Biological sealing aspects surrounding anterior crowns on dental implants: clinical and photographic cases report

The biological sealing (BS) around implants is a dominant factor to determine the long-term success of peri-implant health. There are several features of the BS around implants in common with the soft tissue attached to teeth, such as the presence of crevicular fluid, acquired pellicle, epithelium; otherwise, the quality of the BS around implants is weaker compared with the junctional epithelium of natural teeth. Then, this article aimed to describe three cases report showing the presence of a BS (cuticle-crevice fluid-acquired pellicle) around the fixed crowns on dental implants in the anterior zone, through photographic analysis. It was used a Nikon 8100 camera with a 105 mm macro lens and a Macro Ring circular flash. A photographic profile examination was made always showing the clinical case and, specifically, the focal point in the crown-gingival tissue (prosthesis boundary and peri-implant tissue), highlighting the anatomical gingiva on the ceramic prosthetic crown at an angle between 140 to 160 degrees. Although cases 1 and 2 had 1-year follow-up and case 3 around 4 years, the common findings for all treatments done were: (i) oral rehabilitation with crowns on dental implants; (ii) patients satisfied with the esthetic and functional result; (iii) stability of the soft tissue around the crowns; (iv) all the patients had a good oral hygiene; (v) presence of a thin membrane associated with the acquire pellicle, similar to an annular cuticle, which we named cuticle-acquired pellicle complex or tertiary cuticle or prosthetic-implant cuticle. This complex (cuticle-crevicular fluid-acquired pellicle) is suggested to be the responsible by the BS on dental implants. Moreover, the cuticle (epithelial part in the peri-implant sulcus), although similar to teeth, may be considered a tertiary pellicle due to be found on ceramic crowns on dental implants, differently of the primary and secondary pellicle. Whitin the limitation of these three cases reports, the BS was reported and can be introduced the new concept of the "cuticle-crevicular fluid-acquired pellicle complex" or "prosthetic-implant cuticle".

Prevalencia de Porphyromonas gingivalis en un grupo de pacientes con aparatología fija de ortodoncia / Prevalence of Porphyromonas gingivalis in a group of patients with fixed orthodontic appliances

Introducción: existen diversos patógenos que pueden afectar no sólo la salud periodontal, sino también la salud general de los pacientes. Objetivo: determinar la Porphyromonas gingivalis (PG) en el primer molar superior derecho de adolescentes, de entre 12 y 18 años, con al menos un mes de tratamiento de ortodoncia con aparatología fija. Material y métodos: se realizó un estudio observacional, descriptivo, transversal de casos en un grupo de 26 adolescentes con tratamiento de ortodoncia, compuesto de brackets metálicos, tubos o bandas, arcos NiTi termoactivos, módulos, cadenas o ligaduras; sin importar sexo, edad, tiempo de tratamiento o maloclusión. Se formaron dos pares de grupos 1 y 2 (15 mujeres y 11 hombres), A y B (13 mujeres y 13 hom- bres) comparando los resultados obtenidos entre los grupos. Resulta- dos: dentro del grupo 1 y 2 la detección molecular de microorganismos arroja que 80% fueron positivas a la PG, 58.33% presenta maloclusión y en promedio 89% de las pacientes son positivas a PG. La detección molecular del grupo A y B indica que 54.54% fueron positivos a PG, mientras que 83.3% presenta maloclusión y en promedio 47% son positivos a PG. Conclusión: la explicación de los eventos moleculares que se desencadenan en la cavidad oral y los sistemas afectados por PG contribuyen a la prevención de complicaciones al tener una mejor comprensión de los fenómenos infecciosos (AU)

Introduction: there are various pathogens that can affect not only periodontal health, but also the general health of patients. Objective: to determine Porphyromonas gingivalis (PG) in the upper right first molar of adolescents, between 12 and 18 years old, with at least one month of orthodontic treatment with fixed appliances. Material and methods: a cross-sectional descriptive observational study of cases was carried out in a group of 26 adolescents with orthodontic treatment, consisting of metal brackets, tubes or bands, thermoactive NiTi archwires, modules, chains or ligatures; regardless of sex, age, treatment time or malocclusion. Two pairs of groups 1 and 2 (15 women and 11 men), A and B (13 women and 13 men) were formed, comparing the results obtained between the groups. Results: within group 1 and 2, the molecular detection of microorganisms shows that 80% were positive for PG, 58.33% presented malocclusion and an average of 89% of patients were positive for PG. The molecular detection of group A and B indicates that 54.54% were positive for PG while 83.3% presented malocclusion and on average 47% were positive for PG. Conclusion: the explanation of the molecular events that are triggered in the oral cavity and the systems affected by PG contribute to the prevention of complications by having a better understanding of the infectious phenomena (AU)

Gingival crevicular fluid as Biomarker's source for alzheimer's disease / Fluido crevicular gingival como biomarcador de enfermedad de Alzheimer

Abstract Periodontitis is a low-grade inflammatory disease caused by a subgingival dysbiotic microbiota. Multiple studies have determined the higher prevalence of tooth loss and poor oral hygiene in patients with Alzheimer's disease (AD). However, the periodontal diagnosis, periodontal bacteria or mediators has not been measured to date. Aim: To determine the periodontal status, the pro-inflammatory mediators, Porphyromonas gingivalis load, and Apoliporpotein E (ApoE) in patients with AD. A complete dental examination was performed on 30 patients, and cognitive status was determined by the Montreal Cognitive Assessment (MoCA). Subgingival microbiota and GCF samples were then taken from all patients from the deepest sites. Total DNA was isolated from the microbiota samples for the quantification of the 16S ribosomal subunit. Pro-inflammatory mediators and ApoE were quantified from the gingival crevicular fluid (GCF). Patients with AD had periodontitis stage III-IV in 80%, a higher concentration of pro-inflammatory and ApoE mediators, and a higher P. gingivalis load compared to healthy subjects. The pro-inflammatory mediators, P. gingivalis load had a negative correlation with the MoCA test scores. Finally, a ROC curve was performed to assess the specificity and sensitivity of ApoE levels, detecting an area of 84.9%. In AD patients, we found a more severe periodontitis, a higher levels of pro-inflammatory mediators, and higher bacterial load. In addition, there is an increase in ApoE that allows to clearly determine patients with health, periodontitis and periodontitis and AD.

Resumen La periodontitis es una enfermedad crónica no transmisible que se caracteriza por generar una inflamación sistémica de bajo grado causada por una microbiota disbiótica subgingival. Múltiples estudios han determinado la mayor prevalencia de pérdida de dientes y mala higiene bucal en pacientes con enfermedad de Alzheimer (EA). Sin embargo, el diagnóstico periodontal, bacterias periodontales o mediadores pro-inflamatorio no se ha medido hasta la fecha. Determinar el estado periodontal, los mediadores pro-inflamatorios, la carga de Porphyromonas gingivalis y la apoliporpoteína E (ApoE) en pacientes con EA. Se realizó un examen odontológico completo en 30 pacientes y el estado cognitivo se determinó mediante la Evaluación Cognitiva de Montreal (MoCA). Luego, se tomaron muestras de microbiota subgingival y FCG de todos los pacientes de los sitios más profundos. Se aisló el DNA total de las muestras de microbiota para la cuantificación de la subunidad ribosómica 16S. Los mediadores pro-inflamatorios y la ApoE se cuantificaron a partir del líquido crevicular gingival (GCF). Los pacientes con EA tenían periodontitis en estadio III-IV en 80%, una mayor concentración de mediadores pro-inflamatorios y ApoE, y una mayor carga de P. gingivalis en comparación con los sujetos sanos. Los mediadores pro-inflamatorios y la carga de P. gingivalis tuvieron una correlación negativa con las puntuaciones de la prueba MoCA. Finalmente, se realizó una curva ROC para evaluar la especificidad y sensibilidad de los niveles de ApoE, detectando un área del 84,9%. En los pacientes con EA encontramos una periodontitis más severa, mayores niveles de mediadores pro-inflamatorios y mayor carga bacteriana. Además, un aumento de ApoE que permite determinar claramente a los pacientes con salud, periodontitis y periodontitis y EA.

Quantitative Assessment of Dentine Sialophosphoprotein, Aspartate Aminotransferase and Lactate Dehydrogenase in Gingival Crevicular Fluid of Teeth with Root Resorption

ABSTRACT@#Root resorption is a shortening of root dentine which occurs physiologically in deciduous teeth. The present study aimed to quantify dentine sialophosphoprotein (DSPP), aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) in gingival crevicular fluid (GCF) during the physiological process of root resorption of deciduous teeth. A cross-sectional study was conducted with 25 children aged between 4 and 10 years old. GCF was collected from the gingival sulcus using periopaper strips from the upper first deciduous molar (n = 45). The samples were divided equally into three groups, no resorption (R0), moderate resorption (RM) and severe resorption (RS), based on the existing radiographs taken. The GCF samples were then analysed using an enzyme-linked immunosorbent assay (ELISA) kit to determine the DSPP concentration levels and BioAssays System kit for AST and LDH. One-way ANOVA was used to determine the statistical differences between the means of the DSPP, AST and LDH concentration level in the three groups. A difference was considered significant when p < 0.05. High concentration levels of DSPP were significantly noted in RS (p < 0.05), compared to RM and R0. AST also portrayed significant high activity level (p < 0.05) similar to DSPP but LDH showed no significant changes between groups (p > 0.05). The high quantification of DSPP and AST levels in the severe and moderately resorbed roots indicated the potential use of this protein as a biomarker for detecting moderate-severe stages of root resorption.

The Effect of Periodontal and Peri-Implanter Health on IL-1 and TNF- Levels in Gingival Crevicular and Peri-Implanter Sulcus Fluid: a Cross-Sectional Study / El efecto de la salud periodontal y peri-implantar en niveles de IL-1ß y TNF-α en el fluido crevicular y sulcus peri-implantador: un estudio transversal

Abstract: It is stated that peri-implanter diseases have destructive effects similar to periodontal diseases. This study aims to compare IL-1β and TNF-α levels in healthy and diseased areas. Forty non-smokers systemically health individuals (40 implants/40 teeth) (age:38-67) were included in the study. In clinical and radiographic examinations; plaque index (PIn), gingival index (GI), periodontal pocket depth (PPD), clinical attachment level (CAL) and marginal bone loss (MBL) values were recorded. The gingival crevicular fluid (GCF) and peri-implanter sulcus fluids (PISF) of the patients were collected, and IL-1β and TNF-α levels were measured by ELISA in the samples. The collected data were analyzed with the help of SPSS v.22 package program. Sample PPD score showed a statistically significant difference between the diseased and healthy groups and also sample CAL showed statistically significant higher in Periodontitis(P) compared to periodontally heathy(H) and Gingivitis(G) (p>0.05). IL-1beta and TNF-α levels in GCF/PISF; In the P and Peri-implantitis (PI) group, it was found statistically significantly higher than the H, Healthy-Implant (HI), besides P showed higher levels compared to G (p<0.05). Within the limitations of our study, it can be said that IL-1β and TNF-α among inflammatory cytokines in GCF/PISF will increase in periodontal and peri-implanter diseases, it can also be said that this increase in cytokines may indicate that periodontal and peri-implanter diseases have similar immunological structure. Peri-implant mucositis without periodontitis history has similarity to peri-implantitis and periodontitis in terms of IL-1β and TNF-α levels in GCF/PISF.

Resumen: Se afirma que las enfermedades peri-implantarias tienen efectos destructivos similares a los de las enfermedades periodontales. Este estudio tiene como objetivo comparar los niveles de IL-1β y TNF-α en zonas sanas y enfermas. Cuarenta individuos no fumadores con salud sistémica (40 implantes/40 dientes) (edad:38-67) fueron incluidos en el estudio. En los exámenes clínicos y radiográficos se registraron los valores de índice de placa (PIn), índice gingival (GI), profundidad de la bolsa periodontal (PPD), nivel de fijación clínica (CAL) y pérdida de hueso marginal (MBL). Se recogieron los fluidos creviculares gingivales (GCF) y los fluidos del surco peri-implantario (PISF) de los pacientes, y se midieron los niveles de IL-1β y TNF-α mediante ELISA en las muestras. Los datos recogidos fueron analizados con la ayuda del programa de paquete SPSS v.22. La puntuación PPD de la muestra mostró una diferencia estadísticamente significativa entre los grupos enfermos y sanos y también la muestra CAL mostró estadísticamente significativa más alta en la Periodontitis (P) en comparación con la salud periodontal (H) y la Gingivitis (G) (p>0.05). Los niveles de IL-1beta y TNF-α en GCF/PISF. En el grupo de P y Peri-implantitis (PI), se encontró estadísticamente significativo más alto que el H, implante sano (HI), además P mostró niveles más altos en comparación con G (p<0.05). Dentro de las limitaciones de nuestro estudio, se puede decir que IL-1β y TNF-α entre las citoquinas inflamatorias en GCF/PISF aumentarán en las enfermedades periodontales y peri-implantarias. También se puede decir que este aumento de citoquinas puede indicar que las enfermedades periodontales y peri-implantarias tienen una estructura inmunológica similar. La mucositis peri-implantaria sin antecedentes de periodontitis tiene similitudes con la peri-implantitis y la periodontitis en cuanto a los niveles de IL-1β y TNF-α en la GCF/PISF.

Levels of the interleukins 17A, 22, and 23 and the S100 protein family in the gingival crevicular fluid of psoriatic patients with or without periodontitis,

Abstract Background: Psoriasis and periodontitis are immunologically mediated chronic inflammatory diseases. Epidemiologic evidence has linked both; however, the change of markers in gingival crevicular fluid has been poorly evaluated. Objective: To evaluate the levels of IL-17A, IL-22, IL-23, S100A7, S100A8, and S100A9 in gingival crevicular fluid of psoriatic and healthy subjects with and without periodontitis and their relations to psoriasis severity. Methods: Cross-sectional study. Sample comprised the following groups: healthy controls without periodontitis or with mild periodontitis (n = 21), healthy controls with moderate or severe periodontitis (n = 18), individuals with psoriasis without or mild periodontitis (n = 11), and individuals with psoriasis and moderate or severe periodontitis (n = 32). Levels of IL-17A, IL-22, IL-23, S100A8, and S100A9 were determined by multiplex assay and S100A7 was measured by ELISA. Results: No inter-group differences in the levels of IL-17A, IL-22, IL-23, and S100A7 were found. S100A8 levels were higher in psoriatic patients than controls (p < 0.05). S100A8 was positively correlated with psoriasis severity in the group with psoriasis (p < 0.05). S100A9 exceeded the detection limits. Study limitations: This pilot study presents a small sample size. Conclusions: The concentrations of S100A8 were highest in psoriatic patients regardless of periodontal health/status. S100A8 was associated with the severity of psoriasis. The concentrations of interleukins and S100A7 were similar in psoriatic patients with or without periodontitis vs. healthy controls.

Association between periodontal indexes and biomarkers in gingival crevicular fluid and preterm birth in pregnancy: a nested case-control study / 华西口腔医学杂志

OBJECTIVES@#This study aimed to investigate the association between periodontal indexes and biomarkers in gingival crevicular fluid (GCF) and preterm birth (PTB) in pregnancy, as well as to assess the clinical value of these indexes as predictors of PTB.@*METHODS@#A nested case-control study was conducted. A total of 300 systematically healthy pregnant women were selected within 36 weeks of gestation and grouped according to the enrolled weeks. Periodontal indexes, including probing depth (PD), bleeding index (BI), gingival index (GI), and five biomarkers in GCF, including interleukin (IL)-1β, IL-6, tumor necrosis factor-α (TNF-α), prostaglandin E2 (PGE2), and 8-hydroxy-2-deoxyguanosine (8-OHdG) were measured at the enrolled date. The detailed birth outcome was recorded.@*RESULTS@#Only women at 24-28 weeks of gestation per PTB case (four full-term births) were selected as controls subjects, PTB displayed significantly greater GI, BI, and 8-OHdG (@*CONCLUSIONS@#Increased BI and 8-OHdG at 24-28 weeks of gestation are risk factors for PTB. Their combined detection may have some value in the prediction of PTB, but further studies with a larger sample size are needed to explore it and thus provide experiment evidence for establishing an early warning system for PTB in pregnant women with periodontal disease.

Immunoglobulin G Levels in the Gingival Crevicular Fluid of Menopausal Patients with Periodontitis

Abstract Objective: To measure the level of immunoglobulin G (IgG) in the gingival crevicular fluid (GCF). Material and Methods: A total of 158 patients aged >45 years were examined for periodontitis and interviewed regarding their menopausal status. The non-menopause group entailed female patients with periodontitis without menopause (n=23). The menopause group included females who stopped menstruating since >1 year, had a pocket depth of 4-5 mm, and did not have other systemic conditions (n=40). Samples were selected based on periodontal and menopausal status. In total, 63 samples of GCF were collected from the participants and tested using an enzyme-linked immunosorbent assay kit for IgG. Results: The median level of IgG in the menopause group was 39.50 (g/mL, whereas that of the non-menopause group was 41.08 (g/mL. There was a positive correlation between the plaque index and IgG level in both groups. In contrast, there was a negative correlation between age and IgG level. However, there was no correlation between plaque index and age regarding the IgG level in both groups (p>0.05). Conclusion: The IgG levels in the menopause group were lower than those in the non-menopause group. As such, menopausal females should take great care of their overall health, including the periodontium.

Endocan (ESM-1) levels in gingival crevicular fluid correlate with ICAM-1 and LFA-1 in periodontitis

Abstract: Endocan, a 50 kDa soluble proteoglycan, also called endothelial cell-specific molecule-1 (ESM-1), is involved in many major cellular activities and has been reported to be overexpressed in inflammatory conditions. This study aims to determine ESM-1 levels in gingival crevicular fluid (GCF) samples from individuals with periodontitis to determine the correlation between the levels of lymphocyte-function-associated antigen-1 (LFA-1), intercellular adhesion molecule-1 (ICAM-1), and clinical findings of periodontitis. This study enrolled 27 individuals diagnosed with Stage III-Grade C generalized periodontitis and 16 individuals as healthy controls. Bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment loss (CAL) were calculated. Enzyme-linked immunosorbent assay (ELISA) test was used for detecting the levels of ESM-1, ICAM-1, and LFA-1 in GCF samples. PPD, BOP, CAL, and GCF volumes were significantly increased in patients with periodontitis in comparison to the control group (p < 0.001). The total amount of ESM-1, ICAM-1, and LFA-1 levels in GCF were increased in the periodontitis group (p < 0.001). ESM-1 level correlated with PPD, BOP, and CAL (p < 0.05). ICAM-1 level correlated with BOP and CAL (p < 0.05). LFA-1 level correlated with PPD and CAL (p < 0.05). Our data indicate that ESM-1, ICAM-1, and LFA-1 levels are increased in GCF of patients with periodontitis. These molecules could be associated with the pathogenesis and progression of periodontal disease.

Lymphocyte B and Th17 chemotactic cytokine levels in peri-implant crevicular fluid of patients with healthy, peri-mucositis, and peri-implantitis implants / Niveles de citoquinas quimiotácticas de linfocitos B y Th17 en el fluido crevicular periimplantario de pacientes con implantes sanos, perimucositis y periimplantitis

Peri-implantitis is one of the leading causes of implant failure and loss, and its early diagnosis is not currently feasible due to the low sensitivity of currents methods. In the current exploratory cross-sectional study, we explored the diagnostic potential of lymphocyte B and Th17-chemotactic cytokine levels in peri-implant crevicular fluid (PICF) in 54 patients with healthy, peri-mucositis, or peri-implantitis implants. Peri-implant crevicular fluid was collected, and the levels of the molecules under study were quantified by Luminex assay. The concentrations of CCL-20 MIP-3 alpha, BAFF/BLYS, RANKL and OPG concentration in PICF were analyzed in the context of patient and clinical variables (smoking status, history of periodontitis, periodontal diagnosis, implant survival, suppuration, bleeding on probing, periodontal probing depth, clinical attachment level, mean of implant probing depth, and plaque index). Patients with peri-implantitis, appear to have an overregulation of the RANKL/BAFF-BLyS axis. This phenomenon needs to be investigated in depth in further studies with a larger sample size.

La periimplantitis es una de las principales causas de falla y pérdida del implante, y su diagnóstico temprano no es factible debido a la baja sensibilidad de los métodos actuales. En este estudio transversal exploratorio, se estudió el potencial diagnóstico de los niveles de citocinas quimiotácticas de linfocitos B y Th17 en el líquido crevicular periimplantario (LCPI) en 54 pacientes con implantes sanos, peri-mucositis o periimplantitis. Se recogió líquido crevicular periimplantario y se cuantificaron los niveles de las moléculas estudiadas mediante Luminex assay. Las concentraciones de CCL-20 MIP-3 alfa, BAFF/BLYS, RANKL y la concentración de OPG en LCPI se analizaron en el contexto de las variables clínicas y del paciente (tabaquismo, antecedentes de periodontitis, diagnóstico periodontal, supervivencia del implante, supuración, sangrado al sondaje, profundidad de sondeo periodontal, nivel de inserción clínica, media de la profundidad de sondeo del implante e índice de placa). Los pacientes con periimplantitis parecen tener una sobrerregulación del eje RANKL/BAFF-BLyS. Este fenómeno debe investigarse en profundidad en futuros estudios con un tamaño de muestra mayor.

Differences of B cells, plasma cells, and related cytokines expression in gingival tissues between periodontitis and periodontal healthy subjects / 华西口腔医学杂志

OBJECTIVE@#This study aimed to compare the differences of B cells, plasma cells, and related cytokines expression in gingival tissues between periodontitis and periodontal healthy subjects.@*METHODS@#Gingival tissues were collected from periodontal healthy subjects (periodontal healthy group, n=12) and periodontitis patients (periodontitis group, n=15). Hematoxylin-eosin (HE) staining was used for histopathological examination. Immunohistochemical staining (CD19, CD38, and CD138) was applied to detect the expression of B cells and plasma cells. B cell-activating factor (BAFF) and soluble receptor activator of nuclear factor-κB ligand (sRANKL) were detected by enzyme-linked immunosorbent assay.@*RESULTS@#Extensive inflam-matory cell infiltration was found in the gingival tissues of the periodontitis group. The number of CD19(+), CD38(+), and CD138(+) cells of the periodontitis group was significantly higher than that of the periodontal healthy group (P<0.000 1). BAFF and sRANKL levels of the periodontitis group were higher than those of the periodontal healthy group (P<0.01, P<
0.001, respectively).@*CONCLUSIONS@#The expression of B cells, plasma cells, and their related BAFF and sRANKL cytokines were significantly higher in periodon-titis patients than those in the periodontal healthy subjects, sug-gesting that B cells and plasma cells may be involved in the development of periodontitis.

Gingival crevicular fluid levels of visfatin in patients with chronic periodontitis and polycystic ovary syndrome

Comparison of protein profiles of the pellicle, gingival crevicular fluid, and saliva: possible origin of pellicle proteins

BACKGROUND: The pellicle, the acellular organic material deposited on the surface of tooth enamel, has been thought to be derived from saliva. In this study, protein compositions of the pellicle, gingival crevicular fluid, and saliva collected from healthy adults were compared to elucidate the origin of pellicle proteins. RESULTS: The pellicle, gingival crevicular fluid, and saliva from the parotid gland or mixed gland were collected; subsequently, protein expression in samples from the respective individual was compared by SDS-PAGE and mass spectrometry. Following SDS-PAGE, proteins in the major bands were identified by mass spectrometry. The band pattern of pellicle proteins appeared different from those of gingival crevicular fluid, or saliva samples. Using mass spectrometry, 13 proteins in these samples were identified. The relative abundance of the proteins was quantitatively analyzed using mass spectrometry coupled with stable isotope labeling and by western blot. Cystatin S and α-amylase detected in pellicle were enriched in saliva samples, but not in gingival crevicular fluid, by western blot, and their abundance ratios were high in saliva and low in gingival crevicular fluid when analyzed by stable isotope labeling. Serotransferrin, however, was found only in the pellicle and gingival crevicular fluid by western blot and its abundance ratio was low in saliva. CONCLUSIONS: Our study revealed that the gingival crevicular fluid appears to contribute to pellicle formation in addition to saliva.

Influência de laminados cerâmicos cimentados sobre dentes naturais sem término cervical na microbiota do fluido gengival crevicular: estudo clínico, prospectivo e longitudinal usando PCR em tempo real / Influence of laminate veneers cemented over natural teeth without finish line on the microbiota of gingival crevicular fluid: clinical, prospective and longitudinal study using real-time PCR

Objetivo: quantificar bactérias colonizadoras do sulco gengival em paralelo à verificação do comportamento clínico periodontal e da adaptação marginal de laminados cerâmicos cimentados sobre dentes sem término cervical. Métodos: 73 laminados cerâmicos em dissilicato de lítio monolítico foram cimentados sobre dentes naturais sem término cervical e com a margem cervical posicionada cerca de 0,5mm no interior do sulco gengival. Para todos os dentes foi feita a coleta do fluido gengival crevicular (FGC) previamente à cimentação da restauração (baseline) e em 7, 180 e 365 dias após a cimentação para quantificação das bactérias S. mitis, P. intermedia e P. gingivalis através de PCR em tempo real. Clinicamente foram avaliados os parâmetros índice de placa visível (IPV), sangramento à sondagem (SS), profundidade de sondagem (PS), perda de inserção clínica (PIC), recessão gengival (RG) e a adaptação marginal da restauração em baseline, 7, 15, 30, 60, 180 e 365 dias. Foram obtidas réplicas da região cervical para análise da adaptação marginal por microscopia eletrônica de varredura (MEV). Resultados: Não houve diferença estatisticamente significante para o IPV, PS, SS em todos os períodos analisados (Anova, p>0,05). Não houve registro de PIC e RG. Houve diferença estatisticamente significante para S. mitis na comparação entre 180 e 365 dias (Dunn, p=0,03). Não foi detectado P. intermedia em nenhum dos sítios e não houve diferença estatisticamente significante para P. gingivalis em todos os tempos do estudo (Friedman, p>0,05). Todas as restaurações receberam o conceito alfa para a adaptação marginal nas análises clínica e microscópica. Conclusões: o sobrecontorno causado pelo laminado cerâmico não contribuiu para o acúmulo de placa na região cervical e para alterações no comportamento clínico periodontal, microbiológico e microscópico em relação aos mesmos dentes antes do tratamento restaurador(AU)

Purpose: quantify colonizing bacteria of the gingival sulcus, in parallel to the verify of the periodontal clinical behavior and the marginal adaptation of natural teeth restored with ceramic veneers without finish line. Methods: 73 ceramic veneers in monolithic lithium disilicate were cemented onto natural teeth without finish line and with the cervical margin positioned about 0.5mm inside the gingival sulcus. Gingival crevicular fluid (GCF) was collected for all teeth prior to cementation of the restoration (baseline) and 7, 180 and 365 days after cementation to quantify the bacteria S. mitis, P. intermedia and P. gingivalis through of real-time PCR. Clinically, visible plaque index (PIV), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), gingival recession (GR) and marginal adaptation were evaluated at baseline, 7, 15, 30, 60, 180 and 365 days. Replicas of the cervical region were obtained for analysis of marginal adaptation by scanning electron microscopy (SEM). Results: There was no statistically significant difference for PIV, PD, BOP in all periods analyzed (Anova, p>0.05). There were no records of CAL and RG. There was a statistically significant difference for S. mitis in the comparison between 180 and 365 days (Dunn, p=0.03). P. intermedia was not detected in any of the analyzed samples. There was no statistically significant difference for P. gingivalis at all study times (Friedman, p>0.05). All restorations had an alpha concept for marginal adaptation in clinical and SEM analysis. Conclusions: the overcontouring caused by ceramic veneers did not contribute to the accumulation of plaque in the cervical region and to changes in the clinical, microbiological and microscopic behavior in relation to the same teeth before the restorative treatment(AU)

Fluido gengival e atividade de doença periodontal / Gingival fluid and periodontal disease activity

O fluxo do fluido sulcular gengival (FSG) é fisiológico, proveniente do plexo gengival dos vasos sanguíneos, subjacente ao revestimento epitelial. Aumenta em resposta à inflamação provocada pelo biofilme. Assim como a sua intensidade varia em função da inflamação gengival, observa-se mudanças na sua composição durante a progressão das doenças periodontais. É reconhecido como um grande reservatório de informações moleculares e como uma importante ferramenta de diagnóstico para as doenças periodontais. Sendo assim, o objetivo do deste estudo foi realizar uma revisão da literatura sobre FSG, estabelecer sua relação com a atividade de doença periodontal e sua importância como ferramenta de diagnóstico e prevenção das mesmas. Concluiu-se que os marcadores biológicos do fluido podem ajudar a determinar o risco e a gravidade das doenças periodontais. Essas análises, futuramente, poderão complementar o exame clínico, contribuindo na prevenção, diagnóstico e manejo personalizado de doenças periodontais. Porém, mais estudos devem ser realizados para a utilização rotineira desses métodos nos consultórios odontológicos (AU)

The gingival crevicular fluid flow (GCF) is physiological, that comes from the blood vessels of the gingival plexus, underlying the epithelial lining. It increases in response to the inflammation caused by the biofilm. As its intensity varies due the gingival inflammation degree, changes in its composition are observed during the progression of periodontal diseases. It is recognized as a large reservoir of information about molecules and as an important diagnostic tool for periodontal diseases. Therefore, the aim of this study was to conduct a review of the literature on GCF, to establish its relationship with the activity of periodontal disease and its importance as a tool for diagnosis and prevention. It has been concluded that biological fluid markers can help to determine the risk and severity of periodontal diseases. These analyzes, in the future, may complement the clinical examination, contributing to the prevention, diagnosis and personalized management of periodontal diseases. However, further studies should be performed for the routine use of these methods in dental offices. (AU)

Systematic review of the effect of probiotics on experimental gingivitis in humans

Abstract: Probiotic therapy is a viable alternative to chlorhexidine, a widely used antiseptic in dentistry that produces significant adverse effects. This systematic review aimed to analyze the effects of probiotics on experimental gingivitis in humans. Two independent reviewers conducted a comprehensive literature search until March 2019. Randomized clinical trials and controlled clinical trials were selected. Outcome data were extracted and critically analyzed. A total of five articles were included in the qualitative synthesis. No meta-analysis could be conducted due to the heterogeneity of the selected studies. The use of probiotics showed a slight improvement in clinical parameters. Changes in gingival crevicular fluid volume were lower in the presence of the probiotic than in the placebo group. All the studies showed that the immediate, positive effects of probiotics during the period of discontinued mechanical oral hygiene were due to the modulation of the host response, not the anti-plaque effect. Investigators should conduct randomized clinical trials to elucidate the mechanisms of probiotic action and develop improved delivery systems.

Comparison of TNF-α and IL-1ß Concentrations in Gingival Crevicular Fluid During Early Alignment Stage of Orthodontic Treatment in Adults and Adolescents

Abstract Objective: To compare the levels of TNF-α and IL-1β in the gingival crevicular fluid (GCF) during early leveling stage of orthodontic treatment. Material and Methods: This study was carried out on 20 orthodontic patients, including 10 teenagers and 10 adults. Before bonding, GCF was collected with a paper strip in gingival sulcus of maxillary right central incisor on the disto labial aspect for 60 seconds, followed by bonding and insertion of initial 14 NiTi archwire. GCF collection was repeated 24 hours, 7 days, and 28 days after bonding. Measurement of TNF-α and IL-1β levels was done utilizing Enzyme-Linked Immunosorbent Assay (ELISA). Data were analyzed in SPSS using repeated measurement test. Results: Concentration of TNF-α and IL-1β increased after treatment. There was no significant relationship between TNF-α and IL-1β concentrations subsequent to bonding in comparison to the baseline. There was no significant relationship in TNF-α and IL-1β level changes in the two age groups and between males and females. Conclusion: Concentration of TNF-α and IL-1β increased after treatment. Age and sex had no statically significant effect on the concentration of TNF-α and IL-1β.

The effect of naproxen patches on relieving orthodontic pain by evaluation of VAS and IL-1β inflammatory factor: a split-mouth study

ABSTRACT Introduction: Pain related to orthodontic tooth movement is common and cause dissatisfaction and discomfort. Objective: The present study aimed to compare the efficacy of naproxen patches in pain control during orthodontic tooth separation, by means of visual analogue scale (VAS) and interleukin 1β (IL-1β) levels in gingival crevicular fluid (GCF). Methods: In this split-mouth triple-blind clinical trial, with 40 patients following separation, 5% naproxen or placebo patches were randomly placed on the upper right or left first molars every 8 hours. Pain intensity scores were determined after 2 and 6 hours, sleep time, 24 hours, days 2, 3 and 7 by the patients using a 100-mm VAS ruler. IL-1β levels in GCF were evaluated by ELISA at baseline, 1 and 24 hours and 7 days. Paired samples t-tests and two-way repeated measures ANOVA analysis of variance with a significance level of 0.05 were applied. Results: A total number of 30 patients (13 males and 17 females) finished the trial. Significant differences were found in pain scores (p< 0.0001) and IL-1β levels (p= 0.047) between naproxen and placebo groups. Lower pain scores were reported for the patients using naproxen patches at all time points, except 1 hour after separation. IL-1β levels were lower for the patients using naproxen patches only 1 hour after separation (p= 0.047). The peak of pain scores and IL-1β levels were calculated at 24 hours. Conclusion: In the light of VAS scores and IL-1β levels, naproxen patches reduced the pain caused by separator placement.

RESUMO Introdução: a dor relacionada à movimentação dentária ortodôntica é comum e causa insatisfação e desconforto. Objetivo: o presente estudo teve como objetivo avaliar a eficácia de curativos de naproxeno no controle da dor durante a separação ortodôntica dos dentes, por meio de escalas visuais analógicas (EVA) e dos níveis de interleucina 1β (IL-1β) no fluido crevicular gengival (FCG). Métodos: neste ensaio clínico, triplo-cego, boca dividida, com 40 pacientes após a separação dos dentes, foram aplicados, de forma aleatória, curativos com naproxeno a 5% ou placebo, nos primeiros molares superiores, direito ou esquerdo, a cada 8 horas. Os escores de intensidade da dor foram registrados pelos pacientes após 2 e 6 horas, durante o sono, após 24 horas, 2, 3 e 7 dias, usando uma EVA de 100 mm. Os níveis de IL-1β no FCG foram avaliados pelo ELISA no momento inicial, e após 1 e 24 horas e 7 dias. Foram aplicados testes t para amostras pareadas e ANOVA de duas vias para medidas repetidas, com nível de significância de 0,05. Resultados: no total, 30 pacientes (13 homens e 17 mulheres) terminaram o ensaio clínico. Diferenças significativas foram encontradas nos escores de dor (p< 0,0001) e níveis de IL-1β (p= 0,047) entre os grupos naproxeno e placebo. Índices mais baixos de dor foram relatados pelos pacientes que usaram curativos de naproxeno em todos os tempos avaliados, com exceção de 1 hora após a separação. Os níveis de IL-1β foram menores nos pacientes que usaram os curativos de naproxeno apenas 1 'hora após a separação (p= 0,047). Os picos dos escores de dor e dos níveis de IL-1β foram registrados 24 horas após a separação. Conclusão: considerando-se os escores das EVAs e os níveis de IL-1β, pode-se concluir que os curativos de naproxeno reduziram a dor causada pela instalação dos separadores ortodônticos.

Azithromycin and full-mouth scaling for the treatment of generalized stage iii and iv periodontitis: a 6-month randomized comparative clinical trial

Abstract The effectiveness of azithromycin combined with full-mouth scaling procedures was compared to quadrant-wise scaling combined with the same dosage of azithromycin when treating periodontitis patients over a 6-month period. In this randomized clinical trial study, thirty-four individuals diagnosed with generalized stage III and IV periodontitis underwent baseline, 3-month, and 6-month post-treatment examinations. The study population was randomly assigned to either full-mouth scaling (FMS) or quadrant-wise scaling and root planning (QSRP) in addition to their taking of systemic azithromycin (500 mg/day) for three consecutive days. Periodontal probing depth (PD), clinical attachment level (CAL), gingival index (GI), and plaque index (PI) were monitored along with the quantification of total bacterial load and red complex bacterial species (Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola) in subgingival samples by real time polymerase chain reaction. The volume of gingival crevicular fluid (GCF) was also monitored over time. The primary outcomes included improvements of PD and CAL. Data was statistically analyzed through a repeated-measures analysis of variance (ANOVA) test, multiple least significant difference (LSD) comparisons, Kruskal-Wallis, Friedman, and paired Student t-tests (p<0.05). FMS and QSRP provided similar PD, CAL, GI, PI, and GCF improvements. After treatment, the FMS group displayed lower mean values of total bacterial load and red complex bacterial species in comparison to the QSRP group. FMS and QSRP in conjunction with systemic azithromycin appeared to be an effective and reliable short-term therapeutic approach for the treatment of generalized stage III and IV periodontitis. However, FMD demonstrated superiority in regard to the 6-month antibacterial effects when compared to QSRP.

Resumo A efetividade da azitromicina combinada com a técnica de desinfecção total da boca (DTB) foi comparada a raspagem por quadrante (RQ) utilizando a mesma dosagem de azitromicina no tratamento de indivíduos com periodontite generalizada estágio III e IV, em um período de 6 meses. Trinta e quatro indivíduos foram submetidos aos exames no baseline, 3 e 6 meses pós-tratamento. A população estudada foi alocada aleatoriamente no grupo DTB ou RQ associado a três dias consecutivos de azitromicina (500 mg/dia). Profundidade de sondagem (PS), nível clínico de inserção (NIC), índice gengival (IG) e o índice de placa (IP) foram monitorados, além da quantificação da carga bacteriana total e das espécies bacterianas do complexo vermelho (Porphyromonas gingivalis, Tannerella forsythia e Treponema denticola), em amostras subgengivais, a partir da reação em cadeia da polimerase em tempo real. O volume de fluido crevicular gengival (FCG) também foi monitorado ao longo do tempo. Os resultados primários foram melhorias de PS e NIC. Os dados foram analisados estatisticamente por Análise de variância (ANOVA), comparações múltiplas de diferença menor (LSD), Kruskal-Wallis, Friedman e teste t de Student emparelhado (p<0,05). DTB e RQ forneceram melhorias em PS, NIC, IG, IP e FCG semelhantes. Após o tratamento, o grupo DTB apresentou valores médios mais baixos da carga bacteriana total e de espécies bacterianas do complexo vermelho em comparação com o grupo RQ. DTB e RQ associado a azitromicina sistêmica mostraram ser similarmente uma abordagem terapêutica de curto prazo, eficaz e confiável para o tratamento de periodontite generalizada estágio III e IV. No entanto, DTB demonstrou superioridade sobre os efeitos antibacterianos aos 6 meses em comparação com RQ.

Effect of orthodontic forces on levels of enzymes in gingival crevicular fluid (GCF): A systematic review

Abstract Objective: Orthodontic force application releases multiple enzymes in gingival crevicular fluid (GCF) for activation, resorption, reversal, deposition of osseous elements and extracellular matrix degradation. The current systematic review critically evaluated all existing evidence on enzymes in orthodontic tooth movement. Methods: Literature was searched with predetermined search strategy on electronic databases (PubMed, Scopus, Embase), along with hand search. Results: Initial search identified 652 studies, shortlisted to 52 studies based on PRISMA. Quality assessment further led to final inclusion of 48 studies (13 moderately and 35 highly sensitive studies). Primary outcomes are significant upregulation in GCF levels of enzymes-aspartate aminotransferase (AST), alkaline phosphatase (ALP), matrix metalloproteinases (MMPs), lactate dehydrogenase (LDH), β-glucuronidase (βG), tartrate resistant acid phosphatase (TRAP), acid phosphatase (ACP) and down regulation in cathepsin B (Cb). Site specificity is shown by ALP, TRAP, AST, LDH, MMP9 with levels at compression site increasing earlier and in higher quantities compared with tension site. ALP levels are higher at tension site only in retention. A positive correlation of LDH, ALP and AST is also observed with increasing orthodontic force magnitude. Conclusions: A strong evidence of variation in enzymes (ALP, AST, ACP TRAP, LDH, MMPs, Cb) in GCF is found in association with different magnitude, stages and sites of orthodontic force application.

Resumo Objetivo: a aplicação da força ortodôntica libera múltiplas enzimas no fluído crevicular gengival (FCG), desencadeando a ativação, reabsorção, reversão, deposição de elementos ósseos e degradação da matriz extracelular. A presente revisão sistemática avaliou criticamente toda a evidência disponível sobre os níveis de enzimas durante a movimentação ortodôntica. Métodos: utilizando-se estratégias predeterminadas, foram realizadas buscas em bases de dados eletrônicas (PubMed, Scopus, Embase), sendo também feitas buscas manuais. Resultados: a busca inicial identificou 652 estudos e, com base nas diretrizes do PRISMA, foram selecionados 52 estudos. A avaliação qualitativa resultou na inclusão final de 48 estudos (13 estudos com moderada sensibilidade e 35 com alto nível de sensibilidade). Os desfechos primários foram o aumento significativo dos níveis no FCG das enzimas aspartato aminotransferase (AST), fosfatase alcalina (FA), metaloproteinases de matriz (MMPs), lactato desidrogenase (LDH), β-glucuronidase (βG), fosfatase ácido-resistente ao tartarato (TRAP), fosfatase ácida (FAC) e baixa regulação de catepsina B (Cb). Especificidade quanto ao local foi mostrada para FA, TRAP, AST, LDH e MMP9 com os níveis no lado de compressão aumentando mais rápido e em maiores quantidades, quando comparado ao lado de tensão. Os níveis de FA foram maiores no lado de tensão somente no período de contenção. Uma correlação positiva de LDH, FA e AST também foi observada à medida que a magnitude de força ortodôntica aumentou. Conclusões: há fortes evidências indicando que as variações nas enzimas (FA, AST, FAC, TRAP, LDH, MMPs, Cb) presentes no FCG estão associadas a diferentes magnitudes, estágios e locais de aplicação da força ortodôntica.