RESUMO
BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the effect of nonsurgical periodontal therapy on clinical parameters and gingival crevicular fluid levels of tissue/blood vessel-type plasminogen activator (t-PA) and plasminogen activator inhibitor-2 (PAI-2) in patients with periodontitis, with or without rheumatoid arthritis (RA). MATERIAL AND METHODS: Fifteen patients with RA and chronic periodontitis (RA-P), 15 systemically healthy patients with chronic periodontitis (H-P) and 15 periodontally and systemically healthy volunteers (C) were included in the study. Plaque index, gingival index, probing pocket depth, clinical attachment level, bleeding on probing, gingival crevicular fluid t-PA and PAI-2 levels, erythrocyte sedimentation rate, serum C-reactive protein and disease activity score were evaluated at baseline and 3 mo after mechanical nonsurgical periodontal therapy. RESULTS: All periodontal clinical parameters were significantly higher in the RA-P and H-P groups compared with the C group (p < 0.001) and decreased significantly after treatment (p < 0.001). Pretreatment t-PA levels were highest in the RA-P group and significantly decreased post-treatment (p = 0.047). Pre- and post-treatment PAI-2 levels were significantly lower in controls compared with both periodontitis groups (p < 0.05). Gingival crevicular fluid volume and the levels of t-PA and PAI-2 were significantly correlated. CONCLUSION: In patients with periodontitis and RA, nonsurgical periodontal therapy reduced the pretreatment gingival crevicular fluid t-PA levels, which were significantly correlated with gingival crevicular fluid PAI-2 levels. The significantly higher t-PA and PAI-2 gingival crevicular fluid levels in periodontal patients, regardless of systemic status, suggest that the plasminogen activating system plays a role in the disease process of periodontitis.
Assuntos
Artrite Reumatoide/metabolismo , Periodontite Crônica/complicações , Líquido do Sulco Gengival/química , Inibidor 2 de Ativador de Plasminogênio/análise , Ativadores de Plasminogênio/análise , Adulto , Artrite Reumatoide/complicações , Sedimentação Sanguínea , Proteína C-Reativa/análise , Estudos de Casos e Controles , Periodontite Crônica/metabolismo , Periodontite Crônica/terapia , Índice de Placa Dentária , Raspagem Dentária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Perda da Inserção Periodontal/complicações , Perda da Inserção Periodontal/metabolismo , Perda da Inserção Periodontal/terapia , Índice Periodontal , Aplainamento RadicularRESUMO
OBJECTIVES: To examine the effect of zoledronic acid (ZOL) on cortical bone modelling and healing of extraction sockets in the jaw bones of a rodent model. We hypothesized ZOL suppresses both the bone formation in the modelling mode in the jaw bones and alters the extraction site healing. MATERIAL & METHODS: Rice rats were administered saline solution and two dose regimens of ZOL: 0.1 mg/kg, twice a week, for 4 weeks (n=17, saline=8 & ZOL=9) and a higher dose of 0.4 mg/kg, weekly, for 9 weeks (n=30, saline=15 & ZOL=15). Two pairs of fluorochrome bone labels were administered. Extraction of maxillary teeth was performed in maxilla. Mineral apposition rate, mineralizing surface and bone formation rate (BFR) were quantified on periodontal (PDL), alveolar and basal bone surfaces, and in the trabecular bone of proximal tibia. Bone volume (BV) was evaluated at extraction sockets. Multivariate Gaussian models were used to account for repeated measurements, and analyzes were conducted in SAS V9.3. RESULTS: ZOL suppressed bone modelling (BFR/BS) at the PDL surfaces in the mandible (P<.05), but its effect was not significant at the periosteal surfaces of both jaws. BV for the healing sockets of ZOL treated animals was not significantly different (P=.07) compared to the saline group. ZOL suppressive effect was higher in the tibia compared to the jaws. CONCLUSION: ZOL severely suppresses coupled remodelling in the tibia, and the suppression of bone formation in the modelling mode in the jaws demonstrates the site specific effects of ZOL in rice rats.
Assuntos
Difosfonatos/farmacologia , Imidazóis/farmacologia , Osteogênese/efeitos dos fármacos , Animais , Densidade Óssea/efeitos dos fármacos , Difosfonatos/administração & dosagem , Imidazóis/administração & dosagem , Mandíbula/efeitos dos fármacos , Maxila/efeitos dos fármacos , Ratos , Sigmodontinae , Tíbia/efeitos dos fármacos , Extração Dentária , Ácido ZoledrônicoRESUMO
OBJECTIVE: The aim of this study was to evaluate the effects of non-surgical periodontal therapy on gingival crevicular fluid levels of matrix metalloproteinase-8 (MMP-8), interleukin-6 (IL-6) and prostaglandin E2 (PGE2 ) in patients with rheumatoid arthritis (RA) with periodontal disease. MATERIAL AND METHODS: Twenty-seven patients with gingivitis and periodontitis with RA, 26 patients with gingivitis and periodontitis that were systemically healthy and 13 periodontally and systemically healthy volunteers (control group) were included in this study. RA activity was assessed by disease activity score test. The clinical periodontal parameters, fasting venous blood and gingival crevicular fluid samples were obtained and gingival crevicular fluid MMP-8, IL-6 and PGE2 levels were evaluated at baseline and at 3 mo follow-up after non-surgical periodontal treatment. RESULTS: Gingival crevicular fluid MMP-8, PGE2 and IL-6 levels were higher in all groups than the control group. Following periodontal therapy, there were significant decreases in gingival crevicular fluid MMP-8, PGE2 and IL-6 levels from patients with RA with periodontitis (p < 0.05). Plaque index, gingival index and bleeding on probing were significantly correlated with IL-6 and PGE2 at baseline and at 3 mo follow-up after non-surgical periodontal treatment. CONCLUSION: Non-surgical periodontal therapy of patients with RA with periodontitis may provide beneficial effects on local inflammatory control via decreases in gingival crevicular fluid MMP-8, PGE2 and IL-6 levels.
Assuntos
Artrite Reumatoide/complicações , Dinoprostona/análise , Líquido do Sulco Gengival/química , Interleucina-6/análise , Metaloproteinase 8 da Matriz/análise , Doenças Periodontais/complicações , Doenças Periodontais/terapia , Adulto , Artrite Reumatoide/sangue , Biomarcadores/análise , Índice de Placa Dentária , Raspagem Dentária , Feminino , Gengivite/complicações , Gengivite/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Perda da Inserção Periodontal/classificação , Perda da Inserção Periodontal/complicações , Perda da Inserção Periodontal/terapia , Índice Periodontal , Bolsa Periodontal/classificação , Periodontite/classificação , Periodontite/complicações , Periodontite/terapia , Aplainamento Radicular , TurquiaRESUMO
The most abundant protein of bone's organic matrix is collagen. One of its most important properties is its cross-linking pattern, which is responsible for the fibrillar matrices' mechanical properties such as tensile strength and viscoelasticity. We have previously described a spectroscopic method based on the resolution of the Amide I and II Fourier transform Infrared (FTIR) bands to their underlying constituent peaks, which allows the determination of divalent and pyridinoline (PYD) collagen cross-links in mineralized thin bone tissue sections with a spatial resolution of ~6.3 µm. In the present study, we used FTIR analysis of a series of biochemically characterized collagen peptides, as well as skin, dentin, and predentin, to examine the potential reasons underlying discrepancies between two different analytical methodologies specifically related to spectral processing. The results identified a novel distinct FTIR underlying peak at ~1,680 cm(-1), correlated with deoxypyridinoline (DPD) content. Furthermore, the two different methods of spectral resolution result in widely different results, while only the method employing well-established spectroscopic routines for spectral resolution provided biologically relevant results, confirming our earlier studies relating the area of the underlying 1,660 cm(-1) with PYD content. The results of the present study describe a new peak that may be used to determine DPD content, confirm our earlier report relating spectroscopic parameters to PYD content, and highlight the importance of the selected spectral resolution methodology.
Assuntos
Osso e Ossos/metabolismo , Calcificação Fisiológica/fisiologia , Colágeno Tipo I/metabolismo , Espectroscopia de Infravermelho com Transformada de Fourier , Aminoácidos/metabolismo , Animais , Reagentes de Ligações Cruzadas/metabolismo , Análise de Fourier , Humanos , Espectroscopia de Infravermelho com Transformada de Fourier/instrumentação , Espectroscopia de Infravermelho com Transformada de Fourier/métodosRESUMO
BACKGROUND AND OBJECTIVE: A prevailing dental problem in the periodontal patient is root caries. Specifically, periodontal involvement often results in root surfaces becoming exposed and at risk for this condition. Periodontal therapy often leads to increased gingival recession as well, and the associated increased root caries risk may compromise the long-term success and survival of periodontally treated teeth.This narrative review will address the topic of root caries in the periodontal patient, focusing on unmet research needs. MATERIAL AND METHODS: The Medline database was searched to identify items dealing with root caries, in terms of clinical features, diagnosis, pathogenic mechanisms and histopathology, as well as epidemiology, focusing then on the relationship between root caries and periodontal disorders. RESULTS: Although there is extensive literature on root caries, consensus is lacking regarding certain aspects, such as diagnostic criteria, prevalence within populations and indisputable risk factors. Advancing age could be an aggravating factor in susceptibility to root caries for the periodontal patient; however, definitive evidence in this regard is still missing. Similarly, full awareness of the increased risk of root caries in patients with periodontal disease or long-term periodontal treatment appears to be still lacking. CONCLUSION: Research regarding root caries in age-specific (elderly) periodontal patients is needed. Improved oral hygiene practices, locally applied preventive measures, good dietary habits and regular dental check-ups are crucial approaches to prevent both periodontal disease progression and root caries. Periodontal patients with root exposure should follow a strict root caries prevention protocol, as an integral component of their periodontal maintenance therapy.
Assuntos
Doenças Periodontais/complicações , Cárie Radicular/etiologia , Suscetibilidade à Cárie Dentária/fisiologia , Progressão da Doença , Retração Gengival/complicações , Humanos , Fatores de Risco , Cárie Radicular/prevenção & controleRESUMO
The discoidin domain receptors, DDR1 and DDR2, are nonintegrin collagen receptors and tyrosine kinases. DDRs regulate cell functions, and their extracellular domains affect collagen fibrillogenesis and mineralization. Based on the collagenous nature of dentoalveolar tissues, we hypothesized that DDR1 plays an important role in dentoalveolar development and function. Radiography, micro-computed tomography (micro-CT), histology, histomorphometry, in situ hybridization (ISH), immunohistochemistry (IHC), and transmission electron microscopy (TEM) were used to analyze Ddr1 knockout (Ddr1-/-) mice and wild-type (WT) controls at 1, 2, and 9 mo, and ISH and quantitative polymerase chain reaction (qPCR) were employed to assess Ddr1/DDR1 messenger RNA expression in mouse and human tissues. Radiographic images showed normal molars but abnormal mandibular condyles, as well as alveolar bone loss in Ddr1-/- mice versus WT controls at 9 mo. Histological, histomorphometric, micro-CT, and TEM analyses indicated no differences in enamel or dentin Ddr1-/- versus WT molars. Total volumes (TVs) and bone volumes (BVs) of subchondral and ramus bone of Ddr1-/- versus WT condyles were increased and bone volume fraction (BV/TV) was reduced at 1 and 9 mo. There were no differences in alveolar bone volume at 1 mo, but at 9 mo, severe periodontal defects and significant alveolar bone loss (14%; P < 0.0001) were evident in Ddr1-/- versus WT mandibles. Histology, ISH, and IHC revealed disrupted junctional epithelium, connective tissue destruction, bacterial invasion, increased neutrophil infiltration, upregulation of cytokines including macrophage colony-stimulating factor, and 3-fold increased osteoclast numbers (P < 0.05) in Ddr1-/- versus WT periodontia at 9 mo. In normal mouse tissues, ISH and qPCR revealed Ddr1 expression in basal cell layers of the oral epithelia and in immune cells. We confirmed a similar expression pattern in human oral epithelium by ISH and qPCR. We propose that DDR1 plays an important role in periodontal homeostasis and that absence of DDR1 predisposes mice to periodontal breakdown.
Assuntos
Receptor com Domínio Discoidina 1/genética , Atrofia Periodontal/genética , Animais , Colágeno , Humanos , Camundongos , Camundongos Knockout , Osteoclastos , Microtomografia por Raio-XRESUMO
Clonidine has recently been used as a pre-operative medication and sedative/anxiolytic drug. Its extended duration of action makes it suitable for longer procedures. In this randomized, crossover, placebo-controlled clinical trial, we characterized the effects of oral clonidine pre-treatment on intravenous diazepam/meperidine sedation using the bi-spectral index (BIS) in 13 participants. Clonidine significantly increased the numbers of BIS-depressed readings and percent memory loss during sedation, while reducing total diazepam and post-operative analgesic dosages by 44% and 55%, respectively. Systolic, diastolic, and mean arterial blood pressures, as well as pulse rates, were reduced. Respiratory rate, oxygen saturation, end-tidal CO(2), and recovery from sedation were unchanged. Participants, surgeons, and sedationists preferred clonidine over the placebo. Clonidine pre-treatment increased and prolonged sedation and amnesia and stabilized vital signs while significantly decreasing diazepam and post-operative analgesic usage. These results suggest that pre-operative clonidine administration could be a useful supplement to intravenous sedation for dental procedures of long duration.
Assuntos
Agonistas alfa-Adrenérgicos/administração & dosagem , Anestesia Dentária/métodos , Clonidina/administração & dosagem , Sedação Consciente/métodos , Medicação Pré-Anestésica , Administração Oral , Adulto , Analgésicos Opioides/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Estudos Cross-Over , Diazepam/administração & dosagem , Eletroencefalografia/efeitos dos fármacos , Feminino , Humanos , Funções Verossimilhança , Masculino , Meperidina/administração & dosagem , Pessoa de Meia-Idade , Respiração/efeitos dos fármacos , Estatísticas não Paramétricas , Inquéritos e QuestionáriosRESUMO
Papillon-Lefèvre syndrome (PLS), palmoplantar hyperkeratosis with periodontitis, has been genetically characterized. However, suspected associated immune dysfunctions remain elusive. The purpose of this study was to evaluate peripheral blood lymphocyte levels and natural killer (NK) cell cytotoxicity in PLS. Twenty patients and 20 healthy controls were examined. Peripheral blood lymphocytes were analyzed by flow cytometry for surface markers. NK cell cytotoxicity against K562 cells was determined by means of a 51Cr release assay. White blood cell differential and proportions of B-, T-, T-helper, T-suppressor, and NK cells revealed only sporadic borderline variations from control values. In contrast, NK cell cytotoxicity was consistently and severely depressed (32-53% of control values) in all patients. To the best of our knowledge, this newly described impairment of NK cell cytotoxic function is the first consistent immune dysfunction reported in PLS. This suggests that the impaired NK cell cytotoxicity might contribute to the pathogenesis of PLS-associated periodontitis.
Assuntos
Citotoxicidade Imunológica/imunologia , Doença de Papillon-Lefevre/imunologia , Adolescente , Adulto , Linfócitos B/imunologia , Criança , Pré-Escolar , Radioisótopos de Cromo , Feminino , Citometria de Fluxo , Humanos , Células K562 , Células Matadoras Naturais/imunologia , Contagem de Leucócitos , Contagem de Linfócitos , Masculino , Periodontite/imunologia , Compostos Radiofarmacêuticos , Linfócitos T/imunologia , Linfócitos T Auxiliares-Indutores/imunologia , Linfócitos T Reguladores/imunologiaRESUMO
We describe a mutation and haplotype analysis of Papillon-Lefèvre syndrome probands that provides evidence of a founder effect for four separate cathepsin C mutations. A total of 25 different cathepsin C mutations have been reported in 32 families with Papillon-Lefèvre syndrome (PLS) and associated conditions. A characteristic of these findings is the diversity of different cathepsin C mutations that have been identified. To evaluate the generality of cathepsin C mutations, PLS probands representative of five reportedly unrelated Saudi Arabian families were evaluated by mutational and haplotype analyses. Sequence analysis identified two cathepsin C gene mutations: a novel exon 7 G300D mutation was found in the proband from one family, while probands from four families shared a common R272P mutation in exon 6. The R272P mutation has been previously reported in two other non-Saudi families. The presence of the R272P mutation in probands from these four Saudi families makes this the most frequently reported cathepsin C mutation. To distinguish between the presence of a possible founder effect or a mutational hot spot for the R272P mutation, we performed haplotype analysis using six novel DNA polymorphisms that span a 165 kb interval containing the cathepsin C gene. Results of haplotype analysis for genetic polymorphisms within and flanking the cathepsin C gene are consistent with inheritance of the R272P mutation "identical by descent" from a common ancestor in these four Saudi families. Haplotype analysis of multiple PLS probands homozygous for other cathepsin C mutations (W249X, Q286X, and T153I) also supports inheritance of each of these mutations from common ancestors. These data suggest that four of the more frequently reported cathepsin C mutations have been inherited from common ancestors and provide the first direct evidence for a founder effect for cathepsin C gene mutations in PLS. Identification of these six short tandem repeat polymorphisms that span the cathepsin C gene will permit haplotype analyses to determine other founder haplotypes of cathepsin C mutations in additional PLS families.
Assuntos
Catepsina C/genética , Efeito Fundador , Doença de Papillon-Lefevre/genética , Substituição de Aminoácidos , Sequência de Bases , Cromossomos Humanos Par 11/genética , DNA/química , DNA/genética , Análise Mutacional de DNA , Saúde da Família , Haplótipos , Humanos , Repetições de Microssatélites , Mutação , Mutação PuntualRESUMO
Evidence indicates that incisor crown form correlates with clinical periodontal features. It was hypothesized that incisor crown form may explain subject differences in gingivitis expression. The present experimental gingivitis study aimed to assess the effect of incisor crown form on plaque accumulation and gingival inflammation, and on individual susceptibility to plaque-induced gingivitis. Eighty-five periodontally healthy subjects were evaluated. A negative correlation was found between incisor crown width/crown length ratio and bleeding score (p = 0.045). From the 85 subjects, two groups of subjects with either 'long-narrow' or 'short-wide' incisor form were identified. The 'long-narrow' group had a significantly higher bleeding score than the 'short-wide' group (p = 0.014). No significant differences were found in the incisor crown width/crown length ratio between previously identified 'high responder' and 'low responder' subjects (Trombelli et al., 2004a). In conclusion, incisor crown form appears to affect the bleeding response of inflamed gingival tissues, while it exerts no influence on explaining differences in individuals' susceptibility to plaque-induced gingivitis.
Assuntos
Placa Dentária/complicações , Gengivite/etiologia , Incisivo/anatomia & histologia , Coroa do Dente/anatomia & histologia , Adulto , Área Sob a Curva , Placa Dentária/patologia , Índice de Placa Dentária , Suscetibilidade a Doenças , Feminino , Líquido do Sulco Gengival , Hemorragia Gengival/etiologia , Humanos , Masculino , Odontometria , Índice PeriodontalRESUMO
Interleukin-10 regulates pro-inflammatory cytokines, including those implicated in alveolar bone resorption. We hypothesized that lack of interleukin-10 leads to increased alveolar bone resorption. Male interleukin-10(-/-) mice, on 129/SvEv and C57BL/6J background, were compared with age-, sex-, and strain-matched interleukin-10(+/+) controls for alveolar bone loss. Immunoblotting was used for analysis of serum reactivity against bacteria associated with colitis and periodontitis. Interleukin-10(-/-) mice had significantly greater alveolar bone loss than interleukin-10(+/+) mice (p = 0.006). The 30-40% greater alveolar bone loss in interleukin-10(-/-) mice was evident in both strains, with C57BL/6J interleukin-10(-/-) mice exhibiting the most bone loss. Immunoblotting revealed distinct interleukin-10(-/-) serum reactivity against Bacteroides vulgatus, B. fragilis, Prevotella intermedia, and, to a lesser extent, against B. forsythus. The results of the present study suggest that lack of interleukin-10 leads to accelerated alveolar bone loss.
Assuntos
Perda do Osso Alveolar/imunologia , Interleucina-10/imunologia , Perda do Osso Alveolar/classificação , Perda do Osso Alveolar/microbiologia , Animais , Anticorpos Antibacterianos/sangue , Bacteroides/imunologia , Bacteroides fragilis/imunologia , Immunoblotting , Interleucina-10/sangue , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Endogâmicos , Porphyromonas gingivalis/imunologia , Prevotella intermedia/imunologia , Estatísticas não ParamétricasRESUMO
This review discusses the effects of interleukin-1 (IL-1) on bone metabolism and the evidence implicating IL-1 in periodontal disease. IL-1 is a potent cytokine with significant effects on the metabolism of many tissues, including bone. Several in vitro and in vivo studies have established the potent bone-resorbing effect of IL-1. Studies have indicated that IL-1 inhibits bone formation, although it can stimulate formation under certain conditions. Osteoblastic cells are the bone cells expressing IL-1 receptors and responding to IL-1. IL-1 effects on osteoblastic cells include stimulation of prostaglandin formation and modulation of gene expression of several proteins (cytokines, enzymes, enzyme inhibitors, matrix proteins, etc.). Osteoblastic cells also produce IL-1, suggesting an autocrine/paracrine function of IL-1 in bone. IL-1 has been shown to interact with other osteotropic factors, both systemic and local. These interactions modulate the effects of IL-1 on bone. The IL-1 effects on bone metabolism, along with other observations, suggest that IL-1 may be involved in the pathogenesis of bone diseases. Evidence from in vivo and in vitro studies suggests that IL-1 is an important factor in periodontal tissue breakdown. The ability of periodontopathic bacteria to stimulate IL-1 production, the detection of elevated IL-1 levels in periodontally-diseased tissues, and the effects of IL-1 on cells of the periodontium provide a plausible sequence of events in the pathogenesis of periodontal disease. Finally, therapeutic modalities aimed to control the actions of IL-1 are also discussed.
Assuntos
Osso e Ossos/metabolismo , Interleucina-1/fisiologia , Osso e Ossos/citologia , Humanos , Doenças Periodontais/etiologiaRESUMO
BACKGROUND: HLA-B27 transgenic rats exhibit generalized, severe inflammatory reactions and spontaneously develop arthritis and chronic gastrointestinal inflammation, as well as inflammatory lesions in other tissues. Our hypothesis was that HLA-B27 rats would also be susceptible to inflammatory periodontal disease, and therefore alveolar bone loss. The purpose of this investigation was to compare the naturally occurring alveolar bone loss in HLA-B27 and wild type rats. METHODS: Age- and sex-matched HLA-B27 transgenic (TG) and wild type Fischer 344 (WT) female retired breeders, and their age-matched male WT breeding mates, were examined for alveolar bone loss (ABL). Thirty-eight animals were used: twelve, 20, and 6 animals were 6, 8, and 12 months old, respectively. ABL was measured as the exposed root surface area (mm2) in the defleshed maxilla and mandible. RESULTS: The coefficient of variation for replicate ABL measurements was 4.4%. For the 6- and 8-month age groups, ABL was significantly greater in TG rats compared to WT rats. The observed difference in ABL between TG and WT animals did not reach statistical significance for the 12-month age group. Within each of the two animal groups (TG and WT), ABL was significantly different between age groups. The ABL rate of TG female rats was 42% to 250% greater than that of WT female rats, depending on the age range examined. CONCLUSIONS: HLA-B27 rats are susceptible to accelerated alveolar bone loss and could serve as an animal model of alveolar bone loss pathogenesis.
Assuntos
Perda do Osso Alveolar/genética , Perda do Osso Alveolar/imunologia , Modelos Animais de Doenças , Antígeno HLA-B27/imunologia , Ratos Endogâmicos F344/genética , Animais , Animais Geneticamente Modificados/imunologia , Feminino , Genes MHC Classe I , Predisposição Genética para Doença , Antígeno HLA-B27/genética , Humanos , Masculino , Ratos , Ratos Endogâmicos F344/imunologia , Reprodutibilidade dos Testes , Organismos Livres de Patógenos Específicos , Estatísticas não ParamétricasRESUMO
This clinicopathologic case report documents severe gingival recession in the primary dentition of a trisomy 18 patient. Primary molar and canine teeth exhibited recession extending beyond the midpoint of the buccal aspect of the root, occasionally reaching the root apex. Radiographic examination revealed taurodontism in both primary and permanent teeth. Clinical and histopathologic findings, along with case history, eliminated the possibility of prepubertal periodontitis and suggested a diagnosis of self-inflicted injury associated with mental retardation. Histologic examination of the primary teeth revealed normal cementum and dentin structure. Taurodontism, histologic structure of the dentition, and severe attachment loss in the primary dentition have not been described previously in trisomy 18.
Assuntos
Anormalidades Múltiplas , Aberrações Cromossômicas/patologia , Cromossomos Humanos Par 18/genética , Assistência Odontológica para Doentes Crônicos , Retração Gengival/etiologia , Automutilação/patologia , Trissomia , Anormalidades Múltiplas/patologia , Criança , Transtornos Cromossômicos , Feminino , Retração Gengival/diagnóstico , Retração Gengival/patologia , Humanos , Deficiência Intelectual/complicações , Automutilação/complicações , Automutilação/etiologia , Anormalidades Dentárias/etiologia , Dente DecíduoRESUMO
BACKGROUND: Gingival recession represents a significant concern for patients and a therapeutic problem for clinicians. Several techniques have been proposed to achieve root coverage. The purpose of this randomized clinical trial was to evaluate the effect of a guided tissue regeneration (GTR) procedure in comparison to connective tissue graft (CTG) in the treatment of gingival recession defects. METHODS: Twelve patients, each contributing a pair of Miller Class I or II buccal gingival recessions, were treated. In each patient one randomly chosen defect received a poly(lactic acid)-based bioabsorbable membrane, while the paired defect received a CTG. Clinical recordings included oral hygiene standards and gingival health, recession depth (RD), recession width (RW), probing depth (PD), clinical attachment level (CAL), and keratinized tissue width (KT). RESULTS: Mean RD statistically significantly decreased from 2.5 mm presurgery to 0.5 mm with GTR (81% root coverage), and from 2.5 mm to 0.1 mm with CTG (96% root coverage), at 6 months postsurgery. Prevalence of complete root coverage was 58% for the GTR group and 83% for the CTG group. Mean CAL gain was 2.0 mm for the GTR group and 2.2 mm for the CTG group. No statistically significant differences between treatment groups were observed for changes in RD, RW, PD, CAL, and KT. CONCLUSIONS: Treatment of human gingival recession defects by means of either GTR or CTG results in clinically and statistically significant improvement of the soft tissue conditions of the defect when pre- and post-treatment measurements were compared. Although differences between CTG and GTR in mean root coverage and prevalence of complete coverage consistently favored the CTG procedure, the differences in measurements were not statistically significant.
Assuntos
Implantes Absorvíveis , Gengiva/transplante , Retração Gengival/cirurgia , Gengivoplastia/métodos , Regeneração Tecidual Guiada Periodontal/métodos , Adulto , Análise de Variância , Distribuição de Qui-Quadrado , Tecido Conjuntivo/transplante , Feminino , Gengiva/patologia , Retração Gengival/patologia , Humanos , Ácido Láctico , Masculino , Membranas Artificiais , Pessoa de Meia-Idade , Índice Periodontal , Poliésteres , Polímeros , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
This clinicopathologic case report documents an adverse effect associated with the use of a polylactic acid-based barrier in the treatment of human gingival recession defects. A total of 27 consecutively treated patients, in whom guided tissue regeneration with a polylactic acid barrier was used to correct gingival recession defects, were evaluated. This adverse effect consisted of a midradicular-apical swelling, generally asymptomatic, with no apparent predilection for gender, age, tooth type or location (maxilla/mandible), or surgical procedure. It was observed in 14 of 27 (52%) patients and 22 of 41 (54%) defects. The swelling decreased in size over time and in most cases, it completely resolved within 12 months postsurgery. Histopathologic evaluation of a 14-week specimen indicated characteristics (multinucleated giant cells, foamy macrophages) consistent with a foreign body reaction. These findings suggest that patients undergoing GTR procedures with synthetic absorbable devices for the treatment of gingival recession defects should be advised of the possible occurrence of such an adverse effect.
Assuntos
Implantes Absorvíveis/efeitos adversos , Materiais Biocompatíveis/efeitos adversos , Retração Gengival/cirurgia , Regeneração Tecidual Guiada Periodontal/instrumentação , Ácido Láctico/efeitos adversos , Membranas Artificiais , Polímeros/efeitos adversos , Adulto , Edema/etiologia , Edema/patologia , Feminino , Células Espumosas/patologia , Seguimentos , Reação a Corpo Estranho/etiologia , Reação a Corpo Estranho/patologia , Células Gigantes/patologia , Gengivite/etiologia , Gengivite/patologia , Regeneração Tecidual Guiada Periodontal/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Poliésteres , Remissão EspontâneaRESUMO
BACKGROUND: Although the need for "adequate" amount of keratinized tissue (KT) for periodontal health is questionable, the mucogingival junction (MGJ) often serves as a measurement landmark in periodontal evaluations. Limited information is available on the reproducibility of KT width (KTW) assessment. The purpose of this study was to assess intra- and inter-examiner reproducibility in measuring KTW by using 3 different methods to identify MGJ location. METHODS: Fifteen patients provided 17 teeth which had undergone a gingival augmentation procedure (connective tissue graft; surgery group) and an equal number of contralateral, non-treated teeth (control group). At the midbuccal aspect of each tooth, KTW was assessed by 2 independent examiners after MGJ identification by the visual (VM), functional (FM), and visual with histochemical staining (HM) method. Data analysis was based on intra-class correlation coefficients (ICC) and 3-way analysis of variance (ANOVA) for differences between replicate measurements. RESULTS: KTW was significantly different between treated and control teeth. No significant differences in KTW were found in relation to method for MGJ determination and examiner. Intra- and inter-examiner reproducibility was high, regardless of treatment status or method for MGJ determination (ICC = 0.92 - 0.99). Standard deviations of the difference between replicate measurements ranged from 0.46 mm for VM to 0.21 mm for HM. CONCLUSIONS: Intra- and inter-examiner reproducibility has been shown to be substantially consistent when different methods for MGJ determination are used to measure the apico-coronal dimension of the gingiva. The level of reproducibility does not seem to be affected whether or not the mucogingival complex has been surgically altered by a gingival augmentation procedure.
Assuntos
Gengiva/patologia , Gengivoplastia , Mucosa Bucal/patologia , Adulto , Idoso , Análise de Variância , Calibragem , Corantes , Tecido Conjuntivo/transplante , Feminino , Gengiva/transplante , Gengivoplastia/métodos , Humanos , Queratinas , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Índice Periodontal , Periodontia/instrumentação , Reprodutibilidade dos TestesRESUMO
The purpose of the present clinical study was to evaluate the effect of guided tissue regeneration (GTR) in comparison to subpedicle connective tissue graft (SCTG) in the treatment of gingival recession defects. A total of 12 patients, each contributing a pair of Miller's Class I or II buccal gingival recessions, was treated. According to a randomization list, one defect in each patient received a polyglycolide/lactide bioabsorbable membrane, while the paired defect received a SCTG. Treatment effect was evaluated 6 months postsurgery. Clinical recordings included full-mouth and defect-specific oral hygiene standards and gingival health, recession depth (RD), recession width (RW), probing depth (PD), clinical attachment level (CAL), and keratinized tissue width (KT). Mean RD significantly decreased from 3.1 mm presurgery to 1.5 mm at 6 months postsurgery for the GTR group (48% root coverage), and from 3.0 mm to 0.5 mm for the SCTG group (81% root coverage). RD reduction and root coverage were significantly greater in SCTG group compared to GTR group. Mean CAL gain amounted to 1.7 mm for the GTR group, and 2.3 mm in the SCTG group. No significant differences in PD changes were observed within and between groups. KT increased significantly from presurgery for both treatment groups, however gingival augmentation was significantly greater in the SCTG group compared to GTR group. Results indicate that: 1) treatment of human gingival recession defects by means of both GTR and SCTG procedures results in clinically and statistically significant improvement of the soft tissue conditions of the defect; and 2) treatment outcome was significantly better following SCTG compared to GTR in terms of recession depth reduction, root coverage, and keratinized tissue increase.
Assuntos
Implantes Absorvíveis , Gengiva/transplante , Retração Gengival/cirurgia , Regeneração Tecidual Guiada Periodontal , Adulto , Materiais Biocompatíveis/uso terapêutico , Tecido Conjuntivo/transplante , Feminino , Regeneração Tecidual Guiada Periodontal/métodos , Humanos , Ácido Láctico/uso terapêutico , Masculino , Membranas Artificiais , Pessoa de Meia-Idade , Poliésteres , Polímeros/uso terapêutico , Retalhos Cirúrgicos , Resultado do TratamentoRESUMO
A concept of space provision to support skeletal repair has long been used in orthopedic and oral maxillofacial reconstructive therapy. More recently, this concept has been studied and adapted to periodontal reconstructive therapy. Other studies have demonstrated that skeletal tissues represent a significant reservoir of growth factors, including bone morphogenetic proteins. Such factors have been shown to stimulate skeletal repair in preclinical models and in clinical defects. We herein review studies using the critical size supraalveolar periodontal defect model in which clinically meaningful periodontal regeneration was achieved following reconstructive surgery, including space provision by reinforced expanded polytetrafluoroethylene membranes or including surgical implantation of recombinant human bone morphogenetic protein-2. Potential mechanisms involved in observed regeneration are discussed.
Assuntos
Substâncias de Crescimento/uso terapêutico , Regeneração Tecidual Guiada Periodontal , Membranas Artificiais , Doenças Periodontais/cirurgia , Periodonto/fisiologia , Politetrafluoretileno , Proteínas/uso terapêutico , Regeneração , Proteínas Morfogenéticas Ósseas , Terapia Combinada , Humanos , Doenças Periodontais/tratamento farmacológico , Proteínas RecombinantesRESUMO
This study was designed to evaluate bone formation and reosseointegration following surgical implantation of recombinant human bone morphogenetic protein-2 (rhBMP-2) in peri-implantitis defects. Hydroxyapatite-coated dental implants were placed bilaterally in the mandibular and maxillary premolar area in four rhesus monkeys and were allowed to osseointegrate for 1 year. Cotton ligatures were then placed around the healing abutments, and plaque was allowed to accumulate for 11 months. Resulting circumferential peri-implantitis defects exhibited a large intrabony and horizontal component. At reconstructive surgery, peri-implantitis defects in contralateral jaw quadrants were randomly assigned to receive rhBMP-2 (0.43 mg/mL implant volume) in an absorbable collagen sponge carrier or a carrier control. The animals were sacrificed 4 months postsurgery, and block sections were prepared for histometric analysis. Summary statistics included means calculated per animal. Paired t tests were used to evaluate differences between experimental conditions (n = 4). Defect depth amounted to 3.4 +/- 0.9 mm and 3.2 +/- 0.9 mm for rhBMP-2 and control defects, respectively. Vertical bone gain in rhBMP-2 defects (2.6 +/- 1.2 mm) was significantly greater than in controls (0.8 +/- 0.8 mm; P < .01). Reosseointegration within the confines of the defect for rhBMP-2 defects (29.0 +/- 10.5%) differed significantly from that in the control (3.5 +/- 2.5%; P < .01). Reosseointegration within the extent of newly formed bone averaged 40.0 +/- 11.0% in rhBMP-2 defects as compared to 8.9 +/- 7.8% in the control (P < .01). Osseointegration in resident bone amounted to 69.5 +/- 6.9% and 72.6 +/- 8.0% for rhBMP-2 and control defects, respectively. There is significant evidence that rhBMP-2 has potential to promote bone formation and reosseointegration in advanced peri-implantitis defects in a demanding nonhuman primate model.