Guía clínica para el tratamiento de lesiones endoperiodontales sin compromiso radicular en pacientes periodontales / Clinical practice guide for the treatment of endoperiodontal lesions without root compromise in periodontal patients

La comunicación patológica entre la pulpa y el pe-riodonto se denomina lesión endoperiodontal. Puede presentarse de forma aguda o crónica, y su mani-festación más común es la presencia de un absceso acompañado de dolor. Es importante realizar una detenida evaluación clínica y radiográfica para esta-blecer un correcto diagnóstico y plan de tratamiento. Por este motivo, el objetivo de esta guía es presentar un protocolo consensuado entre las Cátedras de Pe-riodoncia y Endodoncia de la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA), para su tratamiento (AU)

The pathological communication between the pulp and the periodontium is called Endoperiodontal Lesion. It can be presented in an acutely or chronically form and its most common manifestation is the presence of an abscess accompanied by pain. It is important to carry out a careful clinical and radiographic evaluation to establish a correct diagnosis, prognosis, and treatment plan. For this reason, the objective of this guide is to present a consensus protocol between Periodontics and Endodontics Departments of the Faculty of Dentistry of the University of Buenos Aires (FOUBA) for their treatment (AU)

Efectividad de antimicrobianos en el tratamiento del raspado y alisado radicular en el adulto mayor / Effectiveness of antimicrobials in the treatment of scaling and root planing in the elderly

RESUMEN Introducción: La terapia antimicrobiana después del raspado y alisado radicular en el anciano no ha sido evaluada en la Clínica Estomatológica Provincial Docente "Mártires del Moncada", de Santiago de Cuba. Objetivo: Evaluar la efectividad de la tetraciclina y azitromicina en el tratamiento del raspado y alisado radicular en el adulto mayor. Método: Estudio cuasiexperimental de intervención terapéutica, realizado entre 2018-2019, en 30 pacientes con 60 y más años y con diagnóstico de periodontitis crónica. Se crearon tres grupos con 10 casos mediante el método aleatorio simple. El Grupo 1 tratado con la técnica convencional y los Grupos 2 y 3, después de la técnica, se aplicó una concentración subgingival de tetraciclina y azitromicina respectivamente y la colocación de cemento quirúrgico por siete días. Se emplearon variables como edad, sexo, cuadro clínico, evolución de signos y síntomas al séptimo día, 1 y 3 meses, y efectividad de curación. La validación estadística fue a través de la prueba Chi-cuadrado, con un 95 % de confiabilidad y la efectividad antimicrobiana, mediante el Análisis de Varianza ANOVA. Resultados: Predominio del grupo 65-69 años y sexo femenino, persistencia de inflamación gingival en el 30,0 % del Grupo 1 al tercer mes, disminuyó la profundidad al sondaje y hubo ganancia de inserción clínica, mejorando sus medias en el tiempo. Se logró un 100,0 % de efectividad de curación en los Grupos 2 y 3. Conclusiones: Elevada efectividad de la aplicación tópica subgingival de tetraciclina y azitromicina con cemento quirúrgico, sobre aquellos tratados con raspado y alisado radicular convencional.

ABSTRACT Introduction: Antimicrobial therapy after scaling and root planing treatment in the elderly has not been evaluated at the "Mártires del Moncada" Provincial Teaching Stomatology Clinic in Santiago de Cuba. Objective: To evaluate the effectiveness of tetracycline and azithromycin in the treatment of scaling and root planing in the elderly. Method: Quasi-experimental study of therapeutic intervention, carried out between 2018 and 2019, on 30 patients with the age of 60 and over and diagnosed with chronic periodontitis. Three groups with 10 cases were created using the simple randomized method. Group 1 treated with the conventional technique and groups 2 and 3, after using the same technique, a subgingival concentration of tetracycline and azithromycin was applied respectively and surgical cement placement for 7 days. Variables such as age, sex, clinical picture, evolution of signs and symptoms at the seventh day, 1 and 3 months, and healing effectiveness were used. The statistical validation was through the Chi-square test, with a 95% reliability and the antimicrobial effectiveness, through the Analysis of Variance ANOVA. Results: Predominance of the group age between 65 and 69 years and female sex, persistent gingival inflammation in 30,0 % of group 1 at the third month, decreased the depth of the catheterization and there was a clinical insertion gain, improving their averages in time. A 100.0% healing effectiveness was achieved in groups 2 and 3. Conclusions: High effectiveness of subgingival topical application of tetracycline and azithromycin with surgical cement, over patients treated with conventional scaling and root planing.

Comparison of full-mouth scaling and quadrant-wise scaling in the treatment of adult chronic periodontitis

Abstract In the search for the ideal treatment of periodontal disease various non-surgical techniques should be considered. The objective of this study was to evaluate the efficacy of full-mouth scaling (FMS) by clinical and microbiological parameters. 670 individuals were evaluated with 230 subjects meeting the selection criteria and were divided into two groups; 115 subjects treated with FMS and 115 treated with weekly sessions of scaling and root planning (SRP). The patient population had a mean age of 51.67 years, with moderate chronic periodontitis. Subjects were evaluated prior to treatment (T1) and 90 days after execution of therapy (T2), with regards to: probing depth (PD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and microbial detection for the presence of Porphyromonas gingivalis (P.g.) and Prevotella intermedia (P.i.) by culture method and confirmed by biochemical tests. Subjects treated in the FMS group also rinsed with 0.12% chlorhexidine mouthwash for seven days following treatment. The results were analyzed using statistical Student's t-test and chi-square test. No statistically significant differences were observed for PD and CAL between T1 and T2 in both groups. For GI and PI significant difference was observed between the groups. For the evaluated microbial parameters was observed reduction of P.g. and P.i., but only for P.g. with a significant reduction in both groups. The full mouth scaling technique with the methodology used in this study provided improved clinical conditions and reduction of P.g. in subjects with moderate periodontitis, optimizing the time spent in the therapeutic execution.

Resumo Na busca do tratamento ideal da doença periodontal varias são técnicas não-cirúrgicas que podem ser consideradas. O objetivo deste estudo foi avaliar a eficácia da técnica de desinfecção total de boca (FMD, na sigla em Inglês) por parâmetros clínicos e microbiológicos. Foram avaliados 670 indivíduos com 230 indivíduos atendendo aos critérios de seleção e divididos em dois grupos; 115 indivíduos tratados com FMD e 115 tratados com sessões semanais de raspagem e alisamento corono radicular (SRP, na sigla em Inglês). A população avaliada tinha idade média de 51,67 anos, com periodontite crônica moderada. Os sujeitos foram avaliados antes do tratamento (T1) e 90 dias após a execução da terapia (T2), quanto à profundidade de sondagem (PS), nível de inserção clínica (NIC), índice de placa (IP), índice gengival (IG) e detecção microbiana da presença de Porphyromonas gingivalis (P.g.) e Prevotella intermedia (P.i.) por método de cultura e confirmada por testes bioquímicos. Os indivíduos tratados no grupo FMD também realizaram bochechos com clorexidina 0,12% durante sete dias após o tratamento. Os resultados foram analisados ​​utilizando o teste estatístico t de Student e o teste de qui-quadrado. Não foram observadas diferenças estatisticamente significativas para PS e NIC entre T1 e T2 em ambos os grupos. Para IG e IP observou-se diferença significativa entre os grupos. Para os parâmetros microbianos avaliados foi observada redução de P.g. e P.i., mas apenas para P.g. com uma redução significativa em ambos os grupos. A técnica FMD com a metodologia utilizada neste estudo proporcionou condições clínicas melhoradas e redução da P.g. Em indivíduos com periodontite moderada, otimizando o tempo gasto na execução terapêutica.

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.

Eficacia de la azitromicina asociada al raspado y alisado radicular en periodontitis crónica / Efficacy of azithromycin associated with scaling and root planing in chronic periodontitis

RESUMEN: Objetivo: evaluar la eficacia de la azitromicina asociada al RAR asociada al (raspado y alisado radicular) en pacientes con periodontitis crónica. Material y método: El presente ensayo clínico paralelo aleatorizado, controlado y triple ciego, se desarrolló en la Clínica Estomatológica de la Universidad Católica Los Ángeles de Chimbote (Trujillo, Perú), entre marzo y diciembre de 2015. Participaron 30 pacientes adultos, distribuidos aleatoriamente en 2 grupos, designados con las letras A y B, de 15 integrantes cada uno. Cada paciente fue evaluado periodontalmente antes de realizarle el raspado y alisado radicular y optimización de las técnicas de higiene. A los pacientes del grupo A se les indicó tratamiento antibiótico con Azitromicina 500 mg por vía oral cada 24 horas durante 3 días y al grupo B se les indicó un placebo con las mismas características físicas del antibiótico escogido. Los pacientes fueron evaluados a los 3, 4 y 5 meses. La eficacia fue evaluada mediante el test T de Student para comparación de medias, considerando un nivel de significancia para los valores de p<0,05. Resultados: Se encontró que ambos grupos lograron mejorar la profundidad de sondaje y el nivel de inserción clínica sin embargo no presentaron diferencias estadísticamente significativas entre ellos. Conclusión: La azitromicina asociada al RAR no es eficaz como terapia coadyuvante en pacientes con periodontitis crónica.

ABSTRACT: Objective: To evaluate the efficacy of azithromycin associated with the RAR (scaling and root planing) in patients with chronic periodontitis. Material and Methods: This clinical trial parallel randomized, controlled, triple blind, was developed in the Stomatology Clinic of the Catholic University Los Angeles of Chimbote (Trujillo, Peru), between March and December 2015. The participants were 30 adult patients randomized 2 groups, designated by the letters A and B of 15 members each. Each patient was evaluated periodontally before Give you the scaling and root planing and optimization hygiene techniques. Patients in group A, were prescribed antibiotic treatment with azithromycin 500 mg orally every 24 hours for 3 days. While, group B were prescribed a placebo with the same physical characteristics of the antibiotic chosen. Patients were evaluated at 3, 4 and 5 months. The efficacy was evaluated using the Student t test to compare means, considering a level of significance for the values of p <0.05. Results: It was found that both groups were able to improve probing depth and clinical attachment level however no statistically significant differences between them. Conclusion: Azithromycin associated with the RAR is not effective as adjunctive therapy in patients with chronic periodontitis.

Terapia fotodinámica como adyuvante en el tratamiento periodontal no quirúrgico: evaluación clínica / Photodynamic therapy as an adjuvant in nonsurgical periodontal treatment:A clinical evaluation

La terapia fotodinámica es considerada como un procedimiento no invasivo dentro de la práctica periodontal, reduciendo la morbilidad e incrementando la comodidad del paciente. Objetivo: el objetivo del presente estudio fue evaluar la eficacia clínica del uso de terapia fotodinámica como adyuvante al raspado y alisado radicular en periodontitis crónica. Material y métodos: se realizó un estudio comparativo, correlacional, aplicado a 20 pacientes con periodontitis crónica moderada-avanzada (pérdida de inserción clínica >- 6 mm) durante el raspado y alisado radicular no quirúrgico, con la adición de azul de metileno, donde se administró la terapia fotodinámica en dos sesiones, evaluando los parámetros clínicos (profundidad de bolsa, nivel de inserción clínico, índice de placa, sangrado al sondeo y recesión gingival). Resultados: tras cuatro semanas de evaluación postratamiento, no se observaron diferencias significativas en los parámetros clínicos entre el grupo experimental y control, aunque se encontró un mayor aumento de recesión gingival con el uso de la terapia fotodinámica (p=0,353). Conclusión: el uso de la terapia fotodinámica como adyuvante durante el raspado y alisado radicular convencional no proporciona beneficios adicionales al tratamiento periodontal convencional.

Photodynamic therapy is considered a non-invasiveprocedure in periodontal practice, one which reduces morbidity andincreases patient comfort. Objective: The aim of this study was toevaluate the clinical effi cacy of photodynamic therapy as an adjuvantto scaling and root planing in chronic periodontitis. Material andmethods: A comparative and correlational study was carried out on 20patients with moderate to advanced chronic periodontitis (attachmentloss ≥ 6 mm) during nonsurgical scaling and root planing, including theaddition of methylene blue. The photodynamic therapy was applied intwo sessions, during which the clinical parameters (pocket depth, clinicalattachment level, plaque index, bleeding on probing, and gingivalrecession) were assessed. Results: After four weeks of post-treatmentassessment, no signifi cant diff erences were found between the clinicalparameters of the experimental and control groups, although a greaterincrease in gingival recession was found when photodynamic therapywas used (p = 0.353). Conclusion: The use of photodynamic therapyas an adjuvant in conventional scaling and root planing provides noadditional benefi ts to conventional periodontal treatmen.

Efecto clínico del uso de probiótico en el tratamiento de la periodontitis crónica: ensayo clínico / Clinical effect of probiotic in treatment of chronic periodontitis: clinical trial

Objetivo El objetivo de este ensayo clínico aleatorizado, doble ciego, de brazos paralelos y controlado por placebo fue evaluar el efecto clínico del consumo de Lactobacillus rhamnosus SP1 en un polvo de disolución oral, adicional a la terapia periodontal no quirúrgica. Material y método Cuarenta y nueve sujetos fueron examinados para participar en este estudio. Veintiocho participantes sistémicamente sanos, con diagnóstico de periodontitis crónica, fueron reclutados y monitorizados clínicamente en el tiempo basal, 3 y 6 meses después de la terapia periodontal. Los parámetros clínicos registrados fueron presencia de placa, sangrado al sondaje, profundidad al sondaje y pérdida de inserción clínica. Todos recibieron terapia periodontal no quirúrgica, incluyendo pulido y alisado radicular (PAR), y fueron asignados aleatoriamente al grupo experimental (PAR + probiótico, n = 14) o control (PAR + placebo, n = 14). Luego de la última sesión de PAR debieron ingerir un sobre con polvo de disolución oral de Lactobacillus rhamnosus SP1 o placebo, una vez al día durante 3 meses. Resultados Ambos grupos mejoraron sus parámetros clínicos en todos los tiempos evaluados. Además, el grupo experimental redujo significativamente el porcentaje de sitios, dientes y número de participantes con profundidad al sondaje ≥ 5 mm entre el tiempo basal y los 6 meses postratamiento. Conclusiones La administración oral de L. rhamnosus SP1 asociado a la terapia periodontal genera similares mejorías en los parámetros clínicos comparado con solo usar terapia periodontal en el tratamiento de la periodontitis crónica en adultos.

Objective The aim of this double- blind, placebo- controlled parallel- arm, randomised clinical trial was to evaluate the clinical effects of a sachet of Lactobacillus rhamnosus SP1-containing probiotic as an adjunct to non-surgical therapy. Material and method Fourty- nine subjects were screened for their elegibility to participate in this study. Twenty-eight systemically healthy volunteers with chronic periodontitis were enrolled and monitored clinically at baseline, and at 3 and 6 months after therapy. Clinical parameters measured included plaque index, bleeding on probing, pocket probing depths (PPD), and clinical attachment loss. Patients received non-surgical therapy including scaling and root planing (SRP), and were randomly assigned to a test (SRP + probiotic, n = 14) or control (SRP + placebo, n = 14) group. The administration of a sachet of Lactobacillus rhamnosus SP1 probiotic once a day for 3 months commenced after the last session of SRP. Results Both test and control groups showed improvements in clinical parameters at all time points evaluated. Furthermore, at initial visits and after 6 months follow-up, the test group showed a statistically significant reduction in percentage of sites, teeth, and number of participants with PPD ≥ 5 mm. Conclusions The results of this trial indicate that oral administration of L. rhamnosus SP1 sachets during initial therapy resulted in similar clinical improvements compared to SRP alone.

Prevalence of periodontopathogens and Candida spp. in smokers after nonsurgical periodontal therapy - a pilot study

Abstract This pilot study aimed to evaluate the influence of smoking on clinical and microbiological parameters after nonsurgical periodontal therapy. Forty-eight subjects were grouped into smokers (SM, n = 24) and nonsmokers (NS, n = 24) and paired according to gender, age, ethnicity, and periodontal status. Both groups received oral hygiene education and scaling and root planing. Clinical evaluation was performed using plaque index (PI), bleeding on probing (BOP), pocket probing depth (PPD), gingival recession (GR), and clinical attachment level (CAL) before instrumentation (baseline) and at 3 and 6 months. The prevalence of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Candida albicans, Candida glabrata, Candida tropicalis, and Candida dubliniensis in subgingival biofilm was determined by polymerase chain reaction. The data were statistically analyzed considering p < 0.05. Clinical conditions improved between baseline and 3 months after periodontal treatment. However, NS had a better clinical response, presenting greater PPD reduction and CAL increase in comparison to SM. Periodontal treatment reduced the levels of P. gingivalis, A. actinomycetemcomitans, and T. forsythia individually after 3 months for the NS group and after 6 months for both groups. The prevalence of Candida species was markedly higher in SM than in NS at all time points evaluated. Periodontopathogens associated or not with C. albicans or C. dubliniensis were more prevalent in SM than in NS at baseline and after 3 months. It was concluded that smoking impairs clinical and microbiological responses to periodontal therapy. Periodontopathogens combined or not with some Candida species are resistant to short-term periodontal therapy in SM.

Supragingival biofilm control and systemic inflammation in patients with type 2 diabetes mellitus

The objective of this study was to evaluate the effect of strict supragingival biofilm control on serum inflammatory markers and on periodontal clinical parameters in type 2 diabetes mellitus (T2DM) patients with chronic severe periodontitis. Twenty-four individuals with T2DM and periodontitis were randomly allocated to two treatment groups. The supragingival therapy group (ST, n = 12) received supragingival scaling, whereas the intensive therapy group (IT, n = 12) underwent supra- and subgingival scaling, as well as root planing. Patients from both groups received professional oral hygiene instructions every month. Data regarding visible plaque index (VPI), gingival bleeding index (GBI), bleeding on probing (BOP), probing pocket depth (PPD), clinical attachment level (CAL), serum levels of interleukin (IL)-6, IL-17A, IL-8, tumor necrosis factor α (TNF-α), monocyte chemoattractant protein (MCP)-1 enzyme-linked immunosorbent assay (ELISA), and glycated hemoglobin (HbA1c) levels were obtained at baseline and at 6 months post-therapy. Both therapies resulted in the improvement of almost all clinical periodontal parameters (p < 0.05). There were no differences in TNF-α, IL-8, IL-17A and HbA1c levels in either group (p >0.05), between the two periods. However, MCP-1 levels were significantly reduced in both the ST (p = 0.034) and the IT (p = 0.016) groups, whereas the serum IL-6 levels were significantly reduced only in the IT group (p = 0.001). Strict control of supragingival biofilm has a limited effect on systemic inflammatory markers, and a moderate effect on periodontal clinical parameters.

Terapia fotodinâmica no tratamento periodontal: comparação microbiológica entre dois métodos / Photodynamic therapy adjunct in the treatment periodontal: microbiological comparison between two methods

a terapia fotodinâmica (PDT) tem a finalidade de reduzir os periodontopatógenos no biofilme dental através da associação de um laser a um corante fotossensibilizador, que culmina na produção de oxigênio singleto, levando à morte celular. Este estudo-piloto compara dois diferentes métodos de irradiação do laser de baixa potência na PDT, através da análise dos patógenos periodontais Porphyromonas gingivalis (P.g.), Tannerella forsythia (T.f.), Treponema denticola (T.d.) e Aggregatibacter actinomycetencomitans (A.a.). Material e métodos: este estudo-piloto é parte de um estudo clínico longitudinal, prospectivo, randomizado e duplo-cego. Foram selecionados cinco pacientes portadores de periodontite crônica, com dois dentes unirradiculares contralaterais com profundidade de sondagem maior ou igual a 5 mm, sem comprometimento sistêmico. Os pacientes foram submetidos à raspagem e alisamento radicular, e subsequentemente à PDT nos dentes experimentais. Estes foram alocados em dois grupos, de acordo com a maneira de entrega do laser: grupo A (transgengival) e grupo B (intrasulcular). A quantificação dos periodontopatógenos foi avaliada pela PCR em tempo real, sete e 30 dias após a intervenção, sendo adotado o nível de significância p ≤ 0,05. Resultados: não houve diferença entre os grupos A (irradiação transgengival) e B (irradiação intrasulcular), em relação aos níveis de A.a., T.f. e T.d. em qualquer momento do estudo. Em relação aos níveis de Pg, houve diferença significativa entre os grupos após 30 dias (p=0,032). Conclusão: os dois métodos foram semelhantes na redução de A.a., T.d. e T.f.. O método B (intrasulcular) mostrou uma redução significativa do patógeno P.g. no sétimo e 30º dia de avaliação.

Introduction: photodynamic therapy (PDT) has the purpose of reducing the periodontal biofilm by combining a laser with a photosensitizing dye that culminates in the production of singlet oxygen, leading to cell death. This pilot study compares two different methods of irradiation of low power laser in PDT, by analyzing the periodontal pathogen Porphyromonas gingivalis (P.g.), Tannerella forsythia (T.f.), Treponema denticola (T.d.) and actinomycetencomitans Aggregatibacter (A.a.). Material and methods: this pilot is part of a longitudinal, prospective, randomized, double-blind study. Were selected five patients with chronic periodontitis with two contralateral single-rooted teeth with depth greater than or equal to 5 mm, without systemic involvement. Patients underwent scaling and root planing and subsequent to PDT in experimental teeth, which were divided into two groups according to the manner of delivery of the laser: group A (transgingival) and group B (intrasulcular). The reduction of periodontal pathogens was evaluated by PCR real-time, 7 and 30 days after the intervention, with significance level p ≤ 0.05. Results: there was no difference between groups A (transgingival irradiation) and B (intrasulcular irradiation) with respect to A.a., T.f. and T.d. at any time during the study. With respect to levels of P.g., a significant difference between groups at 30 days (p=0.032). Conclusions: the two methods were similar in reducing A.a., T.d., T.f.. The method B (intrasulcular) showed a significant reduction in pathogen P.g. 7 and 30 days of evaluation.

Microbiological effects of periodontal therapy plus azithromycin in patients with diabetes: results from a randomized clinical trial

Evidencia actual sugiere que la infección periodontal puede agravar el control de la diabetes. El objetivo de este estudiofue determinar los cambios en la frecuencia de detección de porphyromonas gingivalis, Tannerella forsythia, Treponema denticola y Aggregatibacter actinomycetemcomitans en pacientes con diabetes con el uso de terapia mecánica no quirúrgica mas azitromicina en un estudio clínico controlado aleatorizado.Ciento cinco pacientes (105) con diabetes y perio -dontitis fueron asignados aleatoriamente en tres grupos: terapiamecánica mas azitromicina, terapia mecánica mas placebo y profilaxis supragingival mas azitromicina. Un análisis periodontal completo y detección de patógenos perio dontales por medio de reacción en cadena de la polimerasa (PCR) se realizaron al inicio, 3, 6 y 9 meses después de la terapia pe -riodontal. La frecuencia de detección de Porphyromonas gingivalis, Treponema denticola y Aggregatibacter actinomycetemcomitans disminuyó a los 3 meses en todos los grupos. La frecuencia de detección de Tannerella forsythia se incrementó a los 3 meses en todos los grupos. Todos los patógenosperiodontales mostraron una frecuencia de detección similar a los 9 meses en todos los grupos. La terapia periodontal mas azitromicina no tuvo efectos adicionales sobre la frecuencia dedetección de los patógenos periodontales investigados en pacientes diabéticos...

Photodynamic therapy associated with full-mouth ultrasonic debridement in the treatment of severe chronic periodontitis: a randomized-controlled clinical trial

Background: Photodynamic therapy (PDT) is a method of microbial reduction which can benefit periodontal treatment in areas of difficult access, such as deep pockets and furcations. The aim of this randomized controlled clinical trial was to evaluate the effects of PDT as an adjunct to full-mouth ultrasonic debridement in the treatment of severe chronic periodontitis. Material and Methods: Twenty-two patients with at least one pocket with a probing depth (PD) of ≥7 mm and one pocket with a PD of ≥5 mm and bleeding on probing (BOP) on each side of the mouth were included, characterizing a split mouth design. The control group underwent full-mouth ultrasonic debridement and the test group received the same treatment associated with PDT. The PDT was performed on only one side of the mouth and the initial step consisted of subgingival irrigation with 0.005% methylene blue dye. Two minutes after applying the photosensitizer, the low power laser – AsGaAl (Photon Lase III – PL7336, DMC, São Carlos -São Paulo, Brazil) was applied (660 nm, 100 mW, 9 J, 90 seconds per site, 320 J/cm 2 , diameter tip 600 µm). The following clinical parameters were evaluated: plaque index, gingival index, BOP, gingival recession (GR), PD, and clinical attachment level (CAL). All parameters were collected before, 1, 3 and 6 months after treatment. Results: An improvement in BOP, PD and CAL was observed after treatment, in both groups, but without any difference between them. After 6 months, the PD decreased from 5.11±0.56 mm to 2.83±0.47 mm in the test group (p<0.05) and from 5.15±0.46 mm to 2.83±0.40 mm in the control group (p<0.05). The CAL changed, after 6 months, from 5.49±0.76 mm to 3.41±0.84 mm in the test group (p<0.05) and from 5.53±0.54 to 3.39±0.51 mm in the control group (p<0.05). Conclusion: Both approaches resulted in significant clinical improvements in the treatment of severe chronic periodontits, however, the PDT did not provide any additional benefit to those obtained with full-mouth ultrasonic debridement used alone.

Activity of platelet activating factor acetylhydrolase following phase I periodontal therapy / Actividad de la acetilhidrolasa del factor activador de las plaquetas tras la fase I de la terapia periodontal

OBJECTIVE: Elevated levels of platelet activating factor (PAF), a potent inflammatory mediator, in perio-dontal disease and decreased PAF levels following periodontal surgical therapy have been previously detected in gingival tissues and gingival crevicular fluid (GCF). Platelet activating factor acetylhydrolase (PAF-AH) is a calcium-independent phospholipase A2 that catalyses the hydrolysis of PAF, thereby inactivating this mediator. The hypothesis, a relationship between activity of PAF-AH and healing following periodontal therapy, was tested by detecting activity of PAF-AH in GCF samples collected from sites that had undergone phase I periodontal therapy with generalized chronic periodontitis. METHODS: Twenty patients with generalized chronic periodontitis were divided into two groups (n = 10): group 1 with probing pocket depth (PPD) 4-5 mm and group 2 with PPD > 6-8 mm. Clinical parameters were recorded and GCF was sampled before phase I periodontal therapy and at the 2nd, 7th, 14th, 21st and 28th day follow-up evaluation visits. Activity of PAF-AH in GCF was analysed by enzyme-linked immunosorbent assay (ELISA). RESULTS: Probing pocket depth at the 21st and 28th day in group 1, and PPD at the 14th, 21st and 28th day in group 2 were significantly decreased when compared to the baseline values (p < 0.001). Activity of PAF-AH (µmol/ml) was significantly decreased at the 7th, 14th, 21st and 28th day following phase I periodontal therapy in both groups 1 and 2 compared to the baseline values (p < 0.05). CONCLUSION: Platelet activating factor acetylhydrolase is detectable in GCF by ELISA and showed a continuous decrease following phase I periodontal therapy. Changes in the PAF-AH activity would be a progressive marker of periodontal healing to evaluate the success of periodontal therapies.

OBJETIVO: Niveles elevados del factor activador de las plaquetas (PAF) - un potente mediador inflamatorio en la enfermedad periodontal - y niveles disminuidos de PAF tras la terapia quirúrgica periodontal, han sido detectados previamente en los tejidos gingivales y el fluido crevicular gingival (FCG). La acetilhidrolasa del factor activador de las plaquetas(PAF-AH) es una fosfolipasa A2 independiente del calcio, que cataliza la hidrólisis de PAF, inactivando así este mediador. La hipótesis - la existencia de una relación entre la actividad de PAF-AH y la curación tras la terapia periodontal - fue sometida a comprobación mediante la detección de la actividad de PAF-AH en muestras de FCG recogidas de sitios que pasaron por la fase I de la terapia periodontal por periodontitis crónica generalizada. MÉTODOS: Veinte pacientes con periodontitis crónica generalizada fueron divididos en dos grupos (n = 10): grupo 1 con una profundidad de bolsa al sondeo (PPD) de 4-5 mm, y grupo 2 con PPD = 6-8 mm. Se registraron los parámetros clínicos, y se obtuvieron muestras de FCG antes de la fase I de la terapia periodontal, y en las visitas de evaluación de seguimiento los días 2, 7, 14, 21 y 28. La actividad de PAF-AH en FCG se analizó mediante ensayo por inmunoabsorción ligada a enzimas (ELISA). RESULTADOS: La profundidad de bolsa al sondeo los días 21 y 28 en el grupo 1, y PPD los días 14, 21 y 28 en el grupo 2 se vieron disminuidas significativamente cuando se les comparó con los valores iniciales (p < 0.001). La actividad de PAF-AH (µmol/ml) disminuyó significativamente los días 7, 14, 21 y 28 tras la fase I de la terapia periodontal en ambos grupos 1 y 2 en comparación con los valores al inicio del estudio (p< 0.05). CONCLUSIÓN: La acetilhidrolasa del factor activador de las plaquetases detectable en FCG mediante ELISA, y mostró una disminución continua tras la fase I de la terapia periodontal. Los cambios en la actividad de la PAF-AH sería un marcador progresivo de la curación periodontal para evaluar el éxito de las terapias periodontales.

Effectiveness of non-surgical treatment to reduce il-18 levels in the gingival crevicular fluid of patients with periodontal disease

The aim of this study was to evaluate the effectiveness of the non-surgical periodontal treatment in reducing the gingival crevicular fluid (GCF) levels of IL-18 from inflamed periodontal sites. Fourteen patients with periodontal disease were included, being 9 patients with chronic periodontitis (mean age: 48.8 SD ± 7.4 years) and 5 patients with gingivitis (mean age: 43.6 SD ± 11.8). The patients were divided in the following groups: gingivitis sites from periodontitis patients (sites GP), periodontitis sites from periodontitis patients (sites PP), and gingivitis sites from gingivitis patients (sites GG). Probing pocket depth (PPD), probing attachment level (AL), plaque index (PI) and gingival index (GI) were recorded, and gingival fluid samples were collected. The subjects received non-surgical treatment and were re-evaluated 30 days after treatment (day 30 AT). There was a significant reduction in PI in GG (1.0 ± 0.4 to 0.5 ± 0.2), GP (1.2 ± 0.3 to 0.5 ± 0.3), and in PP (1.3 ± 0.4 to 0.7 ± 0.3) 30 AT. There was also a significant reduction in the GI in GG (1.3 ± 0.3 to 0.7 ± 0.4). PPD reduced significantly in GG (2.4 ± 0.6 to 1.9 ± 0.1), and PP (6.7 ± 1.1 to 5.2 ± 0.9) 30 AT. When all the samples were analyzed together, there was a significant reduction in IL-18 (12.9 ± 7.2 to 10.0 ± 3.1). This study showed that non-surgical treatment was effective in reducing GCF levels of IL-18 from inflamed periodontal sites.

O objetivo desse estudo foi avaliar o efeito do tratamento periodontal não-cirúrgico sobre os níveis da IL-18 em sítios inflamados de pacientes com doença periodontal. Foram avaliados 14 pacientes com doença periodontal, sendo 9 pacientes com periodontite crônica generalizada (idade média: 48,8 DP ± 7,4 anos) e 5 pacientes com gengivite (idade média: 43,6 DP ± 11,8 anos). Os pacientes foram divididos nos seguintes grupos: sítios sem perda de inserção nos pacientes com periodontite (GP), sítios com perda de inserção nos pacientes com periodontite (PP) e sítios sem perda de inserção nos pacientes com gengivite (GG). Profundidade de bolsa (PB), nível de inserção (NI), índice de placa (IP) e índice gengival (IG) foram avaliados e amostras do fluido gengival foram coletadas. Os pacientes receberam terapia não-cirúrgica e foram reavaliados 30 dias após tratamento (AT). Houve uma redução significante no IP dos GG (1,0 ± 0,4 para 0,5 ± 0,2), GP (1,2 ± 0,3 para 0,5 ± 0,3) e PP (1,3 ± 0,4 para 0,7 ± 0,3) 30 AT. Também houve uma redução significante no IG do GG (1,3 ± 0,3 para 0,7 ± 0,4). A profundidade de bolsa reduziu no GG (2,4 ± 0,6 para 1,9 ± 0,1) e no PP (6,7 ± 1,1 para 5,2 ± 0,9) 30 AT. Quando todas as amostras foram analisadas juntas, houve uma redução significante do IL-18 (12,9 ± 7,2 para 10,0 ± 3,1). Esse estudo mostrou que a terapia periodontal não-cirúrgica é eficaz em reduzir os níveis de IL-18 no fluido gengival de sítios inflamados.

Efeitos da profilaxia profissional repetida como terapia adjunta à raspagem e alisamento radicular / The efect of professional supragengival plaque control as part of the active phase of periodontal therapy

O objetivo deste estudo foi avaliar os efeitos clínicos e microbiológicos da terapia de raspagem e alisamento radicular (RAR) isoladamente ou em combinação com o controle profissional da placa supragengival (CPP). Foram selecionados 30 indivíduos com periodontite crônica e, posteriormente, distribuídos aleatoriamente em dois grupos terapêuticos: controle (RAR) e teste (RAR + CPP). Os exames clínicos (índice de placa, índice gengival, profundidade de sondagem, nível clínico de inserção, sangramento à sondagem e supuração) e microbiológico (Teste BANA) foram realizados no momento inicial, 40 e 60 dias após a terapia de RAR. A terapia de RAR foi realizada em 21 dias e o CPP foi iniciado juntamente com a RAR, duas vezes semanais, e prosseguiu durante 40 dias após o término desta. Os parâmetros clínicos foram reduzidos significativamente aos 60 dias pós-terapia em ambos os grupos terapêuticos (p6 mm) no grupo CPP tiveram melhores resultados em relação à redução do acúmulo de placa e na profundidade de sondagem em comparação ao grupo controle. Ambas as terapias levaram a melhora microbiológica durante o período experimental (p0,05). Em conclusão, a combinação do CPP com a RAR promove benefícios clínicos em comparação com a RAR isolada.

The purpose of the present study was to evaluate the clinical and microbiological effects of scaling and root planing (RAR) alone or in combination with professional supragingival pla- que control (CPP). Thirty subjects with chronic periodontitis were assigned into two therapeutic groups: Control (RAR) and Test (RAR + CPP). Clinical (visible plaque, gingival bleeding, probing depth, clinical attachment levei, bleeding on probing and suppuration) and microbiological (BANA Test] examinations were performed at baseline, 40 and 60 days post-SRP. The CPP treatment was made twice a week and began with SRP and was continued for 40 days post-SRP. The clinical pa- rameters were significantly reduced at 60 days post-therapy in both treatment groups (p6mm) in the PPC group also had a better reduction in the percentage of sites with bleeding on probing and in probing depth and in the gain of clinical attachment compared to the control group. Both therapies led to a microbiological improvement overtime (p0.05). In conclusion, the combination of CPP and RAR leads to clinical benefits in comparison to RAR alone.

The use of topical subgingival gels of non-steroidal anti-inflammatory drugs (NSAIDs) as an adjunct to non-surgical management of chronic periodontitis / Topicación subgingival con geles de drogas antiinflamatorias no esteroides (AINEs) como coadyuvante en el manejo no quirúrgico de la periodontitis crónica

The treatment of chronic periodontitis consists of conventional mechanical debridement and removal of plaque and calculus 1. Topical NSAIDs could be used to complement the therapy as an adjunct to resolve the inflammatory process and clinical signs of the disease more rapidly. A randomized clinical trial was performed on 33 systemically healthy patients diagnosed with chronic periodontitis, aged 21 to 40 years. All patients underwent scaling and root planing on one quadrant per week, and sub-gingival gel was applied 48 hours after each session. Patients were grouped into 4 treatment protocols with gels containing: (1) placebo, (2) 1%acetyl-salicylic acid (ASA), (3) 1% ketoprofen (KTP) and (4) 2% ketoprofen. The clinical variables studied were: probing depth, attachment level, tooth mobility, plaque index, gingival index and bleeding on probing. All protocols (groups 1, 2, 3 and 4) induced a reduction of probing depths, plaque and gingival indices and bleeding on probing. The 1% ASA and 2% KTP protocols (groups 2 and 4) significantly reduced the probing depth variable (ANOVA p<0.05).

El tratamiento de la periodontitis crónica, consiste en el desbridamiento convencional mecánico de remoción de placa y cálculo1. El uso de AINEs en forma tópica como complemento de la terapia podría coadyuvar a resolver con más rapidez el proceso inflamatorio y los signos clínicos de la enfermedad. Se realizó un estudio clínico randomizado en el que participaron 33 pacientes con diagnóstico de periodontitis crónica, sistémicamente sanos de edades entre 21 y 40 años. A todos los pacientes se les realizó raspaje y alisado radicular en un cuadrante por semana, aplicándose subgingivalmente el gel a las 48 hs de cada sesión. Para esto, los pacientes fueron agrupados en 4 protocolos de tratamiento con geles conteniendo:(1) placebo, (2) ácido acetilsalicílico (AAS) 1 por ciento, (3) Ketoprofeno (KTP) 1 por ciento y (4) ketoprofeno 2 por ciento. Las variables clínicas estudiadas fueron: profundidad de sondaje, nivel de inserción, movilidad dentaria, índice de placa, índice gingival y sangrado al sondaje. Todos los protocolos (grupo 1, 2, 3 y 4) indujeron una disminución en la profundidad al sondaje, los índices de placa y gingival y el sangrado al sondaje. Los protocolos del AAS al 1 por ciento y el KTP 2 por ciento (grupo 2 y 4) redujeron significativamente la variable de profundidad al sondaje (ANOVA p<0,05).

Avaliação clínica do uso de pontas ultra-sônicas diamantadas na terapia peiodontal não-cirúrgica / Clinical evaluate of the use of diamond-coated ultrasonic scaler in non-surgical periodontal therapy

A avaliação da resposta clínica dos tecidos periodontais à terapia periodontal não-cirúrgica utilizando pontas ultra-sônicas diamantadas (CVDentUS), em dentes unirradiculares, sob os parâmetros clínicos (índice de Placa - IR Sangramento à Sondagem - SS, Profundidade de Sondagem - PS, Nível de Inserção Clínica Relativo - NICR e Recessão Gengival - RG), comparados à instrumentação com curetas Gracey. Trata-se de um estudo clínico controlado e randomizado, com um desenho em boca dividida, envolvendo 15 pacientes com periodontite crônica (profundidade de sondagem > 3 mm e < 5 mm). Os pacientes foram submetidos à descontaminação da superfície radicular com as pontas ultra-sônicas diamantadas CVDentUS (lado teste) e com curetas Gracey 5/6 (lado controle). Os parâmetros clínicos foram avaliados no tempo inicial, 30, 60 e 90 dias após os tratamentos. Os resultados não mostraram diferença significante entre os tratamentos. Dentro dos limites deste estudo, podemos concluir que, clinicamente, as pontas ultra-sônicas diamantadas CVDentUS foram tão eficientes quanto às curetas na terapia periodontal não-cirúrgica.

Redução bacteriana em lesões de furca grau II após raspagem associada ou não à aplicação do laser de Nd: YAG / Bacterial reduction in class II furcation after root debridment with or without Nd: YAG laser irradiation

O uso do laser de Nd:YAG para redução bacteriana como coadjuvante dos procedimentos básicos no tratamento periodontal tem sido demonstrado em vários estudos. O objetivo desse ensaio clínico aleatório duplo-cego, foi avaliar a redução bacteriana obtida com o laser de Nd: YAG, associado aos procedimentos básicos periodontais em furcas grau II de pacientes com periodontite crônica. Num modelo de boca dividida, 34 furcas foram selecionadas de 17 pacientes. As 17 furcas do grupo Controle receberam duas sessões de raspagem manual associado ao ultra-som, com intervalo semanal. O grupo Teste recebeu o mesmo tratamento que o grupo anterior, seguido da aplicação do laser de Nd:YAG (100 mJ/pulso; 15 Hz; 1,5 W; 60 s). O número total de Unidades Formadores de Colônias (UFC) de bactérias anaeróbias; número total de UFC de bactérias pigmentadas de preto; porcentagem de Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis e Prevotella intermedia foram coletados antes, imediamente após e um mês depois do tratamento. Os resultados demonstraram uma redução significativa das UFC de bactérias anaeróbias em ambos os grupos, sendo esta maior no grupo Teste. Após um mês, houve um aumento desse número, porém não alcançando os níveis iniciais para ambos os grupos. As UFC de bactérias pigmentadas e a porcentagem de Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis e Prevotella intermedia se comportaram da mesma forma em ambos os grupos, tendo uma redução imediatamente após o tratamento e um retorno a níveis próximos dos iniciais 30 dias após. Os autores concluíram que o laser de Nd:YAG associado à raspagem promoveu redução bacteriana nas furcas grau II imediamente após duas aplicações.

Hand and ultrasonic instrumentation in the treatment of chronic periodontitis after supragingival plaque control

Este estudo comparou, clinicamente, o efeito de raspagem e alisamento radicular por instrumentações manual e ultra-sônica no tratamento da periodontite crônica, após o controle de placa supragengival em 20 pacientes. Os parâmetros clínicos profundidade de sondagem (PS), nível de inserção clínica (NIC) e sangramento à sondagem (SS) foram avaliados por um examinador calibrado e cego. Os dentes experimentais foram alocados para uma das seguintes abordagens subgengivais, de acordo com a profundidade de sondagem: 1) manual, 2) manual associada à irrigação, 3) ultra-sônica, 4) ultra-sônica previamente à manual. O tempo usado nos procedimentos foi registrado. Avaliações foram feitas 30 e 90 dias após os tratamentos. Médias individuais de SS, PS e NIC foram analisadas pelo teste ANOVA de medidas repetidas (p < 0,05). Diferenças no tempo de instrumentação foram analisadas por meio do teste ANOVA para um critério de classificação (p < 0,05). Os resultados revelaram que os tratamentos produziram alterações significativas nos parâmetros clínicos sem diferenças estatisticamente significantes entre os quatro grupos. Observaram-se reduções no SS, que, nas faces proximais, variou de 67,21 a 79,17%, no início, para 45,75 a 51,54% no final. Também foram observadas reduções significativas na PS e no NIC em todos os grupos, tanto para faces livres quanto proximais: as médias da PS aos 90 dias reduziram entre 0,92 e 1,14 mm nas faces livres e entre 1,01 e 1,35 mm nas proximais, enquanto para NIC as reduções foram de 0,43 a 0,82 mm e 0,60 a 0,73 mm, para as faces livres e proximais respectivamente. A média do tempo operatório variou de 4,77 a 5,30 minutos. Pôde-se concluir que as quatro modalidades terapêuticas de instrumentação subgengival foram igualmente eficazes na melhora dos parâmetros clínicos estudados.