Update on the use of 45S5 bioactive glass in the treatment of bone defects in regenerative medicine.

Bone regeneration is a critical area in regenerative medicine, particularly in orthopedics, demanding effective biomedical materials for treating bone defects. 45S5 bioactive glass (45S5 BG) is a promising material because of its osteoconductive and bioactive properties. As research in this field continues to advance, keeping up-to-date on the latest and most successful applications of this material is imperative. To achieve this, we conducted a comprehensive search on PubMed/MEDLINE, focusing on English articles published in the last decade. Our search used the keywords "bioglass 45S5 AND bone defect" in combination. We found 27 articles, and after applying the inclusion criteria, we selected 15 studies for detailed examination. Most of these studies compared 45S5 BG with other cement or scaffold materials. These comparisons demonstrate that the addition of various composites enhances cellular biocompatibility, as evidenced by the cells and their osteogenic potential. Moreover, the use of 45S5 BG is enhanced by its antimicrobial properties, opening avenues for additional investigations and applications of this biomaterial.

Reproducibility and comparison between methods for gingival color evaluation: a validation study

Aim This study aims to evaluate and validate the sensibility and the level of agreement between different gingival color measures obtained by a spectrophotometer (SPECTRO) and a photography (PHOTO) method. Methods Among 40 patients, the color was measured 2 mm apical to the gingival margin by CIE L*, a*, b* system using a reflectance spectrophotometer and the photography's plus software. The level of agreement between three different measures (m1, m2, m3) in parameters L*, a*, b*, and ∆E (color variation) was evaluated by random and systematic errors, as well as the limits and coefficient of concordance. A comparison between the methods was performed by the Bland-Altman test and the sensibility level was evaluated accordingly to the ∆E: 3.7 thresholds with p<0.05 as the level of significance for these comparisons. Results The SPECTRO method has not presented the systematic error (p>0.05) and had reproducibly and agreement level in three variable measures L* (r: 0.6), a* (r: 0.3), and b* (r: 0.5) as to the PHOTO method L* (r: 0.6), a* (r: 0.5), and b* (r: 0.5), which presented systematic error in L* values (p<0.05). The means of ∆E between measurements were: 6.5 SPECTRO and 5.9 PHOTO. There was no good level of sensitivity ∆E> 3.7 and agreement between the methods, mainly for the a* values. On the other hand, for the L* and in for the most comparisons of b* values, the level of agreement was higher. Conclusion Both methods could quantify the gingival color from the coordinates L *, a *, and b *, which has shown greater reliability between the measurements acquired by the SPECTRO method.

Association among gestational diabetes mellitus, periodontitis and prematurity: a cross-sectional study.

Objective: Gestational diabetes mellitus (GDM) causes maternal and infant morbidity. Periodontitis is associated with adverse pregnancy outcomes. The aim of this study was to evaluate periodontal status, prematurity and associated factors in pregnant women with and without GDM. Methods: This observational cross-sectional study included 80 pregnant women with GDM (G1 = 40) and without GDM (G2 = 40). Demographic and socioeconomic status, systemic and periodontal health condition, prematurity and newborns' birth weight were analyzed. For bivariate analysis, Mann-Whitney U-test, t test and Chi-squared test were used. Binary logistic regression analyzed independent variables for periodontitis and prematurity (p < 0.05). Results: Patients from G1 presented lower socioeconomic status, higher weight and body mass index (BMI). Prematurity (G1 = 27.5%; G2 = 2.5%; p < 0.05) and severe periodontitis percentages (G1 = 22.5%; G2 = 0; p = 0.001) were higher in G1 than in G2. Logistic regression analysis showed that household monthly income (OR = 0.65; 95% CI 0.48-0.86; p = 0.003) and maternal BMI (adjusted OR = 1.12; 95% CI 1.01-1.25; p = 0.028) were significant predictors of periodontitis during the third trimester of pregnancy. Presence of GDM remained in the final logistic model related to prematurity (adjusted OR = 14.79; 95% CI 1.80-121.13; p = 0.012). Conclusion: Pregnant women with GDM presented higher severity of periodontitis, lower socioeconomic status, higher overweight/obesity and a 10-fold higher risk of prematurity. Socioeconomic-cultural status and BMI were significant predictors for periodontitis, and GDM was a predictor to prematurity.

Biological Behavior of Xenogenic Scaffolds in Alcohol-Induced Rats: Histomorphometric and Picrosirius Red Staining Analysis.

In this experimental protocol, the objective was to evaluate the biological behavior of two xenogenic scaffolds in alcohol-induced rats through histomorphometric and Picrosirius Red staining analysis of non-critical defects in the tibia of rats submitted or not to alcohol ingestion at 25% v/v. Eighty male rats were randomly divided into four groups (n = 20 each): CG/B (water diet + Bio-Oss® graft, Geistlich Pharma AG, Wolhusen, Switzerland), CG/O (water diet + OrthoGen® graft, Baumer, Mogi Mirim, Brazil), AG/B (25% v/v alcohol diet + Bio-Oss® graft), and AG/O (25% v/v alcohol diet + OrthoGen® graft). After 90 days of liquid diet, the rats were surgically obtained, with a defect in the tibia proximal epiphysis; filled in according to their respective groups; and euthanized at 10, 20, 40 and 60 days. In two initial periods (10 and 20 days), all groups presented biomaterial particles surrounded by disorganized collagen fibrils. Alcoholic animals (AG/B and AG/O) presented, in the cortical and medullary regions, a reactive tissue with inflammatory infiltrate. In 60 days, in the superficial area of the surgical cavities, particles of biomaterials were observed in all groups, with new compact bone tissue around them, without complete closure of the lesion, except in non-alcoholic animals treated with Bio-Oss® xenograft (CG/B), where the new cortical interconnected the edges of the defect. Birefringence transition was observed in the histochemical analysis of collagen fibers by Picrosirius Red, in which all groups in periods of 10 and 20 days showed red-orange birefringence, and from 40 days onwards greenish-yellow birefringence, which demonstrates the characteristic transition from the formation of thin and disorganized collagen fibers initially to more organized and thicker later. In histomorphometric analysis, at 60 days, CG/B had the highest volume density of new bone (32.9 ± 1.15) and AG/O the lowest volume density of new bone (15.32 ± 1.71). It can be concluded that the bone neoformation occurred in the defects that received the two biomaterials, in all periods, but the Bio-Oss® was superior in the results, with its groups CG/B and AG/B displaying greater bone formation (32.9 ± 1.15 and 22.74 ± 1.15, respectively) compared to the OrthoGen® CG/O and AG/O groups (20.66 ± 2.12 and 15.32 ± 1.71, respectively), and that the alcoholic diet interfered negatively in the repair process and in the percentage of new bone formed.

Association among gestational diabetes mellitus, periodontitis and prematurity: a cross-sectional study

ABSTRACT Objective: Gestational diabetes mellitus (GDM) causes maternal and infant morbidity. Periodontitis is associated with adverse pregnancy outcomes. The aim of this study was to evaluate periodontal status, prematurity and associated factors in pregnant women with and without GDM. Subjects and methods: This observational cross-sectional study included 80 pregnant women with GDM (G1 = 40) and without GDM (G2 = 40). Demographic and socioeconomic status, systemic and periodontal health condition, prematurity and newborns' birth weight were analyzed. For bivariate analysis, Mann-Whitney U-test, t test and Chi-squared test were used. Binary logistic regression analyzed independent variables for periodontitis and prematurity (p < 0.05). Results: Patients from G1 presented lower socioeconomic status, higher weight and body mass index (BMI). Prematurity (G1 = 27.5%; G2 = 2.5%; p < 0.05) and severe periodontitis percentages (G1 = 22.5%; G2 = 0; p = 0.001) were higher in G1 than in G2. Logistic regression analysis showed that household monthly income (OR = 0.65; 95% CI 0.48-0.86; p = 0.003) and maternal BMI (adjusted OR = 1.12; 95% CI 1.01-1.25; p = 0.028) were significant predictors of periodontitis during the third trimester of pregnancy. Presence of GDM remained in the final logistic model related to prematurity (adjusted OR = 14.79; 95% CI 1.80-121.13; p = 0.012). Conclusions: Pregnant women with GDM presented higher severity of periodontitis, lower socioeconomic status, higher overweight/obesity and a 10-fold higher risk of prematurity. Socioeconomic-cultural status and BMI were significant predictors for periodontitis, and GDM was a predictor to prematurity.

Beneficial effects of a mouthwash containing an antiviral phthalocyanine derivative on the length of hospital stay for COVID-19: randomised trial.

The risk of contamination and dissemination by SARS-CoV-2 has a strong link with nasal, oral and pharyngeal cavities. Recently, our research group observed the promising performance of an anionic phthalocyanine derivative (APD) used in a mouthwash protocol without photoexcitation; this protocol improved the general clinical condition of patients infected with SARS-CoV-2. The present two-arm study evaluated in vitro the antiviral activity and cytotoxicity of APD. Additionally, a triple-blind randomized controlled trial was conducted with 41 hospitalized patients who tested positive for COVID-19. All the included patients received World Health Organization standard care hospital treatment (non-intensive care) plus active mouthwash (experimental group AM/n = 20) or nonactive mouthwash (control group NAM/n = 21). The adjunct mouthwash intervention protocol used in both groups consisted one-minute gargling/rinsing / 5 times/day until hospital discharge. Groups were compared considering age, number of comorbidities, duration of symptoms prior admission and length of hospital stay (LOS). The associations between group and sex, age range, presence of comorbidities, admission to Intensive care unit (ICU) and death were also evaluated. The in vitro evaluation demonstrated that APD compound was highly effective for reduction of SARS-CoV-2 viral load in the 1.0 mg/mL (99.96%) to 0.125 mg/mL (92.65%) range without causing cytotoxicity. Regarding the clinical trial, the median LOS of the AM group was significantly shortened (4 days) compared with that of the NAM group (7 days) (p = 0.0314). Additionally, gargling/rinsing with APD was very helpful in reducing the severity of symptoms (no ICU care was needed) compared to not gargling/rinsing with APD (28.6% of the patients in the NAM group needed ICU care, and 50% of this ICU subgroup passed way, p = 0.0207). This study indicated that the mechanical action of the protocol involving mouthwash containing a compound with antiviral effects against SARS-CoV-2 may reduce the symptoms of the patients and the spread of infection. The use of APD in a mouthwash as an adjuvant the hospital COVID-19 treatment presented no contraindication and reduced the hospital stay period.Trial registration: The clinical study was registered at REBEC-Brazilian Clinical Trial Register (RBR-58ftdj).

Deposition of Immune Complexes in Gingival Tissues in the Presence of Periodontitis and Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) is a complex chronic autoimmune disease characterized by tissue damage and widespread inflammation in response to environmental challenges. Deposition of immune complexes in kidneys glomeruli are associated with lupus nephritis, determining SLE diagnosis. Periodontitis is a chronic inflammatory disease characterized by clinical attachment and bone loss, caused by a microbial challenge - host response interaction. Deposition of immune complex at gingival tissues is a common finding in the course of the disease. Considering that, the primary aim of this study is to investigate the deposition of immune complexes at gingival tissues of SLE patients compared to systemically healthy ones, correlating it to periodontal and systemic parameters. Twenty-five women diagnosed with SLE (SLE+) and 25 age-matched systemically healthy (SLE-) women were included in the study. Detailed information on overall patient's health were obtained from file records. Participants were screened for probing depth (PD), clinical attachment loss (CAL), gingival recession (REC), full-mouth bleeding score (FMBS) and plaque scores (FMPS). Bone loss was determined at panoramic X-ray images as the distance from cementenamel junction to alveolar crest (CEJ-AC). Gingival biopsies were obtained from the first 15 patients submitted to surgical periodontal therapy of each group, and were analyzed by optical microscopy and direct immunofluorescence to investigate the deposition of antigen-antibody complexes. Eleven (44%) patients were diagnosed with active SLE (SLE-A) and 14 (56%) with inactive SLE (LES-I). Mean PD, CAL and FMBS were significantly lower in SLE+ than SLE-(p < 0.05; Mann Whitney). The chronic use of low doses of immunosuppressants was associated with lower prevalence of CAL >3 mm. Immunofluorescence staining of markers of lupus nephritis and/or proteinuria was significantly increased in SLE+ compared to SLE-, even in the presence of periodontitis. These findings suggest that immunomodulatory drugs in SLE improves periodontal parameters. The greater deposition of antigen-antibody complexes in the gingival tissues of patients diagnosed with SLE may be a marker of disease activity, possibly complementing their diagnosis.

Impact of Subepithelial Connective Tissue for Root Coverage on Brazilian Patients' Quality of Life: A Longitudinal Clinical Study.

Aims: Gingival recession has been associated with dentin hypersensitivity and aesthetic impairment. The impact of gingival recession and periodontal surgical procedures on adult patients' quality of life are scarce. The aim of this study was to evaluate the quality of life of patients submitted to root coverage procedures with subepithelial connective tissue grafts and coronally advanced flap. Materials and methods: Patients were asked to use a numerical rating scale to classify their dentin hypersensitivity, aesthetics, pain/discomfort, chewing, and brushing abilities in gingival recession sites treated with subepithelial connective tissue grafts plus coronally advanced flap. The patients answered a self-administered questionnaire about quality of life-related to oral health (OHIP-14) after 7, 14, 30, 90, and 180 days. Descriptive statistics were used to synthesize the data recorded. Results: Mean percentage of root coverage was positively related to OHIP-14 (dimension 2- physical pain) in 90 days postoperatively. The quality of life (OHIP-14 total score) significantly improved from baseline to 90 and 180 days postoperatively. The numerical rating score analysis revealed significant improvement in the chewing and brushing abilities when period of 7 days was compared to 90 and 180 days and from 14 to 180 days. Conclusions: Root coverage procedures with subepithelial connective tissue grafts plus coronally advanced flap result in a positive effect on adult patients' quality of life.

Laser and LED photobiomodulation effects in osteogenic or regular medium on rat calvaria osteoblasts obtained by newly forming bone technique.

The purposes of this study are to evaluate the effects of photobiomodulation (PBM) with laser and LED on rat calvaria osteoblasts (rGO lineage), cultured in osteogenic (OST) or regular (REG) medium, after induction of a quiescent state and to test if PBM is capable of osteogenic induction and if there is a sum of effects when combining OST medium with PBM. Before irradiation, the cells were put in a quiescent state (1% FBS) 24 h, when red (AlGaInP-660 nm) and infrared laser (GaAlAs-808 nm) and LED (637 ± 15 nm) were applied. The groups were as follows: red laser (RL3-5 J/cm2, 3 s and RL5-8.3 J/cm2, 5 s, 1.66 W/cm2); infrared laser (IrL3-5 J/cm2, 3 s and IrL5-8.3 J/cm2, 5 s); LED (LED3-3 s and LED5-5 s, 0.02 J/cm2, 0.885 W/cm2); positive (C+, 10% FBS) and negative control (C-, 1% FBS). For alkaline phosphatase (ALP) and mineralization assays, the cells were cultured in REG (DMEM 10% FBS) and OST medium (DMEM 10% FBS, 50 µg/mL ascorbic acid, 10 mM ß-glycerophosphate). Statistical analysis was performed using ANOVA and Tukey's tests (p < 0.05). RL5 and LED5 increased proliferation, in vitro wound closure, ALP, and mineralization in rGO cells (p < 0.05). PBM with red laser and LED induced mineralization by itself, without osteogenic medium, not observed for infrared laser (p < 0.05). A sum of effects was observed in osteogenic medium and PBM by infrared, red laser, and LED (5 s). Red laser and LED increased proliferation, migration, and secretory phases in rGO cells in a dose-dependent manner. PBM with red laser and LED promotes osteogenic induction by itself. PBM with infrared laser and osteogenic medium potentializes mineralization.

Clinical and patient-centered outcomes using two types of subepithelial connective tissue grafts: A split-mouth randomized clinical trial.

BACKGROUND: This split-mouth randomized clinical trial compared two different types of subepithelial connective tissue grafts (SCTG) considering clinical parameters and patient-centered outcomes in patients with bilateral recession type 1 multiple gingival recessions after 6 months postoperatively. METHODS: A total of 21 patients were surgically treated with coronally advanced flap (CAF) associated with SCTG harvested by: double blade scalpel (DBS) and de-epithelialized (DE) SCTG. Periodontal clinical parameters and esthetics were evaluated by a calibrated periodontist at baseline and after 6 months. Patient-centered outcomes related to pain/discomfort and esthetics were assessed with visual analogue scale after 7 days and 6 months, respectively. RESULTS: All clinical parameters, with the exception of probing depth, demonstrated differences in intragroup evaluation, comparing baseline to 6-month evaluation (P <0.05). Both groups presented reduction of recession depth and recession width and gain of keratinized tissue thickness, keratinized tissue width, and clinical attachment level (P <0.05). Intergroup comparison (DBS × DE) demonstrated no significant differences considering clinical parameters and periods. Both techniques improved esthetics evaluated by patients, without a difference between groups in patients and professional analysis. However, DBS group presented inferior pain/discomfort compared with DE (P <0.05). CONCLUSION: DBS and DE associated with CAF presented satisfactory clinical outcomes. However, DBS presented inferior morbidity, an important fact for decision-making process.

Deposition of immune complexes in gingival tissues in the presence of periodontitis and Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a complex chronic autoimmune disease characterized by tissue damage and widespread inflammation in response to environmental challenges. Deposition of immune complexes in kidneys glomeruli are associated with lupus nephritis, determining SLE diagnosis. Periodontitis is a chronic inflammatory disease characterized by clinical attachment and bone loss, caused by a microbial challenge ­ host response interaction. Deposition of immune complex at gingival tissues is a common finding in the course of the disease. Considering that, the primary aim of this study is to investigate the deposition of immune complexes at gingival tissues of SLE patients compared to systemically healthy ones, correlating it to periodontal and systemic parameters. Twenty-five women diagnosed with SLE (SLE+) and 25 age-matched systemically healthy (SLE­) women were included in the study. Detailed information on overall patient's health were obtained from file records. Participants were screened for probing depth (PD), clinical attachment loss (CAL), gingival recession (REC), full-mouth bleeding score (FMBS) and plaque scores (FMPS). Bone loss was determined at panoramic X-ray images as the distance from cementenamel junction to alveolar crest (CEJ-AC). Gingival biopsies were obtained from the first 15 patients submitted to surgical periodontal therapy of each group, and were analyzed by optical microscopy and direct immunofluorescence to investigate the deposition of antigen-antibody complexes. Eleven (44%) patients were diagnosed with active SLE (SLE-A) and 14 (56%) with inactive SLE (LES-I). Mean PD, CAL and FMBS were significantly lower in SLE+ than SLE­(p < 0.05; Mann Whitney). The chronic use of low doses of immunosuppressants was associated with lower prevalence of CAL >3 mm. Immunofluorescence staining of markers of lupus nephritis and/or proteinuria was significantly increased in SLE+ compared to SLE­, even in the presence of periodontitis. These findings suggest that immunomodulatory drugs in SLE improves periodontal parameters. The greater deposition of antigen-antibody complexes in the gingival tissues of patients diagnosed with SLE may be a marker of disease activity, possibly complementing their diagnosis.

Surface roughness of titanium disks influences the adhesion, proliferation and differentiation of osteogenic properties derived from human.

PURPOSE: The aim of this study was to investigate the response of osteogenic cell lineage and gingival fibroblastic cells to different surface treatments of grade IV commercially pure Titanium (cpTi) disks. MATERIAL AND METHODS: Grade IV cpTi disks with different surfaces were produced: machined (M), sandblasting (B), sandblasting and acid subtraction (NP), and hydrophilic treatment (ACQ). Surface microtopography characteristics and chemical composition were investigated by scanning electron microscopy (SEM) and energy dispersive x-ray spectrometry (EDS). Adhesion and proliferation of SC-EHAD (human surgically-created early healing alveolar defects) and HGF-1 (human gingival fibroblasts) on Ti disks were investigated at 24 and 48 h, and osteogenic differentiation and mineralization were evaluated by assessing alkaline phosphatase (ALP) activity and alizarin red staining, respectively. RESULTS: No significant differences were found among the various surface treatments for all surface roughness parameters, except for skewness of the assessed profile (Rsk) favoring M (p = 0.035 ANOVA). M disks showed a slightly higher (p > 0.05; Kruskal-Wallis/Dunn) adhesion of HGF-1 (89.43 ± 9.13%) than SC-EHAD cells (57.11 ± 17.72%). ACQ showed a significantly higher percentage of SC-EHAD (100%) than HGF-1 (69.67 ± 13.97%) cells adhered at 24 h. SC-EHAD cells expressed increased ALP activity in osteogenic medium at M (213%) and NP (235.04%) surfaces, but higher mineralization activity on ACQ (54.94 ± 4.80%) at 14 days. CONCLUSION: These findings suggest that surface treatment influences the chemical composition and the adhesion and differentiation of osteogenic cells in vitro. CLINICAL RELEVANCE: Hydrophilic surface treatment of grade IV cpTi disks influences osteogenic cell adhesion and differentiation, which might enhance osseointegration.

Free gingival graft and acellular dermal matrix for gingival augmentation: a 15-year clinical study.

OBJECTIVES: This study evaluated clinical outcomes of acellular dermal matrix (ADM) allograft compared with autogenous free gingival graft (FGG) for gingival augmentation after 15 years. MATERIAL AND METHODS: Twenty-two patients were originally included and evaluated by de Resende et al. (Clin Oral Investig 23:539-550, 2019), and 12 accepted to participate in this longitudinal evaluation. Clinical parameters evaluated were recession depth (RD), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), and soft tissue thickness (TT). In addition, esthetic perception was evaluated by patients and by a calibrated periodontist. Data were evaluated by ANOVA complemented by Tukey tests (p < 0.05). RESULTS: After 15 years, both treatments provided a significant increase in KTW and TT but with superior results for the FGG group (p < 0.05). No differences were observed between groups for PD and CAL. In the ADM group, RD significantly increased in long term, as well as the rate of tissue contraction. The percentage of shrinkage for the ADM group was 59.6%. Conversely, the FGG group presented a creeping attachment of 17.6% and RD significantly decreased in long term. The ADM group presented superior results considering professional esthetic perception. CONCLUSIONS: Both treatments longitudinally promoted significant gain of keratinized tissue width and thickness with superior outcomes for the FGG group. The ADM group demonstrated more tissue contraction and gingival recession whereas the FGG group presented creeping attachment. Professional esthetic perception was superior for the ADM group. CLINICAL RELEVANCE: This study added important clinical data with long-term evaluation of ADM compared with FGG.

Evaluation of Regular Market Ethyl Cyanoacrylate Cytotoxicity for Human Gingival Fibroblasts and Osteoblasts.

Background: The aim of this study was to evaluate the cytotoxicity of cyanoacrylate adhesives in an indirect contact assay in human gingival fibroblast (FGH) and oral osteoblasts (GO) lineages. Methods: Cover glasses were glued with adhesives following the ISO 10993-2012 protocol. The groups were: C (control with cells and regular Dulbecco Modified Eagle Medium; LC (liquid ethyl-cyanoacrylate); GC (ethyl-cyanoacrylate gel); EGC (easy gel [ethyl-cyanoacrylate]); and D (Dermabond [octyl-cyanoacrylate]). Each cell linage was plated in the sixth passage using 104 cells. Cell viability was measured by the MTT test at 24, 48, 72, and 96 hours. Data were analyzed by two-way analysis of variance complemented by the Tukey test, with p < 0.05 being significant. Results: Dermabond stimulated osteoblast viability at 72 h (p < 0.05). All other groups were similar to the control cells (p > 0.05). For the fibroblasts, there was no difference in the groups, including the control except that EGC was cytotoxic for these cells (p < 0.05). Conclusions: Ethyl-cyanoacrylate gel and liquid forms available on the general chemical market were not cytotoxic for oral osteoblasts and fibroblasts in most cases. However, the easy gel form was cytotoxic for fibroblasts.

Root coverage stability with acellular dermal matrix in multiple gingival recessions in esthetic zone: A clinical case report with 12-year follow-up.

The importance of surgical intervention for the maintenance of long-term results by root coverage of multiple gingival recessions in an esthetic area treated with a tissue substitute (acellular dermal matrix [ADM]-Alloderm®) is widely required. The present case report highlights the effectiveness of the ADM for the treatment of multiple recession defects in a female patient with Class I and II gingival recession in relation to maxillary anterior associated with esthetics and dentin hypersensitivity demands. The root coverage rate for the anterior area showed greater value with 70% of coverage; at 90 days and 2 and 12 years of follow-up, it showed 70.5%, 79%, and 77%, respectively. Conversely, for the posterior area, these rates were 68.5%, 63%, and 57% for the same follow-up periods. Results regarding gain of keratinized tissue demonstrated superior values for the anterior area, namely 3.92, 3.34 and 3.22 mm at 90 days and 2 and 12 years. These values for the posterior area were 0.54 mm, 2.41, and 1.87 mm, respectively. These findings suggest that the tissue substitute Alloderm® showed excellent long-term results for areas of multiple recessions, providing root coverage and stability of keratinized tissue gain. After this long period of evaluation, some local factors associated with recurrence of gingival recessions were detected, and a lack of proper periodontal maintenance care was observed. However, esthetic and functional outcomes achieved with surgical procedure were maintained.

Root surface demineralization by citric acid/tetracycline gel and aPDT associated to subepithelial connective tissue graft improves root coverage outcomes. A 12-month preliminary randomized clinical trial.

Root conditioners are used to promote root surface biomodification to increase the success rate of root coverage. Citric acid and tetracycline are commonly used. There is recent indication for using antimicrobial photodynamic therapy (aPDT) with this purpose. The aim of this study is to evaluate the effects of citric acid/tetracycline gel and aPDT in root coverage of gingival recessions using subepithelial connective tissue graft. This parallel, double-blinded clinical trial enrolled 17 patients (60 recession defects; 20/group). Experimental groups were: Control group (SRP) - scaling and root planing only; Citric acid/tetracycline gel (CAT) group - SRP plus citric acid/tetracycline gel; aPDT - SRP, toluidine blue O (100 µl/ml) and red laser. At baseline and after 3, 6 and 12 months, the clinical parameters were evaluated: recession depth (RD), percentage of root coverage (%RC), keratinized tissue width (KTW), soft tissue thickness (STT), probing depth (PD), clinical attachment level (CAL), dentin hypersensitivity (HYPER) and esthetic perception by patient (EST). CAT group presented reduction in PD, CAL, RD, increase in KTW and STT, higher %RC (81.6%) and better esthetic in relation to SRP group (p < .05). aPDT treatment promoted CAL reduction, gain of KTW and STT and higher %RC (82.1%) in relation to SRP (57.7%) (p < .05). There was a reduction in dentin sensitivity in all groups. Complete root coverage was higher for CAT group (65%) and aPDT group (70%) in relation to SRP (30%) (p < .05). Root conditioning, with citric acid/tetracycline gel and aPDT, promotes better long-term clinical outcomes and root coverage after SCTG procedures.

Bone demineralization promotes superior spread of preosteoblast in culture.

Previous studies have shown substances capable of similar effects of demineralization, accelerating the process of bone remodeling. This study investigated preosteoblasts behavior in cell culture after bone demineralization with citric acid and tetracycline. Seventy-four Wistar rats provided 144 calvarial bone samples, 126 of which were randomly divided in seven groups according to the treatment given to the surface: no demineralization (C), citric acid (CA), tetracycline (TCN) during 15, 30, and 60 s. Each group received preosteoblasts cultured for 24, 48, and 72 hr. Eighteen remaining samples were analyzed for the atomic percentage (A%) by energy dispersive spectroscopy (EDS) before and after demineralization. The average percentage of bone area covered by cells increased with time and it was significantly higher after 24 and 48 hr of culture in groups CA15s, CA30s, CA60s, TCN15s, and TCN30s than in groups TCN60 and C (p < 0.05). The cell morphology in all CA and TCN groups was shown to be compatible with more advanced stages of differentiation than in C group. The A% changed after demineralization. We conclude that demineralization with citric acid or tetracycline for 15-30 s increased the area of bone surface covered by preosteoblasts. The A% changes were not sufficient to impair the cells spreading and morphology. Bone demineralization may promote potential benefits in bone regenerative procedures. HIGHLIGHTS: Low pH effects did not interfere on cell growth. Bone demineralization favored the preosteoblasts growth. A possible alternative to improve graft consolidation.

Blue photosensitizers for aPDT eliminate Aggregatibacter actinomycetemcomitans in the absence of light: An in vitro study.

The main treatment of periodontal disease is the mechanical removal of supra and subgingival biofilm. Adjuvant therapies as antimicrobial photodynamic therapy (aPDT) may offer improved clinical and microbiological results. The aim of this in vitro study was to evaluate the effect of toluidine and methylene blue dyes, associated with red laser and LED, on elimination of a suspension of Aggregatibacter actinomycetemcomitans (A.a). Experimental groups (n = 29) consisted of positive (broth) and negative (gentamicin) controls, three different dyes concentrations (0.05; 0.1; 10 mg/ml) alone or associated with laser (660 nm) at two power settings (70 and 100 mW) and LED (627 ±â€¯10 nm). Bacterial suspension received all treatments, and after serial dilutions they were cultured for 24 h in petri dishes for colony forming unit counts. Data were analyzed by ANOVA complemented by Tukey's test (p < 0.05). The results showed that both dyes, at a concentration of 10 mg/ml, alone or associated with laser and LED, caused 100% of death similar to the negative control (p > 0.05). It can be concluded that blue dyes for aPDT, at high concentration (10 mg/ml), are capable of eliminating A.a without adjuvant use of light sources.