Randomized controlled trial of the effect of periodontal treatment on cardiovascular risk biomarkers in patients with stable coronary artery disease: Preliminary findings of 3 months.

AIM: To assess the effect of periodontal therapy (PT) on cardiovascular blood biomarkers. MATERIALS AND METHODS: This single-blind, parallel-design, randomized controlled trial included patients with stable coronary artery disease and periodontitis. The test group (TG) received non-surgical PT, whereas the control group (CG) received one session of plaque removal. Plasma levels of C-reactive protein (CRP), glycated haemoglobin, lipids and cytokines (IL-1ß, IL-6, IL-8, IL-10, IFN-γ and TNF-α) were measured at baseline and after 3 months. RESULTS: Eighty-two patients (74.4% women, mean age 59.6 years) were analysed. TG had significantly better periodontal parameters than CG after 3 months, but no significant differences in blood markers were observed between them. In a post hoc subgroup analysis in patients with baseline CRP <3 mg/L, a significant increase in CRP was observed in CG (1.44 ± 0.82 mg/L to 4.35 ± 7.85 mg/L, p = 0.01), whereas CRP remained unchanged in TG (1.40 ± 0.96 mg/L to 1.33 ± 1.26 mg/L, p = 0.85), resulting in a significant difference between groups at 3 months. In patients with CRP ≥3 mg/L, a significant reduction in CRP was observed only in TG (11.3 ± 12.8 mg/L to 5.7 ± 4.1 mg/L, p = 0.04). Levels of IL-6 and IL-8 were significantly lower in TG than CG at 3 months. CONCLUSIONS: PT leads to lower levels of CRP, IL-6 and IL-8 in cardiovascular patients with high CRP levels.

Periodontal therapy and endothelial function in coronary artery disease: A randomized controlled trial.

OBJECTIVE: To assess the effects of periodontal treatment on endothelial function in patients with coronary artery disease. MATERIALS AND METHODS: A randomized controlled trial was conducted with 69 patients with stable coronary disease and severe periodontitis. The test group received nonsurgical periodontal therapy consisting of personalized oral hygiene instructions, subgingival scaling, and root planing per quadrant, whereas the control group received equal treatment after the study period. Endothelial function was assessed by measurement of brachial artery flow-mediated dilation, concentrations of sVCAM-1, sICAM-1, and P-selectin in serum before and 3 months after periodontal therapy. RESULTS: The test group exhibited statistically better periodontal parameters-plaque, probing depth, periodontal attachment loss, and bleeding on probing. No significant improvements were observed in the control (1.37%) and test (1.39%) groups in flow-mediated dilation, with no significant between-group difference. sVCAM-1 concentration increased in the control group (997.6 ± 384.4-1201.8 ± 412.5; p = 0.03), whereas in the test group, no significant changes were observed (915.1 ± 303.8-1050.3 ± 492.3; p = 0.17), resulting in a significant difference between the two groups (p = 0.04). The same pattern was observed for concentrations of sICAM-1. CONCLUSION: Periodontal treatment did not provide better vasodilation in patients with coronary disease in a short-term follow-up period, although it maintained blood concentrations of markers of vascular inflammation.

Aumento de coroa clínica com a técnica flapless: relato de caso / Clinical crown lengthning with flapless technique: case report

A cirurgia plástica periodontal tem sido indicada para pacientes que apresentam descontentamento com seu sorriso ou desarmonia em relação a sua anatomia gengival. O procedimento tradicional tem sido realizado através da elevação de um retalho para expor o tecido ósseo e subsequente, osteotomia/osteoplastia. Este procedimento exige sutura e um maior tempo de cicatrização, tornando o pós-operatório mais desfavorável em relação às técnicas menos invasivas. Com o avanço das técnicas minimamente invasivas, tem sido proposta a técnica Cirúrgica Periodontal "Flapless", um procedimento minimamente invasivo e inovador, com resultados clínicos extremamente favoráveis. Tem como principal indicação pacientes com o biótipo periodontal fino e intermediário e o planejamento cirúrgico consiste na realização de uma tomografia computadorizada do paciente utilizando um afastador bucal tipo expandex para afastar os tecidos moles e facilitar a visualização da crista óssea vestibular e, desta forma,visualizar e calcular a quantidade de tecido ósseo a ser removido. Após a excisão do tecido gengival, é realizada a osteotomia via sulco gengival, sem abertura de retalho, com utilização de microcinzéis. Um dos principais benefícios é a finalização do procedimento sem a necessidade de suturas, menor desconforto pós-operatório, melhor reparação tecidual e harmonia estética. As evidências clínicas e científicas mostram que o aumento de coroa clínica com a técnica "Flapless" atinge resultados satisfatórios em menor tempo, melhor pós-operatório e previsibilidade (AU)

The increase in clinical crown "Flapless" is a common procedure employed at periodontal plastic to patients with discontent with its gummy smile or with the in harmonious of its gumlines hape. The traditional procedure is performed it the flap lifting to expose the bone and then, osteotomy/ osteoplasty. As a resultof the flap, it requires suturing, making it uncomfortable postoperative. However, with the advancement in a esthetic and constant demands for searching improved results, it was proposed the "Flapless" Technique, which consist of minimally invasive and innov ative procedure, with very favorable clinical out comes. It is mainly indicated to treat patients with thin and intermediate periodontal biotype. Aided by computerized tomography with Expandex, we have a predictability of the amount of bone to be removed. After excision of gingival tissue, gingival sulcus via osteotomy is performed with out opening flap, using micro-chisels. One of the main benef its is the completion of the procedure without sutures, less postoperative discomfort, optimizedt issue repair and perfect as the tic harmony. Clinical and scientific evidence shows that te increase in clinical crown flapless reache satisfactory results in a shorter time, best post operative and predictability in clinical out come. (AU)

Periodontal disease and inflammatory blood cytokines in patients with stable coronary artery disease.

MATERIAL AND METHODS: This cross-sectional study included 91 patients with stable CAD who had been under optimized cardiovascular care. Blood levels of IL-1ß, IL-6, IL-8, IL-10, IFN-γ, and TNF-α were measured by Luminex technology. A full-mouth periodontal examination was conducted to record probing depth (PD) and clinical attachment (CA) loss. Multiple linear regression models, adjusting for gender, body mass index, oral hypoglycemic drugs, smoking, and occurre:nce of acute myocardial infarction were applied. RESULTS: CAD patients that experienced major events had higher concentrations of IFN-γ (median: 5.05 pg/mL vs. 3.01 pg/mL; p=0.01), IL-10 (median: 2.33 pg/mL vs. 1.01 pg/mL; p=0.03), and TNF-α (median: 9.17 pg/mL vs. 7.47 pg/mL; p=0.02). Higher numbers of teeth with at least 6 mm of CA loss (R2=0.07) and PD (R2=0.06) were significantly associated with higher IFN-γ log concentrations. Mean CA loss (R2=0.05) and PD (R2=0.06) were significantly related to IL-10 concentrations. Elevated concentrations of TNF-α were associated with higher mean CA loss (R2=0.07). CONCLUSION: Periodontal disease is associated with increased systemic inflammation in stable cardiovascular patients. These findings provide additional evidence supporting the idea that periodontal disease can be a prognostic factor in cardiovascular patients.

Periodontal disease and inflammatory blood cytokines in patients with stable coronary artery disease

ABSTRACT Periodontal disease has been associated with elevations of blood cytokines involved in atherosclerosis in systemically healthy individuals, but little is known about this association in stable cardiovascular patients. The aim of this study was to assess the association between periodontal disease (exposure) and blood cytokine levels (outcomes) in a target population of patients with stable coronary artery disease (CAD). Material and Methods This cross-sectional study included 91 patients with stable CAD who had been under optimized cardiovascular care. Blood levels of IL-1β, IL-6, IL-8, IL-10, IFN-γ, and TNF-α were measured by Luminex technology. A full-mouth periodontal examination was conducted to record probing depth (PD) and clinical attachment (CA) loss. Multiple linear regression models, adjusting for gender, body mass index, oral hypoglycemic drugs, smoking, and occurre:nce of acute myocardial infarction were applied. Results CAD patients that experienced major events had higher concentrations of IFN-γ (median: 5.05 pg/mL vs. 3.01 pg/mL; p=0.01), IL-10 (median: 2.33 pg/mL vs. 1.01 pg/mL; p=0.03), and TNF-α (median: 9.17 pg/mL vs. 7.47 pg/mL; p=0.02). Higher numbers of teeth with at least 6 mm of CA loss (R2=0.07) and PD (R2=0.06) were significantly associated with higher IFN-γ log concentrations. Mean CA loss (R2=0.05) and PD (R2=0.06) were significantly related to IL-10 concentrations. Elevated concentrations of TNF-α were associated with higher mean CA loss (R2=0.07). Conclusion Periodontal disease is associated with increased systemic inflammation in stable cardiovascular patients. These findings provide additional evidence supporting the idea that periodontal disease can be a prognostic factor in cardiovascular patients.

Impacto da Doença Periodontal no Perfil Lipídico de Pacientes com Doença Arterial Coronariana Crônica: uma Coorte Retrospectiva de 3 anos / Impact of Periodontal Disease in the Lipid Profile of Patients With Chronic Coronary Artery Disease: a 3-Year, Retrospective Cohort

Fundamento: A inflamação tem sido reconhecida como um importante fator de risco para as doenças cardiovasculares. A doença periodontal pode acarretar alterações de alguns marcadores plasmáticos envolvidos no processo aterogênico. Objetivo: Avaliar a associação entre a doença periodontal e os níveis lipídicos ao longo do tempo em pacientes com doença arterial coronariana crônica. Métodos: Este estudo de coorte retrospectivo incluiu uma amostra de pacientes cardiopatas crônicos recebendo atendimento em um ambulatório de atenção terciária de cardiopatia isquêmica. Dos 239 pacientes elegíveis, foram incluídos 80 que apresentavam dados retrospectivos de perfil lipídico entre 2009 e 2011. Foram realizados exames periodontais de todos os dentes presentes em 2011. Modelos múltiplos de equações de estimação generalizada foram aplicados para avaliar a associação entre parâmetros periodontais e alterações ao longo do tempo nos seguintes desfechos: triglicerídeos, colesterol total, LDL-colesterol e HDL-colesterol, com ajustes para idade, índice de massa corporal, fumo, uso de hipoglicemiante oral e tempo de acompanhamento. Resultados: Durante um tempo médio de acompanhamento de 713 dias, não houve mudanças significativas nas concentrações de triglicerídeos, colesterol total e LDL-colesterol. Um aumento significativo de 31,6% nos níveis de HDL-colesterol foi observado entre 2009 e 2011. Observamos uma associação negativa e significativa entre a média individual de perda de inserção periodontal e nível de HDL-colesterol, indicando que quanto maior a perda de inserção, mais baixos os níveis de HDL-colesterol ao longo do tempo. Conclusão: A doença periodontal destrutiva pode estar relacionada com um pior controle lipídico, particularmente relacionado a níveis de HDL-colesterol, em pacientes cardiopatas crônicos

Background: Inflammation has been recognized as an important risk factor for cardiovascular diseases. Periodontal disease may alter some plasma markers involved in the atherogenic process. Objective: To assess the association between periodontal disease and lipid levels over time in patients with chronic coronary artery disease.Methods: This retrospective cohort study included a sample of patients with chronic heart disease receiving care in an outpatient tertiary care for ischemic heart disease. Of 239 patients eligible for the study, we included 80 patients who had available retrospective data of lipid profile between 2009 and 2011. We performed periodontal examinations of all teeth present in 2011. Multiple models of generalized estimating equations were applied to assess the association between periodontal parameters and changes over time in the following outcomes: triglycerides, total cholesterol, LDL-cholesterol, and HDL-cholesterol levels adjusted for age, body mass index, smoking, use of oral hypoglycemic, and follow-up duration. Results: During a mean follow-up time of 713 days, there were no significant changes in the concentrations of triglycerides, total cholesterol, and LDL-cholesterol. A significant 31.6% increase in HDL-cholesterol levels was observed between 2009 and 2011. We observed a significant negative association between mean individual periodontal attachment loss and HDL- cholesterol levels, indicating that the greater the attachment loss, the lower the HDL-cholesterol level over time. Conclusion: Destructive periodontal disease may be related to a worse lipid control, specifically regarding HDL-cholesterol levels, in chronic cardiac patients

A importância da interdisciplinaridade no restabelecimento da função e da estética: relato de caso / The importance of interdisciplinarity in the restoration of function and aesthetics: a case report

A crescente busca pelo sorriso perfeito, aliada a um bom desempenho funcional, exige do cirurgião-dentista conhecimento das novas técnicas, mas principalmente a realização de um adequado diagnóstico e planejamento. Em muitos casos, a interação de mais de uma área da odontologia é necessária para restabelecer a estética e especialmente a função dos elementos dentais. Dessa forma, este artigo tem como objetivo relatar um caso no qual houve a interação da ortodontia, periodontia e dentística para o melhor tratamento da paciente...

The growing search for a perfect smile, along with a good functional performance require dentist knowledge of new techniques, but mainly to carry out a proper diagnosis and planning. In many cases, the interaction of more than one area of Dentistry is necessary to restore the appearance and primarily function of the dental elements. Therefore, this article is a case report where Orthodontics, Periodontics and Restorative Dentistry were associated for optimally treating of the patient...

Doença periodontal como fator de prognóstico para doença cardiovascular / Periodontal disease as a prognostic factor in cardiovascular disease ­ a literature review

O objetivo dessa revisão da literatura foi apresentar evidências que sustentam a doença periodontal como um fator de prognóstico para a doença cardiovascular (DCV). Fator de risco refere-se a um fator que está relacionado diretamente com o estabelecimento da doença. Por outro lado, fator de prognóstico está relacionado com o curso de uma doença já existente. A evidência científica é bastante vasta sobre o papel da doença periodontal no desenvolvimento da doença cardiovascular, contudo, existe um número de estudos relativamente pequeno quando a doença periodontal é avaliada como fator de prognóstico. Esses estudos se diferem fundamentalmente pelo fato de que a amostra é composta exclusivamente por pacientes já com diagnóstico de doença cardiovascular. Nesta revisão, foram encontrados estudos observacionais e intervencionais, com desfechos principalmente de natureza sanguínea avaliando citocinas e marcadores inflamatórios cardiovasculares. De maneira geral, estudos observacionais encontraram associação entre presença de doença periodontal e maiores níveis séricos de proteína C-reativa (PCR), lipídeos e algumas citocinas (IL-6 e TNF alpha). Estudos de intervenção demonstraram que, após o tratamento periodontal, os níveis de PCR, fibrinogênio e IL-6 reduzem nos pacientes cardiopatas. Por outro lado, uma série de citocinas envolvidas no processo aterogênico ainda não foi avaliada em pacientes cardiopatas com doença periodontal. Pôde-se concluir que a doença periodontal pode vir a ser um importante fator de prognóstico para a doença cardiovascular, e isso tem implicações importantes no manejo clínico de pacientes cardiopatas por médicos e dentistas.

The purpose of this literature review is to present evidence to support periodontal disease as a prognostic factor for CVD. Risk factor is directly related to disease onset only. On the other hand, prognostic factors deal with prediction of the course of an existing disease. There is great amount of scientifi c evidence on the role of periodontal disease in the development of cardiovascular disease, however there are a relatively small number of studies where periodontal disease is evaluated as a prognostic factor. These studies are fundamentally different because the sample is composed exclusively of patients with diagnosis of the cardiovascular disease. In this review, we found observational and interventional studies with secondary outcomes, evaluating cytokines and cardiovascular infl ammatory markers. In general, observational studies associated the periodontal disease with higher serum levels of C-reactive protein (CRP), lipids and some cytokines (IL-6 and TNF alpha). Intervention studies demonstrated a reduction in CRP levels, fi brinogen, and IL-6 in cardiac patients after periodontal treatment. Moreover, a number of cytokines involved in the atherosclerotic process haven't been evaluated in cardiac patients with periodontal disease. It can be concluded that periodontal disease may be an important prognostic factor for cardiovascular disease and this has important implications for the clinical management of cardiac patients by health professionals.

Relationship between vascular endothelium and periodontal disease in atherosclerotic lesions: Review article.

Inflammation and endothelial dysfunction are linked to the pathogenesis of atherosclerotic disease. Recent studies suggest that periodontal infection and the ensuing increase in the levels of inflammatory markers may be associated with myocardial infarction, peripheral vascular disease and cerebrovascular disease. The present article aimed at reviewing contemporary data on the pathophysiology of vascular endothelium and its association with periodontitis in the scenario of cardiovascular disease.

Reconstrução da papila interdental usando enxerto de tecido conjuntivo / Reconstruction of the interdental papilla with an underlying subepithelial connective tissue graft. Case report

A literatura odontológica apresenta vários trabalhos relatando técnicas cirúrgicas de reconstrução da papila interdental e quão grande são os desafios para a Periodontia atual, pois este problema está relacionado à perda do septo ósseo interdental e, consequentemente, à perda da papila. Esta ausência pode acarretar limitações estéticas, dificuldade na fonética e impactação de alimentos. Este relato de caso descreve a aplicação clínica de uma técnica, na qual um retalho avançado coronalmente, associado a um enxerto de tecido conjuntivo, é utilizado para reconstrução da papila interdental. Apesar do resultado satisfatório obtido ao final deste caso, ainda são necessários estudos longitudinais em que possamos nos basear e avaliar a previsibilidade das técnicas cirúrgicas que envolvem a reconstrução da papila interdental.

The effect of periodontal therapy on C-reactive protein, endothelial function, lipids and proinflammatory biomarkers in patients with stable coronary artery disease: study protocol for a randomized controlled trial.

BACKGROUND: Scarce information exists regarding the preventive effect of periodontal treatment in the recurrence of cardiovascular events. Prevention may be achieved by targeting risk factors for recurrent coronary artery disease (CAD) in patients with previous history of cardiovascular events. The aim of this trial is to compare the effect of two periodontal treatment approaches on levels of C-reactive protein, lipids, flow-mediated dilation and serum concentrations of proinflammatory and endothelial markers in stable CAD patients with periodontitis over a period of 12 months. METHODS/DESIGN: This is a randomized, parallel design, examiner blinded, controlled clinical trial. Individuals from both genders, 35 years of age and older, with concomitant diagnosis of CAD and periodontitis will be included. CAD will be defined as the occurrence of at least one of the following events 6 months prior to entering the trial: documented history of myocardial infarction; surgical or percutaneous myocardial revascularization and lesion >50% in at least one coronary artery assessed by angiography; presence of angina and positive noninvasive testing of ischemia. Diagnosis of periodontitis will be defined using the CDC-AAP case definition (≥2 interproximal sites with clinical attachment loss ≥6 mm and ≥1 interproximal site with probing depth ≥5 mm). Individuals will have to present at least ten teeth present to be included. One hundred individuals will be allocated to test (intensive periodontal treatment comprised by scaling and root planing) or control (community periodontal treatment consisting of one session of supragingival plaque removal only) treatment groups. Full-mouth six sites per tooth periodontal examinations and subgingival biofilm samples will be conducted at baseline, 3, 6 and 12 months after treatment. The primary outcome of this study will be C-reactive protein changes over time. Secondary outcomes include levels of total cholesterol, LDL-C, HDL-C, triglycerides, IL-1ß, IL-6, TNFα, fibrinogen, ICAM-1, VCAM-1 and E-selectin. These outcomes will be assessed at all time points over 12 months. Flow-mediated dilation will be assessed at baseline, 1, 3 and 6 months after periodontal therapy. DISCUSSION: This trial will provide new evidence regarding the effect of periodontal treatment on risk markers for recurrence of cardiovascular events in stable coronary artery disease patients. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier, NCT01609725.