Enilson A Sallum

Publications of Enilson A Sallum

• Diabetes Mellitus May Increase Bone Loss After Occlusal Trauma and Experimental Periodontitis.

  Authors: Claudia Kelly de Oliveira Diniz, Mônica Grazieli Corrêa, Marcio Z Casati, Francisco H Nociti, Karina G Ruiz, Glaucia M Brosi Ambrosano, Enilson A Sallum

  Journal of periodontology. 02/2012;

  Background: Diabetes Mellitus (DM) involves metabolic changes that can negatively influence periodontal tissues resulting in more prevalent and severe periodontitis and impaired bone formation.Background: Diabetes Mellitus (DM) involves metabolic changes that can negatively influence periodontal tissues resulting in more prevalent and severe periodontitis and impaired bone formation. Occlusal trauma (OT) is an injury of the supportive periodontium that results in bone loss. It can be hypothesized that DM would increase bone loss after OT, mainly when associated with periodontitis. Thus, the aim of the present study was to evaluate the influence of DM on bone response in the furcation area of teeth subjected to OT in the presence or absence of experimental periodontitis (EP) in the rat model. Material and Methods: Thirty-two Wistar rats were assigned to four groups: Group 1 (G1), DM+OT+EP (n=08); Group 2 (G2), DM+OT (n=08); Group 3 (G3), OT+EP (n=08); Group 4 (G4), OT (n=08). The animals of G1 and G2 received a single intraperitoneal injection of streptozotocin (STZ). After ten days, the animals of G1 and G3 were subjected to EP by ligature placement. Fifteen days after the start of EP, OT was induced by the creation of a premature contact. The animals were euthanized 35 days after DM induction. Results: DM enhanced bone loss in the presence of OT combined with EP, but did not increase bone loss in teeth subjected to OT alone. EP caused greater bone loss when associated with OT. Conclusion: Within the limits of this animal study, it can be concluded that DM enhances bone loss in the presence of occlusal trauma associated to EP.

• Impact of supragingival therapy on subgingival microbial profile in smokers versus non-smokers with severe chronic periodontitis.

  Authors: Tatiana Meulman, Renato C V Casarin, Daiane C Peruzzo, Ana Paula Giorgetti, André Barbagallo, Márcio Z Casati, Enilson A Sallum, Reginaldo B Gonçalves, Francisco H Nociti

  Journal of oral microbiology. 01/2012; 4.

  The aim of this study was to assess subgingival microbiological changes in smokers versus non-smokers presenting severe chronic periodontitis after supragingival periodontal therapy (ST). Non-smokersThe aim of this study was to assess subgingival microbiological changes in smokers versus non-smokers presenting severe chronic periodontitis after supragingival periodontal therapy (ST). Non-smokers (n=10) and smokers (n=10) presenting at least nine teeth with probing pocket depth (PPD) (≥5 mm), bleeding on probing (BoP), and no history of periodontal treatment in the last 6 months were selected. Clinical parameters assessed were plaque index (PI), BoP, PPD, relative gingival margin position (rGMP) and relative clinical attachment level (rCAL). Subgingival biofilm was collected before and 21 days after ST. DNA was extracted and the 16S rRNA gene was amplified with the universal primer pair, 27F and 1492R. Amplified genes were cloned, sequenced, and identified by comparison with known 16S rRNA sequences. Statistical analysis was performed by Student's t and Chi-Square tests (α=5%). Clinically, ST promoted a significant reduction in PI and PPD, and gain of rCAL for both groups, with no significant intergroup difference. Microbiologically, at baseline, data analysis demonstrated that smokers harbored a higher proportion of Porphyromonas endodontalis, Bacteroidetes sp., Fusobacterium sp. and Tannerella forsythia and a lower number of cultivated phylotypes (p<0.05). Furthermore, non-smokers featured significant reductions in key phylotypes associated with periodontitis, whereas smokers presented more modest changes. Within the limits of the present study, ST promoted comparable clinical improvements in smokers and non-smokers with severe chronic periodontitis. However, in smokers, ST only slightly affected the subgingival biofilm biodiversity, as compared with non-smokers.

• Correction of Hypophosphatasia (Hpp) Associated Mineralization Deficiencies In vitro by Phosphate/Pyrophosphate Modulation in Periodontal Ligament Cells.

  Authors: Thaisângela L Rodrigues, Brian L Foster, Karina G Silverio, Luciane Martins, Marcio Z Casati, Enilson A Sallum, Martha J Somerman, Francisco H Nociti

  Journal of periodontology. 10/2011;

  Background: Mutations in the Alpl gene in hypophosphatasia (HPP) reduce the function of tissue nonspecific alkaline phosphatase (TNAP), resulting in increased pyrophosphate (PP(i)) and a severeBackground: Mutations in the Alpl gene in hypophosphatasia (HPP) reduce the function of tissue nonspecific alkaline phosphatase (TNAP), resulting in increased pyrophosphate (PP(i)) and a severe deficiency in acellular cementum. We hypothesized that exogenous phosphate (P(i)) would rescue the in vitro mineralization capacity of periodontal ligament (PDL) cells harvested from HPP-diagnosed subjects, by correcting P(i)/PP(i) ratio and modulating expression of genes involved with P(i)/PP(i) metabolism. Methods: Ex vivo and in vitro analyses were employed to identify mechanisms involved in HPP-associated PDL/tooth root deficiencies. Constitutive expression of PP(i)-associated genes was contrasted in PDL versus pulp tissues obtained from healthy subjects. Primary PDL cell cultures from HPP subjects (monozygotic twin males) were established to assay alkaline phosphatase activity (ALP), in vitro mineralization, and gene expression. Exogenous P(i) was provided to correct P(i)/PP(i) ratio. Results: PDL tissues obtained from healthy individuals featured higher basal expression of key PP(i) regulators, genes Alpl, progressive ankylosis protein (Ankh) and ectonucleotide pyrophosphatase/phosphodiesterase 1 (Enpp1), versus paired pulp tissues. A novel Alpl mutation was identified in the twin HPP subjects enrolled in this study. Compared to controls, HPP-PDL cells exhibited significantly reduced ALP and mineralizing capacity, which were rescued by addition of 1mM P(i). Dysregulated expression of PP(i) regulatory genes Alpl, Ankh, and Enpp1 was also corrected by adding P(i), though other matrix markers evaluated in our study remained down-regulated. Conclusions: These findings underscore the importance of controlling P(i)/PP(i) ratio toward development of a functional periodontal apparatus, and support P(i)/PP(i) imbalance as the etiology of HPP-associated cementum defects.

• Surgical Microscope May Enhance Root Coverage With Subepithelial Connective Tissue Graft: A Randomized-Controlled Clinical Trial.

  Authors: Sandro Bittencourt, Erica Del Peloso Ribeiro, Enilson A Sallum, Francisco H Nociti Júnior, Márcio Zaffalon Casati

  Journal of periodontology. 08/2011;

  Background: 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 rootBackground: 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. Methods: 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: 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 analogue visual scale and questionnaire. Patient satisfaction was also evaluated with a questionnaire. Descriptive statistics were expressed as mean ± standard deviation (SD). Repeated measures ANOVA 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. Results: The average percentages of root coverage for test and control treatments, after 12 months, were 98.0% and 88.3%, respectively (p<0.05). 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 with control group (p<0.05). In the test group, all patients were satisfied with the esthetics obtained, and 19 patients (79.1%) in the control group. For postoperative morbidity, 14 patients in each of the two treatment groups did not use analgesics for pain control. Conclusion: 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.

• Clinical and patient-centered outcomes after minimally invasive non-surgical or surgical approaches for the treatment of intrabony defects: a randomized clinical trial.

  Authors: Fernanda V Ribeiro, Renato C V Casarin, Maria A G Palma, Francisco H N Júnior, Enilson A Sallum, Márcio Z Casati

  Journal of periodontology. 02/2011; 82(9):1256-66.

  The present study aims to compare the performance of minimally invasive non-surgical and surgical approaches for the therapy of intrabony defects. Twenty-nine patients who presented with intrabonyThe present study aims to compare the performance of minimally invasive non-surgical and surgical approaches for the therapy of intrabony defects. Twenty-nine patients who presented with intrabony defects were randomly assigned to: 1) a minimally invasive non-surgical technique (MINST) group, or 2) minimally invasive surgical technique (MIST) group. The chair time of each therapeutic procedure was calculated. The probing depth (PD), position of the gingival margin (PGM) and relative clinical attachment level (RCAL) were evaluated at 3 and 6 months after treatments. The patient perception of discomfort/pain experienced during and after therapy and patient satisfaction regarding treatments were also evaluated. Significant PD reductions, RCAL gains, and no changes in the PGM were obtained at 3 and 6 months in MINST and MIST groups (P <0.05). No differences were observed between groups at any time points (P >0.05). Patient-oriented outcomes did not demonstrate differences between therapeutic approaches (P >0.05). Significant higher chair times were required in the MIST group than in the MINST group (P <0.05). Minimally invasive non-surgical and surgical approaches were successfully used for the treatment of intrabony defects and achieved periodontal health in association with negligible morbidity and suitable patient satisfaction. However, non-surgical therapeutic modality presented an advantage in terms of a reduction of treatment chair time.

• The impact of cigarette smoke inhalation on the outcome of enamel matrix derivative treatment in rats: histometric analysis.

  Authors: Mônica G Corrêa, Mirella L Gomes Campos, Bruno Braga Benatti, Marcelo Rocha Marques, Marcio Z Casati, Francisco H Nociti, Enilson A Sallum

  Journal of periodontology. 12/2010; 81(12):1820-8.

  Tobacco use is the most significant risk factor of periodontal disease. Clinical evidence has demonstrated that tobacco may negatively influence the results after surgical and non-surgicalTobacco use is the most significant risk factor of periodontal disease. Clinical evidence has demonstrated that tobacco may negatively influence the results after surgical and non-surgical periodontal therapy. Enamel matrix derivative (EMD) have been used in periodontal regenerative procedures resulting in improvement of clinical parameters. The effect of EMD in the presence of tobacco compounds is unclear. Thus, the aim of the present study is to evaluate the impact of cigarette smoke inhalation (CSI) on the results of EMD treatment. Twenty-two Wistar rats were assigned to two groups: Group 1, CSI (n = 11); Group 2, non-exposed (n = 11). Thirty days after initiation of CSI, fenestration defects were created at the buccal aspect of the first mandibular molar. The study followed a split-mouth design. After the surgeries the defects were randomly assigned to two subgroups: non-treated control and treated with EMD. The animals were sacrificed 21 days later and the percentage of defect fill, density of newly formed bone, and new cementum formation were histometrically assessed. The number of osteoclasts was determined by tartrate-resistant acid phosphatase. CSI was associated with less bone density compared to the non-exposed group. EMD provided an increased defect fill and new cementum formation in both groups. The number of tartrate-resistant acid phosphatase-positive osteoclasts was significantly higher in the CSI non-treated control group compared to the non-treated control of the non-exposed animals. EMD may provide increased defect fill and cementum formation in the presence or absence of CSI. However, tobacco smoke produced a detrimental effect on bone healing when density of newly formed bone was considered.

• The role of enamel matrix derivative protein in minimally invasive surgery in treating intrabony defects in single-rooted teeth: a randomized clinical trial.

  Authors: Fernanda V Ribeiro, Renato C V Casarin, Francisco H N Júnior, Enilson A Sallum, Márcio Z Casati

  Journal of periodontology. 11/2010; 82(4):522-32.

  This study investigates the impact of enamel matrix derivative (EMD) proteins on the outcome of a minimally invasive surgical technique (MIST) for the treatment of intrabony defects. Thirty patientsThis study investigates the impact of enamel matrix derivative (EMD) proteins on the outcome of a minimally invasive surgical technique (MIST) for the treatment of intrabony defects. Thirty patients who presented with intrabony defects were randomly assigned to treatment with: 1) MIST plus EMD or 2) MIST alone. Probing depth (PD), position of the gingival margin (PGM), and relative clinical attachment level (RCAL) were evaluated at 3 and 6 months after treatment. Radiographs and markers in gingival crevicular fluid associated with periodontal regeneration were also evaluated. Significant PD reductions, RCAL gains, and no changes in PGM were obtained at 3 and 6 months in both groups. Clinical and radiographic evaluations and levels of mediators of wound healing did not present differences between therapies at any time. The use of EMD did not provide superior benefits on the outcome of the minimally invasive surgical approach for the treatment of intrabony defects.

• Periosteum-derived cells as an alternative to bone marrow cells for bone tissue engineering around dental implants. A histomorphometric study in beagle dogs.

  Authors: Fernanda V Ribeiro, Fabricia F Suaid, Karina G S Ruiz, Cristiane R Salmon, Telma Paparotto, Francisco H Nociti, Enilson A Sallum, Márcio Z Casati

  Journal of periodontology. 06/2010; 81(6):907-16.

  The aim of this study is to investigate the potential use of periosteum-derived cells (PCs) for tissue engineering in peri-implant defects. Bone marrow cells (BMCs) and PCs were harvested from sevenThe aim of this study is to investigate the potential use of periosteum-derived cells (PCs) for tissue engineering in peri-implant defects. Bone marrow cells (BMCs) and PCs were harvested from seven adult beagle dogs, cultured in vitro, and phenotypically characterized with regard to their osteogenic properties. The animals were then subjected to teeth extraction, and 3 months later, two implant sites were drilled, bone dehiscences created, and dental implants placed. Dehiscences were randomly assigned to one of two groups: PCs (PCs + carrier) and BMCs (BMCs + carrier). After 3 months, the animals were sacrificed and the implants with adjacent hard tissues were processed for undecalcified sections. Bone-to-implant contact, bone fill within the limits of implant threads, and new bone area in a zone lateral to the implant were histometrically obtained. In vitro, phenotypic characterization demonstrated that both cell populations presented osteogenic potential, as identified by the mineral nodule formation and the expression of bone markers. Histometrically, an intergroup analysis showed that both cell-treated defects had similar bone fill within the limits of implant threads and bone-to-implant contact (P >0.05), and although a trend toward higher new bone area values was found for the PC group, there was no significant difference between the experimental groups (P >0.05). Periosteal and bone marrow cells presented a similar potential for bone reconstruction. As such, periosteum may be considered as an alternative source of osteogenic cells in implant dentistry.

• Full-mouth ultrasonic debridement associated with amoxicillin and metronidazole in the treatment of severe chronic periodontitis.

  Authors: Erica Del Peloso Ribeiro, Sandro Bittencourt, Iriana Carla Junqueira Zanin, Glaucia Maria Bovi Ambrosano, Enilson A Sallum, Francisco H Nociti, Reginaldo Bruno Gonçalves, Márcio Zaffalon Casati

  Journal of periodontology. 08/2009; 80(8):1254-64.

  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-mouthBackground: 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 reaction (PCR) was used for quantitative analysis of Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans), Porphyromonas gingivalis, and Tannerella forsythia (previously T. forsythensis). The enzyme-linked immunosorbent assay (ELISA) technique permitted the detection of prostaglandin E(2,) interleukin-1beta, 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 <0.05). Data also showed RAL gain >/=2 mm at 43.52% of sites in control patients compared to 58.03% of sites in test patients (P <0.05). However, both groups had similar mean RAL gain (1.68 and 1.88 mm for the control and test groups, respectively). Real-time PCR and ELISA failed to identify significant differences between the groups. Conclusions: Both treatments resulted in significant clinical improvements; however, there was a slight, but significantly greater, improvement in BOP and the percentage of sites with PD >/=5 mm exhibiting RAL gain >/=2 mm in the test group. Nevertheless, no improvement in the microbiologic or immunologic outcome was observed with the adjunctive use of systemic amoxicillin and metronidazole.

• Semilunar coronally positioned flap or subepithelial connective tissue graft for the treatment of gingival recession: a 30-month follow-up study.

  Authors: Sandro Bittencourt, Erica Del Peloso Ribeiro, Enilson A Sallum, Antônio W Sallum, Francisco H Nociti, Márcio Zaffalon Casati

  Journal of periodontology. 08/2009; 80(7):1076-82.

  Background: 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 flapBackground: 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. Methods: Seventeen patients with bilateral Miller Class I gingival recessions (</=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. Results: 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 (P >0.05); complete root coverage was observed in 58.82% and 88.24% of patients, respectively. SCTG maintained a statistically significant increase in TKT (P <0.05) 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. Conclusions: 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.

• Radiographic characteristics of furcation involvements in mandibular molars as prognostic indicators of healing after nonsurgical periodontal therapy.

  Authors: Hugo Felipe Do Vale, Erica Del Peloso Ribeiro, Sandro Bittencourt, Francisco H Nociti, Enilson A Sallum, Márcio Zaffalon Casati

  Journal of the American Dental Association (1939). 05/2009; 140(4):434-40.

  BACKGROUND: The authors conducted a study to evaluate the radiographic characteristics of Class II mandibular furcation involvements as prognostic indicators of healing after nonsurgical periodontalBACKGROUND: 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.

• Histometric evaluation of bone around titanium implants with different surface treatments in rats exposed to cigarette smoke inhalation.

  Authors: Mônica G Correa, Mirella L Gomes Campos, João B César-Neto, Marcio Z Casati, Francisco H Nociti, Enilson A Sallum

  Clinical oral implants research. 03/2009;

  Abstract Objectives: There is a lack of histological information about the influence of cigarette smoke on bone around surface-treated implants. The aim of the present study was to test the influenceAbstract Objectives: There is a lack of histological information about the influence of cigarette smoke on bone around surface-treated implants. The aim of the present study was to test the influence of titanium surface treatment on osseointegration in animals that were exposed to intermittent cigarette smoke inhalation. Material and methods: Twenty-two male Wistar rats were used. One tibia, chosen at random, received a machined titanium implant (MI) while the other received an aluminum oxide-blasted surface implant (ABI). The animals were randomly assigned to one of the following groups: Group 1 - control (n=11) and Group 2 - intermittent cigarette smoke inhalation (n=11). Sixty days after surgery, the animals were sacrificed. The degree of bone-to-implant contact (BIC), bone filling (BF) within the limits of the threads of the implants and bone density (proportion of mineralized bone in a 500-mum-wide zone lateral to the implant - BD) were measured in the cortical (zone A) and cancellous bone (zone B) areas. Results: Data analysis showed significant differences when comparing the groups and implant surfaces in both zones for BIC (two-way ANOVA -P<0.05). The two groups presented higher BIC mean values for ABI, when compared with MI (P<0.05). In group 2, cigarette smoke inhalation negatively affected BF in both zones (P<0.05). Group 2 presented a significantly decreased BD in both zones (P<0.05). No statistically significant differences were observed between surfaces in any of the groups for BD. Conclusion: Within the limits of the present study, it can be concluded that the aluminum oxide blast surface treatment may increase the degree of BIC but cannot overcome the detrimental effect of tobacco smoke on bone around titanium implants. To cite this article: Correa MG, Campos MLG, César-Neto JB, Casati MZ, Nociti FH, Sallum EA. Histometric evaluation of bone around titanium implants with different surface treatments in rats exposed to cigarette smoke inhalation. Clin. Oral Impl. Res. xx, 2009; 000-000. doi: 10.1111/j.1600-0501.2008.01695.x.

• Periodontal debridement as a therapeutic approach for severe chronic periodontitis: a clinical, microbiological and immunological study.

  Authors: Erica Del Peloso Ribeiro, Sandro Bittencourt, Enilson A Sallum, Francisco H Nociti, Reginaldo Bruno Gonçalves, Márcio Zaffalon Casati

  Journal of clinical periodontology. 09/2008; 35(9):789-98.

  To clinically, microbiologically and immunologically characterize periodontal debridement as a therapeutic approach for severe chronic periodontitis. Twenty-five patients presenting at least eightTo clinically, microbiologically and immunologically characterize periodontal debridement as a therapeutic approach for severe chronic periodontitis. 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. 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. 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.

• Chronic stress may modulate periodontal disease: a study in rats.

  Authors: Daiane C Peruzzo, Bruno B Benatti, Isabela B Antunes, Monica L Andersen, Enilson A Sallum, Márcio Z Casati, Francisco H Nociti, Getúlio R Nogueira-Filho

  Journal of periodontology. 05/2008; 79(4):697-704.

  BACKGROUND: The present study aimed to evaluate whether chronic stress (CS) affects ligature-induced periodontal disease and to investigate the impact of CS on the mRNA levels of interleukinBACKGROUND: The present study aimed to evaluate whether chronic stress (CS) affects ligature-induced periodontal disease and to investigate the impact of CS on the mRNA levels of interleukin (IL)-1beta, -1 receptor antagonist, -6, and -10, interferon-gamma (IFN-gamma), receptor activator of nuclear factor-kappa B ligand (RANKL), and osteoprotegerin in the gingival tissues of rats. METHODS: Sixty male Wistar rats were assigned randomly to three groups: G1 (control; non-ligated sites), G2 (periodontal disease), and G3 (periodontal disease associated with restraint stress for 12 hours/day for the entire study). After 30 days, all animals were sacrificed by decapitation. Blood samples were taken, and the concentrations of corticosterone and catecholamines were measured as biomarkers of CS. Marginal tissues around ligated and non-ligated teeth were harvested, and gene expression was assessed by quantitative polymerase chain reaction. Moreover, the area of bone loss (ABL) was determined histometrically. RESULTS: Data analysis showed that CS increased serum levels of stress biomarkers (P <0.05), ligature placement resulted in a significant ABL compared to non-ligated sites, CS significantly increased the amount of ABL in inflamed sites (P <0.001), and CS significantly increased mRNA levels of proinflammatory (IL-1beta and -6 and IFN-gamma) and anti-inflammatory (IL-10) cytokines and proresorptive factor (RANKL) in ligated sites (P <0.05). CONCLUSION: CS significantly increased bone loss resulting from ligature-induced periodontitis by a local increase in proinflammatory and proresorptive factors.

• Root coverage outcome may be affected by heavy smoking: a 2-year follow-up study.

  Authors: Denise C Andia, Angela G Martins, Márcio Z Casati, Enilson A Sallum, Francisco H Nociti

  Journal of periodontology. 04/2008; 79(4):647-53.

  BACKGROUND: Although subepithelial connective tissue graft (CTG) has been reported to be a predictable procedure for root coverage, the impact of smoking on the long-term outcome of periodontalBACKGROUND: Although subepithelial connective tissue graft (CTG) has been reported to be a predictable procedure for root coverage, the impact of smoking on the long-term outcome of periodontal plastic surgery is unclear. Hence, the aim of this study was to evaluate the effect of smoking, on a long-term basis, on the stability of gingival tissue following CTG treatment of gingival recession. METHODS: Twenty-two defects were treated by CTG in canine and premolar Miller Class I and II gingival recessions (11 smokers and 11 non-smokers). The following clinical measurements were obtained at baseline and at 1, 2, 3, 4, 6, 12, 18, and 24 months after surgery: plaque and gingival indexes, extension of gingival recession (GR), probing depth (PD), clinical attachment level (CAL), and gingival thickness. Individuals smoking > or =20 cigarettes/day for > or =5 years were considered smokers. RESULTS: Data analysis demonstrated that both groups presented similar plaque and gingival indexes (P >0.05), and an intragroup analysis showed that CTG was able to promote root coverage and increase gingival thickness in both groups over time (P <0.05). However, at 24 months postoperatively, statistical analysis showed that smokers presented poorer outcomes with regard to PD, GR, and CAL (P <0.05); in addition, a more satisfactory stabilization of the gingival tissue was found in the non-smoker group. CONCLUSION: Smoking may represent a challenge to root coverage outcome for CTG because smoking significantly affected the stability of gingival tissue over time.

• Root cementum may modulate gene expression during periodontal regeneration: a preliminary study in humans.

  Authors: Patricia F Gonçalves, Liana L Lima, Enilson A Sallum, Márcio Z Casati, Francisco H Nociti

  Journal of periodontology. 02/2008; 79(2):323-31.

  BACKGROUND: Previous data demonstrated that root cementum may affect periodontal regeneration. As such, this study aimed to explore further possible mechanisms involved in this process byBACKGROUND: Previous data demonstrated that root cementum may affect periodontal regeneration. As such, this study aimed to explore further possible mechanisms involved in this process by investigating in humans whether root cementum modulates gene expression in the regenerating tissue formed under membrane-protected intrabony defects. METHODS: Thirty subjects with deep intrabony defects (> or =5 mm; 2- or 3-wall) were selected and assigned to the control or test group. The control group received scaling and root planing with the removal of granulation tissue and root cementum; the test group underwent removal of granulation tissue and soft microbial deposits by cleaning the root surface with a microbrush and saline solution, aiming at cementum preservation. Guided tissue regeneration (GTR) was applied to both groups. Twenty-one days later, the newly formed tissue under the membrane was assessed for the expression of the following genes: alkaline phosphatase (ALP), osteopontin (OPN), osteocalcin (OCN), platelet-derived growth factor-alpha (PDGFA), bone sialoprotein (BSP), and basic fibroblast growth factor (bFGF). RESULTS: Data analysis demonstrated that mRNA levels for PDGFA, BSP, and bFGF were higher in the sites where root cementum was kept in place compared to the sites where root cementum was removed completely as part of the periodontal therapy (P <0.05); in contrast, OCN levels were lower (P <0.05). No difference for ALP or OPN was observed between the control and test groups (P >0.05). CONCLUSION: Root cementum may modulate the expression of growth and mineral-associated factors during periodontal regeneration.

• A systematic review of stress and psychological factors as possible risk factors for periodontal disease.

  Authors: Daiane C Peruzzo, Bruno B Benatti, Glaucia M B Ambrosano, Getúlio R Nogueira-Filho, Enilson A Sallum, Márcio Z Casati, Francisco H Nociti

  Journal of periodontology. 09/2007; 78(8):1491-504.

  BACKGROUND: Clinical observations and epidemiologic studies suggest that some negative life events and psychological factors may contribute to an increased susceptibility to periodontal disease. TheBACKGROUND: Clinical observations and epidemiologic studies suggest that some negative life events and psychological factors may contribute to an increased susceptibility to periodontal disease. The aim of the present study was to systematically review the evidence from case-control studies, cross-sectional studies, and prospective clinical trials reporting on the influence of stress and psychological factors on periodontal disease. The focused question addressed in this systematic review was whether the scientific evidence is enough to consider stress and psychological factors as risk factors for periodontal disease. METHODS: A literature search was conducted using two databases (MEDLINE and the Cochrane Oral Health Group specialist trials register) in addition to searching reference lists of original and review articles. The search strategy used was the combination of the terms: "stress," "periodontal disease," and "psychosocial disorders." Studies were selected if they were published in dental journals between January 1, 1990 and April 1, 2006; only human studies and studies with adults and middle-aged subjects were included. Suitable variables included control for the potential effect of confounding factors, adequate criteria to define periodontal disease, adequate criteria for establishing stress, and methodologic quality. Only English-language articles were considered, and unpublished data were not sought. Two reviewers independently extracted information regarding quality and study characteristics in duplicate. The studies were assessed regarding their methodologic characteristics, statistical analysis, characteristics of the periodontal outcome measures, and psychological measurements. RESULTS: Of the 58 articles identified in the search, 10 were excluded because they were reviews and 34 did not comply with the selection criteria. Fourteen articles (seven case-control studies, six cross-sectional studies, and one prospective clinical trial) were included in the analysis; their quality and main study characteristics were assessed according to the criteria preestablished in the protocol of the study. With regard to the results of the studies, 57.1% found a positive outcome between psychosocial factors/stress and periodontal disease, 28.5% observed a positive outcome for some characteristics and a negative outcome for others, and 14.2% found a negative outcome. CONCLUSIONS: Within the limitations of this systematic review, the majority of studies showed a positive relationship between stress/psychological factors and periodontal disease. However, in the future, well-designed and more representative studies should be considered to confirm these factors as a risk for periodontal disease.

• Comparative study of ultrasonic instrumentation for the non-surgical treatment of interproximal and non-interproximal furcation involvements.

  Authors: Erica Del Peloso Ribeiro, Sandro Bittencourt, Francisco H Nociti, Enilson A Sallum, Antônio W Sallum, Márcio Zaffalon Casati

  Journal of periodontology. 02/2007; 78(2):224-30.

  BACKGROUND: The aim of this clinical trial was to compare the outcome of non-surgical treatment of interproximal and non-interproximal Class II furcation involvements. METHODS: Thirty-eight patientsBACKGROUND: The aim of this clinical trial was to compare the outcome of non-surgical treatment of interproximal and non-interproximal Class II furcation involvements. METHODS: 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. Results: Six months after treatment, both groups had similar means of RAL and RHAL gain (P >0.05). 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; P <0.05). The BLFI group presented fewer sites with PD > or = 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. CONCLUSION: Buccal and lingual Class II furcation involvements respond better to non-surgical therapy compared to interproximal Class II furcation involvements.

• Enamel matrix derivative versus guided tissue regeneration in the presence of nicotine: a histomorphometric study in dogs.

  Authors: Suzana Peres Pimentel, Antonio Wilson Sallum, Juliana Bezerra Saldanha, Márcio Zaffalon Casati, Francisco H Nociti, Enilson A Sallum

  Journal of clinical periodontology. 12/2006; 33(12):900-7.

  AIM: The goal of this histometric study was to compare the healing process of dehiscence-type defects treated by enamel matrix derivative (EMD) or guided tissue regeneration (GTR) under the effect ofAIM: The goal of this histometric study was to compare the healing process of dehiscence-type defects treated by enamel matrix derivative (EMD) or guided tissue regeneration (GTR) under the effect of nicotine in the dog model. MATERIALS AND METHODS: Eight mongrel dogs were used. Buccal osseous dehiscences were surgically created on the mesial roots of the mandibular third and fourth pre-molars. The defects were exposed to plaque accumulation for 3 months. After this period, the defects were randomly assigned to one of the treatments: open flap debridement (OFD), EMD or GTR with a resorbable membrane. During 4 months, the dogs received subcutaneous administration of nicotine (2 mg/kg twice a day with a 12 h interval between the applications). After this period, the animals were killed and the blocks were processed. The histometric parameters evaluated included gingival recession, epithelial length, connective tissue adaptation, new cementum and new bone. RESULTS: A superior length of new cementum was observed in the sites treated by EMD in comparison with OFD (p< or =0.05). No statistically significant differences were observed between GTR and the other groups. CONCLUSIONS: In the presence of nicotine, EMD may promote more new cementum formation than OFD while GTR failed to provide a significant difference.

• Selective cyclooxygenase-2 inhibitor may impair bone healing around titanium implants in rats.

  Authors: Fernanda V Ribeiro, João B César-Neto, Francisco H Nociti, Enilson A Sallum, Antonio W Sallum, Sérgio de Toledo, Márcio Z Casati

  Journal of periodontology. 11/2006; 77(10):1731-5.

  BACKGROUND: The aim of this study was to investigate the effect of a selective cyclooxygenase-2 inhibitor, meloxicam, on bone healing around titanium implants in rats. METHODS: Thirty-one adult maleBACKGROUND: The aim of this study was to investigate the effect of a selective cyclooxygenase-2 inhibitor, meloxicam, on bone healing around titanium implants in rats. METHODS: Thirty-one adult male Wistar rats were included in this study, and one screw-shaped titanium implant was inserted in the tibiae of each rat. The animals were randomly assigned to one of the following groups for daily subcutaneous injections: control (N = 14): saline solution; and test (N = 17): 3 mg/kg of meloxicam, each administered daily for 60 days. After the treatment, animals were sacrificed, and undecalcified sections were obtained. Bone-to-implant contact (BIC) and bone area (BA) within the limits of implant threads and bone density (BD) in a 500 mum-wide zone lateral to the implants were obtained and arranged for cortical (zone A) and cancellous (zone B) bone regions. RESULTS: Intergroup comparisons demonstrated that meloxicam significantly reduced bone healing around implants. For zone A, significant differences were observed regarding BIC (47.01 +/- 10.48 A; 35.93 +/- 12.25 B), BA (86.42 +/- 3.66 A; 61.58 +/- 12.09 B), and BD (96.86 +/- 0.96 A; 91.06 +/- 3.05 B) for control and test groups, respectively (P <0.05). For zone B, data analysis also showed significant differences among groups for BIC (30.76 +/- 13.80 A; 16.86 +/- 11.48 B), BA (34.83 +/- 8.18 A; 25.66 +/- 9.16 B), and BD (15.76 +/- 7.05 A; 7.73 +/- 4.61 B) for control and test groups, respectively (P <0.05). CONCLUSION: Meloxicam may negatively influence bone healing in the cortical and cancellous bone around titanium implants inserted in rats after continuous administration.