Triatomine Fauna and Recent Epidemiological Dynamics of Chagas Disease in an Endemic Area of Northeast Brazil.

Updated information of the dispersion dynamics of Chagas disease (CD) and a systemic analysis of these data will aid the early identification of areas that are vulnerable to transmission and enable efficient intervention. This work synthesized spatiotemporal information regarding triatomine fauna and analyzed this information in combination with the results from serological tests to elucidate the epidemiological panorama of CD in the state of Sergipe, Brazil. This is a retrospective analytical study that utilized information from the database of the National Chagas Disease Control Program. Between 2010 and 2016, 838 triatomines of eight species, namely, Panstrongylus geniculatus, which was first recorded in the state of Sergipe, Panstrongylus lutzi, P. megistus, Triatoma brasiliensis, T. pseudomaculata, T. tibiamaculata, T. melanocephala, and Rhodnius neglectus, were collected. Optical microscopy revealed that 13.2% of triatomines examined were infected by Trypanosoma cruzi-like flagellates. The distribution of triatomines exhibits an expanding south-central to northern dispersion, with a preference for semiarid and agreste areas and occasional observations in humid coastal areas due to anthropogenic actions reflected in the environment. Of the human cases analyzed from 2012 to 2016, 8.3% (191/2316) presented positive serology for Trypanosoma cruzi, and this proportion showed a gradual increase in the southern center of the state and new notifications in coastal regions. There is a need for intensification and continuity of the measures adopted by the Chagas Disease Control Program in Sergipe, identifying new priority areas for intervention and preferential ecotopes of the vectors, considering the occurrence of positive triatomines intradomicilliary and a source of new triatomines in the peridomiciles.

Phlebotominae Fauna (Diptera: Psychodidae) and the Spatial Distribution of Species in Sergipe, Brazil.

Some sand fly species are the vectors responsible for the transmission of Leishmania spp. (Kinetoplastida: Trypanosomatidae), the etiological agent of leishmaniasis, and in the state of Sergipe, the two main forms of the disease (visceral and cutaneous) are recorded. Few works show information about the species that form the Phlebotominae fauna in Sergipe. This study aimed to update and determine how they are distributed throughout the state. The study used data from surveys about phlebotomines in Sergipe, from the Program of Surveillance and Control of Visceral Leishmaniasis, carried out by the Central Public Health Laboratory of Sergipe, from 2008 to 2018, along with review and original data from 2022. The commentary on this information was developed with focus on the species that can be vectors for the disease. Sergipe has, up to now, 27 registered species of phlebotomines from 12 genera, 15 of them are of sanitary relevance. Twenty two of these species are in the mesoregion East, 19 in the Agreste, and 11 in the Sertão of Sergipe. The species with the greatest distribution was Evandromyia lenti (Mangabeira, 1938), present in 74.6% of the municipalities of Sergipe, followed by Lutzomyia longipalpis (Lutz & Neiva, 1912), the main vector of the etiological agent of visceral leishmaniasis in Brazil, present in 68% of the municipalities studied. This study expands the number and distribution of species recorded in the state. This information can contribute to disease containment plans and support health education actions aimed at the control of leishmaniasis in Sergipe.

Coronally positioned flap for root coverage in smokers and non-smokers: stability of outcomes between 6 months and 2 years.

BACKGROUND: Smoking adversely affects the short-term outcomes of coronally positioned flap (CPF) root coverage procedures, but the long-term stability of this procedure in smokers has not been studied. The objective of this study was to evaluate the effect of smoking on the long-term outcomes of CPF in recession treatment. METHODS: CPF was used to treat a Miller Class I defect in a maxillary canine or premolar in 10 current smokers (> or =10 cigarettes daily for > or =5 years) and 10 non-smokers (never smokers). At baseline and 6, 12, and 24 months, clinical parameters, including probing depth (PD), clinical attachment level (CAL), recession depth (RD), and width of keratinized tissue (KT), were determined. RESULTS: Intragroup analysis showed that CPF failed to maintain the gingival margin at the initially achieved position. RD significantly increased in smokers (from 0.84 +/- 0.49 to 1.28 +/- 0.58 mm) and in non-smokers (from 0.22 +/- 0.29 to 0.50 +/- 0.41 mm) between 6 and 24 months. Further analysis showed that 50% of smokers and 10% of non-smokers lost between 0.5 and 1.0 mm of root coverage in the same period. Intergroup analysis showed that smokers had significantly greater residual recession (P = 0.001) at 24 months. Both smokers and non-smokers lost CAL and experienced decreases in KT. CONCLUSIONS: The long-term stability of CPF outcomes is less than desirable, particularly in smokers. Two years after a CPF procedure, smokers have significantly greater residual recession compared to non-smokers both statistically and clinically.

First report of naturally infected Aedes aegypti with chikungunya virus genotype ECSA in the Americas.

BACKGROUND: The worldwide expansion of new emergent arboviruses such as Chikungunya and Zika reinforces the importance in understanding the role of mosquito species in spreading these pathogens in affected regions. This knowledge is essential for developing effective programs based on species specificity to avoid the establishment of endemic transmission cycles sustained by the identified local vectors. Although the first autochthonous transmission of Chikungunya virus was described in 2014 in the north of Brazil, the main outbreaks were reported in 2015 and 2016 in the northeast of Brazil. METHODOLOGY/PRINCIPAL FINDINGS: During 5 days of February 2016, we collected mosquitoes in homes of 6 neighborhoods of Aracaju city, the capital of Sergipe state. Four mosquito species were identified but Culex quinquefasciatus and Aedes aegypti were the most abundant. Field-caught mosquitoes were tested for Chikungunya (CHIKV), Zika (ZIKV) and Dengue viruses (DENV) by qRT-PCR and one CHIKV-infected Ae. aegypti female was detected. The complete sequence of CHIKV genome was obtained from this sample and phylogenetic analysis revealed that this isolate belongs to the East-Central-South-African (ECSA) genotype. CONCLUSIONS: Our study describes the first identification of a naturally CHIKV-infected Ae. aegypti in Brazil and the first report of a CHIKV from ECSA genotype identified in this species in the Americas. These findings support the notion of Ae. aegypti being a vector involved in CHIKV outbreaks in northeast of Brazil.

Coronally positioned flap for root coverage: poorer outcomes in smokers.

BACKGROUND: Gingival recession is significantly more common among smokers, while the relative outcome of various root coverage procedures in smokers, compared to non-smokers, is debatable. The objective of this study was to evaluate the influence of cigarette smoking on the outcome of coronally positioned flap (CPF) in the treatment of Miller Class I gingival recession defects. METHODS: Ten current smokers (> or = 10 cigarettes daily for at least 5 years) and 10 non-smokers (never smokers), each with one 2- to 3-mm Miller Class I recession defect in an upper canine or bicuspid, were treated with CPF. At baseline and 6 months, clinical parameters, probing depth (PD), clinical attachment level (CAL), recession depth (RD), and apico-coronal width of keratinized tissue (KT) were determined. RESULTS: Intragroup analysis showed that CPF was able to reduce RD and improve CAL in both groups (P <0.05). Intergroup analysis demonstrated that smokers presented greater residual RD at 6 months and lower percentage of root coverage (69.3% versus 91.3%; P <0.05). No smokers obtained complete root coverage compared to 50% of non-smokers (P <0.05). CONCLUSIONS: Within the limits of the present study, it can be concluded that CPF provides benefits for both smokers and non-smokers in terms of root coverage of shallow Miller Class I recession defects. However, cigarette smoking negatively impacts the clinical outcomes, specifically residual recession, percent root coverage, and frequency of complete root coverage.

Coronally positioned flap with subepithelial connective tissue graft for root coverage: various indications and flap designs.

Aesthetic concerns and functional abnormalities, such as dentin hypersensitivity, are often associated with gingival recession defects. Root coverage procedures aim to restore both gingival aesthetics and function in recession defects. The coronally positioned flap combined with the subepithelial connective tissue graft is one of the most widely used root coverage procedures. The present report illustrates four different indications where this procedure has been successfully employed. An isolated Miller class II recession defect associated with frenum pull, multiple adjacent Miller class I defects in the aesthetic zone, an isolated Miller class I defect associated with dentin hypersensitivity, and an isolated Miller class II defect on a retained deciduous tooth are the four diverse conditions treated by periodontal plastic surgery. Different approaches were used to create the coronally positioned flap. Treatment resulted in complete root coverage, resolution of hypersensitivity, and satisfaction of the patients' aesthetic concerns. An effective and predictable treatment modality, such as the coronally positioned flap combined with the subepithelial connective tissue graft, should be considered when treatment planning for gingival recession defects.

Clinical and radiographic evaluation of periodontal intrabony defects treated with guided tissue regeneration. A pilot study.

BACKGROUND: The aim of this clinical and radiographic study was to evaluate the effect of guided tissue regeneration using a bioabsorbable barrier in the treatment of intrabony defects in humans. METHODS: Intrabony osseous defects (2 or 3 walls) around mandibular canines and premolars were treated in 10 systemically healthy patients with ages ranging from 35 to 56 years. Prior to the surgical phase, patients were enrolled in a strict maintenance program including oral hygiene instructions and scaling and root planing (presurgical Pi and GI < 10%). Patients were seen for professional prophylaxis during the duration of the study. Clinical measurements were performed with an electronic probe at baseline and at reentry 8 months following surgical therapy. Measurements included clinical attachment levels (CAL), gingival margin levels (GML), probing depths (PD), bone defect levels (BDL), and alveolar crest level (ACL). A split mouth design was used. Quadrants were randomly assigned for treatment by GTR (experimental) or open flap debridement alone (control). Standardized radiographs were taken at baseline and at reentry. Digital images were analyzed by subtraction to assess changes in area (A) and optical density (OD). Data were evaluated using paired t test. RESULTS: Statistically significant differences were found in both groups when comparing baseline and post-treatment values for CAL, GML, PD, and BDL (P < 0.0 1). Greater reductions in BDL and gain in A and OD were observed in the GTR group when compared to control (P < 0.01). Both therapies were effective in improving the clinical parameters assessed. CONCLUSION: Clinical and radiographic findings from this study demonstrated more bone fill in sites treated with GTR.

Root coverage: comparison of coronally positioned flap with and without titanium-reinforced barrier membrane.

BACKGROUND: Various surgical procedures have been proposed as effective treatment methods for recession defects. The purpose of this study was to evaluate the clinical outcome of root coverage comparing the coronally positioned flap (CPF) with and without guided tissue regeneration (GTR) using a titanium-reinforced expanded polytetrafluoroethylene barrier in paired gingival recession defects. METHODS: Procedures were performed in 10 patients having bilateral buccal recession defects > or = 2.0 mm on maxillary canines and first premolars. Mucoperiosteal flaps were raised and root surfaces were scaled, planed, and conditioned. Randomly assigned sites received either GTR + CPF or CPF treatment. Clinical parameters measured at baseline and at 6 months after the procedure included gingival recession depth (GRD), clinical attachment level (CAL), probing depth (PD), keratinized gingival width (KGW), and alveolar crest level (ACL). RESULTS: GRD decreased from 3.4 +/- 0.6 mm to 1.9 +/- 1.2 mm with GTR (45% root coverage) and from 3.3 +/- 0.4 mm to 1.3 +/- 0.7 mm with CPF (60% root coverage). The difference in GRD decrease between procedures was significant. CAL, KGW, and PD differences between procedures were not significant. ACL mean gain was significant (1.0 +/- 0.6 mm in the GTR group and 0.2 +/- 0.3 mm in the CPF group; P < 0.05). CONCLUSIONS: Both GTR and CPF procedures result in root coverage. The amount of root coverage obtained with CPF was greater than that observed with GTR, although GTR resulted in significantly greater ACL gain.

Clinical and radiographic evaluation of soft and hard tissue changes around implants: a pilot study.

BACKGROUND: The aim of this study was to evaluate the clinical and radiographic changes in the peri-implant tissues around one-stage implants with different smooth neck portion lengths before and after functional prosthetic loading. METHODS: Twelve one-stage implants were placed in adult patients with bilateral edentulous posterior mandibular ridges. The sites were randomly assigned into two groups of six each: group 1: 2.8 mm neck implants and group 2: neck implants. The parameters plaque index (PI), gingival index (GI), probing depth (PD), gingival margin level (GML), relative clinical attachment level (r-CAL), and optical density (OD) were measured at loading (4 months) and 12 months after implant placement. The radiographic parameter osseous level (OL) was measured at implant placement, loading, and at 12 months. Analysis of variance and the paired Student t test were used to detect difference over time and between groups. RESULTS: The results showed significant differences (P<0.05) for both groups for PD, r-CAL, and OL for intragroup comparisons over time. However, no significant differences were found for PI, GI, PD, GML, OD, and OL for between-group comparisons. CONCLUSION: Bony loss occurred before loading, supporting the soft tissues and maintaining the biologic width irrespective of the smooth portion length.

The influence of enamel matrix derivative associated with insulin-like growth factor-I on periodontal ligament fibroblasts.

BACKGROUND: Enamel matrix derivative (EMD) has recently been shown to promote periodontal regeneration in vivo. Insulin-like growth factor-I (IGF-I) is a potent modulator of periodontal regeneration stimulating cell proliferation, differentiation, synthesis of type I collagen, and non-collagenous proteins. However, the biochemical effects of these factors on periodontal ligament (PDL) fibroblasts are not completely understood. The objective of the present study was to evaluate the effect of EMD, IGF-I, and the combination of these two factors on the proliferation, adhesion, migration, and expression of type I collagen in PDL fibroblasts. METHODS: The proliferation rate was measured by automated cell counting and immunohistochemical expression of proliferating cell nuclear antigen (PCNA). The cell adhesion was analyzed by a colorimetric assay and cell migration was measured in Boyden chambers. Type I collagen expression and production was determined by semi-quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA), respectively. RESULTS: The results indicated that the proliferation of PDL fibroblasts was significantly stimulated by EMD and EMD plus IGF-I in a dose- and time-dependent manner. EMD, IGF-I, and the combination of both factors had no effects on cellular migration and adhesion or expression and production of type I collagen. CONCLUSION: Our results showed that EMD, IGF-I, and the combination of both factors stimulated PDL fibroblast proliferation, whereas these factors did not affect adhesion, migration, or expression of type I collagen of these cells.

Root coverage using the coronally positioned flap with or without a subepithelial connective tissue graft.

BACKGROUND: Various surgical techniques have been proposed for treating gingival recession. This randomized clinical trial compared the coronally positioned flap (CPF) alone or in conjunction with a subepithelial connective tissue graft (SCTG) in the treatment of gingival recession. METHODS: Eleven non-smoking subjects with bilateral and comparable Miller Class I recession defects were selected. The defects, at least 3.0 mm deep, were randomly assigned to the test (CPF + SCTG) or control group (CPF alone). Recession depth (RD), probing depth (PD), clinical attachment level (CAL), width of keratinized tissue (KT), and gingival/mucosal thickness (GT) were assessed at baseline and 6 months postoperatively. RESULTS: Recession depth was significantly reduced 6 months postoperatively (P<0.05) for both groups. Mean root coverage was 75% and 69% in the test and control groups, respectively. There were no significant differences between the two groups in RD, PD, or CAL, either at baseline or at 6 months postoperatively. However, at 6 months postoperatively, the test group showed a statistically significant increase in KT and GT compared to the control group (P<0.05). CONCLUSIONS: The results indicate that both surgical approaches are effective in addressing root coverage. However, when an increase in gingival dimensions (keratinized tissue width, gingival/mucosal thickness) is a desired outcome, then the combined technique (CPF + SCTG) should be used.

Smoking influences on the thickness of marginal gingival epithelium.

Smoking patients show reduction of inflammatory clinical signs that might be associated with local vasoconstriction and an increased gingival epithelial thickness. The purpose of this work was to evaluate the thickness of the marginal gingival oral epithelium in smokers and non-smokers, with clinically healthy gingivae or with gingivitis. Twenty biopsies were obtained from four different groups. Group I: non-smokers with clinically healthy gingivae (n = 5). Group II: non-smokers with gingivitis (n = 5). Group III: smokers with clinically healthy gingivae (n = 5). Group IV: smokers with gingivitis (n = 5). These biopsies were histologically processed, serially sectioned at 5 microns, stained with H. E., and examined by image analysis software (KS400), which was used to perform the morphometric evaluation and the quantification of the major epithelial thickness, the epithelial base thickness and the external and internal epithelial perimeters. Differences between the four groups were analyzed using ANOVA test and Tukey's test. The criteria for statistical significance were accepted at the probability level p < 0.05. A greater epithelial thickness was observed in smokers independent of the gingival health situation.

[Comparison between gingival and periodontal ligament fibroblasts from the same subject]. / Comparação entre fibroblastos gengivais e do ligamento periodontal de um mesmo indivíduo.

The objective of this study was to compare fibroblasts from the periodontal ligament (PLF) and gingival fibroblasts (GF) as to morphology, proliferation rate and protein synthesis. PLF and GF were explanted from tissues of the same patient. To characterize and compare the morphology of cells, PLF and GF were plated and analyzed under phase-contrast and optical microscopies. Proliferation rates were determined by means of automated counts carried out in days 1, 4, 7, 15 and 21, and also by means of the bromodeoxyuridine labelling index (BrdU). Total protein content was analyzed by means of electrophoresis in 10% polyacrylamide gel and zimography containing gelatin as substrate. PLF were bigger and more elongated than GF in subconfluence and confluence conditions. The proliferative rate of PLF was higher than that of GF at 1, 4, and 7 days (p < 0.05). At 15 and 21 days, there was no statistically significant difference as to the number of cells. PLF presented a significantly greater proliferative potential, in relation to GF (p < 0.05). The synthesis of protein in a period of 24 hours was similar for both PLF and GF. Our results demonstrated that PLF and GF are different as to morphology and proliferative capacity, however, they do not differ as to protein synthesis.

Triatomines in dwellings and outbuildings in an endemic area of Chagas disease in northeastern Brazil.

INTRODUCTION: The present study identified the triatomines collected in intra and peri-domestic environments, observed the occurrence of Trypanosoma cruzi infection in triatomines and correlated this information with housing conditions and the fauna associated with the rural areas of the City of Itabaianinha, located in the State of Sergipe, Brazil. METHODS: Quarterly visits were conducted between March 2009 and March 2010, and the homes to be visited for the active search of insects were determined by random selection. In each housing unit, the insects were collected by a manual search with a metal clip and flashlight to inspect openings and cavities, with a collection time of one hour/home/individual. The Pirisa® dislodge chemical was used to force the insects to leave their ecotopes. Analysis of the intestinal contents of triatomines was performed in the laboratory to establish the presence of Trypanosomatidae. RESULTS: Of the 103 dwellings surveyed, 17.5% were infested with Panstrongylus megistus. The village of Mutuca exhibited the highest infestation rate (38.1%). All the villages with relevant infestation rates were situated in the northern area of the city. The highest percentage of vector infection was found in the village of Água Boa (56.5%). The rural dwellings were found to be primarily brick or wooden house with or without roughcast or plastered walls, and the outbuilding most frequently associated with triatomines was the chicken run. CONCLUSIONS: These results emphasise the need for broader vector control and surveillance and for educational campaigns in the context of the Chagas Disease Control Program.

Morphological and chemical analysis of bone substitutes by scanning electron microscopy and microanalysis by spectroscopy of dispersion energy.

This study evaluated the morphological and chemical composition of the following bone substitutes: cancellous and cortical organic bovine bone with macro and microparticle size ranging from 1.0 to 2.0 mm and 0.25 to 1.0 mm, respectively; inorganic bovine bone with particle size ranging from 0.25 to 1.0 mm; hydroxyapatite with particle size ranging from 0.75 to 1.0 mm; and demineralized freeze-dried bone allograft with particle size ranging from 0.25 to 0.5 mm. The samples were sputter-coated with gold in an ion coater, the morphology was observed and particle size was measured under vacuum by scanning electron microscopy (SEM). The chemical composition was evaluated by spectroscopy of dispersion energy (EDS) microanalysis using samples without coating. SEM analysis provided visual evidence that all examined materials have irregular shape and particle sizes larger than those informed by the manufacturer. EDS microanalysis detected the presence of sodium, calcium and phosphorus that are usual elements of the bone tissue. However, mineral elements were detected in all analyzed particles of organic bovine bone except for macro cancellous organic bovine bone. These results suggest that the examined organic bovine bone cannot be considered as a pure organic material.

Triatomines in dwellings and outbuildings in an endemic area of Chagas disease in northeastern Brazil / Triatomíneos no intra e peridomicílio de área endêmica de doença de Chagas no Nordeste do Brasil

INTRODUCTION: The present study identified the triatomines collected in intra and peri-domestic environments, observed the occurrence of Trypanosoma cruzi infection in triatomines and correlated this information with housing conditions and the fauna associated with the rural areas of the City of Itabaianinha, located in the State of Sergipe, Brazil. METHODS: Quarterly visits were conducted between March 2009 and March 2010, and the homes to be visited for the active search of insects were determined by random selection. In each housing unit, the insects were collected by a manual search with a metal clip and flashlight to inspect openings and cavities, with a collection time of one hour/home/individual. The Pirisa® dislodge chemical was used to force the insects to leave their ecotopes. Analysis of the intestinal contents of triatomines was performed in the laboratory to establish the presence of Trypanosomatidae. RESULTS: Of the 103 dwellings surveyed, 17.5% were infested with Panstrongylus megistus. The village of Mutuca exhibited the highest infestation rate (38.1%). All the villages with relevant infestation rates were situated in the northern area of the city. The highest percentage of vector infection was found in the village of Água Boa (56.5%). The rural dwellings were found to be primarily brick or wooden house with or without roughcast or plastered walls, and the outbuilding most frequently associated with triatomines was the chicken run. CONCLUSIONS: These results emphasise the need for broader vector control and surveillance and for educational campaigns in the context of the Chagas Disease Control Program.

INTRODUÇÃO: O presente trabalho teve como objetivo identificar os triatomíneos coletados no intra e peridomicílio, assim como verificar a ocorrência de infecção por Trypanosoma cruzi e correlacionar essas informações às condições habitacionais e à fauna associada na zona rural de Itabaianinha, Sergipe, Brasil. MÉTODOS: Visitas trimestrais foram realizadas entre março de 2009 e março de 2010, e as casas visitadas para a busca ativa de insetos foram determinadas por sorteio. Em cada unidade habitacional, os insetos foram capturados por coleta manual com pinça e lanterna para examinar aberturas e cavidades, com um tempo de coleta de uma hora/casa/indivíduo. O desalojador químico Pirisa® foi utilizado para forçar os insetos a abandonar seus ecótopos. A análise do conteúdo intestinal dos triatomíneos foi realizado no laboratório para estabelecer a presença de tripanosomatídeos. RESULTADOS: Em 103 unidades domiciliares examinadas, 17,5% estavam infestadas por triatomíneos da espécie Panstrongylus megistus. O Povoado Mutuca apresentou a mais elevada taxa de infestação das unidades domiciliares (38,1%). Todos os povoados que apresentaram índices de infestação relevantes estavam localizados na região norte do município. A maior percentagem de infecção desse vetor foi observada no Povoado Água Boa (56,5%). As habitações rurais observadas eram em sua maioria de tijolo ou madeira com as paredes rusticamente rebocadas ou sem reboco, e o anexo frequentemente associado ao triatomíneo foi o galinheiro. CONCLUSÕES: Os resultados obtidos ressaltam a necessidade de vigilância e controle vetorial mais abrangentes, bem como de campanhas educativas no contexto do PCDCh.

[Characteristics of implant surface and implant-abutment gap in two- and one-stage systems]. / Características da superfície e da fenda implante-intermediário em sistemas de dois e um estágios.

The aim of this study was to evaluate under scanning electron microscopy the characteristics of the implant surface and the gap between the components of two- and one-stage systems. Three two-stage implants coated with RBM and three one-stage implants coated with TPS were selected. In the two-stage implants, the esthetic-cone abutments were adapted and screw tightened with 20 N/cm . In the one stage implants, solid abutments were adapted and torque tightened mechanical frictional with 30 N/cm. The specimens were mounted on stubs and analyzed under scanning electron microscopy. The gap in each implant was measured in four different points and repeated three times. The paired Student-t test was applied to detect the difference in the gap extension. The results showed that no significant differences (P > 0.05) were found regarding the gap extension between two- and one-stage systems and that the treatments produced different surface roughness.

Clinical and radiographic treatment evaluation of class III furcation defects using GTR with and without inorganic bone matrix.

OBJECTIVE: The aim of this study was to evaluate the effect of guided tissue regeneration (GTR) alone and in conjunction with a bovine inorganic bone matrix in furcation defects. MATERIAL AND METHODS: Twenty class III furcation defects were treated in 18 non-smoker patients, 35-75 years old. Horizontal (CAL-H) and vertical clinical attachment levels (CAL-V), probing depths (PD), gingival margin levels (GML), horizontal (BDL-H) and vertical bone defect levels (BDL-V), and alveolar crest levels (ACL) were performed at baseline and at 6-month re-entry procedures. Subtraction radiography was used to assess gain or loss in optical density (OD) and area of bone fill (A) (baseline/6 months). After flap elevation, the sites were randomly assigned to receive GTR + Bio-Oss (test) or GTR treatment alone (control). Results were evaluated using anova. RESULTS: Differences were statistically significant between baseline and re-entry for PD, ACL (p < 0.01) and GML (p < 0.05) for the control group, and for BDL-V (p < 0.01) for the test group. There was a gain in ACL for the test group and a reduction in ACL for the control group (p < 0.01). No differences were observed for OD and A. CONCLUSION: The results of this study indicate that class III furcation defects are not predictably resolved utilizing GTR or GTR in combination with an inorganic bone matrix.

Clinical and Radiographic Evaluation Periodontal Intrabony Defects Treated With Guided Tissue Regeneration. A Pilot Study.

BACKGROUND: The aim of this clinical and radiographic study was to evaluate the effect of guided tissue regeneration using a bioabsorbable barrier in the treatment of intrabony defects in humans. METHODS: Intrabony osseous defects (2 or 3 walls) around mandibular canines and premolars were treated in 10 systemically healthy patients with ages ranging from 35 to 56 years. Prior to the surgical phase, patients were enrolled in a strict maintenance program including oral hygiene instructions and scaling and root planing (presurgical PI and GI <10%). Patients were seen for professional prophylaxis during the duration of the study. Clinical measurements were performed with an electronic probe at baseline and at reentry 8 months following surgical therapy. Measurements included clinical attachment levels (CAL), gingival margin levels (GML), probing depths (PD), bone defect levels (BDL), and alveolar crest level (ACL). A split mouth design was used. Quadrants were randomly assigned for treatment by GTR (experimental) or open flap debridement alone control). Standardized radiographs were taken at baseline and at reentry. Digital images were analyzed by subtraction to assess changes in area (A) and optical density (OD). Data were evaluated using paired t test. RESULTS: Statistically significant differences were found in both groups when comparing baseline and post-treatment values for CAL, GML, PD, and BDL (P <0.01). Greater reductions in BDL and gain in A and OD were observed in the GTR group when compared to control (P <0.01). Both therapies were effective in improving the clinical parameters assessed. CONCLUSION: Clinical and radiographic findings from this study demonstrated more bone fill in sites treated with GTR. J Periodontol 2002;73:353-359.

Therapy with adjunctive doxycycline local delivery in patients with type 1 diabetes mellitus and periodontitis.

OBJECTIVES: The purpose of this study was to evaluate the effect of subgingival administration of doxycycline as an adjunct to periodontal therapy in type 1 diabetes mellitus (DM) patients. MATERIAL AND METHODS: Twenty-two paired periodontal defects > or =5.0 mm were treated in 11 patients (35-55 years old). After initial therapy the sites were randomly assigned into test (scaling and root planing+subgingival administration of 10% doxycycline hyclate gel) or control (scaling and root planing+subgingival placebo gel) groups. The clinical parameters of clinical attachment level (CAL), probing depth (PD) and gingival margin level (GML) for recession determination were assessed at baseline, after 6 weeks, and 6, 9 and 12 months, using a computerized probe. Data were statistically evaluated using Duncan and F tests. RESULTS: Between study group comparisons indicated PD reduction and CAL gain were greater in the test group than in the control group at 6 weeks and 6, 9 and 12 months but only statistically significant at 12 months (p<0.05). Within study group comparisons indicated statistically significant differences were found for CAL and PD values favouring the adjunctive doxycycline group from baseline to 6 weeks and 6, 9 and 12 months (p<0.05). CONCLUSIONS: These findings suggest that subgingivally delivered doxycycline hyclate produces additional favorable clinical results to periodontal therapy in type 1 DM patients.