DIFFERENT THERAPEUTIC METHODS RELATED TO PERI-IMPLANTITIS: AN UMBRELLA REVIEW

As doenças peri-implantares são definidas como lesões inflamatórias dos tecidos que circundam os implantes dentários, abrangendo a mucosite peri-implantar e a peri-implantite. O objetivo deste trabalho foi avaliar as revisões sistemáticas publicadas em periódicos indexados sobre os diversos tipos de tratamento para a peri-implantite. Uma visão geral de revisões sistemáticas (Umbrella Review) foi realizada através da avaliação de periódicos publicados em banco de dados eletrônicos (PubMed, Cochrane, MEDLINE, LILACS, Science Direct), utilizando os descritores: Peri-implantite OU Doença Peri-implantar OU Infecção peri-implantar E Tratamento peri-implantar OU Terapia peri-implantar, sem restrição de idiomas, entre 2011 e 2022. Também foi realizada uma estratégia de busca manual específica nas referências dos artigos selecionados. Quarenta e oito artigos foram encontrados, destes, 34 artigos foram eleitos para compor esse estudo. Foram excluídos relatos de casos, estudos observacionais, ensaios clínicos randomizados ou não randomizados, estudos experimentais, comentários, resumos expandidos, e estudos em duplicata. A terapia peri-implantar não cirúrgica envolve o debridamento mecânico da superfície do implante usando curetas, dispositivos ultrassônicos ou abrasivos a ar ou lasers, com ou sem o uso adjuvante de antibióticos ou antissépticos locais. A eficácia das diversas terapias peri-implantares mostrou‐se limitada, inclusive para a associação de antimicrobianos, especialmente em termos de redução da profundidade de sondagem e ganho de tecido ósseo. Dessa forma, sugere-se a necessidade da realização de novas revisões sistemáticas com melhor delineamento metodológico e mínimo de vieses. Assim, resultados mais previsíveis serão alcançados e promoverão uma maior confiança na escolha da forma terapêutica ideal para cada situação clínica.Peri-implant diseases are defined as inflammatory lesions of the tissues surrounding dental implants, including peri-implant mucositis and peri-implantitis. The aim of this study was to evaluate the systematic reviews published in indexed journals on the different types of treatment for peri-implantitis. An Umbrella Review was performed by evaluating journals published in electronic databases (PubMed, Cochrane, MEDLINE, LILACS, Science Direct), using the descriptors: Peri-implantitis OR Peri-implant disease OR Infection peri-implant AND peri-implant treatment OR peri-implant therapy, without language restriction, between 2011 and 2022. A specific manual search strategy was also performed in the references of the selected articles. Forty-eight articles were found, of these, 34 articles were chosen to compose this study. Case reports, observational studies, randomized or non-randomized clinical trials, experimental studies, reviews, expanded abstracts, and duplicate studies were excluded. Nonsurgical peri-implant therapy involves mechanical debridement of the implant surface using curettes, ultrasonic or air abrasive devices, or lasers, with or without the adjunctive use of antibiotics or local antiseptics. The effectiveness of the various peri-implant therapies has been shown to be limited, including the combination of antimicrobials, especially in terms of reduced probing depth and bone tissue gain. Thus, it is suggested the need to carry out new systematic reviews with better methodological design and minimal bias. Thus, more predictable results will be achieved and will promote greater confidence in choosing the ideal therapeutic form for each clinical situation.As doenças peri-implantares são definidas como lesões inflamatórias dos tecidos que circundam os implantes dentários, abrangendo a mucosite peri-implantar e a peri-implantite. O objetivo deste trabalho foi avaliar as revisões sistemáticas publicadas em periódicos indexados sobre os diversos tipos de tratamento para a peri-implantite. Uma visão geral de revisões sistemáticas (Umbrella Review) foi realizada através da avaliação de periódicos publicados em banco de dados eletrônicos (PubMed, Cochrane, MEDLINE, LILACS, Science Direct), utilizando os descritores: Peri-implantite OU Doença Peri-implantar OU Infecção peri-implantar E Tratamento peri-implantar OU Terapia peri-implantar, sem restrição de idiomas, entre 2011 e 2022. Também foi realizada uma estratégia de busca manual específica nas referências dos artigos selecionados. Quarenta e oito artigos foram encontrados, destes, 34 artigos foram eleitos para compor esse estudo. Foram excluídos relatos de casos, estudos observacionais, ensaios clínicos randomizados ou não randomizados, estudos experimentais, comentários, resumos expandidos, e estudos em duplicata. A terapia peri-implantar não cirúrgica envolve o debridamento mecânico da superfície do implante usando curetas, dispositivos ultrassônicos ou abrasivos a ar ou lasers, com ou sem o uso adjuvante de antibióticos ou antissépticos locais. A eficácia das diversas terapias peri-implantares mostrou‐se limitada, inclusive para a associação de antimicrobianos, especialmente em termos de redução da profundidade de sondagem e ganho de tecido ósseo. Dessa forma, sugere-se a necessidade da realização de novas revisões sistemáticas com melhor delineamento metodológico e mínimo de vieses. Assim, resultados mais previsíveis serão alcançados e promoverão uma maior confiança na escolha da forma terapêutica ideal para cada situação clínica.Las enfermedades periimplantarias se definen como lesiones inflamatorias de los tejidos que rodean los implantes dentales, que abarcan la mucositis periimplantaria y la periimplantitis. El objetivo de este estudio fue evaluar las revisiones sistemáticas publicadas en revistas indexadas sobre los diversos tipos de tratamiento para la periimplantitis. Se realizó una visión general de las revisiones sistemáticas (Umbrella Review) a través de la evaluación de revistas publicadas en bases de datos electrónicas (PubMed, Cochrane, MEDLINE, LILACS, Science Direct), utilizando los descriptores: Periimplantitis O enfermedad periimplantaria O infección periimplantaria Y Tratamiento periimplantario O terapia periimplantaria, sin restricción de idioma, entre 2011 y 2022. También se realizó una estrategia específica de búsqueda manual en las referencias de los artículos seleccionados. Se encontraron cuarenta y ocho artículos, de estos, 34 artículos fueron elegidos para componer este estudio. Se excluyeron los informes de casos, los estudios observacionales, los ensayos clínicos aleatorizados o no aleatorizados, los estudios experimentales, los comentarios, los resúmenes ampliados y los estudios duplicados. La terapia periimplantaria no quirúrgica implica el desbridamiento mecánico de la superficie del implante utilizando curetas, dispositivos de aire ultrasónicos o abrasivos, o láseres, con o sin el uso adyuvante de antibióticos o antisépticos locales. La eficacia de las diversas terapias periimplantarias fue limitada, incluso para la combinación de antimicrobianos, especialmente en términos de reducción de la profundidad del sondeo y obtención de tejido óseo. Por lo tanto, se sugiere la necesidad de nuevas revisiones sistemáticas con mejor diseño metodológico y sesgo mínimo.

Influence of glycemic control on the levels of subgingival periodontal pathogens in patients with generalized chronic periodontitis and type 2 diabetes

Abstract Objective This study evaluated the influence of glycemic control on the levels and frequency of subgingival periodontal pathogens in patients with type 2 diabetes mellitus (DM) and generalized chronic periodontitis (ChP). Material and Methods Fifty-six patients with generalized ChP and type 2 DM were assigned according to the levels of glycated hemoglobin (HbA1c) into one of the following groups: HbA1c<8% (n=28) or HbA1c&#8805;8% (n=28). Three subgingival biofilm samples from sites with probing depth (PD)<5 mm and three samples from sites with PD&#8805;5 mm were analyzed by quantitative Polymerase Chain Reaction (PCR) for the presence and levels of Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Eubacterium nodatum, Parvimona micra, Fusobacterium nucleatum ssp. and Prevotella intermedia. Results The mean counts of F. nucleatum ssp. were statistically significantly higher in the sites with PD&#8805;5 mm of the HbA1c&#8805;8% group (p<0.05). Frequencies of detection of T. forsythia, E. nodatum, P. micra and F. nucleatum ssp. were all higher in the sites with PD&#8805;5 mm of the patients with HbA1c&#8805;8%, compared with those of patients with HbA1c<8% (p<0.05). Frequency of detection of P. intermedia was higher in the sites with PD<5 mm of the patients with HbA1c&#8805;8% than those of the patients with HbA1c<8% (p<0.05). Conclusions Poor glycemic control, as indicated by HbA1c&#8805;8%, is associated with increased levels and frequencies of periodontal pathogens in the subgingival biofilm of subjects with type 2 DM and ChP

Distinctive genes and signaling pathways associated with type 2 diabetes-related periodontitis: Preliminary study.

The biological mechanisms underlying the pathogenesis of type 2 diabetes (T2DM)-related periodontitis remain unclear. This cross-sectional study evaluated the distinctive transcriptomic changes between tissues with periodontal health and with periodontitis in patients with T2DM. In this cross-sectional study, whole transcriptome sequencing was performed on gingival biopsies from non-periodontitis and periodontitis tissues from non-diabetic and diabetic patients. A differentially expressed gene (DEG) analysis and Ingenuity Pathway Analysis (IPA) assessed the genes and signaling pathways associated with T2DM-related periodontitis. Immunohistochemistry was performed to validate selected DEGs possibly involved in T2DM-related periodontitis. Four hundred and twenty and one thousand five hundred and sixty-three DEGs (fold change ≥ 2) were uniquely identified in the diseased tissues of non-diabetic and diabetic patients, respectively. The IPA predicted the activation of Phagosome Formation, Cardiac β-adrenergic, tRNA Splicing, and PI3K/AKT pathways. The IPA also predicted the inhibition of Cholesterol Biosynthesis, Adrenomedullin, and Inositol Phosphate Compounds pathways in T2DM-related periodontitis. Validation of DEGs confirmed changes in protein expression of PTPN2, PTPN13, DHCR24, PIK3R2, CALCRL, IL1RN, IL-6R and ITGA4 in diseased tissues in diabetic subjects. Thus, these preliminary findings indicate that there are specific genes and functional pathways that may be involved in the pathogenesis of T2DM-related periodontitis

Influence of glycemic control on the levels of subgingival periodontal pathogens in patients with generalized chronic periodontitis and type 2 diabetes

Objective This study evaluated the influence of glycemic control on the levels and frequency of subgingival periodontal pathogens in patients with type 2 diabetes mellitus (DM) and generalized chronic periodontitis (ChP). Material and Methods Fifty-six patients with generalized ChP and type 2 DM were assigned according to the levels of glycated hemoglobin (HbA1c) into one of the following groups: HbA1

Influence of glycemic control on the levels of subgingival periodontal pathogens in patients with generalized chronic periodontitis and type 2 diabetes

Abstract Objective This study evaluated the influence of glycemic control on the levels and frequency of subgingival periodontal pathogens in patients with type 2 diabetes mellitus (DM) and generalized chronic periodontitis (ChP). Material and Methods Fifty-six patients with generalized ChP and type 2 DM were assigned according to the levels of glycated hemoglobin (HbA1c) into one of the following groups: HbA1c<8% (n=28) or HbA1c≥8% (n=28). Three subgingival biofilm samples from sites with probing depth (PD)<5 mm and three samples from sites with PD≥5 mm were analyzed by quantitative Polymerase Chain Reaction (PCR) for the presence and levels of Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Eubacterium nodatum, Parvimona micra, Fusobacterium nucleatum ssp. and Prevotella intermedia. Results The mean counts of F. nucleatum ssp. were statistically significantly higher in the sites with PD≥5 mm of the HbA1c≥8% group (p<0.05). Frequencies of detection of T. forsythia, E. nodatum, P. micra and F. nucleatum ssp. were all higher in the sites with PD≥5 mm of the patients with HbA1c≥8%, compared with those of patients with HbA1c<8% (p<0.05). Frequency of detection of P. intermedia was higher in the sites with PD<5 mm of the patients with HbA1c≥8% than those of the patients with HbA1c<8% (p<0.05). Conclusions Poor glycemic control, as indicated by HbA1c≥8%, is associated with increased levels and frequencies of periodontal pathogens in the subgingival biofilm of subjects with type 2 DM and ChP

Demographic characteristics, glycemic and periodontal parameters (mean ± SD) of the study population.

Demographic characteristics, glycemic and periodontal parameters (mean ± SD) of the study population.</p

The DEGs expressed in the non-diabetic patients (yellow), in patients with T2DM (blue) and the commonly expressed in both the non-diabetic and diabetic patients.

HH: non-diabetic patients without periodontitis; HP: non-diabetic patients with periodontitis; DH: T2DM patients without periodontitis; DP: T2DM patients with periodontitis. (JPEG)</p

The DEGs that are a part of the most critical canonical pathways in patients with T2DM and periodontitis compared with the patients with T2DM and without periodontitis.

The DEGs that are a part of the most critical canonical pathways in patients with T2DM and periodontitis compared with the patients with T2DM and without periodontitis.</p

Ingenuity canonical pathways related to DEGs expressed exclusively in non-diabetic patients and the respective genes that function within each of these signaling pathways.

Ingenuity canonical pathways related to DEGs expressed exclusively in non-diabetic patients and the respective genes that function within each of these signaling pathways.</p