes mellitus.

Prevalence and features of palato-radicular grooves: an in-vitro study.

The presence of a morphological defect called a palato-radicular groove (PRG) is considered to be an important contributing factor to the development of localized chronic periodontitis, for it favors the accumulation and proliferation of bacterial plaque deep into the periodontium. This anomaly affects maxillary incisors, especially lateral incisors. The prevalence and different morphologic conditions of the PRG were evaluated in 376 maxillary lateral and central incisors. The teeth were evaluated by a single examiner, considering their presence, localization, origin of formation, extension and depth in millimeters, using a magnifying glass, a precision pachymeter and a millimeter-scaled periodontal probe. Results showed a higher prevalence in lateral incisors (11.1%), with higher prevalence in proximal localization (62.8%), origination from central fossa (57.1%) and predominance in oblique trajectory (62.8%). Of all these teeth, only 8.6% of PRGs reached the root apex, while 97.1% were considered as flat (< 1 mm). Thus, in the presence of a PRG, periodontal pathologic conditions could be more severe in proximal faces, reaching in a few cases the tooth apex and the pulp canal.

Root trunk height as a risk factor for periodontal furcation involvement in maxillary first molars: an in vitro study.

The aim of this study was to correlate the root trunk height from the furcation openings on the buccal, mesial and distal surfaces to the cemento-enamel junction in upper first permanent molars in human beings with risk for periodontal disease progression. One hundred extracted maxillary first molars were used. Reference points and demarcations were determined from the entrance of the buccal (F1), mesial (F2) and distal (F3) furcations to the cemento-enamel junction in millimeters. The mean distances found were 3.50 mm, 4.44 mm and 4.26 mm for the buccal, mesial and distal furcations, respectively, in relation to the cemento-enamel junction. The statistical analyses were Student's t-test and Chi-square (X2). With periodontal disease progression, the buccal furcation presents a greater compromising risk due to its proximity to the cemento-enamel junction, while the mesial furcation is the most distant, comprising a lesser risk.

Relationship between gingival clinical parameters and the reactivity of the BANA test in subgingival samples from children.

Gingivitis is the first manifestation of periodontal disease, and is characterized by painless and slow evolution. Early diagnosis and intervention must be done to avoid the possibility of precocious periodontitis during the childhood or teenage years. The enzymatic BANA test (N-benzoyl-DL-arginine-naphthylamide) was used to evaluate subgingival samples from 54 children between 6 and 9 years of age. Plaque index (PI) and gingival index (GI) were assessed according to the criteria recommended by Löe (1967). Subgingival plaque was collected from the region that featured the greatest periodontal alteration, represented by a higher gingival index. Resulting data were grouped individually according to visible and non-visible plaque and bleeding and non-bleeding gingiva. Results showed that there was no statistically significant correlation between the presence of visible plaque and the positivity of the BANA test, nor was there a statistically significant correlation between the presence of bleeding and the positivity of the BANA test in subgingival samples obtained from children. This study concluded that the BANA test is not an ideal diagnostic test to be applied to children.

Biometric analysis of the maxillary permanent molar teeth and its relation to furcation involvement.

A high rate of root exposure and consequently the exposure of the furcation area is usually observed in multirooted teeth. In maxillary molar teeth, this fact may endanger the three existent furcations (buccal, mesial and distal), causing serious problems. In this research, distance measures from the buccal furcation to the mesial (F1M) and distal (F1D) surfaces of the mesio-buccal and disto-buccal roots; from the mesial furcation to the buccal (F2B) and palatal (F2P) surfaces of the mesio-buccal and palatal roots and from the distal furcation to the buccal (F3B) and palatal (F3P) surfaces of the disto-buccal and palatal roots, respectively were established. One hundred maxillary first molar teeth were used, 50 of the right and 50 of the left side. Reference marks and demarcations were determined on the furcations and also on the root surfaces involved in the measures. We concluded that these measurements are important because they may effectivelly contribute to diagnosis, prevention and treatment of periodontal problems.

Reliability of bleeding and non-bleeding on probing to gingival histological features.

Given the extensive use in periodontal diagnosis of the clinical sign of bleeding on probing, the reliability of the technique in relation to gingival histological features and the need for a better understanding of its significance was investigated. Bleeding (B) and non-bleeding (NB) buccal gingival tissues, were measured through manual probing during gingivectomy procedures. The histological evidence of inflammation was used as the gold standard. The established histological descriptive patterns showed statistically significant differences between B and NB sites (chi2 = 20.842, p < 0.05). The reliability scores were found to be of high sensitivity (90.9%) and negative predictive value (89.5%) as well as of fair specificity (77.3%) and positive predictive value (80%). The accuracy was found to be 84.1%. The histological quantitative analysis showed no statistically significant difference for any HGI (Histological Gingival Index). B sites presented HGI = 1 in 72.8%, close to the NB sites, which showed 63.4% for the same histological score. Furthermore, Pearson's analysis showed a low correlation between the studied clinical signs and the histological quantitative analysis (r = 0.265, p > 0.05). We conclude that the clinical parameter of bleeding on probing is a reliable tool for diagnosing gingival inflammation, whereas the clinical sign of non-bleeding on probing is not a safe criteria for evaluating gingival health.