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BACKGROUND This split-mouth randomized clinical trial compared two different types of subepithelial connective tissue grafts (SCTG) considering clinical parameters and patient-centered outcomes in patients with bilateral recession type 1 multiple gingival recessions after 6 months postoperatively. METHODS A total of 21 patients were surgically treated with coronally advanced flap (CAF) associated with SCTG harvested by: double blade scalpel (DBS) and de-epithelialized (DE) SCTG. Periodontal clinical parameters and esthetics were evaluated by a calibrated periodontist at baseline and after 6 months. Patient-centered outcomes related to pain/discomfort and esthetics were assessed with visual analogue scale after 7 days and 6 months, respectively. RESULTS All clinical parameters, with the exception of probing depth, demonstrated differences in intragroup evaluation, comparing baseline to 6-month evaluation (P

Background Previous data suggest that bone demineralization may promote bone graft consolidation as well as proliferation and differentiation of pre-osteoblasts, but the biological mechanisms involved in this process need to be clarified. This study investigated the effects of bone demineralization with citric acid (CA) and tetracycline (TCN) on the repair of onlay bone grafts. Methods Onlay bone grafts were performed on the calvaria of 126 Wistar rats. The contacting surfaces between bone graft and receptor bone bed were demineralized for 15, 30, and 60 seconds with TCN (50 mg/mL), or 10% CA, (pH 1), constituting the following test groups (n = 18): TCN15, TCN30, TCN60, CA15, CA30, and CA60. Control grafts (C) were performed without demineralization (n = 18). After 7, 30, and 60 days, biopsies were obtained for quantitative and qualitative histological analysis (a = 6). Results Demineralization accelerated the bone repair early from 7 days of healing. Higher percentage area of newly formed bone was observed in CA15 and TCN60 groups when compared to C in all evaluation periods (P = 0.02). At 30 days, C specimens had lower percentage of consolidated surfaces than TCN60, TCN30 and CA15 (P = 0.0015). At 60 days, CA15, CA60, and TCN60 presented bone surfaces almost completely filled by newly formed bone, against about 75% in C specimens (P = 0.0015). Conclusions Both CA and TCN were effective in accelerating osteogenesis at the interface between bone grafts and receptor bone beds, especially when applied for 15 seconds and 60 seconds, respectively.

The purposes of this study are to evaluate the effects of photobiomodulation (PBM) with laser and LED on rat calvaria osteoblasts (rGO lineage), cultured in osteogenic (OST) or regular (REG) medium, after induction of a quiescent state and to test if PBM is capable of osteogenic induction and if there is a sum of effects when combining OST medium with PBM. Before irradiation, the cells were put in a quiescent state (1% FBS) 24 h, when red (AlGaInP—660 nm) and infrared laser (GaAlAs—808 nm) and LED (637 ± 15 nm) were applied. The groups were as follows: red laser (RL3—5 J/cm2, 3 s and RL5—8.3 J/cm2, 5 s, 1.66 W/cm2); infrared laser (IrL3—5 J/cm2, 3 s and IrL5–8.3 J/cm2, 5 s); LED (LED3—3 s and LED5—5 s, 0.02 J/cm2, 0.885 W/cm2); positive (C+, 10% FBS) and negative control (C−, 1% FBS). For alkaline phosphatase (ALP) and mineralization assays, the cells were cultured in REG (DMEM 10% FBS) and OST medium (DMEM 10% FBS, 50 μg/mL ascorbic acid, 10 mM β-glycerophosphate). Statistical analysis was performed using ANOVA and Tukey’s tests (p

Background: The aim of this study was to evaluate the cytotoxicity of cyanoacrylate adhesives in an indirect contact assay in human gingival fibroblast (FGH) and oral osteoblasts (GO) lineages. Met...

The perception of Periodontology learning environment was measured before and after curricular restructuring by theDundee Ready Education Environment Measure (DREEM). Undergraduate students (2nd, 3rd, 4thyears; n = 266) were divided into two main groups: former curriculum (n = 131) and current one (n = 131).Total DREEM score, its five dimensions, Periodontology grades and their weighted average were compared. Student’s t test and ANOVA were used for analysis (p < 0.05). There was a statistically significant difference between the second (teachers) and fifth (social relations) dimensions and between Periodontology grades and the weighted average in both curricula. For each year, higher scores in the second dimension, Periodontology grades and the weighted average were obtained for current curriculum. Both curricula presented a significant correlation between Periodontology grades and their weighted average. Total DREEM scores for2nd, 3rd and 4thyearsof current curriculum presented no differences (p > 0.05). The implementation of a new curriculum had an important impact on the students’ positive perceptions, which reflected in their academic performance El ambiente de aprendizaje de Periodoncia fue analizado antes y después de la reestructuración curricular a través del Dunde Ready Education Environment Measure (DREEM). Estudiantes (2º, 3º, 4º años, n = 266) fueron divididos entre los currículos (n = 131). El total del DREEM, sus dimensiones, notas de Periodoncia y medias ponderadas fueron comparadas. Para el análisis se utilizó la prueba t de Student y ANOVA (p < 0,05). Se observaron diferencias estativas en las dimensiones dos (percepción sobre los profesores) y cinco (relaciones sociales), notas de la disciplina de Periodoncia y medias ponderadas entre ambos currículos. Para cada año, se obtuvieron mayores puntuaciones en la dimensión dos, en las notas de Periodoncia y las medias ponderadas en el currículo actual. Ambos currículos presentaron una correlación significativa entre las notas de Periodoncia y la media ponderada. El total del DREEM no presentó diferencia significativa (p > 0,05). La implementación de un nuevo currículo tuvo un impacto positivo importante en la percepción de los alumnos, lo que reflejó el desempeño académico. O ambiente de aprendizagem de Periodontia foi analizado antes e após a reestruturação curricular através do Dundee Ready Education Environment Measure (DREEM). Graduandos (2º, 3º, 4º anos; n = 266) foram divididos entre os currículos (n = 131). O total do DREEM, suas dimensões, notas de Periodontia e médias ponderadas foram comparadas. Para análise utilizou-se o teste t de Student e ANOVA (p < 0,05). Houve diferenças estatistícas nas dimensões dois (percepção sobre os professores) e cinco (relações sociais), nas notas da disciplina de periodontia e nas médias ponderadas entre ambos os currículos. Para cada ano, maiores pontuações foram obtidas na dimensão dois, nas notas de Periodontia e nas médias ponderadas no currículo atual. Ambos os currículos apresentaram uma correlação significativa entre as notas de Periodontia e a média ponderada. O total do DREEM não apresentou diferença significativa (p > 0,05). A implementação de um novo currículo teve impacto positivo importante na percepção dos alunos, o que refletiu no desempenho acadêmico.

This study evaluated clinical outcomes of acellular dermal matrix (ADM) allograft compared with autogenous free gingival graft (FGG) for gingival augmentation after 15 years. Twenty-two patients were originally included and evaluated by de Resende et al. (Clin Oral Investig 23:539–550, 2019), and 12 accepted to participate in this longitudinal evaluation. Clinical parameters evaluated were recession depth (RD), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), and soft tissue thickness (TT). In addition, esthetic perception was evaluated by patients and by a calibrated periodontist. Data were evaluated by ANOVA complemented by Tukey tests (p

The main treatment of periodontal disease is the mechanical removal of supra and subgingival biofilm. Adjuvant therapies as antimicrobial photodynamic therapy (aPDT) may offer improved clinical and microbiological results. The aim of this in vitro study was to evaluate the effect of toluidine and methylene blue dyes, associated with red laser and LED, on elimination of a suspension of Aggregatibacter actinomycetemcomitans (A.a). Experimental groups (n = 29) consisted of positive (broth) and negative (gentamicin) controls, three different dyes concentrations (0.05; 0.1; 10 mg/ml) alone or associated with laser (660 nm) at two power settings (70 and 100 mW) and LED (627 ± 10 nm). Bacterial suspension received all treatments, and after serial dilutions they were cultured for 24 h in petri dishes for colony forming unit counts. Data were analyzed by ANOVA complemented by Tukey's test (p 0.05). The results showed that both dyes, at a concentration of 10 mg/ml, alone or associated with laser and LED, caused 100% of death similar to the negative control (p 0.05). It can be concluded that blue dyes for aPDT, at high concentration (10 mg/ml), are capable of eliminating A.a without adjuvant use of light sources.

Background and objective The aim of this interventional, parallel-assignment, single-blinded, randomized, efficacy study was to investigate the efficacy of the treatment of gingival recessions by osteogenic cell transfer. This is the first randomized clinical trial of this nature. Material and methods Treatment of Miller class I or II gingival recessions >4 mm was randomly defined by casual sorting and performed by newly forming bone graft (NFBG) and coronally advanced flap (CAF) or subepithelial connective tissue graft (SCTG) and CAF (control). Clinical examinations were performed by a single blinded examiner at baseline and at 3, 6, and 9 months after surgery. Parameters investigated were recession height (REC), probing depth (PD), clinical attachment level, gingival bleeding index (GBI), plaque index (PlI), and keratinized gingiva width (KGW). Results Both techniques achieved similar percentage of root coverage, but NFBG was more effective in pocket depth reduction, attachment level gain, and reduction of plaque accumulation and of bleeding on probing. Conclusions These findings suggest that the transfer of osteogenic cells by NFBG is able to improve clinical attachment level and to cover denuded roots. NFBG can be used as an alternative treatment of deep recessions (≥4 mm), where the restoration of lost periodontal tissues is intended.

Aim This research suggested an in vitro virucidal action of a dental gel and a mouthwash with phthalocyanine derivative. Purpose The aim of this study was to report an in vitro study evaluating the virucidal capacity of mouthwash and dental gel containing anionic phthalocyanine derivate (APD). Methods The research followed the recommendations of the National Health Surveillance Agency (ANVISA) and adapted methodology, described in the standards EN14776: 2015; ASTM E1053-11 and the Robert Koch Institute – RKI, in addition to good laboratory practices (GLP). The determination of the percentage of inactivation of the SARS-CoV-2 virus particles was carried out by imposing the viral solution in contact with the respective tested products, with intervals of 30 seconds, 1 and 5 minutes, with subsequent submission of the aliquots, recovered in cell culture microplates following virus titration using the TCID50 (50% Median Tissue Culture Infectious Dose). Results The Mouthwash APD presented 90% of viral inactivation percentage, while the dental gel APD demonstrated 99.99% of viral inactivation. Conclusion In vitro analyses showed that mouthwash and dental gel APD can reduce the viability of SARS-CoV-2 virus particles., Video abstract Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/4Jc6fufVwms

Background: The risk of contamination and dissemination by SARS-CoV-2 has a strong link with nasal, oral and pharyngeal cavities. Recently, our research group observed the promising performance of an anionic phthalocyanine derivative (APD) used in a mouthwash protocol without photoexcitation; this protocol improved the general clinical condition of patients infected with SARS-CoV-2. Methods: The present two-arm study evaluated in vitro the antiviral activity and cytotoxicity of APD. Additionally, a triple-blind randomized controlled trial was conducted with 41 hospitalized patients who tested positive for COVID-19. All the included patients received World Health Organization standard care hospital treatment (non-intensive care) plus active mouthwash (experimental group AM/n=20) or nonactive mouthwash (control group NAM/n=21). The adjunct mouthwash intervention protocol used in both groups consisted one-minute gargling/rinsing / 5 times/day until hospital discharge. Groups were compared considering age, number of comorbidities, duration of symptoms prior admission and length of hospital stay (LOS). The associations between group and sex, age range, presence of comorbidities, admission to Intensive care unit (ICU) and death were also evaluated. Results: The in vitro evaluation demonstrated that APD compound was highly effective for reduction of SARS-CoV-2 viral load in the 1.0 mg/mL (99.96%) to 0.125 mg/mL (92.65%) range without causing cytotoxicity. Regarding the clinical trial, the median LOS of the AM group was significantly shortened (4 days) compared with that of the NAM group (7 days) (p=0.0314). Additionally, gargling/rinsing with APD was very helpful in reducing the severity of symptoms (no ICU care was needed) compared to not gargling/rinsing with APD (28.6% of the patients in the NAM group needed ICU care, and 50% of this ICU subgroup passed way, p=0.0207). Conclusions: This study indicated that the mechanical action of the protocol involving mouthwash containing a compound with antiviral effects against SARS-CoV-2 may reduce the symptoms of the patients and the spread of infection. The use of APD in a mouthwash as an adjuvant the hospital COVID-19 treatment presented no contraindication and reduced the hospital stay period. Trial Registration: The clinical study was registered at REBEC - Brazilian Clinical Trial Register (RBR-58ftdj) in 10/28/2020.

Background: The risk of contamination and dissemination by SARS-CoV-2 has a strong link with nasal, oral and pharyngeal cavities. Recently, our research group observed the promising performance of an anionic phthalocyanine derivative (APD) used in a mouthwash protocol without photoexcitation; this protocol improved the general clinical condition of patients infected with SARS-CoV-2. Methods: The present two-arm study evaluated in vitro the antiviral activity and cytotoxicity of APD. Additionally, a triple-blind randomized controlled trial was conducted with 41 hospitalized patients who tested positive for COVID-19. All the included patients received World Health Organization standard care hospital treatment (non-intensive care) plus active mouthwash (experimental group AM/n=20) or nonactive mouthwash (control group NAM/n=21). The adjunct mouthwash intervention protocol used in both groups consisted one-minute gargling/rinsing / 5 times/day until hospital discharge. Groups were compared considering age, number of comorbidities, duration of symptoms prior admission and length of hospital stay (LOS). The associations between group and sex, age range, presence of comorbidities, admission to Intensive care unit (ICU) and death were also evaluated. Results: The in vitro evaluation demonstrated that APD compound was highly effective for reduction of SARS-CoV-2 viral load in the 1.0 mg/mL (99.96%) to 0.125 mg/mL (92.65%) range without causing cytotoxicity. Regarding the clinical trial, the median LOS of the AM group was significantly shortened (4 days) compared with that of the NAM group (7 days) (p=0.0314). Additionally, gargling/rinsing with APD was very helpful in reducing the severity of symptoms (no ICU care was needed) compared to not gargling/rinsing with APD (28.6% of the patients in the NAM group needed ICU care, and 50% of this ICU subgroup passed way, p=0.0207). Conclusions: This study indicated that the mechanical action of the protocol involving mouthwash containing a compound with antiviral effects against SARS-CoV-2 may reduce the symptoms of the patients and the spread of infection. The use of APD in a mouthwash as an adjuvant the hospital COVID-19 treatment presented no contraindication and reduced the hospital stay period. Trial Registration: The clinical study was registered at REBEC - Brazilian Clinical Trial Register (RBR-58ftdj).

Recently, the use of type I collagen obtained from Nile Tilapia (Oreochromis niloticus) was proposed for the treatment of second and third-degree burning lesions and diabetic ulcers due to its occlusive and healing properties. The aim of this report is to describe the use of Nile tilapia skin as an occlusive barrier to protect palatal wounds after the removal of free autogenous soft tissue grafts. Two patients with a deficiency in the height of keratinized mucosa were indicated for treatment with free gingival grafts. The palatal donor area was covered with a Nile tilapia skin, stabilized by sutures. Seven days after surgery, patients returned for post-operative care. Patients’ reported outcomes were investigated by the use of a visual analogue scale and included pain, discomfort, impact on chewing and speaking. Analgesics consumption was also recorded. Standardized photographs were obtained to monitor wound healing. Patients were followed up for 30 days. Patients reported reduced pain levels, with low consumption of analgesics during the first week after surgery. No discomfort or difficulty in chewing or speaking was reported. No complications such as hemorrhage or edema were observed. These findings suggest that the Nile Tilapia skin may be an interesting alternative as an occlusive biological dressing in palatal wounds harvest of free gingival grafts. Recientemente, se propuso el uso de colágeno tipo I obtenido de la Tilapia del Nilo (Oreochromis niloticus) para el tratamiento de las quemaduras de segundo y tercer grado, y úlceras diabéticas por sus propiedades oclusivas y cicatrizantes. El objetivo de este informe es describir el uso de piel de tilapia del Nilo como barrera oclusiva para proteger la herida palatina después de la extracción de injertos autógenos libres de tejido blando. Dos pacientes con deficiencia en la altura de la mucosa queratinizada fueron indicados para tratamiento con injertos gingivales libres. El área donante palatina se cubrió con una piel de tilapia del Nilo, estabilizada mediante sutura. Siete días después de la cirugía, los pacientes regresaron para recibir atención posoperatoria. Los resultados informados por los pacientes se investigaron mediante el uso de una escala analógica visual e incluyeron dolor, malestar, impacto al masticar y hablar. También se registró el consumo de analgésicos. Se obtuvieron fotografías estandarizadas para monitorear la cicatrización de heridas. Los pacientes fueron seguidos durante 30 días. Los pacientes informaron disminución del nivel de dolor, con bajo consumo de analgésicos durante la primera semana después de la cirugía. No se informó de molestias o dificultad para masticar o hablar. No se observaron complicaciones como hemorragia o edema. Estos hallazgos sugieren que la piel de Tilapia del Nilo puede ser una alternativa interesante como apósito biológico oclusivo en heridas palatinas después de la extracción de injertos gingivales libres. Recentemente, o uso do colágeno tipo I obtido da tilápia-do-Nilo (Oreochromis niloticus) foi proposto para o tratamento de lesões em queimados de segundo e terceiro graus, e em úlceras diabéticas, devido às suas propriedades oclusivas e cicatrizantes. O objetivo deste relato de casos é descrever o uso da pele de tilápia-do-Nilo como uma barreira oclusiva para proteger a ferida palatina após a remoção de enxertos autógenos de tecido mole. Dois pacientes com deficiência na altura de mucosa queratinizada foram indicados para tratamento com enxertos gengivais livres. A ferida palatina foi recoberta com pele de tilápia-do-Nilo e estabilizada por suturas. Sete dias após a cirurgia, os pacientes retornaram para cuidados pós-operatórios, e foram acompanhados por 30 dias. As avaliações foram investigadas pelo uso de escala visual analógica que incluíram dor, desconforto, impacto na mastigação e na fala. O consumo de analgésicos também foi registrado. Fotografias padronizadas foram obtidas para monitorar a cicatrização das feridas. Nos resultados, os pacientes relataram baixos scores de dor e de consumo de analgésicos, na primeira semana de pós-operatório. Nenhum desconforto ou dificuldade para mastigar ou falar foi relatado. Não foram observadas complicações como hemorragia ou edema. Esses achados sugerem que a pele de tilápia-do-Nilo pode ser uma alternativa interessante como curativo biológico oclusivo em feridas palatinas após remoção dos enxertos gengivais livres.

BACKGROUND Bone demineralization has shown to be advantageous in autogenous onlay bone grafts and in pre-osteoblasts cultures, but such procedure has never been evaluated in particulate bone grafts. This study aimed to investigate the role of two demineralizing agents in the repair of the 8-mm critical-size defects in rats' calvaria. METHODS Eighty adult male Wistar rats were randomly assigned to one of eight groups as follows: particulate autogenous bone demineralized with citric acid for 15 seconds (CA15), 30 seconds (CA30), or 60 seconds (CA60); particulate autogenous bone demineralized with tetracycline hydrochloride for 15 seconds (TCN15), 30 seconds (TCN30), or 60 seconds (TCN60); blood clot (NC), and non-demineralized autogenous bone (PC). The calvariae were harvested at 30 and 60 postoperative days (n = 5) for blinded histological and histometric analysis of the percentage area of newly formed bone within the defects. RESULTS In the NC and TCN groups, bone formation was limited to the margins of the defects at 30 postoperative days, whereas complete closure was present in all the specimens from CA15 group. Both at 30 and 60 postoperative days, histomorphometry showed significant higher area of newly formed bone in specimens demineralized with CA than in those demineralized with TCN or non-demineralized (P

Periodontal patients often report dentin hypersensitivity (DH) caused by root surface exposure or periodontal treatment. Tubular blocking technologies in toothpastes are effective for pain relief, but no specific chemical/physical agent has been reported for periodontal patients. This double-blind randomized clinical trial compared the effects of three technologies in reducing DH in periodontal patients. Eighteen (18) participants were randomly assigned into three groups: SEN (NOVAMIN technology); REG (REFIX technology); REGK (REFIX technology + potassium citrate). Periodontal patients presenting with DH were evaluated at 6 moments: T1 and T2 - immediately before and after scaling and root planing procedures (SRP); T3 - after polishing sensitive areas with their assigned dentifrice and T4, T5, T6 - after 2, 4 and 8 weeks of SRP respectively. Sensitivity was assessed by air blast (Schiff scale) and patients’ perceptions using the visual analogue scale (VAS). Data were analyzed by two-way repeated measures ANOVA complemented by the Tukey test with significance set at 5% (p

Systemic lupus erythematosus (SLE) is a complex chronic autoimmune disease characterized by tissue damage and widespread inflammation in response to environmental challenges. Deposition of immune complexes in kidneys glomeruli are associated with lupus nephritis, determining SLE diagnosis. Periodontitis is a chronic inflammatory disease characterized by clinical attachment and bone loss, caused by a microbial challenge – host response interaction. Deposition of immune complex at gingival tissues is a common finding in the course of the disease. Considering that, the primary aim of this study is to investigate the deposition of immune complexes at gingival tissues of SLE patients compared to systemically healthy ones, correlating it to periodontal and systemic parameters. Twenty-five women diagnosed with SLE (SLE+) and 25 age-matched systemically healthy (SLE–) women were included in the study. Detailed information on overall patient's health were obtained from file records. Participants were screened for probing depth (PD), clinical attachment loss (CAL), gingival recession (REC), full-mouth bleeding score (FMBS) and plaque scores (FMPS). Bone loss was determined at panoramic X-ray images as the distance from cementenamel junction to alveolar crest (CEJ-AC). Gingival biopsies were obtained from the first 15 patients submitted to surgical periodontal therapy of each group, and were analyzed by optical microscopy and direct immunofluorescence to investigate the deposition of antigen-antibody complexes. Eleven (44%) patients were diagnosed with active SLE (SLE-A) and 14 (56%) with inactive SLE (LES-I). Mean PD, CAL and FMBS were significantly lower in SLE+ than SLE–(p< 0.05; Mann Whitney). The chronic use of low doses of immunosuppressants was associated with lower prevalence of CAL >3 mm. Immunofluorescence staining of markers of lupus nephritis and/or proteinuria was significantly increased in SLE+ compared to SLE–, even in the presence of periodontitis. These findings suggest that immunomodulatory drugs in SLE improves periodontal parameters. The greater deposition of antigen-antibody complexes in the gingival tissues of patients diagnosed with SLE may be a marker of disease activity, possibly complementing their diagnosis.

Introduction: Multiple gingival recessions (GR) are often associated with high hypersensitivity and esthetics concerns due to exposed roots. The collagen matrix (CM) associated with coronally advanced flap (CAF) may be a suitable treatment for multiple GR in esthetic areas. However, there is a lack of long term follow up investigations. Objective: To evaluate a 24-month follow-up of the CM + CAF treatment for multiple RT1 GRs in esthetics areas. Materials and Methods: Six patients presenting 6 adjacent Cairo’s gingival recessions type 1 (RT1) in the anterior maxilla were treated with CM + CAF, and based on these patients a brief statistical analysis was conduct. The evaluated parameters included gingival recession depth (GRD), gingival recession width (GRW), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), gingival thickness (GT), and mean root coverage (MRC). Patient-related outcomes measurements (PROMs) were assessed using an oral health impact profile (OHIP-14) questionnaire and visual analogue scale (VAS). Results: There was significant improvement in GRD, GRW, and CAL measurements at 3 months postoperatively (p

Aim This prospective cohort study evaluated late complications (LC) on recipient sites comparing two types of connective tissue grafts (CTG). Materials and methods Participants (n: 60) were treated with coronally advanced flap (CAF) plus CTG harvested by de-epithelialized technique (DE) (n:31) or two-parallel incision (PI) (n:29). Areas were evaluated to identify white discharge associated or not with gingival cul-de-sac. Patients were ordered in groups with (DE+ and PI+) or without (DE- and PI-) LC. Biopsies for histopathological analysis in LC areas were proposed. Results Six cases exhibited LC, 5 in DE graft (DE+) and 1 in PI graft (PI+) group; 2 were diagnosed at 3 months postoperatively, 3 at 6 months and one at 12 months. The relative risk for LC was 1.7 times greater for DE graft (p: 0.01; CI: 1.10 to 2.72; RR>1). Differences were not observed for clinical outcomes after both types of CTGs (p>0.05). Biopsies showed deep invagination of the epithelial lining suggesting cyst-like area/ cavity with keratin content and consolidated in fibrous connective tissue. After 24 months biopsied areas presented no recurrence of LC, in non-biopsied patients the clinical condition remained unchanged. Conclusions Considering the limitations of this study, LC on recipient sites demonstrated no statistical difference between two types of CTG.

The importance of surgical intervention for the maintenance of long-term results by root coverage of multiple gingival recessions in an esthetic area treated with a tissue substitute (acellular dermal matrix [ADM]-Alloderm®) is widely required. The present case report highlights the effectiveness of the ADM for the treatment of multiple recession defects in a female patient with Class I and II gingival recession in relation to maxillary anterior associated with esthetics and dentin hypersensitivity demands. The root coverage rate for the anterior area showed greater value with 70% of coverage; at 90 days and 2 and 12 years of follow-up, it showed 70.5%, 79%, and 77%, respectively. Conversely, for the posterior area, these rates were 68.5%, 63%, and 57% for the same follow-up periods. Results regarding gain of keratinized tissue demonstrated superior values for the anterior area, namely 3.92, 3.34 and 3.22 mm at 90 days and 2 and 12 years. These values for the posterior area were 0.54 mm, 2.41, and 1.87 mm, respectively. These findings suggest that the tissue substitute Alloderm® showed excellent long-term results for areas of multiple recessions, providing root coverage and stability of keratinized tissue gain. After this long period of evaluation, some local factors associated with recurrence of gingival recessions were detected, and a lack of proper periodontal maintenance care was observed. However, esthetic and functional outcomes achieved with surgical procedure were maintained.

Background The granulation tissue present in surgically-created early healing sockets has been considered as a possible source of osteoprogenitor cells for periodontal regeneration, as demonstrated in animal studies. However, the in vitro osteogenic properties of tissue removed from human surgically-created early healing alveolar defects (SC-EHAD) remains to be established, being that the aim of this study. Methods Surgical defects were created in the edentulous ridge of two systemically healthy adults. The healing tissue present in these defects was removed 21 days later for the establishment of primary culture. The in vitro characteristics of the cultured cells were determined by Armelin method, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, immunohistochemistry, alkaline phosphatase (ALP) activity, mineralization assay, and flow cytometry for detection of stem cells/osteoprogenitor cell markers. Results Cells were able to adhere to the plastic and assumed spindle-shaped morphology at earlier passages, changing to a cuboidal one with increasing passages. Differences in the proliferation rate were observed with increasing passages, suggesting osteogenic differentiation. ALP and mineralization activities were detected in conventional and osteogenic medium. Fresh samples of SC-EHAD tissue exhibited CD34- and CD45- phenotypes. Cells at later passages (14th) exhibited CD34- , CD45- , CD105- , CD166- , and collagen type I+ phenotype. Conclusion Tissue removed from SC-EHAD is a possible source of progenitor cells.

Pacientes com necessidades especiais (PNE) representam uma porcentagem significativa da população brasileira, correspondendo a 24% da parcela populacional. Entretanto, esses pacientes podem enfrentar diversas barreiras de acesso ao tratamento. O objetivo desse trabalho é conhecer as percepções e dificuldades encontradas por estudantes de Odontologia, referentes ao atendimento de PNE. Foi realizada a aplicação de um questionário aos graduandos do 2º ao 4º ano da Faculdade de Odontologia de Bauru (n=122), com questões referentes ao atendimento odontológico e suas percepções sobre os PNE. Observa-se que parcela significativa dos estudantes não se sentem preparados para esse atendimento, chegando a 95% no 4º ano. Sobre a percepção quanto ao preparo para atender PNE, os graduandos do 4º ano referem-se como regular, enquanto a maioria dos que cursam o 2º e 3º anos acredita não estar preparada para o atendimento. O tratamento odontológico é fundamental para o estabelecimento da saúde bucal dos pacientes, principalmente quando relacionado aos PNE, sendo essencial o conhecimento das limitações e dos recursos que levam ao acolhimento do paciente por parte dos graduandos. O contato com PNE durante a graduação é extremamente importante para o conhecimento e a ruptura de possíveis preconceitos que possam envolver o atendimento dessa população, a fim de promover saúde bucal e qualidade de vida aos PNE

The objective of this study was to investigate the impact of oral health on the quality of life of patients with head and neck cancer (HNC) before and after oncologic treatment.Forty cancer-free individuals (Cf group) and 40 HNC patients (Hnc group) were included in this study. Hnc group was also divided into two subgroups: Hnc 1 (pre-cancer therapy, n = 20) and Hnc 2 (post-cancer therapy, n = 20). Participants were asked to complete a short form of Oral Health Impact Profile (OHIP-14). The results were statistically analyzed with the multivariate analysis of variance with post-hoc Scheffé multiple comparison.It was observed a moderate impact on the quality of life on HNC patients, with values on Hnc 2 group significantly higher in the functional limitation when compared to the Hnc 1 group (p 0.05). When compared to the Cf group, the values found on Hnc group were higher on functional limitation (p 0.01) and at the total score (p 0.05), whereas Hnc 2 group had significant superior values on functional limitation (p 0.01), physical pain (p 0.05), and total score (p 0.01) CONCLUSION: These results show that there is an oral impairment that depreciates the quality of life of patients with an experience of HNC, principally after treatment, indicating the importance of the inclusion of professionals responsible for dental and oral care with the oncologic team to monitor the oral condition of these patients.

ResumoA vitamina D (calciferol) possui papel importante no metabolismo ósseo (turnover), mantendo os níveis de cálcio e fósforo no sangue. A principal fonte de produção é pela pele estimulada pelos raios solares, porém, as características da vida moderna como o receio de danos dermatológicos e uso de agentes protetores têm dificultado/diminuído a exposição ao sol. Desta forma, há o comprometimento da síntese adequada dessa vitamina, o que pode influenciar negativamente no sucesso clínico de implantes dentários. O objetivo dessa revisão de literatura é abordar a importância da vitamina D e o efeito de sua deficiência sobre a saúde sistêmica e a repercussão na cavidade bucal com implantes dentários. Para isso, foi realizado uma busca nas bases de dados Scielo, Pubmed e Scopus com os descritores: “deficiency and vitamin D and dental implants”. Foram selecionados 13 artigos para revisão e análise dos dados. A carência de vitamina D gera inúmeras alterações, desde hipocalcemia leve, perda de osso trabecular, como a quadros graves com comprometimento ósseo, muscular, imunológico e metabólico. No caso de suspeita de deficiência de vitamina D no paciente que irá receber ou possui implante dentário, deve-se encaminhar o paciente a um médico e nutricionista, que analisará a existência real da hipovitaminose e indicará uma adequada abordagem terapêutica. Os estudos in vitro e em animais demonstram os efeitos da deficiência ou efeito da suplementação da vitamina D no metabolismo ósseo ao redor de implantes dentários. Já os estudos em humanos apresentam grande heterogenidade, não apresentando uma ligação entre baixos níveis séricos de vitamina D com o risco aumentado na perda precoce de implantes. Portanto, são necessárias mais pesquisas, incluindo investigações clínicas longitudinais e revisões sistemáticas, que possam elucidar melhor os mecanismos de ação da vitamina D nos processos de metabolismo ósseo e de osseointegração, auxiliando cirugiões-dentistas, médicos e nutricionistas quando em contato com os pacientes que utilizam ou irão utilizar implantes dentários.

Made available in DSpace on 2022-04-28T19:10:55Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-07-01 Subepithelial connective tissue graft (SCTG) presents favorable outcomes. However, the harvesting technique can influence the anatomical and histological composition of the SCTG. Within the limitations of a case report, the behavior of SCTGs removed by two techniques was evaluated bilaterally in one patient using double blade scalpel (DBS) and de-epithelialized graft (DE). Clinical parameters, laser Doppler flowmetry (LDF) and histological analysis were assessed. Complete root coverage was observed bilaterally, as well as improvement in width and thickness of keratinized tissue 2 years postoperatively. The LDF analysis demonstrated better revascularization in the DBS recipient area compared to DE. The histological evaluation showed differences in tissue composition and organization of collagen fibers. Similar clinical outcomes were observed bilaterally, nevertheless greater morbidity and aesthetic was reported in the DE harvesting area. Department of Prosthodontics and Periodontics Division of Periodontics Bauru School of Dentistry University of Saõ Paulo Department of Mathematics Saõ Paulo State University

This study investigated the behavior of fibroblasts from human periodontal ligament (hPLF) cultured on dental roots subjected to different protocols of citric acid conditioning.32 human teeth extracted due to advanced periodontal disease provided 63 radicular fragments, which were randomly divided in groups according to the treatment given to the surface: rinsing with saline solution for 90 s (C), 10 % citric acid (CA10), or 50 % citric acid (CA50). The treatments were applied during 90 s, 120 s and 180 s (n = 9). hPLF were cultured for 24, 48 and 72 h (n = 3) on the treated samples and analyzed by scanning electron microscopy (SEM) for surface area covered by cells and dentinal tubules widening.Excepting group C, all the other groups showed almost complete coverage of root surface by hPLF with time. At 24 h of cell culture, the largest area of coverage was seen in the samples treated with CA10-90 (98 ± 0.89 %) at 24 h of cell culture and this difference was significant (p 0.05) in comparison to CA10-180 (84.04 ± 5.01 %), CA50-90 (63.28 ± 12.46 %), CA50-180 (56.59 ± 8.76 %) and C (0.06 ± 0.11 %). In all the other comparisons, there was no statistically significant differences between CA10 and CA50 (p 0.05). Cells grown on surfaces treated with CA10 were more spread and flatten than in the CA50 specimens.Periodontally compromised roots surfaces conditioned with 10 % citric acid for 90 s resulted in better substrate for hPLF proliferation, in initial periods of culture than 50 % citric acid. The enlargement of the dentinal tubules did not seem to be influenced by the acid concentration.

Purpose The aim of this study was to investigate the response of osteogenic cell lineage and gingival fibroblastic cells to different surface treatments of grade IV commercially pure Titanium (cpTi) disks. Material and methods Grade IV cpTi disks with different surfaces were produced: machined (M), sandblasting (B), sandblasting and acid subtraction (NP), and hydrophilic treatment (ACQ). Surface microtopography characteristics and chemical composition were investigated by scanning electron microscopy (SEM) and energy dispersive x-ray spectrometry (EDS). Adhesion and proliferation of SC-EHAD (human surgically-created early healing alveolar defects) and HGF-1 (human gingival fibroblasts) on Ti disks were investigated at 24 and 48 h, and osteogenic differentiation and mineralization were evaluated by assessing alkaline phosphatase (ALP) activity and alizarin red staining, respectively. Results No significant differences were found among the various surface treatments for all surface roughness parameters, except for skewness of the assessed profile (Rsk) favoring M (p = 0.035 ANOVA). M disks showed a slightly higher (p > 0.05; Kruskal-Wallis/Dunn) adhesion of HGF-1 (89.43 ± 9.13%) than SC-EHAD cells (57.11 ± 17.72%). ACQ showed a significantly higher percentage of SC-EHAD (100%) than HGF-1 (69.67 ± 13.97%) cells adhered at 24 h. SC-EHAD cells expressed increased ALP activity in osteogenic medium at M (213%) and NP (235.04%) surfaces, but higher mineralization activity on ACQ (54.94 ± 4.80%) at 14 days. Conclusion These findings suggest that surface treatment influences the chemical composition and the adhesion and differentiation of osteogenic cells in vitro. Clinical relevance Hydrophilic surface treatment of grade IV cpTi disks influences osteogenic cell adhesion and differentiation, which might enhance osseointegration.

Background: The PHTALOX® mouthwash appears in this case series as a promising alternative for reducing the viral load of SARS-CoV-2 and for clinical improvement of infected patients. Objectives: The aim of this study was to report a case series of mouthwash to reduce clinical symptoms in patients diagnosed with COVID-19. Methods: Eight patients used 5ml of PHTALOX® mouthwash for gargling/rinsing during 1 minute/ five times a day during 14 days. Two measurement scales were applied for each patient in different periods to verify sore throat - VAS – Visual Analogic Scale for Pain and the clinical conditions - PS – Performance Status. Results: All patients presented a significant reduction in clinical symptoms with PHTALOX® mouthwash for gargling/rinsing after few days of use, without hospitalization. Conclusion: The PHTALOX® mouthwash protocol appears as a promising alternative for clinical improvement of COVID-19 infected patients. Daily use of this mouthwash rapidly reduced clinical symptoms such as sore throats, coughs and mouth ulcers. Clinical trials are necessary to confirm the effectiveness of PHTALOX® protocol against COVID-19.

Root conditioners are used to promote root surface biomodification to increase the success rate of root coverage. Citric acid and tetracycline are commonly used. There is recent indication for using antimicrobial photodynamic therapy (aPDT) with this purpose. The aim of this study is to evaluate the effects of citric acid/tetracycline gel and aPDT in root coverage of gingival recessions using subepithelial connective tissue graft. This parallel, double-blinded clinical trial enrolled 17 patients (60 recession defects; 20/group). Experimental groups were: Control group (SRP) - scaling and root planing only; Citric acid/tetracycline gel (CAT) group - SRP plus citric acid/tetracycline gel; aPDT - SRP, toluidine blue O (100 μl/ml) and red laser. At baseline and after 3, 6 and 12 months, the clinical parameters were evaluated: recession depth (RD), percentage of root coverage (%RC), keratinized tissue width (KTW), soft tissue thickness (STT), probing depth (PD), clinical attachment level (CAL), dentin hypersensitivity (HYPER) and esthetic perception by patient (EST). CAT group presented reduction in PD, CAL, RD, increase in KTW and STT, higher %RC (81.6%) and better esthetic in relation to SRP group (p .05). aPDT treatment promoted CAL reduction, gain of KTW and STT and higher %RC (82.1%) in relation to SRP (57.7%) (p .05). There was a reduction in dentin sensitivity in all groups. Complete root coverage was higher for CAT group (65%) and aPDT group (70%) in relation to SRP (30%) (p .05). Root conditioning, with citric acid/tetracycline gel and aPDT, promotes better long-term clinical outcomes and root coverage after SCTG procedures.

Objetivo: revisar a literatura sobre o tratamento das doenças periodontais associado à probióticos, identificando as funcionalidades e os principais agentes microbianos empregados. Material e método: foi realizada busca nas bases de dados eletrônicas PubMed e ScienceDirect, empregando os termos de busca probiotics e periodontal diseases. Como critérios de inclusão, foram selecionadas pesquisas clínicas originais e ensaios clínicos publicados em português ou inglês. Resultados: após pesquisa e minuciosa revisão por título e resumo de cada estudo, 40 ensaios clínicos randomizados foram selecionados para avaliação dos desfechos observados. Todos os estudos empregaram probióticos associados à raspagem, alisamento e polimento coronorradicular. A cepa bacteriana mais utilizada é o Lactobacillus reuteri.Foi demonstrado que os probióticos conferem potencial auxilio ao tratamento das lesões periodontais. Embora os parâmetros avaliados nem sempre sejam beneficiados pelo tratamento, o uso dos microrganismos benéficos reduziu a necessidade de intervenção cirúrgica principalmente em pacientes com bolsas profundas. Considerações finais: A utilização dos probióticos se mostra segura e traz pequenos ganhos auxiliares no tratamento das doenças que acometem o periodonto. Desenhos de estudos com rigor metodológico e amostras representativas são encorajados visando analisar e testar os benefícios desses agentes. Palavras-chave: Doenças periodontais. Lactobacillus. Probióticos.

Background and Objective Many techniques and flap designs have been used to treat gingival recession by root coverage, but subepithelial connective tissue graft (SCTG) seems to be the gold standard procedure. In an attempt to improve the healing process and increase the success rate of root coverage, some authors have used root modifiers, including different root conditioners, lasers, EMD, recombinant human growth factors and platelet-rich plasma (PRP). The aim of this systematic review was to evaluate the effects of root biomodification in clinical outcomes of gingival recessions treated with SCTG. Material and Methods Studies reporting SCTG associated with any form of root surface biomodification for root coverage of gingival recessions (Miller Class I and Class II) were considered as eligible for inclusion. Studies needed to have data of clinical outcomes in a follow up of at least 6 months. Screening of the articles, data extraction and quality assessment were conducted independently and in duplicate. Results None of the products evaluated (citric acid, EDTA, PRP, lasers and EMD) showed evident benefits in clinical outcomes. Test and control groups presented similar outcomes related to root coverage and periodontal parameters, with no statistical differences between them. The exception was root biomodification with the neodymium-doped yttrium aluminium garnet (Nd:YAG) laser, which impaired root coverage and had a detrimental effect on clinical outcomes. Conclusion Based on the present clinical data, the use of root surface modifiers to improve clinical outcomes in gingival recessions treated with SCTG is not justified. More in vivo studies, and randomized clinical trials with larger sample sizes and extended follow up, are necessary.

Purpose This animal study investigated vertical bone formation (VBF) around implants and used histomorphometric analysis to compare different bone-filling materials associated with a massive titanium dome as a tissue barrier. Materials and methods Seven dogs were submitted to surgical procedures with extraoral access to the lower edge of the mandible, and four implants were semi-inserted in each animal. Each implant received one treatment: autogenous bone with clot (AB), control clot (C), synthetic graft (Biogran [BG]), or xenograft (Bio-Oss [BO]). Massive titanium domes were stabilized over the implants. Histologic analysis was performed after 3 months, and quantitative aspects were evaluated in extraosseous and intraosseous threads on Image Pro-Plus software. Results VBF around implants exhibited significant values in AB compared with other groups. BG and BO presented statistical equivalency to AB and C in the apposition and filling of extraosseous threads. There was no difference between groups for parameters evaluated in intraosseous threads. Conclusion The experimental model was valid for evaluation of VBF around implants placed in atrophic mandibles. Considering the limitations of this study, histomorphometric analysis evidenced better outcomes for group AB. Even though groups BG and BO presented worse outcomes than AB, they were slightly better compared with the control group.

Aim To report a well succeeded use of cyanoacrylate adhesive for fixating a resorbable membrane during a guided tissue regeneration procedure (GTR). Background The immobilization of membranes in GTR is essential for establishing proper environment for cell differentiation and tissue regeneration. However, some membranes are very difficult to be kept in position by sutures and its fixation by mini screws or pins may be time consuming and expensive. Case description A 47-year-old woman presenting a vertical bone defect at the palatal aspect of the left central incisor was treated by GTR using particulate autogenous bone graft associated to a collagen membrane. The membrane was glued to the bone surrounding the defect and to the tooth surface with cyanoacrylate adhesive. The postoperative period was uneventful and 4 years later, excellent results in terms of radiographic filling of the defect and reduction of the probing depth were seen. For illustrative purposes, histological findings obtained during a previous experiment in calvaria of guinea pigs is shown, characterizing a foreign body granuloma and proving that the cyanoacrylate adhesive is a safe tool in GTR. Conclusion The use of a membrane glued with cyanoacrylate to immobilize membranes in GTR is viable and safe from both technical and biological standpoints and may be advantageous for clinical and research purposes. Clinical significance The alternative method for membrane fixation shown in this case report can contribute to simplify the technique in GTR procedures. How to cite this article de Rezende MLR, de Oliveira Cunha P, Damante CA, Santana ACP, Greghi SLA, Zangrando MSR. Cyanoacrylate Adhesive as an Alternative Tool for Membrane Fixation in Guided Tissue Regeneration. J Contemp Dent Pract 2015;16(6):512-518.

Root demineralization is used in Periodontics as an adjuvant for mechanical treatment. The aim of this study was to evaluate the effects of root surface modification with mechanic, chemical, and photodynamic treatments on adhesion and proliferation of human gingival fibroblasts and osteoblasts. Root fragments were treated by scaling and root planing (C-control group), EDTA (pH 7), citric acid plus tetracycline (CA-pH 1), and antimicrobial photodynamic therapy (aPDT) with toluidine blue O and red laser (pH 4). Cells were seeded (104 cells/well, 6th passage) on root fragments of each experimental group and cultured for 24, 48, and 72 h. Cells were counted in scanning electron microscopy images by a calibrated examiner. For fibroblasts, the highest number of cells were present at 72-h period (p 0.05). EDTA group showed a very low number of cells in relation to CA group (p 0.05). CA and aPDT group presented higher number of cells in all periods, but without differences between other treatment groups (p 0.05). For osteoblasts, there was a significant increase in cell numbers for aPDT group at 72 h (p 0.05). In conclusion, aPDT treatment provided a positive stimulus to osteoblast growth, while for fibroblasts, aPDT and CA had a tendency for higher cell growth.

Pyogenic granuloma is a traumatic lesion that affects the mucocutaneous tissues of oral cavity. It is more prevalent in gingival tissues and in young women. The purpose of this report is to present an atypical case where anatomical features, detectable only by complementary exams, implied on the recurrence of the lesion. A 21-year-old caucasian female presented a recurrent oral pyogenic granuloma after two excisional biopsies and curettage of the periosteum. A cone beam computed tomography revealed a feeder vessel in an intraseptal centered position, up to the base of the lesion. Therefore, the third surgery included the vessel cauterization with a high power diode laser. After one year of the third surgery, no recurrence was noted. This case reinforces the use of imaging exams to investigate the presence of intraosseous vascular networks associated to recurrent pyogenic granuloma, principally on the absence of significant local irritants, such as trauma and calculus, or systemic changes. After lesion removal, the cauterization of the feeding vessel with a high power laser is an efficient approach.

Objective The aim of this study was to compare the effect of root biomodification by lasers, citric acid and antimicrobial photodynamic therapy (aPDT) on viability and proliferation of human gingival fibroblasts (FGH). Design Groups were divided in control (CC – only cells), and root fragments treated by: scaling and root planing (positice control – SC), Er:YAG (ER–60 mJ,10pps,10 Hz,10s,2940 nm), Nd:YAG (ND–0.5W,15 Hz,10s,1640 nm), antimicrobial photodynamic therapy (PDT–InGaAIP,30 mW,45J/cm 2 ,30s,660 nm,toluidine blue O), citric acid plus tetracycline (CA). Fibroblasts (6th passage, 2 × 10 3 ) were cultivated in a 24-h conditioned medium by the treated root fragments. Cell viability was measured by MTT test at 24, 48, 72 and 96 h. In a second experiment, FGH cells (10 4 ) were cultivated on root fragments which received the same treatments. After 24, 48, 72 h the number of cells was counted in SEM pictures. In addition, chemical elements were analyzed by energy dispersive spectroscopy (EDS). Data was analyzed by two-way ANOVA (first experiment), repeated measures ANOVA (second experiment) and ANOVA (EDS experiment) tests complemented by Tukey’s test (p Results ND, PDT and CA promoted higher cell viability (p Conclusions All treatments but scaling and root planing stimulated fibroblast viability while Er:YAG and Nd:YAG treated root surfaces presented higher number of cells.

A reabilitação de pacientes parcialmente desdentados é um tratamento viável e com excelente prognóstico. Todavia, a disponibilidade óssea em altura é um fator crucial para o sucesso desse tratamento. O levantamento de seio maxilar, apesar da baixa qualidade óssea da maxila posterior, é considerado um procedimento bastante previsível. Entretanto, técnicas reconstrutivas em mandíbula não possuem a mesma previsibilidade, além de apresentar maior morbidade pós-operatória. Apesar da alta previsibilidade dos implantes com altura reduzida, poucos são os estudos que avaliam a real necessidade da esplintagem do mesmo em mandíbula posterior atrófica. Dessa forma, o objetivo do presente estudo foi avaliar a necessidade de um implante curto ser esplintado a outro. Após análise criteriosa da literatura concluiu-se que os implantes com altura reduzida unitários apresentam igual previsibilidade em relação ao esplintado. Todavia, a heterogeneidade dos estudos e a falta de ensaios clínicos randomizados justifica a elaboração de novas pesquisas.

A prevenção é essencial para o estabelecimento de saúde bucal dos pacientes, principalmente quando relacionada aos indivíduos com deficiência, como os pacientes com Síndrome de Down (SD). O objetivo deste estudo foi identificar as percepções de pais e/ou responsáveis sobre a saúde bucal e em seguida formular um manual sobre escovação dentária, além de encontrar recursos lúdicos de manejo comportamental para o paciente com SD. Com os participantes com SD foram realizadas oficinas de arte e outras atividades lúdicas com caráter de educação em saúde. Participaram do estudo 15 pacientes com SD com idade entre 3 e 16 anos, com seus respectivos pais/cuidadores da Associação de Pais e Amigos das Pessoas com SD de Lençóis Paulista - SP (Brasil). Observou-se que ainda grande parte dos pais desconhece quais doenças que acometem a cavidade bucal dos pacientes com SD e como isso afeta sua saúde sistêmica. Constatou-se que os participantes com SD aceitaram e adotaram de maneira mais efetiva as instruções de higiene bucal por meio da música fortalecendo o vínculo paciente-profissional. Portanto, atividades de extensão para essa parcela da população são fundamentais para promoção de saúde bucal, inclusão social e qualidade de vida dos mesmos.

Data sourcesMedline, Embase, Cochrane CENTRAL and OpenGREY databases without language restriction until March 2016 plus manual searching of four specific journals and consideration of reference lists.Study selectionStudies evaluating different methods of periodontal treatment in Down syndrome patients measuring at least two periodontal parameters at different periods of assessment. Titles, abstracts and full texts were considered by two independent reviewers and a third where discussion did not reach consensus. Randomised controlled trials were evaluated using the Cochrane risk of bias tool. The observational studies were evaluated using an adapted version of the Newcastle-Ottawa Scale.Data extraction and synthesisData extraction was carried out independently by two reviewers and organised into evidence tables. No meta-analysis was undertaken, however a narrative synthesis was presented.ResultsNine studies met the inclusion criteria; four longitudinal studies, one prospective case series and four clinical trials which included two cross-over studies and a controlled trial. The studies showed marked heterogeneity in terms of methodology, intervention and outcome measures. All studies, however, included assessment of different plaque and gingival indices.Three studies investigated outcomes after scaling and root planing, one of which compared surgical and non-surgical approaches. Periodontal pockets of 1-3 mm were statistically significantly improved with non-surgical treatment in comparison with pockets greater than 4 mm which showed greater reduction with surgical treatment. Six studies investigated different forms and uses of chlorhexidine, three of which investigated its use as an adjuvant to mechanical debridement and one which also included plaque disclosing as an intervention. Chlorhexidine was shown to be most effective when used daily as a 1% gel for toothbrushing. The use of a plaque disclosing tablet and fluoridated tooth paste, however, showed further improved outcomes with regards to plaque control.ConclusionsEight of the nine studies included showed improvement in the primary outcomes of improved plaque and gingival bleeding indices. Professional intervention and periodontal maintenance significantly reduced plaque and gingival indices, irrespective of the treatment performed. Increased frequency of interventions was associated with better outcomes, especially in younger age groups.

Antimicrobial photodynamic therapy (aPDT) in Dentistry has important effects as bacterial destruction in areas with periodontal disease. Some dyes applied in aPDT could present low pH and, consequently, result in tooth demineralization. This study evaluated demineralization produced by aPDT with toluidine blue O (TBO) at low pH and analyzed adhesion/proliferation of human gingival fibroblasts (HGF).In the 1st phase, bovine enamel and root dentin fragments received 2 treatments: PDT4 group (TBO-100 μg/ml-pH 4-60s) plus laser (660 nm, 45 J/cm(2), 1.08 J, 30 mW, 30 s, spot 0.024 cm(2), 1.25 W/cm(2), sweeping, non-contact) and CA group (citric acid plus tetracycline-pH 1-180 s). Surface hardness loss and tooth wear were statistically analyzed (Student's t test, ANOVA/Tukey, p0.05). In the 2nd phase, human dentin fragments were divided in C (control group-scaling and root planing), PDT4 and CA. HGF (10(4), 5th passage) were cultured on these fragments for 24, 48 and 72 h and counted in scanning electron microscopy photographs. Number of HGF was analyzed using repeated-measures ANOVA and Tukey (p0.05).Percentage of surface hardness loss was similar in dentin for PDT4 (71.5%) and CA (76.1%) (p0.05) and higher in enamel for CA (68.0%) compared to PDT4 (34.1%) (p0.05). In respect to wear, no difference was found between PDT4 (dentin: 12.58 μm, enamel: 12.19 μm respectively) and CA (dentin: 11.74 μm and enamel: 11.03 μm) (p0.05). Number of HGF was higher after 72 h in CA group (2.66, p0.05) compared to PDT4 (2.2) and C (1.33).PDT4 is not as aggressive as CA for enamel. However, dentin demineralized promoted by PDT4 does not stimulate HGF adhesion and proliferation as CA.

Background: The aim of this systematic review is to evaluate the long-term outcomes of patients with periodontitis submitted to periodontal therapy/maintenance and implant placement. Methods: Studies reporting clinical and/or long-term implant outcomes from partially edentulous patients with periodontitis who were treated and followed periodontal maintenance for >5 years were considered eligible for the review. Screening of the articles, data extraction, and quality assessment were conducted independently and in duplicate. Results: Search of MEDLINE, EMBASE, and CENTRAL databases resulted in 959 papers, and of them 931 were excluded after title/abstract assessment. The full texts of 28 potentially eligible publications were screened, but only 10 studies met inclusion criteria. Most of the included studies (77.8%) presented a medium/high methodologic quality. The results demonstrated that patients with a diagnosis of periodontitis had satisfactory implant outcomes. Implant survival was high (92.1%) within studies reporting 10 years of follow-up. Parameters related to probing depth, clinical attachment level, and bone loss around teeth increased the occurrence of peri-implantitis and implant loss. Non-attendance to periodontal maintenance and smoking habits were also associated with less favorable implant outcomes. Conclusions: This systematic review confirmed that implant therapy can be successfully used in patients with a diagnosis of periodontitis who underwent proper therapy and regular periodontal maintenance. Residual pockets, nonattendance to the periodontal maintenance program, and smoking were considered to be negative factors for the long-term implant outcomes.

Focused Clinical Question: How to diagnose, classify and treat cases of Altered Passive and Active Eruption?Summary: Frequently, a Gummy Smile is related to aesthetic problems and is caused by several factors such as: vertical maxillary growth, dentoalveolar extrusion, short upper lip, upper lip hyperactivity, Altered Passive Eruption, (APE), and/or; a combination of these factors. APE is a genetic or developmental condition characterized by coronal positioning of the gingival margin over the enamel, resulting in short clinical crowns. Active Eruption is defined as the tooth movement in the occlusal direction as the tooth erupts from its osseous crypt. Altered Active Eruption, (AAE), occurs when teeth achieve the opposite relationship to the occlusal plane prematurely and the osseous crest is on, or very close to the Cement-Enamel Junction, (CEJ). Thus, the correct understanding of the biological events related to AAE and APE should be considered in the classification of a Gummy Smile. This article propos...

Clinical education in dental practice is a challenge for professionals and students. The traditional method of clinical training in Periodontology usually is based on following the procedure and practicing under supervision, until achieving proficiency. However, laboratory practice is required before direct care in patients. Specific anatomic plastic models can be useful, but animal cadaver models provide better similarity to human tissues. The objectives of this study are to describe a model for training periodontal surgical techniques in a pig mandible model and evaluate the effect of the program on student’s progress. Several surgical procedures were critically analyzed and trained with graduate students, including: gingivoplasty/gingivectomy, distal wedge procedure, frenectomy, internal bevel incision, total/partial flap, furcation access, gingival grafts and suture techniques. These procedures were theoretically reminded before laboratory practice. A questionnaire was applied concerning aspects of the laboratory and students provided their concepts and impression. The majority of the students scored positive aspects related to laboratory practice. Based on the questionnaire answers, we observed that the practical laboratory helped in the assimilation of the theoretical content and improved skills in the practice of periodontal surgical techniques. Graduate students were also more confident in performing these surgical procedures directly on the patient. Another positive aspect is the similarity of pig teeth and gingival tissues to human correspondent, being especially appropriate for surgical demonstration and training with excellent reproducibility. The laboratorial practice with pig mandible for graduate students was a valuable tool to improve periodontal surgical techniques.

O objetivo deste estudo clínico aleatório, boca dividida e duplo cego foi avaliar por meio de mensurações radiográficas lineares, o tratamento de defeitos infra-ósseos de 2 ou 3 paredes com retalho de espessura total reposto (RET) associado ou não à proteína derivada da matriz do esmalte (PME) após 24 meses. Foram avaliados 10 pacientes com periodontite crônica apresentando 2 ou mais defeitos infra-ósseos, totalizando 43 defeitos. As tomadas radiográficas foram realizadas antes do procedimento cirúrgico e após 24 meses. Foram confeccionados registros oclusais individualizados para padronização das radiografias. As películas radiográficas foram digitalizadas (500dpi/8bits) em um escaner (SprintScan 35 Plus scanner-Polaroid). O software AxioVision (version 3.0-Carl Zeiss) foi utilizado para mensurar as distâncias da junção esmalte-cemento (JEC) à crista óssea alveolar (CO), JEC ao fundo do defeito (FD) e o ângulo do defeito infra-ósseo. Uma escala milimétrica foi adquirida através da calibração de uma tela radiográfica de 1x1mm. Um examinador cego e calibrado realizou todas as mensurações radiográficas. A análise estatística utilizou nível de significância p=0,05. Após 24 meses, foi observada uma significante perda da crista óssea (JEC-CO) para PME (1,01mm; p=0,049), mas não para RET (0,14mm; p=0,622), no entanto, sem diferenças estatisticamente significantes entre os grupos (p=0,37). A redução da profundidade do defeito ósseo (JEC-FD) foi significante para RET (0,70mm; p=0,005), mas não para PME (-0,04mm; p=0,86), sem diferenças detectadas entre os grupos (p=0,87). Ambos PME (0,69; p=0,82) e RET (5,71; p=0,24) demonstraram um aumento nas medidas do ângulo do defeito, mas sem diferenças após 24 meses ou entre os grupos (p=0,35). Nesta amostra, a análise por meio de medidas radiográficas lineares computadorizadas não foi capaz de demonstrar superioridade do tratamento de defeitos infra-ósseos de 2 e 3 paredes com a aplicação da PME em comparação ao RET após 24 meses. The aim of this randomized, double-blind, split-mouth clinical trial was evaluate, using linear radiographic measurements, infra-bony defects treated with enamel matrix protein (EMP) or repositioned flap (RF), after 24 months. Ten healthy patients with chronic periodontitis presenting 2 or more defects were selected, totalizing 43 defects. Radiographic data were collected just before surgery and after 24 months. An individualized film holder was used to take standardized radiographs. Images were digitized (500dpi/8bits) with the SprintScan 35 Plus scanner (Polaroid). The AxioVision (version 3.0) software (Carl Zeiss) was used to measure the distances from the cemento-enamel junction (CEJ) to the alveolar crest (AC), CEJ to the bottom of the defect (BD) and infra-bony defect angle. A milimetric scale was achieved after calibration with a 1x1mm grid. A blind calibrated examiner performed all radiographic measurements. Statistical analysis used a level of significance of p=0,05. After 24 months, a significant crestal bone loss (CEJ-AC) was observed for EMP (1,01mm; p=0,049) but not for RF (0,14mm; p=0,622), however, no differences were detected between groups (p=0,37). Reduction of the bone defect depth (CEJBD) was significant for RF (0,70mm; p=0,005) but not for EMP (-0,04mm; p=0,86), while no differences were detected between them (p=0,87). Both EMP (0,69; p=0,82) and RF (5,71; p=0,24) showed an improvement in defect angle measurements but no significant differences were observed after 24 months or between them (p=0,35). In this sample, the linear radiographic analysis was not able to demonstrate the superiority of EMP treated infra-bony defects when compared to RF alone after 24 months.