Condição periodontal em pacientes com artrite reumatóide

Tendo em vista que existem controvérsias na literatura quanto à existência de associação entre a doença periodontal e a artrite reumatóide e que as metodologias empregadas são tão diversas quanto os seus resultados e conclusões, este estudo transversal teve por objetivo avaliar a condição periodontal em portadores de artrite reumatóide e verificar se existe associação entre essas duas condições. Para isso, foram aplicados questionários de saúde geral e bucal, e foi realizado o exame periodontal em 49 portadores de artrite reumatóide e em 22 indivíduos não portadores de artrite reumatóide ou qualquer outra doença auto-imune. Fumantes e portadores de diabetes mellitus foram excluídos deste estudo. Os resultados indicaram que portadores de artrite reumatóide possuem menor número de dentes na cavidade bucal, apresentam maior extensão de placa bacteriana e maior proporção de sítios com perda de inserção periodontal avançada do que os indivíduos não portadores de artrite reumatóide Apesar da maior extensão de placa bacteriana dentre portadores de artrite reumatóide, a porcentagem de sítios que apresentaram sangramento marginal foi semelhante nos dois grupos, provavelmente devido ao uso de drogas antiinflamatórias e drogas de base, imunoreguladoras. Além disso, portadores de artrite reumatóide que utilizavam a associação de drogas de base apresentaram menor perda de inserção periodontal do que aqueles que não utilizavam a associação dessas drogas. Os resultados do estudo sugerem que existe associação entre periodontite e artrite reumatóide e que novos estudos serão necessários para identificar os fatores presentes nos portadores de artrite reumatóide que predispõem esses indivíduos a uma maior perda de inserção periodontal.There are controversies in the literature concerning the association between periodontal disease and rheumatoid arthritis. There are no consistent methodologies and results. The aim of this cross-sectional study was to assess periodontal condition in rheumatoid arthritis patients and verify if there is an association between these two conditions. We have produced general and dental health questionnaires and periodontal examination was achieved in 49 rheumatoid arthritis patients and 22 healthy individuals. Smokers and diabetes mellitus patients were excluded of the sample. Our results indicated that rheumatoid arthritis patients had lesser remaining teeth, higher extension of dental plaque and higher proportion of sites presenting advanced attachment loss than controls. Although rheumatoid arthritis patients had higher extension of dental plaque than the control group, gingival bleeding was similar between them, maybe because of the fact that rheumatoid arthritis patients take anti-inflammatory and disease-modifying antirheumatic drugs (DMARDs) for their treatment. Rheumatoid arthritis patients who were taking an association of two or more disease-modifying antirheumatic drugs had lesser attachment loss than patients that were taking only one of these drugs. Our results suggest that there is an association between periodontitis and rheumatoid arthritis and that more studies are required to identify specific risk factors for attachment loss in rheumatoid arthritis patients.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Eficácia do cloridrato de tetraciclina na remoção da smear layer e na exposição do colágeno da matriz dentinária

A remoção da smear layer e a exposição da matriz colágena da dentina de superfícies radiculares desprovidas de sua inserção conjuntiva tem o potencial de auxiliar o tratamento e/ou a regeneração periodontal. O objetivo deste estudo in vitro foi avaliar, por meio de microscopia eletrônica de varredura, a remoção da smear layer e a exposição da matriz colágena da dentina produzidas pela aplicação de cloridrato de tetraciclina (TTC-HCl). O cemento radicular das amostras foi removido com fresas diamantadas, processo seguido de raspagem e alisamento radicular com cureta. As 450 amostras foram divididas em 10 grupos: controle (soro fisiológico) e os que compreendiam a aplicação de TTCHCl nas concentrações: 10mg/ml, 25mg/ml, 50mg/ml, 75mg/ml, 100mg/ml, 125mg/ml, 150mg/ml, 200mg/ml e 250mg/ml. Todos os grupos receberam essa aplicação de diferentes formas (passiva, pincel e fricção) e em diferentes tempos (1, 2 e 3 minutos). A avaliação foi feita por um examinador treinado, calibrado e que não conhecia o grupo ao qual as amostras pertenciam, utilizando o índice de Sampaio (1999) modificado para este estudo. Os dados foram analisados pelos testes de Kruskal- Wallis e de Dunn. As concentrações de 50mg/mL e 75mg/mL aplicadas por fricção e por pincelamento foram as mais efetivas na remoção de smear layer e na exposição de colágeno. O modo de aplicação passivo mostrou-se inferior aos demais (p=0,0001) com relação aos mesmos parâmetros, assim como o tempo de aplicação de 1 minuto também foi inferior em relação aos demais (p=0,002). Concluiu-se que as concentrações de 50mg/mL e 75mg/mL aplicadas por pincelamento ou fricção durante 2 ou 3 minutos foram as mais efetivas.Smear layer removal and collagen fibers exposure may improve periodontal treatment and regeneration. This in vitro study assessed smear layer removal and collagen fibers exposure after application of tetracycline hydrochloride (TTC-HCl) on root surfaces by means of scanning electron microscopy. Root cementum was removed with diamond burs followed by scaling and root planning. Four hundred and fifty samples were divided into 10 groups: control (application of saline) and application of TTC-HCl 10mg/ml, 25mg/ml, 50mg/ml, 75mg/ml, 100mg/ml, 125mg/ml, 150mg/ml, 200mg/ml and 250mg/ml. The TTCHCl application was performed in all groups in 3 different ways (passive, brushing and burnishing) and in 3 different times (1, 2 and 3 minutes). A previously trained, calibrated and blind examiner evaluated the photomicrographs using the Sampaio index (1999) modified for this study. Statistical analysis was performed by Kruskal-Wallis and Dunn tests. The 50mg/mL and 75mg/mL concentrations applied by burnishing or brushing were the most effectives in smear layer removal and collagen fibers exposure. Both, the passive mode of application (p=0.0001) and 1-minute time of application (p=0,002) were the less effectives. In conclusion, the 50mg/mL and 75mg/mL concentrations applied by brushing or burnishing during 2 or 3 minutes were the most effectives.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Periodontal condition in patients with rheumatoid arthritis

The purpose of this clinical study was to investigate if periodontal disease and rheumatoid arthritis (RA) are associated. The study included 39 RA patients (test group) and 22 age- and gender-matched healthy individuals (control group). Questionnaires on general and oral health were applied and a complete periodontal exam, including visible plaque, marginal bleeding, attachment loss (AL) and number of teeth present, was also performed by a single calibrated examiner. Diabetes mellitus patients and smokers were excluded. RA patients had fewer teeth, higher prevalence of sites presenting dental plaque and a higher frequency of sites with advanced attachment loss. Although the prevalence of dental plaque was higher in the test group (Chi-square test, p = 0.0006), the percentage of sites showing gingival bleeding was not different (Fisher’s exact test, p > 0.05). Based on our results, we suggest that there is an association between periodontal disease and RA

Influence of dental exposure to oral environment on smear layer removal and collagen exhibition after using different conditioning agents

Although in vitro studies have shown encouraging results for root surface conditioning with demineralizing agents, in vivo studies have failed to show its benefits in periodontal healing. This can be attributed to several factors, among which, the hypermineralization of dental surface. Therefore, this in vitro study compared, using scanning electron microscopy (SEM), the effect of root surface conditioning with different conditioners (1% and 25% citric acid, 24% EDTA and 50 mg/mL tetracycline hydrochloride) in impacted teeth and in teeth that had their roots exposed to the oral environment. One trained examiner assessed the SEM micrographs using a root surface modification index. There was a tendency of more root surface modification in the group of impacted teeth, suggesting that the degree of root mineralization influences its chemical demineralization

Smear layer removal and collagen fiber exposure using tetracycline hydrochloride conditioning

Aim: Smear layer removal and collagen fiber exposure may improve periodontal treatment and regeneration. This in vitro study assessed smear layer removal and collagen fiber exposure after tetracycline hydrochloride (TTC) application on root surfaces using scanning electron microscopy (SEM). Methods and Materials: Root cementum was removed with diamond burs followed by scaling and root planning. Four hundred fifty samples were divided into ten groups: a control (saline application) and nine different TTC concentrations were applied at doses of 10, 25, 50, 75, 100, 125, 150, 200, and 250 mg/ml. The TTC application was performed in all groups in three different ways (passive, brushing, and burnishing) and at three different periods of conditioning (1, 2, and 3 minutes). A previously trained, calibrated, and blind examiner evaluated photomicrographs of the samples using Sampaio's index (2005). Statistical analysis was performed using the Kruskal-Wallis' and Dunn's tests. Results: The concentrations of 50 mg/mL and 75 mg/mL applied by burnishing were the most effective in smear layer removal and collagen fiber exposure. Both the passive mode of application (p=0.0001) and 1 minute period of application (p=0.002) were the least effective. Conclusions: The concentrations of 50 mg/mL and 75 mg/mL applied by burnishing during 2 or 3 minutes were the most effective. Clinical Significance: These parameters may be applied in periodontal procedures involving TTC root conditioning to optimize results

Blood cells attachment after root conditioning and PRP application: An in vitro study

Aim: Root conditioning is aimed at smear layer removal and at dental matrix collagen exposure, which may promote periodontal regeneration. This in vitro study assessed smear layer removal, collagen fiber exposure and the influence of PRP (platelet-rich plasma) application on adhesion of blood cells to the root surface using scanning electron microscopy (SEM). Materials and methods: Scaled root samples (n = 160) were set in five groups and conditioned with: group I - control group (saline solution); group II (EDTA 24%); group III (citric acid 25%); group IV (tetracycline hydrochloride 50 mg/ml); group V (sodium citrate 30%). Eighty samples were assessed using the root surface modification index (RSMI). The other eighty samples were set in two groups. The first group (n = 40) received PRP gel application with a soft brush and the second group (n = 40) received PRP application and then a blood drop. The fibrin clot formation was assessed in the first group and the blood cells adhesion was assessed in the second group using the BEAI (blood elements adhesion index). A previously trained, calibrated, and blind examiner evaluated photomicrographs. Statistical analysis was performed using the Kruskal-Wallis's and Dunn's tests. Results: Group III attained the best results for RSMI and BEAI. Moreover, it was the only group showing fibrin clot formation. Conclusion: Citric acid was the most efficient conditioner for smear layer removal, collagen fiber exposure and blood cell adhesion. Moreover, it was the only group showing fibrin clot formation after PRP application. Clinical significance: This study demonstrated that root conditioning followed by PRP application may favor blood cell adhesion on root surface which may optimize periodontal healing

Periodontal disease-associated compensatory expression of osteoprotegerin is lost in type 1 diabetes mellitus and correlates with alveolar bone destruction by regulating osteoclastogenesis

Alveolar bone resorption results from the inflammatory response to periodontal pathogens. Systemic diseases that affect the host response, such as type 1 diabetes mellitus (DM1), can potentiate the severity of periodontal disease (PD) and accelerate bone resorption. However, the biological mechanisms by which DM1 modulates PD are not fully understood. The aim of this study was to determine the influence of DM1 on alveolar bone resorption and to evaluate the role of receptor activator of nuclear factor-kappaB ligand (RANKL)/osteoprotegerin (OPG) in osteoclastogenesis in rats. PD was induced by means of ligature in nondiabetic and in streptozotocyn-induced DM1 rats. Morphological and morphometric analyses, stereology and osteoclast counting were performed. RANKL and OPG mRNA levels, protein content, and location were determined. PD caused alveolar bone resorption, increased the number of osteoclasts in the alveolar bone crest and also promoted changes in RANKL/OPG mRNA expression. DM1 alone showed alveolar bone destruction and an increased number of osteoclasts at the periapical and furcal regions. DM1 exacerbated these characteristics, with a greater impact on bone structure, resulting in a low OPG content and a higher RANKL/OPG ratio, which correlated with prominent osteoclastogenesis. This work demonstrates that the effects of PD and DM1 enhance bone destruction, confirms the importance of the RANKL signaling pathway in bone destruction in DM1 in animal models and suggests the existence of alternative mechanisms potentiating bone degradation in PD

Lesão endoperio: apicectomia com abordagem palatina: Relato de caso clínico com 30 meses de acompanhamento

Traditionally, the apicoectomies are carried out with the vestibular approach for visibility and easiness of access. The aim of this study was to present a case report of a patient with extensive injury endo-periodontal opted for the surgical access through a palatal incision. The patient presented with abscess drainage via periodontal ligament. The periodontal probing coincident with the radiographic apex in mesial tooth on dental element 22. Radiographically it was noted that the periapical lesion extended from the distal of the tooth 11 to the mesial of tooth 23. The tooth 22 had undergone endodontic treatment and showed signs of shutter material extravasation. It was decide to carry out an approach by the Palatine of the tooth to prevent gingival. After the flap elevation, the injury was debrided and apicoectomy was performed. The patient reported no pain or discomfort after surgery. Furthermore, as follow-up of 30 months there was total remission of signs and symptoms presented initially and absence of gingival recession. Therefore, according to the results showed in this case report, it is suggested that the Palatine access is an alternative approach that can be successfully employed in cases of apicoectomies in order to avoid the occurrence of gingival recessions.Tradicionalmente, as apicectomias são realizadas com abordagem pela vestibular, pela visibilidade e facilidade de acesso local. O objetivo deste estudo foi apresentar o caso clínico de um paciente com extensa lesão endoperiodontal, no qual se optou pelo acesso cirúrgico realizado por meio de incisão através da face palatina. O paciente se apresentou com drenagem do abscesso via ligamento periodontal e sondagem periodontal coincidente com o ápice radiográfico na mesial do dente 22. Radiograficamente, constatou-se que a lesão periapical se estendia da mesial do dente 11 à distal do dente 23. O dente 22 havia sido submetido a tratamento endodôntico e apresentava sinais de extravasamento de material obturador. Optou-se por realizar uma abordagem por palatino, para evitar a ocorrência de recessão na vestibular. Após a elevação do retalho, foi realizada a raspagem/alisamento radicular e a apicectomia. O paciente não relatou dor ou desconforto pós-operatório. Conforme acompanhamento de 30 meses, houve remissão total dos sinais e dos sintomas apresentados inicialmente e ausência de recessão na face palatina. Portanto, de acordo com os resultados apresentados, sugere-se que a abordagem por palatino é uma alternativa que pode ser empregada com sucesso em casos de apicectomia, quando se deseja evitar a ocorrência de recessões gengivais