DNA methylation profile of genes related to immune response in generalized periodontitis.

BACKGROUND AND OBJECTIVE: Epigenetic events, as the DNA methylation, may be related to development of inflammatory diseases. Due to the important role of host's response in the pathogenesis of periodontitis, the purpose of the present study was to investigate the methylation profile of genes related to immune response in gingival tissues from patients with generalized periodontitis (GP) compared to healthy individuals. METHODS: Gingival tissues were collected from 20 individuals with GP and 20 healthy individuals. Genomic DNA was extracted and submitted to enzymatic digestions. An initial screening using a panel of genes involved with the response immune was performed in pools containing six samples of each group. Genes that presented different levels of methylation between the groups were selected for individual assays for validation. RESULTS: The array results showed an unmethylated profile in the majority of genes evaluated in both groups. MALT1, LTB, and STAT5 genes presented a profile of partial methylation in the control compared with GP group. Validation individual assays using a larger number of samples (n = 20, each group) confirmed the hypomethylation of STAT5 in the GP group compared with control group (P < .001). CONCLUSION: Generalized periodontitis is associated with hypomethylation of the STAT5 gene. Further studies are necessary to evaluate the functional impact these findings.

Effect of Periodontal Therapy on Serum Levels of IL-6 in Type 2 Diabetics: A Systematic Review.

The objective of this systematic review was to search for scientific evidence regarding the impact of periodontal therapy on serum levels of interleukin 6 (IL-6) in type 2 diabetics. A survey was conducted in five databases. Two researchers read titles and abstracts for initial selection and full text for inclusion. Data extraction and methodological quality assessment were performed. Four hundred and fifty-five studies were identified and 15 were included. Significant divergence on the effect of periodontal intervention on IL-6 levels in diabetics was observed among studies. The evaluation results of studies that controlled obesity indicate that periodontal therapy seems to have beneficial effects on IL-6 levels.

Effect of compliance during periodontal maintenance therapy on levels of bacteria associated with periodontitis: A 6-year prospective study.

BACKGROUND: It is well established that regular compliance during periodontal maintenance therapy (PMT) maintains the stability of periodontal clinical parameters obtained after active periodontal therapy (APT). However, compliance during PMT has not yet been related to subgingival bacterial levels. Thus, this study followed individuals in PMT over 6 years and longitudinally evaluated the effects of compliance on periodontitis-associated bacterial levels and its relation to periodontal status. METHODS: From a 6-year prospective cohort study with 212 individuals in PMT, 91 were determined to be eligible. From this total, 28 regular compliers (RC) were randomly selected and matched for age and sex with 28 irregular compliers (IC). Complete periodontal examination and microbiological samples were obtained 5 times: T1 (prior to APT), T2 (after APT), T3 (2 years), T4 (4 years), and T5 (6 years). Total bacteria counts and levels of Actinomyces naeslundii, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were evaluated through quantitative polymerase chain reaction. RESULTS: RC had less tooth loss and better clinical and microbiological conditions over time when compared with IC. IC had higher total bacterial counts and higher levels of T. denticola. Moreover, among IC, total bacterial counts were positively associated with plaque index and bleeding on probing, while levels of A. naeslundii, T. forsythia, and T. denticola were negatively associated with clinical attachment loss (4 to 5 mm) among RC. CONCLUSIONS: Compliance positively influenced subgingival microbiota and contributed to stability of periodontal clinical status. Regular visits during PMT sustained microbiological benefits provided by APT over a 6-year period.

Associação entre beta-defensinas e periodontite / Association between beta-defensins and periodontitis: literature review

Objetivo: as beta-defensinas humanas (hBDs) podem ter um papel-chave na susceptibilidade às doenças na cavidade bucal. Além do efeito antimicrobiano direto, as hBDs aumentam a imunidade adaptativa. O objetivo deste estudo foi realizar uma revisão de literatura científica sobre a relação entre beta-defensinas (hBD) e periodontite. Material e métodos: foi realizada uma pesquisa bibliográfica na base de dados PubMed sobre a expressão de hBDs em indivíduos com periodontite. Os termos beta defensins e periodontitis foram utilizados nessa busca. Resultados: foram selecionados, por um revisor, sete artigos para serem incluídos nessa revisão de literatura: dois estudos de intervenção e cinco estudos transversais. Conclusão: o número de estudos sobre a expressão de beta-defensinas em indivíduos com periodontite é reduzido. O conhecimento sobre o papel das beta-defensinas na periodontite pode trazer um maior entendimento de sua etiopatogenia, além de possibilitar novos indicadores de risco e terapias. Estudos adicionais são necessários para a elucidação da relação entre esses peptídeos antimicrobianos e a periodontite.

Objective: human beta-defensins (hBDs) may play a key role in the susceptibility to diseases in the oral cavity. In addition to the direct antimicrobial effect, hBDs enhance adaptive immunity. The objective of this study was to investigate the literature on the relationship between hBD and periodontitis. Material and methods: a literature review was conducted in the PubMed database on the expression of hBDs in subjects with periodontitis. The terms "beta-defensins" and "periodontitis" were used in this search. Results: seven articles were selected being: two intervention studies and fi ve cross-sectional studies. Conclusion: the number of studies on the expression of beta-defensins in individuals with periodontitis is reduced. Knowledge about the role of beta-defensins in periodontitis may lead to a better understanding of their etiopathogenesis, in addition to providing new risk indicators and therapies. Additional studies are needed to elucidate the relationship between these antimicrobial peptides and periodontitis.

Avaliação do risco periodontal em terapia periodontal de manutenção / Periodontal risk assessment in maintenance therapy

Este estudo teve como objetivo fazer uma avaliação do risco em indivíduos cooperadores inseridos em um programa de terapia de manutenção periodontal (TMP), através do modelo ARP (avaliação do risco periodontal) proposto por um estudo prévio1. Metodologia: foram elegíveis para determinação do risco individual pelo modelo ARP, 150 indivíduos considerados cooperadores regulares, que finalizaram terapia periodontal ativa na Faculdade de Odontologia da Universidade Federal de Minas Gerais, Brasil. Resultados: a amostra total foi composta de dois indivíduos (1,3%) de baixo risco (BR), 83 (55,3%) de moderado risco (MR) e 65 (43,4%) de alto risco (AR) à periodontite. Na última rechamada, os 150 indivíduos tinham médias de sangramento a sondagem (SS) de 29,06%, sendo em BR=16,07; MR=24,21 e AR=35,65, e média de bolsas residuais (profundidade de sondagem ≥ 5 mm) =1,15 mm (BR sem bolsas; MR=0,58 e AR=1,91). A amostra tinha um total de 854 dentes perdidos, com média de perda dentária de 5,69 (BR=1,50; MR=4,54 e AR=7,29 dentes perdidos). O fator relação perda óssea por idade teve uma média de 1,00 (BR=0,54; MR=0,87 e AR=1,19). Conclusão: a adoção do modelo ARP contribui para a determinação do risco dos indivíduos, permitindo que estes escores sejam comparados ao longo do tempo. Assim, este instrumento pode ser válido para monitorar variáveis mutáveis de risco e auxiliar na estratégia de tratamento e cooperação nos programas de TMP.

Brain-derived neurotrophic factor in chronic periodontitis.

Brain-derived neurotrophic factor (BDNF) is a member of the neurotrophic factor family. Outside the nervous system, BDNF has been shown to be expressed in various nonneural tissues, such as periodontal ligament, dental pulp, and odontoblasts. Although a role for BDNF in periodontal regeneration has been suggested, a function for BDNF in periodontal disease has not yet been studied. The aim of this study was to analyze the BDNF levels in periodontal tissues of patients with chronic periodontitis (CP) and periodontally healthy controls (HC). All subjects were genotyped for the rs4923463 and rs6265 BDNF polymorphisms. Periodontal tissues were collected for ELISA, myeloperoxidase (MPO), and microscopic analysis from 28 CP patients and 29 HC subjects. BDNF levels were increased in CP patients compared to HC subjects. A negative correlation was observed when analyzing concentration of BDNF and IL-10 in inflamed periodontium. No differences in frequencies of BDNF genotypes between CP and HC subjects were observed. However, BDNF genotype GG was associated with increased levels of BDNF, TNF-α, and CXCL10 in CP patients. In conclusion, BDNF seems to be associated with periodontal disease process, but the specific role of BDNF still needs to be clarified.

Transtorno afetivo bipolar e doença periodontal / Bipolar affective disorder and disease periodontal – literature review

Estudos epidemiológicos sugerem que o transtorno afetivo bipolar pode alterar a instalação e a progressão da doença periodontal. O processo inflamatório, induzido por esta alteração psiquiátrica, e o biofilme dentário podem atuar sinergicamente estimulando uma intensa resposta do sistema imunológico, influenciando a progressão das doenças periodontais. O objetivo do presente trabalho foi revisar a literatura em relação aos principais estudos que investigaram a possível correlação entre o transtorno afetivo bipolar e a doença periodontal. Concluiu-se que a maioria dos estudos publicados, até o momento, não apresenta estratégias metodológicas que avaliem corretamente a possível associação entre a doença periodontal e o transtorno bipolar especificamente. São necessários maiores estudos com metodologias que envolvam as características epidemiológicas, microbiológicas e imunológicas desta possível associação, propiciando um melhor entendimento da mesma.

Epidemiological studies suggest that bipolar disorder can alter the onset and progression of periodontal disease. The inflammatory process induced by this amendment psychiatric, and dental biofilm can act synergistically stimulate an intense immune response influencing the progression of periodontal diseases. The objective of this paper is to review the literature in relation to the main studies that investigated the possible correlation between bipolar affective disorder and periodontal disease. It was concluded that most studies published so far do not present search strategies that evaluate the association between periodontal disease and bipolar disorder specifically. Larger studies with methodologies involving epidemiological, microbiological and immunological features of this possible association, providing better understanding of it are needed.

Hypermethylation and low transcription of TLR2 gene in chronic periodontitis.

Periodontitis is an inflammatory disorder characterized by interactions between periodontal pathogens and host's immune response. Epigenetic may contribute to disease development and outcome by influencing the expression of genes involved in the immune response. It has been shown that Toll-like receptors (TLR) play an important role in the response to periodontopathic bacteria. The aim of study was to evaluate the methylation status and the expression of TLR2 gene in gingival samples from individuals with and without periodontitis. DNA was analyzed using the Methyl Profiler DNA Methylation qPCR assay. DNA methylation and transcript levels were evaluated by real-time polymerase chain reaction. The periodontitis group showed a hypermethylated profile and a low expression of gene. Positive correlation between the TLR2 methylation frequency and probing depth was observed. This study gives the first evidence of methylation frequency in inflamed periodontal tissues and of the possible participation of methylation in the development of periodontitis.

Transcription factor STAT1 gene polymorphism is associated with the development of severe forms of periodontal disease.

INTRODUCTION: Periodontal disease (PD) is one of the most common inflammatory diseases, affecting about 10 % of the world population. The establishment of PD is influenced by polymorphisms in genes involved with the inflammatory response. Signal Transducer and Activator of Transcription (STAT)-1 is a transcription factor that plays a key role in the intracellular signaling triggered by cytokines and, thus, its activation is critical in inflammatory diseases. AIM AND METHODS: We aim to evaluate the occurrence of association between STAT-1 (rs3771300) polymorphism and distinct clinical forms and severity of PD; we genotyped 180 subjects using realtime PCR. RESULTS AND CONCLUSION: We observed that the presence of the G allele for STAT-1 was associated with twice as high of a chance to develop aggressive periodontitis, and the most severe form of the disease.

Expression, polymorphism and methylation pattern of interleukin-6 in periodontal tissues.

Periodontitis is considered an inflammatory disorder of bacterial etiology that results in periodontal tissue destruction, as a result of complex interactions between periodontal pathogens, host and immune response. Genetic and epigenetic mechanisms may modulate the individual response since it is able to influence the gene expression. The aim of this study was to evaluate the impact of -174 G/C polymorphism and the methylation status of the promoter region of IL-6 gene on the expression of IL-6 in gingival samples from individuals with chronic periodontitis. Gingival biopsies were collected from 21 patients with chronic periodontitis and 21 controls. Histologic sections stained by hematoxylin-eosin were used for histopathological evaluation. The IL-6 gene expression was assessed by quantitative real-time PCR. The polymorphism IL-6 -174 C/G was studied by polymerase chain reaction (PCR) amplification and restriction endonuclease digestion (HspII). Methylation-specific polymerase chain reaction was used to verify the DNA methylation pattern. The number of inflammatory cells in tissue fragments from individuals with chronic periodontitis was higher than in the control group and the inflammatory infiltrate was predominantly mononuclear. The expression of IL-6 was higher in the group with periodontitis. In polymorphism assay, no statistical difference in the distribution of genotypes and alleles in both groups were observed. The most of samples were partially methylated. No difference was observed in methylation pattern from two different regions of the IL-6 gene among groups. The high expression of IL-6 is an important factor related to chronic periodontitis, but was not associated with methylation status or the -174 (G/C) genetic polymorphism, suggesting that other mechanisms are involved in this gene transcription regulation.

Halitosis in obese patients and those undergoing bariatric surgery.

BACKGROUND: Patients undergoing bariatric surgery often complain of bad breath. However, the relationship between bariatric surgery and halitosis is relatively unknown. The purpose of the present study was to evaluate and compare the occurrence of halitosis among patients before and after a specific type of bariatric surgery, Roux-en-Y gastric bypass, and its relationship with the tongue coating index, plaque index, and salivary flow rate. METHODS: A total of 62 patients with good oral health and in treatment for obesity at the walk-in clinic of Santa Casa Hospital, Belo Horizonte, Brazil, were selected. Of this sample, 31 were bariatric surgery candidates (control group) and 31 had already undergone Roux-en-Y gastric bypass surgery (case group). After completing a questionnaire, all patients underwent an oral clinical examination. Halitosis was measured using an organoleptic scale and a portable sulfide monitor. RESULTS: The Spearman correlation demonstrated a strong positive relation between the organoleptic rates and the concentration of volatile sulfur compounds determined using the sulfide monitor (rs = .58; P = .0001). No difference was found in the prevalence of halitosis between the 2 groups (P = .48). Only the salivary flow rate was significantly reduced in the control group compared with the case group (P = .02). In the case group, the concentration of volatile sulfur compounds correlated negatively with the salivary flow rate (P = .04) and positively with the tongue coating index (P = .005). The tongue coating index was significantly increased in those patients who did not brush the tongue (P < .04) and who had had episodes of vomiting (P = .02). CONCLUSION: These data suggest that no significant association exists between halitosis and Roux-en-Y gastric bypass. However, they do highlight the possible effect of this surgery on the oral cavity.

Evaluation of IL17A expression and of IL17A, IL17F and IL23R gene polymorphisms in Brazilian individuals with periodontitis.

The IL23/Th17 axis plays an important role in the pathogenesis of cell-mediated tissue damage caused either by autoimmunity or immune responses against bacterial infection. Single nucleotide polymorphisms in the IL17A, IL17F and IL23R genes have been associated with several inflammatory diseases. However, these polymorphisms have not yet been studied in periodontitis. The aim of present study was to evaluate the expression of IL17A and occurrence of the IL17A (rs2275913), IL17F (rs763780) and IL23R (rs11209026) gene polymorphisms in different clinical forms or severity of periodontitis in a sample of Brazilian individuals. Peripheral blood was obtained from 30 non-smoker individuals and analyzed by flow cytometry to determine IL-17 expression. Genomic DNA was obtained from oral swabs in 180 individuals and analyzed by Real-time PCR. The study group was composed by individuals without periodontitis (control), with aggressive periodontitis (AP) and with chronic periodontitis (CP). Higher frequency of IL17A+CD4+ T cells was observed in control group. The A+ genotype from IL17A (rs2275913) was associated with lack of disease. No association was found considering the IL17F and IL23R polymorphisms. Our data suggest that IL17A and the presence of IL17A (rs2275913) A allele are associated with the absence of periodontal disease.

Doença periodontal e intercorrências gestacionais / Periodontal disease and adverse pregnancy outcomes: a critical review

A doença periodontal, por se tratar de uma doença infecciosa inflamatória crônica, tem sido relatada como um fator de risco para certas condições sistêmicas. O objetivo deste estudo foi avaliar a associação entre doença periodontal (DP) e intercorrências gestacionais: o parto pré-termo (PPT), o baixo peso ao nascimento (BPN) e a pré-eclâmpsia (PEC). Foi realizada uma revisão bibliográfica nas principais bases de dados dos últimos 15 anos. Foram selecionados estudos observacionais (caso-controle, transversal e longitudinal), estudos de intervenção e revisões sistemáticas. Os dados na literatura são controversos. A maior parte dos estudos transversais, caso-controle e longitudinais mostram associação positiva entre DP e as intercorrências gestacionais, reportando taxas de risco variadas. Alguns estudos observacionais falharam em demonstrar tal associação. Estudos de intervenção mostraram redução na incidência das intercorrências gestacionais após terapia periodontal durante a gestação. Entretanto, existem ensaios clínicos que falharam em demonstrar a efetividade do tratamento periodontal na redução do risco para as intercorrências gestacionais. As revisões sistemáticas reportam a possibilidade de uma associação moderada entre DP e as intercorrências citadas, mas apontam a necessidade de realização de estudos com metodologias mais rigorosas, abrangendo diferentes populações, para a confirmação desta associação e da efetividade do tratamento periodontal na redução do risco destas intercorrências gestacionais. Assim, os estudos indicam uma evidência moderada de associação entre DP e as intercorrências gestacionais. Entretanto, mais estudos, principalmente de coorte e intervenção, se fazem necessários.

Association between severity of body mass index and periodontal condition in women.

This study evaluated the association between body mass index (BMI) and periodontal condition in a population of Brazilian women. A hospital convenience sample of 594 eligible women was recruited from a women's health reference center of Belo Horizonte, Brazil. Four groups were formed considering BMI levels: BMI normal group (n = 352), overweight (n = 54), obesity level I (n = 48), obesity level II (n = 56), and obesity level III (n = 74). Full-mouth periodontal examination was performed and biological, demographic, and behavioral risk variables were evaluated. Obese and overweight women showed statistically significant differences in bleeding on probing, probing depth and clinical attachment level ≥ 4 mm, and frequency of periodontitis (p < 0.05) compared to women showing normal BMI. The final multivariate model for the occurrence of periodontitis revealed that obesity groups were significantly associated with periodontitis. In addition, age (25-45), smoking, diabetes, and hypertension remained significantly associated with the occurrence of periodontitis (p < 0.05). Periodontitis was positively associated with obesity, and this association was more evident as obesity levels increases. These findings indicate the need for early diagnosis and the inclusion of periodontal care in health care programs for obese women.

Peri-implant disease in subjects with and without preventive maintenance: a 5-year follow-up.

AIM: To determine the incidence of peri-implantitis in individuals with mucositis in a 5-year follow-up study. MATERIAL AND METHODS: A sample of 212 partially edentulous individuals, rehabilitated with dental implants, underwent periodontal and peri-implant clinical examinations in 2005 (baseline). Five years later, 80 individuals who had been diagnosed with mucositis in the baseline examination were re-examined. These individuals were divided into two groups: one group with preventive maintenance during the study period (GTP; n = 39), and another group without preventive maintenance (GNTP; n = 41). The following parameters were clinically evaluated: plaque index, bleeding on periodontal and peri-implant probing, periodontal and peri-implant probing depth, suppuration and peri-implant bone loss. The influence of biological and behavioural risk variables associated with the occurrence of peri-implantitis was analysed using univariate and multivariate logistic regression analyses. RESULTS: The incidence of peri-implantitis in the global sample was 31.2% (GNTP = 43.9% and GTP = 18.0%). CONCLUSION: The absence of preventive maintenance in individuals with pre-existing peri-implant mucositis was associated with a high incidence of peri-implantitis. Clinical parameters, such as bleeding on peri-implant probing, periodontal probing depth and the presence of periodontitis were associated with a higher risk of developing peri-implantitis.

Prospective study in periodontal maintenance therapy: comparative analysis between academic and private practices.

BACKGROUND: This prospective study aims to evaluate and compare the periodontal status, periodontitis progression, tooth loss, and influence of predictable risk variables of two periodontal maintenance therapy programs over a 12-month period. METHODS: A total of 288 individuals diagnosed with chronic moderate-to-advanced periodontitis, who had finished active periodontal treatment, were evaluated in a public academic environment (AG) (n = 138), as well as in a private clinic (PG) (n = 150). A full-mouth periodontal examination was performed at baseline and at quadrimestral recalls, evaluating plaque index, probing depth, clinical attachment level, furcation involvement, bleeding on probing (BOP), and suppuration. Individuals' social, demographic, and biologic data, as well as compliance with recalls, were recorded. The effect of variables of interest and confounders were tested by univariate and multivariate analysis. RESULTS: The PG demonstrated lower rates of periodontitis progression and tooth loss than did the AG. After adjusting for confounders, the risk variables of BOP (P = 0.047), smoking (P = 0.003), and diabetes (P = 0.028) for the PG and smoking (P = 0.047) for the AG showed a negative influence on periodontal status. CONCLUSIONS: In both groups, the periodontal maintenance therapy minimized the negative effect of the risk variables. However, PG showed significantly less progression of periodontitis and tooth loss compared to AG.

Influence of obesity and bariatric surgery on the periodontal condition.

BACKGROUND: Recent studies have shown that being overweight or obese is associated with a higher risk of periodontitis. However, the literature offers an insufficient number of published reports regarding the effect of bariatric surgery on oral health. As such, the present study aims to determine the association between periodontal status and being overweight/obese in prebariatric and postbariatric surgery populations of Brazil. METHODS: Three hundred forty-five participants between 18 and 60 years of age, from both sexes, were grouped according to prebariatric or postbariatric surgery and underwent a complete periodontal examination. Biologic, demographic, and behavioral variables were analyzed in a Poisson regression model. RESULTS: Considering the timing of bariatric surgery, the sample was divided into three groups: PRE-OP (preoperative, n = 133), POS-OP1 (postoperative ≤6 months, n = 72), and POS-OP2 (post-surgery >6 months, n = 140). Regardless of the type of surgery (PRE-OP, POS-OP1, POS-OP2), the prevalence of periodontitis proved to be high (81.45%). There was a statistically significant difference in the prevalence of periodontitis among the PRE-OP, POS-OP1, and POS-OP2 groups (P = 0.040). In the Poisson regression model, after adjusting for biologic, demographic, and behavioral risk variables, only bleeding on probing remained significantly associated with the prevalence of periodontitis (P <0.001). CONCLUSION: Differences in periodontal condition were observed in individuals at different times of the bariatric surgery, showing a high prevalence of periodontitis in both preoperative and postoperative follow-up.

Periodontal risk assessment model in a sample of regular and irregular compliers under maintenance therapy: a 3-year prospective study.

BACKGROUND: The purpose of this study is to investigate the association of the periodontal risk assessment (PRA) model with the recurrence of periodontitis and tooth loss during periodontal maintenance therapy (PMT). METHODS: In a prospective PMT program, 75 regular complier (RC) and 89 erratic complier (EC) patients were selected. A periodontal examination and PRA were performed after active periodontal therapy and after 3 years of PMT. Risk profiles (low, moderate, or high) of participants were evaluated, and the recurrence of periodontitis and tooth loss were analyzed using univariate and multivariate analyses. RESULTS: RCs showed less recurrence of periodontitis and tooth loss than ECs (P <0.05). Rates of periodontitis recurrence in RCs and ECs were 2.7% and 3.4%, respectively, for the moderate-risk profile and 6.7% and 11.2%, respectively, for the high-risk profile. During PMT, 49 teeth (0.65 ± 1.4 teeth per participant) were lost in the RC group, and 70 teeth (0.78 ± 2.1 teeth per participant) were lost in the EC group. High-risk profile participants showed more recurrence of periodontitis and lost significantly more teeth than did participants with moderate- or low-risk profiles in RC and EC groups (P <0.05). CONCLUSION: The risk profile influenced the recurrence of periodontitis and tooth loss. RCs had less recurrence of periodontitis and less tooth loss. The PRA model can be useful in particularizing the risk of patients and adjusting recall intervals.

Células-tronco e regeneração periodontal / Stem cells and periodontal regeneration

A Periodontite é uma doença inflamatória que se manifesta clinicamente com a perda dos tecidos de suporte periodontal, incluindo osso alveolar, ligamento periodontal e cemento. Um dos objetivos do tratamento periodontal é a obtenção da regeneração dos tecidos visando reparar os danos ocasionados pela doença. As principais terapias utilizadas para esse fim incluem condicionamento da superfície radicular, enxertos e substitutos ósseos, fatores de crescimentos, proteínas derivadas da matriz do esmalte e regeneração tecidual guiada. As células-tronco são células com capacidade de proliferação, autorrenovação e diferenciação em células especializadas que poderiam regenerar os tecidos e os órgãos. As células-tronco podem ser classificadas como embrionárias ou não embrionárias, conhecidas também como células-tronco adultas, e estas são divididas em hematopoiéticas e mesenquimais. Pesquisas recentes têm demonstrado que populações de célula-tronco adulta residem no ligamento periodontal humano. Avanços da bioengenharia abrem caminho para o desenvolvimento de novas terapias para obtenção de um sucesso efetivo para a regeneração dos tecidos periodontais.

Terapia de manutenção periodontal e avaliação do nível de cooperação dos indivíduos / Periodontal maintenance therapy and assessment of the level of compliance of individuals

A doença periodontal é uma condição inflamatória dos tecidos periodontais. É caracterizada pela destruição progressiva dos tecidos que suportam o dente na cavidade bucal. Sendo consenso que inúmeros fatores podem influenciar na progressão e/ou gravidade desta doença. Além disso, são infecções com alto potencial para recorrência e, eventualmente, perda dentária. A terapia periodontal objetiva controlar e/ou eliminar a etiologia microbiana e os fatores de riscos contribuintes para susceptibilidade e gravidade da periodontite, impedindo a progressão e a recorrência da doença, preservando a dentição em estado de saúde, conforto e função com estética. A terapia de manutenção periodontal (TMP) é uma parte integrante da terapia, iniciada após a terapia periodontal ativa ser completada em intervalos que variam de acordo com a condição e o risco de cada indivíduo. Outro fator importante a considerar em relação a periodicidade é o nível de controle do biofilme dental do indivíduo, ou seja, quanto menor este controle, menor deve ser o intervalo para a rechamada. Entretanto, sabe-se que indivíduos com doenças crônicas tendem a cooperar pobremente, especialmente se a doença não é percebida de forma ameaçadora, se a terapia consome tempo ou se os sintomas não são perturbadores. Assim, o objetivo desta revisão foi avaliar criticamente os estudos realizados com o intuito de avaliar o grau de cooperação dos indivíduos durante a TMP.