Do the progression of experimentally induced gingivitis and peri-implant mucositis present common features? A systematic review of clinical human studies.

This systematic review evaluated the features of the progression of experimentally induced gingivitis and peri-implant mucositis in humans. Included were studies that evaluated clinical, immunological, or microbiological responses between experimentally induced gingivitis and peri-implant mucositis in periodontally healthy patients. A total of 887 articles were initially identified, but only 12 were included in the final analysis. Implants accumulate less biofilm and suffer the most heterogeneous alterations in the microbiota, in the abstinence of oral hygiene, compared with the tooth. Interestingly, although dental implants presented less biofilm accumulation, the peri-implant mucosa showed a more exacerbated clinical response than the gingival tissue. The risk of bias of the selected studies was moderate to low, with one study presenting serious risk. The progression events of peri-implant mucositis were similar to those of experimental gingivitis but led to a different host response. This review was registered in the PROSPERO database CRD420201 123360.

Polydioxanone-Based Membranes for Bone Regeneration.

Resorbable synthetic and natural polymer-based membranes have been extensively studied for guided tissue regeneration. Alloplastic biomaterials are often used for tissue regeneration due to their lower immunoreactivity when compared with allogeneic and xenogeneic materials. Plenum® Guide is a synthetic membrane material based on polydioxanone (PDO), whose surface morphology closely mimics the extracellular matrix. In this study, Plenum® Guide was compared with collagen membranes as a barrier material for bone-tissue regeneration in terms of acute and subchronic systemic toxicity. Moreover, characterizations such as morphology, thermal analysis (Tm = 107.35 °C and crystallinity degree = 52.86 ± 2.97 %, final product), swelling (thickness: 0.25 mm ≅ 436% and 0.5 mm ≅ 425% within 24 h), and mechanical tests (E = 30.1 ± 6.25 MPa; σ = 3.92 ± 0.28 MPa; ε = 287.96 ± 34.68%, final product) were performed. The in vivo results revealed that the PDO membranes induced a slightly higher quantity of newly formed bone tissue than the control group (score: treated group = 15, control group = 13) without detectable systemic toxicity (clinical signs and evaluation of the membranes after necropsy did not result in differences between groups, i.e., non-reaction -> tissue-reaction index = 1.3), showing that these synthetic membranes have the essential characteristics for an effective tissue regeneration. Human adipose-derived stem cells (hASCs) were seeded on PDO membranes; results demonstrated efficient cell migration, adhesion, spread, and proliferation, such that there was a slightly better hASC osteogenic differentiation on PDO than on collagen membranes. Hence, Plenum® Guide membranes are a safe and efficient alternative for resorbable membranes for tissue regeneration.

Does Non-Surgical Periodontal Treatment Improve Glycemic Control? A Comprehensive Review of Meta-Analyses.

AIM: Periodontal treatment is reported to be associated with an improved periodontal condition in diabetic patients. Therefore, a comprehensive review of meta-analyses was conducted to evaluate whether periodontal treatment can improve glycemic control in patients with type 2 diabetes. MATERIALS AND METHODS: The search on electronic databases included PubMed-Medline, Cochrane Library, Scopus, and LILACS databases. The methodological quality of the systematic reviews was evaluated using AMSTAR, and primary studies were performed in accordance with PRISMA guidelines. The weighted mean difference (WMD) was calculated, nested in a random-effects model with corresponding Z scores, p-values, and 95% confidence intervals. RESULTS: A total of 11 meta-analyses were included, and a meta-analysis of 11 primary studies comprising a total of 1341 participants was carried out. All the studies evaluated glycosylated hemoglobin (Hb1Ac), and 6 of the 11 publications evaluated fasting plasma glucose (FPG). The AMSTAR scores ranged between 9 and 11, with a median of 10.3. Statistically significant reductions were observed in HbA1c values [-0.32% (3.5 mmol/ mol); 95%CI: -0.50 to -0.15] and FPG values (-11.59 mg/dl; 95%CI: -15.16 to -8.01). CONCLUSION: The review of currently available clinical studies concludes that periodontal treatment is associated with improved glycemic control in patients with type 2 diabetes. New guidelines, including periodontal treatment as a routine public health measure to improve glycemic control in diabetic patients, would be of great value.

Clinical efficacy of xenogeneic and allogeneic 3D matrix in the management of gingival recession: a systematic review and meta-analysis.

OBJECTIVE: A systematic review and meta-analysis was thus conducted to answer the following focused question based on PICO strategy: Is there any 3D matrix biomaterial used for root coverage of human Miller class I and II defects equivalent with the connective tissue graft in localized defects of at least 2 mm and 3 mm? MATERIAL AND METHODS: The search on electronic database included MEDLINE, Cochrane Central Register of Controlled Trials, Clinical Trials.gov, Web of Science, and New Zealand/Australian Clinical Trials. Only randomized clinical trials (RCTs) that compared connective tissue graft (CTG) with at least one 3D matrix alone for root coverage in Class I and II Miller localized defects of at least 2 mm, with at least 6 months follow-up, were included in this systematic review. RESULTS: A total of 14 studies were included for meta-analysis (12 compared CTG with acellular dermal matrix allograft and 2 compared CTG with Xenogenic Collagen Matrix). Relative root coverage showed no significant difference among the materials, for either 2 or 3 mm minimal recessions. For keratinized tissue width, on 2 mm recessions, CTG showed superiority above other biomaterials, but on 3 mm recessions, it seemed to have the same results. The percentage of recessions with complete root coverage for both 2 and 3 mm recessions showed similar results for all biomaterials. CONCLUSIONS: With their limits, the present data concluded that CTG, acellular dermal matrix allograft, and xenogenic collagen matrix provided similar results for root coverage. CLINICAL RELEVANCE: To know if there is a 3D matrix with equivalent predictable results for root coverage, that we could avoid the morbidity of the connective tissue graft for these cases.

Recobrimento radicular de retração unitária classe II de Miller / Root coverage of a Miller Class II single recession ­ case report

Objetivo: apresentar um relato de caso cirúrgico para tratamento de uma retração unitária classe II de Miller, com um acompanhamento de seis meses. Relato de caso: retração classe II de Miller no dente 31 foi submetida a um procedimento cirúrgico com enxerto subepitelial, associado ao deslocamento coronário do retalho, em uma paciente com queixa de sensibilidade dentinária e dificuldade de higienização local. Resultados: os resultados demonstraram recobrimento radicular satisfatório, atingindo cerca de 83% da superfície radicular, e um evidente aumento da altura e espessura de tecido gengival queratinizado, bem como melhora da sensibilidade dentinária e capacidade de higienização local. Conclusão: o enxerto subepitelial associado ao deslize coronário do retalho proposto neste caso foi uma abordagem eficiente para o recobrimento radicular de uma lesão classe II de Miller, pois proporcionou alta taxa de recobrimento, ganho de tecido queratinizado e satisfez o anseio da paciente.

Objective: to present a surgical case report for treatment of Miller Class II single defect at 6 months follow-up. Case report: a Miller Class II recession at tooth 31 underwent a surgical procedure with subepithelial connective tissue associated with coronally advanced flap in a patient complaining of dentin hypersensitivity and local hygiene difficulty. Results: the results showed satisfactory root coverage reaching about 83% of the root surface and an evident increase in width and thickness of keratinized tissue, as well as improvement of dentin hypersensitivity and local hygiene ability. Conclusion: the subepithelial connective tissue associated with coronally advanced flap proposed in this case was an efficient approach to root coverage of a Miller class II lesion because it provided a high level of root coverage, keratinized tissue gain and satisfied the patient's longing.

Avaliação compreensiva da efetividade da proteína da matriz do esmalte no tratamento de recessões gengivais através da revisão sistemática de ensaios pré-clínicos e clínicos / Comprehensive evaluation of the effectiveness of enamel matrix protein in gengival recessions treatment through systematic review of pre-clinical and clinical trials

A proteína da matriz do esmalte (Emdogain, Straumann, Basel, Switzerland) vem ganhando amplo destaque no tratamento das recessões gengivais, por permitir a regeneração dos tecidos de suporte perdidos. O objetivo desta revisão sistemática foi avaliar compreensivamente a efetividade da proteína da matriz do esmalte no recobrimento radicular. Os artigos inclusos nesta revisão foram encontrados através de uma pesquisa eletrônica na base de dados Medline/Pubmed, e a busca estratégica incluiu a seguinte combinação de palavras para estudos pré-clínicos: “periodontal disease AND gingival ressection OR root coverage AND enamel matrix protein AND animal”; e para os estudos clínicos: “periodontal disease AND gingival ressection OR root coverage AND enamel matrix protein”. Não foram inseridos critérios de refinamento de busca. Inicialmente, 64 artigos foram selecionados para análise. Os estudos pré-clínicos incluídos deveriam ser clínicos, pré-clínicos (em animais) e analisar a efetividade da proteína da matriz do esmalte. Os estudos clínicos deveriam apresentar dados numéricos (média e desvio-padrão) inicias e finais relativos às mensurações de nível clínico de inserção (NCI), de profundidade de sondagem (PS), de mucosa queratinizada (MC), de recessão gengival (RG) e período de observação mínimo de 12 meses. Ao final da análise, 18 artigos – cinco estudos pré-clínicos e 13 estudos clínicos longitudinais – foram inclusos e analisados. As evidências científicas analisadas compreensivamente nesta revisão sistemática sugerem que a utilização da proteína da matriz do esmalte é efetiva, apresentando boa estabilidade e previsibilidade no tratamento de recessões gengivais.

Tratamento de maxilas atróficas por meio de fixações zigomáticas sob carregamento imediato: relatos de coorte histórico com 8-60 meses de acompanhamento / Treatment of atrophic maxillary arches with zygomatic fixations under immediate loading: historical cohort report with 8-60 months of follow-up

Objetivo: este estudo retrospectivo avaliou o índice de sucesso de restaurações implantossuportadas de função imediata, com fixações zigomáticas associadas aos implantes convencionais. Material e métodos: foram avaliadas as fichas clínicas de todos os pacientes atendidos na clínica particular dos autores. Os critérios de inclusão foram: edentulismo total ou parcial de maxila, com indicação de extração dos dentes remanescentes; saúde geral compatível; ausência de hábitos parafuncionais; capacidade física para a manutenção e higienização das próteses; seios maxilares saudáveis; ausência de enxertia óssea prévia; procedimentos cirúrgicos e protéticos pelo mesmo cirurgião e protesista. Após exame prévio e confecção do guia cirúrgico, os pacientes foram operados com a técnica preconizada por Stella e Warner, 2000. Os controles foram realizados após dez, 30, 60 dias e, posteriormente, a cada seis meses para avaliação dos implantes, da higiene oral, da condição da prótese e da oclusão. Resultados: 12 pacientes com maxilas atróficas foram incluídos no estudo, sendo oito mulheres (66,7%) e quatro homens (33,3%). A idade dos pacientes variou entre 41 e 73 anos, com média de 56,5. Foram instalados 22 implantes zigomáticos e 38 implantes convencionais.As próteses foram instaladas e ajustadas de 24 a 36 horas após o procedimento cirúrgico. Ao longo das avaliações, os pacientes apresentaram ausência de infecção peri-implantar e poucas complicações compatíveis com o procedimento realizado (três cirúrgicas, seis protéticas). Conclusão: nos limites desse estudo observacional, longitudinal e retrospectivo com implantes zigomáticos, pôde-se concluir que todos os implantes avaliados estavam nos critérios de sobrevivência e de sucesso no período de observação.

Objective: this retrospective study evaluated the success index of immediate implant-supported restorations with zygomatic fi xations associated to conventional implants. Material and methods: the clinical records of all treated patients at the author´s clinics were evaluated. The inclusion criteria were as follows: partial or total maxillary edentulism, indications for tooth extraction, adequate general health, lack of parafunctional habits, capacity for good oral hygiene, healthy maxillary sinuses, lack of previous bone grafting, surgical and prosthetic procedures made by the same practitioner. After previous examining and surgical guide fabrication, all surgeries were performed according the Stella and Warner´s technique (2000). Follow-ups were made at 10, 30, 60 days, and each six months for implant, occlusal, and oral hygiene related conditions. Results: 12 patients with atrophic maxillae were included, being 8 women (66.7%) and 4 men (33.3%). Patient´s age varied from 41 to 73 years-old (mean 56,5 years). Twenty-two zygomatic and 38 conventional implants were, installed. All prostheses were delivered at 24 or 36 hours after the surgical procedure. No peri-implant infections were observed, and a few complications (3 surgical, 6 prosthodontic) were seen. Conclusion: within the limits of this observational, longitudinal, and retrospective study with zygomatic implants, all installed fixtures fit the survival criteria over the studied period.