Racial differences in systemic sclerosis disease presentation: a European Scleroderma Trials and Research group study

Objectives. Racial factors play a significant role in SSc. We evaluated differences in SSc presentations between white patients (WP), Asian patients (AP) and black patients (BP) and analysed the effects of geographical locations.Methods. SSc characteristics of patients from the EUSTAR cohort were cross-sectionally compared across racial groups using survival and multiple logistic regression analyses.Results. The study included 9162 WP, 341 AP and 181 BP. AP developed the first non-RP feature faster than WP but slower than BP. AP were less frequently anti-centromere (ACA; odds ratio (OR) = 0.4, P < 0.001) and more frequently anti-topoisomerase-I autoantibodies (ATA) positive (OR = 1.2, P = 0.068), while BP were less likely to be ACA and ATA positive than were WP [OR(ACA) = 0.3, P < 0.001; OR(ATA) = 0.5, P = 0.020]. AP had less often (OR = 0.7, P = 0.06) and BP more often (OR = 2.7, P < 0.001) diffuse skin involvement than had WP.AP and BP were more likely to have pulmonary hypertension [OR(AP) = 2.6, P < 0.001; OR(BP) = 2.7, P = 0.03 vs WP] and a reduced forced vital capacity [OR(AP) = 2.5, P < 0.001; OR(BP) = 2.4, P < 0.004] than were WP. AP more often had an impaired diffusing capacity of the lung than had BP and WP [OR(AP vs BP) = 1.9, P = 0.038; OR(AP vs WP) = 2.4, P < 0.001]. After RP onset, AP and BP had a higher hazard to die than had WP [hazard ratio (HR) (AP) = 1.6, P = 0.011; HR(BP) = 2.1, P < 0.001].Conclusion. Compared with WP, and mostly independent of geographical location, AP have a faster and earlier disease onset with high prevalences of ATA, pulmonary hypertension and forced vital capacity impairment and higher mortality. BP had the fastest disease onset, a high prevalence of diffuse skin involvement and nominally the highest mortality

Adesão de células sanguineas em raízes biomodificadas de pacientes fumantes

The periodontal treatment begins with scaling and root planning and patient motivation, aiming at an increase in oral health. Scaling and root planning produce smear layer which impairs periodontal regeneration. Chemical substances are used to remove this layer exposing a sound root surface and collagens fibers. Some substances are proposed to it: tetracycline, EDTA, citric acid and lasers. Several researches were conducted in order to determine the best way to apply those substances. These researches determined the adequate concentration, period and method of application to promote root demineralization. The aim of this study was to evaluate blood cell adhesion to collagen of demineralized dental surfaces in association of plasma rich platelet application. 24% EDTA, 25% citric acid (pH 1.5) and distilled water (control) were used in the teeth of the smoking patients. After the samples were photographed in a scanning electron microscope, non-parametrical analysis was performed to evaluate the formation and interlacing of network fibrinolytic and adhesion of blood cells to the root surface. It can be concluded that the use of EDTA and citric acid did not affect the adhesion of blood cells. The application of PRP before the deposition of tissue blood seems to have influenced the adhesion of cells to the root surface. The use of EDTA and citric acid in combination to PRP favored the adhesion of blood cells. EDTA and citric acid removed smear layer and exposed dentinal tubules; but were not effective in the exposure of collagen fibers.O tratamento periodontal inicia-se com raspagem e aplainamento radicular e a motivação do paciente, visando melhoria na higienização e na saúde bucal do indivíduo. A raspagem e o aplainamento radicular formam smear layer, dificultando a reparação periodontal. Substâncias químicas são utilizadas para remoção desta camada, promovendo a exposição de superfície radicular sadia e fibras colágenas. Vários agentes condicionantes são propostos: tetraciclina, EDTA, ácido cítrico e laser. Para determinar a melhor maneira de utilizar essas substâncias, foram realizados estudos que determinaram quais as concentrações, tempos e modos de aplicação em relação à biomodificação radicular. O objetivo deste estudo foi avaliar a adesão das células sanguíneas ao colágeno da superfície dental, exposto por condicionadores associados ao plasma rico em plaquetas. Assim, utilizou-se o EDTA 24%, o ácido cítrico 25% (pH 1,5) e a água destilada (controle) em dentes de pacientes fumantes. Após, as amostras foram fotografadas em microscópio eletrônico de varredura, realizada análise estatística não paramétrica quanto ao grau de formação e entrelaçamento da rede fibrinolítica e a adesão das células sanguíneas à superfície radicular. Pôde-se concluir: a utilização de EDTA e ácido cítrico não influenciaram na adesão de células sanguíneas; a aplicação de PRP antes da deposição do tecido sanguíneo parece ter influenciado a adesão de células à superfície radicular; a utilização de EDTA e ácido cítrico em associação ao PRP favoreceram a adesão de células sanguíneas; o EDTA e o ácido cítrico removeram smear layer e expuseram túbulos dentinários, mas não foram eficazes na exposição de fibras colágenas.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Effects of Er,Cr:YSGG Laser Irradiation on Root Surfaces for Adhesion of Blood Components and Morphology

Objective: This in vitro study evaluated the effects of Er,Cr:YSGG laser irradiation on root surfaces for adhesion of blood components and morphology. Background Data: No previous research has evaluated the biocompatibility of root surfaces irradiated by Er, Cr: YSGG laser. Materials and Methods: Fifteen teeth were studied from nonsmoking patients with severe periodontal disease. Sixty root surface specimens were obtained by selecting four from each tooth. Specimens were divided into three groups of 20 each, according to treatments. Group 1 (G1) was treated by scaling and root planing (SRP), group 2 (G2) was irradiated by Er, Cr: YSGG laser, and group 3 (G3) was treated by SRP and Er, Cr: YSGG laser irradiation. Blood was placed on each of 10 specimens from each of the three groups, to evaluate adhesion of blood components to the root surfaces. A morphological analysis was made of the root surfaces of the other 10 specimens from each group. All were photomicrographed in a scanning electron microscope (SEM) and classified according to the index of blood component adhesion and modified index for analysis of morphology. Statistical processing was done with the Kruskal-Wallis and Mann-Whitney tests (p<0.05). Results: No statistical differences for adhesion of blood components to root surfaces were found between the groups (p=0.359). However, morphological analysis disclosed that all root surfaces irradiated by Er,Cr:YSGG laser (100%) were rougher than surfaces that were not irradiated (G1-G2: p=0.0003 and G1-G3: p=0.0003). Conclusion: Er, Cr: YSGG laser irradiation produced rougher root surfaces than treatment by SRP. However, it did not interfere with the adhesion of blood components to the root surfaces.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Saliva substitutes in combination with high-fluoride gel

Objective This study aimed to determine whether the application of a high-fluoride gel could increase the remineralization of subsurface dentin lesions stored in saliva substitutes. Materials and methods Demineralized bovine dentin specimens were stored in mineral water (W), Glandosane (G), or modified Saliva natura (SN). Different treatments were applied twice daily: no treatment, Elmex sensitive mouth rinse (E), ProSchmelz gel (P), Duraphat toothpaste (D), ED, PD, and EPD. Differences in mineral loss were evaluated by transversal microradiography after 2 and 5 weeks. Results The treatments with E, D, and ED inhibited the mineral loss induced by G and enabled some mineral gain. ProSchmelz was not able to inhibit the demineralizing effect of G. This high-fluoride gel induced an erosive mineral loss in combination with G. The use of ProSchmelz in combination or not with other fluoride products did not increase remineralization of specimens stored in SN or W (p>0.05). ProSchmelz resulted in an erosion of the specimens stored in W and revealed a lower mineralized surface layer of specimens stored in SN. Conclusion Topical application of high-fluoride gel reduced the mineral loss induced by G but resulted in an erosion of specimens’ surface. In addition, ProSchmelz did not demonstrate beneficial effects in combination with SN on subsurface dentin lesion remineralization. Clinical relevance Within the limitations of an in vitro study, it was concluded that the application of a high-fluoride gel did not promote additional effects on remineralization of subsurface dentin lesions in combination with saliva substitutes when compared to products with lower fluoride concentration.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Análise dos troncos radiculares, abertura da raízes e projeções cervicais de esmalte de furcas de molares superiores e inferiores: Estudo in vitro

Periodontal treatment of teeth with furcation lesions often have unpredictable results due to several factors that may hinder therapy or influence the progress of periodontal disease. Of these, the length of the root trunk may contribute to the early injury of the furcations or even cause complications for the application of the treatment; the opening of the roots can guide the type of treatment to be instituted and cervical enamel projections may hinder the instrumentation of the region or even act as a retention plate niche. Thus, the purpose of this study was measured using a digital caliper, root logs database 400 molar both the 1st and the 2nd and both upper and lower as well as analyze using appropriate index type projection cervical enamel and through appropriate classification the opening of the roots in order to guide the diagnosis and treatment plan. We conclude that there is variation in measures of root trunk between the faces of the teeth examined and that greater cervical enamel projection (ECP) correlates with a decrease in the length of the root trunk in the sample evaluated as the first molars have higher occurrence of roots with a degree of opening larger than the second molars.O tratamento periodontal de dentes que apresentam lesão de furca, muitas vezes, tem resultados imprevisíveis devido a diversos fatores que podem dificultar a terapia ou influenciar no progresso da doença periodontal. Destes, o comprimento do tronco radicular pode contribuir para a lesão precoce das furcas ou mesmo trazer complicações para a aplicação do tratamento. A abertura das raízes pode orientar o tipo de tratamento a ser instituído e as projeções cervicais de esmalte podem dificultar a instrumentação da região, ou mesmo atuar como nicho de retenção de placa. Assim, o propósito deste estudo foi medir, por meio de um paquímetro digital, os troncos radiculares de 400 molares de banco, tanto os primeiros como os segundos, e tanto os superiores como os inferiores, assim como analisar, por meio de índice apropriado, o tipo da projeção cervical de esmalte e, por meio de classificação apropriada, a abertura das raízes, com o objetivo de orientar no diagnóstico e no plano de tratamento. Concluiu-se que há variação das medidas de tronco radicular entre as faces dos dentes avaliados e que uma maior projeção cervical de esmalte (PCE) correlaciona-se com uma diminuição do comprimento de tronco radicular na amostra avaliada, assim como os primeiros molares apresentam maior ocorrência de raízes com grau de abertura maior do que os segundos molares

Efeito do fumo sobre os tecidos periodontais: uma revisão de literatura

Smoking is one of the most important risk factors for periodontal disease. Increased destruction of periodontal tissues has been observed in smokers. Studies show changes caused by different cigarette components, morphological, microbiological and immunological alterations which could lead to clinical changes. However, the pathophysiology of smoking on periodontal tissues are not completely understood. Therefore, this article aims to present a review of the literature addressing the changes on the periodontal tissues caused by the main components of the smoke observed in recent studies.O fumo é um dos mais importantes fatores de risco para a doença periodontal. Maior destruição dos tecidos periodontais vem sendo observada em indivíduos fumantes. Estudos mostram diferentes alterações provocadas pelos componentes do cigarro, alterações morfológicas, microbiológicas e imunológicas que poderão levar a alterações clínicas. Porém, os mecanismos etiopatogênicos do fumo sobre os tecidos periodontais não estão completamente esclarecidos. Portanto, o presente artigo teve como objetivo apresentar uma revisão da literatura abordando as alterações sobre os tecidos periodontais, provocadas pelos principais componentes do fumo, observadas em estudos recentes

Recobrimento radicular por enxerto de tecido conjuntivo subepitelial

Gingival recession lesions are characterized by apical migration of gingival margin with consequent exposure of the root surface, which constitutes an aesthetic problem for the patient. Several surgical techniques have been used for the root coverage, and the technique of subepithelial connective gingival graft has greater predictability of root coverage and best aesthetic results with fewer postoperative side effects in relation to the epithelial free gingival graft. The goal of this case repot is to describe the technique of subepithelial connective tissue graft and demonstrates its result in a coverage Miller class I root recessions. After two years we can see excellent root coverage with significant aesthetic improvement of the case. The free subepithelial connective tissue graft technique was effective in coverage Miller class I root recession presented in this clinical case.As recessões gengivais são lesões caracterizadas por uma migração apical da margem gengival com consequente exposição da superfície radicular, que constitui um problema estético para o paciente. Várias técnicas cirúrgicas têm sido indicadas para o recobrimento das recessões gengivais, sendo a técnica de enxerto de tecido conjuntivo a de maior previsibilidade de recobrimento e de melhores resultados estéticos e menores efeitos colaterais pós-operatórios em relação ao enxerto gengival livre epitelizado. O objetivo da descrição desse caso clínico foi de descrever a técnica de enxerto gengival livre subepitelizado demonstrando seu resultado no recobrimento de uma recessão Classe I de Miller. Após dois anos percebe-se excelente recobrimento radicular com significante melhora estética do caso. A técnica de enxerto gengival livre subepitelial foi eficaz no recobrimento de recessão Classe I de Miller apresentada nesse caso clínico

Use of salivary biomarkers for diagnosis of periodontal disease activity: a literature review

Periodontal disease is an infectious disease characterized by the connective tissue destruction and consequent alveolar bone loss in response to plaque accumulation on the tooth surface. The clinical diagnosis of periodontal disease is based both on clinical examination involving the evaluation of probing depth and radiographic examination of alveolar bone loss but these examinations are not enough to determine the activity of the disease process. For that reason, it has been proposed to seek predictive disease markers in an attempt to assess the disease activity and so, evaluate the efficacy of the periodontal disease treatment. The aim of this review is to present recent advances in the development of proteomic, genomics and microbial biomarkers and potential clinical applications. It was concluded that periodontal treatment based on assessing the levels of salivary biomarkers emerges as a promising method in near future and will become an integral part of the evaluation of periodontal health

Recobrimento radicular para o tratamento de hipersensibilidade dentinária cervical persistente

Gingival recession has a high prevalence in the population. This alteration may promote several complications such as cervical dentinal hypersensitivity (HSDC), carious and non-carious cervical lesions, and cosmetic changes due to the increase of the clinical crown length. To treat HSDC there are several therapeutic possibilities that should aim to eliminate pain after external stimulus. Treatment of this alteration can be performed by a conventional or invasive procedure, depending on the clinical condition and patients' desires. In situations where aesthetics is not the main complaint and HSDC persists even after conservative procedures, it is possible to indicate a procedure to achieve root coverage in Miller's Class I and II recessions. The aim of this paper is to report a case where the HSDC was not eliminated by conventional methods, which was resolved only after performing a minimally invasive surgery that promoted total root coverage.A recessão gengival é uma alteração periodontal de alta prevalência na população e pode promover uma série de complicações, como hipersensibilidade dentinária cervical (HSDC), lesões cervicais cariosas e não cariosas, além de alterações estéticas pelo aumento do comprimento da coroa clínica dentária. Para tratar a HSDC existem diversas possibilidades terapêuticas que devem visar a total erradicação da sensibilidade dolorosa frente a estímulos externos. O tratamento desta alteração pode ser realizado de maneira conservadora ou invasiva, dependendo de cada situação clínica e dos anseios dos pacientes. Em situações onde a estética não é a principal queixa do paciente e a HSDC persista mesmo após a realização de procedimentos conservadores é possível indicar um procedimento para recobrimento radicular em recessões Classe I e II de Miller. O objetivo deste artigo foi relatar um caso clínico onde a HSDC não foi eliminada pelos métodos convencionais, sendo sanada após a realização de uma cirurgia minimamente invasiva que promoveu total recobrimento radicular

Effect of Er,Cr:YSGG and Er:YAG laser irradiation on the adhesion of blood components on the root surface and on root morphology

The aim of this study was to conduct an in vitro evaluation, by scanning electron microscopy (SEM), of the adhesion of blood components on root surfaces irradiated with Er,Cr:YSGG (2.78 mu m) or Er:YAG (2.94 mu m) laser, and of the irradiation effects on root surface morphology. Sixty samples of human teeth were previously scaled with manual instruments and divided into three groups of 20 samples each: G1 (control group) - no treatment; G2 - Er,Cr:YSGG laser irradiation; G3 - Er:YAG laser irradiation. After performing these treatments, blood tissue was applied to 10 samples of each group, whereas 10 samples received no blood tissue application. After performing the laboratory treatments, the samples were observed under SEM, and the resulting photomicrographs were classified according to a blood component adhesion scoring system and root morphology. The results were analyzed statistically (Kruskall-Wallis and Mann Whitney tests, alpha = 5%). The root surfaces irradiated with Er:YAG and Er,Cr:YSGG lasers presented greater roughness than those in the control group. Regarding blood component adhesion, the results showed a lower degree of adhesion in G2 than in G1 and G3 (G1 x G2: p = 0.002; G3 x G2: p = 0.017). The Er:YAG and Er,Cr:YSGG laser treatments caused more extensive root surface changes. The Er:YAG laser treatment promoted a greater degree of blood component adhesion to root surfaces, compared to the Er,Cr:YSGG treatment