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Objetivo: Estudos sugerem uma associação entre a doença periodontal e a doença pulmonar obstrutiva crônica (DPOC). Esta associação pode acontecer pela presença de bactérias na cavidade oral (aspiradas ou via corrente sanguínea) e porque ambas são condições mediadas pelo paciente com muitos fatores de risco e comorbidades em comum. O objetivo deste estudo foi avaliar a frequência e gravidade da doença periodontal em pacientes com DPOC. Método: Este estudo transversal incluiu 33 pacientes com DPOC e 30 pacientes sem DPOC (grupo controle). Todos os pacientes realizaram espirometria e foram examinados por um dentista. A condição periodontal foi avaliada através dos seguintes índices: número de dentes, índice de placa (IP), índice de sangramento gengival (IG), profundidade de sondagem (PS), PS dos sítios doentes (PSD), nível de inserção clínica (NIC), NIC dos sítios doentes (NICD) e percentual de sítios doentes (NICDP). A doença periodontal foi classificada quanto à severidade e extensão. Para análise estatística foram utilizados o teste de qui-quadrado de Pearson, o teste t de Student, análise de regressão logística e cálculo do odds ratio. Resultados: O grupo DPOC apresentou maiores IP (p=0,01), NIC (p=0,001) e NICDP (p

Orientadores: Marcio Zaffalon Casati, Enilson Antonio Sallum Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba Resumo: O objetivo deste estudo clínico contralado foi avaliar a utilização do microscópio operatório no tratamento de recessões gengivais com a técnica de enxerto conjuntivo supepitelial (ECS). Foram selecionados 24 pacientes com recessões gengivais bilaterais = 2,0 mm, classe I ou II de Miller, localizadas em caninos ou pré-molares superiores ¿Observação: O resumo, na íntegra poderá ser visualizado no texto completo da tese digital. Abstract: The purpose of this controlled clinical trial was to evaluate the use of a surgical microscope in the treatment of gingival recessions witch the subepithelial connective tissue graft (SCG) technique. Twenty-four patients witch bilateral Miller's Class I or II buccal gingival recessions of > 2.0 mm in canines or premolars were selected ...Note: The complete abstract is available with the full electronic digital thesis or dissertations. Doutorado Periodontia Doutor em Clínica Odontológica

INTRODUÇÃO: O uso de antibióticos em Implantodontia é amplamente empregado a fim de prevenir a infecção pós-operatória e perda do implante. No entanto, sua necessidade e eficácia não são consensuais na literatura. OBJETIVO: estre trabalho visa verificar a necessidade de profilaxia antibiótica em pacientes submetidos à cirurgia de implantes osseointegrados. MATERIAIS E MÉTODOS: buscou-se publicações sobre a temática nas bases de dados LILACS, SCIELO e PUBMED, nos idiomas português e inglês. RESULTADOS: a análise de literatura mostrou que a profilaxia antibiótica está indicada para pacientes com risco de endocardite infecciosa, imunodeprimidos, quando sítio cirúrgico esteja previamente infectado, em procedimentos extensos que necessitem de grande quantidade de implantes e/ou uso de biomateriais. Os ensaios clínicos randomizados publicados na literatura não têm padronização na metodologia, tipo de antibiótico, protocolos de posologia, procedimentos envolvidos, quantidade de implantes instalados por paciente, controle e falta de padronização dos operadores, que dificulta estabelecer um protocolo. CONCLUSÃO:o índice de sucesso dos implantes osseointegrados não está associado com a prescrição pré ou pós-operatória de antibióticos, mas sim com a correta indicação, planejamento, adequada técnica cirúrgica e aos procedimentos pré e pós-cirúrgicos eficientes. A profilaxia antibiótica deve ser indicada para pacientes que possuam alguma condição sistêmica que justifique seu uso. Em pacientes saudáveis, deve ser realizada uma rigorosa assepsia local, correta manipulação dos tecidos e utilização de técnica adequada para proporcionar ao paciente um excelente pós-operatório e igualmente, sucesso no tratamento.

Objetivo: realizar uma revisão acerca da associação da doença periodontal com a Doença Pulmonar Obstrutiva Crônica (DPOC).Metodologia e resultados: Trata-se de um estudo de revisão de literatura. Os descritores em português foram selecionados no DeCS (BVS), “doença periodontal”, “doença pulmonar obstrutiva crônica” e “periodontite crônica”, e em inglês, no MeSH, “periodontal disease”, “chronic obstructive pulmonary disease” e “chronic periodontitis”. A busca foi realizada nas bases de dados MEDLINE, LILACS e SciELO, através dos portais PubMed, Capes e BVS, no período de 1999 a 2018. Foram selecionados 49 artigos e o relatório de consenso elaborado pela Iniciativa Global para DPOC (GOLD).Conclusões: A DPOC é a quarta causa de morte no mundo e apesar do número crescente de publicações, poucos estudos foram realizados na América do Sul. Os estudos mostram que a DPOC e a doença periodontal possuem fatores de risco e comorbidades em comum e cuja associação pode acontecer pela presença de bactérias na cavidade oral (aspiradas ou via corrente sanguínea) e por serem, ambas, doenças inflamatórias de caráter essencialmente neutrofílico. A maioria dos estudos evidenciou piores índices periodontais nos pacientes com DPOC, associando-se a uma maior frequência de exacerbações. Por outro lado, a DPOC também pode ser um fator de risco para o aumento da severidade da doença periodontal. Desta forma, a introdução do tratamento periodontal e ações educativas para promoção de saúde bucal no protocolo de acompanhamento da DPOC pode propiciar maior abrangência e resolutividade no tratamento destes pacientes.

Objetivo:Avaliar o efeito do debridamento ultrassônico de boca toda no trata-mento da periodontite crônica severa em pacientes diabéticos, determinandoas alterações nos parâmetros clínicos periodontais após a terapia periodontal não-cirúrgica. Material e métodos: 9 pacientes diabéticos descompensados (HbA1c ³ 7%) com periodontite crônica severa foram separados aleatoriamente em 2 grupos: Grupo controle: raspagem e alisamento radicular por quadran-te/4 semanas e Grupo teste: debridamento ultrassônico em sessão única de 45minutos. Os parâmetros de Índice de placa, Índice gengival, Sangramento àsondagem, Profundidade de sondagem (PS), Nível de inserção clínico (NIC),Posição da margem gengival (PMG) foram avaliados. Amostras do fluidogengival foram obtidas de sítios com PS ³ 6 mm para verificar a presença dascitocinas IL-6, IL-10, IL-17 e IL- 23 pelo teste Elisa. Todas as variáveis foramavaliadas antes, 1 e 3 meses após o tratamento. Para análise das variáveisquantitativas (PS, NIC e PMG de bolsas moderadas) foram realizados ANOVAe teste de Tukey e para os demais parâmetros clínicos foram utilizados ostestes de Friedman e Mann-Whitney. Resultados:Ambos os grupos apresenta-ram resultados comparáveis quanto aos tratamentos instituídos, não havendodiferença estatisticamente significante. A IL-23 foi a única citocina que sofreuaumento aos 3 meses no grupo teste (p£0,05). Conclusão:O debridamentoultrassônico promoveu resultados clínicos similares à terapia convencional notratamento da periodontite crônica severa em pacientes diabéticos.

Após a exodontia de uma unidade dentária o alvéolo passa por um processo de remodelação, mesmo após a implantação imediata, o que pode interferir esteticamente no tratamento executado. A estabilidade do tecido peri-implantar neste contexto é um dos aspectos que contribui com a estética e pode sofrer influência de vários fatores, dentre os quais biótipo gengival, tipo de cirurgia(com ou sem retalho), espessura da tábua óssea, distância entre implante eparede alveolar vestibular, posicionamento do implante e preenchimento do“gap”, que serão abordados neste trabalho. Vislumbrando uma Odontologiabaseada em evidências alguns artigos científicos foram revisados e aspectos quparecem interferir nas transformações peri-implantares foram pontuados. Apesarda falta de padronização entre as metodologias dos estudos consultados, o quedificulta a comparação entre os resultados e estabelecimento da superioridadeentre materiais utilizados, foi possível concluir que o biótipo gengival exerceinfluência na estabilidade dos tecidos peri-implantares. Além disso nota-se anecessidade de estudos clínicos controlados e com metodologia bem descritaà fim de facilitar as comparações dos resultados.

This clinical study evaluated the tissue repair process using different bone grafts. Nine dental patients with indication for posterior implantodontic treatment were submitted to maxillary sinus lifting procedures associated to grafting. After 6 months, bone biopsies (6 sites with allogenous bone grafting and 13 sites with bovine xenogenous bone grafting/OsseusTM) were removed and processed for histopathological and histomorphometric analyses (ANOVA and Tukey's test). Both groups had tissue biocompatibility without significant inflammatory response, only punctual presence of multinucleated giant cells in xenograft group. Osteoconductive potential was evidenced by new bone tissue surrounding and in direct contact with the granules of both grafts. Volume density of connective tissue was similar between groups, although there were significant differences in allograft group in comparison to xenograft as the presence of new bone formation (48.50%±13.93 versus 29.83±9.56, respectively, pTM can be satisfactorily used as grafts in minor oral surgeries for bone augmentation in humans.

Background: Photodynamic therapy (PDT) is a method of microbial reduction which can benefit periodontal treatment in areas of difficult access, such as deep pockets and furcations. The aim of this randomized controlled clinical trial was to evaluate the effects of PDT as an adjunct to full-mouth ultrasonic debridement in the treatment of severe chronic periodontitis. Material and Methods: Twenty-two patients with at least one pocket with a probing depth (PD) of ≥7 mm and one pocket with a PD of ≥5 mm and bleeding on probing (BOP) on each side of the mouth were included, characterizing a split mouth design. The control group underwent full-mouth ultrasonic debridement and the test group received the same treatment associated with PDT. The PDT was performed on only one side of the mouth and the initial step consisted of subgingival irrigation with 0.005% methylene blue dye. Two minutes after applying the photosensitizer, the low power laser – AsGaAl (Photon Lase III – PL7336, DMC, São Carlos -São Paulo, Brazil) was applied (660 nm, 100 mW, 9 J, 90 seconds per site, 320 J/cm 2 , diameter tip 600 µm). The following clinical parameters were evaluated: plaque index, gingival index, BOP, gingival recession (GR), PD, and clinical attachment level (CAL). All parameters were collected before, 1, 3 and 6 months after treatment. Results: An improvement in BOP, PD and CAL was observed after treatment, in both groups, but without any difference between them. After 6 months, the PD decreased from 5.11±0.56 mm to 2.83±0.47 mm in the test group (p

Minimally invasive techniques have broadened the horizons of periodontal plastic surgery to improve treatment outcomes. Thus, the purpose of this clinical trial was to compare root coverage, postoperative morbidity, and esthetic outcomes of subepithelial connective tissue graft (SCTG) technique with or without the use of a surgical microscope in the treatment of gingival recessions.In this split-mouth study, twenty-four patients with bilateral Miller's Class I or II buccal gingival recessions ≥2.0 mm in canines or premolars were selected. Gingival recessions were randomly designated to receive treatment with SCTG with or without the assistance of the surgical microscope (test and control groups, respectively). Clinical parameters evaluated included the following: depth (RH) and width (RW) of the gingival defect, width (WKT) and thickness (TKT) of keratinized tissue, probing depth (PD), and clinical attachment level (CAL). Postoperative morbidity was evaluated by means of an analog visual scale and questionnaire. Patient satisfaction was also evaluated with a questionnaire. Descriptive statistics were expressed as mean ± SD. Repeated-measures analysis of variance was used for examination of differences regarding PD, CAL, and TKT. The Wilcoxon test was used to detect differences between groups and the Friedman test to detect differences within group regarding WKT, RH, and RW.The average percentages of root coverage for test and control treatments, after 12 months, were 98.0% and 88.3%, respectively (P0.05). Complete root coverage was achieved in 87.5% and 58.3% of teeth treated in test and control groups, respectively. For all parameters except recession height, there was an improvement in the final examination but without difference between treatments. For the RH, a lower value was found in the test group compared to the control group (P0.05). In the test group, all patients were satisfied with the esthetics obtained, and 19 patients (79.1%) were satisfied in the control group. For postoperative morbidity, 14 patients in each of the two treatment groups did not use analgesics for pain control.Both approaches were capable of producing root coverage; however, use of the surgical microscope was associated with additional clinical benefits in the treatment of teeth with gingival recessions.

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

The objective of this prospective, controlled clinical trial was to evaluate the long-term outcomes of subepithelial connective tissue graft (SCTG) or semilunar coronally positioned flap (SCPF) for the treatment of Miller Class I gingival recession defects.Seventeen patients with bilateral Miller Class I gingival recessions (or =4.0 mm) in maxillary canines or premolars were selected. The recessions were randomly assigned to receive SCPF or SCTG. Recession height (RH), recession width (RW), width of keratinized tissue (WKT), thickness of keratinized tissue (TKT), probing depth (PD), and clinical attachment level (CAL) were measured at baseline and at 6 and 30 months post-surgery. Patient satisfaction with esthetics and root sensitivity was also evaluated.The root-coverage outcomes obtained at 6 months were maintained throughout the study. At the 30-month examination, the average percentage of root coverage was 89.25% for SCPF and 96.83% for SCTG (P0.05); complete root coverage was observed in 58.82% and 88.24% of patients, respectively. SCTG maintained a statistically significant increase in TKT (P0.05) at 30 months. At this time, there were no significant differences between the two groups with regard to RH, RW, WKT, PD, and CAL. The evaluation of the esthetic outcome by the patient showed a preference for the SCTG treatment. Furthermore, in this group, no patient complained of residual or additional root hypersensitivity. In the SCPF group, three patients had this complaint at 30 months.SCPF and SCTG can be successfully used to treat Class I gingival recession, presenting outcomes with long-term stability. However, patient-oriented outcomes, such as esthetics and root sensitivity, favor SCTG therapy.

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

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

Supragingival plaque control is a requisite for the success of any periodontal procedure. However, little is know about the effect of this procedure alone on periodontitis. The aim of this study was to determine the effect of supragingival plaque control on clinical and biochemical parameters of chronic periodontitis. Twenty-five subjects exhibiting at least 4 pockets > 5mm, non-smokers and with no relevant systemic diseases, were selected for the study. The clinical and biochemical assessments were done before and 21 days after removal of plaque retentive factors, extraction of affected teeth and instruction in oral hygiene. The statistical analysis was done with the Student paired t-test (p

This paper aims to evaluate the effects of smoking on periodontal microsurgery technique using the subepithelial connective tissue graft (SCTG) for treatment of gingival recession on smokers. 14 patients nonsmokers and 12 smokers were selected, presenting Miller’s Class I and II gingival recession ≥ 2.0 mm. For both groups, the subepithelial connective tissue graft was used with the aid of a surgical microscope. The clinical parameters of width and height of the gingival recession, height and thickness of keratinized tissue, probing depth and clinical attachment level were evaluated before and six months after surgery. At the end of the study, there were obtained an average percentage of 96.66% of root coverage on nonsmokers and 82.49% on smokers (p=0.03). Complete root coverage was observed in 78,57% and 50% of patients, respectively. Therapy can benefit both groups, but smokers have less favorable outcomes to root coverage with periodontal microsurgery using the SCTG.

A recessão gengival é definida como a localização da margem tecidual apical à junção cemento-esmalte e pode ser causada pelo biofilme bacteriano, fator etiológico primário da inflamação periodontal, assim como pelo trauma de escovação. O tratamento da recessão gengival é normalmente um recontorno da arquitetura gengival, com ou sem associação de técnicas, para alcançar o recobrimento da superfície radicular exposta e aumentar a quantidade de tecido queratinizado. Estes procedimentos visam a uma melhoria estética e tratamento da hipersensibilidade dentinária, assim como a redução do risco de cárie. O retalho posicionado coronalmente é uma técnica muito utilizada para realização de recobrimento radicular. Na literatura, têm sido relatados diversos fatores que podem interferir no sucesso dessa técnica, dentre os quais estão os relacionados ao tecido periodontal, à técnica cirúrgica e aos hábitos dos pacientes. O objetivo desse artigo foi reunir os fatores que poderiam influenciar no resultado final da técnica de retalho posicionado coronalmente, mediante uma revisão de literatura.

The aggressive periodontitis (AgP) occurs on clinically health individuals, except for the presence of periodontal disease, is characterized by rapid attachment loss and bone destruction and also by family aggregation, among other secondary characteristics. The rapid periodontal destruction observed in AgP is an extremely important factor and have raised the researchers attention all over the world, once one come across an infection characterized by a highly virulent microorganism and/or by highly susceptible individuals. The risk of tooth loss and function and esthetic compromising, mainly in young patients, more commonly affected by the AgP, also stimulates the search for answers and more efficient treatments in the disease control. Therefore, the aim of this study is to review the literature of aggressive periodontitis considering the findings in the microbial etiology and individual susceptibility, as well as its response to periodontal therapy and the search for alternatives that lead to benefits in the periodontal clinical parameters.

Purpose: To review the literature and show a case treated by an integrated restorative and periodontal approach. Case description: A treatment of a Miller Class III gingival recession associated with cervical abrasion on his maxillary left canine, which was previously restored with resin composite and covered by a subepthelial connective tissue graft showed improvement of the hypersensitivity and esthetics with no signs of gingival inflammation. Conclusions: The Miller Class I and II gingival recession with cervical abrasion can be successfully treated associating the defect restoration with the root recover. However, it’s necessary more studies to support these positive results.

The aim of this study was to evaluate whether there is a positive correlation between the width of the zone of gingival keratinized tissue and its thickness. Maxillary right canines, lateral incisors, and central incisors of 60 patients (30 men, 30 women) between the ages of 20 and 35 years were examined. Using an endodontic spacer with a rubber cursor and a digital caliper of 0.01-mm resolution, the values of the width of the zone of gingival keratinized tissue and gingival thickness were obtained. It was observed that the lateral incisor has the largest mean zone of gingival keratinized tissue (5.54 ± 1.09 mm), followed by the central incisor (4.62 ± 1.02 mm) and canine (4.32 ± 1.33 mm). The mean gingival thickness was greater in the central incisor (1.17 ± 0.20 mm), followed by the lateral incisor (1.04 ± 0.24 mm) and canine (0.87 ± 0.27 mm). No statistically significant difference was verified for the mean width of the zone of gingival keratinized tissue and gingival thickness between men and women. A positive correlation between gingival thickness and width of the zone of gingival keratinized tissue was observed in the maxillary canine (Pearson r = 0.398, P.05), lateral incisor (Pearson r = 0.369, P.05), and central incisor (Pearson r = 0.492, P.05). In patients 20 to 35 years of age, there was a positive correlation between gingival thickness and width of the zone of gingival keratinized tissue for the maxillary right canine, lateral incisor, and central incisor.

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

Background: The purpose of this study was to evaluate the adjunctive clinical, microbiologic, and immunologic effects of the systemic administration of amoxicillin and metronidazole in the full-mouth ultrasonic debridement of patients with severe chronic periodontitis. Methods: Twenty-five patients presenting at least eight teeth with probing depth (PD) ‡5 mm and bleeding on probing (BOP) were selected and randomly assigned to full-mouth ultrasonic debridement + placebo (control group) or full-mouth ultrasonic debridement + amoxicillin and metronidazole (test group). The clinical outcomes evaluated were visible plaque index, BOP, position of the gingival margin, relative attachment level (RAL), and PD. Real-time polymerase chain react ion (PCR) was used for quantitative analysis of Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans), Porphyromonas gingivalis ,a ndTannerella forsythia (previously T. forsythensis). The enzyme-linked immunosorbent assay (ELISA) technique permitted the detection of prostaglandin E2, interleukin-1b, and interferon-gamma levels in gingival crevicular fluid. All parameters were evaluated at baseline and at 3 and 6 months post-treatment. Results: At 6 months, the test treatment resulted in lower BOP and an additional reduction (0.83 mm) in PD (P

Background The authors conducted a study to evaluate the radiographic characteristics of Class II mandibular furcation involvements as prognostic indicators of healing after nonsurgical periodontal therapy. Methods Twenty-three patients with chronic periodontitis (Class II furcation involvements in mandibular molars, probing pocket depth [PPD] of 5 millimeters or greater and bleeding on probing [BOP]) were selected to receive nonsurgical periodontal treatment. The authors evaluated visible plaque index, BOP, position of the gingival margin, PPD, relative attachment level (RAL) and relative horizontal attachment level. On radiographs, the authors measured root trunk, bone attachment level in the furcation region, lesion height (Lh), furcation width at alveolar crest level inside furcation (Fw) and 2 mm apical to the fornix (Fw2), and the perpendicular distance from the horizontal line connecting mesial and distal radiographic alveolar crest to furcation fornix. They analyzed all data using linear multiple regression. Results Six months after treatment, the furcations showed a mean RAL gain of 1.08 mm (± 1.25 mm) and a PPD decrease of 2.74 mm (± 1.58 mm). The authors found a statistically significant influence between Fw and PPD ( P = .0044), Fw2 and PPD ( P = .0014), Lh and PPD ( P = .0241), and Fw2 and RAL ( P = .0037). Conclusions Within the limitations of this study, the results suggest that Fw, Fw2 and Lh may influence the response of Class II mandibular furcations to nonsurgical periodontal therapy and may serve as prognostic indicators for this therapy. Thus, narrower and shorter root furcations would be expected to have better outcomes.

Aim To clinically, microbiologically and immunologically characterize periodontal debridement as a therapeutic approach for severe chronic periodontitis. Material and methods Twenty-five patients presenting at least eight teeth with a probing pocket depth (PPD) of >or=5 mm and bleeding on probing (BOP) were selected and randomly assigned to quadrant-wise scaling and root planing or one session of full-mouth periodontal debridement. The following clinical outcomes were assessed: plaque index, BOP, position of gingival margin, relative attachment level (RAL) and PPD. Real-time PCR was used for quantitative analysis of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia. The enzyme-linked immunosorbent assay permitted the detection of IL-1beta, prostaglandin E(2), INF-gamma and IL-10 in gingival crevicular fluid (GCF). All the parameters were evaluated at baseline, and at 3 and 6 months after treatment. Results Both the groups had similar means of PPD reduction and attachment gain over time. Besides a significant reduction in the bacterial level after treatment in both groups, microbiological analysis failed to demonstrate significant differences between them. Finally, no difference was observed between groups with respect to the levels of inflammatory mediators in GCF. Conclusion Periodontal debridement resulted in a similar clinical, microbiological and immunological outcome when compared with standard scaling and root planing and therefore may be a viable approach to deal with severe chronic periodontitis.

The purpose of this randomized clinical trial was to evaluate the outcome of gingival recession therapy using the semilunar coronally repositioned flap (SCRF) with or without EDTA application for root surface biomodification.Fifteen patients with bilateral Miller Class I buccal gingival recessions (or =4.0 mm) were selected. Thirty teeth with recessions were assigned randomly to receive the semilunar coronally repositioned flap with (SCRF-E group) or without (SCRF group) the application of an EDTA gel. Recession height (RH), recession width (RW), width (WKT) and thickness of keratinized tissue, probing depth, and clinical attachment level (CAL) were measured at baseline and 6 months post-surgery. Patient perception of root sensitivity and postoperative pain also was evaluated.Both treatments yielded significant improvements in terms of RH and RW decrease and CAL gain compared to baseline values. For SCRF-E and SCRF, the average root coverage was 70.2% and 90.1%, respectively (P = 0.01), and the complete root coverage was 40.0% and 66.7%, respectively. Only the SCRF group had a significant (P0.05) increase in WKT. The SCRF group showed a greater reduction (P0.05) in RW and RH compared to the SCRF-E group. No patient in either group reported any pain during the postoperative course; however, 6 months later, patients in the SCRF-E group complained more of residual or new root sensitivity compared to patients in the SCRF group.The use of EDTA gel as a root surface biomodifier agent negatively affected the outcome of root coverage with the SCRF.

The aim of this clinical trial was to compare the outcome of non-surgical treatment of interproximal and non-interproximal Class II furcation involvements.Thirty-eight patients presenting at least one Class II furcation involvement that bled on probing with a probing depth (PD)or = 5 mm were recruited. Furcation involvements were grouped as either buccal and lingual furcation involvements (BLFI) or interproximal furcation involvements (IFI). The following clinical outcomes were evaluated: visible plaque index, bleeding on probing (BOP), position of the gingival margin, relative attachment level (RAL), PD, and relative horizontal attachment level (RHAL). N-benzoyl-l-arginine-p-nitroanilide (BAPNA) testing was used to analyze trypsin-like activity in dental biofilm. All parameters were evaluated at baseline and 1, 3, and 6 months after non-surgical subgingival instrumentation.Six months after treatment, both groups had similar means of RAL and RHAL gain (P0.05). These variables were 1.22 and 1.07 mm in the IFI group and 1.38 and 1.20 mm in the BLFI group, respectively. The PD reduction was significantly greater in the BLFI group than in the IFI group (2.59 and 2.11 mm, respectively; P0.05). The BLFI group presented fewer sites with PDor = 5 mm than the IFI group at all post-treatment periods. At 6 months, the BAPNA test showed that only the BLFI group had values significantly different from baseline. This means that the BLFI group had significantly lower BAPNA values compared to the IFI group at 6 months.Buccal and lingual Class II furcation involvements respond better to non-surgical therapy compared to interproximal Class II furcation involvements.

The continuous search for improved surgical procedures to address gingival deformities is a consequence of an increasing demand for aesthetics in the periodontal clinical practice. Innovative techniques have been reported to help clinicians achieve predictability in root coverage. Significant progress can be attributed to the inclusion of the operative microscope in periodontal therapy, particularly in regards to obtaining primary closure. This article describes a microsurgical technique used to treat gingival recessions, showing its potential for obtaining optimal aesthetic results.

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

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

Orientador: Marcio Zaffalon Casati, Francisco Humberto Nociti Junior Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba Resumo: O objetivo deste estudo clínico controlado foi avaliar a utilização do retalho semilunar posicionado coronariamente (RSPC)para tratamento de recessões gengivais, comparando-o ao enxerto de tecido conjuntivo subepitelial (ECS). Foram selecionados dezessete pacientes com recessões gengivais vestibulares bilaterais classe I de Miller com altura:S 4,0 mm, em caninos ou pré-molares superiores. Um dente em cada paciente foi aleatoriamente designado para receber o retalho semilunar posicionado coronariamente (tratamento teste) ou o enxerto de tecido conjuntivo subepitelial (tratamento controle). Os parâmetros clínicos: altura e largura da recessão, nível de inserção clínica, profundidade de sondagem, altura da faixa de tecido queratinizado e espessura gengival foram avaliados antes dos procedimentos e 3 e 6 meses após com o uso de um paquímetro digital com precisão de 0,01 mm. Satisfação estética, hipersensibilidade dentinária e dor pós-operatória dos pacientes também foram analisadas. As médias percentuais de recobrimento radicular, após seis meses de acompanhamento, para o RSPC e o ECS, foram 90,95% e 96,10%, respectivamente. Não foi encontrada diferença significante na quantidade de recobrimento radicular entre RSPC e ECS. Completo recobrimento radicular foi alcançado em 52,94% e 76,46% dos dentes tratados com o RSPC e ECS, respectivamente. Com relação à espessura gengival foi encontrado um aumento estatisticamente significativo para o tratamento ECS (p

A associação entre a doença periodontal e a doença pulmonar obstrutiva crônica (DPOC) tem sido investigada nos últimos anos. Os estudos sugerem que esta associação acontece pela presença de bactérias na cavidade oral (aspiradas ou via corrente sanguínea) e por serem, ambas, doenças inflamatórias de caráter essencialmente neutrofílico que possuem muitos fatores de risco e comorbidades em comum. O impacto dessa associação é proposto como uma relação bidirecional, na qual o agravamento do curso clínico e do risco de desenvolver a DPOC pode ser provocado pela doença periodontal e vice-versa. Apesar do número crescente de publicações, poucos estudos foram realizados no Brasil. OBJETIVO: Trata-se de um estudo transversal que teve como objetivo inicial realizar uma revisão aprofundada da literatura acerca desta associação a fim de fundamentar a análise observacional da frequência e gravidade da doença periodontal em pacientes com DPOC comparados com o grupo controle. MATERIAL E MÉTODOS: Os descritores em português foram selecionados no DeCS, da BVS, e em inglês, no MeSH, para posterior pesquisa nas bases MEDLINE, LILACS e SciELO, através dos portais PubMed, Capes e BVS, no período de 1999 a 2018. Foram selecionados 69 artigos e um relatório de consenso (GOLD). Além destes, um capítulo de livro e a legislação foram também utilizados nas referências. Foram selecionados 33 pacientes com DPOC e 30 pacientes sem DPOC (grupo controle). Todos os pacientes realizaram espirometria e foram examinados por um dentista para avaliar os seguintes parâmetros: número de dentes, índice de placa (IP), índice de sangramento gengival (IG), profundidade de sondagem (PS), PS dos sítios doentes (PSD), nível de inserção clínica (NIC), NIC dos sítios doentes (NICD) e percentual de sítios doentes (NICDP). A doença periodontal foi então classificada quanto à severidade e extensão (Associação Americana de Periodontia, 1999). Para análise estatística foram utilizados o teste de qui-quadrado de Pearson, o teste t de Student, análise de regressão logística e cálculo do odds ratio. RESULTADOS: Em ambos os grupos prevaleceu o sexo masculino, com média de idade de 67 anos (DPOC) e 66 anos (controle). A relação VEF1/CVF teve média de 56% (±10) no grupo DPOC e 85% (±4) no grupo controle com p

Os instrumentos rotatórios e ondas ultrassônicas (piezoelétricas) são utilizados para perfurações e osteotomias em implantodontia e cirurgia buco-maxilo-facial. Apesar da capacidade de corte destes instrumentos, sempre existe a formação de uma zona necrótica que poderá interferir no reparo ósseo. Tendo em vista a importância que a necrose da superfície óssea apresenta na regeneração e na integração dos implantes dentários, os instrumentos de fresagem precisam ser estudados a fim de se evidenciar aqueles que menos danos causam ao osso. Ressalta-se que na literatura vigente, existe uma escassez de trabalhos científicos discutindo a avaliação de desgaste das brocas para implantes, a determinação de quantas vezes as brocas podem ser utilizadas sem causar danos excessivos ao tecido ósseo. O presente trabalho tem como objetivo discutir os estudos na literatura que fizeram a avaliação do desgaste das brocas, da necrose óssea superficial ocasionada pela fresagem tanto com as brocas convencionais como com as pontas piezoelétricas observando vantagens e desvantagens de cada método. Conclui-se que o controle da osteotomia é de suma importância para favorecer um processo de reparo fisiológico, com mínimo dano às células ósseas.

Após a exodontia de uma unidade dentária o alvéolo passa por um processo de remodelação, mesmo após a implantação imediata, o que pode interferir esteticamente no tratamento executado. A estabilidade do tecido peri-implantar neste contexto é um dos aspectos que contribui com a estética e pode sofrer influência de vários fatores, dentre os quais biótipo gengival, tipo de cirurgia (com ou sem retalho), espessura da tábua óssea, distância entre implante e parede alveolar vestibular, posicionamento do implante e preenchimento do “gap”, que serão abordados neste trabalho. Vislumbrando uma Odontologia baseada em evidências alguns artigos científicos foram revisados e aspectos que parecem interferir nas transformações peri-implantares foram pontuados. Apesar da falta de padronização entre as metodologias dos estudos consultados, o que dificulta a comparação entre os resultados e estabelecimento da superioridade entre materiais utilizados, foi possível concluir que o biótipo gengival exerce influência na estabilidade peri-implantar. Além disso, nota-se a necessidade de estudos clínicos controlados e com metodologia bem descrita à fim de facilitar as comparações dos resultados.