Luiz Antonio Pugliesi Alves de Lima

Root-Coverage Procedures for the Treatment of Localized Recession-Type Defects: A Cochrane Systematic Review

BACKGROUND The purpose of this review is to evaluate the effectiveness of different root-coverage procedures in the treatment of recession-type defects. METHODS The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched for entries up to October 2008. There were no restrictions regarding publication status or the language of publication. Only clinical randomized controlled trials (RCTs) with a duration > or = 6 months that evaluated recession areas (Miller Class I or II > or = 3 mm) that were treated by means of periodontal plastic surgery procedures were included. RESULTS Twenty-four RCTs provided data. Only one trial was considered to be at low risk of bias. The remaining trials were considered to be at high risk of bias. The results indicated a significantly greater reduction in gingival recession and gain in keratinized tissue for subepithelial connective tissue grafts (SCTGs) compared to guided tissue regeneration (GTR) with bioabsorbable membranes (GTR bms). A significantly greater gain in keratinized tissue was found for enamel matrix protein compared to a coronally advanced flap (0.40 mm) and for SCTGs compared to GTR bms plus bone substitutes. Limited data exist on the changes of esthetic conditions as related to the opinions and preferences of patients for specific procedures. CONCLUSIONS SCTGs, coronally advanced flaps alone or associated with other biomaterial, and GTR may be used as root-coverage procedures for the treatment of localized recession-type defects. In cases where root coverage and gain in keratinized tissue are expected, the use of SCTGs seems to be more adequate.

Effects of Occlusal Overload on Peri‐Implant Tissue Health: A Systematic Review of Animal‐Model Studies

BACKGROUND This study systematically evaluates the effect of occlusal overload (OV) on peri-implant tissue health in animal studies. METHODS MEDLINE, EMBASE, and LILACS databases were searched for articles published up to and including January 2010. Studies that reported outcomes of non-splinted titanium dental implants submitted to OV were eligible for inclusion. Probing depth (PD), clinical attachment level (CAL), radiographic and histologic distances from the implant base to the most coronal point of bone-to-implant contact (RDIB and DIB, respectively), and bone density (BD) were the main outcomes of interest. RESULTS Two controlled trials were included in this review and both were considered at a high risk of bias. The marked heterogeneity between studies did not allow data to be combined for meta-analyses. Two studies reported no association between OV and peri-implant tissue breakdown in the absence of dental plaque, with PD and CAL varying from 2 to 3 mm at the end of the experiments. In the presence of plaque accumulation, OV played a key role in peri-implant tissue breakdown (PD change: 5.3 mm; DIB: 6.0 mm). Trends suggested that OV may increase BD. CONCLUSIONS Data on OV on stable implants are limited and conflicting. OV may lead to bone loss in the presence of dental plaque and to an increase in BD in areas where plaque control is performed.

Assessment of linear measurements of bone for implant sites in the presence of metallic artefacts using cone beam computed tomography and multislice computed tomography

The objective was to evaluate the influence of dental metallic artefacts on implant sites using multislice and cone-beam computed tomography techniques. Ten dried human mandibles were scanned twice by each technique, with and without dental metallic artefacts. Metallic restorations were placed at the top of the alveolar ridge adjacent to the mental foramen region for the second scanning. Linear measurements (thickness and height) for each cross-section were performed by a single examiner using computer software. All mandibles were analysed at both the right and the left mental foramen regions. For the multislice technique, dental metallic artefact produced an increase of 5% in bone thickness and a reduction of 6% in bone height; no significant differences (p>0.05) were detected when comparing measurements performed with and without metallic artefacts. With respect to the cone-beam technique, dental metallic artefact produced an increase of 6% in bone thickness and a reduction of 0.68% in bone height. No significant differences (p>0.05) were observed when comparing measurements performed with and without metallic artefacts. The presence of dental metallic artefacts did not alter the linear measurements obtained with both techniques, although its presence made the location of the alveolar bone crest more difficult.

Relationship Between Herpesviruses and Periodontopathogens in Patients With HIV and Periodontitis

BACKGROUND The purpose of the present study is to verify a possible association between herpesviruses and periodontal pathogens in individuals with human immunodeficiency virus (HIV) and periodontitis. METHODS Twenty-seven patients with HIV and chronic periodontitis and 23 patients with HIV and gingivitis were included in the study. Probing depth, clinical attachment loss, gingival index, and plaque index were recorded. Blood, saliva, and subgingival plaque were processed for viral and bacterial identification. Bacteria were identified by 16S rRNA-based polymerase chain reaction and viruses by the nested polymerase chain reaction. RESULTS For the chronic periodontitis group, Epstein-Barr (EBV)-1 (70.4%) and Tannerella forsythia (Tf) (51.8%) presented higher detection in subgingival plaque and saliva (81.5% and 40.7%, respectively) than in blood (22% and 0%, respectively) (P <0.005 and P <0.0001, respectively). Porphyromonas gingivalis (Pg) was more frequent in subgingival plaque (77.7%; P <0.0001). In the gingivitis group, Pg and human cytomegalovirus (HCMV) presented higher frequency in subgingival plaque (95.6% and 91.3%, respectively; P <0.0001 and P = 0.004). Tf and EBV-1 were detected more frequently in subgingival plaque (47.8% and 78.3%, respectively) and saliva (52.2% and 52.2%, respectively; P = 0.004 and P <0.005) than in blood. EBV-1, EBV-1-HCMV, and presence of different viruses presented an association with periodontitis in saliva. CONCLUSIONS No association was detected for herpesviruses and periodontal pathogens in patients who are HIV-positive with periodontitis. EBV-1 and coinfection (EBV-1-HCMV) were associated with patients who are HIV-positive with periodontitis.

Otimização das superfícies dos implantes: plasma de titânio e jateamento com areia condicionado por ácido - estado atual

The aim of this review was to update the concepts regarding the preparation of the surfaces of titanium implants, focusing on TPS (titanium plasma-sprayed implants) and SLA (sandblasted and acid etched implants). Texture was the most remarkable isolated feature, regarded as an osseointegration promoter. In a comprehensive review of the effects of implant surface topography on cell behavior, one can verify that there is bone apposition onto the implant surface regardless of its characteristics: polished or rough, made of titanium or ceramic. Roughness is not mandatory for bone apposition. However, it has been shown that roughness may play an important role in the percentage of bone apposition as well as in the velocity of apposition. In this review, a quite promising type of surface called SLA is pointed out, showing that either roughness or acid conditioning of the surfaces can significantly improve shear strength. Besides optimizing the procedure, these surface characteristics may, eventually, allow for an earlier loading of the implant and extend the indications for implants in low-density alveolar bone and in regenerated bone.

Effect of enamel matrix proteins on the treatment of intrabony defects: a split-mouth randomized controlled trial study

The objective of this split-mouth, double-blind, randomized controlled trial was to compare the clinical effect of treatment of 2- or 3-wall intrabony defects with open flap debridement (OFD) combined or not with enamel matrix proteins (EMP). Thirteen volunteers were selected with one pair of or more intrabony defects and probing pocket depth (PPD) > or = 5 mm. All individuals received instructions regarding oral hygiene and were submitted to scaling and root planing. Each participant received the two treatment modalities: test sites were treated with OFD and EMP, and control sites received only OFD. After 6 months, a significant reduction was observed in PPD for the EMP group (from 6.42 +/- 1.08 mm to 2.67 +/- 1.15 mm) and for the OFD group (from 6.08 +/- 1.00 mm to 2.00 +/- 0.95 mm) (p < 0.0001), but with no significant difference between groups (p = 0.13). A significant gain in relative attachment level (RAL) was observed in both groups (EMP: from 13.42 +/- 1.88 mm to 10.75 +/- 2.26 mm, p < 0.001; OFD: from 12.42 +/- 1.98 mm to 10.58 +/- 2.23 mm, p = 0.013), but with no significant difference between groups (p = 0.85). Gingival recession (GR) was higher in the EMP group (from 1.08 +/- 1.50 mm to 2.33 +/- 1.43 mm; p = 0.0009) than in the OFD group (from 0.66 +/- 1.15 mm to 1.16 +/- 1.33 mm; p = 0.16), but this difference was not significant (p = 0.06). In conclusion, the results showed that OFD combined with EMP was not able to improve treatment of intrabony defects compared to OFD alone.

Subgingival ultrasonic instrumentation of residual pockets irrigated with essential oils: a randomized controlled trial

AIM To evaluate the clinical efficacy of subgingival ultrasonic instrumentation irrigated with essential oils (EOs) of residual periodontal pockets. MATERIAL AND METHODS Sixty-four individuals with chronic periodontitis were invited to participate in this randomized, double-blind, parallel, and placebo-controlled clinical trial. All subjects received non-surgical periodontal therapy. After re-evaluation (baseline), residual pockets (pocket depth ≥5 mm) received test (ultrasonic instrumentation irrigated with EOs) or control therapy (ultrasonic instrumentation irrigated with negative control). Probing pocket depth (PPD), gingival recession (R), clinical attachment level (CAL), bleeding on probing (BOP), and plaque were assessed at baseline and after 4, 12, and 24 weeks. Differences between groups and changes over the course of time were analysed according to a generalized linear model. RESULTS There was a significant reduction in PPD and BOP, as well as a significant CAL gain in the two groups (p<0.001). Nevertheless, there were no differences between the groups at any time of the study. When only initially deep pockets (PPD ≥7 mm) were analysed, a significantly greater CAL gain (p=0.03) and PPD reduction (p=0.01) was observed in the test group. CONCLUSION The adjunctive use of EOs may promote significant CAL gain and PPD reduction in deep residual pockets.

Immunolocalization of bone morphogenetic protein 2 during the early healing events after guided bone regeneration

OBJECTIVE The objective of this study was to evaluate the immunolocalization of bone morphogenetic protein 2 (BMP-2) after autogenous block grafting covered or not with an e-PTFE membrane. STUDY DESIGN Forty-eight rats were divided into 2 groups, autogenous block graft (B) and autogenous block graft + e-PTFE membrane (MB), and were evaluated by immunohistochemistry at baseline and 3, 7, 14, 21, and 45 days. RESULTS The largest number of positive cells in the recipient bed was observed after 3 days in both groups. At the graft border, the largest number of positive cells was seen after 7 days in group B and after 14 days in group MB. The highest proportion of staining in the graft was observed after 3 days in group B and after 21 days in group MB. CONCLUSIONS High proportions of stain were related to intense revascularization and osteogenesis. Except for the interface, BMP-2 staining occurred later in group MB than in group B in all structures analyzed.

Characterization of bone cells obtained from the calvaria of neonatal rats (osteo-1) after serial subculture

The objective of the present study was to characterize bone cells grown in two culture media, and to determine the effective concentration of OP-1 on the growth of osteo-1 cells. Subcultured rat bone cells (osteo-1) were grown in alpha-modified Eagle’s minimal essential medium (α-MEM) and Dulbecco’s modified Eagle’s medium (DMEM) and total protein content, alkaline phosphatase activity and the formation of mineralized nodules were evaluated after 7, 14 and 21 days. Cells were exposed to different concentrations of rhOP-1 for 1, 3, 5 and 7 days and compared with an untreated control. Osteo-1 cells presented a significant increase in alkaline phosphatase activity and calcium deposits were observed at 21 days. Cells treated with 10 and 20 ng/mL rhOP-1 for 24 h showed a significant increase in cell viability when compared to control. Osteo-1 cells cultured on DMEM demonstrated an osteoblastic phenotype as indicated by high alkaline phosphatase activity and the presence of calcified nodules. The results suggest that low concentrations of OP-1 may promote an osteogenic effect on osteo-1 cells.

Dynamics of soft tissue healing at implants and teeth: a study in a dog model

OBJECTIVE The aim of this study was to describe and to compare some characteristics of the soft tissue healing process around teeth and implants after flap surgery. MATERIAL AND METHODS Five adult beagle dogs had their third and fourth lower premolars extracted. After 3 months, four implants per dog were placed on the healed alveolar ridge and allowed to heal non-submerged during 3 months. After 3 months, four regions characterized by one implant and one adjacent tooth were identified in each dog. One region was randomly selected and soft tissue ressective flap surgery was performed at its buccal aspect. The remaining three regions were randomly treated in an identical manner, and the dogs were sacrificed to provide biopsies representing healing intervals of 1, 2, 4, and 12 weeks. The biopsies were prepared for histological and morphological analyses. RESULTS Morphometric and histometric analyses have shown that the gingival tissues surrounding teeth were completely healed after a 4-week interval. However, it took from 4 to 12 weeks for the peri-implant mucosa to heal completely. CONCLUSION The healing process around teeth and implants follows a similar sequence of events. Nevertheless, the complete process of healing and maturation of the peri-implant tissues takes longer than around teeth.