Efeito da aPDT na osseointegração de implantes em alvéolos contaminados

Objective: The aim of this study is to evaluate by histometric and immunohistochemistry analysis the effects of antimicrobial photodynamic therapy (aPDT) in alveolar prior to placement of mini-implants in animals with or without induced periodontal disease. Material and method: Thirty-two rats were used. Periodontal disease (PD) was induced by ligature in the lower left first molar. After 7 days of PD evolution, it was performed removal of the ligature and extraction of the left lower first molars in all animals. Thus, animals were divided into 2 groups (n=16) according to the treatments in the dental alveolus before immediate implant installation: MD (control) : mechanical debridement (MD), irrigation with 1 ml of saline solution followed by implant installation; aPDT- MD, irrigation with 1 ml of Toluidine Blue-O and low intensity laser (LLLT) and implant installation. Eight animals from each group were euthanized at 15 and 30 days after the installation of mini-implants. Specimens were processed for histologic, immunohistochemical and histometric analysis. The histometric data were processed for statistical analysis (Kruskall-Wallis and Dunn test; p <0.05). Result: In treatment analysis, results indicated that there was a greater BIC in implants installed in uncontaminated alveolus treated with a PDT ( p<0,05) and greater imuno-reactivity to OPG in bone issue treated with aPDT. Conclusion: The aPDT proved to be effective in bone loss control in no contaminated area and it has increased the bone loss and metabolic activity in alveolus irradiated prior to implant installation.

Cárie oculta extensa: relato de caso clínico

The pattern of caries lesions has been modified over decades. If the presence or absence of a caries lesion is based upon only a visual examination, its diagnosis might become underestimated since dentinal lesions underneath non cavitated or minimally demineralized enamel is highly frequent in dental clinics. The aim of this paper is to report a clinical case of a child with an upper molar with questionable occlusal aspect, presenting asymptomatic pulpal hyperplasia on the distolingual pit. Periapical radiographic examination was essential for diagnosing hidden caries and elaborating the treatment plan. As part of the approach, removal of the decayed tissue and pulpotomy with calcium hydroxide were performed. The association of an accurate visual examination to an adequate oral radiographyis is extremely important in cases which the presence of hidden caries is doubtful. As a result, an early diagnosis and the reduction of more invasive interventions related to the oral health care of pediatric patients can be achieved as well.

External apical root resorption in retracted incisors

AIM: To evaluate the occurrence of external apical root resorption (EARR) in the incisors after anterior retraction in corrective orthodontic treatment with first premolar extractions and whether it was related with the type of root apex movement and its inclination. METHOD: The maxillary and mandibular incisors of 22 patients (12 to 25 years of age; 9 males and 13 females) were treated with fixed appliances and premolar extraction. EARR was defined as the difference in root length before and after incisal retraction on periapical radiographs. Distortion of radiographic images and changes due to incisal tipping were controlled for. Pre- and post-incisal retraction lateral cephalometric radiographs established the relationship between EARR and the tipping of the incisors, along with the vertical, horizontal, and total movement of the root apex. RESULTS: There was significant EARR (1.51 to 2.37 mm) during incisor retraction, but this was not related to the movement or the tipping of the root apex of almost all teeth. It was observed that after the retraction stage, EARR occurred in all evaluated incisors, but it was more significant (P < .05) in the mandibular right lateral incisor. CONCLUSION: The EARR that did occur was unrelated to movement or tipping of the root apex, except for the vertical root apex movement of the mandibular left central incisor and the inclination of the maxillary right lateral incisor.

Doença periodontal em pacientes com Diabetes Mellitus: influência de polimorfismos genéticos?

Currently it is clear that there are several factors that can act as modifiers of diseases, without causing them directly, but having the potential to make these conditions to progress faster and more severe. There is a growing number of studies investigating the relationship between Diabetes Mellitus (DM) and Periodontal Disease (PD), including some studies focusing on the influence of genetic factors in this process. The aim of this study was to verify through a literature review, the influence of genetic polymorphisms in the development of PD in patients with DM. PubMed and BIREME were used as databases and the terms Periodontitis or Periodontal Disease, Polymorphism, Diabetes Mellitus were searched. After a refinement in the literature, five studies were selected and they were related to chronic PD with DM and polymorphisms in cytokine genes, especially interleukin 1 (IL1) e IL6. Polymorphisms were associated with a higher concentration of pro-inflammatory cytokines in the gingival crevicular fluid of diabetic patients when compared to non-diabetic. In conclusion, it is necessary to confirm this association with longitudinal studies that must investigate a larger number of cytokine genes in order to understand the cause-effect relationship between genetic polymorphisms, DM and PD.

Osteomielitis crónica con periostitis proliferativa

Chronic osteomyelitis with proliferative periostitis is a kind of osteomyelitis that is characterized by a great periosteal reaction resulting of low grade stimulation, usually a caries lesion associated a periapical pathology. It affects especially children and young adults, with the mandible as the most common site, usually in the inferior aspect. Clinically presents as a painless hard swelling intra and/or extra-oral. Radiographic aspects include bone layers new formed, parallel to each other and to the underlying cortical surface, giving the characteristic appearance of "onion skin". Treatment includes elimination of the cause, with or without antibiotics, being restored the facial symmetry of patient. The present article is a clinical case report of chronic osteomyelitis with proliferative periostitis affecting a female 11 year old patient, caused by a caries lesion in the left permanent first molar, that was submissed to a exodontia and the facial symmetry of the patient was restored with management.

Nasopalatine duct cyst: a case report within 3 years follow-up

The nasopalatine duct cyst (NPDC) is considered to be the most common non-odontogenic cyst in oral cavity. These cysts are usually asymptomatic; however they can result in swelling, pain and drainage. The radiological analysis can reveal a round, oval or heart shaped well-demarcated image, which can be confounding with inflammatory lesions. The aim of this paper is report a clinical case of NPDC in a patient of 33 years old, occurring near a periapical inflammatory lesion. During clinical examination, it was not possible to detect swelling of the anterior palate and patient didn´t complain painful symptoms. Surgical treatment, enucleation, was performed under local anesthesia and there was no post operative complications. Histological results showed the presence of a cuboidal and respiratory epithelium associated with vessels, nerves and inflammatory cells. The patient’s 3 years follow-up was uneventful with subsequent bone regeneration and no sign of the lesion recurrence.

Periodontal disease-associated compensatory expression of osteoprotegerin is lost in type 1 diabetes mellitus and correlates with alveolar bone destruction by regulating osteoclastogenesis

Alveolar bone resorption results from the inflammatory response to periodontal pathogens. Systemic diseases that affect the host response, such as type 1 diabetes mellitus (DM1), can potentiate the severity of periodontal disease (PD) and accelerate bone resorption. However, the biological mechanisms by which DM1 modulates PD are not fully understood. The aim of this study was to determine the influence of DM1 on alveolar bone resorption and to evaluate the role of receptor activator of nuclear factor-kappaB ligand (RANKL)/osteoprotegerin (OPG) in osteoclastogenesis in rats. PD was induced by means of ligature in nondiabetic and in streptozotocyn-induced DM1 rats. Morphological and morphometric analyses, stereology and osteoclast counting were performed. RANKL and OPG mRNA levels, protein content, and location were determined. PD caused alveolar bone resorption, increased the number of osteoclasts in the alveolar bone crest and also promoted changes in RANKL/OPG mRNA expression. DM1 alone showed alveolar bone destruction and an increased number of osteoclasts at the periapical and furcal regions. DM1 exacerbated these characteristics, with a greater impact on bone structure, resulting in a low OPG content and a higher RANKL/OPG ratio, which correlated with prominent osteoclastogenesis. This work demonstrates that the effects of PD and DM1 enhance bone destruction, confirms the importance of the RANKL signaling pathway in bone destruction in DM1 in animal models and suggests the existence of alternative mechanisms potentiating bone degradation in PD.

Fractal dimension of the mandibular trabecular bone measured on digital and digitized images.

Aims: This study compared fractal dimension (FD) values on mandibular trabecular bone in digital and digitized images at different spatial and contrast resolutions. Materials and Methods: 12 radiographs of dried human mandibles were obtained using custom-fabricated hybrid image receptors composed of a periapical radiographic film and a photostimulable phosphor plate (PSP). The film/ PSP sets were disassembled, and the PSPs produced images with 600 dots per inch (dpi) and 16 bits. These images were exported as tagged image file format (TIFF), 16 and 8 bits, and 600, 300 and 150 dpi. The films were processed and digitized 3 times on a flatbed scanner, producing TIFF images with 600, 300 and 150 dpi, and 8 bits. On each image, a circular region of interest was selected on the trabecular alveolar bone, away from root apices and FD was calculated by tile counting method. Two-way ANOVA and Tukey’s test were conducted to compare the mean values of FD, according to image type and spatial resolution (α = 5%). Results: Spatial resolution was directly and inversely proportional to FD mean values and standard deviation, respectively. Spatial resolution of 150 dpi yielded significant lower mean values of FD than the resolutions of 600 and 300 dpi ( P < 0.05). A nonsignificant variability was observed for the image types ( P > 0.05). The interaction between type of image and level of spatial resolution was not signi fi cant (P > 0.05). Conclusion: Under the tested, conditions, FD values of the mandibular trabecular bone assessed either by digital or digitized images did not change. Furthermore, these values were in fluenced by lower spatial resolution but not by contrast resolution.

Porphyromonas endodontalis in chronic periodontitis: a clinical and microbiological cross-sectional study

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Microbial invasion: focal infection and relationship with atherosclerosis

Os extraordinários avanços no desempenho de técnicas laboratoriais corroboram na evolução do entendimento dos mecanismos das doen- ças de modo geral, facilitando o tratamento e/ou a prevenção. De fato, informações equilibradas, acuradas e atuais estão colaborando de forma estimulante no estudo da relação entre doença periodontal e periapical crônica com o desenvolvimento ou estabelecimento de algumas doen- ças cardiovasculares. Dessa forma, o objetivo da presente trabalho foi descrever de forma sucinta e objetiva a relação entre doença periodontal crônica e doença periapical como fatores de risco para o desenvolvimento ou estabeleciomento da aterosclerose. Estudos epidemiológicos têm procurado demonstrar que indivíduos com doença periodontal ou periapical poderiam apresentar um aumento significativo do risco de desenvolver algumas doenças sistêmicas incluindo a aterosclerose.

Diretrizes para o tratamento e acompanhamento periodontal durante o tratamento ortodôntico

The aim of this paper was to search though a revision of the literature the cares before, during and after the orthodontic treatment in patients with a periodontal disease. The literature shows that the orthodontical treatment in healthy patients brings no risk to the periodontium, although the presence of an active periodontal disease counter indicates the dental movement. Thus, it is extremely important to execute a correct diagnosis of any periodontal alteration and treat them before the beginning of the orthodontical treatment. Besides, during the whole orthodontical treatment is also important to have a periodontal control with periodic reevaluations and at the end of the orthodontical treatment, a new oral hygiene orientation may be needed to finally establish the follow-up of the patient according to the risk of periodontal disease.

Detecção de Periodontopatógenos, Glicoproteína Emmprin (Cd-147) e sua correlação com MMP-2 e MMP-9

Periodontitis is an infectious disease characterized by the secretion of a variety of inflammatory mediators that lead to destruction of tooth supporting tissues, including the possible loss of alveolar bone, in association with infection with multiple species of bacteria. It is estimated that more than 400 species colonize the biofilm and some oral species related to periodontal disease is present in the subgingival including P. gingivalis, T. forsythia and T. denticola. However, other organisms may be related of this disease, as Filifactor allocis and Prevotella tannerae. These microorganisms and subproducts such as endotoxins released into the extracellular lead to the stimulation of metalloproteinase inducer glycoprotein (EMMPRIN, CD-147), which stimulates the release of MMPs by host cells, like fibroblasts and endothelial cells, thus leading to tissue destruction. The objective of this study was to detect F. allocis, P. tannerae, T. denticola and the glycoprotein EMMPRIN (CD-147) and its correlation with MMP-2 and MMP-9 in subgingival fluid samples of patients with chronic periodontitis. Fluids were collected from healthy and disease subgingival sites of 20 healthy individuals before basic periodontal treatment and after of 60 days of treatment. Their DNAs were extracted and portions of the 16S gene were amplified and performed conventional PCR. For immunological analysis and quantification of EMMPRIN (CD-147), MMP-2 and MMP-9 was used ELISA-Sandwich. Results demonstrated that the disease group showed significantly high amounts of T. denticola, F. alocis and P. tannerae when compared with health sites. MMP-2 and MMP-9 were detected in high concentrations with statistically significantly reduction after periodontal treatment to MMP-2, but without correlation with EMMPRIN.

Efeitos de drogas antiplaquetárias na doença periodontal

The association between platelets, angiogenesis and progression or repair of periodontal disease has been little explored and, consequently, the results are inconclusive. The pathogenic bacteria present in the periodontal pocket release endotoxins that affect the endothelial integrity and are able to induce the production of chemical mediators derived from plasma proteins and blood clotting while altering platelet function. There is great interest in the modulation of platelet activity in vascular disorders, especially cardiovascular diseases. For this reason, antiplatelet drugs, that are commonly used in the prevention of thromboembolic diseases, such as myocardial infarction, ischemic stroke and peripheral arterial disease, have been used. Aspirin is the only non-steroidal antiinflammatory agent with antiplatelet activity. In the periodontium, instead of only reduces levels of inflammatory cytokines, also significantly affects bleeding on probing, suggesting a dose-dependent modulation of periodontitis. In contrast, clopidogrel and ticlopidine are thienopyridine drugs with no known antiinflammatory action, suggesting that this benefit is related to an antiinflammatory effect indirectly correlated to their antiplatelet activity already established. In the literature there is limited information about the effect of these drugs on periodontium and periodontal disease development. Antiplatelet drugs hypothetically can change both the pathogenesis of periodontitis and subsequent periodontal tissue repair by blocking the secretion of chemical mediators which in general are important in modulating inflammation and tissue repair.

Patógenos periodontais: comparação entre cultura bacteriana e PCR em tempo real para teste diagnóstico

The correct distinguishment of microorganisms involved in the periodontal disease pathogen, it is important in the understanding of its progression and adequate treatment planning. Considering this fact, some molecular methods of identification and quantification were developed and are extremely sensitive and precise in the characterization of different bacteria species. The present study aimed to realize a literature review, including studies that realized a comparative analysis between bacterial culture and real time PCR methods in the identification of pathogens. The bacterial culture method can possibly identify new microorganisms and realize antibiotics sensitivity tests. The real time PCR is a microbiologic test that identifies and quantifies bacterial species, through gene amplification of predetermined DNA fragments, with high sensitivity and specificity, and need a shorter operation time of the operator when compared to the bacterial culture method. In this way, to determine a specific diagnostic test, should be considered not only its precision in the identification of microorganisms, but the cost-benefit relationship as well.

Aspectos atuais do tratamento da infecção endodôntica

Endodontics is a science that embodies etiology, diagnosis, prevention, and treatment of apical periodontitis and its repercussion in the organism. Technological resources in diagnosis and root canal negotiation, and new strategies , associated to mainly cleaning and eliminating the infection of the root canal system, shaping, and filling the endodontic space, according to biological bases, will allow us to reach higher standards of post-treatment success.