Cláudio Mendes Pannuti

Evidence-based periodontal plastic surgery. II. An individual data meta-analysis for evaluating factors in achieving complete root coverage.

BACKGROUND The aim of this review is to conduct an individual patient data meta-analysis of randomized controlled clinical trials (RCTs) to evaluate whether baseline recession-, patient-, and procedure-related factors can influence the achievement of complete root coverage (CRC). METHODS A literature search with no restrictions regarding status or the language of publication was performed for MEDLINE (for Medical Literature Analysis and Retrieval System Online), EMBASE (for Excerpta Medica Database), CENTRAL (for Cochrane Central Register of Controlled Trials), and the Cochrane Oral Health Groups Specialized Register databases up to and including March 2011. Only RCTs, with a duration of ≥6 months evaluating recession areas (Miller Class I or II) that were treated by means of root coverage procedures were included. Mixed-effects logistic regression analyses were conducted to evaluate associations between five baseline variables and CRC. RESULTS Of the 70 potentially eligible trials, 22 were included in the meta-analyses. In total, the data from 320 patients and 16 procedures were evaluated. None of the RCTs were classified as low risk of bias. Of the 602 recessions treated, 310 (51.5%) achieved CRC. Subepithelial connective tissue grafts (SCTGs), matrix grafts, and enamel matrix derivative protein (EMD) procedures were superior in achieving CRC when compared to coronally advanced flap (CAF) alone. For the adjusted covariates, the greater the baseline recession depth, the smaller the chance of achieving CRC (individual procedure analysis [odds ratio (OR) = 0.55; 95% confidence interval (CI) = 0.44, 0.70] and grouped procedure analysis [OR = 0.56; 95% CI = 0.45, 0.71]), as well as studies with conflict of interest were more likely to achieve CRC than those without conflict of interest (individual procedure analysis [OR = 6.78; 95% CI = 1.78, 25.86]). CONCLUSIONS SCTGs, matrix grafts, and EMD were superior to CAF in achieving CRC, but SCTGs showed the best predictability. The impossibility of inclusion of all identified RCTs should be taken into consideration when interpreting the present findings.

Evidence grade associating periodontitis to preterm birth and/or low birth weight: I. A systematic review of prospective cohort studies

AIM The aims of this systematic review (SR) were to evaluate the association between maternal periodontitis and preterm birth (PB) and/or low birth weight (LBW), and the methodological quality of prospective cohort studies conducted for such a purpose. METHODS MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched up to and including October 2010 to identify prospective studies on the association of periodontitis with PB and/or LBW. Search was conducted by two independent reviewers. The methodological quality of the observational studies was assessed using a specially designed methodological tool. Random effects meta-analyses were conducted thoroughly. RESULTS Search strategy identified 1680 potentially eligible articles, of which 12 prospective studies were included. One cohort study had their data reported in two articles. Of the 11 studies, 10 showed a high methodological quality and one a medium methodological quality. Nine studies (81.8%) found an association between periodontitis and PB and/or LBW. Meta-analysis showed a significant risk of preterm delivery for pregnant women with periodontitis [risk ratio (RR): 1.70 (95% confidence interval (CI): 1.03, 2.81)] and a significant risk for LBW [RR: 2.11 (95% CI: 1.05, 4.23)] or PB/LBW [RR: 3.57 (95% CI: 1.87, 6.84)], as well as a high and unexplained degree of heterogeneity between studies. CONCLUSION Although this SR found a consistent association between periodontitis and PB and/or LBW, this finding should be treated with great caution until the sources of heterogeneity can be explained.

Evidence grade associating periodontitis with preterm birth and/or low birth weight: II. A systematic review of randomized trials evaluating the effects of periodontal treatment

AIM The aim of this systematic review was to evaluate whether maternal periodontal disease treatment (MPDT) can reduce the incidence of preterm birth (PB) and/or low birth weight (LBW). METHODS The Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE were searched for entries up to October 2010 without restrictions regarding the language of publication. Only randomized-controlled clinical trials (RCTs) that evaluated the effect of MPDT on birth term and birth weight were included. The search was conducted by two independent reviewers and random-effects meta-analyses were conducted methodically. RESULTS Thirteen RCTs provided data, but only five trials were considered to be at a low risk of bias. The results of eight studies (61.5%) showed that MPDT may reduce the incidence of PB and/or LBW. However, the results of all meta-analyses showed contrasting results for PB [RR: 0.88 (95% CI: 0.72, 1.09)], LBW [RR: 0.78 (95% CI: 0.53, 1.17)] and PB/LBW [RR: 0.52 (95% CI: 0.08, 3.31)]. CONCLUSION The results of this review show that MPDT did not decrease the risk of PB and/or LBW; however, the influence of specific aspects that were not investigated (disease diagnosis, extension and severity and the success of MPDT) should be evaluated by future RCTs.

Efficacy of a herbal toothpaste on patients with established gingivitis: a randomized controlled trial

The aim of this randomised, double blind controlled trial was to verify the efficacy of a herbal dentifrice on the reduction of plaque and gingivitis. Forty eight volunteers with established gingivitis were randomly assigned to either a test group (herbal dentifrice) or positive control group (dentifrice with triclosan and fluoride). The dentifrices were distributed in plain white tubes by an independent pharmacy, which revealed the contents of each tube only after the experimental period. Plaque and gingivitis assessments were carried out on baseline and after 28 days of product use. All examinations were conducted by the same calibrated investigator. Subjects were instructed to brush their teeth three times daily using their assigned dentifrice for 28 days. There was a significant reduction in plaque levels in both the test and control groups. However, there was no significant difference between the groups. A significant reduction in gingivitis was observed in both groups, although there was no significant difference between them. No adverse reactions were reported. The authors concluded that both dentifrices were effective in reducing plaque and gingivitis in subjects with established gingivitis.

Clinical effect of a herbal dentifrice on the control of plaque and gingivitis: a double-blind study

The aim of this randomized, double-blind clinical trial was to evaluate the effect of the Paradontax dentifrice on the reduction of plaque and gingivitis. Subjects were randomly allocated into either the test group (n = 15, Paradontax) or the control group (n = 15, standard dentifrice with fluoride). Plaque levels were measured using the Turesky modification of the Quigley & Hein Plaque Index (PI), and gingivitis was evaluated with the Gingival Index (GI). Subjects were asked to brush their teeth with the allocated dentifrice, three times a day, for 21 days. There was no significant difference between groups in relation to the PI and GI medians, at baseline and at the end of the 21-day period. There was no significant reduction in PI in either the test or control groups. There was a significant decrease in GI in the test group. The authors concluded that there was no difference between the dentifrices in the reduction of plaque and gingivitis.

Association between periodontal diseases and systemic diseases

Current evidence suggests that periodontal disease may be associated with systemic diseases. This paper reviewed the published data about the relationship between periodontal disease and cardiovascular diseases, adverse pregnancy outcomes, diabetes and respiratory diseases, focusing on studies conducted in the Brazilian population. Only a few studies were found in the literature focusing on Brazilians (3 concerning cardiovascular disease, 7 about pregnancy outcomes, 9 about diabetes and one regarding pneumonia). Although the majority of them observed an association between periodontitis and systemic conditions, a causal relationship still needs to be demonstrated. Further studies, particularly interventional well-designed investigations, with larger sample sizes, need to be conducted in Brazilian populations.

Efficacy of high intensity diode laser as an adjunct to non-surgical periodontal treatment: a randomized controlled trial.

The high intensity diode laser has been studied in periodontics for the reduction of subgingival bacteria in non-surgical treatment. Our study evaluated the bacterial effect as well as changes in periodontal clinical parameters promoted by root scaling and planing associated with this wavelength. Twenty-seven patients randomly assigned in two groups underwent root scaling and planing on the tested sites, and only the experimental group received the diode laser irradiation. Among the clinical parameters studied, the clinical probing depth (CPD) and the clinical attachment level (CAL) resulted in significant enhancement in the control group when compared with the experimental group (P = 0.014 and P = 0.039, respectively). The results were similar for both groups regarding the plaque index (PI) and bleeding on probing (BP). No significant difference in the microbiological parameters was observed between the control and experimental groups. It was possible to conclude that the high power diode laser adjunct to the non-surgical periodontal treatment did not promote additional effects to the conventional periodontal treatment.

A prospective 12-month study of the effect of smoking cessation on periodontal clinical parameters

AIM The aim of this 12-month prospective study was to assess the adjunctive effect of smoking cessation in non-surgical periodontal therapy of subjects with severe chronic periodontitis. MATERIALS AND METHODS Of the 201 subjects enrolled from a smoking cessation clinic, 93 were eligible and received non-surgical periodontal treatment and concurrent smoking cessation treatment. Periodontal maintenance was performed every 3 months. Full-mouth periodontal examination in six sites per tooth was performed by a calibrated examiner, blinded to smoking status, at baseline, 3, 6 and 12 months after non-surgical periodontal treatment. Furthermore, expired air carbon monoxide concentration measurements and interviews based on a structured questionnaire were performed in order to collect demographic and smoking data. RESULTS Of the 93 eligible subjects, 52 remained in the study after 1 year. Of these, 17 quit smoking and 35 continued smoking or oscillated. After 1 year, only quitters presented significant clinical attachment gain (p=0.04). However, there were no differences between the groups regarding clinical attachment level, probing depth, bleeding on probing and plaque index after 1 year (p>0.05). CONCLUSION Smoking cessation promoted clinical attachment gain in chronic periodontitis subjects from a smoking cessation clinic after 1 year of follow-up.

Porphyromonas Gingivalis is Associated With Protease-Activated Receptor-2 Upregulation in Chronic Periodontitis

BACKGROUND We previously reported a higher expression of protease-activated receptor-2 (PAR(2)) together with higher interleukin (IL)-1α, IL-6, IL-8, and tumor necrosis factor-α levels, total proteolytic activity, Porphyromonas gingivalis (Pg) prevalence, and neutrophil-protease 3 messenger RNA (mRNA) expression in patients with chronic periodontitis compared to healthy control patients. The aim of the present study is to expand this observation by considering the site level according to the presence of Pg. METHODS Microbiologic and gingival crevicular fluid samples were collected from patients with chronic periodontitis. Pg presence was evaluated by polymerase chain reaction and PAR(2) mRNA expression was evaluated by reverse-transcription polymerase chain reaction. Total proteolytic activity in the crevicular fluid was analyzed by using a specific substrate benzoylarginine nitroanilide, and the proinflammatory mediators IL-1α, IL-6, IL-8, and tumor necrosis factor-α were analyzed by enzyme-linked immunosorbent assay. RESULTS In Pg-positive periodontal sites, the mean probing depth and clinical attachment level, the prevalence of bleeding on probing sites, and crevicular fluid volume were higher (P <0.05) compared to Pg-negative sites. In addition, with the exception of IL-8, all other inflammatory mediators were positively (P <0.05) associated with Pg presence. Pg presence was also positively associated with a higher proteolytic activity (P = 0.0037) and higher PAR(2) mRNA expression (P = 0.0271). CONCLUSIONS We conclude that in chronic periodontitis, periodontal pockets presenting Pg show an upregulation of PAR(2) gene expression, and higher proinflammatory profile associated with advanced clinical destruction, therefore suggesting that Pg plays a pivotal role on PAR(2)-mediated periodontal inflammation in humans.

Tooth loss prevalence and risk indicators in an isolated population of Brazil

Objective. The aim of this study was to assess the prevalence, extent, and risk indicators of tooth loss in an isolated population of Brazil. Material and methods. Two-hundred-and-forty-two subjects, ranging in age from 14 to 82 years (mean 36.2 years), were identified by census in an isolated population of Brazil. All consenting subjects received a full-mouth clinical (DFT index and information about missing teeth) and periodontal examination of 6 sites per tooth. Furthermore, they were interviewed using a structured written questionnaire in order to gather information about demographic, environmental, and biological variables. Results. Of the 200 subjects (80% response rate), 19 (9.5%) were edentulous, 90% had lost at least one tooth, and 39% had lost more than 8 teeth. The mean number of teeth lost was 9.5 (95% CI = 8.2–10.8). First mandibular molars were the most commonly missing teeth. In a multiple logistic regression analysis based on a theoretical hierarchical model of tooth loss, having more than 8 teeth lost was strongly associated with adult age (OR = 18.3–17.3, 95% CIs = 4.8–69.7 and 4.0–75.1) and female gender (OR = 5.9, 95% CI = 1.9–18.2) in the final model. Conclusions. Tooth loss was highly prevalent and extensive in this isolated population. Demographic and behavioral factors played an important role in tooth loss prevalence in this population.