Mariana Schutzer Ragghianti Zangrando

Long-term evaluation of periodontal parameters and implant outcomes in periodontally compromised patients: a systematic review.

BACKGROUND The aim of this systematic review is to evaluate the long-term outcomes of patients with periodontitis submitted to periodontal therapy/maintenance and implant placement. METHODS Studies reporting clinical and/or long-term implant outcomes from partially edentulous patients with periodontitis who were treated and followed periodontal maintenance for ≥5 years were considered eligible for the review. Screening of the articles, data extraction, and quality assessment were conducted independently and in duplicate. RESULTS Search of MEDLINE, EMBASE, and CENTRAL databases resulted in 959 papers, and of them 931 were excluded after title/abstract assessment. The full texts of 28 potentially eligible publications were screened, but only 10 studies met inclusion criteria. Most of the included studies (77.8%) presented a medium/high methodologic quality. The results demonstrated that patients with a diagnosis of periodontitis had satisfactory implant outcomes. Implant survival was high (92.1%) within studies reporting 10 years of follow-up. Parameters related to probing depth, clinical attachment level, and bone loss around teeth increased the occurrence of peri-implantitis and implant loss. Non-attendance to periodontal maintenance and smoking habits were also associated with less favorable implant outcomes. CONCLUSIONS This systematic review confirmed that implant therapy can be successfully used in patients with a diagnosis of periodontitis who underwent proper therapy and regular periodontal maintenance. Residual pockets, non-attendance to the periodontal maintenance program, and smoking were considered to be negative factors for the long-term implant outcomes.

Prevention and Periodontal Treatment in Down Syndrome Patients: A Systematic Review.

The aim of this systematic literature review was to evaluate which type of periodontal preventive and therapeutic approaches presents superior outcomes in patients with Down syndrome (DS). Studies reporting different methods of periodontal care from DS patients were considered eligible. Included clinical studies should indicate at least two periodontal parameters in different periods of assessment. Screening of the articles, data extraction and quality assessment were conducted independently and in duplicate. Electronic search according to the PICO search, with both Key-words and MESH terms were conducted in MEDLINE, EMBASE and CENTRAL databases until March 2016. Manual search was conducted in four journals, namely Journal of Periodontology, Journal of Clinical Periodontology, Journal of Periodontal Research and Special Care in Dentistry and their electronic databases were searched. Electronic and manual search resulted in 763 papers, and of them 744 were excluded after title/abstract assessment. The full text of 19 potentially eligible publications was screened and 9 studies met inclusion criteria. The results demonstrated the importance to introduce youngest DS patients in preventive programs, as well as participation of parents, caregivers or institutional attendants in supervising/performing oral hygiene. In studies with higher frequency of attendance, all age groups presented superior preventive and therapeutic results, irrespective of the therapeutic approach used (surgical/nonsurgical/periodontal care program). The important factors for reducing periodontal parameters were the frequency of the appointments and association with chlorhexidine/plaque disclosing agents as adjuvant treatment. This systematic review demonstrated that early introduction in periodontal care, participation of parents/caregivers/institutional attendants, frequency of attendance and association with chemical adjuvants (independently of the periodontal treatment adopted) seems to improve periodontal outcomes in preventive and periodontal treatment of DS patients. Registration number (Prospero): CRD42016038433.

In vitro evaluation of adhesion/proliferation of human gingival fibroblasts on demineralized root surfaces by toluidine blue O in antimicrobial photodynamic therapy

BACKGROUND Antimicrobial photodynamic therapy (aPDT) in Dentistry has important effects as bacterial destruction in areas with periodontal disease. Some dyes applied in aPDT could present low pH and, consequently, result in tooth demineralization. This study evaluated demineralization produced by aPDT with toluidine blue O (TBO) at low pH and analyzed adhesion/proliferation of human gingival fibroblasts (HGF). METHODS In the 1st phase, bovine enamel and root dentin fragments received 2 treatments: PDT4 group (TBO-100 μg/ml-pH 4-60s) plus laser (660 nm, 45 J/cm(2), 1.08 J, 30 mW, 30 s, spot 0.024 cm(2), 1.25 W/cm(2), sweeping, non-contact) and CA group (citric acid plus tetracycline-pH 1-180 s). Surface hardness loss and tooth wear were statistically analyzed (Students t test, ANOVA/Tukey, p<0.05). In the 2nd phase, human dentin fragments were divided in C (control group-scaling and root planing), PDT4 and CA. HGF (10(4), 5th passage) were cultured on these fragments for 24, 48 and 72 h and counted in scanning electron microscopy photographs. Number of HGF was analyzed using repeated-measures ANOVA and Tukey (p<0.05). RESULTS Percentage of surface hardness loss was similar in dentin for PDT4 (71.5%) and CA (76.1%) (p>0.05) and higher in enamel for CA (68.0%) compared to PDT4 (34.1%) (p<0.05). In respect to wear, no difference was found between PDT4 (dentin: 12.58 μm, enamel: 12.19 μm respectively) and CA (dentin: 11.74 μm and enamel: 11.03 μm) (p>0.05). Number of HGF was higher after 72 h in CA group (2.66, p<0.05) compared to PDT4 (2.2) and C (1.33). CONCLUSION PDT4 is not as aggressive as CA for enamel. However, dentin demineralized promoted by PDT4 does not stimulate HGF adhesion and proliferation as CA.

Oral health impact profile of head and neck cancer patients after or before oncologic treatment: an observational analytic case-control study

PurposeThe objective of this study was to investigate the impact of oral health on the quality of life of patients with head and neck cancer (HNC) before and after oncologic treatment.MethodsForty cancer-free individuals (Cf group) and 40 HNC patients (Hnc group) were included in this study. Hnc group was also divided into two subgroups: Hnc 1 (pre-cancer therapy, n = 20) and Hnc 2 (post-cancer therapy, n = 20). Participants were asked to complete a short form of Oral Health Impact Profile (OHIP-14). The results were statistically analyzed with the multivariate analysis of variance with post-hoc Scheffé multiple comparison.ResultsIt was observed a moderate impact on the quality of life on HNC patients, with values on Hnc 2 group significantly higher in the functional limitation when compared to the Hnc 1 group (p < 0.05). When compared to the Cf group, the values found on Hnc group were higher on functional limitation (p < 0.01) and at the total score (p < 0.05), whereas Hnc 2 group had significant superior values on functional limitation (p < 0.01), physical pain (p < 0.05), and total score (p < 0.01)ConclusionThese results show that there is an oral impairment that depreciates the quality of life of patients with an experience of HNC, principally after treatment, indicating the importance of the inclusion of professionals responsible for dental and oral care with the oncologic team to monitor the oral condition of these patients.

Stimulation of human gingival fibroblasts viability and growth by roots treated with high intensity lasers, photodynamic therapy and citric acid

OBJECTIVE The aim of this study was to compare the effect of root biomodification by lasers, citric acid and antimicrobial photodynamic therapy (aPDT) on viability and proliferation of human gingival fibroblasts (FGH). DESIGN Groups were divided in control (CC - only cells), and root fragments treated by: scaling and root planing (positice control - SC), Er:YAG (ER-60mJ,10pps,10Hz,10s,2940nm), Nd:YAG (ND-0.5W,15Hz,10s,1640nm), antimicrobial photodynamic therapy (PDT-InGaAIP,30mW,45J/cm2,30s,660nm,toluidine blue O), citric acid plus tetracycline (CA). Fibroblasts (6th passage, 2×103) were cultivated in a 24-h conditioned medium by the treated root fragments. Cell viability was measured by MTT test at 24, 48, 72 and 96h. In a second experiment, FGH cells (104) were cultivated on root fragments which received the same treatments. After 24, 48, 72h the number of cells was counted in SEM pictures. In addition, chemical elements were analyzed by energy dispersive spectroscopy (EDS). Data was analyzed by two-way ANOVA (first experiment), repeated measures ANOVA (second experiment) and ANOVA (EDS experiment) tests complemented by Tukeys test (p<0.05). RESULTS ND, PDT and CA promoted higher cell viability (p<0.05). ND and ER groups presented higher number of cells on root surfaces (p<0.05). ER group presented higher calcium and CA group a higher carbon percentages (p<0.05). CONCLUSIONS All treatments but scaling and root planing stimulated fibroblast viability while Er:YAG and Nd:YAG treated root surfaces presented higher number of cells.

Clinical parameters, histological analysis, and laser Doppler flowmetry of different subepithelial connective tissue grafts

Subepithelial connective tissue graft (SCTG) presents favorable outcomes. However, the harvesting technique can influence the anatomical and histological composition of the SCTG. Within the limitations of a case report, the behavior of SCTGs removed by two techniques was evaluated bilaterally in one patient using double blade scalpel (DBS) and de-epithelialized graft (DE). Clinical parameters, laser Doppler flowmetry (LDF) and histological analysis were assessed. Complete root coverage was observed bilaterally, as well as improvement in width and thickness of keratinized tissue 2 years postoperatively. The LDF analysis demonstrated better revascularization in the DBS recipient area compared to DE. The histological evaluation showed differences in tissue composition and organization of collagen fibers. Similar clinical outcomes were observed bilaterally, nevertheless greater morbidity and aesthetic was reported in the DE harvesting area.

Bone graft and substitutes associated with titanium dome for vertical bone formation in osseointegrated implants: histomorphometric analysis in dogs

PURPOSE This animal study investigated vertical bone formation (VBF) around implants and used histomorphometric analysis to compare different bone-filling materials associated with a massive titanium dome as a tissue barrier. MATERIALS AND METHODS Seven dogs were submitted to surgical procedures with extraoral access to the lower edge of the mandible, and four implants were semi-inserted in each animal. Each implant received one treatment: autogenous bone with clot (AB), control clot (C), synthetic graft (Biogran [BG]), or xenograft (Bio-Oss [BO]). Massive titanium domes were stabilized over the implants. Histologic analysis was performed after 3 months, and quantitative aspects were evaluated in extraosseous and intraosseous threads on Image Pro-Plus software. RESULTS VBF around implants exhibited significant values in AB compared with other groups. BG and BO presented statistical equivalency to AB and C in the apposition and filling of extraosseous threads. There was no difference between groups for parameters evaluated in intraosseous threads. CONCLUSION The experimental model was valid for evaluation of VBF around implants placed in atrophic mandibles. Considering the limitations of this study, histomorphometric analysis evidenced better outcomes for group AB. Even though groups BG and BO presented worse outcomes than AB, they were slightly better compared with the control group.

Altered Active and Passive Eruption: A Modified Classification

Focused Clinical Question: How to diagnose, classify and treat cases of Altered Passive and Active Eruption?Summary: Frequently, a Gummy Smile is related to aesthetic problems and is caused by several factors such as: vertical maxillary growth, dentoalveolar extrusion, short upper lip, upper lip hyperactivity, Altered Passive Eruption, (APE), and/or; a combination of these factors. APE is a genetic or developmental condition characterized by coronal positioning of the gingival margin over the enamel, resulting in short clinical crowns. Active Eruption is defined as the tooth movement in the occlusal direction as the tooth erupts from its osseous crypt. Altered Active Eruption, (AAE), occurs when teeth achieve the opposite relationship to the occlusal plane prematurely and the osseous crest is on, or very close to the Cement-Enamel Junction, (CEJ). Thus, the correct understanding of the biological events related to AAE and APE should be considered in the classification of a Gummy Smile. This article propos...

Peri-implantitis: Critical and current overview of etiological factors, clinical/radiographic diagnosis and prognosis. A literature review

Abstract / Introduction: Peri-implantitis has been more frequently diagnosed; however, the best treatment method has not yet been established. It is paramount to understand its etiology, as well as clinical and radiographic diagnosis to prevent, treat and control peri-implant infections and, as a result, achieve implant success. Objective: his literature review aims to address the etiology, diagnosis and prognosis of peri-implantitis in a critical and up-to-date manner. It is based on articles retrieved from PubMed and Science Direct databases. Results: Peri-implantitis is an infectious/inlammatory process afecting the peri-implant tissues around dental implants and of multifactorial etiology. Some clinical/radiographic, diagnostic methods are essential to assess the occurrence and progression of peri-implantitis. Despite existing in high numbers, scientiic studies are divergent and inconclusive with regard to ideal treatment and prognosis. Conclusion: Peri-implantitis is a disease that must be diagnosed at an early stage. Regular monitoring of patients is important for treatment and implant success.