A scoping review on hyposalivation associated with systemic conditions: the role of physical stimulation in the treatment approaches.

BACKGROUND: Several systemic conditions can result in distinct degrees of salivary gland damage and consequent hypofunction. The development of successful management schemes is highly challenging due to the complexity of saliva. This study aimed to systematically map the literature on the physical stimulation of salivary glands for hyposalivation management and the response of individuals according to different systemic conditions causing salivary impairment. METHODS: A systematic search in the literature was performed. Two reviewers independently selected clinical trials, randomized or not, that used physical stimulation to treat hyposalivation caused by systemic conditions. Studies evaluating healthy subjects without hyposalivation were included as controls. Single-arm clinical studies or case series were also included for protocol mapping (PRISMA extension for scoping reviews). RESULTS: Out of 24 included studies, 10 evaluated healthy subjects, from which 9 tested transcutaneous electrical nerve stimulation (TENS) and 1 tested acupuncture and electroacupuncture. Fourteen studies evaluated individuals with hyposalivation: 6 applied TENS, 6 applied low-level laser therapy (LLLT), and 2 applied acupuncture, carried out in post-chemotherapy, medication use, postmenopausal women, hemodialysis patients, smokers, diabetics, Sjögren's syndrome (SS). All showed increased salivation after treatment, except for two LLLT studies in individuals with SS. CONCLUSIONS: Among the different patient groups, individuals with Sjögren's syndrome (SS) exhibited the poorest responses, while those with medication-induced hyposalivation demonstrated the most favorable treatment outcomes, independently of the management strategy for saliva stimulation. It means that physical stimulation of salivary glands holds promise as an alternative for managing hyposalivation in cases of reversible gland damage. However, to make informed decisions in current practice, it is necessary to conduct new well-designed randomized clinical trials with appropriate methodologies.

Clinical management of salivary gland hypofunction in patients with head and neck cancer: a scoping review of physical salivary stimulation methods.

OBJECTIVE(S): This scoping review aims to map the scientific literature on the therapies currently available for physical salivary stimulation in individuals with hyposalivation caused by radiotherapy. STUDY DESIGN: Studies were included when they comprised the target population of adult individuals receiving radiotherapy of the head and neck region and who developed or were at risk of developing hyposalivation. Two reviewers selected the studies and extracted data on the type of physical salivary stimulation therapy used, the degree of glandular tissue involvement, and the percentage of salivary flow alteration. Therapies were classified according to either prophylactic application (before/during radiotherapy) or therapeutic application (post-radiotherapy). RESULTS: Sixteen articles were included: 4 tested transcutaneous electrical nerve stimulation (TENS), 3 studied low-level lasers, 7 researched acupunctures, and 2 investigated acupuncture-like TENS. The outcomes of the prophylactic studies indicated beneficial effects (similar salivary flow or reduced salivary flow loss), although most studies did not include a comparable control group. Therapeutic studies presented conflicting results. CONCLUSION(S): Prophylactic therapies of physical salivary stimulation may produce better effects than therapeutic applications. However, the protocols best indicated could not be defined. Well-designed, controlled clinical trials should be researched in the future to support the clinical recommendation of any of these treatments.

Can hyperglycemia be associated with caries activity and root caries in adults?

AIMS: A previous meta-analysis showed that individuals with Type 2 diabetes mellitus (T2D) have a greater chance of developing both coronal caries and root caries than systemically healthy ones, which can be influenced by hyperglycemia per se. This study aimed to associate blood and salivary glucose levels with caries. METHODS: This research is a subset of a cross-sectional study. N = 39 individuals underwent a dental examination and salivary glucose, fasting blood glucose (FBG) and glycated hemoglobin (A1c) measurements. RESULTS: The prevalence of active coronal caries was 10.2%, and that of root caries was 20.5%. A1c and FBG averages were higher in individuals with root caries (9.75 ± 1.71 and 186.3 ± 62.5) than without (7.01 ± 2.23 and 115.1 ± 48.6; p < 0.05). Individuals with T2D showed weak correlation of salivary glucose and number of active coronal caries. Significant correlations were observed between salivary and blood glucose. There was relevance of A1c (0.53; CI=0.124-0.941; p = 0.01) and FBG (0.019; CI=0.006-0.033; p = 0.006) toward the increased number of root caries lesions, even after adjustment for salivary flow and age. CONCLUSION: Blood glucose levels are associated with an increased number of root caries in adults with or without T2D. In individuals with T2D, salivary glucose was correlated with active coronal caries. Additional studies are needed to support this association.

Expression of inflammatory mediators in periodontitis and T2D patients: a systematic review and meta-analysis.

The high concentration of glucose in the blood in Type 2 diabetes (T2D) may be related to either insulin resistance or insulin deficiency. Moreover, the literature points to periodontitis as the main oral disease caused by glycemia imbalance. The quantification of inflammatory markers in blood or saliva samples of T2D patients may represent a valuable tool in revealing how well an individual's immune system can respond to injuries and periodontal treatment. In addition, an evaluation of the cytokine expression is extremely relevant to help understand the connection between periodontitis and T2D. This systematic review and meta-analysis aimed to evaluate the expression of inflammatory markers in T2D patients with periodontitis, compared with non-diabetic patients with periodontitis. A total of 3,894 studies were retrieved after a systematic literature search, 15 of which were included in the systematic review, and 4 of these 15, in the meta-analysis. The results did not indicate any statistical difference between the groups regarding TNF-α and IL-6 markers. T2D patients with periodontitis had increased levels of IL-10, compared with non-diabetic individuals with periodontitis (p = 0.003). On the other hand, the IL-4 concentration in non-diabetic individuals with periodontitis was high, compared with the T2D group (p< 0.001). Several studies did not include quantitative results and were excluded from the meta-analysis. The high IL-10 expression and low IL-4 expression in the T2D group suggest an association between the level of these markers and the impairment of the immune response in T2D patients with periodontitis.

Enrichment of sulphate-reducers and depletion of butyrate-producers may be hyperglycaemia signatures in the diabetic oral microbiome.

Objectives: This study aimed to investigate oral microbial signatures associated with hyperglycaemia, by correlating the oral microbiome with three glycaemic markers. Potential association between clinical parameters and oral bacterial taxa that could be modulating the hyperglycaemic microbiome was also explored. Methods: Twenty-three individuals diagnosed with type 2 Diabetes Mellitus (T2D) and presenting periodontitis were included, as well as 25 systemically and periodontally healthy ones. Fasting blood glucose, glycated haemoglobin, salivary glucose, periodontitis classification, caries experience and activity and salivary pH were evaluated. The V4 region of the 16S rRNA gene was amplified from total salivary DNA, and amplicons were sequenced (Illumina MiSeq). Results: Hyperglycaemia was correlated with proportions of Treponema, Desulfobulbus, Phocaiecola and Saccharimonadaceae. Desulfobulbus was ubiquitous and the most enriched organism in T2D individuals (log2FC = 4). The Firmicutes/Bacteroidetes ratio was higher at alkali salivary pH than acidic pH. In the network analysis, Desulfobulbus was clustered in a negative association with caries-associated and butyrate-producing bacteria. Conclusion: The salivary microbiome is shaped by systemic hyperglycaemia, as well as changes in the salivary pH, which may be linked to local hyperglycaemia. The enrichment of predictive biomarkers of gut dysbiosis in the salivary microbiome can reflect its capacity for impairment of hyperglycaemia.

The Complex Interrelationship between Diabetes Mellitus, Oral Diseases and General Health.

There is emerging evidence that several oral diseases and conditions can be associated with DM. Dental caries, hyposalivation, fungal diseases and endodontics lesions may represent potential oral complications that can be aggravated by chronic hyperglycemia. Individuals with DM have a low perception of oral diseases which can lead to clinically important oral and systemic complications. This review aims to provide data on the most common oral signs and symptoms related to DM and to explore the mechanisms that might explain associations between DM and oral diseases in order to clarify the risks posed by poor oral health in DM. Since the linkage between oral diseases and DM is part of multifactorial aspects related to chronic hyperglycemic status and several common conditions affecting the whole body, both require rigorous self-control from patients and attention from medical and dental professionals.

Expression of inflammatory mediators in periodontitis and T2D patients: a systematic review and meta-analysis

Abstract The high concentration of glucose in the blood in Type 2 diabetes (T2D) may be related to either insulin resistance or insulin deficiency. Moreover, the literature points to periodontitis as the main oral disease caused by glycemia imbalance. The quantification of inflammatory markers in blood or saliva samples of T2D patients may represent a valuable tool in revealing how well an individual's immune system can respond to injuries and periodontal treatment. In addition, an evaluation of the cytokine expression is extremely relevant to help understand the connection between periodontitis and T2D. This systematic review and meta-analysis aimed to evaluate the expression of inflammatory markers in T2D patients with periodontitis, compared with non-diabetic patients with periodontitis. A total of 3,894 studies were retrieved after a systematic literature search, 15 of which were included in the systematic review, and 4 of these 15, in the meta-analysis. The results did not indicate any statistical difference between the groups regarding TNF-α and IL-6 markers. T2D patients with periodontitis had increased levels of IL-10, compared with non-diabetic individuals with periodontitis (p = 0.003). On the other hand, the IL-4 concentration in non-diabetic individuals with periodontitis was high, compared with the T2D group (p< 0.001). Several studies did not include quantitative results and were excluded from the meta-analysis. The high IL-10 expression and low IL-4 expression in the T2D group suggest an association between the level of these markers and the impairment of the immune response in T2D patients with periodontitis.

Systemic conditions of diabetic patients diagnosed with apical periodontitis / Condições sistêmicas de pacientes diabéticos diagnosticados com periodontite apical

ABSTRACT Objective: This study aimed to evaluate the association between glycemic control status in type 2 diabetes mellitus (T2DM) patients and apical periodontitis. Methods: Twenty-seven patients were involved in this study. The survey was based on anamnesis, intra and extra oral examination and radiographic evaluation. Diabetes mellitus information involved type of diabetes and blood glucose analysis. Patients were divided according to their metabolic control status (glycemic controlled and poorly controlled T2DM patients). Results: A higher fasting blood glucose level (p = 0.004) and a higher percentage of HbA1c (p = 0.0001) were demonstrated in poorly controlled T2DM patients when compared to glycemic controlled T2DM. However, the frequency of apical periodontitis and the elapsed time since diabetes mellitus diagnosis were higher in controlled T2DM patients, reaching 64%. Nevertheless, controlled T2DM patients presented a higher number of apical periodontitis cases (p < 0.05). Findings support that controlled patients T2DM presented higher presence of apical periodontitis than poorly controlled T2DM ones. In these patients, the time elapsed since the diagnosis was higher, which may have provided a longer period of oscillation and/or uncontrolled metabolism. Conclusions: Therefore, it might contribute to the development and maintenance of apical periodontitis in glycemic controlled patients of this study.

RESUMO Objetivo: Este estudo objetivou avaliar a associação entre o estado de controle glicêmico em pacientes com diabetes mellitus tipo 2 (DM2) e a periodontite apical. Métodos: Vinte e sete pacientes foram envolvidos neste estudo. A pesquisa baseou-se na anamnese, exame intra e extraoral e avaliação radiográfica. As informações sobre o diabetes mellitus envolveram o tipo de diabetes e a análise da glicose sanguínea. Os pacientes foram divididos de acordo com seu estado de controle metabólico (pacientes com DM2 com controle glicêmico e pacientes com DM2 mal controlados). Resultados: Um maior nível de glicose em jejum (p = 0,004) e uma maior porcentagem de HbA1c (p = 0,0001) foram demonstrados em pacientes com DM2 mal controlada quando comparados com DM2 com controle glicêmico. Porém, a frequência de periodontite apical e o tempo decorrido desde o diagnóstico de diabetes mellitus foram maiores nos pacientes com DM2 controlado, chegando a 64%. No entanto, os pacientes com DM2 controlada apresentaram um maior número de casos de periodontite apical (p < 0,05). Os achados suportam que pacientes controlados com DM2 apresentam maior presença de periodontite apical do que pacientes com DM2 mal controlada. Nesses pacientes, o tempo decorrido desde o diagnóstico foi maior, o que pode ter proporcionado um período maior de oscilação e/ou metabolismo descontrolado. Conclusão: Portanto, pode contribuir para o desenvolvimento e manutenção da periodontite apical nos pacientes com controle glicêmico deste estudo.

Atuação odontológica em UTI: a importância da Periodontia na qualidade de saúde do paciente crítico / Dental practice in ICU: the importance of periodontics in critical patient care quality

A pneumonia nosocomial é uma doença sistêmica que acomete o paciente no ambiente hospitalar após 48 horas da sua admissão, principalmente nas unidades de terapia intensiva (UTIs). O acúmulo de biofilme dentário, saburra lingual e processos inflamatórios decorrentes da presença de doença periodontal podem contribuir para a formação de reserva microbiana associada à pneumonia nosocomial. A prevenção da pneumonia nosocomial é muito importante para garantir a saúde do paciente. O uso de clorexidina 0,12% para a higienização de língua, dentes e mucosas é um grande aliado na redução de bactérias, prevenindo o aparecimento de infecções nos pacientes internados, além do combate das mesmas, como a pneumonia nosocomial. O treinamento da equipe de enfermagem para realização dessas manobras, assim como para entender a importância da relação entre saúde bucal e infecções respiratórias, deve ser reforçado, visto que parece ser deficiente. A presença do cirurgião-dentista em uma equipe multidisciplinar de UTI é indispensável. Sua presença parece ser mais importante na equipe de coordenação, para o treinamento e capacitação dos profissionais ali envolvidos, além da realização de procedimentos mais complexos, como exodontia e raspagem e alisamento coronorradicular.

Nosocomial pneumonia is a systemic disease that affects the inpatient after 48 hours of admission, especially in intensive care units (ICUs). The dental plaque accumulation, tongue coating and inflammatory processes arising from the presence of periodontal disease may contribute to the formation of microbial reservatories associated with nosocomial pneumonia. Prevention of nosocomial pneumonia is very important to ensure the health of the patient. The use of 0.12% chlorhexidine for tongue, teeth and also mucosal cleaning is important to reduce bacteria and to prevent the appearance of infections in hospitalized patients, such as nosocomial pneumonia. The training of nursing staff to perform these procedures, as well as to understand the importance of the relationship between oral health and respiratory infections, should be strengthened, since it appears to be defi cient. The presence of the dentist in multidisciplinary ICU team is indispensable. Because the practitioner can coordinate a team for training and qualification of professionals involved there, in addition to performing more complex procedures such as tooth extraction and scaling and root planning.

Soluções cirúrgicas combinadas para o sorriso gengival / Surgical combined solutions for the gummy smile

A estética vem sendo cada vez mais requisitada em nossos consultórios, dada a sua divisão entre "estética branca" e "estética vermelha". A gengiva compõe um belo sorriso de maneira tão importante quanto os dentes. A exposição gengival excessiva gera desarmonia estética e é denominada sorriso gengival. O tratamento do sorriso gengival vem sendo cada vez mais desmistificado e apresenta maior procura e aceitação por parte dos pacientes. Do ponto de vista periodontal, pode-se realizar gengivoplastia e gengivectomia com bisel interno ou externo, com ou sem osteotomia, dependendo da etiologia e características periodontais do paciente. No presente estudo, foram realizadas, na mesma paciente, a técnica de bisel interno no arco superior e a técnica de bisel externo no inferior. Buscou-se, assim, esclarecer em qual momento cada técnica é indicada.

Esthetics has been a common issue in the dental offi ce, for this being divided into "white" and "pink" esthetics. The gingival tissue is so fundamental as the dental element in the smile composition. Excessive gingival display results in what has been known as the gummy smile. The proposed treatments have been simplifi ed and more and more requested by patients. From the periodontal point of view, the gingivoplasty and the gingivectomy can be made with internal or external bevel, with or without osteotomy, depending on the etiology and periodontal characteristics. In this case report, the internal bevel technique was performed in the maxillary arch and the external bevel technique in the mandibular arch. The indications for both techniques are discussed here.

Salivary function impairment in type 2 Diabetes patients associated with concentration and genetic polymorphisms of chromogranin A.

OBJECTIVES: The purpose of this study was to evaluate the effect of type 2 diabetes mellitus (T2DM) on salivary function impairments according to glycemic control status and subsequently compare the concentration of chromogranin A (CHGA) with its genetic profile. MATERIALS AND METHODS: Thirty-six patients with controlled T2DM, 36 with poorly controlled T2DM, and 38 nondiabetic subjects underwent salivary flow rate measurements by means of unstimulated labial (ULS), unstimulated whole (UWS), and stimulated whole saliva (SWS) collections. CHGA concentrations were determined in saliva and plasma with ELISA, and two CHGA polymorphisms (T-415C and Glu264Asp) were analyzed by polymerase chain reaction-restriction fragment length polymorphism. RESULTS: T2DM patients presented significantly lower ULS and UWS flow rates regardless of glycemic control status compared to controls (P = 0.002 and P = 0.027, respectively). The SWS flow rate in the poorly controlled T2DM was the lowest among the groups (P = 0.026). Significantly higher plasma and salivary CHGA levels were found in T2DM groups (P = 0.019 and P < 0.001, respectively). CHGA gene variants (T-415C and Glu264Asp) revealed significant differences between diabetics and control subjects when associated with lower salivary flow and higher salivary CHGA production (P < 0.05). CONCLUSIONS: T2DM causes abnormalities in the function of salivary glands. However, poorly controlled T2DM has the most influence on SWS flow rates. Our findings indicate an association between plasma and salivary CHGA levels and T2DM patients. Furthermore, the results suggest that CGHA polymorphisms might be associated with salivary gland hypofunction and higher salivary CHGA production in T2DM patients. Nevertheless, further epidemiological studies are required to elucidate this clinical implication. CLINICAL RELEVANCE: Salivary impairments and high levels of CHGA are associated with T2DM patients. In addition, CGHA polymorphisms might be associated with salivary gland hypofunction and higher salivary CHGA production in T2DM patients. This could be a significant insight to establish a role for salivary CHGA as a potential clinical biomarker to T2DM.

Impact of glycemic control on oral health status in type 2 diabetes individuals and its association with salivary and plasma levels of chromogranin A.

OBJECTIVE: To evaluate the effect of glycemic control status in type 2 diabetes mellitus (T2DM) individuals on clinical oral health indicators and to compare the concentrations of plasma and salivary chromogranin A (CHGA) among nondiabetic subjects and T2DM patients, exploring their associations. DESIGN: In this cross-sectional study, 32 patients with controlled T2DM, 31 with poorly controlled T2DM and 37 nondiabetic subjects underwent a clinical and periodontal examination. CHGA concentrations were determined in saliva and plasma with ELISA. RESULTS: Poorly controlled T2DM group exhibited significantly higher mean buffering capacity, plaque index and bleeding on probing than other groups (P<0.05). No difference was found to DMFT (decayed, missed and filled teeth) index between groups. Sites with clinical attachment loss (CAL) of 4 and 5-6mm were significantly higher in both diabetic groups compared to control group (P<0.05). Poorly controlled T2DM group had significantly higher sites with CAL ≥ 7 mm than other groups (P=0.001). Significantly higher plasma and salivary CHGA levels were found in T2DM groups (P<0.05). In both diabetic groups, probing depths 5-6mm and CAL 5-6mm were associated with higher salivary CHGA concentration (P<0.05). CONCLUSIONS: The findings revealed that T2DM patients were more prone to periodontal tissue damage than to caries risk. The results also provide some evidence that the degree of attachment loss deteriorates significantly with poor glycemic control in T2DM (CAL ≥ 7 mm). Moreover, the results suggest that high concentrations of salivary CHGA are associated with worse periodontal parameters and T2DM, and this could be related to the pathogenesis of both diseases.

Percepções de pacientes sobre a relação entre diabetes mellitus e saúde oral: um estudo transversal / Patients perceptions towards diabetes mellitus and oral health: a cross-sectional study

Purpose: To evaluate the knowledge of diabetic patients towards the connection between diabetes mellitus (DM) and oral diseases. Oral status was also assessed in order to evaluate the correlation among patients' perception and their oral health. Material and Methods: A sample of 132 diabetic subjects answered a questionnaire containing 12 questions addressing their knowledge, attitudes and practices related to oral health. Oral examination accessed the presence of cavity carious lesions, residual roots, dental biofilm, calculus, gingivitis, tooth mobility and gingival recession. Results: Fifty-four percent of the sample had never been instructed by their health professionals that DM could cause oral diseases. However, 66% presumed being more vulnerable to develop oral illnesses and 57.5% answered that they assumed having no oral disturbances at that moment. In contrast, intraoral clinical examination showed that 99% presented at least one oral injury such as caries lesions, plaque/calculus, gingival inflammation, tooth mobility, residual root and xerostomia. Conclusions: Health care professionals usually neglect oral status in diabetic patients. Above all, there is a huge gap between patients' perceptions towards oral health and their real oral status. This study highlights the need of developing new models of prevention that properly address the important clinical relation between oral diseases and DM.(AU)

Uso de antimicrobianos no tratamento da doença periodontal em pacientes diabéticos – revisão de literatura / Antimicrobial use in the treatment of Periodontal Disease in Diabetic patients - Literature Review

A Doença Periodontal e o Diabetes Mellitus apresentam uma relação bidirecional extensivamente reportada na literatura científica. Assim como o paciente diabético mal controlado apresenta maior risco de desenvolver a periodontite em sua forma mais grave, a doença periodontal também interfere negativamente no controle glicêmico e nas complicações do diabetes. Desta forma o tratamento da doença periodontal é essencial para o controle não só da infecção local, como também, para a prevenção e o controle de suas repercussões sistêmicas. O objetivo da presente revisão de literatura foi estudar os efeitos do uso de antimicrobianos no tratamento periodontal de pacientes diabéticos. O uso de antibióticos adjunto ao tratamento periodontal mecânico convencional demonstrou melhores resultados quando comparados apenas à raspagem, em termos de redução dos microrganismos periodontopatogênicos, melhoras nos parâmetros clínicos periodontais, além da diminuição dos níveis de hemoglobina glicada. Os antibióticos mais utilizados, na forma sistêmica foram a Doxiciclina, Azitromicina, Amoxicilina e Ácido Clavulânico e a associação de Metronidazol e Amoxicilina. A Doxiciclina apresentou melhores resultados em relação a redução nos níveis glicêmicos. No entanto, mais pesquisas ainda são necessárias para verificar os medicamentos e posologias mais eficazes, além dos benefícios dos antibióticos como terapia adjunta ao tratamento mecânico para o controle da doença periodontal em diabéticos.

The bidirectional relationship between periodontal disease and diabetes mellitus has been extensively discussed in the literature. The poorly controlled diabetic patient has higher risk of developing periodontitis in its most severe form, where as periodontal diseases negatively influence the glycemic control and also the on set of diabetic’s complications. Therefore, the treatment of periodontal disease is essential not only for the local infection control but also for the prevention of their systemic repercussions and complications.The objective of this literature review was analyzing the effects of adjunctive use of antibiotics in the periodontal treatment of diabetic patients. The use of antibiotics adjunct to conventional mechanical periodontal treatment showed better results when compared to debride mental one.Periodonto pathogens reductions, improvement in the periodontal clinical outcomes and also reduction in the glycated hemoglobin levels was demonstrated when an antibiotic was associated with mechanical debridement. The most prescribed systemic antibiotics were Doxycline, Azitromycin, Amoxicillin/Clavulanic Acid and Metronidazole + Amoxicillin. Doxycline demonstrated better results in terms of glycemic control. Further researches are required to determine the most effective drugs, posology’s and also the benefits of using antibiotics as an adjunctive therapy to mechanical periodontal therapy in the treatment of diabetic patients with periodontitis.

Cirurgia minimamente invasiva em casos de hiperplasia de papilas - descrição de técnica / Minimally invasive surgery in cases of papilla hyperplasia - technique description

A utilização da microscopia operatória é baseada nos conhecimentos e nas técnicas de cirurgia minimamente invasiva (CMI), onde os recursos de amplificação de imagem são fundamentais para uma melhor visualização, permitindo uma modificação e um refinamento da técnica cirúrgica, que é um dos fatores que influencia os resultados da cirurgia periodontal. Dentro deste contexto, os benefícios da CMI e da utilização do microscópio operatório estão relacionados a aumento da acuidade visual, melhor magnificação e iluminação do campo cirúrgico e, consequentemente, a maior precisão da técnica cirúrgica. A utilização desse recurso para a correção de hiperplasia de papilas é plausível, uma vez que promove mínimo traumatismo tecidual e a preservação da altura das papilas interdentárias. Dessa forma, o objetivo desse trabalho foi mostrar o recurso da CMI para correção de hiperplasia de papilas, onde são propostas algumas alterações na técnica clássica de gengivoplastia.

Técnica para a utilização de matriz dérmica acelular no tratamento de recessões gengivais múltiplas / Technique for root coverage with acellular dermal matrix in the treatment of multiple gingival recessions

A proposta deste artigo é apresentar uma técnica cirúrgica para a utilização da matriz dérmica acelular (MDA) no tratamento de recessões gengivais múltiplas. O procedimento combina a preservação do suprimento sanguineo do leitor receptor, através da realização de um retalho de espessura parcail, com um desenho de incisões oblíquas nas áreas interdentais que promove uma correta adaptação do retalho. A adaptação da MDA e o deslocamento coronal do retalho são realizados de forma a avitar o comprometimento da sua vascularização. Assim, a abordagem terapêutica apresentada preserva o suprimento sanguíneo do leito cirúrgico, promove uma correta adaptação do retalho deslocado e previne a exposição do enxerto, podendo ser uma alternativa de tratamento de recessões múltiplas adjacentes associada a uma pequena faixa de mucosa ceratizada.

The aim of this article is to present a surgical technique for the treatment of multiple gingival recessions with Acelular Dermal Matrix. The therapeutic approach preserves the sanguine supply of the surgical bed by a partial thickness flap likewise a correct adaptation of the flap through the oblique incisions in the interdental area that prevents the graft exposition. The ADM placement and coronally advanced flap are perfomed so as not to damage to blood suply. This technique could be a treatment option of adjacent multiple recessions related with a little amount of keratinized tissue apical to defect.

Comparative clinical study of a subepithelial connective tissue graft and acellular dermal matrix graft for the treatment of gingival recessions: six- to 12-month changes.

Different techniques have been proposed for the treatment of gingival recession. This study compared the clinical results of gingival recession treatment using a subepithelial connective tissue graft and an acellular dermal matrix allograft. Seven patients with bilateral Miller class I or II gingival recession were selected. Twenty-six recessions were treated and randomly assigned to the test group. In each case the contralateral recession was assigned to the control group. In the control group, a connective tissue graft in combination with a coronally positioned flap was used; in the test group, an acellular dermal matrix allograft was used as a substitute for palatal donor tissue. Probing depth, clinical attachment level, gingival recession, and width of keratinized tissue were measured two weeks prior to surgery and at six and 12 months post-surgery. There were no statistically significant differences between the groups in terms of recession reduction, clinical attachment gain, probing pocket depth, and increase in the width of the keratinized tissue after six or 12 months. There was no statistically significant increase in the width of keratinized tissue between six and 12 months for either group. Within the limitations of this study, it can be suggested that the acellular dermal matrix allograft may be a substitute for palatal donor tissue in root coverage procedures and that the time required for additional gain in the amount of keratinized tissue may be greater for the acellular dermal matrix than for the connective tissue procedures.

Transmissão de bactérias periodontais: [revisão] / Transmission of periodontal bacteria: [review]

Periodontite corresponde a uma diversidade de doenças clinicamente diferentes, associadas com uma microbiota subgengival variável entre os diferentes grupos de pacientes. A maioria das espécies bacterianas subgengivais é indígena à cavidade bucal. Aggregatibacter actinomycetemcomitans e Porphyromonas gingivalis são considerados patógenos periodontais importantes que apresentam características de patógenos exógenos e não são frequentemente detectados em indivíduos com periodonto sadio. A transmissão de microrganismos entre pais e filhos (transmissão vertical) é particularmente evidente. Técnicas de genética molecular têm demonstrado que se uma criança é colonizada por uma espécie potencialmente patogênica, então um dos pais comumente abriga a bactéria idêntica genotipicamente. Os dados também indicam que transferência de bactéria entre cônjuges (transmissão horizontal) ocorre, embora não frequentemente. Todavia, a transferência de microrganismos não resulta necessariamente em colonização ou infecção do hospedeiro. Além disso, há indivíduos que abrigam periodonto patógenos e não manifestam qualquer sinal de doença periodontal. O propósito deste artigo é apresentar uma revisão da literatura sobre a transferência de bactérias associadas com as doenças periodontais entre membros da família.

Periodontitis corresponds to a variety of clinically different diseases associated with a variable subgingival microbiotaamong different patient groups. The majority of subgingival bacterial species are indigenous to the oral cavity.Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis are adjudged as important periodontais pathogen that presents characteristicsof exogenous pathogens and are infrequently detected in subjects with healthy periodontium. The transmission of microorganisms between parentsand children (ver tical transmission) is particularly evident. Molecular genetic techniques have demonstrated that if a child is colonized by a potentially pathogenic species, then one of the parents usually harbor genotypically identical bacteria. The data also indicate that transfer of bacteria between spouses (horizontal transmission) occurs, although infrequently. However, the transfer of microorganisms does not necessarily result in colonization or infection of the host. Furthermore, there are individuals who harbor periodontopathogens and do notmanifest any signs of periodontal disease. The purpose of this article is to present a review of the literature about the intra-familial transfer of bacteria associated with periodontal diseases.

Scanning electron microscopic analysis of the effect of Carisolv gel on periodontally compromised human root surfaces.

The aim of this study was to analyze, under scanning electron microscopy (SEM), the morphologic characteristics of root surfaces after application of Carisolv gel in association with scaling and root planing (SRP). Sixty periodontally compromised extracted human teeth were randomly assigned to 6 groups: 1) SRP alone; 2) passive topical application of Carisolv + SRP; 3) active topical application of Carisolv + SRP; 4) multiple applications of Carisolv + SRP; 5) SRP + 24% EDTA; 6) topical application of Carisolv + SRP + 24% EDTA. Carisolv gel was applied to root surfaces for 30 s, followed by scaling and root planing, consisting of 50 strokes with Gracey curettes in an apical-coronal direction, parallel to the long axis of the tooth. The only exception was group 4, in which the roots were instrumented until a smooth, hard and glass-like surface was achieved. All specimens were further analyzed by SEM. The results showed that the treatment with Carisolv caused significant changes in root surface morphology of periodontally compromised teeth only when the chemical agent was actively applied (burnishing technique). Carisolv failed to remove the smear layer completely, especially with a single application, independently of the method of application. Multiple applications of Carisolv were necessary to achieve a smear layer reduction comparable to that obtained with 24% EDTA conditioning.

Scanning electron microscopic analysis of the effect of CarisolvTM gel on periodontally compromised human root surfaces

A utilização do CarisolvTM tem sido proposta como um método auxiliar à raspagem e ao alisamento radicular (RAR), a fim de facilitar a descontaminação da superfície da raiz. O objetivo deste estudo foi avaliar, através da microscopia eletrônica de varredura (MEV), as características das superfícies radiculares, após a aplicação do CarisolvTM em associação à RAR. Sessenta dentes humanos extraídos devido à doença periodontal foram divididos em 6 grupos: 1) RAR ; 2) CarisolvTM (aplicação passiva) + RAR; 3) CarisolvTM (aplicação ativa) + RAR; 4) CarisolvTM (aplicações múltiplas) + RAR; 5) RAR + EDTA a 24%; 6) CarisolvTM + RAR + EDTA a 24%. CarisolvTM foi aplicado às superfícies radiculares por 30 s, seguido de raspagem e alisamento radicular, que consistiu de 50 movimentos com curetas de Gracey no sentido corono-apical, co o instrumento paralelo ao longo eixo do dente. A única exceção foi o grupo 4, no qual as raízes foram instrumentadas até obter uma superfície lisa, dura e com aspecto vítreo. Os espécimens tratados foram preparados e examinados em MEV. Os resultados demonstraram que a associação do CarisolvTM aos procedimentos periodontais mecânicos proporcionou modificações significativas na superfície radicular quando comparada à raspagem e ao alisamento radicular, apenas quando o CarisolvTM foi aplicado de forma ativa. A aplicação do CarisolvTM uma única vez, apresentou um efeito limitado na capacidade de remoção de smear layer, sendo que aplicações sucessivas apresentaram resultados comparáveis àqueles obtidos após a aplicação do EDTA.