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OBJECTIVES: The aim of this study was to assess the prevalence of certain microbiota and their potential correlation with clinical parameters, expression of proinflammatory cytokines, Notch signalling pathway molecules and bone remodelling mediators among different peri-implant conditions. MATERIALS AND METHODS: Included participants had at least one dental implant minimally 1 year in function. They were divided into peri-implantitis (PI), peri-implant mucositis (PM) and healthy implants (HIs) groups. Prevalence of P. ginigvalis, Fusobacterium spp., EBV and C. albicans was detected in participants' crevicular fluid (CF) using quantitative real-time polymerase chain reaction, different markers' expression, as well as clinical data, were correlated with the microbial presence. RESULTS: CF samples taken from one chosen implant from each of the 102 participants were analyzed. Significantly higher levels of P. gingivalis were found in PI compared with HI (p = .012) and PM (p = .026). Fusobacterium spp. was also more prevalent in PI (p = .041) and PM (0.008) than in HI. P. gingivalis was a predictor of PPDi (p = .011, R2 = 0.063) and CALi (p = .049, R2 = 0.038). A positive correlation was found in PI for the level of Fusobacterium spp. and TNFα expression (ρ = 0.419, p = .017) while in PM, P. gingivalis and Notch 2 expression were correlated (ρ = 0.316, p = .047). CONCLUSIONS: P. gingivalis appears to be involved in the osteolysis in patients with PI, while the positive correlation of its level with Notch 2 expression in patients with PM suggests a potential involvement of P. gingivalis in the progression of PM into PI.
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Implantes Dentários , Peri-Implantite , Humanos , Implantes Dentários/microbiologia , Estudos Transversais , Peri-Implantite/microbiologiaRESUMO
BACKGROUND & OBJECTIVE: Notch signaling pathway has been linked to bone loss in periodontitis and peri-implantitis. This research aimed to determine the Notch signaling molecules expression levels (Notch1, Notch2, Jagged1, Hes1, and Hey1), along with bone remodeling mediators (RANKL and OPG) and proinflammatory cytokines (TNF-α, IL-17, IL-1ß, and IL-6) in patients with peri-implant diseases. The aforementioned markers' expression was evaluated in patients with different RANKL/OPG ratios. METHODS: Fifty patients with peri-implantitis (PI group) and 45 patients with peri-implant mucositis (PM group) were enrolled. Relative gene expression levels of investigated molecules were determined by reverse transcriptase-real-time polymerase chain reaction. On the basis of RANKL/OPG ratio, all peri-implant lesions were divided into subgroups: RANKL-predominant (RANKL > OPG) and OPG-predominant (RANKL < OPG). Clinical periodontal parameters (probing depth-PD, bleeding on probing-BOP, clinical attachment level-CAL and plaque index-PLI), were recorded for each patient around every tooth, and around placed implants (PDi, BOPi, CALi, PLIi). RESULTS: RANKL-predominant PM patients exhibited higher expression levels of Notch2 (p = .044) and Hey1 (p = .005) compared to OPG-predominant lesions. In all RANKL-predominant cases, Hey1 (p = .001), IL-1ß (p = .005), IL-6 (p = .002) were overexpressed in PI comparing to PM, accompanied with significantly higher PDi, CALi and PLIi in PI than PM (p = .001, p = .001 and p = .009). CONCLUSIONS: Notch2 upregulation in RANKL-predominant PM lesions could be an important contributor to alveolar bone resorption and represent a predictor of PM to PI transition. Similarly, the overexpression of IL-1ß and IL-6 might provide an osteoclastogenic environment in PI RANKL-predominant lesions.
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Perda do Osso Alveolar , Peri-Implantite , Receptores Notch , Transdução de Sinais , Humanos , Perda do Osso Alveolar/metabolismo , Perda do Osso Alveolar/patologia , Citocinas/metabolismo , Implantes Dentários/efeitos adversos , Interleucina-6 , Peri-Implantite/metabolismo , Receptores Notch/metabolismo , Ligante RANK/metabolismo , Osteoprotegerina/metabolismoRESUMO
Objective: To assess the potential correlation between clinical peri-implant parameters and the presence of Porphyromonas gingivalis in different peri-implant conditions. Material and methods: The study included 30 patients from the Department of Periodontology and Oral Medicine divided into three equal groups, defined according to the following diagnoses: peri-implantitis (PI), peri-implant mucositis (PM), and peri-implant health (HI). Clinical parameters such as peri-implant probing depth (PPD), bleeding on probing (BOP), suppuration on probing (SUP), and plaque index (PI) were recorded. The samples of peri-implant crevicular fluid were collected and relative levels of Porphyromonas gingivalis were analyzed using Real-Time PCR (Reverse transcriptase - real-time polymerase chain reaction). Results: The mean patient age was 51.33 ± 12.61 years. The mean value for Porphyromonas ginigvalis relative level was higher in the PI group (14.80 ±31.51) compared to PM and HI group (0.48 ± 1.34 and 0.06 ± 0.12, respectively). This parameter significantly differed between PI and HI (p=0.012), as well as PI and PM (p=0.049). The mean whole mouth probing pocket depth (PPD) in the PI group (4.02mm ± 0.77mm) was also significantly greater compared to the other two groups (3.39mm ± 0.52mm in PM and 1.97mm ± 0.54mm in the HI group. The SUP in the PI (mean value of 18%) group was more frequent than in PM (mean value of 14%) while the SUP was not detected in the HI group. The correlation between clinical parameters and relative levels of Porphyromonas gingivalis was not significant. Conclusions: The findings of this research indicate higher relative levels of Porphyromonas gingivalis in peri-implant lesions, especially in peri-implantitis.
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OBJECTIVES: Notch signaling pathway, known to influence bone resorption in several oral diseases, has not been analyzed in peri-implantitis yet. Therefore, the aims of the present study were to determine the levels of Notch cascade, bone remodeling mediators, and pro-inflammatory cytokines, in conjunction with clinical parameters, in subjects with peri-implant mucositis and peri-implantitis. MATERIAL AND METHODS: Clinical parameters: peri-implant probing depth, bleeding on probing, suppuration on probing, and plaque index (PI) were recorded. Samples were collected from 130 participants, divided into peri-implantitis (PI), peri-implant mucositis (PM), and healthy implants (HI) group. Relative expression levels (REL) of Notch 1, Notch 2, Jagged 1, Hes 1, Hey 1, TNF-α, IL-17, IL-1ß, IL-6, RANKL, and OPG mRNA were determined by reverse transcriptase-real-time polymerase chain reaction. Quantitation of Notch 1, Il-17, and IL-6 proteins was performed using ELISA assays. RESULTS: All clinical parameters were significantly higher in PI compared to HI. Significant decrease of Notch 1, and higher REL of Hey 1, IL-1ß, IL-6, and RANKL were found in PI compared to HI. PM showed significant increase of IL-1ß REL in comparison with HI. In PI versus PM, significantly higher REL was found for Hey 1, TNF-α, IL-17, IL-1ß, IL-6, and RANKL. Additionally, higher protein concentrations of IL-6 and IL-17 were detected in PI versus PM and versus HI group. CONCLUSION: The combined effect of Notch 1 down-regulation and elevated expression of some key inflammation modulators might result in osteoclast activity increase and subsequent osteolysis in peri-implantitis.
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Implantes Dentários , Mucosite , Peri-Implantite , Estudos Transversais , Citocinas/metabolismo , Regulação para Baixo , HumanosRESUMO
OBJECTIVES: To report assessments of four systematic reviews (SRs) on (i) clinical outcomes of all-ceramic implant-supported crowns (iSCs), (ii) production time, effectiveness, and costs of computer-assisted manufacturing (CAM), (iii) computer-assisted implant planning and surgery (CAIPS) time and costs, and (iv) patient-reported outcome measures (PROMS). MATERIAL AND METHODS: An author group consisting of experienced clinicians and content experts discussed and evaluated the SRs and formulated consensus on the main findings, statements, clinical recommendations, and need for future research. RESULTS: All four SRs were conducted and reported according to PRISMA and detailed comprehensive search strategies in at least three bibliometric databases and hand searching. The search strategies were deemed reproducible. Variation was noted regarding language restrictions and inclusion of grey literature, but the search comprehensiveness appeared persuasive. The SRs included bias risk assessments of the primary studies, and their study methodology impacted the interpretations of the extracted data. CONCLUSIONS: (i) There is limited evidence (49 NRCT) showing that veneered and monolithic all-ceramic iSCs have excellent outcomes observed up to 3 years. (ii) There is no evidence evaluating production time and effectiveness comparing subtractive and additive CAM of implant models, abutments and crowns. (iii) There is limited evidence (4 RCT) that CAIPS involves more time and costs when considering the entire workflow and for diagnostics, manufacturing, and insertion of the restoration. Time seems to be the decisive factor for higher costs. (iv) Patients' comfort increases when optical compared to conventional impressions are used for fabricating iSCs and short-span FPDs (2 RCT, 5 NRCT).
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Coroas , Planejamento de Prótese Dentária , Desenho Assistido por Computador , Humanos , Fluxo de TrabalhoRESUMO
BACKGROUND AND OBJECTIVE: Notch signalling cascade has recently been connected to alveolar bone resorption in periodontitis. Hence, the present cross-sectional study aimed to analyze the expression of Notch signalling pathway (Notch 1, Notch 2, Jagged 1, Hes 1, Hey 1) and periodontitis-related (tumor necrosis factor alpha- TNF-α, interleukin 17-IL-17, receptor activator of nuclear factor-kappa B ligand-RANKL, osteoprotegerin-OPG) molecules and correlate it with clinical parameters in aggressive (AP) and chronic (CP) periodontitis. Additionally, the aforementioned markers' expression was evaluated in periodontitis patients with different RANKL/OPG ratios. MATERIAL AND METHODS: Eighty patients were enrolled either in AP or CP group. Clinical attachment level (CAL), bleeding on probing (BOP), periodontal probing depth (PPD) and plaque index (PI) were recorded for each patient. Total RNA was extracted from gingival crevicular fluid samples. Relative gene expression of investigated markers was determined by reverse transcriptase-real-time polymerase chain reaction. RESULTS: Significantly higher values of PPD were observed in AP compared to CP (P = .010). Negative correlations between OPG and CAL, and OPG and PI, were found in AP (P = .045, P = .006, respectively), while Hey 1 and PI had a positive correlation (P = .049). In multivariate linear regression analysis, OPG and Notch 2 were predictors of CAL in AP group. TNF-α and IL-17 were higher in RANKL predominant than in OPG predominant cases (P = .007, P = .001, respectively). In RANKL predominant lesions Notch 1 and Jagged 1 were down-regulated in AP compared to CP patients (P = .010, P = .025, respectively). CONCLUSION: The present study demonstrated that changes in Notch 2 expression affected CAL in AP cases hence this molecule could be considered as a contributor to alveolar bone loss. In RANKL-activated settings, the down-regulation of Notch 1 might participate in more severe bone resorption in AP.
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Reabsorção Óssea , Periodontite , Estudos Transversais , Líquido do Sulco Gengival/química , Humanos , Osteoprotegerina/genética , Ligante RANK/análise , Ligante RANK/genética , Transdução de Sinais , Fator de Necrose Tumoral alfaRESUMO
OBJECTIVE: To assess the clinical efficacy and esthetic outcome of porcine-derived dermal collagen matrix in comparison with connective tissue graft in the treatment of multiple adjacent gingival recessions (MAGR), 6 and 12 months after the surgery. MATERIALS AND METHODS: Twenty patients with bilateral type I MAGR were treated randomly with porcine-derived dermal collagen matrix (test site) or connective tissue graft (control site) in combination with a modified coronally advanced tunnel technique. The primary objectives were to evaluate the mean and complete root coverage. The secondary objectives were to assess keratinized tissue width, gingival thickness gain, and root coverage esthetic score. RESULTS: Six and 12 months postoperatively, both groups achieved significant improvements in all clinical parameters compared to baseline, with no statistically significant differences between the groups. Mean root coverage change (Δ12m - 6 m) was statistically significant between the groups in favor of connective tissue graft, and twice as many patients exhibited a complete coverage of all recessions in the control group than the test group. CONCLUSION: The porcine-derived dermal collagen matrix combined with a modified coronally advanced tunnel technique resulted in satisfactory clinical and esthetic outcomes, which were similar to connective tissue graft. CLINICAL SIGNIFICANCE: Porcine-derived dermal collagen matrix (XDM) may be proposed as a substitute for connective tissue graft in multiple adjacent recession treatment due to successful root coverage, a significant increase of gingival thickness, and high esthetic outcomes. The clinical benefits for the use of XDM could be: (a) second surgical wound avoidance, (b) patient discomfort decrease, and (c) lower complications' rate.
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Retração Gengival , Animais , Colágeno , Tecido Conjuntivo , Gengiva , Retração Gengival/cirurgia , Humanos , Retalhos Cirúrgicos , Suínos , Raiz Dentária , Resultado do TratamentoRESUMO
INTRODUCTION: Gingival recession is a displacement of gingival margin apically to cement-enamel junction. OBJECTIVE: The aim of this study was to compare the results achieved with two different surgical procedures used in gingival recession treatment. METHODS: Ten patients with bilateral buccal recession on maxillary canines or premolars were included in the study. Professional teeth cleaning was performed before surgery. Recession on the experimental side was treated with connective tissue graft in combination with coronally advanced, split thickness flap (tunnel technique). Control side recession was treated with connective tissue graft in combination with trapezoidal coronally advanced, full thickness flap. Coin toss was used for side decision. The following parameters were evaluated before surgery and 6 months post-op: Vertical Recession Dimension, Clinical Attachment Level, Apico-coronal width of the keratinized tissue, Healing index (Laundry), RES index, and Patient evaluation of esthetic results. Student's t-test was used for statistical analysis. RESULTS: Six months after surgery, mean root coverage was 91.5 +/- 14.1% and 90.1 +/- 14.6% on the experimental and on the control side, respectively. RES index, Healing index (Laundry) and Patient Subjective evaluation of esthetic results showed significantly better results (p < 0.05). CONCLUSION: Both surgical procedures produce highly successful clinical results based on evaluated parameters, but this tunnel technique provides significantly better esthetic results.
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Retração Gengival/cirurgia , Procedimentos Cirúrgicos Bucais/métodos , Adulto , Dente Pré-Molar/cirurgia , Aloenxertos Compostos/transplante , Tecido Conjuntivo/transplante , Estética Dentária , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Retalhos Cirúrgicos , Raiz Dentária/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: The rehabilitation of edentulous mandibles with implant-supported overdentures is a state-of-the-art contemporary implant treatment. Computer-assisted flapless surgery is associated with decreased chairside treatment time, as well as significant reduction in patient postoperative morbidity and discomfort. The aim of this study was to evaluate the protocol of computer-guided surgery in the treatment of edentulous mandibles with overdentures supported by four intraforaminal implants and retained by Locator® attachments in elderly patients, both from a clinician's and a patient's perspective, as well as to assess the stability of the results in a 2-year period. METHOD AND MATERIALS: 15 patients presenting edentulous mandibles and discomfort while wearing conventional overdentures were enrolled in the study. Careful presurgical and computer-assisted 3D treatment planning was performed. Patients were treated with four intraforaminal implants using a computer-assisted flapless approach. All patients were prosthetically rehabilitated with overdentures. Clinical parameters such as peri-implant probing depth (PPD), Plaque Index (PI), and bleeding on probing (BOP) were evaluated. Patients' perceptions regarding the outcome were assessed on visual analog scales (VAS). RESULTS: Out of 15 patients consecutively included in the study, only 10 patients could be treated with the designed protocol. A total of 40 Camlog implants were placed. No implant was lost over a 2-year period. BOP was negative in 82% of sites; mean PPD was 2.34 mm; 8 of the 40 implants showed the absence of keratinized tissue on the lingual or the vestibular aspect. The VAS score of 9.9 demonstrated the satisfaction of the patients. CONCLUSIONS: Within the limitations of this study, the data demonstrate that in a significant number of cases this protocol could not be used for anatomical or technical reasons. In the cases where it could be used, the computer-assisted protocol appeared suitable for treating elderly patients with mandibular edentulism and restoring them with an overdenture in a minimally invasive way. The possibility of placing implants outside the borders of the keratinized tissue is relevant.
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Prótese Dentária Fixada por Implante , Revestimento de Dentadura , Arcada Edêntula/reabilitação , Cirurgia Assistida por Computador , Idoso , Feminino , Seguimentos , Humanos , Masculino , Mandíbula , Estudos Prospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: Fibrin, fibronectin, platelet derived growth factor, and transforming growth factors from platelet concetrate are crucial for tissue reparation and regeneration. OBJECTIVE: This study was designed to evaluate clinical effectiveness of activated platelet-rich fibrin (PRF) membrane in treatment of gingival recession. METHODS: 19 gingival recessions Miller class I or II were treated with a coronally advanced flap and the PRF membrane (PRF group). Following the elevation of the flap, bone and root surfaces were covered with the PRF membrane. After suturing, the PRF membrane was covered with a coronally advanced flap. In the same patients, 19 other gingival recessions were treated with CTG in combination with the coronally advanced flap (the CTG group). Clinical recordings were made of vertical recession depth (VRD), probing depth (PD), clinical attachment level (CAL) and keratinized tissue width (KTW) before and 12 months after mucogingival surgical treatment. Clinical evaluation of healing events was estimated with recordings of the healing index (HI). Recordings of HI were performed in the 1st, 2nd and 3rd week post-surgically. RESULTS: Mean root coverage was significant in both groups (the PRF group 79.94% and the CTG group 88.56% %; p < 0.01). The difference between the two tested groups was not statistically significant. Results of the keratinized tissue width showed significant increase (p < 0.05) 12 months after the surgery in both, the PRF and CTG groups. Results of KTW showed statistical significance of recorded differences obtained in the two evaluated groups (p < 0.05). There was no statistical significance in reduction of PD and CAL recorded in the PRF and CTG groups. The values of HI recorded in the 1st and 2nd week postoperatively were significantly enhanced in the PRF group (p < 0.05). CONCLUSION: Results of this study confirm both procedures as effective with equivalence of clinical results in solving gingival recession problems. The utilization of the PRF resulted in a decreased postoperative discomfort and advanced tissue healing.