Effects of cervical restorations on the periodontal tissues: 5-year follow-up results of a randomized clinical trial.

OBJECTIVE: This study evaluated the effect of resin composite restorations of non-carious cervical lesions (NCCLs) on the occurrence/progression of gingival recession (GR), considering different tooth isolation techniques. METHODS: A randomized controlled split-mouth and blinded trial was carried out. Patients (n = 38) with at least two NCCLs were included. Before the cervical restoration placement, the NCCLs (181 teeth) were randomly allocated into two treatment groups according to the tooth isolation techniques: cotton roll or rubber dam. Experienced, trained, blinded, and calibrated examiners performed periodontal evaluations at baseline and 5-year follow-up, using a periodontal probe. Restorations were assessed with the FDI criteria. Thirty-two patients (154 teeth) were evaluated at 5 years. The occurrence/progression of GR between baseline and follow-up was considered the primary outcome. The relative risk (RR) and 95 % confidence interval (95 %CI) were calculated by Poisson regression (α < 0.05). RESULTS: After 5 year, 31 teeth (13.6 %) presented occurrence/progression of GR. In the multivariate analyses, the occurrence/progression of GR was associated with the use of rubber dam isolation (RR; 95 %CI: 2.65; 1.01-7.00) and a lack of marginal adaptation of the restoration (RR; 95 %CI: 10.98; 2.31-52.30). Toothbrush stiffness, use of abrasive dentifrice, tooth type, and the presence of biofilm or gingivitis did not present a statistically significant higher risk for occurrence/progression of GR. CONCLUSION: The use of rubber dam isolation associated with retraction clamp and the lack of a proper marginal adaptation of the composite restorations are risk indicators for the occurrence/progression of GR in individuals who received a restoration for an NCCL. CLINICAL SIGNIFICANCE: Isolation with a rubber dam and dental clamps may promote GR in sites with restored NCCLs. Moreover, clinical examinations for lack of marginal adaptations of the restorations may be included in a clinical setting.

Periodontitis and identification of undiagnosed hyperglycemia / Periodontite e identificação da hiperglicemia não diagnosticada

Introduction Individuals with pre-diabetes have altered glycemic levels, are generally asymptomatic, and are at increased risk for developing type 2 diabetes mellitus. Objective Identify the prevalence of periodontal individuals with undiagnosed hyperglycemia and associated impact factors. Material and method Fifty-six patients with periodontitis and without diabetes self-report, users of dental clinic services at Federal University of Juiz de Fora were included in this research, during one year and a half of experimental evaluation. Socioeconomic and demographic data, anthropometric patterns, fasting capillary blood glucose, and complete periodontal examination (six sites per tooth) were evaluated. Result The sample consisted of 58.9% female, mean age 53 years old, 58.9% obese/overweight and 45.3% had a low level of education. A total of 28.6% (n=16) participants had undiagnosed hyperglycemia (between 100 to 160 mm / dL), of which 81.3% were obese/overweight, 25% were smokers, 56.3% reported having a history of diabetes in the family, 93.8% had a family income up to 2 brazilian´s minimum wages. BMI values ​​were higher in the group of patients with hyperglycemia (29.8 ± 5.7, p = 0.03) compared to the group without hyperglycemia (26.6 ± 5.6). Patients with hyperglycemia had a greater number of sites with clinical attachment loss (CAL) between 4 and 6 mm (p = 0.04) when compared with the normoglycemic group. Conclusion Undiagnosed CAL attachment loss between 4 and 6 mm due to periodontitis than normoglycemic individuals.

Introdução Indivíduos com pré-diabetes apresentam níveis glicêmicos alterados, geralmente são assintomáticos e apresentam risco aumentado para desenvolver diabetes mellitus tipo 2. Objetivo Identificar a prevalência de indivíduos periodontais com hiperglicemia não diagnosticada e os fatores de impacto associados. Material e método Cinquenta e seis pacientes com periodontite e sem autorrelato de diabetes, usuários de serviços de clínica odontológica da Universidade Federal de Juiz de Fora foram incluídos nesta pesquisa, durante um ano e meio de avaliação experimental. Foram avaliados dados socioeconômicos e demográficos, padrões antropométricos, glicemia capilar de jejum e exame periodontal completo (seis sítios por dente). Resultado A amostra foi composta por 58,9% do sexo feminino, média de idade de 53 anos, 58,9% obesidade / sobrepeso e 45,3% com baixa escolaridade. Um total de 28,6% (n=16) participantes tinham hiperglicemia não diagnosticada (entre 100 a 160 mm / dL), dos quais 81,3% eram obesos / com sobrepeso, 25% eram fumantes, 56,3% relataram ter histórico de diabetes na família, 93,8% tinham renda familiar de até 2 salários mínimos brasileiros. Os valores de IMC foram maiores no grupo de pacientes com hiperglicemia (29,8 ± 5,7, p = 0,03) em comparação ao grupo sem hiperglicemia (26,6 ± 5,6). Pacientes com hiperglicemia apresentaram maior número de sítios com perda clínica de inserção (CAL) entre 4 e 6 mm (p = 0,04) quando comparados ao grupo normoglicêmico. Conclusão A perda de inserção de CAL não diagnosticada entre 4 e 6 mm devido à periodontite do que indivíduos normoglicêmicos.

Maternal periodontal disease and adverse perinatal outcomes: is there an association? A hospital-based case-control study.

Objectives: The association between maternal periodontal disease and adverse perinatal outcomes although extensively studied remains unclear. The aim of this study was to evaluate, by a case-control study, conducted in three hospitals the association between preterm birth and/or low birth weight (PTB/LBW) and clinical parameters of maternal periodontal disease. Material and methods: Postpartum women who gave birth to a newborn PTB/LBW (case group), and postpartum women who had babies at full term with normal weight (control group) were included, in 1:2 ratio. Data were collected through medical records, interview, and periodontal clinical parameters. Bivariate analysis was performed to assess the PTB/LBW proportion relative to independent variables and multiple logistic regression analysis to assess the association between adverse perinatal outcomes and independent variables. Results: The sample consisted of 148 cases and 296 controls. By the 148 postpartum women with PTB/LBW in case group, 126 (87.5%) had preterm birth, and 75 (50.7%) had PTB and LBW. The periodontal status and generalized periodontitis presence were not associated with any adverse pregnancy outcomes. Having made four or more prenatal visits was a protective factor for all outcomes. The history of previous PTB/LBW was a risk factor for new cases of PTB and PTB and/or LBW. The presence of systemic disease was associated with preterm and low birth weight (PTLBW). Preeclampsia and cesarean delivery were associated with all outcomes. Conclusions: The clinical parameters of maternal periodontitis were not considered as a risk factor for the studied adverse perinatal outcomes. Clinical relevance: The present study demonstrated no association between maternal periodontitis and PTB/LBW.

Clinical peri-implant parameters and inflammatory cytokine profile among smokers of cigarette, e-cigarette, and waterpipe.

BACKGROUND: To date, there has been no study identified that assessed peri-implant parameters and local levels of proinflammatory cytokines between waterpipe smokers (WS) and electronic cigarette users (VS). To evaluate the true effect of the risk indicator (WS and VS), a positive control (cigarette smokers [CS]) was added in the study design. PURPOSE: To compare clinical and radiographic peri-implant parameters and proinflammatory cytokine profile in the peri-implant sulcular fluid (PISF) among CS, WS, VS, and nonsmokers (NS). MATERIALS AND METHODS: Forty CS, WS, VS, and NS were included. Details regarding demographics, duration of implants, and habits were recorded. Clinical examination for periodontal and peri-implant plaque index (PI), bleeding on probing (BOP), and probing depth (PD ≥ 4 mm) were assessed. Radiographic bone loss (RBL) was assessed using digital periapical radiographs and viewed on a calibrated computer screen using an image analyzer. Levels of tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, and IL-1ß in PISF were evaluated using enzyme-linked immunosorbent assay. RESULTS: Mean peri-implant PI (P < .05), PD ≥ 4 mm (P < .05), and total RBL (P < .01) was significantly higher among CS, WS, and VS compared with NS. Statistical differences in BOP were observed in NS (P < .01) compared to CS, WS, and VS. CS and WS showed significantly higher PD ≥ 4 mm and RBL compared with VS (P < .05). Levels of TNF-α, IL-6, and IL-1ß were significantly higher in CS, WS, and VS compared to NS. There were no statistical differences in the mean levels of all proinflammatory cytokines among individuals in CS and WS. CONCLUSION: Tobacco smoking is associated with poor peri-implant health. The effect of waterpipe smoking was of largely the same extent as that of cigarette smoking. Higher levels of inflammatory cytokines in tobacco smokers may propose increased peri-implant inflammatory process which could play a principal role in the progression of peri-implant tissue damage.

Microbiological changes after periodontal therapy in diabetic patients with inadequate metabolic control.

The present study investigated the effect of non-surgical periodontal treatment (SRP) on the composition of the subgingival microbiota of chronic periodontitis (CP) in individuals with type 2 diabetes (DM2) with inadequate metabolic control and in systemically healthy (SH) individuals. Forty individuals (20 DM2 and 20 SH) with CP underwent full-mouth periodontal examination. Subgingival plaque was sampled from 4 deep sites of each individual and tested for mean prevalence and counts of 45 bacterial taxa by the checkerboard method. Clinical and microbiological assessments were performed before and 3 months after SRP. At baseline, those in the DM2 group presented a significantly higher percentage of sites with visible plaque and bleeding on probing compared with those in the SH group (p<0.01). Those in the DM2 group presented significantly higher levels of C. rectus and P. gingivalis, and lower prevalence of P. micra and S. anginosus, compared with those in the SH group (p≤0.001). At the 3-month visit, both groups showed a significant improvement in all clinical parameters (p<0.01). Those in the DM2 group showed significantly higher prevalence and/or levels of A. gerencseriae, A. naeslundii I, A. oris, A. odontolyticus, C. sputigena, F. periodonticum, and G. morbillorum compared with those in the SH group (p≤0.001). However, those in the DM2 group showed a significant reduction in the levels of P. intermedia, P. gingivalis, T. forsythia, and T. denticola (p≤0.001) over time. Those in the SRP group showed improved periodontal status and reduced levels of putative periodontal pathogens at 3 months' evaluation compared with those in the DM2 group with inadequate metabolic control.

Risk factors for gingivitis in a group of Brazilian schoolchildren.

OBJECTIVE: Studies on gingivitis in children and adolescents are scarce and the results are inconclusive. The aim of this study was to assess the prevalence and extension of gingivitis and associated factors in Brazilian schoolchildren. METHODS: Cross-sectional data from 1,211 schoolchildren 8 to 12 years old from Southern Brazil in 20 public and private schools were analyzed. Socioeconomic, demographic, and oral hygiene habits were assessed by questionnaires answered by parents and children. Buccal examination assessed presence of plaque, crowding, and gingivitis. Data were analyzed using Poisson regression [prevalence ratio (PR); 95% confidence interval (CI)]. RESULTS: Prevalence of visible plaque was 89.7% (95% CI 88.0-91.3) and gingival bleeding on probing was 78.4% (95% CI 76.1-81.0). The mean and median numbers of sites with gingival bleeding were 3.10 and 2 (SD ± 3.22), respectively. In multivariate adjusted analysis, the presence of a greater number of sites with plaque was significantly associated with gingivitis (PR 1.26; 95% CI 1.07-1.47) and its extension (PR 1.96; 95% CI 1.53-2.51). Lighter-skinned black children had a lower probability of having severe gingivitis (PR 0.69; 95% CI 0.48-0.98) compared with white children. This association was observed after adjusting for other variables. CONCLUSIONS: Gingivitis was associated with higher number of sites with plaque and with skin color, reflecting the influence of biological and demographic factors on this oral condition.

Influence of diltiazem in combination with a sucrose-rich diet on gingival alterations in rats.

The aim of this study was to evaluate the influence of diltiazem in combination with a sucrose-rich diet on gingival alterations in rats. One hundred and twenty male Holtzman rats were randomly assigned to 10 groups (n = 12), being 2 control groups treated with saline and 8 test groups treated with diltiazem in daily doses of 5, 25, 50 and 100 mg/kg during 40 or 60 days. Afterwards, the mandibles were removed for macroscopic, histologic and histometric analyses of the buccal gingiva of the mandibular right first molar. No macroscopic characteristic of gingival overgrowth was observed in any of the groups. The microscopic analysis showed characteristics of normality with inflammatory cells only adjacent to the crevicular epithelium in all groups for both periods. The histometric analysis showed significant differences only for the epithelial tissue area in the 40-day period (Kruskal-Wallis; P = 0.032). Comparing the periods, significant differences regarding the connective and epithelial tissue areas were observed only in the group treated with a 25 mg/kg dose (Mann-Whitney; P = 0.004 and P = 0.007, respectively). Oral administration of diltiazem in combination with a sucrose-rich diet did not induce gingival alterations in rats.

Influence of diltiazem in combination with a sucrose-rich diet on gingival alterations in rats

The aim of this study was to evaluate the influence of diltiazem in combination with a sucrose-rich diet on gingival alterations in rats. One hundred and twenty male Holtzman rats were randomly assigned to 10 groups (n = 12), being 2 control groups treated with saline and 8 test groups treated with diltiazem in daily doses of 5, 25, 50 and 100 mg/kg during 40 or 60 days. Afterwards, the mandibles were removed for macroscopic, histologic and histometric analyses of the buccal gingiva of the mandibular right first molar. No macroscopic characteristic of gingival overgrowth was observed in any of the groups. The microscopic analysis showed characteristics of normality with inflammatory cells only adjacent to the crevicular epithelium in all groups for both periods. The histometric analysis showed significant differences only for the epithelial tissue area in the 40-day period (Kruskal-Wallis; P = 0.032). Comparing the periods, significant differences regarding the connective and epithelial tissue areas were observed only in the group treated with a 25 mg/kg dose (Mann-Whitney; P = 0.004 and P = 0.007, respectively). Oral administration of diltiazem in combination with a sucrose-rich diet did not induce gingival alterations in rats.

In vitro evaluation of the effect of natural orange juices on dentin morphology.

The patient's diet has been considered an important etiological factor of dentin hypersensitivity. The frequent ingestion of acidic substances can promote the loss of dental structure or remove the smear layer. The purpose of this study was to evaluate the degree of smear layer removal and dentinal tubules exposure by different natural orange juices. Extracted human teeth were submitted to manual scaling in order to develop the smear layer. Seventy dentin samples were obtained and distributed into the following groups: Control, lime orange, lime, valência orange, navel orange, mandarin, and tangerine. Each group included 2 methods of application: Topical and topical + friction. After preparation for SEM analysis, photomicrographs were assessed by a blind calibrated examiner using an index system. The Kruskal-Wallis test indicated a significant influence of the orange juices on smear layer removal. Significant difference was observed between navel orange, valência orange, mandarin and the control group (p < 0.05). These orange juices resulted in greater removal of the smear layer and greater opening of dentinal tubules. The comparison between the application methods for each group using the Mann-Whitney test showed that friction increased smear layer removal significantly only for lime orange and lime. The data suggest that certain natural orange juices are more effective in terms of smear layer removal and dentinal tubules exposure than others.

The effect of non-surgical periodontal therapy on peroxidase activity in diabetic patients: a case-control pilot study.

OBJECTIVE: To evaluate the effect of periodontal therapy on clinical parameters as well as on total salivary peroxidase (TSP) activity and myeloperoxidase (MPO) activity in the gingival crevicular fluid (GCF) of patients with type 2 diabetes mellitus (DM2) and of systemically healthy individuals. MATERIAL AND METHODS: Twenty DM2 subjects with inadequate metabolic control (test group) and 20 systemically healthy individuals (control group), both groups with chronic periodontitis, were enrolled. Periodontal clinical parameters, namely periodontal probing depth (PD), clinical attachment level (CAL), visible plaque index (VPI), bleeding on probing (BOP), gingival bleeding index (GBI) and presence of suppuration (SUP), as well as TSP activity and GCF MPO activity, were assessed before and 3 months after non-surgical periodontal therapy. RESULTS: At baseline and 3 months post-treatment, the test group presented a higher percentage of sites with VPI and BOP (p<0.01). MPO activity in the GCF presented lower values (p<0.05) for the test group at both baseline and the post-treatment period. The periodontal treatment resulted in a significant improvement of most clinical and enzymatic parameters for both groups (p<0.05). CONCLUSIONS: In both groups, the periodontal therapy was effective in improving most clinical parameters and in reducing salivary and GCF enzymatic activity. The diabetic individuals presented lower MPO activity in the GCF.

In vitro evaluation of the effect of natural orange juices on dentin morphology

The patient's diet has been considered an important etiological factor of dentin hypersensitivity. The frequent ingestion of acidic substances can promote the loss of dental structure or remove the smear layer. The purpose of this study was to evaluate the degree of smear layer removal and dentinal tubules exposure by different natural orange juices. Extracted human teeth were submitted to manual scaling in order to develop the smear layer. Seventy dentin samples were obtained and distributed into the following groups: Control, lime orange, lime, valência orange, navel orange, mandarin, and tangerine. Each group included 2 methods of application: Topical and topical + friction. After preparation for SEM analysis, photomicrographs were assessed by a blind calibrated examiner using an index system. The Kruskal-Wallis test indicated a significant influence of the orange juices on smear layer removal. Significant difference was observed between navel orange, valência orange, mandarin and the control group (p < 0.05). These orange juices resulted in greater removal of the smear layer and greater opening of dentinal tubules. The comparison between the application methods for each group using the Mann-Whitney test showed that friction increased smear layer removal significantly only for lime orange and lime. The data suggest that certain natural orange juices are more effective in terms of smear layer removal and dentinal tubules exposure than others.

Avaliação in vitro uma morfologia do efeito dos sucos de laranja natural sobre um

A dieta do paciente Sido considerada TEM UM Importante fator etiológico da Hipersensibilidade dentinária . A Ingestão freqüente de substancias ACIDAS PoDE promover uma Perda de Estrutura OU dental removedor uma camada de esfregaço . O Objetivo Deste estudo Foi avaliar o grau de Remoção da smear layer e túbulos dentinários Exposição dos Diferentes de sucos de laranja natural. Dentes Humanos Foram extraídos submetidos à raspagem manual parágrafo desenvolver uma camada de esfregaço . Setenta amostras de dentina obtidos Foram Distribuídos e posições seguintes Grupos : Controle , laranja lima , limão , laranja valência , laranja de umbigo , tangerina e mexerica . CADA grupo Incluiu Duas Formas de aplicação: tópica e tópica atrito +. Após o preparo Para análise em MEV, como fotomicrografias Foram avaliadas UM Por Examinador cego calibrado Utilizando UM índice . O teste de Kruskal -Wallis indicou Influência Significativa dos sucos de laranja nd Remoção da camada de esfregaço. Foi observada diferença significativa Entre laranja de umbigo , laranja valência mandarim , EO grupo controle (p < 0,05). Estes sumos de laranja Maior resultou em Remoção da camada de esfregaço e Maior abertura dos túbulos dentinários . Uma Comparação entre os Métodos de Aplicação n CADA grupo Através do teste de Mann -Whitney Que Mostrou o atrito Maior Remoção de smear layer de forma Significativa Apenas para uma laranja lima e limão . Os Dados sugerem Que determined sumos de laranja natural Mais São eficazes em Em termos de Remoção da camada de esfregaço e Exposição dos túbulos dentinários fazer Outros que ( UA)

Treatment of gingival fibromatosis associated with Zimmermann-Laband syndrome.

BACKGROUND: Gingival fibromatosis is a rare condition characterized by a generalized enlargement of the buccal and lingual aspects of the attached and marginal gingiva. METHODS: This case report describes the periodontal management of a 13-year-old female patient with gingival fibromatosis associated with Zimmermann-Laband syndrome. The patient presented with gingival enlargement involving the maxillary and the mandibular arches, anterior open bite, and non-erupted teeth. Periodontal treatment included gingivectomy in all four quadrants. RESULTS: Histopathologic evaluation of the excised tissue supported the diagnosis of gingival fibromatosis. A significant improvement in esthetic appearance and eruption of the non-erupted teeth were obtained. The patient was referred for appropriate orthodontic treatment and has been closely followed for the earliest signs of recurrence of gingival enlargement. CONCLUSIONS: The successful therapy for gingival fibromatosis depends on correctly identifying the etiological factors and improving the impaired function and esthetic appearance through surgical intervention and adjunctive orthodontics. Maintaining treatment results depends on preservation of periodontal health.

Influence of natural fruit juices in removing the smear layer from root surfaces--an in vitro study.

Certain elements of a patient's diet may be associated with dentin hypersensitivity. The intent of this study was to evaluate the degree of removal of the smear layer from dentin surfaces by various fruit juices. A smear layer was created on extracted human teeth by manual scaling. The roots were reduced and distributed into 8 experimental groups. Distilled water was the negative control. The juices were applied by 2 methods: topical application and topical application with friction. Specimens were photomicrographed and graded according to an index of smear layer removal. With topical application, all but 2 of the tested substances resulted in significantly greater removal of the smear layer and opening of dentinal tubules than was the case with the negative control (p = 0.05); the exceptions were Gala apple and Italian grape juices, which were no different from the control. For the active application (with friction), most substances removed more smear layer than the control (p < 0.05); Gala apple, Italian grape and orange juices were similar to the control. For each of the tested substances, removal of the smear layer did not differ with the method of application (topical vs. friction; p > 0.05). It is concluded that natural fruit juices can remove the smear layer from dentin surfaces, and the efficacy of this removal varies with the type of juice.

The influence of vinegars on exposure of dentinal tubules: a SEM evaluation.

Dentin hypersensitivity is a common painful condition observed in clinics. Dietary habits have been much associated with its development and persistence during and following periodontal treatment. The aim of this in vitro study was to evaluate the influence of vinegars on the removal of smear layer and exposure of dentinal tubules. Extracted human teeth were submitted to manual scaling with Gracey curettes in order to remove the cementum as well as to form a smear layer. Dentin samples with 3 mm(2) were obtained and distributed into six experimental groups: one control and five types of vinegars (alcohol, apple, rice, white wine and balsamic). Each group included two methods of vinegar application: topical and friction. After routine preparation for SEM analysis, photomicrographs were assessed by a calibrated and blind examiner using an appropriate index system. Kruskal-Wallis test indicated a significant influence of vinegars on smear layer removal. There was a statistically significant difference between groups treated with apple, white and rice vinegars and the control group (p < 0.05). Nevertheless, Mann-Whitney test indicated that removal of smear layer did not vary with the method of application (topical versus friction) for any of the tested substances. We can conclude that the contact of vinegar may remove smear layer and expose dentinal tubules, regardless of the type of application. However, balsamic vinegar was associated with less removal of smear layer after both methods of application.

The influence of vinegars on exposure of dentinal tubules: a SEM evaluation

A hipersensibilidade dentinária cervical é uma condição dolorosa muito comum nos consultórios. A dieta tem sido bastante associada ao seu aparecimento, assim como a sua persistência após o tratamento periodontal. o objetivo deste trabalho foi avaliar in vitro a influência dos vinagres na remoção de "smear layer" e exposição dos túbulos dentinários. Dentes de humanos foram instrumentados com curetas Gracey para a remoção do cemento e formação de "smear layer". Foram obtidas amostras de dentina com 3 mm2, divididas entre o grupo controle (água destilada) e cinco grupos de vinagre: branco, maçã, arroz, vinho branco e balsâmico. Cada grupo incluiu duas formas de aplicação da substância, tópica ou por fricção. Após o preparo para observação em MEV (microscopia eletrônica de varredura), as fotomicrografias foram avaliadas por um examinador previamente calibrado utilizando um índice apropriado. O teste de Kruskal-Wallis indicou influência significativa dos vinagres na remoção de "smear layer". Foi constatada uma diferença estatística significante entre os grupos maçã, branco e arroz e o grupo controle (p < 0,05). O teste de Mann-Whitney, porém, indicou que a remoção de "smear layer" não variou para nenhuma das substâncias segundo a forma de aplicação. Conclui-se que os vinagres podem remover "smear layer" da superfície radicular e expor túbulos dentinários, não sendo influenciados pelo tipo de aplicação. Dentre os tipos de vinagres testados, o balsâmico esteve associado a menor remoção de "smear layer" após ambas as formas de aplicação.