Tooth loss in patients under periodontal maintenance in a private practice : a retrospective study

The aim of the present study was to evaluate the incidence and causes of tooth loss in periodontal subjects from a private practice in Brazil. Two trained examiners extracted data from the records of subjects who sought periodontal treatment from 1980 to 2013. Only records of patients who completed the non-surgical periodontal treatment and had at least one visit for maintenance were included. Data were analyzed by chi-square test, Student’s t-test, Kaplan-Meier survival curve and Cox regression. A total of 3,319 records were reviewed and 737 records included (58.6% women, mean age of 46.6±13.0 years at the beginning of the treatment). Maintenance period ranged from 1 to 33 years (7.4±6 years). During this period, 202 individuals (27.4%) lost 360 teeth, 47.5% of losses within the first five years (n=171). Non-compliers lost more teeth than compliers (p<0.001), respectively 211 and 149 teeth. Regarding reasons of tooth loss, 84 individuals lost 38% of the teeth from periodontal disease progression (n=137). Survival analysis showed that most patients lost only one tooth from periodontal disease, and differences in the survival rates between compliers and non-compliers were observed following the second tooth loss. Approximately one-third of tooth losses was related to periodontal disease progression, and there was stability in time of the proportion of losses from disease progression and other reasons. Therefore, it is possible to conclude that compliant patients in a private practice lose fewer teeth than do non-compliers. Among compliers, periodontal disease progression was not the main cause of tooth loss

The minipig intraoral dental implant model: A systematic review and meta-analysis

Objectives The objective of this report was to provide a review of the minipig intraoral dental implant model including a meta-analysis to estimate osseointegration and crestal bone remodeling. Methods A systematic review including PubMed and EMBASE databases through June 2021 was conducted. Two independent examiners screened titles/abstracts and selected full-text articles. Studies evaluating titanium dental implant osseointegration in native alveolar bone were included. A quality assessment of reporting was performed. Random-effects meta-analyses and meta-regressions were produced for bone-implant contact (BIC), first BIC, and crestal bone level. Results 125 out of 249 full-text articles were reviewed, 55 original studies were included. Quality of reporting was generally low, omissions included animal characteristics, examiner masking/calibration, and sample size calculation. The typical minipig model protocol included surgical extraction of the mandibular premolars and first molar, 12±4 wks post-extraction healing, placement of three narrow regular length dental implants per jaw quadrant, submerged implant healing and 8 wks of osseointegration. Approximately 90% of studies reported undecalcified incandescent light microscopy histometrics. Overall, mean BIC was 59.88% (95%CI: 57.43–62.33). BIC increased significantly over time (p 90%, p<0.001). Conclusions The minipig intraoral dental implant model appears to effectively demonstrate osseointegration and alveolar bone remodeling similar to that observed in humans and canine models

RESTABELECIMENTO DA DISTÂNCIA BIOLÓGICA POR MEIO DE GENGIVECTOMIA

 O acúmulo do biofilme bacteriano é um dos fatores etiológicos das principais doenças periodontais, a gengivite e a periodontite. Quando este biofilme se limita aos tecidos de margem, desenvolve-se a gengivite, que quando tratada é de fácil reversão. Quando está doença tem um quadro agravante, o tecido gengival responde com uma hiperplasia, tentando evitar que os microorganismos invadam os tecidos de sustentação. O objetivo deste trabalho é apresentar, por meio de um relato de caso clínico, o restabelecimento do contorno gengival anatômico de um paciente com quadro clínico de hiperplasia generalizada. A paciente procurou a clínica da disciplina de Periodontia da UFPR para “tratar a gengiva”. Ao exame clínico observou-se grande acúmulo de biofilme bacteriano, e hiperplasia gengival generalizada. O plano de tratamento proposto ao paciente foi: instrução de higiene oral, controle mecânico do biofilme bacteriano, e quando na ausência de sinais inflamatórios, correção cirúrgica do periodonto. Após três semanas, o procedimento cirúrgico foi realizado e a paciente compareceu para acompanhamento pós-operatório aos 7, 15, 30 e 60 dias. Observou-se um padrão de cicatrização adequado, e a paciente continua em tratamento, sendo agora na terapia periodontal de suporte

USO DO ENXERTO DE TECIDO CONJUNTIVO SUBEPITELIAL NA CORREÇÃO DE DEFEITOS PERIIMPLANTARES

A utilização de implantes osseointegráveis na reabilitação de indivíduos desdentados é relatada com sucesso na literatura. Atualmente, os casos mais desafiadores são as restaurações unitárias na região anterior superior. A reabsorção óssea excessiva e a dificuldade na manipulação dos tecidos moles são os fatores que agravam este problema, uma vez que o aumento da demanda estética e funcional requerem o contorno do tecido periimplantar em harmonia com a dentição natural. O tratamento por meio da regeneração tecidual guiada (RTG) do tecido periimplantar é difícil, e muitas vezes são necessários procedimentos cirúrgicos de enxerto ósseo associado ou não a enxertos de tecido gengival. O objetivo deste trabalho é apresentar, por meio de um relato de caso clínico, a correção da falta de volume tecidual em implante unitário, realizada através de um enxerto de tecido conjuntivo subepitelial. A paciente B.T. compareceu à clínica da disciplina de Periodontia para “correção da gengiva do implante”. Ao exame clínico e radiográfico, observou-se a falta de volume tecidual. O plano de tratamento constituiu-se de cirurgia de enxerto de tecido conjuntivo subepitelial associada a instalação do cicatrizador. No pós operatório imediato pode-se observar o restabelecimento da espessura do tecido gengival, bem como um contorno de margem aceitável

Screening of Hydroxyapatite Biomaterials for Alveolar Augmentation Using a Rat Calvaria Critical-Size Defect Model: Bone Formation/Maturation and Biomaterials Resolution

Background: Natural (bovine-/equine-/porcine-derived) or synthetic hydroxyapatite (HA) biomaterials appear to be the preferred technologies among clinicians for bone augmentation procedures in preparation for implant dentistry. The aim of this study was to screen candidate HA biomaterials intended for alveolar ridge augmentation relative to their potential to support local bone formation/maturation and to assess biomaterial resorption using a routine critical-size rat calvaria defect model. Methods: Eighty adult male Sprague Dawley outbred rats obtained from a approved-breeder, randomized into groups of ten, were used. The calvaria defects (ø8 mm) either received sham surgery (empty control), Bio-Oss (bovine HA/reference control), or candidate biomaterials including bovine HA (Cerabone, DirectOss, 403Z013), and bovine (403Z014) or synthetic HA/ß-TCP (Reprobone, Ceraball) constructs. An 8 wk healing interval was used to capture the biomaterials’ resolution. Results: All biomaterials displayed biocompatibility. Strict HA biomaterials showed limited, if any, signs of biodegradation/resorption, with the biomaterial area fraction ranging from 22% to 42%. Synthetic HA/ß-TCP constructs showed limited evidence of biodegradation/erosion (biomaterial area fraction ≈30%). Mean linear defect closure in the sham-surgery control approximated 40%. Mean linear defect closure for the Bio-Oss reference control approximated 18% compared with 15–35% for the candidate biomaterials without significant differences between the controls and candidate biomaterials. Conclusions: None of the candidate HA biomaterials supported local bone formation/maturation beyond the native regenerative potential of this rodent model, pointing to their limitations for regenerative procedures. Biocompatibility and biomaterial dimensional stability could suggest their potential utility as long-term defect fillers

Immunological evaluation of two protocols of periodontal care during preventive periodic maintenance phase – a subsample secondary analysis of a randomized clinical trial

Introdução: A necessidade de pacientes serem inseridos em protocolos de manutenção periodontais (PMP) após tratamento periodontal é bem estabelecida na literatura. No entanto, ainda não é bem estabelecido quais procedimentos são necessários para manter a saúde periodontal. O objetivo do presente estudo foi identificar quais os biomarcadores relacionados com a doença periodontal e comparar o efeito de dois PMPs nos níveis destes biomarcadores pró e antiinflamatórios do fluido crevicular gengival (FCG) durante 1 ano. Materiais e Métodos: Após o tratamento periodontal não-cirúrgico, 34 sujeitos (14H/20M, idade média 54 anos) diagnosticados com periodontite crônica foram randomicamente alocados em um dos seguintes grupos: a) somente raspagem supragingival; b) raspagem supra e subgengival. Todos os participantes receberam instruções de higiene oral personalizados e polimento dos dentes. Os indivíduos foram vistos em intervalos de três meses para a realização de exames clínicos, coleta de FCG e procedimentos de manutenção periodontal. As principais citocinas pró- e anti-inflamatórias e quimiocina relacionadas com a doença periodontal foram identificadas por meio de uma revisão sistemática da literatura com metanálise. Em seguida, os níveis de FCG de 16 citocinas e quimiocinas dos 34 sujeitos incluídos no estudo foram medidos por meio de um imunoensaio múltiplo. Resultados: Não foram observadas diferenças significativas nos parâmetros clínicos ou imunológicos entre os dois PMPs. Os níveis médios de concentração no FCG da maioria das citocinas pró-inflamatórias foram geralmente baixos / moderados durante todo o período de estudo, com exceção da IL-1β. Os níveis das citocinas anti-inflamatórias IL-4 e IL-13 foram moderado / alto. Entre as quimiocinas, os níveis de MIP-1α e MCP-1 foram altos, e a concentração de IL-8 foi muito alta durante todo o estudo. Conclusões: Os resultados sugerem que um PMP baseado apenas no controle do biofilme supragengival é tão eficaz na manutenção de baixos níveis de inflamação periodontal e estabilidade clínica após o tratamento quanto um PMP baseado em controle supra e subgengival.Introduction: The need for patients to be enrolled into periodontal maintenance protocols (PMP) after periodontal treatment is well established in the literature. However, it is still unknown which interventions are necessary to maintain periodontal health. The aim of the present study was to identify the biomarkers related to periodontal disease, and to compare the 1-year effect of two periodontal maintenance protocols (PMP) on gingival crevicular fluid (GCF) levels of pro- and anti-inflammatory biomarkers. Material and Methods: Following non-surgical periodontal treatment, 34 subjects (14M/20F, mean age: 54 years) diagnosed with chronic periodontitis were randomly assigned into one of the following study arms: a) supragingival scaling only; b) supra and subgingival scaling. All subjects received personalized oral hygiene instructions and tooth polishing. Subjects were seen at 3 months intervals for periodontal maintenance, clinical data and GCF collection. The major pro-and anti-inflammatory cytokines and chemokine related to periodontal disease were identified through a systematic review of the literature with metaanalysis. After that, GCF levels of 16 different cytokines and chemokines from the 34 subjects included in the study were measured using a multiplex immunoassay. Results: No significant differences between PMPs were observed for any clinical parameters or immunological biomarkers. Median GCF concentration levels for most pro-inflammatory cytokines were generally low/moderate throughout the study period, with the exception of IL-1β. GCF levels of anti-inflammatory cytokines IL-4 and IL-13 were moderate/high. For chemokines, GCF levels for MIP-1α and MCP-1 were high, and concentration for IL-8 was very high. Conclusion: Our findings suggest that a PMP based on supragingival biofilm control alone is as effective in maintaining low levels of periodontal inflammation and clinical stability after treatment as a PMP based on combined supra/subgingival biofilm control

Tradução e validação de um questionário de saúde bucal a médicos obstetras e residentes em obstetrícia

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Tradução e validação de um questionário de saúde bucal a médicos obstetras e residentes em obstetrícia

Resum

Tooth loss in patients under periodontal maintenance in a private practice : a retrospective study

The aim of the present study was to evaluate the incidence and causes of tooth loss in periodontal subjects from a private practice in Brazil. Two trained examiners extracted data from the records of subjects who sought periodontal treatment from 1980 to 2013. Only records of patients who completed the non-surgical periodontal treatment and had at least one visit for maintenance were included. Data were analyzed by chi-square test, Student’s t-test, Kaplan-Meier survival curve and Cox regression. A total of 3,319 records were reviewed and 737 records included (58.6% women, mean age of 46.6±13.0 years at the beginning of the treatment). Maintenance period ranged from 1 to 33 years (7.4±6 years). During this period, 202 individuals (27.4%) lost 360 teeth, 47.5% of losses within the first five years (n=171). Non-compliers lost more teeth than compliers (p<0.001), respectively 211 and 149 teeth. Regarding reasons of tooth loss, 84 individuals lost 38% of the teeth from periodontal disease progression (n=137). Survival analysis showed that most patients lost only one tooth from periodontal disease, and differences in the survival rates between compliers and non-compliers were observed following the second tooth loss. Approximately one-third of tooth losses was related to periodontal disease progression, and there was stability in time of the proportion of losses from disease progression and other reasons. Therefore, it is possible to conclude that compliant patients in a private practice lose fewer teeth than do non-compliers. Among compliers, periodontal disease progression was not the main cause of tooth loss