[Show abstract][Hide abstract] ABSTRACT: About 50 years ago, lasers started to be used in periodontal treatment following evidence that wounds produced in animals healed more quickly after being irradiated with low-intensity lasers. Increased production of growth factors, stimulated mainly by red and infrared lasers, may participate in this process by influencing the behavior of various types of cells. High-intensity lasers have been used as an alternative to nonsurgical periodontal therapy in root biomodification and to reduce dentin hypersensivity; low-intensity lasers are frequently employed to improve tissue repair in regenerative procedures and in antimicrobial photodynamic therapy. Despite the abundance of promising data on the advantages of their use, there is still controversy regarding the real benefits of lasers and antimicrobial photodynamic therapy in periodontal and peri-implant treatment. A huge variation in the parameters of laser application among studies makes comparisons very difficult. An overview of the current concepts and findings on lasers in periodontal therapy is presented with emphasis on data collected from Latin-American researchers.
[Show abstract][Hide abstract] ABSTRACT: Background:
Autologous bone grafts are usually well consolidated after 4 to 5 months but can be incompletely interlocked with the native bone. This study investigated the effect of acid demineralization of the graft-bed interface on graft consolidation.
Onlay bone grafts were performed on the calvaria of 36 guinea pigs. Half of the animals had the graft-bed contacting surfaces demineralized with 50% citric acid (pH 1.0) for 3 minutes (test group). The other half received no demineralization (control group). The bone grafts were immobilized by a resorbable membrane glued to the recipient bed with cyanoacrylate. After 7, 30, and 90 days, specimens (n = 6) were obtained for light microscopy. Data from qualitative analysis and computerized histomorphometry were statistically processed at a significance level of 5%.
Osteogenesis was not seen at the interface after 7 days. After 30 days, the test group showed 34.39% ± 13.4% of the interface area filled with mineralized tissue, compared to 17.14% ± 8.6% in the control group (P = 0.026). After 90 days, the mean percentages of mineralized tissue at the interface in the test and control specimens were 54.00% ± 11.23% and 38.65% ± 7.76% (P = 0.041), respectively. Within groups, a higher percentage of the area filled with mineralized tissue was seen at 90 days compared to 30 days (P = 0.004 for control and 0.041 for test).
Demineralization of the contacting surfaces between autologous bone graft and bone bed improved new bone formation and bone consolidation. These data need to be confirmed in humans.
Journal of Periodontology 10/2013; 85(5). DOI:10.1902/jop.2013.130298 · 2.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Demineralization of root surfaces as an adjunct in regenerative periodontal procedures has been documented in several studies utilizing different demineralizing agents.
Objective: This study aimed to analyze and compare four commonly used demineralizing agents for their capacity of reattachment of collagen fibers (CF) to the root surface and the severity of the resultant inflammatory response.
Method: Fragments of human dental roots previously exposed to periodontal disease were scaled and randomly divided into the following groups of treatments (n=15; etching time 3min): CA–citric acid pH 1; TC-tetracycline HCL; PA–37% phosphoric acid; EDTA–24% EDTA; C+-rubbing of saline solution; C--no treatment. All fragments were implanted in rat subcutaneous tissue. After 3, 7 and 28 days, histological evaluation was used for qualitative analysis using a scoring system for CF formation, granulomatous reactionary tissue (GRT) thickness and inflammatory infiltrate, and quantitative analysis by measuring area and thickness of GRT and CF reattachment (ImageJ; ANOVA and Tukey's; p≤0.05).
Result: Initially, significantly thicker GRT were obtained for FA (110,37±46,17) and EDTA (124,36±93,52) groups, confirming results obtained for these agents on the qualitative analysis. Thinner GRT values were obtained in all periods of observation for CA group (13,06±15,14; 17,95±17,95; 25,64±11,62), followed closely by the TC group (67,53±63,74; 47,12±12,91; 33,29±13,13), also confirming the qualitative analysis. Significantly higher extension of CF reattachment was observed after 7 days, for the CA (39,4±17,77) and TC (42,2±6,71) groups, with the exception of C- group (100±0). With time all treatment groups, except C+ group, significantly increased their extent of CF reattachment, with superiority for the TC (100±0; 100±0) and CA (97,58±4,18; 84,35±11,53) groups.
Conclusion: Among the demineralizing agents studied, CA and TC showed superior biological effects than the other agents. PA and EDTA did not show satisfactory results initially, but over time, got similar to the other agents.
[Show abstract][Hide abstract] ABSTRACT: Background:
To the best of the authors' knowledge, a standard protocol for treating peri-implantitis is not yet established.
A total of 150 titanium disks with smooth or rough surfaces contaminated with microbial biofilm were implanted subcutaneously in rats after undergoing one of three treatments: 1) low-intensity laser (LIL); 2) antimicrobial photodynamic therapy (aPDT); or 3) toluidine blue O (TBO). Sterile and contaminated disks served as negative (NC) and positive (C) control groups, respectively. After days 7, 28, and 84, tissue inflammation was evaluated microscopically by measuring the density of collagen fibers (degree of fibrosis) and concentration of polymorphonuclear neutrophils.
Surface texture did not affect the degree of inflammation, but the area of reactive tissue was significantly greater for rough implants (2.6 ± 3.7 × 10(6) µm(2)) than for smooth ones (1.9 ± 2.6 × 10(6) µm(2); P = 0.0377). Group C presented the lowest and group NC presented the highest degree of fibrosis with significance only after day 7; these groups had the highest and lowest scores, respectively, for degree of inflammation. Group C showed the largest area of reactive tissue (9.11 ± 2.10 × 10(6) µm(2)), but it was not significantly larger than group LIL (P = 0.3031) and group TBO (P = 0.1333). Group aPDT showed the smallest area (4.34 ± 1.49 × 10(6) µm(2)) of reactive tissue among the treatment groups. After day 28, groups LIL, aPDT, TBO, and C resembled group NC in all the studied parameters.
Group aPDT showed more favorable results in parameter area of reactive tissue than the other methods after day 7, but over longer time periods all methods produced outcomes equivalent to sterile implants.
Journal of Periodontology 06/2012; 84(5). DOI:10.1902/jop.2012.120166 · 2.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Many techniques have been proposed for root coverage. However, none of them presents predictable results in deep and wide recessions.
The aim of this case series report is to describe an alternative technique for root coverage at sites showing deep recessions and attachment loss >4 mm at buccal sites.
Four patients presenting deep recession defects at buccal sites (>4 mm) were treated by the newly forming bone graft technique, which consists in the creation of an alveolar socket at edentulous ridge and transferring of granulation tissue present in this socket to the recession defect after 21 days. Clinical periodontal parameters, including recession depth (RD), probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), plaque index (PI) and keratinized gingiva width (KGW) were evaluated by a single examiner immediately before surgery and at 1, 3, 6 and 9 months postoperatively.
All cases showed reduction in RD and PD, along with CAL gain, although no increase in KGW could be observed. These findings suggest that the technique could favor periodontal regeneration along with root coverage, especially in areas showing deep recessions and attachment loss.
Journal of applied oral science: revista FOB 06/2012; 20(3):392-8. DOI:10.1590/S1678-77572012000300016 · 0.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Most studies investigating the impact of oral contraceptives have been performed some years ago, when the level of sexual hormones was greater than the actual formulations.
The aim of this study was to evaluate the effects of current combined oral contraceptives (COC) on periodontal tissues, correlating the clinical parameters examined with the total duration of continuous oral contraceptive intake.
Twenty-five women (19-35 years old) taking combined oral contraceptives for at least 1 year were included in the test group. The control group was composed by 25 patients at the same age range reporting no use of hormone-based contraceptive methods. Clinical parameters investigated included pocket probing depth (PD), clinical attachment level (CAL), sulcular bleeding index (SBI) and plaque index (Pl.I). Data were statistically evaluated by unpaired t test, Pearson's correlation test and Spearman's correlation test.
The test group showed increased PD (2.228±0.011 x 2.154±0.012; p<0.0001) and SBI (0.229±0.006 x 0.148±0.005, p<0.0001) than controls. No significant differences between groups were found in CAL (0.435±0.01 x 0.412±0.01; p=0.11). The control group showed greater Pl.I than the test group (0.206±0.007 x 0.303±0.008; p<0.0001). No correlation between the duration of oral contraceptive intake, age and periodontal parameters was observed.
These findings suggest that the use of currently available combined oral contraceptives can influence the periodontal conditions of the patients, independently of the level of plaque accumulation or total duration of medication intake, resulting in increased gingival inflammation.
Journal of applied oral science: revista FOB 04/2012; 20(2):253-9. DOI:10.1590/S1678-77572012000200022 · 0.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective. To shed light on the role of KG, its influence on periodontal behavior was investigated. Methods. Tissue fluid transudation was assessed in alveolar mucosa (P1A), outer gingival margin (P1B), at entrance of (P2) and within gingival sulcus (P3), before and after chewing of fibrous food in 16 patients portraying ≥2 mm KG at one tooth (group 1), and <2 mm at another homologous tooth (group 2). Results. There was a significant increase in GCF after chewing at P1B and P3 in group 1 and at P1A in group 2 (t-test, P < 0.05). Conclusions. The results suggest that KG plays a role in marginal periodontal homeostasis.
International Journal of Dentistry 11/2011; 2011(10):953135. DOI:10.1155/2011/953135
[Show abstract][Hide abstract] ABSTRACT: Dental roots that have been exposed to the oral cavity and periodontal pocket environment present superficial changes, which can prevent connective tissue reattachment. Demineralizing agents have been used as an adjunct to the periodontal treatment aiming at restoring the biocompatibility of roots.
This study compared four commonly used demineralizing agents for their capacity of removing smear layer and opening dentin tubules.
Fifty fragments of human dental roots previously exposed to periodontal disease were scaled and randomly divided into the following groups of treatment: 1) CA: demineralization with citric acid for 3 min; 2) TC-HCl: demineralization with tetracycline-HCl for 3 min; 3) EDTA: demineralization with EDTA for 3 min; 4) PA: demineralization with 37% phosphoric acid for 3 min; 5) Control: rubbing of saline solution for 3 min. Scanning electron microscopy was used to check for the presence of residual smear layer and for measuring the number and area of exposed dentin tubules.
Smear layer was present in 100% of the specimens from the groups PA and control; in 80% from EDTA group; in 33.3% from TC-HCl group and 0% from CA group. The mean numbers of exposed dentin tubules in a standardized area were: TC-HCl=43.8±25.2; CA=39.3±37; PA=12.1±16.3; EDTA=4.4±7.5 and Control=2.3±5.7. The comparison showed significant differences between the following pairs of groups: TC-HCl and Control; TC-HCl and EDTA; CA and Control; and CA and EDTA. The mean percentages of area occupied by exposed dentin tubules were: CA=0.12±0.17%; TC-HCl=0.08±0.06%; PA=0.03±0.05%; EDTA=0.01±0.01% and Control=0±0%. The CA group differed significantly from the others except for the TC-HCl group.
There was a decreasing ability for smear layer removal and dentin tubule widening as follows: AC>TC-HCl>PA>EDTA. This information can be of value as an extra parameter for choosing one of them for root conditioning.
Journal of applied oral science: revista FOB 10/2011; 19(5):469-75. DOI:10.1590/S1678-77572011000500006 · 0.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the effects of non-surgical treatment of periodontal disease during the second trimester of gestation on adverse pregnancy outcomes.
Pregnant patients during the 1st and 2nd trimesters at antenatal care in a Public Health Center were divided into 2 groups: NIG--"no intervention" (n=17) or IG--"intervention" (n=16). IG patients were submitted to a non-surgical periodontal treatment performed by a single periodontist consisting of scaling and root planning (SRP), professional prophylaxis (PROPH) and oral hygiene instruction (OHI). NIG received PROPH and OHI during pregnancy and were referred for treatment after delivery. Periodontal evaluation was performed by a single trained examiner, blinded to periodontal treatment, according to probing depth (PD), clinical attachment level (CAL), plaque index (PI) and sulcular bleeding index (SBI) at baseline and 35 gestational weeks-28 days post-partum. Primary adverse pregnancy outcomes were preterm birth (<37 weeks), low birth weight (<2.5 kg), late abortion (14-24 weeks) or abortion (<14 weeks). The results obtained were statistically evaluated according to OR, unpaired t test and paired t test at 5% significance level.
No significant differences were observed between groups at baseline examination. Periodontal treatment resulted in stabilization of CAL and PI (p>0.05) at IG and worsening of all periodontal parameters at NIG (p<0.0001), except for PI. Significant differences in periodontal conditions of IG and NIG were observed at 2nd examination (p<0.001). The rate of adverse pregnancy outcomes was 47.05% in NIG and 6.25% in IG. Periodontal treatment during pregnancy was associated to a decreased risk of developing adverse pregnancy outcomes [OR=13.50; CI: 1.47-123.45; p=0.02].
Periodontal treatment during the second trimester of gestation contributes to decrease adverse pregnancy outcomes.
Journal of applied oral science: revista FOB 04/2011; 19(2):130-6. DOI:10.1590/S1678-77572011000200009 · 0.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives: The aim of this study was to investigate oral health status of pregnant women under prenatal care at a Public Health Care Center. Methods: A total of 85 pregnant women in their first (1T), second (2T) and third (3T) gestational trimester, 10 days3 months (1PP) and 3-6 months (2PP) after delivery were evaluated by a single examiner according to probing depth (PD), clinical attachment level (CAL), sulcular bleeding index (SBI), plaque index (PI) and CPITN. Oral hygiene status was evaluated by PHP, and tooth brushing and flossing frequency. Overall oral health conditions were investigated by DMFT. Data were statistically evaluated according to Kruskal-Wallis/Dunn's methods. Correlation of periodontal parameters was investigated by Spearman's test. Results: A poor oral hygiene status was observed, as evaluated by PHP (2.78 1.25), inadequate tooth brushing (82.35%) and flossing (77.64%) frequencies. DMFT suggests extremely high caries prevalence (14.88 4.93). PD, CAL, SBI and PI were increased at 1PP, but no significant differences were observed among the different groups (p>0.05). CPITN scores 3 and 4 were significantly increased at 3T than 2T and 1T (p=0.0003). Conclusions: The findings of this study suggest that preventive oral health measures should be established during antenatal care at public health services in order to improve oral health conditions of pregnant women.
[Show abstract][Hide abstract] ABSTRACT: To investigate into oral health status and its association with health status in hospitalized patients.
A total of 82 patients were examined and 49 (59.7%) patients were men. The patients answered a survey and oral examinations to detect the number of teeth, oral hygiene index, prostheses hygiene, oral lesions, caries, dental plaque index (DPI), gingival inflammation index (GI), gingival bleeding index, periodontitis and periodontal index.
Oral hygiene was associated with age, but it was not related to physical disability. Difficulty eating was mainly associated with age and tooth loss. All full and partially dentate patients presented dental plaque, 38 (69%) poor oral hygiene, 58 (98.1%) gingival inflammation, 41 (74.5%) periodontal disease and 33 (60%) caries. Oral lesions were detected in 30 (36.5%) and candidiasis (n = 16, 19.6%) was the most frequent mucous lesion. Caries were associated with smoking and poor oral hygiene. Hospital length of stay and age were associated with increased DPI and GI.
The majority of hospitalized patients did not present satisfactory oral hygiene. Caries and periodontal diseases are associated with health behaviours. Increased time length at hospital could increase gingival inflammation and dental plaque accumulation.
International Journal of Dental Hygiene 02/2011; 9(1):21-9. DOI:10.1111/j.1601-5037.2009.00423.x · 1.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study assessed the bone density gain and its relationship with the periodontal clinical parameters in a case series of a regenerative therapy procedure.
Using a split-mouth study design, 10 pairs of infrabony defects from 15 patients were treated with a pool of bovine bone morphogenetic proteins associated with collagen membrane (test sites) or collagen membrane only (control sites). The periodontal healing was clinically and radiographically monitored for six months. Standardized pre-surgical and 6-month postoperative radiographs were digitized for digital subtraction analysis, which showed relative bone density gain in both groups of 0.034 ± 0.423 and 0.105 ± 0.423 in the test and control group, respectively (p>0.05).
As regards the area size of bone density change, the influence of the therapy was detected in 2.5 mm² in the test group and 2 mm² in the control group (p>0.05). Additionally, no correlation was observed between the favorable clinical results and the bone density gain measured by digital subtraction radiography (p>0.05).
The findings of this study suggest that the clinical benefit of the regenerative therapy observed did not come with significant bone density gains. Long-term evaluation may lead to a different conclusions.
Journal of applied oral science: revista FOB 08/2010; 18(4):379-84. DOI:10.1590/S1678-77572010000400010 · 0.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Fibroblasts are considered important cells in periodontitis. When challenged by different agents, they respond through the release of cytokines that participate in the inflammatory process. The aim of this study is to evaluate and compare the expression and production of macrophage inflammatory protein (MIP)-1alpha, stromal-derived factor (SDF)-1, and interleukin (IL)-6 by human cultured periodontal ligament and gingival fibroblasts challenged with lipopolysaccharide (LPS) from Porphyromonas gingivalis.
Fibroblasts were cultured from biopsies of gingival tissue and periodontal ligament of the same donors and used on the fourth passage. After confluence in 24-well plates, the culture medium alone (control) or with 0.1 to 10 microg/ml of LPS from P. gingivalis was added to the wells, and after 1, 6, and 24 hours, the supernatant and the cells were collected and analyzed by enzyme-linked immunosorbent assay and real-time polymerase chain reaction, respectively.
MIP-1alpha, SDF-1, and IL-6 protein production was significantly greater in gingival fibroblasts compared to periodontal ligament fibroblasts. IL-6 was upregulated in a time-dependent manner, mainly in gingival fibroblasts (P <0.05), which secreted more MIP-1alpha in the lowest concentration of LPS used (0.1 microg/ml). In contrast, a basal production of SDF-1 that was inhibited with the increase of LPS concentration was detected, especially after 24 hours (P <0.05).
The distinct ability of the gingival and periodontal ligament fibroblasts to secrete MIP-1alpha, SDF-1, and IL-6 emphasizes that these cells may differently contribute to the balance of cytokines in the LPS-challenged periodontium.
Journal of Periodontology 02/2010; 81(2):310-7. DOI:10.1902/jop.2009.090375 · 2.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This article reports the longitudinal follow-up of a familial case of aggressive periodontitis treated by a combined regenerative approach that consisted of root conditioning, bone grafting, and membrane positioning. Treatment resulted in attachment level gain, reduction of probing depth, absence of bleeding on probing, and complete bone filling of the defect. The short-term results obtained after surgery were maintained after 6 years, suggesting that the combined regenerative approach is able to completely arrest the disease with long-term stability.
The International journal of periodontics & restorative dentistry 03/2009; 29(1):69-79. · 1.42 Impact Factor