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Periodontitis is a multifactorial disease that causes tooth loss. The complex pathogenesis of periodontitis implies the involvement of a susceptible host and a bacterial challenge. Many studies have provided a valuable contribution to understanding the genetic basis of periodontal disease, but the specific candidate genes of susceptibility are still unknown. In fact, genome-wide studies and screening of single-nucleotide polymorphisms have yielded new genetic information without a definitive solution for the management of periodontal disease. In this manuscript, we provide an overview of the most relevant literature, presenting the main concepts and insights of the strategies that have been emerging to better diagnose and treat periodontal disease based on biomarker analysis and host modulation.

The aim of this study is to compare the macro- and microsurgery techniques for root coverage using a coronally positioned flap (CPF) associated with enamel matrix derivative (EMD).Thirty patients were selected for the treatment of localized gingival recessions (GRs) using CPF associated to EMD. Fifteen patients were randomly assigned to the test group (TG), and 15 patients were randomly assigned to the control group (CG). The microsurgical approach was performed in the TG, and the conventional macrosurgical technique was performed in the CG. The clinical parameters evaluated before surgery and after 6 months were GR, probing depth, relative clinical attachment level, width of keratinized tissue (WKT), and thickness of keratinized tissue (TKT). The discomfort evaluation was performed 1 week postoperative.There were no statistically significant differences between groups for all parameters at baseline. At 6 months, there was no statistically significant difference between the techniques in achieving root coverage. The percentage of root coverage was 92% and 83% for TG and CG, respectively. After 6 months, there was a statistically significant increase of WKT and TKT in TG only. Both procedures were well tolerated by all patients.The macro- and microsurgery techniques provided a statistically significant reduction in GR height. After 6 months, there was no statistically significant difference between the techniques regarding root coverage, and the microsurgical technique demonstrated a statistically significant increase in WKT and TKT.

Diabetes and periodontitis produce a protein discharge that can be reflected in saliva. This study evaluates the salivary concentrations of interleukin (IL)-6, matrix metalloproteinase (MMP)-8, and osteoprotegerin (OPG) in patients with periodontitis with type 2 diabetes.Whole saliva samples were obtained from 90 subjects who were divided into four groups: healthy (control; n = 22), untreated periodontitis (UPD; n = 24), diabetes mellitus (DM; n = 20), and UPD + DM (n = 24) groups. Clinical and metabolic data were recorded. Salivary IL-6, MMP-8, and OPG concentrations were determined by a standard enzyme-linked immunosorbent assay.The UPD and UPD + DM groups exhibited higher salivary IL-6 than the control and DM groups (P0.01). The salivary MMP-8 concentrations in all diseased groups (UPD, DM, and UPD + DM) were higher than in the control group (P0.01). The salivary OPG concentrations in the DM group were higher than in the UPD and control groups (P0.05). In the UPD + DM group, salivary IL-6 was correlated with glycated hemoglobin (HbA1c) levels (r = 0.60; P0.05). The regression analysis indicated that the number of remaining teeth, clinical attachment level, and IL-6 might have influenced the HbA1c levels in patients with diabetes.Salivary IL-6 concentrations were elevated in patients with periodontitis with or without diabetes. Salivary MMP-8 and OPG concentrations were elevated regardless of periodontal inflammation in patients with diabetes. Therefore, periodontitis and diabetes are conditions that may interfere with protein expression and should be considered when using saliva for diagnoses.

Background: This study aimed at comparing the levels of matrix metalloproteinase (MMP)-8, tissue Inhibitor of MMPs (TIMP)-1 and TIMP-2, Myeloperoxidase (MPO), and MMP-9 in the gingival crevicular fluid (GCF) of chronic periodontitis (CP) patients and controls at baseline and 3 months after non-surgical therapy. Materials and Methods: GCF was collected from one site of 15 control subjects and 27 CP patients. MMP-8, MMP-9, TIMP-1, and TIMP-2 were determined by Enzymelinked immunoabsorbent assay; different forms of MMP-9, by gelatin zymography; and MPO, colorimetrically. Results: At baseline, higher levels of MMP-8, TIMP-2, MPO, and the 87kDa-MMP-9 were found in patients compared with controls (po0.001), and these molecules decreased after therapy (po0.03). There were no differences between the groups with respect to the higher molecular forms of MMP-9 (180, 130, 92kDa) or total MMP-9 at baseline. No differences were observed in TIMP-1 levels. In controls, decreased levels of TIMP-2 and the higher molecular forms of MMP-9 (180, 130, 92kDa) were found 3 months after therapy compared with baseline (po0.01). Conclusions: Higher levels of MMP-8, TIMP-2, MPO, and 87kDa MMP-9 were found in the GCF of patients compared with controls, and these markers decreased 3 months after periodontal therapy.

The aim of this study was to evaluate, through fluorescence analysis, the effect that different interimplant distances, after prosthetic restoration, will have on bone remodeling in submerged and nonsubmerged implants restored with a "platform switch."Fifty-six Ankylos implants were placed 1.5 mm subcrestally in seven dogs. The implants were placed so that two fixed prostheses, with three interimplant contacts separated by 1-mm, 2-mm, and 3-mm distances, could be fabricated for each side of the mandible. The sides and the positions of the groups were selected randomly. To better evaluate bone remodeling, calcein green was injected 3 days before placement of the prostheses at 12 weeks postimplantation. At 3 days before sacrifice (8 weeks postloading), alizarin red was injected. The amounts of remodeled bone within the different interimplant areas were compared statistically before and after loading in submerged and nonsubmerged implants.Statistically significant differences existed in the percentage of remodeled bone seen in the different regions. Mean percentages of remodeled bone in the submerged and nonsubmerged groups, respectively, were as follows: for the 1-mm distance, 23.0% +/- 0.05% and 23.1% +/- 0.03% preloading and 27.0% +/- 0.03% and 25.2% +/- 0.04% postloading; for the 2-mm distance, 18.2% +/- 0.05% and 18.1% +/- 0.04% preloading and 21.3% +/- 0.07% and 19.9% +/- 0.03% postloading; for the 3-mm distance, 18.3% +/- 0.03% and 18.3% +/- 0.03% preloading and 18.8% +/- 0.04% and 19.8% +/- 0.04% postloading; for distal-extension regions, 16.6% +/- 0.02% and 17.4% +/- 0.04% preloading and 17.0% +/- 0.04% and 18.4% +/- 0.04% postloading.Based upon this animal study, loading increases bone formation for submerged or nonsubmerged implants, and the interimplant distance of 1 mm appears to result in more pronounced bone remodeling than the 2-mm or 3-mm distances in implants with a "platform switch."

Background: The aim of this study was to compare the potential of bioactive glass particles of different size ranges to affect bone formation in periodontal defects, using the guided tissue regeneration model in dogs. Methods: In six dogs, 2-wall intrabony periodontal defects were surgically created and chronified on the mesial surfaces ofmandibularthirdpremolarsandfirstmolarsbilaterally.After 1month,eachdefectwasrandomlyassignedtotreatmentwith bioabsorbable membrane in association with bioactive glass with particle sizes between 300 and 355 mm (group 1) or between 90 and 710 mm (group 2), membrane alone (group 3), or negative control (group 4). The dogs were sacrificed 12 weeks after surgeries, and histomorphometric measurementswere made of the areas of newly formed bone, new mineralized bone, and bioactive glass particle remnants. Results: With regard to the area of bioactive glass particle remnants, there was a statistically significant difference between groups 1 and 2, favoring group 1. There were greater areas of mineralized bone in groups 1 and 2 compared to groups 3 and 4 (P

Hopeless retained primary teeth without permanent successors represent a restorative challenge for clinicians, along with esthetic and functional problems for patients. While various treatment approaches for congenitally missing teeth have been proposed, the replacement of a missing tooth with a dental implant offers specific advantages, such as preservation of the alveolar crest and elimination of the need to restore the adjacent teeth, over other options for tooth replacement. The aim of this article was to illustrate the surgical and prosthetic treatment with implants of a patient with primary teeth without permanent successors.

Among the different properties that influence bone apposition around implants, the chemical or biochemical composition of implant surface may interfere on its acceptance by the surrounding bone. The aim of this study was to investigate if a biofunctionalization of implant surface influences the bone apposition in a dog model and to compare it with other surfaces, such as a microstructured created by the grit-blasting/acid-etching process. Eight young adult male mongrel dogs had the bilateral mandibular premolars extracted and each one received 6 implants after 12 weeks, totaling 48 implants in the experiment. Four groups of implants were formed with the same microrough topography with or without some kind of biofunctionalization treatment. After histomorphometric analysis, it was observed that the modified microstructured surface with a "low concentration of the bioactive peptide" provided a higher adjacent bone density (54.6%) when compared to the other groups (microstructured + HA coating = 46.0%, microstructured only = 45.3% and microstructured + "high concentration of the bioactive peptide" = 40.7%), but this difference was not statistically significant. In conclusion, biofunctionalization of the implant surface might interfere in the bone apposition around implants, especially in terms of bone density. Different concentrations of bioactive peptide lead to different results.

OBJECTIVES: This study assessed the bone density gain and its relationship with the periodontal clinical parameters in a case series of a regenerative therapy procedure. MATERIAL AND METHODS: Using a split-mouth study design, 10 pairs of infrabony defects from 15 patients were treated with a pool of bovine bone morphogenetic proteins associated with collagen membrane (test sites) or collagen membrane only (control sites). The periodontal healing was clinically and radiographically monitored for six months. Standardized pre-surgical and 6-month postoperative radiographs were digitized for digital subtraction analysis, which showed relative bone density gain in both groups of 0.034 ± 0.423 and 0.105 ± 0.423 in the test and control group, respectively (p>0.05). RESULTS: As regards the area size of bone density change, the influence of the therapy was detected in 2.5 mm² in the test group and 2 mm² in the control group (p>0.05). Additionally, no correlation was observed between the favorable clinical results and the bone density gain measured by digital subtraction radiography (p>0.05). CONCLUSIONS: The findings of this study suggest that the clinical benefit of the regenerative therapy observed did not come with significant bone density gains. Long-term evaluation may lead to a different conclusions.

Different techniques have been proposed for the treatment of gingival recession. This study compared the clinical results of gingival recession treatment using a subepithelial connective tissue graft and an acellular dermal matrix allograft. Seven patients with bilateral Miller class I or II gingival recession were selected. Twenty-six recessions were treated and randomly assigned to the test group. In each case the contralateral recession was assigned to the control group. In the control group, a connective tissue graft in combination with a coronally positioned flap was used; in the test group, an acellular dermal matrix allograft was used as a substitute for palatal donor tissue. Probing depth, clinical attachment level, gingival recession, and width of keratinized tissue were measured two weeks prior to surgery and at six and 12 months post-surgery. There were no statistically significant differences between the groups in terms of recession reduction, clinical attachment gain, probing pocket depth, and increase in the width of the keratinized tissue after six or 12 months. There was no statistically significant increase in the width of keratinized tissue between six and 12 months for either group. Within the limitations of this study, it can be suggested that the acellular dermal matrix allograft may be a substitute for palatal donor tissue in root coverage procedures and that the time required for additional gain in the amount of keratinized tissue may be greater for the acellular dermal matrix than for the connective tissue procedures.

Background: The CXC chemokine receptor 4 (CXCR4) and its ligand, stromal cell–derived factor-1 (SDF-1a or CXC chemokine ligand 12) are involved in the trafficking of leukocytes into and out of extravascular tissues. The purpose of this study was to determine whether SDF-1a secreted by host cells plays a role in recruiting inflammatory cells into the periodontia during local inflammation. Methods: SDF-1a levels were determined by enzyme-linked immunosorbent assay in gingival crevicular fluid (GCF) of 24 individuals with periodontitis versus healthy individuals in tissue biopsies and in a preclinical rat model of Porphyromonas gingivalis lipopolysaccharide–induced experimental bone loss. Neutrophil chemotaxis assays were also used to evaluate whether SDF-1a plays a role in the recruitment of host cells at periodontal lesions. Results: Subjects with periodontal disease had higher levels of SDF-1a in their GCF compared to healthy subjects. Subjects with periodontal disease who underwent mechanical therapy demonstrated decreased levels of SDF-1a. Immunohistologic staining showed that SDF-1a and CXCR4 levels were elevated in samples obtained from periodontally compromised individuals. Similar results were observed in the rodent model. Neutrophil migration was enhanced in the presence of SDF-1a, mimicking immune cell migration in periodontal lesions. Conclusions: SDF-1a may be involved in the immune defense pathway activated during periodontal disease. Upon the development of diseased tissues, SDF-1a levels increase and may recruit host defensive cells into sites of inflammation. These studies suggest that SDF-1a may be a useful biomarker for the identification of periodontal disease progression. J Periodontol 2008;79:845-853.

Two bovine hydroxyapatites (BHAs), one with granule size of 150 to 200 microm and one with granule size of 300 to 329 micro, and 2 synthetic hydroxyapatites (SHAs), with granule size of 150 and 300 microm, respectively, were compared for effectiveness in repairing circumferential bone defects in dogs. The hydroxyapatites (HAs) were characterized through powder x-ray diffraction (XRD) analysis and scanning electron microscopy (SEM). Three trephined bone defects (5.0 mm wide x 4 mm long) were created in the humeruses of 8 dogs. In a random manner, the defects on each side were treated with either BHA with small granules (BHA[s]), BHA with large granules (BHA[L]), SHA with small granules (SHA[s]), SHA with large granules (SHA[L]), or left to heal unaided (bilateral control). Four dogs were sacrificed after 6 and 12 postoperative weeks, respectively. Ground sections of each defect were submitted to histologic and histomorphometric analysis (percentage of area occupied by bone, bone marrow, and biomaterial). As a rule, the HA granules exhibited direct bone contact, regardless of the origin and the size of the granules. Control sites were related and had an increased amount of connective tissue infiltration. At 12 weeks, BHA(s) exhibited improved bone formation compared with SHA(s) and SHA(L). The SHA(s) delivered reduced amounts of bone compared with the remaining groups (control included). The area of bone measured in BHA(s) sites was significantly higher at 12 weeks than 6 weeks. The XRD revealed the tested HA samples to be highly crystalline, while BHA appeared with rougher surface at SEM analysis. The BHA(s) performed better than the SHA(s) and SHA(L), as assessed by the amount of bone measured in both implantation sites at 12 weeks. The BHA's material characteristic itself rather than granules size accounted for the distinctive biological behavior. The increased roughness of the BHAs' surface, as assessed through SEM, seemed to benefit the osteoconduction process.

The aim of this randomized, controlled, clinical investigation was to compare two surgical techniques for root coverage with the acellular dermal matrix graft to evaluate which technique provided better root coverage, a better esthetic result, and less postoperative discomfort.Fifteen patients with bilateral Miller Class I or II gingival recessions were selected. Fifteen pairs of recessions were treated and assigned randomly to the test group, and the contralateral recessions were assigned to the control group. The control group was treated with a broader flap and vertical releasing incisions; the test group was treated with the proposed surgical technique, without vertical releasing incisions. The clinical parameters evaluated were probing depth, relative clinical attachment level, gingival recession (GR), width of keratinized tissue, thickness of keratinized tissue, esthetic result, and pain evaluation. The measurements were taken before the surgeries and after 6 months.At baseline, all parameters were similar for both groups. At 6 months, a statistically significant greater reduction in GR favored the control group. The percentage of root coverage was 68.98% and 84.81% for the test and control groups, respectively. The esthetic result was equivalent between the groups, and all patients tolerated both procedures well.Both techniques provided significant root coverage, good esthetic results, and similar levels of postoperative discomfort. However, the control technique had statistically significantly better results for root coverage of localized gingival recessions.

The treatment of aggressive periodontitis has always presented a challenge for clinicians, but there are no established protocols and guidelines for the efficient control of the disease.Ten patients with a clinical diagnosis of aggressive periodontitis were treated in a split-mouth design study to either photodynamic therapy (PDT) using a laser source with a wavelength of 690 nm associated with a phenothiazine photosensitizer or scaling and root planing (SRP) with hand instruments. Clinical assessment of plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and relative clinical attachment level (RCAL) were made at baseline and 3 months after treatment with an automated periodontal probe.Initially, the PI was 1.0 +/- 0.5 in both groups. At the 3-month evaluation, the plaque scores were reduced and remained low throughout the study. A significant reduction of GI and BOP occurred in both groups after 3 months (P0.05). The mean PD decreased in the PDT group from 4.92 +/- 1.61 mm at baseline to 3.49 +/- 0.98 mm after 3 months (P0.05) and in SRP group from 4.92 +/- 1.14 mm at baseline to 3.98 +/- 1.76 mm after 3 months (P0.05). The mean RCAL decreased in the PDT group from 9.93 +/- 2.10 mm at baseline to 8.74 +/- 2.12 mm after 3 months (P0.05), and in the SRP group, from 10.53 +/- 2.30 mm at baseline to 9.01 +/- 3.05 mm after 3 months.PDT and SRP showed similar clinical results in the non-surgical treatment of aggressive periodontitis.

Aim: The objective of this study was to evaluate the effects of enamel matrix derivative (EMD), transforming growth factor-β1 (TGF-β1), and a combination of both factors (EMD+TGF-β1) on periodontal ligament (PDL) fibroblasts. Material and methods: Human PDL fibroblasts were obtained from three adult patients with a clinically healthy periodontium, using the explant technique. The effects of EMD, TGF-β1, or a combination of both were analysed on PDL cell proliferation, adhesion, wound healing, and total protein synthesis, and on alkaline phosphatase (ALP) activity and bone-like nodule formation. Results: Treatment with EMD for 4, 7, and 10 days increased cell proliferation significantly compared with the negative control (p

The aim of this study was to evaluate the influence of bone condensation and crestal preparation on the bone response of implants designed to promote osseocompression.In the first phase, the mandibular premolars of 6 dogs were extracted bilaterally. After 8 weeks, each dog received 8 Xive implants (4 per hemimandible). One hemimandible was randomly assigned to the experimental group and the other to the control group. The implant site was prepared using conventional standard drills. Prior to implant placement the crestal drill was used in the experimental group but not in the control group. After 12 weeks, the animals were sedated and sacrificed. The hemimandibles were removed and prepared for histomorphometric analysis of bone-implant contact (BIC) and bone density of areas adjacent to and further from the implant surface.The mean +/- SD percentages of BIC attained were 71.1% +/- 11.8% and 45.1% +/- 16.1% for the experimental and control groups, respectively. The bone density analysis revealed that in the control group, percentage BIC was a mean of 55.6% +/- 11.3% adjacent to the implant and 50.7% +/- 17.9% distant from the implant. In the experimental group, percentage BIC was a mean of 71.1% +/- 8.6% adjacent to the implant and 55.6 +/- 11.3 distant from the implant. The difference between the experimental and control groups was statistically significant for both parameters, BIC and bone density, in the adjacent areas (P.0001).Crestal preparation is of fundamental importance for this implant system, since it led to better bone response, represented by the improved BIC and bone density.

Implant esthetics have been the focus of attention for the last few years, and one of the most important points is the effect that interimplant distances can have on papilla formation and bone loss. The aim of this study was to evaluate the effect that distances of 1, 2, and 3 mm between implants after prosthetic restoration will have on crestal bone resorption (from the top of the implant to the bone crest [TI-BC]) and bone resorption (from the top of the implant to the first bone-to-implant contact TI-BIC) in two-stage implants used in a submerged and non-submerged protocol.The mandibular bilateral premolars of seven dogs were extracted, and after 12 weeks, each dog received eight implants. The implants were placed so that three interimplant contact points were created, with 1-mm (group 1), 2-mm (group 2), and 3-mm (group 3) distances constructed on each side. The sides and the position of the groups were randomly selected. After 12 weeks, the implants received metallic prostheses with 5 mm between the contact point and the bone crest. After 8 weeks more, the animals were sacrificed.The TI-BC was 0.20 and 0.18 mm for group 1, 0.15 and 0.14 mm for group 2, and 0.15 and 0.15 mm for group 3 for non-submerged and submerged implants, respectively. At the proximal region, the TI-BC was 0.16 mm for non-submerged and 0.16 mm for submerged implants. The TI-BIC was 0.32 and 0.30 mm for group 1, 0.19 and 0.21 mm for group 2, and 0.30 and 0.24 mm for group 3 for non-submerged and submerged implants, respectively. At the proximal region, the TI-BIC was 0.26 mm for non-submerged and 0.25 mm for submerged implants. There was no statistical difference for any of the parameters (analysis of variance [ANOVA]).Distances of 1, 2, and 3 mm between implants do not result in statistically significant differences on TI-BC and TI-BIC around submerged or non-submerged implants with a Morse cone connection and a platform switch.

Implant esthetics has been the focus of attention for the past decade, and one vital issue is the effect of interimplant distance on interimplant papilla formation and crestal bone loss. The aim of this study was to evaluate the effect of 1, 2, and 3 mm of interimplant distance on papilla formation and crestal resorption in submerged and nonsubmerged Ankylos implants after prosthetic restoration. Bilateral mandibular premolars of 7 dogs were extracted, and after 12 weeks each dog received 8 implants. Implants were placed so that 3 interimplant distances were created at 1 mm (group 1), 2 mm (group 2), and 3 mm (group 3). The sides and the position of the groups were randomly selected. Twelve weeks after placement, the implants received metallic prostheses that allowed 5 mm of space between the prosthetic contact point (CP) and the crestal bone (CB). After 8 weeks, the distance between the CP and the papilla (CP-P) and the gingival height at the distal proximal aspect of the prosthesis (CP-DE) was clinically measured. Radiographic images were obtained to measure the distance of the CP to the CB within the interimplant surfaces (CP-IP) and adjacent to the edentulous surfaces (CP-ED). The clinical measurement of CP-P for submerged and nonsubmerged implants was 3.57 ± 1.17 mm and 3.10 ± 0.82 mm for group 1, 3.57 ± 0.78 mm and 3.16 ± 0.87 mm for group 2, and 3.35 ± 0.55 mm and 3.07 ± 0.93 mm for group 3. The CP-DE was 3.25 ± 0.77 mm for submerged and 2.78 ± 0.64 mm for nonsubmerged implants. The CP-IP for the submerged and nonsubmerged implants was 6.91 ± 0.95 mm and 7.68 ± 2.73 mm for group 1, 7.46 ± 1.43 mm and 5.87 ± 1.71 mm for group 2, and 7.72 ± 0.81 mm and 7.59 ± 1.33 mm for group 3. The CP-ED was 6.77 ± 1.33 mm for submerged implants and 6.03 ± 1.58 mm for nonsubmerged implants. There were no statistical significant differences for any of the measured parameters. We conclude that when the distance from the CP to the CB was 5 mm, interimplant distances of 1 to 3 mm did not affect papilla formation or crestal resorption of submerged or nonsubmerged implants in the dog model.

UNLABELLED Acellular dermal matrix (ADM) has been used as a substitute for gingival allografts. The aim of this study was to evaluate the effectiveness of ADM with partial thickness flap in the elimination of gingival melanic pigmentations. Fifteen patients presenting bilateral gingival melanin pigmentation were selected for this study. Each side of the pigmentation was randomly assigned to be part of a group. The sites of the experimental group had a partial thickness flap raised, excised, followed by adaptation and suture of the ADM. On the opposite side (ie, sites from the control group), the oral epithelium was removed with a diamond bur. The healing process was evaluated at 1 and 2 weeks, and 1, 3, 6, 9, and 12 months postoperatively. Images of the patient's follow-up were digitalized, and occurrence and quantification of clinical repigmentation were evaluated. After 12 months, minimal repigmentation (mean 3.14 +/- 7.45%) was noted in 8 of 15 sites from the ADM group, while significant repigmentation (mean 55.84 +/- 27.25%) was seen in 15 of 15 abrasion sites. According to our results, it can be concluded that ADM may be successfully used in the elimination or greater reduction of gingival melanic pigmentations, and is more efficient than epithelium abrasion after 12 months (p < 0.0001). CLINICAL SIGNIFICANCE Gingival pigmentation is a common finding in several ethnic groups. Although physiologic melanin pigmentation is not a medical problem, cosmetic demands may turn it into a problem of social acceptance in different cultures. In this way, different treatment modalities have been used with the aim of removing pigmentations for esthetic reasons. In the present study, the use of ADM with partial thickness flap resulted in more effective elimination of gingival melanin pigmentation, as repigmentation occurred later and was much weaker when compared to the outcomes of epithelial abrasion.

Nowadays there is a trend in developing biologic modalities that may enhance wound healing of specific sites. In this regard, a cell-binding activity of type I collagen provided by a synthetic peptide (P-15) was incorporated in a scaffold (anorganic bovine matrix [ABM]) to facilitate the attachment, migration, and differentiation of cells. This case series describes a surgical protocol for the placement of ABM/P-15 "flow" during regenerative procedures.Wide periodontal defects were treated with sulcular incisions preserving the papillae, full-thickness flap reflection, granulation tissue debridement, mechanical and chemical root surface treatment, placement of the ABM/P-15 "flow," and wound-closure sutures. Weekly, and then monthly, deplaquing was performed until the 12-month postoperative recall, in which the clinical parameters were reevaluated.Significant clinical changes, including probing depth reduction and relative clinical attachment level gain, were achieved after the 12-month period. The radiographs demonstrated increase in radiopacity when compared to those taken initially, suggesting hard tissue improvements.The topography of the defects described here could be understood as a challenge for regeneration, once the previous breakdown of the supporting tissues had diminished the source of cells for the healing process and reduced the number of residual walls to retain the graft material. Thus, it seems that the ABM/P-15 "flow" contributed to the clinical success achieved. Based on this result, ABM/P-15 "flow" could be a useful and beneficial material for the treatment of periodontal defects.

This study evaluated the influence of early removal of an expanded polytetrafluoroethylene (ePTFE) membrane on periodontal regeneration.The third and fourth mandibular bicuspids of six healthy mongrel dogs were used. Class II furcation lesions were surgically created making lesions chronic for 21 days. Full flaps were elevated, and ePTFE membranes were adapted over the defects. The membranes were removed at 2 weeks on the experimental sides (test group [TGr]) and at 4 weeks on the control side (control group [CGr]). The dogs were sacrificed 12 weeks following placement of the membranes, and the teeth were histologically processed. Area measurements of new tissue (NT), epithelium (EP), connective tissue (CT), and new bone (NB) and linear measurements of bone height (BH) and new cementum (NC) were made. Wilcoxon signed rank test (P0.05; N = 6) was carried out to determine differences between groups.The area measurements (in mm2) for TGr and CGr, respectively, were as follows: 14.32 +/- 4.01 and 12.46 +/- 3.54 (NT); 0.04 +/- 0.09 and 0.01 +/- 0.04 (EP); 2.31 +/- 2.60 and 1.91 +/- 2.96 (CT); and 9.56 +/- 3.77 and 8.79 +/- 2.99 (NB). The results of the linear measurements (in mm) for TGr and CGr, respectively, were as follows: 3.85 +/- 1.21 and 4.03 +/- 0.94 (BH) and 10.91 +/- 1.72 and 10.59 +/- 1.80 (NC). There were no statistically significant differences between TGr and CGr for any measurement.The early removal of ePTFE membranes in Class II furcation defects in dogs did not affect periodontal regeneration.

The resorption of alveolar bone following tooth extraction results in a narrowing and shortening of the residual ridge, which leads to esthetic and restorative problems, and reduces the bone volume available for implant therapy. The aim of this study was to evaluate the prevention of alveolar collapse after tooth extraction, using titanium membrane (Frios Boneshield; DENTSPLY Friadent, Mannheim, Germany), associated (or not) with autologous bone graft.A total of 10 nonsmoking healthy subjects, ranging from 35 to 60 years old, were selected for this study. Each patient had a minimum of 2 uni-radicular periodontally hopeless teeth, which were scheduled for extraction. After the procedure, 2 titanium pins were fixed on the vestibular bone surfaces that were used as references for the initial measures (depth, width, and height) of the socket. Of the sockets,1 was randomly chosen to be filled with autologous bone graft (test) removed from superior maxillary tuber, and the other one did not receive the graft (control). A titanium membrane was adapted and fixed, covering the sockets, which remained for at least 10 weeks. After a 6-month healing, the final measures were performed.There was exposure of the membrane in 5 of the 10 treated subjects. Average bone filling (+/-standard deviation) among the 10 subjects was 8.80 +/- 2.93 mm (range 4-13) in the control group and 8.40 +/- 3.35 mm (range 4-13) in the test group. Average bone loss in width in both group was 1.40 +/- 1.97 mm (range -4-1) in the control group and 1.40 +/- 0.98 mm (range -4-0) in the test group. There was no significant statistical difference between groups considering the evaluated standards.The use of titanium membrane, alone or in association with autogenous bone, favored the prevention of alveolar ridge after tooth extraction. This membrane seems to be a possible and safe alternative to other nonresorbable membranes when the prevention of alveolar ridge resorption is the objective.

The purpose of this study was to evaluate in dogs the area between implants after prosthetic restoration within 5 mm distance between the contact point (CP) between crowns and the bone crest (BC).The mandibular premolars of 6 dogs were extracted bilaterally. After 12 weeks of healing, each dog received 8 implants. On each side, 2 implants were separated by 2 mm (group 1) and 2 by 3 mm (group 2). After a healing period (3 months), the implants were restored with temporary acrylic resin prostheses and after 4 more weeks, with definitive metallic prostheses. After 8 weeks, the distance between the CP and the papilla (P) was measured. The distance between a line extending from the CP and the gingival height at the distal extension of the prosthesis (DE) was also measured. Digital radiographic images were obtained for evaluation of the CP-BC and BC-P distances and the analysis of bone resorption adjacent to the implant surfaces.The median CP-P distances were 1.75 mm and 1.98 mm for groups 1 and 2, respectively; the median CP-DE distances were 2.60 and 2.69, respectively. The mean CP-BC distances were 5.64 mm and 6.45 mm, for groups 1 and 2, respectively; mean BC-P distances were 3.07 mm and 3.55 mm, respectively.The differences in distances of 2 and 3 mm between implants did not present significant differences in the formation of papillae or in crestal resorption. The CP-BC distances for prostheses should be different from those of natural teeth because in natural teeth, the biologic width is already present, and in the case of implant-supported prostheses, it will develop following second-stage surgery.

Up until now, no predictable periodontal regeneration of Class III furcation defects has been demonstrated after treatment with different available techniques. Recently, a bone graft enriched with a peptide was developed and has shown satisfactory results when applied in intrabony defects. The aim of this study was to compare the use of expanded polytetrafluoroethylene (ePTFE) membrane associated (test group) or not (control group) with anorganic bovine-derived bone matrix (ABM)/synthetic peptide, in the treatment of Class III furcation defects in dogs.Six mongrel dogs were used in this study, and the second and fourth mandibular lower premolars were extracted. Class III furcation defects were surgically created in the third premolars and filled with impression material. Afterwards, the defects were surgically assessed for debridement and root planing. Teeth were randomly assigned into test and control groups. The membranes were removed after 4 weeks, and the animals were sacrificed 12 weeks later.Comparisons between groups by the Wilcoxon signed rank test showed no statistically significant differences in the parameters evaluated. In the control group, a new bone area (NBA) of 41.71%+/-24.07%, connective tissue area (CTA) of 36.34%+/-15.50%, and epithelium tissue area (ETA) of 9.39%+/-5.85% were observed. The new cementum extension (NCE) was 24.16%+/-13.18%. The test group presented an NBA of 31.84%+/-12.58%, CTA of 47.72%+/-11.33%, ETA of 9.17%+/-6.81%, and an NCE of 30.13%+/-16.43%.There was no statistically significant difference between the two therapies: ePTFE membrane associated with ABM/synthetic peptide flow or ePTFE membrane only.

Initial breakdown of the implant-tissue interface generally begins at the crestal region in successfully osseointegrated implants. The purpose of this study was to evaluate the effect on crestal bone loss (CBL) around implants specially developed for immediate loading with a unique crestal drill. After 8 weeks postextraction, 6 young male mongrel dogs received 48 implants (XiVE) in the region corresponding to the 4 mandibular premolars. The implant sites were prepared according to the manufacturer's protocol with conventional standard drills. Before implant placement, the crestal drill was used in the experimental group but not in the control group. After a healing period of 12 weeks, the dogs were sedated and euthanized. Through linear measurements, from the top of the implant to the first bone-implant contact, the amount of CBL was determined. The histomorphometric results of CBL (mean +/- SEM) were 0.88 +/- 0.13 mm (range 0.0-3.0 mm) in the experimental group and 1.69 +/- 0.17 mm (range 0.0-4.2 mm) in the control group. The difference was statistically significant (P.05) when the implants were used as the experimental units. The statistical analysis also revealed significance when the dogs were used as the experimental units (P.05). When the median was used for analyses, the CBL was 0.44 mm for the experimental group and 1.91 mm for the control group. Crestal bone loss was minimized when the crestal preparation protocol was carefully followed by using the osseocondensating XiVE implant system.

Repair of tooth supporting alveolar bone defects caused by periodontal and peri-implant tissue destruction is a major goal of reconstructive therapy. Oral and craniofacial tissue engineering has been achieved with limited success by the utilization of a variety of approaches such as cell-occlusive barrier membranes, bone substitutes and autogenous block grafting techniques. Signaling molecules such as growth factors have been used to restore lost tooth support because of damage by periodontal disease or trauma. This paper will review emerging periodontal therapies in the areas of materials science, growth factor biology and cell/gene therapy. Several different polymer delivery systems that aid in the targeting of proteins, genes and cells to periodontal and peri-implant defects will be highlighted. Results from preclinical and clinical trials will be reviewed using the topical application of bone morphogenetic proteins (BMP-2 and BMP-7) and platelet-derived growth factor-BB (PDGF) for periodontal and peri-implant regeneration. The paper concludes with recent research on the use of ex vivo and in vivo gene delivery strategies via gene therapy vectors encoding growth promoting and inhibiting molecules (PDGF, BMP, noggin and others) to regenerate periodontal structures including bone, periodontal ligament and cementum.

Background: Amelogenesis imperfecta (AI) is a group of hereditary conditions that primarily involves the defective formation and/or calcification of enamel. The association of AI with gingival enlargement-like lesions has also been reported. Methods: This paper reports a case of a hypoplastic AI associated with unusual generalized gingival hyperplasia. Results: Histological aspect of the gingival growth was characterized by a dense connective tissue with a mild mononuclear inflammatory infiltrate, calcified bodies, and islands of odontogenic epithelium. Conclusion: The present case represents a very interesting demonstration of the fact that, although rare, AI may be associated with generalized gingival enlargement. J Periodontol 2005;76:1563-1566.

The purpose of this study was the histomorphologic analysis of the efficacy of bioactive glass particles with a narrow size range (Biogran) in the periodontal healing of 2-wall intrabony defects in monkeys. The 2-wall defects were made in the mesial area of the left and right second premolars of four monkeys, filled with gutta-percha and, after 15 days, they were debrided and either naturally filled with coagulum (control) or implanted with bioactive glass (test). In the control sites, the junctional epithelium migrated up to the base of the defect. The presence of newly formed cementum was more significant in the test defects. Both control and test sites showed newly formed bone at the base of the defect. The test defects presented foci of newly formed bone around and within the glass particles localized in the middle third, distant from the defect walls. Histologic analysis showed that the 300- to 355-µm bioactive glass particles aided new periodontal insertion. In conclusion, the tested bioactive glass had better healing potential than debridement only. The graft material showed a promising inhibition of apical migration of the junctional epithelium and greater cementum deposition on the radicular surface of the intrabony defects. The replacement of bioactive glass particles by new bone occurred due not only to an osteoconductive property, but also to an osteostimulatory capacity. Future investigations should evaluate this potential comparatively or together with other grafting materials, regenerative techniques and biological modifiers, as well as assess the longitudinal stability of the new attachment. A proposta desse estudo foi avaliar histologicamente a eficácia de um vidro bioativo com pequena variação de tamanho de partículas (Biogran) na cicatrização periodontal de defeitos infra-ósseos de 2 paredes em macacos. Os defeitos foram feitos na mesial dos segundos pré-molares direito e esquerdo de 4 macacos, a seguir foram preenchidos com guta-percha e, após 15 dias, foram debridados e preenchidos naturalmente com coágulo (controle) ou com vidro bioativo (teste). Nos sítios-controle, o epitélio juncional migrou até a base do defeito. A formação de novo cemento foi mais significante nos defeitos-teste. Ambos os tipos de defeitos, controle e teste, apresentaram formação de novo osso na área da base dos defeitos. Os defeitos-teste apresentaram deposição de novo osso ao redor e dentro de partículas de vidro bioativo localizadas no terço médio, distantes das paredes do defeito. A análise histológica demonstrou que o vidro bioativo com partículas de 300 a 355 µm favoreceu nova inserção periodontal. Concluiu-se que o vidro bioativo testado teve melhor potencial de cura que o debridamento. O material enxertado mostrou promissora inibição da migração apical do epitélio junctional e maior deposição de cemento na superfície radicular em defeitos infra-ósseos A substituição das partículas de vidro bioativo por novo osso ocorreu devido não apenas a uma atividade osteo-condutora, mas também a uma capacidade osteo-estimuladora. Futuras investigações devem avaliar esse potencial comparativamente a outros materiais de enxerto, técnicas regenerativas e modificadores biológicos, assim como, avaliar longitudinalmente a estabilidade dessa nova inserção.

The purpose of this study was to evaluate the influence of root trunk concavities on guided tissue regeneration in humans and to determine if a modification in membrane design could improve the results.Ten patients who provided 10 pairs of similar Class II furcation defects were recruited for the study. Each defect was randomly assigned to treatment with either a normal expanded polytetrafluoroethylene (ePTFE) membrane (NM) or a modified ePTFE membrane (MM). The MM were made by removing the collar from an NM, cutting it into 2 mm segments, and suturing each of the segments to the collar of each MM. Following basic therapy, baseline clinical measurements were recorded using an acrylic stent, including probing depth (PD) and clinical attachment level (CAL). Full flaps were elevated, the defects were carefully debrided, and the root surfaces were decontaminated with manual and ultrasonic instruments. Hard tissue measurements were performed during surgery to determine vertical (VD) and horizontal defect (HD) depths. Then, NM and MM were sutured to their corresponding tooth and the flaps sutured. Membranes remained in position for 6 weeks. After 1 year, all sites were re-entered and soft and hard tissue measurements were recorded.After 1 year, there were no statistically significant differences (Mann-Whitney test) between NM and MM groups in percentages of PD reduction (P= 0.27), CAL change (P= 0.26), or VD resolution (P = 0.13). However, percentage of HD resolution (NM: 24.3+/-11.8; MM: 44.8+/-16.0) was significantly different between groups (P= 0.008).The modified membranes resulted in greater horizontal resolution of Class II furcation defects. The collars of the membranes should be modified to improve results when root trunk concavities are present.

La desnutricion postnatal esta asociada a un conjunto de secuelas agudas y cronicas, y su recuperacion es aun asunto controvertido. En Brasil, a pesar de estar disminuyendo la desnutricion, algunos estudios han demostrado que alrededor del 31% de los ninos presentan malnutricion moderada o severa. El objetivo del presente estudio fue inducir una desnutricion precoz en ratas y observar los efectos inmediatos (desnutricion) y permanentes (depues de la recuperacion) sobre las celulas de defensa involucradas en la cicatrizacion. La desnutricion fue provocada separando las crias de sus madres, por 10 horas diarias, durante el periodo de lactancia (21 dias de nacidos). Como contoles fueron usadas ratas de la misma edad no sometidas a restricion lactea. Los estados de desnutricion y de recuperacion fueron evaluados por el peso corporal. Las heridas fueron realizadas en la piel rasurada del dorso de los animales desnutridos, recuperados y controles, bajo anestesia con tribromoetanol. Los animales fueron sacrificados 1, 3, 7 y 14 dias despues de la cirugia y los tejidos de la region cicatricial fueron procesados histologicamente y examinados al microscopio optico. Los resultados mostraron que: 1) el numero de neutrofilos, linfocitos y macrofagos en la area de cicatrizacion, fue menor en los animales desnutridos y en recuperacion que en los controles; 2) enlos animales recuperados hubo una deficiencia basal en el numero de linfocitos y macrofagos, lo que no ocurrio en los animales con desnutricion aguda. Estos resultados permitieron concluir que los animales sometidos a desnutricion postnatal mostraron una recuperacion completa en el peso fisico despues del periodo de recuperacion nutricional, pero que la region de cicatrizacion mostro menor densidad de celulas de defensa, sugiriendo secuelas permanentes de la desnutricion postnatal

The acellular dermal matrix graft (ADMG) has become widely used in periodontal surgeries as a substitute for the subepithelial connective tissue graft (SCTG). These grafts exhibit different healing processes due to their distinct cellular and vascular structures. Therefore the surgical technique primarily developed for the autograft may not be adequate for the allograft. This study compared the clinical results of two surgical techniques--the "conventional" and a modified procedure--for the treatment of localized gingival recessions with the ADMG.A total of 32 bilateral Miller Class I or II gingival recessions were selected and randomly assigned to test and control groups. The control group received the SCTG and the test group the modified surgical technique. Probing depth (PD), relative clinical attachment level (RCAL), gingival recession (GR), and width of keratinized tissue (KT) were measured 2 weeks prior to surgery and 6 months post-surgery.Both procedures improved all the evaluated parameters after 6 months. Comparisons between the groups by Mann-Whitney rank sum test revealed no statistically significant differences in terms of CAL gain, PD reduction, and increase in KT from baseline to 6-month evaluation. However, there was a statistically significant greater reduction of GR favoring the modified technique (P = 0.002). The percentage of root coverage was 79% for the test group and 63.9% for the control group.We conclude that the modified technique is more suitable for root coverage procedures with the ADMG since it had statistically significant better clinical results compared to the traditional technique.

This study aimed to clarify the extent to which gingival health status alters probing measurements. One hundred sites from 26 patients undergoing periodontal treatment were selected as follows: 50 sites without inflammation and 50 sites with bleeding on probing even after basic therapy. All sites required periodontal surgery and were submitted to two probings with a constant-force probe (0.25 N). The pre-surgical probing (S1) measured the relative attachment level. The second probing (S2), during an open flap procedure, in the same location as S1, measured the distance between the occlusal surface of the stent and the bone crest. The difference between the measurements of the two probings (S2 - S1) performed at each site determined the distance between the bottom of the clinical pocket and the bone crest (S3). The median and the mean of the S1 measurements were 1.60 mm and 1.64 +/- 1.23 mm in the healthy sites and 1.50 mm and 1.63 +/- 1.03 mm in the bleeding sites, respectively. There was no statistically significant difference between healthy and bleeding sites (Mann-Whitney test, p = 0.625). It may be concluded that the penetration of the constant-force periodontal probe (0.25 N) was not influenced by bleeding on probing.

Gingival inflammation is clinically characterized by gingival redness, swelling and increased tendency of bleeding of the soft tissue. Bacterial biofilm is the etiological agent. If, at this stage, the bacterial biofilm is removed and appropriate control methods are applied, remission of gingival inflammation occurs. This study evaluated the effectiveness of a single session of ultrasonic prophylaxis for the reduction of gingivitis in an adolescent population using the Plaque Index (PI) and Gingival Index (GI). The study sample consisted of 15 male adolescent students selected at a dentist's office of a public high school. Prior to treatment (baseline), plaque index (PI) and bleeding on probing (BOP) were recorded. The patients then received oral hygiene instructions and ultrasonic prophylaxis. Follow-up exams were made 15 and 30 days after the ultrasonic prophylaxis, again recording PI and BOP. The data were analyzed by the Student's t-test for dependent samples. Correlation analysis between presence of biofilm and bleeding on probing was also made using the Pearson correlation test. There was a statistically significant decrease in the plaque index and bleeding on probing between baseline and examinations at both 15 days and 30 days (p

Polychromatic sequence labeling of bone was used to study the effect of periodontal infection on the immediate placement of Frialit-2 implants.In the surgical first phase, periodontitis was induced with ligatures involving the mandibular premolars of 5 mongrel dogs, and the contralateral teeth were used as controls (received only prophylaxis). After 3 months, the second phase was initiated and 40 implants were placed in the alveoli of both experimental and control teeth. During the healing period, fluorescent bone markers were injected to study bone formation around the implants. The dyes were injected in the following sequence: oxytetracycline hydrochloride at 3 days after implant placement, calcein green 4 weeks after implant placement, oxytetracycline 8 weeks after implant placement, and alizarin red S 3 days before sacrifice. Following a healing period of 12 weeks, the animals were euthanized and the hemimandibles were removed, dissected, fixed, and prepared for histomorphometic analysis of the percentage of each bone marker present.Fluorescence microscopy showed a similar sequence of bone remodeling (Mann-Whitney test) for both groups: experimental group, 9% bone formation at 3 days, 29% at 4 weeks, 21.6% at 8 weeks, and 52% at 12 weeks; control group, 14% at 3 days, 35.2% at 4 weeks, 32.3% at 8 weeks, and 45.8% at 12 weeks.Remodeling in both groups had similar characteristics in the degree of bone formation.It was concluded that periodontal disease does not affect bone remodeling around immediate implants. Although the healing in periodontally infected sites was slower initially, it reached the levels of the non-diseased sites after 12 weeks.

Objectives . Host modifying factors, such as genetic predisposition, may increase severity of periodontitis. Genetic polymorphisms in interleukin-4 (IL-4) genes seem to influence host response to microbial challenge. Two IL-4 polymorphisms were found in association with asthma and atopy, and later with aggressive periodontitis in Caucasians. There seems to be a trend for racial differences regarding polymorphisms. Therefore, this study aimed to evaluate if these IL-4 polymorphisms were associated with periodontal disease in a Brazilian population of African heritage. Methods . Sixty patients were divided into two groups: periodontitis group ( n =30) and control group ( n =30). Blood samples were taken and genomic DNA was amplified by polymerase chain reaction (PCR). Identification of 70 bp repeat polymorphism in intron 2 and in the −590 position of the promoter region was performed through PCR–RFLP and electrophoresis in agarose gel. Results . No significant differences were found in the genotype frequency of the polymorphisms between control and periodontitis group. Chi square test and Mann–Whitney test were used for statistical analysis. Conclusions . We concluded that the studied IL-4 polymorphisms were not related to periodontal disease susceptibility in this African-American Brazilian population.

The placement of implants allows for re-establishment of function and esthetics following tooth loss. Immediate implant placement is a relatively recent procedure and has advantages, such as reduced number of surgical procedures, preservation of alveolar bone, reduction of cost and period of edentulism, and increased patient acceptance. However, there are some specific contraindications for the technique, such as the presence of an infection caused by periodontal disease and periapical lesions. The objective of this study was to evaluate the percentage of bone-implant contact of immediate implants placed in periodontally infected sites.In the first phase, periodontitis was induced with ligatures in the mandibular premolars of 5 mongrel dogs, using the contralateral teeth as controls (received prophylaxis only). After 3 months, in the second phase of the study, 40 implants were placed in the alveoli of both experimental and control teeth. After a healing period of 12 weeks, the animals were euthanized, and the hemimandibles were removed, dissected, fixed, and prepared for histomorphometric analysis of percentage of bone-implant contact. The Mann-Whitney test was used for statistical analysis.The results of the histomorphometric analysis indicated mean bone-implant contact of 62.4% in the control group and 66.0% in the experimental group, a difference that was not statistically significant.Histomorphometric results revealed similar bone-implant contact in both groups, with no signs of infection.It was concluded that periodontally infected sites may not be a contraindication for immediate implantation in this animal model system, if adequate pre- and postoperative care is taken.

A buccal plate destroyed as a result of a longitudinal root fracture was completely restored by the use of a Frialit-2 implant placed in the alveolus of the fractured maxillary left first bicuspid. An acellular dermal matrix material was used as a membrane barrier to cover the implant, and a bioactive glass was used as grafting material. After 6 months, the defect around the implant was completely filled by mineralized tissue.

Fueron estudiados los efectos del acido acetilsalicilico (AAS) sobre la restriccion de crecimiento intrauterino inducida por el consumo materno de etanol. Una unica dosis intraperitoneal de etanol (2,96 g/kg de peso corporal), inyectada en el 10 dia de prenez (PD10), disminuyo significativamente la ganancia de peso materno, peso fetal, volumen del liquido amniotico y longitud del cordon umbilical. En cambio, el etanol no afecto el peso de la placenta ni el tamano de la nidada. Una unica dosis intraperitoneal de AAS (200 mg/g de peso corporal), inyectada en el PD10, no modifico la ganancia de peso materno, tamano de la nidada, los pesos fetal y placentario, ni el volumen del liquido amniotico, pero disminuyo significativamente la longitud del cordon umbilical. La inyeccion intraperitoneal de AAS (200 mg/g de peso corporal) y de etanol (2.96 g/kg de peso corporal) en el PD10, demostro que el AAS antagoniza, por lo menos en parte, los efectos del etanol sobre la ganancia de peso materno, peso fetal y volumen del liquido amniotico. Al contrario, el AAS potencializa el efecto del etanol sobre la longitud del cordon umbilical

Different techniques have been proposed for the treatment of gingival recessions. This study compared the clinical results of gingival recession treatment using a subepithelial connective tissue graft and an acellular dermal matrix allograft.Nine patients with bilateral Miller Class I or II gingival recessions were selected. A total of 30 recessions were treated and randomly assigned to the test group and the contralateral recession to the control group. In the control group, the exposed root surfaces were treated by the placement of a connective tissue graft in combination with a coronally positioned flap; in the test group, an acellular dermal matrix allograft was used as a substitute for palatal donor tissue. Probing depth, clinical attachment level, gingival recession, and width of keratinized tissue were measured 2 weeks prior to surgery and 3 and 6 months postsurgery.There were no statistically significant differences between the test group and the control group in terms of recession reduction, clinical attachment gain, and reduction in probing depth. The control group had a statistically significant increased area of keratinized tissue after 3 months compared to the test group. Both procedures, however, produced an increase in keratinized tissue after 6 months, with no statistically significant difference.The acellular dermal matrix allograft may be a substitute for palatal donor tissue in root coverage procedures.

Although periodontitis is initiated by specific oral pathogens that colonize and invade the oral tissues, the host inflammatory response is a major factor in disease progression. Soluble protein delivery of antagonists to tumor necrosis factor alpha (TNF-receptor:Fc fusion protein) inhibit alveolar bone resorption. However, the clinical use of recombinant p75-TNFR:Fc fusion protein raises several concerns, such as reoccurrence of disease activity after cessation of therapy. Objectives: This pilot study used adeno-associated virus (AAV) as a mode to deliver the TNFR:Fc transgene to periodontal lesions in an experimental model of P. gingivalis LPS-mediated bone loss. Methods: Three groups of Sprague-Dawley rats received one of three treatments: LPS delivered to the maxillary interdental gingivae thrice weekly for 8 weeks; vehicle alone (PBS) or LPS plus the single local delivery of pseudotyped AAV[2/5]-TNFR:Fc vector [6 sites|[times]|15uL of 8|[times]|1011 DNase I-resistant particles (DRP)] at baseline. Microcomputed tomography (MicroCT), systemic blood levels of TNFR:Fc protein and cytokine profiles were performed at various timepoints ranging from baseline to 8 weeks following TNFR:Fc transgene delivery. Results: TNFR protein serum levels were low to undetectable in all groups over the entire observation period indicating that local vector delivery did not result in systemic distribution of the soluble TNFR:Fc protein. Real-time PCR showed higher expression of both TNFR1 and TNFR2 than controls (p