Enamel matrix derivative proteins for the treatment of proximal class II furcation involvements: a prospective 24-month randomized clinical trial.

OBJECTIVE: This study aimed to evaluate the response of proximal furcations treated with enamel matrix derivative proteins (EMD) in a 24-month follow-up. MATERIALS AND METHODS: Twelve patients presenting bilateral class II proximal furcation with vertical probing depth (PD) ≥5 mm and bleeding on probing were selected. The furcations were assigned to: a control group (n=12), open flap debridement (OFD)+EDTA and a test group (n=12) - OFD+EDTA+EMD. The gingival margin position, PD, relative vertical and horizontal clinical attachment level (RVCAL and RHCAL), vertical and horizontal bone level (VBL and HBL) and furcation closure were evaluated before treatment and after 6, 12 and 24 months. RESULTS: After follow-up, no statistical difference could be seen between groups. At 24 months, the test group showed 1.9 ± 1.6 mm PD reduction whereas the control group showed 1.0 ± 1.3 mm PD reduction. RHCAL gains of the control and the test group were 0.7 ± 1.3 and 1.4 ± 0.9 mm, respectively. However, at 24 months, the test group only presented five remaining class II furcations versus 10 furcations in the control group (p<0.05). CONCLUSION: It could be concluded that EMD therapy promoted a reduction in the number of proximal furcations presenting a diagnosis of class II after 24 months of treatment compared with OFD therapy.

Semilunar coronally positioned flap or subepithelial connective tissue graft for the treatment of gingival recession: a 30-month follow-up study.

BACKGROUND: The objective of this prospective, controlled clinical trial was to evaluate the long-term outcomes of subepithelial connective tissue graft (SCTG) or semilunar coronally positioned flap (SCPF) for the treatment of Miller Class I gingival recession defects. METHODS: Seventeen patients with bilateral Miller Class I gingival recessions (< or =4.0 mm) in maxillary canines or premolars were selected. The recessions were randomly assigned to receive SCPF or SCTG. Recession height (RH), recession width (RW), width of keratinized tissue (WKT), thickness of keratinized tissue (TKT), probing depth (PD), and clinical attachment level (CAL) were measured at baseline and at 6 and 30 months post-surgery. Patient satisfaction with esthetics and root sensitivity was also evaluated. RESULTS: The root-coverage outcomes obtained at 6 months were maintained throughout the study. At the 30-month examination, the average percentage of root coverage was 89.25% for SCPF and 96.83% for SCTG (P >0.05); complete root coverage was observed in 58.82% and 88.24% of patients, respectively. SCTG maintained a statistically significant increase in TKT (P <0.05) at 30 months. At this time, there were no significant differences between the two groups with regard to RH, RW, WKT, PD, and CAL. The evaluation of the esthetic outcome by the patient showed a preference for the SCTG treatment. Furthermore, in this group, no patient complained of residual or additional root hypersensitivity. In the SCPF group, three patients had this complaint at 30 months. CONCLUSIONS: SCPF and SCTG can be successfully used to treat Class I gingival recession, presenting outcomes with long-term stability. However, patient-oriented outcomes, such as esthetics and root sensitivity, favor SCTG therapy.

Full-mouth ultrasonic debridement associated with amoxicillin and metronidazole in the treatment of severe chronic periodontitis.

BACKGROUND: The purpose of this study was to evaluate the adjunctive clinical, microbiologic, and immunologic effects of the systemic administration of amoxicillin and metronidazole in the full-mouth ultrasonic debridement of patients with severe chronic periodontitis. METHODS: Twenty-five patients presenting at least eight teeth with probing depth (PD) > or =5 mm and bleeding on probing (BOP) were selected and randomly assigned to full-mouth ultrasonic debridement + placebo (control group) or full-mouth ultrasonic debridement + amoxicillin and metronidazole (test group). The clinical outcomes evaluated were visible plaque index, BOP, position of the gingival margin, relative attachment level (RAL), and PD. Real-time polymerase chain reaction (PCR) was used for quantitative analysis of Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans), Porphyromonas gingivalis, and Tannerella forsythia (previously T. forsythensis). The enzyme-linked immunosorbent assay (ELISA) technique permitted the detection of prostaglandin E(2,) interleukin-1beta, and interferon-gamma levels in gingival crevicular fluid. All parameters were evaluated at baseline and at 3 and 6 months post-treatment. RESULTS: At 6 months, the test treatment resulted in lower BOP and an additional reduction (0.83 mm) in PD (P <0.05). Data also showed RAL gain > or =2 mm at 43.52% of sites in control patients compared to 58.03% of sites in test patients (P <0.05). However, both groups had similar mean RAL gain (1.68 and 1.88 mm for the control and test groups, respectively). Real-time PCR and ELISA failed to identify significant differences between the groups. CONCLUSIONS: Both treatments resulted in significant clinical improvements; however, there was a slight, but significantly greater, improvement in BOP and the percentage of sites with PD > or =5 mm exhibiting RAL gain > or =2 mm in the test group. Nevertheless, no improvement in the microbiologic or immunologic outcome was observed with the adjunctive use of systemic amoxicillin and metronidazole.

Root surface biomodification with EDTA for the treatment of gingival recession with a semilunar coronally repositioned flap.

BACKGROUND: The purpose of this randomized clinical trial was to evaluate the outcome of gingival recession therapy using the semilunar coronally repositioned flap (SCRF) with or without EDTA application for root surface biomodification. METHODS: Fifteen patients with bilateral Miller Class I buccal gingival recessions (< or =4.0 mm) were selected. Thirty teeth with recessions were assigned randomly to receive the semilunar coronally repositioned flap with (SCRF-E group) or without (SCRF group) the application of an EDTA gel. Recession height (RH), recession width (RW), width (WKT) and thickness of keratinized tissue, probing depth, and clinical attachment level (CAL) were measured at baseline and 6 months post-surgery. Patient perception of root sensitivity and postoperative pain also was evaluated. RESULTS: Both treatments yielded significant improvements in terms of RH and RW decrease and CAL gain compared to baseline values. For SCRF-E and SCRF, the average root coverage was 70.2% and 90.1%, respectively (P = 0.01), and the complete root coverage was 40.0% and 66.7%, respectively. Only the SCRF group had a significant (P <0.05) increase in WKT. The SCRF group showed a greater reduction (P <0.05) in RW and RH compared to the SCRF-E group. No patient in either group reported any pain during the postoperative course; however, 6 months later, patients in the SCRF-E group complained more of residual or new root sensitivity compared to patients in the SCRF group. CONCLUSION: The use of EDTA gel as a root surface biomodifier agent negatively affected the outcome of root coverage with the SCRF.

Amoxicillin/metronidazole associated with nonsurgical therapy did not promote additional benefits in immunologic parameters in generalized aggressive periodontitis: A randomized controlled clinical trial.

OBJECTIVE: This randomized, blinded, placebo-controlled clinical trial compared the levels of interferon γ (IFN-γ), prostaglandin E2 (PGE2), and interleukin 6 (IL-6) in the gingival crevicular fluid (GCF) from generalized aggressive periodontitis (GAgP) patients treated with nonsurgical therapy associated or not with amoxicillin/metronidazole adjunctive. METHOD AND MATERIALS: Thirty-nine GAgP patients were followed during 6 months. The patients were randomly allocated to one of the groups: experimental (scaling and root planing plus 375 mg amoxicillin and 250 mg metronidazole for 7 days) and control (scaling and root planing + placebo). Probing pocket depth (PPD), relative clinical attachment level (rCAL), gingival margin position (GMP), and IL-6, IFN-γ, and PGE2 levels in GCF were evaluated at baseline, and at 3 and 6 months after treatment. RESULTS: Both therapies promoted PPD reductions, rCAL gains, and recession in GMP at the end of the study, with the experimental group presenting an additional PPD reduction in fullmouth analysis and deep pockets at the 3- and 6-month follow-ups (P < .05). During the period of the study, only the experimental group promoted a reduction in PGE2 levels in deep pockets at 3 and 6 months, while IFN-γ and IL-6 levels remained unchanged. However, the differences in the immunologic parameters were not statistically significant among the groups. CONCLUSION: It can be concluded that amoxicillin/ metronidazole associated with nonsurgical therapy promotes an additional PPD reduction in the treatment of GAgP; however, this therapy did not promote additional benefits in the evaluated immunologic parameters.

[Integrated approach to the oral health of drug-addicted undergoing rehabilitation]. / Abordagem integrada da saúde bucal de droga-dependentes em processo de recuperação.

Considering the current context of increasing and early utilization of licit or illicit drugs (habit-forming substances), the aim of this study was to evaluate the oral health conditions of 102 males from the Esquadrão da Vida rehabilitation center, in Bauru, São Paulo, Brazil. The evaluation was carried out by means of the assessment of caries experience (DMFT), dental plaque (PHP), gingival index and salivary flow. This study also aimed at instituting an educational-preventive program and evaluating its efficacy. The subjects' mean age was 29.17 years (sd = 11.40; n = 95). From all subjects (n = 102), 72.54% had the habit of eating between meals, and 69.60% did not utilize dental floss. The observed DMFT was 14.88 (sd = 6.38; n = 86). The initial PHP was 2.34 (sd = 0.69; n = 14) and, after 3 months, it was reduced to 1.91 (sd = 0.74; n = 14). The initial salivary flow was 1.31 ml/min (sd = 0.7; n = 97). Due to the fluctuation of this group, only 13 of the original subjects were reevaluated after 3 months, when a salivary flow of 1.13 ml/min (sd = 0.49) was registered. The initial gingival index and PHP presented r = 0.30 (p = 0.002 - statistically significant). The objective need for treatment and the subjective importance given to oral health were negatively correlated (r = -0.26; p = 0.019 - statistically significant), which indicates that the value attributed to oral health influences health care and affects the oral health-sickness process.

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/cm², 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.

Non-surgical instrumentation associated with povidone-iodine in the treatment of interproximal furcation involvements.

OBJECTIVE: The aim of this controlled clinical trial was to evaluate the effect of topically applied povidone-iodine (PVP-I) used as an adjunct to non-surgical treatment of interproximal class II furcation involvements. MATERIAL AND METHODS: Thirty-two patients presenting at least one interproximal class II furcation involvement that bled on probing with probing pocket depth (PPD) ≥ 5 mm were recruited. Patients were randomly chosen to receive either subgingival instrumentation with an ultrasonic device using PVP-I (10%) as the cooling liquid (test group) or identical treatment using distilled water as the cooling liquid (control group). The following clinical outcomes were evaluated: visible plaque index, bleeding on probing (BOP), position of the gingival margin, relative attachment level (RAL), PPD and relative horizontal attachment level (RHAL). BAPNA (N-benzoyl-L-arginine-p-nitroanilide) testing was used to analyze trypsin-like activity in dental biofilm. All parameters were evaluated at baseline and 1, 3 and 6 months after non-surgical subgingival instrumentation. RESULTS: Six months after treatment, both groups had similar means of PPD reduction, RAL and RHAL gain (p>0.05). These variables were, respectively, 2.20 ± 1.10 mm, 1.27 ± 1.02 mm and 1.33 ± 0.85 mm in the control group and 2.67 ± 1.21 mm, 1.50 ± 1.09 mm and 1.56 ± 0.93 mm in the test group. No difference was observed between groups at none of the posttreatment periods, regarding the number of sites showing clinical attachment gain ≥ 2 mm. However, at 6 months posttreatment, the test group presented fewer sites with PPD ≥ 5 mm than the control group. Also at 6 months the test group had lower BAPNA values than control group. CONCLUSION: The use of PVP-I as an adjunct in the non-surgical treatment of interproximal class II furcation involvements provided limited additional clinical benefits.

Free gingival grafts: graft shrinkage and donor-site healing in smokers and non-smokers.

BACKGROUND: This prospective clinical study aims to evaluate the influence of cigarette smoking on free gingival graft (FGG) healing, by assessing FGG dimensional changes and donor-site wound healing. METHODS: Twelve non-smokers and 10 smokers treatment planned for FGG to augment keratinized tissue dimensions in the mandibular incisor area completed the study. All subjects received standardized FGG of same dimensions. Probing depth, gingival margin position, clinical attachment level, keratinized tissue (KT) width, gingival thickness, and FGG dimensions (width, length, and area) were assessed and recorded before surgery, and 7, 15, 30, 60, and 90 days postoperatively. The palatal donor area was evaluated for immediate bleeding and complete wound epithelialization. Differences between the two groups (smokers and non-smokers) were statistically analyzed. RESULTS: FGG dimensions changed significantly postoperatively. At 90 days postoperatively, FGG width, length, and area were respectively reduced by 31%, 22%, and 44% in non-smokers and by 44%, 25%, and 58% in smokers (no significant differences between groups; P >0.05). Significant KT increases were observed in both non-smokers and smokers (5.4 and 4.8 mm, respectively). Donor-site immediate bleeding was significantly more prevalent in non-smokers (75%) compared to smokers (30%) (P = 0.04). At 15 days postoperatively, donor-site complete epithelialization was much more prevalent in non-smokers (92%) than in smokers (20%) (P <0.002). CONCLUSION: Smoking alters FGG donor-site wound healing by reducing immediate bleeding incidence and by delaying epithelialization, although it does not have discernible effects on postoperative FGG dimensional changes.

Influence of immediate attachment loss during instrumentation employing thin ultrasonic tips on clinical response to nonsurgical periodontal therapy.

OBJECTIVE: Mechanical instrumentation is fundamental to periodontal treatment. However, independent of the instrument used in scaling, an immediate attachment loss occurs at the bottom of the periodontal pocket. This study aimed to determine the influence of tip diameter on attachment loss and the influence of attachment loss on the periodontal response to nonsurgical treatment. METHOD AND MATERIALS: Fifteen patients presenting periodontal pockets with a probing depth of 3.5 mm or more in bilateral teeth were divided into two groups: test group-instrumented with a thin tip, and control group-instrumented with a traditional tip. Probing depth, relative gingival position, and relative attachment level were evaluated immediately before and after and at 1 and 3 months after treatment using an electronic computerized probe. The data were analyzed using ANOVA and Tukey tests (P = .05). RESULTS: Both groups presented attachment loss immediately after instrumentation; however, the thin tip resulted in statistically higher immediate clinical attachment loss than the traditional tip (0.85 and 0.15 mm, respectively; P < .0001). However, both groups showed a similar healing after the ultrasonic therapy, at all parameters evaluated (P > .05). CONCLUSION: In spite of the higher immediate clinical attachment loss inflicted by thin ultrasonic tips during instrumentation, this did not affect the clinical response to the nonsurgical treatment.

Influence of crown shape on root coverage therapy.

OBJECTIVES: The aim of this study was to evaluate the influence of the crown shape on the outcomes of root coverage procedures. MATERIAL AND METHODS: Eighty patients with Miller class I gingival recessions in maxillary canines or premolars were selected. The recession areas were treated using the subepithelial connective tissue grafting. The following clinical parameters were analyzed: crown length (CL) and width (CW), recession height and width, probing depth, clinical attachment level, width and thickness of the keratinized tissue and percentage of root coverage achieved. These measurements were recorded at baseline and 6 months after the surgical procedure. The CW/CL ratio was calculated for each tooth and the median obtained (0.83). Patients were then ranked into two groups, according to the shape of the tooth with gingival recession: Group A - square crown shape (CW/CL values above 0.83) and Group B - long and narrow crown shape (CW/CL values below 0.83). RESULTS: No statistically significant differences (p>0.05) were found between groups in any of the clinical parameters at baseline. After 6 months, both groups presented improved clinical outcomes for all parameters analyzed compared to baseline (p>0.05). The mean percentages and standard deviations of root coverage achieved in Group A and Group B was 91.37 (16.75) and 85.49 (23.55), respectively (p>0.05). CONCLUSIONS: Crown shape did not influence the root coverage obtained with the subepithelial connective tissue graft technique.

Influence of anatomic features on the effectiveness of enamel matrix derivative proteins in the treatment of proximal Class II furcation involvements.

OBJECTIVES: To evaluate the influence of furcation anatomy and bone defect morphology on the treatment of Class II proximal furcations treated with enamel matrix derivative (EMD) proteins. METHOD AND MATERIALS: Eighteen Class II proximal furcations were treated with open-flap debridement + 24% EDTA conditioning + EMD proteins. Probing depth, gingival margin position, relative vertical and horizontal clinical attachment level, and vertical and horizontal bone levels were evaluated immediately before and 6 months after the surgeries. The changes in these parameters were correlated with vertical defect depth, number of walls, depth defect, interdental distance, root divergence, furcation distance, horizontal measure, root trunk, and furcation height, using the Pearson and Spearman rank correlation tests (a = 5%). RESULTS: The depth defect correlated with gingival margin position (r = 0.52; P = .03), probing depth (r = 0.63; P = .005), and horizontal bone level (r = -0.46; P = .05). The furcation height also correlated with gingival margin position (r = 0.53; P = .02) and horizontal bone level (r = -0.57; P = .01). Moreover, the number of walls of vertical defect positively influenced relative vertical clinical attachment level (r = 0.47; P = .05). CONCLUSIONS: Within the limits of this study, furcation anatomy and defect morphology influence the clinical response of EMD protein therapy in Class II proximal furcation involvements.

Dentin hipersensitivity following non-surgical periodontal therapy with hand or ultrasonic instruments / Hipersensibilidade dentinária após terapia periodontal não cirúrgica com instrumentos manuais ou ultrassônicos

Periodontal instrumentation aims to remove plaque and calculus from the root surface. Both manual and ultrasonic instruments have been used for such decontamination; however, establishing a healthy periodontium can result in adverse effects, such as dentin hypersensitivity. Objective: To evaluate the effects of hand or ultrasonic instrumentation on dentin hypersensitivity in patients undergoing non-surgical periodontal treatment. For this controlled clinical trial of a "split mouth" design, 14 patients were selected with homologous teeth in the incisor to premolar region and probing depth ≥ 5 mm on the buccal aspect of the teeth. One side (control) was instrumented with hand instruments and the other side (test) with ultrasonic instruments. Dentin hypersensitivity was assessed on baseline and during the 4 weeks after treatment, with a periodontal probe scratching the root surface and with an air jet. The patient's response was detected by a visual analog scale of 10 cm. There was no statistical difference between the effectiveness and the occurrence of hypersensitivity between the proposed therapies. After the instrumentation the occurrence of hypersensitivity occurred at low levels, and disappeared completely at 4 weeks of evaluation. In the first week, there was a statistically significant increase in hypersensitivity in the control group after stimulation with air. The air jet stimulus, in comparison to scratching caused more discomfort during the hypersensitivity evaluation after the both treatments on the 1st, 2nd and 3rd weeks. Based on these conditions, this study demonstrated that there was no difference in dentin hypersensitivity following ultrasonic or hand instrumentation (AU)

A instrumentação periodontal tem como objetivo remover biofilme e cálculo dental da superfície radicular. Tanto instrumentos manuais quanto ultrassônicos já foram consolidados como capazes de promover essa descontaminação. Contudo, o estabelecimento de um periodonto saudável pode resultar em efeitos adversos como a hipersensibilidade dentinária. O objetivo do presente estudo foi avaliar os efeitos da instrumentação manual ou ultrassônica sobre a hipersensibilidade dentinária em pacientes submetidos ao tratamento periodontal não-cirúrgico. Para realização deste estudo clínico controlado de "boca dividida" foram selecionados 14 pacientes com dentes homólogos na região de incisivos a pré-molares com profundidade de sondagem ≥ 5 mm, na face vestibular. Um lado (controle) recebeu instrumentação com curetas e o outro (teste) instrumentação ultrassônica. A hipersensibilidade dentinária foi avaliada, antes e durante 4 semanas após o tratamento, com uma sonda periodontal arranhando a superfície radicular e com um jato de ar. A resposta do paciente foi detectada por meio de uma Escala Visual Analógica (EVA) de 10 cm. Não houve diferença estatística entre a efetividade e a ocorrência de hipersensibilidade das terapias propostas. Após as instrumentações a ocorrência da sensibilidade ocorreu em níveis leves, e desapareceu completamente na 4ª semana de avaliação. Na primeira semana houve aumento da hipersensibilidade estatisticamente significante apenas no grupo controle após estímulo com ar. O estímulo do jato de ar em comparação ao estímulo da ranhura causou maior desconforto na avaliação da hipersensibilidade após o tratamento com curetas ou pontas ultrassônicas na 1ª, 2ª e 3ª semanas. Dentro dessas condições, este estudo demontrou que não ocorreu diferença da hipersensibilidade dentinária produzida pela instrumentação manual e ultrassônica. (AU)

Obesidade, um possível indicador de risco para a doença periodontal? / Obesity, a possible risk indicator for periodontal disease?

A prevalência da obesidade vem aumentando nas últimas décadas, representando uma preocupação para a saúde pública. Essa patologia é um importante fator de risco para o desenvolvimento de várias doenças sistêmicas,como diabetes mellitus tipo II, hiperlipidemia, hipertensão, doenças cardiovasculares e colelitíase.Estudos epidemiológicos recentes demonstraram uma possível relação entre a obesidade e a periodontite,uma patologia infecto-inflamatória do tecido gengival e do periodonto de sustentação, cujo fator etiológico primário é a presença do biofilme bacteriano nos dentes. A associação entre a periodontite e a obesidade está diretamente relacionada ao processo inflamatório, pois mediadores pró-inflamatórios são secretados pelo tecido adiposo, o que faz com que estejam presentes em maior quantidade em pacientes obesos, podendo, por conseguinte, levar a um estado hiperinflamatório, aumentando o risco ou a progressão das doenças periodontais. Diante disso, o objetivo deste trabalho é apresentar e discutir, por meio de uma revisão de literatura, as evidências científicas e os mecanismos biológicos que mostram a obesidade como um possível indicador de risco para a periodontite.

The prevalence of obesity has increased in recent decades, representing a concern for public health. Thisdisease is an important risk factor for the development of several systemic diseases such as diabetes mellitustype II, hyperlipidemia, hypertension, cardiovascular disease and cholelithiasis. Recent epidemiologicalstudies have shown a possible link between obesity and periodontitis, which is an infectious inflammatorydisease of the gingival tissue and periodontal support, whose primary etiological factor is thepresence of biofilm on the teeth. The association between periodontitis and obesity is directly related tothe inflammatory process, as pro-inflammatory mediators are secreted by adipose tissue, which are presentin greater quantities in obese patients and may therefore lead to a hypertensive state inflammation,increasing the risk or progression of periodontal diseases. Thus, the objective was to provide, through aliterature review, the scientific evidence and biological mechanisms that show obesity as a possible riskindicator for periodontitis.

Influência da macro-geometria na estabilidade primária dos implantes / Influence of macro-geometry in the primary stability of implants

A estabilidade primária dos implantes está intimamente relacionada à macro-geometria dos implantes na medida que pode aumentar o contato íntimo entre o biomaterial e a estrutura óssea. O objetivo do presente estudo foi avaliar a influência da macro-geometria na estabilidade primária dos implantes. Foram utilizados dois tipos de implantes, um cilíndrico e com rosca única (grupo controle) e outro com conicidade apical e três tipos de roscas (grupo teste). Os implantes foram instalados por três operadores em osso bovino fresco. Cada profissional fez a instalação de oito implantes (4 teste e 4 controle) em osso bovino. Os parâmetros avaliados foram: torque de inserção, frequência de ressonância e torque de remoção. A análise dos resultados permitiu a detecção de que os torques de inserção foram maiores no grupo teste (p < 0,05). Não foi observada influência do operador nas variáveis analisadas. Pode-se então concluir que a macro-geometria dos implantes do grupo teste favoreceu a estabilidade primária do implante.

The primary stability of implants is related to implant geometry since it can raise the intimate contact between biomaterial and bone structure. The aim of the present study was to evaluate the influence of implant geometry on primary stability. It was used two types of implants, one cylindrical and with an unique thread (control group) and another tapered with three types of threads (test group). Implants were placed by three professionals in bovine bone. Each operator installed eight implants (4 test and 4 control). The parameters analyzed were: inserting torque, unscrewing torque and resonance frequency. As results it was detected that insertion torque was higher in the test group (p < 0,05). It was not observed influence of the operator in the parameters analyzed. Thus, it can be concluded that geometry of implants in the test group improved implant primary stability.

Diretrizes para a utilização adjunta da antibioticoterapia sistêmica no tratamento das doenças periodontais / Guide for adjunct use of systemic antibiotic in the treatment of periodontal disease

O tratamento das doenças periodontais é direcionado para redução ou eliminação de periodontopatógenos por meio da instrumentação periodontal associado a um efetivo controle do biofilme dental. A terapia não cirúrgica é efetiva em resolver a maioria das infecções periodontais. Contudo, em algumas situações clínicas específicas, as técnicas de raspagem e alisamento radicular são ineficazes em estabilizar o processo saúde-doença. Nessas situações as terapias adjuntas podem ser indicadas com a finalidade de potencializar os efeitos da instrumentação mecânica. Vários antibióticos, isolados ou em associação, têm sido usados com essa finalidade, mas as evidências mais fortes favorecem a associação de amoxicilina e metronidazol no tratamento das doenças periodontais. Entretanto, questões importantes sobre o seu uso como para quais casos indicar, o tempo e o momento de administração e a dosagem ideal permanecem controversas. A falta de respostas para esses questionamentos tem gerado dúvidas quanto a sua utilização na prática clínica diária. Além do mais, devido aos efeitos adversos que podem advir com o uso dos antibióticos, a decisão pelo seu emprego deve ser criteriosa e baseada em evidências científicas. Só assim os benefícios clínicos almejados podem sobrepujar os riscos. Portanto, o objetivo deste estudo é, por meio de uma revisão de literatura, apresentar uma análise crítica do papel dos antibióticos no tratamento periodontal com a fi nalidade de tentar esclarecer dúvidas clinicamente importantes quanto ao seu uso na prática diária.

Treatment of periodontal disease, with subgingival instrumentation and supragingival plaque control, is directed to the reduction or elimination of periodontal pathogens. However, in some specific clinical situations, scaling and root planing are not effective and adjunct therapies can be indicated to potentize the effects of mechanical instrumentation. Many antibiotics have been used, but there are strong evidence favoring the association of metronidazole and amoxicillin in the treatment of periodontitis. However, important questions about its use, when to indicate, time and moment of administration and ideal dosage, remain controversy. The lack of answers to these questions generates doubts about the use of systemic antibiotic in the clinical practice. Besides, the decision about its use has to be done with caution and based on scientific evidence, since the use of systemic antibiotic can cause many adverse effects. This is the only way that the clinical benefits can overcome the risks. Thus, the aim of the present study is to, with a literature review, present a critical analysis of the systemic antibiotic use in the treatment of periodontal disease and clarify clinical important doubts about its indication in daily practice.

Métodos de diagnóstico do biotipo gengival em implantes imediatos / Diagnostics methods of gingival biotype in immediate implants

A reabilitação com implantes instalados em alvéolos frescos e reabilitados com prótese provisória imediata tem como um de seus objetivos a manutenção da margem gengival. O diâmetro do implante, o posicionamento tridimensional e o biotipo gengival podem influenciar a recessão marginal comprometendo a estética. O objetivo deste artigo foi demonstrar métodos de diagnóstico do biotipo gengival aplicados à reabilitação de um primeiro pré-molar inferior comprometido, utilizando o procedimento de implante imediato e provisionalização. O procedimento de instalação de implante imediato, seguido de provisionalização, quando associado a um biotipo gengival espesso e um posicionamento tridimensional adequado, favorece a estabilidade da margem gengival.

The rehabilitation with implants placed in extraction sockets and rehabilitated with immediate provisional prosthesis has as one of its objectives the maintenance of the gingival margin. The diameter of the implant, the three-dimensional positioning and biotype gingival can influence the recession marginal compromising aesthetics. The objective of this article is to demonstrate the gingival biotype diagnostic methods applied to rehabilitation of a compromised lower first premolar using the immediate implant procedure and temporization. The immediate implant installation procedure, followed by temporization, when associated with a thick gingival biotype and an appropriate three-dimensional positioning, favors the stability of the gingival margin.

The effect of one session of supragingival plaque control on clinical and biochemical parameters of chronic periodontitis.

Supragingival plaque control is a requisite for the success of any periodontal procedure. However, little is know about the effect of this procedure alone on periodontitis. The aim of this study was to determine the effect of supragingival plaque control on clinical and biochemical parameters of chronic periodontitis. Twenty-five subjects exhibiting at least 4 pockets > 5mm, non-smokers and with no relevant systemic diseases, were selected for the study. The clinical and biochemical assessments were done before and 21 days after removal of plaque retentive factors, extraction of affected teeth and instruction in oral hygiene. The statistical analysis was done with the Student paired t-test (p<0,05) and demonstrated a reduction on the percentage of sites with bleeding on probing from 42.72 ± 15.83 to 35.87 ± 13.30 (p=0.002). Reduction in probing depth was detected on anterior teeth (initial/final mean: 2.88 mm/2.78 mm; p=0.01) and interproximal sites (initial/final mean: 3.80 mm/3.65 mm; p=0.001). There was an increase from 66.81% to 68.65% in the number of sites with probing depth of 1 to 3mm and a decrease from 26.21% to 24.17% in those with probing depth of 4 to 6mm. The BAPNA results showed a decrease from 51.44 ± 20.78 to 38.64 ± 12.34 (p=0.04). This study demonstrated that supragingival plaque control provides a reduction in gingival inflammation and alterations in the subgingival microflora detected by the BAPNA test.

Non-surgical instrumentation associated with povidone-iodine in the treatment of interproximal furcation involvements

OBJECTIVE: The aim of this controlled clinical trial was to evaluate the effect of topically applied povidone-iodine (PVP-I) used as an adjunct to non-surgical treatment of interproximal class II furcation involvements. MATERIAL AND METHODS: Thirty-two patients presenting at least one interproximal class II furcation involvement that bled on probing with probing pocket depth (PPD) >5 mm were recruited. Patients were randomly chosen to receive either subgingival instrumentation with an ultrasonic device using PVP-I (10 percent) as the cooling liquid (test group) or identical treatment using distilled water as the cooling liquid (control group). The following clinical outcomes were evaluated: visible plaque index, bleeding on probing (BOP), position of the gingival margin, relative attachment level (RAL), PPD and relative horizontal attachment level (RHAL). BAPNA (N-benzoyl-L-arginine-p-nitroanilide) testing was used to analyze trypsin-like activity in dental biofilm. All parameters were evaluated at baseline and 1, 3 and 6 months after non-surgical subgingival instrumentation. RESULTS: Six months after treatment, both groups had similar means of PPD reduction, RAL and RHAL gain (p>0.05). These variables were, respectively, 2.20±1.10 mm, 1.27±1.02 mm and 1.33±0.85 mm in the control group and 2.67±1.21 mm, 1.50±1.09 mm and 1.56±0.93 mm in the test group. No difference was observed between groups at none of the posttreatment periods, regarding the number of sites showing clinical attachment gain >2 mm. However, at 6 months posttreatment, the test group presented fewer sites with PPD >5 mm than the control group. Also at 6 months the test group had lower BAPNA values than control group. CONCLUSION: The use of PVP-I as an adjunct in the non-surgical treatment of interproximal class II furcation involvements provided limited additional clinical benefits.

O impacto do biotipo gengival nas reabilitações implantossuportadas na zona estética – conhecimentos atuais / The impact of gingival biotype on implant-supported prostheses in the anterior esthetic zone – current knowledge

O objetivo deste artigo foi realizar uma revisão da literatura demonstrando o impacto do biótipo gengival na composição estética e funcional das reabilitações com implantes na região anterior da maxila. O biotipo tecidual ao redor de implantes pode ser classificado como fino ou espesso. Estes biotipos estão associados a diferentes características clínicas, podendo resultar em comportamentos divergentes pós-tratamento com implantes. O biotipo gengival espesso está relacionado com menores índices de complicações estéticas, como a recessão, e maior estabilidade óssea. Desta forma, o diagnóstico do biotipo tecidual durante a fase de planejamento deverá ser inserido na rotina clínica, devendo ser selecionado um método de diagnóstico eficaz, reprodutível, pouco oneroso e pouco invasivo. A partir de um correto diagnóstico, existe a possibilidade da conversão do biotipo fino para espesso através de técnicas cirúrgicas de manejo do tecido mole e da prótese. Portanto, o diagnóstico e a conversão de biotipos finos poderão resultar em maior previsibilidade estético-funcional das reabilitações implantossuportadas.

The tissue biotype around implants can be classifi ed as thin or thick. These biotypes are associated with different clinical characteristics and may result in different behaviors after treatment with implants. The thick gingival biotype is associated with lower rates of aesthetic complications, as well as recession and increased bone stability. Thus, the diagnosis of tissue biotype during the planning phase should be inserted in the clinical routine and it must be an effective, reproducible, inexpensive and less invasive method. From a correct diagnosis, a conversion from thin to thick biotype through surgical techniques and soft tissue prosthesis management is possible. Therefore, diagnosis and conversion of thin biotypes may result in greater aesthetic and functional predictability of implant restorations.