Search

Background Previous systematic reviews showed additional benefit of adjuvant bisphosphonates (BP) in the treatment of periodontitis. In contrast, it is unclear the effect of BP in patients with diabetes and smokers, its pooled effect when administered locally or systemically is also unknown. Objectives This study aimed to systematically review the literature about the use of BP as adjuvant to nonsurgical scaling and root planning (SRP). Methodology This study followed the PRISMA guideline. This study included randomized clinical trials that administered locally or systemically BPs as adjuvant for periodontal treatment. Five databases were used. Meta-analyses were performed, using the pooled mean differences (MD) for clinical attachment level (CAL) and probing pocket depth (PPD). Standard mean difference (SMD) was used for radiographic assessment (RADIO). Subgroup analyses were performed for locally delivered meta-analyses, considering diabetes and smoking exposure. Results Thirteen studies were included. It was showed MD of 1.52 ​mm (95%CI: 0.97–2.07) and 1.44 ​mm (95%CI: 1.08–1.79) for PPD reduction and CAL gain, respectively, for locally delivered BP. BP was not able to provide significant improvements in smokers (subgroup analysis) when considering CAL (MD: 1.37; 95%CI: −0.17–2.91) and PPD (MD: 1.35; 95%CI: −0.13–2.83). Locally delivered BP also improved significantly the RADIO assessments (SMD: 4.34; 95%CI: 2.94–5.74). MD for systemically administered BP was 0.40 ​mm (95%CI: 0.21–0.60), 0.51 ​mm (95%CI: 0.19–0.83) and 1.05 (95%CI: 0.80–1.31) for PPD, CAL and RADIO, respectively. Conclusion The administration of BP in adjunct to SRP may result in additional clinical effects.

The aim of this article was to perform a systematic review on the effectiveness of local adjuvant therapies in the treatment of aggressive periodontitis (AgP), now reported as periodontitis grade C. The authors selected randomized clinical trials of AgP patients who received local therapy as adjuvants to non-surgical periodontal with a duration of at least 90 days. Seven databases were searched up to January 2020. The gain in clinical attachment level (CAL) and reduction of probing depth (PD) were the outcomes of interest. Of the 3583 studies found, only five articles were included in the qualitative analysis. Among the substances analyzed, only 1.2 mg of simvastatin gel (SMV) (1.2 mg/0.1 ml), 1% of alendronate gel (ALN) (10 mg/ml), and 25% metronidazole gel (MTZ) (Elyzol@) showed a significant decrease in the probing depth when compared with their respective control groups. The gain CAL was shown using 1.2 mg SMV gel (1.2 mg/0.1 ml) and 1% ALN gel (10 mg/ml). Although 1.2 mg SMV gel (1.2 mg/0.1 ml), 1% ALN gel (10 mg/ml), and 25% MTZ gel (Elyzol) have shown better results, local therapies adjuvant to SRP the data found were limited. Future clinical studies with appreciable methodological quality should be conducted. Despite some benefits of local delivery therapy, up to now, it has not been possible to prove the efficacy of local therapy as an adjunct to standard treatment of AgP (periodontitis grade C).

Background Low-level laser therapy (LLLT) has been suggested to improve primary stability at the early stages of osseointegration in animal models. However, there is still scarce evidence about its influence on implant stability in humans. Purpose To assess the influence of LLLT on implant stability in implants placed in fresh extraction sockets. Material and methods A randomized controlled trial was designed according to the SPIRIT guidelines and is reported following the CONSORT. Patients were randomly allocated according to control or LLLT groups. LLLT consisted in the application of GaAlAs laser (808 nm, avg. power density: 50 mW, circular spot diameter and area: 0.71 cm/0.4cm2 ) applied in six points in contact mode with peri-implant soft tissue (1.23 minutes in each point of application; dose per point 11 J) before bone perforation and after suturing. The total dose resulted in 66 J per application moment. This LLLT protocol was applied only in the dental implant placement session. Implant stability was by ISQ at implant placement (T0 ) and the abutment selection (Ta ). Digital radiographs for T0 and Ta were used to assess the distance between the implant platform and alveolar bone crest, in millimeters. T-test and Shapiro-Wilk test were used to analyze data between groups using the implant as a unit of analysis. Results Fifty implants were placed in 44 patients. The insertion torque ranged from 15 to 60 N.cm (mean 35.64 ± 13.34). Two implants of the LLLT and one of the control groups were lost to follow-up and one implant of the control group failed to osseointegrate (4.3%). ISQ at T0 ranged from 17 to 79 (mean 59.33 ± 13.05) and from 40 to 89 (mean 66.46 SD ± 11.56) at Ta . No differences were observed when comparing the groups with ISQ difference (P = .433) or radiographical peri-implant alterations (P = .261). Conclusions LLLT did not influence implant stability in implants placed in fresh extraction sockets when assessed at healing abutment installation.

Objective This study evaluated the effect of resin composite restorations of non-carious cervical lesions (NCCLs) on the occurrence/progression of gingival recession (GR), considering different tooth isolation techniques. Methods A randomized controlled split-mouth and blinded trial was carried out. Patients (n = 38) with at least two NCCLs were included. Before the cervical restoration placement, the NCCLs (181 teeth) were randomly allocated into two treatment groups according to the tooth isolation techniques: cotton roll or rubber dam. Experienced, trained, blinded, and calibrated examiners performed periodontal evaluations at baseline and 5-year follow-up, using a periodontal probe. Restorations were assessed with the FDI criteria. Thirty-two patients (154 teeth) were evaluated at 5 years. The occurrence/progression of GR between baseline and follow-up was considered the primary outcome. The relative risk (RR) and 95 % confidence interval (95 %CI) were calculated by Poisson regression (α Results After 5 year, 31 teeth (13.6 %) presented occurrence/progression of GR. In the multivariate analyses, the occurrence/progression of GR was associated with the use of rubber dam isolation (RR; 95 %CI: 2.65; 1.01–7.00) and a lack of marginal adaptation of the restoration (RR; 95 %CI: 10.98; 2.31–52.30). Toothbrush stiffness, use of abrasive dentifrice, tooth type, and the presence of biofilm or gingivitis did not present a statistically significant higher risk for occurrence/progression of GR. Conclusion The use of rubber dam isolation associated with retraction clamp and the lack of a proper marginal adaptation of the composite restorations are risk indicators for the occurrence/progression of GR in individuals who received a restoration for an NCCL. Clinical significance Isolation with a rubber dam and dental clamps may promote GR in sites with restored NCCLs. Moreover, clinical examinations for lack of marginal adaptations of the restorations may be included in a clinical setting.

Made available in DSpace on 2020-12-10T20:04:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-07-09 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) University of Western Sao Paulo Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Objective The purpose of this study was to evaluate influence of topical sodium alendronate (ALN), photodynamic therapy (aPDT), or a combination thereof as adjuvant to scaling and root planing (SRP) in the treatment of experimental periodontitis in rats. Background Therapeutic protocols to control periodontitis progression that aim to equalize bacterial action and load with tissue immune response are well addressed in current scientific research. Methods Experimental periodontitis was induced in 96 rats with a ligature around the mandibular left first molar. After 7 days, ligature was removed and animals were treated according to the following experimental groups (n = 8): control-SRP plus saline solution; ALN-SRP plus ALN; aPDT-SRP plus methylene blue irrigation, followed by low-level laser therapy (LLLT); and ALN/aPDT-SRP plus ALN and methylene blue irrigation followed by LLLT. The animals were euthanized at 7, 15, and 30 days after treatments. Collagen maturation (picrosirius red staining) and immunohistochemical analyses (TRAP, RANKL and osteoprotegerin [OPG]) were performed. Data were submitted to statistical analysis (P < .05). Results At 7 days, group ALN presented a significantly higher number of TRAP-positive cells and percentage of immature collagen fibers than group ALN/aPDT, while group ALN/aPDT presented a significantly higher percentage of mature collagen fibers than group ALN. At 30 days, group ALN presented significantly lower percentage of immature collagen fibers and higher percentage of mature collagen fibers than control. Conclusion It can be concluded that topical use of ALN coadjutant to SRP, alone or combined with aPDT, enhanced collagen maturation and reduced osteoclastogenesis during the healing of experimental periodontitis. Univ Western Sao Paulo, Dent Sch Presidente Prudente, Grad Program Dent GPD Masters Degree, Presidente Prudente, Brazil Univ Fed Pelotas, Grad Program Dent, Pelotas, RS, Brazil Univ Estadual Paulista, Dent Sch Aracatuba, Dept Basic Sci, Aracatuba, Brazil Univ Estadual Paulista, Dent Sch Aracatuba, Dept Basic Sci, Aracatuba, Brazil FAPESP: 2016/04163-0 University of Western Sao Paulo: 3080 University of Western Sao Paulo: 3771

Made available in DSpace on 2020-12-10T19:55:11Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-02-01 FAPERGS (the Research Support Foundation of Rio Grande do Sul) Objectives: To assess whether subgingival irrigation with 0.12 % or 0.2 % chlorhexidine (CHX) immediately after scaling and root planing (SRP) enhances periodontal tissue repair compared to irrigation with saline solution (control). Materials and methods: Periodontitis was ligature-induced in rat molars for 7 days. Animals were distributed into three groups: 1) SRP group, SRP and irrigation with 0.9 % saline (n = 30); 2) SRP + 0.12 % CHX group, SRP and irrigation with 0.12 % CHX (n = 30); 3) SRP + 0.2 % CHX group, SRP and irrigation with 0.2 % CHX (n = 30). Animals were killed at 7, 15, and 30 days after treatment. Furcation region was histometrically analyzed to determine the bone area. Immunohistochemical reactions were performed for receptor activator of nuclear factor-kB ligand (RANKL), osteoprotegerin (OPG) and tartrate-resistant acid phosphatase (TRAP). Results: Both chlorhexidine groups presented less inflammation and improved tissue repair along the entire experiment when compared with the SRP group. In the histometric analysis at 7, 15 and 30 days, SRP group (4.58 +/- 2.51 mm2, 4.21 +/- 1.25 mm2, 3.49 +/- 1.48 mm2), showed statistically less bone area than groups SRP + 0.12 % CHX (1.86 +/- 1.11 mm(2) ; 0.79 +/- 0.27 mm(2) ; 0.34 +/- 0.14 mm(2)) and SRP + 0.2 % CHX (1.14 +/- 0.51 mm(2); 0.98 +/- 0.40 mm(2) ; 0.41 +/- 0.21 mm(2)). Both chlorhexidine concentrations modulated the expression of TRAP, RANKL and OPG. Conclusions: Subgingival irrigation with chlorhexidine contributed for a quicker shift from a proinflammatory destructive profile to healing of periodontal tissues. Univ Fed Pelotas, Sch Dent, Grad Program Dent, Pelotas, RS, Brazil Univ Western Sao Paulo, Dent Sch Presidente Prudente, Grad Program Dent GPD Masters Degree, Presidente Prudente, Brazil Sao Paulo State Univ, Dent Sch Aracatuba, Dept Basic Sci, Sao Paulo, Brazil Aarhus Univ, Dept Dent & Oral Hlth, Sect Periodontol, Aarhus, Denmark Sao Paulo State Univ, Dent Sch Aracatuba, Dept Basic Sci, Sao Paulo, Brazil

Traumatic dental injuries in primary dentition present risk of sequelae in the permanent dentition. In this case report, we describe the management and long term follow-up of sequelae affecting permanent central incisor due to prior intrusive luxation and subluxation of the corresponding primary tooth. A 5-year-boy was referred for treatment, with history of fall by the age of 21 months, which caused subluxation of the primary maxillary right and left central incisors, and intrusion of the maxillary right lateral incisor. Radiographic and clinical monitoring was regularly performed. Hypoplasia and crown dilaceration of the permanent maxillary right central incisor was detected, as well as an enamel bridge between the central and lateral right incisors was diagnosed by cone bean tomography. Gingevectomy followed by the breaking of the enamel junction between the crowns of lateral and central incisors and indirect facet in composite resin were used to treat the sequelae. A precise diagnosis, involving a multidisciplinary team, contributed to the success of treatment. Key words:Case reports, follow-up studies, pediatric dentistry, tooth, deciduos, complications.

Objetivo: Avaliar o efeito da irrigação subgengival com clorexidina a 0,12% ou 0,2% como adjuvantes à raspagem e alisamento radicular (RAR) para tratamento de periodontite experimental (PE).Metodologia: A PE foi induzida em ratos e tratada em grupos analisados aos 7, 15 ou 30 dias: A - RAR e irrigação subgengival com solução salina, B - RAR e irrigação com clorexidina 0,12% e C - RAR e irrigação com clorexidina 0,2%. Três espécimes de cada subgrupo foram submetidos à reações imunoistoquímicas para detecção de tartarato-resistente ácido fosfatase (TRAP), osteoprotegerina (OPG) e ligante do receptor do fator nuclear kapa B (RANKL). Células imunomarcadas foram analisados qualitativamente através de escores. Resultados: TRAP - Os animais dos grupos A (7,15 e 30 dias) e C (7 e 15 dias) apresentaram imunomarcação discreta a moderada e os animais dos Grupos B (7, 15 e 30 dias) e C (30 dias) apresentaram imunomarcação intensa. OPG - os animais dos grupos A e C (7, 15 e 30 dias) e os animais do Grupo B (7 e 15 dias) apresentaram imunomarcação de intensidade discreta a moderada e os animais do Grupo B (30 dias) apresentaram imunomarcação intensa. RANKL - os animais dos grupos A (7, 15 e 30 dias), B (7, 15 e 30 dias) e C (7 e 15 dias) apresentaram imunomarcação moderada a intensa e os animais do Grupo C (30 dias) apresentaramimunomarcação moderada.Diferentes concentrações de clorexidina para irrigação subgengival após raspagem e alisamento radicular podem influenciar no processo de reabsorção óssea durante o tratamento da periodontite.

Este estudo avaliou os efeitos da irrigação subgengival utilizando clorexidina (RAR) 0,12% e 0,2% como adjuvante ao tratamento mecânico da periodontite induzida por ligadura de algodão em ratos. A periodontite foi induzida por ligadura de algodão amarrada subgengivalmente ao redor do primeiro molar inferior esquerdo em noventa ratos. A ligadura foi removida após sete dias e os animais foram distribuídos nos grupos: 1) grupo RAR, raspagem e alisamento radicular (RAR) e irrigação subgengival com solução salina a 0,9% (n = 30); 2) grupo RAR + 0,12% CHX, RAR e irrigação com CHX a 0,12% (n = 30); 3) RAR + grupo CHX a 0,2%, RAR e irrigação com CHX a 0,2% (n = 30). Dez animais de cada grupo foram sacrificados aos 7, 15 e 30 dias após o tratamento. A região de furca foi analisada histometricamente para determinar a área de perda óssea. Os dados foram analisados com a análise de variância unidirecional de Kruskal-Wallis (ANOVA) seguida pelo teste de Dunn (p 0,05) do que os grupos RAR + 0,12% CHX (1,86 ± 1,11 mm2, 0,79 ± 0,27 mm2, 0,34 ± 0,14 mm2) e RAR + 0,2% CHX (1,14 ± 0,51 mm2, 0,98 ± 0,40 mm2, 0,41 ± 0,21 mm2), respectivamente. A irrigação subgengival com clorexidina parece apresentar propriedades antiinflamatórias com características histoprotetoras durante o tratamento da periodontite.

Introduction: The coverage of denuded roots represents one of the challenges of periodontal treatment. Among the several techniques for this purpose is the laterally positioned flap, which has undergone some modifications since its first reports and is currently combined with other techniques such as subepithelial connective tissue graft. Objective: To report a case of a 41-year-old female patient who presented Miller class I gingival recession at labial surface of tooth #43. Case report: The main symptom of the patient was dentin hypersensitivity. Clinical and radiographic exams were performed and gingival inflammation due to the presence of bacterial plaque was diagnosed as the main cause of root recession. After basic periodontal treatment, surgery for root coverage was performed. Since the area adjacent to the recession showed a good amount of attached gingiva and no interproximal bone loss, the surgical technique of choice was a laterally positioned flap associated with a subepithelial connective tissue graft. Conclusion: Postoperative assessment showed complete root coverage, an increased keratinized gingival band, absence of dentin hypersensitivity, and an excellent esthetic outcome.