Periodontal granulation tissue - To remove or not to remove, that is the question.

Formation of granulation tissue is a fundamental phase in periodontal wound healing with subsequent maturation leading to regeneration or repair. However, persistently inflamed granulation tissue presents in osseous defects as a result of periodontitis and is routinely disrupted and discarded with non-surgical and surgical therapy to facilitate wound healing or improve chances of regeneration. Histological assessment suggests that granulation tissue from periodontitis-affected sites is effectively a chronic inflammatory tissue resulting from impaired wound healing due to persistence of bacterial dysbiotic bioflim. Nevertheless, the immunomodulatory potential and stem cell characteristics in granulation tissue have also raised speculation about the tissue's regenerative potential. This has led to the conception and recent implementation of surgical techniques which preserve granulation tissue with the intention of enhancing innate regenerative potential and improve clinical outcomes. As knowledge of fundamental cellular and molecular functions regulating periodontitis-affected granulation tissue is still scarce, this review aimed to provide a summary of current understanding of granulation tissue in the context of periodontal wound healing. This may provide new insights into clinical practice related to the management of granulation tissue and stimulate further investigation.

Minimally invasive non-surgical periodontal therapy of intrabony defects: A prospective multi-centre cohort study.

AIM: To assess the potential benefits of minimally invasive non-surgical therapy (MINST) in teeth with intrabony defects and to explore factors associated with the outcomes. MATERIALS AND METHODS: A multi-centre trial was conducted in 100 intrabony defects in periodontitis patients in private practice. Steps 1 and 2 periodontal therapy including MINST were provided. Clinical and radiographic data were analysed at baseline and 12 months after treatment, with the primary aim being change in radiographic defect depth at 12 months. RESULTS: Eighty-four patients completed the 12-month follow up. The mean total radiographic defect depth reduced by 1.42 mm and the defect angle increased by 3° (both p < .05). Statistically significant improvements in probing pocket depth (PPD) and clinical attachment level (CAL) were seen at 12 months compared to baseline (p < .001). Fifty-six defects (66.7%) achieved pocket closure (PPD ≤ 4 mm) and 49 defects (58.3%) achieved the composite outcome (PPD ≤ 4 mm and CAL gain ≥3 mm). Deeper and narrower angled defects were positively correlated with radiographic and clinical improvements, respectively. CONCLUSIONS: Improvements in clinical and radiographic outcomes were seen after MINST. This study highlights the generalizability and wide applicability of this approach, further supporting its effectiveness in the treatment of intrabony defects. CLINICAL TRIAL REGISTRATION: NCT03741374. https://clinicaltrials.gov/study/NCT03741374?cond=minimally%20invasive%20non%20surgical%20therapy&locStr=UK&country=United%20Kingdom&distance=50&rank=2.

Vital root resection with radicular retrograde partial pulpotomy in furcation-involved maxillary molars in patients with periodontitis: Technique description and case series considering clinical and economic aspects.

AIM: Conventional root resection in periodontally compromised furcation-involved maxillary molars requires preceding endodontic treatment and is therefore associated with loss of tooth vitality, higher invasiveness, treatment time and costs, and the risk of endodontic complications. Vital root resection (VRR) could overcome these disadvantages while establishing stable periodontal and endodontic conditions. This case series aimed to introduce the concept of one-stage VRR with radicular retrograde partial pulpotomy (VRRretro). SUMMARY: Seven vital maxillary molars with residual probing pocket depths (PPD) ≥ 6 mm and furcation ≥ class 2 of five patients with stage III/IV periodontitis were treated with VRRretro using mineral trioxide aggregate. Teeth with residual through-and-through furcations were additionally tunnelled. Follow-up up to 2.5 years postoperatively during supportive periodontal care included full periodontal status, percussion and thermal sensitivity testing. Periapical radiographs were obtained to rule out possible periradicular radiolucencies. All seven treated molars were in-situ at an average of 26.84 ± 5.37 months postoperatively and were clinically and radiographically inconspicuous independent of tooth position, the resected root, the need for tunnelling and the restorative status. The mean PPD on the seven treated molars was 4.02 ± 0.85 mm (6-10 mm) preoperatively and 2.62 ± 0.42 mm (3-4 mm) at the last follow-up. Clinical attachment level and bleeding on probing could also be decreased. The teeth showed no mobility over time and furcations class 2 were reduced to class 1 while the tunnelled furcations were accessible with interdental brushes. All molars reacted negatively to percussion and positively to thermal sensitivity testing. KEY LEARNING POINTS: In carefully selected cases considering patient- and tooth-related factors, VRRretro could be a promising treatment option to establish stable periodontal and endodontic conditions in furcation-involved maxillary molars while preserving tooth vitality.

Laser Therapy Effects on Periodontal Status: A Randomized Study Using Gaussian Network Analysis and Structural Equation Modeling Approach.

Background and Objectives: This paper aims to assess the role of laser therapy in periodontitis through an innovative approach involving computational prediction and advanced modeling performed through network analysis (Gaussian graphical models-GGMs) and structural equations (SEM). Materials and Methods: Forty patients, exhibiting periodontal pockets with a minimum depth of 5 mm, were randomly divided into two groups: a control group and a laser group. Four specific indicators were measured for each tooth, namely periodontal pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), and plaque index (PI), and the mean of six measured values was recorded at five time markers (baseline, 6 months, 1 year, 2 years, and 4 years). The assessment algorithm included enrollment, measurements, and differential non-surgical periodontal treatment, according to the group allocation. Scaling, root planing, and chlorhexidine 1% were conducted for the control group, and scaling, root planing and erbium, chromium:yttrium-scandium-gallium-garnet (Er,CR:YSGG) laser therapy were conducted for the laser group. Results: The main results highlight that the addition of laser treatment to scaling and root planing led to notable clinical improvements, decreasing the PPD values, reducing the BOP scores, and increasing the CAL. Conclusions: Notable relationships between the specific indicators considered were highlighted by both the GGMs and by SEM, thus confirming their suitability as proxies for the success of periodontal treatment.

Combined Periodontal-Orthodontic Treatment with Periodontal Corticotomy Regenerative Surgery in an Adult Patient Suffering from Periodontitis and Skeletal Class II Malocclusion: A Case Report with 5-Year Longitudinal Observation.

A thick periodontal phenotype with thick gingiva and alveolar bone volume is required for safe orthodontic tooth movement and long-term stability. A high incidence of dehiscence and fenestration in the labial aspect of mandibular anterior teeth may limit the correction of deformity and orthodontic treatment, especially when the lower anterior teeth are needed to have a large range of movement. This study reports a combination of periodontal therapy and orthodontic therapy with periodontal corticotomy regenerative surgery (PCRS) in a 25-year-old patient suffering from skeletal Class II malocclusion and periodontitis. The patient received periodontal therapy 5 years ago and commenced orthodontic treatment 4.5 years ago. During the 4 years of follow-up for PCRS, the clinical and radiographic evaluations revealed significant improvements in the periodontal phenotype of the mandibular anterior region. The periodontal phenotypes in the mandibular incisors region were all modified from thin to thick. Supplementing orthodontic treatment with labial PCRS could be a promising treatment strategy to maintain long-term periodontal health in adult patients with alveolar deficiency and thin gingiva tissue.

Pretreatment periodontitis is predictive of a poorer prognosis after esophagectomy for esophageal cancer.

BACKGROUND: Poor oral health is an independent risk factor for upper-aerodigestive tract cancers, including esophageal cancer. Several studies have investigated short-term outcomes after esophagectomy and the impact of periodontal disease, but few have examined the impact of periodontal disease on long-term outcomes. The purpose of this study was to investigate the rate of periodontitis among esophagectomy patients and the prognostic value of periodontitis and its effect on prognosis after esophagectomy. METHODS: A total of 508 patients who underwent esophagectomy received oral health care from a dentist before cancer treatment at Akita University Hospital between January 2009 and December 2021. We assessed the presence and severity of the patients' periodontitis and divided them into no-periodontitis, mild periodontitis, severe periodontitis and edentulous jaw groups. We then assessed 10-year overall survival (OS) and disease-specific survival (DSS) and determined whether periodontitis was an independent prognostic factor affecting OS and DSS. RESULTS: We found that 101 (19.9%) patients had no periodontitis, 207 (40.8%) had mild periodontitis, 176 (34.6%) had severe periodontitis requiring tooth extraction, and 24 (4.7%) had edentulous jaw. Both OS and DSS were significantly poorer in the periodontitis than no-periodontitis group (p < 0.001). In detail, the edentulous jaw group had the poorest prognosis (p < 0.001). Multivariate analysis showed that periodontitis was an independent risk factor affecting OS and DSS. CONCLUSION: Esophageal cancer patients had a high prevalence of periodontitis. Moreover, the presence of periodontitis and severity of periodontitis are independent risk factors contributing to a poorer prognosis after esophagectomy.

Entire papilla preservation technique for treatment of periodontal intrabony defects: a series of cases.

OBJECTIVE: Periodontitis is characterized by bone resorption. Vertical bone loss results in an intraosseous defect. Multiple surgical approaches for treating intrabony defects have shown different grades of effectiveness. Recently, the entire papilla preservation technique has been proposed, improving clinical parameters, such as pocket depth and clinical attachment level. This series of cases aimed to describe the use of the entire papilla preservation surgical technique without using biomaterials to regenerate periodontal intrabony defects. The influence on the clinical periodontal parameters and radiographic parameters was measured through CBCT, the latter not described until now, and analyzed the possible postoperative complications. METHOD AND MATERIALS: A total of six intrabony periodontal defects associated with at least one periodontal pocket with probing depths equal to or greater than 6 mm were treated with the entire papilla preservation technique. The clinical and radiographic parameters were evaluated at the beginning and 6 months after surgery. RESULTS: The mean probing pocket depth reduction was 4.00 ± 0.63 mm, the mean clinical attachment level gain was 3.67 ± 1.03 mm, and the mean radiographic intrabony filling was 2.41 ± 2.03 mm. Early healing was uneventful; the mean visual analog scale at 7 days was 0. CONCLUSIONS: This minimally invasive technique results in an improvement in clinical and radiographic parameters, the latter showing a filling of the bone defect observed during the 6-month evaluation after surgical treatment. These results confirm the importance of clot and flap stability in regenerating intraosseous defects.

[A prospective cohort study on the effect of implant restoration following micro crestal flap-alveolar ridge preservation at molar extraction sockets with severe periodontitis].

Objective: To evaluate the survival rate, success rate, soft tissue conditions and marginal bone level changes of implants following micro crestal flap-alveolar ridge preservation at molar extraction sockets with severe periodontitis, compared to natural healing. Methods: From March 2015 to January 2017, patients scheduled for molar extraction as a consequence of severe periodontitis and planned implant-retained prostheses from Department of Periodontology Peking University School and Hospital of Stomatology were selected. A total of 40 molar extraction sockets from 40 patients received implant placement following micro crestal flap-alveolar ridge preservation or natural healing. The front consecutive 20 teeth were assigned to the natural healing group, and the back ones were assigned to the micro crestal flap-alveolar ridge preservation (MCF-ARP) group. The superstructures were placed 6 months later. Within 2 weeks (baseline) and 1, 2 and 3 years after implant crown restoration, modified plaque index, probing depth, modified bleeding index and keratinized tissue width were recorded every six months. Parallel periapical radiographs were taken to evaluate the peri-implant marginal bone level and to calculate marginal bone loss. Independent sample t test or Mann-Whitney U test were used to compare the differences in the above clinical and imaging indicators between the two groups. Results: The implant survival rate and success rate of the two groups were both 100% (20/20). There were no significant differences in the modified plaque index, probing depth, modified bleeding index, buccal keratinized tissue width and marginal bone loss between two groups at 1, 2 and 3 years after implant crown restoration (all P>0.05). Marginal bone loss was 0.22 (0.14, 0.34) mm in the natural healing group and 0.21 (0.12, 0.30) mm in the MCF-ARP group at a 3-year post-loading evaluation. Conclusions: Within the limitations of the present study, implants placed at ridge preserved and naturally healed molar extraction sockets with severe periodontitis demonstrate comparable clinical outcomes at a 3-year post-loading evaluation.

The effect of titanium-platelet rich fibrin on periodontal intrabony defects: A randomized controlled split-mouth clinical study.

This study aimed to determine the contribution of titanium prepared platelet-rich fibrin (T-PRF) with open flap debridement (OFD) on clinical, biochemical and radiographic measurements of periodontal regeneration. Twenty periodontitis patients with bilateral intrabony defects and stage III grade A periodontitis were included in the study. A total of 40 defects were randomly selected for OFD alone (control group, n = 20) or combined OFD+ T-PRF (test group, n = 20). Clinical and radiographic parameters (at baseline and nine months after surgery), and growth factor levels in gingival crevicular fluid (at baseline and at two, four, six, and twelve weeks after surgical treatment) were also evaluated. Considering the clinical parameters, alterations in probing pocket depth, gingival marginal level and clinical endpoint in the test regions treated with T-PRF significantly improved (P<0.05). Fibroblast growth factor-2 and platelet-derived growth factor-BB levels between the two groups in the second and fourth weeks were also significantly different (P<0.05). Furthermore, the receptor activator of nuclear factor κB ligand/osteoprotegerin ratio between the groups was significantly different in the second, fourth, sixth, and twelfth weeks (P<0.05). The bone-filling rate was also significantly greater in the test group than in the control group (P <0.001). Compared with OFD alone, combining T-PRF with the procedure was more successful with regards to clinical, radiographic, and biochemical measurements of periodontal regeneration.

Effect of Dental Implant System-Assisted Tooth Intentional Replantation in the Treatment of Anterior Teeth with Pathological Tooth Flaring, Drifting and Elongation in Patients with Stage III/IV Periodontitis: a Case Series.

OBJECTIVE: To investigate the clinical effect of implant-assisted dental intentional replantation (IR) for the treatment of "drifted" anterior periodontally hopeless teeth (PHT). METHODS: The present authors recruited 22 patients with stage III/IV periodontitis who suffered drifting of the maxillary anterior teeth, with a total of 25 teeth. The PHT were extracted for in vitro root canal treatment (RCT). The root surface was smoothed and the shape was trimmed, and the alveolar socket was scratched. The dental implant system was used to prepare the alveolar socket according to the direction, depth and shape of the tooth implantation. The PHT were reimplanted into the prepared alveolar socket. The periodontal indicators were analysed statistically before and after surgery. RESULT: Twenty-two patients who completed the full course of treatment, with a total of 25 PHT, had a successful retention rate of 88%. Mean periodontal probing depth (PPD) decreased by 2.880 ± 0.556 mm and 3.390 ± 0.634 mm at 6 months and 1 year, respectively, and clinical attachment loss (CAL) decreased by 2.600 ± 0.622 mm and 2.959 ± 0.731 mm at the same time points, respectively, showing significant improvement (P < 0.05). CONCLUSION: Dental implant system-assisted IR can effectively preserve "drifted" natural PHT in patients with stage III/IV periodontitis.

[A novel periodontal endoscopy-aided non-incisional periodontal regeneration technique：a case series study].

PURPOSE: To investigate the effect of endoscopy-aided non-incisional periodontal regeneration technique (NIT) in the treatment of alveolar bone angular resorption. METHODS: Thirteen patients with severe periodontitis(13 diseased teeth) were selected. All patients had alveolar bone angular resorption on adjacent surface. The patients received NIT treatment 6 weeks after periodontal primary therapy. The visualization of subgingival environment was acquired by the periodontal endoscopy. Following the removal of the subgingival plaque, calculus and intra-bony granulation tissue, bone grafting materials were placed into the intra-bony defects with the assistance of a delicate gingival protector. No flap was elevated and no sutures were applied. Probing depth (PD), gingival recession (GR), clinical attachment level (CAL), as well as radiographic parameters were evaluated at baseline and 2 years after treatment. SPSS 22.0 software package was used for data analysis. RESULTS: At 2-years follow-up, an average CAL gain of (3.65±2.10) mm (P＜0.001), PD reduction of (4.42±1.66) mm (P＜0.001), and minimal increase in GR of (0.38±0.87) mm (P=0.25) were observed. Alveolar bone was significantly improved at 2-years follow-up on radiographs (P＜0.001). CONCLUSIONS: For angular resorption site of alveolar bone, NIT treatment can obtain good periodontal regeneration results without flap inversion.

Optimizing esthetic zone periodontal regeneration in a 1-2-wall infrabony defect using recombinant human platelet-derived growth factor BB and ß-tricalcium phosphate: A case report.

OBJECTIVE: Periodontitis is an inflammatory condition induced by subgingival bacterial dysbiosis, resulting in inflammatory-mediated destruction of tooth-supporting structures, potentially leading to the formation of infrabony defects. This case report describes the treatment of a patient who presented with a combination 1-2-wall defect on tooth 21. To maintain the residual periodontal attachment and minimize esthetic consequences, a regenerative approach was performed using recombinant human platelet-derived growth factor-BB (rh-PDGF-BB) and ß-tricalcium phosphate (ß-TCP). MATERIALS AND METHODS: At the time of postscaling/root planing reevaluation, a 34-year-old Asian male initially diagnosed with molar/incisor pattern stage III grade C periodontitis exhibited a 6-mm residual probing depth on the mesiopalatal aspect of tooth 21. Periodontal regenerative surgery was performed using rh-PDGF-BB with ß-TCP, without the use of a membrane. RESULTS: At the 1-year follow-up, a significant reduction in probing depth and radiographic evidence of bone fill were observed. Additionally, re-entry surgery for implant placement at site tooth 23 confirmed bone fill in the defect on tooth 21. CONCLUSION: These results demonstrate the efficacy of rh-PDGF-BB with ß-TCP in enhancing periodontal regeneration and support its use as a treatment option when treating poorly contained infrabony defects in the esthetic zone.

Clinical effectiveness of regenerative periodontal surgery and orthodontic tooth movement with clear aligners in stage IV periodontitis: a case series.

OBJECTIVES: To evaluate the clinical effectiveness of regenerative treatment of intrabony defects in combination with consecutive orthodontic therapy with clear aligners in stage IV (type 2) periodontitis. METHOD AND MATERIALS: Ten patients with a total of 103 intrabony defects were analyzed after regenerative surgery using collagen-deproteinized bovine bone mineral with or without collagen membrane or enamel matrix derivative followed by orthodontic therapy with clear aligners. Changes in radiographic bone level and probing pocket depths were evaluated after 1 year (T1) and at final splinting (T2) after orthodontic tooth movement. RESULTS: Mean radiographic bone level gain was significant, with 2.13 ± 1.64 mm at T1 and 3.02 ± 2.00 mm at T2. Mean probing pocket depth was significantly reduced from 5.40 ± 1.80 mm at baseline to 3.78 ± 1.73 mm at T1, and remained stable with 3.73 ± 1.70 mm at T2. Pocket closure (≤ 4 mm probing pocket depth) was accomplished in 76% of all defects. Tooth loss amounted to 2.9%. CONCLUSION: Within the limitations of the retrospective study design, the findings suggest that the interdisciplinary treatment of periodontitis stage IV by regenerative periodontal surgery and consecutive orthodontic therapy with clear aligners can lead to favorable results.

[Evaluation of the efficacy of combined application of concentrated growth factors in ridge preservation of teeth with severe periodontitis].

PURPOSE: To evaluate the efficacy of combination of deproteinized bovine bone matrix and concentrated growth factors in maintaining the three-dimensional contour of alveolar bone in ridge preservation of teeth with severe periodontitis. METHODS: Thirty patients with posterior teeth suffering from severe periodontitis requiring extraction and with the intention of implant restoration were selected and randomly divided into the experimental group and control group, with 15 cases in each group. In the experimental group, DBBM combined with CGF fluid was used as bone graft material and placed in the extraction socket of the patient after minimally invasive tooth extraction and thorough debridement,while DBBM was used in the control group mixed with normal saline as the bone graft material.The extraction wounds of both groups were covered with absorbable biofilm and free gingival tissue. CBCT was performed at the initial diagnosis, immediately after operation, and 6 months after operation, and the CT images were imported into Mimics 20.0 software package to measure the difference after fitting to obtain data, SPSS 26.0 software package was used for statistical analysis of the data. RESULTS: The vertical height of the alveolar bone in the experimental group and the control group was significantly increased 6 months after operation compared with the initial diagnosis (P＜0.05), but there was no significant difference between the 2 groups(P＞0.05). There was significant difference in the change of the alveolar bone width at 1 mm below the alveolar crest between the two groups at the initial diagnosis and 6 months after operation(P＜0.05), and the horizontal width absorption in the experimental group was smaller than that in the control group. The horizontal absorption rate of bone graft material in the two groups at 1 mm below the alveolar crest showed that the experimental group was lower than the control group, and the difference was statistically significant(P＜0.05). CONCLUSIONS: Compared with DBBM alone, combined application of DBBM and CGF can better maintain the alveolar bone contour of the extraction socket with severe periodontitis.

Vigilancia clínica-microbiológica de una Periodontitis Grado C etapa III en cinco años / Clinical-microbiological vigilance of a C Grade Periodontitis Stage III in five years

Resumen Introducción: Diversas técnicas se utilizan para tratar y mantener los dientes afectados con Periodontitis de estadio III grado C, sin embargo, hay poca información sobre cómo se modifican los parámetros clínicos periodontales y la composición microbiológica durante el tratamiento convencional y quirúrgico. Objetivo: Evaluar la respuesta clínica y microbiológica en una paciente con periodontitis estadio III grado C generalizada durante 5 años. Cuyo tratamiento consistió en terapia periodontal no quirúrgica y quirúrgica utilizando material regenerativo y sustituto óseo. Metodología: Se realizó raspado y alisado radicular progresivo, combinado con antibióticos y cirugía en sitios con defectos infraóseos. Se tomó registro de placa bacteriana subgingival (PB), hemorragia (H), profundidad de la bolsa (PS) y nivel de inserción clínica (NIC) en cada momento del tratamiento. Se tomaron muestras de la profundidad de las bolsas para identificar bacterias periodontales por biología molecular. Resultados: Se observó una mejoría de PB, H, PS y ganancia de NIC a lo largo de los 5 años. Con los injertos óseos la PS disminuyó 5 mm y de NIC se ganó 5 mm, con amelogeninas las diferencias fueron de 4,5 mm respectivamente. En colgajos de acceso, la PS disminuyó 3 mm y de NIC se ganó 2 mm. Se identificó T.denticola a los 36 meses, en todas las bolsas tratadas con colgajo de acceso y en el 50% de las bolsas con injertos óseos; y P. gingivalis a los 60 meses. Conclusiones: El tratamiento periodontal aplicado evitó la pérdida de los dientes afectados. El mejoramiento de los parámetros clínicos se asoció con una microbiota no agresiva.

Abstract Introduction: There are several techniques to treat and maintain teeth affected by stage III, grade C periodontitis, nonetheless, the scientific evidence available on how periodontal clinical parameters and microbiological composition may be modified during the conventional and surgical treatment is scarce. Objective: To evaluate the clinical and microbiological response of a patient with stage III grade C, generalized periodontitis, during 5 years, treated with non-surgical and surgical periodontal therapy using regenerative material and bone substitute. Methodology: The patient was treated with scaling and progressive root planning, combined with antibiotics and surgical therapy was performed in sites with infraosseous defects. At each time of treatment, subgingival bacterial plaque (PB), haemorrhage (H), probing depth (PD) and clinical attachment level (CAL) were recorded. To identify periodontal bacteria by molecular biology samples were taken with endodontic cones from the pocket depth. Results: A significant difference of PB, H, PD was observed. The PD decreased and CAL was gained throughout the treatment. PD decreased 5 mm with the application of bone substitute, and CAL gained 5 mm, with the use of amelogenins the difference of PD and CAL was 4.5 mm. In access flap the PD decreased 3 mm and the CAL improved 2 mm. T. denticola was identified at 36 months in all pockets treated with access flap and in 50% of the pockets with bone graft, and P. gingivalis at 60 months. Conclusions: The periodontal treatment applied prevented the loss of the affected teeth. Improvement of clinical parameters was associated with a non-aggressive microbiota.

Cirugía ósea resectiva / Resective osseous surgery

Una de las causas de la evolución de la periodontitis es la formación de defectos óseos y pérdida de inserción clínica. Una manera de eliminar el defecto intraóseo y su bolsa periodontal es eliminar las paredes de hueso que componen el defecto para colocar el complejo dentogingival en una posición más apical. La cirugía ósea es un procedimiento periodontal resectivo que involucra la modificación del tejido óseo del soporte dental, la cual es una modalidad del tratamiento periodontal quirúrgico que puede utilizarse para eliminar eficazmente los defectos óseos periodontales para estabilizar la inserción periodontal. El objetivo del presente estudio es realizar una revisión de la literatura sobre las consideraciones actuales, técnicas y principios de la cirugía ósea resectiva en el paciente periodontalmente comprometido (AU)

One of the causes of the evolution of periodontitis is the formation of bone defects and loss of clinical attachment, where one way to eliminate the intraosseous defect and its periodontal pocket is to eliminate the bone walls that make up the defect to place the dentogingival complex in a more apical position. Bone surgery is periodontal surgery that involves the modification of the supporting bone tissue of the teeth, which is a modality of surgical treatment that can be used to effectively eliminate periodontal defects and stabilize the periodontal insertion. The aim of the present study is to conduct a literature review about the considerations, techniques and principles of resective bone surgery in the periodontally compromised patient (AU)

Literature Review: Dental Aspects in Gaucher Disease / Revisión de la Literatura: Aspectos Dentales en la Enfermedad de Gaucher

SUMMARY: Knowledge about Gaucher disease, characteristics, clinical and radiographic alterations, demonstrate the importance of using anamnesis, laboratory tests and radiological images, among these dental analysis and images, making possible the early detection in the oral manifestations and the success in the control and treatment of the disease.

RESUMEN: El conocimiento sobre la enfermedad de Gaucher, características, alteraciones clínicas y radiográficas, demuestra la importancia de utilizar la anamnesis, los exámenes de laboratorio e imágenes radiológicas, entre ellas las odontológicas, posibilitando la detección precoz de las manifestaciones orales, y el éxito en el control y tratamiento de la enfermedad.

Detección de microorganismos anaerobios en pacientes con pericoronaritis y sensibilidad a los antimicrobianos / Anaerobic microorganisms detection in patients with pericoronaritis and antimicrobial susceptibility

El propósito de este estudio fue la identificación de microorganismos anaerobios más frecuentemente encontrados en pericoronaritis y realizar pruebas de sensibilidad a los antimicrobianos. Se estudiaron los sacos pericoronarios del tercer molar en 20 pacientes. De las muestras recogidas en los 20 pacientes que presentaron pericoronaritis, solo en 7 (35%) hubo crecimiento de microorganismos anaerobios estrictos mientras que en los 13 restantes (65%) no se detectaron estos. En cuanto a las 12 cepas aisladas del saco pericoronario de los 7 pacientes, el microorganismo más frecuentemente encontrado fue Bifidobacterium spp en 5 casos (42%), Bifidobacterium adolescentis en 2 casos (17%), Veillonella spp en dos casos también (17%), Prevotella melaninogenica en 1 caso (8%), 1 caso Prevotella loescheii (8%) y en 1 caso a Prevotella oralis (8%). De los resultados obtenidos las bacterias anaerobias estrictas detectadas a partir de muestras de sacos pericoronarios fueron: Bifidobacterium spp., B. adolescentis, Veillonella spp, P. loeschii, P. melaninogenica y P. oralis.

Periodontal response to subgingival restorations in dogs with periodontitis

The aim of this study was to evaluate the periodontal response to subgingival restorations in dogs with naturally occurring periodontitis. At the baseline, the experimental teeth from three dogs (2nd and 3rd upper premolars and 2nd, 3rd and 4th lower premolars) were randomly assigned to Resin-modified Glass Ionomer Cement (RMGIC) and Amalgam (AM) restorations or controls (CT) at the buccal sites with (SUPRA+) or without mechanical supragingival plaque control (SUPRA-) and maintained for 90 days. Clinical [Periodontal Probing Depth (PPD), Clinical Attachment Loss (CAL), and Gingival Margin Recession (GMR)], histological (connective tissue inflammatory and epithelium condition) and histometric evaluation (distance between the apical border of the cavity and the bone level and between the apical extension of the epithelium and the bone level) were performed by a calibrated blinded examiner. Better clinical (especially regarding CAL) and histological results (unaltered epithelium and less severe inflammatory connective tissue) were observed associated with RMGIC sites. Histometric evaluation showed less bone loss associated to RMGIC. Overall, SUPRA+ sites presented less inflammatory response. It could be concluded that in dogs with periodontitis, subgingival RMGIC restorations, especially in the presence of supragingival plaque control, elicited better periodontal response than AM restorations.

O objetivo do presente estudo foi avaliar a resposta do periodonto a restaurações subgengivais em cães com diagnóstico de periodontite. No início do estudo, os dentes experimentais de três cães (2o e 3o molares superiores e 2o, 3o e 4o premolares inferiores) foram randomicamente designados para restauração com cimento de ionômero de vidro modificado por resina (CIVMR), amálgama (AM) ou Controle (CT) nos sítios vestibulares submetidos (SUPRA+) ou não (SUPRA-) a controle mecânico de placa supragengival e mantidos por 90 dias. Avaliações clínicas [Profundidade de Sondagem (PS), Nível de Inserção Clínica (NIC), Recessão Gengival (RG)], histológicas (condições inflamatórias do tecido epitelial e conjuntivo) e histométricas (distância entre a margem apical da cavidade e o nível ósseo e entre a extensão apical do epitélio e o nível ósseo) foram realizadas por examinador calibrado e cego. Melhores resultados clínicos (especialmente quanto à PI) e histológicos (epitélio sem alterações e tecido conjuntivo com menor severidade de infiltrado inflamatório) foram observados em associação a sítios restaurados com CIVMR. A avaliação histométrica mostrou menor perda óssea associada a restauração com CIVMR. Todos os sítios SUPRA+ exibiram menor resposta inflamatória. Pode ser concluído que, em cães com periodontite, restaurações subgengivais realizadas com CIVMR, especialmente na presença de controle mecânico de placa supragengival, apresentaram melhor resposta do periodonto quando comparadas com restaurações de amálgama.

Láser terapia en el tratamiento de la periodontitis / Laser Therapy in the Periodontitis Treatment

Se realizó un ensayo clínico controlado para evaluar la eficacia del láser de baja potencia combinado con la cirugía parodontal en el tratamiento de las periodontitis en pacientes intervenidos quirúrgicamente por esta afección en la Clínica Norte del municipio Morón de Febrero a Julio de 2006. El universo de trabajo estuvo constituido por todos los pacientes con diagnóstico de periodontitis que en este período de tiempo fueron intervenidos quirúrgicamente en la Clínica Norte del Municipio Morón (N=86), quedando conformada la muestra por 80 pacientes. En los pacientes donde se aplicó la cirugía parodontal combinada con la radiación láser de baja potencia el dolor sólo apareció en un pequeño número de los casos y a las 48 horas ninguno necesitó el uso de analgésicos. A los siete días el mayor porciento de los individuos presentó una cicatrización total de sus tejidos blandos. No aparecieron efectos colaterales al tratamiento. Los pacientes tratados con cirugía parodontal, en su totalidad necesitaron del uso de analgésicos en las primeras 24 horas y aún a las 72 horas después de la cirugía en algunos pacientes; a los siete días el número de pacientes con cicatrización parcial de los tejidos blandos fue elevado aunque predominó la cicatrización total. No hubo ganancia ósea, los pacientes se mantuvieron estables, lográndose sólo detener el proceso. Se encontraron diferencias estadísticamente significativas entre ambos grupos que permiten plantear que el tratamiento del láser de baja potencia en el acto quirúrgico de las periodontitis además de ser fácil de aplicar resultó ser eficaz.

A controlled clinical test was made to evaluate the efficacy of the low power laser combined with the periodontal surgery in the periodontitis treatment in patients with surgical intervention for this affection in the North Clinic of Mor¨®n city from February to July 2006. The universe of work was composed of all patients with periodontitis diagnosis, the ones who had surgical intervention in this period of time in the North Clinic of Mor¨®n city (N=86) getting shaped the sign for 80 patients of any sex who were selected and distributed taking into account the diagnostic criterion at random in two groups according to the diagnostic criteria, the inclusion, exclusion and the pre-established exit. In the studied cases the bigger percent affected for periodontal patients is a member of the masculine sex and they are in the group of 35 and more years. In patients where periodontal surgery combined with the low power radiation laser was applied the pain just appears only in a Little number of the cases and no one needed pain-relievers the next 48 hours. Seven days later the bigger percent of cases showed a total cicatrisation of their soft tissues. In this population an osseous- regeneration signs were seeing in three months from the beginning of the treatment and a year over the 50.00 percent showed somehow osseous profit. Just the minority keeps stable. Moderate periodontitis was predominated in this group and in all cases an answer to the treatment was achieved. In all patients with APP and Love's index ¡Ý 20.00 percent no answer to the treatment was achieved neither in the bigger number of smoker. Collateral effects to the treatment didn't appear. All patients with periodontal surgery needed pain relievers in the first 24 hours and there were some patients that were still maintaining this need to the 72 hours after the surgery...