Photodynamic therapy associated with full-mouth ultrasonic debridement in the treatment of severe chronic periodontitis: a randomized-controlled clinical trial

Background: Photodynamic therapy (PDT) is a method of microbial reduction which can benefit periodontal treatment in areas of difficult access, such as deep pockets and furcations. The aim of this randomized controlled clinical trial was to evaluate the effects of PDT as an adjunct to full-mouth ultrasonic debridement in the treatment of severe chronic periodontitis. Material and Methods: Twenty-two patients with at least one pocket with a probing depth (PD) of ≥7 mm and one pocket with a PD of ≥5 mm and bleeding on probing (BOP) on each side of the mouth were included, characterizing a split mouth design. The control group underwent full-mouth ultrasonic debridement and the test group received the same treatment associated with PDT. The PDT was performed on only one side of the mouth and the initial step consisted of subgingival irrigation with 0.005% methylene blue dye. Two minutes after applying the photosensitizer, the low power laser – AsGaAl (Photon Lase III – PL7336, DMC, São Carlos -São Paulo, Brazil) was applied (660 nm, 100 mW, 9 J, 90 seconds per site, 320 J/cm 2 , diameter tip 600 µm). The following clinical parameters were evaluated: plaque index, gingival index, BOP, gingival recession (GR), PD, and clinical attachment level (CAL). All parameters were collected before, 1, 3 and 6 months after treatment. Results: An improvement in BOP, PD and CAL was observed after treatment, in both groups, but without any difference between them. After 6 months, the PD decreased from 5.11±0.56 mm to 2.83±0.47 mm in the test group (

Metronidazole and amoxicilin asociated with periodontal debridement in the treatment of severe chronic periodontitis

Orientadores: Marcio Zaffalon Casati, Sergio de ToledoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: O objetivo do presente estudo foi avaliar o efeito do debridamento periodontal associado ou não à administração sistêmica de metronidazol e amoxicilina no tratamento da periodontite crônica avançada. Foram selecionados 50 pacientes com pelo menos 8 dentes com sangramento à sondagem (SS) e profundidade de sondagem (PS) = 5 mm, sendo 2 dentes com PS = 6 mm e mais 2 com PS = 7 mm. Os pacientes foram divididos, aleatoriamente, em 4 grupos: raspagem e alisamento radicular + placebo (RAR); RAR + metronidazol e amoxicilina (RAR/AB); debridamento periodontal + placebo (DB) e DB + metronidazol e amoxicilina (DB/AB). Os seguintes parâmetros clínicos foram avaliados: índice de placa, índice gengival, SS, posição da margem gengival, PS e nível clínico de inserção relativo (NICr). A avaliação microbiológica foi feita através da reação da polimerase em cadeia (PCR) em tempo real para quantificação de Porphyromonas gingivalis, Tannerella forsythia e Aggregatibacter actinomycetemcomitans. O teste imunoenzimático (ELISA) permitiu a detecção dos níveis de PGE2, IL-1ß, IFN-? e IL-10 no fluido gengival. Os parâmetros descritos foram avaliados antes do tratamento, 1, 3 e 6 meses após. Não foi observada diferença estatística entre os grupos quanto ao SS, PMG e NICr (p>0,05). Em relação à redução na PS, esta foi, no 6° mês, inferior no grupo DB quando comparada aos grupos RAR/AB e DB/AB (p0.05). Six months after treatment, the DB group showed less PPD reduction than SRP/AB and DB/AB groups (p<0.05). The results of realtime PCR failed to demonstrate significant differences between groups in the prevalence and quantity of A. actinomycetemcomitans, P. gingivalis and T. forsythia. Also, no difference was observed between groups in the levels of PGE2, IL-1ß, IFN-?, IL-10 and on the proportion of IL-1ß/IL-10. It can be concluded that periodontal debridement is a justified approach for the treatment of severe chronic periodontitis and that only benefit of the adjunct use of metronidazole and amoxicillin was the reduction in the need of retreatment.DoutoradoPeriodontiaDoutor em Clínica Odontológic

Providone-iodine used as an adjunct to non-surgical treatment of furcation involvements

Orientadores: Marcio Zaffalon Casati, Sergio de ToledoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: O objetivo do presente estudo foi avaliar a ação de uma solução de iodo povidine (PVP-I), associada à raspagem e alisamento radicular, no tratamento de lesões de bifurcação. Foram selecionados 44 pacientes com pelo menos um molar com lesão de bifurcação classe II, em face livre, profundidade de sondagem ³ 5 mm e sangramento à sondagem. Os pacientes foram divididos aleatoriamente em 2 grupos: grupo controle - raspagem e alisamento radicular com ultra-som e água destilada como solução refrigerante; grupo teste - raspagem e alisamento radicular com ultra-som e PVP-I 10% como solução refrigerante. Foram avaliados os seguintes parâmetros clínicos: índice de placa (IP), sangramento à sondagem (SS), posição da margem gengival (PMG), nível clínico de inserção relativo (NICr), profundidade de sondagem (PS) e nível clínico de inserção horizontal relativo (NICHr). A avaliação bioquímica da atividade de enzimas tipo tripsina no biofilme subgengival foi feita pelo teste BAPNA. Os parâmetros descritos acima foram avaliados antes do tratamento, 1, 3 e 6 meses após. Ambos os grupos apresentaram médias semelhantes de redução da PS, ganho de NICr e de NICHr. Aos 6 meses, esses valores foram, respectivamente, 2,31 mm, 1,17 mm e 1,00 mm no grupo controle e 2,31 mm, 1,23 mm e 1,02 mm no grupo teste (p>0,05). Diferença estatisticamente significante também não foi observada entre os grupos quanto ao número de sítios que ganharam 2 mm ou mais de inserção. Aos 6 meses, os grupos controle e teste apresentaram, respectivamente, 45,16% e 30,77% das áreas com ganho de inserção = 2 mm. Na comparação entre os grupos quanto ao SS das lesões de bifurcação aos 6 meses e à quantidade de áreas que exigiram retratamento no 3° mês foi encontrado p=0,06, favorecendo o grupo teste. O teste BAPNA não detectou diferença entre os grupos, entretanto, foi observada diferença intra-grupo, indicando redução na atividade de enzimas do tipo tripsina. Pôde-se concluir que o PVP-I, usado como adjunto da instrumentação periodontal traz benefícios clinicamente significantes ao tratamento de lesões de bifurcação classe II, em faces livresAbstract: The aim of this randomized single-blind controlled clinical trial was to evaluate the effect of topically applied povidone-iodine (PVP-I), used as an adjunct to non-surgical therapy of furcation involvements. Forty-four patients presenting at least one class II furcation involvement that bled on probing, in bucal or lingual surfaces, with probing pocket depth ³ 5 mm were recruited. Patients were stratified into 2 treatment groups: subgingival instrumentation by an ultrasonic device using PVP-I (10%) as the cooling liquid (test group); identical treatment using distilled water as the cooling liquid (control group). The following clinical outcomes were evaluated: plaque index, bleeding on probing (BOP), position of the gingival margin, relative attachment level (RAL), probing pocket depth (PPD) and relative horizontal attachment level (RHAL). BAPNA test was used to analysis the trypsin-like activity in dental biofilm. The clinical and biochemical parameters were evaluated at baseline and 1, 3 and 6 months after therapy. Both groups had similar means of PPD reduction and RAL and RHAL gain. At 6 months, these variables were, respectively, 2.31 mm, 1.17 mm and 1.00 mm in the control group and 2.31 mm, 1.23 mm and 1.02 mm in the test group (p<0.05). No differences were observed in terms of the frequency distribution of sites demonstrating RAL gain ³ 2 mm. The comparison between groups on BOP of the furcation sites, at 6 months and on the number of sites referred for re-treatment at 3 months showed better values in the test group (p=0.06). The results of BAPNA test failed to demonstrate significant differences between groups. The use of topically applied PVP-I with subgingival instrumentation may provide additional clinical significant benefits to the treatment of class II furcation involvementsMestradoPeriodontiaMestre em Clínica Odontológic

Self-perception of generalized aggressive periodontitis symptoms and its influence on the compliance with the oral hygiene instructions - a pilot study

Aim: Patient&apos;s adherence to the periodontal treatment is fundamental to the success of the therapy. Lack of response to the clinician&apos;s instructions is influenced by various factors, including gender, age and psychosocial profile. The aim of the present study was to evaluate the relationship between self-perceived symptoms of generalized aggressive periodontitis and compliance with the oral hygiene instructions. Methods: Twenty-six subjects presenting a generalized aggressive form of periodontal disease were selected. The subjects answered a questionnaire to rate the perceived symptoms of periodontal disease with a sensitivity scale, in which a numeric score is attributed to each mentioned symptom. The percentage of sites with pocket probing depth (PPD) e" 5mm as well as the plaque index (PI) and gingival index (GI) were evaluated and the patients received a full mouth prophylaxis. One month later, the patients were re-evaluated for PI, GI, and PPD, and their percent reductions were correlated with the numeric score attributed to the aggressive periodontitis symptoms. Spearman&apos;s correlation and Wilcoxon&apos;s test were used with a significance level of 5%. Results: The greater the self-perception of some of the symptoms, the greater the adherence to the oral hygiene instructions. A positive correlation was observed between the reduction of GI and self perception of bleeding on tooth brushing (p=0.04, r=0.27) and redness and swelling of gums (p=0.04, r=0.26). Conclusions: The self-perception of symptoms of generalized aggressive periodontitis could have an influence on the patient&apos;s response to the oral hygiene instructions

The Combination of Amoxicillin and Metronidazole Improves Clinical and Microbiologic Results of One-Stage, Full-Mouth, Ultrasonic Debridement in Aggressive Periodontitis Treatment

Background: The aim of the present study is to assess clinical, microbiologic, and immunologic benefits of amoxicillin/metronidazole (AM) when performing full-mouth ultrasonic debridement (FMUD) in generalized aggressive periodontitis (GAgP) treatment.Methods: Twenty-four GAgP patients were divided into two groups: the FMUD group (n = 12), which received FMUD plus placebo, and the FMUD+AM group (n = 12), which received FMUD and 375 mg amoxicillin plus 250 mg metronidazole for 7 days. The following clinical outcomes were tested: plague and bleeding on probing indices, pocket probing depth (PD), relative gingival margin position (GMP), and relative clinical attachment level (CAL). Total amount of Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans (Aa), Tannerella forsythia (Tf), and gingival crevicular fluid (GCF) concentration of interleukin (IL)-10 and IL-1 beta were also determined. All clinical, microbiologic, and immunologic parameters were assessed at baseline and at 3 and 6 months post-therapy. The ANOVA/Tukey test was used for statistical analysis (alpha = 5%).Results: Amoxicillin/metronidazole used as an adjunct to the FMUD protocol added clinical and microbiologic benefits to GAgP treatment (P0.05).Conclusion: It may be concluded that amoxicillin/metronidazole improves clinical and microbiologic results of FMUD in GAgP treatment. J Periodontol 2012;83:988-998.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Self-perception of generalized aggressive periodontitis symptoms and its influence on the compliance with the oral hygiene instructions - a pilot study

tients adherence to the periodontal treatment is fundamental to the success of the therapy. Lack of response to the clinicians instructions is influenced by various factors, including gender, age and psychosocial profile. The aim of the present study was to evaluate the relationship between self-perceived symptoms of generalized aggressive periodontitis and compliance with the oral hygiene instructions. Methods: Twenty-six subjects presenting a generalized aggressive form of periodontal disease were selected. The subjects answered a questionnaire to rate the perceived symptoms of periodontal disease with a sensitivity scale, in which a numeric score is attributed to each mentioned symptom. The percentage of sites with pocket probing depth (PPD) e 5mm as well as the plaque index (PI) and gingival index (GI) were evaluated and the patients received a full mouth prophylaxis. One month later, the patients were re-evaluated for PI, GI, and PPD, and their percent reductions were correlated with the numeric score attributed to the aggressive periodontitis symptoms. Spearmans correlation and Wilcoxons test were used with a significance level of 5%. Results: The greater the self-perception of some of the symptoms, the greater the adherence to the oral hygiene instructions. A positive correlation was observed between the reduction of GI and self perception of bleeding on tooth brushing (p=0.04, r=0.27) and redness and swelling of gums (p=0.04, r=0.26). Conclusions: The self-perception of symptoms of generalized aggressive periodontitis could have an influence on the patients response to the oral hygiene instructions