Differences in periodontal parameters between SPT patients who regularly and irregularly visited the dental clinic analyzed at tooth level: a 14-year retrospective cohort study.

The purpose of this study was to evaluate the periodontal status of patients who routinely did SPT, when compared to patients that did not SPT. This retrospective cohort study was conducted at a general dental office from 2001 to 2019. Patients aged 18 to 81 years who visited the dental office over a 10-year period were assigned into two groups: an SPT group, which included patients who continually visited the dental office for SPT one or more times every year, and an irregular group, consisting of patients who did not visit the dental office at least once a year. A total of 7307 teeth (SPT group) and 4659 teeth (irregular group) were evaluated, and the periodontal conditions were compared between the first and latest visits. Multiple regression analysis was used to analyze the results. The mean follow-up time was 13.74 years. The risk factors for improvements in probing pocket depth included age, sex, smoking, diabetes mellitus, molar tooth, and irregular SPT group (p < 0.001), and that for a positive bleeding on probing site was the irregular group (odds ratio 2.94; 95% confidence interval 2.63-3.29). This study showed that lack of routine in attending the SPT program significantly decreased the periodontal parameters, thus highlighting the importance of continuing with the program to maintain the periodontal health.

Evaluation of adjunctive efficacy of diode laser in the treatment of peri-implant mucositis: a randomized clinical trial.

Peri-implant disease may affect survival of dental implants. The aim of the study is to analyze the effectiveness of diode laser as a supportive modality to the non-surgical conventional treatment of peri-implant mucositis (PiM) and initial peri-implantitis (PI). Twenty-three patients with single implants suffering from PiM or initial PI were selected and randomly divided into two groups; control group (CG) received non-surgical conventional treatment, and test group (TG) received non-surgical conventional treatment and diode laser application with wavelength of 980 nm. Probing pocket depth (PPD) and bleeding on probing (BOP) were recorded at baseline (T0) and at 3 months follow-up (T1). The average of PPD value for TG was 4.04 ± 0.54 mm at T0 and it was 2.98 ± 0.70 mm at T1. In the CG, PPD average was 3.8 ± 1.24 mm at T0 and was 3.54 ± 0.35 mm at T1. In TG, the BOP was positive in 44 sites at T0 and in 6 sites at T1. In CG, the BOP was positively observed in 52 sites at T0 and in 28 sites at T1. The 980-nm diode laser may be considered an adjunct to the conventional non-surgical treatments of PiM and initial PI.

Avaliação da suplementação diária de ácidos graxos poli-insaturados de ômega-3 e aspirina em baixa dosagem no tratamento de periodontite agressiva generalizada: estudos clínicos controlados randomizados / Evaluation of omega-3 polyunsaturated fatty acids daily supplementation plus low-dose aspirin to treat generalized aggressive periodontitis: randomized controlled clinical trials

A destruição periodontal resulta principalmente da resposta inflamatória exacerbada do hospedeiro frente ao desafio bacteriano. Por isso, pesquisas envolvendo a modulação da resposta do hospedeiro têm sido desenvolvidas com o objetivo de facilitar a resolução da inflamação, bem como promover reparação tecidual e estabilidade periodontal. Recentemente, o uso de ácidos graxos poli-insaturados de ômega-3 (AGP Ω-3) e ácido acetilsalicílico (AAS) foi relacionado à produção de mediadores lipídicos mais bioativos e à melhores resultados clínicos no tratamento de periodontite crônica. Desse modo, pesquisas envolvendo modulação das respostas inflamatórias de portadores de periodontite agressiva (PAg) podem ser de grande valia. Assim, o objetivo dos presentes estudos clínicos controlados randomizados foi avaliar a utilização da suplementação de 900 mg AGP Ω-3 e 100 mg de AAS por 180 dias como adjuvantes ao tratamento de PAg generalizada (PAgG). (1) Selecionou-se 38 pacientes com PAgG os quais receberam debridamento subgengival associado a AGP Ω-3 e AAS (n=19) ou placebo (n=19). Ambos os grupos apresentaram diminuição (p<0,05) em todos os parâmetros clínicos avaliados, bem como em IL-1ß, sem diferença entre os tratamentos (p>0,05). O nível de TIMP-2 diminuiu significantemente no grupo controle, porém se manteve estável no grupo teste. Concluiu-se que a nova terapia proposta não trouxe benefícios clínicos no tratamento não-cirúrgico de PAgG. (2) Selecionou-se 34 pacientes com PAgG previamente submetidos à terapia básica que apresentavam bolsas residuais e foram submetidos à cirurgia de acesso para raspagem e alisamento radicular associado a AGP Ω-3 e AAS (n=17) ou placebo (n=17). Após 6 meses, ambos os grupos obtiveram diminuição na PS (p<0,05), porém somente o grupo teste obteve ganho no NIC na comparação intergrupo (p=0,02), assim como apresentou menor recessão gengival (p=0,03), diminuição da hipersensibilidade dentinária (p=0,01), menor consumo de analgésicos (p=0,02) e diminuição intragrupo de IL-10 (p<0,05). Concluiu-se que a nova terapia proposta trouxe benefícios clínicos no tratamento de bolsas residuais de pacientes com PAgG(AU)

Periodontal destruction results mainly from the exacerbated host inflammatory response to the bacterial challenge. For this reason, research involving the modulation of host response has been developed aiming to facilitate the resolution of inflammation, as well as to promote tissue repair and periodontal stability. Recently, the use of omega-3 polyunsaturated fatty acids (Ω-3 PUFA) and low-dose acetylsalicylic acid (ASA) was related to the production of enhanced lipidic mediators and to better clinical outcomes in the treatment of chronic periodontitis. Thus, the aim of the present randomized controlled clinical trials was to evaluate the use of 900 mg Ω-3PUFA and 100 mg ASA for 180 days as adjuvants to the treatment of generalized aggressive periodontitis (GAgP). (1) Thirty-eight GAgP patients were submitted to subgingival debridement associated with Ω-3 PUFA and ASA (n=19) or placebo (n=19). Both groups showed a statistically significant decrease (p<0.05) in all clinical parameters, as well as a decrease in IL-1ß, with no difference between treatments (p>0.05). The TIMP-2 level significantly decreased in the control group and remained stable in the test group. It was concluded that the proposed new therapy did not bring clinical benefits in the non-surgical treatment (NST) of GAgP. (2) Thirty-four GAgP patients previously submitted to NST with residual pockets were selected and underwent open flap debridement associated with Ω-3 PUFA 3 and ASA (n=17) or placebo (n=17). After 6 months, both therapies led to decreased PD (p>0.05), but only the test group had CAL gain in the intergroup comparison (p=0,02), as well as presented less gingival recession (p=0,03), decreased dentin hypersensitivity (p=0,01), lower consumption of analgesics (p=0,02) and significant intragroup reduction of IL-10 (p<0.05). It was concluded that the proposed new therapy brought clinical benefits in the surgical treatment of GAgP patient(AU)

Quantification of TNF-α in Patients with Periodontitis and Type 2 Diabetes.

OBJECTIVE: The present study aimed to compare variations in quantified tumor necrosis factor-alpha (TNF-α) levels in patients with periodontitis stage 2 grade B (POD2B) and/or type 2 diabetes (T2D) and to identify any relationships between this cytokine and these diseases. METHODS: Levels of the cytokine TNF-α in gingival crevicular fluid in patients with POD2B and/or T2D were evaluated. A total of 160 subjects were distributed into four groups: those with POD2B (n=44); those with T2D (n=37); those with POD2B/T2D (n=40); and healthy subjects (n=39). Glycosylated hemoglobin (HbA1c) and blood glucose (BG) levels were quantified in each subject. Data were collected on body mass index (BMI), loss of insertion (LI), and probe depth (PD). Gingival crevicular fluid samples were collected from the most acutely affected periodontal pocket and gingival sulcus in each subject, and TNF-α was quantified by multiplex analysis. RESULTS: Kruskal Wallis tests was used to identify differences in TNF-α levels, LI, PD, BMI, BG, and HbA1c by group. Differences (p<0.001) were found for LI, PD, BG, and HbA1c. A Spearman test was used to calculate possible correlations between TNF-α levels and LI or PD identified a weak but significant negative correlation of TNF-α with LI (Rho=-0199; p=0.012), and a moderately positive correlation of LI with PD (Rho=0.509; p < 0.001). CONCLUSIONS: No variation was found between TNF-α levels and the presence of POD2B, POD2B/T2D, or T2D, suggesting the absence of any direct relationship between progression of these diseases and TNF-α levels. However, a correlation was present between low TNF-α concentrations and greater LI.

Photobiomodulation for the treatment of periodontal pockets in patients with type 2 diabetes: 1-year results of a randomized clinical trial.

This study investigated the local effect of photobiomodulation (PBM) for the treatment of periodontal pockets in patients with periodontitis and type 2 diabetes. Thirty-eight periodontal pockets presenting probing depth (PD) and clinical attachment level (CAL) ≥ 5 mm were selected from 19 patients (two pockets/patient). The selected periodontal pockets were randomly assigned to receive mechanical debridement only (control group) or mechanical debridement with PBM (PBM group). Clinical measures, such as PD, CAL, bleeding on probing (BoP), and presence of supragingival biofilm (PI), were collected and compared at baseline, 3, 6, and 12 months. After 12 months, no statistically difference was observed for mean PD and mean CAL when control and PBM groups were compared. The frequency of pockets with PD 5-6 mm was significantly lower for the PBM group at 6 months when compared to the control group. Pockets with PD ≥ 7 mm changed significantly between baseline and 3, 6, and 12 months for the PBM group, while for the control group, statistical significance was only observed between baseline and 6 months. The PBM protocol used in this study did not provide significant changes for PD and CAL in periodontal pockets when compared to mechanical therapy only. However, PBM was more effective in reducing the percentage of moderate periodontal pockets at 6 months in patients with type 2 DM.

Diode Laser as an Adjunct to Kirkland Flap Surgery-A Randomized Split-Mouth Clinical and Microbiological Study.

Background: Mechanical methods of periodontal therapy alone may fail to eliminate the tissue-invasive pathogenic flora; therefore, considerable attention has been given to adjunctive antimicrobial measures. Objective: The aim of this study was to investigate and compare the clinical and microbiological effects of diode laser (DL) as an adjunct to Kirkland flap surgery versus Kirkland flap surgery alone for the treatment of generalized chronic periodontitis. Materials and methods: A total of 20 patients with generalized chronic periodontitis with probing pocket depth ≥5 mm after phase I therapy were included in this split-mouth study. Two contralateral quadrants of each patient were randomly assigned to either test or control group. Control group was treated with Kirkland flap surgery alone, whereas test group was treated with DL as an adjunct to Kirkland flap surgery. Periodontal parameters were recorded, and subgingival plaque samples were collected from both the control and test groups at baseline and third and sixth month. The plaque samples were then analyzed for red complex organisms using quantitative real-time polymerase chain reaction. Results: Compared with baseline, both treatments showed an improvement in periodontal parameters at the third and sixth month. However, test group produced a significant improvement in plaque index (1.039 ± 0.069 vs. 1.392 ± 0.17, p < 0.001), bleeding on probing (16.512 ± 5.982 vs. 37.051 ± 7.459, p < 0.001), probing pocket depth (1.727 ± 0.39 vs. 3.016 ± 0.47, p < 0.001), and clinical attachment level (2.054 ± 0.524 vs. 3.354 ± 0.728, p < 0.001) at third and sixth month compared with the control group. Moreover, in the test group, levels of red complex bacteria were significantly reduced at third and sixth month compared with the control group. Conclusions: DL as an adjunct to Kirkland flap surgery has resulted in a greater reduction in clinical and microbiological parameters compared with Kirkland flap surgery alone, thereby offering additional benefit in treating generalized chronic periodontitis patients.

Alcohol use and periodontal pocket development: findings from a 4-yr longitudinal study.

This study investigated whether alcohol use influences periodontal pocket development during a 4-yr follow-up period. The study included those participants who took part in both the Health 2000 Survey and the Follow-up Study on Finnish Adults' Oral Health. The participants at baseline were aged ≥30 yr, periodontally healthy, and did not have diabetes or rheumatoid arthritis. The development of periodontal pockets at follow-up was measured as the number of teeth with periodontal pockets and the presence of periodontal pockets. Alcohol use at baseline was measured as g/wk, frequency, and use over the risk limit. Incidence rate ratios with 95% CI were estimated using negative binomial regression models and Poisson regression models with a robust variance estimator. No consistent association was found between any of the alcohol variables and periodontal pocket development in the total population or among non-smokers. Among smokers, a positive association was found with the frequency of alcohol use. In general, risk estimates were slightly higher for women than for men. In summary, light-to-moderate alcohol use appears not to be consistently associated with the development of periodontal pockets. The adverse effects on the periodontium seem, to some extent, to be dependent on gender and smoking.

The severity of periodontitis and metabolic syndrome in Korean population: The Dong-gu study.

OBJECTIVES: We assessed the association between periodontal disease status and metabolic syndrome (MetS) and its individual components in Korean adults over 50 years old. MATERIAL AND METHODS: In the Dong-gu study, 5078 men and women aged over 50 years were included. They underwent a questionnaire survey, physical assessment, biochemical assessment and periodontal assessment. The percentages of sites with periodontal probing depth ≥4 mm, and clinical attachment loss ≥4 mm were recorded for each participant. Periodontal disease was also classified by the Centers for Disease Control and Prevention/American Academy of Periodontology definition of periodontitis and the American Academy of Periodontology definition (1999). MetS was defined by the 2009 guidelines of the International Diabetes Federation. This study used multivariate negative binominal regression analysis to assess the association between the severity of periodontitis and MetS, after age, smoking habits, alcohol consumption and physical activity related factors were adjusted for. RESULTS: Prevalence of MetS was 32.3%, 36.2% and 45.9% among men with no or mild, moderate and severe periodontitis, respectively. The severity of periodontitis was positively associated with the prevalent MetS in men but not in women. In men, severe periodontitis showed a higher risk of MetS than those with no or mild periodontitis (relative risk 1.43, 95% confidence interval 1.17-1.73) after adjusting for confounders. Periodontal probing depth was positively associated with the prevalence of MetS in both genders. In the analysis separated by individual MetS components, periodontitis severity was positively associated with hypertriglyceridemia and low high-density lipoprotein cholesterol in men, while positively associated with low high-density lipoprotein cholesterol and abdominal obesity in women. CONCLUSION: Increasing the severity of periodontitis was associated with the risk of prevalent MetS in Korean adults. This result confirmed that periodontal inflammation might be a contributive factor of MetS.

Waist circumference and waist-to-height ratio are associated with periodontal pocketing-results of the Health 2000 Survey.

BACKGROUND: Body mass index (BMI) has been found to associate with different parameters of chronic periodontal disease in previous studies. It is reasonable to expect that central adiposity measures, such as waist circumference and waist-to-height ratio, which indirectly takes into account visceral fat, are more accurate measures of obesity-related oral health risks than BMI. The aim of this study was to examine whether central obesity is associated with periodontal pocketing, an indication of infectious chronic periodontal disease. METHODS: The study was based on a subpopulation from the national Health 2000 Survey in Finland. It included dentate, non-diabetic, never-smoking subjects aged 30-49 (n = 1287). The outcome variable was the number of teeth with deepened periodontal pockets (4 mm or more) and the number of teeth with deep periodontal pockets (6 mm or more). Central obesity was measured by means of waist circumference (WC) and waist-to-height ratio (WHtR). Poisson regression models were used to estimate prevalence rate ratios (PRR) and their 95% confidence intervals. RESULTS: Our main finding was that both WC and WHtR were associated with the number of teeth with deeper (4 mm or more) periodontal pockets; the PRR for the fifth quintile in WC was 1.5, CI: 1.2-1.9 and in WHtR 1.4, CI: 1.1-1.7, when compared to the lowest quintile. Corresponding figures for deep (6 mm or more) periodontal pockets were 2.3, CI: 0.9-6.1 for WC and 1.9, CI: 0.8-4.4 for WHtR. There were no essential differences in the strengths of the associations between WC and WHtR and the number of teeth with deepened periodontal pockets. CONCLUSION: Both central adipose measures-WC and WHtR-seem to be associated with periodontal pocketing in non-diabetic, never-smoking subjects aged 30-49 years old.

Effect of maternal periodontitis and low birth weight--a case control study.

INTRODUCTION: Since the 1990s, evidence has been raised that there is an association between maternal periodontal disease and undesirable gestational events, for example low birth weight; this issue is controversial. OBJECTIVE: To evaluate whether there is an association between maternal periodontitis and low birth weight (LBW). METHODS: A case-control study was carried out on 951 mothers that had been cared for by the Brazilian Unified Health System in Petrolina-PE and Juazeiro-BA, Brazil. The case group (n = 269) consisted of mothers of newborns with birth weight <2500 g and a control group (n = 682) of mothers of newborns with birth weight ≥2500 g. An interview was realized, using a questionnaire as well as a full mouth examination to diagnose the periodontal condition. Women who had at least four teeth with probing depth ≥4 mm and clinical attachment loss ≥3 mm, with bleeding on probing at the same site, were diagnosed with periodontitis. The birth weight was obtained through the hospital book record. The main association was evaluated using the multivariate regression model, considering confounders. RESULTS: The frequency of periodontitis was 16.4% (case group) and 17.4% (control group). Periodontitis did not show an association with LBW (ORcrude = 0.92; 95% CI = 0.63-1.35), even after adjustment for the following confounders: maternal age, pre-gestational body mass index, number of pre-natal consultations, number of pregnancies, maternal schooling level, smoking habit during pregnancy and hypertension (ORadjusted = 1.00; 95% CI = 0.61-1.68). CONCLUSION: The findings of this study showed no association between maternal periodontal disease and low birth weight, even after appropriate adjustments for confounding factors.

Significance of maxillary sinus mucosal thickening in patients with periodontal disease.

AIM: To characterise and measure the Schneiderian membranes of individuals with periodontal diseases in China and to analyse the factors impacting maxillary sinus mucosal thickness using cone-beam computed tomography (CBCT). MATERIAL AND METHOD: A cohort of 221 patients with periodontal disease was subjected to cross-sectional CBCT examination. Various parameters, including age, sex, alveolar bone loss, furcation lesions and vertical infrabony pockets, were analysed as correlates of mucosal thickening (MT). Sinus mucosal thickness ≥ 2 mm qualified as MT. RESULTS: MT was detected in 103 (48.9%) patients, increasing in frequency as the degree of alveolar bone loss advanced (mild, 14.5%; moderate, 29.5%; severe, 87.9%). The association between MT and vertical infrabony pockets was statistically significant (P < 0.001). The likelihood of MT increased with moderate [odds ratio (OR) = 1.02] and severe (OR = 4.62) periodontal bone loss (P < 0.001), as well as with furcation lesions (OR = 2.76) and vertical infrabony pockets (OR = 13.58). CONCLUSIONS: Relative to the case in patients with periodontitis and normal mucosa, the probability of MT increased dramatically as alveolar bone loss worsened. Periodontal pathologies (i.e. furcation lesions and vertical infrabony pockets) were also more likely to coincide with MT.

Association Between Periodontal Disease and Kidney Function Decline in African Americans: The Jackson Heart Study.

BACKGROUND: Chronic kidney disease (CKD) remains a prevalent public health problem that disproportionately affects African Americans, despite intense efforts targeting traditional risk factors. Periodontal disease, a chronic bacterial infection of the oral cavity, is both common and modifiable and has been implicated as a novel potential CKD risk factor. The authors seek to examine to what extent periodontal disease is associated with kidney function decline. METHODS: This retrospective cohort study examines 699 African American participants with preserved kidney function (defined by estimated glomerular filtration rate (eGFR) >60 mL/minute/1.73 m(2) at baseline) who underwent complete dental examinations as part of the Dental-Atherosclerosis Risk in Communities study (1996 to 1998) and subsequently enrolled in the Jackson Heart Study (2000 to 2004). Using multivariable Poisson regression, the authors examined the association of periodontal disease (severe versus non-severe) with incident CKD, defined as incident eGFR <60 mL/minute/1.73 m(2) and rapid (5% annualized) eGFR decline at follow-up among those with preserved eGFR at baseline. RESULTS: Mean (± SD) age at baseline was 65.4 (± 5.2) years, and 16.3% (n = 114) had severe periodontal disease. There were 21 cases (3.0%) of incident CKD after a mean follow-up of 4.8 (± 0.6) years. Compared with participants with non-severe periodontal disease, those with severe periodontal disease had a four-fold greater rate of incident CKD (adjusted incidence rate ratio 4.18 [95% confidence interval 1.68 to 10.39], P = 0.002). CONCLUSIONS: Severe periodontal disease is prevalent among a population at high risk for CKD and is associated with clinically significant kidney function decline. Further research is needed to determine if periodontal disease treatment alters the trajectory of renal deterioration.

Pathological periodontal pockets are associated with raised diastolic blood pressure in obese adolescents.

BACKGROUND: Obesity, a well-known risk factor for developing cardiovascular disease (CVD), is associated with chronic periodontitis in adults. This cross-sectional pilot study on obese adolescents was designed to investigate whether periodontal disease in terms of pathological periodontal pockets is associated with raised blood pressure and other risk markers for CVD. METHODS: The study included 75 obese subjects between 12 to 18 years of age, mean 14.5. Subjects answered a questionnaire regarding health, oral hygiene habits and sociodemographic factors. A clinical examination included Visible Plaque Index (VPI %), Gingival inflammation (BOP %) and the occurrence of pathological pockets exceeding 4 mm (PD ≥ 4 mm). Blood serum were collected and analyzed. The systolic and diastolic blood pressures were registered. RESULTS: Adolescents with pathological periodontal pockets (PD ≥ 4 mm; n = 14) had significantly higher BOP >25% (P = 0.002), higher diastolic blood pressure (P = 0.008), higher levels of Interleukin (IL)-6 (P < 0.001), Leptin (P = 0.018), Macrophage Chemoattractant Protein-1 (MCP-1) (P = 0.049) and thyroid stimulating hormone (TSH) (P = 0.004) in blood serum compared with subjects without pathological periodontal pockets (PD ≥ 4 mm; n = 61). The bivariate linear regression analysis demonstrated that PD ≥ 4 mm (P = 0.008) and systolic blood pressure (P < 0.001) were significantly associated with the dependent variable "diastolic blood pressure". The association between PD ≥ 4 mm and diastolic blood pressure remained significant (P = 0.006) even after adjusting for potential confounders BMI-sds, age, gender, mother's country of birth, BOP >25%, IL-6, IL-8, Leptin, MCP-1, TSH and total cholesterol in the multiple regression analysis. CONCLUSION: In conclusion, this study indicates an association between pathological periodontal pockets and diastolic blood pressure in obese adolescents. The association was unaffected by other risk markers for cardiovascular events or periodontal disease. The results call for collaboration between pediatric dentists and medical physicians in preventing obesity development and its associated disorders.

Influence of inter-dental tissues and root surface condition on complete root coverage following treatment of gingival recessions: a 1-year retrospective study.

AIM: To explore the influence of inter-dental tissues and root surface condition on complete root coverage following surgical treatment of gingival recessions. METHODS: Three hundred and eighty-six single recessions treated over 28 years were assessed. Patient-level and periodontal variables, presence/loss of inter-dental tissues, and presence/absence of non-carious cervical lesions (NCCLs) were recorded. Root coverage was assessed 1-year post-surgery. Multilevel analysis was performed to identify predictors of CRC. RESULTS: Based on type of root coverage procedure four patient groups were created: free gingival graft (FGG) (n = 116), coronally advanced flap (CAF) (n = 107), CAF+connective tissue graft (CTG) (n = 131), and guided tissue regeneration (GTR) (n = 32). Percentages of complete root coverage (CRC) were 18.1% for FGG, 35.5% for CAF, 35.1% for CAF+CTG, and 18.8% for GTR. There was an OR = 0.26 (p < 0.0001) of achieving CRC in cases with loss of inter-dental tissue compared with cases with no inter-dental tissue loss. Similarly, cases with presence of NCCL showed an OR = 0.28 (p < 0.0001) of achieving CRC compared with cases without a NCCL. FGG achieved less CRC then CAF+CTG (p = 0.0012; OR = 0.32). CONCLUSIONS: NCCLs, just like inter-dental tissue loss, are significant negative prognostic factors in achieving CRC following root coverage procedures.

Expression of Leptin and Visfatin in Gingival Tissues of Chronic Periodontitis With and Without Type 2 Diabetes Mellitus: A Study Using Enzyme-Linked Immunosorbent Assay and Real-Time Polymerase Chain Reaction.

BACKGROUND: The aim of this study is to investigate the protein and gene expression of leptin and visfatin in gingival tissue from patients with chronic periodontitis (CP), patients with CP and type 2 diabetes mellitus (T2DM), and healthy individuals. METHODS: The study includes 50 individuals: 10 healthy individuals, 20 patients with CP, and 20 patients with CP and T2DM. Plaque index, gingival index, probing depth, and clinical attachment loss were measured, and gingival biopsies were obtained. Leptin and visfatin protein expression in gingival tissues was determined using enzyme-linked immunosorbent assay, and messenger RNA (mRNA) expression was measured via real-time polymerase chain reaction. RESULTS: The highest leptin mRNA and protein expression was observed in the control group and was significantly (P ≤0.05) different from the CP and CP+T2DM groups. Gingival tissues from patients with CP and T2DM had a significant increase in visfatin and a decrease in leptin gene and protein expression (P <0.05) compared with both controls and patients with CP. CONCLUSION: Expression of leptin and visfatin in the gingival tissues suggests a possible role for these adipokines in the pathogenesis of CP and T2DM.

Lactoferrin levels in gingival crevicular fluid and saliva of HIV-infected patients with chronic periodontitis.

AIM: This study compared lactoferrin (LF) levels in the gingival crevicular fluid (GCF) and saliva between HIV-infected and noninfected patients with chronic periodontitis. METHODS: For each subject, LF levels were analyzed in one shallow site (SS; PD ≤3 mm), one deep site (DS; PD >5 mm) and in resting whole saliva. Two groups, 28 HIV-infected and 10 noninfected, were selected. RESULTS: Although the salivary LF levels were higher in HIV-infected than in noninfected individuals, especially in AIDS patients, this was not statistically significant (P > 0.05). Subgingival LF levels for SS and DS were lower among HIV-infected individuals, although AIDS patients showed the lowest levels. Age, smoking, gender, T CD4 lymphocytes levels and viral load did not influence subgingival LF levels, neither for SS nor for DP. Positive fungal culture was observed in 24 HIV-infected patients, but only observed in one in the control group. Overall, LF concentration was significantly higher in DS than SS, both in HIV-infected and noninfected individuals (P < 0.05) and salivary LF levels were always higher than GCF levels. CONCLUSION: The data indicate that LF levels in the GCF and saliva are not different between HIV-infected and noninfected patients with chronic periodontitis.

Long-term evaluation of periodontal parameters and implant outcomes in periodontally compromised patients: a systematic review.

BACKGROUND: The aim of this systematic review is to evaluate the long-term outcomes of patients with periodontitis submitted to periodontal therapy/maintenance and implant placement. METHODS: Studies reporting clinical and/or long-term implant outcomes from partially edentulous patients with periodontitis who were treated and followed periodontal maintenance for ≥5 years were considered eligible for the review. Screening of the articles, data extraction, and quality assessment were conducted independently and in duplicate. RESULTS: Search of MEDLINE, EMBASE, and CENTRAL databases resulted in 959 papers, and of them 931 were excluded after title/abstract assessment. The full texts of 28 potentially eligible publications were screened, but only 10 studies met inclusion criteria. Most of the included studies (77.8%) presented a medium/high methodologic quality. The results demonstrated that patients with a diagnosis of periodontitis had satisfactory implant outcomes. Implant survival was high (92.1%) within studies reporting 10 years of follow-up. Parameters related to probing depth, clinical attachment level, and bone loss around teeth increased the occurrence of peri-implantitis and implant loss. Non-attendance to periodontal maintenance and smoking habits were also associated with less favorable implant outcomes. CONCLUSIONS: This systematic review confirmed that implant therapy can be successfully used in patients with a diagnosis of periodontitis who underwent proper therapy and regular periodontal maintenance. Residual pockets, non-attendance to the periodontal maintenance program, and smoking were considered to be negative factors for the long-term implant outcomes.

Histological and profilometric evaluation of the root surface after instrumentation with a new piezoelectric device - ex vivo study.

OBJECTIVES: An ex vivo model was designed to profilometrically and histologically assess root changes resulting from scaling with a new ultrasonic device, designed for bone piezoelectric surgery, in comparison with curettes. METHODS: Three groups of 10 periodontal hopeless teeth were each subjected to different root instrumentation: Gracey curettes (CUR); ultrasonic piezoelectric device, Perio 100% setting, level 8 (P100); and ultrasonic piezoelectric device Surg 50% setting, level 1 (S50). After extraction, all teeth were photographed to visually assess the presence of dental calculus. The treated root surfaces were profilometrically evaluated (Ra, Rz, Rmax). Undecalcified histological sections were prepared to assess qualitative changes in cementum thickness. Statistical analysis was carried out using one-way anova test with a significance level of 95%. RESULTS: Both instruments proved to be effective in the complete removal of calculus. The CUR group presented the lowest Ra [2.28 µm (±0.58)] and S50 the highest [3.01 µm (±0.61)]. No statistically significant differences were detected among the three groups, for Ra, Rz and Rmax. Histologically, there was a cementum thickness reduction in all groups, being higher and more irregular in S50 group. CONCLUSIONS: Within the limits of this study, there were no statistically significant differences in roughness parameters analyzed between curettes and the ultrasonic piezoelectric unit. This new instrument removes a smaller amount of cementum, mainly at the Perio 100% power setting, which appears to be the least damaging. The ultrasonic device is effective in calculus removal, proving to be as effective as curettes.

Prognostic factors relating to the outcome of endodontic microsurgery.

INTRODUCTION: The aim of this retrospective study was to evaluate the outcome of endodontic microsurgery and to examine prognostic factors related to healing. METHODS: The clinical records of all patients who had undergone endodontic microsurgery from 1997-2003 at the National Dental Centre of Singapore were examined. Teeth with a recall period of 1-2 years were selected. All surgical procedures, except for flap raising and suturing, were performed under a surgical operating microscope. Root-end cavities prepared with ultrasonic tips were filled with Intermediate Restorative Material (Caulk, Milford, DE) or mineral trioxide aggregate. Teeth were evaluated for clinical signs and symptoms after surgery. Preoperative and postoperative radiographs were evaluated independently by 2 endodontists. RESULTS: Of 243 root-end surgeries performed, 93 were eligible for the study. Outcomes were categorized as healed, healing, or persistent disease; 78.5% of teeth were assessed to be healed or healing, and 21.5% had persistent disease. The percentages of healed and healing teeth for anterior and posterior root-end surgeries were 76.5% and 80.4%, respectively, with no significant difference in the procedures (P = .8). Ordinal logistic regression showed a higher likelihood of healing in females compared with males (P = .001) and maxillary anterior teeth compared with mandibular anterior teeth (P = .03). Preoperative probing depths of ≤3 mm were significantly associated with healing (P = .05). CONCLUSIONS: The use of modern endodontic surgical techniques resulted in 78.5% healed and healing teeth with a recall period of 1-2 years. Prognostic factors affecting successful healing include sex, tooth type, and preoperative probing depths.

Treatment decisions in 330 cases referred for apical surgery.

INTRODUCTION: Apical surgery is an important treatment option for teeth with postendodontic apical periodontitis. However, little information is available regarding treatment planning in cases referred for apical surgery. This study evaluated the decisions made in such cases and analyzed the variables influencing the decision-making process. METHODS: The study retrospectively assessed clinical and radiographic data of 330 teeth that had been referred to a specialist in apical surgery with regard to the treatment decisions made in those teeth. The clinical and radiographic variables were divided into subcategories to analyze which factors influenced the decision-making process. RESULTS: The treatment decisions included apical surgery (59.1%), tooth extraction (25.8%), no treatment (9.1%), and nonsurgical endodontic retreatment (6.1%). Variables that showed statistically significant differences comparing treatment decisions among subcategories included probing depth (P = .001), clinical attachment level (P = .0001), tooth mobility (P = .012), pain (P = .014), clinical signs (P = .0001), length (P = .041) and quality (P = .026) of the root canal filling, and size (P = .0001) and location (P = .0001) of the periapical lesion. CONCLUSIONS: This study shows that apical surgery was the most frequently made treatment decision in teeth referred to a specialist in apical surgery, but every fourth tooth was considered nonretainable and was scheduled for extraction. The data showed that the most common variables that influenced the decision to extract teeth were teeth with an increased probing depth and tooth mobility and teeth presenting with lesions not located at the apex.