Gingival crevicular fluid response to protocols of non-surgical periodontal therapy: A longitudinal evaluation.

CONTEXT AND AIM: Gingival crevicular fluid (GCF) volume reflects the level of periodontal inflammation. This secondary analysis aimed to evaluate the GCF volume in patients submitted to non-surgical periodontal therapies under a split-mouth design. MATERIALS AND METHODS: GCF volume of 25 participants (47.24 ± 6.47 years) with moderate-to-severe chronic periodontitis was collected at Days 0, 30, 60, 90, 120, 270, and 450. The participants were submitted to three different non-surgical therapies randomly assigned per quadrant [GI: supragingival control (Supra) as only intervention (one quadrant); GII: Supra plus scaling and root planing (SRP) on Day 0 (two quadrants); GIII: Supra on Day 0 and SRP 30 days later (one quadrant)]. During treatment (0-60 days) and maintenance (90-450 days) participants were submitted to supragingival plaque control reinforcements. GCF volumes were analyzed after logarithmic transformation (log10) and linear models were used for intra- and inter-group comparisons, considering the data dependence. RESULTS: Baseline GCF volumes were similar between groups (GI: 0.39 ± 0.22 µl; GII: 0.42 ± 0.26 µl; GIII: 0.41 ± 0.14 µl;P > 0.05). At Day 60, GCF volumes were significantly reduced (GI: 0.20 ± 0.13 µl; GII: 0.18 ± 0.11 µl; GIII: 0.22 ± 0.13 µl; P < 0.001), without inter-groups differences. These results were maintained along maintenance period (P > 0.05). Even in sites bleeding on probing (BOP) + the means of GCF volume did not differ between groups (P > 0.05). CONCLUSIONS: All therapies determined reductions on the GCF volume along time. Supragingival plaque control modulated the subgingival area during the study, reinforcing the importance of this control over the subgingival inflammatory response.

Comparative analysis between hard- and soft-filament toothbrushes related to plaque removal and gingival abrasion.

OBJECTIVE: The aim of this split-mouth, examiner-blind study was to compare the dental plaque removal and incidence of gingival abrasion associated with the use of hard- and soft-filament toothbrushes. METHODOLOGY: The test group consisted of 20 non-dental students, mean age 25 years. After a three-day period of plaque accumulation following the use of a disclosing solution, the Quigley-Hein Plaque Index was recorded, while the presence of gingival abrasion was measured from photographs. Pairs of quadrants 1-3 and 2-4 were allocated to supervised brushing with hard- or soft-filament toothbrushes for 30 seconds, limited to the buccal aspects of the teeth. Plaque levels and gingival abrasion were again assessed. Initial and final values of the plaque index and the mean number of abrasions were compared with the Friedman and Wilcoxon tests (p < or = 0.05). RESULTS: Plaque indices were reduced significantly from a baseline of 4.12 in both groups to 1.21 after the use of hard-filament toothbrushes, and to 1.67 after the use of soft-filament toothbrushes. The use of hard-filament toothbrushes resulted in a significantly higher mean number of lesions when compared to the soft-filament toothbrushes; 11.6 and 7.9, respectively (p = 0.018). CONCLUSION: Hard-filament toothbrushes remove more plaque than soft filament brushes, but also cause a higher number of gingival abrasions.

Self-perception of patients after periodontal treatment: A longitudinal study.

AIMS: To investigate the perceptions of subjects regarding nonsurgical periodontal treatment over a period of 1 year. SETTINGS AND DESIGN: This is a secondary analysis of a randomized clinical trial, in a longitudinal observational design. METHODS: Nineteen subjects (47.24 ± 6.47 years) with moderate to severe periodontitis completed a questionnaire at two different times after a nonsurgical periodontal treatment: 30 (T1) and 390 days (T2). The questionnaire with 40 items was divided into three domains: 1-perception of changes in clinical signs of periodontal disease, 2-psychological aspects of the subject regarding their oral health status, and 3-satisfaction with the treatment. STATISTICAL ANALYSIS: Each response on the Likert scale initially showed scores ranging from 1 to 5 points. The results for each question were dichotomized into 1 or 0, respectively, showing if the subject was favorable or unfavorable to treatment. A descriptive data analysis was performed, assessing the agreement of the results in T1 and T2 (Kappa). RESULTS: The results generally showed a favorable perception related to the treatment and continued satisfaction over time. The exceptions were in regards to gingival recession, persistent bleeding and bad breath, and difficulty in performing the mechanical control imposed by the professional. CONCLUSION: It was concluded that the therapy used was satisfactory to the subjects and that a favorable perception was maintained after 1 year of follow-up.

Supragingival treatment as an aid to reduce subgingival needs: a 450-day investigation.

This study investigated the clinical effects of using a supragingival biofilm control regimen (SUPRA) as a step prior to scaling and root planing (SRP). A split-mouth clinical trial was performed in which 25 subjects with periodontitis (47.2 ± 6.5 years) underwent treatment (days 0­60) and monitoring (days 90­450) phases. At Day 0 (baseline) treatments were randomly assigned per quadrant: SUPRA, SRP and S30SRP (SUPRA 30 days before SRP). The full-mouth visible plaque index (VPI), gingival bleeding index (GBI), periodontal probing depth (PPD), bleeding on probing (BOP), and clinical attachment loss (CAL) were examined on days 0, 30, 60, 90, 120, 270, and 450. Baseline data were similar among all groups. From days 0 to 60, the groups showed similar significant decreases in VPI and GBI. Reductions in PPD for the SRP (3.39 ± 0.17 to2.42 ± 0.16 mm) and S30SRP (3.31 ± 0.11 to 2.40 ± 0.07 mm) groups were greater (p < 0.05) than those for the SUPRA group. This pattern was also observed for BOP. Attachment gain was similar and greater for the SRP (3.34 ± 0.28 to 2.58 ± 0.26 mm) and S30SRP (3.25 ± 0.21 to 2.54 ± 0.19 mm) groups compared to the SUPRA group. Results were maintained from day 90 forward. Overall, the S30SRP treatment reduced the subgingival treatment needs in 48.16%. Performance of a SUPRA step before SRP decreased subgingival treatment needs and maintained the periodontal stability over time.

Influência do tabagismo em doenças peri-implantares / The influence of smoking on periimplant diseases

A peri-implantite é uma doença bacteriana infecciosa que afeta tecidos moles e duros em torno do implante, promovendo a perda de osseointegração. Entre os fatores de risco, podemos considerar o tabagismo e doença periodontal, pois, quando presentes, podem exacerbar a perda de altura óssea, dificultar a cicatrização após cirurgia mucogingival, e causar a falha do implante. Com base nisso, este estudo objetiva fazer uma revisão de literatura sobre a relação entre tabagismo e doenças peri-implantares. A pesquisa foi realizada na base de dados pubmed. O principal achado foi que o tabagismo é considerado um fator de risco para falha de implantes dentários e para o desenvolvimento da peri-implantite. Na comparação de fumantes com não fumantes, os autores consideraram que a falha no tratamento do implante é maior nos fumantes, bem como na presença de doenças peri-implantes. As taxas de falha de implantes colocados em seios maxilares enxertados são observadas duas vezes mais em fumantes do que em não fumantes, além da maior da perda óssea marginal.

Peri-implantite is an infectious bacterial disease that affects soft and hard tissues around the implant, promoting the loss of osseointegration. Among the risk factors, we can consider tobacco and periodontal disease important factors that can exacerbate loss of bone height, worse healing after mucogingival surgery and implant failure. The aim of this study was to review the literature about the relation between smoking and peri-implant diseases. The search was performed in the pubmed database. The main finding was that smoking is considered a risk factor for failure of dental implants and for the development of peri-implantitis. In the comparison of smokers with nonsmokers, the authors considered that the failure of implant treatment is greater in smokers, as well as the presence of peri-implant diseases. The failure rates of implants placed in maxillary sinuses grafted in smokers are more than two-fold observed than in nonsmokers and smokers show increased marginal bone loss.

Efeito do controle do biofilme supragengival na condição periodontal de pacientes tabagistas: uma revisão sistemática / Effect of supragingival plaque control on periodontal disease in smokers: a systematic review

Objetivo: avaliar, por meio de uma revisão sistemática da literatura, se o controle do biofilme supragengival, em pacientes fumantes, é capaz de alterar os critérios clínicos e microbiológicos associados à periodontites. Metodologia: a estratégia de busca envolveu o uso de bases de dados eletrônicos: MEDLINE e Cochrane Oral Health Group, entre 1965 e Janeiro de 2009. As palavras-chave utilizadas no MEDLINE foram: supragingival plaque control AND (subgingival OR debridement OR scaling and root planing OR non surgical OR oral hygiene OR periodontitis OR gingivitis OR plaque subgingival OR lost attachment OR probing pocket depth OR bleeding).Nessa busca foram localizadas 307 referências bibliográficas, contemplando os mais variados tipos de estudos. No Cochrane as palavras-chave aplicadas foram: supragingival plaque control AND oral hygiene, sendo obtidas 137 referências. A aplicação de critérios de inclusão permitiu que 4 estudos fossem avaliados na íntegra: 3 ensaios clínicos com seleção randômica de sítios experimentais e 1 ensaio clínico sem randomização. Resultados: dos estudos avaliados, 2 avaliaram somente a intervenção supragengival e 2avaliaram, também, a intervenção subgengival. Pôde-se observar que o controle supragengival, como intervenção única, foi capaz de determinar redução dos indicadores clínicos e microbiológicos periodontais, sendo os melhores resultados condicionados a um adequado programa de controle do biofilme supragengival. Conclusão: o estudo mostrou que o efeito do controle de biofilme supragengival em pacientes tabagistas é capaz de melhorar significativamente os indicadores clínicos e microbiológicos associados à gengivite e periodontite.

Aim: to conduct a systematic review of the literature to assess whether supragingivalplaque control is able to change clinical and microbiological markers associated with periodontal disease in smokers. Methodology: articles published between 1965 and January 2009 and indexed in the MEDLINE and Cochrane Oral Health Group databases were browsed. The following keywords were used on MEDLINE: supragingival plaque control AND (subgingival OR debridement OR scaling and root planing OR non surgical OR oral hygiene OR periodontitis OR gingivitis OR plaque subgingival OR lost attachment OR probing pocket depth OR bleeding);the search on MEDLINE yielded 307 references, including different types of studies. On Cochrane, the keywords employed were supragingival plaque control AND oral hygiene; this search yielded 137 studies. After application of inclusion criteria, four studies were selected for full-text review: three clinical trials with randomly selected experimental sites and one nonrandomized clinical trial. Results: of the four studies reviewed, two assessed the effects of supragingival plaque control alone, whereas the other two assessed both supragingival and subgingival interventions.It was possible to observe that supragingival plaque control alone was able to reduce clinical and microbiological indicators associated with periodontal disease, and that the best results were obtained after an adequate supragingival plaque control regimen. Conclusion: our study showed that supragingival plaque control is able to significantly improve clinical and microbiological markers associated with gingivitis and periodontitis in smokers.

Disinfection of gutta-percha cones with chlorhexidine and sodium hypochlorite.

OBJECTIVES: To evaluate the effectiveness of chlorhexidine (CHX) or sodium hypochlorite (NaOCl) in disinfecting gutta-percha cones, to verify contamination of gutta-percha cones in their boxes, and to identify microorganisms after intentional contamination by handling cones. STUDY DESIGN: Gutta-percha cones contaminated in vitro with several microorganisms were left in contact with tested disinfecting solutions for different times, sterility of storage boxes was evaluated by immersing cones in broth medium, and the microorganisms most frequently found in handling cones were identified using biochemical tests. RESULTS: CHX was not effective in eliminating Bacillus subtilis spores on gutta-percha cones after 72 h of contact with the disinfecting substance. 5.25% NaOCl eliminated spores from gutta-percha after 1 min of disinfection. The cones evaluated from their boxes did not show contamination in 94.5% of the cases. The microbial genus most frequently found after intentional contamination with gloves was Staphylococcus. CONCLUSION: 5.25% NaOCl is an effective agent for a rapid disinfection of gutta-percha cones.