Systemic benefits of periodontal therapy in patients with obesity and periodontitis: a systematic review.

This systematic review aimed to answer the focused question: "What are the benefits of subgingival periodontal therapy on blood hematological and biochemical index, biomarkers of inflammation and oxidative stress, quality of life, and periodontal pathogen counts in patients with obesity and periodontitis?". A systematic literature search was performed in six databases: PubMed, Embase, LILACS, Web of Science, Cochrane and SCOPUS and other sources, and a manual search was conducted as well. Inclusion criteria were randomized and non-randomized clinical trials, and before-and-after studies on patients with obesity subjected to periodontal therapy. The results were synthesized qualitatively. Risk of bias within studies was assessed using RoB 2 and ROBINS-I tools. The certainty of evidence was evaluated following the GRADE approach. Three randomized controlled trials and 15 before-and-after studies were included. Randomized controlled trials were considered to have a low risk of bias, as compared to before-and-after studies assessed as having low, serious, and critical risks of bias. Non-surgical periodontal therapy plus azithromycin, chlorhexidine, and cetylpyridinium chloride reduced blood pressure and decreased serum levels of HbA1c, hsCRP, IL-1ß, and TNF-α. Salivary resistin level also decreased in patients with obesity and periodontitis after therapy and chlorhexidine mouth rinse. Before-and-after data suggest an improvement in total cholesterol, LDL, triglycerides, insulin resistance, C3, GCF levels of TNF-α, chemerin, vaspin, omentin-1, visfatin, 8-OHdG, and periodontal pathogen counts after therapy.

Effect of simvastatin topical use on alveolar bone after tooth extraction: a scoping review.

OBJECTIVES: Conducting a scoping review (SR) to assess scientific evidence for topical simvastatin's impact on alveolar bone regeneration and determine its level of support for clinical applications. MATERIALS AND METHODS: This SR followed the PRISMA-ScR and OSF registries protocol; systematic searching was conducted on MEDLINE/PubMed, Cochrane, Embase, Scopus, Web of Science, and LILACS, to identify relevant articles until June 2023. Inclusion criteria covered clinical trials, case series, prospective and retrospective studies, along with in vivo investigations, involving participants of any sex and age. RESULTS: Out of 1312 identified studies, 20 (9 in vivo, 11 RCTs) met inclusion criteria. RCTs focused on third molar extraction, in vivo on mandibular incisor surgery. The majority of RCTs employed a collagen sponge and a simvastatin concentration of 10mg; conversely, most in vivo studies favored polylactide-co-glycolide and a 2 mg simvastatin concentration. RCTs had 3-month follow-ups; in vivo, studies extended to 8 weeks. Seven RCTs assessed pain outcomes, simvastatin did not significantly affect pain in six studies. Among four RCTs on postoperative swelling, only two observed a significant increase in the simvastatin group. In general, positive bone formation and the absence of adverse effects directly linked to topical simvastatin were observed across the study models. CONCLUSIONS: Intra-alveolar simvastatin post-tooth extraction has been to be shown to be effective and safe for preserving alveolar bone, with varied concentrations and carriers, with no significant adverse effects. CLINICAL RELEVANCE: This review provides critical insights into the effects of simvastatin on alveolar bone regeneration, informing potential benefits and possible challenges associated with its post-extraction application. OSF REGISTRY PROTOCOL: osf.io/q3bnf.

Neo-osteogenesis using an intentionally exposed polypropylene membrane after tooth extraction versus guided bone regeneration technique: a single-blind randomized controlled trial / Neo-osteogénesis utilizando una membrana de polipropileno expuesta intencionalmente después de la extracción del diente versus técnica de regeneración ósea guiada: ensayo clínico aleatorizado ciego / Neo-osteogênese utilizando uma membrana de polipropileno exposta intencionalmente após extração dentária versus técnica de regeneração óssea guiada: ensaio clínico randomizado e cego

Introduction: The intentionally exposed polypropylene (PP) membrane has been proposed for guided bone regeneration (GBR) of the alveo lar bone after extraction; however, there are biological limitations to this proposal. This study aimed to describe the effects of the PP membrane on neo-osteogenesis after tooth extraction, comparing to intentionally ex posed and primary soft tissue coverage techniques. Methodology: This clinical trial followed the TIDieR checklist and guide. Clinical and histo logical parameters of alveolar repair were compared between groups: 1 (control group), without regenerative procedure; 2, GBR; and 3, inten tionally exposed membrane. Results: Group 3 showed slight effect on the quality of new bone, compared to the control group. Although the GBR was underestimated by the early exposure of the membrane, alveo lar repair and newly formed bone were superior to the other groups. Poly propylene membrane intentionally exposed compromised the volume density of the immature and mineralized bone matrix, the osteoblast and osteocyte count, and stimulated the granulation tissue formation and local inflammatory infiltrate. Conclusions: Despite the exposure of the PP membrane in GBR, this technique improved the quality of new bone and alveolar repair compared to the surgical technique of intentional exposure and alveolus only sutured.

RESUMEN Introducción: La membrana de polipropileno (PP) intencionalmente expuesta ha sido propuesta para la regeneración ósea guiada (GBR) del hueso alveolar después de la extracción; sin embargo, existen limitaciones biológicas a esta propuesta. Este estudio tuvo como objetivo describir los efectos de la membrana de PP en la neo-osteogénesis después de la extracción del diente, en comparación con las técnicas de cobertura de tejido blando primarias y expuestas intencionalmente. Metodología: Este ensayo clínico siguió la lista de verificación y la guía TIDieR. Se compararon los parámetros clínicos e histológicos de la reparación alveolar entre los grupos: 1 (grupo control), sin procedimiento regenerativo; 2, GBR; y 3, membrana expuesta intencionalmente. Resultados: el grupo 3 mostró un ligero efecto sobre la calidad del hueso nuevo, en comparación con el grupo de control. Aunque la GBR fue subestimada por la exposición temprana de la membrana, la reparación alveolar y el hueso neoformado fueron superiores a los otros grupos. La membrana de polipropileno expuesta intencionalmente comprometió la densidad de volumen de la matriz ósea inmadura y mineralizada, el recuento de osteoblastos y osteocitos, y estimuló la formación de tejido de granulación y el infiltrado inflamatorio local. Conclusiones: A pesar de la exposición de la membrana de PP en GBR, esta técnica mejoró la calidad del hueso nuevo y la reparación alveolar en comparación con la técnica quirúrgica de exposición intencional y alvéolo solo suturado.

Introdução: A membrana de polipropileno (PP) intencionalmente exposta tem sido proposta para regeneração óssea guiada (ROG) do osso alveolar após exodontia; no entanto, existem limitações biológicas a esta proposta. Este estudo teve como objetivo descrever os efeitos da membrana de PP na neo-osteogênese após a extração dentária, comparando com as técnicas de exposição intencional e cobertura primária de tecidos moles. Metodologia: Este ensaio clínico seguiu a lista de verificação e o guia TIDieR. Parâmetros clínicos e histológicos do reparo alveolar foram comparados entre os grupos: 1 (grupo controle), sem procedimento regenerativo; 2, GBR; e 3, membrana intencionalmente exposta. Resultados: O Grupo 3 apresentou leve efeito na qualidade do novo osso, em comparação com o grupo controle. Embora o GBR tenha sido subestimado pela exposição precoce da membrana, o reparo alveolar e o osso neoformado foram superiores aos outros grupos. A exposição intencional da membrana de polipropileno comprometeu a densidade volumétrica da matriz óssea imatura e mineralizada, a contagem de osteoblastos e osteócitos e estimulou a formação de tecido de granulação e infiltrado inflamatório local. Conclusões: Apesar da exposição da membrana PP na ROG, esta técnica melhorou a qualidade do novo osso e da reparação alveolar em comparação com a técnica cirúrgica de exposição intencional e alvéolo apenas suturado.

The Effect of Advanced Platelet-Rich Fibrin in Tissue Regeneration in Reconstructive and Graft Surgery: Systematic Review.

This systematic review answered the guiding question using the PICO system: "What are the effects of advanced platelet-rich fibrin (A-PRF) on alveolar ridge preservation and tissue gain in reconstructive and jaw graft surgery?" Searches were performed in the PubMed|MEDLINE, Scopus, Embase, Web of Science, Cochrane Library, and LILACS|bvs databases. In total, 573 articles were found in the initial search, and 564 were evaluated after the removal of duplicates, of which 5 randomized controlled trials met the eligibility criteria and were included 2 studies investigated the effect of A-PRF on the preservation of the bone ridge, 1 study evaluated the tissue repair after tooth extraction with A-PRF, 1 evaluated the peri-implant gap filling with A-PRF-xenograft mixture, and other the A-PRF on the treatment of alveolar osteitis. Advanced-PRF preparation protocol varied between the included studies from 8 to 13 minutes of centrifugation, at 1300 RPM (200 g ). The use of A-PRF provided greater dimensions of height and more favorable maintenance of the ridge profile, probing depth, and gingival margin level after extraction. Advanced-PRF also increased bone density, vital bone, epithelial healing, and control of postoperative pain and swelling after tooth extraction and in the treatment of alveolar osteitis.

Biological and Cellular Properties of Advanced Platelet-Rich Fibrin (A-PRF) Compared to Other Platelet Concentrates: Systematic Review and Meta-Analysis.

Platelet concentrates are used for cell induction and stimulation in tissue repair processes. The aim of the present systematic review and meta-analysis was to compare the biological and cellular properties of advanced platelet-rich fibrin (A-PRF) to those of other platelet concentrates. Searches were conducted on the PubMed/Medline, Scopus, Web of Science, Embase and LILACS databases using a search strategy oriented by the guiding question. A total of 589 records were retrieved. Seven articles of in vitro experimental studies were selected for qualitative data analysis and four were selected for meta-analysis. The release of growth factors, distribution of cells in the fibrin membrane, and cell viability, the fibrin network, and fibroblast migration were investigated. In the final analysis, statistically significant differences were found for the A-PRF group with regard to platelet-derived growth factor, transforming growth factor, epidermal growth factor and vascular endothelial growth factor at all assessment times. A difference was found with regard to bone morphogenetic protein only in the later assessment, and no differences among groups were found with regard to platelet-derived growth factor or insulin-like growth factor. The results of this systematic review and meta-analysis suggest that A-PRF has superior cellular properties and better release of growth factors compared to other platelet concentrates.

Influence of sociodemographic factors on users' perception of the quality of public oral health service: a cross-sectional study

Objective: study to assess the influence of sociodemographic factors on the individual perception of oral health and quality of oral health services in the municipality of Piraí, Rio de Janeiro State, Brazil. Materials and Methods: this cross-sectional was conducted from August to October 2014 and included 118 users of the ESF (Estratégia de Saúde da Família) oral health service aged 18 years or over, without cognitive disability. The self-reported assessment of the quality of oral health services in the Family Health Units followed the QASSaB questionnaire, using a semi-structured interview technique. Results: sex, marital status, family income, education and self-perception of oral health were statistically associated with the dimensions of the QASSaB questionnaire. Dental equipment was considered modern by SUS users. Patients' perceptions of efficacy, effectiveness and acceptability were negative for quality of service, resources spent and postoperative complications. In addition, the possibility of choosing the day and/ or time of dental appointments, satisfaction with the appearance of treated teeth and perception of oral health varied significantly with schooling and Family income. In general, individuals with better socioeconomic indices had a positive self-perception of the SUS units and professionals evaluated, compared with lower income and lower education. Conclusion: the ESF oral health service facilities were positively evaluated, while the self-perception of oral health, effectiveness and acceptability of the oral health service require adjustments and investments. The self-perception of the efficacy and effectiveness of dental care by ESF users varied with the family income, and the education level also influenced the assessment of effectiveness.

Objetivo: avaliar a influência de fatores sociodemográficos na percepção individual de saúde bucal e na qualidade dos serviços de saúde bucal no município de Piraí, Estado do Rio de Janeiro, Brasil. Materiais e Métodos: este estudo transversal foi realizado de agosto a outubro de 2014 e incluiu 118 usuários do serviço de saúde bucal da ESF (Estratégia de Saúde da Família) com idade igual ou superior a 18 anos, sem deficiência cognitiva. A avaliação autorreferida da qualidade dos serviços de saúde bucal nas Unidades de Saúde da Família seguiu o questionário QASSaB, utilizando a técnica de entrevista semiestruturada. Resultados: gênero, estado civil, renda familiar, escolaridade e autopercepção de saúde bucal estiveram estatisticamente associados às dimensões do questionário QASSaB. Os equipamentos odontológicos foram considerados modernos pelos usuários do SUS. As percepções dos pacientes sobre eficácia, efetividade e aceitabilidade foram negativas para qualidade do serviço, recursos gastos e complicações pós-operatórias. Além disso, a possibilidade de escolha do dia e/ou horário das consultas odontológicas, satisfação com a aparência dos dentes tratados e percepção de saúde bucal variaram significativamente com escolaridade e renda familiar. Em geral, os indivíduos com melhores índices socioeconômicos apresentaram autopercepção positiva das unidades e profissionais do SUS avaliados, em comparação com menor renda e menor escolaridade. Conclusão: as unidades do serviço de saúde bucal da ESF foram avaliadas positivamente, enquanto a autopercepção de saúde bucal, efetividade e aceitabilidade do serviço de saúde bucal requerem ajustes e investimentos. A autopercepção da eficácia e efetividade do atendimento odontológico pelos usuários da ESF variou com a renda familiar, e a escolaridade também influenciou na avaliação da efetividade.

Is the injection of tramadol effective at control of pain after impacted mandibular third molar extractions? A systematic review and meta-analysis

Background: Third molar extraction is among the most common surgical procedures performed by oral-maxillofacial surgeons. Postoperative pain, swelling and trismus are common, especially in wisdom teeth, due to trauma to local tissues and the duration of the surgical procedure, among other factors. Material and methods: This systematic review was conducted in accordance with the 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' in order to answer the focused question: 'Is the local submucosal injection of tramadol effective at the control of postoperative pain in patients submitted to impacted mandibular third molar extractions?'. We analyzed papers published until March 30, 2021 in the MEDLINE|PubMed, Web of Science and Cochrane Library databases. Gray literature was also consulted. Standard pairwise meta-analyses of direct comparisons were performed using a fixed-effect model; I2 ≥ 50 % or ≥ 75 % indicated moderate or high heterogeneity, respectively. Risk of bias was assessed by Cochrane Collaboration's tool. Results: In total, 172 participants (98 males and 74 females, aged 18 or over) from three randomized placebo-controlled trials were considered for analysis. The submucosal injection of 2 ml of tramadol adjacent to the impacted mandibular third molar was effective in controlling pain up to 6-hours after surgery, in increasing the onset of consumption of rescue analgesic and in reducing the total number of rescue analgesics used. Conclusions: The submucosal injection of tramadol can be considered a safe and effective procedure for pain control after impacted mandibular third molar extractions. (AU)

Lateral periodontal cyst: A rare clinicopathological presentation mimicking a residual cyst.

This article describes an unusual clinical-radiographic presentation of a lateral periodontal cyst, as a differential diagnosis of a residual cyst, following the 'CARE guidelines for case reports'. The radiolucent lesion was identified on the imaging exam of a 53-year-old male patient. Based on radiographic findings and aspiration puncture, the probable diagnosis was a residual cyst; however, histological analysis revealed a thin, non-inflamed fibrous capsule covered by some epithelial layers in most of the lesion. The definitive diagnosis was a lateral periodontal cyst with unusual clinical and radiographic features. The cyst was surgically enucleated and local bone neoformation was observed, with no signs of recurrence after 12 months. The results of this study suggest that a radiolucent lesion, suggestive of a residual cyst or keratocyst in the maxilla, may correspond to a lateral periodontal cyst. In this context, the histopathological analysis of the cyst is essential for the definitive diagnosis. Key words:Cysts, odontogenic cysts, periapical cysts, periodontal cysts.

Tomographic evaluation of the effect of simvastatin topical use on alveolar bone microarchitecture, pain and swelling after mandibular third molar extraction: a randomized controlled trial.

OBJECTIVES: To evaluate the effect of a collagen sponge containing simvastatin on socket healing in terms of bone microarchitecture through tomographic analysis, pain, and swelling after impacted third molar extraction. MATERIALS AND METHODS: In this single-blind, split-mouth, randomized clinical trial, 29 patients undergoing impacted third molar extraction were allocated into two groups: (i) test group, a collagen sponge containing simvastatin was inserted within the sockets; and (ii) control group, in which sockets retained the clot. Bone volume (BV), bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular spacing (Tb.Sp), and gray scale were evaluated using cone beam computed tomography (CBCT) acquired immediately postoperative and 3 months after surgery. Pain, swelling, and wound healing were evaluated using the 10-point visual analogue scale, three extra-oral reference measurements, and the Landry index. RESULTS: In total, 22 participants remained in the study; no loss-to-follow-up was related to the intervention. BV and BV/TV were significantly higher at 3 months postoperatively in the test group compared with the control group and were correlated with greater bone trabeculation. Pain, edema, and the Landry index revealed a greater inflammatory response in the test group during early repair. Simvastatin contributed to bone healing, with no adverse effects or postoperative complications. CONCLUSIONS: The absorbable collagen sponge containing simvastatin improved BV, BV/TV, and trabecular bone, indicating the potential of this drug to induce the formation of autogenous bone. CLINICAL RELEVANCE: Intraosseous statins represent a promising, low-cost, and easy-to-use alternative for alveolar ridge preservation and bone regeneration. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (REBEC), No. RBR-523N7R.

Do Computerized Delivery Systems Promote Less Pain and Anxiety Compared to Traditional Local Anesthesia in Dental Procedures? A Systematic Review of the Literature.

PURPOSE: The aim of this study is to assess whether the use of computerized devices to deliver local anesthesia results in less pain and anxiety compared to traditional anesthesia in adult dental procedures. METHODS: This review was registered at PROSPERO (CRD 42021265046), based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and was structured according to the PICO strategy. The studies were selected based on eligibility criteria, and data were collected by 1 author and reviewed by another. RESULTS: Nine of the 10 studies included were randomized controlled trials. Differences related to pain and anxiety were observed, which favored computerized techniques; however, caution should be exercised when interpreting these results due to differences in assessment methods. The studies used different local anesthetics, including 2% lidocaine, 4% articaine, or 3% mepivacaine with epinephrine diluted 1:80,000 to 1:200,000. A total of 560 patients were evaluated. CONCLUSIONS: Computerized anesthesia devices yielded better results than conventionally delivered anesthesia after qualitative evaluation. Nevertheless, conventional anesthesia is widely used, safe, and effective. Due to the heterogeneity among the included studies, it is strongly recommended that new randomized clinical trials using well-defined methodologies be performed to improve the quality of evidence regarding this topic.

Toxicity potential of denture adhesives: A scoping review.

STATEMENT OF PROBLEM: Denture adhesives are widely used products, but limited evidence regarding their toxicity is available. PURPOSE: The purpose of this scoping review was to map the existing literature on the toxic potential of denture adhesives. MATERIAL AND METHODS: This scoping review was structured based on the 5-step methodology proposed by Arksey and O'Malley and The Joanna Briggs Institute Manual for Evidence Synthesis and followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The methods were registered on the Open Science Framework (). The following research question was formulated: Are there any toxic effects related to the use of denture adhesives? The electronic literature search was performed independently by 2 authors in the following databases: PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library. The inclusion criteria were in vitro and clinical studies; studies that evaluated the cytotoxic properties of denture adhesives as local or systemic implications; and studies published in English. RESULTS: The search conducted in October 2020 provided 1099 articles. In total, 33 studies were included, 14 in vitro and 19 clinical studies. Commercially available denture adhesives have a dose-dependent cytotoxic effect on fibroblasts and keratinocytes, with poor cell recovery noted in older human fibroblasts. Patients presented different levels of neurologic or hematological alterations associated with the excessive use of denture adhesives. CONCLUSIONS: Most commercially available denture adhesives have a dose-dependent cytotoxic effect, and the use of well-adapted removable dental prostheses, proper patient follow-ups, and correct instructions for their use when indicated should be a priority.

Evolution of Hematological Parameters in Patients Undergoing Orthognathic Surgery With a View to Hospital Discharge: A Prospective Study.

BACKGROUND: The length of hospital stays of patients undergoing orthognathic surgery depends on related local and systemic factors. Hematological changes resulting from orthognathic surgery, followed up in the postoperative period until hospital discharge, have neither yet been established for specific cases, nor for normal situations. This study aimed to describe the hemodynamic parameters of patients undergoing orthognathic surgery, considering a prediction of hospital discharge. A prospective analytical study was carried out on a sample of convenience for this purpose. METHODS: The erythrogram, leukogram, and platelet count were assessed 24 and 72 hours after surgery and compared with preoperative values. Intraoperative volume loss was also assessed. Inferential statistical analyses were performed as analysis of variance or Friedman test, paired Wilcoxon test, Mann-Whitney test, and 2-tailed Spearman correlation. RESULTS: The red blood cell count (mean ±â€Šstandard deviation [median]); (4.60 ±â€Š0.24 [4.56]), hemoglobin (12.82 ±â€Š1.03 [12.75]), hematocrit (39.51 ±â€Š3.47 [39.60]), and red cell distribution with (32.60 ±â€Š0.88 [33.05]) were higher preoperatively (P < 0.001). Mean corpuscular volume (83.87 ±â€Š5.63 [83.10]), mean corpuscular hemoglobin (27.50 ±â€Š1.47 [28.00]), leukocytes (6262.00 ±â€Š1448.36 [6380.00]). The volume loss varied between 463.87 and 752.13 mL (608.00 ±â€Š144.13 [630.00]). CONCLUSIONS: The results of the hematological evaluations corroborate the expectation of standard discharge from the hospital, with reflected changes resulting from volume loss and intense postoperative inflammatory response, even under the anti-inflammatory pharmacological effect.

Impact of violacein from Chromobacterium violaceum on the mammalian gut microbiome.

Violacein is a violet pigment produced by Chromobacterium violaceum that possesses several functions such as antibacterial, antiviral, antifungal, and antioxidant activities. The search for potential compounds and therapies that may interfere with and modulate the gut microbial consortia without causing severe damage and increased resistance is important for the treatment of inflammatory, allergic, and metabolic diseases. The aim of the present work was to evaluate the ability of violacein to change microbial patterns in the mammalian gut by favoring certain groups over the others in order to be used as a therapy for diseases associated with changes in the intestinal microflora. To do this, we used male Wistar rats, and administered violacein orally, in low (50 µg/ml) and high (500 µg/ml) doses for a month. Initially, the changes in the microbial diversity were observed by DGGE analyses that showed that the violacein significantly affects the gut microbiota of the rats. Pyrosequencing of 16S rDNA was then employed using a 454 GS Titanium platform, and the results demonstrated that higher taxonomic richness was observed with the low violacein treatment group, followed by the control group and high violacein treatment group. Modulation of the microbiota at the class level was observed in the low violacein dose, where Bacilli and Clostridia (Firmicutes) were found as dominant. For the high violacein dose, Bacilli followed by Clostridia and Actinobacteria were present as the major components. Further analyses are crucial for a better understanding of how violacein affects the gut microbiome and whether this change would be beneficial to the host, providing a framework for the development of alternative treatment strategies for intestinal diseases using this compound.

Hydroxyapatite calvaria graft repair in experimental diabetes mellitus in rats.

Among the systemic conditions that impact negatively on the planning and execution of surgical procedures, diabetes mellitus (DM) is the primary clinical condition responsible for complications. This study investigated bone formation in critical defects surgically filled with hydroxyapatite (HA) in diabetic rats. A descriptive, randomized sample and blinded analysis were conducted to test bone regeneration in critical bone defects surgically performed in rat calvaria. Twenty adult male Wistar rats were randomly divided into two groups: control, normoglycemic animals (CG); and test, streptozotocin-induced hyperglycemic animals (TG). A circular bone defect was filled with HA and maintained subperiosteally. The clinical parameters evaluated were body weight, water and food intake, fasting blood glucose, and bone alkaline phosphatase. Bone-grafted area samples were submitted for histomorphometric and stereological analysis. The TG showed a significantly higher rate of new bone formation compared with the CG, sacrificed 15 days after surgery (p < 0.0001). However, at the end of the study, there was no significant difference in the amount of bone formed between groups (p = 0.077). In parallel, with the increase in osteoblastic activity observed in the TG by the measurement of systemic bone alkaline phosphatase (p = 0.016), the analysis of polarized microscopy and stereology demonstrated a lower level collagen maturation and mineralization in the TG. Quantitatively, the TG showed significantly better results for bone gain in the first 15 days. Qualitative assessments, however, showed fewer collagen fibers and bone maturation in the TG compared with the CG both at 15 and 45 days. Therefore, the postoperative evaluation of bone grafts with HA in hyperglycemic situations should consider the systemic and local effects of this condition on the quality of bone repair, rather than identifying the filling or stability of the grafted area after the process. We conclude that clinically detectable bone repair in diabetic animal models submitted to hydroxyapatite grafts may be satisfactory in the early stages. However, hyperglycemia compromises the quality of the newly formed bone and the collagen cross-linking involved in this process.

Tissue healing with polypropylene membrane used as conventional guided bone regeneration and exposed to the oral cavity for post-dental extraction: a case report

Introduction: The maintenance of the alveolar ridge after tooth loss is very important for the installation of an osseointegrated dental implant and for the aesthetic result of the rehabilitation prosthesis. Regenerative surgery is often needed to recover the volume lost when a tooth is extracted. The blood clot that forms is very important in regenerative surgery because it allows the mesenchymal cells to differentiate into osteoprogenitor cells, which leads to bone regeneration. Objective: This case report compares the bone repair after dental extraction in the same patient via three different protocols and the healing in preparation for posterior implant placement. Case Report: A patient 50 year-old female required dental extraction of elements 15, 24 and 26 and prosthetic rehabilitation. The first technique used was tooth extraction and suture only, the second technique used exposedBoneHeal® polypropylene membrane after extraction, and the third technique usedBoneHeal membrane subperiosteally. After a few days, the subperiosteal membrane became exposed and it was not possible to keep it in position. However, the two regions in which the membrane was used obtained a greater increase in soft tissue. Conclusion: In our study case, the polypropylene membrane seemed to repair tissue.

Introdução: A manutenção do rebordo alveolar após a extração dentária é muitoimportante para a instalação de um implante osseointegrável e para o resultado estético da reabilitação protética. A cirurgia regenerativa é frequentemente necessária para recuperar o volume perdido quando um dente é extraído. O coágulo sanguíneo que se forma é muito importante na cirurgia regenerativa porque permite que as células mesenquimais se diferenciem em células osteoprogenitoras, o que leva à regeneração óssea. Objetivo: Esse relato de caso compara o reparo ósseo após a extração dentária em um mesmo paciente através de três protocolos diferentes em preparação para posterior instalação de implante. Relato de Caso: Paciente de 50 anos, sexo feminino, necessitou de extração dentária dos elementos 14, 24 e 26 com posterior reabilitação. A primeira técnica utilizada foi a remoção dentária com sutura somente, a segunda utilizou a membrana de polipropileno BoneHeal de forma exposta após a extração, e a terceira técnica utilizou a membrana BoneHeal de subperiostealmente. Após alguns dias, a membrana subperiosteal expôs e não foi possível continuar em posição. No entanto, as duas regiões que a membrana foi utilizada, obtiveram um maior aumento no tecido mole. Conclusão: Em nosso estudo de caso, a membrana de polipropileno pareceu reparar tecido.

Chlorhexidine mouthwash as an adjunct to mechanical therapy in chronic periodontitis: A meta-analysis.

BACKGROUND: Through a systematic literature review, the authors evaluated the use of chlorhexidine (CHX) mouthwash as an adjunct to mechanical periodontal therapy for chronic periodontitis. TYPES OF STUDIES REVIEWED: The authors performed a systematic search by using PubMed (MEDLINE), Scopus, Scientific Electronic Library Online, and Cochrane Central Register of Controlled Trials. The authors selected randomized controlled clinical trials in which the investigators evaluated the probing depth (PD) and clinical attachment level (CAL) in test groups by using CHX as an adjuvant and in control groups and subject to mechanical periodontal therapy (scaling and root planing [SRP] 4-6 visits or 24 hours). RESULTS: The literature search resulted in 8 articles, which the authors then assessed for quality. After testing for heterogeneity, the authors performed a meta-analysis only in the SRP group with 4 to 6 visits. Results were positive for both PD and CAL with use of CHX. However, the summary measure was significant (P < .05) only for PD at 40 to 60 days (0.33 millimeters; 95% confidence interval, 0.08 to 0.58 mm) and 180 days (0.24 mm; 95% confidence interval, 0.02 to 0.47 mm) of follow-up, showing positive results for the use of CHX at those times. Although those differences were statistically significant, they could be interpreted as clinically slight. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Adjunctive use of CHX mouthrinse with mechanical SRP resulted in slightly greater PD reduction than did SRP alone. Clinicians must consider the small additional gain in PD reduction, negligible effect on CAL, and potential for tooth staining when using CHX as an adjunct to SRP in treating chronic periodontitis.

No association between periodontitis, preterm birth, or intrauterine growth restriction: experimental study in Wistar rats.

BACKGROUND: The biologic plausibility of the possible association between periodontitis and adverse pregnancy outcomes has been assessed with the use of different experimental models. However, most experimental studies did not induce periodontitis in the animals but promoted an acute microbial challenge with selected periodontal pathogens or their products subcutaneous or intravenous or intraamniotic. The present study was then conducted to verify the biologic plausibility of such association by experimentally inducing periodontitis in Wistar rats. OBJECTIVE: An experimental study on an animal model by the induction of periodontitis in 50% of sites and assessment of the presence of cytokines in the gingival tissue, serum, placenta, cord, and amniotic fluid was designed to test the null hypothesis that experimental periodontitis that is induced on rats does not result in adverse pregnancy outcomes. STUDY DESIGN: Forty female Wistar rats were included in 2 groups: a periodontally healthy (without ligatures) and an experimentally induced periodontitis group (test, with ligatures). Forty-five days after the induction, the mating was initiated. Males were placed with females in the ratio of 1:2 for a period of 12 hours. The bodyweight of the female, from then on, was recorded daily. When the pregnancy was confirmed on day 20, laparotomy was performed. The amniotic fluid, placenta, umbilical cord, blood (serum) and maternal and gingival tissue samples were subjected to quantitative analysis for interleukin 1α, -6, -10, -4, -12p70, and -17a, tumor necrosis factor-α, and interferon-γ by multiplex methods. Mean scores, standard deviations, and standard errors for estimated measures were calculated. For cytokines analyses, the Mann-Whitney test was conducted to compare the concentration of the analytes from control and test groups in the different tissues samples. For comparison of cytokines reduction from gingival tissue to serum and from serum to placenta, the Wilcoxon Test was performed. Spearman's correlation was conducted among cytokines in the 5 different tissues that were evaluated. RESULTS: The induced periodontitis in Wistar rats did not result in adverse outcomes of pregnancy. There were no statistically significant differences between groups in relation to prematurity, fetal, or birth weight. Regarding cytokines, there were no statistically significant differences in concentrations that were measured in each tissue between the groups with periodontitis and controls. Furthermore, all cytokine levels in the placenta, except interleukin-6, were diminished compared with the amniotic fluid or maternal serum, which suggested that the cytokines cannot easily be transferred via this tissue in maternal-fetal or fetomaternal direction. The fertility rate was reduced significantly in the group with periodontitis. CONCLUSION: Periodontitis that is induced in rats is not a risk factor for preterm birth or low birthweight.