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AIM: To evaluate the changes in periodontal parameters (reduction in probing pocket depth [PPD], gain in clinical attachment level [CAL] and reduction in full-mouth bleeding on probing [BoP]) after subgingival instrumentation of periodontal pockets at different time points in systemically healthy patients suffering from periodontitis. MATERIALS AND METHODS: Four databases were searched for RCTs that carried out subgingival instrumentation in periodontal pockets and evaluated PPD at a minimum of two consecutive time points other than baseline. The analysis was conducted for both all pocket depths and stratified for initially shallow (4-5 mm) and deep (≥6 mm) pockets and data were extracted for various time points, 1-2, 3-4 and 5-6 months. Weighted mean effects (WMEs) were calculated with 95% confidence interval (CI) and predictive intervals were calculated. RESULTS: Twenty-nine RCTs were identified, and all of them were included in the meta-analysis. The results showed that for both shallow and deep pockets there was a small though clinically meaningful change between 1- to 2-month and 3- to 4-month time points and between these and 5-6 months. CONCLUSIONS: In systemically healthy patients, the greater part of reduction in PPD and gain in CAL occurs within the first 1-2 months after subgingival instrumentation. However, additional benefits in terms of pocket depth reduction occur beyond these early time points.
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AIM: To assess the efficacy of Er:YAG laser (ERL) and erythritol powder air-polishing (AP) in addition to the submarginal instrumentation in the non-surgical treatment of peri-implant mucositis (PM). MATERIALS AND METHODS: Patients with at least one implant diagnosed with PM were included in the present 6-month randomized clinical trial (RCT). Implants were randomly assigned to one of the three treatment groups after submarginal instrumentation: AP (test 1 group), ERL (test 2 group) or no adjunctive methods (control group). The primary and secondary outcomes were, respectively, bleeding on probing (BoP) reduction and, complete disease resolution (total absence of BoP) and probing pocket depth (PPD) changes. The patient and the implant were considered the statistical unit. A multivariate logistic regression analysis was performed. RESULTS: A total of 75 patients were enrolled in the study. At each time point, significant BoP and PPD reductions were observed within each group. Intergroup analysis did not show statistically significant differences. Complete disease resolution ranged between 29% and 31%. The logistic regression showed that supramucosal restoration margin, PPD < 4 mm and vestibular keratinized mucosa (KM) significantly influenced the probability to obtain treatment success. CONCLUSION: The adjunctive use of AP and ERL in PM non-surgical therapy does not seem to provide any significant or clinically relevant benefit in terms of BoP and PPD reductions and complete disease resolution, over the use of submarginal instrumentation alone. Baseline PPD < 4 mm, presence of buccal KM and supramucosal restoration margin may play a role in the complete resolution of PM.
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Implantes Dentários , Lasers de Estado Sólido , Mucosite , Peri-Implantite , Humanos , Mucosite/complicações , Pós/uso terapêutico , Eritritol/uso terapêutico , Lasers de Estado Sólido/uso terapêutico , Peri-Implantite/tratamento farmacológico , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate the impact of COVID-19 pandemic among a sample of Italian dentists in terms of infection, strategies for infection control, organization of the dental clinic, attitude, and behavior. MATERIAL AND METHODS: This was a cross-sectional survey. The sample consisted of 8000 Italian dentists selected among 63,375 using a computerized random sampling method. An electronic informed consent had to be signed. The questionnaire categories were on demographic, infection risk management, organization, and dentists' attitude and behavior. Geographic macro-areas were used for subgroup analysis. RESULTS: Among 8000 invited dentists, 2443 agreed to participate to the survey (30.6%). Mean age was 51.2 years, women were 34.5%. A total of 6.1% self-reported COVID-19 experience and higher rate of infection was reported in north Italy compared to the south (p < 0.05). FFP2/FFP3 respirators (97.1%) and visors (97.4%) were used by almost all dentists. While, natural ventilation and mouthwashes were the most frequent approaches used to reduce the infection risk. Most of the dentists reported positive attitude, nevertheless 83.6% felt an increased responsibility. CONCLUSION: The self-reported COVID-19 prevalence was 6.1% with some differences among geographic areas. COVID 19 had a deep impact on preventive strategies, dental office organization, and behavior within this sample.
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OBJECTIVES: Primary focused question for this systematic review (SR) was "Which is the evidence about surfaces decontamination and protection masks for SARS-Cov-2 in dental practice?" Secondary question was "Which is the evidence about surfaces decontamination and protection masks against airborne pathogens and directly transmitted viral pathogens causing respiratory infections?" MATERIALS AND METHODS: PRISMA guidelines were used. Studies on surface decontamination and protective masks for SARS-CoV-2 in dental practice were considered. Studies on other respiratory viruses were considered for the secondary question. RESULTS: No studies are available for SARS-CoV-2. Four studies on surface disinfection against respiratory viruses were included. Ethanol 70% and sodium hypochlorite 0,5% seem to be effective in reducing infectivity by > 3log TCID. Four RCTs compared different types of masks on HCW. The single studies reported no difference for laboratory-diagnosed influenza, laboratory-diagnosed respiratory infection, and influenza-like illness. A meta-analysis was not considered appropriate. CONCLUSIONS: There is lack of evidence on the efficacy of surface disinfection and protective masks to reduce the spread of SARS-CoV-2 or other respiratory viruses in dentistry. However, the consistent use of respirator and routine surface disinfection is strongly suggested. There is urgent need of data on the efficacy of specific protection protocols for dental HCW against viral infections.
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COVID-19 , Influenza Humana , Dispositivos de Proteção Respiratória , Infecções Respiratórias , Viroses , Humanos , SARS-CoV-2 , Máscaras , COVID-19/prevenção & controle , Desinfecção/métodosRESUMO
Current evidence suggests that SARS-CoV-2, the virus that causes COVID-19, is predominantly spread from person to person. Aim of this narrative review is to explore transmission modality of SARS-CoV-2 to provide appropriate advice to stakeholders, in order to support the implementation of effective public health measures and protect healthcare workers that primary face the disease. "In vivo" and "in vitro" studies from laboratories and hospitals confirmed the presence of surface contamination and provided insight of SARS-CoV-2 detection in the air, particularly in indoor settings with poor ventilation where aerosol-generating procedures were performed. Measures for aerosol reduction, in conjunction with other effective infection control strategies, are needed to prevent the spread of SARS-CoV-2 in dental setting.
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COVID-19 , Aerossóis , Pessoal de Saúde , Humanos , Saúde Pública , SARS-CoV-2RESUMO
AIM: To compare soft tissue dimensional changes and relative differences in soft and hard tissue volumes 4 months after single-tooth extraction and three different treatment modalities: spontaneous healing (SH) and alveolar ridge preservation by means of a deproteinized bovine bone mineral and a collagen matrix, with (IMPL/DBBM/CM) or without (DBBM/CM) immediate implant placement. MATERIALS AND METHODS: STL files from study casts obtained at baseline and after 4 months were matched to calculate buccal soft tissue linear and volumetric changes. DICOM files from CBCTs were superimposed to STL files allowing the evaluation of soft tissue thickness at baseline and 4 months. RESULTS: Mean horizontal reduction accounted for 1.46 ± 0.20 (SH), 0.85 ± 0.38 (DBBM-CM) and 0.84 ± 0.30 IMPL/DBBM-CM, with no statistical differences. Soft tissue thickness had a significant mean increase of 0.95 for SH group, compared to a non-significant mean decrease for DBBM-CM (0.20) and IMPL/DBBM-CM groups (0.07). CONCLUSION: A preservation technique with DBBM-CM, with or without immediate implant placement, did not reduce the horizontal linear and volumetric changes at the buccal soft tissue profile significantly at 4 months after tooth extraction when compared to spontaneous healing. This is due to a significant increase in soft tissue thickness in spontaneously healing sites.
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Perda do Osso Alveolar , Aumento do Rebordo Alveolar , Dente , Animais , Bovinos , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/prevenção & controle , Processo Alveolar/diagnóstico por imagem , Processo Alveolar/cirurgia , Extração Dentária , Alvéolo Dental/diagnóstico por imagem , Alvéolo Dental/cirurgia , Cicatrização , HumanosRESUMO
OBJECTIVES: The aim of this cross-sectional study is to (i) determine the prevalence, extent, severity, and distribution of gingival recessions and patient perception in a young population and (ii) to identify potential risk indicators. MATERIAL AND METHODS: Two hundred fifty-one students with a mean age of 22.9 ± 4.7, attending the School of Dentistry and Dental Hygiene of Vita-Salute San Raffaele University (Milan, Italy) were included. The subjects had undergone a clinical evaluation, by two calibrated examiner, and a questionnaire. Demographic and clinical data were collected to evaluate association of these factors with gingival recessions. RESULTS: The prevalence of gingival recessions at patient and tooth level was 39% and 5.2%, respectively. The only factor associated with the presence of GR was age. On the other hand, age and smoking were associated with the extent, whereas BOP, NCCLs and KT were associated with the severity. Out of 98 subjects presenting at least one GR, 63 (64%) were conscious of the presence of the GR. NCCLs were also strongly associated with the perception of the recession by the patient. CONCLUSIONS: There is a low prevalence of buccal gingival recessions in this sample of Italian students. More than 50% of the sample was aware of the problem. Almost all patients presenting symptomatology or aesthetic concern requested appropriate therapy. CLINICAL RELEVANCE: The findings highlight the low relevance of gingival recessions in daily practice and the importance of controlling potential risk indicators in young populations.
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Retração Gengival , Adolescente , Adulto , Estudos Transversais , Estética Dentária , Retração Gengival/epidemiologia , Humanos , Itália , Higiene Bucal , Prevalência , Adulto JovemRESUMO
OBJECTIVES: To compare the use of diode laser with conventional surgery evaluating the effectiveness of gingivectomy as an adjunct to non-surgical periodontal treatment in the management of gingival enlargement (GE) during orthodontic treatment. TRIAL DESIGN: Prospective three-arm parallel group randomized clinical trial with 1:1:1 allocation ratio. METHODS: Sixty subjects (33 males and 27 females), with a mean age of 14.4 ± 1.9 years, were selected according to inclusion criteria: overgrown gingivae on the labial side of the anterior teeth secondary to fixed appliance therapy, six maxillary anterior teeth present, and healthy non-smokers patients. Patients were enrolled in the study and randomly assigned to three groups by a computer-generated randomization list and by a block size of 4. The allocation information was concealed in opaque and sealed envelopes by the statistician. In the first group, all subjects underwent a conventional scalpel gingivectomy of the maxillary anterior sextant. In the second group, all subjects were treated using laser-assisted gingivectomy; while subjects assigned to the third group underwent only non-surgical periodontal treatment and served as control group (CG). The observer who performed all the measurements was blinded to the group assignment. Blinding was obtained by eliminating from the elaboration file every reference to patient group assignment. Intergroup comparisons of changes in the periodontal parameters were conducted at 1, 3, and 6 months using ANOVA with repeated measures and Tukey's post hoc tests. The significance level was set at P <0.05. RESULTS: After 1 month, the TGs showed a significant improvement of all periodontal parameters when compared with the CG. No statistically significant differences were observed between the two TGs. At the 3-month observation, a relapse occurred in the TGs, while the CG showed the greater improvement of soft tissue health. In the 6-month versus 3-month evaluation, no significant differences between the three groups were found for any periodontal measurements. In the long-term evaluation (6 months versus baseline), a significant greater reduction of pockets were found in the TGs when compared with the CG. CONCLUSIONS: The adjunct use of both scalpel gingivectomy and laser gingivectomy was more effective in controlling gingival inflammation than non-surgical periodontal treatment alone at 1, 3 and 6 months. In the control group, greater improvement in the periodontal parameters were observed within 3 months, depending on a self-care approach for the management of GE. LIMITATIONS: This study was a short-term study (6-month follow-up). TRIAL REGISTRATION: ClinicalTrials.gov (registration number: NCT03514316).
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Gengivectomia , Gengivite , Aparelhos Ortodônticos , Adolescente , Criança , Feminino , Gengivite/etiologia , Gengivite/cirurgia , Humanos , Masculino , Aparelhos Ortodônticos/efeitos adversos , Estudos ProspectivosRESUMO
AIM: To radiographically evaluate the effect of immediate implant placement plus alveolar ridge preservation (ARP) with a deproteneized bovine bone mineral and a collagen matrix (IMPL/DBBM/CM) as compared to ARP (DBBM/CM) or spontaneous healing (SH) on vertical and horizontal bone dimensional changes after 4 months of healing. MATERIALS AND METHODS: Thirty patients requiring extraction of one single-rooted tooth or premolar were randomly assigned to IMPL/DBBM/CM, ARP DBBM/CM or SH. Cone-beam computed tomography (CBCT) scans, performed before tooth extraction and after 4 months, were superimposed in order to assess changes in ridge height at the buccal and lingual aspect and in ridge width at 1 mm, 3 mm and 5 mm apical to the bone crest. Kruskal-Wallis test was applied for comparison of differences between groups. RESULTS: No statistically significant differences between the groups were observed for the vertical bone resorption of the buccal and the lingual side, while significant differences were found between SH group (-3.37 ± 1.55 mm; -43.2 ± 25.1%) and both DBBM/CM (-1.56 ± 0.76 mm; -19.2 ± 9.1%) and IMPL/DBBM/CM (-1.29 ± 0.38 mm; -14.9 ± 4.9%) groups in the horizontal dimension at the most coronal aspect. CONCLUSION: Ridge preservation techniques using DBBM and CM reduce the horizontal bone morphological changes that occur, mostly in the coronal portion of the buccal bone plate following tooth extraction, when compared to spontaneous healing. This is true regardless of whether immediate implant placement is performed or not.
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Perda do Osso Alveolar , Aumento do Rebordo Alveolar , Processo Alveolar , Animais , Bovinos , Tomografia Computadorizada de Feixe Cônico , Humanos , Radiografia Dentária , Extração Dentária , Alvéolo DentalRESUMO
AIM: To assess the effectiveness, in terms of clinical performance and patient perception, of minimally invasive periodontal surgeries (MIPSs), and to compare MIPSs to traditional surgery in the treatment of periodontal infrabony defects. MATERIALS AND METHODS: An electronic search and a manual search were carried out to identify studies investigating clinical (CAL, PPD, REC), radiographic (bone fill) and patient's centred (VAS) outcomes at least 6 months after MIPSs. A linear mixed-effect model was used for meta-analysis. Subgroup analyses were performed according to the study quality (RCT or case series). A meta-analysis assessing differences in clinical parameters between MIPSs and traditional flaps was also performed. RESULTS: Meta-analysis from the 18 included studies revealed a PPD reduction of 4.24 mm (95% CI = 3.79-4.69 mm), a CAL gain of 3.89 mm (95% CI = 3.42-4.35 mm), a REC increase of 0.44 mm (95% CI = 0.11-0.77 mm), a radiographic bone fill gain of 58.25% (95% CI = 42.30%-74.21%) and a VAS value of 1.16 (95% CI = 0.78-1.54). Based on 2 RCTs, MIPSs are more effective than traditional surgery for PPD reduction (0.93 mm, 95% CI = 1.71-0.15) and CAL gain (1 mm, 95% CI = 1.75-.24). CONCLUSION: Minimally invasive periodontal surgeries may be considered for the treatment of periodontal infrabony defects. However, the real effect cannot be systematically evaluated due to the paucity of studies comparing MIPSs to traditional flap for periodontal reconstructive surgery.
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Perda do Osso Alveolar , Regeneração Tecidual Guiada Periodontal , Transplante Ósseo , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Perda da Inserção Periodontal , Retalhos Cirúrgicos , Resultado do TratamentoRESUMO
BACKGROUND: This report is intended to present a supplemental analysis of data from a prior report (Aroca et al., ) to investigate factors associated with a complete root coverage at 1 year. The purpose of the prior report was to investigate at 1 year the adjunction effect of EMD for the treatment of Miller's class III recession defects using a coronally advanced modified tunnel/CTG technique with (test group) or without (control group). The purpose of this report was to investigate additional factors associated with root coverage in the same data set. MATERIALS AND METHODS: On the 138 observations collected from 20 patients, a regression model was used to highlight the relationship between the percentages of root coverage (RC) and three following covariates: the distance from the tip of the papilla and the contact point (DCP) at baseline, the group membership (control vs. test) and tooth position in the mouth (maxillary vs. mandibular). RESULTS: The statistical analysis showed that there was a significant effect of the DCP at baseline (p = 0.01) and of the tooth type (p < .001) on the percentage of RC at 1 year, whereas no significant difference between the two techniques (group membership effect) was shown (p = 0.69). CONCLUSION: The probability to obtain a complete root coverage decreases when the DCP at baseline increases. Moreover, maxillary teeth are more likely to give better RC than mandibular teeth. However, in this analysis similar to the last, there was no group effect.
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Retração Gengival , Tecido Conjuntivo , Gengiva , Gengivoplastia , Humanos , Prognóstico , Retalhos Cirúrgicos , Raiz Dentária , Resultado do TratamentoRESUMO
AIM: To evaluate the possible benefit on wound healing and flap stability of periosteum inclusion, comparing a "split-full-split" thickness flap elevation versus a "split" thickness approach performed during CAF for the treatment of isolated-type gingival recessions in the upper jaw. MATERIAL AND METHODS: Forty patients were randomized, 20 were treated with "split-full-split" (test group) and 20 with a "split" approach (control group). Analysed parameters at 1 year were CRC, percentage of recession coverage (RC), keratinized tissue (KT) gain and patient-related outcome measurements. RESULTS: After 12 months, CRC was 80% in the test group and 35% in the control group. Percentages of RC and KT gain were higher in the test group, and a significant association between CRC and the thickness of the flap after elevation was found. Patient-related outcomes measurements were better for the test group. CONCLUSIONS: Flap thickness preservation and the presence of the periosteum in part of the flap may play a fundamental role in obtaining CRC.
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Retração Gengival , Periósteo , Tecido Conjuntivo , Método Duplo-Cego , Humanos , Raiz Dentária , Resultado do TratamentoRESUMO
AIM: The aim of this article is to systematically review the effect of subcrestal implant placement compared with equicrestal position on hard and soft tissues around dental implants with platform switch. MATERIAL AND METHODS: A manual and electronic search (National Library of Medicine and Cochrane Central Register of Controlled Trials) was performed for animal and human studies published up to December 2016. Primary outcome variable was marginal bone level (MBL) and secondary outcomes were crestal bone level (CBL), soft tissue dimensions (barrier epithelium, connective tissue, and peri-implant mucosa), and changes in the position of soft tissue margin. For primary and secondary outcomes, data reporting mean values and standard deviations of each study were extracted and weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated. RESULTS: A total of 14 publications were included (7 human studies and 7 animal investigations). The results from the meta-analyses have shown that subcrestal implants, when compared with implants placed in an equicrestal position, exhibited less MBL changes (human studies: WMD = - 0.18 mm; 95% CI = - 1.31 to 0.95; P = 0.75; animal studies: WMD = - 0.45 mm; 95% CI = - 0.66 to - 0.24; P < 0.001). Furthermore, the CBL was located at a more coronal position in subcrestal implants with respect to the implant shoulder (WMD = - 1.09 mm; 95% CI = - 1.43 to - 0.75; P < 0.001). The dimensions of the peri-implant mucosa seem to be affected by the positioning of the microgap and were greater at implants placed in a subcrestal position than those inserted equicrestally (WMD = 0.60 mm; 95% CI = 0.26 to 0.95; P < 0.001). While the length of the barrier epithelium was significantly greater in implants placed in a subcrestal position (WMD = 0.39 mm; 95% CI = 0.19 to 0.58; P < 0.001), no statistical significant differences were observed between equicrestal and subcrestal implant positioning for the connective tissue length (WMD = 0.17 mm; 95% CI = - 0.03 to 0.36; P = 0.10). CONCLUSION: This systematic review suggests that PS implants placed in a subcrestal position have less MBL changes when compared with implants placed equicrestally. Furthermore, the location of the microgap seems to have an influence on the dimensions of peri-implant soft tissues. Clinical relevance When compared with PS placed in an equicrestal position, subcrestal implant positioning demonstrated less peri-implant bone remodeling.
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Processo Alveolar/cirurgia , Projeto do Implante Dentário-Pivô/métodos , Implantação Dentária Endóssea/métodos , Implantes Dentários , Animais , Remodelação Óssea , HumanosRESUMO
OBJECTIVE: To analyse alveolar ridge volume changes after immediate implant placement, with or without a regenerative technique. METHODS: Studies investigating the effect of immediate implant placement on ridge dimensional changes were identified through an electronic search conducted using MEDLINE (PubMed) and EMBASE. Weighted mean changes (WMC) between baseline and follow-up time were calculated and subgroup analysis was performed according to study design, evaluation method and regenerative strategies. RESULTS: After immediate implant placement alone WMC of RCTs showed a loss in width and height of 1.1 mm. After flapless immediate implant placement with immediate provisionalization and a graft WMC showed a loss in width and height of 1.02 mm and 0.79 mm, while after flapped immediate implant placement and a graft WMC showed a gain of 1.79 mm. After immediate implant placement plus a non-resorbable membrane WMC showed a loss in height of 0.07 mm. After immediate implant placement plus a resorbable membrane and a graft WMC showed a gain in height of 1.09 mm. CONCLUSIONS: Immediate implant placement does not seem to counteract alveolar ridge modelling after tooth extraction. Furthermore, the currently available evidence does not allow for any conclusive statements regarding the efficacy of a concomitant regenerative technique in preventing the amount of alveolar reduction.
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Processo Alveolar/patologia , Aumento do Rebordo Alveolar/métodos , Implantação Dentária Endóssea/métodos , Implantes Dentários , Implantes Absorvíveis , Perda do Osso Alveolar/etiologia , Regeneração Óssea/fisiologia , Remodelação Óssea/fisiologia , Transplante Ósseo/métodos , Seguimentos , Humanos , Carga Imediata em Implante Dentário/métodos , Membranas ArtificiaisRESUMO
BACKGROUND: A lack of evidence is present in literature regarding the clinical relevance of micropollution and bacterial contamination present on customized titanium abutments following laboratory stages and steaming cleaning procedures. To preserve abutments from such pollutants, plasma of argon cleaning of customized abutments was advocated. AIM: The aim of this prospective, randomized, match-paired, triple-blinded, controlled, clinical trial is to longitudinally assess radiographical marginal bone-level changes around implants restored according to the platform switching and "one-abutment-one-time" concepts, using commercially available abutments, with and without plasma of argon cleaning treatment after customization. MATERIALS AND METHODS: Thirty patients with thin gingival biotype, a history of periodontal disease, and in general good health received one implant in the anterior maxilla or premolar region. Patients were randomly assigned to control (abutment subjected only to usually adopted cleaning protocol by steam) and test group (abutment subjected to plasma of argon treatment). Periapical standardized digital radiographs were taken at the time of crown connection (T0), 6 (T1) and 24 months after the final restoration (T2). Average mesial-distal bone-level changes mean values with standard deviations (SD) were calculated. The Mann-Whitney U-test was selected to identify differences in bone-level changes between test and control groups. RESULTS: An average interproximal bone loss of 0.16 mm (SD: 0.17) and 0.07 mm (SD: 0.34) was revealed in the control and test group at 6 months (T1), respectively, while after 24 months, groups showed a mean bone-level changes of 0.38 mm (SD: 0.44) and 0.11 mm (SD: 0.14), respectively. Statistically significant differences among control and test groups were found at both time points. Intergroup comparison relived absence of statistically significant difference. CONCLUSION: Plasma-cleaning treatment of implant titanium abutments, together with platform switching and one-abutment-one-time concepts, could be favorable in terms of hard-tissue-level changes, also in critical conditions such as in patients with a history of periodontal disease, presenting thin gingival biotype.
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Perda do Osso Alveolar/diagnóstico por imagem , Argônio/uso terapêutico , Dente Suporte , Projeto do Implante Dentário-Pivô , Implantes Dentários para Um Único Dente , Doenças Periodontais/complicações , Esterilização/métodos , Adulto , Idoso , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia Dentária Digital , Propriedades de Superfície , TitânioRESUMO
AIM: The aim of this article was to systematically review histological and histomorphometrical data from literature that provide information regarding the effect of alveolar ridge preservation procedures on healing after tooth extraction in humans. MATERIALS AND METHODS: The MEDLINE-PubMed and the Cochrane CENTRAL databases were searched up to September 2012; 38 papers were selected from 646 founded. A meta-analysis was performed regarding the variations in the mean percentage of Bone, Connective Tissue and Residual Graft Material between three different types of Procedures. RESULTS: The highest value regarding bone percentages is produced at 3 months by Procedures with Allografts (54.4%), while the lowest is obtained, at 5 months, by those using Xenografts (23.6%). Referring to connective tissue, the highest and lowest values are shown at 7 months, with Allografts (67%) and Alloplasts (27.1%), respectively. Regarding residual graft material, the lowest rates are displayed by Procedures with Allografts (12.4-21.11%), while those using Xenografts and Alloplasts showed the best results at 7 months (37.14 and 37.23%). No statistical difference was found. CONCLUSIONS: With the limitations due to the features of the selected papers, no major histological and histomorphometrical differences arose among different procedures or when compared to spontaneous healing. Thus, it might be argued that in preserved sites it is unnecessary to wait over 3 to 4 months prior to implant insertion.
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Perda do Osso Alveolar/patologia , Perda do Osso Alveolar/prevenção & controle , Aumento do Rebordo Alveolar/métodos , Transplante Ósseo/métodos , Extração Dentária , Cicatrização/fisiologia , Implantação Dentária Endóssea , HumanosRESUMO
AIM: To identify critical elements in design and execution of coronally advanced flap, lateral positioned flap and their variations for the treatment of facial gingival recessions or peri-implant soft tissue dehiscences. MATERIALS AND METHODS: Clinical studies were identified with both electronic and hand searches, and examined for the following aspects: flap design and incision techniques, flap elevation, root conditioning, flap mobility, flap stability and suturing. Moreover, prognostic factors for complete recession coverage were identified. RESULTS: Some critical elements are evident in flap design and execution: the dimension and the thickness of tissue positioned over the denuded roots; the use on root surface of enamel matrix derivate; the stability and suturing of the flap in a position coronal to the cemento-enamel junction. The pre-determination of the clinical cemento-enamel junction, smoking status, operator surgical skills and the compliance to a supportive care programme have a role in obtaining and maintaining a complete root coverage. CONCLUSIONS: Different flap approaches are available when performing periodontal plastic surgery, resulting in a great variability in clinical outcomes. The possibility of using pedicle flaps alone to achieve complete soft tissue coverage of facial implant dehiscence has not yet been investigated.
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Implantação Dentária Endóssea/métodos , Doenças da Gengiva/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos/cirurgia , Proteínas do Esmalte Dentário/uso terapêutico , Retração Gengival/cirurgia , Humanos , Planejamento de Assistência ao Paciente , Retalhos Cirúrgicos/classificação , Deiscência da Ferida Operatória/cirurgia , Técnicas de Sutura , Raiz Dentária/cirurgiaRESUMO
AIM: To assess and characterize pollution micro-particles and bacterial growth on customized titanium abutments after steaming, ultrasonic and plasma cleaning treatments. MATERIALS AND METHODS: Thirty commercially available implant abutments, after customization, were randomly divided into 3 groups of 10 and cleansed by steam (considered as control group), ultrasonic cleaning (test group 1) and plasma of Argon (test group 2). For all specimens, SEM analysis and EDAX microanalysis were performed to count and characterize pollution micro-particles, both on the abutment surface and implant-abutment connection. For the control and test groups, mean values and standard deviations were calculated for number and density of micro-particles. Statistical differences were determined by one-way ANOVA with Scheffe multiple comparison test. The level of statistical significance was set at P ≤ 0.05. Additional microbiologic analysis was performed to detect bacterial contamination on the abutment surface. RESULTS: In the control group, the number of micro-particles on average was 117.5, and 14.1, respectively, on the abutment surface and connection. In the test groups, no pollution was revealed on the abutment (average of 1.09 and 1.13 spots, respectively, in test group 1 and test group 2) and connection (1.28 and 1.41, respectively, in test group 1 and test group 2). The analysis of variance (ANOVA) showed a statistically significant difference for all the variables examined. For each variable, at least one of the groups differs from the others. Scheffe multiple comparison test showed that all comparisons for every variables between the control group and both groups are significant, while there were some comparisons between test group 1 and test group 2 that were not significant. EDAX microanalysis identified micro-particles as residual of lubricant mixed with traces of Titanium and other metals. Microbiologic analysis demonstrated the presence of bacterial growth on the abutment surface only in the control group (111.5 ± 11.43 CFU/ml/implant-abutment as mean value). In the test groups, absence of growing microorganisms was found. CONCLUSIONS: This study confirmed that both plasma and ultrasonic treatments can be beneficially adopted for abutment cleaning process after laboratory technical stages, to supposedly favor soft tissue healing and implant-prosthetic connection stability.
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Dente Suporte/microbiologia , Desinfecção/métodos , Titânio/química , Planejamento de Prótese Dentária , Contaminação de Equipamentos , Microscopia Eletrônica de Varredura , Tamanho da Partícula , Propriedades de SuperfícieRESUMO
BACKGROUND: In daily clinical practice of a dental department it's common to find gingival overgrowth (GO) in periodontal patients under treatment with Cyclosporine A (CsA). The pathogenesis of GO and the mechanism of action of Azithromycin (AZM) are unclear. A systematic review was conducted in order to evaluate the efficacy of Azithromycin in patients with gingival overgrowth induced by assumption of Cyclosporine A. METHODS: A bibliographic search was performed using the online databases MEDLINE, EMBASE and Cochrane Central of Register Controlled Trials (CENTRAL) in the time period between 1966 and September 2008. RESULTS: The literature search retrieved 24 articles; only 5 were Randomised Controlled Trials (RCTs), published in English, fulfilled the inclusion criteria. A great heterogeneity between proposed treatments and outcomes was found, and this did not allow to conduct a quantitative meta-analysis. The systematic review revealed that a 5-day course of Azithromycin with Scaling and Root Planing reduces the degree of gingival overgrowth, while a 7-day course of metronidazole is only effective on concomitant bacterial over-infection. CONCLUSION: Few RCTs on the efficacy of systemic antibiotic therapy in case of GO were found in the literature review. A systemic antibiotic therapy without plaque and calculus removal is not able to reduce gingival overgrowth. The great heterogeneity of diagnostic data and outcomes is due to the lack of precise diagnostic methods and protocols about GO. Future studies need to improve both diagnostic methods and tools and adequate classification aimed to determine a correct prognosis and an appropriate therapy for gingival overgrowth.
RESUMO
This report describes the long-term outcomes of nonsurgical periodontal therapy and supportive periodontal treatment (SPT) of a 21-year-old patient affected by generalized aggressive periodontitis at multiple teeth with a compromised prognosis. After 25 years of SPT, no teeth had been extracted and no periodontal pockets associated with bleeding on probing were present. Radiographic analysis showed an improvement in infrabony defects, demonstrating long-term improvement is possible with nonsurgical periodontal treatment provided that smoking is not present and the patient is included in a strict SPT.