Cytokine levels in the gingival crevicular fluid and their association with periodontal status of down syndrome patients: a cross-sectional study.

OBJECTIVE: To evaluate cytokine levels of interleukin (IL)-1ß, IL-4, IL-6, IL-17a, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ in the gingival crevicular fluid (GCF) of periodontal sites in individuals with Down syndrome (DS) and analyze their relationship with clinical periodontal parameters. MATERIALS AND METHODS: A cross-sectional study was conducted with 49 DS patients and 32 individuals without DS (non-DS group). Periodontal probing depth (PPD), clinical attachment level (CAL), bleeding on probing (BoP), and visible plaque index (VPI) were evaluated. The periodontal sites were classified as shallow, moderate, and deep. GCF was collected in all shallow sites and, when present, in moderate and deep sites for the analysis of cytokine levels. The cytokines, IL-1ß, IL-4, IL-6, IL-17a, TNF-α, and IFN-γ, were quantified using the Luminex® automatic analyzer system. RESULTS: The DS group presented greater severity of periodontitis compared to the non-DS group (P = 0.005). The DS group showed a significant direct correlation of IL-1ß and an inverse correlation of IFN-γ and IL-14 with all periodontal variables. In the analysis stratified by periodontal pocket depth, we observed a higher level of IFN-γ, IL-17a, IL-1ß, and IL-6 in the shallow sites, and IL-17a, IL-1ß, and IL-6 in deep pockets of DS group individuals. Multivariate models showed that higher levels of IL-1ß, IL-4, IL-6, and IL-17a were associated with Down syndrome even after adjusting for periodontal status, sex, and age. CONCLUSION: The findings suggest that people with DS have greater periodontal impairment and higher levels of cytokines in GCF, even in sites having clinical periodontal parameters similar to those of individuals without DS. These data reiterate the concept of an altered and less effective immune response in the population with DS in the face of a periodontal microbial challenge. CLINICAL RELEVANCE: Elevated periodontal inflammation burden can be observed with higher cytokine levels in the gingival crevicular fluid of people with Down syndrome, especially IL-1, IL-4, IL-6, and IL-17, regardless of the stage of periodontitis.

Comparative Study on the Periodontal Parameters Used in Diagnosing Periodontitis in Puerperae and Periodontitis' Relationship with the Birth of Preterm Infants: A Case-Control Study.

To compare different criteria for the diagnosis of periodontitis and to evaluate the association of this condition with prematurity, this case-control study was conducted on 283 mothers of infants, divided into two groups based on gestational age (cases: <37 weeks, controls: ≥37 weeks), with 71 cases and 212 controls. The periodontal evaluation included probing depth (PD), clinical attachment level (CAL), plaque index, and bleeding on probing (BOP). Participants were classified regarding periodontitis per 14 criteria based on different periodontal parameters. The criterion selected as the gold standard was the presence of at least four teeth with one or more sites with a PD ≥ 4 mm, CAL ≥ 3 mm, and BOP at the same site. The prevalence of periodontal disease ranged from 8.1% to 55.1%. Moreover, compared to the gold standard, the sensitivities of the other criteria were 100%, while specificity ranged from 50.4% to 96.4%. Periodontitis, defined by six of the selected criteria, was associated with prematurity after multivariate adjustment, with OR ranging from 1.85 to 2.69 and 95% CI from 1.01 to 5.56; one of them was the gold standard mentioned above. Measurements using the clinical parameters of PD, CAL, and bleeding at the same site (criteria 5, 6, 7, 8), CPI (criterion 10), and at least four teeth with a PD ≥ 4 mm and CAL ≥ 3 mm (criterion 11) to define periodontitis showed a statistically significant association (p < 0.05). Given this study's limitations, we can conclude that the diagnostic criteria for a periodontitis definition using a PD ≥ 4 mm and CAL ≥ 3 mm in two or more teeth, with BOP at the same site, seem stronger when detecting an association between periodontitis and prematurity.

Identifying metabolic parameters related to severity and extent of periodontitis in down syndrome patients.

BACKGROUND AND OBJECTIVE: Systemic metabolic status and periodontitis can be related in patients with Down syndrome (DS). The objective of this study was to identify metabolic indicators (anthropometric measurements, blood pressure, and serum markers) related to severity and extent of periodontitis in DS patients. METHODS: A cross-sectional study was conducted with 49 patients with DS. Periodontal evaluation included the periodontal probing depth (PPD), clinical attachment level (CAL), gingival bleeding index (GBI), and visible plaque index (VPI). Periodontitis severity was classified by the stages system. The extent of periodontitis was assessed as the percentage of sites with CAL ≥3 mm, CAL ≥4 mm, PPD ≥4 mm, and PPD ≥5 mm. The metabolic condition of the participants was determined by analyzing anthropometric parameters, blood pressure, and serum markers. Data were analyzed using the Mann-Whitney test, Spearman's correlation coefficient, and multivariate regression analysis. RESULTS: Periodontitis stage 3/4 was detected in 32.7% of patients, with high values of VPI (54.6 ± 35.8) and GBI (42.4 ± 33.3). The severity of periodontitis was related to higher mean corpuscular hemoglobin (ß = .291, p = .028) and mean corpuscular volume values (ß = .293, p = .046). Arm circumference measurements were inversely related to CAL ≥3 mm (ß = -.408, p = .023), PPD ≥4 mm (ß = -.475, p = .006), and PPD ≥5 mm (ß = -.443, p = .010). CONCLUSIONS: The findings suggest that the severity and extent of periodontitis may be related to some metabolic parameters in DS patients.

Impact of resveratrol in the reduction of the harmful effect of diabetes on peri-implant bone repair: bone-related gene expression, counter-torque and micro-CT analysis in rats.

OBJECTIVE: Investigate the impact of resveratrol (RESV) on peri-implant repair and its effect on bone-related markers in rats with induced diabetes mellitus (DM). MATERIAL AND METHODS: Ninety rats were divided into: DM + RESV (n = 18); DM + placebo (PLAC) (n = 18); DM + insulin (INS) (n = 18); DM + RESV + INS (n = 18); Non-DM (n = 18). Diabetes was induced by streptozotocin. One screw-shaped titanium implant was inserted in each tibiae of animals. Treatments were administered during 30 days. After, one of the implants was removed for counter-torque and the peri-implant tissue was collected for mRNA quantification of BMP-2, OPN, Runx2, Lrp-5, Osx, ß-catenin, Dkk1, OPG, and RANKL by Real-time PCR. The other tibia was submitted to MicroCT analysis to measure: bone volume (BV/TV), trabecular thickness (Tb.Th) and bone-implant contact (BIC). RESULTS: Higher counter-torque values were observed for implant removal in DM + RESV, DM + RESV + INS and Non-DM groups when compared to DM + PLAC (p < .05). Augmented Tb.Th was observed in DM + RESV and Non-DM when compared to DM + PLAC group (p < .05), whereas higher BIC was detected in DM + RESV, DM + RESV + INS and Non-DM animals when compared to DM + PLAC (p < .05). Levels of RANKL were downregulated by the RESV and/or INS therapy, whereas only the association of RESV and INS upregulated the levels of Runx2 (p < .05). CONCLUSIONS: The therapy with RESV may favour peri-implant bone repair improving bone formation around implants.

Effect of a single-tufted toothbrush on the control of dental biofilm in orthodontic patients: A randomized clinical trial.

OBJECTIVE: To compare the effect of a single-tufted toothbrush combined or not with a conventional toothbrush to control dental biofilm in healthy orthodontic patients. MATERIALS AND METHODS: Twenty orthodontic patients were randomly assigned to receive three different treatments: Group 1-conventional toothbrush; Group 2-single-tufted toothbrush and Group 3-combination of single-tufted and conventional toothbrushes. Stained plaque index (SPI), visible plaque index (VPI) and gingival bleeding index (GBI) were recorded. The data were analysed by Kolmogorov-Smirnov test. Wilcoxon test was used for intragroup comparison and Friedman test for the intergroup comparison (α = 5%). RESULTS: Intragroup analysis showed that VPI and SPI significantly decreased (P < 0.05) after 72 hour in Group 3. Anterior and posterior teeth did not show any significant statistical differences after 72 hour (P > 0.05), but VPI values in the labial surfaces were different to Group 3 (P < 0.05) in comparison with the other groups after 72 hour. Group 3 showed a statistically significant reduction (P < 0.05) for SPI in the interproximal surfaces when compared with Group 1. CONCLUSION: The combination of single-tufted and conventional toothbrushes was effective for controlling dental biofilm formation in orthodontic patients.

Glycemic control and the production of cytokines in diabetic patients with chronic periodontal disease / Controle glicêmico e produção de citocinas em pacientes diabéticos com doença periodontal crônica

ABSTRACT Objective: To evaluate the association of glycemic control and cytokine production in type 2 diabetic subjects with chronic periodontitis Methods: Gingival biopsies were performed in 40 patients, divided into four groups: systemically healthy subjects without periodontal disease (S); systemically healthy patients with chronic periodontitis (P); patients with well-controlled type 2 diabetes mellitus (DM) with chronic periodontitis (C); poorly controlled type 2 diabetes mellitus with chronic periodontitis (D). The production of interleukin (IL) -4, -6, -10, -17 and interferon (IFN) -γ was quantified by ELISA. Results: The production of IL-4, IL-10, IL-17 and INF-γ was higher on group D when compared to other groups (p <0.05), which in turn were similar (p ≥0.05). In addition, there was no difference in the production of IL-6 in any of the evaluated groups (p≥0.05). Conclusion: Were observed significantly elevated levels of pro-inflammatory and anti-inflammatory cytokines in patients with poorly controlled type 2 diabetes and chronic periodontitis, demonstrating that glycemic control may be associated to the immune inflammatory response of sites with chronic periodontitis.

RESUMO Objetivo: Avaliar a associação do controle glicêmico e a produção de citocinas em indivíduos diabéticos tipo 2 com doença periodontal crônica. Métodos: Foram realizadas biópsias gengivais de 40 pacientes, distribuídos nos seguintes grupos: sistemicamente saudáveis sem doença periodontal (S); pacientes sistemicamente saudáveis com periodontite crônica (P); pacientes com diabetes mellitus (DM) tipo 2 controlado com periodontite crônica (C); pacientes com diabetes mellitus tipo 2 não controlado com periodontite crônica (D). Foram quantificadas através de ELISA, a produção das interleucinas (IL) -4, -6, -10, -17 e interferon (IFN) -γ. Resultados: A produção de IL-4, IL-10, IL-17 e INF-γ foi maior no grupo D quando comparada aos demais grupos (p<0.05), que por sua vez foram similares entre si (p≥0.05). Além disso, não houve diferença na produção de IL-6 em nenhum dos grupos avaliados (p≥0.05). Conclusão: Foram observados níveis significativamente elevados de citocinas pró-inflamatórias e anti-inflamatórias nos pacientes com diabetes mellitus tipo 2 não controlado e com periodontite crônica, demonstrando que o controle glicêmico pode estar associado com a resposta imunoinflamatória de sítios com periodontite crônica.

Salivary levels of inflammatory cytokines and their association to periodontal disease in systemic lupus erythematosus patients. A case-control study.

Both Systemic Lupus Erythematosus (SLE) and periodontal disease (PD) present a similar immunological profile mainly characterized by altered cytokine levels. In this study we sought to investigate the salivary levels of inflammatory cytokines and their association with PD in SLE patients. 60 patients with SLE and 54 systemically healthy individuals underwent a full periodontal clinical examination. They were then grouped according to their periodontal status. Stimulated saliva was collected in order to evaluate the salivary levels of interferon (IFN-γ), Interleukin (IL)-10, IL-17, IL-1ß, and IL-4. Systemically healthy individuals with periodontitis (group P) presented higher levels of cytokines when compared to systemically healthy individuals, with no periodontal disease (group S) (p<0.05). Additionally, in the P group, patients presented similar levels of cytokines to those of the patients with SLE, regardless of the presence of PD (p>0.05), for most of the analyzed cytokines. There was a positive correlation in SLE patients, including IL-1ß and all periodontal clinical parameters (p<0.05), and between IL-4 and gingival bleeding index and the presence of biofilm (p<0.05). Thus, our results confirmed, that patients with PD showed higher salivary levels of cytokines and, in SLE patients, the increased levels of salivary cytokines were observed even in the absence of periodontitis. IL-1ß and IL-4 salivary levels were also positively correlated with periodontal status indicating their potential as markers of the amount and extent of periodontal damage in patients with SLE.

Glycemic control and the production of cytokines in diabetic patients with chronic periodontal disease / Controle glicêmico e produção de citocinas em pacientes diabéticos com doença periodontal crônica

Objective: To evaluate the association of glycemic control and cytokine production in type 2 diabetic subjects with chronic periodontitis. Methods: Gingival biopsies were performed in 40 patients, divided into four groups: systemically healthy subjects without periodontal disease (S); systemically healthy patients with chronic periodontitis (P); patients with well-controlled type 2 diabetes mellitus (DM) with chronic periodontitis (C); poorly controlled type 2 diabetes mellitus with chronic periodontitis (D). The production of interleukin (IL) -4, -6, -10, -17 and interferon (IFN) -g was quantified by ELISA. Results: The production of IL-4, IL-10, IL-17 and INF-g was higher on group D when compared to other groups (p <0.05), which in turn were similar (p ³0.05). In addition, there was no difference in the production of IL-6 in any of the evaluated groups (p³0.05). Conclusion: Were observed significantly elevated levels of pro-inflammatory and anti-inflammatory cytokines in patients with poorly controlled type 2 diabetes and chronic periodontitis, demonstrating that glycemic control may be associated to the immune inflammatory response of sites with chronic periodontitis.

Objetivo: Avaliar a associação do controle glicêmico e a produção de citocinas em indivíduos diabéticos tipo 2 com doença periodontal crônica. Métodos: Foram realizadas biópsias gengivais de 40 pacientes, distribuídos nos seguintes grupos: sistemicamente saudáveis sem doença periodontal (S); pacientes sistemicamente saudáveis com periodontite crônica (P); pacientes com diabetes mellitus (DM) tipo 2 controlado com periodontite crônica (C); pacientes com diabetes mellitus tipo 2 não controlado com periodontite crônica (D). Foram quantificadas através de ELISA, a produção das interleucinas (IL) -4, -6, -10, -17 e interferon (IFN) -g. Resultados: A produção de IL-4, IL-10, IL-17 e INF-g foi maior no grupo D quando comparada aos demais grupos (p<0.05), que por sua vez foram similares entre si (p³0.05). Além disso, não houve diferença na produção de IL-6 em nenhum dos grupos avaliados (p³0.05). Conclusão: Foram observados níveis significativamente elevados de citocinas pró-inflamatórias e anti-inflamatórias nos pacientes com diabetes mellitus tipo 2 não controlado e com periodontite crônica, demonstrando que o controle glicêmico pode estar associado com a resposta imunoinflamatória de sítios com periodontite crônica.

Relationship between periodontal status and degree of visual impairment in institutionalized individuals.

OBJECTIVE: Periodontal disease is a set of inflammatory infections that affect the supporting structures of the dentition. Patients with visual impairment (VI) may have more difficulty in cleaning and maintaining oral health. The purpose of this study was to investigate the possible relationship between periodontal status and degree of VI in institutionalized individuals. MATERIALS AND METHODS: Fifty-two visually impaired individuals were included in this cross-sectional study. The periodontal parameters assessed were clinical attachment level (CAL), probing depth (PD), and visible plaque index. The degree of VI was established as: Group 1 (mild or moderate VI), Group 2 (severe or profound VI), and Group 3 (completely blind); and the types of VI were considered as congenital and acquired. Fisher's exact, Kruskal-Wallis, Mann-Whitney, and Spearman correlation coefficient test were used. The level of significance was set at 5%. RESULT: Only plaque index was higher on proximal surfaces of subjects with mild/moderate VI when compared to the other degrees of VI (P = 0.01). Furthermore, we observed higher values for interproximal CAL (P = 0.01), total PD (P = 0.04), and interproximal PD in subjects with acquired VI when compared to subjects with congenital VI (P = 0.01). CONCLUSIONS: These findings suggest that periodontal status may be more related to the type of disability than with the degree of VI. Acquired VI people presented a worse periodontal health than the group with congenital VI.

Multidisciplinary Treatment of a Fenestration-type Defect.

The case report aimed at treating a fenestration-type defect with multidisciplinary conventional and advanced surgical techniques. Fenestrations are isolated areas in which the exposed root surface is covered only by the periosteum and gingiva, but the remaining cortical bone remains intact. Root coverage is indicated in cases of root hypersensitivity, treatment of shallow caries lesions, cervical abrasions, and esthetic and cosmetic needs. In this case report, after proper hygiene instruction and dental biofilm control, a fenestration-type defect was treated using guided tissue regeneration (anorganic bovine matrix and resorbable membrane) and a connective tissue grafts, associated to an endodontic apicoectomy. After reevaluation, the remaining gingival recession was treated with a second gingival connective tissue graft covered with q double papillae type in order to reconstruct the periodontal tissues of the involved tooth. In this clinical case, the interaction between the different areas of dentistry has made it possible to correct a fenestration-type defect, following procedures based on scientific evidence, restoring periodontal health, esthetics, self-esteem, and meeting the patient's expectations regarding her initial complaint. This case report shows the important role of interdisciplinary approach to treating a patient with a complex periodontal defect that required different types of knowledge and abilities to achieve the best results based on the current status of dentistry possibilities.

Intermittent parathyroid hormone administration improves periodontal healing in rats.

BACKGROUND: Intermittent administration of parathyroid hormone (PTH) promotes new bone formation in patients with osteoporosis and bone fractures. It was shown previously that PTH also reduces periodontitis-related bone loss. The aim of this study is to evaluate the effect of treatment with PTH on periodontal healing in rats. METHODS: Fenestration defects were created at the buccal surface of the distal root of the mandibular first molars, and both periodontal ligament (PDL) and cementum were removed. Animals were then assigned to two groups (eight animals per group): group 1: control, placebo administration; and group 2: test, human PTH (hPTH) 1-34 administration at a concentration of 40 µg/kg. For both groups, the animals were injected every 2 days, and the animals were sacrificed at 14 and 21 days after surgery. Specimens were harvested and processed for routine decalcified histologic sections. The following parameters were assessed: 1) remaining bone defect extension (RBDE); 2) newly formed bone density (NFBD); 3) total callus area (TCA); 4) osteoclast number (ON) in the callus region; and 5) newly formed dental cementum-like tissue (NFC). Birefringence of root PDL reattachment was also evaluated. RESULTS: Birefringence analysis showed root PDL reattachment for both groups 21 days after treatment. Intermittent hPTH 1-34 administration decreased RBDE (P <0.01) and increased NFBD (P <0.01), TCA (P <0.01), area of NFC (P <0.01), and ON in the callus region (P <0.01). CONCLUSION: Within the limits of the present study, intermittent administration of hPTH 1-34 led to an enhanced periodontal healing process compared with non-treated animals.

Relação entre doença periodontal e anemia / Relationship between periodontal diseases and anemia

Doença Periodontal é um grupo de doenças inflamatórias de origem infecciosa que afetam os tecidos de proteção e sustentação do dente. A perpetuação da resposta do hospedeiro devido à infecção bacteriana persistente interrompe os mecanismos homeostáticos e resulta na liberação de citocinas pró-inflamatórias, proteases e prostanóides, que podem promover destruição da matriz extracelular na gengiva e estimular a reabsorção óssea, além de estimular a produção de proteínas de fase aguda, sendo a IL-6 seu principal indutor. Dentre as proteínas de fase aguda cuja produção é intensamente aumentada durante a infecção e inflamação está a hepcidina que é predominantemente produzida pelo fígado, tendo como principal função a regulação homeostática do metabolismo de ferro, a modulação da defesa orgânica e contribuindo para a patogênese de anemias de causas diversas. O objetivo do estudo foi realizar uma revisão da literatura utilizando uma consulta às bases de dados Cochrane, Bireme e MedLine, tendo como eixo as seguintes palavras-chaves em associação: periodontite crônica, Inflamação e hemoglobina. Foram encontradas 101 publicações científicas por meio de busca eletrônica, sendo 9 da Bireme, 21 do Pubmed e 71 da Cochrane, além de títulos oriundos de referências de outros artigos. Concluiu-se que há indícios que hepcidina esteja associada ao processo inflamatório sendo responsável pela homeostase do ferro e, desta forma, contribuindo para processo patológico da anemia da inflamação crônica. Constatou-se ainda a escassez de artigos que investiguem a possível associação entre a doença periodontal e a anemia

Periodontal diseases can be defined as inflammatory disease from infectious origin that affect the protection and support tooth tissues. The host response perpetuation due to persistent bacterial infection disrupts the homeostatic mechanisms and results in releasing of the proinflammatory cytokines, proteases and prostanoids that can promote the destruction of extracellular matrix in the gingiva and cause bone resorption, also stimulate the production of acute phase proteins, being the IL-6 the main inductor. Among the acute phase proteins whose production is widely increased during infection and inflammation, there is hepcidin which is predominantly produced by the liver, having as main function the homeostatic regulation of iron metabolism, organic defense modulation and contributing to the pathogenesis of various causes of anemias. The aim of the study was to perform a literature review by using databases Cochrane, Bireme and MedLine, and the following keywords in combination: chronic periodontitis, inflammation and hemoglobin. A total of 101 scientific publications was found by electronic search, 9 from Bireme, 21 from PubMed and 71 from Cochrane, also titles from references by other articles. It was concluded that the hepcidin is associated to inflammatory process and it is responsible for the iron homeostasis therefore leading is associated to the pathologic process of the chronic disease anemia. Also, it was noted the lack of manuscripts that investigate the possible association between periodontal diseases and anemia.

Preoperative gingival conditioning as a guide for implant installation and to achieve proper dentogingival contours.

A successful esthetic outcome for implant-supported dentures depends on the careful manipulation of peri-implant tissue as well as the precise placement of the implant. In addition, careful surgical and prosthetic planning is essential for esthetically important areas, especially in partially edentulous cases. This study describes a clinical case that presented absent maxillary central incisors in which prior prosthetic planning was used to perform provisional restorations, that was used to condition the gingival tissues and guide implant installation. These procedures made it possible to achieve a dentogingival contour, interdental papillae, and an emergence profile in the edentulous area. The techniques outlined here proved to be sufficient and support the peri-implant tissues to create a more esthetic final prosthesis.

Avaliação de lesões cervicais não-cariosas em adultos: estudo piloto / Evaluation of non-carious cervical lesions in adults: a pilot study

Objetivo: determinar as características clínicas e a prevalência de lesões cervicais não-cariosas (LCNCs) em pacientes adultos. Métodos: a coleta dos dados foi realizada por meio de exame clínico e questionário. Um total de 491 dentes foi avaliado em 23 pacientes, dos quais 121 dentes apresentavam LCNCs. Critérios como forma, dimensão horizontal e vertical, profundidade, término, classificação e sensibilidade dentinária das lesões, além dos fatores oclusais fizeram parte da avaliação. Os dados foram submetidos à análise estatística pelo teste não paramétrico Exato de Fischer, com nível de significância de 5%. Uma análise descritiva foi utilizada para dados que caracterizavam a amostra no nível do indivíduo (sexo e fatores etiológicos das LCNCs) e no nível do dente (presença, tipo e formato da lesão; dentes e faces mais comprometidos). Resultados: um total de 24,64% dos dentes apresentava algum tipo de lesão cervical, sendo os dentes pré-molares inferiores os mais acometidos (30,58%). A abfração foi a lesão mais presente (52,89%). A face vestibular foi mais comprometida pelas LCNCs com significância estatística (p = 0,013). As cavidades rasas foram mais prevalentes em todos os tipos de lesões (p = 0,001). Facetas de desgaste foram bastante encontradas nos dentes com LCNCs (p = 0,008). A sensibilidade dentinária severa foi mais observada em dentes com abrasão (p=0,037). Conclusão: dentre as LCNCs, as lesões de abfração foram mais encontradas em pessoas do sexo feminino, nas faces vestibulares de dentes pré-molares e com profundidade rasa...

Objective: To determine the clinical characteristics and prevalence ofnon-carious cervical lesions (NCCL) in adult patients. Method: Data were collected by clinical examination and questionnaire-based interviews. A total of 491 teeth from 23 patients were examined, resulting in a sample of 121 teeth with NCCL. The evaluation criteria included shape, horizontal and vertical dimensions, depth, cervical margin, classification, presence of dentinal hypersensitivity and occlusal factors. The data were subjected to statistical analysis by the non-parametric Fisher?s exact test at a 5% significance level. Descriptive analysis was used for the data that characterized the sample at individual level (gender and NCCL etiologic factors) and tooth level (presence, type and shape of the lesion, and the most affected teeth and surfaces). Results: As much as 24.64% of the teeth presented some kind of cervical lesion, the mandibular premolars being the most affected (30.58%). Abfraction was the prevalent type of lesion (52.89%). The buccal surface was the most affected by NCCL (p=0.013). Shallow cavities were the most prevailing lesion type (p=0.001). Wear facets were largely found in teeth with NCCL (p=0.008). Severe dentinal hypersensitivity was mainly observed in abraded teeth (0.037).Conclusion: Among the types of NCCL, abfraction lesions were mostly found in female patients, in the buccal surface of premolars and had shallow depth...

Improving the esthetic replacement of missing anterior teeth: interaction between periodontics and a rotational path removable partial denture.

The rotational path of insertion concept for removable partial dentures (RPDs) can be used in esthetically demanding situations. This clinical report describes the treatment of a patient with an anterior maxillary edentulous area using a rotational path RPD. To optimally improve gingival esthetics and to allow proximal retention on the surveyors, a crown-lengthening surgical procedure was performed prior to prosthetic treatment on all teeth involved in this rehabilitation. When correctly planned and fabricated, this prosthesis allows excellent functional and esthetic results, minimizes tooth preparation, and reduces the tendency toward plaque accumulation.

The impact of cigarette smoke inhalation on the outcome of enamel matrix derivative treatment in rats: histometric analysis.

BACKGROUND: Tobacco use is the most significant risk factor of periodontal disease. Clinical evidence has demonstrated that tobacco may negatively influence the results after surgical and non-surgical periodontal therapy. Enamel matrix derivative (EMD) have been used in periodontal regenerative procedures resulting in improvement of clinical parameters. The effect of EMD in the presence of tobacco compounds is unclear. Thus, the aim of the present study is to evaluate the impact of cigarette smoke inhalation (CSI) on the results of EMD treatment. METHODS: Twenty-two Wistar rats were assigned to two groups: Group 1, CSI (n = 11); Group 2, non-exposed (n = 11). Thirty days after initiation of CSI, fenestration defects were created at the buccal aspect of the first mandibular molar. The study followed a split-mouth design. After the surgeries the defects were randomly assigned to two subgroups: non-treated control and treated with EMD. The animals were sacrificed 21 days later and the percentage of defect fill, density of newly formed bone, and new cementum formation were histometrically assessed. The number of osteoclasts was determined by tartrate-resistant acid phosphatase. RESULTS: CSI was associated with less bone density compared to the non-exposed group. EMD provided an increased defect fill and new cementum formation in both groups. The number of tartrate-resistant acid phosphatase-positive osteoclasts was significantly higher in the CSI non-treated control group compared to the non-treated control of the non-exposed animals. CONCLUSIONS: EMD may provide increased defect fill and cementum formation in the presence or absence of CSI. However, tobacco smoke produced a detrimental effect on bone healing when density of newly formed bone was considered.

Inflammatory and bone-related genes are modulated by aging in human periodontal ligament cells.

Periodontal ligament cells (PDLC) play a major role in periodontal tissues homeostasis and destruction. Most age-associated diseases seem to be closely related to an underlying chronic inflammatory state. Thus, the present study aimed at evaluating in PDLC the effect of aging on the basal levels of inflammatory and bone-related genes. Primary PDLC cultures were obtained from subjects aged 15-20 years (control- n=5), and subjects aged more than 60 years (test- n=5). Proliferation, cell viability and total secreted protein assays were performed, and mRNA levels were quantitatively assessed for interleukin (IL)-1beta, IL-4, IL-6 and IL-8, and for receptor activator of nuclear factor-kappaB ligand (RANKL) and osteoprotegerin (OPG) by real time PCR. Data analysis demonstrated that aging negatively influenced cell proliferation, whereas cell viability and total secreted protein were not affected (p>0.05). Gene expression analysis showed that mRNA levels for RANKL and IL-8 were not affected by aging (p>0.05) whereas, mRNA levels for IL-4 was significantly lower in aged cells (p<0.05) and OPG, IL-1beta and IL-6 mRNA levels were higher (p<0.05). Data analysis suggests that aging decreased the ability of PDLC to proliferate and modulated the expression of important inflammatory and bone-related genes in periodontal ligament cells, favoring a proinflammatory and an antiresorptive profile.

Influence of aging on biological properties of periodontal ligament cells.

The majority of patients eligible for periodontal regenerative therapies are aged subjects. Since periodontal ligament cells (PDLC) are essential for periodontal regeneration, the aim of the present study was to determine the effect of cellular aging on PDLC, including genes associated with extracellular matrix metabolism and growth-associated factors. PDLC cultures were obtained from subjects aged 15 to 20 years and subjects aged more than 60 years. Proliferation, cell viability, mineralization assays, and mRNA levels were assessed for type I and III collagen, platelet-derived growth factor (PDGF)-1, basic fibroblast growth factor (bFGF), metalloproteinase (MMP)-2 and-8, and tissue inhibitor of metalloproteinases (TIMP)-1 and-2. Data analysis demonstrated that aging negatively influenced cell proliferation and mineral nodule formation (p < 0.05). Gene expression analysis further showed that mRNA levels for bFGF, PDGF-1, and TIMP-2 were not affected by aging (p > 0.05). In addition, mRNA levels for type I and III collagen were significantly lower in aged cells (p < 0.05), whereas MMP-2 and-8 and TIMP-1 mRNA levels were higher (p < 0.05). Within the limits of the present study, data analysis suggests that aging modulates important biological properties of periodontal ligament cells, diminishes the potential for mineral nodule formation, and favors extracellular matrix degradation.

Stem cells: potential therapeutics for periodontal regeneration.

This paper is concerned about dental-derived stem cells and their characterization in vitro and in vivo. Additionally, since conventional periodontal techniques remain insufficient to attain complete and reliable periodontal regeneration, the potential of dental-derived stem cells in promoting periodontal tissue regeneration is also reviewed.

Fibroma ossificante periférico extenso em um paciente periodontal: relato de caso / Extensive peripheral ossifying fibroma in a periodontal patient: case report

O Fibroma Ossificante Periférico (FOP) é uma hiperplasia inflamatória, causada pela proliferação de células mesenquimais do ligamento periodontal induzidas por irritantes locais. Este relato de caso documentou um FOP em uma paciente periodontal, discutindo os aspectos clínicos e histológicos no diagnóstico diferencial. Além disso, foi proposto um modelo para o manejo clínico desta patologia, enfatizando a necessidade da remoção total da lesão, curetagem dos tecidos adjacentes, eliminação dos irritantes locais e implementação de uma terapia de manutenção.

Peripheral Ossifying Fibroma (POF) is an inflammatory hyperplasia, produced by mesenchymal cells of the periodontal ligament and associated with local irritants such as calculus and plaque accumulation. This case report documented an extensive POF in a periodontal patient, discussing the clinical and histological aspects to be considered in the differential diagnosis as well a rational model for clinical management. Furthermore, this report emphasized the need of total lesion removal, curettage of the adjacent tissues and supportive periodontal therapy for prevention of its recurrence.