Comparison between full-mouth scaling and root planing and quadrant-wise basic therapy of aggressive periodontitis: 6-month clinical results.

BACKGROUND: The aim of this study was to test the hypothesis that there are no differences in clinical parameters in generalized aggressive periodontitis patients after full-mouth scaling and root planing (FRP) or quadrant-wise basic periodontal therapy (BPT) when combined with an antibiotic regimen. METHODS: Patients were allocated randomly to BPT (N = 15; mean age: 29.5 +/- 5.7 years) or FRP (N = 15; mean age: 28.4 +/- 5.7 years). All subjects received oral hygiene instructions including the use of a 0.12% chlorhexidine mouthrinse solution twice a day for 2 months. Patients also received amoxicillin, 500 mg, and metronidazole, 250 mg, three times a day for 7 days. Probing depth (PD), clinical attachment level, visible plaque, and bleeding on probing were recorded at baseline and at 2, 4, and 6 months post-therapy. Statistically significant changes within and between groups were determined using the general linear model repeated measures procedure. RESULTS: Both groups showed a significant improvement in all clinical parameters post-therapy, which was particularly evident at 2 months in the sites that had been deepest at baseline. For instance, the mean PD at sites with mean PD > or =7 mm at baseline had decreased 3.9 mm in the BPT group and 3.6 mm in the FRP group. At 6 months, the percentage of sites with PD > or =7 mm decreased from 13.2% +/- 3.2% to 0% in the BPT group and from 13.3% +/- 3.5% to 0.2% +/- 0.1% in the FRP group. No statistically significant differences were observed between groups for most clinical parameters. CONCLUSION: Within the limits of the present investigation, FRP and BPT caused comparable clinical effects in aggressive periodontitis patients when an adjunctive combined antibiotic regimen was included.

Guided bone regeneration of a pronounced gingivo-alveolar cleft due to orthodontic space closure.

BACKGROUND: Gingival invagination is a relatively common occurrence following orthodontic closure of extraction sites. The present paper reports a combined periodontal and orthodontic treatment in a patient with a severe gingivo-alveolar cleft due to orthodontic closure of maxillary central incisor extraction space. METHODS: A definite interdental gingival cleft, extending 8 mm into the alveolar bone, required the correction of the gingival deformity as a first step, followed by guided bone regeneration (GBR). The GBR approach included the emptying of the incisive foramen to approximately 5 mm in depth followed by the insertion of bioabsorbable hydroxyapatite and covering with a bioabsorbable barrier membrane. Six months afterward, the orthodontic therapy was resumed. RESULTS: Radiographs and clinical examination 4 years after the completion of therapy indicates functionally and aesthetically satisfactory and stable results. CONCLUSION: The present paper illustrates an additional application for the guided bone regeneration technique.

Ligneous periodontitis and Ehlers-Danlos syndrome.

BACKGROUND: Generalized membranous gingival enlargement due to an accumulation of fibrin deposits associated with severe alveolar bone loss (ligneous periodontitis) is a rare condition, and plasminogen deficiency seems to play a central role in its pathogenesis. However, this condition has not been described in association with syndromes. This article reports a case of ligneous periodontitis in a boy with the classic type of Ehlers-Danlos syndrome (EDS). METHODS: A 12-year-old white male presented with generalized gingival overgrowth and severe alveolar bone loss. A physical examination revealed clinical signs of EDS (velvety skin with mild hyperextensibility, marked hypermobility of the limb joints, atrophic scars on his knees, and easy bruising), which is associated with a positive family history for joint hypermobility. A biopsy of gingival tissues was submitted for routine histology, hematoxylin and eosin (H&E), and direct immunofluorescence (antifibrinogen). An evaluation of plasminogen activity was also performed. RESULTS: Histopathology revealed chronic periodontitis with fibrinoid material deposition, and direct immunofluorescence proved to be positive for fibrin. Functional plasminogen was reduced. A conclusive diagnosis of ligneous periodontitis due to plasminogen deficiency associated with the classic type of EDS was rendered. CONCLUSIONS: Ehlers-Danlos syndrome can be associated with ligneous periodontitis. In the present case, the histologic examination represented an important tool in the differential diagnosis, because it ruled out EDS type VIII as the associated systemic factor to periodontal breakdown.

Oral health impacts on daily living related to four different treatment protocols for chronic periodontitis.

BACKGROUND: The aims of this study were to evaluate the oral health impacts perceived by patients submitted to different treatments of chronic periodontitis and their association with clinical parameters. METHODS: Sixty patients were assigned to one of the following therapeutic groups: control, treated with full-mouth scaling and root planing (SRP); test 1, treated with SRP and 400 mg systemically administered metronidazole (MET) three times per day for 10 days; test 2, treated with SRP and professional supragingival plaque removal (PP) every week for 3 months; and test 3, treated with SRP and MET plus PP. Clinical periodontal measurements and data regarding patients' oral health impacts (perceived impacts on bleeding gums, gingival recession, sensitivity to cold, packing foods, aesthetics, bad breath, and tooth mobility) were collected at baseline and 3 months after therapy. RESULTS: All groups presented significant improvement in oral health perceived impacts. There was no statistically significant difference in the improvement of oral health impacts among groups subjected to different treatments. The clinical data of percentage of deep probing depth, deep clinical attachment level, and bleeding on probing were found to be correlated significantly with oral health impacts. CONCLUSIONS: Periodontal treatment leads to a significant reduction of self-perceived impacts regardless of the non-surgical treatment protocol employed. Most of the clinical data were associated with oral health impacts.

Quantification and localization of platelet-derived growth factor in gingiva of periodontitis patients.

BACKGROUND: Platelet-derived growth factor (PDGF) is a mitogen and chemoattractant for cells of mesenchymal origin. Over-expression of PDGF-B can promote formation of inflammatory lesions in the lungs of transgenic mice. Moreover, continuous exposure to PDGF inhibits collagen production by osteoblastic cells. Thus, the expression of mitogenic factors in an inflammatory context may limit the differentiated function of cells, and thereby limit repair following periodontal attachment and bone loss. The goals of the present study were to test whether PDGF is present at increased levels in inflamed gingiva and to localize its expression in gingival biopsies from individuals with chronic periodontitis. METHODS: Tissues obtained during therapeutic procedures from inflamed and control sites of 9 patients were subjected to protein extraction, descriptive histology by hematoxylin and eosin, or immunohistochemistry assays. Quantification was calculated with an enzyme-linked immunosorbent assay (ELISA) kit specific for PDGF-AB. For the immunolocalization, anti-PDGF-A and -B antibodies were employed. RESULTS: PDGF concentration in the total protein extract was approximately 3 times higher in the inflamed sites (0.60 +/- 0.18 ng/mg versus 0.20 +/- 0.05 ng/mg; P = 0.03). Immunohistochemistry revealed prominent expression of PDGF in the pocket epithelial cells as well as the adjacent connective tissue. In contrast, little or no expression was detected in control biopsies devoid of the pocket epithelium and granulation tissue. CONCLUSIONS: PDGF is present in increased levels in the human inflamed gingiva and is mainly localized to the pocket epithelium. It is possible that chronic expression of PDGF contributes to the inflammatory changes that occur during periodontal diseases.

Systemic antimicrobials adjunctive to a repeated mechanical and antiseptic therapy for aggressive periodontitis: a 6-month randomized controlled trial.

BACKGROUND: The purpose of this study is to compare the additional benefit of systemic antimicrobials versus placebos to a repeated mechanical instrumentation combined with comprehensive local chemical plaque control for the periodontal treatment of generalized aggressive periodontitis (GAgP). METHODS: This was a 6-month randomized, double-masked, placebo-controlled clinical trial. All GAgP patients received full-mouth disinfection followed by staged scaling and root planing without (placebo group; n = 17) or with (test group; n = 18) systemic antimicrobials (500 mg amoxicillin [AMX] + 250 mg metronidazole [MET]; three times a day for 10 days). Clinical parameters were measured at baseline and 3 and 6 months post-therapy. Significant differences between groups at baseline were sought by using the Mann-Whitney U test, whereas comparisons over time were examined by using a general linear model repeated measures procedure. RESULTS: Both groups demonstrated similar improvements in most parameters over time. The test group presented a greater mean probing depth (PD) reduction and clinical attachment level (CAL) gain at sites with initially moderate PD at 6 months (P <0.03). No differences were seen between groups regarding mean reductions and mean gains, respectively, for PD and CAL initially ≥7 mm. The test group presented a higher percentage of sites that improved ≥2 mm and ended up with PD ≤4 mm or a lower percentage of sites that worsened ≥2 mm and remained with PD >4 mm at 3 months (P <0.01). No differences were noticed between groups for these parameters at 6 months. CONCLUSION: AMX + MET brought additional clinical effects to the repeated mechanical and antiseptic treatment of GAgP in a very short time (3 months), which tended to fade away over time (6 months).

Molecular size distribution analysis of human gingival glycosaminoglycans in cyclosporin- and nifedipine-induced overgrowths.

Glycosaminoglycans are thought to accumulate in formative lesions like drug-induced gingival overgrowth. Recent evidences, however, suggest that the amounts of glycosaminoglycans are comparable in overgrown and healthy gingiva. Besides, alterations in the size distribution of glycosaminoglycan molecules isolated from phenytoin-induced overgrown samples have also been suggested. Therefore, we sought to determine possible differences in molecular size distribution of gingival glycosaminoglycans in other types of drug-induced overgrowths. Purified gingival glycosaminoglycans from healthy and cyclosporin- and nifedipine-induced overgrown gingival tissues were analyzed by agarose gel electrophoresis and their molecular-size distribution was evaluated by both gel filtration chromatography and polyacrylamide gel electrophoresis. Our results on the gingival glycosaminoglycan composition showed presence of chondroitin sulfate, dermatan sulfate, heparan sulfate and hyaluronic acid in all types of gingival tissues examined. In addition, hyaluronic acid was predominantly of a large size eluting near to the void volume of a Superose-6 column, while the sulfated glycosaminoglycans were mainly composed of low molecular size glycosaminoglycans. Our results show no differences in the molecular-size distribution of hyaluronic acid and sulfated glycosaminoglycans among healthy and drug-induced overgrown gingival tissues.

Relação entre o tratamento periodontal e o controle metabólico do diabetes mellitus: revisão de literatura / The relationship between periodontal treatment and metabolic control of diabetes mellitus: a review of literature

Diabetes Mellitus (DM) é uma doença metabólica devido a alterações na produção de insulina ou resistência tecidual à mesma, levando a alteração no metabolismo de lipídeos, de açúcares e de proteína. A hiperglicemia resultante pode induzir diversas patologias de sistemas orgânicos. Por sua vez, a Doença Periodontal (DP) promove um desafio bacteriano constante, o que gera maior atividade de monócitos/macrófagos, aumentando a secreção de citocinas pró-inflamatórias. Em estados hiperglicêmicos, existe a formação de produtos finais de glicação avançada (AGEs). O acúmulo nos tecidos de AGEs em diabéticos gera uma resposta hiperinflamatória. Esses fatores, em conjunto, levam a uma alteração na resposta imuno-inflamatóriado hospedeiro, gerando uma menor resistência à infecção e capacidade reparadora. Sendo assim, a terapia periodontal, através do controle do biofilme dental a níveis compatíveis com saúde, reduz a carga microbiana local e,conseqüentemente, diminui os desafios metabólicos nestes indivíduos. Assim, o objetivo deste trabalho, foi revisar os mecanismos pelos quais a DP, bem como a sua terapia associada ou não ao uso de antimicrobianos sistêmicos, podem atuar sobre o controle sistêmico do DM. Conclui-se que, apesar de existir discordância na literatura, os periodontistas deveriam atuar de forma educativa com seus pacientes e seus médicos alertando para a relação entre DP e DM.

Diabetes Mellitus (DM) is a metabolic disease due to alterations in the production of insulin or tissue resistance to it, leading to abnormal fat, sugar, and protein metabolism. Resultant hyperglycemia can induce diverse multiple systems pathologies. On the other hand, periodontal disease (PD)promotes a constant bacterial challenge, which increases monocyte/macrophage activity, and pro-inflammatory cytokines secretion. In hyperglycemic states, there is advanced glycation end-products (AGEs) production. In diabetic subjects, the AGEs accumulation in the tissue leads to a hyper-inflammatory response, generating po or resistance to infections and impaired wound healing. There fore, periodontal therapy, through dental biofilm control, decreases the microbial load and, as a consequence, reduces the metabolic challenges in those subjects. The present paper aims to review the mechanisms through what periodontal disease and its treatment, associated or not to systemic antibiotics, can affect systemic control of DM. It was concluded that despite the existing lack of agreement in the studied literature, periodontists should warn their patients and their doctors about the relationship between PD and DM.