RESUMO
Introduction: The pathological teeth migrations require correct multidisciplinary treatment which consists of periodontal surgery associated with early or late orthodontic treatment. The aim of this study was to know which of the two orthodontic treatments would have a better periodontal response. Material and Method: Two parameters, radiological (the height of the alveolar bone) and clinical (the depth of the periodontal pocket), were used to meet the objective of this work. Eighteen patients received early orthodontic treatment (straight wire appliance) after periodontal flap debridement surgery and eighteen others late orthodontic treatment (straight wire appliance). Results: The results showed the absence of significant difference between the two early and late orthodontic treatments after periodontal flap debridement surgery. Conclusion: Orthodontic treatment can be started early seven to ten days after periodontal surgery.
Introduction: Les migrations dentaires pathologiques exigent un traitement pluridisciplinaire correct qui consiste en une chirurgie parodontale associée à un traitement orthodontique précoce ou tardif. Le but de cette étude était de connaître lequel des deux traitements orthodontiques aurait une meilleure réponse parodontale. Matériel et méthode: Deux paramètres, radiologique (la hauteur du défaut osseux) et clinique (la profondeur de la poche parodontale), ont été utilisés afin de répondre à l'objectif de ce travail. Dix-huit patients ont reçu, après la chirurgie parodontale par un lambeau d'assainissement, un traitement orthodontique précoce (technique d'arc droit) et dix-huit autres un traitement orthodontique tardif (technique d'arc droit). Résultats: Les résultats ont montré l'absence de différence significative entre les deux traitements orthodontiques, précoce et tardif, après la chirurgie parodontale par un lambeau d'assainissement. Conclusion: Le traitement orthodontique peut débuter précocement dès sept à dix jours après la chirurgie parodontale.
Assuntos
Migração de Dente , Humanos , Feminino , Masculino , Adulto , Migração de Dente/etiologia , Migração de Dente/terapia , Fatores de Tempo , Perda do Osso Alveolar/etiologia , Retalhos Cirúrgicos/cirurgia , Pessoa de Meia-Idade , Desbridamento Periodontal/métodos , Ortodontia Corretiva/métodos , Adulto Jovem , Bolsa Periodontal/cirurgia , Bolsa Periodontal/etiologiaRESUMO
Periodontal mechanical debridement is the most common therapy for the treatment of periodontitis. However, depending on the severity of the disease, mechanical debridement has been recommended in combination with systemic antibiotics. In this study, we performed an overview of systematic reviews using the Friendly Summaries of Body of Evidence using Epistemonikos (FRISBEE) methodology on the effectiveness and safety of mechanical debridement combined with amoxicillin and metronidazole compared to mechanical debridement alone for the treatment of chronic periodontitis. We conducted a systematic search of the Epistemonikos database, extracted data from 10 systematic reviews and re-analyzed data from 23 primary studies to generate a summary of findings (SoF) table. We used RevMan 5.3 and GRADEpro for data analysis and data presentation. The following outcomes were analyzed: probing depth (mean difference (MD): 0.07 mm); clinical attachment level (MD: 0.04 mm); bleeding on probing (MD: 5.06%); and suppuration (MD: 0.31%). There was no evidence of a clinically relevant benefit of periodontal mechanical debridement therapy combined with amoxicillin and metronidazole compared to periodontal mechanical debridement therapy alone for the treatment of chronic periodontitis in the studied periodontal outcomes.
Assuntos
Amoxicilina , Antibacterianos , Periodontite Crônica , Metronidazol , Desbridamento Periodontal , Humanos , Amoxicilina/uso terapêutico , Amoxicilina/administração & dosagem , Antibacterianos/uso terapêutico , Periodontite Crônica/terapia , Periodontite Crônica/tratamento farmacológico , Terapia Combinada , Metronidazol/uso terapêutico , Metronidazol/administração & dosagem , Desbridamento Periodontal/métodosRESUMO
PURPOSE: This study investigated the magnitude, direction, and temporal aspects of the force applied during instrumentation with a piezoelectric ultrasonic periodontal scaler, compared this force with recommendations in the literature, and assessed the influence of the profession (dentist or dental hygienist) and calculus hardness. MATERIALS AND METHODS: The force applied by ten dental hygienists and six dentists during debridement of comparatively soft and hard artificial dental calculus with a piezoelectric ultrasonic scaler was recorded in-vitro. The total force and its components in three axes were statistically analysed. RESULTS: During debridement of soft artificial dental calculus, the mean total force applied by dental hygienists was 0.34 N (± 0.18 N, range: 0.13 N to 0.59 N) and by dentists 0.28 N (± 0.33 N, range: 0.06 N to 0.95 N), and the total force exceeded 0.5 N approximately 23% and 14% of the time for dental hygienists and dentists, respectively. During debridement of hard artificial dental calculus, the mean total force applied by dental hygienists was 0.63 N (± 0.40 N, range: 0.28 N to 1.64 N) and by dentists 0.57 N (± 0.17 N, range: 0.34 N to 0.76 N); the total force exceeded 0.5 N more than half of the time for both professions. On average, dental hygienists applied 1.85x (p = 0.04) and dentists 2.04x (p = 0.06) higher force on hard than on soft artificial calculus. However, dental hygienists and dentists used similar forces during the debridement of both hard (p = 1.00) and soft (p = 0.26) calculus. CONCLUSION: The force applied during the debridement of hard artificial dental calculus was statistically significantly higher than during the debridement of soft artificial dental calculus. No statistically significant difference between dentists and dental hygienists was found. The force applied by both groups on soft and hard artificial dental calculus frequently exceeded recommended values.
Assuntos
Cálculos Dentários , Higienistas Dentários , Raspagem Dentária , Desbridamento Periodontal , Cálculos Dentários/terapia , Humanos , Raspagem Dentária/instrumentação , Desbridamento Periodontal/métodos , Desbridamento Periodontal/instrumentação , Odontólogos , Dureza , Técnicas In Vitro , Terapia por Ultrassom/instrumentaçãoRESUMO
Background and Objectives: This randomized, double-arm, multicentric clinical trial aims to compare the clinical outcomes following the treatment of suprabony periodontal defects using open flap debridement (OFD) with or without the application of hyaluronic acid (HA). Materials and Methods: Sixty systemically healthy patients with at least two teeth presenting suprabony periodontal defects were randomly assigned with a 1:1 allocation ratio using computer-generated tables into a test (OFD + HA) or control group (OFD). The main outcome variable was clinical attachment level (CAL). The secondary outcome variables were changes in mean probing pocket depth (PPD), gingival recession (GR), full-mouth plaque score (FMPS), and full-mouth bleeding score (FMBS). All clinical measurements were carried out at baseline and 12 months. Results: Sixty patients, thirty in each group, were available for statistical analysis. The mean CAL gain was statistically significantly different (p < 0.001) in the test group compared with the control group (3.06 ± 1.13 mm vs. 1.44 ± 1.07 mm). PPD reduction of test group measurements (3.28 ± 1.14 mm) versus the control group measurements (2.61 ± 1.22 mm) were statistically significant (p = 0.032). GR changes were statistically significant only in the test group 0.74 ± 1.03 mm (p < 0.001). FMBS and FMPS revealed a statistically significant improvement mostly in the test group. Conclusions: Suprabony periodontal defects could benefit from the additional application of HA in conjunction with OFD in terms of improvement of the clinical parameters compared with OFD alone.
Assuntos
Desbridamento , Ácido Hialurônico , Retalhos Cirúrgicos , Humanos , Ácido Hialurônico/uso terapêutico , Ácido Hialurônico/administração & dosagem , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Desbridamento/métodos , Resultado do Tratamento , Cicatrização/efeitos dos fármacos , Retração Gengival/cirurgia , Desbridamento Periodontal/métodosRESUMO
PURPOSE: To investigate the microbiological outcomes obtained with either subgingival debridement (SD) in conjunction with a gel containing sodium hypochlorite and amino acids followed by subsequent application of a cross-linked hyaluronic acid gel (xHyA) gel, or with SD alone. MATERIALS AND METHODS: Forty-eight patients diagnosed with stages II-III (grades A/B) generalised periodontitis were randomly treated with either SD (control) or SD plus adjunctive sodium hypochlorite/amino acids and xHyA gel (test). Subgingival plaque samples were collected from the deepest site per quadrant in each patient at baseline and after 3 and 6 months. Pooled sample analysis was performed using a multiplex polymerase chain reaction (PCR)-based method for the identification of detection frequencies and changes in numbers of the following bacteria: Aggregatibacter actinomycetemcomitans (A.a), Porphyromonas gingivalis (P.g), Tannerella forsythia (T.f), Treponema denticola (T.d), and Prevotella intermedia (P.i). RESULTS: In terms of detection frequency, in the test group, statistically significant reductions were found for P.g, T.f, T.d and P.i (p < 0.05) after 6 months. In the control group, the detection frequencies of all investigated bacterial species at 6 months were comparable to the baseline values (p > 0.05). The comparison of the test and control groups revealed statistically significant differences in detection frequency for P.g (p = 0.034), T.d (p < 0.01) and P.i (p = 0.02) after 6 months, favouring the test group. Regarding reduction in detection frequency scores, at 6 months, statistically significant differences in favour of the test group were observed for all investigated bacterial species: A.a (p = 0.028), P.g (p = 0.028), T.f (p = 0.004), T.d (p <0.001), and P.i (p = 0.003). CONCLUSIONS: The present microbiological results, which are related to short-term outcomes up to 6 months post-treatment, support the adjunctive subgingival application of sodium hypochlorite/amino acids and xHyA to subgingival debridement in the treatment of periodontitis.
Assuntos
Aggregatibacter actinomycetemcomitans , Aminoácidos , Placa Dentária , Ácido Hialurônico , Porphyromonas gingivalis , Prevotella intermedia , Hipoclorito de Sódio , Tannerella forsythia , Treponema denticola , Humanos , Ácido Hialurônico/uso terapêutico , Hipoclorito de Sódio/uso terapêutico , Aggregatibacter actinomycetemcomitans/efeitos dos fármacos , Aggregatibacter actinomycetemcomitans/isolamento & purificação , Porphyromonas gingivalis/efeitos dos fármacos , Feminino , Pessoa de Meia-Idade , Masculino , Prevotella intermedia/efeitos dos fármacos , Tannerella forsythia/efeitos dos fármacos , Treponema denticola/efeitos dos fármacos , Adulto , Placa Dentária/microbiologia , Aminoácidos/uso terapêutico , Desbridamento Periodontal/métodos , Carga Bacteriana/efeitos dos fármacos , Géis , Terapia Combinada , Seguimentos , Reagentes de Ligações Cruzadas/uso terapêutico , Bolsa Periodontal/microbiologia , Bolsa Periodontal/terapia , Periodontite/microbiologia , Periodontite/terapia , Periodontite/tratamento farmacológicoRESUMO
OBJECTIVE: This meta-analysis was conducted to assess the effectiveness of photodynamic therapy (PDT) as an adjunct to conventional mechanical debridement (CMD) for the management of peri-implant mucositis (p-iM). METHODS: We systematically searched four databases (PubMed, Embase, Web of Science, and Cochrane Library) for randomized controlled trials (RCTs) investigating PDT + CMD for p-iM from their inception to March 13, 2023. Meta-analysis was performed using RevMan 5.4 software. RESULTS: Seven RCTs met the inclusion criteria. The meta-analysis revealed that PDT + CMD treatment was more effective than CMD alone in reducing probing depth (PD) (Mean Difference [MD]: -1.09, 95% Confidence Interval [CI]: -1.99 to -0.2, P = 0.02) and plaque index (PI) (MD: -2.06, 95% CI: -2.81 to -1.31, P < 0.00001). However, there was no statistically significant difference in the improvement of bleeding on probing (BOP) between the PDT + CMD groups and CMD groups (MD: -0.97, 95% CI: -2.81 to 0.88, P = 0.31). CONCLUSIONS: Based on the current available evidence, this meta-analysis indicates that the addition of PDT to CMD significantly improves PD and PI compared to CMD alone in the treatment of p-iM. However, there is no significant difference in improving BOP.
Assuntos
Fotoquimioterapia , Humanos , Fotoquimioterapia/métodos , Estomatite/terapia , Estomatite/tratamento farmacológico , Desbridamento/métodos , Terapia Combinada , Peri-Implantite/terapia , Peri-Implantite/tratamento farmacológico , Implantes Dentários , Ensaios Clínicos Controlados Aleatórios como Assunto , Desbridamento Periodontal/métodos , Resultado do Tratamento , Índice PeriodontalRESUMO
AIM: This Bayesian network meta-analysis of randomized controlled trials assessed the effect of adjuvant periodontal treatment in both periodontal and HbA1c outcomes in adult individuals with type 2 diabetes (T2DM). MATERIALS AND METHODS: A systematic search was done up to February 2023 comparing sub-gingival debridement (SD) in combination with local or systemic adjuvant treatment with SD alone for individuals with T2DM. The primary outcomes were changes in absolute HbA1c levels and full-mouth probing depth reported at 3- to 6-month post-treatment. RESULTS: Seventy-two eligible publications evaluating 27 adjuvant treatments were retrieved. The combination of SD and systemic antibiotic metronidazole or SD and antioxidant alpha lipoic acid provided, respectively, 1.4% (95% credible interval [CrI] 0.48; 2.20) and 2.4% (95% CrI 1.50; 3.30) more significant improvement on HbA1c levels, and 0.89 mm (95% CrI 0.23; 1.50) and 0.92 mm (95% CrI 0.02; 0.92) greater periodontal probing depth reductions. Other adjuvant treatments provided added benefit to the periodontal outcomes without discernible effects on HbA1c. CONCLUSIONS: Adjuvant use of metronidazole or alpha lipoic acid was the best adjunct option to provide clinically meaningful HbA1c levels and probing depth reductions. However, no strong recommendation can be drawn due to the scarcity of studies for each adjuvant treatment and the low certainty of the resultant evidence.
Assuntos
Teorema de Bayes , Diabetes Mellitus Tipo 2 , Hemoglobinas Glicadas , Metronidazol , Metanálise em Rede , Ácido Tióctico , Humanos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Metronidazol/uso terapêutico , Hemoglobinas Glicadas/análise , Ácido Tióctico/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Terapia Combinada , Antioxidantes/uso terapêutico , Resultado do Tratamento , Desbridamento Periodontal/métodos , Bolsa Periodontal/terapiaRESUMO
OBJECTIVE: To assess whether there is sufficient evidence of a difference in efficacy between subgingival air polishing (SubAP) and subgingival debridement as periodontal support treatment. The systematic review protocol was registered in the PROSPERO database under no. CRD42020213042. METHODS: A comprehensive search was conducted using eight online databases to develop straightforward clinical questions and search strategies, from their inception to 27 January 2023. The references of identified reports were also retrieved for inclusion in the analysis. The risk-of-bias of the included studies was evaluated using the Revised Cochrane Risk-of-Bias tool (RoB 2). A meta-analysis was performed on five clinical indicators using the Stata 16 software. RESULTS: Twelve randomized controlled trials were ultimately included, and most included studies had varying degrees of risk-of-bias. The results of the meta-analysis indicated that there was no significant difference between SubAP and subgingival scaling in terms of improving probing depth (PD), clinical attachment loss (CAL), plaque index (PLI), and bleeding on probing% (BOP%). The results of the visual analogue scale score analysis indicated that SubAP produced less discomfort than did subgingival scaling. DISCUSSION: SubAP can provide better treatment comfort than subgingival debridement. There was no significant difference in the efficacy of the two modalities in improving PD, CAL, and BOP% in supportive periodontal therapy. CONCLUSION: Currently, evidence for assessing the difference in the efficacy of SubAP and subgingival debridement in improving the PLI is insufficient, and further high-quality clinical studies are needed.
Assuntos
Polimento Dentário , Raspagem Dentária , Humanos , Desbridamento , Revisões Sistemáticas como Assunto , Desbridamento Periodontal/métodosRESUMO
PURPOSE: The present study systematically reviewed randomised controlled trials (RCT) to investigate the efficacy of Er:YAG laser (ERL) as a debridement method in surgical treatment of advanced peri-implantitis. MATERIALS AND METHODS: An electronic database search and a manual search were performed until March 2022. Outcome measures were clinical attachment level (CAL) gain, probing depth (PD) reduction, plaque index (PI) and bleeding on probing (BOP). The addressed PICO question was: Is ERL an effective debridement tool in the surgical treatment of advanced peri-implantitis? RESULTS: Five eligible randomised clinical trials (RCTs) were included in the qualitative analysis, one of which had unclear risk of bias. One study reported a statistically significant difference in terms of implant CAL gain and PD reduction in favour of the experimental group vs the control group, while four studies did not report any difference between the two groups. CONCLUSION: Due to methodological heterogeneity, such as non-standard control groups and laser parameters, this systematic review demonstrated inconclusive findings in terms of the efficacy of Er:YAG laser as a debridement method in surgical treatment of advanced peri-implantitis. The results of this review should be considered preliminary and further, well-designed studies with standardised comparators with laser parameters are warranted.
Assuntos
Implantes Dentários , Lasers de Estado Sólido , Peri-Implantite , Humanos , Peri-Implantite/cirurgia , Peri-Implantite/tratamento farmacológico , Lasers de Estado Sólido/uso terapêutico , Desbridamento , Desbridamento Periodontal/métodos , Resultado do Tratamento , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Aim: To evaluate the effect of the systemic administration of azi-thromycin (AZM) as an adjunct to non-surgical periodontal therapy (NSPT) on the clinical and microbiological variables of patients with periodontitis. Material and Methods: Eighteen volunteers received NSPT combined with placebo or AZM (500 mg/day) for 3 days (n=9/group). They were monitored clinically for probing pocket depth (PPD), clinical attachment level (CAL), O'Leary index (OI), bleeding on probing (BoP) at baseline and during the first, third and sixth month and microbiologically, at baseline and at 3 and 6 months after therapy, by conventional polymerase chain reaction tests. Results: Fourteen patients completed the study (n=7/group). Differences statistically significant were observed among both groups. The experimental group presented: A PPD mean (p=0.04) significantly lower and PPD reduction (p=0.02), at 6-months post NSPT. Regarding changes (∆), at the third month post NSPT, there was a significant increase in the number of shallow sites (p<0.001) and a decrease in the intermediate sites (p<0.001). In addition, a significant decrease in the mean number of deep sites (p=0.04) was detected at 6 months post treatment. There was also a significant decrease in periodontal index BoP at 1 (p=0.01), 3 (p<0.001) and 6 (p=0.01) months and OI at 3- and 6-months (p<0.001), post treatment. Regarding the presence of periodontal pathogens, no significant differences were observed, intra and inter groups. Conclusion: AZM as an adjuvant to NSPT provides additional beneficial effects for PPD and BoP compared to NSPT alone.
Objetivo: Evaluar el efecto de la administración sistémica de azitromicina (AZM) como coadyuvante de la terapia periodontal no quirúrgica (TPNQ) en las variables clínicas y microbiológicas de pacientes con periodontitis. Material y Métodos: Dieciocho voluntarios recibieron TPNQ combinado con placebo o AZM (500 mg/día) durante 3 días (n=9/grupo). Fueron monitoreados clínicamente para determinar Profundidad de Sondaje del Saco (PSS), Nivel de Inserción Clínica (NIC), Índice de O'Leary (IO), Sangrado al sondaje (SS) al inicio y durante el primer, tercer y sexto mes y microbiológicamente, al inicio y a los 3 y 6 meses después de la terapia, mediante la reacción en cadena de la polimerasa convencional. Resultados: Catorce pacientes completaron el estudio (n=7/grupo). Se observaron diferencias estadísticamente significativas entre ambos grupos. El grupo experimental presentó una media de PSS significativamente menor (p=0,04) y una reducción de PSS (p=0,02), a los 6 meses post TPNQ. En cuanto al delta (∆) pre y post tratamiento, al tercer mes post TPNQ, hubo un aumento significativo en el número de sitios poco profundos (p<0.001) y una disminución en los sitios intermedios (p<0.001). Además, se detectó una disminución significativa en la media de los sitios profundos (p=0.04) a los 6 meses post tratamiento. También hubo una disminución significativa en el índice SS al primer (p=0.01), tercer (p<0. 0 01) y sexto mes (p=0.01) post TPNQ y del IO al tercer y sexto mes (p<0.001), post tratamiento. En cuanto a la presencia de patógenos periodontales, no se observaron diferencias significativas tanto intra como ínter grupos. Conclusión: AZM como adyuvante a TPNQ proporciona efectos benéficos adicionales en la PSS y SS en comparación a TPNQ solo.
Assuntos
Humanos , Masculino , Feminino , Doenças Periodontais/tratamento farmacológico , Periodontite/terapia , Azitromicina/administração & dosagem , Desbridamento Periodontal/métodos , Índice Periodontal , Resultado do TratamentoRESUMO
BACKGROUND: The aim of the present study was to compare repeated applications of antimicrobial photodynamic therapy (aPDT) to open flap debridement (OFD) in the treatment of residual periodontal pockets in non-furcation sites. METHODS: Forty-six subjects with a diagnosis of Stage III or IV Grade C periodontitis, that had been previously treated, participated in the study. Residual pockets were divided between two groups: (1) aPDT group: received ultrasonic periodontal debridement followed by immediate application of aPDT, and repeated on1st, 2nd, 7th, and 14th days; and (2) OFD group: treated by modified papilla preservation technique, where granulation tissue and visible calculus were removed with hand curettes and an ultrasonic device. Clinical, immunological, and microbiological parameters were evaluated before and after treatment. RESULTS: Both treatments were effective reducing clinical parameters of disease. OFD resulted in a greater mean probing pocket depths (PPD) reduction in deep pockets (p = 0.001). However, aPDT resulted in a lower occurrence of gingival recession (GR), dentin hypersensitivity (DH) and analgesic intake. Reduction in Porphyromonas gingivalis was observed in both groups. Only the OFD group had a significant reduction in Aggregatibacter actinomycetemcomitans. aPDT group had greater increase in interleukin 10 (IL-10) levels and a greater reduction of interleukin 1 beta (IL-1ß) at 14 days when compared to the OFD group (p < 0.05). CONCLUSION: OFD was superior in reducing PPD in deep pockets compared to the aPDT. However, OFD resulted in greater GR. Both treatments lowered P. gingivalis levels but only OFD reduced levels of A. actinomycemtemcomitans.
Assuntos
Retração Gengival , Fotoquimioterapia , Humanos , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Desbridamento , Terapia Combinada , Desbridamento Periodontal/métodos , Retração Gengival/tratamento farmacológico , Retração Gengival/cirurgia , Resultado do TratamentoRESUMO
AIM: To assess the efficacy of the adjunct use of a subgingival erythritol powder air-polishing device (EPAP) in comparison to conventional subgingival instrumentation alone during initial non-surgical periodontal therapy. MATERIALS AND METHODS: Twenty-one patients with generalized Stages 2 and 3 grade B periodontitis were included in this single centre, single blinded, split-mouth, randomized clinical trial. Teeth on the control side were treated with conventional hand and ultrasonic instrumentation, while those on the contralateral test side was treated using EPAP as adjunct to conventional subgingival instrumentation with hand and ultrasonic instruments. Three months after initial instrumentation, persisting pockets of ≥4 mm were re-treated, in both control and test sides, again with the respective treatment approach-subgingival instrumentation alone on control, and subgingival instrumentation + EPAP on test side. Clinical parameters such as probing pocket depth (PPD), bleeding on probing, and relative attachment level were recorded at baseline and 3 and 6 months following the initial instrumentation. Subgingival plaque samples were collected at baseline, immediately post surgery, as well as at 1 week, 1 month, 3 months, and 6 months after initial instrumentation. RESULTS: In the test group after 6 months, a significantly larger number of initially deep pockets (PPD ≥ 5.5 mm) were reduced to shallow (PPD ≤ 3.4 mm), and a larger attachment gain was observed. No statistically significant microbiological differences could be found between test and control group. CONCLUSIONS: The results of the present study indicate that the adjunct use of subgingival airflow therapy with EPAP during initial non-surgical periodontal therapy might be beneficial in initially deep pockets (PPD ≥ 5.5 mm).
Assuntos
Raspagem Dentária , Eritritol , Desbridamento , Raspagem Dentária/métodos , Eritritol/uso terapêutico , Humanos , Desbridamento Periodontal/métodos , Bolsa Periodontal/microbiologia , Bolsa Periodontal/terapia , Pós , Resultado do TratamentoRESUMO
The aim of this retrospective study was to assess the outcomes of non-surgical and surgical mechanical root debridement for the treatment of infrabony defects and explore potential prognostic factors. Treated infrabony defects followed for at least 1 year were selected. All data pertaining to the clinical outcomes were recorded. Multi-level regression analysis and Cox Proportional-Hazards Models were used to assess the immediate (3-6 months) clinical outcomes, survival of the treated teeth, and factors influencing these results. 132 patients were included in the analysis. The analysis showed 1.42 ± 1.71 and 2.23 ± 1.64 mm in pocket depth (PD) reduction, 0.13 ± 1.83 and 0.08 ± 1.76 mm in clinical attachment level (CAL) gain, and 1.29 ± 1.56 and 2.15 ± 1.33 mm increase in gingival recession (REC) for the non-surgical and surgical groups, respectively. The 5-year survival rates were 93% for the non-surgically and 90% for the surgically treated teeth. Several factors affected clinical outcomes and tooth survival. Within its limitations, the treatment of infrabony defects with non-surgical and surgical mechanical root debridement was found to result in moderate but significant PD reduction, nevertheless, this may also be attributable to the resultant REC.
Assuntos
Perda do Osso Alveolar/terapia , Desbridamento Periodontal/métodos , Adulto , Perda do Osso Alveolar/etiologia , Gerenciamento Clínico , Suscetibilidade a Doenças , Análise Fatorial , Feminino , Retração Gengival/etiologia , Retração Gengival/patologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Bolsa Periodontal/patologia , Periodontite/complicações , Prognóstico , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: This study is aimed to analyze the prognostic factors affecting the short-term efficacy of non-surgical treatment of patients in periodontitis from stage II to stage IV by the multilevel modeling analysis. MATERIALS AND METHODS: A total of 58 patients with chronic periodontitis were included in this study. Patients were clinically explored before and 3 months after the treatment and the difference in probing depth was determined [Reduction of probing depth (Δ PD) = baseline PD - finial probing depth (FPD)] which is considered as the therapeutic evaluation. Three different levels were analyzed: patients, teeth and sites to construct a multi-layer linear model. RESULTS: Probing depth (PD) improved significantly compared with that before treatment (p < 0.05), in which FPD was (3.90 ± 1.39) mm, and the ΔPD was (1.79 ± 0.97) mm. Compared with the mesial sites and distal sites of the multi-rooted teeth, the number of PD ≥ 5 mm or PD < 5 mm after the treatment was significantly different (P < 0.05), and the proportion of PD < 5 mm was higher in mesial sites. The null model showed that Δ PD varied greatly between groups at various levels (P < 0.001), with prediction variable of site level, tooth level, and patient level accounted for 66%, 18%, and 16% of the overall difference, respectively. The complete model showed that the Δ PD of smokers was significantly lower than that of non-smokers (P < 0.001). The Δ PD of the mesial and distal sites was larger than that of the buccolingual central site (P < 0.001). The Δ PD of single-rooted teeth was larger than that of multi-rooted teeth (P < 0.001). The baseline PD, tooth mobility (TM), bleeding index (BI), clinical attachment loss (CAL) were significantly negatively correlated with Δ PD (P < 0.001). CONCLUSIONS: Patients with periodontitis from stage II to stage IV, who were non-smoking, have good compliance, good awareness of oral health, and low percentage sites with PD ≥ 5 mm at baseline, single-rooted teeth with hypomobility, less clinical attachment loss and lower bleeding index and sites of mesial or distal can obtain an ideal short-term efficacy of non-surgical treatment.
Assuntos
Periodontite Crônica/terapia , Análise Multinível/métodos , Desbridamento Periodontal/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Periodontite Crônica/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Objectives: To clinically and microbiologically evaluate the effects of hyperbaric oxygen (HBO2) therapy in addition to full-mouth ultrasonic subgingival debridement (FM-UD), in the initial treatment of chronic periodontitis. Methods: Twenty patients presenting moderate to severe generalized forms of chronic periodontitis were included in a three-month randomized, parallel-group, single-blinded, prospective study. At baseline patients were randomly assigned to two treatment groups [Test Group (FM-UD+HBO2) and Control Group (FM-UD)]. Both groups were treated with an FM-UD session. Ten HBO2 sessions (one session per day for 10 days at a pressure of 2.5 ATA) were additionally administered to the Test Group. Soft tissues parameters [probing pocket depth (PPD), bleeding on probing (BOP), clinical attachment level (CAL) and visible plaque index (VPI)] were assessed at baseline (immediately before FM-UD treatment), after two weeks, after six weeks and at three months. For each patient, a site presenting PPD ≥ 6mm and positive BOP was selected as a qualifying site (QS), to be monitored clinically (at T0, T1, T2 and T3) and microbiologically (at T0, T1 and T3). Results: There were no statistically significant differences between the two groups for any clinical parameter analyzed after three months, except for BOP, which was significantly (p < 0.05) reduced in the Test Group. Reductions in bacterial levels were detected in both groups after therapy. Faster bacterial recolonization occurred after three months in the Control Group. Conclusion: HBO2 therapy in combination with FM-UD may represent an efficacious approach to the treatment of moderate to severe forms of periodontitis.
Assuntos
Periodontite Crônica/terapia , Oxigenoterapia Hiperbárica/métodos , Desbridamento Periodontal/métodos , Adulto , Periodontite Crônica/microbiologia , Terapia Combinada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Porphyromonas gingivalis/isolamento & purificação , Estudos Prospectivos , Método Simples-Cego , Tannerella forsythia/isolamento & purificação , Treponema denticola/isolamento & purificação , Terapia por Ultrassom/métodos , Adulto JovemRESUMO
RESUMEN Introducción: los agrandamientos gingivales suelen tratarse a través de terapias quirúrgicas de gingivectomías; su tratamiento no quirúrgico mecánico también es una opción sobre todo en los casos de gingivitis asociada a la pubertad como consecuencia de los cambios hormonales. Objetivo: describir el tratamiento no quirúrgico de una paciente de 12 años con agrandamiento gingival asociado a la pubertad y lesiones gingivales inducidas por biofilm dental. Presentación del caso: el caso presentó un agrandamiento gingival leve localizado que remitió al cabo de un mes a la primera fase de tratamiento, después de tres sesiones de fisioterapias con la remoción de biofilm calcificado se obtuvo una reducción del porcentaje del índice de higiene oral sin requerir intervención quirúrgica. A los cuatro años de seguimiento se observó reducción completa del agrandamiento gingival y bolsas periodontales. Conclusiones: la terapia periodontal mecánica es una alternativa eficaz en la reducción de la inflamación gingival inducida por hormonas durante la pubertad sin la necesidad de requerir intervenciones quirúrgicas para el tratamiento del agrandamiento gingival. Otras alternativas como las gingivectomías son aplicables; sin embargo requieren procedimientos más complejos, costosos y aumento de la morbilidad del paciente; en ese sentido el tratamiento mecánico no quirúrgico se muestra como una opción viable(AU)
ABSTRACT Introduction: Gingival enlargement is usually treated with gingivectomy as an alternative to surgery; however, non-surgical mechanical treatment is another option especially in cases of gingivitis associated with puberty as a result of hormonal changes. Objective: To describe the non-surgical treatment of a 12-year-old patient with gingival enlargement associated with puberty and gingival lesions induced by dental biofilm. Case presentation: The patient presented a localized mild gingival enlargement that relapsed to the first phase of treatment after one month. Three months after physiotherapy sessions with removal of calcified biofilm, a reduction in the percentage of oral hygiene index to "good" was obtained; therefore, surgical treatment was not required. Four years later, there was a complete reduction in gingival enlargement and periodontal pockets. Conclusions: Mechanical periodontal therapy is an effective alternative to reduce gingival inflammation induced by hormones during puberty not requiring surgical intervention to treat gingival enlargement. Other alternatives such as gingivectomies are performed; however, they require more complex, expensive procedures and they can also increase patient morbidity. In that sense, the uniqueness of the non-surgical mechanical treatment is chosen as a feasible option(AU)
Assuntos
Humanos , Feminino , Criança , Procedimentos Cirúrgicos Operatórios , Índice de Higiene Oral , Puberdade , Placa Dentária/terapia , Desbridamento Periodontal/métodos , Hipertrofia Gengival/terapiaRESUMO
Introducción: El ozono (O3) presenta múltiples acciones biológicas, entre ellas su efecto antimicrobiano, lo que ha sido beneficioso en odontología, siendo la presentación acuosa la más utilizada (20 µg/ mL), la cual presenta efectos similares a la clorhexidina. Reporte de caso: Paciente masculino de 76 años de edad, diagnosticado con periodontitis crónica moderada localizada, el cual fue tratado mediante ozonoterapia acuosa durante la fase inicial periodontal y la fase quirúrgica en colgajo por debridación. 12 semanas posteriores al acto quirúrgico se obtuvo la eliminación de las bolsas periodontales, encontrándose un surco de 3 y 2 mm y un buen control de placa dentobacteriana. Conclusión: No existen reportes acerca del uso de ozonoterapia acuosa durante un colgajo por debridación. El éxito del tratamiento periodontal consiste en la eliminación del factor causal así como en establecer y mantener un control de placa dentobacteriana adecuado (AU)
Introduction: Ozone (O3) has multiple biological actions, including its antimicrobial effect, which has been beneficial in dentistry, the aqueous presentation being the most used (20 µg/mL), which has similar effects to chlorhexidine. Case report: Male patient of 76 years of age, diagnosed with localized moderate chronic periodontitis, which was treated by aqueous ozone therapy during the initial periodontal phase and surgical phase in debridement flap. Twelve weeks after surgery, the periodontal pockets were eliminated, finding a 3 and 2 mm groove and good control of dentobacterial plaque. Conclusion: There are no reports about the use of aqueous ozone therapy during a debridement flap. The success of the periodontal treatment consists in the elimination of the causal factor, as well as establishing and maintaining an adequate control of plaque (AU)
Assuntos
Humanos , Masculino , Idoso , Ozônio/uso terapêutico , Periodontite Crônica/tratamento farmacológico , Bolsa Periodontal/tratamento farmacológico , Retalhos Cirúrgicos , Periodontite Crônica/cirurgia , Desbridamento Periodontal/métodosRESUMO
Chronic apical periodontitis associated with dental pulp necrosis is the main cause of odontogenic extraoral cutaneous sinus openings. These tracts are often initially misdiagnosed unless the treating clinician considers a dental aetiology. This case report of a 19-year-old woman describes the diagnosis and treatment of an extraoral cutaneous sinus tract of odontogenic origin. Non-surgical conservative endodontic therapy was opted as the involved teeth were restorable. One month after the completion of obturation, there was closure of the sinus tract. One year follow-up showed complete resolution of the sinus tract with minimal scar formation.
Assuntos
Fístula Cutânea/etiologia , Fístula Cutânea/terapia , Abscesso Periodontal/complicações , Desbridamento Periodontal/métodos , Periodontite/terapia , Obturação Retrógrada/métodos , Tratamento do Canal Radicular/métodos , Adulto , Feminino , Humanos , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: This study aimed to analyze the effectiveness of root-shape inserts mounted on a reciprocating handpiece during the procedure of root surface debridement (RSD) on extracted teeth. Three different approaches were compared: ultrasonic scaling, employment of root-shape inserts mounted on a reciprocating handpiece, and a combination of both. MATERIALS AND METHODS: A total of 51 extracted teeth were divided into three groups. The first group was instrumented with an ultrasonic scaler, the second group with flexible root-shape inserts mounted on a reciprocating handpiece (grain size 40, 15, and 4 µm), whereas the final group underwent a combination of both approaches. The time required for the instrumentation was taken. The specimens were subjected to optical and scanning electron microscopy (SEM), and the photographs were evaluated by three examiners who were blinded to the study. The parameters included were: SEM roughness index (SRI) for the roughness calculation, remaining calculus Index (RCI) to evaluate the residual calculus deposits, and loss of tooth substance index (LTSI) to evaluate the loss of tooth substance caused by instrumentation. RESULT: The results revealed that the time taken for the instrumentation was on average longer when the root-shape inserts were employed alone, meanwhile the combined approach did not show significant difference in comparison with the ultrasonic scaling. The lower average RCI was obtained with a combined approach. The use of root-shape inserts seems to cause a moderate increase in LTSI, especially in a combined approach, whereas it resulted in a better average SRI. CONCLUSION: The employment of root-shape inserts seems to be effective in the RSD for its ability to obtain a smooth and calculus-free instrumented surface, especially when used in combination with an ultrasonic scaler, and their use can so represent a valid approach to be tested in further in vivo studies.
Assuntos
Microscopia Eletrônica de Varredura/métodos , Desbridamento Periodontal/métodos , Doenças Periodontais/terapia , Aplainamento Radicular/métodos , Curetagem Subgengival/métodos , Raiz Dentária/cirurgia , Ultrassom/métodos , Raspagem Dentária/instrumentação , Humanos , Doenças Periodontais/patologia , Aplainamento Radicular/instrumentação , Extração Dentária/métodos , Raiz Dentária/ultraestruturaRESUMO
AIMS: The study's aim was to assess the clinical outcome 6 and 12 months after a nonsurgical treatment of peri-implantitis per se or in conjunction with a combination of local antiseptic and anti-inflammatory treatment. MATERIALS AND METHODS: Included were 69 patients with periodontitis, with 106 implants, diagnosed with peri-implantitis. Peri-implantitis was defined as radiographic bone loss ≥3 mm, probing depth (PD) ≥ 6 mm, with bleeding on probing. Group M peri-implantitis was treated with ultrasonic debridement and soft tissue curettage. Group P had additional implant surface treatment with rotatory hand piece composed of chitosan bristle, soft tissue curettage combined with application of 0.95% hypochlorite and 1 mg minocycline HCl. RESULTS: After 6 months, both groups demonstrated significant reduction of mean plaque index, PD, and clinical attachment level (0.71 ± 0.57, 0.81 ± 0.55; 4.77 ± 0.73 mm, 4.42 ± 0.5 mm; 5.03 ± 0.86 mm, 5.13 ± 0.73 mm; respectively) and bleeding on probing. After 6 and 12 months, group P showed significantly better PD results compared to group M. The bleeding was significantly less in group P after 12 months (15.3% ± 6.2, 25.1% ± 8.2, respectively). CONCLUSIONS: Adjunctive treatment with local antiseptic and anti-inflammatories during mechanical phase was positively associated with inflammation reduction and connective tissue reattachment.