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OBJECTIVE: To evaluate cytokine levels of interleukin (IL)-1ß, IL-4, IL-6, IL-17a, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ in the gingival crevicular fluid (GCF) of periodontal sites in individuals with Down syndrome (DS) and analyze their relationship with clinical periodontal parameters. MATERIALS AND METHODS: A cross-sectional study was conducted with 49 DS patients and 32 individuals without DS (non-DS group). Periodontal probing depth (PPD), clinical attachment level (CAL), bleeding on probing (BoP), and visible plaque index (VPI) were evaluated. The periodontal sites were classified as shallow, moderate, and deep. GCF was collected in all shallow sites and, when present, in moderate and deep sites for the analysis of cytokine levels. The cytokines, IL-1ß, IL-4, IL-6, IL-17a, TNF-α, and IFN-γ, were quantified using the Luminex® automatic analyzer system. RESULTS: The DS group presented greater severity of periodontitis compared to the non-DS group (P = 0.005). The DS group showed a significant direct correlation of IL-1ß and an inverse correlation of IFN-γ and IL-14 with all periodontal variables. In the analysis stratified by periodontal pocket depth, we observed a higher level of IFN-γ, IL-17a, IL-1ß, and IL-6 in the shallow sites, and IL-17a, IL-1ß, and IL-6 in deep pockets of DS group individuals. Multivariate models showed that higher levels of IL-1ß, IL-4, IL-6, and IL-17a were associated with Down syndrome even after adjusting for periodontal status, sex, and age. CONCLUSION: The findings suggest that people with DS have greater periodontal impairment and higher levels of cytokines in GCF, even in sites having clinical periodontal parameters similar to those of individuals without DS. These data reiterate the concept of an altered and less effective immune response in the population with DS in the face of a periodontal microbial challenge. CLINICAL RELEVANCE: Elevated periodontal inflammation burden can be observed with higher cytokine levels in the gingival crevicular fluid of people with Down syndrome, especially IL-1, IL-4, IL-6, and IL-17, regardless of the stage of periodontitis.

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To compare different criteria for the diagnosis of periodontitis and to evaluate the association of this condition with prematurity, this case-control study was conducted on 283 mothers of infants, divided into two groups based on gestational age (cases: <37 weeks, controls: ≥37 weeks), with 71 cases and 212 controls. The periodontal evaluation included probing depth (PD), clinical attachment level (CAL), plaque index, and bleeding on probing (BOP). Participants were classified regarding periodontitis per 14 criteria based on different periodontal parameters. The criterion selected as the gold standard was the presence of at least four teeth with one or more sites with a PD ≥ 4 mm, CAL ≥ 3 mm, and BOP at the same site. The prevalence of periodontal disease ranged from 8.1% to 55.1%. Moreover, compared to the gold standard, the sensitivities of the other criteria were 100%, while specificity ranged from 50.4% to 96.4%. Periodontitis, defined by six of the selected criteria, was associated with prematurity after multivariate adjustment, with OR ranging from 1.85 to 2.69 and 95% CI from 1.01 to 5.56; one of them was the gold standard mentioned above. Measurements using the clinical parameters of PD, CAL, and bleeding at the same site (criteria 5, 6, 7, 8), CPI (criterion 10), and at least four teeth with a PD ≥ 4 mm and CAL ≥ 3 mm (criterion 11) to define periodontitis showed a statistically significant association (p < 0.05). Given this study's limitations, we can conclude that the diagnostic criteria for a periodontitis definition using a PD ≥ 4 mm and CAL ≥ 3 mm in two or more teeth, with BOP at the same site, seem stronger when detecting an association between periodontitis and prematurity.

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BACKGROUND AND OBJECTIVE: Systemic metabolic status and periodontitis can be related in patients with Down syndrome (DS). The objective of this study was to identify metabolic indicators (anthropometric measurements, blood pressure, and serum markers) related to severity and extent of periodontitis in DS patients. METHODS: A cross-sectional study was conducted with 49 patients with DS. Periodontal evaluation included the periodontal probing depth (PPD), clinical attachment level (CAL), gingival bleeding index (GBI), and visible plaque index (VPI). Periodontitis severity was classified by the stages system. The extent of periodontitis was assessed as the percentage of sites with CAL ≥3 mm, CAL ≥4 mm, PPD ≥4 mm, and PPD ≥5 mm. The metabolic condition of the participants was determined by analyzing anthropometric parameters, blood pressure, and serum markers. Data were analyzed using the Mann-Whitney test, Spearman's correlation coefficient, and multivariate regression analysis. RESULTS: Periodontitis stage 3/4 was detected in 32.7% of patients, with high values of VPI (54.6 ± 35.8) and GBI (42.4 ± 33.3). The severity of periodontitis was related to higher mean corpuscular hemoglobin (ß = .291, p = .028) and mean corpuscular volume values (ß = .293, p = .046). Arm circumference measurements were inversely related to CAL ≥3 mm (ß = -.408, p = .023), PPD ≥4 mm (ß = -.475, p = .006), and PPD ≥5 mm (ß = -.443, p = .010). CONCLUSIONS: The findings suggest that the severity and extent of periodontitis may be related to some metabolic parameters in DS patients.

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OBJECTIVE: Investigate the impact of resveratrol (RESV) on peri-implant repair and its effect on bone-related markers in rats with induced diabetes mellitus (DM). MATERIAL AND METHODS: Ninety rats were divided into: DM + RESV (n = 18); DM + placebo (PLAC) (n = 18); DM + insulin (INS) (n = 18); DM + RESV + INS (n = 18); Non-DM (n = 18). Diabetes was induced by streptozotocin. One screw-shaped titanium implant was inserted in each tibiae of animals. Treatments were administered during 30 days. After, one of the implants was removed for counter-torque and the peri-implant tissue was collected for mRNA quantification of BMP-2, OPN, Runx2, Lrp-5, Osx, ß-catenin, Dkk1, OPG, and RANKL by Real-time PCR. The other tibia was submitted to MicroCT analysis to measure: bone volume (BV/TV), trabecular thickness (Tb.Th) and bone-implant contact (BIC). RESULTS: Higher counter-torque values were observed for implant removal in DM + RESV, DM + RESV + INS and Non-DM groups when compared to DM + PLAC (p < .05). Augmented Tb.Th was observed in DM + RESV and Non-DM when compared to DM + PLAC group (p < .05), whereas higher BIC was detected in DM + RESV, DM + RESV + INS and Non-DM animals when compared to DM + PLAC (p < .05). Levels of RANKL were downregulated by the RESV and/or INS therapy, whereas only the association of RESV and INS upregulated the levels of Runx2 (p < .05). CONCLUSIONS: The therapy with RESV may favour peri-implant bone repair improving bone formation around implants.

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OBJECTIVE: To compare the effect of a single-tufted toothbrush combined or not with a conventional toothbrush to control dental biofilm in healthy orthodontic patients. MATERIALS AND METHODS: Twenty orthodontic patients were randomly assigned to receive three different treatments: Group 1-conventional toothbrush; Group 2-single-tufted toothbrush and Group 3-combination of single-tufted and conventional toothbrushes. Stained plaque index (SPI), visible plaque index (VPI) and gingival bleeding index (GBI) were recorded. The data were analysed by Kolmogorov-Smirnov test. Wilcoxon test was used for intragroup comparison and Friedman test for the intergroup comparison (α = 5%). RESULTS: Intragroup analysis showed that VPI and SPI significantly decreased (P < 0.05) after 72 hour in Group 3. Anterior and posterior teeth did not show any significant statistical differences after 72 hour (P > 0.05), but VPI values in the labial surfaces were different to Group 3 (P < 0.05) in comparison with the other groups after 72 hour. Group 3 showed a statistically significant reduction (P < 0.05) for SPI in the interproximal surfaces when compared with Group 1. CONCLUSION: The combination of single-tufted and conventional toothbrushes was effective for controlling dental biofilm formation in orthodontic patients.

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ABSTRACT Objective: To evaluate the association of glycemic control and cytokine production in type 2 diabetic subjects with chronic periodontitis Methods: Gingival biopsies were performed in 40 patients, divided into four groups: systemically healthy subjects without periodontal disease (S); systemically healthy patients with chronic periodontitis (P); patients with well-controlled type 2 diabetes mellitus (DM) with chronic periodontitis (C); poorly controlled type 2 diabetes mellitus with chronic periodontitis (D). The production of interleukin (IL) -4, -6, -10, -17 and interferon (IFN) -γ was quantified by ELISA. Results: The production of IL-4, IL-10, IL-17 and INF-γ was higher on group D when compared to other groups (p <0.05), which in turn were similar (p ≥0.05). In addition, there was no difference in the production of IL-6 in any of the evaluated groups (p≥0.05). Conclusion: Were observed significantly elevated levels of pro-inflammatory and anti-inflammatory cytokines in patients with poorly controlled type 2 diabetes and chronic periodontitis, demonstrating that glycemic control may be associated to the immune inflammatory response of sites with chronic periodontitis.

RESUMO Objetivo: Avaliar a associação do controle glicêmico e a produção de citocinas em indivíduos diabéticos tipo 2 com doença periodontal crônica. Métodos: Foram realizadas biópsias gengivais de 40 pacientes, distribuídos nos seguintes grupos: sistemicamente saudáveis sem doença periodontal (S); pacientes sistemicamente saudáveis com periodontite crônica (P); pacientes com diabetes mellitus (DM) tipo 2 controlado com periodontite crônica (C); pacientes com diabetes mellitus tipo 2 não controlado com periodontite crônica (D). Foram quantificadas através de ELISA, a produção das interleucinas (IL) -4, -6, -10, -17 e interferon (IFN) -γ. Resultados: A produção de IL-4, IL-10, IL-17 e INF-γ foi maior no grupo D quando comparada aos demais grupos (p<0.05), que por sua vez foram similares entre si (p≥0.05). Além disso, não houve diferença na produção de IL-6 em nenhum dos grupos avaliados (p≥0.05). Conclusão: Foram observados níveis significativamente elevados de citocinas pró-inflamatórias e anti-inflamatórias nos pacientes com diabetes mellitus tipo 2 não controlado e com periodontite crônica, demonstrando que o controle glicêmico pode estar associado com a resposta imunoinflamatória de sítios com periodontite crônica.

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Both Systemic Lupus Erythematosus (SLE) and periodontal disease (PD) present a similar immunological profile mainly characterized by altered cytokine levels. In this study we sought to investigate the salivary levels of inflammatory cytokines and their association with PD in SLE patients. 60 patients with SLE and 54 systemically healthy individuals underwent a full periodontal clinical examination. They were then grouped according to their periodontal status. Stimulated saliva was collected in order to evaluate the salivary levels of interferon (IFN-γ), Interleukin (IL)-10, IL-17, IL-1ß, and IL-4. Systemically healthy individuals with periodontitis (group P) presented higher levels of cytokines when compared to systemically healthy individuals, with no periodontal disease (group S) (p<0.05). Additionally, in the P group, patients presented similar levels of cytokines to those of the patients with SLE, regardless of the presence of PD (p>0.05), for most of the analyzed cytokines. There was a positive correlation in SLE patients, including IL-1ß and all periodontal clinical parameters (p<0.05), and between IL-4 and gingival bleeding index and the presence of biofilm (p<0.05). Thus, our results confirmed, that patients with PD showed higher salivary levels of cytokines and, in SLE patients, the increased levels of salivary cytokines were observed even in the absence of periodontitis. IL-1ß and IL-4 salivary levels were also positively correlated with periodontal status indicating their potential as markers of the amount and extent of periodontal damage in patients with SLE.

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Objective: To evaluate the association of glycemic control and cytokine production in type 2 diabetic subjects with chronic periodontitis. Methods: Gingival biopsies were performed in 40 patients, divided into four groups: systemically healthy subjects without periodontal disease (S); systemically healthy patients with chronic periodontitis (P); patients with well-controlled type 2 diabetes mellitus (DM) with chronic periodontitis (C); poorly controlled type 2 diabetes mellitus with chronic periodontitis (D). The production of interleukin (IL) -4, -6, -10, -17 and interferon (IFN) -g was quantified by ELISA. Results: The production of IL-4, IL-10, IL-17 and INF-g was higher on group D when compared to other groups (p <0.05), which in turn were similar (p ³0.05). In addition, there was no difference in the production of IL-6 in any of the evaluated groups (p³0.05). Conclusion: Were observed significantly elevated levels of pro-inflammatory and anti-inflammatory cytokines in patients with poorly controlled type 2 diabetes and chronic periodontitis, demonstrating that glycemic control may be associated to the immune inflammatory response of sites with chronic periodontitis.

Objetivo: Avaliar a associação do controle glicêmico e a produção de citocinas em indivíduos diabéticos tipo 2 com doença periodontal crônica. Métodos: Foram realizadas biópsias gengivais de 40 pacientes, distribuídos nos seguintes grupos: sistemicamente saudáveis sem doença periodontal (S); pacientes sistemicamente saudáveis com periodontite crônica (P); pacientes com diabetes mellitus (DM) tipo 2 controlado com periodontite crônica (C); pacientes com diabetes mellitus tipo 2 não controlado com periodontite crônica (D). Foram quantificadas através de ELISA, a produção das interleucinas (IL) -4, -6, -10, -17 e interferon (IFN) -g. Resultados: A produção de IL-4, IL-10, IL-17 e INF-g foi maior no grupo D quando comparada aos demais grupos (p<0.05), que por sua vez foram similares entre si (p³0.05). Além disso, não houve diferença na produção de IL-6 em nenhum dos grupos avaliados (p³0.05). Conclusão: Foram observados níveis significativamente elevados de citocinas pró-inflamatórias e anti-inflamatórias nos pacientes com diabetes mellitus tipo 2 não controlado e com periodontite crônica, demonstrando que o controle glicêmico pode estar associado com a resposta imunoinflamatória de sítios com periodontite crônica.

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OBJECTIVE: Periodontal disease is a set of inflammatory infections that affect the supporting structures of the dentition. Patients with visual impairment (VI) may have more difficulty in cleaning and maintaining oral health. The purpose of this study was to investigate the possible relationship between periodontal status and degree of VI in institutionalized individuals. MATERIALS AND METHODS: Fifty-two visually impaired individuals were included in this cross-sectional study. The periodontal parameters assessed were clinical attachment level (CAL), probing depth (PD), and visible plaque index. The degree of VI was established as: Group 1 (mild or moderate VI), Group 2 (severe or profound VI), and Group 3 (completely blind); and the types of VI were considered as congenital and acquired. Fisher's exact, Kruskal-Wallis, Mann-Whitney, and Spearman correlation coefficient test were used. The level of significance was set at 5%. RESULT: Only plaque index was higher on proximal surfaces of subjects with mild/moderate VI when compared to the other degrees of VI (P = 0.01). Furthermore, we observed higher values for interproximal CAL (P = 0.01), total PD (P = 0.04), and interproximal PD in subjects with acquired VI when compared to subjects with congenital VI (P = 0.01). CONCLUSIONS: These findings suggest that periodontal status may be more related to the type of disability than with the degree of VI. Acquired VI people presented a worse periodontal health than the group with congenital VI.

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The case report aimed at treating a fenestration-type defect with multidisciplinary conventional and advanced surgical techniques. Fenestrations are isolated areas in which the exposed root surface is covered only by the periosteum and gingiva, but the remaining cortical bone remains intact. Root coverage is indicated in cases of root hypersensitivity, treatment of shallow caries lesions, cervical abrasions, and esthetic and cosmetic needs. In this case report, after proper hygiene instruction and dental biofilm control, a fenestration-type defect was treated using guided tissue regeneration (anorganic bovine matrix and resorbable membrane) and a connective tissue grafts, associated to an endodontic apicoectomy. After reevaluation, the remaining gingival recession was treated with a second gingival connective tissue graft covered with q double papillae type in order to reconstruct the periodontal tissues of the involved tooth. In this clinical case, the interaction between the different areas of dentistry has made it possible to correct a fenestration-type defect, following procedures based on scientific evidence, restoring periodontal health, esthetics, self-esteem, and meeting the patient's expectations regarding her initial complaint. This case report shows the important role of interdisciplinary approach to treating a patient with a complex periodontal defect that required different types of knowledge and abilities to achieve the best results based on the current status of dentistry possibilities.

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