Doença periodontal, seus sinais e sequelas: limitações para o tratamento com implantes osseointegrados?

Introdução: o sucesso do tratamento com implantes osseointegrados em pacientes periodontalmente saudáveis tem sido bem documentado em numerosos estudos longitudinais nos últimos anos. Entretanto, a possibilidade de aplicar esses resultados positivos aos pacientes com doenças ou alterações periodontais permanece desconhecida. Objetivo: objetivo desta revisão de literatura foi discutir, baseado evidências científicas, sobre cinco sinais ou sequelas da doença periodontal que possam afetar o prognóstico dos implantes osseointegrados, com o objetivo de verificar se a doença periodontal é um fator de risco para a osseointegração, após longos períodos de observação. Métodos: os cinco sinais ou sequelas da doença periodontal discutidos nessa revisão são: (1) presença de bolsa periodontal em unidades dentárias próximas a sítios com implantes; (2) periodontite agressiva; (3) implantes imediatos em sítios periodontalmente infectados; (4) defeitos em rebordo ósseo; (5) ausência de mucosa queratinizada. Conclusão: o conhecimento de sinais e sequelas da doença periodontal conduz o implantodontista a planejar de forma cautelosa a reabilitação com implantes osseointegrados.

Introduction: the success of treatment with osseointegrated implants in periodontally healthy patients has been well documented in numerous longitudinal studies in recent years. However, the possibility of applying those positive results to patients with periodontal diseases or alterations remains unknown. Aim: the objective of this literature review is to discuss, on the basis of scientific evidence, five of the signs or sequels of periodontal disease which may effect the prognosis in treatment with osseointegrated implants, and to prove whether periodontal diseaes is a long term risk factor for osseointegration, or not. Methods: the five signs or sequels of periodontal disease discussed in this review are: (1) the presence of periodontal pockets bordering teeth adjacent to implant sites; (2) aggressive periodontitis; (3) immediately loaded implants in periodontically infected sites; (4) defects in the bone crest and (5) absence of keratinized mucosa. Conclusion: awareness of the signs and sequels of periodontal disease lead implantologists to plan rehabilitation with osseointegrated implants cautiously.

Adjunctive benefits of systemic etoricoxib in non-surgical treatment of aggressive periodontitis: short-term evaluation.

BACKGROUND: This pilot study assessed the effect of short-duration treatment with etoricoxib as adjuvant therapy to scaling and root planing (SRP) on the clinical and radiographic parameters and prostaglandin E(2) (PGE(2)) levels in aggressive periodontitis. METHODS: Subjects were randomly allocated to test or control treatment (n = 10 in each group) and submitted to SRP and treatment with etoricoxib, 120 mg/day, or placebo for 7 days. Probing depth, clinical attachment level (CAL), gingival recession, visible plaque index, bleeding on probing, linear distance (LD) from the cemento-enamel junction to the alveolar crest, and analysis of the gray levels were recorded before and 1 month after the therapies. The prostaglandin E(2) (PGE(2)) level in the gingival crevicular fluid (GCF) was measured by radioimmunoassay at the beginning of the study and 7 and 30 days after treatment. RESULTS: No significant difference in the clinical parameters was observed between the groups at the end of the experimental period, although both groups presented significant improvement in all variables examined. There was a decrease in CAL from 5.54 +/- 0.47 mm to 3.59 +/- 0.53 mm in the test group and from 5.92 +/- 1.10 mm to 3.69 +/- 0.80 mm in the control group. A significant reduction in PGE(2) was found after 7 days of treatment. LD differed between the groups. CONCLUSION: Etoricoxib did not promote additional improvement in the clinical parameters; however, it produced an initial reduction in the PGE(2) levels in the GCF, which could be related to the discrete improvement in the bone condition.