Clinical and radiographic evaluation of the Periodontium with biologic width invasion.

BACKGROUND: The biologic width is defined as the coronal dimension to the alveolar bone that is occupied by healthy gingival tissue. The objective of the present study was to correlate radiographic findings of biologic width invasion with the periodontium status. METHODS: It were included 14 patients with restored teeth with biological width invasion, on the proximal sites, observed clinically and radiographically. 122 proximal sites were evaluated, 61 in the test group (biological width invasion) and 61 in the control group (adequate biological width). Smokers and patients presenting periodontal disease or restorations with contact in eccentric movements, horizontal over-contour or secondary caries were excluded from the sample. The invasion of the biologic width was diagnosed when the distance from the gingival margin of restoration to the bony crest was less than 3 mm. Intrabony defect and bone crest level, as well as, their vertical and horizontal components were radiographically evaluated when present. Plaque index, bleeding on probing, probing depth, gingival recession height, keratinized gingival height and thickness, and clinical attachment level were clinically evaluated. Data were subjected to Spearman's Correlation and Wilcoxon's test. RESULT: The most prevalent tooth with biological width invasion was the first molar. There was a statistically significant correlation between the bone crest (p < 0.001), vertical (p < 0.001) and horizontal (p = 0.001) components. In the test group, there was a statistically significant correlation between bleeding on probing (p < 0.001; r = 0.618) and width of gingival recession (p = 0.030; r = - 0.602) with the intraosseous component; and between keratinized gingival height and bone level (p = 0.037; r = - 0.267). In the control group, there was a correlation between plaque index (p = 0.027; r = - 0.283) with bone level and correlation between keratinized gingival thickness and bone level (p = 0.034; r = - 0.273) and intrabony component (p = 0.042; r = 0.226). CONCLUSION: A statistically significant relationship was found between bleeding on probing and gingival recession in patients who presented intrabony defects due to the invasion of biological width, which may be also related to the thickness of the keratinized gingiva.

Periodontal clinical evaluation before and after surgically assisted rapid maxillary expansion.

INTRODUCTION: The surgically assisted rapid maxillary expansion is a procedure that reduces the resistance of the sutures correcting the posterior crossbite in adults. OBJECTIVE: The aim of this study was to evaluate the periodontal status of 17 adults submitted to this procedure. METHODS: The clinical attachment level (CAL), gingival recession, attached gingiva and bleeding were evaluated in maxillary first premolars and molars, central and lateral incisors of right and left sides before surgery, 5 days and 6 months after. Means, standard deviation, medians, minimum and maximum values were compared among the evaluations using the Friedman and McNemar tests. RESULTS: There was a statistically significant increase in CAL in the right central incisor, right and left premolars and right and left molars. There was a statistically significant increase in gingival recession in the right and left premolars and molars. The amount of attached gingiva significantly decreased in right premolars and right and left molars. There was increase in bleeding in most of the teeth. CONCLUSION: Results indicated that the surgically assisted rapid maxillary expansion might cause alterations in periodontal tissue.

Periodontal clinical evaluation before and after surgically assisted rapid maxillary expansion

ABSTRACT Introduction: The surgically assisted rapid maxillary expansion is a procedure that reduces the resistance of the sutures correcting the posterior crossbite in adults. Objective: The aim of this study was to evaluate the periodontal status of 17 adults submitted to this procedure. Methods: The clinical attachment level (CAL), gingival recession, attached gingiva and bleeding were evaluated in maxillary first premolars and molars, central and lateral incisors of right and left sides before surgery, 5 days and 6 months after. Means, standard deviation, medians, minimum and maximum values were compared among the evaluations using the Friedman and McNemar tests. Results: There was a statistically significant increase in CAL in the right central incisor, right and left premolars and right and left molars. There was a statistically significant increase in gingival recession in the right and left premolars and molars. The amount of attached gingiva significantly decreased in right premolars and right and left molars. There was increase in bleeding in most of the teeth. Conclusion: Results indicated that the surgically assisted rapid maxillary expansion might cause alterations in periodontal tissue.

RESUMO Introdução: a expansão rápida da maxila assistida cirurgicamente (ERMAC) é um procedimento que reduz a resistência das suturas, corrigindo a mordida cruzada posterior em adultos. Objetivo: o objetivo deste estudo foi avaliar o status periodontal de 17 adultos submetidos a esse procedimento. Métodos: o nível clínico de inserção (NCI), a recessão gengival, gengiva inserida e sangramento foram avaliados nos primeiros pré-molares, molares, incisivos centrais e laterais superiores dos lados direito e esquerdo antes da cirurgia, e depois de 5 dias e 6 meses. Médias, desvios-padrão, medianas, valores mínimos e máximos foram comparados entre as avaliações, usando os testes de Friedman e McNemar. Resultados: houve aumento estatisticamente significativo no NCI no incisivo central direito, pré-molares direito e esquerdo e molares direito e esquerdo. Houve aumento estatisticamente significativo na recessão gengival nos pré-molares e nos molares direito e esquerdo. A quantidade de gengiva inserida diminuiu significativamente nos pré-molares direitos e molares direitos e esquerdos. Houve aumento no sangramento na maioria dos dentes. Conclusão: os resultados indicaram que a ERMAC pode causar alterações no tecido periodontal.

Effect of Alcohol Consumption on Clinical Attachment Loss Progression in an Urban Population From South Brazil: A 5-Year Longitudinal Study.

BACKGROUND: The aim of this study is to investigate the impact of alcohol consumption on clinical attachment loss (AL) progression over a period of 5 years. METHODS: A multistage probability sampling strategy was used to draw a representative sample of the metropolitan area of Porto Alegre, Brazil. Five hundred thirty-two individuals (209 males and 293 females) aged 18 to 65 years at baseline with no medical history of diabetes and at least six teeth were included in this analysis. Full-mouth periodontal examinations with six sites per tooth were conducted at baseline and after 5 years. Alcohol consumption was assessed at baseline by asking participants about the usual number of drinks consumed in a week. Four categories of alcohol consumption were defined: 1) non-drinker; 2) ≤1 glass/week; 3) >1 glass/week and ≤1 glass/day; and 4) >1 glass/day. Individuals showing at least two teeth with proximal (clinical AL) progression ≥3 mm over 5 years were classified as having disease progression. Multiple Poisson regression models adjusted for age, sex, smoking, socioeconomic status, and body mass index were used to estimate relative risks (RRs) and 95% confidence intervals (CIs). RESULTS: Overall, individuals who consumed >1 glass/day had 30% higher risk for clinical AL progression (RR = 1.30; 95% CI: 1.07 to 1.58) than non-drinkers. Among males, risk of clinical AL progression for individuals drinking >1 glass/day was 34% higher than non-drinkers (RR = 1.34; 95% CI: 1.09 to 1.64). Never-smoker males drinking ≤1 glass/week had significantly lower risk for clinical AL progression than non-drinkers (RR = 0.52; 95% CI: 0.30 to 0.89), whereas those drinking >1 glass/day had significantly higher risk (RR = 1.50; 95% CI: 1.08 to 1.99). Among females, no association between alcohol consumption and clinical AL progression was observed. CONCLUSIONS: Alcohol consumption increased the risk of clinical AL progression, and this effect was more pronounced in males. Low dosages (≤1.37 g of alcohol/day) of alcohol consumption may be beneficial to prevent periodontal disease progression in males. The impact of alcohol cessation initiatives on periodontal health should be evaluated.

Bone Density and Clinical Periodontal Attachment in Postmenopausal Women: A Systematic Review and Meta-Analysis.

Osteoporosis is a systemic skeletal disease characterized by low bone mineral density (BMD) and has been considered a risk factor for periodontal disease. The aim of this systematic review and meta-analysis was to verify the scientific evidence for the association of periodontal attachment loss with low BMD in postmenopausal women. A systematic search of the literature was performed in databases until August 2016, in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Eligibility criteria included studies that compared clinical attachment loss (CAL) between postmenopausal women with low and normal BMD. Studies using similar methodology, with lower and higher risk of bias, were pooled into 3 different meta-analyses to compare CAL among women with normal BMD, osteoporosis, and osteopenia. In the first meta-analysis, mean CAL was compared among groups. In the other 2 meta-analyses, the mean percentages of sites with CAL ≥4 mm and ≥6 mm were respectively compared among groups. From 792 unique citations, 26 articles were selected for the qualitative synthesis. Eleven of the studies were appraised as presenting low risk of bias, and the association between low BMD and CAL was observed in 10 of these studies. Thirteen cross-sectional articles were included in the meta-analysis for osteoporosis and 9 in the osteopenia analysis. Women with low BMD presented greater mean CAL than those with normal BMD (osteoporosis = 0.34 mm [95% confidence interval (CI), 0.20-0.49], P < 0.001; osteopenia = 0.07 mm [95% CI, 0.01-0.13], P = 0.02). Only studies with lower risk of bias were available for the analysis of CAL severity. Women with low BMD presented more severe attachment loss, represented as mean percentage of sites with CAL ≥4 mm (osteoporosis = 3.04 [95% CI, 1.23-4.85], P = 0.001; osteopenia = 1.74 [95% CI, 0.36-3.12], P = 0.01) and CAL ≥6 mm (osteoporosis = 5.07 [95% CI, 2.74-7.40], P < 0.001). This systematic review and meta-analysis indicates that postmenopausal women with osteoporosis or osteopenia may exhibit greater CAL compared with women with normal BMD.

Metabolic syndrome as a risk indicator for periodontal disease and tooth loss.

OBJECTIVES: The aim of the present study was to evaluate the association of metabolic syndrome (MS) with periodontitis (PE) and tooth loss (TL). MATERIALS AND METHODS: A cross-sectional study was conducted with 363 individuals who underwent full-mouth periodontal examination, and the association between MS and PE was evaluated considering three outcomes: severe periodontitis, mean probing depth ≥2.4 mm, and mean clinical attachment loss ≥2.0 mm. The prevalence ratio (PR) between MS and PE was calculated using a model adjusted for gender, age, smoking, years of education, and socioeconomic status. RESULTS: The adjusted model showed a PR for severe periodontitis of 1.17 (95 % CI 0.83-1.65). There was no significant association between MS and PE defined as mean probing depth ≥2.4 mm. MS was significantly associated with PE defined as mean attachment loss ≥2 mm in individuals aged 41-60 years (PR 1.47, 95 % CI 1.05-2.06). In addition, MS was associated with TL (>6 teeth) (PR 1.23, 95 % CI 1.02-1.49) for all ages, both in crude and adjusted analyses. CONCLUSIONS: We concluded that there is a weak association of MS with both attachment loss and TL. CLINICAL RELEVANCE: Patients with MS seem to have a higher risk of attachment loss and tooth loss and should be screened for periodontal disease.

Alterations in plaque accumulation and gingival inflammation promoted by treatment with self-ligating and conventional orthodontic brackets.

OBJECTIVE: The aim of the present study was to evaluate, comparatively, the periodontal response during orthodontic treatment performed with self-ligating and conventional brackets. METHODS: Sixteen Caucasian individuals of both sexes, aged between 12 and 16 years old and in permanent dentition were selected. Eight individuals were treated with conventional brackets installed on the lower dental arch and self-ligating brackets on the upper arch. Another eight individuals received self-ligating brackets in the lower arch and conventional brackets in the upper arch. The subjects received material and instructions for oral hygiene. Visible plaque index (VPI), gingival bleeding index (GBI) and clinical attachment level (CAL) were evaluated just after installation of orthodontic appliances, and 30, 60 and 180 days later. Mann-Whitney test was used to compare differences between groups (self-ligating and conventional), two-way ANOVA followed by Tukey's test was used to assess CAL at each site of each tooth. Significance level was set at 5%. RESULTS: No significant changes were found with regard to the assessed parameters (VPI, GBI and CAL) in either one of the systems. CONCLUSION: No significant changes were found with regard to the periodontal response to orthodontic treatment for the variables assessed and between subjects receiving passive self-ligating and conventional brackets. All individuals had received oral hygiene instructions and had their periodontal conditions monitored.

Clinical and Radiographic Evaluation of the Periodontium with Biologic Width Invasion by Overextending Restoration Margins - A Pilot Study.

AIM: The aim of this study was to correlate radiographic examination with the clinical periodontal condition in cases of biologic width invasion by overextending restoration margins in restored premolars and molars. MATERIALS AND METHODS: The present pilot study involved nine people (mean age 32 years) with biologic width invasion by 21 surfaces overextending restoration margins in restored premolars and molars. Radiographs were made in a standardized unit using the interproximal technique and were evaluated by a single calibrated investigator. The clinical periodontal parameters were analyzed with the use of a computerized periodontal probe. Exploratory analysis and Spearman's correlation were used to perform statistical analyses (SPSS, p < 0.05). RESULTS: The most prevalent teeth with biologic width invasion were second premolars and first molars. Mean plaque index was 30.76%, and bleeding on probing was 27.0%. The mesial surface was invaded in 47.6% of cases and the distal surface in 52.4%. The 21 sites with biologic width invasion were found in patients with the following periodontal status: periodontal health (11 sites), gingivitis (2 sites), mild periodontitis (7 sites) and moderate periodontitis (1 site). There was a correlation between plaque index and bleeding on probing with the horizontal component of the bone level. CONCLUSIONS: There was correlation between the radiographic parameters of biologic width invasion and clinical conditions. The measure of the bone crest level correlated with the gingival recession. The horizontal component of bone defect correlated with plaque index and bleeding on probing.

The effect of smoking on bleeding on probing after nonsurgical periodontal therapy: a quasi-experimental study.

The objective of this study was to evaluate the effect of smoking on response to nonsurgical periodontal therapy using the primary outcome measure of bleeding on probing (BoP). An periodontist performed periodontal therapy on 11 smokers and 14 never smokers with periodontitis. Two examiners assessed visible plaque index, gingival bleeding index, probing pocket depth (PPD), BoP, suppuration on probing and clinical attachment level (CAL), at baseline and three months after therapy. BoP was categorized as 0 (absent), 1 (small bleeding point) and 2 (blood flow from the sulcus). Total BoP value was obtained by summing values of 1 and 2. All subjects had significant reductions in mean PPD and percentages of sites with BoP, with no difference between the groups. Only never smokers presented statistically significant CAL gain. BoP was significantly and consistently reduced at sites with initial PPDs of 1-3 mm and 4-6 mm in both groups. At sites with deep PPD ( ≥ 7mm), never smokers showed a greater mean reduction in the number of sites with BoP than did smokers (p < 0.05). Never smokers had significantly greater reduction in BoP 2 than smokers, at sites with moderate and deep baseline PPDs. The first group had a significant increase of BoP 1, at sites with initial PPDs of 4-6 mm. Thus, periodontal therapy reduced BoP in both groups. However, smoking could negatively affect the BoP reduction at deeper sites after nonsurgical periodontal therapy.

Association between gingivitis and anterior gingival enlargement in subjects undergoing fixed orthodontic treatment.

OBJECTIVE: The aim of this study was to investigate the association among gingival enlargement (GE), periodontal conditions and socio-demographic characteristics in subjects undergoing fixed orthodontic treatment. METHODS: A sample of 330 patients undergoing fixed orthodontic treatment for at least 6 months were examined by a single calibrated examiner for plaque and gingival indexes, probing pocket depth, clinical attachment loss and gingival enlargement. Socio-economic background, orthodontic treatment duration and use of dental floss were assessed by oral interviews. Associations were assessed by means of unadjusted and adjusted Poisson's regression models. RESULTS: The presence of gingival bleeding (RR 1.01; 95% CI 1.00-1.01) and excess resin around brackets (RR 1.02; 95% CI 1.02-1.03) were associated with an increase in GE. No associations were found between socio-demographic characteristics and GE. CONCLUSION: Proximal anterior gingival bleeding and excess resin around brackets are associated with higher levels of anterior gingival enlargement in subjects under orthodontic treatment.

Association between gingivitis and anterior gingival enlargement in subjects undergoing fixed orthodontic treatment

OBJECTIVE: The aim of this study was to investigate the association among gingival enlargement (GE), periodontal conditions and socio-demographic characteristics in subjects undergoing fixed orthodontic treatment. METHODS: A sample of 330 patients undergoing fixed orthodontic treatment for at least 6 months were examined by a single calibrated examiner for plaque and gingival indexes, probing pocket depth, clinical attachment loss and gingival enlargement. Socio-economic background, orthodontic treatment duration and use of dental floss were assessed by oral interviews. Associations were assessed by means of unadjusted and adjusted Poisson's regression models. RESULTS: The presence of gingival bleeding (RR 1.01; 95% CI 1.00-1.01) and excess resin around brackets (RR 1.02; 95% CI 1.02-1.03) were associated with an increase in GE. No associations were found between socio-demographic characteristics and GE. CONCLUSION: Proximal anterior gingival bleeding and excess resin around brackets are associated with higher levels of anterior gingival enlargement in subjects under orthodontic treatment. .

OBJETIVO: o objetivo desse estudo foi verificar a associação entre volume gengival (AG) com condições periodontais e características sócio-demográficas em sujeitos com aparelho ortodônticos fixo. MÉTODOS: uma amostra, de 330 participantes com aparelho ortodôntico fixo, por pelo menos seis meses, foi examinada, por um único examinador calibrado, para os índices de placa e gengivais, profundidade de sondagem, nível de inserção clínico e aumento de volume gengival. O status socioeconômico, tempo com aparelho ortodôntico fixo e uso de fio dental foram verificados por entrevista oral. A verificação das associações foi realizada por meio de modelos de regressão de Poisson sem ajuste e ajustados. RESULTADOS: a presença de sangramento gengival (RR 1.01; 95% IC 1.00-1.01) e o excesso de resina em torno dos braquetes (RR 1.02; 95% IC 1.02-1.03) foram associadas a um aumento do AG. Não foram encontradas associações entre características sócio-demográficas e AG. CONCLUSÃO: sangramento gengival proximal na região anterior e excesso de resina no entorno dos braquetes estão associados a níveis mais altos de aumento de volume gengival na região anterior em sujeitos com aparelho ortodôntico fixo. .

Decrease in oral health may be associated with length of time since beginning dialysis.

The aim of this study was to evaluate how oral health is affected by the length of time a patient has been receiving hemodialysis (HD) treatment. Ninety-four subjects participated in this study. Demographic, periodontal parameters, and decayed missing and filled teeth (DMFT) index were recorded by a trained and calibrated examiner. The subjects were divided into two groups: Group L (subjects who had been on HD for less than 36 months), and Group M (those who had been on HD for more than 37 months). In Group M, the mean probing depth was deeper (p= 0.01) and clinical attachment loss was significantly higher (p= 0.02) than subjects in Group L. The DMFT index score was also significantly higher in Group M (p= 0.03). A moderate correlation between length of time on HD and DMFT index, probing depth, and clinical attachment loss was observed. The group of subjects who had been on HD for more than 37 months had more periodontal disease and higher DMFT index scores, suggesting that the length of time on HD could negatively impact oral health.

Tooth and periodontal clinical attachment loss are associated with hyperglycemia in patients with diabetes.

BACKGROUND: Periodontal disease has been associated with diabetes, but there is still controversy on the relationship between periodontal clinical parameters and glycemic control. The purpose of this study is to assess the relationship between blood glucose levels and clinical parameters of periodontal disease in individuals with diabetes. METHODS: A total of 65 individuals with diabetes and 81 individuals without diabetes were included in the study. A full-mouth periodontal examination and preprandial fasting glycemia values were recorded for each individual. Glycosylated hemoglobin was only measured in patients with diabetes. A comparative analysis between groups (Mann-Whitney U test) and a correlation analysis between glycemia and periodontal parameters were performed (Spearman test). RESULTS: Patients without diabetes presented more teeth than individuals with diabetes (P <0.05). Patients with diabetes with periodontitis displayed loss of periodontal clinical attachment compared to patients without diabetes, but the highest value was observed in patients with periodontitis that reported a smoking habit. Furthermore, patients with diabetes with periodontitis presented higher glycemia and glycated hemoglobin values in contrast to patients with gingivitis. Patients with diabetes with hyperglycemia had a higher risk to develop periodontitis (odds ratio = 2.24; 95% confidence interval = 1.02 to 4.93). A positive correlation was observed between glycemia and clinical attachment loss (AL), whereas a negative correlation between glycemia and the number of teeth present was found (P <0.05). CONCLUSIONS: Tooth and periodontal AL were increased by hyperglycemia in individuals with diabetes. This study contributes additional evidence that diabetes could aggravate periodontal disease and affect the systemic health of individuals.

[Evaluation of dental insertion loss in patients with chronic kidney disease]. / Avaliação da perda de inserção dentária em pacientes com doença renal crônica em hemodiálise.

Chronic kidney failure (CKF) is a clinical syndrome due to the slow, progressive and irreversible loss of the glomerular filtration rate. CKF may be associated with several oral manifestations, such as xerostomia, uremic stomatitis and periodontitis, diagnosed as clinical attachment loss (CAL). 92 patients, from the Prontorim Hemodialysis Clinic of Fortaleza, Ceará, Brazil, were investigated. Only 34 patients (37%) were eligible for periodontal investigation, which consisted of CAL measurement (values grater than 2 mm diagnosing periodontitis). CAL measurements ranged from 1.31 to 5.27 mm (2.30 ± 0.96 mm). 18 (52.9%) patients had smaller than 2 mm CAL, while 16 (47.1%) had periodontitis. Tooth loss and considerable CAL were observed in this study. Nevertheless, factors such as social status should be considered in further investigations.

Avaliação da perda de inserção dentária em pacientes com doença renal crônica em hemodiálise / Evaluation of dental insertion loss in patients with chronic kidney disease

A doença renal crônica (DRC) é uma síndrome clínica decorrente da perda lenta, progressiva e irreversível da taxa de filtração glomerular. A DRC pode apresentar várias manifestações bucais, como xerostomia, estomatite urêmica e periodontite, diagnosticada por meio da perda de inserção clínica (PIC). Foram avaliados 92 indivíduos em tratamento de hemodiálise na Clínica de Hemodiálise Prontorim, na cidade de Fortaleza, Ceará. O exame periodontal foi realizado por meio da mensuração da PIC e apenas 34 pacientes (37 por cento) estavam aptos a realizar exame periodontal. A perda de inserção por indivíduo registrada no grupo de dentados ficou entre 1,31 e 5,27 mm, com média de 2,30 ± 0,96 mm. Dezoito pacientes (52,9 por cento) apresentaram PIC menor que 2 mm, enquanto 16 (47,1 por cento) mostraram-se portadores de periodontite. A perda dentária e a presença de considerável perda de inserção foram observadas neste estudo. Contudo, fatores como status social devem ser considerados em futuras investigações.

Chronic kidney failure (CKF) is a clinical syndrome due to the slow, progressive and irreversible loss of the glomerular filtration rate. CKF may be associated with several oral manifestations, such as xerostomia, uremic stomatitis and periodontitis, diagnosed as clinical attachment loss (CAL). 92 patients, from the Prontorim Hemodialysis Clinic of Fortaleza, Ceará, Brazil, were investigated. Only 34 patients (37 percent) were eligible for periodontal investigation, which consisted of CAL measurement (values grater than 2 mm diagnosing periodontitis). CAL measurements ranged from 1.31 to 5.27 mm (2.30 ± 0.96 mm). 18 (52.9 percent) patients had smaller than 2 mm CAL, while 16 (47.1 percent) had periodontitis. Tooth loss and considerable CAL were observed in this study. Nevertheless, factors such as social status should be considered in further investigations.

Periodontal disease in adults with untreated congenital growth hormone deficiency: a case-control study.

AIM: The aim of this study was to investigate the possible associations between isolated growth hormone deficiency (IGHD) and periodontal attachment loss (PAL) in adults affected by congenital IGHD. MATERIALS AND METHODS: Forty-five previously identified IGHD subjects were eligible for this study. The final study sample comprised 32 cases (gender:20M/12F; age:44.8 ± 17.5) matched for age, gender, diabetes, smoking status and income to 32 controls (non-IGHD subjects). Participants were submitted to a full-mouth clinical examination of six sites per tooth and were interviewed using a structured, written questionnaire. Periodontitis was defined as proximal PAL≥5 mm affecting ≥30% of teeth. RESULTS: No significant differences were observed in the percentage of sites with visible plaque between IGHD and non-IGHD subjects (59.4% versus 46.9%, p=0.32). IGHD subjects had significant less supragingival calculus (31.3% versus 59.4%, p=0.02) and more bleeding on probing (71.9% versus 18.8%, p<0.01) than controls. PAL≥5 mm was significantly more prevalent (100% versus 71.9%, p<0.01) and affected more teeth (30.5% versus 6.7%, p<0.01) in cases than in controls. After adjusting for supragingival calculus, IGHD cases had a higher likelihood of having periodontitis than controls (OR=17.4-17.8, 95% CI=2.3-134.9, p=0.004-0.005). CONCLUSION: Congenital IGHD subjects have a greater chance of having PAL.

Influence of antiplatelet drugs in the pathogenesis of experimental periodontitis and periodontal repair in rats.

BACKGROUND: Platelets contain an array of biologic mediators that can modulate inflammation and repair processes including proinflammatory mediators and growth factors. Previous studies have shown that periodontitis and periodontal repair are associated with platelet activation. We hypothesized that drug-induced platelet inactivation may interfere in the processes of inflammation and repair in experimental periodontitis in rats by suppressing the release of biologic mediators from platelets to the site of injury. METHODS: To measure the effects on periodontitis, ligatures were placed around first molars, and aspirin (Asp, 30 mg/kg) or clopidogrel (Clo, 75 mg/kg) was given intragastrically once daily for 15 days. Interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and thromboxane A(2) levels were measured by enzyme-linked immunosorbent assay. To evaluate the effects of antiplatelet drugs on periodontal repair, ligatures were removed after 15 days of periodontitis induction, and Asp or Clo were administered beginning the following day for 15 days. Periodontal repair was assessed by microcomputed tomography. RESULTS: On periodontitis phase, Asp and Clo significantly reduced levels of TNF-α and Il-6 (P <0.05), but only Asp decreased thromboxane A(2) (P <0.05). Asp and Clo decreased inflammatory infiltration; however, this reduction was more pronounced with Clo treatment (P <0.05). Histometric analysis showed that Asp and Clo impaired alveolar bone resorption. During the repair phase and after removal of the ligatures, microcomputed tomography analysis demonstrated that treatment with Asp and Clo did not impair alveolar bone repair. CONCLUSION: Systemic administration of Asp and Clo attenuates the inflammation associated with periodontitis without affecting the repair process when stimulus is removed.

Osteoporosis, the risk of vertebral fracture, and periodontal disease in an elderly group in Mexico City.

OBJECTIVES: The aims of this study were to identify the possible association of osteoporosis, fracture risk and periodontitis, and consider the role of pharmacological treatment of osteoporosis and the periodontal condition. METHODS: Patients aged 60 and older from the Mexican National Medical Science and Nutrition Institute Salvador Zubirán participated in the study. DXA was used to assess osteoporosis and risk of vertebral fracture. A modified version of the extent and severity index (ESI) was applied to evaluate periodontitis (cut-off point for attachment loss ≥ 4 mm) and all teeth were examined. RESULTS: One hundred and sixty-six patients were examined, 88.6% were females, 47.0% had osteoporosis and 38.6% showed a high risk of fracture. The modified ESI was 5.13 mm (SD 1.4), 57.8% (SD 29.7). The model for periodontitis severity showed an association with oral hygiene (OR = 1.85) and use of osteoporosis medication (OR = 0.43). The model for the extent of periodontitis identified an association with smoking (OR = 2.37), osteoporosis (OR = 1.82) and osteoporosis medication (OR = 0.36). The model for tooth loss detected an association with fracture risk (OR = 3.02) and osteoporosis medication (OR = 0.33). CONCLUSION: Periodontitis extent was associated with osteoporosis, and tooth loss with fracture risk.

Influence of immediate attachment loss during instrumentation employing thin ultrasonic tips on clinical response to nonsurgical periodontal therapy.

OBJECTIVE: Mechanical instrumentation is fundamental to periodontal treatment. However, independent of the instrument used in scaling, an immediate attachment loss occurs at the bottom of the periodontal pocket. This study aimed to determine the influence of tip diameter on attachment loss and the influence of attachment loss on the periodontal response to nonsurgical treatment. METHOD AND MATERIALS: Fifteen patients presenting periodontal pockets with a probing depth of 3.5 mm or more in bilateral teeth were divided into two groups: test group-instrumented with a thin tip, and control group-instrumented with a traditional tip. Probing depth, relative gingival position, and relative attachment level were evaluated immediately before and after and at 1 and 3 months after treatment using an electronic computerized probe. The data were analyzed using ANOVA and Tukey tests (P = .05). RESULTS: Both groups presented attachment loss immediately after instrumentation; however, the thin tip resulted in statistically higher immediate clinical attachment loss than the traditional tip (0.85 and 0.15 mm, respectively; P < .0001). However, both groups showed a similar healing after the ultrasonic therapy, at all parameters evaluated (P > .05). CONCLUSION: In spite of the higher immediate clinical attachment loss inflicted by thin ultrasonic tips during instrumentation, this did not affect the clinical response to the nonsurgical treatment.

Influence of alcohol consumption on alveolar bone level associated with ligature-induced periodontitis in rats.

Alcohol consumption is a risk indicator for periodontal disease. The purpose of this study was to morphometrically evaluate the influence of alcohol consumption on alveolar bone level associated with ligature-induced periodontitis in rats. Thirty-six female rats (Wistar, 120 days-old) were randomly divided into three groups that received a daily administration of a water diet (control, n = 12), a 10% alcohol diet (10% ethanol, n = 12) or a 20% alcohol diet (20% ethanol, n = 12). Four weeks after the onset of the experiment, cotton ligatures were placed around the cervix of the upper right second molar in six rats. The other 6 rats in each group remained unligated. The rats were sacrificed four weeks after ligature placement. The maxillary bones were removed and alveolar bone loss was analyzed by measuring the distance between the cementoenamel junction and the alveolar bone crest at 2 buccal and 2 palatal sites on the upper right second molar. Analyses between the ligated and unligated groups showed that the presence of ligature induced alveolar bone loss (p < 0.05). Unligated groups showed no significant differences between each other (p > 0.05). In the ligated groups, rats receiving 20% ethanol showed significantly greater bone loss compared to control rats or rats receiving 10% ethanol. These results demonstrate that alcohol consumption may increase alveolar bone loss in female rats in a dose-dependent manner.