Association among oral health parameters, periodontitis, and its treatment and mortality in patients undergoing hemodialysis.

BACKGROUND: Chronic periodontitis (CP) is a continuous, reversible source of inflammation with a potential impact on mortality in patients undergoing hemodialysis (HD). This study investigates the impact of oral health indicators, CP, and its treatment on survival rates in a group of patients undergoing HD. METHODS: Clinically stable patients undergoing HD were referred for a dental examination. All patients were prospectively followed in the dialysis clinic, and all-cause mortality was recorded. Three groups of patients were analyzed: those who received CP treatment, those who did not, and patients without CP as a control group. RESULTS: A total of 122 patients (79 males and 43 females, aged 23 to 77 years; mean age: 50 years; range: 23 to 77 years) were enrolled. Forty percent reported having rarely been evaluated by a dentist, and 59% had CP. There were 34 fatal events during a mean follow-up time of 64.1 ± 11.2 months. Oral factors associated with death in the univariate analysis were decreased frequency of dental visits; non-use of dental floss; increased decayed, missing, and filled teeth index; presence of CP; and absence of CP treatment. Patients with CP had a higher risk of death from all causes compared with patients without CP in the univariate analysis for untreated patients (hazard ratio 2.65 [95% confidence interval 1.06 to 6.59]; P = 0.036) and to a lesser extent for treated patients (2.36 [1.01 to 5.59]; P = 0.047). These significant differences were not maintained after adjustments for confounders in the multivariate model. CONCLUSIONS: These results suggest that poor oral health, including CP, is a common finding in patients undergoing HD. The results of this study call for intervention trials to test the hypothesis that treatment of CP improves survival in maintenance of patients undergoing HD.

Analysis of the association of an MMP1 promoter polymorphism and transcript levels with chronic periodontitis and end-stage renal disease in a Brazilian population.

UNLABELLED: Chronic periodontitis (CP) and end-stage renal disease (ESRD) are complex inflammatory conditions. Higher levels of MMP-1 were found in fluids and gingival tissues from CP patients and in the blood and tissues from ESRD patients. MMP1-1607 (1G/2G) is a functional polymorphism, as it alters MMP-1 expression. OBJECTIVE: The aim of this study was to investigate the association of the MMP1-1607 (1G/2G) polymorphism with CP and ESRD and evaluate differences in transcript levels between the groups. DESIGN: A total of 254 individuals were divided into four groups: Group 1, without CP and without chronic kidney disease (CKD) (n = 67); Group 2, with CP and without CKD (n = 60); Group 3, without CP and with CKD stage 5 (ESRD) (n = 52), and Group 4, with CP and with ESRD (n = 75). The MMP1-1607 polymorphism was analysed by PCR-RFLP. MMP1 gene transcripts from gingival tissues were analysed by real-time PCR. RESULTS: No association was found between the MMP1-1607 polymorphism and CP or ESRD. Increased levels of MMP1 transcripts were observed in CP patients with or without ESRD. No differences were observed in the transcript levels according to the genotypes. CONCLUSION: It was concluded that the MMP1-1607 polymorphism was not associated with either CP or ESRD. However, higher levels of MMP1 gene transcripts were found at gingival sites of CP in patients both with and without ESRD.

Comparação entre duas técnicas para enxerto de tecido conjuntivo em recessões classes l ou ll de Miller / Comparison between two techniques of connective tissue grafting in Miller recession Class I and II

A recessão gengival é uma condição bastante comum entre pacientes de ambos os sexos e em diferentes idades, aumentando sua frequência com o passar dos anos. As maiores queixas dos pacientes com recessão gengival são hipersensibilidade radicular e aspecto antiestético. Para isto, existem diversos tratamentos, sendo as cirurgias de enxerto as mais utilizadas. Atualmente, o tratamento mais indicado para estes casos são os enxertos de tecido conjuntivo associados a alguma técnica de retalho. Este trabalho visou comparar apenas em recessões profundas, Classes I ou II de Miller, se existiam diferenças entre enxertos realizados com a técnica do envelope e a técnica do retalho posicionado apicalmente (RPA). Optou-se por estas técnicas, já que no envelope parte do enxerto fica exposto e no RPA ele é recoberto e um dos parâmetros avaliados foi o ganho de tecido ceratinizado após os atos cirúrgicos. Concluiu-se que ambas são igualmente satisfatórias quanto a recobrimento neste tipo de recessão, tendo a técnica do envelope um ganho maior de tecido ceratinizado, além de ter a cicatrização mais rápida.

A clinical study of 406 sinus augmentations with 100% anorganic bovine bone.

BACKGROUND: The aim of the present study is to evaluate the use of anorganic bovine bone (ABB) associated with a collagen membrane (CM) for a sinus graft by means of clinical, histologic, and radiographic parameters in cases with bone availability < or =7 mm. A preliminary evaluation consisted of a clinical examination, computed tomography (CT), and a panoramic x-ray. METHODS: Ninety-two patients requiring bilateral sinus grafts and 222 requiring unilateral procedures (total: 406 sinuses) participated in this study. A total of 1,025 implants were placed in the grafted sinuses. A total of 118 implants were placed simultaneously with the sinus graft (one stage), and 907 implants were placed in a subsequent surgery (two stages), 6 to 12 months after the graft was performed. In seven cases, a biopsy was harvested for histomorphometric analysis. Recall appointments were scheduled every 6 months, and panoramic and periapical x-rays were required every year for 3 years. RESULTS: Among 1,025 implants, 19 were lost (survival rate: 98.1%). The difference in survival rates for implants placed in native bone < or =3 mm (98.1%), >3 to < or =5 mm (98.6%), and >5 to < or =7 mm (97.0%) was not statistically significant (P = 0.3408). The survival rates for implants with rough and machined surfaces (98.6% and 97.0%, respectively) were not statistically significant (P = 0.0840). The histomorphometric analysis showed new bone formation (39.0% +/- 12%), marrow space (52.9% +/- 9.3%), and residual ABB (8% +/- 2.7%). CONCLUSION: Our results indicated that 1,025 implants placed in sinuses grafted exclusively with ABB combined with CM led to an excellent and predictable survival rate of 98.1%.

Oral health in Brazilian patients with chronic renal disease.

BACKGROUND: Poor oral health status may have an impact on the health status of patients with chronic renal failure. AIM: To describe the oral health status of a group of Brazilian patients with chronic renal failure. MATERIAL AND METHODS: Retrospective review of the medical records of patients with chronic renal failure, of whom 13 (4.5%) were in a predialysis stage, 158 (55%) were on hemodialysis, 23 (8.4%) were on peritoneal dialysis and 92 (32.1%) were transplanted. General oral health, presence of dental calculus, and halitosis were recorded. The number of decayed, missed and filled teeth was analyzed by means of DMF-T (Decayed, Missed and Filled Teeth) index. RESULTS: The sample was composed of 152 men (53%) and 134 women (47%), aged 42+/-13 years. Oral health status was considered defective in most patients (83%). Eighty-seven percent had dental calculus and 55% had halitosis. Transplant patients reported significantly less halitosis (40.2%) than the rest of the groups. The DMF-T for the whole population was 20.6 and had a positive correlation with age. CONCLUSIONS: This group of patients with chronic renal failure presented a poor oral health status. Dental treatment programs for these patients should be implemented to avoid the exposure to dental pathogens.

Oral health in Brazilian patients with chronic renal disease / Salud oral en pacientes brasileños con insuficiencia renal crónica

Background: Poor oral health status mayhave an impact on the health status of patients with chronic renal failure. Aim: To describe the oral health status of a group of Brazilian patients with chronic renal failure. Material and methods: Retrospective review of the medical records of patients with chronic renal failure, ofwhom 13 (4.5 percent) werein apre dialysis stage, 158 (55 percent) were on hemodialysis, 23 (8.4 percent) were on peritoneal dialysis and 92 (32.1 percent) were transplanted. General oral health, presence of dental calculus, and halitosis were recorded. The number of decayed, missed and filled teeth was analyzed by means of DMF-T (Decayed, Missed and Filled Teeth) índex. Resulte: The sample was composed of 152 men (53 percent) and 134 women (47 percent), aged 42±13 years. Oral health status was considered defective in most patients (83 percent). Eighty-seven percent had dental calculus and 55 percent had halitosis. Transplant patients reponed significantly less halitosis (40.2 percent) than the rest of the groups. The DMF-T for the whole population was 20.6 and had a positive correlation with age. Conclusions: This group of patients with chronic renal failure presented a poor oral health status. Dental treatment programs for these patients should be implemented to avoid the exposure to dental pathogens.

Introducción: Las alteraciones de la cavidad oral pueden tener impacto en la salud de pacientes con insuficiencia renal crónica. Objetivo: Describir la salud oral de pacientes brasileños con insuficiencia renal crónica. Material y métodos: Revisión retrospectiva de las fichas dentales de pacientes con insuficiencia renal crónica, de los cuales 13 (4,5 por ciento) estaban en etapa prediálisis, 158 (55 por ciento) estaban en hemodiálisis, 23 (8,4 por ciento) estaban en peritoneodiálisis y 92 (32,1 por ciento) habían sido trasplantados. Se registró la salud oral general, la presencia de tártaro y halitosis. El número de piezas faltantes y obturadas fue analizado utilizando el índice DMF-T (Decayed, Missed and Filled Teeth o dientes con cañes, faltantes y obturados). Resultados: La muestra estaba constituida por 152 hombres y 134 mujeres con una edad promedio de 42±13 años. La salud dental general era deficitaria en 83 por ciento y 87 por ciento tenía tártaro. El 55 por ciento tenía halitosis y ¡os pacientes trasplantados tenían este problema con una frecuencia significativamente menor que el resto de ¡os grupos. El índice DMF-T global fue 20,6 y tuvo una correlación positiva con la edad. Conclusiones: La salud oral de estos pacientes con insuficiencia renal crónica es mala. Es importante implementar programas de tratamiento dental para estos pacientes para evitarla exposición a patógenos que pueden causar complicaciones sistémicas.

Histologic analysis of the acellular dermal matrix graft incorporation process: a pilot study in dogs.

Clinical results with acellular dermal matrix graft (ADMG) in periodontal surgeries suggest that the material is incorporated by the host tissues. However, histologic studies of the ADMG incorporation process are limited. The objective of this study was to evaluate the incorporation of ADMG into gingival tissues in a dog model. Gingival recession-type defects were created at the canines of six dogs. After 6 weeks, periodontal surgeries to repair the defects were performed using ADMG. Two animals each were sacrificed after 4, 8, and 12 weeks. At 4 weeks, thick collagen fibers from the ADMG were clearly seen in the connective tissue, and some blood vessels were penetrating into the ADMG. At 8 weeks, blood vessel penetration was enhanced, and collagen fiber bundles from the ADMG were seen sending branches into the connective tissue in all directions. After 12 weeks, the ADMG and the connective tissue seemed to be well integrated into a single highly vascularized structure, indicating almost complete incorporation of the ADMG.

Acellular dermal matrix and hydroxyapatite in prevention of ridge deformities after tooth extraction.

The aim of this study was to evaluate the role of acellular dermal matrix graft (ADMG) acting as a membrane, associated with a resorbable hydroxyapatite (RHA) in bone regeneration to prevent ridge deformities after tooth extraction. Fifteen patients who had at least 2 noncontiguous, uniradicular teeth indicated for extraction were selected. In group I, the extraction sockets were covered by ADMG alone; and in group II, the alveoli were filled with RHA before the placement of the ADMG. After 6 months, re-entry surgeries and biopsies were performed. Although ridge thickness had been preserved in both groups, the means were significantly greater (P < 0.05) for group II when compared to group I (6,8 +/- 1.26 and 5.53 +/- 1.06). The histologic analysis showed small bone formation in some samples for group II, where the presence of a highly vascularized fibrous connective tissue surrounding the particles was a common finding. Based on the results, it can be concluded that the ADMG was able to preserve ridge thickness and that the additional use of RHA favored the preservation of the ridges along with an increase in the width of keratinized tissue.

Immediate implant in extraction socket with acellular dermal matrix graft and bioactive glass: a case report.

A buccal plate destroyed as a result of a longitudinal root fracture was completely restored by the use of a Frialit-2 implant placed in the alveolus of the fractured maxillary left first bicuspid. An acellular dermal matrix material was used as a membrane barrier to cover the implant, and a bioactive glass was used as grafting material. After 6 months, the defect around the implant was completely filled by mineralized tissue.