RESUMO
A 60-year-old woman presented with the chief complaint of mobility of tooth #16. Gingival swelling and calculus were observed. Clinical examination revealed that 49.4% of sites had a probing depth (PD) of ≥4 mm and 72% of sites bleeding on probing. Radiographic examination revealed vertical bone resorption in #35 and horizontal resorption in other regions. Periapical region radiolucency on #16 and 27 suggested a perio-endo lesion. The clinical diagnosis was severe chronic periodontitis. Initial periodontal therapy mainly comprised the following: oral hygiene instruction; quadrant scaling and root planing (SRP); extraction of #16, 27, and 31; and placement of provisional restorations. Open flap debridement was performed for teeth with a PD ≥4 mm. Bone defects exceeding the root apex were found in #17, 41, 42, and 45 intraoperatively. Teeth #41, 42, and 45 were extracted. After confirming the stability of the periodontal tissue, final prostheses were placed on #14-17, 13-22, 35-37, 33-43, 44-46, and 47. Following reevaluation, the patient was placed on supportive periodontal therapy (SPT). After 6 years, the patient experienced dull pain in and pus discharge from #17. Repeated SRP yielded no improvement, so the tooth was extracted and a removable partial denture placed on #16 and 17. Nine years have passed since the start of SPT and the level of plaque control has remained adequate and periodontal condition stable.
Assuntos
Periodontite Crônica/cirurgia , Raspagem Dentária , Prótese Parcial Removível , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Aplainamento Radicular , Índice de Gravidade de DoençaRESUMO
Here we report a case of generalized aggressive periodontitis treated with periodontal therapy including adjunct antimicrobial therapy and periodontal surgery. The patient was a 22-year-old woman who presented with the chief complaint of gingival recession. Baseline examination revealed generalized plaque deposition and gingival inflammation. Thirty-nine percent of the sites had a probing depth (PD) of 4-6 mm and 2% a PD of ≥7 mm; 63% exhibited bleeding on probing (BOP). Radiographic examination revealed vertical bone loss in the molars and horizontal bone loss in other teeth. Microbiological examination of subgingival plaque revealed the presence of Aggregatibacter actinomycetemcomitans and Tannerella forsythia. Oral health-related quality of life was assessed as a measure of patient-reported outcome. Based on a clinical diagnosis of generalized aggressive periodontitis, initial periodontal therapy and adjunct antimicrobial therapy were implemented. After reducing inflammation and subgingival bacteria, open flap debridement was performed for teeth with a PD of ≥4 mm. Reevaluation showed no sites with a PD of ≥5 mm, a minimal level of BOP, and a marked reduction in the level of the targeted periodontal pathogens. The patient's oral health-related quality of life was slightly worsened during supportive periodontal therapy (SPT). Implementation of adjunct antimicrobial therapy targeting periodontal pathogens and subsequent periodontal surgery resulted in improvement in periodontal and microbiological parameters. This improvement has been adequately maintained over a 2-year period. However, additional care is necessary to further improve the patient's oral health-related quality of life during SPT.
Assuntos
Periodontite Agressiva/complicações , Periodontite Agressiva/terapia , Perda do Osso Alveolar/terapia , Placa Dentária/terapia , Infecções por Bactérias Gram-Negativas/terapia , Minociclina/uso terapêutico , Infecções por Pasteurellaceae/terapia , Bolsa Periodontal/terapia , Adulto , Aggregatibacter actinomycetemcomitans/patogenicidade , Periodontite Agressiva/epidemiologia , Compostos de Alumínio/uso terapêutico , Perda do Osso Alveolar/etiologia , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Quimioterapia Adjuvante/métodos , Dente Canino/patologia , Proteínas do Esmalte Dentário/uso terapêutico , Placa Dentária/microbiologia , Índice de Placa Dentária , Sensibilidade da Dentina/tratamento farmacológico , Sensibilidade da Dentina/etiologia , Feminino , Fluoretos/uso terapêutico , Defeitos da Furca/etiologia , Defeitos da Furca/cirurgia , Retração Gengival/etiologia , Retração Gengival/cirurgia , Gengivite/etiologia , Gengivite/terapia , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Má Oclusão/complicações , Minociclina/administração & dosagem , Dente Molar/patologia , Higiene Bucal/educação , Infecções por Pasteurellaceae/microbiologia , Planejamento de Assistência ao Paciente , Desbridamento Periodontal/efeitos adversos , Desbridamento Periodontal/métodos , Índice Periodontal , Bolsa Periodontal/etiologia , Bolsa Periodontal/microbiologia , Qualidade de Vida , Compostos de Silício/uso terapêutico , Tannerella forsythia/patogenicidade , Tóquio , Recusa do Paciente ao TratamentoRESUMO
Zonisamide, an antiepileptic drug, is excreted into breast milk, but information regarding the safety of breast-feeding while using this drug is limited. We present the cases of two nursing mothers, taking 300 and 100 mg/day zonisamide. At 5 days after delivery, the milk concentrations and relative infant doses of the drug were 18.0 and 5.1 µg/mL, and 44 and 36%, respectively. In the first case, the mother fed colostrum and continued partial breast-feeding thus reducing the relative infant dose to 8%. The neonatal serum concentration of zonisamide declined to below the limit of detection at day 34 after birth. In the second case, the mother breast-fed partially until 2 weeks postpartum. No adverse effect was observed in the infants. These findings suggest that mothers taking zonisamide should not breast-feed exclusively, but may not have to avoid partial breast-feeding, with significant caution regarding adverse effects in infants.
Assuntos
Anticonvulsivantes/farmacocinética , Aleitamento Materno/efeitos adversos , Isoxazóis/farmacocinética , Lactação/metabolismo , Leite Humano/química , Adulto , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/análise , Anticonvulsivantes/provisão & distribuição , Disponibilidade Biológica , Desenvolvimento Infantil/efeitos dos fármacos , Epilepsia/sangue , Epilepsia/tratamento farmacológico , Epilepsia/metabolismo , Feminino , Sangue Fetal/química , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Isoxazóis/efeitos adversos , Isoxazóis/análise , Isoxazóis/uso terapêutico , Lactação/sangue , Masculino , Leite Humano/metabolismo , ZonisamidaRESUMO
This study aimed to investigate the prevalence and levels of major periodontal pathogens, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia in subgingival plaque samples of a group of Japanese patients with aggressive periodontitis (AgP) and chronic periodontitis (CP). A total of 40 patients with clinical diagnosis of AgP or CP and 10 periodontally healthy volunteers were subjected to clinical and microbiological analysis. Subgingival plaque samples were analyzed for A. actinomycetemcomitans, P. gingivalis and T. forsythia with a real-time polymerase chain reaction (PCR) technique. The prevalence of P. gingivalis and T. forsythia was relatively high in patients with periodontitis: over 60% of AgP or CP patients harbored these pathogens whereas they were not detected in the subgingival plaque samples from periodontally healthy individuals. P. gingivalis and T. forsythia were relatively frequently detected together in AgP and CP patients. No significant differences in the prevalence or level of the 3 pathogens were found between periodontitis groups. The proportion of T. forsythia was approximately 4-fold higher in CP group than in AgP group (P = 0.02). In periodontitis patients, a significant positive correlation was found between periodontal parameters (probing depth and clinical attachment level) and the numbers of total bacteria, P. gingivalis and T. forsythia. No distinct pattern of the subgingival profile of these pathogens was discerned between the two disease entities, except for the difference in the proportion of T. forsythia. The red complex bacteria, P. gingivalis and T. forsythia were highly prevalent in this population of Japanese AgP and CP patients, collaborating their roles in periodontitis.
Assuntos
Aggregatibacter actinomycetemcomitans/isolamento & purificação , Periodontite Agressiva , Bacteroidaceae/isolamento & purificação , Periodontite Crônica , Porphyromonas gingivalis/isolamento & purificação , Adulto , Periodontite Agressiva/epidemiologia , Periodontite Agressiva/microbiologia , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Periodontite Crônica/epidemiologia , Periodontite Crônica/microbiologia , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , PrevalênciaRESUMO
OBJECTIVE: This study aimed to evaluate clinically the effect of a novel dentifrice containing three kinds of bactericidal ingredients on periodontal disease. RESULTS: This was a single-arm, prospective clinical study that enrolled patients with periodontitis undergoing supportive periodontal therapy. Periodontal examination, microbiological testing of saliva samples, and evaluation of inflammatory markers (IL-1ß, IL-6, IL-8, TNF-α) in gingival crevicular fluid were performed. After 4 weeks of the use of test dentifrice, these parameters were re-evaluated. The use of dentifrice was also subjectively evaluated by clinicians and participants. Among 30 participants, there were significant improvements in the periodontal and microbiological parameters, and the level of interleukin-1ß in the gingival crevicular fluid, following the use of the test dentifrice. In clinicians' subjective evaluation of the overall usefulness of the dentifrice, 'mild' and 'moderate' improvement accounted for 83% of the total responses. In the participants' subjective evaluation, the majority indicated their experience of the use as favorable. Within the limitations of this study, it is suggested that the progression of periodontal disease during the supportive periodontal therapy can be prevented by the use of the test dentifrice. Trial registration UMIN Clinical Trials Registry (UMIN-CTR) 000023175. Date of formal registration: July 14, 2016 ( https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000026716 ).
Assuntos
Antibacterianos/farmacologia , Dentifrícios/uso terapêutico , Líquido do Sulco Gengival/imunologia , Periodontite/diagnóstico , Periodontite/tratamento farmacológico , Adulto , Idoso , Antibacterianos/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Resultado do TratamentoRESUMO
OBJECTIVE: To date, enamel matrix derivative (EMD) has been considered to be one of the few biomaterials for clinical use capable of demonstrating true periodontal regeneration. The aim of this two-center prospective clinical study was to evaluate 2-year outcome of periodontal regenerative therapy using EMD in the treatment of intrabony defects, performed as an 'advanced medical treatment' under the national healthcare system in Japan. RESULTS: Patients with chronic periodontitis who have completed initial periodontal therapy at either of the two dental school clinics were enrolled. Each contributed at least one intrabony defect of ≥3 mm in depth. During surgery, EMD was applied to the defect following debridement. Twenty-two participants (mean age 55.2 years old, 9 men and 13 women) completed 2-year reevaluation, and a total of 42 defects were subjected to data analysis. Mean gains in clinical attachment level (CAL) at 1 and 2 years were 2.9 mm (38% of baseline CAL) and 3.1 mm (41%), respectively, both showing a significant improvement from baseline. There was also a significant reduction in probing depth (PD): mean reductions at 1 and 2 years were 3.2 and 3.3 mm, respectively. There was a progressive improvement in the mean percentages of bone fill from 26% at 1 year to 36% at 2 years. No significant difference in CAL gain at 2 years was found between 3-wall bone defects and other defect types combined. In multiple regression analysis, the baseline PD was significantly associated with CAL gain at 2 years. In this population of patients, the treatment of intrabony defects with EMD yielded clinically favorable outcomes, as assessed by periodontal and radiographical parameters, over a period of 2 years.
Assuntos
Periodontite Crônica/cirurgia , Proteínas do Esmalte Dentário , Regeneração Tecidual Guiada Periodontal/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Periodontite Crônica/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Periodontal disease is assessed and its progression is determined via observations on a site-by-site basis. Periodontal data are complex and structured in multiple levels; thus, applying a summary statistical approach (i.e., the mean) for site-level evaluations results in loss of information. Previous studies have shown the availability of mixed effects modeling. However, clinically beneficial information on the progression of periodontal disease during the follow-up period is not available. We conducted a multicenter prospective cohort study. Using mixed effects modeling, we analyzed 18,834 sites distributed on 3,139 teeth in 124 patients, and data were collected 5 times over a 24-month follow-up period. The change in the clinical attachment level (CAL) was used as the outcome variable. The CAL at baseline was an important determinant of the CAL changes, which varied widely according to the tooth surface. The salivary levels of periodontal pathogens, such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans, were affected by CAL progression. "Linear"- and "burst"-type patterns of CAL progression occurred simultaneously within the same patient. More than half of the teeth that presented burst-type progression sites also presented linear-type progression sites, and most of the progressions were of the linear type. Maxillary premolars and anterior teeth tended to show burst-type progression. The parameters identified in this study may guide practitioners in determining the type and extent of treatment needed at the site and patient levels. In addition, these results show that prior hypotheses concerning "burst" and "linear" theories are not valid.