Léo Guimarães Soares

Tomographic evaluation of iliac crest bone grafting and the use of immediate temporary implants to the atrophic maxilla

Sixteen consecutive patients with atrophic maxillae, who had been referred for bone augmentation using iliac bone grafting before the placement of dental implants, received a full clinical examination and underwent a CT scan before and after surgery. Linear vertical and horizontal measurements were made before and 6 months after surgery. Differences in mean bone gain or loss for each area were compared between a group that received an immediate total provisional prosthesis on temporary immediate implants (test group, 12 patients) and a control group (four patients). Both groups showed significant horizontal bone gain in all regions and vertical bone augmentation in the posterior regions. The test group showed no significant difference for bone gain compared to the control group, but half the test group had problems during treatment. Bone augmentation of the atrophic maxilla with iliac crest bone grafting resulted in sufficient vertical and horizontal bone augmentation to install six or eight implants in all patients and successfully rehabilitate them. The results suggest that the use of total provisional prostheses on temporary immediate implants meets the aesthetic demands required, but should be used with care and in special cases.

Effectiveness of full- and partial-mouth disinfection on halitosis in periodontal patients

To compare the effectiveness of full- and partial-mouth disinfection for halitosis control, patients were assigned to treatment with full-mouth therapy (complete scaling and root planing in one stage within 24 h) or conventional therapy in quadrants (scaling and root planing performed by quadrant over a period of 4 weeks) (n = 90 for each group). Both groups were then subdivided: half the patients scraped their tongue daily and half did not. The patients were then evaluated by halimeter, organoleptic testing, and tongue coating index. Halimeter evaluation showed greater reduction of sulfide gases after full-mouth therapy than after conventional therapy (P < 0.001). However, organoleptic testing and the tongue coating index showed no difference among the four treatment groups. There was also no difference in relation to tongue scraping. In conclusion, halimeter evaluation showed that the reduction in volatile sulfur compounds was significantly greater after full-mouth therapy than after conventional therapy. However, this difference was not observed in organoleptic evaluation.

Short-term effect of strontium- and zinc-containing toothpastes and mouthrinses on volatile sulphur compounds in morning breath: a randomized, double-blind, cross-over clinical study.

Zinc (Zn) reduces the formation of volatile sulphur compounds (VSCs) associated with oral malodour. Although strontium (Sr) is included in some products for reducing dental hypersensitivity, it may also have anti-halitosis properties. This randomized, double-blind, cross-over clinical study compared the anti-VSC effect of brushing with commercial toothpastes and rinses containing Zn and Sr. The volunteers (n = 30) either brushed/rinsed with/without tongue brushing using Zn-containing toothpaste/rinse, Sr-containing toothpaste/rinse, or placebo (control). Volatile sulphur compounds [hydrogen sulphide (H2 S) and methyl mercaptan (CH3 SH)] were measured, in morning breath, using gas chromatography. The anti-VSC effects of the test toothpastes and test rinses were significantly better than the anti-VSC effects of the respective controls. Toothbrushing with test toothpastes gave median reductions, compared with the control, of 70% for H2 S and 55-57% for CH3 SH. Rinsing with the Sr- and Zn-containing solutions had the same anti-VSC effect as toothbrushing and tooth- and tongue brushing with the Sr- and Zn-containing toothpastes. Zinc-containing rinse resulted in a significantly higher median salivary level of Zn compared with brushing with Zn-containing toothpaste, although this effect did not correlate with the anti-VSC effect. It can be concluded that the Sr- and Zn-containing toothpastes and the Zn- and Sr-containing rinses, when used in the evening, are equally effective in reducing morning-breath VSCs the following day.

Periodontal Conditions in Human Immunodeficiency Virus-Positive Patients Under Highly Active Antiretroviral Therapy From a Metropolitan Area of Rio De Janeiro.

BACKGROUND The aim of this study is to evaluate the periodontal status and the presence of opportunistic oral lesions in human immunodeficiency virus-positive (HIV+) patients under highly active antiretroviral therapy (HAART) and their association with cluster of differentiation (CD)4+ and CD4+ nadir T-cell counts and viral load levels. METHODS Clinical periodontal parameters and the presence of opportunistic oral lesions along with records of CD4+ counts and viral load levels were evaluated in 29 individuals (16 females; mean age: 42.7 years) with previous serologic diagnosis of HIV, from the acquired immunodeficiency syndrome program of the Health Center of Duque de Caxias, Rio de Janeiro, Brazil. RESULTS All individuals presented gingivitis or periodontitis. A higher non-significant prevalence of periodontitis was found in smokers (93.8%) compared with non-smokers (76.9%). A significant weak positive correlation was observed between CD4+ counts and missing teeth (ρ = 0.380, P <0.05), CD4+ nadir and periodontal diagnosis (ρ = 0.418, P <0.005), and CD4+ nadir and moderate probing depth (PD) (ρ = 0.424, P <0.05). When only non-smokers were analyzed, a significant moderate positive association was found between viral load and moderate clinical attachment level (CAL) (ρ = 0.638, P <0.05), CD4+ nadir and diagnosis (ρ = 0.586, P <0.05), and CD4+ nadir and moderate CAL (ρ = 0.680, P <0.05). Analysis considering only smokers found no correlations between serologic parameters and demographic or clinical parameters. CONCLUSIONS The current investigation demonstrates that HIV+ individuals under HAART presents a high prevalence of mild to moderate periodontal disease. Viral load levels, CD4+ nadir, and CD4+ counts may present a weak to moderate correlation to the number of missing teeth, periodontal diagnosis, moderate PD, and moderate CAL, which may also reflect some effect of these systemic conditions on the periodontal status.

Clinical Efficacy of Full-Mouth Ultrasonic Debridement against Partial-Mouth Ultrasonic Debridement in the Treatment of Chronic Periodontitis: Full-Vs Partial-Mouth Debridement

Aim: To compare the clinical benefit of full-mouth ultrasonic debridement against partial-mouth ultrasonic debridement in patients with chronic periodontitis up to 3 months after therapy. Materials & Methods: Sixty patients with probing pocket depth ≥ 5 mm were randomly assigned to evaluate the clinical efficacy of full-mouth ultrasonic debridement against partial-mouth ultrasonic debridement in the treatment of advanced chronic periodontitis. Results: There was a reduction in the levels of probing pocket depth and relative attachment level but no statistically significant difference between treatment groups in intervals of 30, 60 and 90 days. For bleeding following pocket probing, was found statistical difference for 30 and 60 days, where the groups of full-mouth showed more reduction than conventional therapy. But in 90 days, there was no significant difference between groups. Conclusion: At the evaluation 90 days after treatment, no statistical difference was found be- tween the two periodontal therapies. Clinical relevance: This study tried to verify if full-mouth ultrasonic debridement provides clinically relevant improvements in the periodontal treatment.