Association between cumulative smoking exposure, span since smoking cessation, and peri-implantitis: a cross-sectional study.

OBJECTIVES: To investigate the association of cumulative smoking exposure and span since smoking cessation with the occurrence of peri-implantitis. METHODS: A sample of 350 individuals aged ≥ 35 years, with the presence of at least one osseointegrated implant functioning for > 5 years, were enrolled in the study. According to smoking habits, participants were categorized into 3 groups: non-smokers (NS; n = 212), former smokers (FC; n = 66), and current smokers (CS; n = 72). Complete peri-implant and periodontal examinations were evaluated. Associations between the occurrence of peri-implantitis and smoking habits, as well as potential confounders, were evaluated through univariate and multivariate analyses. RESULTS: The occurrence of peri-implantitis in the NS, FS, and CS groups was 18.2%, 19.7%, and 30.5%, respectively. A high prevalence of the overall number of cases with periodontitis (54.2%) was observed in the CS group when compared to the FS and NS groups. After adjusting for confounders, the odds ratio (OR) for the occurrence of peri-implantitis was 2.63 (1.39-6.77; p < 0.001) for CS compared to NS. There was a significant dose-response relationship between pack/year of smoking and the occurrence of peri-implantitis, as well as a significant decrease in the risk as the years of smoking cessation increased. CONCLUSIONS: The occurrence of peri-implantitis among CS was high. The cumulative smoking exposure in an incremental manner and the shorter smoking cessation span was directly associated with a higher risk for peri-implantitis. CLINICAL RELEVANCE: Educational and preventive strategies in general health services must attempt to reduce the adverse effects of cumulative smoking exposure and to explore the beneficial effects of smoking cessation on peri-implant status.

Association between liver cirrhosis and peri-implant diseases: a case-control study on implant- and patient-related risk factors.

OBJECTIVE: The objective of this study was to evaluate the potential association between liver cirrhosis and peri-implant diseases, as well as the influence of different risk indicators on this association. METHODS: This case-control study included 64 cases with liver cirrhosis and 128 controls without liver diseases that presented the same socio-demographic and economic profile. The specific inclusion criteria were the following: aged group of 35-55 years and presenting at least one osseointegrated implant functioning for >5 years. A full-mouth peri-implant and periodontal examination was performed and risk variables were recorded. The association between risk variables and the occurrence of peri-implant diseases was tested through univariate analysis and multivariate logistic regression, stratified by alcohol status. Additionally, a mediation analysis was performed to examine the mediating effect of age with peri-implantitis. RESULTS: A high prevalence of peri-implantitis (29.7%) was observed among cases when compared to controls (18.0%). Individuals with cirrhosis presented ~2.5 higher chance of having peri-implantitis than controls (p<0.001). Significant variables associated with the occurrence of peri-implantitis in the final logistic model were the following: cirrhosis, alcohol use, age (>55 years), male sex, smoking, periodontitis, and number of ≤14. CONCLUSIONS: An important risk association between liver cirrhosis and peri-implantitis was reported. Future studies with a larger sample size controlling for the patient- and implant-related confounders are needed to better understand the link between peri-implantitis and liver cirrhosis. CLINICAL RELEVANCE: Cirrhosis individuals, age, and periodontitis, as well as alcohol use and smoking interaction, should be considered as potential risk indicators for peri-implantitis.

Periodontitis in individuals with liver cirrhosis: A case-control study.

AIM: The aim of this study was to evaluate the association between liver cirrhosis and periodontitis. METHODS: This case-control study included 294 individuals, 98 cases with liver cirrhosis and 196 controls. A full-mouth periodontal examination was performed and plaque index, probing depth, clinical attachment level and bleeding on probing were recorded. The association of risk variables with periodontitis was tested through univariate analysis and multivariate logistic regression, stratified by alcohol status. RESULTS: A high prevalence of periodontitis was observed among cases (62.2%) when compared to controls (41.8%). Individuals with cirrhosis presented a chance ~2 higher of having periodontitis than controls (OR = 2.28; 95% CI 1.39-3.78; p < .001). Significant variables associated with periodontitis in the final logistic models were as follows: (a) no/occasional alcohol use model-number of teeth up 14, age ≥45-55 years, male sex and smoking; (b) moderate and intensive alcohol use models-cirrhosis, number of teeth up 14, age ≥45-55 years, male sex and smoking. CONCLUSIONS: An important risk association between liver cirrhosis and periodontitis was observed. Additionally, the intensive alcohol use significantly increased the risk for periodontitis.

Surgical and Non-Surgical Procedures Associated with Recurrence of Periodontitis in Periodontal Maintenance Therapy: 5-Year Prospective Study.

BACKGROUND AND OBJECTIVE: Prospective studies that investigated the influence of surgical and nonsurgical procedures in the recurrence of periodontitis and tooth loss in periodontal maintenance therapy (PMT) programs have not been previously reported. The objective of this study was to evaluate longitudinally the recurrence of periodontitis in regular compliers (RC) and irregular compliers (IC) individuals undergoing surgical and non-surgical procedures over 5 years in a program of PMT. MATERIALS AND METHODS: A total of 212 individuals participated in this study. Full-mouth periodontal examination including bleeding on probing, probing depth, and clinical attachment level were determined at all PMT visits over 5 years. The recurrence of periodontitis was evaluated in RC and IC individuals undergoing surgical and non-surgical procedures in PMT. The influences of risk variables of interest were tested through univariate analysis and multivariate logistic regression. RESULTS: Recurrence of periodontitis was significantly lower among RC when compared to IC. Individuals with recurrence of periodontitis and undergoing surgical procedures showed higher probing depth and clinical attachment loss than those who received non-surgical procedures. Recurrence of periodontitis was higher in individual undergoing surgical procedures and irregular compliance during PMT. CONCLUSIONS: Irregular compliance and surgical procedures in individuals undergoing PMT presented higher rates of recurrence of periodontitis when compared to regular compliant patients undergoing non-surgical procedures.

Gingival volume measurement through the analysis of tooth crown area: a digital and computed method.

This paper presents a method for measuring gingival volume through the analysis of the tooth crown area of anterior teeth using digital photographs and computer analysis. Three photographs were taken and manipulated to simulate gingival overgrowth to perform a numeric correlation of change in gingival volume. The proposed method is easy, noninvasive, and provides rich data for statistical analysis or clinical classification of the gingival condition.

Risk variables of external apical root resorption during orthodontic treatment

INTRODUCTION: External apical root resorption (EARR) is an adverse outcome of the orthodontic treatment. So far, no single or associated factor has been identified as responsible for EARR due to tooth movement. OBJECTIVE: This study investigated the association of risk variables (age, gender, extraction for orthodontic treatment and Angle classification) with EARR and orthodontic treatment. METHOD: The sample (n=72) was divided into two groups according to presence (n=32) or absence (n=40) of EARR in maxillary central and lateral incisors after orthodontic treatment. RESULTS: There were no statistically significant differences in EARR according to age, gender, extraction or type of malocclusion (p>0.05). CONCLUSION: The risk variables examined were not associated with EARR in the study population.

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.

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.

Aspectos epidemiológicos, microbiológicos e imunológicos da associação entre alcoolismo e periodontite / Epidemiological, microbiological and immunological aspects of association between alcoholism and periodontitis

As doenças periodontais reúnem um grupo de doenças infeciosas, que resultam da interação entre os biofilmes supra e subgengival e a resposta imuno-inflamatória gerada pelo hospedeiro. Diversos fatores e variáveis de risco podem interferir e modular a relação entre o desafio microbiano e a resposta do hospedeiro. Embora pouco investigado e com dados conflitantes o alcoolismo é um fator comportamental associado à doença periodontal. Adicionalmente, pouco se conhece sobre a sua interferência na resposta microbiana e imunológica frente à periodontite. Neste sentido, este estudo se justifica por buscar maiores esclarecimentos da influência do consumo de álcool na gravidade e susceptibilidade as doenças periodontais. Assim, esta pesquisa objetiva determinar as condições periodontais, perfil epidemiológico, microbiológico e imunológico entre usuários, dependentes e não dependentes de bebidas alcoólicas...

Association of functional gene polymorphism IL-1beta in patients with external apical root resorption.

INTRODUCTION: External apical root resorption (EARR) is a frequent complication of orthodontic treatment. Interleukin 1beta (IL-1beta) is a potent stimulus for bone resorption and osteoclastic cell recruitment during orthodontic tooth movement. The purpose of this study was to assess the association between a polymorphism in the IL-1beta genes and EARR during orthodontic treatment. METHODS: The sample included 61 Brazilian orthodontic patients, divided into 2 groups according to the presence (affected group, n = 23) or absence (control group, n = 38) of EARR in the central and lateral maxillary incisors in the posttreatment period. DNA was obtained from buccal swab cells. The polymorphism was analyzed by the polymerase chain reaction followed by digestion with restriction enzyme. The polymerase chain reaction products were analyzed in 10% polyacrylamide gel and stained with silver. RESULTS: There were significant statistical differences (P <0.05) among the frequencies of the alleles and genotypes of the IL-1beta gene polymorphism between the affected and unaffected groups, suggesting that allele 1 predisposed the subjects to EARR (odds ratio = 4.0). CONCLUSIONS: The polymorphism of the IL-1beta gene is associated with root resorption in the studied population.

Revisão comparativa de terapias com enxertos autógenos e alógenos com osso fresco congelado / Comporative analysis of therapies with autogenous grafts and allogenous grafts with frozen fresh human bone

Na Odontologia, os enxertos autógenos envolvem técnicas cirúrgicas que podem apresentar grande previsibilidade. Já consagrados pela literatura, são considerados o padrão ouro. Têm o objetivo de reparar a anatomia local, possibilitando a reabilitação bucal com implantes e, assim, reconstituir a estética e a função. Porém, a necessidade de uma área doadora os torna mais complexos e com maior risco de morbidade. Para os enxertos alógenos (homoenxertos ou enxertos com osso fresco congelado), o tecido doado advém de um banco de ossos que é responsável pela captação, processamento, análise, conservação e distribuição dos tecidos. Os bancos de tecidos são regulamentados pelo Ministério da Saúde e seguem orientações da American Association Tissue Bank (AATB). A normalização dos bancos de ossos é fundamental, pois toda a fase de processamento, desde a captação até a distribuição, determina sua segurança para uso: o congelamento reduz o potencial antigênico; a seleção do material, testes sorológicos e análise do doador determinam um tecido saudável livre de microorganismos. Assim, os homoenxertos, por apresentarem uma menor complexidade cirúrgica, menor risco de morbidade e por estarem apresentando resultados promissores para cirurgias pré-implantológicas, merecem mais pesquisas para que sua previsibilidade e segurança sejam também consagradas.

Histopathological and morphological alterations of periodontium in rats treated with tacrolimus and cyclosporine.

OBJECTIVE: To evaluate and compare the possible morphological and histopathological changes in gingival tissue of rats under the administration of cyclosporine and tacrolimus. The present study was motivated by the high prevalence of gingival overgrowth observed in subjects under cyclosporine regimens and by studies reporting a significant decrease in gingival overgrowth after the substitution of tacrolimus. METHODS: Five Sprague-Dawley rat groups were administered therapeutic and greater-than-therapeutic doses of cyclosporine and tacrolimus over 54 days. The control group of 10 animals received distilled water as a placebo. The cyclosporine group was divided into two subgroups of 10 animals each, one receiving 10 mg/kg/day (CsA1) and one receiving 30 mg/kg/day (CsA2). The tacrolimus group was also divided in two subgroups of 10 animals each, receiving 3.2 mg/kg/day (Tcr1) or 6.4 mg/kg/day (Tcr2). RESULTS: Gingival overgrowth was higher in the group that was administered the higher cyclosporine dosage (CsA2) than in the group that received the therapeutic dosage, showing a positive relation between dosage and severity of gingival overgrowth. Hypercellularity, vascular congestion and focal inflammatory exudation were observed in the CsA2 subgroup only. There were no morphological or histological alterations in gingival tissue in either tacrolimus subgroups. CONCLUSION: Cyclosporine can induce adverse morphological and histopathological changes in gingival tissue of rats, and these effects are dose-dependent. Tacrolimus induced no gingival alterations in this rat model.

Demographic, pharmacologic, and periodontal variables for gingival overgrowth in subjects medicated with cyclosporin in the absence of calcium channel blockers.

BACKGROUND: The role of cyclosporin in the absence of calcium channel blockers and the associated risk variables of development and severity of gingival overgrowth have not yet been properly established. The present study was conducted to determine the effect of potential risk variables for gingival overgrowth severity in Brazilian renal transplant subjects medicated with cyclosporin in the absence of any calcium channel blockers. METHODS: A cross-sectional study was conducted in a public hospital in Belo Horizonte, Brazil. Demographic, pharmacologic, and periodontal data, recorded from 194 subjects taking cyclosporin in the absence of calcium channel blockers, were analyzed using independent sample t, chi2 statistic, or Mann-Whitney U tests. The effects of potential risk variables of gingival overgrowth severity were determined using backward stepwise regression analysis. RESULTS: The prevalence of clinically significant gingival overgrowth was 34.5% (N = 67). These subjects presented a significantly higher papillary bleeding index and a higher plaque index compared to those without clinically significant gingival overgrowth. When all demographic, pharmacologic, and periodontal data were evaluated in relation to gingival overgrowth severity, time since transplant, papillary bleeding index, serum cyclosporin concentration, and prednisolone and azathioprine dosages were significant in the univariate modeling (P <0.05) and remained significant when evaluated in the multivariate modeling (P <0.0001; adjusted R2 = 39.4%). CONCLUSIONS: In the absence of calcium channel blockers, this study showed that pharmacologic variables, such as cyclosporin serum concentration, prednisolone and azathioprine dosages, and time since transplant, are strongly related to gingival overgrowth. In addition, the periodontal variable papillary bleeding index highlighted the primary role of inflammation on the pathogenesis and severity of gingival overgrowth.

Comportamento do tecido gengival nos indivíduos em uso de ciclosporina: revisão de literatura / Behavior of gingival tissue in patients under cyclosporin use: a literature review

Baseado em revisão de literatura, este estudo tem, como principal objetivo, esclarecer e demonstrar aos profissionais da área odontológica quais as alterações causadas pela ciclosporina nos tecidos periodontais, como tratá-las e como preveni-las. A ciclosporina é um imunossupressor seletivo largamente utilizado na área médica em pacientes transplantados e está associada ao crescimento gengival na maior parte de seus usuários. Alguns estudos mostram que a maior incidência destas alterações ocorre em crianças e adolescentes. Na literatura, discute-se sobre quais são as alterações histológicas ocorridas no tecido periodontal. O crescimento gengival tem sido relacionado ao aumento de fibroblastos, decréscimo de colagenase, exacerbação da inflamação causada pela placa bacteriana, dentre outros. A prevalência das alterações nos tecidos periodontais pode estar associada a múltiplos fatores, como a susceptibilidade individual, a concentração da droga no plasma, a idade, o sexo, o índice de higiene bucal e a presença de irritantes locais...