Treatment of peri-implantitis using nonsurgical debridement combined with bioresorbable doxycycline nanospheres: a case report with 3-year follow-up.

Treatment of peri-implant diseases focuses on reducing the bacterial load and consequent infection control. The use of local antimicrobials as an adjunct to mechanical therapy may result in a better outcome. Among antimicrobials, doxycycline stands out because of its local modulation of cytokines, microbial reduction, and clinical parameters in the treatment of periodontal diseases. The objective of this case report was to describe the combined application of mechanical debridement and bioresorbable doxycycline-loaded nanospheres for the treatment of peri-implantitis in a 71-year-old man. At the 3-year evaluation, the peri-implant tissues had improved, showing decreased probing depths, an absence of bleeding on probing, and no suppuration. This case report highlights the importance of supportive therapy, which is essential for the long-term success of peri-implantitis treatment.

Smoking negatively impacts the clinical, microbiological, and immunological treatment response of young adults with Grade C periodontitis.

OBJECTIVE: This study aimed to investigate the influence of smoking on clinical, microbiological and immunological parameters in young adult with stage III-IV Grade C periodontitis after full-mouth ultrasonic debridement (FMUD) associated with Amoxicillin and Metronidazole (AMX + MTZ), comparing smokers (PerioC-Y-Smk) with non-smokers (PerioC-Y-NSmk). MATERIALS AND METHODS: Fifteen PerioC-Y-NSmk and 14 PerioC-Y-Smk patients underwent FMUD associated with AMX + MTZ for 10 days. All parameters were collected at baseline and 3 and 6 months after treatment. Plaque index (PI), bleeding on probing (BoP), probing depth (PD), clinical attachment level (CAL)- the primary variable-, and gingival recession (GR) were clinically assessed. The impact of PI on CAL change at 6-month was verified by a regression analysis. Samples of the subgingival biofilm was collected for detection of levels of Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), Porphyromonas gingivalis (P.gingivalis), Tannerella forsythia (T. forsythia), and Fusobacterium nucleatum ssp (F. nucleatum), and were analyzed by real-time qPCR; gingival crevicular fluid was collected for detection of levels of interleukin (IL)-1ß, IL-4, IL-6, IL-10, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ, which were analyzed using an enzyme immunoassay. RESULTS: PerioC-Y-Smk had significantly higher PI, BOP, and GR at baseline compared to non-smokers (p < .05). PerioC-Y-Smk presented higher PD, CAL, and GR at 3 and 6 months (p < .05) compared with PerioC-Y-NSmk in the same periods; PI negatively affected CAL gain in PerioC-Y-NSmk at 6-month follow-up (p = .052) and did not impact on clinical response in PerioC-Y-Smk (p = .882). Lower levels of IFN-γ, IL1-ß, and IL-4 were observed at 3 months in the PerioC-Y-NSmk (p < .05) compared with PerioC-Y-Smk. Lower proportions of P. gingivalis were observed in PerioC-Y-NSmk at baseline and at 3 months (p < .05) and lower proportions of F. nucleatum were observed at 6 months, in the PerioC-Y-NSmk (p < .05). CONCLUSIONS: PerioC-Y-Smk presents an unfavorable clinical, microbiological, and immunological response after 3 and 6 months after FMUD associated with AMX + MTZ. CLINICAL RELEVANCE: Smoking worsens periodontal condition of young treated adults presenting stage III/IV Grade C periodontitis.

Enamel matrix protein derivative and/or synthetic bone substitute for the treatment of mandibular class II buccal furcation defects. A 12-month randomized clinical trial.

OBJECTIVE: This study aims to clinically evaluate the treatment of mandibular class II furcation defects with enamel matrix derivative (EMD) and/or a bone substitute graft made of ß-tricalcium phosphate/hydroxyapatite (ßTCP/HA). MATERIALS AND METHODS: Forty-one patients, presenting a mandibular class II buccal furcation defect, probing pocket depth (PPD) ≥4 mm and bleeding on probing, were included. They were randomly assigned to the groups: 1-EMD (n = 13); 2-ßTCP/HA (n = 14); 3-EMD + ßTCP/HA (n = 14). Plaque index (PI), gingival index (GI), relative gingival margin position (RGMP), relative vertical and horizontal attachment level (RVCAL and RHCAL), and PPD were evaluated at baseline and 6 and 12 months. The mean horizontal clinical attachment level gain was considered the primary outcome variable. RESULTS: No significant intragroup differences were observed for RGMP, but significant changes were observed for RVCAL, RHCAL, and PPD for all groups (p < 0.05). After 12 months, the mean horizontal clinical attachment level gain was 2.77 ± 0.93 mm for EMD, 2.64 ± 0.93 mm for ßTCP/HA, and 2.93 ± 0.83 mm for EMD + ßTCP/HA, with no significant differences among the groups. At the end of the study, 85.3 % of the sites were partially closed; however, no complete closure was observed. CONCLUSION: EMD + ßTCP/HA does not provide a significant advantage when compared to the isolated approaches. All three tested treatments promote significant improvements and partial closure of class II buccal furcation defects. Based on its potential to induce periodontal regeneration, EMD may be considered an attractive option for this type of defect, but complete closure remains an unrealistic goal. CLINICAL RELEVANCE: The partial closure of buccal furcation defects can be achieved after the three tested approaches. However, the combined treatment does not provide a significant benefit when compared to the isolated approaches.

Dentin hypersensitivity reduction using an arginine-based approach after non-surgical periodontal treatment.

PURPOSE: To determine the efficacy of two oral hygiene regimens in the reduction of dentin hypersensitivity (DH) on subjects undergoing non-surgical periodontal treatment (NST), over a period of 8 weeks. METHODS: 60 subjects that were randomly assigned to: Test group - NST followed in-office application of an arginine-based professional paste and toothbrushing with arginine-based toothpaste at home (n= 30) and Control group - NST followed in-office application of a fluoride-free prophylaxis paste and toothbrushing with a toothpaste based on sodium monofluorophosphate 0.76%, at home (n= 30). Air blast sensitivity assessments were made using the Schiff scale. The sensitivity parameters were measured at baseline, 1, 4 and 8 weeks. RESULTS: After 1 week, DH reduction was statistically significant for the test group (63.6%) compared to baseline, while no significant reduction was observed for the Control group (4.8%). After 4-8 weeks, the reductions were 81.6%/86.3% for the test group and 9.5%/14.2% for the Control group. When comparing the two groups, the test group showed a superior DH reduction in all evaluation periods (P< 0.05). Within the limits of the present study, it was concluded that the test oral hygiene regimen can effectively reduce dentin hypersensitivity during the most critical period after non-surgical periodontal treatment (up to 8 weeks). CLINICAL SIGNIFICANCE: The arginine-based approach provided significantly greater dentin hypersensitivity (DH) relief after non-surgical periodontal treatment (NST) when compared to the control. The combination of the in-office paste application with the daily used toothpaste may be a useful tool to reduce DH, an unpleasant and common condition that affects a large number of subjects, particularly during the initial weeks following NST.

Efficacy of a combined in-office/home-use desensitizing system containing 8% arginine and calcium carbonate in reducing dentin hypersensitivity: an 8-week randomized clinical study.

PURPOSE: To determine the efficacy in reducing dentin hypersensitivity (DHS) of a combined in-office and home-use desensitizing system, each product containing 8% arginine and calcium carbonate (Test), following a dental scaling procedure, compared to the combination of a conventional prophylactic paste and a potassium nitrate dentifrice (Control), in a group of patients with known dentin hypersensitivity. METHODS: An 8-week clinical study, with 50 subjects, was conducted in Piracicaba, São Paulo, Brazil, using a double-blind/two treatment design. Air blast sensitivity assessments were used to compare the efficacy of the two approaches using both the Schiff scale as well as a Visual Analogue Scale (VAS). RESULTS: Immediately after prophylaxis, the Test treatment provided significant reduction in DHS when compared to baseline values (VAS = 26.2% and Schiff = 29.1%), while for Control treatment this difference was not statistically significant (VAS = 8.1% and Schiff = 6.6%). The comparison between groups after prophylaxis showed a greater DHS reduction for the Test treatment (P < 0.05). The reductions in DHS after 2, 4 and 8 weeks were significant for both groups, however, when considering Schiff scale, the Test treatment provided greater DHS reduction after 2 weeks (44.5% for Test versus 27.7% for Control) and 4 weeks (55.2% for Test and 40.5% for Control), while after 8 weeks there was no significant difference between groups (71.1% for Test versus 61.1% for Control).

Connective tissue graft plus resin-modified glass ionomer restoration for the treatment of gingival recession associated with non-carious cervical lesions: microbiological and immunological results.

OBJECTIVES: It was previously reported the clinical results of placing subgingival resin-modified glass ionomer restoration for treatment of gingival recession associated with non-carious cervical lesions. The aim of this study was to evaluate the influence of this treatment on the subgingival biofilm and gingival crevicular fluid (GCF) inflammatory markers. MATERIALS AND METHODS: Thirty-four patients presenting the combined defect were selected. The defects were treated with either connective tissue graft plus modified glass ionomer restoration (CTG+R) or with connective tissue graft only (CTG). Evaluation included bleeding on probing and probing depth, 5 different bacteria targets in the subgingival plaque assessed at baseline, 45, and 180 days post treatments, and 9 inflammatory mediators were also assessed in the GCF. RESULTS: The levels of each target bacterium were similar during the entire period of evaluation (p > 0.05), both within and between groups. The highest levels among the studied species were observed for the bacterium associated with periodontal health. Additionally, the levels of all cyto/chemokines analyzed were not statistically different between groups (p > 0.05). CONCLUSION: Within the limits of the present study, it can be concluded that the presence of subgingival restoration may not interfere with the subgingival microflora and with GCF inflammatory markers analyzed. CLINICAL RELEVANCE: This approach usually leads to the placement of a subgingival restoration. There is a lack of information about the microbiological and immunological effects of this procedure. The results suggest that this combined approach may be considered as a treatment option for the lesion included in this study.

Association of hyaluronic acid with a collagen scaffold may improve bone healing in critical-size bone defects.

OBJECTIVES: To evaluate the effects of a 1% hyaluronic acid (HA) gel in combination with an absorbable collagen sponge (ACS) in the healing of critical-size calvaria defects in rats. MATERIAL AND METHODS: Thirty-two adult Wistar rats were used. Two 5-mm-diameter critical-size defects were created and the treatments were randomly distributed as follows: (1) 1% HA; (2) 1% HA gel-soaked ACS; (3) control (blood clot); and (4) ACS. The animals were sacrificed 60 days post-surgery, when biopsies were collected and processed for histology and histometric analysis. Bone fill was measured as the difference between the initial and the final defect sizes. Non-parametric tests were used to analyze differences between treatments (α=1%) and a t-test for body weight gain in each treatment group (α=5%). RESULTS: Histological analysis showed bone formation on the edges of the defects, although very limited, and a thin layer of connective tissue occupying the midportion of the defects in the control and the ACS groups. Defects filled with a 1% HA gel and 1% HA gel+ACS had a thicker layer of connective tissue and more new bone formed in the margins of the defects. Linear histometric measures showed no significant differences in the initial defect sizes between the groups (P>0.05). The association 1% HA gel+ACS (0.96 ± 0.14 mm) had significantly greater bone fill than the control (0.5 ± 0.02 mm) and ACS (0.56 ± 0.05 mm)-treated groups (P=0.0043 and 0.0173, respectively). Treatment with a 1% HA gel (0.7 ± 0.14 mm) showed no significant differences when compared with the other treatments. CONCLUSION: Within the limits of this study, a 1% HA gel associated with a collagen scaffold can improve new bone formation in critical-size defects. However, this treatment never resulted in complete closure of the defects and healing in the major portion of the defects was characterized by fibrous tissue.

Gingival recession associated with noncarious cervical lesions: combined periodontal-restorative approach and the treatment of long-term esthetic complications.

Buccal gingival recession is a prevalent problem in populations with a high standard of oral hygiene and is often associated with noncarious cervical lesions (NCCLs), leading to the need for a combined periodontal-restorative approach for better esthetic and functional results. In the literature, resin-modified glass ionomer (RMGI) restorations associated with periodontal surgery have been shown to achieve significant root coverage and reduction of dentin sensitivity; however, changes to the color of some of those restorations have been observed, which could compromise esthetics. Therefore, the aim of the present case report is to describe and discuss the current understanding of treatment for a gingival recession associated with an NCCL with a periodontal-restorative approach, and to describe treatment of RMGI color alteration problems two years after treatment.

Clinical, radiographic, and patient-centered outcomes after use of enamel matrix proteins for the treatment of intrabony defects in patients with aggressive periodontitis: A 12-month multicenter clinical trial.

BACKGROUND: The aim of this study was to evaluate the clinical, radiographic and patient-centered results of enamel matrix derivative (EMD) therapy in intrabony defects in aggressive periodontitis (AgP) patients and compare them with those in chronic periodontitis (CP) patients. METHODS: Sixty intrabony defects in AgP and CP patients associated with ≥ 6 mm residual probing pocket depth (PPD) were included and randomly assigned to one of three groups: AgP+CS (conservative surgery) (n = 20); AgP+CS/EMD (n = 20); CP+CS/EMD (n  =  20). Clinical parameters were measured at baseline and after 6 and 12 months. Defect resolution (DR) and bone filling (BF) were used for radiographic analysis. The quality of life was recorded at baseline and 6 months using OHIP-14 and VAS scale in the early post-therapy period. RESULTS: PPD and relative clinical attachment level (rCAL) improved for all groups during follow-up (P ≤ 0.05), and AgP+CS/EMD presented a higher rCAL gain (2.4 ± 1.0 mm) when compared to AgP control patients (1.6 ± 1.6 mm, P ≤ 0.05) after 12 months. No difference was observed between AgP+CS/EMD and CP+CS/EMD groups (P > 0.05). No radiographic differences were observed among groups at any time point (P > 0.05). All the groups reported a positive impact on OHIP-14 total score, without differences among them. CONCLUSIONS: EMD therapy of intrabony defects promotes additional benefits in AgP patients, presenting a similar regeneration rate compared to CP patients, and has proven to be a viable therapy for the treatment of individuals with AgP.

Enamel matrix derivative proteins for the treatment of proximal class II furcation involvements: a prospective 24-month randomized clinical trial.

OBJECTIVE: This study aimed to evaluate the response of proximal furcations treated with enamel matrix derivative proteins (EMD) in a 24-month follow-up. MATERIALS AND METHODS: Twelve patients presenting bilateral class II proximal furcation with vertical probing depth (PD) ≥5 mm and bleeding on probing were selected. The furcations were assigned to: a control group (n=12), open flap debridement (OFD)+EDTA and a test group (n=12) - OFD+EDTA+EMD. The gingival margin position, PD, relative vertical and horizontal clinical attachment level (RVCAL and RHCAL), vertical and horizontal bone level (VBL and HBL) and furcation closure were evaluated before treatment and after 6, 12 and 24 months. RESULTS: After follow-up, no statistical difference could be seen between groups. At 24 months, the test group showed 1.9 ± 1.6 mm PD reduction whereas the control group showed 1.0 ± 1.3 mm PD reduction. RHCAL gains of the control and the test group were 0.7 ± 1.3 and 1.4 ± 0.9 mm, respectively. However, at 24 months, the test group only presented five remaining class II furcations versus 10 furcations in the control group (p<0.05). CONCLUSION: It could be concluded that EMD therapy promoted a reduction in the number of proximal furcations presenting a diagnosis of class II after 24 months of treatment compared with OFD therapy.

Cervical restoration and the amount of soft tissue coverage achieved by coronally advanced flap: a 2-year follow-up randomized-controlled clinical trial.

BACKGROUND: The aim of this study was to evaluate the 2-year follow-up success of the treatment of gingival recession associated with non-carious cervical lesions by a coronally advanced flap (CAF) alone or in combination with a resin-modified glass ionomer restoration (CAF+R). MATERIAL AND METHODS: Sixteen patients with bilateral Miller Class I buccal gingival recessions, associated with non-carious cervical lesions, were selected. The defects received either CAF or CAF+R. Bleeding on probing (BOP), probing depth (PD), relative gingival recession (RGR), clinical attachment level (CAL) and cervical lesion height (CLH) coverage were measured at the baseline and 6, 12 and 24 months after the treatment. RESULTS: Both groups showed statistically significant gains in CAL and soft tissue coverage. The differences between groups were not statistically significant in BOP, PD, RGR and CAL, after 2 years. The percentages of CLH covered were 51.57 +/- 17.2% for CAF+R and 53.87 +/- 12.6% for CAF (p>0.05). The estimated root coverage was 80.37 +/- 25.44% for CAF+R and 83.46 +/- 20.79% for CAF (p>0.05). CONCLUSION: Within the limits of the present study, it can be concluded that both procedures provide acceptable soft tissue coverage after 2 years, with no significant differences between the two approaches.

Connective tissue graft plus resin-modified glass ionomer restoration for the treatment of gingival recession associated with non-carious cervical lesion: a randomized-controlled clinical trial.

BACKGROUND: The aim of this clinical study was to evaluate the treatment of gingival recession, associated with non-carious cervical lesions by a connective tissue graft (CTG) alone, or in combination with a resin-modified glass ionomer restoration (CTG+R). MATERIALS AND METHODS: Forty patients presenting Miller Class I buccal gingival recessions, associated with non-carious cervical lesions, were selected. The defects were randomly assigned to receive either CTG or CTG+R. Bleeding on probing (BOP), probing depth (PD), relative gingival recession (RGR), clinical attachment level (CAL) and cervical lesion height (CLH) coverage were measured at baseline and 45 days, and 2, 3 and 6 months after treatment. RESULTS: Both groups showed statistically significant gains in CAL and soft tissue coverage. The differences between groups were not statistically significant in BOP, PD, RGR and CAL, after 6 months. The percentages of CLH covered were 74.88 +/- 8.66% for CTG and 70.76 +/- 9.81% for CTG+R (p>0.05). The estimated root coverage was 91.91 +/- 17.76% for CTG and 88.64 +/- 11.9% for CTG+R (p>0.05). CONCLUSION: Within the limits of the present study, it can be concluded that both procedures provide comparable soft tissue coverage. The presence of the glass ionomer restoration may not prevent the root coverage achieved by CTG.

Clinical and Microbiological Evaluation of Surgical and Nonsurgical Treatment of Aggressive Periodontitis.

The present study aimed to evaluate clinical and microbiological effects of surgical and nonsurgical periodontal therapy in generalized aggressive periodontitis (GAgP) treatment. Sixteen GAgP patients were included in this randomized split-mouth design clinical trial. Maxillary quadrants were allocated into two groups: Nonsurgical Therapy (NST) and Surgical Therapy (ST). The following clinical parameters were assessed: plaque index (PI), bleeding on probing index (BoP), probing depth (PD), clinical attachment level (CAL) and gingival margin position (GMP). Concentrations of Porphyromonas gingivalis (Pg) and Aggregatibacter actinomycetemcomitans (Aa) in the subgingival biofilm were also determined. Clinical and microbiological parameters were assessed at baseline (n=16), 3 (n=15), 6 (n=15) and 12 months (n=8) after treatment. ST was able to promote higher PD reduction compared to NST in deep pockets at 12 months (p<0.05) and in posterior teeth at 6 months (p<0.05). In addition, higher gingival recession was observed in posterior teeth of the ST group at the 6th month (p<0.05). However, ST failed to promoted additional CAL gain in any timepoint (p>0.05). Moreover, microbiological evaluation showed no statistical difference in levels of Aa and Pg for both groups at all follow-up periods. Surgical therapy promoted similar clinical benefits to GAgP therapy. Moreover, both therapies failed to reduce Aa and Pg levels at different follow-up times.

A double-blind randomized clinical evaluation of enamel matrix derivative proteins for the treatment of proximal class-II furcation involvements.

OBJECTIVE: The aim of the present randomized, double-blind study was to evaluate the clinical response of proximal furcations treated with enamel matrix derivative proteins (EMD). MATERIAL AND METHODS: Fifteen patients, each with a pair of contralateral class-II proximal furcation involvements, presenting probing depths (PDs) >/=5 mm and bleeding on probing (BOP) were selected. The patients were randomly assigned to: control group (n=15) - open flap debridement (OFD)+24% ethylenediaminetetraacetic acid (EDTA) conditioning; test group (n=15) - OFD+24% EDTA conditioning+EMD application. Plaque index (PI), BOP, PD, gingival margin position (GMP), relative vertical and horizontal clinical attachment level (RVCAL and RHCAL), vertical and horizontal bone level (VBL and HBL) and furcation closure were evaluated immediately before and 2, 4 and 6 months after the surgeries. RESULTS: At 6 months, the RVCAL gains of the control and test group were 0.39 +/- 1.00 and 0.54 +/- 0.95 mm, while the RHCAL gains were 1.21 +/- 2.28 and 1.36 +/- 1.26 mm (p>0.05). The VBL and HBL gains of the control group were 1.04 +/- 1.12 and 1.00 +/- 1.79 mm, and 0.82 +/- 1.82 and 1.17 +/- 1.38 mm for the test group (p>0.05). In addition, a statistical difference was observed in the number of the remaining class-II furcations between the test and control groups (p<0.05) in this period. CONCLUSION: It may be concluded that the use of EMD in proximal furcations did not promote a superior reduction in PD or a gain in clinical and osseous attachment levels, but resulted in a higher rate of class-II to class-I furcation conversion.

Coronally positioned flap plus resin-modified glass ionomer restoration for the treatment of gingival recession associated with non-carious cervical lesions: a randomized controlled clinical trial.

BACKGROUND: The aim of this randomized clinical trial was to evaluate the treatment of gingival recession associated with non-carious cervical lesions by a coronally advanced flap alone (CAF) or in combination with a resin-modified glass ionomer restoration (CAF+R). METHODS: Nineteen subjects with bilateral Miller Class I buccal gingival recessions associated with non-carious cervical lesions were selected. The recessions were assigned randomly to receive CAF or CAF+R. Bleeding on probing (BOP), probing depth (PD), relative gingival recession (RGR), clinical attachment level (CAL), non-carious cervical lesion height (CLH), and dentin sensitivity (DS) were measured at baseline; 45 days; and 2, 3, and 6 months postoperatively. Keratinized tissue width (KTW) and keratinized tissue thickness (KTT) were measured at baseline and 6 months. The height of the non-carious cervical lesion located on the root and crown were estimated, allowing calculation of root coverage. RESULTS: Both groups showed statistically significant gains in CAL and soft tissue coverage. The differences between groups were not statistically significant for BOP, PD, RGR, CAL, KTW, and KTT after 6 months. The percentages of CLH covered were 56.14% +/- 11.74% for CAF+R and 59.78% +/- 11.11% for CAF (P >0.05). The root and crown surfaces affected by the non-carious cervical lesion were 1.67 +/- 0.31 mm and 0.96 +/- 0.29 mm, respectively, for CAF+R and 1.59 +/- 0.37 mm and 1.01 +/- 0.33 mm, respectively, for CAF. The estimated root coverage was 88.02% +/- 19.45% for CAF+R and 97.48% +/- 15.36% for CAF (P >0.05). CAF+R reduced DS significantly compared to CAF (P <0.05). CONCLUSIONS: Both procedures provided similar soft tissue coverage after 6 months. Despite the fact that a greater reduction in DS was observed after CAF+R, longitudinal observations are necessary to confirm these results.

Clinical and laboratory evaluations of non-surgical periodontal treatment in subjects with diabetes mellitus.

BACKGROUND: The aim of this study was to evaluate the clinical and laboratory changes 3 months after full-mouth scaling and root planing in subjects with and without diabetes mellitus. METHODS: This study was performed using 10 subjects with type 2 diabetes mellitus who required insulin therapy (DM) and 10 healthy adult control subjects (NDM) with generalized chronic periodontal disease. Both groups were treated with full-mouth scaling and root planing and given oral hygiene instructions. Clinical parameters, including plaque index (PI), gingival index (GI), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL), were measured at four sites per tooth. Subgingival plaque samples were obtained from sites with the deepest PD (> or =5 mm) and with furcations in each subject. Samples were also tested for the presence of Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans), Porphyromonas gingivalis, and Tannerella forsythia (previously T. forsythensis) by polymerase chain reaction. Glycemic control (glycosylated hemoglobin [HbA1c] and fasting glucose levels) and clinical and microbiologic assessments were recorded at baseline and 3 months after periodontal treatment. RESULTS: Data revealed statistical changes (P < or =0.05; analysis of variance [ANOVA]) in clinical variables (PI, GI, PD, GR, and CAL) between baseline and 3 months in both groups. Conversely, no improvement in the fasting glucose level or glycosylated hemoglobin (P < or =0.05; ANOVA) was found after treatment. Besides some reduction in the bacterial frequency 3 months after treatment, no statistically significant difference was found between the groups. CONCLUSION: Clinical and laboratory responses were similar in DM and NDM groups 3 months after full-mouth scaling and root planing.

An oxidized implant surface may improve bone-to-implant contact in pristine bone and bone defects treated with guided bone regeneration: an experimental study in dogs.

BACKGROUND: The aim of the present study was to histometrically evaluate bone healing in the absence of bone defects and in the presence of surgically created bone defects treated by guided bone regeneration at oxidized and turned implant surfaces. METHODS: Three months after dental extractions, standardized buccal dehiscence defects (height: 5 mm; width: 4 mm) were surgically created following implant site preparation in the mandible of 10 dogs. Oxidized-surface implants (OSI) and turned-surface implants (TSI) were inserted bilaterally, and the bone defects were treated by guided bone regeneration. After 3 months of healing, the animals were sacrificed, blocks were dissected, and undecalcified sections were obtained and processed for histometric analysis. The percentage of bone-to-implant contact (BIC) and bone density (BD) was evaluated inside the threads on the buccal (regenerated bone) and lingual sides (pristine bone) of the implants. Data were evaluated using two-way analysis of variance (P <0.05). RESULTS: New bone formation could be observed in OSI and TSI in the region of the defect creation. The BIC values observed in OSI for pristine and regenerated bone were 57.03% +/- 21.86% and 40.86% +/- 22.73%, respectively. TSI showed lower values of BIC in pristine bone (37.39% +/- 23.33%) and regenerated bone (3.52% +/- 4.87%). The differences between OSI and TSI were statistically significant. BD evaluation showed no statistically significant differences between OSI and TSI in pristine and regenerated bone. CONCLUSION: The oxidized implant surface promoted a higher level of BIC than the turned implant surface at pristine and regenerated bone.

Platelet-rich plasma and connective tissue grafts in the treatment of gingival recessions: a histometric study in dogs.

BACKGROUND: The aim of this study was to histometrically evaluate the healing process of gingival recessions treated with platelet-rich plasma (PRP) in combination with a subepithelial connective tissue graft (SCTG) and to compare it to that obtained with SCTG alone. METHODS: Six mongrel dogs were used in the experiment. Gingival recessions (5 x 7 mm) were surgically created and exposed to plaque accumulation for 1 month. Contralateral defects were randomly assigned to the test group (SCTG + PRP) or the control group (SCTG). Dogs were sacrificed 45 days after the surgeries, and the blocks containing the experimental specimens were processed for histologic analysis. The histometric parameters evaluated were length of sulcular and junctional epithelium, connective tissue adaptation, new cementum, new bone, and defect extension. RESULTS: A greater length of new cementum was observed in the sites treated with PRP (2.18 +/- 0.78 mm) compared to the control group (1.19 +/- 0.62 mm) (P < or =0.05). No statistically significant differences were observed in the remaining parameters. The extension of total epithelium (sulcular and junctional epithelium) was 2.04 +/- 0.57 mm for the test group and 2.49 +/- 0.82 mm for the control group. The new connective tissue adjacent to the root without cementum formation was 0.29 +/- 0.28 mm and 0.23 +/- 0.18 mm for the test and control groups, respectively. Bone position was -0.57 +/- 0.95 mm for the test group and -0.46 +/- 1.34 mm for the control group. CONCLUSION: Within the limits of this study, the combination of PRP with SCTG was more effective in promoting new cementum formation than the graft alone.

Effects of sodium lauryl sulphate (SLS), present in dentifrice, on volatile sulphur compound (VSC) formation in morning bad breath.

The purpose of the present investigation was to evaluate the effects of sodium lauryl sulphate (SLS), present in a commercial dentifrice, on the formation of volatile sulphur compounds (VSC) and tongue coating in a panel of periodontally healthy subjects. A two-step blinded, crossover, randomized study was carried out in 25 dental students with healthy periodontium; these were divided into two experimental groups: SLS (dentifrice with SLS) and WSLS (dentifrice without SLS). The volunteers received the designated dentifrice and a new toothbrush for a 3x/day brushing regimen for 2 periods of 30 days. A seven-day washout interval was used between the periods. The assessed parameters were: plaque index (PI), gingival index (GI), organoleptic breath (ORG), VSC levels by portable sulphide monitor before (H1) and after (H2) cleaning of the tongue, tongue coating wet weight (TC) and benzoyl-DL-arginine-naphthylamide (BANA) test from tongue coating samples. The intra-group analysis showed a decrease in the median of organoleptic scores from 3 to 2 after 30 days for the SLS group (p < 0.05). The inter-group analysis showed lower values in ORG and H1 for the SLS group (p < 0.05). There was no difference between the amount of TC in SLS and WSLS groups. In the BANA test, the presence of SLS did not affect the BANA number of +/- results (p > 0.05). These findings suggest that sodium lauryl sulphate (SLS), present in dentifrice, appears to prevent VSC formation in morning bad breath regardless of the amount of tongue coating in periodontally healthy subjects.

Tetracycline gel as an adjunct to surgical root debridement.

PURPOSE: To evaluate the influence of tetracycline gel, brushed on tooth surfaces, on periodontal clinical parameters following root debridement. METHODS: 20 subjects diagnosed with chronic periodontitis and presenting a minimum of two proximal sites on anterior teeth (maxillary or mandibular) with probing depth +/- 5 mm, were selected. Following oral hygiene instructions and ultrasonic supragingival instrumentation, subjects were assigned to one of the following groups: RDS--root debridement with Gracey curettes and root brushing with saline solution; and RDT--root debridement with Gracey curettes and root brushing with 40% tetracycline gel. Full-thickness flaps were reflected and instrumentation was performed using a clinical microscope to optimize calculus detection. Probing depth (PD), relative gingival margin level (RGML) and relative attachment level (RAL) measures were registered at five visits: baseline and days 30, 60, 90 and 120 postoperative. RESULTS: Both approaches were able to markedly reduce the PD values from baseline in all periods (P < 0.0001). No differences were found for RAL values in any of the groups. No differences were found between groups. In conclusion, the application of tetracycline gel does not seem to provide any additional improvement on clinical periodontal parameters after root debridement.