Root coverage procedures for treating single and multiple recession-type defects: An updated Cochrane systematic review.

BACKGROUND: This updated Cochrane systematic review (SR) evaluated the efficacy of different root coverage (RC) procedures in the treatment of single and multiple gingival recessions (GR). METHODS: We included randomized controlled trials (RCTs) only of at least 6 months' duration evaluating Miller's Class I or II GR (≥3 mm) treated by means of RC procedures. Five databases were searched up to January 16, 2018. Random effects meta-analyses were conducted thoroughly. RESULTS: We included 48 RCTs in the SR. The results indicated a greater GR reduction for subepithelial connective tissue grafts (SCTG) + coronally advanced flap (CAF) compared to guided tissue regeneration with resorbable membranes (GTR rm) + CAF (mean difference [MD]: -0.37 mm). There was insufficient evidence of a difference in GR reduction between acellular dermal matrix grafts (ADMG) + CAF and SCTG + CAF or between enamel matrix derivative (EMD) + CAF and SCTG + CAF. Greater gains in the keratinized tissue width (KTW) were found for SCTG + CAF when compared to EMD + CAF (MD: -1.06 mm), and SCTG + CAF when compared to GTR rm + CAF (MD: -1.77 mm). There was insufficient evidence of a difference in KTW gain between ADMG + CAF and SCTG + CAF. CONCLUSIONS: SCTG, CAF alone or associated with another biomaterial may be used for treating single or multiple GR. There is also some evidence suggesting that ADMG appear as the soft tissue substitute that may provide the most similar outcomes to those achieved by SCTG.

Socket healing with and without immediate implant placement.

The aim of the present review was to describe the studies produced in Latin America that contributed to the elucidation of the effect of tooth extraction with and without immediate implant installation. An electronic search was conducted in MEDLINE (PubMed), Scopus, Scielo, Lilacs, and Embase to include clinical and experimental (animal) studies on immediate implants. The studies selected had to fulfill the following inclusion criteria: (i) to present clinical and/or histological data on socket healing with or without immediate implant installation; (ii) to be approved by a Latin American Ethic Committee or comparable; and (iii) to include at least one author from a Latin American institution or to be conducted in a Latin America institution. Latin American studies that fulfilled these criteria demonstrated that immediate implant installation was conducive for predictable osseointegration and high survival rates but failed to prevent bone modeling and dimensional reduction of the alveolar ridge. In addition, it was also shown that regenerative approaches, including hard and soft tissue grafts at the time of immediate implant placement, may be beneficial to compensate for the alveolar ridge reduction. Regenerative approaches immediately after tooth extraction may decrease the amount of dimension reduction of the alveolar ridge.

Root coverage procedures for treating localised and multiple recession-type defects.

BACKGROUND: Gingival recession is defined as the oral exposure of the root surface due to a displacement of the gingival margin apical to the cemento-enamel junction and it is regularly linked to the deterioration of dental aesthetics. Successful treatment of recession-type defects is based on the use of predictable root coverage periodontal plastic surgery (RCPPS) procedures. This review is an update of the original version that was published in 2009. OBJECTIVES: To evaluate the efficacy of different root coverage procedures in the treatment of single and multiple recession-type defects. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 15 January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 12) in the Cochrane Library (searched 15 January 2018), MEDLINE Ovid (1946 to 15 January 2018), and Embase Ovid (1980 to 15 January 2018). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials (15 January 2018). No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We included randomised controlled trials (RCTs) only of at least 6 months' duration evaluating recession areas (Miller's Class I or II ≥ 3 mm) and treated by means of RCPPS procedures. DATA COLLECTION AND ANALYSIS: Screening of eligible studies, data extraction and risk of bias assessment were conducted independently and in duplicate. Authors were contacted for any missing information. We expressed results as random-effects models using mean differences (MD) for continuous outcomes and odds ratios (OR) for dichotomous outcomes with 95% confidence intervals (CI). We used GRADE methods to assess the quality of the body of evidence of our main comparisons. MAIN RESULTS: We included 48 RCTs in the review. Of these, we assessed one as at low risk of bias, 12 as at high risk of bias and 35 as at unclear risk of bias. The results indicated a greater reduction in gingival recession for subepithelial connective tissue grafts (SCTG) + coronally advanced flap (CAF) compared to guided tissue regeneration with resorbable membranes (GTR rm) + CAF (MD -0.37 mm; 95% CI -0.60 to -0.13, P = 0.002; 3 studies; 98 participants; low-quality evidence). There was insufficient evidence of a difference in gingival recession reduction between acellular dermal matrix grafts (ADMG) + CAF and SCTG + CAF or between enamel matrix protein (EMP) + CAF and SCTG + CAF. Regarding clinical attachment level changes, GTR rm + CAF promoted additional gains compared to SCTG + CAF (MD 0.35; 95% CI 0.06 to 0.63, P = 0.02; 3 studies; 98 participants; low-quality evidence) but there was insufficient evidence of a difference between ADMG + CAF and SCTG + CAF or between EMP + CAF and SCTG + CAF. Greater gains in the keratinized tissue were found for SCTG + CAF when compared to EMP + CAF (MD -1.06 mm; 95% CI -1.36 to -0.76, P < 0.00001; 2 studies; 62 participants; low-quality evidence), and SCTG + CAF when compared to GTR rm + CAF (MD -1.77 mm; 95% CI -2.66 to -0.89, P < 0.0001; 3 studies; 98 participants; very low-quality evidence). There was insufficient evidence of a difference in keratinized tissue gain between ADMG + CAF and SCTG + CAF. Few data exist on aesthetic condition change related to patients' opinion and patients' preference for a specific procedure. AUTHORS' CONCLUSIONS: Subepithelial connective tissue grafts, coronally advanced flap alone or associated with other biomaterial and guided tissue regeneration may be used as root coverage procedures for treating localised or multiple recession-type defects. The available evidence base indicates that in cases where both root coverage and gain in the width of keratinized tissue are expected, the use of subepithelial connective tissue grafts shows a slight improvement in outcome. There is also some weak evidence suggesting that acellular dermal matrix grafts appear as the soft tissue substitute that may provide the most similar outcomes to those achieved by subepithelial connective tissue grafts. RCTs are necessary to identify possible factors associated with the prognosis of each RCPPS procedure. The potential impact of bias on these outcomes is unclear.

Narrow- and regular-diameter implants in the posterior region of the jaws to support single crowns: A 3-year split-mouth randomized clinical trial.

OBJECTIVES: The objective of this 3-year split-mouth randomized controlled clinical study was to compare narrow-diameter implants (NDIs) to regular-diameter implants (RDIs) in the posterior region of the jaws (premolars and molars) in regards to (i) the marginal bone level (MBL) and (ii) implant and prosthesis survival and success rates. MATERIAL AND METHODS: A total of 22 patients were included in the study. Each patient received at least one implant of each diameter (Ø3.3 and Ø4.1 mm), placed either in the maxilla or mandible to support single crowns. A total 44 implants (22 NDIs and 22 RDIs) were placed and included in the study. Twenty-one implants were placed in the premolar, whereas 23 were placed in molar areas. Radiographic evaluations to access the MBL were performed immediately after implant placement, 1 and 3 years after implant loading. Peri-implant clinical variables including probing pocket depth (PPD) and bleeding on probing (BoP) were obtained after crown delivery, 1 and 3 years after loading. Furthermore, the survival and success rates of the implants and prosthesis were also evaluated. RESULTS: Twenty patients were able to complete the study. There was no statistically significant difference regarding MBL between groups at implant placement (p = .084), 1-year (p = .794) and 3-year (p = .598) time intervals. The mean peri-implant bone loss at 3-year follow-up was -0.58 ± 0.39 mm (95% CI: -0.751 to -0.409) and -0.53 ± 0.46 mm (95% CI: -0.731 to -0.329) for NDIs and RDIs, respectively. BoP was present at 15% and 10% of NDIs and RDIs, respectively, at 3-year follow-up. PPD >5 mm was observed in 5% and 0% of the implants of NDIs and RDIs, respectively, at 3-year follow-up. At the 3-year examination, the implant success rates were in the NDIs and RDIs sites, respectively, 95% and 100%. The corresponding values for prosthesis success rates were 90% for NDIs and 95% for RDIs. CONCLUSION: The present study demonstrated that NDIs placed to support single crowns in the posterior region did not differ to RDIs in regards to MBL, implant survival, and success rates.

Multidisciplinary Treatment for Peri-Implantitis: A 24-Month Follow-Up Case Report.

INTRODUCTION: Although osseointegrated implants are a highly predictable and effective alternative in the rehabilitation of partially or totally edentulous patients, the prevalence of implant biologic complications has been rising. This report describes a case of peri-implantitis involving multiple maxillary implants that was successfully treated by combining the removal of two implants, surgical debridement associated with implantoplasty of the remaining implants, and prosthetic design changes. CASE PRESENTATION: A 50-year-old female patient with a fixed full-arch implant-supported maxillary prosthesis presented with chief complaints of halitosis and difficulty in maintaining proper oral hygiene. Based on clinical and radiographic findings, a diagnosis of peri-implantitis was established. Two implants were removed because of advanced peri-implant bone loss and inadequate prosthetic positioning. The remaining implants were treated with access surgery, removal of granulation tissue, and implantoplasty of the exposed implant threads. Three months after surgery, an O-ring-retained bar overdenture was delivered. At 6, 12, and 24 months after treatment completion, peri-implant probing depths (PDs) were reduced significantly. None of the implants exhibited residual PDs >4 mm, bleeding on probing, or suppuration. Moreover, peri-implant bone levels remained stable over time. CONCLUSION: Surgical therapy combined with implantoplasty of the exposed threads and prosthetic design changes can be used successfully for treating peri-implantitis.

Dynamics of soft tissue healing at implants and teeth: a study in a dog model.

OBJECTIVE: The aim of this study was to describe and to compare some characteristics of the soft tissue healing process around teeth and implants after flap surgery. MATERIAL AND METHODS: Five adult beagle dogs had their third and fourth lower premolars extracted. After 3 months, four implants per dog were placed on the healed alveolar ridge and allowed to heal non-submerged during 3 months. After 3 months, four regions characterized by one implant and one adjacent tooth were identified in each dog. One region was randomly selected and soft tissue ressective flap surgery was performed at its buccal aspect. The remaining three regions were randomly treated in an identical manner, and the dogs were sacrificed to provide biopsies representing healing intervals of 1, 2, 4, and 12 weeks. The biopsies were prepared for histological and morphological analyses. RESULTS: Morphometric and histometric analyses have shown that the gingival tissues surrounding teeth were completely healed after a 4-week interval. However, it took from 4 to 12 weeks for the peri-implant mucosa to heal completely. CONCLUSION: The healing process around teeth and implants follows a similar sequence of events. Nevertheless, the complete process of healing and maturation of the peri-implant tissues takes longer than around teeth.

Alveolar socket healing: what can we learn?

Tooth extraction induces a series of complex and integrated local changes within the investing hard and soft tissues. These local alterations arise in order to close the socket wound and to restore tissue homeostasis, and are referred to as '"socket healing". The aims of the present report were twofold: first, to describe the socket-healing process; and, second, to discuss what can be learned from the temporal sequence of healing events, in order to improve treatment outcomes. The socket-healing process may be divided into three sequential, and frequently overlapping, phases: inflammatory; proliferative; and modeling/remodeling. Several clinical and experimental studies have demonstrated that the socket-healing process promotes up to 50% reduction of the original ridge width, greater bone resorption at the buccal aspect than at the lingual/palatal counterpart and a larger amount of alveolar bone reduction in the molar region. In conclusion, tooth extraction, once a simple and straightforward surgical procedure, should be performed in the knowledge that ridge reduction will follow and that further clinical steps should be considered to compensate for this, when considering future options for tooth replacement.

Changing the gingival color discrepancy induced by pigmented root using subepithelial connective tissue graft: a case report.

Metallic alloys can suffer corrosion, and metallic posts and cores used for restorative procedures may develop a blue-gray pigmentation in root dentin, which in turn changes the color of gingival tissues. Removing posts and cores may lead to root fracture, and bleaching agents have a limited effect on staining from alloy corrosion. Surgical techniques for correcting undesirable esthetic deficiencies have been investigated in the literature. This article describes the case of a patient with gingival discoloration caused by root pigmentation in the maxillary area. A subepithelial connective graft harvested from the palate was used to treat the gingival color discrepancy.

Early healing in alveolar sockets grafted with titanium granules. An experimental study in a dog model.

The aim of the present study was to evaluate the effect of the placement of titanium granules in fresh extraction sockets on early bone formation. The mesial roots of the third maxillary premolars of five adult beagle dogs were removed. On one side of the maxilla (Test group) the fresh extraction socket was grafted with titanium granules, while the contra-lateral socket was left non-grafted (Control group). After 1 month of healing, the dogs were euthanized and biopsies were obtained. The healing tissues were described, and histometric measurements were performed to obtain the percentage area occupied by connective tissue, new mineralized bone, bone marrow, and biomaterial particles. After 1 month of healing the findings from the histological examination revealed the titanium graft to be well incorporated into the provisional connective tissue or newly formed woven bone. The histometric measurements showed, however, that less mineralized bone was formed in the Test group than in the Control group. The present study suggests that the use of titanium granules in fresh extraction sockets was conducive to new bone formation. The graft of titanium granules seems, however, to delay the early phase of the healing process.

Estudo comparativo da remodelação das estruturas do rebordo alveolar após elevação do retalho / Comparative study of dimensional alterations in alveolar ridge structures after flap elevation

O objetivo deste estudo foi descrever e comparar algumas características das estruturas alveolares após cirurgia de elevação de retalho. Cinco cães beagle tiveram seus segundos e terceiros pré-molares superiores raspados e alisados com instrumentos manuais e ultrassônicos. Do lado direito da maxila (Grupo teste) um retalho total foi elevado sobre o segundo e o terceiro pré-molares, de maneira a expor o osso alveolar até a junção muco-gengival, durante 15 minutos. Após esse período, os retalhos foram irrigados com soro fisiológico e retornados às suas posições iniciais e mantidos em posição com fio de sutura reabsorvível. Na região contralateral (Grupo controle), dentes/gengiva permaneceram intactos. Após três meses de cicatrização, os animais foram ortotanasiados e biópsias contendo tecidos mole e duro ao redor dos dentes foram obtidas das áreas teste e controle. Os blocos de biópsias foram preparados para analise morfométrica. Sobre os cortes, foram obtidas medidas lineares de ambos os grupos nos tecidos mole e duro, sendo que essas medidas foram obtidas em um, três e cinco milímetros abaixo da junção cemento-esmalte para: espessura do osso alveolar propriamente dito e do osso alveolar, espessura do ligamento periodontal e somente sobre tecido mole: espessura e altura gengival, comprimento do epitélio juncional. Valores médios e desvio padrão foram calculados usando o animal como unidade estatística. Teste t de Student pareado foi utilizado sendo p<0.05 considerado como diferença estatisticamente significante. A análise morfométrica mostrou que noventa dias após elevação do retalho não havia mais sinais de modelação óssea e as dimensões dos tecidos moles e duros periodontais sofreram alterações, com diferença estatisticamente significante: espessura da gengiva supra-crestal e do osso alveolar propriamente dito e comprimento do epitélio juncional (p<0.05). Os resultados sugerem que após elevação do retalho, espessura da gengiva supra-crestal, bem como o comprimento do epitélio juncional e altura da crista óssea sofreram alterações em suas dimensões significativamente; osso alveolar propriamente dito tem espessura constante ao longo do osso alveolar e também representa grande parte do osso alveolar em sua porção mais próxima à junção cemento-esmalte.

The aim of this study was to describe and to compare some characteristics of alveolar ridge structures after flap surgery. Five beagle dogs had their upper second and third premolars selected in both quadrants to be scaled and planned. On the right side (Test group) the buccal flap was elevated on the second and third premolar, exposing the alveolar bone, over the muco-gingival junction for 15 minutes. After that, the flaps were irrigated with saline and returned to the original position and sutured with bioabsorbable mattress. On the contra lateral side (Control group) the teeth and gingiva were maintained intact. After three months of healing, the dogs were sacrificed to provide biopsies containing soft and hard tissue around teeth. The biopsies were prepared for morphometrical analyses. At the sections some linear measurements were obtained from both groups over the soft tissue and one, three and five millimeters below the cement-enamel junction: bundle bone and alveolar bone thickness, periodontal ligament thickness. Only over the soft tissue: gingival thickness and height and junctional epithelium length were measured. Mean values and standard deviations were calculated using the dog as a statistical unit. Students t test was used (p<0.05). The morphometric analyses have shown that 90 days after flap elevation there were no signs of bone modeling; and the dimensions of hard and soft tissues surrounding teeth had changed: gingival and bundle bone thickness; junctional epithelium length (p<0.05). Conclusion: The results have shown that after flap elevation periodontal tissues had reduced permanently; thickness of keratinized gingiva, as well as junctional epithelium length and bone crest height suffered dimensional alterations; the bundle bone had a similar thickness along the alveolar bone and represented an important part of the alveolar crest close to the cementenamel junction.

Estudo piloto sobre a previsibilidade de recobrimento radicular de recessões gengivais classe III de Miller / Pilot study about root coverage predictability in Miller'sclass III gingival recession

O objetivo do presente estudo foi avaliar o grau de recobrimento radicular de recessões classe III de Miller obtido após a realização de reposicionamento coronal do retalho associado a enxerto de tecido conjuntivo subepitelial.Vinte pacientes foram incluídos no estudo, cada um oferecendo uma recessão gengival. Esses indivíduos preencheram os seguintes critérios de inclusão:(a) recessões gengivais únicas ou múltiplas classificadas como classe III de Miller; (b) ausência de comprometimento sistêmico ou uso de medicamentos que os impedisse de sofrer qualquer intervenção cirúrgica; (c) ausência de sinais clínicos de inflamação gengival; (d) perda de inserção interproximal< 4mm; (e) ausência de lesão de cárie radicular. Imediatamente antes do procedimento de recobrimento radicular, o tamanho da recessão gengival foi avaliado com auxílio de uma sonda milimetrada. Um ano após o procedimento de recobrimento radicular, as áreas operadas foram reexaminadas. Os exames clínicos indicaram que havia ausência de supuração, sangramento gengival, sensibilidade e profundidade de sondagem >3mm. A altura média inicial da recessão era de 4mm e, ao final de um ano de acompanhamento, era de 1,2mm. A porcentagem média de recobrimento da distância da junção cemento-esmalte à margem gengival foi de 69% ao final do estudo. O retalho posicionado coronalmente associado ao enxerto de tecido conjuntivo parece ser uma técnica adequada para recobrir parcialmente recessões gengivais classe III de Miller.

The aim of the present study was to evaluate the root coverage outcomes of Miller's class III gingival recession defects achieved with a coronally positioned flap associated with subepithelial connective tissue graft. Twenty patients, each with one gigival recession, were included in thestudy. The inclusion criteria were (a) at least one Miller's class III gingival recession, (b) no systemic disease or use of medication that could disquality the possibility of surgical intervention, (c) absence ofgingival inflammation signals, (d) attachment loss < 4mm, (e) no root caries. Immediately before the root corage procedure the gingival recession height was evaluated with a periodontal probe. One year after the root coverage procedures the operated areas were re-evaluated. The clinical evaluation showed absence of suppuration, gingival bleeding, sensibility, and probing pocket depth > 3mm. The initial mean recession height was 4 mm and after one year it was 1,2 mm. The mean root coravage of the distance between the cementum-enamel junction and gingival margin was 69% at the end of the study. The coronally positioned flap associated with subepithelial connective tissue graft seems to be an adequate technique to partially cover Miller's class III gingival recession defects.

Root-coverage procedures for the treatment of localized recession-type defects: a Cochrane systematic review.

BACKGROUND: The purpose of this review is to evaluate the effectiveness of different root-coverage procedures in the treatment of recession-type defects. METHODS: The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched for entries up to October 2008. There were no restrictions regarding publication status or the language of publication. Only clinical randomized controlled trials (RCTs) with a duration > or = 6 months that evaluated recession areas (Miller Class I or II > or = 3 mm) that were treated by means of periodontal plastic surgery procedures were included. RESULTS: Twenty-four RCTs provided data. Only one trial was considered to be at low risk of bias. The remaining trials were considered to be at high risk of bias. The results indicated a significantly greater reduction in gingival recession and gain in keratinized tissue for subepithelial connective tissue grafts (SCTGs) compared to guided tissue regeneration (GTR) with bioabsorbable membranes (GTR bms). A significantly greater gain in keratinized tissue was found for enamel matrix protein compared to a coronally advanced flap (0.40 mm) and for SCTGs compared to GTR bms plus bone substitutes. Limited data exist on the changes of esthetic conditions as related to the opinions and preferences of patients for specific procedures. CONCLUSIONS: SCTGs, coronally advanced flaps alone or associated with other biomaterial, and GTR may be used as root-coverage procedures for the treatment of localized recession-type defects. In cases where root coverage and gain in keratinized tissue are expected, the use of SCTGs seems to be more adequate.

Contribuições da Ortodontia após tratamento periodontal / Orthodontics contributions after periodontal treatment: literature review

A procura do paciente adulto pelo tratamento ortodôntico vem aumentando significativamente, sendo que as sequelas da doença periodontal como diastemas, perda de papilas, perda da dimensão vertical, extrusões e rotações dentárias são queixas comuns. Baseado na literatura, esta revisão busca discutir aspectos relevantes no planejamento ortodôntico em pacientes com periodonto reduzido.

Root coverage procedures for the treatment of localised recession-type defects.

BACKGROUND: Gingival recession is defined as the oral exposure of the root surface due to a displacement of the gingival margin apical to the cemento-enamel junction and it is regularly linked to the deterioration of dental aesthetics. Successful treatment of recession-type defects is based on the use of predictable periodontal plastic surgery (PPS) procedures. OBJECTIVES: To evaluate the effectiveness of different root coverage procedures in the treatment of recession-type defects. SEARCH STRATEGY: The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched up to October 2008. The main international periodontal journals were handsearched. There were no restrictions with regard to publication status or language of publication. SELECTION CRITERIA: Only randomised controlled clinical trials (RCTs) of at least 6 months' duration evaluating recession areas (Miller's Class I or II > 3 mm) and that were treated by means of PPS procedures were included. DATA COLLECTION AND ANALYSIS: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Authors were contacted for any missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. MAIN RESULTS: Twenty-four RCTs provided data. Only one trial was considered to be at low risk of bias. The remaining trials were considered to be at high risk of bias. The results indicated a significant greater reduction in gingival recession and gain in keratinized tissue for subepithelial connective tissue grafts (SCTG) compared to guided tissue regeneration with resorbable membranes (GTR rm). A significant greater gain in the keratinized tissue was found for enamel matrix protein when compared to coronally advanced flap (0.40 mm) and for SCTG when compared to GTR rm plus bone substitutes. Limited data exist on aesthetic condition change related to patients' opinion and patients' preference for a specific procedure. AUTHORS' CONCLUSIONS: Subepithelial connective tissue grafts, coronally advanced flap alone or associated with other biomaterial and guided tissue regeneration may be used as root coverage procedures for the treatment of localised recession-type defects. In cases where both root coverage and gain in the keratinized tissue are expected, the use of subepithelial connective tissue grafts seems to be more adequate. Randomised controlled clinical trials are necessary to identify possible factors associated with the prognosis of each PPS procedure. The potential impact of bias on these outcomes is unclear.

Características clínicas da mucosa periimplantar e gengiva inserida: revisão da literatura / Clinical characteristics of peri-implant mucosa and gingiva: literature review

Com a evolução da Implantodontia, começaram a ser produzidos estudos comparando as estruturas que suportavam dentes e depois passariam a suportar implantes. Estes estudos foram, e ainda são, importantes, por esclarecerem semelhanças e diferenças entre os tecidos que podem determinar o sucesso ou o fracasso no manejo dos tecidos periimplantares. O objetivo desta revisão é estabelecer diferenças e semelhanças entre os tecidos moles periimplantares e periodontais, em estudos feitos em cães.

With the evolution of the lmplantology studies comparing tissues that supported teeth and later would support fixtures started to be produced. These studies had been important to clarify similarities and differences between tissues, that can determine the success or failure in the handling of peri-implant tissues. The aim of this revision is to establish differences and similarities between soft tissues around implants and teeth, in studies in dogs.

Uso de implantes dentários de diâmetro reduzido na região posterior dos maxilares. Estudo retrospectivo de até 8 anos / The use of reduced diameter implants in posterior maxillary region. Retrospective study until 8 years follow up

O objetivo deste estudo foi avaliar, retrospectivamente, alguns aspectos clínicos e radiográficos de regiões posteriores da mandíbula ou maxila que receberam reabilitação protética suportada por implantes de diâmetro reduzido. Cento e cinqüenta e dois pacientes foram incluídos nesse estudo. Todos os pacientes apresentaram-se com áreas edêntulas na região posterior dos maxilares, com rebordo alveolar atrófico e onde foram instalados 1 ou mais implantes de diâmetro reduzido. De 6 a 16 semanas após a instalação dos implantes, a reconstrução protética foi instalada sobre os implantes. Os implantes foram examinados clínica e radiograficamente após a carga protética, durante um período de tempo compreendido entre 1 e 8 anos. Dos 194 implantes instalados, apenas 3 tiveram que ser removidos. A razão para esta perda de implante foi mobilidade evidente e/ou radiolucência ao redor de toda a superfície do implante. Destes implantes, 2 apresentavam 6 semanas de cicatrização e não estavam conectados a nenhuma prótese e 1 apresentava 2 anos e 10 meses de cicatrização e estava esplintado a outros sete implantes, que sustentavam uma sobredentadura na maxila. Os resultados obtidos pelo presente estudo sugerem que a utilização de implantes reduzidos na região posterior da mandíbula e maxila é efetiva como suporte de próteses. São necessários, no entanto, mais estudos clínicos para confirmar o benefício do uso dos IDRs na região posterior dos maxilares.

The aim of the present retrospective study was to assess some clinical and radiographic aspects of the posterior mandible and maxilla regions in which narrow diameter implants were used to support prosthetic rehabilitations. One hundred and fifty two patients were included in the study. All patients exhibited areas in the posterior region of the jaws with reduced bone volume. Narrow diameter implants were installed in such areas. Following 6 to 16 weeks of healing, prosthetic reconstructions were connected to the implants. Clinical and radiographic evaluations were performed at the implant sites after periods that varied between 1 to 8 years following implant installation. Out of the 194 implants which were installed, 3 were lost. The reason for their lost was either obvious mobility and/or radioluscence around the implant surface. Two af these implants were lost after 6 weeks of healing and were not connected to any prosthetic work. The remaining 1 implant was removed after 2 years and 10 months of healing and was splinted to other 7 implants which supported an overdenture in the upper jaw. The results observed in the present study suggest that the use of narrow diameter implants in the posterior region of the mandible and maxilla is effective in supporting prosthetic rehabilitations. However, more clinical studies are needed to confirm the benefits of using narrow diameter implants in the posterior region of the upper and lower maxilla.

A influência da altura da margem gengival do incisivo lateral superior na percepção estética do sorriso entre leigos e dentistas / The gingival margin height of upper lateral incisor in smile esthetic perception between layperson and dentists

Este estudo buscou avaliar a influência do posicionamento das margens gengivais dos dentes ântero-superiores na percepção estética do sorriso para dentistas e leigos. Para tanto, alterou-se uma foto de um sorriso saudável que apresentava o incisivo lateral esquerdo superior com 1mm além da altura da margem gengival de seus vizinhos, respectivamente canino e incisivo central esquerdo, em mais 1mm. Sessenta indivíduos, 30 dentistas clínicos-gerais e 30 leigos, foram apresentados às imagens, separadamente, e inquiridos se os sorrisos eram agradáveis ou não. Todos os participantes afirmaram ser a imagem original agradável e 50% da amostra de dentistas consideraram a segunda imagem desagradável. Estes resultados sugerem que diferenças de 1mm de altura entre as margens gengivais não foram capazes de comprometer a estética do sorriso; a estética está intimamente relacionada com a cultura dos grupos sociais e com a condição de saúde expressa pelos indivíduos.

The aim of this study was to evaluate the influence of the positioning of the gingival edges of anterosuperior teeth in smile aesthetic perception for dentists and layperson. In such a way, one picture from a healthful smile that had the left upper lateral incisor 1 mm higher than the gingival edges of its neighbors, respectively left canine and central incisor, was altered in more 1 mm. Sixty individuals, 30 general practitioner and 30 layperson, were presented to the images separately and argued if the two smiles were pleasant or not. All the participants had affirmed that the original image was pleasant and 50% of the sample of general practitioner considered the second image unpleasant. These results suggest that height differences of 1 mm among gingival edges had not been able to compromise the aesthetic of smile; the aesthetic is close related with culture, social groups and condition of health expressed by the population.

Ocorrência de Aggregatibacter actinomycetemcomitans no biofilme subgengival de crianças com idade de 6 a 12 anos / Occurrence of Aggregatibacter actinomycetemcomitans in subgengival biofilm of children aged 6-12 years old

O presente estudo avaliou as condições gengivais, sócio-econômicas e a ocorrência de A. actinomycetemcomitans em 233 crianças com idade entre 6 e 1 2 anos, em Araçatuba-São Paulo. Na avaliação clínica periodontal foram utilizados os índices de placa e de sangramento a sondagem. A coleta dos espécimes clínicos de biofilme subgengival foi realizada com cones de papel absorvente, que foram introduzidos no interior dos sulcos gengivais sadios ou inflamados, durante 1 minuto, e transferidos para tubos contendo 3ml de VMGA III e para criotubos com 300µl de água ultrapura. As amostras foram cultivadas em ágar TSBV, em anaerobiose, a 37°C, por 3 dias. A presença desse microrganismo também foi avaliada através de PCR com iniciadores específicos. As condições sócio-econômicas da população estudada foram avaliadas por meio de questionário específico. A maioria das crianças estudadas apresentou gengivite. Verificou-se que a baixa renda familiar e o número de crianças na família estão estatisticamente associados com a gengivite nessas crianças, sendo que a ocorrência de A. actinomycetemcomitans não mostrou correlação com as condições gengivais ou sócio-econômicas da população alvo.

The present study evaluated gingival, socioeconomic conditions and the occurrence of Aggregatibacter actinomycetemcomitans in 233 children from 6 to 12 years-old in Araçatuba-São Paulo. In the periodontal evaluation the plaque index and bleeding on probing index were used. Subgingival biofilm samples were taken through sterile paper points, which were transfered to VMGA III or to criotubes with 300µl of ultrapure water. Microbial isolation was carried out using TSBV agar and the occurrence of A. actinomycetemcomitans was also determined by mean of PCR using specific primer pairs. The socio-economic conditions were evaluated by specific questionaire. The vast majority of studied children exihibited gingivitis and it was statistically correlated low income, family's children number and the gingival status of the patients. The occurence of A. actinomycetemcomitans did not show any correlation between gingival or socio-economic conditions and target population.

Ensaios clínicos multicêntricos: uma revisão de literatura / Multi-center clinical trials: a literature review

Ensaios clínicos multicêntricos são considerados o padrão ouro em pesquisa clínica. São extremamente úteis em pesquisa de doenças raras, na avaliação de novos fármacos e de novas terapias. Por atender comunidades distintas ao mesmo tempo coletando dados de diversas regiões geográficas, seus resultados podem ser interpretados como válidos para a população em geral. Apresentam como vantagem principal a redução no tempo de experimento porém são de alto custo e alta complexidade. Exigem a monitorização constante do desenvolvimento no protocolo, da coleta de dados e calibração constante dos pesquisadores participantes.

Ocorrência de bactérias entéricas em amostras de biofilme subgengival de pacientes com gengivite, periodontite crônica ou periodontite agressiva / Occurrence of enteric bacteria in samples of subgengival biofilm from patients with gingivitis, chronic periodontitis or aggressive periodontitis

O objetivo desse estudo foi determinar a ocorrência de bactérias entéricas no biofilme de 56 pacientes com gengivite, 70 com periodontite crônica e 18 com periodontite agressiva. Os pacientes foram submetidos a anamnese, exame clínico e radiográfico, índice de placa, sangramento à sondagem e perda clínica de inserção. As amostras foram coletadas de sulcos gengivais e bolsas periodontais, transferidos para meio VMGA III e inoculados em meios de cultura seletivos, que foram incubados a 37°C por 48 horas. Os microrganismos isolados foram identificados de acordo com suas características fenotípicas. Enterobacteriaceae e Enterococcus spp. foram detectados em 46,43%, 57,14%, 77,78% dos pacientes com gengivite, periodontite crônica e agressiva. Os isolados foram identificados como Citrobacter freundii, Enterobacter cloacae, E. Sakazakii, Enterococcus faecalis, E. faecium, Klebsiella oxytoca, Pantoa agglomerans, Proteus vulgaris, P. mirabilis, Serratia liquefaciens, e Serratia SP. Conclui-se que esses microrganismos cujo habitat tradicional não inclui a cavidade bucal são comuns em pacientes que apresentam doenças periodontais, de forma que o periodonto pode se comportar como um reservatório desses microrganismos.