Associação da raspagem com antibioticoterapia em um caso de periodontite agressiva generalizada

The treatment of aggressive periodontitis is a challenge to the clinician, therefore the search for effective treatment protocols of this disease is important. The aim of this case report was demonstrate the effectiveness of the combination of systemic antibiotics with non-surgical periodontal therapy in the treatment of generalized aggressive periodontitis. a 27-year-old patient (RCS), smoker for 11 years (10 cigarettes/day on average), with no systemic alteration, attended the periodontal clinic with a complaint abnormal dental position. After the clinical examination, the diagnosis of generalized aggressive periodontitis was defined. The non-surgical periodontal treatment was executed associated with administration of amoxicillin plus metronidazole for ten days. Clinical parameters (Clinical Attachment level, marginal gingival level, periodontal probing depth, bleeding on probing, plaque index and gingival index) and radiographic parameters (distance between the cemento-enamel junction and the bone crest) were evaluated before and after non-surgical periodontal treatment, after antibiotic therapy and three, six and 12 months after the treatment. After one year follow-up, the results showed improvement in clinical and radiographic parameters with stabilized and decreased tooth mobility and absence of tooth loss. It was concluded that the association of non-surgical periodontal therapy with the administration of amoxicillin/metronidazole was effective in the treatment of generalized aggressive periodontitis.

Achados clínicos, genéticos e microbiológicos de uma família com periodontite agressiva de Maceió

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

Claritromicina como adjuvante ao debridamento periodontal no tratamento de periodontite agressiva generalizada: estudo controlado randomizado

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Susceptibilidade antimicrobiana ao metronidazole de microrganismos isolados de periodontite crônica e agressiva

The objective of this study was to evaluate the microbial susceptibility to metronidazole from microorganisms isolated from patients with chronic or aggressive periodontitis. The samples were obtained from 50 patients with periodontitis and microorganisms were isolated onto selective and nonselective culture media, identified by biochemical methods and tested for susceptibility to metronidazole. The results evidenced the susceptibility to metronidazole among gram-negative anaerobes and some intermediate susceptibility and resistance among Grampositive anaerobes and facultatives.

Distribution of serotype-specific genotypes of Aggregatibacter actinomycetemcomitns in Brazilian patients with Down syndrome with different periodontal conditions

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

Potential of Bioactive Glass Particles of Different Size Ranges to Affect Bone Formation in Interproximal Periodontal Defects in Dogs

Background: The aim of this study was to compare the potential of bioactive glass particles of different size ranges to affect bone formation in periodontal defects, using the guided tissue regeneration model in dogs. Methods: In six dogs, 2-wall intrabony periodontal defects were surgically created and chronified on the mesial surfaces of mandibular third premolars and first molars bilaterally. After 1 month, each defect was randomly assigned to treatment with bioabsorbable membrane in association with bioactive glass with particle sizes between 300 and 355 mu m (group 1) or between 90 and 710 mu m (group 2), membrane alone (group 3), or negative control (group 4). The dogs were sacrificed 12 weeks after surgeries, and histomorphometric measurements were made of the areas of newly formed bone, new mineralized bone, and bioactive glass particle remnants. Results: With regard to the area of bioactive glass particle remnants, there was a statistically significant difference between groups 1 and 2, favoring group 1. There were greater areas of mineralized bone in groups 1 and 2 compared to groups 3 and 4 (P<0.05). Conclusion: The bioactive glass particles of small size range underwent faster resorption and substitution by new bone than the larger particles, and the use of bioactive glass particles favored the formation of mineralized bone. J Periodontol 2009;80:808-815.

Cleavage of IgG1 in gingival crevicular fluid is associated with the presence of Porphyromonas gingivalis

BACKGROUND AND OBJECTIVES: Immunoglobulin (Ig) G1 plays an important role in the adaptive immune response. Kgp, a lysine-specific cysteine protease from Porphyromonas gingivalis, specifically hydrolyses IgG1 heavy chains. The purpose of this study was to examine whether cleavage of IgG1 occurs in gingival crevicular fluid (GCF) in vivo, and whether there is any association with the presence of Porphyromonas gingivalis and other periodontopathogens. MATERIAL AND METHODS: GCF was obtained from nine patients with aggressive periodontitis, nine with chronic periodontitis and five periodontally healthy individuals. The bacterial loads of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Treponema denticola, Prevotella intermedia and Tannerella forsythia were analysed by real-time polymerase chain reaction, and the presence and cleavage of IgG1 and IgG2 were determined using Western blotting. Kgp levels were measured by ELISA. RESULTS: Cleaved IgG1 was identified in the GCF from 67% of patients with aggressive periodontitis and in 44% of patients with chronic periodontitis. By contrast, no cleaved IgG1 was detectable in healthy controls. No degradation of IgG2 was detected in any of the samples, regardless of health status. Porphyromonas gingivalis was found in high numbers in all samples in which cleavage of IgG1 was detected (P < 0.001 compared with samples with no IgG cleavage). Furthermore, high numbers of Tannerella forsythia and Prevotella intermedia were also present in these samples. The level of Kgp in the GCF correlated with the load of Porphyromonas gingivalis (r = 0.425, P < 0.01). The presence of Kgp (range 0.07-10.98 ng/mL) was associated with proteolytic fragments of IgG1 (P < 0.001). However, cleaved IgG1 was also detected in samples with no detectable Kgp. CONCLUSION: In patients with periodontitis, cleavage of IgG1 occurs in vivo and may suppress antibody-dependent antibacterial activity in subgingival biofilms especially those colonized by Porphyromonas gingivalis.

Periodontal pathogens affect the level of protease inhibitors in gingival crevicular fluid

In periodontitis, an effective host-response is primarily related to neutrophils loaded with serine proteases, including elastase (NE) and protease 3 (PR3), the extracellular activity of which is tightly controlled by endogenous inhibitors. In vitro these inhibitors are degraded by gingipains, cysteine proteases produced by Porphyromonas gingivalis. The purpose of this study was to determine the level of selected protease inhibitors in gingival crevicular fluid (GCF) in relation to periodontal infection. The GCF collected from 31 subjects (nine healthy controls, seven with gingivitis, five with aggressive periodontitis and 10 with chronic periodontitis) was analyzed for the levels of elafin and secretory leukocyte protease inhibitor (SLPI), two main tissue-derived inhibitors of neutrophil serine proteases. In parallel, activity of NE, PR3 and arginine-specific gingipains (Rgps) in GCF was measured. Finally loads of P. gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia and Treponema denticola were determined. The highest values of elafin were found in aggressive periodontitis and the lowest in controls. The quantity of elafin correlated positively with the load of P. gingivalis, Ta. forsythia and Tr. denticola, as well as with Rgps activity. In addition, NE activity was positively associated with the counts of those bacterial species, but not with the amount of elafin. In contrast, the highest concentrations of SLPI were found in periodontally healthy subjects whereas amounts of this inhibitor were significantly decreased in patients infected with P. gingivalis. Periodontopathogenic bacteria stimulate the release of NE and PR3, which activities escape the control through degradation of locally produced inhibitors (SLPI and elafin) by host-derived and bacteria-derived proteases.

Análise da imuno expressão das proteínas IL-17, IL-23 E RORγt na patogenia da doença periodontal

Periodontal disease is a chronic inflammatory condition primarily caused by bacteria in dental biofilm, which interact with the host, thus determining the nature of the resulting disease. Despite the wide knowledge about the pathogenesis of these diseases, the exact composition of the T cell profile during the active phase of the disease (Th1, Th2 or Th17) remains unknown. This study aimed to evaluate by immunohistochemical expression, the presence of the markers (IL-17, IL-23 and RORγt), involved in Th17 response in clinically healthy gingiva cases (n = 32), biofilm-induced gingivitis (n = 30), chronic periodontitis (n = 32) and aggressive periodontitis (n = 25), in order to analyze if the expression and/or distribution of these molecules in lymphocytes and macrophages, present in the inflammatory infiltrate of periodontal tissue, influences the tissue destruction observed in these diseases. The morphological analysis of cases was performed which assessed the intensity of the inflammatory infiltrate in mild, moderate and intense. For each case, in the area with the most representative immunostaining, 5 fields were chosen and analyzed, both for the intensity of the inflammatory infiltrate as for the quantity of immunostained cells, based on predetermined scores: score 0 (absence of inflammatory infiltrate/immunostaining), score 1 (the infiltrate/immunostaining covered less than 25% of the field area), score 2 (the infiltrate/immunostaining occupied between 25 and 50%) and score 3 (infiltrate/immunostaining present in over 50% of the field area). From this, a median was generated representing each case. The intensity of the inflammatory infiltrate correlated with the disease progression, in other words, it was crescent from clinically healthy gingiva to aggressive periodontitis (P <0.001). It was detected the presence of IL-17, IL-23 and RORγt in most of the evaluated cases and the number of immunostained cells correlated with the intensity of the inflammatory infiltrate (P <0.001) and with the clinical parameters analyzed (P <0.001), showing a positive correlation, mainly moderate. Aggressive periodontitis showed a higher percentage of immunostaining for all markers in relation to other clinical conditions assessed, suggesting a possible association of these markers with the progression of this disease, in which the higher the loss of periodontal support, the greater the amount of inflammatory infiltrate and larger the number of immunostained cells.

Efeitos da terapia periodontal na contagem de leucócitos e níveis do fator de crescimento transformador beta no soro de indivíduos com periodontite severa

Tese (doutorado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, 2015.

Expression of interferon-gamma, interferon-alpha and related genes in individuals with Down syndrome and periodontitis

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

A Putative Otu Domain-containing Protein 1 Deubiquitinating Enzyme Is Differentially Expressed In Thyroid Cancer And Identifies Less-aggressive Tumours.

This study aimed to identify novel biomarkers for thyroid carcinoma diagnosis and prognosis. We have constructed a human single-chain variable fragment (scFv) antibody library that was selected against tumour thyroid cells using the BRASIL method (biopanning and rapid analysis of selective interactive ligands) and phage display technology. One highly reactive clone, scFv-C1, with specific binding to papillary thyroid tumour proteins was confirmed by ELISA, which was further tested against a tissue microarray that comprised of 229 thyroid tissues, including: 110 carcinomas (38 papillary thyroid carcinomas (PTCs), 42 follicular carcinomas, 30 follicular variants of PTC), 18 normal thyroid tissues, 49 nodular goitres (NG) and 52 follicular adenomas. The scFv-C1 was able to distinguish carcinomas from benign lesions (P=0.0001) and reacted preferentially against T1 and T2 tumour stages (P=0.0108). We have further identified an OTU domain-containing protein 1, DUBA-7 deubiquitinating enzyme as the scFv-binding antigen using two-dimensional polyacrylamide gel electrophoresis and mass spectrometry. The strategy of screening and identifying a cell-surface-binding antibody against thyroid tissues was highly effective and resulted in a useful biomarker that recognises malignancy among thyroid nodules and may help identify lower-risk cases that can benefit from less-aggressive management.

Elevated Micronucleus Frequency In Patients With Type 2 Diabetes, Dyslipidemia And Periodontitis.

The over-production of reactive oxygen species (ROS) can cause oxidative damage to a large number of molecules, including DNA, and has been associated with the pathogenesis of several disorders, such as diabetes mellitus (DM), dyslipidemia and periodontitis (PD). We hypothesise that the presence of these diseases could proportionally increase the DNA damage. The aim of this study was to assess the micronucleus frequency (MNF), as a biomarker for DNA damage, in individuals with type 2 DM, dyslipidemia and PD. One hundred and fifty patients were divided into five groups based upon diabetic, dyslipidemic and periodontal status (Group 1 - poor controlled DM with dyslipidemia and PD; Group 2 - well-controlled DM with dyslipidemia and PD; Group 3 - without DM with dyslipidemia and PD; Group 4 - without DM, without dyslipidemia and with PD; and Group 5 - without DM, dyslipidemia and PD). Blood analyses were carried out for fasting plasma glucose, HbA1c and lipid profile. Periodontal examinations were performed, and venous blood was collected and processed for micronucleus (MN) assay. The frequency of micronuclei was evaluated by cell culture cytokinesis-block MN assay. The general characteristics of each group were described by the mean and standard deviation and the data were submitted to the Mann-Whitney, Kruskal-Wallis, Multiple Logistic Regression and Spearman tests. The Groups 1, 2 and 3 were similarly dyslipidemic presenting increased levels of total cholesterol, low density lipoprotein cholesterol and triglycerides. Periodontal tissue destruction and local inflammation were significantly more severe in diabetics, particularly in Group 1. Frequency of bi-nucleated cells with MN and MNF, as well as nucleoplasmic bridges, were significantly higher for poor controlled diabetics with dyslipidemia and PD in comparison with those systemically healthy, even after adjusting for age, and considering Bonferroni's correction. Elevated frequency of micronuclei was found in patients affected by type 2 diabetes, dyslipidemia and PD. This result suggests that these three pathologies occurring simultaneously promote an additional role to produce DNA impairment. In addition, the micronuclei assay was useful as a biomarker for DNA damage in individuals with chronic degenerative diseases.

Clinical Influence Of Different Intracanal Medications On Th1-type And Th2-type Cytokine Responses In Apical Periodontitis.

This clinical study assessed the influence of different intracanal medications on Th1-type and Th2-type cytokine responses in apical periodontitis and monitored the levels of bacteria from primarily infection during endodontic procedures. Thirty primarily infected teeth were randomly divided into 3 groups according to the medication selected: chlorhexidine (CHX), 2% CHX gel; Ca(OH)2/SSL, Ca(OH)2 + SSL; and Ca(OH)2/CHX, Ca(OH)2 + 2% CHX gel (all, n = 10). Bacterial sample was collected from root canals, and the interstitial fluid was sampled from lesions. Culture techniques were used to determine bacterial counts (colony-forming units/mL). Th1 (tumor necrosis factor-α, interferon-γ, and interleukin [IL]-2) and Th2 cytokines (IL-4, IL-5, and IL-13) were measured by enzyme-linked immunosorbent assay. All intracanal medication protocols were effective in reducing the bacterial load from root canals (all P < .05) and lowering the levels of Th1-type cytokines in apical lesions (all P < .05), with no differences between them (P > .05). Both Ca(OH)2 treatment protocols significantly increased the levels of Th2-type cytokines (P < .05), with no differences between them (P > .05). Thus, chlorhexidine medication showed the lowest effectiveness in increasing the levels of Th2-type cytokine. After treatment, regardless of the type of medication, the linear regression analysis indicated the down-regulation of Th2-type cytokines by Th1-type cytokines. All intracanal medication protocols were effective in reducing bacterial load and lowering the levels of Th1-type cytokines. Thus, the use of Ca(OH)2 medications contributed to the increase in the Th2-type cytokine response in apical periodontitis.

Inflammation markers in healthy and periodontitis patients: a preliminary data screening

Advances in diagnostic research are moving towards methods whereby the periodontal risk can be identified and quantified by objective measures using biomarkers. Patients with periodontitis may have elevated circulating levels of specific inflammatory markers that can be correlated to the severity of the disease. The purpose of this study was to evaluate whether differences in the serum levels of inflammatory biomarkers are differentially expressed in healthy and periodontitis patients. Twenty-five patients (8 healthy patients and 17 chronic periodontitis patients) were enrolled in the study. A 15 mL blood sample was used for identification of the inflammatory markers, with a human inflammatory flow cytometry multiplex assay. Among 24 assessed cytokines, only 3 (RANTES, MIG and Eotaxin) were statistically different between groups (p<0.05). In conclusion, some of the selected markers of inflammation are differentially expressed in healthy and periodontitis patients. Cytokine profile analysis may be further explored to distinguish the periodontitis patients from the ones free of disease and also to be used as a measure of risk. The present data, however, are limited and larger sample size studies are required to validate the findings of the specific biomarkers.