Association between the use of statins and periodontal status: a review

ABSTRACT: Background: Statins are drugs used for the treatment of dyslipidemia. However, statins have multiple actions, including anti-inflammatory and immunomodulatory effects, as well as the ability to stimulate new bone formation. Such features could be beneficial for periodontal pathology therapy. Methods: A literature review was conducted using filtered electronic databases (Cochrane and Trip) and unfiltered databases (Medline/PubMed, Scielo and Google Scholar). The articles chosen were controlled and randomized clinical trials that performed local delivery of statins to humans and assessed the effects of immunomodulation and bone regeneration on periodontal disease between 2010 and 2017. All of the studies were blind or double-blind and were written in English. Results: The inclusion criteria were applied to a total of 79 identified articles, and 10 studies were ultimately chosen. The results show that an injected dose of statins or the local delivery of atorvastatin (ATV) leads to a significant improvement in clinical and radiographic periodontal parameters. Moreover, rosuvastatin (RSV) induced stronger beneficial effects when administered systemically, whereas ATV and simvastatin (SMV) had better results following topical delivery. Conclusions: Statins can affect periodontal status, increasing the gain in clinical attachment and decreasing gingival bleeding, probing depth and the magnitude of bone defects. For this reason, statins represent an excellent support measure for conventional periodontal therapy. Specifically, positive effects are seen for local delivery of statins as an adjunct treatment to scaling and root planing (SRP) at doses of 1.2 to 2%. Statins could be administered through topical delivery via direct injection in the periodontal pocket or by brushing with medicated dentifrices. More studies with appropriate designs should evaluate the short and long term clinical benefit of statins inpatients with periodontal pathology. These studies should determine the appropriate dose, timing side effects and ideal vehicles for delivery.

Evaluation of the effect of probiotics in the treatment of peri-implant mucositis: a triple-blind randomized clinical trial.

OBJECTIVES: To determine if the treatment of mucositis with mechanical debridement, 0.12% chlorhexidine, and a further application of Lactobacillus reuteri (L. reuteri) will result in an improvement of the clinical and microbiological parameters in comparison to the treatment with mechanical debridement and 0.12% chlorhexidine alone. MATERIAL AND METHODS: Fifty dental implants with mucositis in 50 patients were randomly assigned to one of the following groups: mechanical debridement, 0.12% chlorhexidine mouthwash, and the subsequent administration of a probiotic agent (test group) or mechanical debridement and 0.12% chlorhexidine mouthwash (control group). Data were analyzed to determine clinical and microbiological changes during treatment and after a follow-up period of 3 months. RESULTS: After the administration of 0.12% chlorhexidine, all clinical parameters improved in the test and the control group, observing a significant decrease in Full Mouth Plaque Index (FMPI), full mouth bleeding on probing (FMBOP), Plaque Index (PI), and bleeding on probing (BOP) at the implant. However, following the administration of probiotics or placebo, the clinical variables, except for probing pocket depth, slightly and progressively increased up to 3 months of follow-up, but without reaching baseline levels. From a microbiological point of view, no major alterations of the subgingival microflora were recorded at different time points between groups during the study. CONCLUSIONS: Treatment with mechanical debridement, oral hygiene reinforcement, and administration of 0.12% chlorhexidine was effective in reducing mucositis, but it did not always result in complete resolution of inflammation. The administration of probiotics did not seem to provide an additional clinical or microbiological benefit. CLINICAL RELEVANCE: The use of probiotics does not seem to provide an additional benefit in the treatment of peri-implant mucositis.

In vitro evaluation of a multispecies oral biofilm over antibacterial coated titanium surfaces.

Peri-implantitis is an infectious disease that affects the supporting soft and hard tissues around dental implants and its prevalence is increasing considerably. The development of antibacterial strategies, such as titanium antibacterial-coated surfaces, may be a promising strategy to prevent the onset and progression of peri-implantitis. The aim of this study was to quantify the biofilm adhesion and bacterial cell viability over titanium disc with or without antibacterial surface treatment. Five bacterial strains were used to develop a multispecies oral biofilm. The selected species represent initial (Streptococcus oralis and Actinomyces viscosus), early (Veillonella parvula), secondary (Fusobacterium nucleatum) and late (Porphyromonas gingivalis) colonizers. Bacteria were sequentially inoculated over seven different types of titanium surfaces, combining different roughness level and antibacterial coatings: silver nanoparticles and TESPSA silanization. Biofilm formation, cellular viability and bacterial quantification over each surface were analyzed using scanning electron microscopy, confocal microscopy and real time PCR. Biofilm formation over titanium surfaces with different bacterial morphologies could be observed. TESPSA was able to significantly reduce the cellular viability when compared to all the surfaces (p < 0.05). Silver deposition on titanium surface did not show improved results in terms of biofilm adhesion and cellular viability when compared to its corresponding non-coated surface. The total amount of bacterial biofilm did not significantly differ between groups (p > 0.05). TESPSA was able to reduce biofilm adhesion and cellular viability. However, silver deposition on titanium surface seemed not to confer these antibacterial properties.

Hombres que tienen sexo con hombres y detección del virus de la inmunodeficiencia humana en odontología / Men who have sex with men and human immunodeficiency virus testing in dental practice

Objetivo: Determinar la percepción de hombres que tienen sexo con hombres (HSH) sobre la aplicación de la prueba rápida del virus de la inmunodeficiencia humana (VIH) 1/2 en el consultorio odontológico, y evaluar el estigma y la discriminación asociados a la orientación sexual percibidos en la consulta odontológica. Método: Estudio transversal mediante cuestionario autoadministrado y estructurado de tipo analítico contestado anónimamente por 185 HSH en México. Además de las variables sociodemográficas, la percepción sobre los servicios y los prestadores de servicios odontológicos, y sobre la aplicación de la prueba rápida anti VIH-1/2, se diseñó y exploró mediante una escala psicométrica tipo Likert la percepción del estigma y la discriminación asociados a la orientación sexual. El análisis estadístico incluyó análisis factorial y análisis de clusters no jerárquico. Resultados: El 86,5% se mostró a favor de la aplicación de la prueba del VIH-1/2 en la consulta odontológica. El 91,9% considera importante que el odontólogo esté capacitado y sensibilizado para realizar la prueba. El análisis factorial reveló dos factores: experiencias de estigma y discriminación en la consulta odontológica, y sentimientos de preocupación por la actitud del odontólogo o su personal hacia su orientación sexual. El análisis de clusters identificó tres grupos: usuarios que no han experimentado estigma ni discriminación (90,3%); usuarios que no han experimentado estigma ni discriminación, pero que sienten una ligera preocupación (8,1%); y usuarios que han experimentado algún tipo de estigma y discriminación, y sienten preocupación (1,6%). Conclusión: La consulta odontológica podría representar una ubicación para realizar la prueba rápida del VIH-1/2, contribuyendo en el diagnóstico temprano de la infección

Objective: To explore the attitudes of men who have sex with men (MSM) towards the implementation of rapid HIV-1/2 testing in the dental practice, and to evaluate MSM's perceptions of stigma and discrimination related to sexual orientation by dental care professionals. Methods: Cross-sectional study using a self-administered, anonymous, structured analytical questionnaire answered by 185 MSM in Mexico. The survey included sociodemographic variables, MSM's perceptions towards public and private dental providers, and dental services, as well as their perception towards rapid HIV-1/2 testing in the dental practice. In addition, the perception of stigma and discrimination associated with their sexual orientation was explored by designing a psychometric Likert-type scale. The statistical analysis included factor analysis and non-hierarchical cluster analysis. Results: 86.5% of the respondents expressed their willingness to take a rapid HIV-1/2 screening test during their dental visit. Nevertheless, 91.9% of them considered it important that dental professionals must be well-trained before administering any rapid HIV-1/2 tests. Factor analysis revealed two factors: experiences of sexual orientation stigma and discrimination in dental settings, and feelings of concern about the attitude of the dentist and dental staff towards their sexual orientation. Based on these factors and cluster analysis, three user profiles were identified: users who have not experienced stigma and discrimination (90.3%); users who have not experienced stigma and discrimination, but feel a slight concern (8.1%), and users who have experienced some form of discrimination and feel concern (1.6%). Conclusion: The dental practice may represent a potential location for rapid HIV-1/2 testing contributing to early HIV infection diagnosis

[Men who have sex with men and human immunodeficiency virus testing in dental practice]. / Hombres que tienen sexo con hombres y detección del virus de la inmunodeficiencia humana en odontología.

OBJECTIVE: To explore the attitudes of men who have sex with men (MSM) towards the implementation of rapid HIV-1/2 testing in the dental practice, and to evaluate MSM's perceptions of stigma and discrimination related to sexual orientation by dental care professionals. METHODS: Cross-sectional study using a self-administered, anonymous, structured analytical questionnaire answered by 185 MSM in Mexico. The survey included sociodemographic variables, MSM's perceptions towards public and private dental providers, and dental services, as well as their perception towards rapid HIV-1/2 testing in the dental practice. In addition, the perception of stigma and discrimination associated with their sexual orientation was explored by designing a psychometric Likert-type scale. The statistical analysis included factor analysis and non-hierarchical cluster analysis. RESULTS: 86.5% of the respondents expressed their willingness to take a rapid HIV-1/2 screening test during their dental visit. Nevertheless, 91.9% of them considered it important that dental professionals must be well-trained before administering any rapid HIV-1/2 tests. Factor analysis revealed two factors: experiences of sexual orientation stigma and discrimination in dental settings, and feelings of concern about the attitude of the dentist and dental staff towards their sexual orientation. Based on these factors and cluster analysis, three user profiles were identified: users who have not experienced stigma and discrimination (90.3%); users who have not experienced stigma and discrimination, but feel a slight concern (8.1%), and users who have experienced some form of discrimination and feel concern (1.6%). CONCLUSION: The dental practice may represent a potential location for rapid HIV-1/2 testing contributing to early HIV infection diagnosis.

Atorvastatin-medicated dentifrice significantly inhibits CD4+ T cell proliferation: in vitro pilot study / Pasta dental medicada con atorvastatina inhibe de forma significativa la proliferación de células T CD4+: un estudio piloto in vitro

Reports indicate that statins (cholesterol-lowering drugs), in addition to lowering cholesterol, have an immunomodulatory effect. This effect may be beneficial for the treatment of several diseases, including periodontal disease. The aim of the present study was to evaluate the immunomodulatory effect of an atorvastatin-medicated dentifrice on CD4+ T cell proliferation. CD4+ T cell proliferation assays and peripheral blood mononuclear cell (PBMC) viability assays were conducted on PBMCs from healthy donors cultured under the following conditions: control, atorvastatin solution, atorvastatin-medicated dentifrice, and dentifrice without atorvastatin at concentrations of 1, 5, 10, 50 and 100 µM. A Generalized Equation Estimation (GEE) model was used to analyze concentration versus proliferation and concentration versus percentage of dead cells within each group evaluated. Atorvastatin-medicated dentifrice (p-value <0.0001) and atorvastatin solution (p-value <0.0001) significantly inhibited CD4+ T cell proliferation in a dose-dependent manner compared with the dentifrice without atorvastatin and control conditions. Only the relationship between atorvastatin solution and percentage of dead cells was significant compared to the other conditions (p-value 0.019). The results revealed that atorvastatin-medicated dentifrice at concentrations of 1 to 100 µM had immunomodulatory effects, inhibiting CD4+ T cell proliferation without affecting PBMC viability. The other components of the dentifrice did not affect CD4+ T cell proliferation or cell viability, indicating its utility as a vehicle to achieve the desired effects of atorvastatin in periodontal tissue. Controlled clinical trials are still needed to evaluate the clinical effects of an atorvastatin-medicated dentifrice on the periodontium.

La literatura indica que las estatinas (medicamentos para bajar el colesterol), además de reducir el colesterol, tienen un efecto inmunomodulador. Este efecto puede ser beneficioso para el tratamiento de varias enfermedades, incluyendo la enfermedad periodontal. El objetivo de este estudio es evaluar el efecto inmunomodulador de una pasta dental medicada con atorvastatina sobre la proliferación celular de linfocitos T CD4+. A partir de células mononucleares de sangre periférica de donantes sanos (PBMC), se realizaron ensayos de proliferación y viabilidad de linfocitos T CD4+ bajo las siguientes condiciones: control, solución de atorvastatina, dentífrico medicado con atorvastatina y dentífrico sin atorvastatina, en concentraciones 1, 5, 10, 50 and 100 µM. Se realizó el análisis estadístico utilizando el modelo Generalized Equation Estimation (GEE) a fin de analizar la concentración versus la proliferación y la concentración versus el porcentaje de muerte celular para cada uno de los grupos. El dentífrico medicado con atorvastatina (valor p <0,0001) y solución de atorvastatina (valor p <0,0001) inhibieron significativamente la proliferación de células T CD4 + de una manera dependiente de la dosis en comparación con el dentífrico sin atorvastatina y condiciones de control. Sólo la relación entre la atorvastatina solución y el porcentaje de células muertas fue significativa en comparación con las otras condiciones (vale-p 0,019). Los resultados revelaron que el dentífrico medicado con atorvastatina en concentraciones de 1 a 100 mM tenía efectos inmunomoduladores, inhibiendo la proliferación de células T CD4 + sin afectar la viabilidad de PBMC. Los otros componentes del dentífrico no afectaron la proliferación de células T CD4 + o la viabilidad celular, indicando su utilidad como vehículo para conseguir los efectos deseados de atorvastatina en el tejido periodontal. Todavía se necesitan ensayos clínicos controlados para evaluar los efectos clínicos de un dentífrico medicado con atorvastatina sobre el periodonto.

Potential gingival crevicular fluid and serum biomarkers by stage of HIV infection.

OBJECTIVE: This study evaluates the potential of gingival crevicular fluid and serum cytokines as HIV stage biomarkers. METHODS: Gingival crevicular fluid (GCF) and serum samples from 78 HIV-positive adult male subjects (cases) and 39 HIV-negative male subjects (controls) from Mexico were examined for 17 cytokines using multiplex ELISA. Participants were divided into five subgroups by HIV stage of infection on age-specific CD4+ T-lymphocyte count and antiretroviral therapy (ART), and further correlated to the cytokine levels. RESULTS: GCF concentrations of IL-6, IL-7, IL-10, IL-12, G-CSF and MCP-1, as well as serum concentrations of IL-1ß, IL-2 and IL-6 showed a statistically significant difference among subgroups. We found a significant effect size correlation on cytokines expression levels. Subjects who were not in ART showed significantly higher levels of some of the analyzed cytokines compared to the rest. We found that GCF IL-8 was a significant predictor for the Non-ART HIV status (p<0.05). We observed the same result for GCF G-CSF in the ART Short-term group and serum GM-CSF in the ART Long-term subgroup. CONCLUSION: Results indicate a high variability of GCF and serum cytokines concentrations and low frequency of their detection in different HIV/ART stages. However, within the limits of the present study, some GCF and serum cytokine concentrations correlate positively. Oral and periodontal innate immunity is affected by HIV viremia and ART. GCF IL-8, G-CSF, as well as serum IL-8, MCP-1 and GM-CSF may be useful biomarkers for the detection of disease presence and/or its severity due to HIV infection and ART use.

Radiographic and histological evaluation of deproteinized bovine bone mineral vs. deproteinized bovine bone mineral with 10% collagen in ridge preservation. A randomized controlled clinical trial.

OBJECTIVES: The aims of this randomized clinical trial were to compare the dimensional changes and the histological composition after using deproteinized bovine bone mineral (DBBM) or deproteinized bovine bone mineral with 10% collagen (DBBM-C) and a collagen membrane in ridge preservation procedures. MATERIAL AND METHODS: Patients who required an extraction and a subsequent implant-supported rehabilitation at a non-molar site were recruited. After extraction, a cone beam computed tomography (CBCT) was performed and sites were randomly treated either with DBBM or DBBM-C plus a collagen membrane. At 5 months, before implant placement, a second CBCT was performed and a biopsy of the area was obtained. A blinded investigator superimposed the CBCTs and performed measurements to determine bone volume changes between the two time points. Additionally, a histomorphometric analysis of the biopsies was performed in a blinded manner. RESULTS: Eleven sites belonged to the DBBM group and eleven to the DBBM-C group. All together, a significant reduction in height and width was observed at 5 months of healing, but no statistically significant differences were observed between the DBBM and the DBBM-C group. The histomorphometric analysis revealed a similar composition in terms of newly formed bone, connective tissue and residual graft particles in both groups. CONCLUSIONS: Deproteinized bovine bone mineral with 10% collagen showed a similar behaviour as DBBM not only in its capacity to minimize ridge contraction but also from a histological point of view. Thus, both graft materials seem to be suitable for ridge preservation procedures.

Dentistry and HIV/AIDS related stigma.

OBJECTIVE: To analyze HIV/AIDS positive individual's perception and attitudes regarding dental services. METHODS: One hundred and thirty-four subjects (30.0% of women and 70.0% of men) from Nuevo León, Mexico, took part in the study (2014). They filled out structured, analytical, self-administered, anonymous questionnaires. Besides the sociodemographic variables, the perception regarding public and private dental services and related professionals was evaluated, as well as the perceived stigma associated with HIV/AIDS, through a Likert-type scale. The statistical evaluation included a factorial and a non-hierarchical cluster analysis. RESULTS: Social inequalities were found regarding the search for public and private dental professionals and services. Most subjects reported omitting their HIV serodiagnosis and agreed that dentists must be trained and qualified to treat patients with HIV/AIDS. The factorial analysis revealed two elements: experiences of stigma and discrimination in dental appointments and feelings of concern regarding the attitudes of professionals or their teams concerning patients' HIV serodiagnosis. The cluster analysis identified three groups: users who have not experienced stigma or discrimination (85.0%); the ones who have not had those experiences, but feel somewhat concerned (12.7%); and the ones who underwent stigma and discrimination and feel concerned (2.3%). CONCLUSIONS: We observed a low percentage of stigma and discrimination in dental appointments; however, most HIV/AIDS patients do not reveal their serodiagnosis to dentists out of fear of being rejected. Such fact implies a workplace hazard to dental professionals, but especially to the very own health of HIV/AIDS patients, as dentists will not be able to provide them a proper clinical and pharmaceutical treatment.

Cambios del estado clínico periodontal según consumo sistémico de estatinas / Changes in clinic periodontal status according to systemic statins intake

Objetivos: Describir los cambios del estado clínico periodontal de pacientes según el consumo sistémico de estatinas por indicación del cardiólogo. Material y método Se realizó un estudio descriptivo en el cual se reclutaron pacientes con periodontitis crónica derivados desde cardiología de la Clínica Dávila. Un grupo de ellos iniciaría terapia de estatinas. Se realizaron mediciones clínicas periodontales de profundidad al sondaje (PS), nivel de inserción clínico, índice de sangrado, área de superficie periodontal inflamada, e índice gingival, al inicio (antes de comenzar la terapia de estatinas) y 6 meses después. Los datos fueron analizados utilizando estadística descriptiva. Resultados Diez pacientes participaron del estudio, 5 con indicación de estatinas. El grupo con estatinas en comparación con el grupo sin estatinas presentó una disminución en promedio: de PS (0,4 mm versus 0,13 mm); porcentaje de sitios con PS > 5 mm (4,16 por ciento versus 1,09 por ciento); de nivel de inserción clínico (0,5 mm versus 0,2 mm), índice de sangrado (27,16 por ciento versus 8,8 por ciento) y área de superficie periodontal inflamada (305,68 mm2 versus 121,35). Conclusiones Estos resultados sugieren que pacientes con periodontitis crónica podrían obtener beneficios de la terapia sistémica con estatinas. Se requiere de estudios clínicos con asignación aleatoria y el óptimo tamaño muestral que comprueben el efecto e impacto de las estatinas sobre el estado periodontal.

Objective: To describe changes in periodontal clinical status of patients according to systemic statin use prescribed by a cardiologist. Material and methods A descriptive study was performed on patients with chronic periodontitis referred from the Department of Cardiovascular Diseases of Dávila Clinic. A group of them began statin therapy. Clinical measurements of periodontal probing depth (PD), clinical attachment level, bleeding index, periodontal inflamed surface area, and gingival index, were performed at baseline (before starting statin therapy) and 6 months later. Data were analyzed using descriptive statistics. Results A total of 10 patients participated in the study, and five of them received statin therapy. The statin group compared to the group without statins, showed a mean decrease in: PD (0.4 mm versus 0.13 mm); percentage of PS sites > 5 mm (4.16 percent versus 1.09 percent); clinical attachment level (0.5 mm versus 0.2 mm), bleeding index (27.16 percent versus 8.8 percent), and periodontal inflamed surface area (305.68 versus 121.35 mm2). Conclusions These results suggest that patients with chronic periodontitis may benefit from systemic therapy with statins. Randomized clinical trials with optimal sample size are required to check the effect and impact of statins on the periodontal status.

Short-term effects of 2% atorvastatin dentifrice as an adjunct to periodontal therapy: a randomized double-masked clinical trial.

BACKGROUND: The pleiotropic effects of statins, such as immunomodulation and anti-inflammatory effects, may also improve periodontal conditions. The aim of the present study is to assess the effectiveness of a dentifrice medicated with 2% atorvastatin in improving clinical periodontal parameters as a complement to non-surgical periodontal treatment (NSPT). METHODS: A randomized, double-masked clinical trial was performed with two parallel groups: 1) atorvastatin group (NSPT plus medicated 2% atorvastatin dentifrice) and 2) placebo group (NSPT plus placebo dentifrice). The effectiveness of these treatments was assessed using periodontal measurements obtained at baseline and 1 month later. The measurements were probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival index (GI), and periodontal inflamed surface area (PISA). Multiple linear regression models were used to compare outcome variables after adjusting for sex, diabetes, and tobacco use. RESULTS: A total of 36 individuals participated in this study (atorvastatin group, n = 18; placebo group, n = 18). Both groups showed improvements in periodontal parameters. The atorvastatin group showed a decrease of 297.63 mm(2) in PISA (95% confidence interval = 76.04 to 519.23; P = 0.01), which was significantly greater than the reduction observed in the placebo group. There was also a significantly greater reduction in mean PD, percentage of sites with PD ≥5 mm, mean CAL, percentage of sites with CAL ≥5 mm, BOP, and GI in the atorvastatin group compared with the placebo group. CONCLUSION: NSPT plus 2% atorvastatin medicated dentifrice was more effective in improving clinical periodontal parameters than NSPT plus a placebo dentifrice.

Dentistry and HIV/AIDS related stigma / La odontología y el estigma asociado al VIH

OBJECTIVE To analyze HIV/AIDS positive individual's perception and attitudes regarding dental services.METHODS One hundred and thirty-four subjects (30.0% of women and 70.0% of men) from Nuevo León, Mexico, took part in the study (2014). They filled out structured, analytical, self-administered, anonymous questionnaires. Besides the sociodemographic variables, the perception regarding public and private dental services and related professionals was evaluated, as well as the perceived stigma associated with HIV/AIDS, through a Likert-type scale. The statistical evaluation included a factorial and a non-hierarchical cluster analysis.RESULTS Social inequalities were found regarding the search for public and private dental professionals and services. Most subjects reported omitting their HIV serodiagnosis and agreed that dentists must be trained and qualified to treat patients with HIV/AIDS. The factorial analysis revealed two elements: experiences of stigma and discrimination in dental appointments and feelings of concern regarding the attitudes of professionals or their teams concerning patients' HIV serodiagnosis. The cluster analysis identified three groups: users who have not experienced stigma or discrimination (85.0%); the ones who have not had those experiences, but feel somewhat concerned (12.7%); and the ones who underwent stigma and discrimination and feel concerned (2.3%).CONCLUSIONS We observed a low percentage of stigma and discrimination in dental appointments; however, most HIV/AIDS patients do not reveal their serodiagnosis to dentists out of fear of being rejected. Such fact implies a workplace hazard to dental professionals, but especially to the very own health of HIV/AIDS patients, as dentists will not be able to provide them a proper clinical and pharmaceutical treatment.

OBJETIVO Analizar la percepción y las actitudes de las personas que viven con VIH/sida hacia los servicios odontológicos.MÉTODOS Participaron 134 voluntarios (30.0% mujeres y 70.0% hombres) de Nuevo León, México (2014), que contestaron un cuestionario estructurado de tipo analítico, auto-administrado y anónimo. Además de las variables sociodemográficas, fueron analizadas la percepción sobre los servicios y los prestadores de servicios odontológicos públicos y privados; igualmente se exploró mediante escala tipo Likert la percepción del estigma asociado al VIH/sida. El análisis estadístico incluyó análisis factorial y declustersno jerárquico.RESULTADOS Se presentaron desigualdades sociales en la búsqueda de atención de prestadores y servicios odontológicos públicos y privados. La mayoría ocultó su serodiagnóstico y concordó en que el odontólogo debe capacitarse en la atención del VIH. El análisis factorial reveló dos factores: experiencias de estigma y discriminación en la consulta odontológica y sentimientos de preocupación por la actitud del odontólogo o su personal hacia el serodiagnóstico del paciente. El análisis de clustersidentificó tres grupos: usuarios que no han experimentado estigma ni discriminación (85.0%); los que no han experimentado estigma ni discriminación, pero sienten una ligera preocupación (12.7%); y finalmente, los que han experimentado estigma y discriminación, y sienten preocupación (2.3%).CONCLUSIONES Se presentó un bajo porcentaje de estigma y discriminación en la consulta odontológica; sin embargo, la mayoría de las personas que viven con VIH/sida no revelan al odontólogo su serodiagnóstico por temor al rechazo. Estos hechos plantean un riesgo laboral para el odontólogo, pero especialmente para la propia salud de las personas que viven con VIH/sida, dado que el odontólogo no podrá proporcionar un tratamiento clínico y farmacológico adecuado.

In vitro evaluation of a multispecies oral biofilm on different implant surfaces.

Biofilm accumulation on implant surfaces is one of the most important factors for early and late implant failure. Because of the related clinical implications, the aim of this in vitro study was to compare the bacterial cell attachment of a four-species oral biofilm on titanium discs of purity grade 2 and 4, with machined surfaces and etched-thermochemically modified with Avantblast®. The in vitro biofilm model was composed of early (Actinomyces naeslundii, Streptococcus gordonii), secondary (Veillonella parvula), and intermediate (Fusobacterium nucleatum ssp. polymorphum) colonizers of tooth surfaces. A total of 36 discs were divided into four groups: Tigr2-c (titanium grade 2, machined surface), Tigr2-t (titanium grade 2, modified surface with Avantblast®), Tigr4-c (titanium grade 4, machined surface), Tigr4-t (titanium grade 4, modified surface with Avantblast®). The experiment was repeated three times. Biofilm viability was tested with 1% 2, 3, 5-triphenyltetrazolium chloride solution and bacterial cell quantification by checkerboard DNA-DNA hybridization. Descriptive analysis was performed to evaluate biofilm composition and differences between groups were checked with the Mann-Whitney test (p < 0.05). After one week, multispecies biofilms showed a similar pattern of bacterial composition on all analyzed implant surfaces. The most prevalent bacterium was V. parvula (∼50% of the total biomass), followed by S. gordonii (∼30%), F. nucleatum ssp. polymorphum (∼10%) and A. naeslundii (<5%). Total bacterial biomass was significantly higher in both grade-4-titanium surfaces (p < 0.05). The results demonstrated that not only implant surface treatment, but also titanium purity, influence early bacterial colonization.

Clinical changes in periodontal subjects with the probiotic Lactobacillus reuteri Prodentis: a preliminary randomized clinical trial.

OBJECTIVES: The aim of this study was to assess the clinical effect of the administration of Lactobacillus reuteri Prodentis as a probiotic agent in the treatment of initial to moderate chronic periodontitis. Secondary objectives were to evaluate the patient 'compliance' factor and to observe the potential side-effects of the probiotic agent. MATERIALS AND METHODS: Twenty systemically healthy, non-smoking subjects with initial-to-moderate chronic periodontitis were enrolled in this 1-month double-blind, placebo-controlled, randomized clinical trial. Subjects were randomly assigned to receive tablets containing Lactobacillus reuteri Prodentis or placebo once a day for 30 days. Clinical parameters were collected at baseline and 30 days post-treatment. RESULTS: Periodontal clinical parameters were improved in the test group after a 30-day intervention. The test group demonstrated a statistically significant reduction (p < 0.05) in all the periodontal parameters included in the study (plaque index, bleeding on probing and pocket probing depths), while the control group treated with placebo did not show any statistically significant change in periodontal parameters. CONCLUSIONS: These data indicate that oral administration of Lactobacillus reuteri Prodentis improved the short-term clinical outcomes in non-smoking patients with initial-to-moderate chronic periodontitis.

0.2% chlorhexidine mouthwash with an antidiscoloration system versus 0.2% chlorhexidine mouthwash: a prospective clinical comparative study.

BACKGROUND: The goal of this study is to evaluate the degree of staining and clinical efficacy of a chlorhexidine mouthwash with an antidiscoloration system (ADS) versus 0.2% chlorhexidine mouthwash (traditional). Secondary objectives are to evaluate the patient "compliance" factor according to patterns assigned by the clinician and to observe the side effects of the two mouthwashes. METHODS: This comparative study is carried out on a sample of 15 non-smoking patients with chronic periodontitis at the Department of Periodontology, the International University of Catalunya, Barcelona, Spain. All patients used either 0.2% chlorhexidine mouthwash (control group = bottle B) or chlorhexidine with ADS (test group = bottle A) for 15 days. Each patient first rinsed with a randomly assigned mouthwash for 15 days followed by a 15-day washout period. Subsequently, each patient used a second mouthwash. Before each cycle, a full dental prophylaxis was performed. The plaque, gingival, and Brecx staining indexes were used. RESULTS: The results showed less tooth staining with the test group (P <0.01). No statistically significant differences were observed in plaque (P = 0.1496) and gingival indexes (P = 0.1688). Eighty-eight percent of patients followed the instructions outlined in the protocol. In terms of other adverse effects, two patients reported a bad taste with both mouthwashes. CONCLUSIONS: The test group with ADS had less staining than the control group during a usage period of 15 days. However, the two mouthwashes seemed to be equally effective as antiplaque and antigingivitis agents.

Efecto de un nuevo agente desinfectante libre de aldehídos sobre la superficie de instrumentos de acero inoxidable / No disponible

Introducción: Existe una gran variedad de productos para la desinfecciónde instrumentos con ultrasonidos, pero inevitablemente suuso prolongado provoca cierto grado de corrosión. El objetivo deeste estudio fue evaluar el efecto corrosivo de un detergente librede aldehídos y fenoles sobre la superficie de acero inoxidable deinstrumentos de uso odontológico.Material y métodos: Se seleccionaron siete instrumentos de uso frecuenteen Odontología de dos calidades de acero inoxidable distintas.Como control de utilizó agua destilada. Mediante microscopía ópticay una escala visual analógica, se evaluó el estado de la superficie alos 0, 200, 400, 600 y 800 ciclos de uso con ultrasonidos.Resultados: Los instrumentos del grupo control y con una aleaciónde baja calidad mostraron mayor corrosión de la superficie al finaldel estudio.Conclusiones: El detergente libre de aldehídos y fenoles deterioramínimamente la superficie de instrumentos de acero inoxidable alcabo de 800 ciclos, mostrando ser un producto de elección parala desinfección de instrumentos odontológicos con ultrasonido (AU)

Background: A wide range of disinfection products with ultrasonicfor instruments is available, but prolonged use inevitably causessome degree of corrosion. The aim of this study was to evaluate thecorrosive effect of a free-aldehydes and phenols detergent on thesurface of stainless steel dental tools.Material and methods: Seven frequently-used dental instruments oftwo different qualities of stainless steel were selected. Distilled waterwas used as control. Corrosion was assessed with optical microscopyand a visual analogue scale (VAS) at 0, 200, 400, 600 and 800cycles of use with ultrasound.Results: Instruments of the control group and with a low stainlesssteel quality showed greater deterioration of the surface at the endof the study.Conclusion: The free-aldehydes and phenols detergent minimallydeteriorate the surface of dental stainless steel instruments at 800cycles. This product has demonstrated to be of choice for disinfectingdental instruments with ultrasonics (AU)

Alargamiento de corona por erupción pasiva alterada. A propósito de un caso / No disponible

La estética en la sonrisa de muchos pacientes está condicionada. Son pacientes que muestran mucha encía al sonreír y/o poseen coronas clínicas cortas, lo cual se puede deber a múltiples factores, siendo uno de ellos la erupción pasiva alterada. La erupción pasiva alterada, también conocida como erupción pasiva retardada, ocurre cuando el margen gingival se encuentra incisal uoclusalmente mal colocado, en la corona anatómica del adulto y no se aproxima a la unión cemento-esmalte. En este artículo mostramos un caso de EPA en el cual la estética juega un papel importante. Y se logra al final del tratamiento quirúrgico proporcionarle a la paciente una sonrisa armoniosa (AU)

In many patients the aesthetics on the smile are seriously determined because they show excessive gingiva when they smile or have short clinics crowns. This can be because many factors and one of themis the altered passive eruption. The altered passive eruption, also called Delayed passive eruption, happens when the gingival margin is not incisal or occlusaly adequate positioned, in the adult anatomic crown and is not approach to the cement enamel junction. This report shows a case of altered passive eruption where the aesthetics play an important role. We achieved give a harmonious smile to the patient at the end of the surgical treatment (AU)

Evaluación del efecto del gel de ácido hialurónico al 0.8% como coadyuvanteen el tratamiento periodontal no quirúrgico. Estudio piloto / No disponible

Introducción: El ácido hialurónico es un glucosaminoglicano de alto peso molecular que se encuentra en concentraciones elevadas enel tejido gingival y participa en la reparación de los tejidos. Se ha utilizado como coadyuvante en procesos de regeneración tisular, osteointegración de implantes, curación de lesiones traumáticas y cirugía maxilofacial, por su efecto antiinflamatorio, cicatrizante y elastizante. El objetivo de este estudio piloto fue evaluar el efecto antiinflamatorio de un gel de ácido hialurónico al 0.8% como coadyuvante a la terapia periodontal no quirúrgica. Material y métodos: Estudio piloto longitudinal a boca partida de 3meses de duración en 4 pacientes (>18 años) con periodontitis crónica generalizada moderada-avanzada. Se aplicó el ácido hialurónico en el lado experimental tras cada una de las sesiones de raspado y alisado radiculares. Se registraron el índice de placa (PI), índice de sangrado (BI), profundidad de sondaje (PD), nivel de inserción(CAL), recesión gingival (GR) y consumo de tabaco. Resultados y discusión: Se observó mayor reducción de la PS y BIen el lado experimental (pvalor<0.05) y una tendencia a mayor RG en el lado control (p>0,05).Conclusiones: El ácido hialurónico parece ser una sustancia eficaz como coadyuvante al tratamiento periodontal no quirúrgico; sin embargo, se requiere mayor número de estudios y tamaño muestral (AU)

Introduction: Hyaluronic acid is a glycosaminogly can with a highmolecular weight that is present in high concentrations in the gingival tissue and is involved in repairing tissue processes. It has been used as an adjuvant in the process of tissue regeneration, osseointegration of implants, healing of traumatic injuries and maxillofacial surgery, for its anti-inflammatory, cicatrizing and elastizing effect. The aim of this pilot study was to evaluate the anti-inflammatory effect of a hyaluronic acid gel to 0.8% as an adjunct to non-surgical periodontal therapy. Material and methods: Longitudinal split-mouth pilot study of 3months in 4 patients (> 18 years) with chronic moderate-advanced periodontitis. Hyaluronic acid was applied in the experimental side after each visit of scaling and root planning. The following parameters were reported: plaque index (PI), bleeding index (BI), probing depth(PD), level of clinical attachment (CAL), gingival recession (GR) and consumption of tobacco. Results: It was observed further reduction of the PS and BI in the experimental side (pvalor <0.05) and a greater tendency to RG in the control side (p> 0.05). Conclussions: The hyaluronic acid appears to be an effective product as a coadjuvant nonsurgical periodontal treatment, but more studies and greater sample size are required (AU)

Evaluación in vitro mediante microscopíaelectrónica de barrido de la oclusiónde túbulos dentinarios de dos agentesdesensibilizantes / No disponible

Introducción: La sensibilidad dentinaria es un motivo de consulta frecuente y los tratamientos disponibles no siempre ofrecen resultados satisfactorios a largo plazo. De aquí surge la necesidad de buscar nuevas alternativas de tratamiento. Objetivos: Evaluar mediante microscopio electrónico de barrido la capacidad de oclusión de los túbulos dentinarios de dos agentes desensibilizantes comercializados compuestos por carbonato y fosfato potásico y cloruro de estroncio y de calcio (TwinGel) y por fluoruro de estaño (Emoflúor).Material y métodos: Se seleccionaron 15 dientes de origen humano y se cortaron 2 discos de dentina de cada diente. Se grabó la superficie dentinaria con ácido ortofosfórico durante 70 segundos y se dividieron los discos en 2 grupos. Al primer grupo se le aplicó el agente desensibilizante compuesto por carbonato y fosfato potásico, cloruro de estroncio y de calcio y al segundo grupo fluoruro de estaño, ambos durante 3 minutos. Posteriormente se observó con microscopía electrónica de barrido la oclusión de los túbulos dentinarios y se realizaron fotografías a 10.000 aumentos. El porcentaje de obturación tubular fue analizado mediante escala visual analógica. Resultados: Para el grupo 1 (Twin Gel) obtuvimos un promedio de oclusión de los túbulos del 73%, y para el grupo 2 (Emofluor) un62%, tras aplicar el agente desensibilizante durante 3 minutos. Discusión y conclusiones: Ambos tienen capacidad para ocluirlos túbulos dentinarios, sin embargo, la aplicación del producto desensibilizante Twin Gel sobre la superficie de dentina produce la oclusión de más de 2/3 partes de la superficie a tratar (AU)

Introduction: Dentinal sensitivity is a common problem. Although there have been described several treatments for this particular entity, none of them has offered the right solution for an extended period of time; for this reason, it is necessary to find new treatment alternatives. Aim: To evaluate the occlusion of dentinal tubules with two desensitizing agents “Twin Gel” (potassium carbonate and phosphate, strontium and calcium chloride) and “Emoflúor” (stannous chloride)using Scanning electron microscopy (SEM).Material and methods: 15 human teeth free of caries and restorations were used in this study. Two discs of each tooth were obtained and etched with ortophosphoric acid 37%. Discs were divided in2 groups. In the first group, a desensitizing agent with potassium carbonate, phosphate and strontium and calcium chloride was applied; in the second group, stannous chloride was used, both for 3minutes. Then, the occlusion of dentinal tubules was observed using SEM at 10.000 X. Percentages of tubular sealing were measured using a analogical visual scale. Results: For the group 1 (Twin Gel), an average of 73% of sealed tubuleswas observed, for the group 2 (Emofluor) a 63% was observed after application of desensitizing agent for 3 minutes. Conclusion: Both desensitizing agents have sealing capacity of dentinal tubules; however, the application of the “TwinGel” desensitizing agent on dentin surface, has an increased capacity of more than 2/3 parts of the treated surface (AU)

Alargamiento quirúrgico de corona por motivos estéticos: a propósito de un caso / No disponible

El alargamiento de corona dentaria es una técnica quirúrgica que pretende conseguir una mayor exposición de la estructura dentaria en pacientes con mutilación de la estructura dental, alteraciones de la erupción o corona clínica corta por agrandamiento gingival. Este tratamiento resulta muy útil para favorecer la estética en pacientes con exposición incompleta de las coronas anatómicas y una línea de sonrisa alta. Cualquier ligera disarmonía debido a erupciones pasivas o debido a desarrollo marcado del complejo dentogingival sepuede resolver, si los tejidos están sanos, con técnicas quirúrgicas mínimamente invasivas que permiten la exposición de la estructura dental selectiva del área cervical. En nuestro artículo se presenta un caso de erupción pasiva alterada con asimetría de los márgenes gingivales de los dos incisivos centrales superiores que se corrige con un alargamiento de corona quirúrgico del diente 1.1 proporcionando a la paciente una sonrisa más armónica y simétrica (AU)

Dental crown lengthening is a surgical technique that aims to achieve greater exposure of the tooth in patients with mutilation of the tooth structure, alterations in the eruption or short clinical crown due to gingival overgrowth. This treatment is very useful to achieve an aesthetic outcome in patients with incomplete exposure of the anatomical crown and a high smile line. Any slight disharmony due to passive eruption or due to the excessive development of the dentogingival complex can be solved, if tissues are healthy, with minimally invasive surgical techniques that allow the selective exposure of the tooth structure in the cervical area. This report documents a case of altered passive eruption with asymmetry of the gingival margins of the two upper central incisors and it is corrected with a surgical crown lengthening of the tooth 1.1providing the patient a more harmonious and symmetrical smile (AU)