Impact of a modified implant macrogeometry on biomechanical parameters and bone-related markers in rats

Abstract This study investigated the impact of a modified implant macrogeometry on peri-implant healing and its effect on bone-related molecules in rats. Eighteen rats received one implant in each tibia: the control group received implants with conventional macrogeometry and the test group received implants with modified macrogeometry. After 30 days, the implants were removed for biomechanical analysis and the bone tissue around them was collected for quantifying gene expression of OPN, Runx2, β-catenin, BMP-2, Dkk1, and RANKL/OPG. Calcein and tetracycline fluorescent markers were used for analyzing newly formed bone at undecalcified sections of the tibial implants. These fluorescent markers showed continuous bone formation at cortical bone width and sparse new bone formed along the medullary implant surface in both groups. However, higher counter-torque values and upregulation of OPN expression were achieved by test implants when compared to controls. The modified macrogeometry of implants optimized peri-implant healing, favoring the modulation of OPN expression in the osseous tissue around the implants.

Does resveratrol favor peri-implant bone repair in rats with ovariectomy-induced osteoporosis? Gene expression, counter-torque and micro-CT analysis

Abstract This study investigated the influence of resveratrol on peri-implant repair and its effects on bone-related markers in ovariectomy-induced osteoporosis in rats. Animals were divided into: OVX+PLAC (n = 10): ovariectomized animals treated with placebo; OVX+RESV (n = 10): OVX treated with resveratrol; OVX+PLAC+ZOL (n = 10): OVX treated with PLAC and zoledronate; OVX+RESV+ZOL (n = 10): OVX treated with RESV and ZOL; and SHOVX+PLAC (n = 10): sham ovariectomy treated with PLAC. RESV and PLAC were administrated after ovariectomy and ZOL after six weeks after OVX, until the end of experiment. One implant was inserted in each tibiae of animals 18 weeks after ovariectomy. After 4 weeks, one implant was removed for counter-torque, and peri-implant tissue was collected for mRNA quantification of several osteogenic markers by PCR. The other tibia was submitted to micro-computed tomography analysis. Reduced counter-torque values, bone-implant contact (BIC) and bone volume fraction (BV/TV), and higher bone porosity (BP) were detected in OVX+PLAC group when compared to SHOVX+PLAC (p < 0.05). OVX+RESV rats presented lower BIC, BV/TV, and trabecular number (Tb.N), and augmented BP and trabecular spacing (Tb.Sp) when compared to SHOVX+PLAC (p < 0.05). Higher Tb.N and connectivity density (Conn.Dn) and reduced Tb.Sp were observed in OVX rats treated with ZOL, independently of RESV, when compared to OVX+PLAC and OVX+RESV groups (p < 0.05), whereas the combination ZOL+RESV promoted lower BP when compared to OVT+PLAC and OVX+RESV (p < 0.05). Gene expression was not influenced by RESV (p > 0.05), whereas ZOL promoted up-regulation of BMP-2 (p<0.05). RESV did not improve peri-implant bone repair in rats with ovariectomy-induced osteoporosis.

Impact of history of periodontitis on gene expression of bone-related factors in young patients

Abstract Although dental implants and bone regenerative procedures are important approaches for the reestablishment of esthetics and function in young patients with a history of generalized aggressive periodontitis (GAP), no predictable outcomes have been reported, and the host osteo-immunoinflammatory response may play a relevant role in this context. In view of the lack of molecular investigations into the bone tissue condition of young patients with periodontitis, the aim of this study was to evaluate the gene expression of bone-related factors in this population. Bone biopsies were obtained from the posterior mandible in 16 individuals previously diagnosed with GAP and on periodontal support therapy and from 17 periodontally healthy (PH) patients. The gene expression of tumor necrosis factor (TNF)-α, transforming growth factor (TGF)-β, receptor activator of the NF-κB ligand (RANKL), osteoprotegerin (OPG), osteocalcin (OC), bone sialoprotein (BSP), and type I collagen (COL-I), important biomarkers of bone turnover, was evaluated by qRT-PCR. Lower TGF-β and OPG mRNA levels were observed in GAP patients compared to PH individuals (p ≤ 0.05). There were no between-group differences in levels of TNF-α, BSP, RANKL, OC, or COL-I mRNA (p>0.05). In young adults, a history of periodontal disease can negatively modulate the gene expression of important bone-related factors in alveolar bone tissue. These molecular outcomes may contribute to the future development of therapeutic approaches to benefit bone healing in young patients with history of periodontitis via modulation of osteo-immuno-inflammatory biomarkers.

Host response and peri-implantitis

Abstract Considering the absence of predictable and effective therapeutic interventions for the treatment of peri-implantitis, scientific evidence concerning the host response profile around dental implants could be important for providing in the future a wider preventive and/or therapeutic window for this peri-implant lesion, indicating biomarkers that provide quantifiable measure of response to peri-implant therapy. Moreover, a better knowledge of pattern of host osteo-immunoinflammatory modulation in the presence of peri-implantitis could either benefit the early diagnostic of the disease or to cooperate to prognostic information related to the status of the peri-implant breakdown. Finally, new evidences concerning the host profile of modulators of inflammation and of osseous tissue metabolism around dental implants could explain the individual susceptibility for developing peri-implant lesions, identifying individuals or sites with increased risk for peri-implantitis. The focus of this chapter was, based on a systematically searched and critically reviewed literature, summarizing the existing knowledge in the scientific research concerning the host osteo-immunoinflammatory response to the microbiological challenge related to periimplantitis.

Preemptive and Postoperative Medication Protocols for Root Coverage Combined with Connective Tissue Graft

Abstract This trial evaluated the preemptive and postoperative effect of dexamethasone and ibuprofen on prevention of pain/discomfort, edema and interference in daily life in patients undergoing root coverage combined with subepithelial connective tissue graft (CAF + CTG). Twenty patients were randomly assigned as follows: NSAID Group: 400mg Ibuprofen 60 min preemptive + 400mg Ibuprofen postoperative; or SAID Group: 4mg Dexamethasone 60 min preemptive + 4mg Dexamethasone postoperative. The postoperative medication was administered 8 and 16 h post-surgery. Each patient received questionnaires based on a numeric scale (101-point numeric scale rate [NRS-101]) and multiple choice questions (four-point verbal rating scale [VRS-4]) about trans-operative pain/discomfort, hourly for 8 h after surgery and once a day for three days. A Visual Analogue Scale (VAS) for edema and interference in daily life during the 1st, 2nd, 3rd and 7th day was also answered. The degree of anxiety was rated statistically by the Chi-square test. The Mann-Whitney and Friedman tests were used for the other questionnaires. The surgery time and number of analgesic pills consumed were compared using Student's t-test. Patients who used dexamethasone presented a trend toward less pain when compared to individuals who ingested ibuprofen, with a significant difference observed 3 h after the procedure (p<0.05). The use of dexamethasone also promoted less edema until the 2nd day and lower interference in daily life on the third day when compared with ibuprofen (p<0.05). We concluded that the use of dexamethasone as a preemptive and postoperative medication was more suitable as a drug therapeutic protocol for CAF + CTG.

Resumo Este estudo avaliou o efeito preventivo e pós-operatório de dexametasona e ibuprofeno na prevenção da dor, desconforto, edema e interferência na vida diária, em pacientes submetidos ao recobrimento radicular associado a enxerto de tecido conjuntivo subepitelial (CAF + CTG). Vinte pacientes foram divididos aleatoriamente: Grupo AINES: Ibuprofeno 400 mg 60 min antes da cirurgia + Ibuprofeno 400 mg no período pós-operatório e Grupo AIES: 4 mg de dexametasona 60 min antes da cirurgia + Dexametasona 4mg no pós-operatório. A medicação pós-operatória foi administrada 8 e 16 horas pós-cirurgia. Cada paciente recebeu questionários com base na escala numérica NRS-101 (101 pontos numéricos) e perguntas de múltipla escolha (VRS-4) sobre dor / desconforto no período transoperatório, de hora em hora durante 8 h e uma vez por dia durante três dias após a cirurgia. A Escala Visual Analógica (VAS) para análise de edema e interferência na vida diária também foi respondida no 1º, 2º, 3º e 7º dia após a cirurgia. O grau de ansiedade foi estatisticamente avaliado pelo teste do Qui-quadrado. Mann-Whitney e Friedman foram utilizados para os demais questionários. Para o tempo de cirurgia e o número de analgésicos consumidos, o teste t de Student foi aplicado. Os pacientes que utilizaram dexametasona apresentaram uma tendência para menores níveis de dor quando comparados aos indivíduos que ingeriram ibuprofeno, com diferença significativa observada 3 h após o procedimento cirúrgico (p<0,05). A utilização de dexametasona também promoveu menores níveis de edema até ao segundo dia e menor interferência na vida diária no terceiro dia, quando comparada com o ibuprofeno (p<0,05). Concluiu-se que a utilização de dexametasona como medicamento preventivo e pós-operatório mostra ser mais adequado como protocolo medicamentosos para cirurgias de recobrimento radicular com associação de enxerto de tecido conjuntivo.

Doença periodontal e artrite idiopática juvenil: uma inter-relação bidirecional / Periodontal disease and juvenile idiopathic arthritis: a bidirectional inter-relationship

Parece haver similaridades entre a patogenia de doenças reumatológicas (artrite reumatoide e artrite idiopática juvenil) e periodontite. Alguns estudos têm sido conduzidos com o objetivo de elucidar os mecanismos que explicam a inter-relação entre essas condições. A artrite reumatoide parece aumentar a suscetibilidade à doença periodontal destrutiva em adultos e em pacientes com artrite idiopática juvenil. No entanto, ainda são pouco conhecidas as vias de associação entre essas condições crônicas infl amatórias (periodontite e artrite). Desta forma, o objetivo deste trabalho foi promover uma revisão da literatura sobre a inter-relação artrite idiopática infantil e doença periodontal.

Similarities between rheumatologic diseases (rheumatoid arthritis and juvenile idiopathic arthritis) and periodontitis pathogenesis are discussed. Some studies have been conducted to elucidate the mechanisms that explain the relationship between these conditions. Rheumatoid arthritis appears to increase susceptibility to destructive periodontal disease in adults and in patients with juvenile idiopathic arthritis. However, the pathway of association between these chronic infl ammatory conditions are barely known. Thus, the aim of this study was to review the literature concerning the relationship between juvenile idiopathic arthritis and periodontitis.

Terapia interdisciplinar na otimização da estética vermelha e branca / Interdisciplinary therapy in the optimization of pink and white aesthetics ­ case report

Este relato descreveu um caso clínico no qual foi realizado um planejamento multidisciplinar priorizando, além do restabelecimento funcional, uma adequada estética ao paciente. Para que tais metas fossem alcançadas, foi importante a implementação de uma visão multidisciplinar do caso, garantindo um planejamento integrado capaz de reunir todos os requisitos para a otimização de resultados satisfatórios, considerando os padrões de estética periodontal e dental. O presente caso clínico descreveu uma abordagem clínica multidisciplinar para reabilitação anterior envolvendo cirurgia plástica periodontal, para aumento de coroa e confecção de facetas em resina composta pela técnica direta para devolução de estética dental, resultando em sucesso clínico e satisfação da paciente.

This report describes a clinical case in which a multidisciplinary planning was performed, prioritizing, in addition to functional restoration, adequate aesthetics to the patient. In order to achieve these goals, it was important to implement an interdisciplinary view of the case, guaranteeing an integrated planning capable of meeting all the requirements for the optimization of satisfactory results, considering the patterns of periodontal and dental aesthetics. The present case report describes a multidisciplinary clinical approach for previous rehabilitation involving periodontal plastic surgery for crown lengthening and direct composite resin veneers to retrieve dental esthetics achieving clinical success and patient satisfaction.

Técnica de enxerto gengival livre para aumento de tecido queratinizado em recessão gengival classe III de Miller / Free gingival graft technique for keratinized tissue increase in Miller III gingival recession ­ a case report

A presença ou ausência de gengiva inserida pode interferir na manutenção da saúde gengival, uma vez que sua deficiência leva à exposição radicular dificultando o processo de higienização, o que resulta na presença de biofilme e inflamação gengival com perda de inserção. Foi realizada terapia periodontal cirúrgica com enxerto gengival livre em paciente com recessão gengival classe III de Miller para aumento de faixa de tecido queratinizado. Após período de pós-operatório e acompanhamento de um ano e 12 meses, foi observado ganho e manutenção de volume e altura do tecido queratinizado enxertado, com saúde gengival e ganho de inserção. Nos casos onde há necessidade de reforçar áreas fragilizadas pela diminuição ou falta de gengiva inserida, a técnica de enxerto gengival livre apresenta boa previsibilidade e manutenção da faixa de tecido queratinizado, favorecendo o controle de biofilme e saúde gengival.

The presence or absence of attached gingiva may interfere with the maintenance of gingival health, since its defi ciency in some cases complicates the process of cleaning, resulting in the presence of biofilm and gingival inflammation with insertion loss. This case report describes a surgical technique based on free gingival graft in a patient with gingival recession Miller class III to increase keratinized tissue band. After the postoperative period of 12 months tissue improvement was observed, as well as, volume maintenance and height of keratinized grafted tissue along with gum health and insertion gain. In cases where there is need to strengthen weakened areas by reducing or lack of attached gingiva, the free gingival graft technique has good predictability and maintenance of keratinized tissue range, favoring the control of biofilm and gingival health.

Impact of micronutrients supplementation on bone repair around implants: microCT and counter-torque analysis in rats

ABSTRACT The use of natural substances and micronutritional approaches has been suggested as a therapeutic alternative to benefit the bone healing associated with no side effects. Nevertheless, the influence of micronutritional interventions with therapeutic proprieties on the bone repair has yet to be intensely evaluated, and no evidence is available exploring the impact of micronutrient supplementation on the peri-implant bone healing. Objective This study investigated the effect of micronutrients supplementation on the bone repair around implants. Material and Methods One screw-shaped titanium implant was inserted in each tibia of each rat, which were assigned to: daily administration, for 30 d, of the placebo solution (Placebo group-n:18) or micronutrients supplementation (Micronutrients group-n:18), based on calcium, magnesium, zinc, and vitamin D3 intake. After, the animals were sacrificed. One of the implants was removed by applying a counter-torque force to evaluate the force to rupture the bone-implant interface. The other implant was evaluated by microcomputed tomography (CT) examination to determine the bone-to-implant contact (BIC) and the bone volume (BV/TV). Results No statistically significant differences were observed between the groups for both counter-torque values and microCT parameters (p>0.05). Conclusion Within the limits of this study, micronutrients supplementation did not provide additional benefits to the bone healing around dental implants.

Maternal periodontitis induces intergenerational injuries on reproductive performance of adult female rat offspring / Periodontite materna induz prejuízos transgeracionais no desempenho reprodutivo da prole feminina na idade adulta

Substantial evidence suggests a direct link between periodontitis in pregnant women and subsequent adverse pregnancy outcomes. However, no studies have evaluated the transgenerational effects of periodontitis on the reproductive performance of subsequent generations. The present study investigated whether maternal periodontal disease exerts deleterious transgenerational effects on reproductive performance in F1 female rats. Rat female offspring from mothers that were subjected to experimentally induced periodontitis or sham operation were mated with sexually experienced male rats. The weight and reproductive performance of these F1 offspring were evaluated on gestation day 21, including maternal weight, litter weight, individual pup weight, number of pups, and number of resorptions. The percentage of dams with resorptions and the litter weight/number of pups were also calculated. Compared with the control group, an increase was observed in the percentage and number of resorptions and litter weight/number of pups, and a decrease was observed in the number of pups born in the experimental group. Maternal weight, litter weight, and individual pup weight were not different between the control and experimental groups. Maternal periodontitis impaired reproductive performance in the F1 generation. We showed that periodontitis may induce reproductive injury in adult offspring even if the offspring do not undergo any inflammatory/infectious process during their postnatal life or during gestation. These findings reinforce the importance of oral care during pregnancy.(AU)

Existem evidências substanciais de uma relação direta entre periodontite em mulheres grávidas com efeitos adversos reprodutivos. No entanto, nenhum estudo avaliou os efeitos intergeracionais da periodontite sobre o desempenho reprodutivo das gerações subsequentes. O presente estudo investigou se a doença periodontal materna exerce efeitos intergeracionais deletérios sobre o desempenho reprodutivo em ratos fêmeas da geração F1. Assim, filhas de ratas cujas mães foram submetidas a periodontite experimental ou falsamente operadas foram acasaladas com ratos machos sexualmente experientes. O peso corporal e desempenho reprodutivo da geração F1 foram avaliados no dia 21 de gestação, incluindo o peso materno, peso da ninhada, peso da individual dos filhotes, número de filhotes e de reabsorções. A percentagem de fêmeas com reabsorção e o peso da ninhada/número de filhotes também foram calculados. Comparados com o grupo controle, observou-se aumento na porcentagem e número de reabsorções e no peso da ninhada/ número de filhotes, e decréscimo no número de filhotes nascidos no grupo experimental. O peso materno, peso da ninhada e individual dos filhotes não foi diferente entre o controle e experimental. Estes resultados mostram que a periodontite experimental materna prejudica o desempenho reprodutivo da geração F1, mesmo que estes animais não tenham sido expostos diretamente a um processo inflamatório.(AU)

Effect of Resveratrol on periodontal pathogens during experimental periodontitis in rats

Abstract The objective of this study was to investigate the antibacterial effect of resveratrol against putative periodontal pathogens during the progression of experimental periodontitis in rats. Periodontitis was induced in rats in one of the first molars chosen to receive a ligature. Animals were assigned to one of two groups: daily administration of the placebo solution (control group, n = 12) or 10 mg/Kg of resveratrol (RESV group, n = 12). The therapies were administered systemically for 30 days, for 19 days before periodontitis induction and then for another 11 days. Then, the presence and concentrations of Porphyromonas gingivalis, Tannerella forsythia and Aggregatibacter actinomycetemcomitans in the cotton ligatures collected from the first molars were evaluated using real-time PCR. Inter-group comparisons of the microbiological outcomes revealed that no differences were detected for P. gingivalis, T. forsythia and A. actinomycetemcomitans levels (p > 0.05). Continuous use of resveratrol did not promote additional benefits in microbiological outcomes during experimental periodontitis in rats.

Explantação de implante e regeneração tecidual guiada em recessão peri-implantar seguindo os conceitos estéticos atuais / Implant explantation and guided tissue regeneration in peri-implant recession following the current esthetic concepts – case report

Na Implantodontia, ter sucesso na maxila anterior é um desafio ao profissional, pois o resultado deve reunir excelência na função e estética, assim como na estabilidade dos tecidos peri-implantares a longo prazo. Contudo, complicações estéticas podem surgir, entre elas: recessão dos tecidos moles peri-implantares, causada por fatores como o posicionamento tridimensional do implante, o biotipo peri-implantar, a reabsorção da parede óssea vestibular, os tipos de implante e a conexão protética. O artigo visa relatar um caso clínico de recessão do tecido mole peri-implantar, com exposição do ombro metálico do implante e alongamento da coroa implantossuportada do elemento 22. Para o restabelecimento da arquitetura peri-implantar e da harmonia protética, foram realizadas a explantação e o reposicionamento tridimensional do implante, associados à regeneração tecidual guiada, com a utilização de enxertos ósseos e de tecido conjuntivo pediculado rotacionado palatino. Concluiu-se que o reposicionamento tridimensional do implante associado à regeneração tecidual guiada pode ser uma alternativa de tratamento para solucionar problemas estéticos na maxila anterior.

Paradigmas associados às doenças peri-implantares: O que se sabe e o que ainda precisa ser pesquisado / Paradigms associated with peri-implant diseases: what is known and what still needs to be researched

A doença peri-implantar é um processo inflamatório de etiologia bacteriana que pode acometer os tecidos ao redor dos implantes. Quando a inflamação atinge exclusivamente os tecidos moles circundantes é denominada mucosite peri-implantar, e quando há também a perda do osso de suporte é denominada peri-implantite. Má higiene oral, tabagismo e histórico prévio de doença periodontal são fatores de risco para a doença peri-implantar. Os parâmetros básicos de diagnóstico e tratamento das doenças peri-implantares são delineados pelos utilizados nas doenças periodontais, principalmente devido às similaridades etiológicas encontradas entre elas. Porém, algumas características dos implantes, como a sua morfologia, rugosidade de superfície e desenho protético, criam condições específicas que desafiam os profissionais a ter protocolos ideais de identificação e tratamento das doenças peri-implantares. O objetivo deste trabalho foi realizar uma revisão da literatura sobre o diagnóstico, os fatores de risco e os tratamentos atualmente pesquisados.

Laminados cerâmicos: detalhes dessa abordagem minimamente invasiva / Ceramic veneers: details of this minimally invasive approach

A remodelação estética do sorriso pode ser realizada de duas maneiras: por meio de restaurações diretas, utilizando-se resinas compostas; ou com restaurações indiretas, utilizando-se coroas, facetas e/ou laminados cerâmicas. A abordagem minimamente invasiva, em foco nos últimos anos, tem-se mostrado efetiva na obtenção de excelentes resultados estéticos, com restaurações imperceptíveis. Desse modo, o presente trabalho demonstra, mediante relato de caso clínico, a abordagem minimamente invasiva, suas vantagens e desvantagens, utilizadas para a remodelação de dois laterais conoides, a qual influenciou a harmonia dos elementos anteriores e a estética do sorriso.

The aesthetic reshaping of the smile can be reached, basically, in two ways: direct restorations using composite resins; or using indirect restorations, such as full crowns and laminate veneers. A minimally invasive approach in focus in the last years, has obtained great results, with imperceptible restorations. In this way, this case report demonstrates the pros and cons of the minimal invasive approach for reshaping lateral conoid shaped incisors, which directly influenced the harmony of the maxillary anterior teeth and the aesthetics of the smile.

Evaluation of the use of systemic antimicrobial agents by professionals for the treatment of periodontal diseases

AIM: To investigate the indication of systemic antimicrobial agents used by dental professionals for treatment of patients affected by periodontal diseases. METHODS: Interviews by a questionnaire were held with 225 professionals of different dental specialties and who performed periodontal treatment. RESULTS: Among interviewees, 94% indicated systemic antibiotics as a form of periodontal disease treatment. Their main indication was for periodontal abscesses (80%) followed by aggressive periodontitis (62%) and necrotizing diseases (45%). The most frequently used antibiotics were amoxicillin (81%) and metronidazole (57%). The medications were indicated in association with mechanical therapy by 67% of the professionals. As regards the occasion of indication, 60% indicated systemic antibiotic therapy before and after mechanical periodontal scaling and root planing. Seventy-eight percent of the professionals indicated antibiotics associated with periodontal surgery for access to scaling, and 76% indicated it before and after the surgical procedure. Among the interviewees, 99% took into account systemic involvement for drug administration. CONCLUSIONS: It was concluded that a considerable portion of professionals indicate systemic antibiotic-therapy in an incoherent manner and in situations in which there is no indication for antibiotic use, or with ineffective protocols.

Effect of crude extract and essential oil of Cordia verbenacea in experimental periodontitis in rats

Aim: To evaluate the effect of crude extract and essential oil of Cordia verbenacea (C.V.),systemically administered, on ligature-induced periodontitis in rats. Methods: Periodontitis wasinduced in 54 Wistar rats: one of the first mandibular molars was randomly assigned to receive aligature, whereas the contralateral molar was left unligated. Then, animals were randomly assignedto one of the following groups: non-treatment group (n=18): animals that received 10 mL/day ofvehicle; C.V. extract group (n=18): animals that received 100 mg/kg/day of crude extract of C.verbenacea; and C.V. essential oil group (n=18): animals that received 100 mg/kg/day of essentialoils free of C. verbenacea. All therapies were administered orally 3 times daily, for 11 days. Next,the animals were sacrificed, and the specimens were processed for morphometric analysis. Boneloss was determined on the buccal surface of the lower first molars by the distance of thecementoenamel junction from the alveolar bone. Results: Both extract and essential oil of C.verbenacea orally administered decreased alveolar bone loss in the ligated teeth when comparedwith the non-treated group (p<0.05). Conclusions: The present study demonstrated that systemicadministration of both formulations of Cordia verbenacea may attenuate the progression of ligatureinducedperiodontitis.

Evaluation of the effect of an organic extract obtained from Ipomoea alba L. on experimental periodontitis in rats

The aim of this study was to evaluate the effect of an organic extract obtained from Ipomoea alba L. (Convolvulaceae or OE 1493), on experimental periodontal disease in rats. Periodontitis was induced in thirty six Wistar rats: a first mandibular molar was randomly assigned to receive a ligature, whereas the contralateral molar was left unligated. Animals were randomly assigned to two groups and treated topically, three times a day, for 11 days, as follows: Control Group - vehicle-treated (n = 18), and Test Group - OE 1493-treated (n = 18). The rats were sacrificed on the 12th day. Morphometrical measurements from the cementoenamel junction to the bone crest were performed to determine alveolar bone loss, using standardized photographs. Single- and multi-dose acute toxicity assays were carried out after OE 1493 treatment. Morphometrical analysis demonstrated that topically-administered OE 1493 showed no effect on reducing bone loss when compared with the control group (p > 0.05). In addition, OE 1493 did not present toxicity. Within the limits of this investigation, it may be concluded that OE 1493 did not show any positive influence on the progression of ligature-induced periodontitis in rats, when administered according to the regimen used in the present study.

Terapia fotodinâmica no tratamento da doença periodontal e peri-implantar / Photodynamic therapy in the treatment of periodontal disease and peri-implant disease

O tratamento periodontal consiste na remoção das bactérias periodontopatogênicas, por meio de raspagem e alisamento radicular (RAR), cujos resultados são bastante satisfatórios. Contudo, determinados sítios periodontais e peri-implantares podem não responder bem à terapia não cirúrgica, ocasionando a permanência de bolsas residuais. Dessa forma, alternativas vêm sendo propostas como adjuvantes à terapia mecânica, como o uso de antimicrobianos locais e sistêmicos, o uso de laser isolado e associado a um corante fotossensibilizador, processo conhecido como terapia fotodinâmica ou PDT (photodynamic therapy). Vários estudos têm mostrado que essa nova terapia parece ser uma abordagem terapêutica original e interessante, podendo ser um tratamento alternativo tanto na terapia da periodontite quanto da peri-implantite, apresentando reduzida morbidade e mínimo desconforto trans e pós-operatório. Contudo, é necessária maior quantidade de investigações clínicas controladas e randomizadas, a fim de comprovar a eficácia da terapia fotodinâmica como adjuvante ou como único tratamento para a resolução de doenças periodontais e peri-implantares.

Steroidal and non-steroidal cyclooxygenase-2 inhibitor anti-inflammatory drugs as pre-emptive medication in patients undergoing periodontal surgery

The aim of the present study was to compare the pre-emptive use of a cyclooxygenase-2 (COX-2) inhibitor with a well established steroidal anti-inflammatory drug for pain and edema relief following periodontal surgery for crown lengthening. Thirty patients requiring periodontal surgery were randomly assigned to receive one of the following medications: selective COX-2 inhibitor or steroidal anti-inflammatory drug, 60 min before the surgical procedure. To examine patient anxiety, a Corah's dental anxiety scale was applied before surgery. Using a visual analog scale, the extent of pain/discomfort during the trans-operative period and immediately after the surgery was measured. Additionally, intensity of pain/discomfort and edema were examined 4, 8, 12 and 24 h postoperatively. With regard to anxiety, no statistical differences between the groups were observed (p>0.05). With respect to the extent of pain/discomfort during the trans-operative, immediate and late postoperative period, data demonstrated no significant differences (p>0.05) between the COX-2 inhibitor and steroidal groups. With regard to edema, intragroup analysis did not reveal any statistically significant difference (p>0.05) during the 24 h following surgery in either group. In conclusion, both anti-inflammatory drugs presented a similar potential for pain and edema relief following periodontal surgery.

O objetivo do presente estudo foi comparar a utilização pré-emptiva de medicamento inibidor da COX-2 (cicloxigenase-2) com uma droga antinflamatória esteroidal amplamente utilizada, para o controle da dor e edema após cirurgia periodontal para aumento de coroa. Trinta pacientes que necessitavam de cirurgia periodontal foram aleatoriamente designados a receber uma das seguintes medicações: inibidor seletivo da COX-2 ou a droga antinflamatória esteroidal, 60 min antes do procedimento cirúrgico. Para avaliar a ansiedade do paciente, a escala de ansiedade ao tratamento dental de Corah foi aplicada antes da cirurgia. Com a utilização de escala analógica visual a extensão de dor/desconforto durante o período trans-cirúrgico e imediatamente após a cirurgia foi mensurada. Adicionalmente, a intensidade de dor/desconforto e edema foram avaliados no periodo pós-operatório tardio 4, 8, 12 e 24 h após o procedimento cirúrgico. Com relação à ansiedade, não foi observada diferença estatística entre os grupos (p>0,05). Com relação à extensão de dor/desconforto durante os períodos trans-cirúrgico e pós operatório imediato e tardio, os dados não demonstraram diferenças entre o grupo que recebeu o inibidor seletivo da COX-2 e o aintinflamatório esteroidal (p>0,05). A avaliação do edema, intragrupo, não revelou diferença estatística durante as primeiras 24 h em nenhum dos grupos estudados (p>0,05). Em conclusão, ambas as drogas antiinflamatórias utilizadas apresentaram um potencial similar no controle da dor e edema após cirurgia periodontal.

Abordagem multidisciplinar para reabilitação implantossuportada em área estética / Multidisciplinary pproach to rehabilitation with implant-supported prothesis in anterior area

Este relato descreve um caso clínico em que foi executado um planejamento multidis¬ciplinar para a reabilitação com pró tese implantossuportada de um dente indicado para ex¬tração por reabsorção radicular. Inicialmente, foi feita extrusão ortodôntica, após o período de contenção foram realizadas a extração do dente e a colocação de implante imediato, com associação de enxerto ósseo e de tecido subepitelial. Após o período de maturação dos tecidos e de ósseointegração a reabilitação protética foi finalizada. Esta abordagem usou técnicas e conhecimentos de várias especialidades, potencializando os resultados estéticos e trazendo satisfação ao paciente.

This study describes a case report of a single tooth implant-supported multidisciplinaryrehabilitation. The tooth indicated for extraction by root resorption was initially orthodonticaly extruded, and after the retention period was performed a tooth extraction, immediate implant placement in association with bone graft and subepithelial connective tissue graft. After tissuesmaturation and osseointegration period, prosthetic rehabilitation was completed.This approach I used techniques and knowledge in various specialties, enhancing the aesthetic results and brin¬ging satisfaction to the patient.