Sebastião Luiz Aguiar Greghi

Gingival recession: prevalence, extension and severity in adults

The gingival recession was assessed in 380 adult individuals aged more than 20 years and comprised both subjects being treated and looking for treatment at Bauru Dental School. Clinical evaluation was conducted by a single examiner in all teeth and involved analysis of four dental aspects (mesial, buccal, distal and lingual). The gingival recession was regarded as present whenever more than 1mm of root surface was exposed, and its vertical width was measured in millimeters from the cementoenamel junction to the gingival margin. The recessions were further scored following the criteria suggested by Miller in 1985. Gingival recession was observed in at least one dental surface in about 89% of the individuals analyzed. The prevalence, extension and severity of this clinical aspect increased with age. Class I recessions were the most frequent, yet there was a gradual increase of Class III and IV recessions as older subjects were evaluated. The mandibular teeth displayed more surfaces with gingival recession than the maxillary teeth and the mandibular incisors were the most affected teeth. Such high prevalence of gingival recession in adult patients demonstrates that dental professionals should provide attention to the clinical relevance of such alterations, as well as to the diagnosis of the etiologic factors.

Differential production of macrophage inflammatory protein-1alpha, stromal-derived factor-1, and IL-6 by human cultured periodontal ligament and gingival fibroblasts challenged with lipopolysaccharide from P. gingivalis.

BACKGROUND Fibroblasts are considered important cells in periodontitis. When challenged by different agents, they respond through the release of cytokines that participate in the inflammatory process. The aim of this study is to evaluate and compare the expression and production of macrophage inflammatory protein (MIP)-1alpha, stromal-derived factor (SDF)-1, and interleukin (IL)-6 by human cultured periodontal ligament and gingival fibroblasts challenged with lipopolysaccharide (LPS) from Porphyromonas gingivalis. METHODS Fibroblasts were cultured from biopsies of gingival tissue and periodontal ligament of the same donors and used on the fourth passage. After confluence in 24-well plates, the culture medium alone (control) or with 0.1 to 10 microg/ml of LPS from P. gingivalis was added to the wells, and after 1, 6, and 24 hours, the supernatant and the cells were collected and analyzed by enzyme-linked immunosorbent assay and real-time polymerase chain reaction, respectively. RESULTS MIP-1alpha, SDF-1, and IL-6 protein production was significantly greater in gingival fibroblasts compared to periodontal ligament fibroblasts. IL-6 was upregulated in a time-dependent manner, mainly in gingival fibroblasts (P <0.05), which secreted more MIP-1alpha in the lowest concentration of LPS used (0.1 microg/ml). In contrast, a basal production of SDF-1 that was inhibited with the increase of LPS concentration was detected, especially after 24 hours (P <0.05). CONCLUSION The distinct ability of the gingival and periodontal ligament fibroblasts to secrete MIP-1alpha, SDF-1, and IL-6 emphasizes that these cells may differently contribute to the balance of cytokines in the LPS-challenged periodontium.

Clinical evaluation of the effects of low-intensity laser (GaAlAs) on wound healing after gingivoplasty in humans

Low-intensity laser therapy aims at pain suppression, edema reduction and acceleration of wound healing. The main goal of this study was to clinically evaluate the effects of Aluminum Gallium Arsenate laser - 670nm in wound healing after gingivoplasty in 11 patients. Surgery was performed in anterior superior and/or inferior regions. The right side of the patient (test group) received a laser energy density of 4J/cm², in a 48-hour interval, during one week, totalizing four sessions. The irradiation was punctual in a contact mode in three points. The left side did not receive irradiation (control group). Clinical evaluation was performed by five specialists in periodontology through photography of the treated areas at post-surgical periods of 7, 15, 21,30,60 days. The observers pointed the best healed side. The Sign test was used for statistical analysis with a confidence level of 5% (P<0.05). The examiners found a better pattern of healing sometimes in the test and sometimes in the control group until 21 days after surgery. After this period there was no apparent difference between them. There was no statistical difference between the sides (p>0.05). These results have shown that low-intensity laser therapy did not accelerate oral mucosa healing after gingivoplasty.

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.

Influence of age, sex, plaque and smoking on periodontal conditions in a population from Bauru, Brazil

Epidemiology is the study of health and disease in populations, and of how these conditions are influenced by heredity, biology, physical environment, social environment, and personal behavior. There are many epidemiological studies in Brazilian population but few about the influence of some risk factors in periodontal conditions. This cross-sectional study was performed to assess the influence of age, sex, plaque and smoking on periodontal disease in a population from Bauru (Brazil). Data concerning periodontal status were collected from 380 patients in the University of São Paulo (USP). Measurements of periodontal pocket depths (PPD), clinical attachment levels (CAL), plaque index (PI) of four sites in all teeth were registered. The influence of age, sex and smoking habits on the periodontal parameters were statistically evaluated using descriptive statistical and ANOVA. The correlation between plaque and periodontal parameters was analyzed by Pearsons correlation coefficient. The results showed an increase in the mean of periodontal destruction (PPD and CAL) and a higher number of sites with severe losses with increasing age. Correlation among percentage of sites with plaque and periodontal parameters (PPD and CAL) were positive but weakly related. The male group showed significantly higher means of CAL than the female. Smokers had significantly higher PPD and CAL means than non-smokers. Aging, smoking habit, male sex, and percentage of sites with plaque were associated with a great increase of periodontal destruction, being important factors in the diagnosis of the periodontal disease in this Brazilian population.

Clinical evaluation of dentin hypersensitivity treatment with the low intensity Gallium-Aluminum-Arsenide laser - AsGaAl

UNLABELLED The dentin hypersensitivity is a painful condition rather prevalent in the general population. There are several ways of treatment for such condition, including the low intensity lasers. The proposal of this study was to verify the effectiveness of the Gallium-Aluminum-Arsenide diode laser in the treatment of this painful condition, using a placebo as control. MATERIALS AND METHODS Thirty-two patients were selected, 22 females and 10 males, with ages ranging from 20 to 52 years old. The 32 patients were randomly distributed into two groups, treated and control; the sample consisted of 68 teeth, 35 in the treated group and 33 in the control group. The treated group was exposed to six laser applications with intervals from 48 to 72 hours, and the control group received, as placebo, applications of a curing light. RESULTS A significant reduction was observed in the pain condition between the initial phase and after six laser applications; however, such reduction could also be observed for the control group exposed to the placebo. CONCLUSION Therapy with the low intensity Gallium-Aluminum-Arsenide laser - AsGaAl induces a statistically significant reduction in the painful condition after each application and between the beginning and end of treatment, although there was no statistically significant difference between the treated group (laser) and the control group (placebo) at the end of treatment and after the mediate evaluation results (after 6 weeks), this way impairing the real measurement of laser effectiveness and placebo effect.

Comparison among four commonly used demineralizing agents for root conditioning: a scanning electron microscopy

Dental roots that have been exposed to the oral cavity and periodontal pocket environment present superficial changes, which can prevent connective tissue reattachment. Demineralizing agents have been used as an adjunct to the periodontal treatment aiming at restoring the biocompatibility of roots. Objective This study compared four commonly used demineralizing agents for their capacity of removing smear layer and opening dentin tubules. Methods Fifty fragments of human dental roots previously exposed to periodontal disease were scaled and randomly divided into the following groups of treatment: 1) CA: demineralization with citric acid for 3 min; 2) TC-HCl: demineralization with tetracycline-HCl for 3 min; 3) EDTA: demineralization with EDTA for 3 min; 4) PA: demineralization with 37% phosphoric acid for 3 min; 5)Control: rubbing of saline solution for 3 min. Scanning electron microscopy was used to check for the presence of residual smear layer and for measuring the number and area of exposed dentin tubules. Results Smear layer was present in 100% of the specimens from the groups PA and control; in 80% from EDTA group; in 33.3% from TC-HCl group and 0% from CA group. The mean numbers of exposed dentin tubules in a standardized area were: TC-HCl=43.8±25.2; CA=39.3±37; PA=12.1±16.3; EDTA=4.4±7.5 and Control=2.3±5.7. The comparison showed significant differences between the following pairs of groups: TC-HCl and Control; TC-HCl and EDTA; CA and Control; and CA and EDTA. The mean percentages of area occupied by exposed dentin tubules were: CA=0.12±0.17%; TC-HCl=0.08±0.06%; PA=0.03±0.05%; EDTA=0.01±0.01% and Control=0±0%. The CA group differed significantly from the others except for the TC-HCl group. Conclusion There was a decreasing ability for smear layer removal and dentin tubule widening as follows: AC>TC-HCl>PA>EDTA. This information can be of value as an extra parameter for choosing one of them for root conditioning.

Pool of bovine morphogenetic proteins and guided tissue regeneration in the treatment of intrabony periodontal defects: I- Clinical measurements

The purpose of this study was to evaluate the effect of the pool of bovine BMPs on the treatment of intrabony defects. The sample comprised 15 patients aged 26 to 57 years old presenting with 10 pairs of lesions of 2 or 3 walls or 2-3 walls ³5mm, located in the same type teeth (premolar or molar) and same jaw. The test defects were treated with combination of a pool of bovine bone morphogenetic and resorbable hydroxyapatite carrier (BMPs- HA), bovine demineralized bone matrix (MB) and coverage by a bovine collagen barrier membrane. The control defects were treated with MB-HA and covered by a bovine collagen membrane. The clinical measurements at six months after therapy in the test group revealed a reduction in the mean probing pocket depth (PPD) of 1.63 ± 1.41mm (B) and 1.93 ± 0.96mm (L) and a mean change in the clinical attachment level (CAL) of 1.60 ± 1.16mm (B) and 1.46 ± 0.97mm (L). The control group showed a mean reduction of PPD of 1.93 ± 1.34mm (B) and 2.0 ± 1.51mm (L) and a mean change of CAL of 1.03 ± 1.24mm (B) and 1.30 ± 1.14 mm (L). The analysis of variance (ANOVA) demonstrated that the changes in the clinical parameters were statistically significant (p<0.05). There were no significant differences between the test and controls subjects (Students test, p<0.005). These findings suggest that the use of a pool of bovine BMPs do not provide added effects to GTR in the treatment of intrabony defects.

Influence of combined oral contraceptives on the periodontal condition

Most studies investigating the impact of oral contraceptives have been performed some years ago, when the level of sexual hormones was greater than the actual formulations. Objective The aim of this study was to evaluate the effects of current combined oral contraceptives (COC) on periodontal tissues, correlating the clinical parameters examined with the total duration of continuous oral contraceptive intake. Material and methods Twenty-five women (19-35 years old) taking combined oral contraceptives for at least 1 year were included in the test group. The control group was composed by 25 patients at the same age range reporting no use of hormone-based contraceptive methods. Clinical parameters investigated included pocket probing depth (PD), clinical attachment level (CAL), sulcular bleeding index (SBI) and plaque index (Pl.I). Data were statistically evaluated by unpaired t test, Pearsons correlation test and Spearmans correlation test. Results The test group showed increased PD (2.228±0.011 x 2.154±0.012; p<0.0001) and SBI (0.229±0.006 x 0.148±0.005, p<0.0001) than controls. No significant differences between groups were found in CAL (0.435±0.01 x 0.412±0.01; p=0.11). The control group showed greater Pl.I than the test group (0.206±0.007 x 0.303±0.008; p<0.0001). No correlation between the duration of oral contraceptive intake, age and periodontal parameters was observed. Conclusions These findings suggest that the use of currently available combined oral contraceptives can influence the periodontal conditions of the patients, independently of the level of plaque accumulation or total duration of medication intake, resulting in increased gingival inflammation.

Demineralization of the Contacting Surfaces in Autologous Onlay Bone Grafts Improves Bone Formation and Bone Consolidation

BACKGROUND Autologous bone grafts are usually well consolidated after 4 to 5 months but can be incompletely interlocked with the native bone. This study investigated the effect of acid demineralization of the graft-bed interface on graft consolidation. METHODS Onlay bone grafts were performed on the calvaria of 36 guinea pigs. Half of the animals had the graft-bed contacting surfaces demineralized with 50% citric acid (pH 1.0) for 3 minutes (test group). The other half received no demineralization (control group). The bone grafts were immobilized by a resorbable membrane glued to the recipient bed with cyanoacrylate. After 7, 30, and 90 days, specimens (n = 6) were obtained for light microscopy. Data from qualitative analysis and computerized histomorphometry were statistically processed at a significance level of 5%. RESULTS Osteogenesis was not seen at the interface after 7 days. After 30 days, the test group showed 34.39% ± 13.4% of the interface area filled with mineralized tissue, compared to 17.14% ± 8.6% in the control group (P = 0.026). After 90 days, the mean percentages of mineralized tissue at the interface in the test and control specimens were 54.00% ± 11.23% and 38.65% ± 7.76% (P = 0.041), respectively. Within groups, a higher percentage of the area filled with mineralized tissue was seen at 90 days compared to 30 days (P = 0.004 for control and 0.041 for test). CONCLUSIONS Demineralization of the contacting surfaces between autologous bone graft and bone bed improved new bone formation and bone consolidation. These data need to be confirmed in humans.