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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 nonsmokers 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, donorsite complete epithelialization was much more prevalent in non-smokers (92%) than in smokers (20%) (P

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.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.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 (P0.05); complete root coverage was observed in 58.82% and 88.24% of patients, respectively. SCTG maintained a statistically significant increase in TKT (P0.05) 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.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.

The aim of the present study was to histometrically evaluate bone healing in the absence of bone defects and in the presence of surgically created bone defects treated by guided bone regeneration at oxidized and turned implant surfaces.Three months after dental extractions, standardized buccal dehiscence defects (height: 5 mm; width: 4 mm) were surgically created following implant site preparation in the mandible of 10 dogs. Oxidized-surface implants (OSI) and turned-surface implants (TSI) were inserted bilaterally, and the bone defects were treated by guided bone regeneration. After 3 months of healing, the animals were sacrificed, blocks were dissected, and undecalcified sections were obtained and processed for histometric analysis. The percentage of bone-to-implant contact (BIC) and bone density (BD) was evaluated inside the threads on the buccal (regenerated bone) and lingual sides (pristine bone) of the implants. Data were evaluated using two-way analysis of variance (P0.05).New bone formation could be observed in OSI and TSI in the region of the defect creation. The BIC values observed in OSI for pristine and regenerated bone were 57.03% +/- 21.86% and 40.86% +/- 22.73%, respectively. TSI showed lower values of BIC in pristine bone (37.39% +/- 23.33%) and regenerated bone (3.52% +/- 4.87%). The differences between OSI and TSI were statistically significant. BD evaluation showed no statistically significant differences between OSI and TSI in pristine and regenerated bone.The oxidized implant surface promoted a higher level of BIC than the turned implant surface at pristine and regenerated bone.

The aim of this study was to evaluate the clinical and laboratory changes 3 months after full-mouth scaling and root planing in subjects with and without diabetes mellitus.This study was performed using 10 subjects with type 2 diabetes mellitus who required insulin therapy (DM) and 10 healthy adult control subjects (NDM) with generalized chronic periodontal disease. Both groups were treated with full-mouth scaling and root planing and given oral hygiene instructions. Clinical parameters, including plaque index (PI), gingival index (GI), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL), were measured at four sites per tooth. Subgingival plaque samples were obtained from sites with the deepest PD (or =5 mm) and with furcations in each subject. Samples were also tested for the presence of Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans), Porphyromonas gingivalis, and Tannerella forsythia (previously T. forsythensis) by polymerase chain reaction. Glycemic control (glycosylated hemoglobin [HbA1c] and fasting glucose levels) and clinical and microbiologic assessments were recorded at baseline and 3 months after periodontal treatment.Data revealed statistical changes (Por =0.05; analysis of variance [ANOVA]) in clinical variables (PI, GI, PD, GR, and CAL) between baseline and 3 months in both groups. Conversely, no improvement in the fasting glucose level or glycosylated hemoglobin (Por =0.05; ANOVA) was found after treatment. Besides some reduction in the bacterial frequency 3 months after treatment, no statistically significant difference was found between the groups.Clinical and laboratory responses were similar in DM and NDM groups 3 months after full-mouth scaling and root planing.

The aim of this study was to histometrically evaluate the healing process of gingival recessions treated with platelet-rich plasma (PRP) in combination with a subepithelial connective tissue graft (SCTG) and to compare it to that obtained with SCTG alone.Six mongrel dogs were used in the experiment. Gingival recessions (5 x 7 mm) were surgically created and exposed to plaque accumulation for 1 month. Contralateral defects were randomly assigned to the test group (SCTG + PRP) or the control group (SCTG). Dogs were sacrificed 45 days after the surgeries, and the blocks containing the experimental specimens were processed for histologic analysis. The histometric parameters evaluated were length of sulcular and junctional epithelium, connective tissue adaptation, new cementum, new bone, and defect extension.A greater length of new cementum was observed in the sites treated with PRP (2.18 +/- 0.78 mm) compared to the control group (1.19 +/- 0.62 mm) (Por =0.05). No statistically significant differences were observed in the remaining parameters. The extension of total epithelium (sulcular and junctional epithelium) was 2.04 +/- 0.57 mm for the test group and 2.49 +/- 0.82 mm for the control group. The new connective tissue adjacent to the root without cementum formation was 0.29 +/- 0.28 mm and 0.23 +/- 0.18 mm for the test and control groups, respectively. Bone position was -0.57 +/- 0.95 mm for the test group and -0.46 +/- 1.34 mm for the control group.Within the limits of this study, the combination of PRP with SCTG was more effective in promoting new cementum formation than the graft alone.

The aim of this randomized clinical trial was to evaluate the treatment of gingival recession associated with non-carious cervical lesions by a coronally advanced flap alone (CAF) or in combination with a resin-modified glass ionomer restoration (CAF+R).Nineteen subjects with bilateral Miller Class I buccal gingival recessions associated with non-carious cervical lesions were selected. The recessions were assigned randomly to receive CAF or CAF+R. Bleeding on probing (BOP), probing depth (PD), relative gingival recession (RGR), clinical attachment level (CAL), non-carious cervical lesion height (CLH), and dentin sensitivity (DS) were measured at baseline; 45 days; and 2, 3, and 6 months postoperatively. Keratinized tissue width (KTW) and keratinized tissue thickness (KTT) were measured at baseline and 6 months. The height of the non-carious cervical lesion located on the root and crown were estimated, allowing calculation of root coverage.Both groups showed statistically significant gains in CAL and soft tissue coverage. The differences between groups were not statistically significant for BOP, PD, RGR, CAL, KTW, and KTT after 6 months. The percentages of CLH covered were 56.14% +/- 11.74% for CAF+R and 59.78% +/- 11.11% for CAF (P0.05). The root and crown surfaces affected by the non-carious cervical lesion were 1.67 +/- 0.31 mm and 0.96 +/- 0.29 mm, respectively, for CAF+R and 1.59 +/- 0.37 mm and 1.01 +/- 0.33 mm, respectively, for CAF. The estimated root coverage was 88.02% +/- 19.45% for CAF+R and 97.48% +/- 15.36% for CAF (P0.05). CAF+R reduced DS significantly compared to CAF (P0.05).Both procedures provided similar soft tissue coverage after 6 months. Despite the fact that a greater reduction in DS was observed after CAF+R, longitudinal observations are necessary to confirm these results.

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 (≥10 cigarettes daily for ≥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.

Despite the common occurrence of localized gingival enlargements, which often represent reactive lesions, the temporal and spatial association of such a lesion with a central jaw lesion has not been reported. The purpose of this case report is to present the exceptional combination of a peripheral ossifying fibroma and a central odontogenic fibroma. The differential diagnosis and management of each lesion is reviewed.A 45-year-old black female presented with a chief complaint of a painless protuberance in the left mandible of 1-year duration. Clinical and radiographic examination revealed a gingival enlargement localized between teeth #21 and #23 and a multilocular radiolucent lesion with radiopaque foci in the same area. Excisional biopsy of the gingival lesion and incisional biopsy of the central lesion were performed, and specimens were submitted for histopathological analysis.Biopsy of the gingival lesion revealed stratified squamous epithelium and highly cellular fibroblastic component presenting central areas of calcification, features consistent with a diagnosis of peripheral ossifying fibroma. The central lesion was characterized by cellular fibrous tissue admixed with rests of odontogenic epithelium and few calcification areas, features consistent with a diagnosis of central odontogenic fibroma/World Health Organization type. Subsequently, the central lesion was enucleated. After 1-year follow-up, no recurrence has been observed.The combination of a rare central lesion with a common gingival lesion may present unique diagnostic and therapeutic challenges. Clinician awareness regarding the possibility of such a combined presentation and its implications will help to ensure optimal treatment outcomes.

The objective of this study was to evaluate clinically the effectiveness of a chlorhexidine gluconate chip in sites still showing signs of disease during periodontal maintenance therapy.Forty-two maintenance non-smoking patients (previously treated with non-surgical scaling and root planing [SRP]), presenting at least one probing depth (PD) of 5 to 8 mm, and bleeding on probing (BOP) at single-rooted teeth were assigned randomly to two groups: treated with a chlorhexidine gluconate chip (CHIP group) and treated with SRP (SRP group). Patients were assessed for plaque index, gingival index, BOP, PD, clinical attachment level (CAL), and gingival recession at baseline, 6 weeks, and 3 and 6 months.Both treatments resulted in improvements in all parameters evaluated. After 6 months, a reduction in PD of 2.64 +/- 0.02 mm and 2.12 +/- 0.02 mm was observed for CHIP and SRP groups, respectively (P0.05). The observed gain in CAL was 2.19 +/- 0.87 mm and 2.07 +/- 1.53 mm for CHIP and SRP groups, respectively (P0.05). In deep pockets, PD reduction was 3.60 +/- 0.70 mm for CHIP group and 2.83 +/- 0.62 mm for SRP group (P = 0.01).Both treatments were equally effective in periodontal health reestablishment in inflamed single-root sites of maintenance patients. However, for deep pockets, the chlorhexidine gluconate chip was more effective than SRP in reducing PD.

The aim of this study was to investigate the effect of a selective cyclooxygenase-2 inhibitor, meloxicam, on bone healing around titanium implants in rats.Thirty-one adult male Wistar rats were included in this study, and one screw-shaped titanium implant was inserted in the tibiae of each rat. The animals were randomly assigned to one of the following groups for daily subcutaneous injections: control (N = 14): saline solution; and test (N = 17): 3 mg/kg of meloxicam, each administered daily for 60 days. After the treatment, animals were sacrificed, and undecalcified sections were obtained. Bone-to-implant contact (BIC) and bone area (BA) within the limits of implant threads and bone density (BD) in a 500 mum-wide zone lateral to the implants were obtained and arranged for cortical (zone A) and cancellous (zone B) bone regions.Intergroup comparisons demonstrated that meloxicam significantly reduced bone healing around implants. For zone A, significant differences were observed regarding BIC (47.01 +/- 10.48 A; 35.93 +/- 12.25 B), BA (86.42 +/- 3.66 A; 61.58 +/- 12.09 B), and BD (96.86 +/- 0.96 A; 91.06 +/- 3.05 B) for control and test groups, respectively (P0.05). For zone B, data analysis also showed significant differences among groups for BIC (30.76 +/- 13.80 A; 16.86 +/- 11.48 B), BA (34.83 +/- 8.18 A; 25.66 +/- 9.16 B), and BD (15.76 +/- 7.05 A; 7.73 +/- 4.61 B) for control and test groups, respectively (P0.05).Meloxicam may negatively influence bone healing in the cortical and cancellous bone around titanium implants inserted in rats after continuous administration.

The purpose of this randomized clinical trial was to compare the outcome of gingival recession therapy using the semilunar coronally positioned flap (SCPF) or the subepithelial connective tissue graft (SCTG).Seventeen patients with bilateral Miller Class I buccal gingival recessions (or=4 mm) in maxillary canines or premolars were selected. The recessions were randomly assigned to receive either the SCPF or the 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 6 months post-surgery. Patient satisfaction with esthetics, root sensitivity, and postoperative pain was also evaluated.The average percentages of root coverage for SCPF and SCTG were 90.95% and 96.10% (P0.05), respectively, and the complete root coverage observed was 52.94% and 76.47%, respectively. The SCTG showed a statistically significant increase in TKT (P0.05). There were no significant differences between the two groups with regard to RH, RW, WKT, PD, and CAL. The esthetic condition after both treatments was considered satisfactory by the patients.The findings from this study indicate that SCPF and SCTG can be successfully used to treat Class I gingival recession.

Although a harmful effect of smoking on titanium implants has been documented, only a few studies have investigated the benefits of smoking cessation. Thus, this study histologically investigated whether smoking cessation influences bone healing around titanium implants and comparatively evaluated temporary versus complete cessation protocols.Sixty-six male Wistar rats were randomly assigned to one of four groups: control (N = 16); CSI, intermittent cigarette smoke inhalation (CSI) throughout the entire 150-day experiment (N = 17); P-CSI, CSI 83 days prior to implant placement (N = 17); or R-CSI, CSI for 83 days, cessation 7 days before and 21 weeks after implant placement, and return to CSI for 39 days (N = 16). The animals were sacrificed and the degree of bone-to-implant contact (BIC) and the bone area (BA) within the limits of the implant threads obtained for cortical (zone A) and cancellous bone (zone B).Intergroup analysis (Kruskal-Wallis test, alpha = 0.05) demonstrated a significant effect of CSI on BA (P0.05) and that temporary or complete CSI cessation protocols resulted in values similar to those of the control group (P0.05) 88.91% +/- 4.29%; 80.66% +/- 6.55%; 84.27% +/- 6.96%; 85.71% +/- 4.7% in zone A, and 51.28% +/- 6.49%; 38.69% +/- 10.78%; 48.87% +/- 8.47%; 49.47% +/- 8.04%; in zone B for groups CTRL, CSI, P-CSI, and R-CSI, respectively.Within the limits of the present investigation, temporary and complete CSI cessation reversed the effect of smoke exposure on bone healing around titanium implants in both cortical and cancellous bone.

Anti-inflammatory agents have been reported as a bone loss mediator in periodontitis. This study aimed to investigate in rats the impact of a selective cyclooxygenase-2 inhibitor (meloxicam) on bone loss in ligature-induced periodontitis and its post-treatment effect after administration withdrawal.Seventy-five adult male Wistar rats were included. After anesthesia, a mandibular first molar was randomly assigned to receive the cotton ligature in the sulcular position, while the contralateral tooth was left unligated. The animals were randomly assigned to one of the following five treatment groups (15 animals each), including daily subcutaneous injections: 1) saline solution for 15 days; 2) saline solution for 45 days; 3) 3 mg/kg of meloxicam for 15 days; 4) 3 mg/kg of meloxicam for 45 days; or 5) 3 mg/kg of meloxicam for 15 days followed by saline solution for 30 days. The animals were sacrificed and the specimens routinely processed. The volume of bone loss was histometrically measured and statistical analysis performed.Intergroup comparisons demonstrated that the drug may significantly reduce periodontitis-related bone loss (group 3: 5.83 +/- 2.04); however, this effect is less evident when the drug is administered in a short period (group 4: 3.59 +/- 1.57). Moreover, after drug withdrawal, no residual effect was observed (6.86 +/- 3.59, 6.09 +/- 2.66, groups 2 and 5, respectively) (P0.05).Within the limits of the present study, it can be concluded that selective cyclooxygenase-2 inhibitors may reduce bone loss associated with experimental periodontitis and that no remaining effect can be expected after its withdrawal.

The goal of this investigation was to histologically and histometrically evaluate the healing process of dehiscence-type defects treated by enamel matrix derivative (EMD) and/or guided tissue regeneration (GTR).Seven mongrel dogs were used. Buccal osseous dehiscences were surgically created on the mesial roots of the mandibular third and fourth premolars. The defects were exposed to plaque accumulation for 3 months. After this period, the defects were randomly assigned to one of the treatments: open flap debridement (OFD), enamel matrix derivative (EMD), GTR with bioabsorbable membrane (GTR), and the combination of both procedures (EMD + GTR). After 4 months of healing, the dogs were sacrificed and the blocks were processed. The histometric parameters evaluated included gingival recession, epithelial length, connective tissue adaptation, new cementum, and new bone.A superior length of new cementum was observed in the sites treated by EMD (3.7 mm) and EMD + GTR (3.8 mm) in comparison with OFD (2.4 mm) (P0.05). No statistically significant differences were found in the remaining histometric parameters.Within the limits of this study, it can be concluded that EMD alone or in combination with GTR barriers may effectively promote new cementum formation. The combination of both therapies may not provide additional benefits.

The aim of the present study was to verify nicotine effects on alveolar bone changes induced by occlusal trauma during a periodontitis experimental model in rats.Thirty adult male rats were used. The animals were randomly assigned to one of three groups receiving daily intraperitoneal injections: A, nicotine solution (0.44 mg/ml) and occlusal overload; B, saline solution and occlusal overload; or C, saline solution. Rats from groups A and B underwent bilateral amputation of the second and third molar cusps to simulate an occlusal overload. The first molars were then randomly assigned to receive a cotton ligature in the sulcular area, while the contralateral tooth was left unligated. The animals were sacrificed 30 days later. The resected mandibles were processed, and histomorphometric measurements were performed in the alveolar bone adjacent to the furcation area of the first molars.Nicotine enhanced the bone loss induced by occlusal trauma (P0.001) on the ligated teeth of group A (12.27 +/- 4.4 mm2), when compared to groups B (8.43 +/- 3.51 mm2) and C (4.43 +/- 2.17 mm2). Alveolar bone loss (P0.01) was also observed in the contralateral teeth of groups A (nicotine + trauma) and B (saline + trauma), when compared to group C (saline only).Within the limits of the study, it is concluded that nicotine may influence the alveolar bone changes induced by occlusal trauma by enhancing bone loss.

This study evaluated the influence of estrogen and calcitonin administration on tibial bone density in a lateral area adjacent to implants placed in ovariectomized rats (OVX).One screw-type titanium implant was placed bilaterally in the ovariectomized rats, and the animals assigned to one of the following groups: group 1 (n = 15): sham surgeries; group 2 (n = 15): OVX; group 3 (n = 14): OVX subcutaneously administered with calcitonin (CT) 4 days/week (16 IU/kg); group 4 (n = 14): OVX administered daily with 17beta estradiol (20 microg/kg). After 60 days, the animals were sacrificed and undecalcified sections obtained. Blood samples were collected to measure serum levels of alkaline phosphatase and calcium at the time of sacrifice. Bone density was measured in a 500 microm wide mineralized zone lateral to the implant.Alkaline phosphatase levels in groups 2 and 3 (P0.05) were statistically higher than groups 1 and 4 (P0.05), and calcium serum levels were higher in group 2 than the other groups (P0.05). Regarding bone density, the data were grouped separately for cortical (zone A) and cancellous (zone B) bone. In zone A, intergroup analysis revealed no significant difference among groups (P0.05). However, in zone B, the animals that received estrogen administration (group 4) presented a higher bone density than groups 2 and 3 (P0.05).It appears that estrogen therapy may prevent the negative influence of endogenous estrogen deficiency on bone density around titanium implants placed in ovariectomized rats.

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.Procedures were performed in 10 patients having bilateral buccal recession defectsor = 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).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; P0.05).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.

The goal of this investigation was to histometrically evaluate the effect of enamel matrix derivative (EMD) on bone healing after guided bone regeneration (GBR) in dehiscence-type osseous defects around dental implants; i.e., in the absence of periodontal ligament cells.Six mongrel dogs were used. The second, third, and fourth mandibular premolars (p2, p3, and p4) and first molars (ml) were extracted. After 3 months, 2 implant osteotomies were prepared in each side of the mandible, dehiscence-type defects were created on the buccal aspect of each implant osteotomy (3.5 mm x 5.0 mm), and titanium implants were placed (3.75 mm x 8.5 mm). The surgically-created defects were randomly assigned to one of the treatments: EMD, GBR, EMD+GBR, or control. After 2 months, 4 additional defects were created and treated. The animals were sacrificed 3 months after the placement of the first implants, thus allowing the healing periods of 1 and 3 months. Undecalcified sections were obtained for the histometric evaluation including the percentage of bone-to-implant contact and new bone area on the implant threads related to the defect.No statistically significant differences were observed among the groups in the evaluated parameters after 1 month of healing. After 3 months, no statistically significant differences were observed among the groups for the percentage of bone-to-implant contact. The values for the new bone area were: 55.5+/-11.8, 53.8+/-16.3, 62.1+/-18.4, and 36.9+/-25.1 for EMD, GBR, EMD+GBR, and control, respectively. The difference between EMD+GBR and control was statistically significant (P0.05).Within the limits of this study, it can be concluded that EMD may positively influence bone healing after GBR around titanium implants. EMD alone, however, had no statistically significant effect.

Immunosuppressive agents have been recognized as a factor affecting bone metabolism. We investigated the consequences of the administration and withdrawal of cyclosporin A/nifedipine on bone around titanium implants to observe whether these changes occur and if they are reversible.Twenty-eight New Zealand rabbits were included in the study. Following anesthesia, the tibiae surface was exposed, and 2 screw-shaped implants 7.0 mm in length and 3.75 mm in diameter were placed bilaterally. The animals were randomly assigned to 1 of 4 experimental groups and received daily subcutaneous injections for 14 days: groups A and C were injected with vehicle while groups B and D received cyclosporin A (10 mg/kg) plus nifedipine (0.5 mg/kg). Groups A and B were sacrificed 14 days and groups C and D 42 days postoperatively. The degree of bone contact with the implant surface and the bone area within the limits of the threads of the implant were measured.Intergroup analysis revealed no significant difference (P0.05) in the degree of bone contact with the implant surface between the control and test groups on days 14 and 42. In contrast, the treated animals demonstrated a significant (P0.05) decrease in the bone area within the limits of the threads of the implant in both periods.The data of the present study suggest that the use of cyclosporin A/nifedipine may influence bone healing around titanium implants. This observation may have important clinical implications.

The aim of this clinical study is to evaluate the 2-year term results of gingival recession (GR) associated with non-carious cervical lesions (NCCLs) treated by connective tissue graft (CTG) alone or in combination with a resin-modified glass ionomer restoration (CTG+R).Thirty-six patients with Miller Class I buccal GR associated with NCCLs completed the follow-up. The defects were randomly assigned to receive either CTG or CTG+R. Bleeding on probing (BOP), probing depth (PD), relative GR, clinical attachment level (CAL), and cervical lesion height coverage were measured at baseline, 6 months, 1 year, and 2 years after treatment.Both groups showed statistically significant gains in CAL and soft-tissue coverage. The differences between groups were not statistically significant in BOP, PD, relative GR, or CAL after 2 years. Cervical lesion height coverage was 79.31% ± 18.51% for CTG and 71.95% ± 13.25% for CTG+R (P0.05). Estimated root coverage was 91.56% ± 11.74% for CTG and 93.29% ± 7.97% for CTG+R (P0.05).Within the limits of the present study, it can be concluded that both procedures provide comparable soft tissue coverage after 2 years of follow-up.

The present study evaluates the influence of local anatomy on the reduction in relative gingival recession (Delta RGR) and gain of clinical attachment level (Delta CAL) achieved by coronally advanced flap alone (CAF), CAF plus restoration (CAF + R), subepithelial connective tissue graft alone (CTG), and CTG plus restoration (CTG + R), to treat Miller Class I gingival recessions associated with non-carious cervical lesions.A total of 78 defects in maxillary canines or premolars were included, and received one of the following treatments: CAF, CAF + R, CTG, or CTG + R. Delta RGR and Delta CAL after 6 months were associated with cervical lesion height (CLH), cervical lesion width, cervical lesion depth (CLD), keratinized tissue width, keratinized tissue thickness, papillae width, papillae height, bone level (BL), and post-surgical position of the gingival margin using stepwise multivariate linear regression.CLH was statistically associated with Delta RGR when CAF (P = 0.02) and CTG + R (P = 0.0002) were analyzed and statistically associated with Delta RGR when overall data (P = 0.005) from both CTG groups were analyzed. CLD was significantly associated with Delta RGR in the CAF group (P = 0.0045). BL was statistically associated with Delta RGR when evaluating the CTG group (P = 0.02). It was also significantly associated with Delta CAL when considering the CTG (P = 0.01) and the overall data (P = 0.04) from CAF (CAF and CAF + R).It can be concluded that CLD may influence Delta RGR when CAF is performed to treat combined defects. Additionally, BL may not negatively influence Delta RGR when the CTG technique is used.

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.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.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 (P0.05) increase in WKT. The SCRF group showed a greater reduction (P0.05) 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.The use of EDTA gel as a root surface biomodifier agent negatively affected the outcome of root coverage with the SCRF.

Background: Paracoccidioidomycosis, a deep mycosis endemic in parts of Latin America, often presents with oral lesions involving the gingiva. Nevertheless, the periodontal literature is devoid of references to oral paracoccidioidomycosis. The purpose of this study was to characterize the gingival involvement in oral paracoccidioidomycosis and to contrast clinical and histopathologic diagnosis of the disease. Differential diagnosis and management of oral paracoccidioidomycosis were reviewed. Methods: From January 1995 to October 2006, the files of the Oral Pathology Laboratory, School of Dentistry, Alfenas Federal University, were reviewed to identify cases referred because of a clinical diagnosis of oral paracoccidioidomycosis. Data collected included patient demographics (age, gender, race, and occupation), clinical information (oral lesion location), and histopathologic diagnosis. Results: Forty-six cases were identified, and 34 were histopathologically confirmed as paracoccidioidomycosis. Of the remaining 12 cases, one-half were diagnosed as either carcinoma or dysplastic leukoplakia. Of the 34 confirmed paracoccidioidomycosis cases, 45% presented with multiple site involvement, whereas the gingiva/alveolar process was the most prevalent site overall (52%). The gingiva/alveolar process was the most prevalent site in both multiple and single site cases. The majority of patients were men (88%), white (75%), and in their fourth decade of life (47%). Statistical analysis revealed that patients with gingival/alveolar process involvement were demographically indistinguishable from those without. Conclusions: Oral paracoccidioidomycosis has a strong predilection for the gingiva, whereas patients with gingival lesions do not differ from patients lacking such involvement. Early diagnosis of gingival/oral lesions may prevent life-threatening complications of this mycosis.

Background: Buccal gingival recession is a prevalent problem in populations with a high standard of oral hygiene and is very often associated with a non-carious cervical lesion, complicating treatment. The purpose of this report is to show three cases treated by an integrated periodontal and restorative dentistry approach. Methods: Three patients with Miller Class I gingival recessions associated with non-carious cervical lesions were enrolled for treatment. One patient received a coronally positioned flap and a resin-modified glass ionomer restoration, and two patients were treated with a coronally positioned flap, resin-modified glass ionomer restoration, and connective tissue graft. Probing depth (PD), relative gingival recession (RGR), and clinical attachment level (CAL) were measured at baseline and at 6 and 8 months after surgery. Results: After the healing period, all patients showed CAL gain and reduction in RGR. No difference was observed on PDs compared to baseline. No signs of gingival inflammation or bleeding on probing were seen. The patients were satisfied with the final esthetics and had no more dentin hypersensitivity. Conclusion: This report indicates that teeth with Miller Class I gingival recessions associated with non-carious cervical lesions can be successfully treated by an integrated periodontal and restorative dentistry approach; however, longitudinal randomized controlled clinical trials must be performed to support this approach.

Preterm low birth weight was reported to be related to periodontal infections that might influence the fetus-placenta complex. The aim of this study was to provide periodontal treatment for pregnant women and to evaluate if this treatment can interfere with pregnancy duration and weight of the newborn.The sample consisted of 450 pregnant women who were under prenatal care at a polyclinic in Três Corações, Brazil. Women with risk factors, such as systemic alterations (ischemic cardiopathy, hypertension, tuberculosis, diabetes, cancer, anemia, seizure, psychopathology, urinary tract infection, sexually transmitted diseases, asthma, and human immunodeficiency virus), and/or users of alcohol, tobacco, and drugs were excluded from the study. Data related to age, socioeconomic level, race, marital status, number of previous pregnancies, and previous preterm delivery also were evaluated. Initially, the sample was divided into two groups: 122 healthy patients (group 1) and 328 patients with periodontal disease (group 2). In group 2, 266 patients underwent treatment and 62 patients dropped out. After mothers gave birth, pregnancy duration and the weight of all infants were analyzed and recorded.There was no statistical difference between the healthy and treated groups. However, there was a difference in the non-treated group, with a 79% incidence of preterm low birth weight. Educational level, previous preterm birth, and periodontal disease were related significantly to preterm delivery (P0.001).Periodontal disease was related significantly to preterm low birth weight.

The aim of this clinical trial was to compare the outcome of non-surgical treatment of interproximal and non-interproximal Class II furcation involvements.Thirty-eight patients presenting at least one Class II furcation involvement that bled on probing with a probing depth (PD)or = 5 mm were recruited. Furcation involvements were grouped as either buccal and lingual furcation involvements (BLFI) or interproximal furcation involvements (IFI). The following clinical outcomes were evaluated: visible plaque index, bleeding on probing (BOP), position of the gingival margin, relative attachment level (RAL), PD, and relative horizontal attachment level (RHAL). N-benzoyl-l-arginine-p-nitroanilide (BAPNA) 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.Six months after treatment, both groups had similar means of RAL and RHAL gain (P0.05). These variables were 1.22 and 1.07 mm in the IFI group and 1.38 and 1.20 mm in the BLFI group, respectively. The PD reduction was significantly greater in the BLFI group than in the IFI group (2.59 and 2.11 mm, respectively; P0.05). The BLFI group presented fewer sites with PDor = 5 mm than the IFI group at all post-treatment periods. At 6 months, the BAPNA test showed that only the BLFI group had values significantly different from baseline. This means that the BLFI group had significantly lower BAPNA values compared to the IFI group at 6 months.Buccal and lingual Class II furcation involvements respond better to non-surgical therapy compared to interproximal Class II furcation involvements.

The aim of this clinical study was to evaluate the association of locally delivered doxycycline 10% with scaling and root planing in the periodontal treatment of smokers during a 2-year period.Forty-eight chronic periodontitis patients, presenting a minimum of four pockets (or=5 mm) that bled on probing on anterior teeth were included. Patients were randomly assigned to receive one of the following treatments: scaling and root planing (SRP) and scaling and root planing followed by local application of doxycycline (SRP-D). Assigned treatments were performed at baseline and at 12 months. Clinical parameters, including probing depth (PD) and relative attachment level (RAL), were recorded at baseline; 45 days; 3, 6, and 12 months (retreatment); 45 days following retreatment; and at 15, 18, and 24 months.In initially deep pockets (or=7 mm), SRP-D showed greater PD reduction than SRP at 6 and 18 months (mean difference between groups of 1.18 and 1.73 mm, respectively; P0.05) and greater RAL gain in all periods after 3 months (mean difference between groups of 1.16, 1.99, and 1.78 mm, at 6, 18, and 24 months, respectively; P0.05). Also, the proportion of sites showingor=2 mm PD reduction was greater for SRP-D at 6 months (81.2% x 50.8%; P0.001) and at 24 months (65.5% x 46.5%; P = 0.01). As for RAL gain, this proportion was 34.4% and 18.1% for SRP-D and SRP at 24 months, respectively (P = 0.008).The use of locally delivered doxycycline may constitute an important adjunct for the active and supportive treatments of severe periodontal disease in smokers.

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.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.Intragroup analysis showed that CPF was able to reduce RD and improve CAL in both groups (P0.05). Intergroup analysis demonstrated that smokers presented greater residual RD at 6 months and lower percentage of root coverage (69.3% versus 91.3%; P0.05). No smokers obtained complete root coverage compared to 50% of non-smokers (P0.05).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.

The aim of the present study was to evaluate the clinical effects of one-stage periodontal debridement with an ultrasonic instrument, associated with 0.5% povidone (pvp)-iodine irrigation in patients with chronic periodontitis.Forty-five patients were randomly assigned into three groups: the control group (CG) received quadrant root planing at 1-week intervals over four consecutive sessions; the periodontal debridement plus pvp-iodine group (PD-PIG) received a 45-minute full-mouth debridement with an ultrasonic instrument, associated with 0.5% pvp-iodine irrigation; and the periodontal debridement group (PDG) received a 45-minute full-mouth periodontal debridement with an ultrasonic instrument, associated with NaCl irrigation.At the 3-month evaluation, the mean probing depth (PD) reduction in CG was 2.51+/-0.52 mm, 2.53+/-0.50 mm in PD-PIG, and 2.58+/-0.60 mm in PDG (P0.05). The clinical attachment level (CAL) analysis showed a statistically significant gain in all groups compared to baseline (1.87+/-0.56 mm [CG], 1.94+/-0.70 mm [PD-PIG], and 1.99+/-0.92 mm [PDG]). Intergroup analysis of PD and CAL at 1 and 3 months showed no differences (P0.05). The N-benzoyl-L-arginine-p-nitroanilide (BAPNA) test showed a significant reduction in trypsin activity only during the first month (P0.05); at 3 months there were no differences compared to baseline (P=0.80).This study provides no evidence that pvp-iodine is effective as an adjunct for one-stage periodontal debridement.

The aim of this clinical trial was to evaluate the effect of topically applied povidone-iodine (polyvinylpyrrolidone and iodine [PVP-I]) used as an adjunct to non-surgical therapy of furcation involvements.Forty-four patients presenting at least one Class II furcation involvement that bled on probing with probing depth (PD)or=5 mm were recruited. Patients were stratified into two treatment groups: 1) subgingival instrumentation by an ultrasonic device using PVP-I (10%) as the cooling liquid (test); and 2) identical treatment using distilled water as the cooling liquid (control). The following clinical outcomes were evaluated: plaque index, bleeding on probing (BOP), position of the gingival margin, relative attachment level (RAL), PD, and relative horizontal attachment level (RHAL). The N-benzoyl-L-arginine-p-nitroanilide (BAPNA) test was used to analyze the trypsin-like activity in dental biofilm. The clinical and biochemical parameters were evaluated at baseline and 1, 3, and 6 months after therapy.Both groups had similar means of PD reduction and RAL and RHAL gain. At 6 months, these variables were, respectively, 2.31, 1.17, and 1.00 mm in the control group and 2.31, 1.23, and 1.02 mm in the test group. There was also no difference between groups regarding the number of furcation sites presenting RAL gainor=2 mm. The results of the BAPNA test failed to demonstrate significant differences between groups.Non-surgical therapy can effectively treat Class II furcation involvements, and the use of topically applied PVP-I as an adjunct to subgingival instrumentation does not provide additional benefits.

Background: It has been previously shown that cigarette smoke inhalation (CSI) enhances bone loss in ligature-induced periodontitis. In this study, the hypothesis that the interruption of smoke exposure would reverse the impact of CSI on mandibular bone quality and periodontitis-related bone loss was tested. Methods: Fifty-three Wistar rats were randomly assigned to one of the following groups: group 1: control, N = 16; group 2: 83 days of CSI prior to ligature placement, N = 17; or group 3: 90 days of CSI before and 60 days after ligature placement, N = 20. Animals were sacrificed 60 days after ligature placement, the jaws removed and immediately radiographed for photodensitometry analysis. Bone loss was histometrically evaluated. Results: CSI did not affect unligated sites in either condition (P >0.05); however, smoke inhalation during the whole experimental period significantly enhanced bone loss in ligated teeth (P

This study evaluated whether alendronate (ALD) influences bone healing around titanium implants inserted in ovariectomized rats and whether it provides a residual effect after its withdrawal.Bilateral ovariectomies were performed in 87 Wistar rats and one screw-shaped titanium implant was placed in the tibiae. The animals were divided into the following groups: group SHAM (N = 15): sham surgeries; group OVX (N = 15): ovariectomy; group AT (N = 15): OVX plus alendronate administration for 80 days; group AW (N = 14): OVX plus alendronate administration for 40 days; group ET (N = 14): OVX plus 17beta estradiol administration for 80 days; or group EW (N = 14): OVX plus 17beta estradiol administration for 40 days. Bone-to-implant contact (BIC), bone area (BA) within the limits of implant threads, and bone density in a 500 microm-wide zone lateral to the implant (BD) were obtained and measured for the cortical (zone A) and cancellous (zone B) regions.In zone A, data analysis showed no significant differences among the groups regarding BIC and BD (P0.05), and a slight beneficial effect of estradiol on BA when compared with the OVX, EW, and AW groups (P0.05). In zone B, OVX negatively impacted bone healing around the implants, resulting in reduced BA and BD (P0.05). ALD (continuous/interrupted) and estradiol (only continuous) positively affected BIC, BA, and BD, resulting in values at the same level as the control group (SHAM).ALD may prevent the negative influence of estrogen deficiency on bone healing around titanium implants inserted in OVX rats. This positive effect, in contrast to estradiol, is sustained following its withdrawal.

The aim of this study was to evaluate the impact of alendronate (ALD) and estrogen (EST) therapies and their withdrawal on bone loss in experimental periodontitis in ovariectomized rats.Eighty-seven Wistar rats were divided into six groups: group 1 (N = 15): sham surgery; group 2 (N = 15): ovariectomy (OVX); group 3 (N = 15): OVX plus alendronate administration for 80 days (AT); group 4 (N = 14): OVX plus alendronate administration for 40 days (AW); group 5 (N = 14): OVX plus 17beta estradiol administration for 80 days (ET); and group 6 (N = 14): OVX plus 17beta estradiol administration for 40 days (EW). Twenty-one days after ovariectomy or sham surgery, one mandibular molar was randomly assigned to receive a ligature, while the contralateral tooth was left unligated. Sixty days later, the animals were sacrificed and the specimens processed.OVX presented a direct impact on alveolar bone, regardless of plaque accumulation and significantly increased bone loss resulting from periodontitis (P0.05). The effect of OVX on unligated sites was significantly reduced by AT, AW, and ET (P0.05), but not by EW (P0.05). In addition, alendronate administration (AT/AW) significantly reduced the impact of OVX on periodontitis-related bone loss (P0.05), while estradiol did not (P0.05).Within the limits of this study, alendronate administration, but not estrogen replacement, may protect against the impact of estrogen deficiency on alveolar bone presenting a significant residual effect after its withdrawal.

The aim of this study was to clinically evaluate the treatment of Class I gingival recessions by coronally positioned flap with or without acellular dermal matrix allograft (ADM).Thirteen patients with comparable bilateral Miller Class I gingival recessions (or = 3.0 mm) were selected. The defects were randomly assigned to one of the treatments: coronally positioned flap and acellular dermal matrix (ADM group) or coronally positioned flap alone (CPF group). The clinical parameters included: probing depth (PD), clinical attachment level (CAL), recession height (RH), recession width (RW), height of keratinized tissue (HKT), thickness of keratinized tissue (TKT), plaque index (PI), and gingival index (GI). The measurements were taken before the surgeries and after 6 months.The mean baseline recession was 3.4 mm and 3.5 mm for ADM group and CPF group, respectively. After 6 months, both treatments resulted in significant root coverage (P0.01), reaching an average of 2.6 mm (76%) in the ADM group and 2.5 mm (71%) in the CPF group. The difference in recession reduction between treatments was not statistically significant. There were no statistically significant differences between the treatments in PD, CAL, RH, RW, and HKT. However, the mean TKT gain was 0.7 mm for the ADM group and 0.2 mm for the CPF group (P0.01).It can be concluded that both techniques could provide significant root coverage in Class I gingival recessions; however, a greater keratinized tissue thickness can be expected with ADM.

Cigarette smoking has been shown to negatively influence healing following periodontal therapeutic procedures. Therefore, the aim of this study was to evaluate the impact of smoking on clinical outcome of root coverage following subepithelial connective tissue graft (CTG) surgery.Eighteen defects were treated in 15 patients (seven smokers and eight non-smokers) who presented canine and pre-molar Miller Class I and II recessions. CTG was performed and clinical measurements were obtained at baseline, and 30, 60, 90, and 120 days after surgery. Clinical measurements included plaque and gingival indexes, gingival recession, probing depth, clinical attachment level, gingival thickness, and keratinized tissue width.Intragroup analysis showed that CTG was able to promote root coverage, increase gingival thickness, and improve clinical attachment level in both groups (P0.05). On the other hand, intergroup analysis demonstrated that smokers presented with a lower percentage of root coverage (58.84% +/- 13.68% versus 74.73% +/- 14.72%), less clinical attachment level gain (2.54 +/- 0.79 mm versus 2.00 +/- 1.04 mm), and deeper probing depths (1.56 +/- 0.53 mm versus 2.35 +/- 0.67 mm) than non-smokers (P0.05). Moreover, 4 months after CTG, smokers presented more keratinized tissue compared to non-smokers (3.30 +/- 0.86 mm versus 4.50 +/- 1.16 mm) (P0.05).Within the limits of the present study, it can be concluded that cigarette consumption may present a negative impact on root coverage outcome by CTG and, therefore, may represent one more challenge for periodontal plastic therapy.

Long-Term Results of Guided Tissue Regeneration Therapy in the Treatment of Class II Furcation Defects: A Randomized Clinical Trial P.R. Cury Department of Prosthodontics and Periodontics, Division of Periodontics, School of Dentistry at Piracicaba, University of Campinas, Piracicaba, Brazil. Dr. E.A Sallum Department of Prosthodontics and Periodontics, Division of Periodontics, School of Dentistry at Piracicaba, University of Campinas, Piracicaba, Brazil. F.H. Nociti Jr. Department of Prosthodontics and Periodontics, Division of Periodontics, School of Dentistry at Piracicaba, University of Campinas, Piracicaba, Brazil. A.W. Sallum Department of Prosthodontics and Periodontics, Division of Periodontics, School of Dentistry at Piracicaba, University of Campinas, Piracicaba, Brazil. M.K. Jeffcoat Department of Periodontics, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL. Background: The purpose of this study was to evaluate the results after guided tissue regeneration (GTR) using a bioabsorbable membrane in Class II furcation defects in mandibular molars over a 24-month period. Methods: Nine patients with 2 comparable Class II furcation defects were included. The defects in each patient were randomly assigned to either test (GTR) or control (open flap debridement) group. Clinical measurements and standardized radiographs were taken at baseline, and at 6, 12, 18, and 24 months. The radiographs were analyzed by subtraction radiography. Results: There were significant probing depth reductions for both test and control groups (P 0.05). Over 24 months, a significant horizontal clinical attachment level gain was observed in the test group compared to control (P

A negative influence of smoking on implant outcomes has been reported. This animal study investigated the influence of cigarette smoke on osseointegration and newly formed bone within implant threads.Male Wistar rats were included in the study. After anesthesia, the tibiae surface was exposed and a screw-shaped titanium implant (4.0 mm in length; 2.2 mm in diameter) was placed bilaterally. The animals were randomly assigned to group 1, control, or group 2, intermittent cigarette smoke inhalation. The animals were sacrificed after 60 days and undecalcified sections obtained. The degree of bone-to-implant contact (BIC) and the bone area (BA) within the implant threads were measured in the cortical (zone A) and cancellous bone (zone B) areas.A slight difference in the BIC was noted between the groups, but this was not statistically significant either in zone A or in zone B (Mann-Whitney test, P0.05). In contrast, the BA close to the implant significantly decreased in both zones for group 2 (84.73% +/- 4.77 versus 79.85% +/- 6.17, zone A in groups 1 and 2, respectively, and 32.01% +/- 6.62 versus 20.71% +/- 8.57, zone B in groups 1 and 2, respectively, P0.05).Within the limits of the present study, intermittent cigarette smoke inhalation may result in a poor bone quality around titanium implants inserted in rats.

This study investigated the influence of implant surface on osseointegration around titanium implants inserted in the tibiae of rabbits administered with nicotine.Thirty-two (32) New Zealand rabbits were included in the study. After anesthesia, the tibia surface was exposed and 2 screw-shaped commercially available pure titanium implants 7.0 mm in length and 3.75 mm in diameter were placed bilaterally. A total of 128 implants were inserted: 64 blasted with Al2O3 particles (Group 1) and 64 with a machined surface finish (Group 2). The animals were randomly assigned to 1 of 4 treatment subgroups, and daily subcutaneous injections of nicotine were administered: A) saline solution; B) 0.37 mg/kg; C) 0.57 mg/kg; and D) 0.93 mg/kg. In order to label regenerated bone, a 2% calcein green solution was administered by intramuscular injection at 0, 7, and 15 days after implant insertion. After 42 days, the animals were sacrificed and undecalcified sections were prepared. The degree of bone contact with the implant surface, the bone area, and the intensity of bone labeling were measured into the limits of the implant threads.Statistical analysis (2-way ANOVA) revealed no significant difference regarding the effect of nicotine on bone healing around the implants (P0.05). However, a significant influence of the implant surface on the degree of bone-to-implant contact was detected in groups C (30.13 +/- 4.97 and 37.85 +/- 8.85, for machined and Al2O3-blasted surfaces, respectively) and D (27.79 +/- 3.93 and 33.13 +/- 8.87, for machined and Al2O3-blasted surfaces, respectively) (P0.05).Although nicotine administration may not statistically influence bone healing around titanium implants, implant surface design may enhance osseointegration after nicotine administration.

The goal of this investigation was to compare, histologically and histometrically, the healing process of dehiscence-type defects treated by guided tissue regeneration (GTR) with bioabsorbable polylactic acid (PLA) membranes and non-resorbable expanded polytetrafluoroethylene (ePTF) membranes.Six mongrel dogs were used. Buccal osseous dehiscences were surgically created on the distal roots of the mandibular third and fourth premolars. The defects were exposed to plaque accumulation for 3 months. After this period, the defects were randomly assigned to one of the treatments: GTR with bioabsorbable membrane (PLA), GTR with non-resorbable membrane (ePTFE), open flap debridement (OFD), and non-treated control (NTC). After 3 months of healing, the dogs were sacrificed and the blocks were processed. The histometric parameters evaluated included: gingival recession, epithelial length, connective tissue adaptation, new cementum, and new bone area.A superior length of new cementum was observed in the sites treated by GTR, regardless of the type of barrier used, in comparison with OFD (P0.05). No statistically significant differences were found between PLA and ePTFE in any of the parameters with the exception of bone area. PLA presented a greater bone area when compared to ePTFE, OFD, and NTC (P0.05).Within the limits of this study, it can be concluded that both barriers are equally effective for new cementum formation. The bioabsorbable membrane may provide a greater bone area than the non-resorbable membrane.

The goal of this investigation was to histologically and histometrically evaluate the healing process of gingival recessions treated by guided tissue regeneration with bioabsorbable polylactic acid membranes (GTR group) and to compare it to that obtained with coronally positioned flaps (CPF group).Gingival recessions were surgically created on the buccal aspect of the upper cuspids of 5 mongrel dogs. The defects (5x7 mm) were exposed to plaque accumulation for 3 months. The contralateral defects were then randomly assigned to each group. After 3 months of healing, the dogs were sacrificed and the blocks were processed. The histometric parameters evaluated included length of sulcular and junctional epithelium, connective tissue adaptation, new cementum, new bone, and defect coverage.The extension of the epithelium was 1.9 +/- 0.8 mm for the GTR-group and 3.0 +/- 0.9 mm for the CPF-group (P = 0.16). The connective tissue adaptation was 0.1 +/- 0.1 and 0.8 +/- 0.5 mm in the GTR group and CPF group, respectively (P = 0.051). The new cementum was 3.8 +/- 1.5 mm and 2.4 +/- 0.3 mm in the GTR group and CPF group, respectively (P= 0.16). Bone formation was 1.1 +/- 0.5 mm in the GTR group and 1.4 +/- 0.2 mm in the CPF group (P = 0.53). Histologically, the defect coverage observed was similar, 90.5% and 91.9% for the GTR group and the CPF group, respectively. No statistical differences in any of the parameters could be detected.Within the limits of this study, it can be concluded that both procedures resulted in a favorable healing response with no significant difference between the treatments.

The systemic administration of steroid hormone (0.400 mg of Dexamethasone every 2 days), during a 28-day period in marmosets (Callithrix jacchus) produced modifications in the evolution of the experimental periodontal traumatism. The observed changes were osteoporosis and reduction of the periodontal fibers in quantity as well as a reduction of repair process, when compared to the control group that only received the action of the trauma from occlusion.