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Abstract The presence of a tooth-surface defect, such as a non-carious cervical lesion (NCCL), associated with sites of gingival recession (GR) defects creates a combined soft tissue/tooth defect (CD) that requires a different treatment plan. This study aimed to critically review the literature regarding the available treatment protocols for CDs and suggest a new decision-making process. NCCLs were classified as Class A-: the cementoenamel junction (CEJ) was visible and the root surface discrepancy was < 0.5 mm (no step); Class A+: CEJ was visible and the root surface discrepancy was > 0.5 mm (with a step); Class B-: unidentifiable CEJ without a step; Class B+: unidentifiable CEJ with a step. NCCLs affecting both root and crown surfaces (Class B) lead to CEJ destruction and consequently eliminate an important landmark used before and after root coverage procedures. The depth of the root surface discrepancy is vital owing to its possible impact on soft tissue adaptation after healing, which, in turn, may influence the treatment options, namely the use of graft and/or composites to compensate for the discrepancy. Clinically, a step with horizontal depth greater than 0.5 mm should be recognized as the minimum threshold value to define this condition. Extremely deep defects tend to assume a V-shaped topography. Therefore, extremely deep V-shaped defects were classified into subclasses A+V, a V-shaped defect, and B+V, a V-shaped defect with loss of CEJ, for management considerations. The treatment options, supported by the literature, and a decision-making process to deal with each condition are presented.

Obesity is a chronic condition that has social and economic implications for public health. It can be associated with periodontal disease since the metabolic alterations observed in that condition could have some influence in immunity. The elevated levels of lipid and glucose can be associated with periodontal disease, contributing to an exacerbated host inflammatory response, alterations in neutrophil function, and with the inhibition of macrophage growth factors, reducing tissuehealing capacity. In this way, obese individuals could have higher chances of undergoing tissue destruction in the presence of periodontal infection. On the other hand, periodontitis may be involved in alterations of lipid metabolism, since gram-negative bacteria could promote a rise in cholesterol and triglyceride levels due to chronic exposure to low levels of LPS in circulating blood, leading to the production of cytokines, which could initiate the production of lipoproteins by the liver. The objective was to review the literature about obesity and periodontal disease and provide a better understanding of their relationship.

OBJECTIVE: This study was designed to evaluate the potential adjunctive benefits of platelet-rich plasma (PRP) when used with guided-tissue regeneration (GTR) and bioactive glass (BG) in the treatment of Class II furcation lesions. MATERIAL AND METHODS: Bilateral Class II furcation lesions were surgically created and allowed to become chronic in the mandibular third premolars of 9 dogs. The defects were randomly assigned to: A) GTR+BG and B) GTR+BG+PRP. Similar defects were created in the maxillary third premolars and received the same treatments after 45 days. Dogs were sacrificed 90 days after the first treatment. The histometric parameters evaluated were: connective tissue adaptation, new cementum, new bone, mineralized bone area, non-mineralized bone area, and residual BG particle area. RESULTS: Data analysis showed a superior length of new cementum and a greater mineralized bone area for group B in both periods (p

Aim: This study evaluated radiographically the effects of 1% hyaluronan in bone healing using a critical size rat-calvaria defect model. Methods: Thirty adult male Wistar rats were used in this study. Two 6-mm-diameter critical-size defects were created and the treatments were randomly distributed as follows: 1) 1% hyaluronan; 2) 1% hyaluronan soak loaded onto an absorbable collagen sponge (ACS) carrier; 3) saline; and 4) ACS alone. The animals were sacrificed at 4 and 8 weeks when biopsies were collected and radiographs obtained using a direct digital radiograph system and a standardAim: This study evaluated radiographically the effects of 1% hyaluronan in bone healing using a critical size rat-calvaria defect model. Methods: Thirty adult male Wistar rats were used in this study. Two 6-mm-diameter critical-size defects were created and the treatments were randomly distributed as follows: 1) 1% hyaluronan; 2) 1% hyaluronan soak loaded onto an absorbable collagen sponge (ACS) carrier; 3) saline; and 4) ACS alone. The animals were sacrificed at 4 and 8 weeks when biopsies were collected and radiographs obtained using a direct digital radiograph system and a standardized protocol. A blind examiner evaluated the radiographic density of the images twice and an intraclass correlation was performed to evaluate examiner reproducibility (R2=0.99, p0.05). When treatments were compared no significant differences between groups were found (p>0.05). Conclusions: Within the limits of this study, it can be concluded that 1% hyaluronan gel alone or its association with a carrier does not improve bone healing.ized protocol. A blind examiner evaluated the radiographic density of the images twice and an intraclass correlation was performed to evaluate examiner reproducibility (R2=0.99, p0.05). When treatments were compared no significant differences between groups were found (p>0.05). Conclusions: Within the limits of this study, it can be concluded that 1% hyaluronan gel alone or its association with a carrier does not improve bone healing.

Ultrasonic and curette instrumentation produces a rougher root surface which could be influenced by working parameters such as instrumentation time, pressure and tip angulations. Thus, the aim of this in vitro study was to evaluate root roughness after ultrasonic instrumentation with different power settings and compared it to curette instrumentation. Ninety extracted human teeth were assigned to one of five groups: control group (without instrumentation), curette instrumentation, ultrasonic instrumentation with low, medium, and high power. Before and after instrumentation, surface roughness was measured with a profilometer and the surfaces were examined under the SEM. The mean roughness values of the treated roots were higher than the non-treated roots (0.40+0.08mm). Roots treated by ultrasonic instrumentation had higher roughness means than roots treated by curettes (1.120+0.241mm). Among ultrasonic groups, the higher power setting produced the higher roughness mean (1.58+0.23mm), which was significantly higher than the roughness obtained with the low power setting (1.39+0.18mm). These findings show that ultrasonic instrumentation with a high power setting produced a rougher root surface than ultrasonic instrumentation with a lower power setting. In addition, manual instrumentation with curettes produced lower roughness than ultrasonic instrumentation independent of power setting

Aim: Patient’s adherence to the periodontal treatment is fundamental to the success of the therapy. Lack of response to the clinician’s instructions is influenced by various factors, including gender, age and psychosocial profile. The aim of the present study was to evaluate the relationship between self-perceived symptoms of generalized aggressive periodontitis and compliance with the oral hygiene instructions. Methods: Twenty-six subjects presenting a generalized aggressive form of periodontal disease were selected. The subjects answered a questionnaire to rate the perceived symptoms of periodontal disease with a sensitivity scale, in which a numeric score is attributed to each mentioned symptom. The percentage of sites with pocket probing depth (PPD) e” 5mm as well as the plaque index (PI) and gingival index (GI) were evaluated and the patients received a full mouth prophylaxis. One month later, the patients were re-evaluated for PI, GI, and PPD, and their percent reductions were correlated with the numeric score attributed to the aggressive periodontitis symptoms. Spearman’s correlation and Wilcoxon’s test were used with a significance level of 5%. Results: The greater the self-perception of some of the symptoms, the greater the adherence to the oral hygiene instructions. A positive correlation was observed between the reduction of GI and self perception of bleeding on tooth brushing (p=0.04, r=0.27) and redness and swelling of gums (p=0.04, r=0.26). Conclusions: The self-perception of symptoms of generalized aggressive periodontitis could have an influence on the patient’s response to the oral hygiene instructions.

OBJECTIVE: This study was designed to evaluate, histomorphometrically, the association of platelet-rich plasma (PRP) and bioactive glass (BG) in the treatment of periodontal intrabony defects. MATERIAL AND METHODS: Nine mongrel dogs were included in the study. Three-wall intrabony defects were surgically created at the mesial and distal aspect of first mandibular molar and exposed to plaque accumulation for 1 month. The defects were randomly assigned to the groups: control, BG, PRP, PRP+BG. Dogs were sacrificed 90 days after the surgeries. The histometric parameters evaluated were: length of sulcular and junctional epithelium, connective tissue adaptation, new cementum, new bone, defect extension and area of new bone filling the defect. RESULTS: A superior area of new bone was observed in PRP+BG and BG (13.80±2.32 mm² and 15.63±2.64 mm², respectively) when compared to the other groups (8.19±1.46 mm² and 8.81±1.47 mm² for control and PRP, respectively). No statistically significant differences were observed in the remaining parameters. CONCLUSIONS: Within the limits of this study, it may be concluded that PRP failed to provide statistically significant improvements in the histometric parameters.

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.

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.

OBJECTIVE: The purpose of this study was to evaluate the root surface roughness after instrumentation with hand curette and diamond-coated sonic and universal ultrasonic tips. MATERIALS AND METHODS: Forty root surfaces of human teeth were randomly assigned to four treatment groups: control group (without instrumentation), curette instrumentation, ultrasonic instrumentation with universal tip and sonic instrumentation with diamond-coated tip. Each sample was instrumented with fifteen strokes. Before and after instrumentation, surface roughness was measured. In addition, the root surface topography was examined after treatment under the scanning electron microscope. RESULTS: Significant statistical differences (p 0.05). CONCLUSION: The diamond-coated tip with sonic scaler instrumentation and ultrasonic instrumentation produce similar root surface roughness, higher than curette instrumentation.OBJETIVO: O objetivo do presente estudo foi avaliar a rugosidade radicular obtida após instrumentação por aparelho sônico com pontas diamantadas, curetas e ultrassom. MATERIAL E MÉTODOS: Quarenta superfícies radiculares, devidamente polidas e incluídas em resina acrílica, foram dividas em 4 grupos de tratamento: grupo controle (sem instrumentação) e instrumentação com cureta Gracey 5/6, ultrassom ou aparelho sônico com ponta diamantada. Em cada amostra foram realizados 15 movimentos de raspagem. Antes e após esta instrumentação foi utilizado um rugosímetro para a medição da rugosidade radicular. Além disso, a topografia da superfície radicular foi avaliada após o tratamento com microscopia eletrônica de varredura. RESULTADOS: Diferenças estatisticamente significantes (p0.05). CONCLUSÃO: A instrumentação sônica com pontas diamantadas promove uma rugosidade radicular equivalente à instrumentação com ultrassom, sendo essa rugosidade superior àquela apresentada pela instrumentação manual.

Anti-inflammatory agents have been reported to regulate bone healing. The aim of this study was to investigate the effect of a selective cyclooxygenase-2 inhibitor (meloxicam) on bone healing in calvarial defects in rats. Thirty-six adult male Wistar rats were included. After anesthesia, a linear incision was made through the skin of the scalp, a full-thickness flap was reflected and a 4 mm round defect was made with a trephine drill. The animals were randomly assigned to one of the following 4 treatment groups (9 animals each), including daily subcutaneous injections: A: saline solution for 15 days; B: saline solution for 45 days; C: 3 mg/kg of meloxicam for 15 days and D: 3 mg/kg of meloxicam for 45 days. The animals were sacrificed and the specimens, routinely processed. The bone filling was histometrically measured and statistical analysis, performed. Intergroup comparisons demonstrated that the meloxicam groups presented a significant reduction in bone healing when compared to their respective controls (group A, 44.5 ± 5.75%, against group C, 57.5 ± 7.25%, p < 0.05; group B, 40.25 ± 13.75%, against group D, 52.25 ± 17.25%). Within the limits of the present study, it can be concluded that selective cyclooxygenase-2 inhibitors may reduce bone healing in calvarial defects in rats after continuous administration.Agentes antiinflamatórios têm sido descritos como reguladores do reparo ósseo. O objetivo deste estudo foi investigar o efeito de um inibidor seletivo da cicloxigenase-2 (meloxicam) no reparo ósseo em defeitos de calvárias de ratos. Trinta e seis ratos machos Wistar foram incluídos no estudo. Após anestesia, incisão linear e rebatimento de retalho de espessura total, um defeito de 4 mm de diâmetro foi criado na calvária dos animais com broca trefina. Os mesmos foram aleatoriamente distribuídos em um dos 4 grupos de tratamento (9 animais por grupo), recebendo injeções subcutâneas diárias de: A: soro fisiológico por 15 dias; B: soro fisiológico por 45 dias; C: 3 mg/kg de meloxicam por 15 dias; D: 3 mg/kg de meloxicam por 45 dias. Os animais foram sacrificados e os espécimes rotineiramente processados. Medidas do preenchimento ósseo foram histometricamente realizadas e analisadas estatisticamente. Comparações intergrupos demonstraram que os grupos com meloxicam apresentaram uma redução significativa no reparo ósseo quando comparados com os respectivos grupos-controle (grupo A, 44,5 ± 5,75%, contra grupo C, 57,5 ± 7,25%, p < 0,05; grupo B, 40,25 ± 13,75%, contra grupo D, 52,25 ± 17,25%). Dentro dos limites do presente estudo, pode ser concluído que os inibidores seletivos da cicloxigenase-2 podem reduzir o reparo ósseo em defeitos em calvárias de ratos após sua administração contínua.

The aim of this study was to evaluate the influence of cigarette smoke inhalation (CSI) and its cessation on tibiae bone quality. Forty-one male Wistar rats were randomly assigned to one of the following groups: Group 1 - control (n = 14), Group 2 - 3 months of CSI and 2 months without exposure to CSI (n = 12), and Group 3 - 5 months of CSI (n = 15). At the end of the experimental period, the animals were sacrificed, the tibiae removed and immediately radiographed for photodensitometric analysis. The results showed that continuous exposure to cigarette smoke promoted a significantly reduced bone density (p < 0.05) (3.22 mm Al eq ± 0.58; 2.93 mm Al eq ± 0.45; 1.86 mm Al eq ± 0.35; for groups 1, 2 and 3, respectively). Similar levels of bone density were observed for the control and cessation groups (groups 1 and 2 - p > 0.05). Thus, within the limits of the present study, it can be concluded that CSI may affect tibiae bone quality, and CSI cessation results in a return towards the level of the control group.O objetivo deste estudo foi avaliar a influência da inalação da fumaça de cigarro (IFC) e o efeito de sua interrupção na qualidade óssea da tíbia. Quarenta e um ratos Wistar machos foram aleatoriamente designados a um dos seguintes grupos: Grupo 1 - controle (n = 14), Grupo 2 - 3 meses de IFC e 2 meses sem exposição à fumaça (n = 12) e Grupo 3 - 5 meses de IFC (n = 15). Ao final do período experimental, os animais foram sacrificados, as tíbias removidas e imediatamente radiografadas para a análise fotodensitométrica. Os resultados mostraram que a exposição contínua à fumaça de cigarro promoveu uma significante redução na densidade óssea (p < 0,05) (3,22 mm Al eq ± 0,58, 2,93 mm Al eq ± 0,45, 1,86 mm Al eq ± 0,35, para os grupos 1, 2 e 3, respectivamente). Níveis semelhantes de densidade óssea foram observados nos grupos controle e interrupção (grupos 1 e 2 - p > 0,05). Portanto, dentro dos limites do presente estudo, pode-se concluir que a IFC pode influenciar a qualidade óssea da tíbia e que a interrupção da inalação parece reverter esse efeito negativo resultando numa densidade óssea semelhante à do grupo controle.

Abstract Periodontitis Stage III-IV, Grade C (PerioC) is a severe form of Periodontitis. The individual genetic background has been shown to be an important etiopathogenic factor for the development of this disease in young, systemically healthy, and non-smokers patients. Recently, after exome sequencing of families with a history of the disease, PerioC was associated with three single nucleotide variations (SNVs) – rs142548867 (EEFSEC), rs574301770 (ZNF136), and rs72821893 (KRT25) – which were classified as deleterious or possibly harmful by prediction algorithms. Objective Seeking to validate these findings in a cohort evaluation, this study aims to characterize the allele and genotypic frequency of the SNVs rs142548867, rs574301770, and rs72821893 in the Brazilian population with PerioC and who were periodontally healthy (PH). Methodology Thus, epithelial oral cells from 200 PerioC and 196 PH patients were harvested at three distinct centers at the Brazilian Southern region, their DNA were extracted, and the SNVs rs142548867, rs574301770, rs72821893 were genotyped using 5′-nuclease allelic discrimination assay. Differences in allele and genotype frequencies were analyzed using Fisher’s Exact Test. Only the SNV rs142548867 (C > T) was associated with PerioC. Results The CT genotype was detected more frequently in patients with PerioC when compared with PH subjects (6% and 0.5% respectively), being significantly associated with PerioC (odds ratio 11.76, p=0.02). Conclusion rs142548867 represents a potential risk for the occurrence of this disease in the Brazilian population.

Abstract Early acquisition of a pathogenic microbiota and the presence of dysbiosis in childhood is associated with susceptibility to and the familial aggregation of periodontitis. This longitudinal interventional case–control study aimed to evaluate the impact of parental periodontal disease on the acquisition of oral pathogens in their offspring. Subgingival plaque and clinical periodontal metrics were collected from 18 parents with a history of generalized aggressive periodontitis and their children (6–12 years of age), and 18 periodontally healthy parents and their parents at baseline and following professional oral prophylaxis. 16S rRNA amplicon sequencing revealed that parents were the primary source of the child's microbiome, affecting their microbial acquisition and diversity. Children of periodontitis parents were preferentially colonized by Filifactor alocis, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Streptococcus parasanguinis, Fusobacterium nucleatum and several species belonging to the genus Selenomonas even in the absence of periodontitis, and these species controlled inter-bacterial interactions. These pathogens also emerged as robust discriminators of the microbial signatures of children of parents with periodontitis. Plaque control did not modulate this pathogenic pattern, attesting to the microbiome's resistance to change once it has been established. This study highlights the critical role played by parental disease in microbial colonization patterns in their offspring and the early acquisition of periodontitis-related species and underscores the need for greater surveillance and preventive measures in families of periodontitis patients.

Abstract In the last decades, Periodontal Regeneration has been one of the most discussed topics in Periodontics, attracting the attention of researchers and clinicians. This can be justified by the evident and continuous progress observed in the field, characterized by a better understanding of the biological mechanisms involved, significant improvement of operative and technical principles, and the emergence of a wide range of biomaterials available for this purpose. Together, these aspects put the theme much in evidence in the search for functional and esthetic therapeutic solutions for periodontal tissue destruction. Despite the evident evolution, periodontal regeneration may be challenging and require the clinician to carefully evaluate each case before making a therapeutic decision. With a critical reassessment of the clinical and preclinical literature, the present study aimed to discuss the topic to answer whether Periodontal Regeneration is still a goal in clinical periodontology. The main aspects involved in the probability of success or failure of regenerative approaches were considered. A greater focus was given to intrabony and furcation defects, clinical conditions with greater therapeutic predictability. Aspects such as more appropriate materials/approaches, long-term benefits and their justification for a higher initial cost were discussed for each condition. In general, deep intrabony defects associated with residual pockets and buccal/lingual class II furcation lesions have predictable and clinically relevant results. Careful selection of the case (based on patient and defect characteristics) and excellent maintenance are essential conditions to ensure initial and long-term success.

Grade C periodontitis in youngers is characterized by a severe form of periodontitis, and IL10 rs6667202 single nucleotide polymorphism (SNP) has been described as an important feature in this disease etiology. Aim: This study aimed to evaluate, in vivo, the functionality of IL10 rs6667202 SNP on IL-10 gingival fluid levels. Methods: Thirty patients with Perio4C were selected, 15 with the IL10 AA genotype (rs6667202) and 15 with AC/CC genotypes. The gingival fluid was collected from two sites with probing depth ≥ 7 mm and bleeding on probing, and two healthy sites. The IL-10 concentration was determined by Luminex/MAGpix platform. Results: In deep pockets, the IL10 AA genotype presented a lower concentration of IL-10 when compared with AC or CC genotypes (p0.05). Conclusion: IL10 rs6667202 SNP decreases the production of IL-10 in crevicular fluid, potentially affecting this disease progression.

Abstract Heterogeneous cell populations of osteo/cementoblastic (O/C) or fibroblastic phenotypes constitute the periodontal dental ligament (PDL). A better understanding of these PDL cell subpopulations is essential to propose regenerative approaches based on a sound biological rationale. Objective Our study aimed to clarify the differential transcriptome profile of PDL cells poised to differentiate into the O/C cell lineage. Methodology To characterize periodontal-derived cells with distinct differentiation capacities, single-cell-derived clones were isolated from adult human PDL progenitor cells and their potential to differentiate into osteo/cementoblastic (O/C) phenotype (C-O clones) or fibroblastic phenotype (C-F clones) was assessed in vitro. The transcriptome profile of the clonal cell lines in standard medium cultivation was evaluated using next-generation sequencing technology (RNA-seq). Over 230 differentially expressed genes (DEG) were identified, in which C-O clones showed a higher number of upregulated genes (193) and 42 downregulated genes. Results The upregulated genes were associated with the Cadherin and Wnt signaling pathways as well as annotated biological processes, including “anatomical structure development” and “cell adhesion.” Both transcriptome and RT-qPCR showed up-regulation of WNT2, WNT16, and WIF1 in C-O clones. Conclusions This comprehensive transcriptomic assessment of human PDL progenitor cells revealed that expression of transcripts related to the biological process “anatomical structure development,” Cadherin signaling, and Wnt signaling can identify PDL cells with a higher potential to commit to the O/C phenotype. A better understanding of these pathways and their function in O/C differentiation will help to improve protocols for periodontal regenerative therapies.

Aim: This study assessed the prevalence of periodontal disease in the adult and elderly populations from Jundiaí City, and its association with individual social inequalities in a conceptual framework approach. Methods: The survey was conducted with a sample of 342 adults and 145 elderly, and periodontal disease was assessed based on the Community Periodontal Index (CPI) and Clinical Attachment Loss (CAL). A questionnaire addressing socio-demographic and behavioral variables, smoking and diabetes was included. Bivariate and multivariate analyses, using binary regression analyses, were carried out in a hierarchical approach with conceptual framework to reveal association among periodontal disease and social-demographic, smoking and diabetes variables. Results: One adult and fifty-six elderly who had lost all teeth were excluded from the sample. Mild periodontal disease (CAL ≤3 mm) was the condition more prevalent in the adult (74%) and elderly populations (60.6%). Adjusted analysis revealed that low educational level (OR 2.65, 95% CI 1.19-5.88), irregular use of tooth floss (OR 1.9, 95% CI 1.06-3.40), and smoking (OR 2.14, 95% CI 1.04-4.42) were independently associated with moderate/severe periodontal disease (CAL and Probing Depth ≥4 mm) in the adult group. For the elderly group, low educational levels (OR 0.16, 95% CI 0.04-0.58), use of public dental service (OR 5.32, 95% CI 1.23-23.03), and diabetes condition (OR 3.78, 95% CI 1.20-11.91) were significantly associated with periodontal disease. Conclusion: In conclusion, the data showed that education level, smoking habits, diabetes, use of dental floss and type of dental service are factors associated to moderate/severe periodontal disease among Brazilians from Jundiaí City.

Periodontal ligament mesenchymal stem cells (PDLMSCs) are an important alternative source of adult stem cells and may be applied for periodontal tissue regeneration, neuroregenerative medicine, and heart valve tissue engineering. However, little is known about the impact of bacterial toxins on the biological properties of PDLSMSCs, including self-renewal, differentiation, and synthesis of extracellular matrix. Objective : This study investigated whether proliferation, expression of pro-inflammatory cytokines, and osteogenic differentiation of CD105-enriched PDL progenitor cell populations (PDL-CD105+ cells) would be affected by exposure to bacterial lipopolysaccharide from Escherichia coli (EcLPS). Material and Methods : Toll-like receptor 4 (TLR4) expression was assessed in PDL-CD105+ cells by the immunostaining technique and confirmed using Western blotting assay. Afterwards, these cells were exposed to EcLPS, and the following assays were carried out: (i) cell viability using MTS; (ii) expression of the interleukin-1 beta (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor alpha (TNF-α) genes; (iii) osteoblast differentiation assessed by mineralization in vitro, and by mRNA levels of run-related transcription factor-2 (RUNX2), alkaline phosphatase (ALP) and osteocalcin (OCN) determined by quantitative PCR. Results : PDL-CD105+ cells were identified as positive for TLR4. EcLPS did not affect cell viability, but induced a significant increase of transcripts for IL-6 and IL-8. Under osteogenic condition, PDL-CD105+ cells exposed to EcLPS presented an increase of mineralized matrix deposition and higher RUNX2 and ALP mRNA levels when compared to the control group. Conclusions : These results provide evidence that CD105-enriched PDL progenitor cells are able to adapt to continuous Escherichia coli endotoxin challenge, leading to an upregulation of osteogenic activities.

Obesity is a chronic condition that has social and economic implications for public health. It can be associated with periodontal disease since the metabolic alterations observed in that condition could have some influence in immunity. The elevated levels of lipid and glucose can be associated with periodontal disease, contributing to an exacerbated host inflammatory response, alterations in neutrophil function, and with the inhibition of macrophage growth factors, reducing tissue-healing capacity. In this way, obese individuals could have higher chances of undergoing tissue destruction in the presence of periodontal infection. On the other hand, periodontitis may be involved in alterations of lipid metabolism, since gram-negative bacteria could promote a rise in cholesterol and triglyceride levels due to chronic exposure to low levels of LPS in circulating blood, leading to the production of cytokines, which could initiate the production of lipoproteins by the liver. The objective was to review the literature about obesity and periodontal disease and provide a better understanding of their relationship. [ABSTRACT FROM AUTHOR]

This article reviews developmental and structural characteristics of cementum, a unique avascular mineralized tissue covering the root surface that forms the interface between root dentin and periodontal ligament. Besides describing the types of cementum and cementogenesis, attention is given to recent advances in scientific understanding of the molecular and cellular aspects of the formation and regeneration of cementum. The understanding of the mechanisms involved in the dynamic of this tissue should allow for the development of new treatment strategies concerning the approach of the root surface affected by periodontal disease and periodontal regeneration techniques.

The aim of the present study was to determinate the incidence of these defects and the therapeutic approaches employed in 105 patients attended in a Brazilian dental school. One-hundred five periodontal charts of patients attended at the Dental Clinic of the Unicamp Dental School were examined, in order to find furcation lesions in molar and premolar teeth (upper and/or lower). The results showed that these 105 subjects exhibited 216 teeth with furcation involvements (131 at the upper jaw and 85 at the lower jaw). It represented a percentual score of furcation defects by jaw: 60.6% at the upper jaw and 39.4% at the lower jaw. The incidence of furcation lesions was higher at the first molar in all of the quadrants and the higher incidence of these defects was on the tooth #16 (34%) and the upper buccal furcation defect was the more incident in this sample (28.2%). The predominant type of furcation lesion at the upper jaw was the class I defect (61.5%) and the more prevalent defect in the lower jaw was class I (65.8%). Considering both the archs, the class I defect appeared in 60.2% of the cases, class II´s, 30.1%, and class III´s, 9.7%. The more used therapeutic approach for furcation involvements was scaling and root planing (69.9%). These data suggest that the upper teeth are more affected by furcation lesions than the lower teeth; the furcation lesions are more frequent on the first molar in all of the quadrants; the class I is the more frequent type of furcation lesion; and the more frequently used approach to treat furcation involvement was scaling and root planing.

The goal of this investigation was to evalute the healing process of class III furcation defects treated with resorbable membranes. Five mongrel dogs were used. Class III furcation defects were surgically created and exposed to plaque accumulation for 3 months. After this period, the defects were randomly assigned to one of the treatments: ATR= non-sutured resorbable barriers (Atrisorb ®), GUI= resorbable barriers stabilized with sutures (Guidor®), OFD= open flap debridement and NTC= non-treated control. After 3 months, the dogs were sacrificed and the blocks were processed. The histometric parameters evaluated included linear and area measurements. The defects treated with membranes presented a superior length of new cementum when compared to NTC (P

The objective of this study was to investigate the histometric impact of nicotine on bone regeneration of surgically created alveolar ridge defects in dogs. Sixteen mongrel dogs were used. One defect was surgically created unilaterally in the mandible, and left to heal spontaneously. The animals were randomly assigned to one of the following groups: Group 1 - control (n = 8) and Group 2 - subcutaneous nicotine administration (2 mg/kg) twice a day (n = 8). After 4 months, the animals were sacrificed and the specimens routinely processed for semi-serial decalcified sections. Bone height (BH), bone width (BW), bone density (BD), and bone area (BA) of the newly-formed bone were evaluated. Intergroup analysis (Mann-Whitney rank sum test) showed that regardless of the presence of nicotine, no significant differences were observed regarding bone width (BW), bone area (BA) and bone height (BH) (p > 0.05). On the other hand, it was demonstrated that nicotine administration significantly influenced the proportion of mineralized tissue within the limits of the newly-formed bone (BD) (p < 0.001). Within the limits of the present study, it can be concluded that nicotine might affect but not prevent bone healing in defects left to heal spontaneously.O objetivo do presente estudo foi avaliar histometricamente a influência da nicotina sobre a regeneração óssea de defeitos criados cirurgicamente em rebordos alveolares edêntulos de cães. Defeitos ósseos foram criados cirurgicamente em um dos lados da mandíbula de dezesseis cães e foram deixados para que curassem espontanea-mente. Os animais foram aleatoriamente designados para um dos seguintes grupos: Grupo 1 - controle (n = 8) e Grupo 2 - administração subcutânea de nicotina (2 mg/kg) duas vezes ao dia durante 4 meses (n = 8). Os animais foram sacrificados, e secções semi-seriadas descalcificadas, obtidas. Os parâmetros histométricos avaliados foram altura, largura, área e densidade do tecido ósseo neoformado. A análise intergrupos (Mann-Whitney "rank sum test") demonstrou que a administração de nicotina não influenciou altura, largura e área de tecido ósseo neoformado (p > 0,05). Entretanto, a administração de nicotina influenciou significativamente a densidade do tecido ósseo neoformado (p < 0,001). Dentro dos limites do presente estudo, pode-se concluir que a nicotina pode afetar, mas não impedir a regeneração de defeitos ósseos criados cirurgicamente em mandíbulas edêntulas de cães.

The goal of the present study was to investigate the relationship between probing and radiographic parameters, and the reliability of repeated longitudinal periodontal probing measurements for early diagnosis of periodontal breakdown in class II furcation defects. Eighteen class II furcation defects in lower molars were included in this study. Standardized radiographs and clinical measurements, relative vertical clinical attachment level (CAL-v) and probing depth (PD) were obtained immediately before periodontal surgeries and at 6, 12, 18, and 24 months after surgery. A total of 72 pairs of radiographs were subtracted following correction for contrast and planar geometric discrepancies, and the bone loss/gain (in mm) was measured. There was no statistically significant correlation between CAL-v and bone height (BH) measurements. A statistically significant correlation for PD reduction at 24 months and BH increase at 18 months was found (r = 0.5, p < 0.05). These results suggest that clinical measurements and radiographic bone height reflect different features of periodontal destruction and periodontal healing, and repeated longitudinal measurements of vertical clinical attachment level are not reliable for early diagnosis of periodontal breakdown in class II furcation defects.O objetivo deste estudo foi investigar a relação entre medidas clínicas e radiográficas durante a terapia de manutenção periodontal e a confiabilidade de medidas clínicas periodontais repetidas para o diagnóstico precoce de destruição periodontal de lesões de furca classe II. Dezoito lesões de furca classe II em molares inferiores foram incluídas neste estudo. Radiografias padronizadas e medidas do nível clínico de inserção vertical (NCI-v) e da profundidade de sondagem (PS) foram obtidas imediatamente antes do tratamento cirúrgico e aos 6, 12, 18 e 24 meses após a cirurgia. Um total de 72 pares de radiografias foram subtraídos após correção das distorções geométricas e de contraste, e a altura de ganho/perda óssea (AO) (em mm) foi medida. Não houve correlação estatisticamente significante entre NCI-v e AO. Houve uma correlação estatisticamente significante entre redução na PS aos 24 meses e aumento na AO aos 18 meses (r = 0,5, p < 0,05). Os resultados deste estudo sugerem que medidas clínicas e radiográficas refletem diferentes características da reparação e destruição periodontais e medidas clínicas longitudinais repetidas do NCI-v não são confiáveis para o diagnóstico precoce de destruição periodontal em lesões de furca classe II.

The aim of this report is to show three cases treated by the free gingival graft technique. Two patients presented multiple andisolated Miller’s Class II and III gingival recessions, localized in the anterior region of mandible. The third patient showed absence ofqueratinized gingiva on the buccal aspect of an osseointegrated implant. All patients received free gingival grafts, and the palate was the donor area. The patients were followed up to one year. After the healing period, all cases showed an increase of the queratinized gingival width and, in cases 1 and 2, a reduction in gingival recession. During follow-up period, no signs of gingival inflammation and bleeding on probing were seen. The patients maintained appropriate plaque control and were satisfied with the final esthetics. This report indicates that free gingival graft technique can be used for successful treatment of multiple and isolated gingival recessions, as well as to increase periimplantar queratinized gingival width.

The presence of furcation lesions is associated with bone resorption and lack of insertion in the inter-radicular space, and is a condition that considerably increases the risk of dental loss, particularly in the absence of adequate treatment. In this context, the object of some of the therapies is to keep teeth with furcation lesions that are important to dental planning, to re-establish an anatomy that enables the patient to remove dental biofilm from the compromised area. However, the long term maintenance and treatment of molars with Class III furcation lesions continues to be a challenge to dentists during periodontal therapy, since the anatomy of the inter-radicular region makes it difficult for both professionals and patients to gain access to perform adequate and efficient control of dental biofilm. The impossibility of obtaining appropriate decontamination of the area involved during the root scraping process, including by means of surgical access, demands thatdentists have adequate knowledge to determine the correct therapeutic approach during the treatment of teeth with advance inter-radicularbone loss. The aim of the present study was to discuss the treatments available for Class III furcation lesions and relate clinical procedures that could be performed for the treatment of this type of defect.

Abstract Periodontitis develops as a result of a continuous interaction between host cells and subgingival pathogenic bacteria. The periodontium has a limited capacity for regeneration, probably due to changes in periodontal ligament stem cells (PDLSCs) phenotype. The aim of this study was to evaluate the effects of lipopolysaccharides from Porphyromonas gingivalis (PgLPS) on mesenchymal phenotype and osteoblast/cementoblast (O/C) potential of PDLSCs. PDLSCs were assessed for Toll-like receptor 2 (TLR2) expression by immunostaining technique. After, cells were exposed to PgLPS, and the following assays were carried out: (i) cell metabolic activity using MTS; (ii) gene expression for IL-1β, TNF-α and OCT-4 by real-time polymerase chain reaction (RT-qPCR); (iii) flow cytometry for STRO-1 and CD105, and (iv) osteogenic differentiation. PDLSCs were positive for TLR2. PgLPS promoted cell proliferation, produced IL-1β and TNF-α, and did not affect the expression of stem cell markers, STRO-1, CD105 and OCT-4. Under osteogenic condition, PDLSCs exposed to PgLPS showed a similar potential to differentiate toward osteoblast/cementoblast phenotype compared to control group as revealed by mineralized matrix deposition and levels of transcripts for RUNX2, ALP and OCN. These results provide evidence that PgLPS induces pro-inflammatory cytokines, but does not change the mesenchymal phenotype and osteoblast/cementoblast differentiation potential of PDLSCs.