Multidisciplinary Treatment: Follow-Up of Dental Autotransplantation for 10 Years.

The objective is to present a clinical case of dental autotransplantation managed with surgery, orthodontics, endodontics, periodontics, and aesthetic rehabilitation. A 10-year-old boy sought treatment after avulsion of the maxillary left central incisor, which was not reimplanted. Based on anamnesis, clinical examination, and complementary examinations, agenesis of the maxillary and mandibular second premolars except the mandibular right second premolar was observed. After a multidisciplinary planning, the space in the maxillary left central incisor region was opened to receive the transplanted mandibular right second premolar. The receptor site was created in a single surgical procedure. Pulp necrosis was noted in the transplanted tooth, which was treated endodontically, and the agenesis spaces were closed using fixed orthodontic appliances. After removing the appliance, gingivectomy with osteotomy was performed in the maxillary right central incisor and the transplanted tooth regions to harmonize the height and shape of the gingival contour. Next, aesthetic readjustment was performed with tooth whitening, using office and home techniques, followed by microabrasion of the vestibular surface of the maxillary right central incisor. Direct composite resin restorations were placed in the maxillary incisors, and the teeth were rehabilitated using incisal and palatal guides. A multidisciplinary approach is essential for reestablishing the function and aesthetics of complex cases involving dental autotransplantation.

Analysis of IL1 gene polymorphisms and transcript levels in periodontal and chronic kidney disease.

UNLABELLED: Chronic kidney disease (CKD) and periodontitis (PD) are complex inflammatory disturbances, influenced by genetic factors. Interleukin (IL)-1 genes code for inflammatory mediators involved in the physiopathogenesis of both diseases. Functional polymorphisms in IL1 genes modulate cytokine levels and have been associated with susceptibility to immune-inflammatory conditions. OBJECTIVES: The aim of this study was investigate the association of functional IL1 gene polymorphisms and transcript levels with susceptibility to CKD and PD. DESIGN: The sample consisted of 246 individuals, mean age 44.8 years, divided into: group 1 (64 patients without CKD and without PD), group 2 (58 without CKD and with PD), group 3 (52 with CKD and without PD) and group 4 (72 with CKD and with PD). DNA was obtained from cells of oral mucosa and polymorphisms IL1AC-889T, IL1BC-511T, IL1BC+3954T and IL1RN (intron 2) were analyzed by PCR-RFLP. Transcript levels from gingival tissues were analyzed by real-time PCR. RESULTS: IL1RN(*)1 allele was associated with almost 4-fold increased risk for CKD (OR 3.92 95% CI=1.6-9.4, p=0.002). IL1RN(*)2 allele was associated with 3-fold increased risk for PD in CKD patients (OR 3.08 95% CI=1.2-7.9, p=0.019). Allele T for polymorphism IL1B+3954 was associated with CKD in PD patients (OR 2.28 95% CI=1.1-4.7, p=0.019). Significantly increased levels of transcripts of IL1A, IL1B and IL1RN genes were found in PD patients. CONCLUSIONS: It was observed an evidence for association of IL1B and IL1RN alleles with susceptibility to CKD and PD. Higher levels of IL1 gene transcripts were found in PD patients.

Orthodontic extrusion and implant site development using an interocclusal appliance for a severe mucogingival deformity: a clinical report.

A multidisciplinary therapy used to treat a patient with a severe mucogingival deformity in the area of maxillary anterior teeth is presented. The simple technique uses an interocclusal appliance and elastic band for orthodontic extrusion to correct the mucogingival deformity and develop an implant site. This approach is designed to increase the amount of keratinized tissue and new alveolar bone, which are necessary for the development of an implant site. Clinical and radiographic examinations at the 5-year follow-up revealed a successful tooth replacement and improved esthetic appearance that was achieved with multidisciplinary treatment. The advantages and disadvantages of this technique are discussed.

Evaluation of 2 techniques of epithelial removal in subepithelial connective tissue graft surgery: a comparative histological study.

PURPOSE: Subepithelial connective tissue grafts (SCTGs) are commonly performed for the treatment of gingival recession due to their high predictability. This study evaluated and histologically compared connective tissue grafts in terms of the presence of epithelial remnants and composition of the tissue types that were present (epithelium, lamina propria, and submucosa). METHODS: Ten patients underwent epithelium removal using 2 different techniques: the use of a blade (group B) and through abrasion (group A). Twenty samples were collected and each tissue type was analyzed histologically in terms of its area, thickness, and proportion of the total area of the graft. RESULTS: In 4 samples (40%) from group B (n=10) and 2 samples (20%) from group A (n=10), the presence of an epithelial remnant was observed, but the difference between the groups was not statistically significant (P>0.05). Likewise, no statistically significant differences were observed between the groups regarding the area, mean thickness, or proportion of the total area for any of the tissue types (P>0.05). CONCLUSIONS: Histologically, SCTGs did not show statistically significant differences in terms of their tissue composition depending on whether they were separated from the epithelial tissue by abrasion or by using a blade.

Vitamin D Receptor Gene Polymorphisms and Environment Influencing the Impact on Survival in Hemodialysis Patients.

INTRODUCTION: The vitamin D-receptor axis is involved in multiple physiological functions and altered states such as hypertension, mineral metabolism disorders, and inflammation. These disturbances are major risk factors for progression to end-stage kidney disease and cardiovascular disease. In addition, changes in internal systemic environment could be influencing the impact of survival in patients with kidney disease. This study aimed to evaluate the impact of vitamin D receptor (VDR) polymorphisms on hemodialysis patients' survival. MATERIAL AND METHODS: A total of 122 hemodialysis patients and 120 healthy controls were compared for VDR gene polymorphism. Markers for full coverage in the VDR gene were selected and genotyped. The hemodialysis patients were followed until death event, which was considered the primary endpoint for the survival analysis. RESULTS: Two tag SNPs (rs10875695 and rs11168293) showed significant differences between the hemodialysis and healthy patients. In survival analysis, the CC genotype for rs2248098, compared to the TT genotype, was associated with a worse mortality rate. After adjustments for age, sex, diabetes mellitus, and cardiovascular disease, the genotype CC (rs2248098) was associated with a higher risk of mortality in a multivariable analysis. CONCLUSIONS: Polymorphisms specific to patients with kidney disease could be influencing different conditions associated with mortality. Thus, these genetic markers, rs2248098 for example, would act in a specific time in the history of kidney disease and would bring different results of patient survival outcomes.

Association between vitamin D receptor gene polymorphisms and susceptibility to chronic kidney disease and periodontitis.

BACKGROUND/AIMS: Chronic kidney disease (CKD) and periodontitis (PD) are serious public-health concerns. Vitamin D is a fat-soluble steroid hormone that interacts with its nuclear receptor (VDR) to regulate a variety of biological processes, such as bone metabolism, immune response modulation and transcription of several genes involved in CKD and PD disease mechanisms. The aim of this work was to investigate the association between polymorphisms in the VDR gene and end-stage renal disease (ESRD) and PD. METHODS: 222 subjects with and without ESRD (in hemodialysis) were divided into groups with and without PD. Polymorphisms TaqI and BsmI in the VDR gene were analyzed by PCR restriction fragment length polymorphism. The significance of differences in allele, genotype and haplotype frequencies between groups was assessed by the chi2 test (p value <0.05) and odds ratio (OR). RESULTS: Allele G was associated with protection against ESRD: groups without versus with ESRD (GG) x (GA+AA): OR = 2.5, 95% CI = 1.4-4.6, p = 0.00; (G x A): OR = 1.5, 95% CI = 1.0-2.3, p = 0.02; (TG + CG) x (TA + CA): OR = 1.5, 95% CI = 1.0-2.3, p = 0.02. No association was observed between the study polymorphisms and susceptibility to or protection against PD. CONCLUSION: Allele G of the VDR BsmI polymorphism was associated with protection against ESRD.

Preprosthetic periodontal surgery in the proximal area with modification of the col area: results following the reestablishment of the contact point.

BACKGROUND: Anatomic characteristics of interproximal areas are dependent on the anatomy, position, and proximal contact of adjacent teeth. The objective of this study was to investigate the influence of the reestablishment of the interproximal contact following the restorative alveolar interface (RAI) procedure on the interproximal gingival COL and formation of the interdental gingival papilla. METHODS: Six mongrel dogs received bilateral apically positioned flaps, crown lengthening, and the RAI procedure on the maxillary fourth bicuspid and first molar. After 2 weeks, in a randomized manner, one side was prepared to receive metallic crowns and the opposite side remained as the control. The crowns were cemented at the 4-week postoperative period, and the dogs were sacrificed after another 4 weeks, totaling a period of 4 weeks with the full crowns in position and a total of 8 postoperative weeks. Histologic specimens were stained with hematoxylin and eosin and Mallory dyes. Sections 6 micro m thick were obtained in a bucco-lingual plane allowing ample visualization of the interproximal area. RESULTS: Clinical measurements revealed that, in the restored sides, four animals had complete fill of the interdental spaces with gingival papilla, whereas the other two dogs had a distance from the contact point to the tip of papilla varying from 0.02 to 0.021 mm. In the control group, papillae were totally reepithelialized with keratinized epithelium and a convex form. The epithelium completely covered the connective tissue and showed both epithelial projections and surface desquamation. On the test group, despite the presence of the prosthesis, the COL morphology modified by preprosthetic surgery was not altered, presenting a convex papilla with a triangular form and with a keratinized epithelium. Additional histologic characteristics were the same as found in the control group. CONCLUSION: Based on the results of this study, the reestablishment of the contact point does not revert what was obtained with the RAI procedure; the interproximal tissues remain convex and keratinized.

Rapid orthodontic extrusion using an interocclusal appliance for the reestablishment of biologic width: a case report.

A multidisciplinary treatment of a case of subgingival fracture in a maxillary anterior tooth is presented. This case report describes a simple method involving an interocclusal appliance and an elastic band for rapid orthodontic extrusion to reestablish biologic width. In addition, a simple technique for surgical recontouring following the coronal displacement of the gingival margin prior to restoration of fractured tooth is explained.

Bismuth subgallate as a topical hemostatic agent at palatal donor sites.

OBJECTIVE: To present bismuth subgallate as a simplified and efficient method for promoting hemostasis at palatal donor sites, as evaluated by measuring hemostasis time and delayed bleeding. METHOD AND MATERIALS: Ten patients received the bismuth subgallate paste as a topical hemostatic agent, while another 10 patients received moistened gauze pressure. The time to obtain complete hemostasis, defined as no visual bleeding, was recorded for each subject. RESULTS: Bismuth subgallate paste was found to decrease hemostasis time, when compared with moistened gauze pressure. The mean hemostasis time for the bismuth subgallate group was significantly shorter (2.6 +/- 0.7 minutes) when compared to the moistened gauze group (7.2 +/- 1.4 minutes). While delayed bleeding was observed in the moistened gauze group, no statistically significant difference was found between the groups (P = .10). CONCLUSION: The use of bismuth subgallate as a topical hemostatic for palatal wounds may be an option when performing free soft tissue grafts.

Efeito da deficiência de estrógeno no preenchimentode defeitos ósseos tratados ou não com biomaterial:um estudo radiográfico em ratas / The effect of estrogen deficiency on filling bone defects treated or not with biomaterial: a radiographic study on rats

Objetivos: O objetivo deste estudo foi avaliar radiograficamente o preenchimento ósseo de defeitos criados em tíbia de ratas ovariectomizadas e não ovariectomizadas, preenchidos por coágulo ou material substituto ósseo. Materiais e métodos: Foram utilizadas 30 ratas wistar, sendo que 15 foram ovariectomizadas(grupo OV) e 15 ratas não receberam ovariectomia (grupo NOV). Decorridos 60 dias da cirurgia de ovariectomia,ambos os grupos foram submetidos à cirurgia para confecção de defeitos ósseos nas tíbias. A tíbia direita foi preenchida por coágulo, e a esquerda, por biomaterial sintético (Bone Ceramic®), formando os seguintes grupos: grupos não ovariectomizados com defeitos preenchidos por coágulo (grupo NOV/C) ou por biomaterial (grupo NOV/B), e grupos ovariectomizados com defeitos preenchidos por coágulo (grupoOV/C) ou por biomaterial (grupo OV/B). Decorridos 60 dias da cirurgia de confecção dos defeitos e seus preenchimentos, as ratas foram mortas e suas tíbias removidas. A densidade óssea das tíbias foi avaliada em radiografias digitais e as imagens foram estudadas no programa de imagem ImageJ, por examinador único.Para a análise estatística, utilizou-se o teste Anova a dois critérios multifatoriais completos com α < 0,05.Resultados: A porcentagem média de preenchimento ósseo para cada grupo foi: grupo NOV/C, 71,55%;grupo NOV/B, 70,44%; grupo OV/C, 21,03% e grupo OV/B, 58,93%. Conclusão: Com base nos resultados par obtidos,pôde-se concluir que a deficiência de estrógeno interferiu no grau de preenchimento ósseo em defeitos cirurgicamente criados em tíbias de ratas, com ou sem o uso de um biomaterial.

Objectives: The aim of this study was to evaluate radiographically the bone filling of defects surgically createdin the tibiae of ovariectomized and non-ovariectomized rats. Defects were filled with coagulum or syntheticbone graft. Materials and methods: Thirty female Wistar rats were divided into two groups: 15 rats receivedovariectomy (group OVX) and 15 did not (group NOVX). Sixty days after ovariectomy surgery, both groups weresubmitted to ostectomy surgery for bone defect creation in the tibiae. The right tibiae were filled with coagulumand the left one with synthetic bone graft (Bone Ceramic®). The groups of study were: non--ovariectomizedgroup, with defects filled with coagulum (group NOV/C) or biomaterial (group NOV/B), and ovariectomizedgroup, with defects filled with coagulum (group OV/C) or biomaterial (group OV/B). After 120 days, the ratswere sacrificed and their tibiae removed. The bone density was evaluated by digital radiograph and the imageswere analyzed by ImageJ program. In order to carry out the statistical analysis, Anova test was applied α <0.05. Results: The mean percentages of bone filling for each group were: group NOV/C, 71.55%; group NOV/B,70.44%; group OV/C, 21.03% and group OV/B, 58.93%. Conclusion: Based on the results obtained, it was possibleto conclude that estrogen deficiency interfered on the level of bone filling of surgically created defects inrats tibiae, with or without the use of biomaterial.

Radiographic evaluation of the effect of porcine submucosamembrane graft and bioactive glass on bone filling in rat calvaria / Avaliação radiográfica do efeito de membrana de submucosa suína e vidro bioativo no preenchimento ósseo em calvária de rato

Objectives: The aim of this study was to radiographically evaluate the filling of standardized bone defectsin rat calvaria treated with bioactive glass and with porcine submucosa membrane, alone or in combination,when compared to defects filled with clot. Materials and methods: Eighty male Wistar rats, weighing 250to 300 g, were divided into four groups, with trial period of two and eight weeks. Standardized bone woundswere surgically created in the calvaria measuring 6 mm in diameter and treated with bioactive glass, porcinesubmucosa membrane, combination of both or only clot. After two or eight weeks, the animals wereeuthanized and bone specimens were collected for evaluation with standard radiographs and digitized foranalysis with ImageJ image analyzer to compare the percentage of filling of the defects by measuring thevariations of levels of gray. Data were scored and analyzed statistically (ANOVA and Tukey HSD, p < 0.05).Results: The association of bioactive glass and submucosa membrane showed the best result of filling ofbone cavities, followed by the single use of bioactive glass. Membrane alone showed similar results withthe clot group. Conclusion: It was possible to conclude that the association of bioactive glass and porcinesubmucosa membrane could be good option for bone filling of bone defects.

Objetivos: O objetivo deste estudo foi avaliar radiograficamente o preenchimento de defeitos ósseos padronizados em calvária de ratos, tratados com vidro bioativo e com membrana de submucosa suína, isolados ou em associação, quando comparados com defeitos preenchidos com coágulo. Materiais e métodos: Oitenta ratos Wistar machos, pesando de 250 a 300 g, foram separados em quatro grupos, com períodos de avaliação de duas ou oito semanas. Defeitos ósseos padronizados foram cirurgicamente criados na calvária medindo 6 mm de diâmetro e tratados com vidro bioativo, membrana submucosa suína, combinação de ambos ou apenas com coágulo. Após duas ou oito semanas, os animais foram mortos e os espécimes ósseos foram coletados para avaliação com radiografias padronizadas e digitalizadas para análise com programa ImageJ, visando a comparar a porcentagem de preenchimento dos defeitos por meio da variação dos níveis de cinza. Os dados foram obtidos e avaliados estatisticamente (ANOVA e Tukey HSD, p < 0,05). Resultados: A associação do vidro bioativo com a membrana submucosa suína demonstrou os melhores resultados de preenchimento das cavidades ósseas,seguido pelo uso isolado do vidro bioativo. A membrana isolada demonstrou resultados semelhantes ao grupo coágulo. Conclusão: Foi possível concluir que a associação do vidro bioativo e da membrana submucosa suína pode ser uma boa opção para o preenchimento de defeitos ósseos.

Condicionamento ácido da superfície radicular em periodontia / Root surface conditioning in periodontal therapy

O objetivo principal da terapia periodontal vem sendo a biocompatibilizaçäo da superfície radicular com os tecidos periodontais adjacentes. A raspagem e alisamento säo ainda procedimentos fundamentais para se atingir este objetivo. No entanto, vem sendo sugerindo que a instrumentaçäo vigorosa da superfície radicular deva ser evitada, a fim de se manter cemento radicular, importante no processo de reparo dos tecidos periodontais de sustentaçäo. O uso de substâncias ácidas, como o ácido cítrico, ácido fosfórico e o EDTA, vem sendo preconizado para a remoçäo das endotoxinas e exposiçäo de fibras colágenas da superfície radicular, favorecendo a obtençäo de nova inserçäo conjuntiva apesar dos trabalhos ainda mostrarem-se inconclusivos quanto à efetividade clínica desse procedimento