Clinical outcomes following atrophic alveolar ridge reconstruction using collagenated xenogeneic bone block or autogenous bone block: One-year follow-up of a randomized controlled clinical.

AIM: This investigation aimed to evaluate the 1-year survival of implants placed after staged lateral alveolar ridge augmentation using equine-derived collagenated xenogeneic bone blocks (CXBBs) or autogenous bone block (ABB). MATERIALS AND METHODS: Fifty patients who underwent lateral augmentation in a previous trial were included. The primary outcome measure was implant survival at the 1-year follow-up, and secondary outcomes included implant success, peri-implant clinical and volumetric parameters, pink aesthetic scores (PES) and patient-reported outcome measures. Data analysis involved Fisher's exact test, the Mann-Whitney U-test and the Wilcoxon signed-rank test. RESULTS: In this study, no late implant failures were observed. The cumulative survival rates were 78.6% for the CXBB group and 90.9% for the ABB group, with no difference between the groups. Similarly, the success rates were 53.6% and 63.6%, respectively, showing no significant difference. Peri-implant clinical and volumetric parameters indicated the presence of healthy peri-implant tissues surrounding implants placed in both CXBB- and ABB-augmented sites. PES were 8.5 and 11.0 for implants placed in CXBB- and ABB-augmented sites, respectively. Furthermore, patient satisfaction rates were high and similar between the groups. CONCLUSIONS: Dental implants placed in both CXBB- and ABB-augmented ridges demonstrated no statistically significant differences in clinical, volumetric and aesthetic outcomes, along with high patient satisfaction rates.

Radiographic outcomes of ridge reconstruction with autogenous bone block versus collagenated xenogeneic bone block: A randomized clinical trial.

AIM: To compare, at different levels from the alveolar crest, the radiographic outcomes of equine-derived collagenated xenogeneic bone blocks (CXBB) and autogenous bone blocks (ABB) used for lateral alveolar ridge augmentation. MATERIALS AND METHODS: Sixty-four patients with tooth gaps in atrophic alveolar ridges with ≤4 mm were randomly assigned to lateral augmentation using CXBB or ABB. The lateral bone thickness (LBT) was measured 2, 4, 6, 8, and 10 mm below the alveolar crest using CBCT scans obtained before augmentation surgery and at 30 weeks, prior to implant placement. Statistical analysis was performed using Shapiro-Wilk, Fisher's exact, Mann-Whitney, and Wilcoxon signed-rank tests. RESULTS: Both CXBB and ABB resulted in significant total and buccal LBT gains at 2, 4, 6, 8, and 10 mm. LBT gains were similar between CXBB- and ABB-augmented sites, except for greater buccal LBT gains at 8 mm at CXBB-augmented sites. While ABB-augmented sites gained vertical bone height, CXBB-treated sites suffered vertical bone loss (CXBB: -0.16 mm; ABB: 0.38 mm, p < .0009). CONCLUSIONS: CXBB and ABB were both associated with significant and similar LBT gains at 30 weeks.

Photodynamic therapy decrease immune-inflammatory mediators levels during periodontal maintenance.

Antimicrobial photodynamic therapy (aPDT) was introduced as a promising adjuvant therapy on the periodontal treatment. The aim of this study was to evaluate the effect of aPDT on inflammatory mediator levels in residual periodontal pockets of patients with severe chronic periodontitis under periodontal maintenance, during 12 months follow-up. A randomized controlled trial study was conducted in 28 patients with severe chronic periodontitis. After non-surgical periodontal treatment, patients with at least four teeth with residual pocket probing depth (PPD) ≥4 mm were randomly assigned to either aPDT or control group. The aPDT (low power laser: 660 nm, 40 mW, 90 J/cm2, methylene blue 0.01 %) was performed at baseline and 3, 6, and 9 months. Clinical parameters were collected before and 3 and 12 months after the intervention, and gingival crevicular fluid was collected in the same times, including 1 week after the intervention. Immunological evaluation was carried out using the Luminex assay which quantified the expression of ten cytokines: interleukin (IL)-1α, IL-1ß, IL-8, IL-1ra, fibroblast growth factor (FGF), vascular endothelial growth factor (VEGF), interferon (IFN)-γ, tumor necrosis factor (TNF)-α, IL-4, and IL-10. All clinical variables showed significant improvement for both groups, but there was no statistical difference between groups with no clinical benefits. IL-1α, IL-1ß, IL-8, and VEGF showed significant differences (p < 0.05) between groups, whereas IL-1ra mediators, IFN-γ, and IL-10 demonstrated a statistical difference (p < 0.01) over time in the same group. At any time, FGF, IL-4, and TNF-α showed no statistical difference between groups (p > 0.05). aPDT therapy can improve the benefits on inflammation control during the periodontal maintenance.

Influência do tratamento periodontal na função endotelial da doença cardiovascular / The influence of periodontal treatment in the endothelial function of cardiovascular disease ­ a systematic review

Objetivo: diversos estudos epidemiológicos vêm estudando a associação entre doença periodontal e doença cardiovascular, defendendo a ideia de que a DP seria um fator de risco para a doença cardiovascular. A doença periodontal é uma inflamação crônica que está associada ao aumento de marcadores inflamatórios sistemicamente e interferência na função endotelial. Vale ressaltar que a inflamação e a função endotelial têm um importante papel na patogênese da aterosclerose. Material e métodos: pouca informação existe a respeito da influência do tratamento periodontal na doença cardiovascular, sendo assim, este trabalho consiste em uma revisão de literatura, através da busca no MedLine/Pubmed de ensaios clínicos randomizados que estudem a influência do tratamento periodontal nos marcadores da doença cardiovascular. Resultados: através deste trabalho, foi possível concluir que o tratamento periodontal parece exercer influência na melhora dos níveis séricos dos marcadores cardiovasculares. Conclusão: mais estudos são necessários para comprovar a real relação.

Objective: several epidemiological studies have investigated the association between periodontal disease and cardiovascular disease, defending the idea that the DP would be a risk factor for cardiovascular disease. Periodontal disease is a chronic inflammation which is associated with inflammatory markers increasing and systemically interference in endothelial function. It is noteworthy that inflammation and endothelial function play an important role in the pathogenesis of atherosclerosis. Material and methods: little information exists about the influence of periodontal treatment in cardiovascular disease; therefore this study consists of a randomized clinical trial literature review to study the influence of periodontal treatment on markers of cardiovascular disease, through search in MedLine/Pubmed. Results: through this work it was possible to conclude that the periodontal treatment looks to influence the improvement of the serious levels of the cardiovascular markets. Conclusion: more studies are necessary to verify the real relationship between them.

Antibioticoterapia como coadjuvante no tratamento periodontal não cirúrgico de pacientes diabéticos / Antibiotic therapy as an adjunct to non-surgical periodontal treatment in diabetic patients ­ a literature review

Objetivo: verificar se o uso de antibióticos sistêmicos, adjunto à terapia periodontal não cirúrgica, em pacientes diabéticos pode trazer benefícios adicionais no controle glicêmico e parâmetros clínicos periodontais. Material e métodos: após a busca nos bancos de dados PubMed e Lilacs, foram incluídos nove ensaios clínicos randomizados para essa revisão da literatura. Resultados: nos desfechos periodontais, seis dos nove ensaios clínicos encontraram algum benefício a favor da antibioticoterapia. Quanto ao controle glicêmico, a maioria dos estudos falhou ao tentar relacionar o uso de antibióticos a uma maior redução da hemoglobina glicada. Conclusão: com base nesta revisão, concluiu-se que o uso de antibióticos sistêmicos em conjunto com o tratamento periodontal não cirúrgico pode oferecer benefícios adicionais, quando comparado ao tratamento periodontal sozinho, no tratamento da periodontite em pacientes com diabetes. Não há evidências de que a antibioticoterapia possa contribuir no controle glicêmico desses pacientes, sendo necessários mais estudos clínicos.

Objective: to verify whether systemic antibiotic therapy along with non-surgical periodontal management in diabetic patients can bring additional benefi ts on the glycemic control and periodontal parameters. Material and methods: after an electronic search on Medline and Lilacs databases, 9 RCTs were included. Results: six articles found favorable outcomes for periodontal clinical parameters. Regarding the glycemic control, most studies failed to prove a relationship between antibiotic use and the reduction on glycated hemoglobin levels. Conclusion: within the limits of this review, it can be concluded that systemic antibioticotherapy added to non-surgical periodontal treatment can bring additional benefits when compared to non-surgical treatment alone for diabetes-affected periodontal patients. However, there is no evidence that antibiotics can contribute to the glycemic control and more studies are necessary on this subject.

O efeito da sinvastatina na osseointegração / The effect of simvastatin on osseointegration ­ a literature review

O crescente aumento de instalações de implantes dentais com carga imediata e de suas fixações em tecido ósseo de baixa densidade tem gerado a necessidade real de aceleração e aprimoramento do processo de osseointegração, e muitos métodos e técnicas têm sido propostos para solucionar este problema. Neste contexto, a presente revisão teve por objetivo discutir os principais aspectos do papel da sinvastatina como intervenção para a melhoria no processo de osseointegração. Os resultados indicaram que a sinvastatina apresentou efeitos positivos em estudos experimentais, sendo necessários ensaios clínicos randomizados.

With increasing applications of dental implants with immediate loading and their installation in low quality bone, there is a real need to speed up and improve the osseointegration process. This review aimed to discuss the use of simvastatin in improving the osseointegration. The results indicate that simvastatin showed positive results in experimental studies, although randomized clinical trials are necessary.

Two-year randomized clinical trial of enamel matrix derivative treated infrabony defects: radiographic analysis.

BACKGROUND: This split-mouth, double-blind randomized controlled trial evaluated radiographic changes in infrabony defects treated with open flap debridement (OFD) or OFD associated with enamel matrix derivative (EMD) after a 24-month follow-up. The radiographic distance from the CEJ to the bottom of the defect (BD) was considered the primary outcome. CEJ-BC and defect angle were secondary outcomes. METHODS: Ten patients presenting 2 or more defects were selected. An individualized film holder was used to take standardized radiographs of the 43 defects, at baseline and after 24 months. Images were digitized and used to measure the distances from the cemento-enamel junction (CEJ) to the alveolar crest (AC), CEJ to the bottom of the defect (BD) and infrabony defect angle. Statistical analysis was performed in SPSS for Windows (version 5.2). Paired samples t test was used to compare test and control groups and to evaluate changes within each group. The level of significance was set at α = 0.05%. RESULTS: After 24 months, a significant crestal bone loss was observed for EMD (1.01 mm; p = 0.049) but not for OFD (0.14 mm; p = 0.622). However, no differences were detected between groups (p = 0.37). Reduction of the bone defect depth was significant for OFD (0.70 mm; p = 0.005) but not for EMD (0.04 mm; p = 0.86), while no differences were detected between them (p = 0.87). Both EMD (0.69°; p = 0.82) and OFD (5.71°; p = 0.24) showed an improvement in defect angle measurements but no significant differences were observed after 24 months or between the groups (p = 0.35). CONCLUSION: Linear radiographic analysis was not able to demonstrate superiority of EMD treated infrabony defects when compared to ODF after 24 months. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02195765. Registered 17 July 2014.

Terapia fotodinâmica no tratamento periodontal: comparação microbiológica entre dois métodos / Photodynamic therapy adjunct in the treatment periodontal: microbiological comparison between two methods

a terapia fotodinâmica (PDT) tem a finalidade de reduzir os periodontopatógenos no biofilme dental através da associação de um laser a um corante fotossensibilizador, que culmina na produção de oxigênio singleto, levando à morte celular. Este estudo-piloto compara dois diferentes métodos de irradiação do laser de baixa potência na PDT, através da análise dos patógenos periodontais Porphyromonas gingivalis (P.g.), Tannerella forsythia (T.f.), Treponema denticola (T.d.) e Aggregatibacter actinomycetencomitans (A.a.). Material e métodos: este estudo-piloto é parte de um estudo clínico longitudinal, prospectivo, randomizado e duplo-cego. Foram selecionados cinco pacientes portadores de periodontite crônica, com dois dentes unirradiculares contralaterais com profundidade de sondagem maior ou igual a 5 mm, sem comprometimento sistêmico. Os pacientes foram submetidos à raspagem e alisamento radicular, e subsequentemente à PDT nos dentes experimentais. Estes foram alocados em dois grupos, de acordo com a maneira de entrega do laser: grupo A (transgengival) e grupo B (intrasulcular). A quantificação dos periodontopatógenos foi avaliada pela PCR em tempo real, sete e 30 dias após a intervenção, sendo adotado o nível de significância p ≤ 0,05. Resultados: não houve diferença entre os grupos A (irradiação transgengival) e B (irradiação intrasulcular), em relação aos níveis de A.a., T.f. e T.d. em qualquer momento do estudo. Em relação aos níveis de Pg, houve diferença significativa entre os grupos após 30 dias (p=0,032). Conclusão: os dois métodos foram semelhantes na redução de A.a., T.d. e T.f.. O método B (intrasulcular) mostrou uma redução significativa do patógeno P.g. no sétimo e 30º dia de avaliação.

Introduction: photodynamic therapy (PDT) has the purpose of reducing the periodontal biofilm by combining a laser with a photosensitizing dye that culminates in the production of singlet oxygen, leading to cell death. This pilot study compares two different methods of irradiation of low power laser in PDT, by analyzing the periodontal pathogen Porphyromonas gingivalis (P.g.), Tannerella forsythia (T.f.), Treponema denticola (T.d.) and actinomycetencomitans Aggregatibacter (A.a.). Material and methods: this pilot is part of a longitudinal, prospective, randomized, double-blind study. Were selected five patients with chronic periodontitis with two contralateral single-rooted teeth with depth greater than or equal to 5 mm, without systemic involvement. Patients underwent scaling and root planing and subsequent to PDT in experimental teeth, which were divided into two groups according to the manner of delivery of the laser: group A (transgingival) and group B (intrasulcular). The reduction of periodontal pathogens was evaluated by PCR real-time, 7 and 30 days after the intervention, with significance level p ≤ 0.05. Results: there was no difference between groups A (transgingival irradiation) and B (intrasulcular irradiation) with respect to A.a., T.f. and T.d. at any time during the study. With respect to levels of P.g., a significant difference between groups at 30 days (p=0.032). Conclusions: the two methods were similar in reducing A.a., T.d., T.f.. The method B (intrasulcular) showed a significant reduction in pathogen P.g. 7 and 30 days of evaluation.

Clinical and microbiological evaluation of high intensity diode laser adjutant to non-surgical periodontal treatment: a 6-month clinical trial.

OBJECTIVES: This randomized split-mouth clinical trial was designed to evaluate the efficacy of scaling and root planing associated to the high-intensity diode laser on periodontal therapy by means of clinical parameters and microbial reduction. MATERIALS AND METHODS: A total of 36 chronic periodontitis subjects, of both genders, were selected. One pair of contralateral single-rooted teeth with pocket depth >5 mm was chosen from each subject. All patients received non-surgical periodontal treatment, after which the experimental teeth were designated to either test or control groups. Both teeth received scaling, root planing and coronal polishing (SRP) and teeth assigned to the test group (SRP + DL) were irradiated with the 808 ± 5 nm diode laser, for 20 s, in two isolated appointments, 1 week apart. The laser was used in the continuous mode, with 1.5 W and power density of 1,193.7 W/cm(2). Clinical and microbiological data were collected at baseline, 6 weeks and 6 months after therapy. RESULTS: There was a significant improvement of all the clinical parameters-clinical attachment level (CAL), probing depth (PD), plaque index (PI) and Bleeding on Probing (BOP)-for both groups (P < 0.001), with no statistical difference between them at the 6 weeks and the 6 months examinations. As for microbiological analysis, a significant reduction after 6 weeks (P > 0.05) was observed as far as colony forming units (CFU) is concerned, for both groups. As for black-pigmented bacteria, a significant reduction was observed in both groups after 6 months. However, the difference between test and control groups was not significant. There was no association between group and presence of Porphyromonas gingivalis, Prevotella intermedia and Aggregatibacter actinomycetemcomitans at any time of the study. CONCLUSIONS: After 6 months of evaluation, the high-intensity diode laser has not shown any additional benefits to the conventional periodontal treatment. CLINICAL RELEVANCE: The high intensity diode laser did not provide additional benefits to non-surgical periodontal treatment. More studies are necessary to prove the actual need of this type of laser in the periodontal clinical practice.

Treatment of infrabony defects with or without enamel matrix proteins: a 24-month follow-up randomized pilot study.

OBJECTIVE: To evaluate a comparison of open-flap debridement (OFD) with or without the use of enamel matrix proteins (EMP) for the treatment of infrabony defects. METHOD AND MATERIALS: Ten volunteers (38 infrabony defects) were randomized to receive OFD+EMP (test site) and OFD (control site). Clinical outcomes included mean changes in Plaque Index, Gingival Index, probing pocket depth (PPD), relative attachment level (RAL), gingival recession, width of keratinized tissue, and dental mobility at baseline and at 24 months. RESULTS: A significant reduction of 4.21+/-0.97 mm was observed in PPD for the OFD+EMP group (from 6.30+/-0.99 mm to 2.09+/-0.97 mm) and of 3.28+/-1.23 mm for the OFD group (from 6.13+/-0.88 mm to 2.85+/-1.42 mm) (P<.001). The reduction in PPD was statistically significantly greater for OFD+EMP compared to OFD (P=.03). The mean RAL decreased from 13.26+/-1.88 mm to 7.57+/-2.05 mm for the OFD+EMP group (a gain of 5.69+/-1.96 mm) and from 13.37+/-1.71 mm to 8.13+/-1.34 mm (P<.001) for the OFD group (a gain of 5.24+/-1.55 mm). Gingival recession was higher in the OFD+EMP group than in the OFD group. The mean keratinized tissue significantly decreased from 4.41+/-1.39 mm to 3.63+/-1.54 mm for OFD flap group (P<.01). CONCLUSION: Both treatment modalities were efficient in improving RAL and PPD. Within groups, there was a significant reduction in keratinized tissue for OFD and a significant postoperative recession for the OFD + EMP group. Infrabony defects treated with OFD + EMP showed significantly more PPD reduction when compared to OFD.

Cooperação consciente: programas de motivação aos retornos periódicos periodontais: revisão de literatura / Compliance: motivation programs to periodic periodontal recalls: literature review

Após o tratamento periodontal ativo, a saúde periodontal é alcançada devido à eliminação ou controle da infecção. Porém, indivíduos que desenvolveram periodontite possuem grande risco de apresentar recorrência da doença, mesmo após um efetivo tratamento periodontal ter sido realizado. Para que o paciente possa manter em longo prazo o estado de saúde obtido com o tratamento, é necessário que se mantenha um programa de manutenções periódicas, com rechamadas em intervalos de tempo regulares, de acordo com a necessidade de cada caso. Este controle e manutenção profissional constituem o único meio de garantir os efeitos benéficos do tratamento e, consequentemente, a sobrevida da dentição. Em geral, o grau de cooperação dos pacientes a estes retornos, entretanto, é bastante baixo. Alguns métodos de motivação foram propostos na literatura para esta finalidade, e esta revisão bibliográfica se propõe a encontrar métodos efetivos de motivação e que possam ser aplicados na clínica periodontal para que um maior número de pacientes colaborem com o programa de controle e manutenção proposto. O envio de cartas e a realização de telefonemas são métodos bastante recomendados. Além disso, a constante estimulação do paciente através de reforços positivos, e principalmente a explicação ao paciente sobre a importância da terapia de manutenção são outros métodos de motivação sugeridos na literatura.

After active periodontal therapy, periodontal health is obtained due to infection elimination or its control. However, individuals who developed periodontitis have greater risk in presenting recurrent disease, even after an effective periodontal treatment. So in order that the patient can maintain and build upon the preceeding periodontal treatment, it is necessary to maintain a periodic maintenance program, with recalls in regular intervals of time, in accordance to the necessity of each case. This professional control and maintenance constitutes the only method to guarantee the beneficial effects of the treatment and, consequently, the dentition maintenance. In general, patient compliance with periodontal maintenance is, however, poor. Some methods of motivation were proposed in the literature for this purpose, and this bibliographical revision aimed to find effective motivation methods applicable in periodontal practice in order to have greater number of compliance patients in the maintenance program proposed. Sending letters and making phone calls are known to be very successful methods. Moreover, the constant stimulation of the patient through positive reinforcements and, mainly, the explanation for the patient about the maintenance therapy importance is another motivation method suggested in the literature.

Terapia fotodinâmica em periodontia clínica / Photodynamic therapy in periodontics

O objetivo do tratamento periodontal é restabelecer a saúde dos tecidos periodontais, através da eliminação e controle dos fatores etiológicos, reduzindo a agressão microbiana. Alguns microrganismos persistem na superfície radicular mesmo após a raspagem. Dessa maneira, o tratamento mecânico convencional pode falhar em reduzir o número dos periodontopatógenos a níveis compatíveis com saúde. O objetivo deste estudo é analisar estudos clínicos que empregaram a Terapia Fotodinâmica (PDT) no tratamento não-cirúrgico da periodontite. A literatura atual mostrou seis ensaios clínicos que empregaram a PDT como coadjuvante ao tratamento não-cirúrgico de periodontite crônica, que apresentaram resultados controversos em relação ao benefício adicional da PDT no tratamento periodontal. Mais estudos são necessários para que se estabeleça um consenso a respeito do uso da PDT na prática clínica.

The goal of periodontal treatment is to restore tissue health through the elimination and control of etiologic factors, reducing the microbial aggression. Some microorganisms persist in the root surface even after scaling. Thus, the conventional mechanical treatment may fail to reduce the number of periodontal pathogens to levels compatible with health. The objective of this study is to analyze clinical studies that used Photodynamic Therapy (PDT) in non-surgical treatment of periodontitis. The current literature showed six clinical trials that used PDT as an adjuvant to non-surgical treatment of chronic periodontitis, which showed controversial results regarding the added benefit of PDT in treating periodontal disease. More studies are needed to establish a consensus regarding the use of PDT in clinical practice.

Effect of enamel matrix proteins on the treatment of intrabony defects: a split-mouth randomized controlled trial study.

The objective of this split-mouth, double-blind, randomized controlled trial was to compare the clinical effect of treatment of 2- or 3-wall intrabony defects with open flap debridement (OFD) combined or not with enamel matrix proteins (EMP). Thirteen volunteers were selected with one pair of or more intrabony defects and probing pocket depth (PPD) > or = 5 mm. All individuals received instructions regarding oral hygiene and were submitted to scaling and root planing. Each participant received the two treatment modalities: test sites were treated with OFD and EMP, and control sites received only OFD. After 6 months, a significant reduction was observed in PPD for the EMP group (from 6.42 +/- 1.08 mm to 2.67 +/- 1.15 mm) and for the OFD group (from 6.08 +/- 1.00 mm to 2.00 +/- 0.95 mm) (p < 0.0001), but with no significant difference between groups (p = 0.13). A significant gain in relative attachment level (RAL) was observed in both groups (EMP: from 13.42 +/- 1.88 mm to 10.75 +/- 2.26 mm, p < 0.001; OFD: from 12.42 +/- 1.98 mm to 10.58 +/- 2.23 mm, p = 0.013), but with no significant difference between groups (p = 0.85). Gingival recession (GR) was higher in the EMP group (from 1.08 +/- 1.50 mm to 2.33 +/- 1.43 mm; p = 0.0009) than in the OFD group (from 0.66 +/- 1.15 mm to 1.16 +/- 1.33 mm; p = 0.16), but this difference was not significant (p = 0.06). In conclusion, the results showed that OFD combined with EMP was not able to improve treatment of intrabony defects compared to OFD alone.

Tratamento regenerativo com proteína da matriz do esmalte (PME): relato de casos clínicos / Regenerative treatment with enamel matrix protein (EMP): case report

O objetivo deste estudo foi descrever um protocolo cirúrgico para a utilização da proteína da matriz do esmalte (PME) e avaliar seus resultados no tratamento de defeitos infra-ósseos. Três pacientes com defeitos infra-ósseos de duas paredes, que após passarem pelos procedimentos básicos de instrução de higiene bucal e raspagem e alisamento radicular de todos os dentes, foram tratados cirurgicamente com a PME. Após doze meses, os resultados clínicos mostraram diminuição da profundidade clínica de sondagem, ganho no nível clínico de inserção e pouca retração gengival. Os resultados radiográficos nos mostraram um preenchimento do defeito com a formação de novo tecido duro. Concluímos que a técnica descrita para o uso da PME é de fácil realização e mostrou resultados clínicos e radiográficos favoráveis em defeitos infra-ósseos.

The aim of this study was describe a surgical protocol to evaluate the outcome following the application of enamel matrix protein (EMP) in the treatment of intrabony defects. Three patients with three 2-walled intrabony defects were selected. All patients received instructions about oral hygiene, and the roots were scaled and planed. During the surgery, the defects were debrided and the root surfaces adjacent to the defects were applied the EMP. After 12 months, the clinical outcomes showed a reduction of probing pocket depths, gain in the clinical attachment level and augment of gingival recession. The radigraphics results showed a hard tissue formation. These results suggest that the described technique to utilizing of EMP is simple to use and shows favorable clinical and radigraphics results in the treatment of intrabony defects.

Effect of enamel matrix proteins on the treatment of intrabony defects: a split-mouth randomized controlled trial study

The objective of this split-mouth, double-blind, randomized controlled trial was to compare the clinical effect of treatment of 2- or 3-wall intrabony defects with open flap debridement (OFD) combined or not with enamel matrix proteins (EMP). Thirteen volunteers were selected with one pair of or more intrabony defects and probing pocket depth (PPD) > 5 mm. All individuals received instructions regarding oral hygiene and were submitted to scaling and root planing. Each participant received the two treatment modalities: test sites were treated with OFD and EMP, and control sites received only OFD. After 6 months, a significant reduction was observed in PPD for the EMP group (from 6.42 ± 1.08 mm to 2.67 ± 1.15 mm) and for the OFD group (from 6.08 ± 1.00 mm to 2.00 ± 0.95 mm) (p < 0.0001), but with no significant difference between groups (p = 0.13). A significant gain in relative attachment level (RAL) was observed in both groups (EMP: from 13.42 ± 1.88 mm to 10.75 ± 2.26 mm, p < 0.001; OFD: from 12.42 ± 1.98 mm to 10.58 ± 2.23 mm, p = 0.013), but with no significant difference between groups (p = 0.85). Gingival recession (GR) was higher in the EMP group (from 1.08 ± 1.50 mm to 2.33 ± 1.43 mm; p = 0.0009) than in the OFD group (from 0.66 ± 1.15 mm to 1.16 ± 1.33 mm; p = 0.16), but this difference was not significant (p = 0.06). In conclusion, the results showed that OFD combined with EMP was not able to improve treatment of intrabony defects compared to OFD alone.

O objetivo deste estudo clínico controlado, randomizado, duplo-cego, tipo boca-dividida foi comparar o efeito clínico do tratamento de defeitos infra-ósseos de 2 ou 3 paredes com retalho de espessura total (RET) associado ou não com a proteína da matriz do esmalte (PME). Treze voluntários com 1 par ou mais de defeitos infra-ósseos foram selecionados com profundidade clínica de sondagem (PCS) > 5 mm. Todos receberam instruções de higiene bucal, raspagem e alisamento radicular. Cada participante recebeu os dois tipos de tratamento: o lado teste foi tratado com RET e PME, e o lado controle recebeu somente RET. Após 6 meses, foi observada uma redução significante na PCS para o grupo PME (de 6,42 ± 1,08 mm para 2,67 ± 1,15 mm) e para o grupo RET (de 6,08 ± 1,00 mm para 2,00 ± 0,95 mm) (p < 0,0001), mas não houve diferença significante entre os grupos (p = 0,13). Um ganho significante de nível clínico de inserção relativo (NCIR) foi observado em ambos os grupos (PME: de 13,42 ± 1,88 mm para 10,75 ± 2,26 mm, p < 0,001; RET: de 12,42 ± 1,98 mm para 10,58 ± 2,23 mm, p = 0,013), mas não houve diferença significante entre os grupos (p = 0,85). A retração gengival (RG) foi maior para o grupo PME (de 1,08 ± 1,50 mm para 2,33 ± 1,43 mm; p = 0,0009) do que para o grupo RET (de 0,66 ± 1,15 mm para 1,16 ± 1,33 mm; p = 0,16), mas essa diferença não foi significante (p = 0,06). Concluiu-se que o tratamento de defeitos infra-ósseos com RET associado à PME não mostrou resultados melhores que o uso de RET sozinho.

Avaliação de um método para melhorar a cooperação dos pacientes em manutenção periodontal / Evaluation of efforts to improve compliance with periodontal maintenance

Estudos mostram um baixo grau de cooperação aos retornos de pacientes em manutenção periodontal. A análise dos pacientes da Clínica de Pós-Graduação Disciplina de Periodontia da Universidade de São Paulo também revelou uma participação insatisfatória dos pacientes no Programa de Controle e Manutenção (CM). Este estudo teve como objetivo avaliara influência de um método para melhorara cooperação de 137 pacientes em manutenção, durante 12 meses. Os pacientes foram classificados em três grupos: Cooperação Completa (retornos regulares), Cooperação Irregular (retornos irregulares, com uma falta ou mais), Nenhuma Cooperação (abandono do programa). O grupo Cooperação Completa recebeu os procedimentos habituais de uma consulta de CM; o grupo Cooperação Irregular recebeu procedimentos habituais e estratégias como: confirmação do horário da próxima consulta, fornecimento de informações detalhadas ao paciente sobre a doença periodontal e importância do CM, incentivo ao paciente que apresentava uma melhora da cooperação; aos pacientes do grupo. Nenhuma Cooperação foram enviadas cartas para incentivar seu retorno, guando retornaram receberam o mesmo tratamento do grupo Cooperação Irregular. Neste período, a taxa de Cooperação Completa entre os pacientes aumentou de 50,4% para 67,9%. Não houve associação entre género e grau de cooperação. Não houve diferença significante entre os grupos de coperação com relação à idade. Os resul-tados mostraram que o método empregado teve influência favorável sobre o grau de cooperação dos pacientes.

Estudo clínico controlado do tratamento de defeitos infra-ósseos de duas ou três paredes com retalho de espessura total reposto, associado ou não à proteína da matriz do esmalte, em humanos / Controlled clinical trial of the treatment of two or three-wall periodontal intrabony defects with open flap debridement with or without enamel matrix protein in humans

o propósito deste trabalho foi comparar os parâmetros clínicos periodontais após tratamento de defeitos infra-ósseos de 2 ou 3 paredes com retalho de espessura total reposto (RET), associado ou não à proteína da matriz do esmalte (PME). Onze pacientes saudáveis apresentando periodontite crônica possuíam um par ou mais de defeitos (n = 44). Após os procedimentos básicos, os parâmetros clínicos foram coletados antes das cirurgias. A técnica cirúrgica consistiu num deslocamento de retalho de espessura total, remoção do tecido de granulação e descobridamento da região. Somente no grupo PME, a superficie radicular foi tratada com EDTA 24% por 2 min, lavado seco, aplicado a PME e suturado. Após 12 meses, observamos que houve uma redução na média de profundidade clínica de sondagem de 4,0 mm para o grupo PME e 3,5 mm para o grupo RET. Para o nível clínico de inserção relativo, o ganho médio foi 3,5 mm em ambos os grupos. Os índices de placa e gengival demonstraram um redução significativa nos dois grupos. Ambos tratamentos resultaram numa significante melhora na PCS, NCIR, IP e IG, entretanto, não houve superioridade entre os grupos.Comcluímos que o tratamento de defeitos infra-ósseos de duas ou três paredes, por meio da associação da proteína da matriz do esmalte com retalho de espessura total reposto, não leva a melhores resultados dos parâmetros clínicos.

Aplicação do laser de Co2 em gengivoplastia e gengivectomia / The use of Co2 laser in gingivoplasty and gingivectomy

O objetivo deste estudo foi avaliar; com o auxílio de Informações contidas na literatura, os aspectos técnico-científicos da aplicação do Ia ser de dióxido de carbono (CO2) nas cirurgias de gengivectomia e gengivoplastia. O laser; desde a sua descoberta por MAIMAN, em 1960, foi adaptado e aplicado em diversas áreas do conhecimento, entre elas. na Odontologia. As aplicações em periodontia envolvem. entre outras, a cirurgia de tecido mole como a gengivoplastia e a gengivectomia. Esse laser tem a habilidade de cortar os tecidos com mínimo sangramento como nos cortes com bisturi a frio e como conseqüência a região operada é mais bem visualizada, o local sob intervenção não é, contaminado, o pós-operatório é mais bem suportado pelo paciente devido a dor e o edema serem minimizados, assim como não é necessária a utilização de Cimento cirúrgico. Conclui-se que o laser de CO2 pode ser usado em manobras cirúrgicas periodontais em gengivectomia e gengivoplastia principalmente em pacientes especiais. Em relação à técnica convencional o laser de CO2 , apresenta benefícios como sangramento mínimo durante o ato cirúrgico, redução da dor e edema pós-operatórios e rapidez na cicatrização dos tecidos moles operados, apesar do custo elevado do equipamento.

O tratamento periodontal de suporte e a importância da cooperaçäo consciente / Supportive periodontal therapy and the importance of conscious cooperation

Com o objetivo de aumentar as possibilidades de sucesso, a longo prazo, da terapia periodontal, a presente revisäo de literatura pretendeu avaliar a importância do tratamento periodontal de suporte (TPS) para a manutençäo da saúde do periodonto, conhecer a porcentagem e as características dos pacientes que cooperam assiduamente com o TPS e identificar as condutas mais eficientes para obter a cooperaçäo consciente desses pacientes. Os trabalhos consultados sugerem que somente com o TPS é possível atingir os objetivos de prevenir ou reduzir a recorrência da doença periodontal (DP), a incidência da perda de dentes, de implantes dentários e/ou condiçöes encontradas na cavidade bucal que interferem na DP. A porcentagem de ccoperaçäo dos pacientes vem aumentando com o passar dos anos. Esse aumento de cooperadoraçäo, entretanto, está intrinsecamente relacionado aos esforços que os profissionais têm enviado para identificar, logo de início, os pacientes näo cooperadores, adotando métodos individuais de instruçöes de higiene bucal e de motivaçäo. Assim, o TPS é parte essencial do tratamento periodontal, e a comunicaçäo é a chave para o sucesso desse tratamento, a longo prazo

Utilizaçäo da própolis em odontologia / The use of propolis in dentistry

O propósito desta revisäo é descrever o uso da própolis na prática odontológica