O uso de fitoterápicos à base de aroeira como coadjuvante no tratamento da gengivite: Revisão Sistemática / The use of aroreira-based phytotherapics as a supporting tool in the treatment of gingivits: A systematic Review

RESUMO O fator mais importante na manutenção da saúde periodontal é o adequado controle do biofilme dentário. Face às dificuldades no controle mecânico por parte dos pacientes, métodos alternativos ou complementares têm sido utilizados como coadjuvantes químicos do controle do biofilme, auxiliando no tratamento da gengivite. Dentre esses métodos alternativos, destaca-se a fitoterapia, através da utilização de plantas medicinais. Dessa forma, esse estudo faz uma revisão sistemática tendo como objetivo a busca, na literatura atual, de estudos que comprovem a eficácia de produtos fitoterápicos à base de aroeira no controle do biofilme dental auxiliando no tratamento da gengivite. Foi realizada busca computadorizada nos indexadores MedLine, Lilacs, BBO e Scielo no período de Setembro a Outubro de 2014. Os descritores de pesquisa utilizados foram “biofilme”, “gengivite”, “aroeira”, “plantas medicinais” e “fitoterápicos”, bem como seus correspondentes em língua inglesa. Através dos descritores utilizados, foram encontrados 54 artigos. Após a aplicação dos critérios de inclusão e exclusão, chegou-se a 08 artigos: 05 revisões, 01 estudo clínico randomizado, 01 estudo experimental e 01 estudo observacional descritivo. De acordo com os estudos analisados, a aroeira apresentou atividades antifúngica e antimicrobiana eficazes, bem como potencial efeito de redução do índice de sangramento gengival, o que justifica seu uso no tratamento da gengivite.

ABSTRACT The most important factor to keep periodontal health is proper control of biofilm. Given the difficulties in the mechanical control by patients, alternative or complementary methods have been used as chemical supporting of biofilm control, helping the treatment of gingivitis. Among these alternatives, there is the phytotherapy, through the use of medicinal plants. Thus, this study it is a systematic review and aims to seek, in the current literature, researches proving the effectiveness of aroeira herbal products in the control of dental biofilm, assisting in the treatment of gingivitis. A computerized search was conducted in Medline, Lilacs, Scielo and BBO, from September to October of 2014. The search words used were “biofilm”, “gingivitis”, “aroeira”, “herbal medicines” and “phytotherapics” in Portuguese and English language. Through this method, 54 articles were found. After applying the inclusion and exclusion criteria, the research reached 08 items: 05 reviews, 01 randomized clinical trial, 01 experimental study and 01 descriptive observational study. According to the analyzed papers, the aroeira demonstrated effective antifungal and antimicrobial activities, as well as a potential reduction impact on gingival bleeding index, which would justify its use in the treatment of gingivitis.

Single crowns in the resorbed posterior maxilla supported by either 6-mm implants or by 11-mm implants combined with sinus floor elevation surgery: a 1-year randomised controlled trial.

PURPOSE: The aim of this randomised controlled trial was to assess the clinical performance of single crowns in the posterior maxilla supported by either 6-mm or 11-mm implants combined with maxillary sinus floor elevation. MATERIALS AND METHODS: 41 consecutive patients with one missing premolar or molar in the posterior maxilla and with an estimated bone height of 6 to 8 mm in that area were included. Each patient was randomly allocated to one of the two treatment groups, namely to receive an 11-mm implant (Osseo Speed 4.0 S, Dentsply Implants, Mölndal, Sweden) in combination with maxillary sinus floor elevation surgery or to receive a 6-mm implant (Osseo Speed 4.0 S) without any grafting. After a 3-month osseointegration period, all implants were restored with custom-made titanium abutments and cemented zirconia-based porcelain crowns. Outcome measures were: implant survival; radiographic bone changes; plaque accumulation; bleeding tendency; peri-implant inflammation; presence of dental calculus; biological and technical complications; and patients' satisfaction. Clinical and radiographic examinations were performed at placement of the crown and 12 months thereafter. Patients' satisfaction was scored before treatment and after 12 months of functioning of the crown. RESULTS: One patient of the 11 mm implant group died during the follow-up. No implant failed and no biological or technical complications occurred. From loading to the 12 months follow-up, no difference was found in mean marginal bone changes between the groups (bone resorption in both groups 0.1 ± 0.3 mm). Clinical items revealed very healthy peri-implant soft tissues in both groups. Patients' satisfaction scores were high in both groups. CONCLUSIONS: 6-mm implants and 11-mm implants combined with sinus floor elevation surgery are equally successful to support a single crown in the resorbed posterior maxilla after 1-year follow-up.

Implant- and patient-centred outcomes of guided surgery, a 1-year follow-up: An RCT comparing guided surgery with conventional implant placement.

AIM: To assess, in a randomized study, the implant (clinical and radiological) and patient outcomes of guided implant placement at 1-year follow-up, compared to conventional implant treatment. MATERIAL AND METHODS: A total of 314 were placed in 59 patients, randomly assigned to one of the treatment groups. Radiographic and clinical parameters were recorded at the time of implant placement, prosthesis instalment (baseline) and at 1-year follow-up. Patient satisfaction was measured with the oral health-related quality of life instrument (OHIP-49). RESULTS: No implants were lost. The mean marginal bone loss after the first year of loading was 0.04 mm (SD 0.34) for the guided surgery and 0.01 mm (SD 0.38) for the control groups. In the guided surgery groups, the mean number of surfaces with BOP and plaque at 1-year follow-up was 1.41 (SD 1.25) and 1.10 (SD 1.22), for the control groups this was, respectively, 1.37 (SD 1.25) and 1.77 (SD 1.64). The mean pocket probing depth was 2.81 mm (SD 1.1) for the guided, and 2.50 mm (SD 0.94) for the control groups. For all treatment groups, a significant improvement in quality of life was observed at 1-year follow-up (p ≤ 0.01), no differences between groups were observed. CONCLUSION: Within the limitations of this study, no difference could be found at 1-year follow-up between the implant and patient outcome variables of guided or conventional implant treatment.

Is gingival bleeding a symptom of patients with type 1 von Willebrand disease? A case-control study.

BACKGROUND: Von Willebrand disease (VWD) is the most common inherent bleeding disorder resulting in prolonged bleeding time. Gingival bleeding is a frequently reported symptom of VWD. However, gingival bleeding is also known as a leading symptom of plaque-induced gingivitis and untreated periodontal disease. Gingival bleeding in VWD patients (VWD) may be triggered by gingival inflammation and not a genuine symptom. Thus, this study evaluated whether type 1 VWD determines an increased susceptibility to gingival bleeding in response to the oral biofilm. METHODS: Fifty cases and 40 controls were examined haematologically (VWF antigen, VWF Ristocetin cofactor, factor VIII activity) and periodontally [Gingival Bleeding Index (GBI), bleeding on probing (BOP), Plaque Control Record (PCR), periodontal inflamed surface area (PISA), vertical probing attachment level]. RESULTS: GBI was significantly higher in controls (12.2%) than in VWD (10%). The study failed to find a significant difference regarding BOP between VWD (17%) and controls (17.2%). Multiple regressions identified PCR and PISA to be associated with GBI and BOP. VWD was negatively associated with GBI. Smoking and number of remaining teeth was negatively associated with BOP. CONCLUSION: VWD is not associated with a more pronounced inflammatory response to the oral biofilm in terms of GBI and BOP.

Circulating undercarboxylated osteocalcin and gingival crevicular fluid tumour necrosis factor-α in children.

BACKGROUND: Osteocalcin, a protein secreted by osteoblasts during bone formation, is negatively associated with adult periodontal disease. Little is known about this association in children. AIM: To examine the extent to which plasma undercarboxylated osteocalcin (ucOC) is associated with gingival crevicular fluid tumour necrosis factor-alpha (GCF TNF-α) - a potential marker of gingival inflammation - in children. METHODS: We used data from the Quebec Adipose and Lifestyle InvesTigation in Youth cohort, an ongoing longitudinal study on the natural history of obesity among Caucasian children with a family history of obesity in Quebec, Canada. This cross-sectional analysis from the baseline visit includes 120 children aged 8-10 years. Plasma ucOC and GCF TNF-α levels were determined by enzyme-linked immunosorbent assay. Linear regression analyses, adjusting for age, gender, family income, sexual maturity stage, daily physical activity, obesity, and fasting glucose were conducted, with TNF-α level as the dependent variable. RESULTS: A 1-ng/ml increase in ucOC was associated with a 0.96% decrease (95% confidence interval (CI): -1.69, -0.23) in GCF TNF-α level. CONCLUSION: A negative association between a marker of bone formation and a marker of gingival inflammation was observed as early as childhood among Caucasian children with a family history of obesity.

Survival and success rates of autotransplanted premolars: a prospective study of the protocol for developing teeth.

INTRODUCTION: The aim of this prospective clinical trial was to examine the predictability of the protocol for premolar transplantation when applied by an inexperienced surgeon. Additional objectives were to examine the hard and soft tissues and to compare the findings with control premolars and also to record the patients' opinions of the treatment provided. METHODS: The sample comprised 23 consecutively transplanted developing premolars in 19 patients. Their mean age at surgery was 12 years 8 months (range, 9 years 10 months-17 years). The mean observation time was 35 months (range, 6-78 months). Plaque accumulation, pocket depth, gingival recession, mobility, and pulp sensitivity were recorded for the transplanted and the control teeth. Standardized radiographs were used to examine hard tissues and crown-to-root ratios. Questionnaires were used to register each patient's opinion about the treatment and its outcome. RESULTS: The survival rate was 100%, and the success rate was 91.3%. No significant differences were recorded between transplanted and control teeth. The patients' perceptions of the surgical management and the treatment outcome were favorable. CONCLUSIONS: The protocol for autotransplantation of developing premolars in growing patients was successfully adopted, regardless of lack of previous experience with this type of treatment.

A 3-year multicenter study of marginal bone level and soft tissue health of a 1-piece implant.

PURPOSE: The study evaluated 1-piece implants in daily clinical situations. MATERIALS AND METHODS: One-piece implants restoring both single teeth and partially edentulous sites were included. A single-stage procedure was used with immediate provisionalization within 24 hours after surgery. The definitive prosthesis was delivered within 6 months of implant insertion. RESULTS: One hundred fifteen implants have been placed in 84 patients at 4 centers. Two implants failed resulting in a cumulative survival rate of 98.3%. Normal periimplant mucosa and no visible plaque were observed in most of the implants. The soft tissue papilla scores improved considerably over time P < 0.001. Patient assessment improved significantly from implant insertion to the 3-year visit, P < 0.001. The mean bone level at implant insertion, 6-month, and 1-, 2-, and 3-year visits was 0.42, -0.58, -0.69, -0.80, and -0.66 mm, respectively. The mean change in bone level from implant insertion to 6 months and 1, 2, and 3 years was reported as -1.02, -1.12, -1.26, and -1.07 mm, respectively. CONCLUSIONS: The results indicate that this implant has the ability to preserve both hard and soft tissues' architecture.

Long-term results of implants immediately placed into extraction sockets grafted with ß-tricalcium phosphate: a retrospective study.

PURPOSE: The aim of this 10 year retrospective study was to evaluate the crestal bone loss around immediate implant placed in tricalcium phosphate (TCP) grafted extraction sockets MATERIALS AND METHODS: Data were collected from files of 58 patients (33 females, 25 males, average age 54.78 years) undergoing immediate implant placement into fresh extraction socket with or without the use of TCP (Cerasorb, Curasan AG, Kleinostheim, Germany) grafting. After implant placement, horizontal gaps larger than 1.5 mm between the implant surface and the bony plate were grafted with TCP without the use of a membrane, while smaller gaps were not grafted. Two hundred fifty-four implants were inserted: 79 were placed immediately with the use of ß-TCP as grafting material (group A), 175 were placed in healed extraction sites, with 61 implants placed with the use of ß-TCP graft material (group B), and 114 implants were placed without any grafting material (group C). Bone loss recordings were performed using periapical radiography. Measurements were performed from the neck of the implant to level of the surrounding bone in the vertical dimension. RESULTS: No implant was lost during the follow-up period. Statistical analysis showed no correlation between implant placement timing (delayed or immediate), the use of bone graft, and extent of bone loss. CONCLUSION: The use of TCP (Cerasorb) as a grafting material during immediate implant placement allowed no bone loss in 72.1% of the implants, which was very similar to the nongrafted cases for which implants were placed in favorable conditions.

Flap design and mandibular third molar surgery: a split mouth randomized clinical study.

The aim of this study was to investigate the effects of two commonly used flap designs (envelope and triangular) used for the removal of mandibular third molars (M3) on postoperative morbidity. 19 patients with bilateral symmetrically impacted mandibular M3 were studied using a split mouth design. Swelling, pain and trismus measures were recorded on days 2, 7 and 14; periodontal indices were recorded on days 7 and 14, one final measure of probing depth on the distal aspect of the mandibular second molar (M2) was taken at the last follow up appointment. Data were analysed using the χ(2) test, the Mann-Whitney U-test and Pearson's correlations. The mean age of the patients was 21.4 ± 2.3 years (± SD). Facial swelling and the reduction in mouth opening were significantly greater in the early postoperative period (P<0.05) with pyramidal flap designs. There was no significant difference in pain scores, plaque accumulation and bleeding on probing indices between the two flap designs (P>0.05). Probing depth was significantly greater with envelope flaps in the early postoperative period (P<0.005). In conclusion, flap design in mandibular M3 surgery has an effect on postoperative recovery.

Immediate loading of tapered implants placed in postextraction sockets: retrospective analysis of the 5-year clinical outcome.

INTRODUCTION: The use of immediate implant loading protocols delivers obvious benefits to the patient. When applied in healed sites, this has not only been well documented in the totally edentolous mandible but has also been documented and reported to be predictable in the upper jaw, and in cases of partial edentoulism, as well. A further application of immediate loading protocol, although still controversial, especially when replacing single maxillary teeth in the anterior zone, is the immediate implant placement and provisionalization in postextractive sockets. In consideration of the oxidized surface promoting bone healing and the tapered shape of the implant body, the Replace Select Tapered TiUnite implants have been used for many years in our clinic when facing these clinical situations. This article will report about our long-term clinical experience with such implants and the relevant role of a correct surgical and prosthetic treatment planning. PURPOSE: The aim of this retrospective study was to report on the 5-year clinical and radiologic outcome of patients treated with Replace Select Tapered TiUnite implants when used according to an immediate loading protocol in postextraction sites. METHOD AND MATERIALS: In routine practice, 56 consecutive patients were treated with 79 implants. The patients, 23 males and 33 females, had a mean age of 50.9 years, range 21-76 years, at implant placement. Forty-seven implants were placed in the maxilla and 32 implants were placed in the mandible. All implants were placed in postextraction sites and were immediately loaded. Provisional restorations were delivered within 2 hours from surgery and all were in occlusion. Forty-three patients received a single implant while in the remaining 13 patients the implants were splinted. Definitive prosthetic restoration was delivered within 1 to 4 months following implant placement. Evaluations of soft tissue health and marginal bone remodeling were conducted. An independent radiologist performed the radiographic evaluation using the top of the implant as the reference point with negative values indicating a level below the reference point. RESULTS: Forty-eight patients, accounting for 66 implants, have passed the 5-year follow-up. No implants have failed resulting in a 5-year cumulative implant survival rate of 100%. Three patients, with six implants, withdrew during the course of the follow-up; one patient passed away and two patients moved. Five patients with seven implants did not show up at 5 years recall. At the 5-year follow-up, majority of the implants that were followed demonstrated normal periimplant mucosa and no visible plaque. The mean bone level at 5-year follow-up was -2.45mm (SD 1.29, n=63) demonstrating a level in line with the first thread. Mean marginal bone loss from implant inserting to 5 years was 0.56 mm (SD 1.98, n=63). In regard with complications, a fracture of the ceramic crown was reported 5 years after implant insertion in a patient who developed bruxism. No other biologic nor mechanical complications were reported. CONCLUSION: This retrospective 5-year follow-up study of 56 patients treated with implants immediately placed in postextraction sockets and immediately loaded demonstrates good treatment outcome with regard to implant survival, soft tissue condition, and marginal bone response.

See you in three months! The rationale for the three monthly periodontal recall interval: a risk based approach.

UNLABELLED: There is significant evidence to support the regular review of patients with chronic periodontitis. There is, however, comparatively little evidence to demonstrate how often such reviews should take place. This paper looks at the periodontal healing period, the risks of periodontal progression and current thinking about maintenance programmes. It thus attempts to establish some guidelines that practitioners may use when calculating recall intervals. CLINICAL RELEVANCE: The choice of individual, patient-focused recall intervals is essential to limit disease progression and maintain healthy periodontal tissues.

Serum interleukin-6 may modulate periodontal inflammation in type 1 diabetic subjects.

AIMS: To evaluate the associations between serum inflammatory biomarkers and periodontal inflammation in subjects with type 1 diabetes mellitus (T1DM). Our hypothesis was that local host responses may be modulated by the serum inflammatory mediators. MATERIAL AND METHODS: Plaque, bleeding on probing and probing pocket depth (PD) were examined in 80 T1DM subjects at the baseline and in 58 subjects 8 weeks after periodontal therapy. The levels of glycosylated haemoglobin, serum interleukin (IL)-6, ultrasensitive C-reactive protein and the lipid profile were measured at the baseline and after therapy. Stratification of the sample separately by smoking and body mass index (BMI) was performed. Adjusted associations between the levels of systemic biomarkers and periodontal parameters were studied using multiple regression models. RESULTS: The level of serum IL-6 was associated with the extent of bleeding and PD≥4 mm at the baseline in non-smokers and in subjects with BMI≤26 kg/m(2). These associations were also evident after periodontal therapy. Subjects with a high after-therapy IL-6 level presented poorer periodontal healing than those with a low level. CONCLUSIONS: The observed associations may be considered to be suggestive of a modulatory effect of IL-6 on host responses in T1DM subjects.

A comparative investigation to evaluate the clinical efficacy of an alcohol-free CPC-containing mouthwash as compared to a control mouthwash in controlling dental plaque and gingivitis: a six-month clinical study on adults in San Jose, Costa Rica.

OBJECTIVE: This study was designed to evaluate the clinical efficacy of an antiplaque alcohol-free mouthwash containing 0.075% cetylpyridinium chloride (CPC) and 0.05% sodium fluoride (NaF), as compared to a control mouthwash containing only 0.05% NaF, in controlling established dental plaque and gingivitis after three and six months of product use. METHODS: This was a single-center, parallel-group, two-cell, double-blind, randomized clinical study. Prospective adult male and female subjects from San Jose, Costa Rica reported to the clinical facility having refrained from all oral hygiene procedures for 12 hours, and from eating, drinking, or smoking for four hours prior to their visit. Qualifying subjects who presented with Gingival Index scores (Löe and Silness Index) of at least 1.0 and Plaque Index scores (Turesky Modified Quigley-Hein Index) of at least 1.5 were allowed to participate in this study. Subjects were randomly assigned to one of two treatment groups according to their baseline gingival and plaque scores. In the first treatment group (Test), subjects used an alcohol-free mouthwash containing 0.075% CPC and 0.05% NaF, whereas in the second treatment group (Control), subjects used a mouthwash containing only 0.05% NaF. Gingivitis and plaque assessments, and examinations of oral hard and soft tissues were conducted after three months and six months of product use. RESULTS: One-hundred and ten (110) subjects complied with the protocol and completed the six-month study. After six months of product use, the Test Mouthwash group exhibited statistically significant reductions from baseline with respect to Gingival (33.5%), Gingival Interproximal (34.5%), Gingival Severity (63.2%), Plaque (33.6%), Plaque Interproximal (30.0%), and Plaque Severity (73.6%) Index scores. After six months of product use, the Control Mouthwash group exhibited statistically significant increases from baseline with respect to Gingival (6.9%), Plaque Interproximal (7.2%), and Plaque Severity (32.7%) Index scores. Furthermore, after six months of product use, the Control Mouthwash group exhibited reductions from baseline with respect to Plaque (6.1%), Gingival Interproximal (3.6%), and Gingival Severity (1.1%) Index scores which were not statistically significant. After three months of product use, the Test Mouthwash group exhibited statistically significant reductions in Gingival (25.0%), Gingival Interproximal (22.3%), Gingival Severity (38.9%), Plaque (26.1%), Plaque Interproximal (22.4%), and Plaque Severity (75.0%) Index scores as compared to the Control Mouthwash group. After six months of product use, the Test Mouthwash group exhibited statistically significant reductions in Gingival (38.1%), Gingival Interproximal (37.1%), Gingival Severity (63.6%), Plaque (36.5%), Plaque Interproximal (33.2%), and Plaque Severity (78.5%) Index scores as compared to the Control Mouthwash group. CONCLUSION: The results of this double-blind clinical study support that 1) an alcohol-free mouthwash containing a combination of 0.075% CPC and 0.05% NaF produces statistically significant reductions in dental plaque and gingivitis after three and six months compared to baseline, and 2) the alcohol-free CPC mouthwash provides a statistically significantly greater level of efficacy in controlling established dental plaque and gingivitis after three and six months of product use as compared to the Control Mouthwash containing only NaF.

Salivary flow rate and periodontal infection - a study among subjects aged 75 years or older.

OBJECTIVE: To analyse the relation of stimulated and unstimulated salivary flow rates to periodontal infection in home-dwelling elderly people aged 75 years or older. SUBJECTS AND METHODS: This study was based on a subpopulation of 157 (111 women, 46 men) home-dwelling, dentate, non-smoking elderly people (mean age 79.8, SD 3.6 years) from the Geriatric Multidisciplinary Strategy for the Good Care of the Elderly Study). The data were collected by interview and oral clinical examination. RESULTS: Persons with very low (< 0.7 ml min⁻¹) and low stimulated salivary flow rates (0.7- < 1.0 ml min⁻¹) had a decreased likelihood of having teeth with deepened (≥ 4 mm) periodontal pockets, RR: 0.7, CI: 0.5-0.9 and RR: 0.7, CI: 0.5-0.9, respectively, when compared with those with normal stimulated salivary flow. Persons with a very low unstimulated salivary flow rate (< 0.1 ml min⁻¹) had a decreased likelihood of having teeth with deepened (≥ 4 mm) periodontal pockets, RR 0.8, CI: 0.6-1.0, when compared with subjects with low/normal unstimulated salivary flow. CONCLUSIONS: In a population of dentate, home-dwelling non-smokers, aged 75 years or older, low stimulated and unstimulated salivary flow rates were weakly associated with a decreased likelihood of having teeth with deep periodontal pockets.

Periodontal and gingival parameters in young adults with acute myeloid leukaemia in Kerala, South India.

PURPOSE: Patients presenting with leukaemic blast crisis with acute myeloid leukaemia (AML) may have gingival enlargements that interfere with oral hygiene. Few large cohort studies of gingival lesions have been carried out on AML patients. The aim of the present study was to assess gingival and periodontal pathology at the time of presentation, prior to chemotherapy, in a cohort of adult patients presenting at a cancer hospital in Kerala, a region located in southern India. MATERIALS AND METHODS: A total of 73 young adult patients (mean age 20.6 ± 2.3) who were diagnosed with AML were examined. These patients did not suffer from any other systemic disorder. The oral hygiene status, gingival overgrowth (GO) and periodontal status were assessed using traditional clinical indices. RESULTS: Around three-quarters of the patients had either fair or poor oral hygiene. A statistically significant association between dental plaque levels and both GO and periodontal index (P < 0.001) was observed. CONCLUSIONS: Poor oral hygiene is a risk factor for leukaemic GO and for destructive periodontal disease. Both conditions add to the microbial burden these patients are exposed to. In patients showing high levels of oral hygiene, the GO tends to be mild and does not seem to be problematic, especially with respect to mechanical tooth cleaning.

Serum cytokine and periodontal profiles in relation to disease activity of rheumatoid arthritis in Japanese adults.

BACKGROUND: Rheumatoid arthritis (RA) and periodontitis are common chronic inflammatory conditions and share many pathologic features. A similar profile of cytokines is involved in the pathogenesis of the two diseases. The relationship between the disease activity of RA and the periodontal condition remains unclear. This study examines whether the disease activity of RA affects serum cytokine and periodontal profiles. METHODS: The study subjects consisted of 84 Japanese adults with RA and 22 race-matched control individuals. After periodontal and rheumatologic examination, the disease activity of RA was determined with the Disease Activity Score including 28 joints using C-reactive protein (DAS28-CRP). Serum levels of cytokines including interleukin (IL)-1beta, IL-6, IL-12, IL-12 p40, IL-18, and tumor necrosis factor-alpha (TNF-alpha) were determined by an enzyme-linked immunosorbent assay. High-sensitive CRP was also measured with a latex particle-enhanced nephelometric method. RESULTS: Of 84 patients with RA, 28 and 56 patients exhibited low and moderate to high disease activity, respectively. Serum levels of IL-6, TNF-alpha, and CRP were significantly different between the two groups (P <0.05). Additionally, a significant correlation was observed between DAS28-CRP and percentage of sites with bleeding on probing (BOP) (P = 0.008) and between serum TNF-alpha levels and percentage of sites with BOP (P = 0.01) in 56 patients with RA with moderate to high activity. CONCLUSION: These results suggest that the disease activity of RA correlated with serum levels of IL-6, TNF-alpha, and CRP, and it might influence BOP in the patients with moderate to high disease activity.

Serum levels of cytokines in subjects with generalized chronic and aggressive periodontitis before and after non-surgical periodontal therapy: a pilot study.

BACKGROUND: The emergence of periodontal medicine has increased interest in defining the serologic profiles of inflammatory mediators in subjects with periodontitis. Thus, the aim of this pilot study is to evaluate the serum levels of tumor necrosis factor-alpha (TNF-alpha), interferon-gamma, and interleukin (IL)-4, -17, and -23 in subjects with generalized chronic periodontitis (GCP) and generalized aggressive periodontitis (GAgP) before and after non-surgical periodontal therapy. METHODS: Cytokines were measured by enzyme-linked immunosorbent assay in serum samples taken from 42 systemically healthy subjects divided according to periodontal status into subjects with GAgP (n = 14) and GCP (n = 14) and periodontally healthy (PH) subjects (n = 14). In addition, the levels of cytokines were reassessed at 6 months after periodontal therapy in the periodontitis groups. Clinical parameters were also evaluated at baseline and 6 months post-therapy. RESULTS: After therapy, both periodontitis groups demonstrated a significant improvement in clinical periodontal status (P <0.05). At baseline, concentrations of TNF-alpha (P = 0.0006) and IL-17 (P = 0.02) were significantly higher in the GAgP group compared to the other groups. There was a significant decrease in serum concentrations of TNF-alpha (P = 0.03) and IL-17 (P = 0.04) at 6 months post-therapy in the GAgP group (P <0.05). The concentration of TNF-alpha remained elevated in the GAgP group compared to the PH group at 6 months post-therapy (P = 0.04). CONCLUSIONS: Subjects with GAgP presented higher levels of TNF-alpha and IL-17 than subjects with GCP and PH subjects. In addition, although the serum levels of these cytokines improved significantly as a result of periodontal therapy, the levels of TNF-alpha remained higher in subjects with GAgP compared to PH subjects.

The influence of academic stress on gingival inflammation.

OBJECTIVE: The aim of the present study was to investigate the effects of academic stress on periodontal health, in relation to inflammatory markers in gingival crevicular fluid (GCF) and cortisol in saliva. MATERIALS AND METHODS: The study included 20 healthy dental hygienists (females: mean age 29.3 +/- 8.5 SD) and was conducted during a major exam period and 4 weeks later after the exams. A clinical examination was performed and GCF was collected from four sites in each subject on these two occasions. Interleukin (IL)-1beta, IL-4, IL-6, IL-10 levels were determined using Luminex 100 and cortisol amounts by radioimmunoassay (RIA (125)I). Students registered their perceived stress on a visual analogue scale (VAS). Significance of the findings was determined using paired t-test, Wilcoxon-matched pair and Spearman's rank correlations. RESULTS: Students had higher amounts of dental plaque (P < 0.007) and gingival inflammation (P < 0.001) during the exam period compared with after the exams. The amounts of IL-6 and IL-10 in GCF were significantly increased during the time of examinations. The median level of cortisol in saliva was also significantly raised during the exam period compared with after the exams, 20.52 nmol/l (range: 11.91-27.34) and 16.41 nmol/l (range: 10.91-24.17) respectively, P < 001. The results from the VAS registration revealed a significant difference (P < 001) between the two occasions. CONCLUSION: Academic stress appears to affect periodontal health, shown by more plaque accumulation, gingival inflammation and increased amounts of IL-6, IL-10 in GCF and cortisol in saliva.

Fully vs. partially rough implants in maxillary sinus floor augmentation: a randomized-controlled clinical trial.

OBJECTIVES: To compare implants with a rough surface in their whole length (FR) with implants having a 2 mm coronal machined portion (PR) when used in association with a sinus-lift procedure. MATERIAL AND METHODS: Twenty-six patients with 2 mm< or =x< or =9 mm residual alveolar crest were prosthetically restored with implants after a staged sinus-lift procedure using osteotomes. In 13 randomly chosen patients, no more than one FR implant was placed (test group), while the rest were PR implants. The other 13 patients received only PR implants (control group). For comparisons, only one implant from each patient was used, i.e., from the test group only the 13 FR implants were used, while from the control group, one PR implant was randomly chosen. The presence/absence of plaque, BOP, PPD and REC were registered at the day of delivery of the restorations and after 1 year. Residual alveolar crest height and marginal bone levels around the implants were evaluated on standardized periapical radiographs taken at various stages. RESULTS: Four FR and two PR implants were lost, and the cumulative survival rate was 82.9% (six lost out of 35). There were no significant differences between the two groups. Implant type, residual alveolar crest height, time of osseointegration, time of implant loading and smoking did not seem to influence implant survival. CONCLUSIONS: FR and PR implants placed in augmented sinuses did not differ in their clinical performance.

Periodontal conditions in male adolescents using smokeless tobacco (moist snuff).

AIM: The aim of this study was to evaluate the potential association of the use of smokeless tobacco (moist snuff) on the periodontal conditions of adolescents. MATERIAL AND METHODS: A subject sample of one hundred and three 19-year-old male individuals (33 snuff users, 70 controls) living in Göteborg, Sweden, were clinically examined with regard to oral hygiene, gingivitis, probing pocket depth (PPD), clinical attachment loss (CAL) and gingival recession. Bitewing radiographs were obtained for assessments of alveolar bone level. Information about tobacco and oral hygiene habits was obtained by a structured questionnaire. Student 's t-test, chi(2)-test and logistic regression analysis were used for statistical analysis. RESULTS: The mean plaque and gingivitis scores in snuff-users were 59% (SD 21.0) and 47% (18.6), respectively, and in controls 64% (22.4) and 50% (18.3), respectively. The average PPD and CAL in snuff-users amounted to 2.3 mm (0.3) and 0.2 mm (0.1), respectively, and in controls 2.4 mm (0.3) and 0.1 mm (0.1) (p>0.05), respectively. The mean bone level was 1.3 mm (0.2) in both groups. The prevalence of subjects showing recession was 42% among snuff-users and 17% among controls (p=0.006). In snuff users, an average of 4% (0.9) of the teeth showed recession, compared with 1% (0.3) in controls (p<0.001). Limiting the analysis to the maxillary anterior tooth region, 33% of the snuff-users and 10% of the controls presented recessions (p=0.002). The use of snuff entailed an OR=5.1 to have gingival recessions. CONCLUSION: In the present population sample of adolescents, the use of smokeless tobacco (moist snuff) was not associated with the presence of periodontal disease except for a significantly high prevalence of gingival recessions.