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.

Effects of artificial accelerated aging on the optical properties of resin composites / Efeitos do envelhecimento acelerado artificial nas propriedades ópticas de resinas compostas

The aim of this study was to evaluate the effects of ultraviolet artificial aging on color, fluorescence, gloss, and translucency of different composite resins. Seventy-five cylindrical-shaped specimens (6 mm in diameter and 1 mm thick) of four different composites: Admira Fusion (VOCO), TPH3 (DENTSPLY), GrandioSO (VOCO) and Filtek™ Z350 XT (3M/ESPE), were built. Enamel samples obtained from bovine incisors were prepared with the same dimensions and used as a control group. Assessments of color, translucency, fluorescence, and gloss were performed at baseline and after artificial aging. Specimens were immersed in artificial saliva and submitted to artificial aging (UV light for 300h). Data were analyzed using one-way ANOVA and Tukey's post hoc test (=0.05). After aging, all resin composites presented significant alterations, mainly Filtek™ Z350 XT. Fluorescence decreased in all resin composites and enamel. Gloss was reduced in all groups, too, with major rates for TPH3 and GrandioSO, which was similar to the enamel reduction. Translucency did not present a significant difference for the resin composites, although there was a reduction in the enamel. After artificial aging resin composites became darker, less fluorescent, less glossy, and with no alteration in translucency.

O objetivo deste estudo foi avaliar os efeitos do envelhecimento artificial ultravioleta na cor, fluorescência, brilho e translucidez de diferentes resinas compostas. Foram confeccionados setenta e cinco espécimes de forma cilíndrica (6 mm de diâmetro e 1 mm de espessura) de quatro compósitos diferentes: Admira Fusion (VOCO), TPH3 (DENTSPLY), GrandioSO (VOCO) e Filtek ™ Z350 XT (3M / ESPE). As amostras de esmalte obtidas a partir de incisivos bovinos foram preparadas com as mesmas dimensões e utilizadas como grupo controle. As avaliações de cor, translucidez, fluorescência e brilho foram realizadas na primeira leitura e após o envelhecimento artificial. Os espécimes foram imersos em saliva artificial e submetidos ao envelhecimento artificial (luz UV por 300h). Os dados foram analisados usando ANOVA e teste post hoc de Tukey ( = 0,05). Após o envelhecimento, todos os espécimes apresentaram alterações significativas, principalmente para a resina Filtek ™ Z350 XT. A fluorescência diminuiu em todos os materiais e no esmalte. O brilho foi reduzido em todos os grupos, também, com taxas maiores para TPH3 e GrandioSO, que foi semelhante à redução do esmalte. A translucidez não apresentou diferença significativa em todos os materiais testados, embora tenha havido uma redução no esmalte. Após o envelhecimento artificial, os compósitos de resina ficaram mais escuros, menos fluorescentes, menos brilhosos e sem alteração na translucidez.

Nova abordagem no tratamento de recessões gengivais associadas à lesão cervical não cariosa / New approach in the treatment of gingival recessions associated with non-carious cervical lesion ­ case report

A recessão gengival está frequentemente associada à lesão cervical não cariosa (LCNC), originando uma lesão combinada que tem um prognóstico de tratamento diferente de quando as duas lesões se apresentam sozinhas. Tratamentos propostos possuem limitações, e o protocolo clínico ideal para o manejo dessas lesões ainda não foi estabelecido. Assim, o objetivo do presente relato de caso foi apresentar uma nova técnica cirúrgico-restauradora para o tratamento de recessões gengivais associadas à LCNC. Para tal, uma restauração parcial em resina composta foi realizada somente na parte coronal da lesão cervical. Em uma segunda sessão, o procedimento cirúrgico para recobrimento radicular com enxerto de tecido conjuntivo foi realizado. Seis meses após o procedimento, a paciente estava satisfeita com o resultado final alcançado, demonstrando que esse protocolo pode ser uma alternativa de tratamento aos protocolos existentes para o tratamento de recessões gengivais associadas à LCNC.

Gingival recession is often associated with non-carious cervical lesion (NCCL), resulting in a combined lesion which has a different treatment prognosis when the two lesions appear alone. Proposed treatments have limitations and the ideal clinical protocol for the management of these lesions has not been established. Thus, the aim of this case report is to present a new surgical-restorative technique for the treatment of gingival recessions associated with NCCL. For this, a composite resin partial restoration was performed only in the coronal part of the cervical lesion. In a second session, the surgical procedure for root coverage with connective tissue graft was performed. Six months after the procedure, the patient was satisfied with the final result achieved, demonstrating that this protocol may be an alternative to the existing protocols for the treatment of gingival recessions associated with NCCL.

Clarithromycin as an Adjunct to One-Stage Full-Mouth Ultrasonic Periodontal Debridement in Generalized Aggressive Periodontitis: A Randomized Controlled Clinical Trial.

BACKGROUND: The aim of the present study is to evaluate the periodontal clinical and microbiologic responses and possible adverse effects of clarithromycin (CLM) combined with periodontal mechanical therapy in the treatment of patients with generalized aggressive periodontitis. METHODS: Forty patients were selected and randomly assigned into one of two groups: 1) CLM (n = 20): one-stage full-mouth ultrasonic debridement (FMUD) associated with CLM (500 mg, every 12 hours for 3 days); and 2) placebo (n = 20): FMUD associated with placebo pills. Clinical and microbiologic parameters were evaluated at baseline and 3 and 6 months postoperatively. RESULTS: Both treatments presented statistically significant clinical and microbiologic improvements. However, the CLM group presented lower means of probing depth for pockets ≥7 mm at 6 months (4.0 ± 1.7 mm) compared with the placebo group (4.7 ± 1.3 mm) (P = 0.04). In addition, the CLM group also presented greater reduction of Porphyromonas gingivalis (Pg) DNA counts at 6 months (P = 0.0001). CONCLUSION: Results from this study suggest both treatments are effective; however, adjunct use of CLM to FMUD leads to better reduction of deep pockets and Pg at 6 months compared with FMUD alone.

A Novel Modification of Semilunar Coronally Advanced Flap for the Treatment of Gingival Recession: Case Series.

This article aims to describe a modification of the semilunar coronally advanced flap. A total of 12 systemically and periodontally healthy patients presenting Miller Class I gingival recession were treated with the modified semilunar coronally advanced flap technique described in this article. After 1 year of follow-up, the mean root coverage was 85.4% ± 24.7%. Significant gingival recession reduction, clinical attachment gain, and reduction in dentin sensitivity was observed 1 year after surgery. This novel semilunar coronally advanced flap technique was demonstrated to be effective for root coverage in Miller Class I gingival recessions.

2-Year Assessment of Tissue Biostimulation With Low-Level Laser on the Outcomes of Connective Tissue Graft in the Treatment of Single Gingival Recession: A Randomized Clinical Trial.

BACKGROUND: Periodontal wound healing has been accelerated by different low-level laser therapy (LLLT) protocols. However, just a few studies have evaluated use of this therapy adjunctive to periodontal plastic surgery procedures. The present study shows 2-year results of a connective tissue graft (CTG) associated with LLLT in the treatment of gingival recession (GR) defects. METHODS: Forty patients presenting Miller Class I and II GRs were previously treated by CTG (control group; n = 20) or CTG + LLLT (test group; n = 20). A diode laser (aluminum-gallium-arsenide, 660 nm) was applied to test sites immediately after surgery and every other day for 14 days (total of eight applications). After a follow-up of 2 years, clinical and esthetic evaluations were performed in 36 patients. RESULTS: Mean percentage of root coverage was 93.43% for the test group and 92.32% for the control group (P = 0.55). Complete root coverage was 79% (n = 15) for the test group and 76% (n = 13) for the control group (n = 13) (P = 0.80). Both groups showed esthetics maintenance after 2 years. CONCLUSION: Within the limitations of this study, results indicate that LLLT showed no additional benefit in the long term when associated with a CTG in the treatment of Miller Class I and II GRs.

Gengivoplastia após procedimentos de recobrimento radicular: série de casos / Gengivoplasty after root coverage procedures: case series

Os procedimentos de recobrimento radicular vêm ocupando cada vez mais espaço na rotina dos cirurgiões-dentistas. Porém, a busca por procedimentos cada vez mais estéticos tem demandado dos clínicos a realização de condutas complementares para corrigir ou aprimorar a estética dos tecidos moles, após as cirurgias mucogengivais. Essas intervenções complementares devem ser seguras, previsíveis, minimamente invasivas e com alto padrão estético, a fim de solucionar as queixas e os anseios do paciente. Nesse sentido, a gengivoplastia se apresenta como uma técnica simples e versátil, de fácil execução e pouco invasiva. O objetivo deste estudo foi demonstrar o uso da gengivoplastia na correção de pequenas falhas estéticas após procedimentos de recobrimento radicular, e discutir os resultados clínicos, as vantagens e as desvantagens da técnica. Para tal, dois anos após o recobrimento radicular, quatro pacientes foram submetidos à gengivoplastia por apresentarem queixas estéticas como volume excessivo e mudança na textura do tecido gengival. Avaliações clínicas e estéticas foram realizadas no pré-operatório e após três meses. Os resultados deste estudo mostraram que a realização da gengivoplastia após procedimentos de recobrimento radicular é uma opção capaz de aprimorar a estética sem interferir no recobrimento radicular.

Patients’ aesthetic demands have become increasingly stringent; thus, clinicians have been required to implement additional aesthetic measures to correct aesthetic failures after procedures such as root coverage. These complementary interventions must be safe, predictable, minimally invasive and high aesthetic to resolve patients’ concerns. In this sense, gingivoplasty is presented as a simple and versatile technique, easy to perform and minimally invasive. The aim of this case series is to demonstrate the use of gengivoplasty to correct cosmetic failures that occurred after root coverage and to discuss the clinical outcome, as well as the advantages and disadvantages, of this technique. Two years after the root coverage, four patients presented aesthetic complaints such as excessive volume and change in tissue texture and were submitted to gengivoplasty to correct cosmetic failures. Clinical measurements and aesthetic evaluations were performed preoperatively and after 3 months. The results of this case series showed that the use of gengivoplasty to correct aesthetic failures after root coverage procedures proved to be a technique capable of promoting aesthetic satisfaction for patients and dentists without interfering with root coverage.

Avaliação da dureza superficial de cimentos de ionômero de vidro reforçados por nanotubos de carbono / Evaluation of surface hardness of glass ionomer reinforced cements by carbon nanotubes

Introdução: Os cimentos de ionômero de vidro (CIV) são materiais com baixa resistência à tração e ao cisalhamento, mostrando-se, portanto, contraindicados para áreas sujeitas às grandes cargas oclusais. Objetivo: Avaliar o efeito da incorporação de nanotubos de carbono em CIV por meio de dureza superficial Knoop. Material e método: Foram confeccionados 48 espécimes, divididos em quatro grupos, de acordo com o tipo de CIV (n=12) - convencional ou de alta viscosidade, incorporados ou não de nanotubos de carbono (NC) a 2%: (A) Vidrion R; (B) Vidrion R + NC 2%; (C) Vitro Molar, e (D) Vitro Molar + NC 2%. Os espécimes foram preparados utilizando-se seringa Centrix, para inserção do material em moldes plásticos, e armazenados em água deionizada por 24 horas. Após polimento, realizou-se o teste de dureza superficial com penetrador do tipo Knoop. Foram realizadas cinco endentações em cada espécime, distanciadas entre si em 100 µm. Resultado: Os valores médios de dureza foram 58,96 ± 8,29 (A), 34,81 ± 5,78 (B), 60,84 ± 4,91 (C) e 41,97 ± 5,45 (D). O teste ANOVA detectou diferenças estatisticamente significantes para os dois parâmetros estudados, tipo de material (p=0,016) e inclusão de NC (p<0,0001). Pelo teste de Tukey, observou-se que os grupos A e C foram estatisticamente semelhantes (p>0,05), enquanto os grupos B e D apresentaram diferenças significativas (p<0,05). Ao comparar o fator incorporação ou não de NC, observou-se diferença significativa entre os grupos A e B, e entre os grupos C e D (p<0,05). Conclusão: A incorporação de nanotubos de carbono influenciou negativamente os valores de dureza superficial para os dois tipos de CIV utilizados. .

Introduction: Glass ionomer cements (GIC) are materials with low tensile and shear bond strength and therefore contraindicated in areas subjected to high occlusal stress loads. Aim: To evaluate the effect of incorporation of carbon nanotubes in GICs, conventional or indicated for the Atraumatic Restorative Treatment (ART), through the superficial microhardness test. Material and method: Forty-eight specimens were prepared and divided into 4 groups according to the type of GIC (n=12): conventional or high viscosity, embedded or not with 2% carbon nanotubes (CN): (A) Vidrion R, (B) Vidrion R + 2% CN, (C) Vitro Molar and (D) Vitro Molar + 2% CN. The specimens were inserted into plastic molds with Centrix syringe and stored in deionized water for 24 hours. After polishing, the superficial hardness was performed with a Knoop indenter. Five indentations were made on each specimen, with distance of 100 micrometers between indentations. Result: The average hardness values were 58.96 ± 8.29 (A) 34.81 ± 5.78 (B) 4.91 ± 60.84 (C) 41.97 ± 5.45 (D). ANOVA detected significant difference for the two varibales, material (p=0,016) and CN inclusion (p<0,0001). Tukey test revealed that the groups A and C were statistically similar (p>0.05), while the B and D groups showed significant differences (p<0.05). When comparing the incorporation or not of factor CN, there was significant difference between groups A and B and between C and D groups (p<0.05). Conclusion: The incorporation of CNTs negatively influenced the values of surface hardness for the two types of GIC used. .

Effect of GaAIAs low-level laser therapy on the healing of human palate mucosa after connective tissue graft harvesting: randomized clinical trial.

Among the available techniques to treat gingival recession, connective tissue graft (CTG) presents more foreseeability and better results in the long term. However, this technique causes morbidity and discomfort in the palatine region due to graft removal at that site. The aim of this clinical trial was to evaluate the influence of low-level laser therapy (LLLT) on the healing of the donor palatine area after CTG. Thirty-two patients presenting buccal gingival recession were selected and randomly assigned to receive LLLT irradiation (test group) or LLLT sham (control group) in the palatine area after connective graft removal. A diode laser (AsGaAl, 660 nm) was applied to test the sites immediately after surgery and every other day for 7 days. The evaluated parameters were wound remaining area (WRA), scar and tissue colorimetry (TC), tissue thickness (TT), and postoperative discomfort (D). These parameters were evaluated at baseline and 7, 14, 45, 60, and 90 days after surgery. Two-way repeated measures ANOVA was used for analysis. The test group presented statistically significant smaller wounds at days 14 and 45. None of the patients presented a scar at the operated area, and colorimetry analysis revealed that there was no statistically significant difference between groups (p > 0.05). Patients reported mild to moderate discomfort, with low consumption of analgesic pills. We concluded that LLLT irradiation can accelerate wound healing on palatine mucosa after connective tissue removal for root coverage techniques (ClinicalTrial.org NCT02239042).

Peri-implantite: Tratamento com acesso cirúrgico, descontaminação com solução de iodo e enxerto ósseo / Iodine decontamination of implant surface associated with bone graft for the treatment of peri-implantitis. Case report

O uso de implantes osseointegrados é uma terapia já difundida e consolidada, com excelentes resultados demonstrados. Porém, assim como os dentes naturais, os implantes podem acumular biofilme e apresentar doenças inflamatórias. A peri-implantite foi definida como um processo inflamatório destrutivo ao redor de implantes osseointegrados, com a formação de bolsas peri-implantares e perda de suporte ósseo. Vários fatores foram apontados como fatores de risco. Entretanto, evidências demonstram que os principais fatores são a higiene oral insatisfatória, o fumo e o histórico de doenças periodontais. Diversos sinais e sintomas podem ser encontrados nos casos com peri-implantite, sendo sangramento e/ou supuração a sondagem peri-implantar, margem tecidual edemaciada e avermelhada os mais encontrados. Defeito ósseo tipicamente em forma de cratera ao redor de todo o implante é frequentemente encontrado em casos de peri-implantite. Existem diversas modalidades de tratamento para os casos de peri-implantite, sendo basicamente divididas em terapias cirúrgicas e não cirúrgicas. Existem limitadas evidências a partir de estudos de casos indicando efeitos benéficos da terapia não cirúrgica, deixando imprevisíveis os resultados desta. As técnicas cirúrgicas utilizadas no tratamento da peri-implantite descritas na literatura são versões modificadas de técnicas primárias usadas por diversos anos para o tratamento de defeitos ósseos ao redor dos dentes naturais. O objetivo deste trabalho foi apresentar um relato de caso clínico no qual se realizou o acesso cirúrgico, a descontaminação da superfície do implante com solução de iodo e o preenchimento do defeito ósseo com enxerto ósseo xenógeno.

Tratamento cirúrgico restaurador de recessão gengival associada à lesão cervical não cariosa / Surgical-restorative treatment of gingival recession associated with non-carious cervical lesion. Case report

Recessão gengival é frequentemente associada a uma lesão cervical não cariosa. Alguns protocolos cirúrgicos restauradores foram propostos para o tratamento dessa lesão combinada. No entanto, esses protocolos possuem algumas limitações. Assim, o objetivo do presente relato de caso foi apresentar um protocolo alternativo para o tratamento de recessões gengivais associadas à lesão cervical não cariosa. Para tal, foi confeccionada uma restauração de resina composta somente na parte coronária da lesão dental; posteriormente, um retalho para tratamento de recessões múltiplas foi realizado, com incisões oblíquas nas papilas e sem incisões relaxantes, para maximizar a estética. Seis meses após o procedimento, o paciente estava satisfeito com o resultado final alcançado, demonstrando que esse protocolo pode ser uma alternativa de tratamento aos já existentes para o tratamento de lesões combinadas.

Gingival recession is often associated with non-carious cervical lesion. There are some available surgical-restorative approaches to deal with this combined lesion. However, these protocols may have some limitations. Therefore, the aim of the present case report is to present an alternative approach to treat the combined lesion. For this, a composite resin filling was performed only on the coronally zone of the cervical lesion. Afterwards, a surgical flap for multiples recessions was performed if order to cover al the recession. After six months, the patient was happy with the final result, showing that this procedure may be alternative to treat gingival recession associated with non-carious cervical lesion.

The influence of single-dose dexamethasone on masseter and temporal muscles after impacted lower third molar extraction. Pilot study through electromyography evaluation / Estudo piloto da influência da dexametasona em dose única nos músculos masseter e temporal após exodontia de terceiros molares inferiores inclusos: avaliação por eletromiografia

This study aimed to evaluate the influence of dexamethasone (Decadron®) administered as preoperative single dose (8 mg) on the electrical activity of the masticatory muscles, superficial masseter and anterior temporal, through electromyographic analysis after lower third molar extraction. Twenty patients who required surgical treatment for extraction of these teeth were selected, treated and evaluated. Patients were randomly assigned to one of the following groups: experimental group that received a single dose of dexamethasone 8 mg 1 h before the procedure, or control group that underwent extraction without the use of medication. Ag/AgCl electrodes were used to record the electrical muscle activity before the procedure, after anesthesia, after root section, immediate postoperative and 7, 15 and 30 days postoperatively. EMG data collected were analyzed by analysis of variance and Tukey’s test with a significance level of 5% for intra and intergroup comparisons. The results showed no statistically significant differences in the comparisons within and between groups (p > 0.05). Based on these findings, it can be concluded that the third molar extraction and the use of dexamethasone as a preoperative single dose may not interfere in the muscle electrical activity.

Este estudo teve como objetivo avaliar a influência da dexametasona (Decadron®) administrada em dose única (8 mg) na atividade elétrica dos músculos mastigatórios bilaterais; masseter superficial e temporal anterior, por meio de análise eletromiográfica em procedimentos de exodontia de terceiros molares inferiores inclusos. Foram selecionados, tratados e avaliados 20 pacientes que necessitavam de tratamento cirúrgico para avulsão de terceiro molar inferior incluso e impactado. Os pacientes foram distribuídos, conforme ordem de chegada, para um dos seguintes grupos: Grupo Experimental que receberam dose única de dexametasona 8 mg 1 h antes do procedimento cirúrgico de exodontia de terceiro molar inferior; ou Grupo Controle que foram submetidos a exodontia sem a utilização da medicação. Para o registro eletromiográfico utilizou-se eletrodos de Ag/AgCl para coleta da atividade elétrica muscular previamente ao procedimento, pós-anestesia, pós-odontosecção, pós-cirúrgico imediato e 7, 15 e 30 dias pós-operatório. Os dados eletromiográficos coletados foram submetidos à análise de variância e ao teste de Tukey com nível de significância de 5% para comparação entre os lados operado versus o lado não operado, dentro de todos os tempos para os músculos masseter e temporal. Os resultados demonstraram que não houve diferença estatisticamente significante quando a comparação intra e intergrupos foram realizadas (p > 0,05). Baseado nisso, pode-se concluir que dentro dos limites do presente estudo, que a cirurgia de terceiro molar e o uso da dexametasona em dose única não interferem na atividade elétrica muscular.