Self-reported questionnaire on periodontal condition validated for use in Brazil

Abstract: There is a current expectation of instruments for periodontal condition surveillance worldwide. The present study aimed to validate the Oral Health Questions Set B (OHQB) for the Brazilian Portuguese and evaluate its temporal stability. This is a sequential mixed-method investigation. After the forward-backward translation process to the Brazilian Portuguese, the OHQB Brazil (OHQB-Br) was applied to 156 participants (39.5 ± 14.14 years; 51.9% males). In sequence, through a full-mouth six-sites/teeth examination and in accordance with the original instrument, the periodontal diagnosis was obtained (March 2020). In January 2021, the OHB-BR was reapplied (n = 71). Ordinal alpha and McDonald's omega tested the internal consistency of the OHQB-Br. Temporal stability was investigated [Spearman correlation, intraclass correlation coefficient (ICC), and the Bland-Altman]. The concurrent validity was also verified, considering the periodontal clinical diagnosis (Kruskal Wallis). The ordinal alpha (0.69) and McDonald's omega (0.73) coefficients showed an adequate internal consistency of the OHQB-Br. The OHQB-Br temporal stability was high, as demonstrated by the Spearman coefficient (0.80) and ICC (0.79) and by the Bland-Altman plot. A concurrent validity showed a direct relationship between the OHQB-Br and the clinical condition of no periodontitis, mild, moderate, and severe periodontitis (p < 0.05). Because the OHQB-Br shows internal validity, temporal stability, and adequately identifies periodontal health and moderate/severe periodontitis, the instrument might represent an important tool, at the public level or other settings, for periodontal surveillance in Brazil.

Periodontitis stage and grade are associated with poor oral-health-related quality of life: Findings from the Porto Alegre cohort study.

AIM: To determine the association between periodontitis stage and grade with oral-health-related quality of life (OHRQoL). MATERIALS AND METHODS: This cohort was derived from the Porto Alegre study. The original sample was representative of more than 3 million inhabitants of a Brazilian urban area. Full-mouth periodontal examinations at six sites per tooth were performed at baseline and 5 years later. Periodontitis grade was determined by direct evidence of progression of attachment loss over the follow-up. Stage of periodontitis and OHRQoL, determined by the oral health impact profile version 14 (OHIP-14), were recorded at the follow-up examination. Mean ratios (MRs) and 95% confidence intervals (95% CIs) were estimated adjusting for age, sex, smoking, systemic diseases, tooth loss, and baseline periodontitis diagnosis. RESULTS: Five-hundred and ninety-nine individuals were analysed. Individuals with periodontitis grade C + stage II (MR = 1.49; 95% CI = 1.08-2.04) and stages III/IV (MR = 1.83; 95% CI = 1.25-2.66) had significantly higher OHIP scores than those without periodontitis or with periodontitis stage I/grade B. Individuals with periodontitis stages II and III/IV + grade B did not differ from those without periodontitis or with periodontitis stage I/grade B. CONCLUSION: Severity and progression rate of periodontitis are associated with poor OHRQoL.

Oral health-related quality of life during supportive periodontal therapy: results from a randomized clinical trial.

AIM: Assessment of Oral Health Impact Profile (OHIP-14) during a randomized controlled trial of supportive periodontal therapy (SPT) consisting of oral prophylaxis with oral hygiene instructions only (test) or in conjunction with subgingival instrumentation (control). METHODS: OHIP-14 was assessed at baseline, 6, 12, 18 and 24 months. Data from 62 participants (50.97 ± 9.26 years, 24 smokers) were analysed by GEE and Logistic regression. OHIP-14 means, effect size, floor and ceiling effect and minimal important difference were calculated. Sum of OHIP-14 (severity), numbers of responses (extent) "fairly often" (FO) or "very often" (VO) and percentage of people (prevalence) reporting FO or VO were computed. RESULTS: At baseline, low scores of OHIP-14 were observed for test (7.67 ± 9.27) and control (6.51 ± 7.47) with a decreasing trend during SPT, without differences between or intra-groups over time. At 6 months, a difference was observed in the OHIP-14 prevalence (p = .03), without differences in severity and extent. Smoking status and plaque >15% (moderate oral hygiene) at 24 months were associated with higher OHIP-14 prevalence scores at that point of time (p = .038 and p = .034, respectively). CONCLUSION: Patients submitted to two different modalities of SPT maintained low OHIP-14 scores over 2 years of care.

Obesity as a risk factor for tooth loss over 5 years: A population-based cohort study.

AIM: To assess obesity as a risk factor for tooth loss over 5 years in an urban sample of Brazilian adults. MATERIALS AND METHODS: A total of 1586 individuals were surveyed using a multistage probabilistic approach. Five years later, 635 individuals 14-64 years old were re-examined. An incident case of tooth loss was determined for a participant that had lost at least one tooth over time. Obesity was evaluated by calculating body mass index at baseline and by the change in obesity status over time. RESULTS: Incident cases of tooth loss were significantly more frequent among obese (47.1%) than normal-weight individuals (32.4%) (p = .004). Obese individuals had 31% higher risk [relative risk (RR) =1.31; 95% confidence interval (95%CI) 1.04-1.65] for tooth loss than normal-weight individuals adjusting for age, socio-economic status, smoking, dental care and periodontitis. This association was significant for females (RR=1.47, 95%CI 1.08-2.01), but not for males. The risk for tooth loss was also modified by presence of periodontitis at baseline and lifetime smoking exposure. There was an increased risk for tooth loss for those that remained obese than those that remained normal weight. CONCLUSION: Obesity is associated with higher risk for tooth loss. This association was modified by sex, periodontal status and smoking.

A systematic review of the microbiota composition in various peri-implant conditions: data from 16S rRNA gene sequencing.

OBJECTIVE: To systematically review the literature regarding the microbiota composition in various peri-implant conditions as analyzed by 16S rRNA gene sequencing methods. METHODS: Electronic searches were conducted at MEDLINE/PubMed, Scopus, Embase, ScienceDirect and Web of Science databases looking for articles published up to April 2020. Observational prospective investigations were considered with systemically healthy patients and that had presented the description of the microbiota composition of peri-implantitis (PI), peri-implant mucositis (PM) and/or health implants (HI) by using 16S rRNA gene sequencing analysis were considered eligible. RESULTS: From 1,380 titles found, 8 studies were considered for qualitative analysis. One article was excluded due to high risk of bias, remaining 7 studies for descriptive analysis. In 6 out of 7 studies the PI microbiota was reported as being in relative abundance and variety though with a different composition from those with HI. There was no consensus regarding which condition had more diversity. The main observed phyla among PI were Firmicutes, Bacteroidetes, Actinobacteria, Fusobacteria and Spirochaetes, while the genera were mainly Actinomyces, Eubacterium, Fusobacterium, Mogibacterium, Moraxella, Treponema and Porphyromonas. Comparisons between PI and PM microbiota showed conflicting results: one study suggested that PI has greater bacterial diversity; another study reported the opposite result, while another investigation found similar variety for both conditions. CONCLUSIONS: The microbiota of peri-implant conditions have been reported as distinct, although the available literature presents discrepancies. Nonetheless, considering the findings in most studies, it can be suggested that the relative abundance of microbiota and bacterial diversity increased with the progress of peri-implant disease.

The impact of maintenance on peri-implant health.

Most of the literature evaluating dental implants focuses on implant survival, which is a limited proxy for the successful rehabilitation of patients with missing teeth. Success should include not only survival but also lack of mechanical, biological, and esthetics problems. A comprehensive review of local and systemic risk factors prior to implant placement will allow the tailoring of treatment planning and maintenance protocols to the patient's profile in order to achieve longitudinal success of the therapy. This review discusses the role of controlling different risk factors and prevention/treatment of peri-implant mucositis in order to avoid peri-implantitis. Although the literature addressing the topic is still scarce, the existing evidence shows that performing optimal plaque control and regular visits to the dentist seem to be adequate to prevent peri-implant lesions. Due to impossibility of defining a probing depth associate with peri-implant health, radiographic evaluations may be considered in the daily practice. So far, there is a strong evidence linking a past history of periodontal disease to peri-implant lesions, but this is not so evident for other factors including smoking and diabetes. The prevention of biological complications starts even before implant placement and include a broader analysis of the patient risk profile and tailoring the rehabilitation and maintenance protocols accordingly. It should be highlighted that the installation of implants does not modify the patient profile, since it does not modify genetics, microbiology or behavioral habits of any individual.

Impact of smoking on gingival inflammation in representative samples of three South American cities.

The aim of this study was to investigate the impact of smoking on gingival inflammation in a representative sample of 1,650 adults from Santiago (Chile), Porto Alegre (Brazil), and Tucumán (Argentina). A questionnaire was administered to participants to gather demographic and behavioral characteristics, including smoking habits. The participants were clinically examined to obtain gingival index (GI), gingival bleeding index (GBI), visible plaque index (VPI), and calculus presence values. Gingival inflammation was defined as a mean GI > 0.5. Heavy smokers presented significantly lower levels of gingival inflammation, as reflected by both GI and GBI, than both light and moderate smokers, despite their having increased amounts of plaque and calculus. Being 50 years old or older [odds ratio (OR), 1.93], a VPI ≥ 30% (OR, 28.1), and self-reported diabetes (OR, 2.79) were positively associated with detection of gingival inflammation. In conclusion, the occurrence of clinically detectable gingival inflammation was lower in heavy smokers than light and moderate smokers. Older age, diabetes, and visible plaque emerged as risk indicators of gingivitis. Plaque and gingival indices are significantly associated regardless of the smoking status.

Supportive periodontal therapy in moderate-to-severe periodontitis patients: A two-year randomized clinical trial.

AIM: Evaluate supportive periodontal therapy (SPT) consisting of oral prophylaxis with oral hygiene instructions as sole intervention (test) or combined with subgingival instrumentation removing/disrupting the subgingival biofilm (control). MATERIAL AND METHODS: Sixty-two treated periodontitis patients (50.97 ± 9.26 years, 24 smokers) were randomly assigned to receive, every 3 months during 2 years, either test or control treatment. Examination included periodontal probing depth (PPD), bleeding on probing (BOP) and clinical attachment loss (CAL). Generalized estimating equations were used for analyses. RESULTS: Baseline demographics and smoking were similar between groups. However, at baseline, mean PPD was greater in test group than in control group (2.32 mm vs. 2.17 mm, p = .03), but similar after 2 years (2.23 mm vs. 2.15 mm, respectively). With time, significant PPD and BOP decrease and CAL increase were observed although without significant differences between groups. At sites ≥ 5 mm, PPD decrease was greater in test group than in control group irrespective of sex and smoking habit (p = .034). The distribution of sites gaining or losing attachment ±2 mm was similar between groups. CONCLUSION: Oral prophylaxis with oral hygiene instructions alone or in combination with subgingival instrumentation was able to maintain the previously obtained periodontal condition to a comparable extent during 2 years of SPT.

Impact of smoking on gingival inflammation in representative samples of three South American cities

Abstract The aim of this study was to investigate the impact of smoking on gingival inflammation in a representative sample of 1,650 adults from Santiago (Chile), Porto Alegre (Brazil), and Tucumán (Argentina). A questionnaire was administered to participants to gather demographic and behavioral characteristics, including smoking habits. The participants were clinically examined to obtain gingival index (GI), gingival bleeding index (GBI), visible plaque index (VPI), and calculus presence values. Gingival inflammation was defined as a mean GI > 0.5. Heavy smokers presented significantly lower levels of gingival inflammation, as reflected by both GI and GBI, than both light and moderate smokers, despite their having increased amounts of plaque and calculus. Being 50 years old or older [odds ratio (OR), 1.93], a VPI ≥ 30% (OR, 28.1), and self-reported diabetes (OR, 2.79) were positively associated with detection of gingival inflammation. In conclusion, the occurrence of clinically detectable gingival inflammation was lower in heavy smokers than light and moderate smokers. Older age, diabetes, and visible plaque emerged as risk indicators of gingivitis. Plaque and gingival indices are significantly associated regardless of the smoking status.

The impact of maintenance on peri-implant health

Abstract Most of the literature evaluating dental implants focuses on implant survival, which is a limited proxy for the successful rehabilitation of patients with missing teeth. Success should include not only survival but also lack of mechanical, biological, and esthetics problems. A comprehensive review of local and systemic risk factors prior to implant placement will allow the tailoring of treatment planning and maintenance protocols to the patient's profile in order to achieve longitudinal success of the therapy. This review discusses the role of controlling different risk factors and prevention/treatment of peri-implant mucositis in order to avoid peri-implantitis. Although the literature addressing the topic is still scarce, the existing evidence shows that performing optimal plaque control and regular visits to the dentist seem to be adequate to prevent peri-implant lesions. Due to impossibility of defining a probing depth associate with peri-implant health, radiographic evaluations may be considered in the daily practice. So far, there is a strong evidence linking a past history of periodontal disease to peri-implant lesions, but this is not so evident for other factors including smoking and diabetes. The prevention of biological complications starts even before implant placement and include a broader analysis of the patient risk profile and tailoring the rehabilitation and maintenance protocols accordingly. It should be highlighted that the installation of implants does not modify the patient profile, since it does not modify genetics, microbiology or behavioral habits of any individual.

A multicenter study of oral health behavior among adult subjects from three South American cities

Abstract The aims of this study were to describe the self-reported oral hygiene habits, dental visit frequency, and gingival bleeding perception in adult populations from three South American cities, and also to assess the association of these variables with sociodemographic data and with the clinical presence of plaque and gingival inflammation. Five-hundred and fifty adult subjects from each city (Porto Alegre, Brazil; Tucumán, Argentina; Santiago, Chile) received full mouth examinations to determine visible plaque and gingival index. A structured questionnaire on demographics, habits, attitudes and knowledge of oral health was also administered. The data were analyzed according to dental visit frequency, toothbrushing frequency, interproximal tooth cleaning frequency, subjects' perception of gum bleeding, and proportion of subject sites with VP and bleeding sites. Analysis of the association among the variables was performed using either a chi-square test or Fischer's exact test. Toothbrushing twice a day or more was reported by 84.2% of the subjects, but only 17.7% reported daily interdental cleaning, and 60.2% reported visiting a dental clinic only in an emergency. Only 2.97% had no bleeding sites, whereas 33.7% had 50% or more bleeding sites. Regular interdental self-cleaning and a dental visit every 3-6 months was associated with less plaque and less gingival bleeding. More than 12 years of education was associated with healthier habits, less bleeding and plaque scores. In conclusion, the oral health behavior of South American adult subjects from these cities is below the international recommendations, especially in relation to interdental cleaning and regular dental visits.

Oral health related quality of life among pregnant women: a randomized controlled trial

Abstract: The aim of the present study was to compare negative impacts of oral conditions in Oral Heath Related Quality of Life (OHRQoL) assessed by the Oral Health Impact Profile-14 (OHIP-14) scores in pregnant women receiving or not comprehensive periodontal treatment. This randomized controlled clinical trial included pregnant women aged between 18 and 35 years old. Participants were randomized in a test group with 96 and a control group with 114 women. Patients in the test group received comprehensive periodontal treatment, supra and subgingival scaling and root-planning and periodontal maintenance appointments. The OHIP-14 was applied before and after treatment. The primary outcome was changes in OHIP-14 scores after follow-up period. The impact of having received or not comprehensive periodontal treatment on the change of the OHIP-14 scores was also investigated. Both groups showed significant reduction in OHIP-14 scores and effect size for the test group was 0.60 and 0.36 for the control group. Multinomial logistic regression analysis showed that participants of the control group had 5.9-fold odds (CI 95% 1.88-18.52) of worsening in OHIP-14 scores and their perception of oral conditions in relation to test group. Comprehensive periodontal treatment during pregnancy can reduce the negative impacts in OHRQoL.

Association between metabolic syndrome and periodontitis: a systematic review and meta-analysis

Abstract The aim of the present study was to evaluate the association between metabolic syndrome (MS) and periodontitis (PD), through a systematic review and meta-analysis. Original observational studies assessing the association between MS and PD in adults, published before May 11th (2017), were identified through electronic searches of MEDLINE, EMBASE and Cochrane Library databases. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was used. For studies to be included, they had to mention the criteria used to diagnose MS and to have used at least one clinical measure to diagnose PD. There was no language restriction. Three reviewers independently identified eligible studies for possible inclusion in the systematic review and meta-analysis. The quality of the studies was evaluated by the Newcastle-Ottawa scale for observational studies. A random model meta-analysis was conducted. The strategies used to investigate heterogeneity were sequential analysis, subgroup analysis, univariate meta-regression and sensitivity analysis. Thirty-three studies met the inclusion criteria for the systematic review, and 26 had enough information to be included in the meta-analysis, totaling 52,504 patients. MS and PD were associated with an odds ratio of 1.38 (95%CI 1.26-1.51; I2 = 92.7%; p < 0.001). Subgroup analysis showed that complete periodontal examination (I2 = 70.6%; p < 0.001) partially explained the variability between studies. The present findings suggest an association between MS and PD. Individuals with MS are 38% more likely to present PD than individuals without this condition. Prospective studies should be conducted to establish cause and effect relations between MS and PD.

Tooth Loss in Patients under Periodontal Maintenance in a Private Practice: A Retrospective Study

Abstract The aim of the present study was to evaluate the incidence and causes of tooth loss in periodontal subjects from a private practice in Brazil. Two trained examiners extracted data from the records of subjects who sought periodontal treatment from 1980 to 2013. Only records of patients who completed the non-surgical periodontal treatment and had at least one visit for maintenance were included. Data were analyzed by chi-square test, Student's t-test, Kaplan-Meier survival curve and Cox regression. A total of 3,319 records were reviewed and 737 records included (58.6% women, mean age of 46.6±13.0 years at the beginning of the treatment). Maintenance period ranged from 1 to 33 years (7.4±6 years). During this period, 202 individuals (27.4%) lost 360 teeth, 47.5% of losses within the first five years (n=171). Non-compliers lost more teeth than compliers (p<0.001), respectively 211 and 149 teeth. Regarding reasons of tooth loss, 84 individuals lost 38% of the teeth from periodontal disease progression (n=137). Survival analysis showed that most patients lost only one tooth from periodontal disease, and differences in the survival rates between compliers and non-compliers were observed following the second tooth loss. Approximately one-third of tooth losses was related to periodontal disease progression, and there was stability in time of the proportion of losses from disease progression and other reasons. Therefore, it is possible to conclude that compliant patients in a private practice lose fewer teeth than do non-compliers. Among compliers, periodontal disease progression was not the main cause of tooth loss.

Resumo O objetivo do presente estudo foi avaliar a incidência e causas de perda dentária em pacientes em manutenção periódica preventiva (MPP) de uma clínica privada. Dois examinadores extraíram os dados de registros de pacientes que procuraram tratamento periodontal entre 1980 a 2013. Os registros de pacientes que completaram o tratamento periodontal não cirúrgico e tiveram ao menos uma visita de MPP foram incluídos. Os dados foram avaliados utilizando os testes chi-quadrado, T de Student, curva de sobrevida de Kaplan-Meier e regressão de Cox. Dos 3.319 prontuários, 737 foram incluídos (58,6% mulheres, 46,6±13,0 anos). O período de MPP variou de 1 a 33 anos (7,4±6 anos). Durante este período, 202 indivíduos (27,4%) perderam 360 dentes, 47,5% das perdas durante os primeiros 5 anos de manutenção (n=171). Indivíduos irregulares nas consultas de MPP perderam mais dentes (p<0.001) do que indivíduos com regularidade, 211 e 149 dentes respectivamente. Oitenta e quatro indivíduos perderam 38% de dentes por progressão de doença periodontal (n=137). A maioria dos indivíduos perdeu 1 dente por doença periodontal, e foram observadas diferenças na sobrevida a partir da segunda perda dentária quando comparados indivíduos regulares e irregulares na MPP. Aproximadamente um terço dos dentes perdidos estava relacionado à progressão de doença periodontal. Foi observada uma estabilidade na proporção de perdas por progressão de doença e outras razões ao longo do tempo. Desta forma, conclui-se que indivíduos com uma frequência regular de MPP perdem menos dentes e a progressão de doença nesses indivíduos não é a principal razão para perda dentária.

Chlorhexidine with or without alcohol against biofilm formation: efficacy, adverse events and taste preference

Abstract In recent years, different chlorhexidine formulations have been tested, including an alcohol-free alternative, but the effect of this solution on early biofilm formation is not clear. A crossover, randomized, double-blind clinical trial was conducted to evaluate the effect of two chlorhexidine solutions against supra- and subgingival biofilm formation (NCT#02656251). Thirty-five participants were randomized and asked to rinse twice daily with 15 ml of an alcohol-containing 0.12% chlorhexidine solution, an alcohol-free 0.12% chlorhexidine solution, or placebo. The study was conducted in three experimental periods of 4 days each, with a 10-day washout between the periods. All the experimental periods followed the same protocol, except that the solutions were switched. Biofilm distribution was evaluated every 24 hours by the Plaque-Free Zone Index, during 96 hours. Adverse events were self-reported and sensory evaluation was performed using a hedonic scale. Compared to the placebo, the chlorhexidine solutions resulted in a significantly higher number of surfaces free of plaque over 96 hours (p < 0.01), and were able to prevent subgingival biofilm formation (p < 0.01). The alcohol-free chlorhexidine solution was associated with a lower incidence of adverse events, compared with alcohol-containing chlorhexidine (p < 0.05); it also received better sensory evaluation and acceptance by trial participants, compared with the alcohol-containing chlorhexidine (p = 0.007), and had a similar inhibitory effect on the formation of supra- and subgingival biofilms.

Microbiological outcomes from different periodontal maintenance interventions: a systematic review

Abstract This study aimed to investigate the differences in the subgingival microbiological outcomes between periodontal patients submitted to a supragingival control (SPG) regimen as compared to subgingival scaling and root planing performed combined with supragingival debridement (SPG + SBG) intervention during the periodontal maintenance period (PMP). A systematic literature search using electronic databases (MEDLINE and EMBASE) was conducted looking for articles published up to August 2016 and independent of language. Two independent reviewers performed the study selection, quality assessment and data collection. Only human randomized or non-randomized clinical trials with at least 6-months-follow-up after periodontal treatment and presenting subgingival microbiological outcomes related to SPG and/or SPG+SBG therapies were included. Search strategy found 2,250 titles. Among these, 148 (after title analysis) and 39 (after abstract analysis) papers were considered to be relevant. Finally, 19 studies were selected after full-text analysis. No article had a direct comparison between the therapies. Five SPG and 14 SPG+SBG studies presented experimental groups with these respective regimens and were descriptively analyzed while most of the results were only presented graphically. The results showed that both SPG and SPG+SBG protocols of PMP determined stability in the microbiological results along time. Nevertheless, new studies comparing these interventions in PMP are needed, especially if the limitations herein discussed could be better controlled.

Effect of obesity on periodontal attachment loss progression: a 5-year population-based prospective study.

AIM: The aim of this study was to assess the effect of overweight and obesity on periodontal attachment loss (PAL) progression in an urban population from south Brazil. METHODS: In 2001, a population-based oral health survey entitled "Epidemiology of periodontal diseases: the Porto Alegre Study" was conducted by drawing a probabilistic sample of 1586 individuals. After 5 years, 755 (participation rate: 47.6%) individuals were re-examined. For this analysis, self-reported diabetics, underweight individuals, and individuals with <6 teeth were excluded. Poisson regressions were used to calculate relative risks (RR) and 95% confidence intervals (CI) adjusted for sex, age, skin colour, education, socio-economic status, smoking and dental care. RESULTS: Five hundred and eighty-two individuals (333 males/249 females, 36.02 ± 14.97 years) were included. Overall, obese individuals had significantly higher risk of experiencing PAL progression than individuals with normal weight after adjusting for important co-factors (RR = 1.36, 95% CI = 1.04-1.78). In a stratified analysis, no statistically significant associations were observed between PAL progression and obesity for males (RR = 1.13, 95% CI = 0.75-1.69), whereas obese females were at statistically significant higher risk than normal weight females (RR = 1.64, 95% CI = 1.11-2.43). CONCLUSION: Obesity appears to be a risk factor for PAL progression for females but not males in this developing country population.

Response to Proximal Restorations Placed Either Subgingivally or Following Crown Lengthening in Patients with No History of Periodontal Disease.

The purpose of this study was to compare the impact of resin restorations placed supragingivally or impinging periodontal biologic width (PBW). Ten patients (aged 19 to 35 years) with at least two contralateral teeth (premolars and molars) in need of proximal subgingival restorations participated. Test group (TG) (impingement of PBW with transsurgical restorations) and control croup (CG) (supragingival restorations after crown lengthening) were randomly assigned. Visible plaque (VP), bleeding on probing (BOP), periodontal probing depth (PPD), and clinical attachment loss (CAL) were evaluated at baseline and at 45, 90, and 180 days, and by transperiodontal probing at baseline and 180 days. Generalized estimating equations, Wald test, and t test were used (P ≤ .05). VP and BOP were reduced and maintained at low levels (less than 10% from day 45 on). PPD initially reduced in the TG. At day 180, no intra- or intergroup differences were observed (P > .05). CAL was higher in the CG after surgery (P < .05) and remained stable for both groups throughout the study. In conclusion, proximal bonded restorations infringing on the PBW may not require clinical crown lengthening.

Predictors of clinical outcomes after periodontal treatment of aggressive periodontitis: 12-month randomized trial

Abstract Little is known about the factors that may be used in clinical practice to predict the therapeutic response of aggressive periodontitis patients. The aim of this study was to determine predictors of clinical outcomes after non-surgical treatment of aggressive periodontitis. A total of 24 patients (aged 13-26 years) received oral hygiene instructions, as well as subgingival scaling and root planing. Twelve subjects received systemic azithromycin at random. Clinical variables were assessed at baseline, 3, 6, 9, and 12 months. Baseline microbiological assessment was performed by checkerboard DNA-DNA hybridization. Multivariable models used generalized estimating equations. There were significant improvements in the entire sample in regard to pocket depth, clinical attachment level and bleeding on probing. Significant predictors of a reduction in mean pocket depth were: use of azithromycin, non-molar teeth, generalized disease and baseline pocket depth. Absence of plaque predicted a 0.22 mm higher attachment gain, whereas a baseline pocket depth ≥7 mm predicted a 1.36 mm higher attachment loss. Azithromycin, plaque, and baseline pocket depth were significant predictors of bleeding on probing. The concomitant presence of all three red complex species predicted a 0.78 mm higher attachment loss. It may be concluded that dental plaque, tooth type, disease extent, baseline pocket depth, and use of azithromycin were significant predictors of the clinical response to treatment for aggressive periodontitis in young individuals. Moreover, the presence of multiple periodontal pathogens may predict challenges in achieving a favorable outcome for aggressive periodontitis.

Do controle de placa ao controle do biofilme supragengival: o que aprendemos ao longo dos anos? / From plaque control to the supragingival biofilm control: what have we learnt over time?

As doenças periodontais de maior prevalência são aquelas relacionadas à presença da placa bacteriana, hoje entendida como um biofilme dental. A compreensão da dinâmica deste reacendeu antigas discussões que, desde então, buscavam determinar quais as formas elegíveis e preferíveis para o tratamento daquelas doenças. Sob o conceito de "placa dentária", o tratamento da gengivite, mas principalmente o da periodontite, ora levaram ao extremo da tentativa de eliminação de toda e qualquer "placa", ora conduziram ao uso, até hoje indiscriminado, de antibióticos. Atualmente, o conceito de biofilme dental, entendido como comunidades microbianas com mecanismos interdependentes de autorregularão, nutrição e comunicação, a ponto de manterem um sinergismo que vai ao encontro da sua subsistência, alterou a forma não só de entender a etiologia das doenças periodontais, mas de como tratá-las. Neste conceito, o papel dos microrganismos não necessariamente aponta para tipos bacterianos específicos como causadores da doença, mas para as doenças periodontais como uma infecção oportunista. Paralelamente, o biofilme supragengival passou a significar mais do que o fator etiológico das gengivites, passando a ser compreendido, também, como fundamental modulador do ambiente subgengival. Neste cenário, a terapia periodontal passa por desafios inerentes a uma mudança conceitual, tais como compreender o significado do controle supragengival para a prevenção, tratamento e manutenção dos resultados terapêuticos. Portanto, esta revisão teve por objetivo apresentar a plausibilidade biológica do controle do biofilme supragengival como fundamental para a terapia periodontal e, além disto, discutir resultados de estudos sob o conceito de doença periodontal como uma infecção oportunista.

The most prevalent periodontal diseases are those associated with the presence of dental plaque, nowadays understood as a dental biofilm. The comprehension of the biofilm dynamics rekindled old discussions that, since then, sought to determine the eligible and preferred therapies for periodontal diseases. Under the concept of "dental plaque", the gingivitis treatment, and also the periodontitis one were based on the elimination of every and any plaque or of some bacteria species. The later determining the indiscriminate use of antibiotics. Currently, the biofilm concept, understood as microbial communities with interdependent mechanisms of self-regulation, nutrition and communication and involved in a synergism to render its subsistence, changed the way not only to understand the periodontal diseases etiology but, in special, the way to treat them. Under this concept, the role of microorganisms not necessarily points to specific bacteria infecting the sites and causing diseases, but to periodontal diseases as an opportunist infection linked to a retro feeding process between the dental biofilm and the host. Alongside, the supragingival biofilm has meant more than the etiologic factor of gingivitis, but also as an important modulator of subgingival environment. In this sense, the periodontal therapy is challenged by conceptual trends, such as the comprehension of the meaning of supragingival control for the prevention, treatment and maintenance of therapeutic results. Therefore, the present review aimed to revise the role of the supragingival biofilm control to periodontal condition, and, also, to discuss results of studies under the concept of periodontal diseases as opportunists infections.