Aggregatibacter actinomycetemcomitans em pacientes com síndrome de down: influência da condição periodontal e higiene bucal

Patients with Down syndrome have varying degrees of mental retardation, physical and motor, and apparently are more susceptible to infectious diseases. Thus, the present study aimed to evaluate the occurrence of Aggregatibacter actinomycetemcomitans in saliva and subgingival biofilms and above of children and adolescents with Down syndrome and analyze the influence of diet, socioeconomic and cultural factors and periodontal condition. After assessing the socio-economic and behavioral, were collected clinical specimens, which were transported to the laboratory of Microbiology and Immunology FOA-UNESP for detection of microorganisms by molecular method and periodontal conditions were evaluated according to the Periodontal Screening Index and Recording. The control group consisted of individuals without the syndrome. The results were analyzed by chi-square test for proportion analysis of variables with three or more categories, or the Mann-Whitney test. The data analysis of this study showed that the occurrence of A. actinomycetemcomitans ranged from 0.0% to 25.0%, both in the group of patients with Down syndrome, as for the control group and this was not affected by socioeconomic characteristics of the target population, either by oral hygiene standards

Associação entre a doença periodontal e doenças sistêmicas crônicas: revisão de literatura

Periodontal disease has been increasingly associated as a supporting factor, and even a precursor to some systemic diseases. Just aim of this paper was to analyze by reviewing the literature, the possible mechanisms involved in the etiopathogenesis of periodontal disease that are common to the current systemic diseases such as obesity, atherosclerosis, diabetes and rheumatoid arthritis. The articles were analyzed with in the publication period of the years 2006 to 2011 and were surveyed in the databases PubMed, LILACS and SciELO. Of a total of 907 articles found by searching the indices and their associations, were selected by inclusion criteria 93 articles. For the preparation of this literature review, only 24 articles were selected because they are based on inflammatory mechanisms, metabolic and infectious, where the considerations for the strongest associations in the literature. This literature review reinforces the association of periodontal disease with systemic diseases analyzed due to presence of inflammatory and immunological mechanisms and similar synergism betwen the two diseases, but some hypotheses still need further clarification. The professional should stick to recent discoveries associations to promote periodontal treatment in preventing the development of systemic diseases, as well as in maintaining the systemic health of patients already suffering from chronic systemic diseases.

Influência de diferentes tratamentos físico-químicos na adesão e viabilidade de fibroblastos de ligamento periodontal à superfície radicular simulando dentes avulsionados

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Influence of combined oral contraceptives on the periodontal condition

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. Objective: 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. Material and methods: 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 (PI.I). Data were statistically evaluated by unpaired t test, Pearson's correlation test and Spearman's correlation test. Results: 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 PI.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. Conclusions: 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.

Cementum, apical morphology and hypercementosis: a probable adaptive response of the periodontal support tissues and potential orthodontic implications

Information about orthodontic movement of teeth with hypercementosis is scarce. As cementum deposition continues to occur, cementum is expected to change the shape of the root and apex over time, but this has not yet been demonstrated. Nor has it ever been established whether it increases or decreases the prevalence of root resorption during orthodontic treatment. The unique biological function of the interconnected network of cementocytes may play a role in orthodontic movement and its associated root resorptions, but no research has ever been conducted on the topic. Unlike cementum thickness and hypercementosis, root and apex shape has not yet been related to patient age. A study of the precise difference between increased cementum thickness and hypercementosis is warranted. Hypercementosis refers to excessive cementum formation above and beyond the extent necessary to fulfill its normal functions, resulting in abnormal thickening with macroscopic changes in the tooth root, which may require the delivery of forces that are different from conventional mechanics in their intensity, direction and distribution. What are the unique features and specificities involved in moving teeth that present with hypercementosis? Bodily movements would be expected to occur, since inclination might prove difficult to achieve, but would the root resorption index be higher or lower?

Clinical and radiographic evaluation of intrabony periodontal defect treatment by open flap debridement alone or in combination with nanocrystalline hydroxyapatite bone substitute

The aim of this study has been to compare the clinical and radiographic outcome of periodontal intrabony defect treatment by open flap debridement alone or in combination with nanocrystalline hydroxyapatite bone substitute application. Thirty patients diagnosed with advanced periodontits were divided into two groups: the control group (OFD), in which an open flap debridement procedure was performed and the test group (OFD+NHA), in which defects were additionally filled with nanocrystalline hydroxyapatite bone substitute material. Plaque index (PI), gingival index (GI), bleeding on probing (BOP), pocket depth (PD), gingival recession (GR) and clinical attachment level (CAL) were measured prior to, then 6 and 12months following treatment. Radiographic depth and width of defects were also evaluated. There were no differences in any clinical and radiographic parameters between the examined groups prior to treatment. After treatment, BOP, GI, PD, CAL, radiographic depth and width parameter values improved statistically significantly in both groups. The PI value did not change, but the GR value increased significantly after treatment. There were no statistical differences in evaluated parameters between OFD and OFD+NHA groups 6 and 12months after treatment. Within the limits of the study, it can be concluded that the additional use of nanocrystalline hydroxyapatite bone substitute material after open flap procedure does not improve clinical and radiographic treatment outcome.

Four-year results following treatment of intrabony periodontal defects with an enamel matrix derivative alone or combined with a biphasic calcium phosphate

The aim of this study was to evaluate the 4-year clinical outcomes following regenerative surgery in intrabony defects with either EMD + BCP or EMD. Twenty-four patients with advanced chronic periodontitis, displaying one-, two-, or three-walled intrabony defect with a probing depth of at least 6 mm, were randomly treated with either EMD + BCP (test) or EMD alone (control). The following clinical parameters were evaluated at baseline, at 1 year and at 4 years after regenerative surgery: plaque index, gingival index, bleeding on probing, probing depth, gingival recession, and clinical attachment level (CAL). The primary outcome variable was CAL. No differences in any of the investigated parameters were observed at baseline between the two groups. The test group demonstrated a mean CAL change from from 10.8 ± 1.6 mm to 7.4 ± 1.6 mm (p < 0.001) and to 7.6 ± 1.7 mm (p < 0.001) at 1 and 4 years, respectively. In the control group, mean CAL changed from 10.4 ± 1.3 at baseline to 6.9 ± 1.0 mm (p < 0.001) at 1 year and 7.2 ± 1.2 mm (p < 0.001) at 4 years. At 4 years, two defects in the test group and three defects in the control group have lost 1 mm of the CAL gained at 1 year. Compared to baseline, at 4 years, a CAL gain of ≥3 mm was measured in 67% of the defects (i.e., in 8 out of 12) in the test group and in 75% of the defects (i.e., in 9 out of 12) in the control group. There were no statistically significant differences in any of the investigated parameters at 1 and at 4 years between the two groups. Within their limits, the present results indicate that: (a) the clinical improvements obtained with both treatments can be maintained over a period of 4 years, and (b) in two- and three-walled intrabony defects, the addition of BCP did not additionally improve the outcomes obtained with EMD alone. In two- and three-walled intrabony defects, the combination of EMD + BCP did not show any advantage over the use of EMD alone.

Periodontal conditions in Swiss army recruits: a comparative study between the years 1985, 1996 and 2006

AIM: To compare the periodontal conditions of Swiss Army recruits in 2006 with those of previous surveys in 1996 and 1985. MATERIAL AND METHODS: A total of six hundred and twenty-six Swiss Army recruits were examined for their periodontal conditions, caries prevalence, stomatological and functional aspects of the masticatory system and halitosis. In particular, this report deals with demographic data, the assessment of plaque index (PlI), gingival index (GI) and pocket probing depth (PPD). RESULTS: Two per cent of all teeth were missing, resulting in a mean of 27.44 teeth per subject, and 77% of the missing teeth were the result of pre-molar extractions due to orthodontic indications. The mean PlI and GI were 1.33 and 1.23, respectively. On average, 27% of the gingival units bled on probing. The mean PPD was 2.16 mm (SD 0.64). Only 3.8% of the recruits showed at least one site of PPD > or = 5 mm, and 1.4% yielded more than one site with PPD > or = 5 mm. In comparison with previous, this survey yielded lower bleeding on probing (BOP) percentages than in 1985, but slightly higher scores than in 1996. This may be attributed to increased PlI scores in 2006. However, PPD remained essentially unaltered from 1996 to 2006 after having improved significantly from 1985. CONCLUSION: A significant improvement of the periodontal conditions of young Swiss males was demonstrated to have taken place between 1985 and 1996, but no further changes during the last decade were noticed.

Changes of periodontal parameters following apical surgery: a prospective clinical study of three incision techniques

AIM: To evaluate periodontal changes following apical surgery, and to relate changes to the type of incision and to the type of restoration present at the gingival margin (GM). METHODOLOGY: Periodontal parameters [probing depth (PD), level of GM and clinical attachment, plaque and bleeding indices] were recorded at baseline and 1 year following apical surgery. The periodontal changes were calculated and assessed with respect to the incision technique (intrasulcular incision, papilla base incision and submarginal incision), as well as to the presence and type of a restoration margin in contact with the gingiva. RESULTS: One hundred and eighty-four teeth could be evaluated. No significant differences between the three incision techniques were found regarding changes in PDs and plaque index over time. However, significant differences between the intrasulcular and submarginal incisions were found for changes in levels of GM and clinical attachment. For example, with the intrasulcular incision, there was a mean recession of 0.42 mm at buccal sites, whereas using the submarginal incision there was a gain of 0.05 mm. No statistically significant influence could be demonstrated for the presence and type of restoration margins, or the smoking habit of the patient. CONCLUSION: The type of incision was found to affect changes significantly in periodontal parameters within an observation period of 1 year following apical surgery, whereas the restoration margin and smoking habit did not prove to have any significant effect.

Increased periodontal inflammation in women with preterm premature rupture of membranes

OBJECTIVES To evaluate possible differences in periodontal inflammatory, microbiological and clinical parameters between women with preterm premature rupture of membranes (PPROM) and controls with uncomplicated pregnancies. MATERIALS AND METHODS Fifty-six women (32 test (PPROM) and 24 controls (uncomplicated pregnancies)) were examined at three time-points (T1: gestational weeks 20-35, T2: within 48 h after parturition, T3: 4-6 weeks after parturition). The examinations included assessment of the Periodontal Screening Index, collection of gingival crevicular fluid (GCF) and subgingival as well as vaginal bacterial sampling. RESULTS Periodontal inflammation was found to be higher in the test compared with the control group (p < 0.05) and decreased over time in both groups (p < 0.05). Microbiological outcomes showed no intergroup differences (p > 0.05) in prevalence of bacteria, but a decrease in subgingival periodontopathogens from T1 to T2 in the test group (p < 0.05) was observed. Interleukin (IL)-1β levels in GCF at T2 were not different between groups (p > 0.05). In women with PPROM, GCF levels of IL-8 (p < 0.05) and C-reactive protein (p < 0.05) were lower and IL-10 levels higher (p < 0.05) compared with controls. CONCLUSIONS Periodontal inflammation is elevated during pregnancy and seems to be more pronounced in women with PPROM. CLINICAL RELEVANCE The findings of the present study revealed an association between periodontal inflammation and PPROM, thus emphasizing the importance of optimizing self-performed oral hygiene in pregnant women.

Long-term follow-up of maxillary fixed retention: survival rate and periodontal health.

AIM To assess the long-term success of maxillary fixed retainers, investigate their effect on gingival health, and analyse the survival rate after a mean period of 7 years (minimum 5 years) in retention. SUBJECTS AND METHODS Forty one subjects were included in the study A clinical examination of the upper canine to canine region including gingival index (GI), plaque index, probing depth, and bleeding on probing (BOP) was performed. Intraoral photographs and dental impressions were taken and irregularity index was determined and compared to the values of the immediate post-therapeutic values; failures of retainers were also recorded and analysed. RESULTS The mean observed retention time was 7 years and 5 months. Irregularity index: Changes occurring during retention were statistically different between the lateral incisors bonded to retainers and the canines not bonded to retainers. Only six patients showed changes in irregularity index of the lateral incisors in spite of a retainer in place. Periodontal health: The median value of the GI for all teeth bonded to upper retainers was 1.10 and the median value of the plaque index (PI) was 1.14. PI was not a significant predictor of GI. The overall BOP of the bonded teeth to the retainer for each participant was 22.3 per cent. Failure rate: Twenty-eight out of 41 patients experienced no failure of the upper bonded retainer (68.3 per cent). Detachments were the most frequent incidents. CONCLUSION Although plaque accumulation might be increased in patients with already poor oral hygiene, maxillary bonded retainers caused no significant negative effects on the periodontal health.

The effects of erythritol air-polishing powder on microbiologic and clinical outcomes during supportive periodontal therapy: Six-month results of a randomized controlled clinical trial.

OBJECTIVES To characterize the physical characteristics of a new low abrasive erythritol powder (EPAP) and to evaluate its influence on the clinical and microbiologic parameters over a period of 6 months in patients undergoing supportive periodontal therapy (SPT). METHOD AND MATERIALS Prior to the clinical application, the particle size and abrasion level of EPAP were compared to glycine air-polishing powder (GPAP) ex vivo. Subsequently, 40 chronic periodontitis patients previously enrolled in SPT were randomly assigned into two groups for the treatment with subgingival EPAP or repeated scaling and root planing (SRP). At baseline (BL), bleeding on probing positive (BOP+) sites with probing pocket depth (PPD) of ≥ 4 mm but no detectable calculus were defined as study sites. During SPT, these sites were either treated by EPAP or SRP at BL, 3, and 6 months (3M, 6M). When indicated, additional SRP was provided. Plaque Index, BOP, PPD, clinical attachment level (CAL), and subgingival plaque were evaluated at BL and 6M. RESULTS EPAP yielded lower abrasiveness and smaller particle sizes when compared to GPAP. In 38 patients completing the study, EPAP and SRP resulted in significant reductions of BOP% (EPAP, 40.45%; SRP, 42.53%), PPD (EPAP, -0.67; SRP, -0.68), and increase of CAL (EPAP, 0.48; SRP, 0.61) while at 6M no statistically significant between-group differences were observed (P > .05). Microbiologic evaluation revealed minor shifts in the composition of the subgingival biofilm without influence on periodontopathogenic bacteria. CONCLUSION The subgingival use of EPAP by means of an air-polishing device may be considered safe and may lead to comparable clinical and microbiologic outcomes to those obtained with SRP. CLINICAL RELEVANCE The subgingival use of EPAP appears to represent a promising modality for the removal of subgingival biofilm during SPT.

Effect of nonsurgical periodontal treatment in conjunction with either systemic administration of amoxicillin and metronidazole or additional photodynamic therapy on the concentration of matrix metalloproteinases 8 and 9 in gingival crevicular fluid in patients with aggressive periodontitis.

BACKGROUND To evaluate in patients with aggressive periodontitis (AgP) the effect of nonsurgical periodontal treatment in conjunction with either additional administration of systemic antibiotics (AB) or application of photodynamic therapy (PDT) on the gingival crevicular fluid (GCF) concentration of matrix metalloproteinases 8 and 9 (MMP-8 and -9). METHODS Thirty-six patients with AgP were included in the study. Patients were randomly assigned to treatment with either scaling and root planing (SRP) followed by systemic administration of AB (e.g. Amoxicillin + Metronidazole) or SRP + PDT. The analysis of MMP-8 and -9 GCF concentrations was performed at baseline and at 3 and 6 months after treatment. Nonparametric U-Mann-Whitney test was used for comparison between groups. Changes from baseline to 3 and 6 months were analyzed with the Friedman's ANOVA test with Kendall's index of consistency. RESULTS In the AB group, patients showed a statistically significant (p = 0.01) decrease of MMP-8 GCF level at both 3 and 6 months post treatment. In the PDT group, the change of MMP-8 GCF level was not statistically significant. Both groups showed at 3 and 6 months a decrease in MMP-9 levels. However, this change did not reach statistical significance. CONCLUSIONS Within the limits of the present study, it may be suggested that in patients with AgP, nonsurgical periodontal therapy in conjunction with adjunctive systemic administration of amoxicilin and metronidazole is more effective in reducing GCF MMP-8 levels compared to the adjunctive use of PDT.

Trends of periodontal conditions in two different randomly selected Swiss (Bernese) cohorts 25 years apart

AIM To assess the periodontal conditions of two randomly selected Swiss cohorts 25 years apart. MATERIAL AND METHODS Standardized examinations were performed to assess the periodontal conditions of two randomly selected populations of the Canton of Bern; oral cleanliness was evaluated using the plaque index (PlI) and the retention index (RI). Gingival health was scored according to the gingival index (GI). Periodontal conditions were evaluated by pocket probing depth (PPD) and loss of attachment (LA). RESULTS At the first examination in 1985, 206 out of 350 subjects were evaluated, while in the second examination in 2010, 134 out of 490 subjects attended the examinations. In 1985, subjects showed a mean PlI of 1.16, and 0.77 in 2010. RI was 0.81 and 0.36 in 1985 and 2010 respectively. Mean GI was 1.34 and 0.6. The mean proportion of PPD ≤3 mm was 72% in 1985 and 97.3% in 2010. PPD ≥ 6 mm affected 2.0% in 1985 and 0.3% in 2010. In 1985, subjects had an average of 20.7 teeth, while in 2010, the average was 24.6. In 1985, 7.3% of the subjects were edentulous, while in 2010, 4.5% had no teeth. CONCLUSIONS Trends to improvements resulting in more teeth in function and better periodontal conditions were recognized.

Avaliação dos efeitos do tratamento periodontal não cirúrgico sobre os sinais e sintomas da síndrome de Sjögren primária

A síndrome de Sjögren primária (SSp) é uma doença crônica autoimune sistêmica que pode levar à hipossalivação e afetar negativamente o ambiente oral. Os objetivos deste estudo foram detectar a influência da SSp nos níveis de biomarcadores inflamatórios na saliva e no fluido gengival nas amostras de pacientes com periodontite crônica, avaliar o efeito do tratamento periodontal não cirúrgico sobre os valores do índice clínico de avaliação da atividade sistêmica de pacientes com SSp e do índice reportado pelo paciente com SSp. Amostras de fluido gengival, saliva e os parâmetros clínicos periodontais que consistiram de medida da profundidade de sondagem (PS), nível clínico de inserção (NCI), sangramento à sondagem (SS) e índice de placa (IP) foram coletadas no início do estudo e 45 dias após a terapia periodontal não-cirúrgica de pacientes sistemicamente saudáveis com periodontite crônica (PC, n = 7) e pacientes com SSp e periodontite crônica (SP, n = 7). Pacientes periodontalmente saudáveis com SSp (SC, n = 7) e sistemicamente saudáveis (C, n = 7) também foram avaliados no início do estudo. Os grupos C, PC e SC foram pareados em gênero, idade e critério socioeconômico com o grupo SP. Os níveis de interleucina-8 (IL-8), IL-10 e IL-1ß foram avaliados por ensaio multiplex. Os níveis de atividade da doença foram medidos usando o Gold Standard da literatura chamado Índice Eular de atividade da síndrome de Sjögren (ESSDAI). Já para avaliação dos sintomas reportados pelo paciente com SSp foi utilizado o Índice Eular reportado pelo paciente com Sjögren (ESSPRI). Os parâmetros clínicos melhoraram após a terapia periodontal (p <0,05). No entanto, o NCI em pacientes com SSp não melhorou significativamente após a terapia (p> 0,05). Houve um aumento nos níveis de IL-1ß, IL-8 e diminuição dos níveis de IL-10 nas amostras de saliva de pacientes do grupo SC em comparação ao grupo C (p <0,05). Já em relação ao fluido gengival, pacientes do grupo SC tiveram maiores níveis de IL-1ß em comparação com o grupo C (p<0,05). Além disso, o tratamento periodontal não cirúrgico resultou num aumento dos níveis de IL-10 no fluido gengival no grupo SP e grupo PC em relação ao valor basal (p <0,05). O fluxo salivar foi significativamente aumentado após o tratamento periodontal apenas em pacientes do grupo SP (p = 0,039). Além disso, o tratamento periodontal não influenciou o índice ESSDAI (p = 0,35) e levou a uma diminuição significativa no índice ESSPRI (p = 0,03). Os presentes dados demonstraram que a SSp influencia os níveis salivares e de fluido gengival de biomarcadores inflamatórios em favor de um perfil próinflamatório, no entanto, este perfil parece não aumentar susceptibilidade dos indivíduos SSp à destruição periodontal. Além disso, os presentes dados demonstraram que o tratamento periodontal não-cirúrgico tem um impacto positivo sobre o fluxo salivar e sobre o índice ESSPRI de pacientes com SSp. Sugere-se assim que o tratamento periodontal pode melhorar a qualidade de vida de indivíduos com SSp.