Tiago Fiorini

Is There a Positive Effect of Smoking Cessation on Periodontal Health? A Systematic Review

BACKGROUND Although the detrimental effects of tobacco on the periodontal tissues have been reported extensively, little is known about the potential beneficial effect of smoking cessation on periodontal health. The aim of this systematic review is to evaluate the effect of smoking cessation on periodontitis progression and response to periodontal therapy. METHODS Two independent reviewers completed the review process through title (n = 118), abstract (n = 24), and whole-paper selection (n = 5). Sources include Medline and EMBASE databases (up to December 2012) and a reference list of selected studies. Prospective studies comparing progression rates of periodontitis between smokers and quitters and clinical trials evaluating the effect of smoking-cessation programs, alone or in combination with periodontal treatment, were included. At least 1 year of follow-up was required for inclusion. RESULTS Of 331 potentially relevant publications, five studies fulfilled the inclusion criteria. Because of heterogeneity of the studies, a meta-analysis could not be performed. One study reported that the progression of clinical attachment loss (AL) ≥3 mm during a 6-year period was approximately three times higher among smokers than quitters (P <0.001). Two studies (10 and 20 years of follow-up) observed a decrease in radiographic bone loss of ≈30% among quitters when compared with smokers. Among individuals receiving non-surgical periodontal treatment, quitters were more likely to have periodontal probing depth reductions (P <0.05) than non-quitters/oscillators. No differences in AL were observed. CONCLUSION Based on the limited available evidence, smoking cessation seems to have a positive influence on periodontitis occurrence and periodontal healing.

Dentine hypersensitivity : analysis of self-care products

Dentine hypersensitivity is a condition that is often present in individuals, leading them to seek dental treatment. It has been described as an acute, provoked pain that is not attributable to other dental problems. Its actual prevalence is unknown, but it is interpreted as very unpleasant by individuals. Several therapeutic alternatives are available to manage dentine hypersensitivity, involving both in-office treatment and home-use products. The aim of this literature review was to evaluate self-care products for managing dentine hypersensitivity. Among the products available, dentifrices and fluorides are the most studied self-care products, with positive effects. However, a high percentage of individuals is affected by the placebo effect. Among dentifrices, those containing potassium salts seem to be the most promising. Dental professionals need to understand the advantages and limitations of these therapies and use this knowledge in a positive approach that might help in decreasing dentine hypersensitivity among patients.

Wound healing following surgical and regenerative periodontal therapy.

Clinical studies have evaluated the effect of conventional periodontal surgical therapy. In general, although some clinical gain in tissue support may be attained, these therapies do not support regeneration of the periodontal attachment. Even though the biological possibility of periodontal regeneration has been demonstrated, the clinical application of this intrinsic potential appears difficult to harness; thus also conceptually most intriguing candidate protocols face clinical challenges. In this review, we explore the bioclinical principles, condiciones sine quibus non, that unleash the innate potential of the periodontium to achieve clinically meaningful periodontal regeneration (i.e. space-provision, wound stability and conditions for primary intention healing). Moreover, limiting factors and detrimental practices that may compromise clinical and biological outcomes are reviewed, as is tissue management in clinical settings.

Effect of rhBMP‐2 dose on bone formation/maturation in a rat critical‐size calvarial defect model

BACKGROUND Application of recombinant human bone morphogenetic protein-2 (rhBMP-2) has been associated with significant adverse events in craniofacial settings, including swelling and seroma formation. Recent work has demonstrated an inverse relationship between bone formation/maturation and rhBMP-2 dose, frequency/severity of adverse events increasing with rising dose. OBJECTIVE The objective of this study was to determine the most effective dose for rhBMP-2 soak-loaded onto an absorbable collagen sponge (ACS) carrier for bone formation/maturation using an established defect model. METHODS One hundred sixty-eight outbred male Sprague-Dawley rats, age 11-13 weeks, weight 325-375 g randomized into seven groups of 24 subdivided into groups of eight, were used to provide radiographic and light microscopy observations of bone formation/maturation and aberrant healing events at 2, 4 and 8 weeks following application of rhBMP-2/ACS into critical-size, ø8-mm, through-through, calvarial osteotomy defects for a dose of 1.25, 2.5, 5.0, 10.0 and 20.0 μg rhBMP-2/defect, or serve as ACS or sham-surgery controls. RESULTS rhBMP-2 dosages ≥ 2.5 μg/defect showed histological defect closure >90% within 2 weeks, and complete resolution within 4 weeks. Adverse healing events including swelling, excessive bone formation or seroma formation could not be determined with certainty in this defect model. Notably ACS control sites showed complete defect closure at the 8-week healing interval. CONCLUSIONS rhBMP-2/ACS accelerates local bone formation in the rat critical-size through-through calvarial defect model once reaching an osteoinductive dose threshold. This threshold may already be reached at a 1.25-/2.5-μg dose in this model. No further enhancement to bone formation/maturation may be observed adding rhBMP-2 above the 2.5-μg dose. The 1.25-20.0 μg dose range did not invoke appreciable aberrant healing events.

Effect of nonsurgical periodontal therapy on serum and gingival crevicular fluid cytokine levels during pregnancy and postpartum

BACKGROUND AND OBJECTIVE A low-grade systemic inflammatory status originating from periodontal infection has been proposed to explain the association between periodontal disease and systemic conditions, including adverse obstetric outcomes. The aim of this study was to evaluate the effect of periodontal therapy during pregnancy on the gingival crevicular fluid and serum levels of six cytokines associated with periodontal disease and preterm birth. MATERIAL AND METHODS A subsample of 60 women (18-35 years of age) up to 20 gestational weeks, previously enrolled in a larger randomized clinical trial, was recruited for the present study. Participants were randomly allocated to receive either comprehensive nonsurgical periodontal therapy before 24 gestational weeks (n = 30, test group) or only one appointment for supragingival calculus removal (n = 30, control group). Clinical data, and samples of blood and gingival crevicular fluid, were collected at baseline, at 26-28 gestational weeks and 30 d after delivery. The levels of interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12p70 and tumor necrosis factor-α were analyzed by flow cytometry. RESULTS After treatment, a major reduction in periodontal inflammation was observed in the test group, with bleeding on probing decreasing from 49.62% of sites to 11.66% of sites (p < 0.001). Periodontal therapy significantly reduced the levels of IL-1β and IL-8 in gingival crevicular fluid (p < 0.001). However, no significant effect of therapy was observed on serum cytokine levels. After delivery, the levels of IL-1β in the gingival crevicular fluid of the test group were significantly lower than were those in the control group (p < 0.001), but there were no significant differences between test and control groups regarding serum cytokine levels. CONCLUSION Although periodontal therapy during pregnancy successfully reduced periodontal inflammation and gingival crevicular fluid cytokine levels, it did not have a significant impact on serum biomarkers.

Relationship between cytokine levels in serum and gingival crevicular fluid (GCF) in pregnant women

BACKGROUND Periodontal disease has been linked to systemic diseases/disorders and a low-grade systemic inflammatory status originated from periodontitis has been proposed as a possible explanation for this association. This study evaluates the relationship, early in pregnancy, between gingival crevicular fluid (GCF) and serum levels of a panel of cytokines that have been implicated in PTB and periodontal disease. METHODS One hundred pregnant women aged 18-35 years old with a gestational age up to 20 weeks were included (mean±SD gestational age:16.1±3.5 weeks). Four periodontal sites per subject were randomly selected for GCF collection. Serum and GCF levels of IL-1β, IL-6, IL-8, IL-10, IL-12p70 and TNF-α were analyzed using a cytometric bead array. Regression and correlation analyses were used to assess the relationship between serum and GCF cytokine levels. RESULTS Participants had widespread periodontal inflammation but limited periodontal destruction. Cytokine levels were significantly higher in GCF than serum for all cytokines but IL-10. GCF levels had small but significant effect on serum levels for IL-10 (β=0.34±0.09, p<0.01), IL-12p70 (β=0.48±0.08, p<0.01) and TNF-α (β=0.29±0.09, p<0.01). Periodontal probing depth and bleeding on probing were significantly associated with GCF levels for IL-1β, IL-6 and IL-8; however, they had negligible effect on serum cytokine levels. Correlation between GCF and serum levels was non-significant, except for IL-12p70, which showed a significant but small correlation between the two sources (r=0.32, p=0.001). CONCLUSIONS GCF cytokine levels were not strongly associated with serum cytokine levels in pregnant women with widespread periodontal inflammation but limited periodontal destruction.

Essential oils-containing mouthwashes for gingivitis and plaque: Meta-analyses and meta-regression.

OBJECTIVES To evaluate the efficacy of EO as adjuncts to mechanical plaque control (MPC) on the reduction of plaque and gingivitis when compared to placebo or cetylpyridium chloride (CPC). DATA Randomized controlled trials of at least 6 months of follow-up including systemically healthy individuals with gingivitis were included. SOURCES MEDLINE, EMBASE, Lilacs and SCOPUS were searched up to April 2016. From 3045 citations, 16 studies were included. 14 studies assessed the Quigley-Hein Plaque Index (QHI) and 11 studies assessed the Modified Gingival Index (MGI) and were included in meta-analyses and meta-regression. STUDY SELECTION The analysis of risk of bias suggested that the quality of the studies ranged from moderate to low. Mean QHI (WMD=-0.86, 95%CI -1.05 to -0.66) and MGI (WMD=-0.52, 95%CI -0.67 to -0.37) were lower for EO+MPC than placebo+MPC. Reductions in plaque and gingivitis were, respectively, 32% and 24% larger for EO+MPC than placebo+MPC. The decreases in QHI (WMD=-0.95, 95%CI -1.26 to -0.63) and in MGI (WMD=-0.34, 95%CI -0.53 to -0.15) observed in the EO+MPC group, compared to placebo+MPC in interproximal areas, were significantly different and in favor to EO+MPC. EO+MPC compared to CPC+MPC resulted in clinically lower levels of plaque and gingivitis. High heterogeneity (I2>95%) was found and explained (MGI-R2=63.6%; QHI-R2=80.1%) by differences between studies in the percentage of males, supervision of the mouthwashes and provision of oral hygiene. CONCLUSIONS EO seems to be superior to placebo+MPC and CPC+MPC for reduction of plaque and gingival inflammation in patients with gingivitis. Expected benefits may be clinically relevant and may also reach the interproximal area. CLINICAL SIGNIFICANCE Mouthwashes containing essential oils should be considered the first choice for daily use as adjuvants to self-performed mechanical plaque control.

Effect of Platform Shift on Crestal Bone Levels and Mucosal Profile Following Flap Surgery and Subcrestal Implant Placement in Presence/Absence of Gap Defects

BACKGROUND Physiologic remodeling resulting in crestal bone loss appears a common corollary to dental implant surgery. Several hypotheses and clinical strategies have been advanced to explain and avert crestal remodeling; however, causative mechanisms remain unclear and the efficacy of clinical protocols uncertain. PURPOSE The objective of the present study was to provide a histologic account of crestal bone levels and mucosal profile at implant sites receiving platform shift/switch and standard abutments following conventional flap surgery and subcrestal implant placement in presence or absence of crestal gap defects using a dog model. MATERIALS AND METHODS Four dental implants were placed into the left/right edentulated posterior mandible in five adult male Hound Labrador mongrel dogs using flap surgery including subcrestal placement with/without a 1 × 5 mm (width × depth) gap defect, and using platform shift/switch and standard abutments. Block biopsies were collected for histological/histometric analysis following an 8-week healing interval. RESULTS No significant differences in crestal resorption were observed among experimental groups; crestal resorption being significantly more advanced at buccal than at lingual sites (p < .001). Similarly, crestal bone-implant contact was not significantly different among groups; crestal bone-implant contact being consistently below the implant platform at buccal sites (p < .01). Moreover, the peri-implant mucosal profile was not statistically different among groups, the mucosal height being significantly greater at buccal than at lingual sites (p < .001). Also, no significant differences among groups were observed for the apical extension of the epithelial attachment, the epithelial attachment being arrested more than 2 mm above the implant platform at both platform shift/switch and standard abutments. CONCLUSIONS Using a clinical strategy including flap surgery and subcrestal implant placement, implant technology comparing platform shift/switch with standard abutments, surgical approach, and abutment selection seems to have a limited impact on crestal remodeling, associated bone loss, and mucosal profile.

Effect of platform shift/switch on crestal bone levels and mucosal profile following flapless surgery and crestal/subcrestal implant placement

BACKGROUND Crestal remodeling/bone loss appears a common sequel to dental implant placement. Several hypotheses and clinical strategies have been advanced to explain and avert crestal remodeling; however, causative mechanisms remain unclear and the efficacy of clinical protocol uncertain. OBJECTIVE The objective of the present study was to provide a histologic record of crestal versus subcrestal implant placement on crestal remodeling and mucosal profile comparing platform shift/switch and standard abutments following flapless implant surgery using a dog model. METHODS Four dental implants each were placed into the left and right edentulated posterior mandibles in five adult male hound-Labrador mongrel dogs using a flapless approach including crestal versus subcrestal placement and using platform shift versus standard abutments. Block biopsies were collected for histological/histometric analysis following an 8-week healing interval. RESULTS Both crestal and subcrestal implant installation resulted in significant crestal remodeling and bone loss, in particular at buccal sites, without significant differences between platform shift/switch and standard abutments. Implants installed subcrestally exhibited a significantly taller mucosal profile over crestal-level implants without significant differences between platform shift/switch and standard abutments; the epithelial attachment at all times arrested on the abutment surface. CONCLUSIONS Comparing platform shift/switch versus standard abutments using a minimally invasive flapless approach including crestal or subcrestal implant placement, the platform shift/switch abutments offer no selective advantage over standard abutments.

Effect of Platform Shift/Switch and Concave Abutments on Crestal Bone Levels and Mucosal Profile following Flap and Flapless Implant Surgery

BACKGROUND Crestal remodeling/bone loss appears to be a common sequel to dental implant placement. Several hypotheses/clinical strategies have been proposed to explain/avert crestal remodeling; however, causative mechanisms remain unclear and the efficacy of these clinical approaches uncertain. OBJECTIVE The objective of the present study was to provide a histological account of crestal bone levels and mucosal profile at platform shift/switch and concave abutments following flapless and conventional flap surgery and subcrestal implant placement using a dog model. METHODS Four dental implants each were placed in the left/right mandibular posterior jaw quadrants in five adult male Hound/Labrador mongrel dogs using flap surgery with a 1 × 5 mm gap defect or using a flapless approach, both involving placement 2 mm subcrestally and platform shift/switch versus concave abutments. Block biopsies for histological/histometric analysis were collected at 8 weeks. RESULTS No significant differences were observed regarding crestal bone levels, with all groups showing mean bone levels above the implant platform. Similarly, crestal bone-implant contact was not significantly different among groups. Moreover, peri-implant mucosal profiles were not statistically different among groups for buccal sites; average mucosal height reached 4.1 to 4.9 mm above the implant platform. Comparison between buccal and lingual sites showed a nonsignificant tendency toward greater crestal resorption at buccal sites, adjusting for other factors. Mean crestal bone-implant contact level approximated the implant platform for lingual sites while consistently remaining below the platform at the buccal sites. Peri-implant mucosal height was significantly higher at buccal than at lingual sites, with the epithelial attachment located a significant distance away from the implant platform at buccal sites. CONCLUSIONS The surgical approaches (subcrestal implant placement by flap surgery or a flapless approach) and abutment designs (platform shift/switch or concave) used in this study seem to have a limited impact on crestal remodeling, associated bone loss, and mucosal profile. Bioclinical strategies should be developed to circumvent the limitations of current clinical protocol.