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.

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.

Rastreabilidade dos usuários atendidos no Núcleo de Acolhimento e Pronto Atendimento de uma clínica-escola de Odontologia / Trazabilidad de los usuarios atendidos en el Centro de Acogida y Urgencias de una clínica-escuela de odontología / Traceability of users attended at the Reception and Emergency Care Center of a dental clinic-school

A pesquisa teve como objetivo verificar a rastreabilidade dos pacientes atendidos no setor de urgência do Núcleo de Acolhimento e Pronto Atendimento da Universidade Federal de Pernambuco (NAPA-UFPE), o tempo decorrido entre seu encaminhamento e a continuidade do tratamento na instituição, além de identificar o perfil dos usuários. Trata-se de estudo observacional descritivo, com coleta de dados a partir dos prontuários físicos e eletrônicos dos pacientes atendidos no segundo semestre de 2014 (2014.2) e no primeiro semestre de 2015 (2015.1). Ao total, foram analisados 373 prontuários. Em ambos os semestres houve maior prevalência do sexo feminino e da faixa etária entre 20 e 59 anos. A rastreabilidade revelou que 40,75% dos pacientes continuaram seus tratamentos na instituição. Nos semestres 2014.2 e2015.1, respectivamente, 31,20% e 82,00% dos pacientes prosseguiram com o tratamento eletivo até 30 dias após a realização do atendimento de urgência. Em conclusão, a rastreabilidade revelou maior prevalência do sexo feminino e da faixa etária adulta. O quantitativo de pacientes que deram continuidade ao tratamento na instituição em até 30 dias após o encaminhamento esteve dentro do previsto, considerando-se as características das clínicas-escola (AU).

El objetivo de la investigación fue verificar la trazabilidad de los pacientes atendidos en el sector de urgencias del Centro de Recepción y Atención de Urgencias de la Universidade Federal de Pernambuco (NAPA-UFPE), el tiempo transcurrido entre su derivación y la continuidad del tratamiento en la institución, además de identificar el perfil de los usuarios. Se trata de un estudio observacional descriptivo, con recolección de datos de los registros físicos y electrónicos de pacientes atendidos en el segundo semestre de 2014 (2014.2) y en el primer semestre de 2015 (2015.1). En total se analizaron 373historias clínicas. En ambos semestres hubo mayor prevalencia del sexo femenino y del grupo de edad entre 20 y 59 años. La trazabilidad reveló que el 40,75% de los pacientes continuaron sus tratamientos en la institución. En los semestres 2014.2 y 2015.1,respectivamente, el 31,20% y el 82,00% de los pacientes continuaron con el tratamiento electivo hasta 30 días después de la atención de emergencia. En conclusión, la trazabilidad reveló una mayor prevalencia del sexo femenino y del grupo etario adulto. Elnúmero de pacientes que continuaron el tratamiento en la institución dentro de los 30 días posteriores a la derivación estuvo dentro del rango esperado, considerando las características de las clínicas docentes (AU).

The objective of this study was to verify the traceability of patients attended in the emergency sector of the Reception and Emergency Care Center of the Federal University of Pernambuco (NAPA-UFPE), the time elapsed between their referral and the continuity of treatment at the institution, in addition to identifying the users' profile. This is a descriptive observational study, with data collection from the physical and electronic medical records of patients treated in the second half of 2014 (2014.2) and in the first half of 2015 (2015.1). A total of 373 medical records were analyzed There was a higher prevalence of females and an age group between 20 and 59 years in both semesters. The traceability revealed that 40.75% of the patients continued their treatments at the institution. Moreover, 31.20% and 82.00% of the patients in the 2014.2 and 2015.1 semesters continued with the elective treatment up to 30 days after the emergency care, respectively. In conclusion, traceability revealed a higher prevalence of females and the adult age group. The number of patients who continued treatment at the institution within 30 days after referral was within the expected range, considering the characteristics of the teaching clinics (AU).

Protective effect of Chromobacterium violaceum and violacein against bone resorption by periodontitis.

OBJECTIVES: The aim of this study was to evaluate the potential protective effect of Chromobacterium violaceum and violacein against periodontitis, in experimental models. MATERIALS AND METHODS: A double-blind experimental study on the exposure to C. violaceum or violacein in experimentally ligature-induced periodontitis, as preventive factors against alveolar bone loss by periodontitis. Bone resorption was assessed by morphometry. Antibacterial potential of violacein was assessed in an in vitro assay. Its cytotoxicity and genotoxicity were evaluated using the Ames test and SOS Chromotest assay, respectively. RESULTS: The potential of C. violaceum to prevent/limit bone resorption by periodontitis was confirmed. Daily exposure to 106 cells/ml in water intake since birth and only during the first 30 days of life significantly reduced bone loss from periodontitis in teeth with ligature. Violacein extracted from C. violaceum was efficient in inhibiting or limiting bone resorption and had a bactericidal effect against Porphyromonas gingivalis in the in vitro assay. CONCLUSIONS: We conclude that C. violaceum and violacein have the potential to prevent or limit the progression of periodontal diseases, in an experimental model. CLINICAL RELEVANCE: The effect of an environmental microorganism with potential action against bone loss in animal models with ligature-induced periodontitis represents the possibility of understanding the etiopathogenesis of periodontal diseases in populations exposed to C. violaceum and the possibility of new probiotics and antimicrobials. This would imply new preventive and therapeutic possibilities.

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.

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.

No association between periodontitis and preterm low birth weight: a case-control study.

PURPOSE: This study aimed to investigate the association between periodontitis in pregnant women and adverse pregnancy outcomes by heeding confounding risk factors for preterm low birth weight infants. METHODS: This study was reported according to The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement. A case-control study was conducted. Medical records of all pregnant women attending a prenatal care clinic were screened. Those between 21 and 34 years and gestational age of 28-32 weeks were initially enrolled in the study. The exclusion criteria were then applied: diabetes mellitus, genitourinary tract infections, or HIV infection; previous multiple gestations; previous preterm birth/low birth weight infants; in vitro fertilization procedures; placental, cervical/uterine abnormalities; history of infertility; history of drug abuse; and any medical conditions that required antibiotics prophylaxis. Patients' anthropometric, demographic, and behavioral characteristics were collected. The periodontal clinical parameters were obtained from six sites per tooth: clinical attachment level, probing pocket depth, dental plaque index, and gingival bleeding index. Women were then allocated into two groups: mothers of preterm and/or low birth weight newborns (cases) and mothers of full-term and normal birth weight newborns (controls). RESULTS: Periodontal clinical parameters were analyzed and reported separately for each group, and no significant differences were observed (p > 0.05). Logistic regression analysis revealed that periodontal clinical parameters were not associated with the adverse pregnancy outcomes. CONCLUSION(S): After controlling for confounding factors, our results suggest that maternal periodontal disease is not a risk factor associated with preterm low birth weight infants.

Periodontal profile and radiographic characterization of the jaws in a patient with autosomal dominant osteopetrosis.

Osteopetrosis (OP) comprehends a rare group of conditions, presenting on radiographs increased bone density, deriving from irregularities in osteoclast differentiation or function. In the autosomal dominant osteopetrosis (ADO), some patients stay asymptomatic for some time, or only develop mild symptoms. The dental surgeon is often the first to presuppose the disease during routine imaging examinations, referring the patient to a specialized medical group. Furthermore, osteomyelitis is one of the major OP complications, and should be refrained through frequent dental monitoring. Signals of cortical interruption, sclerotic sequestra or periosteal new bone formation, should be looked for in these patients. Their dental management is complex and procedures encompassing bone tissue, such as implant procedures, tissue regenerations, tooth extractions, maxillofacial surgeries and orthodontic treatments, when elected, should be avoided. This case report describes a case of ADO with a diagnosis of moderate generalized chronic periodontitis, not statistically related to plaque index. This is the first case to describe such a condition, in which the systemic component and the altered bone metabolism seem to be related to the loss of periodontal apparatus, independent of the biofilm. Concerning prevention, we can reinforce the need for frequent dental monitoring to avoid further interventions in those cases. LEARNING POINTS: This paper reports a case in which the systemic component and the altered bone metabolism seem to have been related to the loss of periodontal attachment apparatus, independent of the biofilm.The periodontal damage observed in the OP patient was not related to the dental plaque, which leads us to suggest that the cases of periodontitis in OP patients should be diagnosed as periodontitis as a manifestation of systemic diseases.The periodontitis prevention should be longed for in OP patients thus, we propose that doctors responsible for patients with OP refer them to a dental service as soon as possible and that dentists should be aware of the preventive dentistry value as well as the most appropriate dental management for those cases.

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.

Avaliação da associação entre a doença periodontal e o parto prematuro e o baixo peso ao nascer: estudo experimental em ratas / Evaluation of the association between the disease periodontal and premature birth and low birth weight: study experimental in rats

A Periodontite é definida como a destruição das estruturas de suporte dentário, uma complexa relação entre um processo infeccioso oral que induz uma resposta inflamatória no hospedeiro, modificada por fatores ambientais. Antígenos e fatores de virulência derivados do biofilme oral aderido à superfície do dente, levam ao recrutamento de células da resposta imune, e a produção de citocinas pró-inflamatórias, que mediam a destruição dos tecidos periodontais. Tem sido, portanto, proposto, que a periodontite possa ser um fator de risco para desfechos adversos da gestação, como o parto prematuro e o baixo peso ao nascimento. O presente estudo foi conduzido para verificar a plausibilidade biológica da possível associação entre a periodontite e o parto prematuro e o baixo peso ao nascer. Um estudo experimental em modelo animal por indução de periodontite por ligaduras em 50% dos sítios, avaliando a presença de citocinas no tecido gengival, soro, placenta, cordão e liquido amniótico foi desenhado para testar a hipótese nula de que a indução da periodontite em ratas não ocasiona resultados adversos da gravidez. Quarenta fêmeas foram incluídas em dois grupos: controle, sem periodontite (sem ligaduras) e teste, com periodontite induzida experimentalmente (ligaduras colocadas ao redor dos segundos molares superiores e dos primeiros molares inferiores). Quarenta e cinco dias após a indução, foi iniciado o acasalamento. Machos foram colocados com as fêmeas, na proporção 1:2, por um período de 12 horas. O peso corporal da fêmea, a partir de então, foi registrado diariamente. Confirmada a prenhez, no 20º dia do período gestacional, foi realizada a laparotomia e as seguintes coletas foram feitas: líquido amniótico, embriões, placenta, cordão umbilical, sangue materno, maxila e mandíbula. O peso corporal das mães, a quantidade de fetos por fêmea e o peso de cada um foram registrados.O pool de líquido amniótico de cada fêmea, as placentas removidas, os cordões umbilicais, o sangue (soro) materno e o tecido gengival coletados foram submetidos à análise quantitativa para IL1-α, IL6, TNF-α, IL10, IL4, IL12p70, IFN-γ e IL17a pela metodologia multiplex (LabMAP, Luminex Corp., Austin, TX, USA). Para confirmação da periodontite, a maxila e a mandíbula removidas foram processadas e submetidas à morfometria. A periodontite induzida em ratas Wistar não resultou em resultados adversos da prenhez. Não houve diferenças estatisticamente significativas entre os grupos em relação à prematuridade, número de fetos ou peso ao nascer. Em relação às citocinas , também não houve diferenças estatisticamente significativas para as concentrações mensuradas em cada tecido, entre os grupos com periodontite e controle. Além disso, os níveis de todas as citocinas na placenta, exceto a IL-6, estavam diminuídos em relação ao soro materno ou líquido amniótico, o que sugere que as citocinas não podem ser facilmente transferidas através deste tecido em direção materno-fetal ou feto-maternal. A taxa de fecundidade foi reduzida significativamente para o grupo com periodontite. As medidas clínicas dos resultados da gravidez, associadas aos resultados das citocinas permitem concluir que a periodontite generalizada induzida experimentalmente em ratos não é um fator de risco para prematuridade ou baixo peso ao nascer. (AU)

Periodontitis, defined as the destruction of the tooth surrounding supportive tissues, is an intricate interrelation between an oral infection process inducing an inflammatory response in the host, modified by behavioral elements. Antigens and various virulence factors derived from plaque biofilm on the root surface initiate a recruitment of immune response cells and the production of proinflammatory cytokines, as IL-1, IL-6 and TNF-α, which are mediators of the connective tissue and bone destruction. Therefore, periodontitis has been proposed as a risk factor for adverse pregnancy outcomes, as preterm birth (PTB) and low birth weight (LBW). The present study was then conducted to verify the biological plausibility of the possible association between periodontitis and preterm birth and low birth weight. An experimental animal model study inducing periodontitis with ligatures in 50% of sites and assessing the presence of cytokines in the gingival tissue, serum, placenta, cord and amniotic fluid was designed to test the null hypothesis that the induction of periodontitis in rats does not result in adverse pregnancy outcomes. Fourty females were included in two groups: a periodontally healthy control (without ligatures) and an experimentally induced periodontitis group (test, with ligatures placed around the cervical region of the second maxillary molars and of the first mandible molars). 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 body weight of the female, from then on, was recorded daily. Confirmed the pregnancy, on the 20th day, laparotomy was performed and the following collections were made: amniotic fluid, embryos, placenta , umbilical cord blood, maternal blood and the jaws . The maternal body weight, the number of fetuses per female and the weight of each were recorded.The pool of amniotic fluid from each female, the removed placenta, umbilical cord, blood (serum) and maternal and gingival tissue samples were subjected to quantitative analysis for IL1 - α, IL-6, TNF - α, IL10, IL4, IL12p70, IFN - γ and IL17a by multiplex methodology (LabMAP, Luminex Corp., Austin, TX, USA). For confirmation of periodontitis, the maxilla and mandible removed were processed and submitted to morphometry. 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 measured in each tissue between the groups with periodontitis and control. Furthermore, the levels of all cytokines in the placenta, except IL-6 were diminished compared to the amniotic fluid or maternal serum, suggesting that the cytokines can not easily be transferred via this tissue in maternal-fetal or feto- maternal direction. The fertility rate was significantly reduced in the group with periodontitis. Clinical measures of pregnancy outcomes, associated with the results of cytokines showed that the generalized periodontitis induced in rats is not a risk factor for preterm birth or low birth weight . (AU)

The effect of periodontal therapy on preterm low birth weight: a meta-analysis.

OBJECTIVE: To systematically review the randomized controlled trials that evaluated the effect of periodontal therapy on preterm birth and low birth weight (LBW). DATA SOURCES: A systematic search was conducted of the PubMed, Bireme, LILACS, and Cochrane databases. METHODS OF STUDY SELECTION: Only randomized controlled trials on the effect of periodontal therapy on preterm birth and LBW were included. The Consolidated Standards of Reporting Trials statement was used in quality assessment and meta-analysis was carried out using random-effects methods. TABULATION, INTEGRATION, AND RESULTS: The search resulted in 14 clinical studies. Ten articles met the inclusion criteria for preterm birth and four for LBW. Five meta-analyses on preterm birth were performed according to different criteria: 1) use of probing depth and attachment loss for periodontitis definition, relative risk (RR) 0.58 (95% confidence interval [CI] 0.29-1.12) (four studies); 2) controlling for multiparity, RR 0.92 (95% CI 0.72-1.17) (eight studies); 3) controlling for previous preterm birth, RR 0.88 (95% CI 0.67-1.16) (seven studies); 4) controlling for genitourinary infections, RR 0.75 (95% CI 0.57-1.05) (six studies); and 5) all the previous criteria, RR 0.63 (95% CI 0.32-1.22) (three studies). Three meta-analysis on LBW were conducted according to controlling for multiparity, RR 1.03 (95% CI 0.76-1.40) (four studies); controlling for previous preterm birth, RR 0.93 (95% CI 0.65-1.30) (three studies); and use of probing depth and attachment loss for periodontitis definition, controlling for multiparity, previous preterm birth, and genitourinary infections, RR 0.52 (95% CI 0.10-2.60) (two studies). In all meta-analyses, the effect of periodontal treatment on preterm birth and LBW was not statistically significant. CONCLUSION: Results of this meta-analysis do not support the hypothesis that periodontal therapy reduces preterm birth and LBW indices.