Getulio Nogueira-Filho

Is keratinized mucosa indispensable to maintain peri‐implant health? A systematic review of the literature

The significance of keratinized mucosa (KM) around dental implants is still not well explained and has been controversial. The aim of this systematic review was to evaluate the importance of KM around dental implants. The electronic databases Cochrane library, MEDLINE, EMBASE, and Virtual Health Library (VHL) databases were utilized to search original articles from 2006 to March 2013. The inclusion and exclusion criteria used to select the articles were: (1) Human studies published in the English language; (2) Study published in international peer-viewed journals; (3) Studies evaluated the association between KM width and the peri-implant tissue health; (4) Studies that have follow up of greater than 12 months; (5) Publication of studies not older than 10 years. The searches retrieved 285 citations. Seven articles fulfilled all of the inclusion criteria. Out of these, three studies were ranked as presenting high methodological quality, and four were judged to be of moderate quality. This systematic review concludes that the presence of an adequate zone of keratinized tissue may be necessary because it was shown to be related to better peri-implant tissue health. Further randomized controlled trials are necessary to support this statement.

Periodontal Inflammatory Conditions Among Gutka Chewers and Non-chewers With and Without Prediabetes

BACKGROUND It is known that gutka chewing jeopardizes periodontal health; however, severity of periodontal inflammation in gutka chewers with and without prediabetes remains unknown. The aim of this study is to investigate the association of periodontal inflammatory conditions with gutka chewing and prediabetes. METHODS In this cross-sectional study, the effect of gutka use on periodontal health is investigated among 44 individuals with prediabetes and 44 without prediabetes. Demographic information regarding age, sex, duration of prediabetes, and gutka-chewing habits was collected using a questionnaire. Periodontal inflammatory conditions (plaque index [PI], bleeding on probing [BOP], probing depth [PD], marginal bone loss [MBL]) and fasting blood glucose levels (FBGLs) were recorded. Group differences in periodontal inflammatory parameters were tested using univariate and multivariable analyses (α ≤5%). RESULTS Periodontal inflammatory parameters (PI, BOP, and PD) were significantly higher in individuals with prediabetes irrespective of gutka-chewing habit (P <0.05). Odds of periodontal inflammation in individuals with prediabetes were nine times higher than in healthy controls (95% confidence interval [CI] = 3.4 to 23.6). Gutka chewing alone, chewing among individuals with prediabetes, and chewing among healthy controls did not significantly increase the odds of periodontal inflammatory conditions. Individuals with prediabetes were significantly more likely to have periodontal inflammation than individuals without prediabetes even after controlling for sex and gutka chewing (odds ratio = 13.2; 95% CI = 4.3 to 40.7). CONCLUSION In medically healthy individuals, periodontal inflammatory conditions are worse in gutka chewers compared to non-chewers; in patients with prediabetes, the severity of periodontal inflammation is governed by hyperglycemia when compared to habitual gutka usage.

A Systematic Review of Clinical Efficacy of Adjunctive Antibiotics in the Treatment of Smokers With Periodontitis

BACKGROUND The aim of this study is to systematically review the evidence of the efficacy of adjunctive antibiotic therapy to periodontal therapy in smokers with periodontitis. METHODS A search was conducted for randomized clinical trials (RCTs) with durations ≥6 months that compared periodontal therapy with and without adjunctive antibiotics for the treatment of periodontitis in smokers. Data sources primarily included PubMed with MeSH terms and free text as well as EMBASE, SCOPUS, and the Cochrane Central Register of Controlled Clinical Trials. In addition, a hand search of selected periodontal journals, bibliographies, and review articles was conducted. Independent reviewers were assigned to make independent searches and quality assessments (MA and DB) of the included studies, and disagreements were resolved by discussion. RESULTS Five RCTs were selected for quantitative and qualitative assessments. Little evidence was found that supported the use of antibiotic therapy in conjunction with surgical periodontal therapy in smokers. With respect to non-surgical therapy, consistent improvements in clinical attachment level (CAL) gain and probing depth (PD) reduction was reported after the use of a 250-mg azithromycin tablet in one study. Adjunctive doxycycline gel and minocycline microspheres statistically improved CAL gain (in one RCT) and PD reduction (in one RCT), respectively. However, the risk of bias in all studies was estimated as high. Also, inadequate and inconsistent data precluded performing meta-analyses. CONCLUSIONS The present systematic review concludes that the evidence for an additional benefit of adjunctive antibiotic therapy in smokers with chronic periodontitis is insufficient and inconclusive. Additional well-designed RCTs are required to assess the effect of antibiotics in conjunction with periodontal treatments in smokers.

Severity of Periodontal Disease in Individuals Chewing Betel Quid With and Without Tobacco

Background:The deleterious effects of chewing betel quid (BQ) with or without tobacco on periodontal health are poorly addressed. The aim of this study was to investigate the severity and extent of periodontal disease among individuals chewing BQ with and without tobacco. Methods:One hundred twenty individuals (70 BQ chewers: 35 with tobacco and 35 without tobacco) and 50 control individuals (non-chewers) were included in this study. Sociodemographic data and information regarding BQ chewing habit were collected using a questionnaire. Plaque index, bleeding on probing and probing pocket depth were measured. Numbers of missing teeth were recorded and marginal bone loss was measured on panoramic radiographs. Statistical analyses were performed using 1-way analysis of variance and Bonferroni post hoc test. Results:The socioeconomic status of subjects in the control group was significantly higher as compared with those chewing BQ either with or without tobacco. Plaque index, bleeding on probing and probing pocket depth were greater in subjects chewing BQ with tobacco than in those chewing BQ without tobacco and the controls. Subjects chewing BQ with tobacco had fewer teeth than those chewing BQ without tobacco and the controls. Marginal bone loss was higher in subjects chewing BQ with tobacco than in those chewing BQ without tobacco and the controls. Conclusions:The severity of periodontal disease is enhanced in subjects chewing BQ with tobacco as compared with those chewing BQ without tobacco. Subjects with a low socioeconomic status and poor education are significantly more likely than others to develop periodontal disease.

Serum cytokine profile among Brazilian children of African descent with periodontal inflammation and sickle cell anaemia.

OBJECTIVE The aim of this study was to evaluate possible immunologic relationships between sickle cell anaemia (SCA) and periodontal inflammation and its impact on serum cytokines. DESIGN Twenty-five Brazilian children of African descent were involved in this study and divided in two groups: SCA (n=10): confirmed diagnosis of homozygous anaemia; and CTR-control (n=15): no sickle anaemia. Clinical examination included comprehensive medical (routine physical evaluation) and periodontal exams: plaque index (PI), bleeding on probing (BoP), and haematological analysis. Serum samples were collected for cytokine evaluation by microarray. Clinical and laboratorial parameters were compared statistically (alpha=5%). RESULTS The higher values of PI and BoP were similar for both groups (p>0.05) confirming a diagnosis of generalized gingivitis for all individuals. Intergroup analysis showed higher levels of interferon gamma (IFNγ), tumour necrosis alpha (TNFα), interleukin (IL)-4, -5, -8, -10 and 13 only in the SCA group (p<0.05). In addition, PI was negatively correlated with IL-2, IL-4, IL-5, IL-6, IL-8 and IL-13, while BoP was positively correlated with IL-10. CONCLUSION Within the limits of the present study, it was concluded that SCA increase the levels of serum cytokines regardless of the presence of periodontal inflammation. Therefore, a direct immunological relationship between SCA and periodontal inflammation was not established.

Cannabis sativa smoke inhalation decreases bone filling around titanium implants: a histomorphometric study in rats.

Purpose:Although the harmful effect of tobacco smoking on titanium implants has been documented, no studies have investigated the effects of cannabis sativa (marijuana) smoking. Thus, this study investigated whether marijuana smoke influences bone healing around titanium implants. Materials:Thirty Wistar rats were used. After anesthesia, the tibiae surface was exposed and 1 screw-shaped titanium implant was placed bilaterally. The animals were randomly assigned to one of the following groups: control (n = 15) and marijuana smoke inhalation (MSI) 8 min/d (n = 15). Urine samples were obtained to detect the presence of tetra-hidro-cannabinoid. After 60 days, the animals were killed. The degree of bone-to-implant contact and the bone area within the limits of the threads of the implant were measured in the cortical (zone A) and cancellous bone (zone B). Results:Tetra-hidro-cannabinoid in urine was positive only for the rats of MSI group. Intergroup analysis did not indicate differences in zone A-cortical bone (P > 0.01), however, a negative effect of marijuana smoke (MSI group) was observed in zone B-cancellous bone for bone-to-implant contact and bone area (Students t test, P < 0.01) values. Conclusions:Considering the limitations of the present study, the deleterious impact of cannabis sativa smoke on bone healing may represent a new concern for implant success/failure.

Longitudinal comparison of cytokines in peri-implant fluid and gingival crevicular fluid in healthy mouths.

BACKGROUND Peri-implant and gingival tissues provide important sealing and protective functions around implants and teeth, but comparisons of the immunologic responses of these tissues after implant placement have not been conducted. Cytokine levels were measured in peri-implant crevicular fluid (PICF) and gingival crevicular fluid (GCF) as surrogate measures of immune function at subcrestally placed dental implants and healthy periodontal sites during a 1-year monitoring period. METHODS A total of 27 dental implants were placed subcrestally in 21 periodontally healthy patients (mean age: 49.0 ± 13.4 years). Repeated clinical and cytokine measurements were obtained over 12 months. GCF and PICF samples were collected and analyzed by cytokine microarray. Data were examined by non-parametric analysis of variance. RESULTS Plaque and bleeding indices were similar among all patients (P >0.05) at baseline. During 1 year of monitoring, the mean volumes of PICF and GCF were similar (P >0.05). The levels of interleukin (IL)-4, -6, -10, and -12p70, tumor necrosis factor-α, and interferon-γ in GCF and PICF were not significantly different and did not vary over time (P >0.05). The levels of IL-1α were higher in GCF than PICF at 1, 2, 6, and 12 months, as were the levels of IL-8 at 1, 2, 4, 6, and 12 months (P <0.001). Transforming growth factor-β1 in PICF and GCF exhibited time-dependent increases, and vascular endothelial growth factor was reduced at 1 year without differences between PICF and GCF (P >0.05). CONCLUSION Within the limitations of this study design, it can be concluded that after subcrestal implant placement, the immune response of peri-implant and periodontal tissues, as assessed by cytokine levels in PICF and GCF, is similar.

Impact of Cannabis Sativa (Marijuana) Smoke on Alveolar Bone Loss: A Histometric Study in Rats

BACKGROUND Cannabis sativa (marijuana) can interfere with bone physiopathology because of its effect on osteoblast and osteoclast activity. However, its impact on periodontal tissues is still controversial. The present study evaluates whether marijuana smoke affects bone loss (BL) on ligature-induced periodontitis in rats. METHODS Thirty male Wistar rats were used in the study. A ligature was placed around one of the mandible first molars (ligated teeth) of each animal, and they were then randomly assigned to one of two groups: control (n = 15) or marijuana smoke inhalation ([MSI] for 8 minutes per day; n = 15). Urine samples were obtained to detect the presence of tetrahydrocannabinol. After 30 days, the animals were sacrificed and decalcified sections of the furcation area were obtained and evaluated according to the following histometric parameters: bone area (BA), bone density (BD), and BL. RESULTS Tetrahydrocannabinol was positive in urine samples only for the rats of the MSI group. Non-significant differences were observed for unligated teeth from both groups regarding BL, BA, and BD (P >0.05). However, intragroup analysis showed that all ligated teeth presented BL and a lower BA and BD compared to unligated teeth (P <0.05). The intergroup evaluation of the ligated teeth showed that the MSI group presented higher BL and lower BD (P <0.05) compared to ligated teeth from the control group. CONCLUSION Considering the limitations of this animal study, cannabis smoke may impact alveolar bone by increasing BL resulting from ligature-induced periodontitis.

Effect of Allium cepa L. on Lipopolysaccharide-Stimulated Osteoclast Precursor Cell Viability, Count, and Morphology Using 4′,6-Diamidino-2-phenylindole-Staining

Allium cepa L. is known to possess numerous pharmacological properties. Our aim was to examine the in vitro effects of Allium cepa L. extract (AcE) on Porphyromonas gingivalis LPS and Escherichia coli LPS-stimulated osteoclast precursor cells to determine cell viability to other future cell-based assays. Osteoclast precursor cells (RAW 264.7) were stimulated by Pg LPS (1 μg/mL) and E. coli LPS (1 μg/mL) in the presence or absence of different concentrations of AcE (10–1000 μg/mL) for 5 days at 37°C/5% CO2. Resazurin reduction and total protein content assays were used to detect cell viability. AcE did not affect cell viability. Resazurin reduction assay showed that AcE, at up to 1000 μg/mL, did not significantly affect cell viability and cellular protein levels. Additionally a caspase 3/7 luminescence assay was used to disclose apoptosis and there was no difference in apoptotic activity between tested groups and control group. Fluorescence images stained by DAPI showed no alteration on the morphology and cell counts of LPS-stimulated osteoclast precursor cells with the use of AcE in all tested concentrations when compared to control. These findings suggest that Allium cepa L. extract could be used for in vitro studies on Porphyromonas gingivalis LPS and Escherichia coli LPS-stimulated osteoclast precursor cells.

Whole-Blood Cultures From Patients With Chronic Periodontitis Respond Differently to Porphyromonas gingivalis but not Escherichia coli Lipopolysaccharide

BACKGROUND Porphyromonas gingivalis lipid A heterogeneity modulates cytokine expression in human cells. This study investigates the effects of two lipid A isoforms of P. gingivalis, lipopolysaccharide (LPS)1435/1449 and LPS1690, on the secretion of proinflammatory and regulatory cytokines in total blood cultures from patients with and without chronic periodontitis (CP). METHODS A cross-sectional study was conducted in 38 systemically healthy individuals divided in two groups: 1) the CP group (n = 19), in which patients were diagnosed with CP; and 2) the no periodontitis (NP) group (n = 19), which included control patients without CP. Blood samples were collected from all patients, and whole-blood cell cultures (WBCCs) were stimulated for 48 hours with P. gingivalis LPS1435/1449 and LPS1690 and Escherichia coli LPS. Unstimulated WBCCs served as negative controls. The secretion of interferon-γ (IFN-γ), interleukin-10 (IL-10), and transforming growth factor-β (TGF-β) was detected in WBCC supernatants by enzyme-linked immunosorbent assays. RESULTS E. coli LPS significantly increased the expression of all cytokines in WBCCs from both the NP and CP groups when compared to non-stimulated cells (control treatment). P. gingivalis LPS preparations increased IFN-γ levels in the CP group but not in the NP group when compared with controls (P <0.05). P. gingivalis LPS preparations also increased IL-10 and TGF-β levels in both CP and NP groups, but P. gingivalis LPS1690 showed a three-fold increase on IL-10 production in the NP group (P <0.05) when compared to P. gingivalis LPS1435/144. CONCLUSIONS These data demonstrate that WBCC cell populations obtained from healthy individuals and patients with CP may differ in the cytokine response to P. gingivalis but not E. coli LPS. This is consistent with the notion that CP alters the systemic WBCC response and that this can be detected by the different P. gingivalis LPS structures.