Osteogenic cells transfer improving root coverage: A randomized clinical trial.

BACKGROUND AND OBJECTIVE: The aim of this interventional, parallel-assignment, single-blinded, randomized, efficacy study was to investigate the efficacy of the treatment of gingival recessions by osteogenic cell transfer. This is the first randomized clinical trial of this nature. MATERIAL AND METHODS: Treatment of Miller class I or II gingival recessions >4 mm was randomly defined by casual sorting and performed by newly forming bone graft (NFBG) and coronally advanced flap (CAF) or subepithelial connective tissue graft (SCTG) and CAF (control). Clinical examinations were performed by a single blinded examiner at baseline and at 3, 6, and 9 months after surgery. Parameters investigated were recession height (REC), probing depth (PD), clinical attachment level, gingival bleeding index (GBI), plaque index (PlI), and keratinized gingiva width (KGW). RESULTS: Both techniques achieved similar percentage of root coverage, but NFBG was more effective in pocket depth reduction, attachment level gain, and reduction of plaque accumulation and of bleeding on probing. CONCLUSIONS: These findings suggest that the transfer of osteogenic cells by NFBG is able to improve clinical attachment level and to cover denuded roots. NFBG can be used as an alternative treatment of deep recessions (≥4 mm), where the restoration of lost periodontal tissues is intended.

Role of occlusion in periodontal disease.

This article deals with establishing a new link between trauma from occlusion and periodontal pockets based on the know-how and background gradually developed. To provide a better understanding to the reader, a historical perspective is firstly presented. The main features on the controversy of the role played by trauma from occlusion on the physiologic behavior of the periodontal structures are shown, together with how deviations from the normal characteristics of this relationship itself affect the integrity of the periodontal tissues when or associated with dental biofilm in the presence or not of periodontal pockets have arisen. The literature provides evidence showing that the very first publication to establish a strong correlation between trauma from occlusion and periodontal pockets in humans was of Latin-American origin. However, subsequently, trauma from occlusion was mostly evaluated by an American group, followed by a Scandinavian group, yet with some contributions from the Latin-American group. Basically trauma from occlusion has been correlated with periodontal pockets in view of the fact that these would render the periodontal supporting tissues more amenable to the spread of inflammation of biofilm-related periodontal pockets. This would facilitate the fast deepening of periodontal pockets, influencing the generation of infrabony periodontal pockets or suprabony periodontal pockets that are deeper than in areas without trauma from occlusion. The factors related to these different behaviors are discussed. Several clinical cases are presented showing evidence that corroborates the possibility of an actual interrelationship between trauma from occlusion and periodontitis. Theoretical evaluations based on recent advances of the mechanisms involving molecular modulation in physiological and altered occlusal functions, as well as on research data, and evaluations from data of clinical cases, support the assumption that trauma from occlusion and periodontitis may embrace the unique pathologic condition of the associated lesion trauma from occlusion plus periodontitis or act independently even if both co-exist simultaneously in a particular case. The link between both conditions that was emphasized as definitively necessary in order for an associated lesion to develop is that both lesions, namely trauma from occlusion and periodontitis, occur in their destructive stage at exactly the same time. This involvement would explain why so many different data are presented in the literature and hopefully will shed some light for development of new methodologies of research. Clinical cases were selected to present a treatment philosophy on the subject.

Isolation and characterization of progenitor cells from surgically created early healing alveolar defects in humans: A preliminary study.

BACKGROUND: The granulation tissue present in surgically-created early healing sockets has been considered as a possible source of osteoprogenitor cells for periodontal regeneration, as demonstrated in animal studies. However, the in vitro osteogenic properties of tissue removed from human surgically-created early healing alveolar defects (SC-EHAD) remains to be established, being that the aim of this study. METHODS: Surgical defects were created in the edentulous ridge of two systemically healthy adults. The healing tissue present in these defects was removed 21 days later for the establishment of primary culture. The in vitro characteristics of the cultured cells were determined by Armelin method, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, immunohistochemistry, alkaline phosphatase (ALP) activity, mineralization assay, and flow cytometry for detection of stem cells/osteoprogenitor cell markers. RESULTS: Cells were able to adhere to the plastic and assumed spindle-shaped morphology at earlier passages, changing to a cuboidal one with increasing passages. Differences in the proliferation rate were observed with increasing passages, suggesting osteogenic differentiation. ALP and mineralization activities were detected in conventional and osteogenic medium. Fresh samples of SC-EHAD tissue exhibited CD34- and CD45- phenotypes. Cells at later passages (14th) exhibited CD34- , CD45- , CD105- , CD166- , and collagen type I+ phenotype. CONCLUSION: Tissue removed from SC-EHAD is a possible source of progenitor cells.

Extrusão ortodôntica de dentes condenados para reconstrução da arquitetura óssea tridimensional previamente à instalação de implantes osseointegrados ­ Análise crítica da literatura / Orthodontic extrusion of hopeless teeth for reconstruction of three-dimensional bone architeture prior to dental implant placement ­ a critical analysis of literature

Objetivo: o objetivo desta revisão sistemática foi investigar se a condição periodontal do defeito ao redor de dentes condenados à extração, por meio de extrusão ortodôntica para reconstrução da arquitetura óssea previamente à instalação de implantes, influencia a qualidade estética final. Material e métodos: estudos relatando extrusão ortodôntica para extração de dentes e posterior instalação de implantes, acompanhados por diferentes períodos após a instalação das próteses, foram considerados elegíveis. A busca por artigos, a extração de dados e a avaliação da estética foram realizadas por examinadores independentes. A condição periodontal inicial foi classificada em tipos, a partir das radiografias iniciais presentes nos estudos: I) sem perda óssea; II) até 75%; III) até 50%; IV) até 25%; ou V) menos de 25% de inserção remanescente. A fotografia final dos casos foi analisada de acordo com o índice de estética rosa (IER). Resultados: a busca no PubMed e Scopus resultou em 453 artigos, dois quais 394 foram excluídos pelo título e 41 por não atender aos critérios de inclusão, restando 18 artigos analisados. Não houve diferença estatisticamente significante no IER observado nos diferentes tipos de defeitos periodontais iniciais (Kruskal-Wallis, p=0,17). Conclusão: esses achados sugerem que a inserção residual existente previamente à extração de dentes por meio de extrusão ortodôntica não influencia a estética final do caso, devido à reconstrução dos tecidos gengival e ósseo, favorecendo o posicionamento ideal dos implantes.

Objective: the aim of this critical analysis of literature was to investigate if the periodontal status of defects surrounding hopeless teeth submitted to extraction by orthodontic extrusion prior to implant installation interfere at the final aesthetic outcome. Material and methods: studies describing this procedure followed by different periods after prosthesis installation were considered eligible. Search, data extraction and aesthetic evaluation were made by independent examiners. Inicial periodontal status was classified in types according inicial radiographs presented on studies: I) without bone loss; II) up to 75%; III) up to 50%; IV) up to 25%; or V) less than 25% remaining insertion. Cases' final photographs were evaluated according the pink aesthetics index (PAI). Results: the search in PubMed and Scopus resulted in 453 papers of which 394 were excluded by title and 41 for not fulfill the inclusion criteria, remaining 18 papers for analysis. No statistical significance difference on PAI was observed at different inicial periodontal defects (Kruskal-Wallis, p=0.17). Conclusion: these findings suggest that the residual insertion existent prior to tooth extraction through orthodontic extrusion do not influence the aesthetic outcome because of the reconstruction of the gingival and bone tissues, favoring an optimal site for implant positioning.

Occlusal trauma and mucositis or peri-implantitis?

BACKGROUND AND OVERVIEW: The aim of this study was to describe the effects of bruxism in peri-implant bone loss 6 years after the placement of a successful implant-supported prosthesis, to describe its treatment, and to propose a differential diagnosis of the lesion. CASE DESCRIPTION: A 62-year-old, nonsmoking, systemically healthy partially edentulous woman received 2 osseointegrated implants in the mandibular left region, which supported a 3-element fixed prosthesis. Six years later, the patient reported the development of bruxism. Clinical examination results indicated bleeding on probing, deepening of the peri-implant sulcus, and marginal soft-tissue overgrowth. Radiographic images suggested peri-implant bone loss. The authors diagnosed the lesion as trauma from occlusion and mucositis. Treatment involved anti-infective therapy and the use of a bite platform, resulting in bone recovery after 10 months. These results were maintained for 4 years. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Considering the existing contradictions in the literature, this case highlights the role of trauma from occlusion in the onset, progression, and treatment of lesions produced by occlusal overload around osseointegrated implants. In addition, it provides clinical background on the outcomes of anti-infective therapy associated with the use of a bite platform in the treatment of combined lesions of mucositis and trauma from occlusion in osseointegrated implants.

Lasers in periodontal therapy.

About 50 years ago, lasers started to be used in periodontal treatment following evidence that wounds produced in animals healed more quickly after being irradiated with low-intensity lasers. Increased production of growth factors, stimulated mainly by red and infrared lasers, may participate in this process by influencing the behavior of various types of cells. High-intensity lasers have been used as an alternative to nonsurgical periodontal therapy in root biomodification and to reduce dentin hypersensivity; low-intensity lasers are frequently employed to improve tissue repair in regenerative procedures and in antimicrobial photodynamic therapy. Despite the abundance of promising data on the advantages of their use, there is still controversy regarding the real benefits of lasers and antimicrobial photodynamic therapy in periodontal and peri-implant treatment. A huge variation in the parameters of laser application among studies makes comparisons very difficult. An overview of the current concepts and findings on lasers in periodontal therapy is presented with emphasis on data collected from Latin-American researchers.

Demineralization of the contacting surfaces in autologous onlay bone grafts improves bone formation and bone consolidation.

BACKGROUND: Autologous bone grafts are usually well consolidated after 4 to 5 months but can be incompletely interlocked with the native bone. This study investigated the effect of acid demineralization of the graft-bed interface on graft consolidation. METHODS: Onlay bone grafts were performed on the calvaria of 36 guinea pigs. Half of the animals had the graft-bed contacting surfaces demineralized with 50% citric acid (pH 1.0) for 3 minutes (test group). The other half received no demineralization (control group). The bone grafts were immobilized by a resorbable membrane glued to the recipient bed with cyanoacrylate. After 7, 30, and 90 days, specimens (n = 6) were obtained for light microscopy. Data from qualitative analysis and computerized histomorphometry were statistically processed at a significance level of 5%. RESULTS: Osteogenesis was not seen at the interface after 7 days. After 30 days, the test group showed 34.39% ± 13.4% of the interface area filled with mineralized tissue, compared to 17.14% ± 8.6% in the control group (P = 0.026). After 90 days, the mean percentages of mineralized tissue at the interface in the test and control specimens were 54.00% ± 11.23% and 38.65% ± 7.76% (P = 0.041), respectively. Within groups, a higher percentage of the area filled with mineralized tissue was seen at 90 days compared to 30 days (P = 0.004 for control and 0.041 for test). CONCLUSIONS: Demineralization of the contacting surfaces between autologous bone graft and bone bed improved new bone formation and bone consolidation. These data need to be confirmed in humans.

Matriz colágena suína no recobrimento radicular e aumentoda faixa de gengiva ceratinizada: revisão sistemática da literatura / Porcine collagen matrix in root coverage and increase of keratinized gingiva width: a systematic literature review

Objetivo: avaliar a eficácia da matriz colágena suína (MC) no recobrimento radicular (RR) e aumento da fai-xa de gengiva ceratinizada (CGC) ao redor de dentes e de implantes. Métodos: foram investigados no MEDLI-NE ensaios clínicos randomizados comparando a eficá-cia da MC ao enxerto de conjuntivo subepitelial (ECS) e/ou deslize coronal de retalho (DCR) para RR e com-parando a MC ao ECS ou enxerto gengival livre (EGL) para aumento da CGC. Os desfechos primários inves-tigados foram: recobrimento radicular completo (RRC), percentual médio de recobrimento radicular (%REC) e aumento da CGC. A seleção, avaliação e extração de dados dos artigos foram realizadas por dois revisores independentemente. Resultados: foram identificados no total 20 artigos para análise, dos quais sete foram in-cluídos. Destes, quatro avaliaram a eficácia da MC no RR comparativamente ao DCR combinado ou não ao ECS, observando-se em três estudos maior RRC e %REC no grupo controle do que no grupo teste. Três artigos avaliaram a eficácia da MC no aumento da CGC com-parativamente ao enxerto gengival livre (EGL) e ECS, observando-se aumento significativo do CGC nos dois grupos (p < 0.05), sem diferenças entre eles (p > 0.05). A MC resultou em igual ou superior mescla de cor e tex-tura com os tecidos adjacentes, menor tempo cirúrgico e morbidade pós-operatória. Conclusões: esses dados sugerem que a MC é eficaz no aumento da faixa de gengiva ceratinizada ao redor de dentes e implantes, podendo ser utilizada ainda como alternativa ao ECS no RR para redução da morbidade pós-operatória e tempo cirúrgico.

Laser therapy as an effective method for implant surface decontamination: a histomorphometric study in rats.

BACKGROUND: To the best of the authors' knowledge, a standard protocol for treating peri-implantitis is not yet established. METHODS: A total of 150 titanium disks with smooth or rough surfaces contaminated with microbial biofilm were implanted subcutaneously in rats after undergoing one of three treatments: 1) low-intensity laser (LIL); 2) antimicrobial photodynamic therapy (aPDT); or 3) toluidine blue O (TBO). Sterile and contaminated disks served as negative (NC) and positive (C) control groups, respectively. After days 7, 28, and 84, tissue inflammation was evaluated microscopically by measuring the density of collagen fibers (degree of fibrosis) and concentration of polymorphonuclear neutrophils. RESULTS: Surface texture did not affect the degree of inflammation, but the area of reactive tissue was significantly greater for rough implants (2.6 ± 3.7 × 10(6) µm(2)) than for smooth ones (1.9 ± 2.6 × 10(6) µm(2); P = 0.0377). Group C presented the lowest and group NC presented the highest degree of fibrosis with significance only after day 7; these groups had the highest and lowest scores, respectively, for degree of inflammation. Group C showed the largest area of reactive tissue (9.11 ± 2.10 × 10(6) µm(2)), but it was not significantly larger than group LIL (P = 0.3031) and group TBO (P = 0.1333). Group aPDT showed the smallest area (4.34 ± 1.49 × 10(6) µm(2)) of reactive tissue among the treatment groups. After day 28, groups LIL, aPDT, TBO, and C resembled group NC in all the studied parameters. CONCLUSION: Group aPDT showed more favorable results in parameter area of reactive tissue than the other methods after day 7, but over longer time periods all methods produced outcomes equivalent to sterile implants.

Newly forming bone graft: a novel surgical approach to the treatment of denuded roots.

UNLABELLED: Many techniques have been proposed for root coverage. However, none of them presents predictable results in deep and wide recessions. OBJECTIVES: The aim of this case series report is to describe an alternative technique for root coverage at sites showing deep recessions and attachment loss >4 mm at buccal sites. MATERIAL AND METHODS: Four patients presenting deep recession defects at buccal sites (>4 mm) were treated by the newly forming bone graft technique, which consists in the creation of an alveolar socket at edentulous ridge and transferring of granulation tissue present in this socket to the recession defect after 21 days. Clinical periodontal parameters, including recession depth (RD), probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), plaque index (PI) and keratinized gingiva width (KGW) were evaluated by a single examiner immediately before surgery and at 1, 3, 6 and 9 months postoperatively. RESULTS: All cases showed reduction in RD and PD, along with CAL gain, although no increase in KGW could be observed. These findings suggest that the technique could favor periodontal regeneration along with root coverage, especially in areas showing deep recessions and attachment loss.

Influence of combined oral contraceptives on the periodontal condition.

UNLABELLED: Most studies investigating the impact of oral contraceptives have been performed some years ago, when the level of sexual hormones was greater than the actual formulations. OBJECTIVE: The aim of this study was to evaluate the effects of current combined oral contraceptives (COC) on periodontal tissues, correlating the clinical parameters examined with the total duration of continuous oral contraceptive intake. MATERIAL AND METHODS: Twenty-five women (19-35 years old) taking combined oral contraceptives for at least 1 year were included in the test group. The control group was composed by 25 patients at the same age range reporting no use of hormone-based contraceptive methods. Clinical parameters investigated included pocket probing depth (PD), clinical attachment level (CAL), sulcular bleeding index (SBI) and plaque index (Pl.I). Data were statistically evaluated by unpaired t test, Pearson's correlation test and Spearman's correlation test. RESULTS: The test group showed increased PD (2.228±0.011 x 2.154±0.012; p<0.0001) and SBI (0.229±0.006 x 0.148±0.005, p<0.0001) than controls. No significant differences between groups were found in CAL (0.435±0.01 x 0.412±0.01; p=0.11). The control group showed greater Pl.I than the test group (0.206±0.007 x 0.303±0.008; p<0.0001). No correlation between the duration of oral contraceptive intake, age and periodontal parameters was observed. CONCLUSIONS: These findings suggest that the use of currently available combined oral contraceptives can influence the periodontal conditions of the patients, independently of the level of plaque accumulation or total duration of medication intake, resulting in increased gingival inflammation.

Newly forming bone graft: a novel surgical approach to the treatment of denuded roots

Many techniques have been proposed for root coverage. However, none of them presents predictable results in deep and wide recessions. OBJECTIVES: The aim of this case series report is to describe an alternative technique for root coverage at sites showing deep recessions and attachment loss >4 mm at buccal sites. MATERIAL AND METHODS: Four patients presenting deep recession defects at buccal sites (>4 mm) were treated by the newly forming bone graft technique, which consists in the creation of an alveolar socket at edentulous ridge and transferring of granulation tissue present in this socket to the recession defect after 21 days. Clinical periodontal parameters, including recession depth (RD), probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), plaque index (PI) and keratinized gingiva width (KGW) were evaluated by a single examiner immediately before surgery and at 1, 3, 6 and 9 months postoperatively. RESULTS: All cases showed reduction in RD and PD, along with CAL gain, although no increase in KGW could be observed. These findings suggest that the technique could favor periodontal regeneration along with root coverage, especially in areas showing deep recessions and attachment loss.

Influence of combined oral contraceptives on the periodontal condition

Most studies investigating the impact of oral contraceptives have been performed some years ago, when the level of sexual hormones was greater than the actual formulations. Objective: The aim of this study was to evaluate the effects of current combined oral contraceptives (COC) on periodontal tissues, correlating the clinical parameters examined with the total duration of continuous oral contraceptive intake. Material and methods: Twenty-five women (19-35 years old) taking combined oral contraceptives for at least 1 year were included in the test group. The control group was composed by 25 patients at the same age range reporting no use of hormone-based contraceptive methods. Clinical parameters investigated included pocket probing depth (PD), clinical attachment level (CAL), sulcular bleeding index (SBI) and plaque index (Pl.I). Data were statistically evaluated by unpaired t test, Pearson’s correlation test and Spearman’s correlation test. Results: The test group showed increased PD (2.228±0.011 x 2.154±0.012; p<0.0001) and SBI (0.229±0.006 x 0.148±0.005, p<0.0001) than controls. No significant differences between groups were found in CAL (0.435±0.01 x 0.412±0.01; p=0.11). The control group showed greater Pl.I than the test group (0.206±0.007 x 0.303±0.008; p<0.0001). No correlation between the duration of oral contraceptive intake, age and periodontal parameters was observed. Conclusions: These findings suggest that the use of currently available combined oral contraceptives can influence the periodontal conditions of the patients, independently of the level of plaque accumulation or total duration of medication intake, resulting in increased gingival inflammation.

A desmineralização de enxertos ósseos autógenos onlay pode melhorar suas propriedades mecânicas: estudo biomecânico e por mev / Biomechanical and SEM studies on the demineralization of onlay bone grafts: implications on mechanical properties

Enxertos ósseos autógenos onlay são amplamente utilizados para reconstrução de rebordos alveolares severamente reabsorvidos para possibilitar a reabilitação oral com implantes. Métodos de tratamento da interface enxerto/leito (IEL) têm sido propostos para melhorar o potencial de consolidação e diminuir a taxa de reabsorção desses enxertos. Este estudo avaliou o efeito da desmineralização com EDTA sobre as propriedades mecânicas da IEL. Foram realizados enxertos ósseos nas tíbias de coelhos após um dos seguintes tratamentos da IEL: desmineralização com EDTA pH neutro a 24% por três minutos (G-EDTA); o mesmo tratamento de G-EDTA associado a perfurações do leito receptor (G-EDTA-P); apenas perfurações do leito (G-P); nenhum tratamento da interface (G-C). Após 90 dias, blocos ósseos contendo os enxertos foram removidos, preparados e submetidos a testes mecânicos de determinação da resistência à tração (RT) e módulo de elasticidade (E) em máquina de ensaio universal. Os resultados para RT foram: G-C= 2,08 ± 1,20 MPa; G-EDTA = 2,03 ± 0,97 MPa; G-EDTA-P = 1,97 ± 0,79 MP; G-P = 1,82 ± 0,80 MPa (p = 0,819). Os valores médios para E foram: G-C = 38,80 ± 22,72 MPa; G-EDTA P = 26,24 ± 14,17 MPa; G-EDTA = 25,11 ± 9,89 MPa; G-P = 17,51 ± 7,94 MPa, com diferença estatística apenas entre o G-C e os demais (Anova; Tukey; p = 0,05). A microscopia eletrônica de varredura evidenciou que todas as fraturas ocorreram na IEL. Concluiu-se que a desmineralização por EDTA não interfere na RT da interface e que tanto a desmineralização como a perfuração parecem resultar em melhor comportamento elástico da interface frente à inserção de implantes.

Autogenous onlay bone grafts are widely used to reconstruct severely resorbed alveolar processes for oral implant rehabilitation purposes and efforts have been directed to maximize its consolidation to the bone bed and diminish its resorption rate. This study evaluated the effect of EDTA demineralization at the bone bed/bone graft contacting surfaces and its effect on biomechanical properties. Onlay bone grafts were performed on rabbits’ tibia after one of the following treatments: demineralization with 24% EDTA for 3 minutes (G-EDTA); the same treatment of G-EDTA associated to perforations of the recipient bed (G-EDTA-P); perforations of the recipient bed only (G-P), and no treatment at the interface (G-C). After 90 days, bone blocks containing the grafts were retrieved, prepared, and undergone to ultimate tensile strength test (UTS) and Young modulus (E). The UTS mean values were: (G-C) = 2.08 ± 1.2 MPa; (G-EDTA) = 2.03 ± 0.97 MPa; (G-EDTA-P) = 1.97 ± 0.79 MPa, and (G-P) = 1.82 ± 0.80 MPa (p=0.819). The E mean values were: (G-C) = 38.80 ± 22.72 MPa, (G-EDTA-P) = 26.24 ± 14.17 MPa, (G-EDTA) = 25.11 ± 9.89 MPa, and (G-P) = 17.51 ± 7.94 MPa, with statistically significant differences among G-C and the other groups (ANOVA and Tukey´s test; p<0.05). SEM analysis evidenced that all fractures occurred at the bone bed/graft interface. It was concluded that the EDTA demineralization did not interfere in the UTS but demineralization and perforations produced increased deformation of the interface, suggesting a better elastic behavior for implant therapy purposes.

Efeito da contaminação por saliva no condicionamento ácido radicular: estudo microscópico em ratos / Effect of saliva contamination in acid conditioned root: microscopic study in rat subcutaneous tissue

A biomodificação radicular empregando ácido cítrico tem sido muito utilizada em procedimentos que visam à reinserção dos tecidos periodontais a raízes que estiveram expostas à doença periodontal. Ainda que trabalhos in vitro demonstrem efetividade da desmineralização radicular na neutralização de endotoxinas bacterianas, na ampliação das aberturas dos túbulos dentinários e na remoção da smear layer resultante da raspagem, os resultados de trabalhos clínicos frequentemente são discretos e nem sempre suportam uma correspondência com esses resultados laboratoriais favoráveis. Até o momento, não existe uma hipótese comprovada para explicar a aparente incongruência entre estudos in vitro e in vivo. A saliva é uma variável presente apenas nos trabalhos clínicos. Considerando seu potencial de penetração nos túbulos dentinários e de remineralização de superfícies de esmalte e dentina, este estudo teve o propósito de verificar e comparar a biocompatibilidade de fragmentos de raízes dentais humanas tratadas por raspagem manual seguida de desmineralização por ácido cítrico e de raízes que, após esse tratamento, foram contaminadas por saliva e implantados no tecido subcutâneo de ratos. Somente no período de avaliação de três dias, a análise microscópica qualitativa apresentou diferença estatisticamente significativa entre o grupo teste e controle, referente a presença de fibras inseridas e intensidade de infiltrado inflamatório. Baseado nos resultados obtidos nas análises microscópica, qualitativa e quantitativa, concluiu-se que a saliva interfere nos processos iniciais de cicatrização, mas ao longo do tempo os parâmetros de grau de fibrosamento do tecido reacional, presença de fibras inseridas e intensidade de infiltrado inflamatório se equiparam.

Keratinized Gingiva Determines a Homeostatic Behavior of Gingival Sulcus through Transudation of Gingival Crevice Fluid.

Objective. To shed light on the role of KG, its influence on periodontal behavior was investigated. Methods. Tissue fluid transudation was assessed in alveolar mucosa (P1A), outer gingival margin (P1B), at entrance of (P2) and within gingival sulcus (P3), before and after chewing of fibrous food in 16 patients portraying ≥2 mm KG at one tooth (group 1), and <2 mm at another homologous tooth (group 2). Results. There was a significant increase in GCF after chewing at P1B and P3 in group 1 and at P1A in group 2 (t-test, P < 0.05). Conclusions. The results suggest that KG plays a role in marginal periodontal homeostasis.

Comparison among four commonly used demineralizing agents for root conditioning: a scanning electron microscopy.

UNLABELLED: Dental roots that have been exposed to the oral cavity and periodontal pocket environment present superficial changes, which can prevent connective tissue reattachment. Demineralizing agents have been used as an adjunct to the periodontal treatment aiming at restoring the biocompatibility of roots. OBJECTIVE: This study compared four commonly used demineralizing agents for their capacity of removing smear layer and opening dentin tubules. METHODS: Fifty fragments of human dental roots previously exposed to periodontal disease were scaled and randomly divided into the following groups of treatment: 1) CA: demineralization with citric acid for 3 min; 2) TC-HCl: demineralization with tetracycline-HCl for 3 min; 3) EDTA: demineralization with EDTA for 3 min; 4) PA: demineralization with 37% phosphoric acid for 3 min; 5) CONTROL: rubbing of saline solution for 3 min. Scanning electron microscopy was used to check for the presence of residual smear layer and for measuring the number and area of exposed dentin tubules. RESULTS: Smear layer was present in 100% of the specimens from the groups PA and control; in 80% from EDTA group; in 33.3% from TC-HCl group and 0% from CA group. The mean numbers of exposed dentin tubules in a standardized area were: TC-HCl=43.8±25.2; CA=39.3±37; PA=12.1±16.3; EDTA=4.4±7.5 and CONTROL=2.3±5.7. The comparison showed significant differences between the following pairs of groups: TC-HCl and CONTROL; TC-HCl and EDTA; CA and CONTROL; and CA and EDTA. The mean percentages of area occupied by exposed dentin tubules were: CA=0.12±0.17%; TC-HCl=0.08±0.06%; PA=0.03±0.05%; EDTA=0.01±0.01% and CONTROL=0±0%. The CA group differed significantly from the others except for the TC-HCl group. CONCLUSION: There was a decreasing ability for smear layer removal and dentin tubule widening as follows: AC>TC-HCl>PA>EDTA. This information can be of value as an extra parameter for choosing one of them for root conditioning.

Comparison among four commonly used demineralizing agents for root conditioning: a scanning electron microscopy

Dental roots that have been exposed to the oral cavity and periodontal pocket environment present superficial changes, which can prevent connective tissue reattachment. Demineralizing agents have been used as an adjunct to the periodontal treatment aiming at restoring the biocompatibility of roots. OBJECTIVE: This study compared four commonly used demineralizing agents for their capacity of removing smear layer and opening dentin tubules. METHODS: Fifty fragments of human dental roots previously exposed to periodontal disease were scaled and randomly divided into the following groups of treatment: 1) CA: demineralization with citric acid for 3 min; 2) TC-HCl: demineralization with tetracycline-HCl for 3 min; 3) EDTA: demineralization with EDTA for 3 min; 4) PA: demineralization with 37 percent phosphoric acid for 3 min; 5) Control: rubbing of saline solution for 3 min. Scanning electron microscopy was used to check for the presence of residual smear layer and for measuring the number and area of exposed dentin tubules. RESULTS: Smear layer was present in 100 percent of the specimens from the groups PA and control; in 80 percent from EDTA group; in 33.3 percent from TC-HCl group and 0 percent from CA group. The mean numbers of exposed dentin tubules in a standardized area were: TC-HCl=43.8±25.2; CA=39.3±37; PA=12.1±16.3; EDTA=4.4±7.5 and Control=2.3±5.7. The comparison showed significant differences between the following pairs of groups: TC-HCl and Control; TC-HCl and EDTA; CA and Control; and CA and EDTA. The mean percentages of area occupied by exposed dentin tubules were: CA=0.12±0.17 percent; TC-HCl=0.08±0.06 percent; PA=0.03±0.05 percent; EDTA=0.01±0.01 percent and Control=0±0 percent. The CA group differed significantly from the others except for the TC-HCl group. CONCLUSION: There was a decreasing ability for smear layer removal and dentin tubule widening as follows: AC>TC-HCl>PA>EDTA. This information can be of value as an extra parameter for choosing one of them for root conditioning.

Efeitos das drogas ilícitas em saúde periodontal e bucal / Ilegal drug effecte on periodontal and oral health

O consumo de drogas ilícitas tem aumentado no Brasil, sendo que a maconha tem apresentado os maiores índices. Os viciados comumente apresentam graus severos de várias patologias bucais e dentarias, mesmo sendo muito jovens. 0 objetivo desse trabalho foi revisar os efeitos das principais drogas ilícitas na saúde bucal, dando ênfase para a saúde periodontal. Entre as drogas revisadas estão os esteroides anabolizantes que podem estar associados a crescimento mandibular, dores faciais e crescimentos gengivais. A maconha pode ser relacionada com queimaduras na mucosa bucal, xerostomia e diminuição na osseointegração de implantes. A cocaína, devido ao seu alto poder vasoconstrictor, pode causar perfurações no septo nasal e palato duro e necrose na mucosa e osso alveolar quando esfregada na gengiva. 0 uso de anestésicos com vasoconstrictores em dependentes de cocaína é de alto risco no consultório odontológico podendo levar a variações bruscas na pressão arterial. 0 ecstasytem um efeito xerostômico prolongado, além da indução do consumo de bebidas doces, apertamento e bruxismo. Essa combinação resulta em lesões de atrição e erosão que podem chegar ao osso alveolar. De modo geral, todas as drogas causam xerostomia e relapso na higiene bucal e os pacientes apresentam altos índices de cárie, gengivite e doença periodontal. 0 cirurgiào-dentista deve conhecer alguns dos sinais intrabucais para realizar um diagnóstico correto e tentar extrair a verdade do paciente a respeito do uso das drogas, além de aconselhá-lo quanto à cessação do vício.