Management of Multiple Recession-Type Defects After Orthodontic Therapy: A Clinical Report Based on Scientific Evidence

Treatment of multiple recession-type defects (MRTDs) developed subsequent to orthodontic therapy requires a solid knowledge of the anatomy/characteristics of the defects. Surgical approaches based on the use of subepithelial connective tissue grafts (SCTGs) are considered the “gold standard” for the treatment of MRTDs, but their use may be limited by the availability of donor tissue. The objective of this case report is to present the outcomes of treatment achieved by a SCTG in a patient presenting MRTDs in all four quadrants of the mouth. Case Presentation: A non-smoking 23-year-old female patient presenting 15 Miller Class I or II gingival recessions (GRs) at anterior and posterior teeth of the maxilla and mandible, developed after orthodontic therapy, was referred for treatment in March 2013. Defects were treated using four SCTG-based procedures using grafts harvested from two donor sites at different time frames. Twenty-four months after treatment, gingival thickness modification led to esthetic and functional results. Conclusion: The use of SCTGs harvested twice from the same donor site for the treatment of MRTDs led to safe and predictable outcomes (i.e., clinically significant gains in GR depth, attachment level, and esthetics)

Prevalência das Doenças Periodontais no Brasil

In 1993 a review of epidemiological surveys of the prevalence of periodontal diseases in Brazil 10 has shown that 86.7% of the total of examined individuals had evidence of marginal gingivitis or periodontal damage. The aim of this paper was to evaluate the prevalence of periodontal disease through a critical review of the dental literature of several independent epidemiologic studies that have been conducted during the last 10 years in Brazil (1993-2003). Differences in epidemiological methodology and clinical differential diagnosis made comparative evaluation of surveys data difficult and subjective. However, it can be concluded that the general prevalence rate of periodontal diseases was 92.92%. This review also revealed a lack of data on the epidemiology of periodontal disease in all Brazilian geographic regions. All the epidemiological data reviewed pointed to dental plaque as the primary aetiological agent in gingivitis and periodontitis.Em 1993, através de uma revisão da literatura dos levantamentos epidemiológicos até então realizados 10 evidenciou que 86,7% do total de indivíduos examinados apresentavam atividade de doença periodontal. O propósito deste artigo foi avaliar a prevalência de doença periodontal através de uma revisão crítica da literatura odontológica referente a diversos estudos epidemiológicos independentes realizados e publicados no Brasil entre 1993 e 2003. Diferenças na metodologia empregada não permitiram muitas comparações entre os dados coletados. Entretanto, concluiu-se que a prevalência geral de doença periodontal encontrada foi de 92,92%. Esta revisão também revelou uma carência de dados sobre a epidemiologia das doenças periodontais em todas as regiões geográficas brasileiras. Todos os levantamentos epidemiológicos estudados apontam a placa dental como único agente etiológico das doenças gengivais e periodontais

Leukocyte- and platelet-rich fibrin does not provide any additional benefit for tooth extraction in head and neck cancer patients post-radiotherapy : a randomized clinical trial

One of the most important complications of radiotherapy (RT) for head and neck cancer (HNC) is osteoradionecrosis (ORN) of the jaws, arising mainly from tooth extractions. Thus, the present study aimed to evaluate the efficacy of leukocyte- and platelet-rich fibrin (L-PRF) in preventing ORN following tooth extraction in post-irradiated HNC patients, as well as other postoperative complications. 23 patients previously submitted to conventionally fractionated 3D-conformational RT for HNC underwent atraumatic tooth extractions with perioperative antibiotic therapy. Besides, they were randomly assigned to receive L-PRF clots to fill and cover the extraction sockets (n=11, Test Group) or not (n=12, Control Group). A visual analog scale was used to quantify postoperative pain on the 3rd and 7th days. For ORN diagnosis, patients were clinically assessed for up to 180 days. Other postoperative complications (edema, alveolitis, suture dehiscence, continuous bleeding, and oroantral communication) were also evaluated within this period. No case of ORN or another surgical complication was observed and there were no differences in the postoperative pain scores between the groups on the 3rd and 7th days. L-PRF did not seem to provide any additional benefits than those achieved by the combination of the surgical and drug protocols used for tooth extractions in the post-irradiated HNC patients

Economic burden of periodontitis in the United States and Europe: An updated estimation

BACKGROUND: The aim of this study is to estimate the direct and indirect economic burdens of periodontal disease in the USA and in Europe. METHODS: We used the most recent data available for the USA and for Europe (32 European countries) to estimate the cost of periodontal disease. Global health, dental and periodontal expenditures were estimated. We tried to estimate the direct and the indirect costs of periodontitis. Indirect costs, those related to productivity losses, are a consequence of periodontal disease proper, plus edentulism and caries due to periodontal disease. RESULTS: In 2018, the aggregate cost in the USA was estimated at $3.49B and €2.52B in Europe. Indirect costs due to periodontal disease amounted to$150.57B (95% confidence interval [CI]: 103.32-189.87) in the USA countries and €156.12B (95% CI: 123.72-221.86) in Europe. The majority of the projected indirect costs were due to edentulism related to periodontal disease and periodontal disease. Indirect costs were the majority of the estimated economic impact with an average of 0.73% (95% CI: 0.50-0.93%) of annual gross domestic product in the USA and 0.99% (95% CI: 0.78-1.40%) in Europe. CONCLUSIONS: Periodontal disease caused an estimated loss of $154.06B in the USA and €158.64B in Europe, in 2018. These results show that the economic burden of periodontal disease is significant and its indirect costs are impactful. This article is protected by copyright. All rights reserved

VISÃO DAS GESTANTES SOBRE PARTO EM UMA UNIDADE BÁSICA DE SAÚDE DURANTE O PRÉ-NATAL

O parto precisa ser resgatado como momento do nascimento, devolvendo à mulher o direito de ser mãe com humanidade e segurança. O objetivo foi identificar durante o pré-natal qual tipo de parto as gestantes gostariam de ter e identificar o perfil sociodemográficos delas. O estudo foi realizado em uma unidade básica de saúde após aprovação do comitê de ética nº. 2520/2012. Participaram 25 gestantes com média de idade de 24 anos que responderam um questionário onde 13 (52%) voluntárias relataram preferência por parto normal e 12 (48%) parto cesárea; 18 (72%) relataram não ter participado de curso de gestante e 7 (28%) participaram. A partir deste estudo, pode-se conhecer qual a visão das gestantes sobre parto durante o pré-natal e concluir que a unidade básica de saúde e os profissionais precisam promover um atendimento mais humanizado e cursos para gestantes, possibilitando esclarecer as dúvidas do ciclo gestacional

Association of -1082 interleukin-10 gene polymorphism in Peruvian adults with chronic periodontitis

Objectives: The aim of this study was to assess association of the -1082 IL-10 gene polymorphism with chronic periodontitis CP in a Peruvian population. Study Design: Samples of venous blood and DNA were obtained from 106 Peruvian subjects: a) 53 periodontally healthy; and b) 53 with CP. The association of the -1082 IL-10 promoter sequences was assessed by Polymerase chain reaction-restriction fragment length polymorfism (PCR-RFLP). Student's t test were used to assess the clinical parameters, as well as the x2 test and the odds ratio (OR), with 95% confidence intervals (CI) used performed for estimates regarding genotype and allele frequencies. Results: There were statistically significant differences between groups regarding the mean bleeding on probing, mean attachment level and mean probing depth (p < 0.00001) indicating that the matching based on the evaluated groups was adequate. The x2 test found a statistically significant imbalance of genotypes between groups (p = 0.0172). The prevalence of CP was significantly higher in subjects harboring at least one A allele at position -1082 (AA and GA genotypes) in comparison to patients with the GG genotype (OR = 2.96; CI: 0.52; 5.41; p = 0.0099). Equally, subjects with the AA genotype were significantly associated to a diagnosis of CP (OR = 2.71; CI: 0.38; 5.04; p = 0.0231). On the other hand, subjects presenting a healthy periodontal status presented at least one G allele in comparison with the AA genotype (OR = 0.37; CI: 0.05, 0.69; p = 0.0231). For subjects with the GG genotype, the same positive association was observed (OR = 0.34; CI: 0.06, 0.62; p = 0.0099). There were no significant differences between groups amongst subjects with the GA genotype (OR = 1.19; CI: 0.22, 2.16; p = 0.6774). Conclusions: Within the limits of this study, IL-10 gene polymorphism at position -1082 does not appear to be associated to CP. Conversely, subjects with AA genotype seem to be at an increased risk of developing CP

The Effect of Partially Exposed Connective Tissue Graft on Root‐Coverage Outcomes: A Systematic Review and Meta‐Analysis

The aim of this systematic review was to compare the root‐coverage outcomes of using a partially exposed connective tissue graft (CTG) technique with a fully covered CTG technique for root coverage. An electronic search up to February 28th, 2017, was performed to identify human clinical studies with data comparing outcomes of root coverage using CTG, with and without a partially exposed graft. Five clinical studies were selected for inclusion in this review. For each study, the gain of keratinized gingiva, reduction of recession depth, number of surgical sites achieving complete root coverage, percentage of root coverage, gain of tissue thickness, and changes of probing depth and clinical attachment level were recorded. Meta‐analysis for the comparison of complete root coverage between the two techniques presented no statistically significant differences. A statistically significant gain of keratinized tissue in favor of the sites with an exposed CTG and a tendency of greater reduction in recession depth were seen at the sites with a fully covered CTG. Based on the results, the use of a partially exposed CTG in root‐coverage procedures could achieve greater gain in keratinized gingiva, while a fully covered CTG might be indicated for procedures aiming to reduce recession depth

Adiponectin, leptin and TNF-α serum levels in obese and normal weight Peruvian adults with and without chronic periodontitis

Background: TNF-α, an adipokine involved in systemic inflammation and a member of a group of cytokines that stimulate the acute phase reaction, has been related to the pathogenesis of both periodontitis and obesity. The objective of this study was to assess the serum levels of adiponectin, leptin and TNF-α of periodontally healthy normal weight (NW) patients, NW patients with chronic periodontitis (CP), periodontally healthy obese patients and obese patients with CP. Material and Methods: Ninety-three patients were enrolled in this cross-sectional study: 30 periodontally healthy NW patients; 18 NW patients with CP; 21 periodontally healthy obese patients; and 24 obese patients with CP. Analyses included clinical and anthropometric outcomes, as well as the assessment of serum levels of adiponectin, leptin and TNF-α by enzyme linked immunosorbent assay (ELISA) or fully automated chemiluminescence immunoassay. One-Way ANOVA, Kruskal-Wallis One-Way on Ranks, Dunn’s Test and multivariable logistic regression (MLR) analyses were conducted to estimate the degree of association between periodontitis and obesity. Results: Obese patients with CP showed significant more bleeding sites than the other three groups ( p <0.05). Moreover, patients from the NWCP and OPH showed similar BOP percentages, as well as OPH group showed more bleeding sites than the NWPH group ( p <0.05). The OPH group showed similar levels of adiponectin and leptin than the OCP group, but significantly higher than the NWPH and NWCP groups( p <0.05). MLR analyses showed that obesity was positively associated with the percentage of sites with bleeding on probing, with an odds ratio of 0.93 (95% confidence interval: -0.88, - 0.98; p =0.012). Conclusions: The serum levels of adiponectin, leptin and TNF-α were not influenced by CP. Obese patients showed almost 10% more sites with BoP. In chronic periodontitis patients, obese subjects presented significant more BOP sites than normal weight subject

Periodontitis Impact in Interleukin-6 Serum Levels in Solid Organ Transplanted Patients: A Systematic Review and Meta-Analysis

Esta revisión sistemática tuvo como objetivo investigar la influencia de la periodontitis en los niveles séricos de IL-6 postrasplante en pacientes trasplantados de órganos sólidos en comparación con sujetos sanos. Se realizaron búsquedas en cuatro bases de datos (PubMed, Scholar, EMBASE y CENTRAL) hasta febrero de 2020 (PROSPERO CRD42018107817). Se incluyeron estudios de casos y controles y de cohortes sobre la asociación de los niveles séricos de IL-6 con el estado periodontal de los pacientes después de un trasplante de órganos sólidos. El riesgo de sesgo de los estudios observacionales se evaluó mediante la Escala de Newcastle-Ottawa (NOS). Se realizaron metanálisis de efectos aleatorios minuciosamente. La evaluación GRADE proporcionó evidencia de calidad. Cuatro estudios de casos y controles cumplieron los criterios de inclusión (274 receptores de trasplantes y 146 controles sanos), todos de bajo riesgo de sesgo. Los metanálisis revelaron niveles de IL-6 significativamente más altos en pacientes trasplantados que en individuos sanos con evidencia de baja calidad (Diferencia de medias (DM): 2.55 (intervalo de confianza (IC) del 95%: 2.07, 3.03)). Los pacientes trasplantados con periodontitis tienen niveles séricos de IL-6 más altos que los pacientes trasplantados sin periodontitis con evidencia de calidad moderada (DM: 2,20 (IC del 95%: 1,00; 3,39)). Encontramos evidencia de baja calidad de niveles más altos de IL-6 que los pacientes sanos en pacientes con trasplante de corazón y riñón. En estos pacientes trasplantados, hubo evidencia de calidad moderada de que la periodontitis se asocia con niveles séricos más altos de IL-6. Las investigaciones futuras deben considerar el impacto de tal diferencia en la insuficiencia orgánica y las complicaciones sistémicas. 55 (intervalo de confianza (IC) del 95%: 2,07, 3,03)). Los pacientes trasplantados con periodontitis tienen niveles séricos de IL-6 más altos que los pacientes trasplantados sin periodontitis con evidencia de calidad moderada (DM: 2,20 (IC del 95%: 1,00; 3,39)). Encontramos evidencia de baja calidad de niveles más altos de IL-6 que los pacientes sanos en pacientes con trasplante de corazón y riñón. En estos pacientes trasplantados, hubo evidencia de calidad moderada de que la periodontitis se asocia con niveles séricos más altos de IL-6. Las investigaciones futuras deben considerar el impacto de tal diferencia en la insuficiencia orgánica y las complicaciones sistémicas. 55 (intervalo de confianza (IC) del 95%: 2,07, 3,03)). Los pacientes trasplantados con periodontitis tienen niveles séricos de IL-6 más altos que los pacientes trasplantados sin periodontitis con evidencia de calidad moderada (DM: 2,20 (IC del 95%: 1,00; 3,39)). Encontramos evidencia de baja calidad de niveles más altos de IL-6 que los pacientes sanos en pacientes con trasplante de corazón y riñón. En estos pacientes trasplantados, hubo evidencia de calidad moderada de que la periodontitis se asocia con niveles séricos más altos de IL-6. Las investigaciones futuras deben considerar el impacto de tal diferencia en la insuficiencia orgánica y las complicaciones sistémicas. Encontramos evidencia de baja calidad de niveles más altos de IL-6 que los pacientes sanos en pacientes con trasplante de corazón y riñón. En estos pacientes trasplantados, hubo evidencia de calidad moderada de que la periodontitis se asocia con niveles séricos más altos de IL-6. Las investigaciones futuras deben considerar el impacto de tal diferencia en la insuficiencia orgánica y las complicaciones sistémicas. Encontramos evidencia de baja calidad de niveles más altos de IL-6 que los pacientes sanos en pacientes con trasplante de corazón y riñón. En estos pacientes trasplantados, hubo evidencia de calidad moderada de que la periodontitis se asocia con niveles séricos más altos de IL-6. Las investigaciones futuras deben considerar el impacto de tal diferencia en la insuficiencia orgánica y las complicaciones sistémicas.This systematic review aimed to investigate the influence of periodontitis on post-transplant IL-6 serum levels of solid organ transplanted patients as compared to healthy subjects. Four databases (PubMed, Scholar, EMBASE, and CENTRAL) were searched up to February 2020 (PROSPERO CRD42018107817). Case-control and cohort studies on the association of IL-6 serum levels with a periodontal status of patients after solid organ transplantation were included. The risk of bias of observational studies was assessed through the Newcastle-Ottawa Scale (NOS). Random effects meta-analyses were thoroughly conducted. GRADE assessment provided quality evidence. Four case-control studies fulfilled the inclusion criteria (274 transplant recipients and 146 healthy controls), all of low risk of bias. Meta-analyses revealed significantly higher IL-6 levels in transplanted patients than healthy individuals with low-quality evidence (Mean Difference (MD): 2.55 (95% confidence interval (CI): 2.07, 3.03)). Transplanted patients with periodontitis have higher serum IL-6 levels than transplanted patients without periodontitis with moderate quality evidence (MD: 2.20 (95% CI: 1.00, 3.39)). We found low-quality evidence of higher IL-6 levels than healthy patients in patients with heart and kidney transplant. In these transplanted patients, there was moderate quality evidence that periodontitis is associated with higher IL-6 serum levels. Future research should consider the impact of such a difference in organ failure and systemic complications