Coronally advanced flap achieved higher esthetic outcomes without a connective tissue graft for the treatment of single gingival recessions: a 4-year randomized clinical trial.

OBJECTIVES: Limited long-term data are available when comparing the esthetic outcomes of coronally advanced flap (CAF) with or without a connective tissue graft (CTG). The aim of this study was to compare the 4-year esthetic outcomes of CAF vs CAF + CTG for the treatment of isolated maxillary gingival recessions. MATERIAL AND METHODS: Forty-eight patients were randomly assigned for treatment either with CAF (control; N = 24) or to CAF + CTG (test group; N = 24). Patients were followed after the surgery until the final evaluation. A professional esthetic evaluation was performed using the Root coverage Esthetic Score (RES). Recession reduction, mean root coverage, and complete root coverage were also evaluated. RESULTS: Forty-two patients completed the study at the 4-year recall. A significant recession reduction was evident at 4 years, without significant intergroup differences. The CAF group showed a statistically significant higher final RES compared with the CAF + CTG group (9.14 ± 1.08 vs 7.25 ± 1.29, respectively, p < 0.001). Regarding the individual components of RES, gingival margin and marginal tissue contour were significantly higher in the CAF group compared with that in the CAF + CTG group. CONCLUSIONS: CAF presented with a significantly higher overall esthetic score than CAF + CTG, and in the individual RES components of marginal tissue contour and gingival margin after 4 years. CLINICAL RELEVANCE: CAF without the addition of CTG provided higher esthetic outcomes for the treatment of isolated gingival recessions.

Adiponectin, leptin and TNF-α serum levels in obese and normal weight Peruvian adults with and without chronic periodontitis.

BACKGROUND: TNF-α, an adipokine involved in systemic inflammation and a member of a group of cytokines that stimulate the acute phase reaction, has been related to the pathogenesis of both periodontitis and obesity. The objective of this study was to assess the serum levels of adiponectin, leptin and TNF-α of periodontally healthy normal weight (NW) patients, NW patients with chronic periodontitis (CP), periodontally healthy obese patients and obese patients with CP. MATERIAL AND METHODS: Ninety-three patients were enrolled in this cross-sectional study: 30 periodontally healthy NW patients; 18 NW patients with CP; 21 periodontally healthy obese patients; and 24 obese patients with CP. Analyses included clinical and anthropometric outcomes, as well as the assessment of serum levels of adiponectin, leptin and TNF-α by enzyme linked immunosorbent assay (ELISA) or fully automated chemiluminescence immunoassay. One-Way ANOVA, Kruskal-Wallis One-Way on Ranks, Dunn's Test and multivariable logistic regression (MLR) analyses were conducted to estimate the degree of association between periodontitis and obesity. RESULTS: Obese patients with CP showed significant more bleeding sites than the other three groups (p<0.05). Moreover, patients from the NWCP and OPH showed similar BOP percentages, as well as OPH group showed more bleeding sites than the NWPH group (p<0.05). The OPH group showed similar levels of adiponectin and leptin than the OCP group, but significantly higher than the NWPH and NWCP groups(p<0.05). MLR analyses showed that obesity was positively associated with the percentage of sites with bleeding on probing, with an odds ratio of 0.93 (95% confidence interval: -0.88, - 0.98; p=0.012). CONCLUSIONS: The serum levels of adiponectin, leptin and TNF-α were not influenced by CP. Obese patients showed almost 10% more sites with BoP. In chronic periodontitis patients, obese subjects presented significant more BOP sites than normal weight subjects. Key words:Periodontitis, obesity, inflammation, adiponectin, leptin.

Evolución temporal del índice gonadal de los erizos marinos Paracentrotus lividus (Echinoida: Echinidae) y Diadema africanum (Diadematoida: Diadematidae) en las islas Canarias (España) / Temporal evolution of the gonad index of the sea urchins Paracentrotus lividus (Echinoida: Echinidae) and Diadema africanum (Diadematoida: Diadematidae) in the Canary Islands (Spain)

Resumen Con el fin de establecer las épocas óptimas de explotación como posible recurso marisquero de dos especies de erizos de mar en Canarias, se estudió la evolución temporal del índice gonadal en diferentes años y localidades de Paracentrotus lividus (abril de 2006 a marzo de 2008 en la isla de Tenerife y en dos localidades: Las Galletas y La Jaca; abril de 2006 a enero de 2009 en la isla de Gran Canaria y en dos localidades: Ojos de Garza y Gando), y de Diadema africanum (de enero de 2010 a mayo de 2011 en la isla de Gran Canaria y en tres localidades: Risco Verde, Arguineguín y Agaete). En el caso de P. lividus, que se encuentra en el límite sur de su distribución, se constató la presencia de varios picos máximos anuales en el índice gonadal, probablemente relacionados con la temperatura. Estas épocas de mayor índice gonadal se correspondieron con los estados de maduración de las gónadas. La principal época de madurez coincidió con el otoño y comienzo del invierno (agosto, octubre y diciembre). Existió emisión de gametos esporádicos en el año según la localidad, en abril, en verano (junio, julio o agosto), otoño (septiembre u octubre) e invierno (diciembre, enero o febrero). Posiblemente esta situación tan dispar sea debido a la exposición al hidrodinamismo de la zona y a la presencia o no de abundante alimento. Para D. africanum se presentó el máximo índice en los meses de mayo-junio, con prácticamente pocas variaciones anuales en la localidad situada más al sur (Arguineguín). En conclusión, las dos especies de erizos serían complementarias como recursos marisqueros, ya que no se superponen sus periodos de máximos IG (época de captura) en el año.

Abstract There are three main species of regular sea urchins in the Canary Islands. To establish the optimal fishing seasons for two of them, we studied the evolution of the gonadal index in several years and locations, of Paracentrotus lividus (April 2006 to March 2008 on Tenerife island in two locations: Las Galletas and La Jaca and from April 2006 to January 2009 in Gran Canaria island in two locations: Ojos de Garza and Gando), and Diadema africanum (January 2010 to May 2011 on Gran Canaria island in three locations: Risco Verde, Arguineguin and Agaete). In the case of P. lividus, located on the southern edge of their distribution, the presence of several annual maximum gonadal indez peak was observed, probably related to the temperature. These times of gonadal index increases corresponded to the stages of maturation. The main period of maturity coincided with the fall and early winter (August, October and December). There was sporadic emissions of gametes depending on location, in April, during the summer (June, July or August), autumn (September or October) and winter (December, January or February). This fragmented situation is possibly due to exposure to the hydrodynamic area's and food abundance. The maximum presence of D. africanum occurred in the months of May to June, with virtually no variations throughout the year, in the southernmost locality (Arguineguin). In conclusion, the two species of sea urchins would be complementary shellfish resources, as their periods of maximum GI (Gonadal Index, capture time) do not overlap during the year. Rev. Biol. Trop. 63 (Suppl. 2): 251-260. Epub 2015 June 01.

Prevalencia de defectos del esmalte dental en niños y adolescentes colombianos / Prevalence of dental enamel defects in children and adolescents from Pasto, Colombia

Introducción: el objetivo de esta investigación fue establecer la prevalencia de defectos del esmalte dental (DE) en niños y adolescentes de Pasto, Colombia. Métodos: quinientos noventa y nueve niños y adolescentes entre 6 y 15 años de edad, de tres corregimientos de Pasto, Colombia, fueron examinados clínicamente para determinar la presencia de opacidad por flúor e hipoplasia del esmalte. Literatura científica y fotografías en color de la cavidad oral fueron estudiadas previamente por dos examinadores, con el propósito de diagnosticar DE en estos corregimientos. La severidad de la opacidad por flúor fue valorada de acuerdo al índice de Dean y la hipoplasia del esmalte al índice de Silberman. Resultados: la prevalencia de DE en niños y adolescentes fue de 49,9% (IC al 95%: 45,8%-53,9%). La mayoría de ellos, 85,3%, presentaron opacidades por flúor (OPF) y 14,7% hipoplasias del esmalte. El tipo de severidad predominante de OPF fue moderada (73,7%). Las OPF fueron más prevalentes en mujeres (86,3%) que en hombres (84,2%) (p > 0,05); mientras que la hipoplasia del esmalte fue más frecuente en hombres (15,8%) que en mujeres (13,7%) (p>0,05). Las hipoplasias del esmalte fueron observadas blancas-cremosas y cafés, y fueron encontradas más frecuentemente en dientes permanentes incisivos centrales superiores. Conclusiones: la prevalencia de DE fue elevada en estos corregimientos. Las opacidades por flúor fueron las más frecuentes y se mostraron moderadas de acuerdo con el índice de Dean. Nuevos diseños de investigación son requeridos para establecer la exposición a diferentes niveles de flúor en estas comunidades. Estos resultados ciertamente representan un problema de salud pública.

Introduction: the objective of this study was to estimate the prevalence of dental enamel defects (ED) in children and adolescents from Pasto, Colombia. Methods: five hundred and ninety-nine children and adolescents aged 6 to 15 years from three municipalities of Pasto, Colombia were clinically examined for fluoride opacity and enamel hypoplasia. Scientific literature and color photographs of the oral cavity were previously studied by two examiners in order to diagnose ED in these municipalities. Severity of fluoride opacity was assessed with Dean’s index and enamel hypoplasia with Silberman’s index. Results: ED prevalence in children and adolescents was 49.9% (95% CI: 45.8% - 53.9%). Most of them, 85.3%, had fluoride opacities (FOP) and 14.7% enamel hypoplasia. The predominant type of FOP severity was the moderate level (73.7%). FOP were more prevalent in females (86.3%) than in males (84.2%) (p > 0.05), while enamel hypoplasia was more frequent in males (15.8%) than in females (13.7%) (p > 0.05). Enamel hypoplasia appeared as creamy-white and brown lesions and were most frequently found in permanent upper central incisors. Conclusions. ED prevalence was high in these municipalities. Fluoride opacities were the most frequent and were classified as moderate according to Dean’s index. New studies are required to establish levels of fluoride exposure in these communities. Certainly, these findings represent a public health problem.

Association of -1082 interleukin-10 gene polymorphism in Peruvian adults with chronic periodontitis.

OBJECTIVES: The aim of this study was to assess association of the -1082 IL-10 gene polymorphism with chronic periodontitis CP in a Peruvian population. STUDY DESIGN: Samples of venous blood and DNA were obtained from 106 Peruvian subjects: a) 53 periodontally healthy; and b) 53 with CP. The association of the -1082 IL-10 promoter sequences was assessed by Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Student's t test were used to assess the clinical parameters, as well as the χ2 test and the odds ratio (OR), with 95% confidence intervals (CI) used performed for estimates regarding genotype and allele frequencies. RESULTS: There were statistically significant differences between groups regarding the mean bleeding on probing, mean attachment level and mean probing depth (p < 0.00001) indicating that the matching based on the evaluated groups was adequate. The χ2 test found a statistically significant imbalance of genotypes between groups (p = 0.0172). The prevalence of CP was significantly higher in subjects harboring at least one A allele at position -1082 (AA and GA genotypes) in comparison to patients with the GG genotype (OR = 2.96; CI: 0.52; 5.41; p = 0.0099). Equally, subjects with the AA genotype were significantly associated to a diagnosis of CP (OR = 2.71; CI: 0.38; 5.04; p = 0.0231). On the other hand, subjects presenting a healthy periodontal status presented at least one G allele in comparison with the AA genotype (OR = 0.37; CI: 0.05, 0.69; p = 0.0231). For subjects with the GG genotype, the same positive association was observed (OR = 0.34; CI: 0.06, 0.62; p = 0.0099). There were no significant differences between groups amongst subjects with the GA genotype (OR = 1.19; CI: 0.22, 2.16; p = 0.6774). CONCLUSIONS: Within the limits of this study, IL-10 gene polymorphism at position -1082 does not appear to be associated to CP. Conversely, subjects with AA genotype seem to be at an increased risk of developing CP.

Predictors of peri-implant bone loss during long-term maintenance of patients treated with 10-mm implants and single crown restorations.

PURPOSE: The aim of this retrospective study was to evaluate the predictors of peri-implant bone loss in a sample of patients treated with 10-mm implants and single crowns who underwent periodontal/peri-implant maintenance (PM) in a Mexican private periodontal practice. MATERIALS AND METHODS: Outcomes of a group of systemically healthy, partially edentulous patients attended up to July 2012 were assessed. Patient data were considered for inclusion if they involved treatment of partially edentulous sites with 10-mm-long implants and single crown restorations, as well as at least 3 years of regular PM following implant placement. Peri-implant bone loss was evaluated from data recorded at the most recent examination. Logistic regression analysis was performed to investigate associations between peri-implant bone loss and sex, duration of PM, location and number of implants placed per patient, region of the mouth, smoking status, type of implant, and retention of restoration. RESULTS: A sample of 104 subjects who had been treated with four different types of dental implants and maintained for at least 3 years was selected. Of the 148 implants placed and followed for an average period of continuing PM of 6 years (range, 3 to 15 years), only one implant (1.8%) was lost. The outcomes of logistic regression analysis showed that the independent variables smoking, retention of restoration (cemented vs screw-retained), and type of implant (internal- or external-hex) were found to be correlated with peri-implant bone loss, with odds ratios of 39.64, 4.85, and 0.04, respectively. CONCLUSIONS: Peri-implant bone loss was significantly associated with smoking status, the type of implant (ie, externally hexed), and type of retention (ie, cemented). Overall, all patients maintained low rates of bone loss.

Association among stress, salivary cortisol levels, and chronic periodontitis.

PURPOSE: Chronic periodontitis (CP) seems to be associated with stress and depression, but little information on this possible association is available in the literature. Thus, the objective of this study was to evaluate the association among stress, the salivary cortisol level (SCL), and CP. METHODS: Seventy systemically healthy subjects were included in the study from January to September 2011. Full medical and dental histories were obtained, and the following measurements were recorded: 1) probing depth; 2) clinical attachment level; 3) bleeding on probing; and 4) tooth mobility. Saliva samples were collected for the evaluation of SCL (via a highly sensitive electrochemiluminescence immunoassay), and all subjects also answered a questionnaire (i.e., the Zung Self-rating Depression Scale). The odds ratio (OR) with a 95% confidence interval (CI) was calculated, and one way analysis of variance and the Tukey-Kramer method were performed. RESULTS: A total of 36 subjects with CP (51.4%) and 34 without CP were evaluated. Of them, all of the subjects with CP and one periodontally healthy subject were diagnosed with depression. Subjects with moderate CP had statistically significantly higher levels of SCL than subjects with a diagnosis of slight CP (P=0.006). Also, subjects with severe CP showed the same outcome when compared to those with slight CP (P=0.012). In addition, 46 subjects presented high SCL whereas 24 had a normal level. CP was found to be correlated with the SCL, with an OR of 4.14 (95% CI, 1.43 to 12.01). CONCLUSIONS: Subjects with a high SCL and depression may show an increased risk for CP.

Enamel matrix derivative and coronal flaps to cover marginal tissue recessions.

BACKGROUND: Correcting recession defects is one of the goals of periodontal therapy, and the efficacy and predictability of the various techniques are important considerations for both patients and clinicians. Several reports have examined the outcome of gingival recession treatment by means of coronally positioned flaps (CPF) and enamel matrix derivative (EMD). The purpose of this study was to clinically evaluate the use of EMD in association with CPF to cover localized gingival recessions compared to CPF alone. METHODS: Twenty-two patients with Miller Class I or II gingival recessions >2 mm were included. One recession from each patient was treated in the study. Two treatments were randomly assigned: coronally positioned flap with EMD (test) and coronally positioned flap alone (control). Clinical parameters measured at baseline and 1, 6, and 12 months included gingival index, plaque index, probing depth, clinical attachment level, vertical and horizontal recession, and width of keratinized gingiva. RESULTS: At 12 months, both treatment modalities showed significant root coverage, gain in clinical attachment, and gain in width of keratinized gingiva (P <0.05). Vertical recessions were reduced from 2.68 +/- 1.63 mm to 0.36 +/- 0.60 mm in the test group and from 2.31 +/- 1.52 mm to 0.90 +/- 0.95 mm in the control group. Horizontal recessions decreased from 4.27 +/- 2.06 mm to 0.77 +/- 0.87 mm in the test group and from 3.68 +/- 1.91 mm to 1.72 +/- 1.31 mm in the control group. Changes in keratinized gingiva went from 3.81 +/- 1.95 mm to 4.63 +/- 2.15 mm in the test group and from 3.31 +/- 1.81 mm to 3.27 +/- 1.80 mm in the control group. When both treatments were compared at 12 months, there was a significant difference in vertical tooth coverage and gain in keratinized gingiva in favor of the experimental group (P <0.05). The average percentage of root coverage for test and control groups was 88.6% and 62.2%, respectively. CONCLUSIONS: The coronally positioned flap alone or with EMD is an effective procedure to cover localized gingival recessions. The addition of EMD significantly improves the amount of root coverage.

Establishment of a binational cohort to study Helicobacter pylori infection in children.

Chronic Helicobacter (H.) pylori infection, typically of childhood onset, causes upper digestive tract diseases of major impact among socioeconomically marginalized populations. This infection is common in children from ethnic minorities in the United States, and particularly so in immigrant children from Mexico. Prevention measures for H. pylori infection do not yet exist, given limited understanding of what causes either acute or persistent infection. To address this gap, we initiated the Pasitos Cohort Study to follow children from low-income families in the border region that includes El Paso County, Texas, and Ciudad Juarez, Chihuahua. The children were enrolled prior to birth, and are examined at 6-month intervals to observe the natural history of H. pylori infection, and to identify risk factors for acquisition, recurrence, and persistence. This report details the study methods, describes how the cohort was established, and discusses the challenges of compliance with follow up in the border setting. Between April 1998 and October 2000, 1,288 pregnant women were screened for eligibility; 807 of 994 eligible women consented to participate. Birth documentation was obtained for 615 infants, and 472 entered follow up. Successful follow up of this cohort requires resources, including a well-trained, dedicated staff, and incentives, to facilitate and motivate long-term participation. Future findings from this ongoing study will help to fill critical gaps in knowledge regarding the epidemiology of H. pylori infection, and will contribute to the identification of prevention strategies.

Regeneration of soft and hard tissue periodontal defects.

Periodontitis is characterized by the formation of periodontal pockets and bone loss. Although the basic treatment emphasizes the control of bacterial plaque, the clinician is confronted with the need to correct soft and/or hard tissue defects that develop as a consequence of the disease. This article reviews the current status of regenerative approaches in treating soft and hard tissue defects (based mainly on findings from our own laboratory) and assessed the global applicability of these procedures. Many different techniques have been suggested to treat those defects with, in general, a high degree of success. From the present knowledge it can be concluded that periodontal soft and hard tissue regeneration is possible. Treatment of areas with localized gingival recession or insufficient keratinized gingiva can be achieved with soft tissue grafts or pedicle flaps, as well as with the use of dermal allografts. The treatment of hard tissue defects around teeth and implants can be approached using different types of bone grafts, guided tissue or bone regeneration, or a combination of these. The predictability of many of these therapies, however, still needs to be improved. Since most of these techniques are sensitive, specific, and expensive, their present universal application is limited.