Treatment of multiple recessions with collagen matrix versus connective tissue: a randomized clinical trial.

The objective of this study was to determine whether collagen matrix (CM) is an alternative to connective tissue graft technique (CTG) in the treatment of multiple gingival recessions (GR). The indication of CM for the treatment of multiple GR is not yet clear. More studies are needed to better understand this treatment modality, as an alternative to CTG. In this single-blind, split-mouth randomized clinical trial, fifteen patients with multiple Miller class I upper GR were selected and randomly assigned to control group (CTG) or test group (CM). Root coverage (RC) and patient-centered outcomes were evaluated at baseline and after 3, 6, and 12 months. A total of 82 GRs were treated. There was no significant difference regarding GR depth (GRD, primary outcome) between CTG (0.5 ± 0.9 mm) and CM groups (0.6 ± 1.0 mm) (p = 0.225). Percentage of RC was 82.14% in CTG and 77.7% in CM. Both groups demonstrated a gain in keratinized tissue width at 12 months (p < 0.05). Dentine hypersensitivity was effectively reduced in both groups. Postoperative pain was significantly higher in the CTG (p = 0.001). Esthetic satisfaction was high for both groups, with no significant difference (p > 0.05) between groups. After 12 months, both surgical treatments were able to promote RC, and GRD was similar in both CTG and CM groups.

Severe loss of clinical attachment level: an independent association with low hip bone mineral density in postmenopausal females.

BACKGROUND: Bone loss is a feature of both periodontitis and osteoporosis, and several studies have analyzed whether the periodontal destruction could have been influenced by systemic bone loss. The aim of this study is to assess the association between clinical attachment level (CAL) and bone mineral density (BMD) at the lumbar spine and hip, lifestyle, smoking, sociodemographic factors, and dental clinical variables in postmenopausal women. METHODS: One hundred forty-eight women were interviewed using a structured written questionnaire and clinically examined. The periodontal examination, which was performed by calibrated investigators, included CAL, probing depth, gingival recession, bleeding on probing (BOP), visible plaque, supragingival calculus, and mean tooth loss. The sample was stratified into two groups: moderate and severe CAL. The moderate group had all sites with CAL ≤5 mm. The severe group had ≥1 site with CAL >5 mm. BMD, measured using dual-energy x-ray absorptiometry, was assessed at the lumbar spine, femoral neck, and total femur (grams per square centimeters). RESULTS: Severe CAL was identified in 86 women (58.1%). The multiple linear regression analysis using CAL (dependent variable), adjusted by menopause, education, and family income, demonstrated an inverse relationship of severe CAL with the BMD of the femoral neck (P = 0.015), as well as a positive association of severe CAL with tooth loss (P = 0.000), BOP (P = 0.004), and heavy smokers (P = 0.001). CONCLUSIONS: Our study demonstrated that severe CAL was associated with low BMD of the femoral neck and deleterious clinical dental parameters and smoking. Our findings suggest that, in addition to appropriate oral care, individuals with severe CAL may also require additional attention to their systemic bone health.

Comparison of the effects of treatment of peri-implant infection in animal and human studies: systematic review and meta-analysis.

OBJECTIVE: The main objective of this systematic review is to compare the effects of treatment of peri-implant infection between animal and human studies. MATERIAL AND METHODS: A literature search was conducted using the Medline, Cochrane Central Register of Controlled Trials, and Latin American and Caribbean Health Sciences Literature databases up to and including May 2008. In addition, bibliographies of systematic reviews on peri-implant diseases were searched manually. Non-surgical and surgical treatments of peri-implantitis/mucositis in animal models or human studies were compared. Meta-analysis was conducted to investigate the difference between the reported treatment effects in animal and human studies. Changes in probing pocket depth (PPD) and probing attachment level (PAL) from baseline measurements were used as measures of outcome. Single-level and multilevel meta-regression analysis was performed by taking into account the different follow-up times of the studies included. RESULTS: The single-level and multilevel random-effects meta-analysis showed that the difference in PPD reduction [0.31 mm, 95% confidence interval (CI): -0.27, 0.88] and in PAL gain (0.21 mm, 95% CI: -0.47, 0.88) between animal and human studies was not statistically significant. The random-effects meta-regression suggested that studies with longer follow-up times revealed greater PPD reduction (0.25 mm per month, 95% CI: 0.14, 0.35). However, when the different follow-up times were taken into account, these differences became greater. Substantial heterogeneity between studies was found in the meta-analyses (I(2)=97.6% for animal studies and 99.9% for human studies). CONCLUSION: There was great heterogeneity between human and animal studies in terms of study designs and treatment procedures. Therefore, the results from this meta-analysis should be interpreted with caution. Heterogeneity between studies and its causes merit further investigations.

Colecistectomia laparoscópica em pacientes de alto risco / Laparoscopic cholecystectomy in high risk patients

OBJETIVO: Relatar a experiência com a colecistectomia laparoscópica na colecistite aguda, em pacientes de alto risco (ASA 4). MÉTODO: De 1982 a 2001 foram realizadas, na Clínica Especializada em Doenças do Aparelho Digestivo (DIGEST), 1507 colecistectomias laparoscópicas, sendo 150 (10 por cento) em colecistite aguda, dentre as quais 10 (0,7 por cento) em pacientes ASA 4. RESULTADOS: Entre estes 10 pacientes observou-se uma faixa etária elevada com média de 70,9 anos (variando entre 50 e 89 anos), maior freqüência do sexo masculino (60 por cento), período de internação pré-operatório bastante variável (de três a 22 dias), prevalência elevada de colecistite aguda alitiásica (30 por cento) e grande freqüência de insuficiência renal (40 por cento) dentre as doenças associadas. Como complicações de pós-operatório houve uma coleção sub-hepática tratada por drenagem guiada por ultrassonografia; duas infecções de sítio operatório, tratadas pela abertura da pele do portal infectado, e um óbito decorrente da perpetuação do quadro séptico em paciente previamente submetido a colecistostomia percutânea. Não houve necessidade de conversão em nenhum dos pacientes operados. CONCLUSÃO: Os autores concluem pela viabilidade do método laparoscópico no tratamento da colecistite aguda em pacientes de alto risco, observando-se algumas estratégias específicas.

BACKGROUND: Evolution and experience with laparoscopic cholecystectomy in acute cholecystitis, a better knowledge of alterations provoked by the laparoscopic approach specially related to pneumoperitonium, allowed accomplishment of this procedure in high risk patients (ASA 4), objective of this research. METHODS: From 1992 to 2001, 1507 patients underwent laparoscopic cholecystectomy at Clínica Especializada em Doenças do Aparelho Digestivo (DIGEST), 150 (10 percent) of them with acute cholecistitis and 10 (0,7 percent) ASA 4 patients. RESULTS: Mean age was 70,9 years, varying between 50 and 89 years, and 60 percent were males. Preoperative hospitalization varied from 3 to 22 days. There was a 30 percent incidence of acute acalculous cholecystitis and 40 percent of renal disfunction. Other associated diseases were also observed. Postoperative complications included a sub-liver collection with associated pneumonia, solved by drainage guided by ultrasound, two surgical site infections, and a death due to perpetuation of sepsis on a patient previously submitted to a percutaneus cholecystostomy. None of the patients needed conversion to open surgery. CONCLUSIONS: We concluded that the laparoscopic technique approach in the treatment of acute cholecystitis in high risk patients is feasible, since some specific strategies are observed.