Detection of misfits at the abutment-prosthesis interface in the esthetic zone: Implications of the radiographic technique and the magnitude of the misfit.

STATEMENT OF PROBLEM: Misfits in the abutment-prosthesis interface represent a setback for implant-supported prostheses. Periapical radiographs have been used as an auxiliary method in the evaluation of prosthesis fit to the abutments; however, the evidence supporting the use of this method is still restricted to studies of low to moderate quality. Furthermore, studies on the diagnostic accuracy of different periapical techniques used to detect misfits in the abutment-prosthesis interface, especially in the esthetic zone, are lacking. PURPOSE: The purpose of this in vitro study was to assess the discrimination power of 3 periapical radiographic techniques in detecting misfits at the abutment-prosthesis interface in the esthetic zone and evaluate whether the magnitude of the misfit influenced the diagnosis. MATERIAL AND METHODS: A total of 15 implants with an internal conical connection were installed in the central incisor region in polyamide jaws. Custom ceramic copings for cemented crowns were made by using a computer-aided design and computer-aided manufacturing (CAD-CAM) system. Misfits of 50, 100, and 150 µm were simulated by interposing 1, 2, or 3 50-µm-thick polyester strips at the abutment-prosthesis interface; the absence of the strip represented the control group. Digital radiographs were obtained by using film holders for the following periapical techniques: bisecting angle (PBA), standard paralleling (PSP), and modified paralleling (PMP). Two radiologists and 1 prosthodontist evaluated a total of 180 radiographs. The values of the area under the receiver operating characteristic curve (Az) were regarded as a measure of diagnostic accuracy and subjected to the Friedman test with post hoc Durbin-Conover (α=.05). RESULTS: The PSP (Az=0.873) had higher Az values than the PBA (Az=0.753) for the 50-µm misfits (P<.05). Larger misfits resulted in greater accuracy than smaller misfits (P<.05). Interactions between the factors radiographic technique and misfit magnitude resulted in statistically significant differences for all comparisons (P<.05), except between the PSP for the 100-µm misfits (Az=0.976) and the PMP for the 150-µm misfits (Az=0.998). CONCLUSIONS: The PSP was more accurate than the PBA in detecting the 50-µm misfits at the abutment-prosthesis interface; larger misfits resulted in more accurate diagnoses, regardless of the technique used.

Manifestações clínicas da disfunção temporomandibular em indivíduos com dentição natural e usuários de prótese total dupla / Clinical manifestations of temporomandibular dysfunction in naturally dented and double total prosthesis users / Expresiones clínicas de disfunción temporomandibular en personas y usuarios dentiados naturales de prostesis doble total

Objetivo: Esta pesquisa teve como objetivo comparar as manifestações clínicas da disfunção temporomandibular (DTM) em indivíduos com dentição natural e usuários de prótese total dupla. Métodos: A amostra do estudo consistiu em 120 participantes, distribuídos em dois grupos de 60 indivíduos cada. O Grupo 1 era composto por pessoas com dentição natural, enquanto o Grupo 2 era composto por indivíduos que utilizavam próteses totais duplas. Para identificar os sinais e sintomas da DTM, foram realizados tanto o índice anamnésico quanto o exame físico específico. Resultados: Os indivíduos que utilizavam prótese total apresentaram um aumento de 2,63 vezes no risco de apresentar dor de ouvido e um aumento de 5,42 vezes de ter limitação do movimento lateral da mandíbula. Por outro lado, os indivíduos com dentição natural apresentaram maior sensibilidade à palpação dos músculos temporal anterior e temporal posterior, além de um risco de 0,27 vezes maior de ter sensibilidade articular. Conclusões: Concluiu-se que os principais sinais clínicos de DTM dos indivíduos dentados naturais foram a sensibilidade à palpação muscular e a sensibilidade à palpação articular e no grupo de desdentados a limitação de movimento lateral da mandíbula e o sintoma de dor de ouvido foram mais frequentes.

Objective: This research aimed to compare the clinical manifestations of temporomandibular dysfunction (TMD) in individuals with natural dentition and users of double total prosthesis. Methods: The study sample consisted of 120 participants, distributed in two groups of 60 individuals each. Group 1 was composed of people with natural dentition, while Group 2 was composed of individuals who used double total prostheses. To identify the signs and symptoms of TMD, both the anamnestic index and the specific physical examination were performed. Results: The individuals who used total prosthesis showed an increase of 2.63 times in the risk of presenting ear pain and an increase of 5.42 times of having limitation of the lateral movement of the jaw. On the other hand, individuals with natural dentition showed greater sensitivity to palpation of the anterior and posterior temporal muscles, in addition to a 0.27 times greater risk of joint tenderness. Conclusions: It was concluded that the main clinical signs of TMD of natural dentate individuals were the sensitivity to muscle palpation and the sensitivity to joint palpation and in the group of toothless individuals the limitation of lateral jaw movement and the ear pain symptom were more frequent.

Propósito: El objetivo de esta investigación fue comparar las manifestaciones clínicas de disfunción temporal (DTM) en individuos con dientes naturales y usuarios de prótesis doble total. Métodos: La muestra de estudio consistió en 120 participantes, distribuidos en dos grupos de 60 individuos cada uno. El grupo 1 estaba formado por personas con dientes naturales, mientras que el grupo 2 estaba formado por individuos con prótesis dobles totales. Para identificar los signos y síntomas de la DTM, se realizó tanto el índice anamésico como el examen físico específico. Resultados: los individuos que utilizaron la prótesis total mostraron un incremento de 2,63 veces en el riesgo de sufrir un dolor de oído y un aumento de 5,42 veces en la limitación del movimiento lateral de la mandíbula. Por otro lado, los individuos con dientes naturales mostraron mayor sensibilidad a la palpación de los músculos temporales anteriores y posteriores, además de un riesgo de 0,27 veces mayor de sensibilidad articular. Conclusiones: Se concluyó que los principales signos clínicos de MSD en sujetos con dientes naturales fueron sensibilidad a la palpación muscular y sensibilidad a la palpación articular y al grupo sin dientes, limitación del movimiento lateral de la mandíbula y síntoma de cefalea fueron más frecuentes.

Influence of chlorhexidine, propolis, pulpal pressure simulation, and aging on dentin bond strength.

The present study evaluated the bond strength (µTBS) of dentin treated with chlorhexidine and propolis subjected to simulated pulpal pressure (SPP) and thermocycle aging. One hundred and twenty healthy human molars were sectioned to obtain 2 mm of dentin thickness and were divided into two groups (n = 60): SPP (15 cm H2 O) and no SPP (Control group). Dentin surfaces were conditioned with 37% phosphoric acid for 15 s and were divided according to the dentin treatment (n = 20): Control; Chlorhexidine gluconate (0.2% for 30 s) and Propolis (aqueous propolis extract for 30 s). Half of the specimens were submitted to 15,000 thermocycle aging (5 ± 2°C and 55 ± 2°C). The samples were sectioned into beams and submitted to µTBS. Data were analyzed by three-way ANOVA (SPP × Dentin treatment × Thermocycle aging) and the Tukey's tests (p < .001). With regard to the SPP, ANOVA revealed that the Control group (32.98 MPa) had significantly higher values of µTBS when compared to the SPP (29.19 MPa). With regard to Thermocycle aging, no aging (34.05 MPa) had significantly higher values of µTBS when compared to the aging (28.12 MPa). With regard to the dentin treatment, Propolis and Chlorhexidine did not statistically influence the results (p > .05). The SPP and thermocycle aging negatively influenced the bond strength between the dentin and resin; the 0.2% chlorhexidine digluconate and aqueous propolis extract solutions did not interfere in the bond strength between the resin and dentin. The use of chlorhexidine and propolis as a dental treatment may not influence the dentin bond strength, but SPP and thermocycle aging may damage the longitudinal dentin bond strength. RESEARCH HIGHLIGHTS: Chlorhexidine and propolis as a dental treatment may not influence the dentin bond strength. Simulated pulpal pressure and thermocycle aging may damage the longitudinal dentin bond strength.

How Water Content Can Influence the Chemomechanical Properties and Physical Degradation under Aging of Experimental Adhesives.

Objective: To evaluate the physicochemical (sorption (SOR), solubility (SOL), and degree of conversion (DC)) and mechanical (flexural strength (FS), modulus of elasticity (ME), and compressive strength (CS)) properties of adhesives with different water contents (D2O). Materials and Methods: An adhesive was formulated: 55 wt% BisGMA, 45 wt% HEMA, 0.5 wt% camphorquinone, 0.5 wt% EDMAB, and 1.0 wt% DPIHP. D2O was added into the adhesives (0 wt%, 10 wt%, and 16 wt%). DC was monitored through the FTIR. FS, ME, CS, SOR, and SOL were tested. The adhesive samples were aged in deionized water, ethanol, and acetone. Data were submitted to ANOVA and Tukey's tests (5%). Results: For DC, the 0 wt% group showed a significant reduction (68.09 ± 0.14A) compared with the 10 wt% (87.07 ± 0.81B) and 16 wt% groups (89.87 ± 0.24B); 10 wt% showed the highest FS (MPa) mean values (141.6 ± 6.71B) compared with the 0 wt% (109.4 ± 20.5A) and 16 wt% (107.8 ± 15.8A). For the CS (MPa) and ME (GPa), the 16 wt% showed the lowest mean values (98.8 ± 18.0B and 2.2 ± 0.3B, respectively) compared with the 10 wt% and 0 wt%. For the SOR, 16 wt% of water showed the highest mean values and the ethanol showed the lowest mean values of SOL regardless of water content. Conclusion: The amount of water content and the types of aging solvents significantly affect the adhesive properties.

Linear dimensional accuracy of stereolithographic surgical guide after chemistry and physics sterilization.

OBJECTIVES: The purpose of this study was to evaluate the dimensional stability of prototyped surgical guides after autoclave and 2% glutaraldehyde sterilization processes. MATERIAL AND METHODS: Twenty prototyped surgical guides were prepared and submitted to two sterilization processes (n = 10): Physics - sterilization by autoclave (saturated water vapor under pressure, temperature of 126 to 130 °C, pressure of 1,7 at 1.9 kgf/cm2, 16 min); Chemistry - sterilization by 2% glutaraldehyde for 10 h. Six pre-established points were measured in the prototyped surgical guides, before and after sterilization, using a digital caliper rule. The comparisons were made using orthogonal contrasts using the linear model of mixed effects (random and fixed). RESULTS: there are no significant differences between autoclave and glutaraldehyde 2% (p>0.05) there are significant differences after autoclave sterilization (p<0.05) and there are not significant differences after 2% glutaraldehyde sterilization (p>0.05). CONCLUSION: autoclave promoted dimensional alteration of the prototyped surgical guides, and the chemical sterilization by glutaraldehyde 2% did not cause dimensional alteration of the prototype surgical guides, being a favorable choice for sterilization. CLINICAL SIGNIFICANCE: the sterilization of surgical guides can be performed through the chemical process with 2% glutaraldehyde without changing the linear precision of the prototype surgical guides.

Association between periodontitis and type 2 diabetes mellitus: study in a population attended by the Brazilian Health System / Associação entre periodontite e diabetes mellitus tipo 2: estudo em uma população atendida pelo Sistema Único de Saúde Brasileiro

Introduction: Periodontitis control helps to prevent and control diabetes mellitus and understanding of this relationship can lead to changes in health policy. Objective: The purpose of this study was to investigate the association between periodontitis, knowledge, and glycemic control. Material and method: This is a cross-sectional analytical epidemiological survey with 216 Type 2 diabetic patients, non-smokers, who had current blood screenings with glycated hemoglobin (HbA1c). Result: Overall, 93.51% of the patients reported brushing their teeth at least twice a day, 62.5% visited the dentist last year, 81.58% have already undergone treatment for periodontal disease, 43.52% reported having periodontitis and 59.72% had controlled diabetes. No significant (p=0.603) association between HbA1c control and the presence of periodontitis was found. Among the patients with periodontitis, no association between HbA1c control and information on the periodontal disease was found (p=0.996), and know/believe in its relationship with diabetes (p=0.659; p=0.973). Conclusion: No relationship between periodontitis and diabetes was found in the sample, as well as in patients with periodontitis, those with knowledge on periodontal disease and knowledge/belief in its relationship with diabetes, which could be justified by the care by a multi-professional health team.

Introdução: O controle da doença periodontal auxilia na prevenção e no controle do diabetes mellitus. A compreensão dessa relação pode desencadear mudanças nas políticas públicas de saúde. Objetivo: O objetivo deste estudo foi investigar a associação entre a doença periodontal, o controle glicêmico e o conhecimento dessa relação. Material e método: Trata-se de um inquérito epidemiológico analítico transversal com 216 pacientes com diabetes mellitus tipo 2, não fumantes, que realizaram exames de sangue atuais com hemoglobina glicada (HbA1c). Resultado: No geral, 93,51% dos pacientes relataram escovar os dentes pelo menos duas vezes ao dia, 62,5% visitaram o dentista no último ano, 81,58% já fizeram tratamento para doença periodontal, 43,52% relataram ter periodontite e 59,72% tinham diabetes controlado. Não foi encontrada associação significativa (p=0,603) entre o controle da HbA1c e a presença de periodontite. Entre os pacientes com periodontite, não foi encontrada associação entre o controle da HbA1c e informações sobre a doença periodontal (p=0,996), e conhecer/acreditar na sua relação com o diabetes (p=0,659; p=0,973). Conclusão: Não foi encontrada relação entre a doença periodontal e diabetes na amostra, o que poderia ser justificado pelo atendimento por uma equipe multiprofissional de saúde no Sistema Único de Saúde Brasileiro.

Influência da qualidade das próteses totais na prevalência de disfunção temporomandibular / Influence of quality of total prostheses on the prevalence of temporomandibular disorder

Introduction Temporomandibular disorder (TMD) involves the mastication and temporomandibular articulation muscles. Completely toothless patients with prostheses should be thoroughly assessed since edentulism causes damage that can lead to TMD onset. Objective This study aims to assess the effect of the technical quality of total prostheses (TPs) on TMD occurrence in patients with bimaxillary TPs. Material and method 154 patients responded to a questionnaire to obtain personal data, information regarding prostheses, anamnestic index for TMD, and the prosthesis quality index. Result Of the 154 patients examined, 64 (41.6%) had no TMD, 61 (39.6%) had mild TMD, 23 (14.9%) moderate, and only 6 (3.9%) showed severe TMD. As for the quality of total prosthesis, 78 (50.6%) completely toothless individuals had satisfactory TPs while 76 (49.4) presented unsatisfactory prostheses. Regarding the time using total prosthesis, around 50% of individuals with up to 10 years use presented some degree of TMD and 70% of individuals with over 10 years presented TMD. Conclusion Considering the methodology used and the population studied, we conclude that the quality of the TPs did not influence the incidence of TMD.

Introdução A disfunção temporomandibular (DTM) é uma desordem que envolve os músculos da mastigação e da articulação temporomandibular. Pacientes desdentados totais e que utilizam protéses requerem uma avaliação criteriosa, já que o edentulismo leva a prejuízos que podem contribuir para o aparecimento de DTM. Objetivo O objetivo deste presente estudo foi avaliar o efeito da qualidade técnica das próteses totais (PTs) na incidência de DTM em pacientes portadores de PTs bi-maxilares. Material e método Foi aplicado um questionário a 154 pacientes contendo os dados pessoais, o histórico das próteses, o índice anamnésico para DTM e o índice de qualidade de prótese. Resultado Dos 154 pacientes examinados, 64 (41,6%) estavam livres de DTM, 61 (39,6%) possuíam DTM leve, 23 (14,9%), moderada e apenas 6 (3,9%) mostravam DTM severa. Quanto à qualidade da prótese total, 78 (50,6%) desdentados totais portavam PTs satisfatórias e 76 (49,4) estavam com próteses insatisfatórias. Quanto ao tempo de uso da prótese total, cerca de 50% dos indivíduos com até 10 anos de uso apresentaram algum grau de DTM e 70% dos indivíduos com mais de 10 anos acusaram a presença de DTM. Conclusão Considerando-se a metodologia empregada e a população estudada, pôde-se concluir que a qualidade das PTs não influenciou na presença de DTM.

Prevalência de lesão periapical radiolúcida nos pacientes com síndrome de Sjögren primária / Prevalence of radiolucid periapical injury in patients with primary Sjögren syndrome

Introdução: Pacientes com Síndrome de Sjögren Primária (SSP) apresentam maior incidência de cárie dentária. Como consequência da cárie, podem ocorrer lesões periapicais radiolúcidas (LPR). Objetivo: Determinar a prevalência de LPR nos pacientes com SSP e caracterizar radiologicamente os dentes associados às LPR. Métodos: Estudo transversal envolvendo pacientes com SSP, recrutados em uma Clínica de Reumatologia (HUCAM-ES), que foram submetidos, inicialmente, a um questionário socioeconômico e avaliação clínica do fluxo salivar. Posteriormente, radiografias foram obtidas por um sistema digital intrabucal, com posicionador para a técnica periapical do paralelismo. Realizou-se a estatística descritiva por meio da média e desvio-padrão para as variáveis quantitativas, e frequências absoluta e relativa para as variáveis qualitativas. Realizou-se o teste qui-quadrado com IC95% e o teste t de Student para comparação dos pacientes com e sem lesão periapical. Resultados: No total, 24 pacientes fizeram parte do estudo, todos do sexo feminino (20 - 71 anos). O número médio de dentes/paciente foi de 23,3 ± 3,1, com prevalência de LPR dentária de 7,86%. Do total de pacientes, 70,8% tinham pelo menos uma LPR. Na comparação dos dentes com e sem LPR, os dentes com LPR apresentaram maior porcentagem de canal tratado e cárie. Conclusão: De acordo com os resultados, pode-se concluir que as LPR encontradas nos pacientes com SSP são uma condição frequente, principalmente quando associadas a dentes com canal(is) obturado(s) (AU).

Introduction: Patients with Primary Sjögren Syndrome (PSS) have a higher incidence of dental caries. As a conse- quence, radiolucent periapical lesions (RPL) may appear. Objective: To determine the prevalence of RPL in patients with PSS and to radiologically characterize the teeth associated with RPL. Methodology: Cross-sectional study involving patients with PSS, recruited at the Rheumatology Clinic (HUCAM-ES), who were initially submitted to a socioeconomic questionnaire and clinical evaluation of salivary flow. Subsequently, radiographs were obtained by a digital intraoral system with positioner for the periapical parallelism technique. Descriptive statistics were calculated by the mean and standard deviation for quantitative variables, and absolute and relative frequencies for qualitative variables. Chi-square test with 95% CI and Student t test were applied to compare patients with and without periapical lesion. Results: Over-all, 24 patients participated in the study and all were females (20-71 years). The mean number of teeth per patient was 23.3±3.1, with prevalence of dental RPL of 7.86%. Among all patients, 70.8% had at least one RPL. When comparing teeth with and without RPL, teeth with RPL showed higher percentage of treated canal and caries. Conclusion: According to the results, it can be concluded that RPL in patients with PSS is a frequent condition, especially when associated with teeth with obturated root canals (AU).

The Importance of Integrated Healthcare in the Association Between Oral Health and Awareness of Periodontitis and Diabetes in Type 2 Diabetics.

PURPOSE: Purpose: To assess the association of various factors including education level and oral health with type 2 diabetics' awareness of periodontitis and periodontitis/diabetes relationship, and to evaluate the importance of integrated healthcare in this association. Materials and Methods: 288 type 2 diabetics were evaluated through a validated structured questionnaire about oral hygiene habits, access and attendance to dental treatment, the presence of periodontitis and previously received information of periodontitis and periodontitis/diabetes relationship. Descriptive data were explored and both simple and multiple logistic regressions were performed. Results: The average age of participants was 62.24 (±10.93) years, 81.6% were previously treated for periodontitis and approximately 70% have never received information on periodontitis and its relationship with diabetes. A higher chance of participants having previously received information regarding periodontitis was associated with more than 8 years of schooling, daily flossing habit, presence of periodontitis and prior treatment for periodontitis (p < 0.005). Regarding previously received information about periodontitis/diabetes relationship, statistically significant associations were observed for more than 12 years of schooling and diabetes diagnosed more than 8 years ago (p < 0.05). Conclusion: The vast majority of participants were previously treated for periodontitis without receiving proper oral health education, which means that access to costly dental treatment is provided while patient education is neglected. It was shown the influence of habits and living conditions on the previously received information about diseases, and therefore, particular attention to the population characteristics is important to make the information accessible to everyone.

Esthetic perception of smiles with different gingival conditions.

This study aimed to compare the perceptions of smile esthetics among general practitioners, periodontists, and laypeople. Photographs of smiles were taken and digitally modified to create different gingival conditions: gingival asymmetry, unilateral gingival recession, and bilateral gingival recession. These photographs were evaluated by 150 volunteers (19-70 years old) using a 100.0-mm visual analog scale. The volunteers consisted of 50 laypeople with no knowledge of dentistry, 50 general dentists, and 50 periodontists. Analysis of variance and Student t test were performed when data presented a normal distribution. If the hypothesis of normality was rejected, the Newman-Keuls test was applied to the data. Results showed that laypeople noticed gingival asymmetry only when it reached 2.0 mm, while periodontists and general dentists noticed it at 1.0 mm. Periodontists and general dentists considered smiles with unilateral recession of ≥1.0 mm to be less attractive, while the smallest modification that was deemed unesthetic by the laypeople was 2.0 mm. In the evaluation of bilateral gingival recession, general dentists and periodontists found smiles with a 1.0-mm modification less attractive, while the changes were not noticed by laypeople until the modification reached 1.5 mm. It can be concluded that laypeople perceived changes in smile esthetics differently than did dental professionals, which suggests that laypeople may be less concerned about the esthetic effects of minor gingival alterations than are dental professionals. Therefore, it is important for the dentist to understand the individual patient's perception of what constitutes an esthetic smile before recommending a dental treatment plan.

Knowledge of oral hygiene of patients attended in a Dentistry Program as a precursor of changes in teaching paradigms / Conhecimentos sobre higiene bucal de pacientes atendidos em um curso de Odontologia como precursor de mudanças de paradigmas de ensino

The practice of healthcare education aims at contributing to healthcare assistance and promotion, providing health-disease control and its management through knowledge. This study aims to compare the degree of knowledge of oral hygiene of individuals who are undergoing treatment at the Integrated Clinic of the Dentistry Program of the Federal University of Espírito Santo (UFES) with individuals who are not undergoing dental treatment. This is a cross-sectional, exploratory study in which we evaluated 174 individuals, of whom 87 were undergoing dental treatment and 87 were in the waiting room accompanying the patients, but who were not undergoing treatment. Regarding the sample profile, women were predominant in both groups (71.26%). As for oral hygiene performed 3 times a day, it corresponded to 50.57% for the group under treatment and 54.02% for the control group. We may conclude that teaching was not highlighted in the prevention, thus justifying the need for changing the paradigm of teaching to a model focused on the person. To do so, we proposed the implementation of a preventive protocol in the teaching Dental Clinic (AU).

A prática de educação em saúde tem como propósito contribuir no cuidado e na promoção da saúde, fornecendo o controle saúde-doença e a condução de seus hábitos por meio da inserção de conhecimento. Este estudo tem por objetivo comparar o grau de conhecimento sobre higiene bucal de indivíduos que estão em tratamento na clínica integrada do Curso de Odontologia da Universidade Federal do Espírito Santo (UFES) com indivíduos que não estão realizando tratamento odontológico. Trata-se de um estudo transversal do tipo exploratório que avaliou 174 indivíduos, dos quais 87 estavam em tratamento odontológico e 87 estavam na sala de espera acompanhando os pacientes atendidos, mas não faziam tratamento odontológico. Em relação ao perfil da amostra, o gênero feminino foi predominante em ambos os grupos (71,26%). Em relação à higiene bucal realizada 3 vezes ao dia correspondeu a 50,57% para o grupo em tratamento e 54,02% para o grupo controle. Pode-se concluir que o ensino não apresentou ênfase na prevenção, justificando a necessidade de mudança de paradigma de ensino para um modelo voltado para a pessoa, e com esta finalidade foi proposta a implementação de um protocolo preventivo na Clínica Odontológica de ensino (AU).

Aesthetic perception of gingival smiles / Percepção estética do sorriso gengivoso

Introduction: Dentists have shown interest in learning new techniques to create more attractive smiles, but with little concern for understanding the reasons why the patient is dissatisfied. Objective: To evaluate the aesthetic perception of laypersons in dentistry in comparison with general practitioner dentists and periodontists regarding the gingival smile, and to compare this aesthetic perception between the male and female genders. Methodology: A photograph of a standard smile was taken and was digitally modified to create the periodontal conditions of a gingival smile from 0.5 mm to 2.5 mm. The photographs were judged by 150 individuals (25-65 years of age), 81 female and 69 male, divided into three groups: 50 laypersons, 50 general practitioners and 50 periodontists. The evaluation was performed using a visual analog scale. The statistical evaluation tests used were the Pearson Chi squared test, Student's t-test, ANOVA and Newman-keuls. Result: The aesthetic perceptions among the professionals are similar, and they observe more subtle changes in the aesthetics of the smile than the laypersons observe. The general practitioners and periodontists were similarly sensitive to changes generated in the gingival smile when these reached 1.5 mm, while laypersons only perceived them when these changes reached 2.5 mm. There was no significant difference in the aesthetic perception of male and female evaluators in any of the groups. Conclusion: The aesthetic perception of the gingival smile between general practitioner dentists and periodontists was similar, and dental professionals were more demanding than the layperson. There was no difference between female and male aesthetic perceptions.

Introdução: Cirurgiões-dentistas têm mostrado interesse em conhecer novos meios para a construção de sorrisos mais atraentes, porém com pouca preocupação em entender os motivos pelos quais o paciente está insatisfeito. Objetivo: Avaliar a percepção estética de pessoas leigas em odontologia em comparação com dentistas clínicos gerais e periodontistas quanto ao sorriso gengivoso, e comparar esta percepção estética do gênero masculino e feminino. Metodologia: Foi realizada fotografia de um sorriso padrão e modificada digitalmente para criar as condições periodontais de sorriso gengivoso de 0,5mm até 2,5mm. As fotografias foram avaliadas por 150 indivíduos (25-65 anos), 81 do gênero feminino e 69 do masculino, divididos em três grupos: 50 leigos, 50 clínicos gerais e 50 periodontistas. A avaliação foi realizada por escala analógica visual. Os testes de avaliação estatística utilizados foram Quiquadrado de Person, t de Student, ANOVA e Newman-keuls. Resultado: As percepções estéticas entre os profissionais são semelhantes, e percebem mudanças na estética do sorriso mais sutis que leigos. Os clínicos gerais e os periodontistas foram sensíveis de forma semelhante às mudanças geradas no sorriso gengivoso quando estas chegaram a 1,5 mm, enquanto que os leigos só perceberam quando estas modificações chegaram a 2,5 mm. Em todos os grupos não houve diferença significativa da percepção estética de avaliadores do gênero masculino e feminino. Conclusão: A percepção estética do sorriso gengivoso entre dentistas clínicos gerais e periodontistas foi semelhante, e os profissionais de odontologia foram mais exigentes do que os leigos. Não houve diferença na percepção estética feminina e masculina.

Periodontal Disease and Body Weight Assessment in Children.

PURPOSE: The purpose of this study was to assess body weight and periodontal disease development in obese and normal weight children. METHODS: Eighty-eight 5- to 10-year-old children participated in this study. Periodontal measurements included the visible plaque index (VPI), community periodontal index (CPI), and bleeding on probing (BOP). Complete periodontal examinations were performed in some children with CPI codes three and four. Anthropometric examination consisted of body mass index (BMI, kg/m2), which was adjusted by age according to percentiles. The groups were divided into children of normal weight (N=43, BMI less than 85 per age) and obese children (N=45, BMI greater than 97 per age). RESULTS: The results showed that the obesity group showed significant proportions of CPI codes one (44.2%) and three (7.4%), when compared with normal weight subjects (P<0.05). VPI was similar between both groups (P>0.05). BOP was higher in obese patients than in children with normal weight (P<0.05). CPI zero was more prevalent in normal weight subjects (62.6%, P<0.05). CONCLUSION: Obese children seem to be more susceptible to periodontal disease.

Association between periodontal disease and subclinical atherosclerosis: the ELSA-Brasil study.

The aim of this study was to investigate the relationship between periodontal disease and increased thickness of the carotid artery intima-media complex. A cross-sectional study was conducted with 220 adults (age ≥ 35 years) among participants in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Carotid artery ultrasound and periodontal clinical examinations were conducted and included visible plaque index, gingival bleeding on probing index, probing pocket depth (PPD), and clinical attachment level (CAL). Individuals with increased carotid artery thickness showed fewer teeth and higher frequency of CAL ≥ 3mm, CAL ≥ 4mm, CAL ≥ 5mm, and CAL ≥ 6mm and PPD ≥ 4mm (p < 0.05). Despite the use of 18 definitions for periodontal disease, only one confirmed the hypothesis of an association between periodontal disease and subclinical atherosclerosis. Individuals with 10% or more sites with CAL ≥ 4mm were more likely to present carotid thickening.

Association between periodontal disease and subclinical atherosclerosis: the ELSA-Brasil study / Associação entre doença periodontal e aterosclerose subclínica: estudo ELSA-Brasil

The aim of this study was to investigate the relationship between periodontal disease and increased thickness of the carotid artery intima-media complex. A cross-sectional study was conducted with 220 adults (age > 35 years) among participants in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Carotid artery ultrasound and periodontal clinical examinations were conducted and included visible plaque index, gingival bleeding on probing index, probing pocket depth (PPD), and clinical attachment level (CAL). Individuals with increased carotid artery thickness showed fewer teeth and higher frequency of CAL > 3mm, CAL > 4mm, CAL > 5mm, and CAL > 6mm and PPD > 4mm (p < 0.05). Despite the use of 18 definitions for periodontal disease, only one confirmed the hypothesis of an association between periodontal disease and subclinical atherosclerosis. Individuals with 10% or more sites with CAL > 4mm were more likely to present carotid thickening.

O objetivo deste trabalho foi investigar a relação entre doença periodontal e a alteração da espessura do complexo médio-intimal da carótida. Foi conduzido um estudo seccional com 220 indivíduos (idade > 35 anos) participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Foram realizados ultrassonografia da artéria carótida e exame clínico periodontal, que incluiu índice de placa visível, índice de sangramento à sondagem, profundidade de bolsa à sondagem (PBS) e nível clínico de inserção (NCI). Indivíduos com espessura da carótida com alteração tiveram menos dentes presentes, maior frequência de NCI > 3mm, NCI > 4mm, NCI > 5mm e NCI > 6mm e PBS > 4mm em comparação com aqueles sem alteração (p < 0,05). Apesar de usadas 17 definições para a doença periodontal, apenas uma confirmou a hipótese de associação entre a doença periodontal e a aterosclerose subclínica. Indivíduos com 10% ou mais dos sítios com NCI > 4mm tiveram maior chance de apresentar espessamento de carótida.

Associação entre doença periodontal e aterosclerose subclínica: uma revisão sistemática / Association betwenn periodontal disease and subclinic atherosclerosis: a sistematic review

A associação entre doença periodontal e o desenvolvimento de aterosclerose tem sido pesquisada. Esta revisão sistemática da literatura se propõe a verificar a associação entre a doença periodontal e a aterosclerose subclínica. A pesquisa utilizou as bases de dados: PubMed, Scopus, LILACS, BBO, Biblioteca Cochrane e Scielo com os termos: "doença periodontal", "periodontite", "carótida" e "aterosclerose". Foram excluídos artigos: que apresentaram resumos escritos em idiomas diferentes do português, inglês e espanhol; com abordagem laboratorial em modelos experimentais; sem descrição ou referência a estimadores de associação entre doença periodontal e aterosclerose subclínica; pesquisas que realizaram a medida da doença periodontal por parâmetros diferentes de exames clínicos; pesquisas que não analisaram a espessura da íntima média da artéria carótida através de exame de ultrassom; e que abordassem grupos específicos. Foram comparados os desenhos de estudo, protocolos de medida e os dados relatados. De um total de 63 referências, apenas 10 artigos contemplavam todos os critérios de inclusão, distribuídos em: 1 estudo longitudinal, 6 transversais e 3 casos controles. Observou-se uma heterogeneidade entre os estudos em relação ao método de mensuração da doença periodontal e os desfechos da aterosclerose. Concluiu-se que infecções periodontais são fortemente associadas ao desenvolvimento da aterosclerose subclínica, entretanto os mecanismos envolvidos no processo patogênico ainda permanecem desconhecidos.

The association between periodontal disease and the development of atherosclerosis has been studied. The systematic review of literature aims to evaluate the association between periodontal disease and subclinical atherosclerosis. A literature search of the PubMed, Scopus, LILACS, BBO, Cochrane Library and Scielo bibliographic databases was conducted using the following descriptors: "periodontal disease", "periodontitis", "carotid", and "therosclerosis". Articles were excluded if they: presented abstracts written in languages other than Portuguese, English and Spanish; experimental studies; did not contain data testing the degree of association between periodontal disease and subclinical atherosclerosis; did measure the extent of periodontal disease by parameters other than the clinical examination; did not measure the carotid artery intima-media wall thickness by ultrasonography; and covered specific population groups. The studies design, measurement protocols and reported data were compared. A total of 63 papers identified only 10 studies that met the inclusion criteria: 1 longitudinal study, 6 cross-sectional, and 3 case control studies. There was a wide heterogeneity between the studies regarding the methods of measuring periodontal disease and atherosclerosis outcomes. The conclusion is that periodontal infections are strongly associated with the development of subclinical atherosclerosis, however the mechanisms involved on the pathogenic process remain unknown.

Estudo clínico da associação de recessões gengivais unilaterais à escovação dentária / Clinical study of the association of unilateral gingival recessions with toothbrushing

A recessão gengival é uma manifestação clínica indesejável, diagnosticada a partir da exposição da superfície radicular após migração apical da gengiva marginal. O estudo trata-se de uma pesquisa de campo por meio da observação direta intensiva, de modo que as condições clínicas das recessões gengivais unilaterais foram analisadas e investigado se houve uma associação com a escovação dentária. A amostra consistiu em 307 pacientes das Clínicas Odontológicas do Centro Biomédico da Universidade Federal do Espírito Santo (Ufes), sendo 157 destros e 63 canhotos com recessão gengival unilateral em caninos e/ou pré-molares em posição normal na arcada e sem trauma oclusal. Foram pesquisados: presença de placa bacteriana, presença de sangramento gengival, medida da profundidade de sondagem, altura da recessão gengival e largura da faixa de tecido ceratinizado, além de ter sido aplicado um questionário a respeito de seus hábitos de higiene oral. A maioria dos indivíduos que possui recessão gengival unilateral apresentou recessão no lado contralateral à mão utilizada para a escovação dentária. A percepção da ocorrência de recessões gengivais é relevante para a prevenção e o controle dessas condições clínicas por meio da efetivação de programas apropriados.

Avaliação do efeito de protocolos parciais de exame periodontal na extensão das doenças periodontais / Evaluation of the effect of partial examination protocols in the extent of periodontal disease

Existem inúmeros índices descritos na literatura utilizados para mensurar a saúde bucal. O objetivo deste trabalho foi avaliar o efeito de quatro protocolos de registros parciais de medidas periodontais de profundidade de bolsa à sondagem e nível clínico de inserção. Exames periodontais completos foram realizados em 159 indivíduos com idade de 35 a 71 anos por um examinador calibrado nos quatro quadrantes em seis sítios por dente: sítios vestibulares e sítios linguais. Quatro Modelos de protocolos de medidas de boca-parciais foram comparados ao exame periodontal completo: Modelo I- Protocolo de dois quadrantes aleatórios, um quadrante superior e um inferior (seis sítios por dente), Modelo II- Protocolo de quatro quadrantes (três sítios vestibulares por dente), Modelo III- Protocolo de dois quadrantes aleatórios, um superior e um inferior (três sítios vestibulares por dente), e Modelo IV- Protocolo de seis sítios por dente nos dentes índices do Índice Periodontal Comunitário. Os escores clínicos médios periodontais foram diferentes no exame de boca inteira e nos registros parciais nos Modelos I, II, III e IV. Diferenças estatisticamente significantes somente foram encontradas em duas categorias das medidas periodontais quando analisados o exame de boca inteira e o Modelo I. Ao comparar com o exame periodontal completo, todos os Modelos apresentaram diferenças estatisticamente significantes dos parâmetros periodontais. O método de escolha de pesquisas que estudam a doença periodontal é o exame periodontal completo, pois somente este é capaz de quantificar a real prevalência da doença tanto no indivíduo quanto coletivamente.

There are numerous indices described in the literature used to measure oral health. The aim of this study was to evaluate the effect of four protocols partial records of measures of periodontal probing pocket depth and clinical attachment level. Complete periodontal examinations were performed on 159 individuals aged 35 to 71 years by an examiner calibratedin the four quadrants at six sites per tooth: buccal sites and lingual sites. Four models of protocols for measurements of partial-mouth periodontal examination were compared to full: Model I- all sites per tooth in the random half-mouth protocol randomly selecting one maxillary and mandibular quadrant, Model II- buccal sites in a full-mouth protocol, Model III buccalsites in the random half-mouth protocol randomly selecting one maxillary and mandibular quadrant, Model IV- all sites per tooth using Community Periodontal Index Teeth. The average clinical scores were different periodontal examination of your whole mouth and records partial models I, II, III and IV. Statistically significant differences were found inonly two categories of measures when analyzed periodontal examination of the entire mouth and the model I. Comparison with a complete periodontal examination, all models showed statistically significant differences in periodontal parameters. The method of choice to conduct research studies that periodontal disease is the complete periodontal examination, because only this is able to quantify the actual prevalence of disease in both the individual and collectively

Treatment of gingival recession with collagen membrane and DFDBA: a histometric study in dogs.

In a previous study, we evaluated the findings related to the use of resorbable collagen membranes in humans along with DFDBA (demineralized freeze-dried bone allograft). The aim of this subsequent study was to histometrically evaluate in dogs, the healing response of gingival recessions treated with collagen membrane + DFDBA (Guided Tissue Regeneration, GTR) compared to a coronally positioned flap (CPF). Two types of treatment were randomly carried out in a split-mouth study. Group 1 was considered as test (GTR: collagen membrane + DFDBA), whereas Group 2 stood for the control (only CPF). The dogs were given chemical bacterial plaque control with 0.2% chlorhexidine digluconate during a 90-day repair period. Afterwards, the animals were killed to obtain biopsies and histometric evaluation of the process of cementum and bone formation, epithelial migration and gingival level. A statistically significant difference was found between groups with a larger extension of neoformed cementum (GTR = 32.72%; CPF = 18.82%; p = 0.0004), new bone (GTR = 23.20%; CPF = 09.90%; p = 0.0401) and with a smaller area of residual gingival recession in the test group (GTR = 50.69%; CPF = 59.73%; p = 0.0055) compared to the control group. The only item assessed that showed no statistical difference was epithelial proliferation on the root surface, with means of 15.14% for the GTR group and 20.34% for the CPF group (p = 0.0890). Within the limits of this study we concluded that the treatment of gingival recession defects with GTR, associating collagen membrane with DFDBA, showed better outcomes in terms of a larger extension of neoformed cementum and bone, as well as in terms of a smaller proportion of residual recessions.