Patricia Furtado Gonçalves

Is Surgical Root Coverage Effective for the Treatment of Cervical Dentin Hypersensitivity? A Systematic Review

BACKGROUND Cervical dentin hypersensitivity (CDH) is characterized by tooth pain arising from root exposure. The aim of the present systematic review is to survey the literature on the efficacy of surgical root coverage techniques at reducing CDH in cases of gingival recession. METHODS An online electronic search was performed in PubMed, Web of Science, and Cochrane Library databases. Randomized clinical trials dating from the inception of the respective databases through November 2011 were selected. Studies addressing clinical parameters of periodontal plastic surgery outcomes and variables related to CDH in patients ≥18 years of age were included. The studies were evaluated by two independent reviewers. For each article, methodologic quality, size effect, the periodontal parameters measured, study design, methods, and results were analyzed. RESULTS Nine relevant articles were analyzed in the present review. A decrease in CDH was observed after periodontal surgery for root coverage. The risk of bias was considered low in two studies, and the size effect was considered large in one study. CONCLUSIONS There is not enough scientific evidence to conclude that surgical root coverage procedures predictably reduce CDH. Well-conducted clinical trials are needed to establish scientific evidence that allows periodontists to indicate root coverage as treatment for CDH.

Effect of Surgical Defect Coverage on Cervical Dentin Hypersensitivity and Quality of Life

BACKGROUND Root exposure due to gingival recession (GR) can cause cervical dentin hypersensitivity (CDH), which is characterized by tooth pain. The aim of this study is to evaluate the effect of surgical defect coverage on CDH and quality of life in patients with GR. METHODS Twenty-five GRs in maxillary canines and premolars were treated with coronally positioned flap plus connective tissue graft. GR dimensions, amount of keratinized gingiva, and clinical attachment level were evaluated. CDH was assessed by thermal and evaporative stimuli. Quality of life was assessed by use of the Oral Health Impact Profile-14 (OHIP-14) questionnaire. All parameters were evaluated at baseline and after 3 months. RESULTS Statistically significant reduction in CDH (P <0.001), significant reduction in impact of oral health on quality of life (P <0.001), and significant changes in periodontal parameters were observed after 3 months. Mean defect coverage of 67.90% was achieved, with full coverage in 11 cases. Percentage defect coverage showed no correlation with air blast-stimulated CDH (P = 0.256) or cold stimulus (P = 0.563). The OHIP-14 physical disability dimension was correlated with the amount of keratinized tissue (P = 0.010) and also with defect coverage (P = 0.035). CONCLUSIONS Surgical defect coverage may reduce CDH and improve patient quality of life, by keratinized gingiva augmentation and impact on physical disability, irrespective of amount of defect coverage.

Guided tissue regeneration may modulate gene expression in periodontal intrabony defects : a human study

BACKGROUND AND OBJECTIVE Guided tissue regeneration has been shown to lead to periodontal regeneration, however, the mechanisms involved remain to be clarified. The present study was carried out to assess the expression of genes involved in the healing process of periodontal tissues in membrane-protected vs. nonprotected intrabony defects in humans. MATERIAL AND METHODS Thirty patients with deep intrabony defects (> or = 5 mm, two or three walls) around teeth that were scheduled for extraction were selected and randomly assigned to receive one of the following treatments: flap surgery alone (control group) or flap surgery plus guided tissue regeneration (expanded polytetrafluorethylene (e-PTFE) membrane) (test group). Twenty-one days later, the newly formed tissue was harvested and quantitatively assessed using the polymerase chain reaction assay for the expression of the following genes: alkaline phosphatase, receptor activator of nuclear factor-kappa B ligand, osteoprotegerin, osteopontin, osteocalcin, bone sialoprotein, basic fibroblast growth factor, interleukin-1, interleukin-4, interleukin-6, matrix metalloproteinase-2 and matrix metalloproteinase-9. RESULTS Data analysis demonstrated that mRNA levels for alkaline phosphatase, receptor activator of nuclear factor-kappa B ligand, osteoprotegerin, osteopontin, bone sialoprotein, basic fibroblast growth factor, interleukin-1, interleukin-6, matrix metalloproteinase-2 and matrix metalloproteinase -9 were higher in the sites where guided tissue regeneration was applied compared with the control sites (p < 0.05), whereas osteocalcin mRNA levels were lower (p < 0.05). No difference was observed in interleukin-4 mRNA levels between control and test groups. CONCLUSION Within the limits of this study, it can be concluded that genes are differentially expressed in membrane barrier-led periodontal healing when compared with flap surgery alone, and this may account for the clinical outcome achieved by guided tissue regeneration.

Cyanoacrylate Versus Laser in the Treatment of Dentin Hypersensitivity: A Controlled, Randomized, Double-Masked and Non-Inferiority Clinical Trial

BACKGROUND Dentin hypersensitivity (DH) is a painful, exaggerated response to normal stimuli, such as cold, sweetness, and brushing. The aim of the present controlled, randomized, double-masked, non-inferiority clinical trial is to evaluate the effectiveness of cyanoacrylate in the treatment of DH when compared to the application of low-intensity laser. METHODS The study includes 434 sensitive teeth from 62 patients. A total of 216 teeth were treated with laser and 218 with cyanoacrylate. A numeric rating scale was used to record the parameters of pain related to the stimuli at baseline and after the treatment at intervals of 24 hours and 30, 90, and 180 days. RESULTS Both groups had significant reductions in DH. However, there was no significant difference between the two groups ≤6 months. Intragroup analysis showed that the effect of cyanoacrylate obtained at 24 hours remained for 90 days in response to air-jet test and 30 days for cold-spray test. There was a statistically significant difference between all other intragroup comparisons at the time intervals (P <0.001). CONCLUSIONS It was concluded that cyanoacrylate is as effective as low-intensity laser in reducing DH. In addition, it is a more accessible and low-cost procedure and can be safely used in the treatment of DH.

Immunosuppressant therapy and bone loss in ligature-induced periodontitis: a study in rats

Immunosuppressive agents have been recognized as a factor affecting the soft tissues of the periodontium. However, little is known about their effect on periodontitis progression. The aim of the present study was to investigate the influence of cyclosporin A (CsA) administration, associated or not with nifedipine, on the bone loss resulting from a ligature-induced periodontitis in rats. Twenty-four adult male Wistar rats were used. After anesthesia, the mandibular first molar was randomly assigned to receive the cotton ligature in the sulcular area while the contralateral tooth was left unligated. The animals were randomly assigned to one of the following treatments: Group A--saline solution; Group B--CsA (10 mg/kg); Group C--nifedipine (50 mg/kg); Group D--CsA (10 mg/kg) plus nifedipine (50 mg/kg). Forty-five days later, the animals were sacrificed and the specimens routinely processed for serial decalcified sections. Intergroup analysis did not reveal significant differences regarding the bone loss volume in the ligated teeth between the experimental treatments (0.46 +/- 0.11, 0.63 +/- 0.32, 0.53 +/- 0.14, 0.50 +/- 0.18, for groups A, B, C and D, respectively--p > 0.05). However, intragroup analysis showed a greater bone loss volume in the ligated teeth than in the unligated ones (p < 0.05). Within the limits of the present study, the conclusion was that the administration of CsA, associated or not with nifedipine, may not influence bone loss in ligature-induced periodontitis in rats.

Oral Health-Related Quality of Life Before and After Treatment of Dentin Hypersensitivity With Cyanoacrylate and Laser

BACKGROUND The aim of this longitudinal study is to verify changes in the oral health-related quality of life of patients 180 days after treatment of dentin hypersensitivity (DH) with laser and cyanoacrylate. METHODS This clinical, controlled, randomized, double-masked trial used a split-mouth design, and quadrants were randomized to receive either laser or cyanoacrylate treatments. All patients received both treatments. The study included 62 patients aged 12 to 60 years (mean: 31.4 years) in whom a total of 432 teeth were treated. Quadrants were randomly distributed into two groups: cyanoacrylate (n = 218 teeth) or laser (n = 216 teeth) treatment. DH was evaluated with air and cold stimuli at 24 hours, 30, 90, and 180 days after treatment. The Oral Health Impact Profile (OHIP-14) questionnaire was applied at baseline and 180 days after treatment. RESULTS There were statistically significant differences in the following OHIP-14 subscales before and after treatment: physical pain (P = 0.002), psychologic discomfort (P <0.001), psychologic disability (P = 0.003), social disability (P = 0.01), and total score (P <0.001). At the end of the study, 80.6% of participants reported an improvement in their condition. CONCLUSION There was a reduction in the impact of DH on the quality of life of study participants after interventions with laser and cyanoacrylate.

A commentary on randomized clinical trials: How to produce them with a good level of evidence

Randomized clinical trial (RCT) is the gold standard study for the evaluation of health interventions and is considered the second level of evidence for clinical decision making. However, the quality of the evidence produced by these studies is dependent on the methodological rigor employed at every stage of their execution. The purpose of randomization is to create groups that are comparable independent of any known or unknown potential confounding factor. A critical evaluation of the literature reveals that, for many years, RCTs have been developed based on inaccurate methodological criteria, and empirical evidence began to accumulate. Thus, guidelines were developed to assist authors, reviewers, and editors in the task of developing and assessing the methodological consistency of this type of study. The objective of this article is to review key aspects to design a good-quality RCT, supporting the scientific community in the production of reliable evidence and favoring clinical decision making to allow the patient to receive the best health care.

Prevalence of bruxism in undergraduate students.

Abstract Objective: The aim of this study was to determine the prevalence of bruxism in students at the Federal University of the Jequitinhonha and Mucuri Valleys in Brazil. The secondary objectives were to identify the factors associated with bruxism; prevalence of dental wear; and to distinguish the signs and symptoms of temporomandibular dysfunction when present, and verify its relationship with bruxism. Methods: Two hundred fifty-three students (106 males, 147 females) were clinically examined and answered a questionnaire. Trained researchers performed the dental wear evaluation. The incisal edge and occlusal surface were classified as follows: no wear, wear into enamel, wear into dentin, and extensive wear into dentin. Demographic data and factors related to bruxism were obtained by a questionnaire. The participants who presented dental wear and habit of clenching/grinding teeth were classified as bruxers. The data were analyzed by the SPSS program (p < 0.05). Results: The results showed that 31.6% of the students had bruxism. Of the 7084 teeth evaluated, 376 (5.3%) had some type of facet wear. The teeth that had the highest prevalence of wear facets were the canines. Stress, muscle pain, temporomandibular joint (TMJ) pain, and TMJ noise were significantly associated with bruxism (p < 0.001). Conclusion: The prevalence of bruxism was 31.6% in this population. The factors most associated with bruxism were stress, muscle pain, TMJ pain, and TMJ noise.

Do TMJ symptoms improve and last across time after treatment with red (660 nm) and infrared (790 nm) low level laser treatment (LLLT)? A survival analysis

Abstract Objective: Temporomandibular disorder (TMD) is a variety of clinical problems that originate from the area of the temporomandibular joint (TMJ), masticatory muscles, and surrounding tissues. There are different treatment options; however, there is no evidence that low level laser treatment (LLLT) will last about six months. The aim of this study was to determine the survival rate of treatment with red (660 nm) and infrared (790 nm) laser in cases of TMDs. Methods: In 19 subjects, one side of the face (half face) was randomly selected to receive intervention, in a total of 116 sensitive points. Pain was measured at baseline and time intervals of 24 h, 30, 90, and 180 days after treatment. Laser irradiation with 4 j/cm² in the TMJs and 8 j/cm² in the muscles was used in three sessions. Kaplan–Meier survival analysis and logistic regression were performed. Results: Both treatments showed statistically significant results (p < 0.001). The survival rate for red and infrared laser was 0.24 and 0.30, respectively, at 180 days. Grinding teeth and headache were associated with recurrent pain. Discussion: Both lasers were effective in the treatment of TMD symptoms and had a low survival rate at 180 days.

Effects of the inspiratory muscle training and aerobic training on respiratory and functional parameters, inflammatory biomarkers, redox status and quality of life in hemodialysis patients: A randomized clinical trial

Objective Evaluate and compare the isolated and combined effects of Inspiratory Muscle Training (IMT) and Aerobic Training (AT) on respiratory and functional parameters, inflamatory biomarkers, redox status and health-related quality of life (HRQoL) in hemodialysis patients. Methods A randomised controlled trial with factorial allocation and intention-to-treat analysis was performed in hemodialysis patients. Volunteers were randomly assigned to performe 8-weeks of IMT at 50% of maximal inspiratory pressure (MIP), low intensity AT or combined training (CT). Before the interventions, all the volunteers went 8-weeks through a control period (without training). Measures are taken at baseline, 8-week (after control period) and 16-week (after the interventions). Primary outcomes were functional capacity (incremental shuttle walk test), MIP and lower limbs strength (Sit-to-Stand test of 30 seconds). Plasma levels of interleukin-6 (IL-6), soluble tumor necrosis factor receptor 1 (sTNFR1) and 2 (sTNFR2), adiponectin, resistin and leptin, redox status parameters and HRQoL (KDQOL-SF questionnaire) were the scondary outcomes. Data analyses were performed by two-way repeated measurements ANOVA. Results 37 hemodialysis patients aged 48.2 years old (IC95% 43.2–54.7) were randomized. Increase of MIP, functional capacity, lower limbs strength and resistin levels, and reduction of sTNFR2 levels in 16-week, compared to baseline and 8-week, were observed in all the groups (p<0.001). IMT improved functional capacity, MIP and lower limbs strength in 96.7m (IC95% 5.6–189.9), 34.5cmH2O (IC95% 22.4–46.7) and 2.2repetitions (IC95% 1.1–3.2) respectively. Increase in resistin leves and reduction in sTNFR2 leves after IMT was 0.8ng/dL (IC95% 0.5–1.1) and 0.8ng/dL (IC95% 0.3–1.3), respectively, without between-group differences. Compared to baseline and 8-week, adiponectin levels (p<0.001) and fatigue domain of the HRQoL (p<0.05) increased in 16-week only in CT. Conclusion IMT, AT and CT improved functional parameters and modulated inflammatory biomarkers, in addition, IMT provoked a similar response to low intensity AT in hemodialysis patients. Trial registration Registro Brasileiro de Ensaios clínicos RBR-4hv9rs.