A new digital evaluation protocol applied in a retrospective analysis of periodontal plastic surgery of gingival recessions.

This research aimed to develop a new digital evaluation protocol to objectively quantify the volumetric changes of root coverage periodontal plastic surgery when combined with connective tissue graft. Consecutive patients with Cairo recession type 1 (RT1) or Cairo recession type 2 (RT2) were treated. Accurate study models obtained at baseline and follow-ups were optically scanned. Healing dynamics were measured by calculating volume differences between time points. Nineteen patients were treated between December 2014 and January 2019. At 3-month follow-up, root coverage was 95.6% (± 14.5%) with tunnel and connective tissue graft (TUN + CTG) technique, and 88.9% (± 20.5%) with the vestibular incision subperiosteal tunnel access and connective tissue graft (VISTA + CTG) technique. Recession decreased 1.33 (± 0.86) mm and 1.42 (± 0.92) mm, respectively (p = 0.337). At 6-month follow-up, root coverage was 96.5% (± 10.4%) with the TUN + CTG and 93.9% (± 10.3%) with the VISTA + CTG. Recession decreased 1.35 (± 0.85) mm and 1.45 (± 0.82) mm, respectively (p = 0.455). Complete root coverage was achieved in 86.7% (± 0.4%) with TUN + CTG and 70.6% (± 0.5%) with VISTA + CTG. No statistically significant differences were found between techniques. The digital protocol presented proved to be a non-invasive technique for accurate measurements of clinical outcomes. Both techniques reduce gingival recessions, with no statistically significant differences.

Preparation and application of chitosan biomaterials in dentistry.

Chitosan is a biodegradable and biocompatible natural polysaccharide that has a wide range of applications in the field of dentistry due to its functional versatility and ease of access. Recent studies find that chitosan and its derivatives can be embedded in materials for dental adhesives, barrier membranes, bone replacement, tissue regeneration, and antimicrobial agent to better manage oral diseases. In this paper, we provide a comprehensive overview on the preparation, applications, and major breakthroughs of chitosan biomaterials. Furthermore, incorporation of chitosan additives for the modification and improvement of dental materials has been discussed in depth to promote more advanced chitosan-related research in the future.

An Antibacterial Strategy of Mg-Cu Bone Grafting in Infection-Mediated Periodontics.

Periodontal diseases are mainly the results of infections and inflammation of the gum and bone that surround and support the teeth. In this study, the alveolar bone destruction in periodontitis is hypothesized to be treated with novel Mg-Cu alloy grafts due to their antimicrobial and osteopromotive properties. In order to study this new strategy using Mg-Cu alloy grafts as a periodontal bone substitute, the in vitro degradation and antibacterial performance were examined. The pH variation and Mg2+ and Cu2+ release of Mg-Cu alloy extracts were measured. Porphyromonas gingivalis (P. gingivalis) and Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), two common bacteria associated with periodontal disease, were cultured in Mg-Cu alloy extracts, and bacterial survival rate was evaluated. The changes of bacterial biofilm and its structure were revealed by scanning electron microscopy (SEM) and transmission electronic microscopy (TEM), respectively. The results showed that the Mg-Cu alloy could significantly decrease the survival rates of both P. gingivalis and A. actinomycetemcomitans. Furthermore, the bacterial biofilms were completely destroyed in Mg-Cu alloy extracts, and the bacterial cell membranes were damaged, finally leading to bacterial apoptosis. These results indicate that the Mg-Cu alloy can effectively eliminate periodontal pathogens, and the use of Mg-Cu in periodontal bone grafts has a great potential to prevent infections after periodontal surgery.

Uso de la Fibrina Rica en Plaquetas Inyectable (i-PRF) en Defectos Infra Óseos en Terapia Periodontal no Quirúrgica. Reporte de Dos Casos / Use of Injectable Platelet-Rich Fibrin (i-PRF) in Infra Osseous Defects in Non-Surgical Periodontal Therapy. Report of Two Cases

RESUMEN: Entre los concentrados plaquetarios de segunda generación, ha suscitado creciente interés, el uso de fibrina rica en plaquetas y leucocitos inyectable (i-PRF); que se obtiene a partir de la centrifugación inmediata de sangre venosa del propio individuo, y que aporta concentraciones elevadas de factor de crecimiento vascular endotelial, factor de crecimiento transformante beta, y factor de crecimiento derivado de plaquetas, entre otras proteínas que inician y coordinan el proceso reparativo. Su nula citotoxicidad y consistencia líquida abren un nuevo campo de estudio y experimentación en el ámbito de la Cirugía Oral y de la Periodoncia, como sustancia para irrigar. El objetivo de este manuscrito fue reportar el uso del i-PRF como irrigador subgingival en el tratamiento periodontal convencional de defectos infra óseos con 6 meses de seguimiento. En ambos casos, se verificó un efecto positivo de irrigación, lo que abre el debate al uso de productos farmacéuticos tradicionales como la clorhexidina versus preparados autólogos sin efectos adversos reportados a la fecha.

ABSTRACT: Second generation platelet concentrates include the use of injectable platelet-rich fibrin (i-PRF), which has generated increasing interest because it is derived from immediate centrifugation of venous blood from the patients themselves. It provides high concentrations of vascular endothelial growth factor, transforming growth factor beta, and platelet-derived growth factor, among other proteins that initiate and coordinate the healing process. Its null cytotoxicity and liquid consistency has opened new research lines in the field of oral surgery and periodontics, as an irrigation substance. The aim of this manuscript was to report the use of i-PRF, as a subgingival irrigator in conventional periodontal treatment of infra osseous defects, with six months follow-up. In both cases, a positive effect of irrigation was confirmed. These findings, open the debate as regards the use of traditional pharmaceutical products (such as chlorhexidine), versus autonomous preparations without adverse effects reported to date.

Gingival crevicular fluid resistin levels in chronic periodontitis with type 2 diabetes before and after non-surgical periodontal therapy: A clinico-biochemical study.

AIM: Periodontitis and diabetes mellitus share a bidirectional relationship. Resistin is an adipocytokine shown to be associated with type 2 diabetes mellitus. Hence, the present study aims to estimate the effect of non-surgical periodontal therapy (NSPT) on GCF resistin levels in healthy individuals with gingivitis and well controlled diabetics with periodontitis, and correlate the same with HbA1c levels of the diabetic subjects. MATERIALS AND METHODS: The present study was a comparative interventional trial set in Department of Periodontics, the Oxford Dental College, Bangalore. Forty subjects participated in the study and were divided into two groups; group I (healthy individuals with gingivitis) and group II (diabetic individuals with mild to moderate periodontitis). Periodontal parameters were assessed and GCF was collected and analysed for resistin before and 3 months after NSPT. STATISTICAL ANALYSIS: All the analysis was done using SPSS version 18. A P value of < 0.05 was considered statistically significant. RESULTS: A significant difference was observed in GCF resistin concentrations between the two groups at baseline, wherein group II had significantly higher values. Following NSPT, there was a significant reduction in GCF resistin concentrations in both the groups, however intergroup comparison showed no difference in the amount of reduction. When all samples were analysed together, no significant correlation could be found between resistin and the parameters assessed. CONCLUSION: Resistin levels are increased in diabetes related periodontitis. However, post treatment a similar response can be seen between healthy and well controlled diabetics. Hence, resistin can be used as an inflammatory biomarker for diabetes related periodontal disease.

A comparative evaluation of transdermal diclofenac patch with oral diclofenac sodium as an analgesic drug following periodontal flap surgery: A randomized controlled clinical study.

BACKGROUND: Pain is an inevitable outcome of any periodontal surgery. Controlling postoperative pain is of utmost importance so as to increase patient compliance. The present study aims to compare the degree of postoperative analgesia with the use of oral diclofenac sodium and transdermal diclofenac patch following periodontal flap surgery in patients with chronic periodontitis. MATERIALS AND METHODS: A total of 20 patients requiring full mouth flap surgery were selected for this study. Flap surgery was performed quadrant-wise and transdermal diclofenac patch was applied on the right arm following surgery of one of the quadrants and 100 mg oral diclofenac sodium twice daily was prescribed following surgery of the subsequent quadrant. The postoperative pain was recorded on visual analog scale and pain intensity scale 24 h after the surgery. RESULTS: Both the statistical and clinical observation showed that diclofenac sodium administered transdermally has equal efficacy as compared to drug administered orally. CONCLUSION: The study concludes that the diclofenac administered transdermally has equal potency in relieving postoperative pain as compared to orally administered diclofenac sodium following modified flap surgery. Transdermal patch has an added advantage of better patient compliance as it does not cause gastric disturbance.

Radiosurgery in dentistry: a review.

The aim of the present study was to analyse the clinical potential of radiosurgery applied to modern dentistry through a revision of the indexed literature. Radiosurgery represents a recent form of electrosurgery working at a frequency of 3.0-4.0 MHz. The depth of penetration of the waves is inversely proportional to the frequency. Radiowaves working at high frequency express a lower penetration with a consequent lower tissue alteration. The authors analyzed the literature in order to give to the scientific community an overview of the possible applications of radiosurgery in the clinical dental practice and their effectiveness. Radiosurgery can be used in prosthodontics, in periodontal and implant surgery, in the treatment of trigeminal neuralgia, in the treatment of obstructive sleep apnea syndromes (OSAS) and in endodontics. Our analysis shows that although there are few articles in indixed literature on the applications of radiosurgery in dentistry, thanks to the benefits that derive from it, radiosurgery will spread more in the daily clinical practice of the dentists.

Accuracy and Usefulness of CBCT in Periodontology: A Systematic Review of the Literature.

A systematic literature review was performed regarding the accuracy and usefulness of cone beam computed tomography (CBCT) in the field of periodontology. A total of 580 articles were identified, of which 13 met the inclusion criteria. Results showed a high accuracy of CBCT in visualizing periodontal structures and the demonstrated the usefulness of CBCT in regenerative periodontal surgery of maxillary molars. It remains questionable whether this gain of additional information actually leads to a better clinical outcome in periodontal treatment. Currently, the use of CBCT in periodontology should be restricted to complex periodontal cases, particularly those involving maxillary molars.

Comparative Evaluation of N-Butyl Cyanoacrylate and Silk Sutures on Healing of Periodontal Flaps: A Clinico Histological Evaluation.

Background The periodontal flap is one of the most frequently employed procedures. Closure of reflected flap is important step in flap surgery. Black silk sutures are most often used material in routine surgical procedures. These suture materials demand more time and effort and expertise from the surgeon. Tissue adhesives have been developed as alternatives to overcome these problems such as cyanoacrylates. Objective The present study is an attempt to compare effectiveness of the black silk suture with cyanoacrylate adhesives in closing reflected periodontal flap. Method Thirty systemically healthy patients who underwent bilateral flap surgery were given 3-0 black silk sutures on one side and N-butyl cyanoacrylate adhesive on the other side to close a surgical incision. All the participants in the study were recalled on the seventh, 21st, 42nd day. Participants were evaluated for healing and plaque accumulation by assessing the gingival index, plaque index, wound healing index. Biopsy specimens were obtained on seventh and 42nd postoperative day. Result The amount of inflammation was less during the first week of healing when cyanoacrylate was compared with silk. However, over a period of 21 days to 42 days, the sites treated with both the materials showed similar healing patterns without any significant difference in the evaluated parameter. Conclusion The result of the study showed that the use of cyanoacrylate for the closure of periodontal flaps results in better initial post-operative healing as compared to closure with silk suture and that this method of closure can be advocated in a routine surgical periodontal practice.

Vestibuloplastia con la técnica de Edlan Mejchar: descripción de cuatro casos clínicos / Vestibuloplasty with Edlan Mejchar technique: description of four clinical cases

Antecedentes: En ocasiones, las retracciones gingivales se asocian a altas fuerzas tensionales de los músculos y a vestíbulos poco profundos. Dichas retracciones generan problemas periodontales a los pacientes por la dificultad de limpiar estas zonas. La vestibuloplastia por medio de la técnica de Edlan Mejchar permite, en una sola intervención y un solo campo quirúrgico, controlar los factores etiológicos y una inserción trepadora de la encía al eliminar las fuerzas tensionales. Objetivo: Describir la efectividad de la técnica de Edlan Mejchar empleada para solucionar retracciones gingivales producidas por fuerzas tensionales en cuatro casos clínicos. Descripción de los casos: Se presentaron cuatro pacientes con retracciones gingivales en dientes incisivos inferiores con poca encía adherida debida a fuerzas tensionales del frenillo labial inferior. Como tratamiento se usó la técnica de Edlan Mejchar que incluyó una incisión supraperióstica y relajantes internas en el tejido conjuntivo. Resultados: El porcentaje de cobertura radicular logrado después del procedimiento fue de aproximadamente el 60 % y se eliminaron inserciones anómalas del frenillo. Conclusiones: La técnica de Edlan Mejchar de vestibuloplastia mostró resultados favorables en los casos descritos en los cuales el frenillo labial ejercía fuerzas tensionales sobre el periodonto de dientes anteriores inferiores.

Background: Sometimes gingival retractions are associated with high muscular tensional forces and shallow vestibules. Such retractions cause periodontal problems to patients due to the cleaning access limitations. Edlan Mejchar vestibuloplasty technique allows controlling, in one intervention and a single surgical field, etiological factors and a creeping gingival attachment by eliminating tensional forces. Purpose: To describe the effectiveness of Edlan Mejchar technique to solve gum retractions caused by tensional forces in four clinical cases. Description of cases: Four patients with gingival retractions in lower incisors and little adhered gingiva due to lower lip frenulum tension seek dental treatment. Edlan Mejchar vestibuloplasty was the surgical treatment chosen, which consisted of supraperiosteal incisions and internal dissections in connective tissue. Results: The percentage of root coverage achieved was close to 60 % and abnormal frenulum insertions were eliminated. Conclusion: Vestibuloplasty through Edlan Mejchar technique showed favorable results in the cases described in which the labial frenum exerted tensional forces on the periodontium of lower anterior teeth.

Nonsurgical and surgical treatment of periodontitis: how many options for one disease?

Treatment of periodontitis aims at preventing further disease progression with the intentions to reduce the risk of tooth loss, minimize symptoms and perception of the disease, possibly restore lost periodontal tissue and provide information on maintaining a healthy periodontium. Therapeutic intervention includes introduction of techniques to change behavior, such as: individually tailored oral-hygiene instructions; a smoking-cessation program; dietary adjustment; subgingival instrumentation to remove plaque and calculus; local and systemic pharmacotherapy; and various types of surgery. No single treatment option has shown superiority, and virtually all types of mechanical periodontal treatment benefit from adjunctive antimicrobial chemotherapy. Periodontal treatment, because of the chronic nature of periodontitis, is a lifelong commitment to intricate oral-hygiene techniques, which, when properly implemented, will minimize the risk of disease initiation and progression.

Periodontal plastic surgery of gingival recessions at single and multiple teeth.

This manuscript aims to review periodontal plastic surgery for root coverage at single and multiple gingival recessions. Techniques are assessed based on biological principles, surgical procedures, prognosticative factors and expected clinical and esthetic outcomes. The use of coronally advanced flap, laterally sliding flap, free gingival graft, the tunnel grafting technique, barrier membranes, enamel matrix derivative, collagen matrix and acellular dermal matrix are evaluated. The clinical scenario and practical implications are analyzed according to a modern evidence-based approach.

Estado periodontal de pacientes con factores de riesgo aterotrombóticos y algunas enfermedades consecuentes / Periodontal status of patients with atherothrombotic risk factors and some subsequent diseases

Introducción: la periodontitis y la infección subgingival anaerobia asociada representan injuria metastásica que disemina mediadores inflamatorios favorecedores de la ateroesclerosis. La alta tasa de mortalidad por enfermedades cardíacas y cerebrovasculares en Cuba demanda estudios sobre factores de riesgo emergentes, para dirigir esfuerzos a su prevención y control. Objetivo: caracterizar la asociación entre enfermedad periodontal inmunoinflamatoria crónica (EPIC) y un grupo de enfermedades derivadas de la aterosclerosis. Materiales y Métodos: entre enero y marzo del 2017 se realizó un estudio transversal descriptivo, de casos y controles, en el consultorio No 13 del Policlínico "19 de Abril", municipio Plaza de la Revolución. Se conformó el grupo de casos con pacientes que padecieron enfermedades seleccionadas derivadas de la ateroesclerosis; el grupo de controles con sujetos que no las habían presentado. Se homologaron según edad, sexo y color de la piel. Se exploraron factores de riesgo ateroescleróticos y prevalencia y severidad de la EPIC según el Índice Periodontal Revisado. Se respetaron normativas bioéticas para investigaciones biomédicas. Se emplearon medidas de resumen para datos cualitativos y la prueba de independencia de chi-cuadrado (x2) para variables cualitativas. Resultados: existió igual cantidad de hombres que de mujeres, mayoritariamente blancos, entre 61 y 70 años. Las complicaciones ateroescleróticas más frecuentes fueron la angina de pecho y el infarto del miocardio. El factor de riesgo más común fue la hipertensión arterial. Solo hubo 3 pacientes sanos según la Periodoncia. Conclusiones: la asociación entre la EPIC y el grupo de enfermedades estudiadas derivadas de la aterosclerosis no fue estadísticamente significativa (AU).

Introduction: Periodontitis and its associated anaerobic subgingival infection represent metastatic injury that disseminates inflammatory mediators, which favor atherosclerosis. The high mortality rate for heart and cerebrovascular diseases in Cuba requires studies on emerging risk factors to direct efforts to their control and prevention. Objective: To characterize the association between chronic immune inflammatory periodontal disease (CIIPD) and some entities derived from atherothrombotic disease. Materials and Methods: Between January and March 2017, a cross - sectional descriptive study of cases and controls was carried out in the Medical Office # 13 of the Policlinic "19 de Abril", municipality of Plaza de la Revolución. The cases group was formed with patients who have suffered the chosen diseases derived from arteriosclerosis. The control group was formed by 1 X 1 mating, with subjects who had not presented diseases derived from atherosclerosis. They were validated according to age, sex and skin color. Atherosclerotic risk factors were explored, and also the prevalence and severity of CIIPD according to the Revised Periodontal Index. Bioethical principles and regulations for biomedical research were fulfilled. Summary measures were used for qualitative data and independent chi square test (X2) for qualitative variables. Results: The amount of men and women was the same, mostly white persons, aged 61-70 years. The most frequent atherosclerotic complications were angina pectoris and myocardial infarction. The most common risk factor was hypertension. From the point of view of Periodontics, there were only 3 healthy patients. Conclusions: The association among CIIPD and the chosen diseases derived from arteriosclerosis was not statiscally significant (AU).

Aplicación del MTA en un caso de restauración endodóntica avanzada por vía directa. Presentación de caso / Direct placement of MTA in a case of advanced endodontic restoration. Case presentation

IIntroducción Las lesiones endoperiodontales son aquellas de carácter inflamatorio que comprometen simultáneamente la pulpa dental y las estructuras del periodonto de inserción, donde se obtiene un pronóstico favorable solo cuando el diente está en un ambiente cerrado y protegido, y se alcanza la cronicidad del componente periodontal de la afección. Para lo cual el uso de los biomateriales y el esquema operatorio tienen un carácter crucial. Objetivo: Describir un caso de restauración endodóntica avanzada por vía directa, con el uso de MTA. Presentación del caso:Paciente de 45 años, masculino, quien acude a consulta presentando una lesión endoperiodontal combinada con toma del fulcron en (46). El mismo requirió una radiculectomía, reconstrucción de corona y raíz por vía directa, y estabilización a través del uso del Agregado Trióxido Mineral (MTA). Conclusiones:La aplicación del MTA en la restauración endodóntica avanzada combinada con el composite nano híbrido por vía directa es una alternativa factible de realizar en una sola visita, y garantiza una rápida recuperación de las funciones buco-dentales del paciente(AU)

Introduction: Endoperiodontal lesions are those lesions that have an inflammatory character that simultaneously compromise the dental pulp and periodontal structures of insertion, where favorable prognosis is obtained only when the tooth is in a closed and protected environment, and the chronicity of the periodontal component is achieved. Consequently, the use of biomaterials and the operative scheme have a crucial character. Objective: To describe a case of advanced endodontic restoration by direct placement of MTA. Case presentation: 45 years old patient who comes to the consultation presenting a combined endoperiodontal lesion, reaching the fulcron in (46). The patient required a radiculectomy, a direct reconstruction of the crown and the root, and stability through the use of Mineral Trioxide Aggregate(MTA). Conclusions: The direct placement of MTA in an advanced endodontic restoration, combined with the nano-hybrid material is an alternative that is viable to do in a single visit and guarantees a fast recovery of the buccal-dental functions of the patient(AU)

Trastornos mucogingivales y su tratamiento, cinco años de seguimiento en pacientes matanceros / Mucogingival dysfunctions and its treatment, 5 years of following in patients from Matanzas

Introducción: la encía marginal, encía adherida, mucosa alveolar y unión mucogingival conforman el complejo mucogingival y las aberraciones adquiridas de la morfología, la posición y la cantidad de gingiva que rodea los dientes constituyen los trastornos mucogingivales. Objetivo: determinar el comportamiento de los trastornos mucogingivales y su tratamiento en el servicio de Periodoncia de la Clínica Estomatológica Docente “III Congreso del PCC” en Matanzas, entre enero 2008 y diciembre 2012. Materiales y métodos: se realizó un estudio observacional, descriptivo, en una población de 329 pacientes de ambos sexos. Resultados: la periodontitis y la recesión periodontal resultaron las afecciones periodontales más frecuentes, con un 58,3 y 26,9 %, respectivamente. La recesión periodontal fue el trastorno mucogingival predominante y se presentó con mayor frecuencia en mujeres entre 19 y 34 años de edad. De los 51 pacientes remitidos de ortodoncia que se mantenían en seguimiento evolutivo periodontal la mayoría, 42 (82,4 %), pertenecían al grupo de edad de 5 a 11 años. Los pacientes entre 35-59 años fueron los más afectados por periimplantitis en ambos sexos. Conclusiones: la periodontitis y la recesión periodontal resultaron las afecciones periodontales mayormente notificadas. La recesión periodontal y los trastornos mucogingivales asociados a zonas implantadas fueron más frecuentes en el sexo femenino. La mayoría de los pacientes remitidos de ortodoncia, estaban en el grupo de 5-11 años y se mantenían bajo control evolutivo periodontal. La técnica de cirugía mucogingival más utilizada fue el injerto libre de tejido conectivo y epitelio en todas las edades (AU).

Introduction: The marginal gum, stuck gum, mucous alveolar and union mucogingival conforms the mucogingival complex and the acquired aberrations of the morphology, the position and the quantity of gingiva that it surrounds the teeth, constitute the dysfunctions mucogingivals. Objective: to determine the behavior of the mucogingival dysfunctions and their treatment in the service of Periodontology of Odontology Clinical "III Congress of PCC" in Matanzas, among January 2008 and December 2012. Materials and methods: it was carried out an observational, descriptive study, in a population of 329 patients of both sexes. Results: Periodontitis and the periodontal recession were the most frequent periodontal affections, with a 58,3 % and 26,9 %, respectively. The periodontal recession was the mucogingival dysfunction predominant and it showed up most often in women among 19 and 34 years of age. Of the 51 remitted patients of Orthodontics that stayed in evolutionary periodontal pursuit most, 42 (82,4 %), they belonged to the age group from 5 to 11 years. The patients among 35-59 years were those more affected by periimplantitis in both sexes. Conclusions: Periodontitis and the periodontal recession were the principal periodontal affections. The periodontal recession and the mucogingival dysfunctions associated to implanted areas, were more frequent in the female. Most of the remitted patients of Orthodontics, were in the 5-11 year old group and they stayed periodontal low evolutionary control. The mucogingival technique of surgery more used was the free autograft of connective tissue and epithelia in all the ages (AU).

[Diagnossis and treatment of complicated anterior teeth esthetic defects by combination of whole-process digital esthetic rehabilitation with periodontic surgery].

OBJECTIVE: To explore a new method of whole-process digital esthetic prosthodontic rehabilitation combined with periodontic surgery for complicated anterior teeth esthetic defects accompanied by soft tissue morphology, to provide an alternative choice for solving this problem under the guidance of three-dimensional (3D) printing digital dental model and surgical guide, thus completing periodontic surgery and digital esthetic rehabilitation of anterior teeth. METHODS: In this study, 12 patients with complicated esthetic problems accompanied by soft tissue morphology in their anterior teeth were included. The dentition and facial images were obtained by intra-oral scanning and three-dimensional (3D) facial scanning and then calibrated. Two esthetic designs and prosthodontic outcome predictions were created by computer aided design /computer aided manufacturing (CAD/CAM) software combined with digital photography, including consideration of white esthetics and comprehensive consideration of pink-white esthetics. The predictive design of prostheses and the facial appearances of the two designs were evaluated by the patients. If the patients chose the design of comprehensive consideration of pink-white esthetics, they would choose whether they would receive periodontic surgery before esthetic rehabilitation. The dentition design cast of those who chose periodontic surgery would be 3D printed for the guide of periodontic surgery accordingly. RESULTS: In light of the two digital designs based on intra-oral scanning, facing scanning and digital photography, the satisfaction rate of the patients was significantly higher for the comprehensive consideration of pink-white esthetic design (P<0.05) and more patients tended to choose priodontic surgery before esthetic rehabilitation. The 3D printed digital dental model and surgical guide provided significant instructions for periodontic surgery, and achieved success transfer from digital design to clinical application. The prostheses were fabricated by CAD/CAM, thus realizing the whole-process digital esthetic rehabilitation. CONCLUSION: The new method for esthetic rehabilitation of complicated anterior teeth esthetic defects accompanied by soft tissue morphology, including patient-involved digital esthetic analysis, design, esthetic outcome prediction, 3D printing surgical guide for periodontic surgery and digital fabrication is a practical technology. This method is useful for improvement of clinical communication efficiency between doctor-patient, doctor-technician and doctors from different departments, and is conducive to multidisciplinary treatment of this complicated anterior teeth esthetic problem.

Microorganismos en lengua y saliva de pacientes edéntulos y con periodontitis crónica y su posible conexión con la Proteína C reactiva / Microorganisms in the Tongue and Saliva of Edentulous and Chronic Periodontal Disease Patients and the Possible Relation to the C-Reactive Protein

Antecedentes: Existe evidencia clínica y experimental que la proteína C reactiva (PCR) es un marcador de inflamación sistêmica asociado a periodontitis crónica. Esta enfermedad es la principal causa de cdcntulismo y ambas condiciones presentan, en algunos casos, los mismos microorganismos. Objetivo : Identificar microorganismos periodontopatógenos presentes en pacientes cdéntulos y en pacientes con periodontitis moderada/avanzada y establecer su relación con la PCR ultrasensible (PCR-us). Métodos: Se realizó un estudio de corte transversal en 61 pacientes mayores de 30 años de edad, divididos en dos grupos: con periodontitis crónica y cdcntulos. A cada paciente se le tomó una muestra de saliva y del dorso de la lengua, para identificación microbiológica de microorganismos, y muestra sérica, para evaluación de PCR-us. Se analizó la asociación entre microorganismos, PCR-us y por grupo de pacientes. Resultados: La PCR-us mostró un valor máximo de 1,12 mg/1 en el grupo de cdéntulos sin mostrar diferencia estadísticamente significativa con el grupo de periodontitis crónica (p = 0,29). Sin embargo, valores mayores de PCR-us se observaron en pacientes con microorganismos como Candida albicans, Porphiromona gingival is, Actinomyces nacslundii (A. nacslundii), Capnocytophaga sp., Streptococcus intermedius (S. intermedius) y Bactcroidcs thctaiotaomicron. Conclusión: De acuerdo con los resultados de este estudio, no hay diferencia en PCR-us entre pacientes cdéntulos y aquellos con enfermedad periodontal. Se encontraron periodontopatógenos en cdéntulos principalmente Capnocytophaga sp., A. nacslundii y S. intermedius, tanto en lengua como en saliva.

Background: Ihcrc is clinical and experimental evidence that C-Rcactivc Protein (CRP) is a systemic inflammation marker associated to the chronic periodontal disease. This disease is the main cause of cdcntulousncss and, in some eases, both conditions involve the same microorganisms. Objective: To identify the pcriodontopathic microorganisms appearing in both edentulous patients and patients with moderate/advanced periodontal disease and to determine how they relate to the ultrasensible CRP (US-CRP). Methods: A cross-sectional study was carried out in 61 patients with ages above 30 years divided into two groups: patients with chronic periodontal disease and edentulous patients. Each patient was taken a saliva sample from the tongue dorsum for microbiologic identification of microorganisms, and scrum samples for US-CRP evaluation. The relation between microorganisms and US-CRP was analyzed and described per group. Results: Ihc US-CRP showed a maximum value of 112 mg/L in the edentulous group without any statistically significant difference as compared to the periodontal chronic disease group (p = 029). However, higher values of US-CRP were observed in patients with microorganisms such as Candida albicans, Porphiromona gingivalis, Actinomyces nacslundii (A. nacslundii), Capnocytophaga sp., Streptococcus intermedius (S. intermedius) and Bactcroidcs thctaiotaomicron. Conclusion: Based on the results herein, no difference is observed for che US-CRP between edentulous patients and chronic periodontal disease patients. 'Ihc main periodontal pathogens found in the edentulous subjects include Capnocytophaga sp., A. nacslundii and S. intermedius, both in the tongue and the saliva.

Minimally invasive periodontal therapy for general practitioners.

There remains a high prevalence of mild-to-moderate forms of periodontal diseases in both developed and developing countries. Although many periodontal specialty practices currently place strong emphasis on implant surgery, periodontal plastic surgery and esthetics, general dentists and hygienists have often assumed more responsibility than periodontal specialty practices for the diagnosis, treatment, assessment and maintenance, and possible referral, of their patients. To address these current trends and challenges, this volume of Periodontology 2000 presents a series of topics on the basic biological principles of periodontal disease, as well as on approaches to diagnosis, treatment planning and treatment, in what is called 'conservative' or 'noninvasive' periodontal therapy. These topics include risk assessment of the periodontal condition; reduction, elimination and/or control of etiologies and risk factors, including mechanical, antimicrobial and host-modulation approaches; considerations for evaluation of clinical outcomes based on treatment approaches; and selected topics in laser therapy, halitosis and gingival recession.

A Ortodontia como adjunto no tratamento periodontal / The orthodontic movementation as an adjunctive to periodontal treatment

O tratamento ortodôntico em adultos com o periodonto reduzido tem exigido uma cooperação interdisciplinar, objetivando transformar pacientes que apresentam espaços interdentais esteticamente não atraentes, extrusões, ou ainda migração dentária patológica, em pessoas com dentições esteticamente melhoradas e função mastigatória restabelecida. O tratamento do paciente com alterações periodontais pode ser afetado pela Ortodontia de maneira positiva através de uma correta indicação, planejamento e execução conjunta das terapias periodontal e ortodôntica. Este trabalho se propôs a revisar a literatura sobre a inter-relação entre a Ortodontia e a Periodontia, apresentando um caso clínico no qual as terapias conjuntas foram essenciais para o estabelecimento da harmonia entre função mastigatória e estética dentogengival.

The orthodontic treatment for adults with reduced periodontium needs a multidisciplinary action, transforming patients with non-attractive interdental spaces, extrusions, or pathologic migrations into esthetically improved dentitions and still retrieving the masticatory function. There is a positive effect of orthodontic treatment for patients with periodontal problems when correct indication, planning, and execution are made. This paper revises the literature regarding the ortho-perio relationship, presenting a clinical case where both therapies were essential to reestablish harmony and function for dentogingival esthetics.

Effect of Nd:YAG laser-assisted non-surgical periodontal therapy on clinical periodontal and serum biomarkers in patients with and without coronary artery disease: A short-term pilot study.

BACKGROUND/OBJECTIVE: We hypothesized that nonsurgical-periodontal-therapy (NSPT) with adjunct Nd:YAG laser therapy is more effective in reducing periodontal inflammatory parameters (plaque index [PI], bleeding-on-probing [BOP], and probing-pocket-depth [PPD]) and serum interleukin-1beta (IL-1ß) and matrix metalloproteinase-9 (MMP-9) levels in patients with and without coronary artery disease (CAD) than NSPT alone. The aim of this short-term pilot study was to assess the effect of NSPT + Nd:YAG laser therapy on periodontal parameters and serum IL-1ß and MMP-9 levels in patients with and without CAD. STUDY DESIGN: A prospective randomized clinical study was conducted on 87 patients who were divided into two groups: Group-1: 44 patients with CAD and periodontal disease (PD) and Group-2: 43 patients with PD alone. Treatment-wise, these individuals were randomly divided into two subgroups: (i) NSPT alone and (ii) NSPT + Nd:YAG laser therapy. Demographic information was collected using a self-completed questionnaire. Periodontal parameters (PI, BOP, and PPD) and serum IL-1ß and MMP-9 levels were measured at baseline and after 3 months of treatment. P-values <0.05 were considered statistically significant. RESULTS: At 3 months follow-up, PI (P < 0.01), BOP (P < 0.01), PPD ≥ 4 mm (P < 0.01), and serum IL-1ß (P < 0.01) and MMP-9 (P < 0.01) levels were significantly higher in patients treated with NSPT alone than those treated with NSPT + Nd:YAG laser therapy. Among patients that underwent NSPT + laser therapy in both groups, periodontal parameters and serum IL-1ß, and MMP-9 levels were comparable at 3-months follow-up. CONCLUSION: NSPT + Nd:YAG laser therapy may be more effective in reducing periodontal inflammation and serum IL-1ß and MMP-9 levels in patients with and without CAD than NSPT alone. Lasers Surg. Med. 48:929-935, 2016. © 2016 Wiley Periodicals, Inc.