Antonio Wilson Sallum

Platelet-derived growth factor/insulin-like growth factor-1 combination and bone regeneration around implants placed into extraction sockets: a histometric study in dogs.

This study evaluated, by histometric analysis, the wound healing process of bone around implants placed into extraction sockets with or without the concurrent application of a combination of platelet-derived growth factor (PDGF) and insulin-like growth factor (IGF-1). Mandibular premolars were removed, and 32 implants were inserted in eight dogs. Before insertion, two implants received a single application of 5 micrograms/mL of PDGF and IGF-1 delivered in 0.10 mL of 4% methylcellulose gel or 0.10 mL of 4% methylcellulose gel only as a control. To label regenerated bone, a 2% calcein green solution was administered by intramuscular injection at 0, 7, 15, 30, 45, 60, and 75 days after implant insertion. Three, 8, and 12 weeks after implant insertion, undecalcified sections were obtained, and the degree of bone contact with the implant surface, the bone area, and the intensity of bone labeling were measured into the limits of the threads of the implant. Greater extension of bone/implant contact (paired t test, P < .05) was observed in test (22.4% +/- 13.7%) than in control (17.2% +/- 13.6%) implants at 3 weeks. One-way ANOVA revealed a higher intensity of bone labeling (P < .05) at 3 weeks than at 12 weeks (127.8 +/- 42.59 and 56.7 +/- 26.34, gray scale values) for test implants. Within the limits of the present study, it was concluded that the combination of PDGF/IGF-I actively took part in the initial phase of bone repair.

Factors associated with the prevalence of periodontal disease in low-risk pregnant women

ObjectiveTo evaluate the prevalence of periodontal disease (PD) among Brazilian low-risk pregnant women and its association with sociodemographic factors, habits and oral hygiene.MethodThis cross-sectional study included 334 low-risk pregnant women divided in groups with or without PD. Indexes of plaque and gingival bleeding on probing, probing pocket depth, clinical attachment level and gingival recession were evaluated at one periodontal examination below 32 weeks of gestation. Independent variables were: age, race/color, schooling, marital status, parity, gestational age, smoking habit, alcohol and drugs consumption, use of medication, presence of any systemic diseases and BMI (body mass index). Statistical analyses provided prevalence ratios and their respective 95%CI and also a multivariate analysis.ResultsThe prevalence of PD was 47% and significantly associated with higher gestational age (PR 1.40; 1.01 - 1.94 for 17-24 weeks and PR 1.52; 1.10 - 2.08 for 25-32 weeks), maternal age 25-29 years, obesity (PR 1.65; 1.02 - 2.68) and the presence of gingival bleeding on probing (ORadj 2.01, 95%CI 1.41 - 2.88). Poor oral hygiene was associated with PD by the mean values of plaque and bleeding on probing indexes significantly greater in PD group.ConclusionsThe prevalence of PD is high and associated with gingival bleeding on probing, more advanced gestational age and obesity. A program of oral health care should be included in prenatal care for early pregnancy, especially for low-income populations.

Free Gingival Grafts: Graft Shrinkage and Donor‐Site Healing in Smokers and Non‐Smokers

BACKGROUND This prospective clinical study aims to evaluate the influence of cigarette smoking on free gingival graft (FGG) healing, by assessing FGG dimensional changes and donor-site wound healing. METHODS Twelve non-smokers and 10 smokers treatment planned for FGG to augment keratinized tissue dimensions in the mandibular incisor area completed the study. All subjects received standardized FGG of same dimensions. Probing depth, gingival margin position, clinical attachment level, keratinized tissue (KT) width, gingival thickness, and FGG dimensions (width, length, and area) were assessed and recorded before surgery, and 7, 15, 30, 60, and 90 days postoperatively. The palatal donor area was evaluated for immediate bleeding and complete wound epithelialization. Differences between the two groups (smokers and non-smokers) were statistically analyzed. RESULTS FGG dimensions changed significantly postoperatively. At 90 days postoperatively, FGG width, length, and area were respectively reduced by 31%, 22%, and 44% in non-smokers and by 44%, 25%, and 58% in smokers (no significant differences between groups; P >0.05). Significant KT increases were observed in both non-smokers and smokers (5.4 and 4.8 mm, respectively). Donor-site immediate bleeding was significantly more prevalent in non-smokers (75%) compared to smokers (30%) (P = 0.04). At 15 days postoperatively, donor-site complete epithelialization was much more prevalent in non-smokers (92%) than in smokers (20%) (P <0.002). CONCLUSION Smoking alters FGG donor-site wound healing by reducing immediate bleeding incidence and by delaying epithelialization, although it does not have discernible effects on postoperative FGG dimensional changes.

Association of IL1 gene polymorphisms with chronic periodontitis in Brazilians

UNLABELLED Chronic periodontal disease (PD) is an infectious immune-inflammatory illness. Polymorphisms in IL1 genes play a role in inflammatory diseases through the modulation of cytokine levels. OBJECTIVE this study aimed to investigate the association between polymorphisms in the IL1 gene cluster and chronic periodontitis in a Brazilian population. DESIGN a sample of 113 subjects over 25 years (mean age 41.2) were grouped into: 44 healthy individuals, 31 subjects with moderate and 38 with severe periodontitis. DNA was obtained through a mouthwash and oral mucosa scraping. PCR-RFLP was used to identify the following polymorphisms: IL1A C-889T (rs1800587), IL1B C-511T (rs16944), IL1B C+3954T (rs11436340), IL1RN intron 2 (rs2234663). Differences in the allele/genotype/haplotype frequencies were assessed by Chi-square test (p<0.05). The risk associated with alleles, genotypes and haplotypes was calculated as odds ratio (OR) with 95% confidence intervals (CI). RESULTS neither IL1A (C-889T) nor IL1B (C+3954T) polymorphisms was associated with chronic PD. Allele T for IL1B (C-511T) only associated with PD in the group of blacks and mulattos. Moreover, genotype 2/2 for IL1RN (intron 2) was associated with severe PD. CONCLUSIONS genotype 2/2 of IL1RN for the whole Brazilian population and allele T of IL1B (C-511T) in a subgroup of Afro-Americans and mulattos were suggested as putative risk indicators for chronic periodontitis.

Connective tissue graft plus resin‐modified glass ionomer restoration for the treatment of gingival recession associated with non‐carious cervical lesion: a randomized‐controlled clinical trial

BACKGROUND The aim of this clinical study was to evaluate the treatment of gingival recession, associated with non-carious cervical lesions by a connective tissue graft (CTG) alone, or in combination with a resin-modified glass ionomer restoration (CTG+R). MATERIALS AND METHODS Forty patients presenting Miller Class I buccal gingival recessions, associated with non-carious cervical lesions, were selected. The defects were randomly assigned to receive either CTG or CTG+R. Bleeding on probing (BOP), probing depth (PD), relative gingival recession (RGR), clinical attachment level (CAL) and cervical lesion height (CLH) coverage were measured at baseline and 45 days, and 2, 3 and 6 months after treatment. RESULTS Both groups showed statistically significant gains in CAL and soft tissue coverage. The differences between groups were not statistically significant in BOP, PD, RGR and CAL, after 6 months. The percentages of CLH covered were 74.88 +/- 8.66% for CTG and 70.76 +/- 9.81% for CTG+R (p>0.05). The estimated root coverage was 91.91 +/- 17.76% for CTG and 88.64 +/- 11.9% for CTG+R (p>0.05). CONCLUSION Within the limits of the present study, it can be concluded that both procedures provide comparable soft tissue coverage. The presence of the glass ionomer restoration may not prevent the root coverage achieved by CTG.

A double‐blind randomized clinical evaluation of enamel matrix derivative proteins for the treatment of proximal class‐II furcation involvements

OBJECTIVE The aim of the present randomized, double-blind study was to evaluate the clinical response of proximal furcations treated with enamel matrix derivative proteins (EMD). MATERIAL AND METHODS Fifteen patients, each with a pair of contralateral class-II proximal furcation involvements, presenting probing depths (PDs) >/=5 mm and bleeding on probing (BOP) were selected. The patients were randomly assigned to: control group (n=15) - open flap debridement (OFD)+24% ethylenediaminetetraacetic acid (EDTA) conditioning; test group (n=15) - OFD+24% EDTA conditioning+EMD application. Plaque index (PI), BOP, PD, gingival margin position (GMP), relative vertical and horizontal clinical attachment level (RVCAL and RHCAL), vertical and horizontal bone level (VBL and HBL) and furcation closure were evaluated immediately before and 2, 4 and 6 months after the surgeries. RESULTS At 6 months, the RVCAL gains of the control and test group were 0.39 +/- 1.00 and 0.54 +/- 0.95 mm, while the RHCAL gains were 1.21 +/- 2.28 and 1.36 +/- 1.26 mm (p>0.05). The VBL and HBL gains of the control group were 1.04 +/- 1.12 and 1.00 +/- 1.79 mm, and 0.82 +/- 1.82 and 1.17 +/- 1.38 mm for the test group (p>0.05). In addition, a statistical difference was observed in the number of the remaining class-II furcations between the test and control groups (p<0.05) in this period. CONCLUSION It may be concluded that the use of EMD in proximal furcations did not promote a superior reduction in PD or a gain in clinical and osseous attachment levels, but resulted in a higher rate of class-II to class-I furcation conversion.

Microbial Diversity Similarities in Periodontal Pockets and Atheromatous Plaques of Cardiovascular Disease Patients

Background and Objective The immune and infectious alterations occurring in periodontitis have been shown to alter the development and severity of cardiovascular disease. One of these relationships is the translocation of oral bacteria to atheroma plaques, thereby promoting plaque development. Thus, the aim of this study was to assess, by 16s cloning and sequencing, the microbial diversity of the subgingival environment and atheroma plaques of patients concomitantly suffering from periodontitis and obstructive coronary artery atherosclerosis (OCAA). Methods Subgingival biofilm and coronary balloons used in percutaneous transluminal coronary angioplasty were collected from 18 subjects presenting with generalized moderate to severe periodontitis and OCAA. DNA was extracted and the gene 16S was amplified, cloned and sequenced. Results Significant differences in microbial diversity were observed between both environments. While subgingival samples mostly contained the phylum Firmicutes, in coronary balloons, Proteobacteria (p<0.05) was predominant. In addition, the most commonly detected genera in coronary balloons were Acinetobacter, Alloprevotella, Pseudomonas, Enterobacter, Sphingomonas and Moraxella, while in subgingival samples Porphyromonas, Filifactor, Veillonella, Aggregatibacter and Treponema (p<0.05) were found. Interestingly, 17 identical phylotypes were found in atheroma and subgingival samples, indicating possible bacterial translocation between periodontal pockets and coronary arteries. Conclusion Periodontal pockets and atheromatous plaques of cardiovascular disease patients can present similarities in the microbial diversity.

Association of hyaluronic acid with a collagen scaffold may improve bone healing in critical-size bone defects.

OBJECTIVES To evaluate the effects of a 1% hyaluronic acid (HA) gel in combination with an absorbable collagen sponge (ACS) in the healing of critical-size calvaria defects in rats. MATERIAL AND METHODS Thirty-two adult Wistar rats were used. Two 5-mm-diameter critical-size defects were created and the treatments were randomly distributed as follows: (1) 1% HA; (2) 1% HA gel-soaked ACS; (3) control (blood clot); and (4) ACS. The animals were sacrificed 60 days post-surgery, when biopsies were collected and processed for histology and histometric analysis. Bone fill was measured as the difference between the initial and the final defect sizes. Non-parametric tests were used to analyze differences between treatments (α=1%) and a t-test for body weight gain in each treatment group (α=5%). RESULTS Histological analysis showed bone formation on the edges of the defects, although very limited, and a thin layer of connective tissue occupying the midportion of the defects in the control and the ACS groups. Defects filled with a 1% HA gel and 1% HA gel+ACS had a thicker layer of connective tissue and more new bone formed in the margins of the defects. Linear histometric measures showed no significant differences in the initial defect sizes between the groups (P>0.05). The association 1% HA gel+ACS (0.96 ± 0.14 mm) had significantly greater bone fill than the control (0.5 ± 0.02 mm) and ACS (0.56 ± 0.05 mm)-treated groups (P=0.0043 and 0.0173, respectively). Treatment with a 1% HA gel (0.7 ± 0.14 mm) showed no significant differences when compared with the other treatments. CONCLUSION Within the limits of this study, a 1% HA gel associated with a collagen scaffold can improve new bone formation in critical-size defects. However, this treatment never resulted in complete closure of the defects and healing in the major portion of the defects was characterized by fibrous tissue.

Periodontal disease and some adverse perinatal outcomes in a cohort of low risk pregnant women

ObjectiveTo evaluate the association of periodontal disease (PD) in pregnancy with some adverse perinatal outcomes.MethodThis cohort study included 327 pregnant women divided in groups with or without PD. Indexes of plaque and gingival bleeding on probing, probing pocket depth, clinical attachment level and gingival recession were evaluated at one periodontal examination below 32 weeks of gestation. The rates of preterm birth (PTB), low birth weight (LBW), small for gestational age (SGA) neonates and prelabor rupture of membranes (PROM) were evaluated using Risk Ratios (95%CI) and Population Attributable Risk Fractions.ResultsPD was associated with a higher risk of PTB (RRadj. 3.47 95%CI 1.62-7.43), LBW (RRadj. 2.93 95%CI 1.36-6.34) and PROM (RRadj. 2.48 95%CI 1.35-4.56), but not with SGA neonates (RR 2.38 95%CI 0.93 - 6.10).ConclusionsPD was a risk factor for PT, LBW and PROM among Brazilian low risk pregnant women.

Enamel matrix derivative proteins for the treatment of proximal class II furcation involvements: a prospective 24‐month randomized clinical trial

OBJECTIVE This study aimed to evaluate the response of proximal furcations treated with enamel matrix derivative proteins (EMD) in a 24-month follow-up. MATERIALS AND METHODS Twelve patients presenting bilateral class II proximal furcation with vertical probing depth (PD) ≥5 mm and bleeding on probing were selected. The furcations were assigned to: a control group (n=12), open flap debridement (OFD)+EDTA and a test group (n=12) - OFD+EDTA+EMD. The gingival margin position, PD, relative vertical and horizontal clinical attachment level (RVCAL and RHCAL), vertical and horizontal bone level (VBL and HBL) and furcation closure were evaluated before treatment and after 6, 12 and 24 months. RESULTS After follow-up, no statistical difference could be seen between groups. At 24 months, the test group showed 1.9 ± 1.6 mm PD reduction whereas the control group showed 1.0 ± 1.3 mm PD reduction. RHCAL gains of the control and the test group were 0.7 ± 1.3 and 1.4 ± 0.9 mm, respectively. However, at 24 months, the test group only presented five remaining class II furcations versus 10 furcations in the control group (p<0.05). CONCLUSION It could be concluded that EMD therapy promoted a reduction in the number of proximal furcations presenting a diagnosis of class II after 24 months of treatment compared with OFD therapy.