Stage II and stage III periodontitis clinical burdens of HIV-1 undergoing antiretroviral therapy.

OBJECTIVES: The aim of this retrospective cross-sectional study was to estimate the association of HIV-1 infection under highly active antiretroviral treatment (HAART) on the clinical parameters of periodontitis. MATERIALS AND METHODS: A total of 205 patients were divided in two groups: 74 HIV + and 131 HIV - . Periodontal probing depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), and visible supragingival biofilm (VSB) were recorded. The association of HIV-1 infection with the presence of at least 3 sites with PPD ≥ 5 mm and/or CAL ≥ 4 mm in non-adjacent teeth was estimated using binary logistic regression models. RESULTS: The variables HIV-1 infection (OR = 5.53, p < 0.0001, 95% CI: 2.45-13.64), age [range 35-50 years old (OR = 5.73, p < 0.0001, 95% CI: 2.49-13.20); > 50 years old (OR = 6.29, p = 0.002, 95% CI: 1.94-20.42)], and VSB (OR = 23.68, p < 0.0001, 95% CI: 8.07-69.53) showed a significant direct association with BOP outcome. CONCLUSIONS: HIV-1 infection under HAART did not have association with the presence of at least 3 sites with PPD ≥ 5 mm and/or CAL ≥ 4 mm. However, HIV patients on HAART had direct association of HIV-1 infection with BOP and an inverse association with PPD. CLINICAL RELEVANCE: These results support that monitoring gingival bleeding associated with oral prophylaxis would be beneficial in the prevention and management of periodontitis in HIV-1 patients on HAART.

Dental implants in individuals living with HIV-1: Results from a prospective study in patients undergoing highly active antiretroviral therapy.

OBJECTIVE: To assess survival and success rates of dental implants and the occurrence of peri-implant diseases (mucositis/peri-implantitis) in HIV-1-infected individuals. MATERIAL AND METHODS: In this prospective study, 13 HIV-1-infected individuals undergoing highly active antiretroviral therapy (with undetectable plasma HIV RNA levels, and CD4+ T cells > 350/mm3 ) were followed after implant placement, as well as 13 non-HIV-1-infected matched controls. Patients enrolled in this study were followed up to 120 months (mean = 40.6 months; standard deviation = 22.2; range 18 -120 months). Twenty-five implants were placed in pristine healed sites for each group and bone augmentation procedures, when needed, were done only for contour augmentation. Patients were enrolled in a strict periodontal/peri-implant supportive therapy protocol with three recalls per year. The two groups were compared regarding subject-level characteristics (age, gender, smoking, diabetes) and implant-level characteristics (marginal bone level, peri-implant health status). RESULTS: All the implants healed uneventfully and reached 100% survival rates (after at least 18 months) in both groups. There were no significant differences between groups for peri-implant diseases (mucositis/peri-implantitis) and for all subject-level co-variables (p > .05). Only the variables dental implant prosthesis type (DIPT) (p = .021, d = .86) and follow up (p = .011, d = .77) showed statistically significant differences between groups. CONCLUSION: The findings suggest that well-controlled HIV-1-infected individuals are eligible to undergo implant therapy, achieving survival and success rates comparable to non-HIV-1-infected controls.

Leukocyte-platelet rich fibrin on the treatment of a large paradental cyst: a novel regenerative approach.

Leukocyte-platelet rich fibrin (PRF) is an autologous biomaterial formed by platelets, cytokines, growth factors and cells imprisoned on a fibrin mesh, produced according to Choukroun's protocol. The aim of the present article was to report the use of PRF, associated with a bone substitute, on the regenerative treatment of a large bone defect resulting from the enucleation of a paradental cyst involving the posterior mandible. The treatment resulted in the maintenance of the bone volume, and radiographic evaluation showed new bone formation after 40 days, suggesting an osteogenic and osteoinductive effect. Also, the current literature was reviewed.

Oral bacteriome of HIV-1-infected children from Rio de Janeiro, Brazil: Next-generation DNA sequencing analysis.

BACKGROUND AND AIM: This study compared the oral bacteriome between HIV-1-infected and non-HIV-1-infected Brazilian children/teenagers. METHODS: Whole saliva, biofilm from the dorsal surface of the tongue and biofilm from supragingival and subgingival sites were collected from 27 HIV-1-infected and 30 non-HIV-1-infected individuals. Bacterial genomic DNA was extracted and 16S rRNA genes were sequenced using next-generation sequencing technology (Ion Torrent). RESULTS: In the supragingival biofilm, the phylum Firmicutes and genus Streptococcus sp. were more frequent in HIV-1-infected (95% and 78%, respectively) than in non-HIV-1-infected individuals (40% and 24%, respectively). In the subgingival biofilm of HIV-infected participants, the relative abundance of the Veillonella sp. and Prevotella sp. genera were higher than in non-HIV-1-infected participants. On the tongue, the genera with greater relative abundance in HIV-1-infected individuals were Neisseria sp. (21%). In saliva, the difference of the genus Prevotella sp. between non-HIV-1-infected and HIV-1-infected individuals was 15% and 7%, respectively. The Chao index revealed an increase in the richness of both sub- and supragingival biofilms in the HIV-1-infected samples compared with non-HIV-1-infected samples. CONCLUSION: HIV-1-infected children/teenagers have a higher frequency of the phyla Firmicutes and genus Streptococcus, and their oral microbiome shows more complexity than that of non-HIV-1-infected children/teenagers.

Recall Rates of Patients in Endodontic Treatments: A Critical Review.

The number of patients that return for recall appointments has great importance to validate endodontic treatment outcomes. The purpose of this review was to investigate the rate of return on recall and the main factors that influence this rate of return. A literature review was performed in the PubMed database for the years from 1978 to 2017, using the following keywords: recall rate, endodontic treatment, endodontic retreatment, apical surgery. The inclusion criteria were: prospective studies in English, and in vivo research with humans, which included patient return rates. A total of 35 studies that fulfilled the established criteria were selected. The percentage of patients who returned on recall was 56%. More female patients (60%) attended the recall appointments than male (40%). The three main reasons for not returning were: patients did not observe the follow-up appointment (490), not returning due to a lack of interest (99) and changing their address (222). The age of the patients attending the appointments varied from 28.6 to 62 years old, with the highest percentage of patients that returned ranging from 40 to 52.5 years old. According to the literature the optimal rate of return for follow-up treatment should be greater than 80%, for the validity of the research. However, the reality presented in the studies is far from ideal. Many studies do not even mention these rates of return in their methodologies or in their results, which may mask the true treatment success rates.

What is the role of Staphylococcus aureus and herpes virus infections in the pathogenesis of atopic dermatitis?

Atopic dermatitis (AD) is a chronic, relapsing disease. Genetic, environmental and immunological factors are involved in its pathophysiology. Individuals with AD have an increased predisposition to colonization and/or infection of the skin by various pathogens, especially Staphylococcus aureus and herpes simplex virus. The composition of their skin microbiome is also different, and changes during flares. The disease severity can be related to the degree of colonization by S. aureus. In addition, the presence of this bacterial species can predispose the host to more severe and disseminated viral infections. This article reviews the role of S. aureus and herpes virus infections and the skin microbiome in the pathogenesis of AD and their importance in the treatment and prevention strategies of this dermatosis.

Odontogenic sinusitis: a comprehensive review.

Odontogenic sinusitis (OS) is a highly prevalent, underappreciated and underdiagnosed disease that has been known for over 100 years. Apical periodontitis, periodontal disease and iatrogenic extrusion of foreign bodies into the sinus are the main causes of OS. Although the prevalence of sinus pathosis of dental origin is still controversial, otolaryngologists recognize that in the presence of recalcitrant sinusitis, a dental origin should be considered and properly treated. Currently, cone-beam computed tomography is the gold-standard imaging technique to assess the relationship between dental conditions, especially apical periodontitis and sinus diseases, and whenever this association is detected, patients should be seen by both a dentist and an otolaryngologist in order to achieve complete recovery. This article reviews the current concepts regarding the definitions, diagnosis and management of OS from a clinical point of view.

Dental implants and bone augmentation in HIV-infected patients under HAART: Case report and review of the literature.

The present study reviewed the literature regarding dental implants in HIV-infected patients and reports the long-term follow-up of three clinical cases of patients under HAART that received bone augmentation and dental implants. The first case presents a young patient with a large defect in the mandible, as a consequence of a longitudinal fracture, that was treated with guided bone regeneration (GBR) previously to implant placement. The second case reported is middle-aged man with a fractured upper lateral incisor treated with immediate placement and simultaneous GBR to repair the dehiscence due to the buccal bone resorption. The third case shows an elderly patient that underwent sinus lifting with the simultaneous placement of two implants. All cases were treated after patients were medically controlled and followed for at least 10 years. Controlled HIV-infected patients undergoing HAART may be candidates to implant rehabilitation, as long as their plasmatic HIV viral load and CD4+ T lymphocytes count are within the parameters that indicate immune stability. Long-term stability of soft and hard tissues can be obtained maintaining function and esthetics. However, stronger evidence, based on prospective, controlled clinical trials is needed to provide the dental and medical teams with conclusive data.

Dental bleaching with and without LED/Laser association: a split-mouth controlled study

Objective: The aim of this study was to compare dental color changes after a one-session tooth bleaching procedure using 35% hydrogen peroxide with and without hybrid light (LED/diode laser) activation. Material and Methods: 20 volunteers were included in a split-mouth controlled clinical trial. A 35% hydrogen peroxide gel was applied directly on the buccal surface and adjacent areas of all upper anterior teeth. The six teeth were divided into two groups: the upper right incisors and canine were submitted to the tooth bleaching with the gel and the hybrid light (LED/diode laser) while the left incisors and canine were submitted to tooth bleaching with only the gel. Dental color was measured with a visual color scale and a spectrophotometer at five different moments: initial appointment, immediately after prophylaxis, and 14, 30 and 180 days after bleaching. Results: The comparison between the results of both treatments (with and without LED/laser) did not show any statistically significant differences (p > 0.05; Wilcoxon test) neither for objective (spectrophotometer) nor for subjective evaluations (visual color scale). Conclusion: The results of the present study showed that there are no differences in dental color changes between dental bleaching with gel and LED/Laser activation and dental bleaching with only gel.

Non-surgical periodontal treatment reduces cardiovascular risk in refractory hypertensive patients: a pilot study.

AIM: To evaluate the effects of non-surgical periodontal treatment on left ventricular mass (LVM), arterial stiffness, systolic and diastolic blood pressure and plasma levels of inflammatory markers (C-reactive protein (CRP), fibrinogen and interleukin-6) in refractory hypertension patients. MATERIAL AND METHODS: This interventional prospective cohort pilot study included 26 patients (53.6 ± 8.0 years old) diagnosed with refractory hypertension and generalized chronic periodontitis. Subjects received non-surgical periodontal treatment according to their needs. Plasma levels of systemic inflammation (CRP; fibrinogen and interleukin-6) and established cardiovascular risk factors [systolic and diastolic blood pressure (SBP and DBP), left ventricular mass (LVM) and arterial stiffness] were assessed at three time points (baseline, 3 months after baseline and 6 months after periodontal therapy). RESULTS: Periodontal therapy significantly reduced all cardiovascular risk markers evaluated. Median values of SBP and DBP were reduced by 12.5 mmHg and 10.0 mmHg, respectively, whereas left ventricular mass (LVM) reduced by 12.9 g and pulse wave velocity reduced by 0.9 m/s (p < 0.01). Levels of CRP, IL-6 and fibrinogen lowered by 0.5 mg/dl, 1.4 pg/dl and 37.5 mg/dl (p < 0.01), respectively, 6 months after periodontal therapy. CONCLUSIONS: Periodontal therapy significantly reduced levels of CRP, IL-6, fibrinogen, blood pressure, LVM and arterial stiffness, lowering cardiovascular risk in refractory hypertensive patients.

Oclusão e protocolos de aplicação de cargas funcionais em implantes unitários posteriores / Occlusion and functional loading protocols for single-tooth posterior implants: literature review

Com a evolução da Implantodontia, há uma demanda crescente por alternativas de tratamento que possibilitem menor tempo para a resolução dos casos clínicos. Uma oclusão bem equilibrada e protocolos de carregamento adequados desempenham um papel fundamental no sucesso e na longevidade dos implantes e das próteses. O presente trabalho visou, por meio de uma revisão da literatura atual, reportar a evolução dos conceitos de oclusão e dos protocolos de carregamento aplicados aos casos reabilitados com implantes unitários nas regiões posteriores de mandíbula e maxila. Apesar da falta de consenso, a literatura, de modo geral, sugere prudência ao adotar protocolos de carregamento imediato ou precoce de implantes unitários, preferencialmente evitando contatos oclusais durante o período de osseointegração.

Recent advances on Implant Dentistry led to an increasing demand for alternatives with less chairside time to finish clinical cases. A well balanced occlusion and adequate loading protocols play a fundamental role on the success and longevity of implants and prostheses. The present paper aims to report, through a review of the current literature, the evolution of the concepts regarding occlusion and loading protocols applied to clinical cases using single-tooth implants on posterior regions. Despite the absence of a consensus about the theme, the current literature suggests, in general, caution when choosing to adopt immediate or premature loading of single-tooth implants placed on posterior regions, preferably avoiding occlusal loads during the osseointegration period.

[Hepatitis C and pregnancy: an analysis of factors associated with vertical transmission]. / Hepatite C e gestação: análise de fatores associados à transmissão vertical.

INTRODUCTION: Data concerning hepatitis C virus infection during pregnancy in Brazilian medical services are scarce. This study aimed to verify factors associated with vertical transmission (VT) of HCV in pregnant women. METHODS: Observational transversal study of pregnant women from Campo Grande, MS, central Brazil, with confirmed reagent serology for HCV infection from 2002 to 2005. Vertical transmission was considered to be positive HCV serology by ELISA, confirmed by PCR, after 18 months of life of the newborn. The factors studied associated with VT were: delivery mode, time of premature rupture of membranes, breastfeeding, blood transfusion history, drug addiction, number of sexual partners and the presence of body tattoos. RESULTS: Fifty-eight pregnant women with HCV infection were identified, indicating a prevalence rate of 0.2% (58/31,187). Of these 58 pregnant women,23 (39.6%) fulfilled the inclusion criteria. The VT rate was 13% (3/23), and the most frequent HCV viral subtypes were 1a (53%), 1b (30%), 2b (4%) e 3a (13.0%). Two (8.7%) patients were coinfected with HIV. A significant association (p < 0.05) was observed between VT and high maternal serum viremia (> 2.5 x 10(6)) and VT and the use of illicit drugs by the mother. CONCLUSIONS: The present study demonstrates that high serum maternal viremia for HCV and the use of illicit drugs by the mother are associated with vertical transmission of HCV.

Hepatite C e gestação: análise de fatores associados à transmissão vertical / Hepatitis C and pregnancy: an analysis of factors associated with vertical transmission

INTRODUÇÃO: Informações sobre hepatite C durante a gestação em serviços brasileiros são escassas. O objetivo deste estudo foi verificar os fatores associados à transmissão vertical do vírus da hepatite C em gestantes. MÉTODOS: Estudo observacional, transversal, realizado em gestantes procedentes do município de Campo Grande/MS, que apresentaram sorologia reagente e confirmada para VHC, no período de 2002 a 2005. Considerou-se transmissão vertical sorologia VHC positiva por ELISA, confirmada com PCR, após os 18 meses de vida do recém-nascido. Considerou-se fatores associados a TV: tipo de parto, tempo de rotura de membranas, amamentação, histórico de transfusões sanguíneas prévias, uso de drogas ilícitas, número de parceiros sexuais e presença de tatuagens pelo corpo. RESULTADOS: Identificou-se 58 gestantes portadoras do VHC, revelando prevalência de infecção de 0,2 por cento (58/31.187). Das 58 pacientes, 23 (39,6 por cento) preencheram os critérios de inclusão no estudo. A taxa de TV foi de 13 por cento (3/23), sendo os subtipos virais mais frequentes: 1a (53 por cento), 1b (30 por cento), 2b (4 por cento) e 3a (13 por cento). Duas (8,7 por cento) pacientes apresentaram co-infecção pelo HIV. Houve associação (p < 0,05) entre TV e carga viral elevada (> 2,5x10(6)) e entre TV e uso de drogas ilícitas pela mãe (p < 0,05). CONCLUSÕES: O presente estudo demonstra que elevada viremia materna e o uso de drogas ilícitas pela mãe associam-se a transmissão materno-fetal do VHC.

INTRODUCTION: Data concerning hepatitis C virus infection during pregnancy in Brazilian medical services are scarce. This study aimed to verify factors associated with vertical transmission (VT) of HCV in pregnant women. METHODS: Observational transversal study of pregnant women from Campo Grande, MS, central Brazil, with confirmed reagent serology for HCV infection from 2002 to 2005. Vertical transmission was considered to be positive HCV serology by ELISA, confirmed by PCR, after 18 months of life of the newborn. The factors studied associated with VT were: delivery mode, time of premature rupture of membranes, breastfeeding, blood transfusion history, drug addiction, number of sexual partners and the presence of body tattoos. RESULTS: Fifty-eight pregnant women with HCV infection were identified, indicating a prevalence rate of 0.2 percent (58/31,187). Of these 58 pregnant women,23 (39.6 percent) fulfilled the inclusion criteria. The VT rate was 13 percent (3/23), and the most frequent HCV viral subtypes were 1a (53 percent), 1b (30 percent), 2b (4 percent) e 3a (13.0 percent). Two (8.7 percent) patients were coinfected with HIV. A significant association (p < 0.05) was observed between VT and high maternal serum viremia (> 2.5x10(6)) and VT and the use of illicit drugs by the mother. CONCLUSIONS: The present study demonstrates that high serum maternal viremia for HCV and the use of illicit drugs by the mother are associated with vertical transmission of HCV.

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.