Liposomal anesthetic gel for pain control during periodontal therapy in adults: a placebo-controlled RCT

Abstract Periodontal therapy usually requires local anesthesia. If effective, a non-invasive, liposomal anesthetic gel could increase the levels of acceptance of patients in relation to periodontal therapy. Objective: This study investigated the efficacy of liposomal anesthetic gel for pain control during periodontal therapy. Methodology: Forty volunteers with moderate to severe chronic periodontitis were recruited, of which at least three sextants required periodontal therapy. At least one of the selected teeth had one site with a probing depth of ≥4 mm. The volunteers received the following three gels: a placebo, lidocaine/prilocaine (Oraqix®), or a liposomal lidocaine/prilocaine, which were applied to different sextants. Pain frequency was registered during treatment and the volunteers received a digital counter to register any painful or uncomfortable experiences. At the end of each session, the volunteers indicated their pain intensity using rating scales (NRS-101 and VRS-4). The volunteers had their hemodynamic parameters measured by a non-invasive digital monitor. Results: Pain frequency/intensity did not show statistical difference between intervention groups. The tested gels did not interfere with the hemodynamic indices. Dental anxiety, suppuration and probing depth could influence pain during periodontal therapy. Conclusion: Our results suggest limited indications for the use of non-invasive anesthesia when used for scaling and root planing. Intra-pocket anesthetic gel could be a good option for anxious patients, or those who have a fear of needles.

Treatment of actinic keratoses and cancerization field of the face and scalp with 0 015% ingenol mebutate gel in Brazilian individuals: safety, tolerability and patients' perspectives

Abstract: Background: Actinic keratosis (AK) represents a risk of progression to squamous cell carcinoma. Ingenol mebutate gel is a novel therapeutic option for field-directed treatment. Objectives: To evaluate the safety, tolerability and patients' perspectives, related to the therapeutic success of managing AKs on the face and scalp with ingenol mebutate gel in Brazilian individuals. Methods: This was an observational, retrospective and descriptive study of 68 areas of actinic keratosis on the face and scalp treated with Ingenol mebutate gel involving a total of 37 patients. The drug was applied for three consecutive days on an area of of 25 cm2 and documentation was performed on baseline and days 4, 8, 15, 60 and 180. On day 4, the composite local skin reaction score was calculated. At the end, a questionnaire was applied to evaluate patients' perspectives about the treatment. Results: Adherence was 100%, no serious adverse events were recorded and the mean composite local skin reaction score (standard deviation) was 8.61±4.22. The treatment was considered optimum by 75.68% of the patients. Study limitations: Calculation of composite local skin reaction score performed only on the fourth day. Conclusions: Treatment with ingenol mebutate gel was considered safe and tolerable in Brazilian subjects. Patients had a maximum adherence rate and a great improvement in self-esteem. The results of this research reproduce the findings of the literature.

Curativo com filme e gel de biopolímero de celulose bacteriana no tratamento de feridas isquêmicas após revascularização de membros inferiores / Bacterial cellulose biopolymer film and gel dressing for the treatment of ischemic wounds after lower limb revascularization

RESUMO Objetivo: avaliar o uso do curativo de filme e gel de biopolímero de celulose bacteriana no tratamento de pacientes com feridas isquêmicas submetidos à revascularização dos membros inferiores. Métodos: ensaio clínico randomizado realizado no ambulatório de Angiologia e Cirurgia Vascular do Hospital das Clínicas da Universidade Federal de Pernambuco, entre janeiro de 2017 e dezembro de 2018. Foram acompanhados 24 pacientes após revascularização de membros inferiores, divididos em dois grupos: Experimental, tratado com filme e gel de biopolímero de celulose bacteriana, e Controle, tratado com ácidos graxos essenciais. Os pacientes foram acompanhados em consultas semanais para troca dos curativos e o processo de cicatrização das feridas foi avaliado em um período de 90 dias. Resultados: a redução da área das feridas isquêmicas no período de 30 dias foi de 4,3cm2 (55%), em média, para o grupo experimental, e de 5,5cm2 (48,5%) para o grupo controle (p>0,05). A taxa de cicatrização completa, em 90 dias, foi de 34,8%, sendo 50% no grupo experimental e 18,2% no grupo controle (p=0,053). Conclusão: o filme de biopolímero de celulose bacteriana associada a gel pode ser utilizado como curativo no tratamento de feridas isquêmicas de pacientes submetidos à revascularização de membros inferiores

ABSTRACT Objective: to evaluate the use of a bacterial cellulose biopolymer film and gel dressing in the treatment of patients with ischemic wounds submitted to lower limb revascularization. Methods: we conducted a randomized clinical trial in the Angiology and Vascular Surgery outpatient clinic of the Clinics Hospital of the Federal University of Pernambuco, between January 2017 and December 2018. We followed 24 patients after lower limb revascularization, divided into two groups: Experimental, treated with bacterial cellulose biopolymer film and gel, and Control, treated with essential fatty acids. Patients attended weekly appointments to change dressings and had their wound healing processes evaluated over a period of 90 days. Results: the reduction of the ischemic wounds' areas after 30 days was 4.3cm2 (55%) on average for the experimental group, and the 5.5cm2 (48.5%) for the control group (p>0.05). The complete healing rate at 90 days was 34.8%, 50% in the experimental group and 18.2% in the control group (p=0.053). Conclusion: the bacterial cellulose biopolymer film associated with gel can be used as a dressing in the treatment of ischemic wounds of patients undergoing revascularization of the lower limbs.

Role of 1% alendronate gel as adjunct to mechanical therapy in the treatment of chronic periodontitis among smokers

Abstract Objective Alendronate (ALN) inhibits osteoclastic bone resorption and triggers osteostimulative properties both in vivo and in vitro, as shown by increase in matrix formation. This study aimed to explore the efficacy of 1% ALN gel as local drug delivery (LDD) in adjunct to scaling and root planing (SRP) for the treatment of chronic periodontitis among smokers. Material and Methods 75 intrabony defects were treated in 46 male smokers either with 1% ALN gel or placebo gel. ALN gel was prepared by adding ALN into carbopol-distilled water mixture. Clinical parameters [modified sulcus bleeding index, plaque index, probing depth (PD), and periodontal attachment level (PAL)] were recorded at baseline, at 2 months, and at 6 months, while radiographic parameters were recorded at baseline and at 6 months. Defect fill at baseline and at 6 months was calculated on standardized radiographs by using the image analysis software. Results Mean PD reduction and mean PAL gain were found to be greater in the ALN group than in the placebo group, both at 2 and 6 months. Furthermore, a significantly greater mean percentage of bone fill was found in the ALN group (41.05±11.40%) compared to the placebo group (2.5±0.93%). Conclusions The results of this study showed 1% ALN stimulated a significant increase in PD reduction, PAL gain, and an improved bone fill compared to placebo gel in chronic periodontitis among smokers. Thus, 1% ALN, along with SRP, is effective in the treatment of chronic periodontitis in smokers.

Improvement of health-related quality of life and adherence to treatment with calcipotriol-betamethasone dipropionate gel in patients with psoriasis vulgaris

Abstract BACKGROUND: Psoriasis is a common, chronic, recurrent, immune-mediated disorder of the skin and joints. It can have a significant negative impact on the physical, emotional and psychosocial wellbeing of affected patients. OBJECTIVES: To measure improvement in health-related QoL (HRQoL) in Greek patients with psoriasis vulgaris after a month of treatment with calcipotriol-betamethasone dipropionate gel; and evaluate adherence to treatment parameters. METHODS: The study included 394 psoriasis vulgaris patients from 16 private dermatological practices in Greece, all treated with calcipotriol-betamethasone dipropionate gel. They were evaluated at the first visit and after 4 weeks. Moreover, they completed the Dermatology Life Quality Index (DLQI), while other data such as disease severity, subjective symptoms and adherence, were collected. RESULTS: At week 4, the DLQI median was reduced by 3.5 points from the baseline (p<0.001; baseline and week 4 median: 4.5 and 1.0 respectively). Pruritus and sleep disorders also improved (p<0.001). Furthermore, 90.1% of the subjects fully adhered to treatment, with a 97.1% mean level of compliance. CONCLUSIONS: The convincing clinical results, with a distinct improvement in HRQoL, plus the high level of adherence due to its advantageous physical properties, make the calcipotriol-betamethasone dipropionate gel formulation an important, effective and well-tolerated topical therapy to treat psoriasis.

Effectiveness of papain gel in venous ulcer treatment: randomized clinical trial / Efetividade do gel de papaína no tratamento de úlceras venosas: ensaio clínico randomizado / Efectividad del gel de papaína en el tratamiento de úlceras venosas: ensayo clínico aleatorio

to assess the effectiveness of 2% papain gel compared to 2% carboxymethyl cellulose in the treatment of chronic venous ulcer patients.

avaliar a efetividade do gel de papaína a 2% comparado ao gel de carboximetilcelulose a 2% no tratamento de pacientes com úlceras venosas crônicas.

evaluar la efectividad del gel de papaína a 2% comparado con el gel de carboximetilcelulosa a 2% en el tratamiento de pacientes con úlceras venosas crónicas.

Application of platelet-rich plasma in the treatment of chronic skin ulcer - Case report

The platelet-rich plasma (PRP) has proved promising regarding its applicability in dermatology, especially in the healing of chronic ulcers. The autologous platelet-rich plasma is obtained by centrifuging the blood, so that the components are separated by density gradient. The final product is a gel rich in growth factors that act in tissue repair by activating fibroblasts and inducing extracellular matrix remodeling.

Alteration of hemostasis in patientes treated with subgingival NSAIDS during periodontal therapy / Alteración de la hemostasia en pacientes tratados con antiinflamatorios no esteroideos por vía subgingival durante la terapia periodontal

El uso de AINEs en forma tópica como complemento de la terapia periodontal podría coadyuvar a resolver con más rapidez el proceso inflamatorio y los signos clínicos de la enfermedad.Se realizó un estudio clìnico randomizado en el que participaron59 pacientes, 33 con periodontitis crónica y 26 controles sanos. A todos los pacientes enfermos se les realizó raspaje y alisado radicular en un cuadrante por semana, aplicándosesubgingivalmente el gel a las 48 hs de cada sesión. Los pacientes sanos recibieron los geles en los mismos intervalos. Se utilizaron 4 tipos de geles conteniendo: placebo, ácido acetilsalicílico (AAS) 1por ciento, Ketoprofeno (KTP) 1 por ciento y Ketoprofeno 2 por ciento. Se estudiaron las variables clínicas: profundidad de sondaje, nivel de inserción, movilidad dentaria, índice de placa, índice gingival y sangrado al sondaje; y bioquímicas: tiempo de sangría (Ivy), recuento plaquetario en sangre entera y plasma rico en plaquetas, y agregación plaquetaria frente a distintos agonistas. En cuanto a los resultados clínicos, el AAS fue el más efectivo en la reducción de la profundidad de sondaje, el Índice gingival y el Sangrado al sondaje (p<0,05). Tanto KTP al 1 por ciento y al 2 por ciento se comportaron en forma similar y menos efectiva que AAS pero con diferencias significativas con respecto al placebo (p<0,05). Conrespecto a las pruebas bioquímicas, el AAS mostró un efecto inhibitorio de la agregación plaquetaria altamente significativo con todos los agonistas utilizados. Respuestas similares pero conmenor intensidad se hallaron con KTP 2 por ciento. El KTP 1 por ciento sólo mostró alterada la primer fase de agregación a la máxima concentraciónde ADP y ninguno a la mínima siendo el valor de p<0.05

Diclofenac in hyaluronic acid gel: an alternative treatment for actinic cheilitis

OBJECTIVE: Actinic cheilitis (AC) is a precancerous lesion of the lip vermillion caused by prolonged exposure to ultraviolet light. The aim of this study was to evaluate the effect of 3 percent diclofenac in 2.5 percent hyaluronic acid gel in the treatment of AC. METHODS: Thirty-four patients with chronic AC were treated twice a day with topical diclofenac during a period of 30 to 180 days. The individuals were followed up every 15 days by means of clinical examination and digital photographic documentation. RESULTS: Of the 27 patients that completed the study, 12 (44 percent) showed complete remission of the whitish plaques and exfoliative areas, and 15 (56 percent) had partial remission of the clinical picture of cheilitis. The latter group was submitted to excision of the leukoplakic areas which diagnosis varied from mild to moderate epithelial dysplasia. CONCLUSIONS: The results suggest a promising role for diclofenac in hyaluronic acid gel in the treatment of AC. This treatment has the advantages of not being invasive and showing few side effects.

Avaliaçäo clínica e microbiológica dos efeitos da irrigaçäo de gel de metronidazol a 20 por cento sobre a raspagem e alisamento radicular em pacientes com doença periodontal crônica / Clinical and microbiological avaluation in the effects of subgingival irrigation with a 20 per cent metronidazole gel over scaling and root planing in patients with periodontal disease

O estudo avaliou o efeito de irrigaçöes com gel de Metronidazol a 20 por cento como coadjuvante à raspagem e alisamento radicular (RAR) em pacientes com doença periodontal. Foram inclusos neste estudo cego seis pacientes com no mínimo três sítios em dentes unirradiculares com Profundidade de Sondagem entre 5-7 mm e BANA-positivos. Após RAR, os 32 sítios foram distribuídos aleatoriamente em um dos grupos: grupo-1; RAR, grupo-2; RAR + irrigaçäo com gel placebo; grupo 3 - RAR + irrigaçäo com gel de metronidazol a 20 por cento. As irrigaçöes foram realizadas após a RAR inicial, 7, 14 e 21 dias após. Os parâmetros clínicos de Indice de Placa, Indice Gengival, Profundidade de Sondagem, Nível de Inserçäo Clínica e Sangramento à Sondagem foram realizados antes do tratamento, 60 e 90 dias após, e a avaliaçäo microbiológica foi realizada com o Teste BANA antes do tratamento e 90 dias após. Os resultados demonstraram uma reduçäo nos parâmetros clínicos sem diferença estatisticamente significante entre os três grupos, com exceçäo da Profundidade de Sondagem, na qual o grupo 3 promoveu uma reduçäo estatisticamente significante em relaçäo aos grupos 1 e 2 aos 60 e 90 dias. Os grupos 2 e 3 promoveram uma reduçäo estatisticamente maior nos sítios BANA-positivos que o grupo 1. Esses resultados sugerem que a associaçäo de irrigaçäo com gel de Metronidazol a 20 por cento à RAR demonstrou efeitos clínicos e microbiológicos semelhantes à terapia de RAR isolada

Subgingival utilization of a 1 percent chlorhexidine collagen gel for the treatment of periodontal pockets: a clinical and microbiological study / Utilização subgengival de gel de colágeno com clorexidina 1 por cento no tratamento de bolsas periodontais: estudo clínico e microbiológico

Este estudo avaliou o efeito de irrigação subgengival de gel colágeno com clorexidina 1 por cento em bolsas periodontais como adjunto à raspagem e alisamento radicular (RAR). Participaram do estudo em 6 pacientes com periodontite periodontal crônica (37 sítios) que apresentavam sítios com profundidade de sondagem entre 5-7 mm e BANA positivos. Foi realizado o tratamento de RAR em todos os sítios, sendo estes distribuídos em um dos 3 grupos: somente RAR (grupo I), RAR + irrigação com gel de colágeno (grupo II), RAR + irrigação com gel de colágeno com clorexidina 1 por cento (grupo III). As irrigações subgengivais foram realizadas após a RAR e nos dias 7, 14 e 21. Os parâmetros clínicos de índice de placa, índice gengival, sangramento à sondagem, nível de inserção, recessão e profundidade de sondagem foram avaliados antes da raspagem 60 e 90 dias após, e o Teste BANA (PERIOSCAN) foi realizado com as amostras de placa dos mesmos sítios, antes da raspagem e 90 dias após. Os resultados obtidos demonstraram uma redução dos parâmetros clínicos sem diferença significante entre os três grupos, com exceção dos parâmetros de índice gengival e sangramento à sondagem onde os resultados foram estatisticamente melhores no grupo III que nos grupos I e II. Os grupos I e II apresentaram redução estatisticamente maior dos sítios BANA positivos quando comparados ao grupo I. Os resultados sugerem que a irrigação subgengival com gel colágeno com clorexidina 1 por cento mostrou-se promissora como coadjuvante ao tratamento de RAR em pacientes com doença periodontal crônica