Avaliação tomográfica das dimensões verticais dos tecidos periodontais supracrestais em dentes anteriores da maxila / Tomographic evaluation of the vertical dimensions of periodontal supracrestal tissues in maxillary anterior teeth

O objetivo do presente estudo foi avaliar em tomografias computadorizadas as dimensões dos tecidos periodontais supracrestais (TPSC). Cem pacientes, 600 dentes anteriores da maxila (200 incisivos centrais, 200 incisivos laterais e 200 caninos), foram avaliados. A distância média da margem gengival até a crista óssea alveolar (COA) foi de 3.25mm (95% IC: 3.20-3.30), enquanto que da junção cemento-esmalte até a COA foi de 1.77mm (95% IC: 1.72-182mm). As medidas foram significativamente diferentes entre os grupos de dentes (ANOVA, p < 0.001). A tomografia, pode representar uma importante ferramenta para a avaliação das dimensões dos TPSC.

The aim of this study was to evaluate the dimensions of the supracrestal periodontal tissues (SPT) on tomographic scans. One hundred patients, 600 maxillary anterior teeth (200 central incisors, 200 lateral incisors and 200 canines), were evaluated. The average distance from the gingival margin to the alveolar bone crest (ABC) was 3.25mm (95% CI: 3.20-3.30), while the distance from the cemento-enamel junction to ABC was 1.77mm (95% CI: 1.72-182mm). The measurements were significantly different between the tooth groups (ANOVA, p < 0.001). When properly indicated, tomography can be an important tool for assessing the dimensions of TPSCs on a case-by-case basis.

Relationship between soft tissue dimensions and tomographic radial root position classification system for immediate implant installation.

The aim of this study was to evaluate the relationship between soft tissue dimensions and radial root position (RRP) classification for immediate implant placement on maxillary anterior teeth. Maxillary anterior teeth (n = 420) were analyzed in the radial plane of cone beam computed tomography (CBCT) scans. Each tooth was classified according to its RRP: class I, (IA, IB); class II (IIA, IIB) class III; class IV, and class V. Soft tissue thickness at different landmarks, supracrestal soft tissue height, and crestal bone thickness were measured in CBCT. Keratinized tissue width was clinically measured. Gingival phenotype (thick or thin) was evaluated by transparency of the periodontal probe and at the landmark 2 mm from the gingival margin in CBCT. Class I tooth position accounted for 31.7%, class II for 45%, class III for 13.3%, class IV for 0.5%, and class V for 9.5%. The gingival phenotype was associated with RRP (χ2 test, p < 0.05). Soft tissue dimensions were significantly different over RRP classes (ANOVA and Tukey tests, p < 0.05). Types IA and IIA presented both thick soft and hard tissues. When planning immediate implants in the anterior maxilla, soft tissue dimensions evaluation should be incorporated into RRP classification to increase the accuracy and predictability of treatment outcomes.

Revisão crítica da nova classificação das periodontites / Critical review of periodontitis classification

Para o correto diagnóstico e tratamento da doença periodontal precisamos usar as classificações da doença periodontal. A mais recente foi proposta pela Academia Americana de Periodontia em conjunto com a Federação Europeia de Periodontia. Para a assimilação dos conceitos estabelecidos precisamos avaliar criticamente as informações que foram trazidas pelo consenso realizado há quase 6 anos. O objetivo do presente estudo é revisar o tópico periodontite da classificação, de forma a colaborar para o entendimento dessa doença pelos estudantes de graduação.

The periodontal diseases classifications are important for the correct diagnosis and treatment of periodontal diseases. The most recent classification was proposed by the American Academy of Periodontology in a consensus with the European Federation of Periodontology. For the assimilation of the established concepts, a critical evaluation of the information that was brought by the consensus almost 6 years ago, must be performed. The objective of the present study is to review the periodontitis topic of the new classification, in order to contribute to the understanding of this disease by undergraduate students.

Current landmarks for gingival thickness evaluation in maxillary anterior teeth: a systematic review.

OBJECTIVES: To identify and report the current landmarks used for measuring gingival thickness (GT) in healthy maxillary anterior teeth. MATERIAL AND METHODS: The protocol of this Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) 2020-compliant systematic review was registered in PROSPERO. A literature search was conducted to identify articles that met the eligibility criteria published up to 2022. The methods of assessing gingival thickness and the landmarks adopted on the studies were described. Primary outcomes were identified, and the frequency of reporting in the selected articles was calculated. Additionally, risk-of-bias assessments were performed for individual articles. RESULTS: Fifty-eight articles (34 with low risk of bias and 24 with medium risk of bias) were selected. A total of 3638 individuals had their gingival thickness measured. Thirty-nine different landmarks were adopted in the studies. Fifty-six articles with 22 landmarks were included in the meta-analysis. A higher heterogeneity was found between the studies (GT ranged from 0.48 to 2.59 mm, mean GT 1.074; 95% CI: 1.024-1.104). The 3 most used landmarks were 2 mm from gingival margin (10 studies, mean GT 1.170 mm, 95% CI: 1.085-1.254), bone crest (9 studies, mean GT 1.01 mm; 95% CI: 0.937-1.083), and cemento-enamel junction (7 studies, mean GT 1.172 mm; 95% CI: 1.105, 1.239). CONCLUSIONS: Within the limits of this study, a large heterogeneity in GT was found, and there was no consensus on the ideal landmark for GT measurement. CLINICAL RELEVANCE: The landmark 2 mm from gingival margin, located at attached gingiva, can be used for GT measurement by clinical and image-based devices. This is an important step for a quantitative instead of a qualitative evaluation of phenotypes.

Relationship between smile type and periodontal phenotype: A clinical and tomographic cross-sectional study.

OBJECTIVES: To evaluate the correlation between smile type (ST) and the periodontal phenotype (PP). MATERIAL AND METHODS: Clinical and photographic examinations of 164 participants (48 men and 116 women, mean age 22.9 ± 4.6 years) were performed, including an evaluation of ST (high, average, and low), gingival phenotype (GP) by transparency of the periodontal probe (TRAN), keratinized tissue width (KTW), gingival architecture (GA), tooth shape (TS), and papilla height (PH). A subgroup of 70 participants underwent soft-tissue cone-beam tomographic examinations (ST-CBCT), in which GP, gingival thickness (GT), buccal bone thickness (BBT), and the distances from the gingival margin and cementoenamel junction to the buccal bone crest (GM-BBC and CEJ-BBC) were evaluated. The data were analyzed using one-way ANOVA, Student's t-test, and chi-square tests, with the level of significance set at 0.05. RESULTS: High, average, and low STs were found in 31.7%, 56.7%, and 11.6% of the participants, respectively. Sex (p=0.001), GP evaluated using TRAN (p=0.021) and ST-CBCT scans (p=0.009), GA (p<0.001), and TS (p=0.001), were associated with STs. The prevalence of thin GP was: 63% in low, 50% in average, and 38% in high smile types. KTW (p=0.004), PH (p<0.001), GT at different landmarks (p<0.05), CEJ-BBC (p=0.017), and GM-BBC (p=0.001) were significantly different among STs. The highest GT and KTW were found in the high-smile group, average-smile presented the higher CEJ-BBC while GM-BBC and PH, were higher in low-smile group. CONCLUSION: Periodontal phenotype components presented important difference over the smile types. CLINICAL RELEVANCE: A detailed examination of smile types is an essential part of treatment planning, especially when the patient has high esthetic demands. Clinical and tomographic individual analysis of periodontal phenotypes over the smile types may be helpful for a case-by-case approach, and for the development of well-defined treatment protocols.

Gingival landmarks and cutting points for gingival phenotype determination: A clinical and tomographic cross-sectional study.

BACKGROUND: This cross-sectional study assessed the role of gingival landmarks (GLs) and cutting points (CPs) for gingival phenotype (GP) determination. METHODS: Six maxillary anterior teeth (70 subjects) were evaluated using soft tissue cone-beam computed tomography (ST-CBCT). Gingival thickness was measured at different GLs: 1) tissue zone (gingival margin [GM], 1 and 2 mm apical to GM, cemento-enamel junction, above the bone crest); 2) bone zone (buccal bone crest [BBC], 1, 2, and 3 mm apical to BBC). CPs of 0.6, 0.8, 1.0, 1.2, and 1.5 mm were used to discriminate between thin and thick GP. The clinical determination of GP was made based on transparency of the periodontal probe (TRAN). RESULTS: The prevalence of thin and thick GP depended on the GL and CP. Considering the CP (1 mm), thin GP at the tissue zone ranged from 99% at the GM to 10.2% above the bone crest. In the bone zone, thick GP ranged from 28% at the BBC to 6% at 3 mm apical to the BBC. The predictability of a correct assessment of GP by TRAN compared with ST-CBCT was influenced by the GLs and CPs. A slight agreement (kappa <0.2) and low accuracy (area under the curve <0.7) were found between methods. CONCLUSIONS: The determination of thin and thick GPs is related to the gingival landmarks and CPs. Further studies are required for a well-defined treatment protocol considering different gingival landmarks in tissue and bone zones. An ST-CBCT may be useful for this purpose.

Tomographic sagittal root position in relation to maxillary anterior bone housing in a Brazilian population.

Purpose: This cross-sectional study evaluated and categorized the tomographic sagittal root position (SRP) of the maxillary anterior teeth in a Brazilian population. Materials and Methods: Cone-beam computed tomographic scans of 420 maxillary anterior teeth of 70 patients (35 men and 35 women, mean age 25.2±5.9 years) were evaluated. The SRP was classified as class I, II, III, or IV. In class I, the root is positioned against the buccal cortical plate; in class II, the root is centered in the middle of the alveolar housing; in class III, the root is positioned against the palatal cortical plate; and in class IV, at least two-thirds of the root engage both the buccal and palatal cortical plates. Results: In total, 274 teeth (65.2%) were class I, 39 (9.3%) were class II, 3 (0.7%) were class III, and 104 (24.8%) were class IV. The frequency distribution over the teeth groups was different from the overall analysis. Important differences were found in the frequencies of classes I, II, and IV compared to other populations. Sex was not associated with the SRP classes (P=0.307). Age distribution was significantly different over the classes (P=0.004). Conclusion: The findings of this study on the distribution of SRP classes among the Brazilian population compared to other populations demonstrate that the SRP should be analyzed on a case-by-case basis for an accurate treatment plan in the maxillary anterior area.

Micro-tomographic analysis of the root trunk and pre-furcation area of the first mandibular molars.

This study analyzed the root trunk (RT) and the pre-furcation area (PFA) of mandibular first molars. Thirty lower first mandibular molars extracted due to advanced periodontal disease were evaluated in a high-energy spiral computerized micro-tomography. Two gutta-percha markings on the cementoenamel junction (CEJ) and at the furcation entrance (FE) at buccal and lingual surfaces served as reference points for measurements of RT length, and PFA width and depth, at the levels of CEJ, 1 mm apical to CEJ, 2 mm apical to CEJ, and at the FE. The mean RT length was 2.49 mm at buccal and 3.18 mm at lingual sides. The mean widths of the PFA at CEJ, at 1 and 2 mm apical to CEJ, and at FE were 2.9, 3.4, 3.9 and 4.3 mm, respectively, while the mean depths were 0.19, 0.32, 0.57 and 1.1 mm, respectively. The PFA coincided with CEJ in 10 buccal and 10 lingual surfaces, representing 33.33% of the sample. There was a negative correlation between RT length and PFA dimensions. This study concludes that the RT length was smaller than previous studies. From the CEJ up to the furcation entrance, the PFA showed a progressive increase in width and depth. The coincidence of the PFA area beginning at the CEJ in 1/3, and the negative correlation between RT length and PFA dimensions may represent greater risk factor for the early development of furcation lesions.

Periodontite agressiva avançada localizada, combinada com gengivite ulcerativa necrosante: dez anos de acompanhamento de um tratamento multidisciplinar / Severe localized aggressive periodontitis combined with necrotizing ulcerative gingivitis: a 10-year follow-up of a multidisciplinary treatment

Este relato de caso descreve o tratamento de um caso de periodontite agressiva avançada localizada, combinada com gengivite ulcerativa necrosante. A paciente apresentava migração patológica dos incisivos superiores com inclinação para vestibular, que exigiu uma abordagem multidisciplinar. Após a conclusão do tratamento periodontal, a terapia ortodôntica foi realizada. O tratamento desta paciente vem sendo conduzido com sucesso ao longo dos últimos dez anos.

Uma discussão sobre o efeito da rhBMP-2 no aumento ósseo alveolar / A discussion on the effect of rhBMP-2 in the alveolar bone augmentation

O objetivo deste trabalho foi apresentar uma revisão da literatura sobre a proteína óssea morfogenética tipo 2 (BMP-2) e seu efeito no aumento ósseo alveolar. A proteína óssea morfogenética (BMP) foi identificada, em 1965, por um norte-americano chamado Marshal Urist, que mostrou que essa proteína, extraída da cortical óssea bovina, poderia induzir a formação de novo osso quando implantada em locais não ósseos. Atualmente, muitos trabalhos têm estudado a regeneração óssea através do uso de BMPs em substituição aos enxertos ósseos. O presente estudo conclui que a proteína óssea morfogenética é capaz de induzir neoformação óssea de maneira eficaz, tornando-se uma alternativa na substituição dos enxertos ósseos e a necessidade da descoberta de novos carreadores facilitando a estabilidade mecânica da BMP-2 no leito receptor.

The aim of this paper is to review the literature about bone morphogenetic protein type 2 (BMP-2) and on the effect in the alveolar bone augmentation. In 1965, the BMP was isolated by Marshal Urist, who showed that this protein extracted from bone narrow could induce bone neoformation when implanted in sites without bone cells. Recently, a lot of studies have been looking for bone regeneration using BMPs without bone grafts. The present study it was concluded that the bone morphogenetic protein induces bone neoformation, being an alternative as a substitute to bone grafts and that new carrier discovery is necessary to smooth stability of this carriers in receptor site.

Evaluation of a dense polytetrafluoroethylene membrane to increase keratinized tissue: a randomized controlled clinical trial.

BACKGROUND: The presence of an adequate zone of keratinized tissue has been associated with implant health. This study evaluated the increasing of the zone of keratinized tissue using dense polytetrafluoroethylene (d-PTFE) membranes over extraction sites, without primary closure. MATERIALS AND METHODS: Fifteen sites received d-PTFE membranes. The control sites received no membranes. All cases were sutured with no attempt to achieve primary closure. Before surgery, initial measurements of buccal and lingual keratinized tissue were taken from the mucogingival line (MGL) to the most coronal gingival margins. Final measurements were taken from the buccal MGL to the lingual MGL, 60 and 90 days after extractions. RESULTS: In the test group, a mean increase in the zone of keratinized tissue of 7.06 ± 2.63 mm and 6.6 ± 2.84 mm was observed in 60 and 90 days, respectively. In the control group, a mean increase of 2.46 ± 1.59 mm and 1.40 ± 1.40 mm was observed in 60 and 90 days, respectively. CONCLUSION: Nonexpanded d-PTFE membranes can predictably be used to increase the zone of keratinized tissue in preparation to implant placement.

Biovidros: composição, indicações e uso clínico em implantodontia / Bioglasses: composition, indications and clinical use in implantology

No presente trabalho de revisão de literatura, foram abordados diversos aspectos sobre a utilização dos biovidros em implantodontia. Foram relatadas suas possíveis indicações clínicas e seus resultados em relação a outros biomateriais e com osso autógeno

In this literature review, general aspects on the bioglasses use in implantology were reviewed. Their clinical indications and results were reported they were also compared with other biomaterials and autogenous bone