Ocorrência de Actinobacillus actinomycetemcomitans em pacientes com periodontite crônica, periodontite agressiva, pessoas saudáveis e crianças com gengivite em duas cidades do Estado de São Paulo, Brasil

The aim of this study was to determine the frequency of isolation of Actinobacillus actinomycetemcomitans (Aa) in 100 patients with chronic periodontitis, 14 patients with aggressive periodontitis, 142 pre-school children with gingivitis and 134 periodontally healthy subjects. Samples of subgingival plaque were taken using sterilized paper points introduced into periodontal pockets or gingival crevice for 60 seconds and inoculated on TSBV agar, which was incubated under anaerobiosis at 37ºC, for 4 days. Microbial identification was performed through biochemical methods and morphocellular and morphocolonial analysis. Aa was detected in 40.3% of healthy subjects, 68% of patients with chronic periodontitis, 92.86% of patients with aggressive periodontitis and 40.14% of children with gingivitis. The rate of recovery of Aa in the tested human groups proved to be higher than previously reported and in agreement with participation of this facultative anaerobe as a member of native microbiota of the periodontium and its relation with aggressive and chronic periodontitis in Brazil.Avaliou-se a ocorrência de Actinobacillus actinmycetemcomitans (Aa) em pacientes 100 pacientes com periodontite crônica, 14 com doença periodontal agressiva, 142 crianças com gengivite em idade pré-escolar e 134 indivíduos adultos saudáveis. Amostras de placa subgengival foram coletadas usando cones de papel estéreis introduzidos nas bolsas periodontais ou no sulco gengival por 60 segundos e inoculadas em ágar TSBV, que foram incubadas em anaerobiose a 37ºC, por 4 dias. A identificação microbiana foi realizada através de análises bioquímicas, morfocelulares e morfocoloniais. Aa foi detectado em 40,3% de indivíduos saudáveis, 68% de pacientes com periodontite crônica, 92,86% de pacientes com periodontite agressiva e 40,14% das crianças com gengivite. A taxa de ocorrência de Aa nos grupos testados provou ser mais alta do que a previamente descrita na literatura e que esse microrganismo é membro freqüente da microbiota de indivíduos adultos periodontalmente sadios e de crianças com idade pré-escolar com gengivite além de sua relação com a periodontite crônica e agressiva no Brasil

Estudo longitudinal da terapia antibiótica local de bolsas periodontais residuais. Análise clínica e microbiológica

Objetivos: Dois estudos controlados cegos aleatórios foram realizados para avaliar os resultados clínicos e microbiológicos iniciais e a longo prazo, da tetraciclina aplicada com o microbrush no tratamento de sítios com bolsa periodontal persistente 5mm e sangramento à sondagem, tratados previamente por raspagem e alisamento radicular (RAR). Material e método: Quarenta e dois pacientes com pelo menos 4 dentes com bolsas periodontais 5 mm e sangramento à sondagem foram divididos em 2 grandes grupos: tetraciclina e controle. Nos grupos tetraciclina, dois dentes receberam aplicação de solução de cloridrato de tetraciclina (100mg/mL) com microbrush uma vez por semana por 4 semanas (grupo T) e os outros dois dentes receberam o mesmo tratamento associado a uma sessão de RAR na primeira consulta (grupo RAR+T). Nos grupos controle, dois dentes receberam uma sessão de RAR (grupo RAR) e outros dois dentes receberam aplicação de solução salina com microbrush uma vez por semana por 4 semanas associada a uma sessão de RAR na primeira consulta (grupo RAR+S). Medidas clínicas de índice de placa visível (IP), índice de sangramento gengival (IG), sangramento à sondagem (SS), profundidade de sondagem (PS), nível de inserção clínica (NIC), recessão gengival (RG), e coletas microbiológicas para identificação das bactérias Aggregatibacter actinomycetemcomitans (Actinobacillus actinomycetemcomitans), Porphyromonas gingivais, Prevotella intermédia, Prevotella nigrescens, Tannerella forsythia, e Treponema denticola foram tomadas no baseline, 30, 90 e 180 dias após o tratamento. Amostras de biofilme subgengival foram analisadas por reação de polimerase em cadeia. Resultados: Todas as terapias resultaram em melhora na PS, NIC e SS, embora as diferenças clínicas entre os grupos não tenham alcançado significância estatística.Objectives: Two randomized controlled single-blind studies were carried out to evaluate the initial and the long term clinical and microbiological results of tetracycline applied with a microbrush in treatment of sites with persistent periodontal pockets 5mm and bleeding on probing previous treated by scaling and root planning (SRP). Methods: For each patient in the test groups, two teeth received 4 applications of tetracycline solution (100mg/ml) with a microbrush once a week (T group) while the other two teeth received the same treatment plus one session of SRP at the first appointment (SRP+T group). For each patient in the control groups, two teeth received one session of SRP (SRP group) and the other two received 4 applications of saline with a microbrush once a week plus one session of SRP (SRP+S group). Clinical measurements were taken at baseline, 30, 90 and 180 days after last treatment. Subgingival biofilme samples were analyzed by polymerase chain reaction for Aggregatibacter actinomycetemcomitans (Actinobacillus actinomycetemcomitans), Porphyromonas gingivais, Prevotella intermédia, Prevotella nigrescens, Tannerella forsythia, e Treponema denticola identification. Results: All therapies provided significant improvement in probing depth, clinical attachment level and bleeding on probing, although the clinical difference did not reach statistically significance. At 1 month post-therapy the prevalence of P. gingivalis was significantly reduced in groups that received SRP plus additional therapy and T. forsythia was significantly reduced in only test groups. Until 6 months P. gingivalis, T. forsythensis,and A. actinomycetemcomitans significantly decrease in prevalence only for tetracycline groups. Conclusion: The results of the present study suggest that tetracycline solution applied with a microbrush may be an alternative in management of persistent periodontal pockets with further microbiologic benefits.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

An alternative technique to the harvesting of a connective tissue graft from a thin palate: Enhanced wound healing

This article describes an alternative surgical approach to the harvesting of subepithelial connective tissue grafts from thin palates. A partial-thickness flap is raised, and a graft composed of epithelium and connective tissue is removed from the palate. The superficial layer ( epithelium and a thin zone of connective tissue) is then dissected from the graft and replaced at the donor site to facilitate faster healing. The subjacent layer of connective tissue is placed as needed to obtain root coverage. The clinical application of this technique is described in two patients with multiple gingival recessions

Periodontal plastic surgery associated with treatment for the removal of gingival overgrowth

Background: Excisional biopsies of gingival overgrowths, performed with safety margins, frequently result in mucogingival defects. These defects may produce esthetic problems and increase the chances of dentin hyperesthesia and its possibility of hindering oral hygiene. Methods: Two clinical cases are reported in which gingival overgrowths were removed by excisional biopsy, resulting in unsightly defects. The first clinical case presents an invasive approach for the treatment of a recurrent pyogenic granuloma in the anterior maxilla, and the second depicts a complete removal of a peripheral odontogenic fibroma in the posterior maxilla. In both situations, the soft-tissue defects were repaired by periodontal plastic surgery, including a laterally positioned flap and a coronally positioned flap, respectively. Results: Periodontal plastic surgery successfully restored the defects that resulted from biopsies, and no recurrence has been noticed in the 5-year postoperative follow-up period. Conclusions: The combination of biopsy and periodontal plastic surgery in a one-step procedure seems to be suitable to remove gingival overgrowths in most areas of the mouth, regardless of esthetic significance. Such procedures seem to restore gingival health, encourage healing, and create both esthetics and function in the excised area

Influence of local tetracycline on the microbiota of alveolar osteitis in rats

The aim of the present study was to evaluate the effects of local tetracycline on the occurrence of alveolar osteitis in rats, and on the microbiota associated to this infection. Forty Wistar rats were randomly assigned to 4 groups (n=10): I - the rats had the maxillary right incisor extracted and the alveolar wound did not receive any treatment; II - adrenaline and Ringer-PRAS were introduced into the alveolar wound; III - the alveolar wound was irrigated with sterile saline; and IV - the alveolar wound was irrigated with an aqueous solution of tetracycline. Microbial samples from the alveolar wounds were collected 2 days after surgery and inoculated on blood agar (with and without 8 μg/mL of tetracycline) and other selective media, and were incubated in either aerobiosis or anaerobiosis at 37°C, for 2 to 14 days. It was verified that tetracycline reduced the occurrence of alveolar osteitis in the rats and caused significant changes in the microbiota of the surgical sites, decreasing the number of anaerobes and increasing the participation of tetracycline-resistant and multi-resistant microorganisms

Occurrence of Actinobacillus actinomycetemcomitans in patients with chronic periodontitis, aggressive periodontitis, healthy subjects and children with gingivitis in two cities of the state of São Paulo, Brazil

The aim of this study was to determine the frequency of isolation of Actinobacillus actinomycetemcomitans (Aa) in 100 patients with chronic periodontitis, 14 patients with aggressive periodontitis, 142 pre-school children with gingivitis and 134 periodontally healthy subjects. Samples of subgingival plaque were taken using sterilized paper points introduced into periodontal pockets or gingival crevice for 60 seconds and inoculated on TSBV agar, which was incubated under anaerobiosis at 37°C, for 4 days. Microbial identification was performed through biochemical methods and morphocellular and morphocolonial analysis. Aa was detected in 40.3% of healthy subjects, 68% of patients with chronic periodontitis, 92.86% of patients with aggressive periodontitis and 40.14% of children with gingivitis. The rate of recovery of Aa in the tested human groups proved to be higher than previously reported and in agreement with participation of this facultative anaerobe as a member of native microbiota of the periodontium and its relation with aggressive and chronic periodontitis in Brazil