Osteogenic cells transfer improving root coverage: A randomized clinical trial.

BACKGROUND AND OBJECTIVE: The aim of this interventional, parallel-assignment, single-blinded, randomized, efficacy study was to investigate the efficacy of the treatment of gingival recessions by osteogenic cell transfer. This is the first randomized clinical trial of this nature. MATERIAL AND METHODS: Treatment of Miller class I or II gingival recessions >4 mm was randomly defined by casual sorting and performed by newly forming bone graft (NFBG) and coronally advanced flap (CAF) or subepithelial connective tissue graft (SCTG) and CAF (control). Clinical examinations were performed by a single blinded examiner at baseline and at 3, 6, and 9 months after surgery. Parameters investigated were recession height (REC), probing depth (PD), clinical attachment level, gingival bleeding index (GBI), plaque index (PlI), and keratinized gingiva width (KGW). RESULTS: Both techniques achieved similar percentage of root coverage, but NFBG was more effective in pocket depth reduction, attachment level gain, and reduction of plaque accumulation and of bleeding on probing. CONCLUSIONS: These findings suggest that the transfer of osteogenic cells by NFBG is able to improve clinical attachment level and to cover denuded roots. NFBG can be used as an alternative treatment of deep recessions (≥4 mm), where the restoration of lost periodontal tissues is intended.

Oral health impact profile of head and neck cancer patients after or before oncologic treatment: an observational analytic case-control study.

PURPOSE: The objective of this study was to investigate the impact of oral health on the quality of life of patients with head and neck cancer (HNC) before and after oncologic treatment. METHODS: Forty cancer-free individuals (Cf group) and 40 HNC patients (Hnc group) were included in this study. Hnc group was also divided into two subgroups: Hnc 1 (pre-cancer therapy, n = 20) and Hnc 2 (post-cancer therapy, n = 20). Participants were asked to complete a short form of Oral Health Impact Profile (OHIP-14). The results were statistically analyzed with the multivariate analysis of variance with post-hoc Scheffé multiple comparison. RESULTS: It was observed a moderate impact on the quality of life on HNC patients, with values on Hnc 2 group significantly higher in the functional limitation when compared to the Hnc 1 group (p < 0.05). When compared to the Cf group, the values found on Hnc group were higher on functional limitation (p < 0.01) and at the total score (p < 0.05), whereas Hnc 2 group had significant superior values on functional limitation (p < 0.01), physical pain (p < 0.05), and total score (p < 0.01) CONCLUSION: These results show that there is an oral impairment that depreciates the quality of life of patients with an experience of HNC, principally after treatment, indicating the importance of the inclusion of professionals responsible for dental and oral care with the oncologic team to monitor the oral condition of these patients.

Bone demineralization improves onlay graft consolidation: A histological study in rat calvaria.

BACKGROUND: Previous data suggest that bone demineralization may promote bone graft consolidation as well as proliferation and differentiation of pre-osteoblasts, but the biological mechanisms involved in this process need to be clarified. This study investigated the effects of bone demineralization with citric acid (CA) and tetracycline (TCN) on the repair of onlay bone grafts. METHODS: Onlay bone grafts were performed on the calvaria of 126 Wistar rats. The contacting surfaces between bone graft and receptor bone bed were demineralized for 15, 30, and 60 seconds with TCN (50 mg/mL), or 10% CA, (pH 1), constituting the following test groups (n = 18): TCN15, TCN30, TCN60, CA15, CA30, and CA60. Control grafts (C) were performed without demineralization (n = 18). After 7, 30, and 60 days, biopsies were obtained for quantitative and qualitative histological analysis (a = 6). RESULTS: Demineralization accelerated the bone repair early from 7 days of healing. Higher percentage area of newly formed bone was observed in CA15 and TCN60 groups when compared to C in all evaluation periods (P = 0.02). At 30 days, C specimens had lower percentage of consolidated surfaces than TCN60, TCN30 and CA15 (P = 0.0015). At 60 days, CA15, CA60, and TCN60 presented bone surfaces almost completely filled by newly formed bone, against about 75% in C specimens (P = 0.0015). CONCLUSIONS: Both CA and TCN were effective in accelerating osteogenesis at the interface between bone grafts and receptor bone beds, especially when applied for 15 seconds and 60 seconds, respectively.

Fluctuations in public water fluoride level in Bauru, Brazil.

OBJECTIVES: The aim of this study was to monitor the quality of public water supply fluoridation in Bauru, in the state of São Paulo, Brazil. METHODS: Water samples collected three times a week during four weeks in 20 areas of distribution of water were supplied by the City Water Department of Bauru, São Paulo, Brazil. Fluoride was analyzed using the ion-specific electrode (Orion model 9409) after sample buffering with an equal volume of TISAB II. Data were compared to fluoride concentration reported by City Water Department. RESULTS: Fluoride content ranged between 0.01 ppm and 9.35 ppm (n = 240). There was great variation among the different areas of distribution of water, as showed by the Levene test (P < .001). Kruskal-Wallis test showed a statistically significant difference in mean fluoride concentration among different areas (P < .001). Mean fluoride concentration was less than the optimum concentration (0.8 ppm) in 89 percent of samples. The values reported by the City water Department were always higher than the analyzed fluoride concentrations. CONCLUSIONS: Based on the results from this study, more rigorous surveillance and monitoring of water fluoridation in Bauru is recommended.

Demineralization of the contacting surfaces in autologous onlay bone grafts improves bone formation and bone consolidation.

BACKGROUND: Autologous bone grafts are usually well consolidated after 4 to 5 months but can be incompletely interlocked with the native bone. This study investigated the effect of acid demineralization of the graft-bed interface on graft consolidation. METHODS: Onlay bone grafts were performed on the calvaria of 36 guinea pigs. Half of the animals had the graft-bed contacting surfaces demineralized with 50% citric acid (pH 1.0) for 3 minutes (test group). The other half received no demineralization (control group). The bone grafts were immobilized by a resorbable membrane glued to the recipient bed with cyanoacrylate. After 7, 30, and 90 days, specimens (n = 6) were obtained for light microscopy. Data from qualitative analysis and computerized histomorphometry were statistically processed at a significance level of 5%. RESULTS: Osteogenesis was not seen at the interface after 7 days. After 30 days, the test group showed 34.39% ± 13.4% of the interface area filled with mineralized tissue, compared to 17.14% ± 8.6% in the control group (P = 0.026). After 90 days, the mean percentages of mineralized tissue at the interface in the test and control specimens were 54.00% ± 11.23% and 38.65% ± 7.76% (P = 0.041), respectively. Within groups, a higher percentage of the area filled with mineralized tissue was seen at 90 days compared to 30 days (P = 0.004 for control and 0.041 for test). CONCLUSIONS: Demineralization of the contacting surfaces between autologous bone graft and bone bed improved new bone formation and bone consolidation. These data need to be confirmed in humans.

Laser therapy as an effective method for implant surface decontamination: a histomorphometric study in rats.

BACKGROUND: To the best of the authors' knowledge, a standard protocol for treating peri-implantitis is not yet established. METHODS: A total of 150 titanium disks with smooth or rough surfaces contaminated with microbial biofilm were implanted subcutaneously in rats after undergoing one of three treatments: 1) low-intensity laser (LIL); 2) antimicrobial photodynamic therapy (aPDT); or 3) toluidine blue O (TBO). Sterile and contaminated disks served as negative (NC) and positive (C) control groups, respectively. After days 7, 28, and 84, tissue inflammation was evaluated microscopically by measuring the density of collagen fibers (degree of fibrosis) and concentration of polymorphonuclear neutrophils. RESULTS: Surface texture did not affect the degree of inflammation, but the area of reactive tissue was significantly greater for rough implants (2.6 ± 3.7 × 10(6) µm(2)) than for smooth ones (1.9 ± 2.6 × 10(6) µm(2); P = 0.0377). Group C presented the lowest and group NC presented the highest degree of fibrosis with significance only after day 7; these groups had the highest and lowest scores, respectively, for degree of inflammation. Group C showed the largest area of reactive tissue (9.11 ± 2.10 × 10(6) µm(2)), but it was not significantly larger than group LIL (P = 0.3031) and group TBO (P = 0.1333). Group aPDT showed the smallest area (4.34 ± 1.49 × 10(6) µm(2)) of reactive tissue among the treatment groups. After day 28, groups LIL, aPDT, TBO, and C resembled group NC in all the studied parameters. CONCLUSION: Group aPDT showed more favorable results in parameter area of reactive tissue than the other methods after day 7, but over longer time periods all methods produced outcomes equivalent to sterile implants.

Fluoride modulates preosteoblasts viability and matrix metalloproteinases-2 and -9 activities.

This study evaluated the influence of fluoride on cell viability and activity of matrix metalloproteinases (MMP) -2 and -9 secreted by preosteoblasts. Preosteoblasts (MC3T3-E1 murine cell line) were cultured in MEM medium supplement with 10% Fetal Bovine Serum (FBS) and nucleosides/ribonucleosides without ascorbic acid. Adherent cells were treated with different concentrations of F (as sodium fluoride-NaF) in medium (5 x 10(-6) M, 10(-5) M, 10(-4) M and 10(-3) M) for 24, 48, 72 and 96 h at 37ºC, 5% CO(2). Control cells were cultivated in MEM only. After each period, preosteoblast viability was assessed by MTT assay. MMP-2 and -9 activities were performed by gel zymography. Also, alkaline phosphatase (ALP) activity was quantified by colorimetry in all experimental groups. It was shown that cultured cells with the highest dose of F (10(-3) M) for 96 h decreased preosteoblast viability while lower doses of F did not alter it, when compared to untreated cells. No differences were observed in ALP activity among groups. Moreover, compared to control, the treatment of cells with F at low dose slightly increased MMP-2 and -9 activities after 24 h. It was concluded that F modulates preosteoblast viability in a dose-dependent manner and also may regulate extracellular matrix remodeling.

Fluoride modulates preosteoblasts viability and matrix metalloproteinases-2 and -9 activities

This study evaluated the influence of fluoride on cell viability and activity of matrix metalloproteinases (MMP) -2 and -9 secreted by preosteoblasts. Preosteoblasts (MC3T3-E1 murine cell line) were cultured in MEM medium supplement with 10% Fetal Bovine Serum (FBS) and nucleosides/ribonucleosides without ascorbic acid. Adherent cells were treated with different concentrations of F (as sodium fluoride-NaF) in medium (5 x 10-6 M, 10-5 M, 10-4 M and 10-3 M) for 24, 48, 72 and 96 h at 37ºC, 5% CO2. Control cells were cultivated in MEM only. After each period, preosteoblast viability was assessed by MTT assay. MMP-2 and -9 activities were performed by gel zymography. Also, alkaline phosphatase (ALP) activity was quantified by colorimetry in all experimental groups. It was shown that cultured cells with the highest dose of F (10-3 M) for 96 h decreased preosteoblast viability while lower doses of F did not alter it, when compared to untreated cells. No differences were observed in ALP activity among groups. Moreover, compared to control, the treatment of cells with F at low dose slightly increased MMP-2 and -9 activities after 24 h. It was concluded that F modulates preosteoblast viability in a dose-dependent manner and also may regulate extracellular matrix remodeling.

Neste estudo, buscou-se avaliar a influência do fluoreto (F) na viabilidade celular e atividade das metaloproteinases de matriz (MMP) -2 e -9 secretado pelos pré-osteoblastos. Pré-osteoblastos (linhagem celular MC3T3-E1 murina) foram cultivados em meio MEM suplementado com 10% de soro fetal bovino (FBS) e nucleosídeos/ribonucleosídeos sem ácido ascórbico. Células aderidas foram tratadas com diferentes concentrações de F (na forma de fluoreto de sódio-NaF) em meio (5 x 10-6 M, 10-5 M, 10-4 M e 10-3 M) por 24, 48, 72 e 96 h a 37ºC, 5 % de CO2. Células do grupo controle foram cultivadas apenas em MEM. Após cada período, a viabilidade dos pré-osteoblastos foi avaliada por MTT. A atividade das MMP-2 e -9 foram analisadas pela zimografia. Além disso, a atividade da fosfatase alcalina (FA) foi quantificada por colorimetria em todos os grupos experimentais. Foi demonstrado que as células cultivadas com a maior dose de F (10-3 M) no período de 96 h tiveram sua viabilidade comprometida, enquanto doses mais baixas de F não a alteraram significativamente, quando comparado com células não tratadas. Não foi observada diferença na atividade da FA entre os grupos. Além disso, o tratamento de células com F em baixas doses, comparado ao grupo controle, promoveu um pequeno aumento da atividade das MMP-2 e -9 após 24 h. Pode-se concluir que o F modula a viabilidade de pré-osteoblastos de uma maneira dose-dependente e também pode regular a remodelação da matriz extracelular.

Histomorphometric study of the healing of human oral mucosa after gingivoplasty and low-level laser therapy.

BACKGROUND AND OBJECTIVES: The aim of the present study was to analyze the effects of diode laser irradiation on the healing of human oral mucosa. MATERIALS AND METHODS: After gingivoplasty, the right hemi-arch (test group) of 16 patients was irradiated with a diode laser. The left side (control group) was not irradiated. Incisional biopsies were performed on both sides at 7, 14, 21, and 60 days after surgery and morphometrically analyzed by light microscopy. RESULTS: Epithelium width ranged from 260.6 to 393.5 microm. Volume densities of basal (20.2%), prickle cell (55.6%), and cornified (24.2%) layers remained stable. The peak number of neutrophils were 6 cells/mm(2) and the mononuclear cells were 44 cells/mm(2). Collagen fibers (80%) and fibroblasts (14%) occupied the main volume of connective tissue. The one-way ANOVA and the paired Student's t-test were used for statistical analysis (P < 0.05). CONCLUSION: Low-level laser therapy did not accelerate the healing of oral mucosa after gingivoplasty.

Princípios ortodôntico-periodontais para homeostasia periodontal e harmonia estética / Orthodontic-periodontal principles for periodontal homeostasis and aesthetic harmony

Introdução: a reabilitação de pacientes periodontais encontra sérios inconvenientes devido ao aumento da coroa clínica gerado por procedimentos cirúrgicos quando se almeja sulco gengival fisiológico. Objetivos: apresentar, por meio de casos clínicos, uma metodologia de tratamento que inclui a integração de Ortodontia, Periodontia e Odontologia Reconstrutiva para preencher requisitos de estética, fonética, função oclusal, fisiologia periodontal e higiene na reabilitação de pacientes periodontais. Métodos: serão apresentados quatro casos clínicos ilustrando como a tração coronal lenta e rápida de dentes com envolvimento das distâncias biológicas pode possibilitar a cirurgia periodontal sem alterar suas coroas clínicas, porém levando ao restabelecimento de sulco gengival raso, viabilizando a obtenção dos requisitos propostos com a reconstrução dentária. Resultados: achados clínicos e radiográficos longitudinais mostraram que pode-se mobilizar a topografia óssea e gengival com o movimento ortodôntico, favorecendo a recomposição das estruturas periodontais de conformidade com os desígnios da natureza, culminando com a obtenção de condições propícias para a reconstrução odontológica restauradora. Conclusões: as metodologias de tração coronal lenta e rápida são meios eficazes para viabilizar o tratamento periodontal restaurador da homeostasia marginal dos tecidos, favorecendo a reconstrução restauradora dentro dos princípios mecânicos, estéticos, fonéticos, funcionais e preventivos e, com isso, reintegrando o paciente à sociedade.

Uso de piercing na língua como fator etiológico incomum de recessões gengivais / Tongue piercing as an unusual etiologic factor for gingival recessions

O uso de adornos em partes não convencionais do corpo incluindo a cavidade oral, é conhecido como body art. Essa antiga prática indígena retornou aos padrões da moda tanto no Brasil quanto em todo o mundo e, apesar de apresentar um contexto social e comportamental, o uso do piercing pode ser perigoso. Inúmeros problemas podem ocorrer devido ao uso nas regiões intra e peribucal, entre elas: fratura e desgaste dentários, trincas de esmalte, dor, dificuldade na fala, mastigação e deglutição, hipersalivação, infecção e recessão gengival. E ainda, complicações mais graves como hemorragia, aspiração do piercing com obstrução de vias aéreas e bacteremia seguida de morte já foram relatadas na literatura. O presente artigo descreve um caso de recessões múltiplas na face lingual de dentes inferiores causadas pelo uso prolongado de piercing na língua. O paciente havia removido o metal dois meses antes do exame periodontal, o que dificultou a obtenção do diagnóstico final, que foi definido após exame intrabucal acurado e análise comportamental detalhada. Como essa prática tem se tornado cada vez mais comum, os cirurgiões-dentistas devem estar alertas sobre o uso de piercing na região bucal e peribucal, conhecer os riscos e aconselhar seus pacientes sobre cuidados, manutenção e possíveis lesões decorrentes do uso dessas bijuterias. Além disso, o uso de piercing deve sempre ser levado em consideração como fator etiológico de lesões dentárias e de tecidos moles da boca como a recessão gengival.

The wearing of jewelry in unconventional parts of the body including oral cavity is known as body art. This practice is a fashion nowadays all over the world. Despite all the social and behavioral reasons for the use of a piercing, it can be harmful. In general the complications of using an intraoral piercing are tooth fracture, chipping tooth, pain, speech, mastication and deglution difficulties, hypersalivation, infection, gingival recession. Moreover, emergency situations such as hemorrhage, collapse, jewelry aspiration and airway obstruction may occur. This paper describes an unusual case of multiple mandibular lingual recessions caused by a prolonged use of a tongue piercing. Since the patient had removed the piercing two months before, the final diagnosis was obtained by an accurate intraoral exam and detailed behavioral history. As this practice is becoming more popular, dentists should be aware of this problem and know how to advise the patients about risks, care and maintenance of such appliances. Furthermore, the use of oral piercing must be remembered as an etiological factor and differential diagnosis for recessions and tooth fracture.