Elton Gonçalves Zenóbio

Impacto da doença periodontal na qualidade de vida de indivíduos diabéticos dentados

The aim of this study was to evaluate the potential impact of periodontal disease on quality of life in diabetics. A total of 159 dentate diabetic individuals registered at the Municipal Hospital in Itaúna, Minas Gerais, Brazil, were examined and interviewed. The clinical periodontal parameters recorded were: gingival bleeding, probing depth, and clinical attachment level. The OHIP-14 form was used to evaluate the impact of periodontal disease on quality of life. In relation to periodontal status, 15.7% of individuals were healthy, 35.2% presented gingivitis, and 49.1% periodontitis (27.7% in the mild-to-moderate and 21.4% in the advanced stages). Association between diagnosis of periodontal disease and impact on quality of life was significant in individuals with periodontitis (p < 0.001). Gingival bleeding, probing depth, and clinical attachment level > 4mm were associated with intensely negative impact on quality of life (p = 0.013, p < 0.001, and p = 0.012 respectively). Diabetics with mild-to-moderate and advanced periodontitis had more negative impact on quality of life than those who were periodontally healthy or with gingivitis.

Stromal myofibroblasts in focal reactive overgrowths of the gingiva

Focal reactive overgrowths are among the most common oral mucosal lesions. The gingiva is a significant site affected by these lesions, when triggered by chronic inflammation in response to microorganisms in dental plaque. Myofibroblasts are differentiated fibroblasts that actively participate in diseases characterized by tissue fibrosis. The objective of this study was to evaluate the presence of stromal myofibroblasts in the main focal reactive overgrowths of the gingiva: focal fibrous hyperplasia (FFH), peripheral ossifying fibroma (POF), pyogenic granuloma (PG), and peripheral giant cell granuloma (PGCG). A total of 10 FFHs, 10 POFs, 10 PGs, and 10 PGCGs from archival specimens were evaluated. Samples of gingival mucosa were used as negative controls for stromal myofibroblasts. Oral squamous cell carcinoma samples, in which stromal myofibroblasts have been previously detected, were used as positive controls. Myofibroblasts were identified by immunohistochemical detection of alpha smooth muscle actin (α-sma). Myofibroblast immunostaining was qualitatively classified as negative, scanty, or dense. Differences in the presence of myofibroblasts among FFH, POF, PG, and PGCG were analyzed using the Kruskal-Wallis test. Stromal myofibroblasts were not detected in FFH, POF, PG, or PGCG. Consequently, no differences were observed in the presence of myofibroblasts among FFH, POF, PG, or PGCG (p > 0.05). In conclusion, stromal myofibroblasts were not detected in the focal reactive overgrowths of the gingiva that were evaluated, suggesting that these cells do not play a significant role in their pathogenesis.

Impact of human maxillary sinus volume on grafts dimensional changes used in maxillary sinus augmentation: a multislice tomographic study

PURPOSE To assess the influence of complete maxillary sinus volume on the dimensional changes of different grafts used in maxillary sinus lift. MATERIALS AND METHODS Analysis of 50 surgical procedures of maxillary sinus lift performed on 43 subjects using different grafting materials: fresh frozen allogenic particulated bone (11), hydroxyapatite (Endobon(®)) (17), 60% hydroxyapatite + 40% beta-tricalcium phosphate (Bone Ceramic(®)) (12) and Bone Ceramic(®) + Emdogain(®) (10). One hundred and fifty multislice tomographic images of the maxillary sinus were obtained using the software Syngo CT 2011 A VOLUME, measuring complete maxillary sinus volume (T0) and dimensional changes of different graft materials during periods of 15 days (T1) and 180 days (T2). The factor studied was the influence of maxillary sinus volume on the dimensional changes of different graft materials used in maxillary sinus lift in patients with posterior edentulism. Data obtained were assessed using the Students t-test and Pearsons correlation coefficient. RESULTS No correlation (r 0.112) between the total maxillary sinus volume and the dimensional changes of the different graft materials used in this study was observed (P > 0.05). CONCLUSION This study demonstrated that there is no sufficient evidence to support the thesis that the volume of the maxillary sinus influences the contraction of the grafts, at least on sample or the biomaterials evaluated in this cohort study.

Differential expression of salivary glycoproteins in aggressive and chronic periodontitis

Objectives The aim of this study was to compare the pattern of secretion and the expression of mucin glycoprotein-2 (MG2) and lactoferrin in individuals with or without periodontitis. Material and Methods Five individuals with aggressive periodontitis (APG), 5 with generalized chronic periodontitis (CPG) and 5 without periodontitis (CG) were enrolled after informed consent. Non-stimulated and stimulated submandibular and sublingual saliva was collected and samples analyzed by Western blot probed with specific antibodies. Results Stimulated and non-stimulated salivary flow rates did not differ among groups. Western blot analysis revealed that stimulation led to: an increase in MG2 expression in all groups, and to lactoferrin expression in APG and CPG. In non-stimulated saliva, CG exhibited the highest expression of both glycoproteins. In stimulated saliva, CG exhibited the highest expression of MG2, whereas APG the highest of lactoferrin. Conclusions The pattern of secretion of MG2 and lactoferrin in health and disease is complex. Although the present study analyzed samples from a limited number of participants, the reduced expression of MG2 and lactoferrin in APG and CPG under non-stimulated condition, the predominant circumstance of salivary secretion during the day, suggests that these salivary constituents may play a role in the etiopathogenesis of these diseases.

Absorbed Radiation Doses During Tomographic Examinations in Dental Implant Planning: A Study in Humans

OBJECTIVE The aim of this human study was to evaluate the radiation doses in the buccal cavity and face, during panoramic, spiral conventional tomography, and helicoidal computerized tomography exams. MATERIAL AND METHODS Lithium fluoride TL detectors (TLD-100) were placed on the skin at anatomic points such as parotid glands, submandibular glands, thyroid glands, and crystalline to assess the skin entrance dose in 19 patients who were to undergo dental implant surgery. RESULTS In the panoramic exam, maximum doses were observed near the parotid glands at 1.57 (±18%) mGy on the right and 1.89 (±18%) mGy on the left. In the spiral conventional tomography exam, the maximum dose was 4.41 (±21%) mGy near the right and left parotid glands, whereas near the right or left submandibular glands, the maximum doses reached 40.7 (±18%) mGy. In the helicoidal computerized tomography for mandibular and maxilla exams, the maximum dose was 40.9 (±15%) mGy near the parotid glands and 41.0 (±18%) mGy near the submandibular glands. Near the thyroid and eye lens, doses were lower than 0.23 (±21%) in all exams. CONCLUSION Regardless of the exam target area, the submandibular and parotid glands represented the most irradiated organs. This data suggests that efforts should be made by professionals to improve and optimize methods in order to reduce doses without losing the information necessary for treatment planning.

Hyaluronic acid on collagen membranes: An experimental study in rats

OBJECTIVE The aim of this study was to evaluate the effect of hyaluronic acid (HA) in the structure and degradation patterns of BioGide® and OsseoGuard™ collagen membranes. HA mediates inflammation and acts in cell migration, adhesion, and differentiation, benefitting tissue remodeling and vascularization. These are desirable effects in guided regeneration procedures, but it is still unknown whether HA alters the barrier properties of absorbable membranes. DESIGN Bone defects were created in the calvaria of rats, which were treated with HA gel 1% (HA group) or simply filled with blood clot (control group), and covered with BioGide® or OsseoGuard™. The animals were euthanized after 1, 30, and 60days, and their calvarias were processed for histological analysis. RESULTS BioGide®, in both HA and control groups, showed vascularization, intense cell colonization, bone formation, and tissue integration at 30 and 60days. In contrast, Osseoguard™ presented minimal cellular colonization, and inflammatory reaction associated to foreign body reaction in both time points and groups. The HA group of BioGide® showed higher cell colonization (574.9±137.6) than the control group (269.1±70.83) at 60days (p<0.05). Despite this finding, the structure and degradation pattern were similar for BioGide® and Osseoguard™ in the HA and control groups. CONCLUSION The results suggest that HA did not interfere with tissue integration and structural degradation of BioGide® and Osseoguard™ membranes.

Peri-implant Plastic Surgery

As reported in Chap. 3, two main terms may be used when planning gingival soft tissue procedures around natural teeth: mucogingival surgery and periodontal plastic surgery. However, such soft tissue augmentation or reduction procedures may be applied at implant sites as well. As a result, the term “peri-implant plastic surgery (PiPS)” appears as the application/translation of the concepts, surgical procedures, and main indications developed for the treatment of tooth soft tissue deformities to dental implants. Consequently, PiPS could be defined as the group of procedures aimed to correct aesthetical and/or functional, peri-implant soft and hard tissue deformities of acquired or pathological origin.

Enamel Pearls Implications on Periodontal Disease

Dental anatomy is quite complex and diverse factors must be taken into account in its analysis. Teeth with anatomical variations present an increase in the rate of severity periodontal tissue destruction and therefore a higher risk of developing periodontal disease. In this context, this paper reviews the literature regarding enamel pearls and their implications in the development of severe localized periodontal disease as well as in the prognosis of periodontal therapy. Radiographic examination of a patient complaining of pain in the right side of the mandible revealed the presence of a radiopaque structure around the cervical region of lower right first premolar. Periodontal examination revealed extensive bone loss since probing depths ranged from 7.0 mm to 9.0 mm and additionally intense bleeding and suppuration. Surgical exploration detected the presence of an enamel pearl, which was removed. Assessment of the remaining supporting tissues led to the extraction of tooth 44. Local factors such as enamel pearls can lead to inadequate removal of the subgingival biofilm, thus favoring the establishment and progression of periodontal diseases.

Cemental tear: a case report with nonsurgical periodontal therapy

OBJETIVO: Relatar um caso de dilaceracao cementaria, uma condicao periodontal rara caracterizada pela separacao total ou parcial do cemento dental, abordando principalmente aspectos relativos ao seu diagnostico e tratamento. DESCRICAO DO CASO: Um homem de 50 anos procurou assistencia odontologica queixando-se de dor localizada no segundo molar inferior que apresentava profundidade de sondagem de 4 mm com presenca de um corpo estranho no sulco gengival da face distal. O exame radiografico demonstrou um fragmento radiopaco destacado da raiz. O fragmento foi removido sem cirurgia periodontal. O exame histopatologico demonstrou tratar-se de um fragmento de cemento com presenca de lamelas cementarias, cementocitos e fibras do ligamento periodontal, confirmando o diagnostico de dilaceracao cementaria. CONCLUSAO: Apos dois anos, o tratamento periodontal nao cirurgico demonstrou aspectos clinicos e radiograficos satisfatorios. Portanto, a terapia periodontal nao cirurgica pode ser uma modalidade de tratamento adequada e previsivel para a dilaceracao cementaria.

Assessment of Dental Implant Stability in Areas Previously Submitted to Maxillary Sinus Elevation

This study aimed to compare the primary and secondary stability, measured by resonance frequency analysis (RFA), in implants of different lengths installed in areas submitted to maxillary sinus lift. Correlation between RFA and implant insertion torque was also assessed. Twenty implants of 9 and 11 mm were inserted in areas submitted to maxillary sinus lift. The insertion torque was measured by the Bien Air motor. Osstell, through RFA, determined the implant stability quotient (ISQ) 2 times: the day of implant installation (T1) and 90 days after implant installation (T2). No differences were observed in the ISQ between T1 and T2 when the 20 implants were grouped, nor when the 9 mm implants were evaluated separately. In contrast, when the 11 mm values were evaluated separately, the ISQ was significantly higher in T2 than in T1 ( P < .05). In T1, 9 mm implants had a higher ISQ than 11 mm ones ( P < .05), whereas in T2, the implants of 11 mm showed a higher ISQ than did the 9 mm implants ( P < .05). There was no difference in insertion torque between 9 and 11 mm implants ( P > .05), nor was there a correlation between ISQ and insertion torque ( P > .05). In conclusion, longer implants (11 mm) presented a significant increase in ISQ values during the healing period when installed in areas previously submitted to maxillary sinus lift. This phenomenon was not observed for shorter implants (9 mm). Finally, no correlation was observed between ISQ and insertion torque.