Non-surgical instrumentation associated with povidone-iodine in the treatment of interproximal furcation involvements

OBJECTIVE: The aim of this controlled clinical trial was to evaluate the effect of topically applied povidone-iodine (PVP-I) used as an adjunct to non-surgical treatment of interproximal class II furcation involvements. MATERIAL AND METHODS: Thirty-two patients presenting at least one interproximal class II furcation involvement that bled on probing with probing pocket depth (PPD) >5 mm were recruited. Patients were randomly chosen to receive either subgingival instrumentation with an ultrasonic device using PVP-I (10 percent) as the cooling liquid (test group) or identical treatment using distilled water as the cooling liquid (control group). The following clinical outcomes were evaluated: visible plaque index, bleeding on probing (BOP), position of the gingival margin, relative attachment level (RAL), PPD and relative horizontal attachment level (RHAL). BAPNA (N-benzoyl-L-arginine-p-nitroanilide) testing was used to analyze trypsin-like activity in dental biofilm. All parameters were evaluated at baseline and 1, 3 and 6 months after non-surgical subgingival instrumentation. RESULTS: Six months after treatment, both groups had similar means of PPD reduction, RAL and RHAL gain (p>0.05). These variables were, respectively, 2.20±1.10 mm, 1.27±1.02 mm and 1.33±0.85 mm in the control group and 2.67±1.21 mm, 1.50±1.09 mm and 1.56±0.93 mm in the test group. No difference was observed between groups at none of the posttreatment periods, regarding the number of sites showing clinical attachment gain >2 mm. However, at 6 months posttreatment, the test group presented fewer sites with PPD >5 mm than the control group. Also at 6 months the test group had lower BAPNA values than control group. CONCLUSION: The use of PVP-I as an adjunct in the non-surgical treatment of interproximal class II furcation involvements provided limited additional clinical benefits.

Amoxicillin/metronidazole or scaling and root planing in the treatment of chronic periodontitis

The aim of the present study was to evaluate the treatment with amoxicillin or metronidazole in comparison to scaling and root planing in the treatment of chronic periodontitis. Randomised clinical trials were searched in the databases MEDLINE, EMBASE, SciELO, Cochrane and Scopus from 1989 to 2010. The search started with 2895 articles.. From this initial number of articles, 10 publications were selected and included in the study according to fixed criteria. Studies included adult patients of both sexes aged between 21 and 80, diagnosed with chronic periodontitis and treated with amoxicillin and/or metronidazole or scaling and root planning. From each article, details were abstracted relating to sample size, design, sex, age, oral hygiene habits, the exposure to drug (doses, schedule), and results such as clinical effect, analysis methods, stratification variables. Conclusion: this meta-analysis showed absence of statistically significant difference between the effects studied.

El objetivo del presente estudio fue evaluar el tratamiento con amoxicilina o metronidazol en comparacion con el raspado y alisado radicular en el tratamiento de la periodontitis cronica. Ensayos clinicos aleatorios se seleccionaron de las bases de datos MEDLINE, EMBASE, Scielo, Cochrane, y Scopus desde el ano 1989 a 2010. La busqueda comenzo con 2895 articulos. A partir de este numero inicial de articulos, 10 publicaciones fueron seleccionadas e incluidas en el estudio de acuerdo a los criterios fijados. Los estudios incluyeron pacientes adultos de ambos sexos, con edades entre 21 y 80 anos, diagnosticados con enfermedad periodontal cronica y tratados con amoxicilina y/o metronidazol o raspaje y alisado radicular. De cada articulo se extrajo el tamano muestral, diseno, genero y edad, habitos de higiene oral, medicacion (dosis y esquema), resultado clinico, metodo de analisis y variables de estratificacion. Conclusion: este meta-analisis mostro ausencia de significacion estadistica entre los efectos estudiados.

Effect of enamel matrix proteins on the treatment of intrabony defects: a split-mouth randomized controlled trial study

The objective of this split-mouth, double-blind, randomized controlled trial was to compare the clinical effect of treatment of 2- or 3-wall intrabony defects with open flap debridement (OFD) combined or not with enamel matrix proteins (EMP). Thirteen volunteers were selected with one pair of or more intrabony defects and probing pocket depth (PPD) > 5 mm. All individuals received instructions regarding oral hygiene and were submitted to scaling and root planing. Each participant received the two treatment modalities: test sites were treated with OFD and EMP, and control sites received only OFD. After 6 months, a significant reduction was observed in PPD for the EMP group (from 6.42 ± 1.08 mm to 2.67 ± 1.15 mm) and for the OFD group (from 6.08 ± 1.00 mm to 2.00 ± 0.95 mm) (p < 0.0001), but with no significant difference between groups (p = 0.13). A significant gain in relative attachment level (RAL) was observed in both groups (EMP: from 13.42 ± 1.88 mm to 10.75 ± 2.26 mm, p < 0.001; OFD: from 12.42 ± 1.98 mm to 10.58 ± 2.23 mm, p = 0.013), but with no significant difference between groups (p = 0.85). Gingival recession (GR) was higher in the EMP group (from 1.08 ± 1.50 mm to 2.33 ± 1.43 mm; p = 0.0009) than in the OFD group (from 0.66 ± 1.15 mm to 1.16 ± 1.33 mm; p = 0.16), but this difference was not significant (p = 0.06). In conclusion, the results showed that OFD combined with EMP was not able to improve treatment of intrabony defects compared to OFD alone.

O objetivo deste estudo clínico controlado, randomizado, duplo-cego, tipo boca-dividida foi comparar o efeito clínico do tratamento de defeitos infra-ósseos de 2 ou 3 paredes com retalho de espessura total (RET) associado ou não com a proteína da matriz do esmalte (PME). Treze voluntários com 1 par ou mais de defeitos infra-ósseos foram selecionados com profundidade clínica de sondagem (PCS) > 5 mm. Todos receberam instruções de higiene bucal, raspagem e alisamento radicular. Cada participante recebeu os dois tipos de tratamento: o lado teste foi tratado com RET e PME, e o lado controle recebeu somente RET. Após 6 meses, foi observada uma redução significante na PCS para o grupo PME (de 6,42 ± 1,08 mm para 2,67 ± 1,15 mm) e para o grupo RET (de 6,08 ± 1,00 mm para 2,00 ± 0,95 mm) (p < 0,0001), mas não houve diferença significante entre os grupos (p = 0,13). Um ganho significante de nível clínico de inserção relativo (NCIR) foi observado em ambos os grupos (PME: de 13,42 ± 1,88 mm para 10,75 ± 2,26 mm, p < 0,001; RET: de 12,42 ± 1,98 mm para 10,58 ± 2,23 mm, p = 0,013), mas não houve diferença significante entre os grupos (p = 0,85). A retração gengival (RG) foi maior para o grupo PME (de 1,08 ± 1,50 mm para 2,33 ± 1,43 mm; p = 0,0009) do que para o grupo RET (de 0,66 ± 1,15 mm para 1,16 ± 1,33 mm; p = 0,16), mas essa diferença não foi significante (p = 0,06). Concluiu-se que o tratamento de defeitos infra-ósseos com RET associado à PME não mostrou resultados melhores que o uso de RET sozinho.

Pool of bovine morphogenetic proteins and guided tissue regeneration in the treatment of intrabony periodontal defects: I- Clinical measurements

Este estudo teve como objetivo avaliar a aplicação do ''pool'' de BMPs bovinas no tratamento de defeitos intra-ósseos. A amostra constou de quinze indivíduos com idade entre 26 e 57 anos, apresentando um par de defeitos intra-ósseos comparáveis, localizados no mesmo arco em dentes do mesmo tipo (pré-molares ou molares) e com perda de inserção (PI) 35mm. Em cada indivíduo, o defeito teste foi tratado com a associação ''pool'' de BMPs- carreador Hidroxiapatita reabsorvível (BMPs-HA), matriz orgânica bovina desmineralizada liofilizada (MO) e barreira de colágeno bovino, enquanto os defeitos controle foram tratados com MO-HA e barreira de colágeno. Na avaliação clínica aos seis meses após a medida inicial, o grupo teste apresentou variação de profundidade de sondagem (PS) de -1,63mm ± 1,141 na vestibular (V) e -1,93mm ± 0,961 na lingual (L) e variação do nível de inserção (NI) de -1,60mm ± 1,168 na V e -1,46mm ± 0,972 na L. O grupo controle apresentou variação de PS de -1,93mm ± 1,347 (V) e -2,0mm ± 1,511 (L) e variação de NI de -1,03mm ± 1,245 (V) e -1,30mm ± 1,114 (L). A análise de variância indicou que a variação de PS e NI foi significativa em ambos os grupos (p<0,05). Entretanto, de acordo com o teste t não houve diferença significativa entre os grupos quanto à variação PS e NI (p<0,05). Em conclusão, a aplicação do ''pool'' de BMPs não oferece benefícios adicionais ao tratamento de defeitos intra-ósseos.