Luis Augusto Esper

Evaluation of the effect of the GaAlAs laser on subgingival scaling and root planing.

OBJECTIVE To evaluate the auxiliary effect of the low-intensity laser in subgingival scaling and root planing by analysis of its clinical aspects, as well as its analgesic potential during the procedure. BACKGROUND DATA Despite the large number of studies conducted on low-intensity laser energy, few clinical studies are available on periodontics. MATERIALS AND METHODS Ten patients were selected and submitted to measurement of six sites per tooth, four teeth per hemiarch (960 sites in all). All patients then received subgingival scaling and root planing. Besides periodontal treatment, the test side was also submitted to laser application. The analysis comprised measurement of probing depth, clinical attachment level, and gingival index. Laser energy was applied at a wavelength of 780 nm (35 J/cm(2), 70 mW, 20 sec per site) for preoperative analgesia, and scaling and root planing were performed with application of laser energy at a wavelength of 780 nm (35 J/cm(2), 70 mW, 20 sec) for analgesia, and at a wavelength of 630 nm (8.8 J/cm(2), 35 mW, 10 sec) for healing. The patients filled out a visual analogue scale to assess the pain they felt during the procedure. After 24 and 48 h, the laser was again applied at the wavelength of 630 nm, and the patients were re-evaluated after 3 d. RESULTS There was a reduction in gingival inflammation, yet without a statistically significant difference between the study and control sides, both in clinical aspects and evaluation of pain during the procedure. CONCLUSION Utilization of the diode laser as an auxiliary in subgingival scaling and root planing did not provide any apparent clinical benefit for teeth with shallow to moderate pockets.

The role of keratinized mucosa in peri-implant health.

Objective To evaluate the role of keratinized mucosa around dental implants, correlating with other clinical parameters related to the success of dental implants. Design Cross-section. Setting Institutional tertiary referral hospital. Patients A total of 202 dental implants fixed in the cleft area of 109 patients with cleft lip and/or palate were evaluated. Interventions The evaluated clinical parameters were probing depth and gingival and plaque indexes on the buccal surface (three sites). Main Outcome Measures All clinical parameters were correlated with the width of keratinized mucosa around the implants. Results The largest probing depths were detected when the width of keratinized mucosa was 2 mm or more, with a statistically significant difference between the means of the probing depth and keratinized mucosa width. Conclusion Even though the present results suggest that peri-implant health can be observed in areas with keratinized mucosa width under 2 mm provided an adequate oral hygiene control is performed, longitudinal randomized studies are necessary to analyze the relationship between the width of keratinized mucosa and the health of peri-implant tissues.

Utilization of low-intensity laser during healing of free gingival grafts.

OBJECTIVES This study evaluates the action of a low-intensity diode laser with gallium-aluminum-arsenide (GaAlAs) active medium on the healing process and analgesia in individuals undergoing free gingival grafts. MATERIAL AND METHOD Ten individuals needing bilateral gingival graft in the mandibular arch were enrolled in a double-blind study. Each individual had a 30-d interval between the two surgeries. The side receiving application of laser was defined as test side and was established upon surgery; laser application was simulated on the control side. The laser was applied in the immediate postoperative period and after 48 h, and patients rated pain on a scale of 0 to 10, representing minimal and maximal pain, respectively. Photographs were obtained at 7, 15, 30, and 60 d postoperatively and evaluated by five periodontists. RESULTS No statistically significant difference was found at any postoperative period between control and test sides, even though greater clinical improvement associated with treatment was observed at 15 d postoperative. At 30 and 60 d, some examiners observed the same or greater clinical improvement for the control. Only one individual reported mild to moderate pain on the first postoperative day. CONCLUSIONS Low-intensity laser therapy did not improve the healing of gingival grafts and did not influence analgesia.

Survival of Dental Implants in the Cleft Area—A Retrospective Study

Objective To evaluate the survival rate of dental implants placed in the cleft area. Design Retrospective study. Setting Hospital for Rehabilitation of Craniofacial Anomalies, Brazil. Institutional Tertiary Healthcare Center. Patients 120 patients who received dental implants in the grafted cleft area in the years 1999 to 2005. Interventions Clinical data were evaluated from the records of 120 patients according to the following criteria: placement grafted, cleft area, and age at surgery; age at placement of dental implants; site and dimension of implants; interval between placement of implants and the last clinical follow-up; and interval between placement and removal or indication for removal of implants. Main Outcome Measures Percentage of survival rate of implants. Results Mean age at placement of the bone graft was 17.6 years and 21 years at placement of implants. A total of 123 cleft areas received secondary bone graft and bone graft to install implants (regraft). The mean survival rate was 34 months since placement of the implant to the last clinical follow-up and 26 months since placement of the prosthesis. Seven dental implants were removed. The survival rate since placement to the last clinical follow-up was 94.3%. Conclusion Rehabilitation of the cleft area with dental implants is a viable and secure alternative, with good prognosis.

Effect of low-level laser on bone defects treated with bovine or autogenous bone grafts: in vivo study in rat calvaria.

Objective. The purpose of this study was to histologically evaluate the effect of low-level laser (LLL) on the healing of critical size defects (CSD) in rat calvaria, filled with autogenous or inorganic bovine bone grafts. Methods. Sixty rats were divided into 6 groups (n = 10): C (control—filled with blood clot), LLL (low-level laser—GaAlAs, λ 780 nm, 100 mW, 210 J/cm2, Φ 0.05 cm2; 6 J/point), AB (autogenous bone), ABL (autogenous bone + low-level laser), OB (inorganic bovine bone), and OBL (inorganic bovine bone + LLL). Material and Methods. The animals were killed after 30 days. Histological and histometric analyses were performed by light microscopy. Results. The groups irradiated with laser, LLL (47.67% ± 8.66%), ABL (39.15% ± 16.72%), and OBL (48.57% ± 28.22%), presented greater area of new bone formation than groups C (9.96% ± 4.50%), AB (30.98% ± 16.59%), and OB (11.36% ± 7.89%), which were not irradiated. Moreover, they were significantly better than group C (Kruskal-Wallis test followed by Dunn test, P < 0.05). Conclusion. The laser accelerated the healing of bone defects and the resorption of particles of the graft material.

The effect of low-level laser on bone healing in critical size defects treated with or without autogenous bone graft: an experimental study in rat calvaria

OBJECTIVE The objective of this study was to evaluate the effect of low-level laser (LLL) on bone healing process in surgically created critical size defects in rat calvaria treated with or without autogenous bone graft (AB). MATERIAL AND METHODS The study was conducted on 40 male rats (Rattusnorvegicus, albinus, Wistar), weighing 250-300 g. For accomplishment of the experimental procedures, the rats were anesthetized with an intramuscular injection of xylazine (0.02 ml/kg) and ketamine hydrochloride (0.4 ml/kg). Acritical size defect with 5-mm diameter was created. The animals were divided into four groups: Group C (Control- filled with blood clot), Group LLL, Group AB (autogenous bone graft), Group AB + LLL (autogenous bone graft and LLL). The animals treated with LLL received applications of LLL at the infrared spectrum wavelength (λ = 810 nm) and energy density of 6 J/cm(2) per point, 60 s per point, adding up to five points on the entire created defect. The animals were euthanized at 30 days postoperatively. After decalcification, each specimen was longitudinally divided into two blocks, exactly along the center of the original surgical defect, processed and embedded in paraffin. Longitudinal serial sections with 6-μm thickness were made, initiating from the center of the original surgical defect. The sections were stained with hematoxylin and eosin (HE) for light microscopy analysis for histomorphometric analysis. RESULTS Group C presented smaller quantity of new bone formation than Groups LLL (P < 0.01), AB (P < 0.01), and AB + LLL (P < 0.01). CONCLUSIONS Utilization of LLL favored the healing process in rat calvaria. The quantity of new bone formation with use of the LLL was similar to the autogenous bone graft.

Esthetic Analysis of Gingival Components of Smile and Degree of Satisfaction in Individuals With Cleft Lip and Palate

Objective: To evaluate soft tissue characteristics in individuals with cleft lip and palate and the degree of satisfaction of these individuals after rehabilitation. Setting: Hospital for Rehabilitation of Craniofacial Anomalies, Brazil. Patients: Forty-five individuals with repaired complete unilateral cleft lip and palate, aged 15 to 30 years. Interventions: One hundred thirty-five frontal facial photographs were obtained at rest and in natural and forced smile. Specialists in periodontics evaluated the soft tissue characteristics. Both patients and specialists evaluated the smiles and scored them as esthetically unpleasant, acceptable, or pleasant. Main Outcome Measures: Comparison of the cleft area with the contralateral region was performed for evaluation of soft tissue. The results of the degree of satisfaction with smile were expressed as percentages and means. The findings between patients and periodontists experienced or inexperienced with cleft care were compared. Results: Statistically significant differences were observed for alveolar process deficiency and absence of papilla in the esthetic area between groups (p < .05). Results show 84.4% of individuals considered their smile as esthetically pleasant. Specialists in periodontics of both groups scored the natural smile and forced smile as esthetically acceptable. There was a statistically significant difference in the mean of patients compared with both groups of specialists in periodontics (p < .05). Conclusions: Evaluation and knowledge of the soft tissue characteristics is extremely important for successful rehabilitation. The esthetic values and degree of patient satisfaction are essential for treatment success, since smile reconstruction should be esthetically pleasant to the patient.

Gingival Recession in Individuals With Cleft Lip and Palate: Prevalence and Severity

Objective To analyze the prevalence and severity of gingival recession in individuals with cleft lip and alveolus with or without cleft palate. Design Cross-sectional. Setting Tertiary referral hospital. Participants A total of 400 individuals with cleft lip and alveolus with or without cleft palate, aged 15 to 49 years, without any previous periodontal treatment. Main Outcome Measures Gingival recession was evaluated by measuring the distance from the cementoenamel junction to the most coronal point on the gingival margin, analyzing the prevalence and scoring its severity as mild (<3 mm), moderate (3 to 4 mm), or severe (4 mm). The prevalence and severity of gingival recession was compared between sextant 2 (cleft sextant) and the mean of the other sextants (1, 3,4,5, and 6: noncleft sextants). The relationship between gingival recession in the cleft area and gender was evaluated and data were analyzed statistically. The correlation between gingival recession and age was assessed also. Results There was no statistically significant gender difference in gingival recession. The prevalence and severity of gingival recession increased with age, and most of the affected teeth were premolars and molars. The cleft area did not present a higher prevalence and severity of gingival recession. Conclusions Individuals with cleft lip and alveolus with or without cleft palate presented the same prevalence and severity of gingival recession compared with other populations. The area adjacent to the cleft (sextant 2) did not show greater risk of gingival recession than other areas (sextants 1, 3, 4, 5, and 6).

Gingival recession in maxillary canines and central incisors of individuals with clefts

BACKGROUND Mucogingival alterations are inherent to clefts and may be worsened by the several plastic surgeries required in these individuals. OBJECTIVE The aim of this study was to evaluate the prevalence, severity, and some possible etiologic factors of gingival recessions in teeth adjacent to the cleft. STUDY DESIGN A total of 641 teeth (maxillary canines and central incisors) of 193 individuals with cleft lip and/or palate were examined. A generalized linear model was used, and the Wilcoxon test was used to compare the recession with cleft types. RESULTS Comparison among cleft types as to the presence of recession revealed a statistically significant positive relationship for the maxillary right and left central incisors only in the group with left cleft lip, alveolus, and palate (P = .034). The most frequently affected tooth was the right maxillary canine (26.16%). CONCLUSION The prevalence of recession in teeth close to the cleft was higher, although it was not very severe.

Esthetic Composition of Smile in Individuals with Cleft Lip, Alveolus, and Palate: Visibility of the Periodontium and the Esthetics of Smile

Objective. To evaluate characteristics of smile related to visibility in individuals with cleft lip, alveolus, and palate. Design. Cross-sectional. Setting. HRAC/USP, Brazil. Patients. Individuals with repaired complete unilateral cleft lip and palate (n = 45), aged 15–30 years. Interventions. Frontal facial photographs were obtained in natural and forced smiles (n = 135). Six specialists in periodontics evaluated the photographs as to the smile line, thickness, and curve of the upper lip. Main Outcome Measures. The cleft area was compared with the contralateral region. Results were expressed as percentages and means. The findings were compared between groups of periodontists. Results. Statistically significant relationship was observed in the smile line between examiners and between natural and forced smiles, regardless of the association with the cleft side. The lip was thicker at rest and thinner in the forced smile, as also evaluated by the group not experienced with cleft care. The curve of the upper lip in natural and forced smiles was considered as close to straight by both groups, regardless of the cleft. Conclusion. The smile in individuals with clefts was regarded as average for both cleft and noncleft sides. The thickness was characterized as average to thin, being thinner in forced smile and when analyzed by the group not experienced with cleft care. In the average, the curve of the upper lip was considered as straight. The present study elucidates some characteristics related to the smile in individuals with repaired unilateral cleft lip, alveolus, and palate.