Effect of two corticotomy protocols on periodontal tissue and orthodontic movement

Objective: To compare two corticotomy surgical protocols in rats to verify whether they alter conventional orthodontic movement. Methodology: Sixty Wistar rats were divided into three groups – orthodontic movement (CG), orthodontic movement and corticotomy (G1) and orthodontic movement with corticotomy and decortication (G2) – and euthanized after 7 and 14 days. Tooth movement (mm), bone volume fraction and bone volume ratio to total volume (BV/TV), and bone mineral density (BMD) were evaluated by micro-CT. The total amount of bone was measured in square millimeters and expressed as the percentage of bone area in the histomorphometry. The number of positive TRAP cells and RANK/RANKL/OPG interaction were also investigated. Results: Day 14 showed a statistically significant difference in orthodontic tooth movement in CG compared with G1 (7.52 mm; p=0.009) and G2 (7.36 mm; p=0.016). A micro-CT analysis revealed a difference between CG, G1 and G2 regarding BV/TV, with G1 and G2 presenting a lower BV/TV ratio at 14 days (0.77 and 0.73 respectively); we found no statistically significant differences regarding BMD. There was a difference in the total amount of bone in the CG group between 7 and 14 days. At 14 days, CG presented a significantly higher bone percentage than G1 and G2. Regarding TRAP, G2 had more positive cells at 7 and 14 days compared with CG and G1. Conclusion: Corticotomy accelerates orthodontic movement. Decortication does not improve corticotomy efficiency

Immunolocalization of markers for bone formation during guided bone regeneration in osteopenic rats

Objective The aim of this paper was to evaluate the repair of onlay autogenous bone grafts covered or not covered by an expanded polytetrafluoroethylene (e-PTFE) membrane using immunohistochemistry in rats with induced estrogen deficiency. Material and Methods Eighty female rats were randomly divided into two groups: ovariectomized (OVX) and with a simulation of the surgical procedure (SHAM). Each of these groups was again divided into groups with either placement of an autogenous bone graft alone (BG) or an autogenous bone graft associated with an e-PTFE membrane (BGM). Animals were euthanized on days 0, 7, 21, 45, and 60. The specimens were subjected to immunohistochemistry for bone sialoprotein (BSP), osteonectin (ONC), and osteocalcin (OCC). Results All groups (OVX+BG, OVX+BMG, SHAM+BG, and SHAM+BMG) showed greater bone formation, observed between 7 and 21 days, when BSP and ONC staining were more intense. At the 45-day, the bone graft showed direct bonding to the recipient bed in all specimens. The ONC and OCC showed more expressed in granulation tissue, in the membrane groups, independently of estrogen deficiency. Conclusions The expression of bone forming markers was not negatively influenced by estrogen deficiency. However, the markers could be influenced by the presence of the e-PTFE membrane

The influence of LLLT applied on applied on calvarial defect in rats under effect of cigarette smoke

Objective: Considering the global public health problem of smoking, which can negatively influence bone tissue repair, the aim of this study is to analyze the influence of photobiomodulation therapy (PBM) on calvaria defects created surgically in specimens under the effect of cigarette smoke and analyzed with use of histomorphometric and immunohistochemistry techniques. Methodology: Calvaria defects 4.1 mm in diameter were surgically created in the calvaria of 90-day-old rats (n=60) that were randomly divided into 4 experimental groups containing 15 animals each: control group (C), smoking group (S), laser group (L), and smoke associated with laser group (S+L). The animals were subjected to surgery for calvaria defects and underwent PBM, being evaluated at 21, 45, and 60 days post-surgery. The specimens were then processed for histomorphometric and immunohistochemistry analyses. The area of bone neoformation (ABN), percentage of bone neoformation (PBNF), and the remaining distance between the edges of the defects (D) were analyzed histometrically. Quantitative analysis of the TRAP immunolabeled cells was also performed. The data were subjected to analysis of variance (ANOVA) in conjunction with Tukey’s test to verify the statistical differences between groups (p<0.05). Results: The smoking group showed less ABN compared to the other experimental groups in all periods, and it also showed more D at 21 days compared to the remaining groups and at 45 days compared to the laser group. The smoking group showed a lower PNBF compared to the laser group in all experimental periods and compared to smoking combined with LLLT group at 21 days. Conclusions: PBM acted on bone biomodulation, thus stimulating new bone formation and compensating for the negative factor of smoking, which can be used as a supportive therapy during bone repair processes

Effect of systemic antibiotic and probiotic therapies as adjuvant treatments of subgingival instrumentation for periodontitis: a randomized controlled clinical study

Objective: This study assessed the efficacy of two adjunct therapies (antibiotic and probiotic) for periodontal treatment based on clinical and immunological parameters in patients with Stage II and III Grade B periodontitis. Methodology: 45 patients were randomly allocated into three groups: control group (CG); antibiotic group (GAtb), in which 500 mg amoxicillin + 400 mg metronidazole were used; and probiotic group (GProb), for which Lactobacillus reuteri was used. Patients received medications after undergoing periodontal debridement. Clinical and immunological parameters were assessed at baseline, 30 days, and 90 days. Results: All therapies reduced bleeding on probing (BoP) in the evaluated periods, and the GAtb had a greater reduction at 90 days (p=0.03). The GProb group showed better results for plaque index (PI) and gingival recession (GR) compared to the GAtb at 90 days (p=0.0014; p=0.006). The area of inflammation (PISA Index) significantly decreased in all therapies in the evaluated periods. Therapies had no significant differences regarding moderate pockets. The GAtb had a greater reduction in probing depth (PD) for deep pockets (p=0.03) at 90 days and in the number of deep pocket sites at 30 days (p=0.04). The occurrence of adverse effects was commonly reported in the GAtb as a percentage per patient. The GAtb had a significant reduction in the concentration of interleukins IL-1β and IL-8 and an increase in IL-10 and TNF-α. The CG had a reduction in IL-6 and IL-1 β, whereas in the GProb there was no difference. Conclusion: After three months, none of the adjuvant therapies provided any additional benefit for subgingival instrumentation

Effect of Photobiomodulation Therapy Associated With Biphasic Phosphate Calcium on Bone Repair: A Histomorphometric Study in Rats

Background: This study aimed to investigate the effects of photobiomodulation therapy associate with biphasic calcium phosphate on calvaria critical defects in rats. Methods: Forty-eight (90days old) adult male rats (Rattus norvegicus, Albinus variation, Wistar) received critical defects with 5 mm in diameter were made on their skull and were randomly assigned into the groups: C-blood clot, B-biphasic calcium phosphate, L-photobiomodulation therapy and B+L-biphasic calcium phosphate+photobiomodulation therapy. A low-level GaAlAs was applied in a single dose tran-surgically, in a wavelength 660 nm, total dense energy density of 45 J/cm2. At 30 and 60 days, animals from each group were euthanized. Histological and histomorphometric analyzes were performed.  Results: In 30 days, almost all specimens (C, L, B and B+L) showed bone neoformation areas in regions near the borders of the surgical defect. In 60 days, in many specimens (C, L, B, B+L), it was possible to see a narrow neoformed bone structure along almost the whole extension of the surgical defect, though being thinner than the original calvary bone.  Data were recorded as mean ± standard deviation, after normality was tested, suitable statistical test was applied (α= 5%). At 60 days, there was a statistically significant difference when comparing the proportion of neoformation area between group L (0.52%±0.13) and B+L (0.20%±0.08). Group L showed a difference compared with all the groups when comparing the remaining distance between de edges of neoformed bone (C×L, p=0.0431; B×L, p=0.0386; L×B+L, p=0.0352), demonstrating a great defect closure.  Conclusions: Our findings suggest that photobiomodulation therapy applied at 45 J/cm² resulted in the highest percentage of bone neoformation area after 60 days, although biphasic calcium phosphate exerts some osteogenic activity during bone repair, photobiomodulation therapy is not able to modulate this process

Periondontal surgery and glass ionomer restoration in the treatment of gingival recession associated with a non-carious cervical lesion

Orientadores: Enilson Antonio Sallum, Marcio Zaffalon CasatiDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: O objetivo desse trabalho foi avaliar clinicamente o recobrimento radicular obtido em recessões gengivais associadas à lesão cervical não-cariosa tratadas com retalho posicionado coronariamente, associado ou não à restauração de ionômero de vidro modificado por resina. Foram selecionados 19 pacientes com recessões gengivais bilaterais comparáveis, associadas à lesões cervicais não cariosas. Os dentes foram distribuídos aleatoriamente para compor o grupo teste: retalho posicionado coronariamente associado à restauração da lesão cervical com ionômero de vidro modificado por resina, ou o grupo controle: retalho posicionado coronariamente associado ao desgaste e regularização da superfície radicular. Os parâmetros avaliados foram: profundidade de sondagem, sangramento à sondagem, nível de inserção clínica, recessão gengival, hipersensibilidade cervical e altura de tecido queratinizado antes dos tratamentos, 45, 60, 90 e 180 dias após. Após 6 meses, as porcentagens médias de recobrimento da altura da lesão cervical não-cariosa foram de 56,14±11,74 para o grupo teste e 59,78±11,11 para o grupo controle, não havendo diferença estatisticamente significante. Foi encontrada diferença (p=0,04) na profundidade de sondagem aos 90 dias em favor do grupo teste. Porém essa diferença não se manteve no período final de avaliação. Foi notada diferença estatisticamente significante quando a hipersensibilidade cervical foi analisada. O grupo teste mostrou-se mais eficaz na resolução desse sintoma (p=0,002). Nos demais parâmetros, não houve diferenças significantes. Dentro dos limites do presente estudo, pode-se concluir que ambos os tratamentos foram efetivos e que a presença da restauração de íonômero de vidro modificado por resina não interfere na taxa de recobrimento quando o retalho posicionado coronariamente é utilizado para tratamento de recessão de tecido gengival classe I de Miller associada à lesão cervical não-cariosaAbstract: The aim of this study was to evaluate the root coverage and the gingival margin stability after coronally advanced flap with or without glass ionomer restoration to treat gingival recession associated with non-carious cervical lesion. Nineteen patients who presented bilateral gingival recession associated with a non-carious cervical lesion were selected. The sites were randomly assigned to the test group: coronally advanced flap plus the non-carious cervical lesion restoration performed with resin glass ionomer cement or to the control group: coronally advanced flap plus scaling and root planning. Probing depth, bleeding on probing, clinical attachment level, gingival recession, dentin sensitivity and keratinized tissue height were measured at baseline, 45, 60, 90 and 180 days after surgery. Average percentage rates of root coverage for test and control group were 56.14% and 59.78%, respectively. At all postoperative evaluations, both treatments result in significant (p<0.05) recession reduction. No significant statistical difference between test and control was observed regarding root coverage. A significant difference (p=0.04) between test and control was found for probing depth at 90 days. The test group was better; however this difference was not seen at 180 days. A significant difference (p=0.002) was found for dentin sensitivity when control and test were compared. The test group showed better results regarding this parameter. When the other parameters were compared between the two groups, o difference was found. According to the findings of this investigation we can provide hat the presence of the glass ionomer restoration does not interfere with root coverage achieved by coronally advanced flaMestradoPeriodontiaMestre em Clínica Odontológic

Survical-restorative treatment of gingival recession associated with non-carious cervical lesion : results of different approaches and the influence of the local factors

Orientador: Enilson Antonio SallumTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Recessões gengivais estão freqüentemente associadas às lesões cervicais não-cariosas. O tratamento dessa lesão combinada é um desafio. Trabalhos recentes têm apresentado resultados de tratamento conjunto de cirurgia periodontal e dentística restauradora para tratamento da lesão combinada. Porém nenhum trabalho demonstrou resultados de longo prazo desse tipo de abordagem, além de variações desse tratamento e dos fatores anatômicos locais que poderiam influenciar na resultado dessas terapias. Portanto, os objetivos do presente estudo foram: 1. Apresentar os resultados após 2 anos de tratamento de recessões gengivais associadas à lesões cervicais tratadas com retalho posicionado coronariamente (RPC) sozinho ou associado à restauração de ionômero de vidro modificado por resina (CIV). 2. Avaliar os resultados, após 6 meses de tratamento do enxerto de tecido conjuntivo (ETC) associado ou não à restauração de CIV para tratamento da lesão combinada. 3. Avaliar a possível influência das características anatômicas locais no recobrimento das lesões combinadas tratadas pelas técnicas do retalho posicionado coronariamente e pelo enxerto de tecido conjuntivo. Para o primeiro objetivo, foi realizado um estudo clínico controlado e randomizado que foram incluídos 16 indivíduos apresentando duas recessões gengivais bilaterais associadas à lesões cervicais em caninos ou pré-molares superiores. Os defeitos foram tratados com RPC sozinho ou associado à restauração de CIV. Os resultados não demonstraram diferença significante entre os grupos após 2 anos com relação à redução da recessão gengival, ganho no nível clínico de inserção e sangramento à sondagem. Para o segundo objetivo, foi realizado um estudo clinico controlado e randomizado que foram incluídos 40 indivíduos apresentando uma recessão gengival associada à lesão cervical em caninos ou pré-molares superiores. Os defeitos foram tratados com ETC sozinho ou associado à restauração de CIV. Os resultados não demonstraram diferença estatisticamente significante entre os grupos após 6 meses com relação à redução da recessão gengival, ganho no nível clínico de inserção, ganho de tecido queratinizado e sangramento à sondagem. No entanto, o grupo que recebeu ETC e a restauração de CIV foi estatisticamente melhor na redução da hipersensibilidade dentinária. Para o terceiro objetivo, as características anatômicas locais dos indivíduos dos dois estudos clínicos prévios foram medidas e analisadas através de regressão linear multipla. Os resultados demonstraram correlação estatisticamente significante entre a profundidade da lesão cervical não-cariosa e o a redução na recessão gengival quando RPC foi utilizado de forma isolada. A altura da lesão combinada também apresentou correlação estatisticamente significante com a redução da recessão gengival para ambos os estudos. Além disso, a deiscência óssea apresentou correlação estatisticamente significante quando ETC foi utilizado. Dentro dos limites desse estudo, pode-se concluir que a restauração de ionômero de vidro modificado por resina parece não interferir no recobrimento da lesão combinada após 2 anos de avaliação, quando o retalho posicionado coronariamente foi utilizado e após 6 meses quando o enxerto de tecido conjuntivo foi utilizado. A profundidade da lesão cervical pode ter alguma influência quando RPC é utilizado e a deiscência óssea parece não interferir negativamente no recobrimento quando ETC foi utilizado.Abstract: Gingival recessions are frequently associated with non-carious cervical lesion. Previous studies have shown results from a combined treatment (periodontal surgery plus restoration of the cervical lesion) to deal with the association of these two lesions. However, there is lack of information regarding the long term evaluation of the combined treatment. Moreover, no additional information regarding other surgical techniques and the influence of the local anatomical characteristics have not been evaluated. Thus, the objectives of this study were: 1. Evaluate the 2-year-follow-up outcome of the treatment of gingival recession associated with non-carious cervical lesions by coronally advanced flap alone (CAF), or in combination with a resin-modified glass ionomer restoration 2. Evaluate the 6-month-follow-up outcome of the treatment of gingival recession associated with cervical lesion by connective tissue graft alone (CTG), or in combination with a resin-modified glass ionomer restoration, and 3. Evaluate the possible influence of local anatomy on the amount of soft tissue coverage achieved and on the clinical attachment gain by the use of CAF and CTG, alone or in combination with resin-modified glass ionomer restoration to treat the combined defect. For the first objective, 16 patients with bilateral Miller Class I buccal gingival recessions, associated with non-carious cervical lesions were selected. The defects received either CAF alone or CAF plus a resin-modified glass ionomer restoration. The results showed that both groups showed statistically significant soft tissue coverage. The differences between groups were not statistically significant in reduction of gingival recession, gain in the clinical attachment level, and bleeding on probing after 2 years. For the second objective, 40 patients with Miller Class I buccal gingival recessions, associated with non-carious cervical lesions were enrolled. The defects were randomly assigned to receive either CTG alone or CTG plus a resin-modified glass ionomer restoration. The results showed that both groups showed statistically significant soft tissue coverage. The differences between groups were not statistically significant in gingival recession, gain in the clinical attachment level, and bleeding on probing, after 6 months. However, the group CTG plus the restoration showed statistically significant reduction in dentin sensitivity when compared to CTG alone. For the third objective, the local anatomical characteristics from the patients enrolled in the 2 previous studies were correlated with the reduction of the gingival recession and the gain in the clinical attachment level using Stepwise Multivariate Linear Regression. The results showed that the cervical lesion depth was significantly correlated with reduction in gingival recession, when considering data from the CAF group. The cervical lesion height was statistically correlated with the reduction in gingival recession when the two groups were analyzed. Additionally, the bone level was statistically correlated with reduction in gingival recession when evaluating the CTG group. Within the limits of the present study it can be concluded that the presence of the resin-modified glass ionomer restoration may not interfere with the amount of coverage achieved either by CAF after 2 years or CTG after 6 months. The cervical lesion depth may have some influence on the final coverage achieved when CAF is applied and the bone level may not play any role when CTG is applied.DoutoradoPeriodontiaDoutor em Clínica Odontológic

Papel do trauma de oclusão na doença periodontal

A relação entre trauma oclusal e a iniciação e a progressão das doenças periodontais tem sido controversa ao longo de um século. Os primeiros estudos do século 20, forças oclusais excessivas eram considerados como o fator etiológico da destruição periodontal e o ajuste oclusal deveria ser feito de forma profilática. Em meados do século passado, Lõe mostrou que o fator etiológico da destruição periodontal é a placa bacteriana. Porém, ainda muito se discute qual o papel do trauma oclusal na destruição dos tecidos de suporte periodontais. Esta monografia tem como propósito revisar os conceitos de trauma de oclusão, seus sinais e sintomas e qual o papel, se realmente existir algum, na iniciação e progressão das doenças periodontais.The relationship between occlusal forces and the initiation or progression of periodontal disease has been controversial for over a century. In early studies, excessive occlusal forces were considered to be the major causative factor for periodontal destruction and that occlusal therapy should be performed to control and prevent the disease. In the last century, Löe showed that plaque was the major causative factor for the periodontal destruction. However, there is a great controversy in what the real role of occlusal trauma plays in the periodontal structures destruction. The aim of this monograph was to review the concepts of the occlusal trauma, its signs and symptoms and what is the role of trauma, if there is one, in the initiation and progression of the periodontal diseases

Xenogenous collagen matrix and/or enamel matrix derivative for treatment of localized gingival recessions: a randomized clinical trial. Part I: clinical outcomes

Considering xenogeneic collagen matrix (CM) and enamel matrix derivative (EMD) characteristics, it is suggested that their combination could promote superior clinical outcomes in root coverage procedures. Thus, the aim of this parallel, double-masked, dual-center, randomized clinical trial is to evaluate clinical outcomes after treatment of localized gingival recession (GR) by a coronally advanced flap (CAF) combined with CM and/or EMD. Methods: Sixty-eight patients presenting one Miller Class I or II GRs were randomly assigned to receive either CAF (n = 17); CAF + CM (n = 17); CAF + EMD (n = 17), or CAF + CM + EMD (n = 17). Recession height, probing depth, clinical attachment level, and keratinized tissue width and thickness were measured at baseline and 90 days and 6 months after surgery. Results: The obtained root coverage was 68.04% ± 24.11% for CAF; 87.20% ± 15.01% for CAF + CM; 88.77% ± 20.66% for CAF + EMD; and 91.59% ± 11.08% for CAF + CM + EMD after 6 months. Groups that received biomaterials showed greater values (P <0.05). Complete root coverage (CRC) for CAF + EMD was 70.59%, significantly superior to CAF alone (23.53%); CAF + CM (52.94%), and CAF + CM + EMD (51.47%) (P <0.05). Keratinized tissue thickness gain was significant only in CM-treated groups (P <0.05). Conclusions: The three approaches are superior to CAF alone for root coverage. EMD provides highest levels of CRC; however, the addition of CM increases gingival thickness. The combination approach does not seem justified881213091318FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP2013/19473-