RESUMO
OBJECTIVES: The purpose of this study was to evaluate the clinical and microbiological impact of adjunctive metronidazole to periodontal surgery. MATERIALS AND METHODS: Systemically healthy patients, with stages III-IV, grades B-C periodontitis, were randomly assigned to receive metronidazole or placebo adjunctive to periodontal surgery, after subgingival instrumentation. Clinical variables were recorded at the initial visit, 6 weeks after subgingival instrumentation, and 3, 6, and 12 months after surgery. Microbiological samples were taken at initial and final visits and analyzed by quantitative polymerase chain reaction. RESULTS: Our results showed no statistically significant differences in the reduction of probing depth between the initial and final (1 year) visits in the two treatment groups. Additionally, no statistically significant differences were observed between study groups when comparing the post-subgingival instrumentation and final visits. However, 3 months after surgery, probing depth (mean difference, MD = 0.31 mm, 95% confidence interval, CI [0.13; 0.49]; p = 0.001) and clinical attachment level (MD = 0.64 mm, 95% CI [0.02; 1.27]; p = 0.044) were significantly lower in the test group. CONCLUSIONS: The adjunctive use of systemic metronidazole to periodontal surgery has a limited clinical and microbiological impact in the present study, and therefore, its use is not recommended. CLINICAL RELEVANCE: There are no studies that have evaluated the clinical and microbiological impact of the adjunctive use of systemic metronidazole to periodontal surgery (step 3 of periodontal therapy). The results of the present study do not support the adjunctive use of systemic metronidazole to periodontal surgery.
Assuntos
Metronidazol , Periodontite , Amoxicilina , Antibacterianos/uso terapêutico , Raspagem Dentária , Método Duplo-Cego , Humanos , Metronidazol/uso terapêutico , Perda da Inserção Periodontal/tratamento farmacológico , Bolsa Periodontal/tratamento farmacológico , Bolsa Periodontal/cirurgia , Periodontite/tratamento farmacológico , Periodontite/microbiologia , Periodontite/cirurgiaRESUMO
Resumen Introducción: Diversas técnicas se utilizan para tratar y mantener los dientes afectados con Periodontitis de estadio III grado C, sin embargo, hay poca información sobre cómo se modifican los parámetros clínicos periodontales y la composición microbiológica durante el tratamiento convencional y quirúrgico. Objetivo: Evaluar la respuesta clínica y microbiológica en una paciente con periodontitis estadio III grado C generalizada durante 5 años. Cuyo tratamiento consistió en terapia periodontal no quirúrgica y quirúrgica utilizando material regenerativo y sustituto óseo. Metodología: Se realizó raspado y alisado radicular progresivo, combinado con antibióticos y cirugía en sitios con defectos infraóseos. Se tomó registro de placa bacteriana subgingival (PB), hemorragia (H), profundidad de la bolsa (PS) y nivel de inserción clínica (NIC) en cada momento del tratamiento. Se tomaron muestras de la profundidad de las bolsas para identificar bacterias periodontales por biología molecular. Resultados: Se observó una mejoría de PB, H, PS y ganancia de NIC a lo largo de los 5 años. Con los injertos óseos la PS disminuyó 5 mm y de NIC se ganó 5 mm, con amelogeninas las diferencias fueron de 4,5 mm respectivamente. En colgajos de acceso, la PS disminuyó 3 mm y de NIC se ganó 2 mm. Se identificó T.denticola a los 36 meses, en todas las bolsas tratadas con colgajo de acceso y en el 50% de las bolsas con injertos óseos; y P. gingivalis a los 60 meses. Conclusiones: El tratamiento periodontal aplicado evitó la pérdida de los dientes afectados. El mejoramiento de los parámetros clínicos se asoció con una microbiota no agresiva.
Abstract Introduction: There are several techniques to treat and maintain teeth affected by stage III, grade C periodontitis, nonetheless, the scientific evidence available on how periodontal clinical parameters and microbiological composition may be modified during the conventional and surgical treatment is scarce. Objective: To evaluate the clinical and microbiological response of a patient with stage III grade C, generalized periodontitis, during 5 years, treated with non-surgical and surgical periodontal therapy using regenerative material and bone substitute. Methodology: The patient was treated with scaling and progressive root planning, combined with antibiotics and surgical therapy was performed in sites with infraosseous defects. At each time of treatment, subgingival bacterial plaque (PB), haemorrhage (H), probing depth (PD) and clinical attachment level (CAL) were recorded. To identify periodontal bacteria by molecular biology samples were taken with endodontic cones from the pocket depth. Results: A significant difference of PB, H, PD was observed. The PD decreased and CAL was gained throughout the treatment. PD decreased 5 mm with the application of bone substitute, and CAL gained 5 mm, with the use of amelogenins the difference of PD and CAL was 4.5 mm. In access flap the PD decreased 3 mm and the CAL improved 2 mm. T. denticola was identified at 36 months in all pockets treated with access flap and in 50% of the pockets with bone graft, and P. gingivalis at 60 months. Conclusions: The periodontal treatment applied prevented the loss of the affected teeth. Improvement of clinical parameters was associated with a non-aggressive microbiota.
Assuntos
Humanos , Feminino , Adulto , Periodontite/cirurgia , Periodontite/tratamento farmacológicoRESUMO
Una de las causas de la evolución de la periodontitis es la formación de defectos óseos y pérdida de inserción clínica. Una manera de eliminar el defecto intraóseo y su bolsa periodontal es eliminar las paredes de hueso que componen el defecto para colocar el complejo dentogingival en una posición más apical. La cirugía ósea es un procedimiento periodontal resectivo que involucra la modificación del tejido óseo del soporte dental, la cual es una modalidad del tratamiento periodontal quirúrgico que puede utilizarse para eliminar eficazmente los defectos óseos periodontales para estabilizar la inserción periodontal. El objetivo del presente estudio es realizar una revisión de la literatura sobre las consideraciones actuales, técnicas y principios de la cirugía ósea resectiva en el paciente periodontalmente comprometido (AU)
One of the causes of the evolution of periodontitis is the formation of bone defects and loss of clinical attachment, where one way to eliminate the intraosseous defect and its periodontal pocket is to eliminate the bone walls that make up the defect to place the dentogingival complex in a more apical position. Bone surgery is periodontal surgery that involves the modification of the supporting bone tissue of the teeth, which is a modality of surgical treatment that can be used to effectively eliminate periodontal defects and stabilize the periodontal insertion. The aim of the present study is to conduct a literature review about the considerations, techniques and principles of resective bone surgery in the periodontally compromised patient (AU)
Assuntos
Humanos , Periodontite/cirurgia , Perda do Osso Alveolar/cirurgia , Processo Alveolar/cirurgia , Osteotomia/métodos , Bolsa Periodontal/cirurgia , Retalhos Cirúrgicos , Aumento da Coroa Clínica/métodosRESUMO
Mesenchymal stem cell (MSC) grafting is a highly promising alternative strategy for periodontal regeneration in periodontitis, which is one of the primary causes of tooth loss in the elderly. However, aging progressively decreases the proliferative and differentiation potential of MSCs and diminishes their regenerative capacity, which represents a limiting factor for their endogenous use in elderly patients. Therefore, tissue regeneration therapy with MSCs in this age group may require a cellular source without the physiological limitations that MSCs exhibit in aging. In this sense, exogenous or allogeneic MSCs could have a better chance of success in regenerating periodontal tissue in elderly patients. This review examines and synthesizes recent data in support of the use of MSCs for periodontal regenerative therapy in patients. Additionally, we analyze the progress of the therapeutic use of exogenous MSCs in humans.
Assuntos
Transplante de Células-Tronco Mesenquimais , Periodonto/fisiologia , Regeneração , Fatores Etários , Idoso , Regeneração Tecidual Guiada Periodontal , Humanos , Células-Tronco Mesenquimais/fisiologia , Periodontite/cirurgiaRESUMO
We sought to better characterize the progression of periodontal tissue breakdown in rats induced by a ligature model of experimental periodontal disease (PD). A total of 60 male Sprague-Dawley rats were evenly divided into an untreated control group and a PD group induced by ligature bilaterally around first and second maxillary molars. Animals were sacrificed at 1, 3, 5, 7, 14, and 21 days after the induction of PD. Alveolar bone loss was evaluated by histomorphometry and microcomputed tomography (µCT). The immune-inflammatory process in the periodontal tissue was assessed using descriptive histologic analysis and quantitative polymerase chain reaction (qPCR). This ligature model resulted in significant alveolar bone loss and increased inflammatory process of the periodontal tissues during the initial periods of evaluation (0-14 days). A significant increase in the gene expression of pro-inflammatory cytokines, interleukin-1ß (IL-1ß), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α), and proteins involved in osteoclastogenesis, receptor activator of nuclear factor-k B ligand (RANKL) and osteoprotegerin (OPG) was observed in the first week of analysis. In the later periods of evaluation (14-21 days), no significant alterations were noted with regard to inflammatory processes, bone resorption, and expression of cytokine genes. The ligature-induced PD model resulted in progressive alveolar bone resorption with two different phases: Acute (0-14 days), characterized by inflammation and rapid bone resorption, and chronic (14-21 days) with no significant progression of bone loss. Furthermore, the gene expressions of IL-6, IL-1ß, TNF-α, RANKL, and OPG were highly increased during the progress of PD in the early periods. RESEARCH HIGHLIGHTS: Ligature-induced bone resorption in rats occurred in the initial periods after disease induction The bone resorption was characterized by two distinct phases: Acute (0-14 days), with pronounced inflammation and alveolar bone loss Chronic phase (14-21 days): No further disease progression Several pro-inflammatory cytokines were increased during the progress of periodontitis.
Assuntos
Ligadura/efeitos adversos , Periodontite/cirurgia , Perda do Osso Alveolar/etiologia , Perda do Osso Alveolar/genética , Perda do Osso Alveolar/metabolismo , Animais , Modelos Animais de Doenças , Humanos , Interleucina-1beta/genética , Interleucina-1beta/metabolismo , Interleucina-6/genética , Interleucina-6/metabolismo , Masculino , Dente Molar/metabolismo , Dente Molar/cirurgia , Periodontite/complicações , Periodontite/genética , Periodontite/metabolismo , Ligante RANK/genética , Ligante RANK/metabolismo , Ratos , Ratos Sprague-Dawley , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/metabolismoRESUMO
SUMMARY: Knowledge about Gaucher disease, characteristics, clinical and radiographic alterations, demonstrate the importance of using anamnesis, laboratory tests and radiological images, among these dental analysis and images, making possible the early detection in the oral manifestations and the success in the control and treatment of the disease.
RESUMEN: El conocimiento sobre la enfermedad de Gaucher, características, alteraciones clínicas y radiográficas, demuestra la importancia de utilizar la anamnesis, los exámenes de laboratorio e imágenes radiológicas, entre ellas las odontológicas, posibilitando la detección precoz de las manifestaciones orales, y el éxito en el control y tratamiento de la enfermedad.
Assuntos
Humanos , Periodontite/cirurgia , Odontalgia/cirurgia , Hemorragia Gengival/terapia , Cárie Dentária/terapia , Doença de Gaucher/complicações , Periodontite/etiologia , Odontalgia/etiologia , RadiografiaRESUMO
The purpose of this study was to evaluate the influence of an erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser in the absence or presence of manual scaling and root planning (SRP) for the treatment of induced periodontitis in rats. Ligatures were placed in the subgingival region of the maxillary first molar. After a 7-day period, the ligatures were removed, and 40 rats were randomly divided into four groups (G), as follows: (GI) no treatment, (GII) scaling and root planning (SRP) with curettes, (GIII) Er,Cr:YSGG laser irradiation and (GIV) SRP with curettes followed by Er,Cr:YSGG laser irradiation. Seven and 30 days after the treatment, the animals were sacrificed and histologic, histometric and immunohistochemistry analyses were performed. All groups showed similar histopathological characteristics during the evaluation period. The histometric analysis was confirmed using Bonferroni and paired t tests. At 7 and 30 days, groups II, III and IV exhibited greater bone formation in the furcation area when compared to group I (p < 0.0001; p < 0.05). During the 7-day period, the groups irradiated with the laser (III and IV) showed a statistically larger new bone area than the group treated with SRP (II) (p < 0.01). Immunohistochemistry analysis revealed that the control group exhibited a higher expression of tartrate-resistant acid phosphatase (TRAP) and the receptor activator of nuclear factor κΒ ligand (RANKL) when compared to groups II, III and IV (p < 0.05). All treatments were able to reduce the inflammatory processes, consequently enabling the repair of periodontal tissues. The results achieved with the application of the Er,Cr:YSGG laser suggest that this laser can stimulate greater bone formation, especially over a shorter period of time.
Assuntos
Lasers de Estado Sólido , Periodontite/cirurgia , Fosfatase Ácida , Animais , Raspagem Dentária/métodos , Isoenzimas , Terapia a Laser , Masculino , Dente Molar/patologia , Dente Molar/efeitos da radiação , Ratos , Fosfatase Ácida Resistente a TartaratoRESUMO
El propósito de este estudio fue la identificación de microorganismos anaerobios más frecuentemente encontrados en pericoronaritis y realizar pruebas de sensibilidad a los antimicrobianos. Se estudiaron los sacos pericoronarios del tercer molar en 20 pacientes. De las muestras recogidas en los 20 pacientes que presentaron pericoronaritis, solo en 7 (35%) hubo crecimiento de microorganismos anaerobios estrictos mientras que en los 13 restantes (65%) no se detectaron estos. En cuanto a las 12 cepas aisladas del saco pericoronario de los 7 pacientes, el microorganismo más frecuentemente encontrado fue Bifidobacterium spp en 5 casos (42%), Bifidobacterium adolescentis en 2 casos (17%), Veillonella spp en dos casos también (17%), Prevotella melaninogenica en 1 caso (8%), 1 caso Prevotella loescheii (8%) y en 1 caso a Prevotella oralis (8%). De los resultados obtenidos las bacterias anaerobias estrictas detectadas a partir de muestras de sacos pericoronarios fueron: Bifidobacterium spp., B. adolescentis, Veillonella spp, P. loeschii, P. melaninogenica y P. oralis.
Assuntos
Humanos , Masculino , Adulto , Feminino , Anti-Infecciosos , Bactérias Anaeróbias/crescimento & desenvolvimento , Periodontite/cirurgia , Periodontite/microbiologia , Infecção Focal Dentária/diagnóstico , Dente Serotino/lesõesRESUMO
BACKGROUND: This study has evaluated the effect of antimicrobial photodynamic therapy (aPDT) used in conjunction with non-surgical and surgical periodontal treatment (PT) in modulating gene expression during periodontal wound healing. METHODS: Fifteen patients with chronic periodontitis, presenting bilaterally lower molars with class III furcation lesions and scheduled for extraction, were selected. In initial therapy, scaling and root planing (SRP) was performed in the Control Group (CG), while SRP+aPDT were performed in the Test Group (TG). 45days later, flap surgery plus SRP, and flap surgery plus SRP+aPDT were performed in the CG and TG, respectively. At 21days post-surgery, the newly formed granulation tissue was collected, and Real-time PCR evaluated the expression of the genes: tumor necrosis factor-α, interleukin-1ß, interleukin-4, interleukin-10, matrix metalloproteinase-2 (MMP-2), tissue inhibitor of metalloproteinase-2 (TIMP-2), osteoprotegerin (OPG), receptor activator of nuclear factor-κB ligand (RANKL), type I collagen, alkaline phosphatase, osteopontin, osteocalcin, and bone sialoprotein. RESULTS: There were statistically significant differences between the groups in relation to mRNA levels for MMP-2 (TG=3.26±0.89; CG=4.23±0.97; p=0.01), TIMP-2/MMP-2 ratio (TG=0.91±0.34; CG=0.73±0.32; p=0.04), OPG (TG=0.84±0.45; CG=0.30±0.26; p=0.001), and OPG/RANKL ratio (TG=0.60±0.86; CG=0.23±0.16; p=0.04), favoring the TG. CONCLUSION: The present data suggest that the aPDT associated to nonsurgical and surgical periodontal therapy may modulate the extracellular matrix and bone remodeling by up regulating the TIMP- 2/MMP-2 and OPG/RANKL mRNA ratio, but the clinical relevance needs to be evaluated in further studies.
Assuntos
Anti-Infecciosos/farmacologia , Regulação da Expressão Gênica/efeitos dos fármacos , Regulação da Expressão Gênica/efeitos da radiação , Periodontite/tratamento farmacológico , Periodontite/cirurgia , Fotoquimioterapia , Perda do Osso Alveolar/complicações , Cemento Dentário/efeitos dos fármacos , Cemento Dentário/efeitos da radiação , Humanos , Periodontite/complicações , Periodontite/genéticaRESUMO
PURPOSE: To assess the long-term behavior of wedge-shaped implants and evaluate the influence of the associated risk factors on implant survival rates. MATERIALS AND METHODS: A retrospective review of clinical records of patients treated with wedge-shaped implants between 1992 and 2011 was conducted. Data on patient sex, age, smoking habits, and history of periodontitis; details of implant length, diameter, angle, and location; and data on surgical, reconstructive, and prosthetic procedures, and systemic disease were selected for analysis. RESULTS: A total of 1,169 implants placed in 154 patients (mean age 55.17 ± 11.33 years) were evaluated. Women received 637 implants, and men received 532 implants; 60.4% were placed in patients who were undergoing periodontal maintenance care, 17.9% in smokers, 17.7% in hypertensive patients, 5.7% in diabetic patients, and 4.4% in cardiac patients. The mean overall survival for implants was 194.26 ± 9.91 months. Seventy-three implants were lost: 3 before implant loading and 70 after loading. The cumulative survival rates at 5 and 10 years were 96.6% (confidence interval [CI]: 95.5% to 97.7%) and 91.8% (CI: 90.1% to 94.1%), respectively. Univariate analysis indicated tobacco smoking (P = .014) and implant location (P < .001) as significant risk factors for implant failure. The multivariate analysis showed tobacco smoking (P = .016), location (P = .001), and male sex (P = .038) as significant, and the latter factor was associated with previous periodontal disease. CONCLUSIONS: Overall survival of the wedge-shaped implant showed good long-term results. Male sex, tobacco smoking, and posterior maxillary location were associated with a greater risk of implant failure.