The Impact of Type 2 Diabetes Mellitus on Non-Surgical Periodontal Treatment: A Non-Randomized Clinical Trial.

Background/Objectives: Periodontitis (P), a chronic inflammatory condition that affects the supportive tissues around the teeth, is three to four times more prevalent in individuals with diabetes mellitus (DM), with a direct correlation between its severity and the levels of glycosylated hemoglobin (HbA1c). This study aimed to evaluate the periodontal clinical parameters following non-surgical periodontal treatment (NSPT) in P patients with or without type 2 DM. Methods: Forty patients with P were divided into two groups: Group DM/P and Group P. All the patients were assessed at baseline and at 90 and 180 days after receiving NSPT. The parameters evaluated included the HbA1c level, plaque index (PI), probing pocket depth (PPD), clinical attachment level (CAL), and bleeding on probing (BoP). A statistical analysis was performed with a significance level set at α = 5%. Results: There were significant differences in the HbA1c levels between the DM/P and P groups at baseline, 90, and 180 days, as expected. Importantly, the HbA1c levels did not change after NSPT. Group P showed a significant reduction in both the PI and the BoP values at 90 and 180 days (p < 0.05). In contrast, Group DM/P demonstrated a significant increase in the percentage of sites with a PPD ≥ 5 mm at 180 days (p < 0.05). Additionally, Group P exhibited an increase in sites with a PPD ≤ 4 mm and a decrease in sites with a PPD ≥ 5 mm at both 90 and 180 days (p < 0.05). Conclusions: Our findings suggest that DM may compromise the effectiveness of NSPT, potentially hindering favorable outcomes during the follow-up period.

The Effect of Non-Surgical Periodontal Treatment on Patients with Combined Refractory Arterial Hypertension and Stage III, Grade B Periodontitis: A Preliminary Prospective Clinical Study.

We sought to evaluate the effects of non-surgical periodontal treatment (NSPT) on periodontal clinical parameters, systemic blood pressure (BP), and plasma levels of systemic inflammation markers in patients with combined refractory arterial hypertension (RAH) and stage III grade B periodontitis. Twenty-seven participants with RAH and periodontitis received NSPT. The analyzed clinical parameters were probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and plaque index (PI). An assessment was performed for systemic BP, complete blood count, coagulogram, creatinine measurement, C-reactive protein (CRP), glycated hemoglobin, cholesterol, glutamic oxaloacetic transaminase, glutamate pyruvic transaminase, waist-hip ratio, and body mass index. In the follow-up period, twenty-two patients were evaluated at baseline and after 90 and 180 days. The data were submitted for statistical analysis (α = 0.05%). As expected, the clinical results showed a significant improvement in the percentages of PI, BOP, PD, and CAL, which were statistically significant at 90 and 180 days (p < 0.0001). Importantly, NSPT significantly reduced the blood level of CRP (p < 0.02). However, no significant reduction in BP parameters was noted in the evaluated follow-up periods. NSPT, despite the benefits in periodontal clinical parameters, reduced the plasma level of CRP but not the BP in patients with combined RAH and periodontitis.

A Novel Irrigation System to Reduce Heat Generation during Guided Implantology: An In Vitro Study.

The purpose of this in vitro study is to evaluate the effectiveness of incorporating a new irrigation system into a surgical guide and monitor its effect on heat generation during implant bed preparation. A total of 48 surgically guided osteotomies were performed on 12 bovine ribs divided into 4 groups, using different irrigation techniques: Group A (test) had entry and exit channels incorporated into the guide; Group B had a similar design with an entry channel only; Group C had conventional external irrigation; and Group D (control) had no irrigation. Heat generation during the osteotomies was measured using thermocouples placed at a depth of 2 mm and 6 mm. The lowest mean temperature was observed in Group A (22.1 °C at 2 mm and 21.4 °C at 6 mm), which was statistically significant when compared with Groups C and D (p < 0.001). Group A showed a lower mean temperature compared with Group B as well; however, it was statistically significant only at 6 mm depth (p < 0.05). In conclusion, the proposed surgical guide has significantly reduced heat generation during implant osteotomy compared to conventional external irrigation. The integration of an exit cooling channel can resolve limitations found in previously designed surgical guides such as debris blockage and can be easily incorporated into computer designing and 3D printing software.

A systematic review on neutrophils interactions with titanium and zirconia surfaces: Evidence from in vitro studies.

OBJECTIVES: This systematic review aimed to assess in vitro studies that evaluated neutrophil interactions with different roughness levels in titanium and zirconia implant surfaces. MATERIAL AND METHODS: An electronic search for literature was conducted on PubMed, Embase, Scopus, and Web of Science and a total of 14 studies were included. Neutrophil responses were assessed based on adhesion, cell number, surface coverage, cell structure, cytokine secretion, reactive oxygen species (ROS) production, neutrophil activation, receptor expression, and neutrophil extracellular traps (NETs) release. The method of assessing the risk of bias was done using the toxicological data reliability assessment tool (TOXRTOOL). RESULTS: Ten studies have identified a significant increase in neutrophil functions, such as surface coverage, cell adhesion, ROS production, and NETs released when interacting with rough titanium surfaces. Moreover, neutrophil interaction with rough-hydrophilic surfaces seems to produce less proinflammatory cytokines and ROS when compared to naive smooth and rough titanium surfaces. Regarding membrane receptor expression, two studies have reported that the FcγIII receptor (CD16) is responsible for initial neutrophil adhesion to hydrophilic titanium surfaces. Only one study compared neutrophil interaction with titanium alloy and zirconia toughened alumina surfaces and reported no significant differences in neutrophil cell count, activation, receptor expression, and death. CONCLUSIONS: There are not enough studies to conclude neutrophil interactions with titanium and zirconia surfaces. However, different topographic modifications such as roughness and hydrophilicity might influence neutrophil interactions with titanium implant surfaces.

Serum level changes of long chain-polyunsaturated fatty acids in patients undergoing periodontal therapy combined with one year of omega-3 supplementation: a pilot randomized clinical trial.

PURPOSE: We aimed to investigate the impact of nonsurgical periodontal treatment combined with one-year dietary supplementation with omega (ω)-3 on the serum levels of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), docosapentaenoic acid (DPA), and arachidonic acid (AA). METHODS: Fifteen patients with chronic generalized periodontitis were treated with scaling and root planing. The test group consisted of seven patients (43.1±6.0 years) supplemented with ω-3, consisting of EPA plus DHA, three capsules, each of 300 mg of ω-3 (180-mg EPA/120-mg DHA), for 12 months. The control group was composed of eight patients (46.1±11.6 years) that took a placebo capsule for 12 months. The periodontal examination and the serum levels of DPA, EPA, DHA, and AA were performed at baseline (T0), and 4 (T1), and 12 (T2) months after therapy. RESULTS: In the test group, AA and DPA levels had been reduced significantly at T1 (P<0.05). AA and EPA levels had been increased significantly at T2 (P<0.05). The ΔEPA was significantly higher in the test compared to the placebo group at T2-T0 (P=0.02). The AA/EPA had decreased significantly at T1 and T2 relative to baseline (P<0.05). CONCLUSIONS: Nonsurgical periodontal treatment combined with ω-3 supplementation significantly increased the EPA levels and decreased the AA/EPA ratio in serum after one year follow-up. However, no effect on the clinical outcome of periodontal therapy was observed.

Níveis elevados de il-6 no fluido gengival de pacientes com periodontite crônica e retrocolite ulcerativa idiopática / High levels of IL-6 in gingival crevicular fluid from patients with chronic periodontitis and ulcerative colitis

O nosso objetivo foi mensurar os níveis de IL-6 no fluido gengival de pacientes com periodontite e doença inflamatória intestinal (DII), comparando-os com pacientes sistemicamente saudáveis, com periodontite. Como objetivo secundário avaliamos a IL-6 no soro desses pacientes. Foram selecionados 15 pacientes com doença de Crohn (DC, idade média 38.2, DP ± 11.4 anos), 15 com retrocolite ulcerativa idiopática (RCUI, 45.0 ± 10.5 anos) e 15 pacientes saudáveis (C, 42.1 ± 7.8 anos). A Profundidade de Bolsa (PB), nível de inserção clínica (NI), presença de placa e de sangramento a sondagem foram avaliados em seis sítios por dente. O fluido gengival foi coletado de 4 sítios comperiodontite (PP: PB > 5mm, NI > 3mm) e 4 sítios com gengivite (GP: PB < 3mm e NI< 1mm) em dentes diferentes, com pontas de papel absorvente pré-fabricadas. O soro destes pacientes também foi coletado. A análise da IL-6 foirealizada pelo LUMINEX®. A quantidade total e concentração da IL-6 estavam significantemente maior no fluido gengival dos sítios PP do grupo RCUI quando comparados ao sitios PP do grupo controle (p=0,028; p=0,044, respectivamente). O grupo DC apresentou a quantidade total de IL-6 significantemente maior no sítio PP do que no GP (p=0,028). Já no soro, a IL-6 não diferiu entre os grupos. Sendo assim, podemos concluir que os indivíduos com retrocolite ulcerativa idiopática apresentavam níveis mais altos de IL-6 nos sítios com periodontite, o que pode indicar um importante papel dessa citocina no estabelecimento e progressão da doença periodontal nesses pacientes.

Our aim was to measure the levels of IL-6 in gingival crevicular fluid (GCF) from pat ients with periodontitis and inflammatory bowel disease (IBD), and compare withsystemically healthy controls with periodontitis. Besides, we measured IL-6 levels in serum. Fifteen patients withCrohn’s disease (CD, mean age 38.2 ± 11.4 years ), 15 with ulcerative colitis (RCUI, 45.0 ± 10.5) and 15 controls (C,42.1 ± 7.8) participated in this study. Probing pocket depth (PPD), attachment loss (CAL), presence of plaque andpresence of bleeding on probing, were assessed in six sites per tooth. In each subject, GCF from 4 sites with gingivits (GP- PPD and CAL < 3mm and NI <1mm) and from 4 sites with periodontitis (PP- PPD > 5mm and CAL > 3mm),on different teeth, were collected with pre-fabricated paper strips. The serum of those patients were also collected. The IL-6 was analyzed in the LUMINEX®. The total amount and the concentration of IL-6 in GCF was significantly higher in PP sites from RCUI than in controls (p=0.028 e p=0.044, respectively). The total amountof IL-6 was significantly higher in PP than GP sites in the DC group (p=0.0 28). In serum, IL-6 does not differ between groups. Therefore we concluded that subjects with ulcerative colitis showed higher levels of IL-6 in periodontitissites, which might indicate an important role of this cytokine in the onset and progression of periodontal disease in suchpatients.

Periodontal therapy reduces plasma levels of interleukin-6, C-reactive protein, and fibrinogen in patients with severe periodontitis and refractory arterial hypertension.

BACKGROUND: Recent epidemiologic studies suggest that inflammation is the link between periodontal diseases and cardiovascular complications. This study aimed to evaluate the effects of non-surgical periodontal treatment on plasma levels of inflammatory markers (interleukin [IL]-6, C-reactive protein [CRP], and fibrinogen) in patients with severe periodontitis and refractory arterial hypertension. METHODS: Twenty-two patients were examined and randomly divided into two groups. The test group was composed of 11 patients (mean age, 48.9 +/- 3.9 years) who received periodontal treatment, whereas the control group had 11 patients (mean age, 49.7 +/- 6.0 years) whose treatment was delayed for 3 months. Demographic and clinical periodontal data were collected, and blood tests were performed to measure the levels of IL-6, CRP, and fibrinogen at baseline and 3 months later. RESULTS: The clinical results showed that the mean percentages of sites with bleeding on probing, probing depth (PD) 4 to 5 mm, PD > or =6 mm, clinical attachment loss (CAL) 4 to 5 mm, and CAL > or =6 mm were significantly reduced in the test group 3 months after periodontal treatment. There were no significant differences between the data at baseline and 3 months in the control group. Periodontal treatment significantly reduced the blood levels of fibrinogen, CRP, and IL-6 in the test group. CONCLUSION: Non-surgical periodontal therapy was effective in improving periodontal clinical data and in reducing the plasma levels of IL-6, CRP, and fibrinogen in hypertensive patients with severe periodontitis.

Índice elevado de CPOD em pacientes com doença inflamatória intestinal / Elevated DMFT index in patients with inflammatory bowel disease

O objetivo deste estudo foi o de avaliar a presença de lesões cariosas, restauradas, elementos perdidos por cárie (CPOD) e a condição da mucosa oral em pacientes com Doença Inflamatória Intestinal e compará-los com pacientes saudáveis sistemicamente. Foram examinados 99 pacientes com Doença de Crohn (DC), 80 com Colite Ulcerativa (UC) e 74 controles (C). No exame clínico, foram registrados o índice CPOD, o índice de placa e a presença de lesões no tecido mole oral. A idade média, em anos, foi de 38,99 (DP± 12,90); 43,33 (DP ± 13,21) e 40,28 (DP ± 12,87) para os grupos DC, UC e C, respectivamente. Houve aumento significante na prevalência do índice de CPOD no grupo DC (p = 0,016) e UC (<0,0001), quando comparado ao C. A porcentagem de placa foi menor no grupo DC 44,04 (DP± 30,49) que no C 54,10 (DP ±26,4), p= 0,017, mas não houve diferença entre UC e C. Com relação ao número total de lesões orais, foi observada diferença significante entre os grupos DC (p= 0.041) e UC (p= <0.0001) e o grupo C, sendo a pioestomatite a lesão significantemente diferente entre esses grupos. Assim, conclui-se que, quando as doenças inflamatórias intestinais (DC e UC) são avaliadas separadamente, elevado índice de CPOD foi observado em relação ao grupo de controle; e pacientes com comprometimento intestinal apresentam mais lesões bucais que os pacientes do grupo de controle, sendo que, quando as lesões são observadas separadamente, a pioestomatite vegetante é a única que se mostra significantemente prevalente naqueles grupos.

Higher elastase activity associated with lower IL-18 in GCF from juvenile systemic lupus patients.

PURPOSE: Our aim was to evaluate the expression of interleukin-18 (IL-18), interleukin-l-beta (IL-1beta) and the amount of elastase activity in gingival crevicular fluid (GCF) from inflamed gingival sites in patients with juvenile systemic lupus erythematosus (JSLE), and compare these to the expression in GCF from inflamed sites in generally healthy controls. In addition, the local inflammation in periodontal tissues was related to systemic inflammation by the assessment of IL-18 levels in plasma. MATERIALS AND METHODS: GCF from 16 patients with JSLE and 14 controls were collected using a washing device. Elastase activity was measured with a specific substrate, and IL-18 and 11-1 were measured by ELISA. RESULTS: The percentage of visible plaque index, gingival bleeding index and attachment level were similar in JSLE and controls, while the percentage of probing depth greater or equal to 3 mm was significantly higher in the controls. The total amount of IL-1beta and IL-18 in GCF were significantly decreased in JSLE, while the total amount and the percentage of free elastase activity were significantly higher in JSLE when compared with the controls. The plasma levels of I1-18 and the erythrocyte sedimentation rate were significantly higher in JSLE patients. CONCLUSION: We found more active elastase in GCF from inflamed sites in JSLE patients even in the presence of significantly lower levels of IL-18 and IL-13. The increased elastase activity suggests a hyperactivity of neutrophils in JSLE, possibly generated by a priming effect caused by the higher plasma levels of IL-18 found in these JSLE patients.

Prevalência de periodontite em pacientes com doença inflamatória intestinal / Prevalence of periodontits in patients with inflammatory bowel disease

O objetivo deste estudo foi avaliar a prevalência de periodontite em pacientes com doenças inflamatórias intestinal (DII), e compará-los a pacientes saudáveis sistemicamente. Foram examinados 99 pacientes com Doença de Crohn (DC) (39 DP ± 12,9 anos), 80 com Retocolite Ulcerativa (RCUI) (43,3 ± 13,2 anos) e 74 no grupo controle (C ) (40,3 ± 12,9 anos). A condição periodontal foi avaliada através da placa visível, do sangramento à sondagem, da profundidade de sondagem (OS) e do nível clínico de inserção (NCI). Indivíduos que apresentavam pelo menos quatro sítios com NCI ≥ 3 mm foram considerados como portadores de periodontite. Havia mais pacientes com periodontite nos grupos RCUI (92,6%, p=0,004) e DC (91,9%, p=0,019), comparado ao grupo C (79,7%). O grupo com DC apresentava significativamente menos placa (p=0,017), menos sangramento à sondagem (p-0,038) e menos sítios com os ≥ 4mm (p=0,02) quando comparado ao grupo controle. Nenhuma relação de significância ocorreu nestes índices entre os grupos RCUI e C. Conclui-se que tanto os pacientes com DV quanto com RCUI apresentaram maior prevalência de periodontite do que o grupo controle.

Associação de suscetibilidade dos alelos HLA-DRB1 e HLADQB1 com a periodontite agressiva localizada / Suscetibility association between HLA-DRB1 and DQB1 with localized aggressive periodontitis

O objetivo deste estudo foi analisar o perfil HLA classe II em indivíduos portadores de periodontite agressiva localizada e generalizada e comparar com pacientes periodontalmente sadios (grupo controle, GC). As amostras foram compostas por 34 patientes com periodontite agressiva generalizada (média de idade = 29.4, DP ± 4.6), 8 patientes com periodontite agressiva localizada (23.9, DP ± 5.8) e 46 patientes-controle (média de idade 42.8. DP ± 8.6). As amostras foram analisadas pelo método PCR-SSP para análise de genótipo para HLA. As freqüências genéticas dos alelos HLA-DRB1* e HLA-DQB1* foram calculadas. Os resultados mostraram que os alelos HLA-DRB1*08 e -DQB1*04 estavam com sua freqüência significantemente aumentada (p < 0,05) na periodontite agressiva localizada. Sendo assim, podemos concluir que pode existir uma associação de suscetibilidade entre os alelos HLA-DRB1*08 e HLA-DQB1*04, separados ou em combinação, e a periodontite agressiva localizada.

Changes in periodontal and rheumatological conditions after 2 years in patients with juvenile idiopathic arthritis.

BACKGROUND: The aim of this study was to monitor changes in periodontal inflammation in patients with juvenile idiopathic arthritis (JIA) for 2 years. We investigated the influence of rheumatic disease activity and antirheumatic medication on clinical and immunological parameters of periodontal inflammation in these individuals. METHODS: Two years after a baseline examination, the periodontal and rheumatological conditions of 18 adolescents with JIA and 14 control subjects were described. The clinical periodontal inflammation was monitored by registration of visual plaque, marginal bleeding, probing depth, and clinical attachment loss (AL). Periodontal inflammation was also assessed by analysis of the cytokines interleukin (IL)-1beta and IL-18 and the collagenase matrix metalloproteinase (MMP)-8 by enzyme-linked immunosorbent assay. RESULTS: The erythrocyte sedimentation rate and clinical rheumatological parameters were significantly improved at the 2-year follow-up. The number of sites with plaque decreased, and the number of pockets >/=4 mm increased, whereas bleeding levels and the extension of AL remained unchanged. IL-1beta in gingival crevicular fluid decreased significantly in the JIA group after 2 years. No differences were observed for IL-1beta, MMP-8, or IL-18 levels between groups after 2 years. CONCLUSION: Two years after the baseline examination, no clinical or laboratory differences in periodontal inflammation could be found between JIA patients and control subjects.

Increased interleukin-18 in patients with juvenile idiopathic arthritis and early attachment loss.

BACKGROUND: Patients with juvenile idiopathic arthritis (JIA) have been shown to have incipient attachment loss (AL) more frequently than systemically healthy individuals. This study investigated neutrophil activity and proinflammatory cytokines in these patients and aged-matched controls. METHODS: Elastase activity, measured with a low molecular weight substrate (S-2484), and interleukin-1beta (IL-1beta), measured with the enzyme-linked immunosorbent assay (ELISA), were analyzed in the gingival fluid of 38 patients with JIA and 29 controls. IL-1beta and interleukin-18 (IL-18) were measured with ELISA in the serum of the same groups. Subgingival plaque was analyzed by DNA probes to detect 12 bacteria. RESULTS: Significantly elevated serum levels of IL-1beta and IL-18 were found in the JIA group. No differences were found in the gingival fluid levels of elastase and IL-1beta between groups, or in the frequency of subjects positive to most of the bacteria analyzed, except F. nucleatum, C. rectus, P. micros, and S. intermedius, which were significantly more frequent in the control group. When the JIA group was subdivided according to the presence/absence of AL, IL-18 was significantly increased in the JIA subgroup with AL compared to those without it. There were no differences in the subgingival microbiota between the subgroups. CONCLUSION: The findings of increased serum IL-18 and IL-1beta in patients with JIA accompanied by a similar subgingival microbiota suggest that the increased frequency of incipient attachment loss observed in these patients might be due to their altered systemic inflammatory response, making them more susceptible to periodontal disease.

Periodontal conditions in patients with juvenile idiopathic arthritis.

OBJECTIVE: Our aim was to compare the periodontal conditions in a group of juvenile idiopathic arthritis (JIA) patients with those in a control group of healthy subjects (CTR). MATERIAL AND METHODS: Thirty-two patients with JIA and 24 controls were selected. The measurements used to diagnose periodontal disease included plaque and bleeding scores, probing depths (PDs) and clinical attachment loss (CAL). Laboratory indicators of JIA activity included the erythrocyte sedimentation rate (ESR) and capsule-reactive protein (CRP). The Mann-Whitney test was used to evaluate the data (alpha = 0.05). RESULTS: The mean ages were 15.9 (+/- 2.7) years and 14.7 (+/- 2.3) years for groups JIA and CTR, respectively. The median ESR was 42 mm/h 13 mm/h in the CTR group (p = 0.032) and the median CRP was 1.9 and 0.4 mg/l, respectively (p = 0.001). The prevalence of patients with a proximal attachment loss of 2mm or more in the JIA group was 25% and in controls it was 4.2%. The mean percentages of visible plaque and marginal bleeding were similar in the JIA (54 +/- 22 and 30 +/- 16, respectively) and CTR groups (44 +/- 18 and 29 +/- 11, respectively). The mean percentages of sites with PD > or = 4 mm were significantly higher in the JIA group (3 +/- 4.7) than in the CTR group (0.4 +/- 1.7) (p = 0.012). The mean percentages of sites with proximal CAL > or = 2 mm were 0.7 (+/- 1.4) in the JIA group and 0.001 (+/- 0.2) in the CTR group (p = 0.022). CONCLUSION: Adolescents with JIA present more periodontal attachment loss than healthy controls, in spite of similar plaque and marginal bleeding levels.